by Marion Nestle

Search results: dietary guidelines

Feb 27 2018

New process for Dietary Guidelines: open for comments

I was on a conference call yesterday with representatives from USDA and HHS announcing the new process for doing the 2020-2025 Dietary Guidelines for Americans.

The idea is to follow recommendations of the National Academy of Medicine to make the process more scientifically rigorous and transparent.

To that end, the agencies have posted the topics they want the Dietary Guidelines Advisory Committee (DGAC) to discuss and have opened these suggestions to immediate public comment.

Once the agencies decide on the topics, they will call for nominations for DGAC members.  They hope to do this by late spring or early summer 2018 so the guidelines can be released by the end of 2020.

If I understand this correctly, this means that the DGAC:

  • Will be appointed and meet sometime in the fall.
  • Will not decide on the scientific issues to review.
  • Will have maybe a year and a half to review the research on those questions, write its report, and submit the report to the agencies.

The agencies will then turn the research report into published guidelines.

This, of course, means that the scientific decisions are made by the agencies, not the DGAC.  A case of politics trumping science?

Reporters asked whether USDA thinks it’s really necessary to revise the guidelines (yes, because the Farm Bill said the guidelines should deal with life stages), whether the guidelines would focus on dietary patterns (yes), whether all this is because of the fuss over sustainability in the last set of guidelines (waffle), and whether there would be other changes in the process (they will tell us later).

The scientific questions posed on the website seem worth attention.  They are divided into life stages.

If you disagree, or can think of others, now is the time to weigh in.  You only have one months to do this.

 

Feb 7 2018

Food industry lobbyists running the dietary guidelines?

This tweet certainly got my attention:

It referred to Alex Kotch’s article in the International Business Times about how White House lawyer Donald McGahn has granted a waiver of conflict of interest rules to allow Kailee Tkacz, a former lobbyist for the Snack Food Association and, more recently, for the Corn Refiners Association, to advise the USDA about the forthcoming 2020 dietary guidelines.

Ms. Tkacz also was food policy director for the Corn Refiners Association, which represents producers of high fructose corn syrup (HFCS).

McGahn explained that this waiver would allow Ms. Tkacz “to advise the Secretary of Agriculture and other senior Department officials with respect to the Dietary Guidelines for Americans process.”

He says “it is in the public interest to grant this limited waiver because of Ms. Tkacz’s expertise in the process by which the Dietary Guidelines for Americans are issued every five years.”

The dietary guidelines historically have issued recommendations to consume less salt and sugar.  Snack foods are major sources of salt in U.S. diets.  Soft drinks sweetened with HFCS are major sources of sugars.

USDA is the lead agency for the 2020 guidelines.

Want to make some bets on what they will say about salt and sugar (a wild guess: the science isn’t firm enough to suggest eating less of either).

Feb 8 2017

Review committee says Dietary Guidelines process needs a fix

You may recall that one result of the fuss over the highly controversial BMJ article attacking the Dietary Guidelines process was appointment of a committee to review that process.

It has just published the first of its reports, which deals only with the first of the four charges to the committee, which were to determine:

1. How the selection process for the Dietary Guidelines Advisory Committee (DGAC) can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints;
2. How the Nutrition Evidence Library (NEL) is compiled and used, including whether the NEL reviews and other systematic reviews and data analysis are conducted according to rigorous and objective scientific standards;
3. How systematic reviews are conducted on long-standing DGAC recommendations, including whether scientific studies are included from scientists with a range of viewpoints; and
4. How the DGA can better prevent chronic disease, ensure nutritional sufficiency for all Americans, and accommodate a range of individual factors, including age, gender, and metabolic health.

The committee identified values governing the committee selection process:

  • Enhance transparency
  • Promote diversity of expertise and experience
  • Support a deliberative process
  • Manage biases and conflicts of interest
  • Adopt state-of-the-art processes and methods

Its recommendations:

  • Employ an external third party to review the candidate pool for committee members.
  • Make the list of provisional appointees open for public comment.
  • Publicly disclose nominees’ biases and conflicts of interest; develop a plan for managing them; have them reviewed by a federal ethics officer; document all this in the advisory committee’s report.
  • Adopt a system for continuous process improvement in the selection process.

Good recommendations and good luck with them.

I can hardly wait to see this committee’s report on the remaining charges.

In the meantime, it’s about time to start appointing the 2020 Dietary Guidelines Advisory Committee, no?

