Search results: dietary guidelines

I am indebted to Margarita Raycheva, who writes for the highly informative newsletter, IEG Policy Agribusiness, for her recent article, which certainly got my attention: “Coca-Cola asks DGAC to develop detailed dietary recommendations for beverages” (this is probably behind a paywall).

Her article is about comments filed by Coca-Cola to the DGAC, the 2020 Dietary Guidelines Advisory Committee.  She did not provide a link to those comments, so I had to search for them.  This involved finding the DGAC comments page, searching for Coca-Cola, locating the company’s letter, and opening the pdf attachment.

The 12-page document reads like a highly sophisticated advertisement for Coca-Cola’s astounding number of beverage options, many of them low in sugar or sugar-free.

Over the last few years, Coca-Cola has been transforming to become a total beverage company that meets Americans’ fast-changing preferences across a wide array of beverage categories. We support the World Health Organization’s recommendation that people should limit added sugar to no more than 10% of their total daily calorie consumption1 and are rethinking existing recipes, package sizes and offerings to ensure we are helping consumers manage their daily intake of added sugar and other nutrients from our portfolio.  Today, we offer more than 800 drinks in the U.S. alone, ranging from soft drinks to juices, teas, coffee, dairy, sports drinks, water and more – more than 250 of which are low- or zero-sugar options. More than 40% of our sparkling beverage brands in the U.S. are now available in package sizes that are smaller than 8.5 ounces. We are increasing marketing support for low-sugar, no-sugar and unsweetened products…; we are introducing less sweet versions of classic soft drinks…; and we are accelerating our expansion into new beverage categories through the acquisition of brands….We are taking these actions because we recognize the critical role that we – and the entire industry – can play in advancing nutritional goals by using our scale for good.

Why do this?

• About 15% of energy comes from beverages
• Beverages, such as sweetened soft drinks, coffee and tea contribute more than 40% of daily added sugar intake
• Beverages, mainly milk and 100% juice, contribute over 40% of vitamin C and D intake and more than 20% intake of carbohydrates, calcium, potassium and magnesium
• Fruit intake (0.9 cup/day) is half of recommended levels (2 cups/day); 100% fruit juice contributes up to 24% of fruit intake in children, but decreases after adolescence
• Coffee and tea contribute up to 12% of potassium intake in adults
• Waters contribute up to 10% of calcium intake in adults

In other words, drink more (of our) beverages!

Coca-Cola’s proposals for how beverages can enhance diets:

• Hydration
• Nutrition and health
• Enjoyment
• Performance

What should the DGAC do?

By creating a framework that includes guidance for all types of beverages, the DGA can help drive Americans towards healthier versions of drinks they are typically consuming. Recommending limited
consumption or small shifts towards healthier beverages is more effective than simply discouraging the consumption of entire beverage categories.

The company’s proposals for how the DGAC can help it sell more beverages include sample statements like these examples [with my translations]:

• Water should be the primary beverage choice [recommend our bottled water]
• Milk plays an important role in development and health, and contributes essential nutrients to healthy eating patterns, including protein, calcium, vitamin D and potassium [recommend our milk drinks]
• When fortified, plant-based beverages may provide nutrients and support consumer choice, but generally should not be considered a replacement for dairy [please don’t recommend almond, soy, or oat milks–we don’t make any of those drinks]
• Juice contributes to the public’s consumption of essential nutrients, phytonutrient and fruit/vegetable intake [recommend our juice drinks]
• Coffee and tea are sources of health-promoting phytonutrients and are associated with reduced risk of rtain non-communicable diseases (NCDs) [recommend them; we sell those too]
• Replace sugar-sweetened beverages >40 kcal that do not contribute significantly to nutrition needs with these beverages to reduce calorie and sugar consumption [if you must recommend avoing sugary beverages, at least recommend replacement with everything else we sell]
• Sports drinks can be beneficial for individuals who engage in prolonged vigorous physical activity, or those sweating for prolonged hours due to warm to hot temperatures [OK, they have sugar, but recommend them anyway]

I can’t wait to see what the DGAC does with this impressively written document.

Not that it matters, really.  Recall: The DGAC submits the research report, but the agencies—USDA takes the lead this time—write the actual guidelines.

Very late in the process, the USDA and HHS have finally announced the membership of the Dietary Guidelines Advisory Committee for 2020:

Today the Secretaries of USDA and HHS announced 20 nationally recognized experts who have been selected to serve on the 2020 Dietary Guidelines Advisory Committee.

The independent Advisory Committee will review the scientific evidence on topics from the Departments and provide a report to the Secretaries that, along with public and agency comments, will help inform USDA and HHS’s development of the 2020-2025 Dietary Guidelines for Americans.

• See the list of members [this includes explanations of how they were selected]
• View the topics and scientific questions that will direct the Advisory Committee’s work.
• Learn more and stay connected with us at DietaryGuidelines.gov.

I know several of the members.  I served with Barbara Schneeman on the 1995 DGAC, for example.

Some members have financial ties to food companies with deep interests in the what the guidelines say.  This is despite the agencies’ statements that

The vetting process also included a background check by the USDA Office of the Secretary to determine if any of the candidates have a financial, ethical, legal, and/or criminal conflict of interest that would prohibit them from serving on the Committee…Each Committee member submitted a financial disclosure report prior to appointment and will continue to do so annually thereafter. Each report was reviewed by USDA ethics officials for financial conflicts of interest and compliance with Federal ethics rules.

Politico’s Helena Bottemiller Evich asked groups to say who they nominated to the committee.  What she found is here, but behind a paywall.  I’ve added the information from these lists in red.  She is still trying to find out who nominated the others.

