Currently browsing posts about: Dietary-Guidelines

The 2025-2030 Dietary Guidelines Advisory Committee did not make a recommendation about alcohol.  The agencies, HHS and USDA, will do that later based on two expert reviews.

I wrote about the first, from the National Academies, last week: Review of Evidence on Alcohol and Health.

I also wrote about the Surgeon General’s Advisory on Alcohol and Cancer Risk

Still to come is the report from the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).

At issue is the amount of alcohol that is safe to drink, if any.

Just for fun, I did a summary of what the Dietary Guidelines say about alcohol from 1980 to 2020.  Note that the Moderation advice has not changed since 1990 (but then see the note on 2020).

                                      Alcohol recommendations: Dietary Guidelines for Americans

YEAR	ALCOHOL ADVICE	BENEFITS	MODERATION
1980	“If you drink alcohol, do so in moderation.”		“One or two drinks daily appear to cause no harm in adults.”
1985	“If you drink alcoholic beverages, do so in moderation.”		“One or two standard-size drinks daily appear to cause no harm in normal, healthy, nonpregnant adults.”
1990	Ditto	“Some studies have suggested that moderate drinking is linked to lower risk for heart attacks.”	No more than 1 drink/day for women, and 2 for men.
1995	Ditto	“Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history…Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals.”	Ditto
2000	Ditto	“Even one drink per day can slightly raise the risk of breast cancer…Drinking in moderation may lower risk for coronary heart disease, mainly among men over age 45 and women over age 55.”	Ditto
2005	“Those who choose to drink alcoholic beverages should do so sensibly and in moderation.”	“Alcohol may have beneficial effects when consumed in moderation.  The lowest all-cause mortality  [and heart disease mortality] occurs at an intake of one or two drinks per day…compared with women who do not drink, women who consume one drink per day appear to have a slightly higher risk of breast cancer.”	Ditto
2010	“If alcohol is consumed, it should be consumed in moderation…and only by adults of legal drinking age.”	“Strong evidence from observational studies has shown that moderate alcohol consumption is associated with a lower risk of cardiovascular disease….[and] reduced risk of all-cause mortality among middle-aged and older adults and may help to keep cognitive function intact with age…[but also] increased risk of bfreast cancer, violence, drowning, and injuries from falls and motor vehicle crashes.”	Ditto
2015	Ditto	[heart disease and breast cancer not mentioned	Ditto
2020*	“Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages”	“Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day). Caution, therefore, is recommended.”	Ditto

*From the 2020 Dietary Guidelines Advisory Committee report: “evidence points to a general rule that drinking less is better for health than drinking more. Therefore, the focus should remain on reducing consumption among those who drink, particularly among those who drink in ways that increase the risk of harms. The Committee concluded that no evidence exists to relax current Dietary Guidelines for Americans recommendations, and there is evidence to tighten them for men such that recommended limits for both men and women who drink would be 1 drink per day on days when alcohol is consumed.

Despite the language in the 2020 guideline, the agencies did not change the overall recommendation about moderate drinking.

Will the Surgeon General’s Advisory and the upcoming third report cause the agencies to suggest no more than one drink a day for men?  Or suggest that no level of alcohol intake is safe?

I’m looking forward to finding out.

Resource: the process for alcohol in the Dietary Guidelines

I.  Darius Mozaffarian, a nutrition professor at Tufts University, has an editorial in the American Journal of Clinical Nutrition:“The Dietary Guidelines for Americans—is the evidence bar too low or too high?”

He writes about an analysis of the systematic literature reviews SRs) that form the basis of science-based decisions in the guidelines.  His comments gives an insight into the Dietary Guidelines process worth seeing.

For the 2025–2030 DGAC, I served as a peer reviewer for the SR on UPFs…I felt that the SR’s question, design, and planned methods were appropriate, but that its implementation and conclusions were weakened by important deviations from these standards. For example, contradicting its stated eligibility criteria, the SR included numerous studies that did not appropriately or adequately define or assess UPF. Following inclusion of such heterogeneous studies, the SR concluded that the scientific evidence on UPF was limited due to many studies having serious concerns around exposure misclassification as well as evaluating dietary patterns not directly varying in amounts of UPF. This demonstrated a circular and dismaying reasoning: the SR included studies it should not have that had heterogeneous and poorly characterized assessments of UPF, and then concluded that heterogeneous and poorly characterized assessments of UPF limited the strength of the evidence.