Jan 11 2016

The 2015 Dietary Guidelines’ hidden advice about sugary drinks: definitely there, but hard to find 

I’m indebted to Maria Godoy of NPR’s The Salt for pointing out where in the new 2015 Dietary Guidelines you can find advice about cutting down on sugary drinks.  As she puts it, this is easy to miss.

Here’s my wonky analysis.

In my post about the 2015 Dietary Guidelines, I noted that they are unambiguous about the need to reduce added sugars to 10% or less of calories.  But what they say about cutting down on sugary drinks—the leading source of sugars in US diets—is buried deep in the text.  Fortunately, Deborah Noble of slowfoodfast.com has performed a great public service by producing the 2015 Dietary Guidelines in a searchable pdf format.Here’s where to find advice about cutting down on sugary drinks:

The Executive Summary: See under “Cross-Cutting Topics of Public Health Importance:”

Similarly, added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options, such as water in place of sugar-sweetened beverages.

Figure 2-10 explains:

The major source of added sugars in typical U.S. diets is beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters.

Reading the Figure tells you that beverages comprise a whopping 47% of added sugars (closer to half if you add in sweetened milks, teas, and coffees).  The text following the Figure says:

Shift to reduce added sugars consumption to less than 10 percent of calories per day: Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars.

Strategies?  How about just saying: “Cut down on sugary drinks” or “Drink water instead of sugary drinks.”

Figure ES-1 in the Executive Summary illustrates the 2015-2020 Dietary Guidelines for Americans at a Glance.  All it says is:

Limit calories from added sugars…Consume an eating pattern low in added sugars…Cut back on food and beverages higher in these components to amounts that fit within healthy eating patterns.

Figure 3.2 shows Implementation of the Guidelines through MyPlate: “Drink and eat less…added sugars,” but nothing about sugary drinks.

This circumspection is weird.  Clear, straightforward advice to cut down on sugary beverages has plenty of historical precedent.

Both Figures ES-1 and 3.2 are most certainly derived from a USDA graphic on the MyPlate website (dated January 2016).  This says flat out:

Drink water instead of sugary drinks.

This statement, in turn, derives from:

  • The precepts issued with the 2010 Dietary Guidelines in January 2011
  • The statements issued with the MyPlate graphic in June 2011

myplate

  • The USDA’s May 2012 tip for making better beverage choices.

The 2015 DGAC (Dietary Guidelines Advisory Committee) repeatedly urged limits on consumption of sugar-sweetened beverages.  Statements like this one, for example, appear throughout the document:

To decrease dietary intake from added sugars, the U.S. population should reduce consumption of sugar-sweetened beverages.

Why did the USDA and HHS writing committee choose to waffle about his point?

This cannot be an accident.  It must be deliberate.  And it can have only one explanation: politics.

Jan 7 2016

The 2015 Dietary Guidelines, at long last

The 2015 Dietary Guidelines are out.

Picture1

They are now online in a version that takes up dozens of screens with annoying drop-down boxes.  It’s hard to navigate, and if it’s searchable, I can’t figure out how (OK, it’s searchable but doesn’t work all that well).

First the good news.  These Dietary Guidelines—for the first time—attempt to focus on foods and dietary patterns:

Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. However, people do not eat food groups and nutrients in isolation but rather in combination, and the totality of the diet forms an overall eating pattern.

They almost succeed in this mission.  The Guidelines say:

  • Follow a healthy eating pattern across the lifespan [Pattern].
  • Focus on variety, nutrient density, and amount [Pattern].
  • Limit calories from added sugars and saturated fats and reduce sodium intake [Oops: Nutrients].
  • Shift to healthier food and beverage choices [Pattern].
  • Support healthy eating patterns for all [Pattern].

A healthy eating pattern, they say:

  • Includes foods from various groups [Pattern].
  • Limits saturated fats, trans fats, added sugars, and sodium [Oops: Nutrients].

As for (Oops) Nutrients:

  • Less than 10% of calories from added sugars [this is new, but consistent with many other reports such as the one from WHO]
  • Less than 10% of calories from saturated fats [in the Guidelines since 1990]
  • Less than 2,300 mg sodium [no change from 2010]

Why Oops?  Because these Dietary Guidelines, like all previous versions, recommend foods when they suggest “eat more.”   But they switch to nutrients whenever they suggest “eat less.”

In the 2015 Dietary Guidelines,

  • Saturated fat is a euphemism for meat.
  • Added sugars is a euphemism for sodas and other sugar-sweetened beverages.
  • Sodium is a euphemism for processed foods and junk foods.

