Currently browsing posts about: Dietary-Guidelines

The 2015 Dietary Guidelines Advisory Committee is meeting today by teleconference.

One issue, no doubt, will be the House directive in the appropriations bill (page 50 of this draft):

Dietary Guidelines.—The Committee is concerned that the advisory committee for the 2015 Dietary Guidelines for Americans is considering issues outside of the nutritional focus of the panel. Specifically, the advisory committee is showing an interest in incorporating sustainability, climate change, and other environmental factors and production practices into their criteria for establishing the next dietary recommendations, which is clearly outside of the scope of the panel. The Committee directs the Secretary to ensure that the advisory committee focuses only on nutrient and dietary recommendations based upon sound nutrition science and not pursue an environmental agenda. Should environmental or production factors be included in the panel’s recommendations to USDA and
the Department of Health and Human Services, the Committee expects the Secretary to reject their inclusion in the final 2015 Dietary Guidelines for Americans.

Amazing, how Congress thinks it knows more about nutrition thank nutrition scientists.

Let’s grant that Congress knows what the political fallout will be from these guidelines.

NPR interviewed Kate Clancy, who has been arguing for the need to include environmental considerations in dietary guidelines for years.

In 1986, nutritionist Kate Clancy, then teaching at Syracuse University, co-authored [with Joan Gussow] an article called “Dietary Guidelines for Sustainability.” It was addressed to her colleagues, Clancy says. She wanted them “to take a broader view of what they were advising people to do, with regard to their diet. It wasn’t just nutrients.” She urged them to consider not just what foods contribute to personal health, but also what types of food “contribute to the protection of our natural resources.”

Makes sense, no?

Too bad politics trumps science in this Congress.

Brazil has just released the final version of its Dietary Guidelines for the Brazilian population in English as well as in Portuguese (I wrote about the draft version in an earlier post).

As explained in the press release (also in English), the guidelines include ten steps to healthy diets:

1. Make natural or minimally processed foods the basis of your diet
2. Use oils, fats, salt, and sugar in small amounts when seasoning and cooking natural or minimally processed foods and to create culinary preparations
3. Limit consumption of processed foods
4. Avoid consumption of ultra-processed products
5. Eat regularly and carefully in appropriate environments and, whenever possible, in company
6. Shop in places that offer a variety of natural or minimally processed foods
7. Develop, exercise and share culinary skills
8. Plan your time to make food and eating important in your life
9. Out of home, prefer places that serve freshly made meals
10. Be wary of food advertising and marketing

Traditionally, families based their diets on natural and minimally processed foods.  The guidelines are based on the actual, traditional dietary patterns of a substantial proportion of the Brazilian population of all ages and classes throughout the country.

Carlos Monteiro, the Brazilian nutrition professor listed as the technical formulator of the guidelines, was in Washington DC last week to speak at a conference on the 2015 Dietary Guidelines.   Monteiro’s speech is here.  Tweets sent during the meeting are here.

I hope everybody listened.

I received an e-mail from the communications director of the Independent Women’s Forum, a group whose mission is to “improve the lives of Americans by increasing the number of women who value free markets and personal liberty.”

Interesting.

The group and its friends have just sent a letter to USDA and HHS complaining that the 2015 Dietary Guidelines Advisory Committee (DGAC) is exceeding its mandate.

Among our most acute concerns is the “mission creep” of the Committee, which has expanded to include non-dietary factors such as “carbon footprints,” “climate change,” “urban agriculture,” and “green cleaning and pest control practices.”

This likely reflects the composition of the Committee, which is nearly all epidemiologists from elite academic institutions with no direct experience in the practical realities of how food is produced and what average Americans may choose to eat.

We need only consider the strongly negative reaction to recent changes to the school lunch rules to understand what is at risk if this Committee attempts to dictate over-reaching changes to the American diet.

This would be funny if it weren’t part of the Republican agenda to roll back improvements in nutrition advice and practice aimed at preventing obesity and its related chronic diseases.

What the IWF is saying is that its members know better about what’s good for health than all those elite epidemiologists, scientists, and other experts on the committee who are worried about what climate change will do to our food supply.