He observes:

Most importantly, the DGA and SR requirements make clear that guiding Americans toward a healthier diet is an unfair fight from the start. The food industry can do almost anything it wishes to our food, combining diverse ingredients, additives, and processing methods with virtually no oversight or required evidence for long-term safety  In contrast, the DGAs and other federal agencies can only make recommendations to avoid certain foods or limit certain manufacturing methods when there is extensive, robust, and consistent evidence for harm. In this severely imbalanced playing field, industry wins again and again.

II.  Senator Bernie Sanders posted on Facebook Sanders Statement on How to Make America Healthy Again.  Among other issues, he’s taking on the food industry.

Reform the food industry. Large food corporations should not make record-breaking profits addicting children to the processed foods which make them overweight and prone to diabetes and other diseases. As a start, we must ban junk food ads targeted to kids and put strong warning labels on products high in sugar, salt and saturated fat. Longer term, we can rebuild rural America with family farms that are producing healthy, nutritious food.

III.  California Governor Gavin Newsom “issues executive order to crack down on ultra-processed foods and further investigate food dyes.”

The food we eat shouldn’t make us sick with disease or lead to lifelong consequences. California has been a leader for years in creating healthy and delicious school meals, and removing harmful ingredients and chemicals from food. We’re going to work with the industry, consumers and experts to crack down on ultra-processed foods, and create a healthier future for every Californian.

Comment

Mozaffarian offers these opinions despite disclosing financial ties to food companies.  Sanders is a welcome addition to the handful of legislators concerned about food issues.  Newsom is making it easier for other states to take similar steps.

Maybe there’s a glimmer of hope for coalition building among advocates for healthier food systems.  Maybe this really is a movement!

How’s that for a cheery thought for 2025.  Happy new year everyone!

What are we to make of this?

The National Academies of Sciences, Engineering, and Medicine’s Review of Evidence on Alcohol and Health says moderate drinking

• Reduces all-cause mortality (moderate certainty)
• Reduces the risk of cardiovascular disease (moderate certainty)
• Increases the risk of breast and colorectal cancer (but can’t decide about others)

The Surgeon General, Vivek Murthy, says in his Advisory on Alcohol and Cancer Risk

• Consuming alcohol increases the risk of developing at least 7 types of cancer.
• The causal relationship between alcohol consumption and cancer is firmly established.

Let me try some context.

That alcohol is a risk factor for cancer has been known since the 1980s.

The Surgeon General’s conclusion is especially noteworthy for its lack of ambiguity.  He says flat out: alcohol causes cancer, and 7 kinds no less.

In contrast, the NASEM report talks about low and moderate certainty for its conclusions.

Presumably, both reports were based on the same data.

Here’s what this is about.

At issue: what the 2025-2030 Dietary Guidelines will say about how much alcohol is safe to drink (if any).

Since 1990, Dietary Guidelines have said two standard drinks a day for men and one for women could be considered low risk.

But the 2020-2025 Dietary Guidelines Advisory Committee, based on recent research indicating harm from any level of alcohol intake, said only one drink a day for both men and women was probably OK.

This alarmed the alcohol industry and other industries that profit from drinking.  They convinced Congress and federal agencies to revisit the effects of moderate drinking.

Yet another report on moderate drinking and health, this one from federal agencies, is expected any day now.

The bottom line

While all this is going on, the moral is pretty clear: the less alcohol, the better.

Resources

NASEM report press release

Industry pressure to make sure Dietary Guidelines to not toughen alcohol restrictions

New York Times: What is Moderate Drinking?

Example of alcohol industry pressure on Dietary Guidelines

Rani Rabin has been right on top of this fuss.  See, for example

• Surgeon General calls for cancer warnings on alcohol
• The battle over what to tell Americans about drinking
• US diet panel adds another researcher with alcohol industry ties
• Major study of drinking will be shut down

 

 

 

 

The USDA announced last week the arrival of the Scientific Report of the Dietary Guidelines Advisory Committee (DGAC).

The DGAC deserves much praise for getting this job done on time under what I consider to be difficult constraints (large committee size, large areas of research to review, requirement that all recommendations be “evidence-based” which sounds good, but is unreasonable given the inability to conduct long-term controlled clinical studies).

The report is now open for public comment (see information at bottom of post).

The process to develop the Dietary Guidelines for Americans, 2025-2030 is under way. Get involved by providing written and oral comments to the Departments on the Scientific Report of the 2025 Dietary Guidelines Advisory Committee (Scientific Report). You may also sign up to receive email updates on news related to the development of the next edition of the Dietary Guidelines…For more information, visit the Public Comments to the Departments page.