If the Guidelines really focused on dietary patterns, they wouldn’t pussyfoot.  They would come right out and say:

  • Eat less meat [OK, they do but only under the euphemism of “protein” and only for males. “Some individuals, especially teen boys and adult men, also need to reduce overall intake of protein foods (see Figure 2-3) by decreasing intakes of meats, poultry, and eggs and increasing amounts of vegetables or other underconsumed food groups.”  But what about processed meats?  Not a word that I can find.
  • Cut down on sugary drinks [OK, it says “drink water instead of sugary drinks,” but good luck finding that statement without knowing where it is].
  • Eat less processed and junk food.

Why don’t they?  Politics, of course.

Recall that Congress weighed in with an Appropriations Bill that called for an investigation of the scientific basis of the Guidelines and granted $1 million to the National Academy of Medicine to take them over.

Recall also that the secretaries of USDA and HHS said that the Guidelines would not say anything about sustainability as a rationale for advising eating less meat.

So let’s count the 2015 Guidelines as a win for the meat, sugary drink, processed, and junk food industries.

Other concerns, nutritional and otherwise:

  • Calories: The Guidelines deemphasize calories.  They dropped the information about food sources of calories from the 2010 edition, even though calorie balance remains a—if not the—major public health nutrition problem (an Appendix gives calorie needs).
  • Portion sizes: the best way to control calorie intake is by eating smaller or moderate portions. If the Guidelines talk about portion size, it must be well hidden.
  • Cholesterol: the recommendation to limit cholesterol has been dropped, but the document says, confusingly, that “this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”  Could the dropping of the limit have anything to do with egg-industry funding of research on eggs, the largest source of dietary cholesterol, and blood cholesterol?  The Physicians Committee for Responsible Medicine has just filed a lawsuit on that very point.
  • Protein: My pet peeve.  The Guidelines use this as yet another euphemism for meat.  “Protein” lumps meat together with seafood, poultry, eggs, nuts, seeds, and soy.  But grains and dairy also have protein, so using this term makes no nutritional sense and obfuscates the message to eat less meat.
  • Seafood: the document recommends 8 ounces a week of seafood high in omega-3s but low in methylmercury. That pretty much means salmon and sardines (anchovies are too salty).

I might have more to say when I can look at a document that is easier to read.

Full disclosure: I was a peer reviewer on an earlier version of this document.

Documents and commentary

Jan 5 2016

Rogue Dietary Guidelines

While we are endlessly waiting for the release of the 2015 Dietary Guidelines, Tamar Haspel and I thought we would jump the gun and write up for the Washington Post what we think most makes sense: How to eat more healthfully, in 6 easy steps.

Here are our Rogue Dietary Guidelines:

Go through the fine print of the omnibus spending bill just passed by Congress, and you’ll see that the 2015 Dietary Guidelines, scheduled for release in — you guessed it — 2015, have been pushed out to 2016. You wouldn’t think that the government’s efforts, every five years, to help Americans eat more healthfully would turn into a political football. But when its appointed scientists reviewed the literature on meat and health, for example, they did something quite radical. They said what they meant with no equivocations: Americans should eat less meat.

As if that were not radical enough — previous committees had pussyfooted with such euphemisms as “choose lean meats to reduce saturated fat” — this committee insisted on an additional reason beyond health: environmental considerations.

The result? Uproar.

Arguments like the ones over the Dietary Guidelines, fueled by lobbyists, politicians and agenda-driven groups, make diet advice seem maddeningly inconsistent, but the fundamentals haven’t changed much at all.

It’s time to take back the process, so we’re going rogue and issuing our own Dietary Guidelines, untainted by industry lobbying, unrestricted by partisan politics. Here, in six easy steps, is our advice for the new year: what we think dietary guidelines ought to say.

  1. Eat more plants. You heard it from your grandmother. You heard it from Michael Pollan. Now you hear it from us: Eat your vegetables. Add fruits, beans and whole grains, and the wide-ranging plant category should make up most of your diet. Variety is the key. Plants offer us such an astonishing range of roots, stems, leaves, flowers, buds and seeds that there is bound to be something even the most jaded vegetable skeptic can love.
    Vegetables, fruits, beans and whole grains: Plants should make up most of our diet. (J. Scott Applewhite/Associated Press)
  2. Don’t eat more calories than you need. Although on any given day it’s hard to tell whether you’re doing that, over the long term, your scale is a sure-fire indicator. If the pounds are going up, eat less.

Let’s pause here for the good news. If you follow our first two guidelines, you can stop worrying. Everything else is fine-tuning, and you have plenty of leeway.