• Jamy Ard, MD – Wake Forest University
• Regan Bailey, PhD, MPH, RD – Purdue University, Department of Nutrition Science Academy of Nutrition and Dietetics
• Lydia Bazzano, MD, PhD – Tulane University  Atkins Nutritional
• Carol Boushey, PhD, MPH, RD – University of Hawaii  National Cattlemen’s Beef Association
• Teresa Davis, PhD – Baylor College of Medicine
• Kathryn Dewey, PhD – University of California, Davis
• Sharon Donovan, PhD, RD – University of Illinois
• Steven Heymsfield, MD – Louisiana State University American Beverage Association
• Ronald Kleinman, MD – Harvard University
• Heather Leidy, PhD – University of Texas National Cattlemen’s Beef Association
• Richard Mattes, PhD, MPH, RD – Purdue University Academy of Nutrition and Dietetics
• Elizabeth Mayer-Davis, PhD, RD – University of North Carolina
• Timothy Naimi, MD – Boston University
• Rachel Novotny, PhD, RDN, LD – University of Hawaii
• Joan Sabaté, DrPH, MD – Loma Linda University
• Barbara Schneeman, PhD – University of California, Davis  American Beverage Association
• Linda Snetselaar, PhD, RD – University of Iowa Academy of Nutrition and Dietetics
• Jamie Stang, PhD – University of Minnesota, School of Public Health, Division of Epidemiology & Community Health Academy of Nutrition and Dietetics
• Elsie Taveras, MD, MPH – Massachusetts General Hospital, Harvard Medical School, and Harvard Chan School of Public Health
• Linda Van Horn, PhD, RDN, LD – Northwestern University

As for transparency:

Helena Bottemiller Evich (@hbottemiller) tweeted at 11:36 AM on Fri, Feb 22, 2019:
Everyone says they want a “more transparent” Dietary Guidelines process, but the minute I ask for who X group nominated to be on DGAC food/ag/health groups are like https://t.co/6J8GJnGpD7
(https://twitter.com/hbottemiller/status/1099030227009835008?s=03)

Overall, this looks to me like any other DGAC except that there are twice as many members as in the past.

Their job is to review the research and write a report.  The agencies write the guidelines.

I will be following all this with great interest, as always.

Remember the Dietary Guidelines?  Those pesky things that have to be revised every five years by order of Congress?

This time, the USDA is firmly in charge of the joint process with HHS.

It says the updating process is well underway.

The call has gone out for nominations of advisory committee members.  This is now closed and USDA expects to appoint the committee within the next few months.

And now it has put the official charter for the process out for comment.

It also has issued a Q and A.

And provides a schedule for public engagement.

A few aspects of this especially interest me:

• Nothing has been said about a new food guide (MyPlate is left over from the 2010 guidelines).
• USDA’s close control.  It says this is mandated by Congress.
• The level of scrutiny of the process will be exceptional, giving the fuss about the 2015 guidelines.
• Expect the process to be highly politicized.

This committee will have its work cut out for it.  Much appreciation to the brave souls willing to take this on.

I can’t wait to see who they are.

Stay tuned.

The USDA has issued a Call for Nominations for the 2020 Dietary Guidelines Advisory Committee

The independent advisory committee will review the scientific evidence to help inform the next edition of the Dietary Guidelines for Americans. The deadline to submit nominations for the Dietary Guidelines Advisory Committee is October 6, 2018, at 11:59 pm, Eastern Time.

Good luck with this. I don’t envy anyone serving on this committee.

The issues:

• The late start. By law, the guidelines are supposed to be submitted in 2020. The committee will be under pressure to move quickly.
• USDA’s dominance. The guidelines are supposed to be jointly produced by two agencies; the other is HHS. The absence of HHS from this announcement seems curious. USDA must be the lead this year and can be expected to allow politics to trump (pardon the expression) science.
• Science politics. Questions—qualitative and quantitative—about fat v. carbohydrates are hotly debated and not easy to resolve.
• Food industry influence. This is always a problem but this influence—on research and policy—is now under sharp scrutiny (my forthcoming book adds to the scrutiny, I hope).
• Government interference. The committee writes an advisory report. Then USDA and HHS take over and do what they please with what the committee produces.  And we know, because USDA said so, that this administration intends to take a more active role in setting the agenda and in committee discussions.
• Spotlight. Everything this committee does will be public and publicized on the front pages of newspapers and in social media.
• Courage. It will take plenty.

Here’s what USDA says about factors to be considered in reviewing nominations:

• Educational background – advanced degree in nutrition- or health-related field, including registered dietitians, nutrition scientists, physicians, and those with public health degrees
• Professional experience – at least 10 years of experience as an academic, researcher, practitioner, or other health professional in a field related to one or more of the topics to be examined; consideration of leadership experience and participation on previous committees or panels
• Demonstrated scientific expertise – expertise related to one or more of the topics to be examined by the committee as demonstrated by number and quality of peer-reviewed publications and presentations
• Obligations under the Federal Advisory Committee Act – ensuring the Committee is balanced fairly in points of view and types of expertise
• Requirements regarding a balanced membership – including, to the extent possible, individuals who are minorities, women, persons with disabilities, and representatives from different geographic areas and institutions

More information is available on DietaryGuidelines.gov:

• See What to Include in a Nomination Package
• See the Topics and Scientific Questions to be Examined by the Committee
• Learn How USDA-HHS Will Establish the Committee
• Additional Resources

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.

• National Academy of Medicine report I: Optimizing the process
• National Academy of Medicine report II: Redesigning the process

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.

• Submit Public Comments February 28 to March 30, 2018
• The press release
• Learn More About This Call for Public Comments
• See the Proposed Topics and Scientific Questions
• Additional Resources
• Federal Register notice preview

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).

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?

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

• 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.