A reminder about the process:  The DGAC report is advisory.  Since 2005, the agencies appoint an entirely separate internal governmental committee to write the actual guidelines.  This, of course, makes the process far more political and subject to lobbying (file comments!).

The recent election will install new leaders of USDA and HHS.  If they follow the same process, they will appoint and instruct the new committee.  Or, they can change the process entirely.

Another reminder: When I was on the DGAC in 1995, our committee chose the research questions, did the research, wrote the scientific report, and wrote the actual guidelines.  Those were the days.

Comments on the DGAC report

For starters, it’s 421 pages.

Its bottom line:

This healthy dietary pattern for individuals ages 2 years and older is: (1) higher in vegetables, fruits, legumes, nuts, whole grains, fish/seafood, and vegetable oils higher in unsaturated fat; and (2) lower in red and processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fat. A healthy dietary pattern, as indicated by the systematic reviews, may also include consumption of fat-free or low-fat dairy and foods lower in sodium, and/or may include plant-based dietary options.

The proposed guidelines:

1. Follow a healthy dietary pattern at every life stage. At every life stage—infancy, toddlerhood, childhood, adolescence, adulthood, pregnancy, lactation, and older adulthood—it is never too early or too late to eat healthfully.
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
3. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits.
4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

This looks like all the other Dietary Guidelines since 1980.  Its bottom-line statement is more explicit than previously about reducing red meat and sugar-sweetened beverages.

Worth reading

• Support federal data.  I especially appreciated the strong support for strengthening nutrition monitoring, food composition data (FoodData Central, an invaluable resource), and updating the Dietary Reference Intakes.  Yes!
• The chapter on portion size.  At last!  Larger portions have more calories!

What’s missing

• A separate chapter on calories stated explicitly.  The report discusses concerns about obesity and diet-related chronic disease in an excellent paragraph on page 1, and mentions calories but “stay within calorie limits” doesn’t get at what’s needed.  I want more on “…adults and children [should] consume smaller portions of foods and beverages that are high in energy density and low in nutrient density.”
• A guideline to reduce consumption of ultra-processed foods.  This committee, unwisely in my view, chose not to advise minimizing intake of ultra-processed foods, deeming their definition too uncertain and ignoring what are now three controlled clinical trials demonstrating that diets based on these food induce people to overconsume calories.

What’s confusing

–The addition of recommendations for diets in early childhood.  This was done for the 2020-2025 guidelines and it involved doubling the size of the committee. This makes the committee’s work much harder and its report insufferably long.  I would rather see a separate report on children (this could deal with the effects of food marketing as well).

–The health equity lens.  I’m all for this but its discussion dominates the report.  It is discussed in a separate chapter but then in boxes and other places throughout.  The word “equity” is mentioned 217 times and “health equity lens” 38 times.

Although prior Committees incorporated basic demographic factors such as age, race, and ethnicity into their reviews of the science, this Committee considered additional factors and did so in a holistic manner as it reviewed, interpreted, and synthesized evidence across data analysis, systematic reviews, and food pattern modeling. In particular, this Committee considered factors that reflect social determinants of health (SDOH). In doing so, the Committee could interpret the evidence based on both demographic factors (which are considered to be downstream, i.e., more proximal in terms of their influence on behavior) and socioeconomic and political factors (which are considered to be upstream, i.e., broader societal factors that influence the distribution of power and resources). Addressing SDOH is considered key to achieving a just, equitable society.

Other comments

From the Meat Institute:  Meat Institute Issues Statement on the Scientific Report of the 2025 Dietary Guidelines Advisory Committee

“The Meat Institute remains strongly opposed to the Report’s recommendation to reduce meat consumption and will urge the agencies to reject it,” said Meat Institute President and CEO Julie Anna Potts.

From the Physicians Committee for Responsible Medicine: Prioritizing Plant-Based Protein in the Scientific Report of the 2025-2030 Dietary Guidelines for Americans Committee is a Step Forward, Doctors Say

For the first time, the advisory committee tasked with making scientific recommendations for revising the Dietary Guidelines for Americans recommended that the 2025-2030 Dietary Guidelines “include more nutrient-dense plant-based meal and dietary recommendation options,” prioritize plant-based protein over animal protein, and recognize the many benefits of beans, peas, and lentils as a protein source. The Dietary Guidelines Advisory Committee (DGAC) continued to discourage consuming foods like red meat, eggs, and dairy that are high in saturated fat, while also suggesting that the next Dietary Guidelines for Americans specifically recommend plain drinking water as the primary beverage for people to consume.