  1. Eat less junk. “And what’s junk?” we hear you asking. We have faith that you know exactly what junk is. It’s foods with lots of calories, plenty of sugar and salt, and not nearly enough nutritional value. It’s soda and sugary drinks. It’s highly processed, packaged foods designed to be irresistible. It’s fast food. You know it when you see it. When you do, don’t eat too much of it.
  2. Eat a variety of foods you enjoy. There is research on the health implications of just about any food you can think of. Some — such as fish — may be good for you. You should eat others — such as meat and refined grains — in smaller amounts. The evidence for most foods is so inconsistent that you should never force yourself to eat them if you don’t want to, or deny yourself if you do. If you love junk foods, you get to eat them, too (in moderation, of course). You have bought yourself that wiggle room by making sure the bulk of your diet is plants and by not eating more than you need.

This is an appropriate place to talk about a phrase that has been thrown around a lot in the Dietary Guidelines brouhaha: “science-based.”

As a journalist (Tamar) and a scientist (Marion), we’re very much in favor of science. But in this situation, the food industry’s frequent calls for “science-based” guidelines really mean, “We don’t like what you said.”

Arriving at truths about human nutrition isn’t easy. We can’t keep research subjects captive and feed them controlled diets for the decades it takes many health problems to play out. Nor can we feed them something until it kills them. We have to rely on animal research, short-term trials and population data, all of which have serious limitations and require interpretation — and intelligent people can come to quite different opinions about what those studies mean.

Which is why “eat some if you like it” isn’t a wishy-washy cop-out. It acknowledges science’s limitations. We do know that plants are good, and we do know that junk foods aren’t, but in between is an awful lot of uncertainty. So, eat more plants, eat less junk, and eat that in-between stuff moderately. That is exactly the advice science demands.

What we eat and how we eat go hand in hand. We’ve all been there, sitting in front of a screen and finding that, all of a sudden, that bag, box or sleeve of something crunchy and tasty is all gone. We’re so focused on what to eat that how to eat gets short shrift. So:

  1. Find the joy in food. Eat mindfully and convivially. One of life’s great gifts is the need to eat, so don’t squander it with mindless, joyless consumption. Try to find pleasure in every meal, and share it with friends, relatives, even strangers.
  1. Learn to cook. The better you cook, the better you eat. There are days when cooking feels like a chore, but there are also days when you find profound satisfaction in feeding wholesome homemade food to people you love. And foods you make at home are worlds apart from foods that manufacturers make in factories. No home kitchen ever turned out a Lunchable.

If you go out in the world armed only with these guidelines, you’ll do great. Sure, there’s much more to know, if you want to know it. We’ve forged careers writing about food and nutrition, and either one of us could talk micronutrients until your eyes glaze over. But these few basics are all you need to make good food decisions. Choose foods you like, cook them and enjoy them.

It really is that simple.

Haspel is the James Beard award-winning writer of Unearthed, a Washington Post column devoted to finding out what’s actually true about food.

Nestle is professor of nutrition, food studies and public health at New York University and is the author, most recently, of “Soda Politics: Taking on Big Soda (and Winning).”

 

Dec 16 2015

House Appropriations Bill Affects 2015 Dietary Guidelines

The bill just passed by the House contains this language:

SEC. 734. None of the funds made available by this or any other Act may be used to release or implement the final version of the eighth edition of the Dietary Guidelines for Americans, revised pursuant to section 301 of the National Nutrition Monitoring and Related Research Act of 1990 (7 U.S.C. 5341), unless the Secretary of Agriculture and the Secretary of Health and Human Services ensure that each revision to any nutritional or dietary information or guideline contained in the 2010 edition of the Dietary Guidelines for Americans and each new nutritional or dietary information or guideline to be included in the eighth edition of the Dietary Guidelines for Americans.

(1) is based on significant scientific agreement; and

(2) is limited in scope to nutritional and dietary information.

SEC. 735.

(a) Not later than 30 days after the date of the enactment of this Act, the Secretary of Agriculture shall engage the National Academy of Medicine to conduct a comprehensive study of the entire process used to establish the Advisory Committee for the Dietary Guidelines for Americans and the subsequent development of the Dietary Guidelines for Americans, most recently revised pursuant to section 301 of the National Nutrition Monitoring and Related Research Act of 1990 (7 U.S.C. 5341). The panel of the National Academy of Medicine selected to conduct the study shall include a balanced representation of individuals with broad experiences and viewpoints regarding nutritional and dietary information.