Let’s hope the agencies ignore this letter.

Mal Nesheim and I have an editorial in a recent issue of the American Journal of Clinical Nutrition: “Advice for fish consumption: challenging dilemmas.”

We commented on a research article evaluating blood mercury levels in adults eating seafood.

In it, we point out that

the 2010 Dietary Guidelines for Americans advise Americans to consume 8 ounces (227 g) of seafood per week to reach an average intake of 250 mg/d of the omega-3 fatty acids EPA and DHA.

This recommendation represents a substantial increase over current consumption amounts of ∼3.5 oz/wk. It is based on “moderate, consistent evidence” that the health benefits of increased seafood consumption outweigh the risks associated with methylmercury, a toxic contaminant of large predatory food fish (tilefish, shark, swordfish, king mackerel) and, to a lesser extent, albacore (white) tuna.

To avoid this toxin, the guidelines advise eating seafood typically found to be low in methylmercury, such as salmon, anchovies, sardines, and trout.

Such advice, however, leads to at least 3 dilemmas. Eating more fish might raise methylmercury intake above safe amounts. Pressures to consume more fish might place impossible demands on an already threatened seafood supply. And the obvious solution—fish farming—raises concerns about what farmed fish are fed and how farmed fish affects the environment.

We urge the 2015 Dietary Guidelines committee to take all this into consideration when making recommendations about fish consumption: “We hope that its advice for seafood consumption will help a confused public resolve some of these dilemmas and make wise seafood choices.”

Wise seafood choices may be an oxymoron, alas.

The food movement must be succeeding beyond anyone’s wildest expectations.

Now it’s the Dietary Guidelines Advisory Committee’s (DGAC’s) turn to come under attack.

The Guidelines:  These are principles of healthful diets aimed at policymakers  (not the general public).

The history:  They have been published every five years since 1980, so we are now in round #8 scheduled for publication in 2015.

The process: Two federal departments, USDA and Health and Human Services, appoint an advisory committee of nutrition scientists.  The committee reviews the science and prepares a report.  Since 2005, the agencies have written the guidelines, not the committee.     

Disclosure: I was a member of the advisory committee for the 1995 Guidelines.

The fireworks: According to ProPolitico Morning Agriculture (behind a pay wall, alas), the committee is attracting unusual attention from the right:

• The Washington Examiner, writes that “committee members…are hijacking the guidelines to advance a range of ideological agendas having nothing to do with healthy eating.”
• The Daily Caller asks “Are Progressives Inserting Their Agenda Into Your Diet?” Tuesday.
• The Washington Free Beacon wants you to “Meet the Radicals Creating the New Federal Dietary Guidelines.”

A clue to what is upsetting these folks comes from the committee’s request for public comments.  It is asking for comments that address:

• Elements of a whole food system
• Information on specific food groups or commodities
• Sustainability metrics that have been implemented or are in development

These, apparently, are fighting words.

Yesterday, Fox News asked why “ivory tower types” were in charge of determining food choices for Americans.

Its story particularly singled out Miriam Nelson, a professor at Tufts (not New York University—could Fox be confusing her with me?):

New York University professor Miriam Nelson, said at the committee’s last meeting, “We need to make sure that the guidelines and the policies are promoting those foods … [that] are sustainably grown and have the littlest impact on the environment.”

…The professors of the DGAC may think their job is save the planet by promoting sustainable agriculture and plant-based diets, but if they don’t understand the real-world implications of their work, they’ll be oblivious to the havoc they’ll wreak on the millions of Americans whose diets hinge on their guidelines.

By this time, the Dietary Guidelines are hardly of interest to anyone but policy wonks (really, they never change all that much).  Cheers to the current committee for injecting some life into them.

The 2015 Guidelines will be fun to watch.

What is a poor eater to do?

The latest meta-analysis of the effects of saturated fat on heart disease finds—none.

This study, reported in the Annals of Internal Medicine (doi: 10.7326/M13-1788), examined the results of

• 32 observational studies involving 530 525 participants
• 17 observational studies involving 25 721 participants
• 27 randomized controlled trials involving 103 052 participants

The result?

Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats. 

This meta-analysis follows an editorial in a Mayo Clinic publication (http://dx.doi.org/10.1016/j.mayocp.2013.11.006) by authors who argue that saturated fat is not the problem.  Carbohydrates (e.g., sugars) are the problem.  The authors argue:

• Effects of saturated fat on blood cholesterol are weak and transient.
• Meta-analyses have found a lack of an association between heart disease mortality and saturated fat intake.
• Stroke studies find that patients with stroke had eaten less saturated fat.
• Long-term studies find that people with the highest dairy consumption have the lowest mortality risk, and also low diabetes and heart disease.
• Dietary trials find trivial or no benefit at all from decreasing saturated fat and/or increasing intake of polyunsaturated fat.

On this basis, they say that advice to reduce intake of saturated fat is irrational.

The New York Times asked several experts for comment on the meta-analysis, among them Dr. Frank Hu of Harvard:

The single macronutrient approach is outdated…I think future dietary guidelines will put more and more emphasis on real food rather than giving an absolute upper limit or cutoff point for certain macronutrients…people should try to eat foods that are typical of the Mediterranean diet, like nuts, fish, avocado, high-fiber grains and olive oil.

Dr. Hu was referring to a large clinical trial (not included in the meta-analysis), which concluded that a diet with more nuts and extra virgin olive oil reduced heart attacks and strokes when compared with a lower fat diet with more starches.

The Times story contained a reminder that the American Heart Association issued dietary guidelines last year to “restrict saturated fat to as little as 5 percent of their daily calories, or roughly two tablespoons of butter or two ounces of Cheddar cheese for the typical person eating about 2,000 calories a day.”

How to make sense of this?

I vote with Frank Hu that dietary advice should focus on food, not nutrients.

Focusing on one or another nutrient—fat, saturated fat, cholesterol, or sugar—takes foods out of their caloric as well as dietary context.

My guess: If you balance food intake with physical activity and are not overeating, the specific proportion of fat, carbohydrate, and protein won’t matter nearly as much.

While the arguments about fat v. sugar go on and on:  Eat your veggies, vary the foods you eat, don’t gorge, and enjoy what you eat.

Brazil has issued new dietary guidelines open for public comment.  For the Brazilian Dietary Guidelines document (in Portuguese), click here..

Brazilian health officials designed the guidelines to help protect against undernutrition, which is already declining sharply in Brazil, but also to prevent the health consequences of overweight and obesity, which are sharply increasing in that country.

The guidelines are remarkable in that they are based on foods that Brazilians of all social classes eat every day, and consider the social, cultural, economic and environmental implications of food choices.

The guide’s three “golden rules:”

• Make foods and freshly prepared dishes and meals the basis of your diet.
• Be sure oils, fats, sugar and salt are used in moderation in culinary preparations.
• Limit the intake of ready-to-consume products and avoid those that are ultra-processed.

The ten Brazilian guidelines:

1. Prepare meals from staple and fresh foods.
2. Use oils, fats, sugar and salt in moderation.
3. Limit consumption of ready-to-consume food and drink products
4. Eat regular meals, paying attention, and in appropriate environments.
5. Eat in company whenever possible.
6. Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption.
7. Develop, practice, share and enjoy your skills in food preparation and cooking.
8. Plan your time to give meals and eating proper time and space.
9. When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
10. Be critical of the commercial advertisement of food products.

Now if only our Dietary Guidelines Advisory Committee would take note and do the same?

Would you like us to have sensible, unambiguous food-based guidelines like these?  You can file comments on the 2015 Dietary Guidelines here.

Thanks to Professor Carlos A. Monteiro of the Department of Nutrition, School of Public Health at the University of Sao Paulo for sending the guidelines and for their translation, and for his contribution to them.

I’ve only just come across this USDA chart, which first appeared in an article in Amber Waves.

USDA’s Economic Research Service (ERS) researchers looked at 1998-2006 grocery store food expenditures and compared what consumers buy to dietary guidelines for healthy eating.  

Oops.