I can’t wait to see what comes next.

How to commennt

A 60-day public comment period on the Committee’s Scientific Report is open through February 10, 2025. More information about how to provide written and oral comments to the Departments is available at DietaryGuidelines.gov.

• Read about opportunities to provide public comments, including requirements for oral comments 
• Register to provide oral comments to the Departments.   Note: do this now.  Spaces are limited.
• Submit written public comments to the Departments
• Register to attend the virtual public meeting to hear oral comments on the Scientific Report  

Read the Committee’s Scientific Report 

What are healthy diets? Joint statement by the Food and Agriculture Organization of the United Nations and the World Health Organization

What this is about:

Healthy diets promote health, growth and development, support active lifestyles, prevent nutrient deficiencies and excesses, communicable and noncommunicable diseases, foodborne diseases and promote wellbeing. The exact make-up of a diet will vary depending on individual characteristics, preferences and beliefs, cultural context, locally available foods and dietary customs. However, the basic principles of what constitutes healthy diets remain the same.

The guiding principles: Adequate, Balanced, Moderate, Diverse.

Here’s what they mean by Balance:

The actual guidelines are discussed under the Moderate principle.

• Sodium: restrict to 2 grams/d (5 g table salt)
• Sugars: restrict to 10% or less of daily calories.
• Saturated fat: restrict to 10% of calories, with no more than 1% from trans fat

FAO and WHO duck making a clear statement about the next two issues, although their implications are clear.

• Red and processed meat: even low levels may have negative health consequences
• Ultra-processed foods: these have negative health consequences

I wish they had stated these recommendations more clearly.  Yes they are controversial with big industries lobbying against any suggestion to eat less of these foods, but these agencies, or at least WHO, should put public health first.

I recognize that these agencies have constituencies of nearly 200 countries, many with strong meat and ultra-processed food industries.  I also recognize that the agencies have no power other than leadership to get any of those countries to do anything.

They at least stated what they thought.  It’s up to country governments to take action.  I hope they do.

DietaryGuidelines.gov provides handouts on Food Sources of Select Nutrients.

Alas, calories are not among these handouts, even though 75% of American adults are now considered overweight or obese.

These are meant for nutrition professionals but are fun to see if you want to see what they get.

The page lists lots of other resources.

• Download Handouts & SpreadsheetLearn More About Food Sources
• Print materials on the professional resources page 
• MyPlate Quiz
• MyPlate Plan
• MyPlate Kitchen
• Professional food photography

Will these help you make healhier dietary choices?

Nutrients are not the problem; calories are the problem.

To do something about them, we need a healthier food environment.

I wish the USDA would give that as much attention as it gives nutrients.

The 2025-2030 Dietary Guidelines Advisory Committee (DGAC) report is well underway.   The committee either has submitted or is about to submit its report to HHS and USDA;.  The report has not yet been posted, but presumably will be posted soon.

But understand: the scientific advisory committee is just that: advisory.

The agencies, HHS and USDA, are responsible for writing the actual guidelines.  They choose an internal committee to do that work.  That new committee can pick, choose, add, or subtract from the advisory committee’s report.

So yes, the new Secretaries of HHS and USDA can have a lot of input (and veto power) into the new guidelines.

As I’m fond of repeating, the guidelines process was quite different when I was on the DGAC in 1995.  Then, our committee chose the research topics, reviewed the research, wrote the advisory committee report, and wrote the actual dietary guidelines.  The agencies made only minor tweakings.

The agencies have written the guidelines since 2005, making the process much more subject to politics.

The DGAC, for example, viewed the evidence on ultra-processed foods as too limited to take a stand, yet RFK, Jr says ultra-processed foods are killing us.

The development of the 2025-2030 guidelines will be most interesting to watch.  Stay tuned.

Every five years since 1980, we get to go through the most enormous fuss about dietary guidelines that have not changed in any fundamental way since then.

Then and now, they say eat more vegetables, balance calories, and reduce intake of foods high in sugar, salt, and fat.

You don’t believe me?  Here is the much more straightforward 1980 version.

Reminder: The Dietary Guidelines Advisory Committee is just that: advisory.  The agencies will write the actual guidelines.  Until the guidelines actually appear, everything remains speculative.  They are due to appear by the end of 2025.  Between now and then, we have an election to deal with.  No matter who wins, political appointees in the two sponsoring departments will change and could greatly intervene.

I love the Dietary Guidelines.  They are endlessly entertaining examples of food politics in action.