(b) The study required by subsection (a) shall include the following:

(1) An analysis of each of the following:

(A) How the Dietary Guidelines for Americans can better prevent chronic disease, ensure nutritional sufficiency for all Americans, and accommodate a range of individual factors, including age, gender, and metabolic health.

(B) How the advisory committee selection process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints.

(C) How the Nutrition Evidence Library is compiled and utilized, including whether Nutrition Evidence Library reviews and other systematic reviews and data analysis are conducted according to rigorous and objective scientific standards.

(D) How systematic reviews are conducted on longstanding Dietary Guidelines for Americans recommendations, including whether scientific studies are included from scientists with a range of viewpoints.

(2) Recommendations to improve the process used to establish the Dietary Guidelines for Americans and to ensure the Dietary Guidelines for Americans reflect balanced sound science.

(c) There is hereby appropriated $1,000,000 to conduct the study required by subsection (a).

Comment:  I continue to be astonished that the House of Representatives would take such an intense interest in the science of nutrition when it is so uninterested in the science of climate change.  And I am puzzled as to why the House thinks that nutrition scientists appointed by the Academy of Medicine (formerly Institute of Medicine) would have views any different from those of the current Dietary Guidelines Advisory Committee.

Will the USDA and HHS release the 2015 Dietary Guidelines before the Senate passes its version of the Appropriations bill?

I’m in Geneva this week and am hoping they wait until I get back.

Oct 7 2015

The bizarre saga of the 2015 Dietary Guidelines: Continued

Two events yesterday:

#1.  USDA and HHS announce that sustainability will not be part of the Dietary Guidelines.

This year, we will release the 2015 edition, and though the guidelines have yet to be finalized, we know they will be similar in many key respects to those of past years. Fruits and vegetables, low-fat dairy, whole grains and lean meats and other proteins, and limited amounts of saturated fats, added sugars and sodium remain the building blocks of a healthy lifestyle.

…In terms of the 2015 Dietary Guidelines for Americans (DGAs), we will remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (NNMRRA), which is to provide “nutritional and dietary information and guidelines”… “based on the preponderance of the scientific and medical knowledge.”  The final 2015 Guidelines are still being drafted, but because this is a matter of scope, we do not believe that the 2015 DGAs are the appropriate vehicle for this important policy conversation about sustainability.

OK, but see Michele Simon’s analysis of the legal issues related to sustainability in the guidelines, and My Plate My Planet’s analysis of the comments filed on the sustainability question.

As my analysis shows, the USDA and HHS would be well within its legal authority to include sustainability. In summary:

    • A plain reading of the statute does not preclude sustainability;
    • The Congressional intent was to further a broad agenda on health;
    • Previous DGA versions included issues beyond “nutrition and diet”.

And also see Kathleen Merrigan et al’s argument in favor of sustainable dietary guidelines in Science Magazine.

So this is about politics, not science.

#2.  A coalition of critics of the Dietary Guidelines is attempting to block their release.

Yesterday’s Hagstrom Report and, later, Politico (both behind paywalls) reported that this group is calling on  USDA and HHS to turn over the guidelines to a committee of the National Academy of Sciences Food and Nutrition Board for reexamination before releasing them to the public.

The issues?  The meat and beverage recommendations.

The group is funded by philanthropists Laura and John D. Arnold, who fund Nina Teicholz’s work.

Teicholz is on the board of the group as is Cheryl Achterberg, dean of the Ohio State University College of Education, and John Billings, who directs the Wagner School’s Health Policy and Management Program at NYU (why they agreed to do this is beyond me).

Hagstrom notes that coordinating support is coming from Beth Johnson, a former undersecretary for food safety at USDA who has her own consulting firm with clients apparently including the National Restaurant Association and the National Cattlemen’s Beef Association.

Other members of the advisory board include several scientists who do research funded by food companies.

The Coalition’s website is here.

This morning’s Politico Pro Agriculture has a long piece on the funding behind the coalition.

In the lead up to congressional hearings on the proposed 2015 dietary guidelines, the Arnolds are spending an initial $200,000 to communicate that critique and to advocate for changes that they say would improve the process. They have funded the new political action group, called The Nutrition Coalition, whose well-placed lobbyists have helped Teicholz score face-to-face meetings with top officials in Congress and the White House to push for an independent review of the guideline process. The team helped persuade lawmakers to insert language in the fiscal 2016 House agriculture spending bill to direct the National Academy of Medicine to conduct such a review.

Really? Eating fruits and vegetables and not overeating calories requires this level of lobbying?

This too is about politics.

The mind boggles.

Addition

The Hagstrom Report is keeping track of the testimony at today’s congressional hearing on the guidelines.