Currently browsing posts about: Dietary-Guidelines

The 2010 Dietary Guidelines for Americans were just released.  Here are the take-home messages:

Balancing Calories

• Enjoy your food, but eat less.

• Avoid oversized portions.

Foods to Increase

• Make half your plate fruits and vegetables.

• Switch to fat-free or low-fat (1%) milk.

Foods to Reduce

• Compare sodium in foods like soup, bread, and frozen meals—and choose the foods with lower numbers.

• Drink water instead of sugary drinks.

I’m in shock.  I never would have believed they could pull this off.  The new guidelines recognize that obesity is the number one public health nutrition problem in America and actually give good advice about what to do about it: eat less and eat better. For the first time, the guidelines make it clear that eating less is as priority.

My two quibbles:

Quibble #1: They still talk about foods (fruits, vegetables, seafood, beans, nuts) when they say “eat more.”   But they switch to nutrient euphemisms  (sodium, solid fats and added sugars) when they mean “eat less.”

They say, for example: “limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.”

This requires translation: eat less meat, cake, cookies, sodas, juice drinks, and salty snacks.

That’s politics, for you.

Let’s give them credit for “drink water instead of sugary drinks.”  That comes close. But I listened in on the press conference and conference call and several people pushed federal officials about why they didn’t come out and say “eat less meat.”  The answers waffled.

Quibble #2: This is all about personal responsibility.  What about the “toxic” food environment?  Shouldn’t these guidelines be directed at the food and restaurant industries?  The Dietary Guidelines Advisory Committee made a big point of that.  Apparently, that’s in the full dietary guidelines report but I’ve only seen the executive summary.

For background, see my previous posts, one on the politics of this report, and one on the science of the dietary guidelines.

Overall, the new guidelines aren’t perfect but they are a great improvement.

Next: let’s see what they do to improve the implementation guide—the pyramid or its equivalent.  This, they say will come out in a few months.  Stay tuned.

Here’s what I’m going to be doing on Monday morning:

INVITATION TO KEY STAKEHOLDERS TO JOIN IN THE NATIONAL RELEASE OF THE 2010 DIETARY GUIDELINES FOR AMERICANS

The U.S. Departments of Agriculture and Health and Human Services Will Release the 2010 Dietary Guidelines for Americans at a Joint Press Conference Monday, January 31, 2011

On Monday, January 31, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) will hold a joint press a conference at The George Washington University Jack Morton Auditorium to release the new 2010 Dietary Guidelines for Americans.

Agriculture Secretary Tom Vilsack and HHS Secretary Kathleen Sebelius will discuss the Guidelines and provide key insights into the new recommendations. Joining the Secretaries will be Dr. Robert Post, Deputy Director of USDA’s Center for Nutrition Policy and Promotion and Rear Admiral Penelope Slade-Sawyer, HHS Deputy Assistant Secretary for Health Disease Prevention and Health Promotion. Immediately following the presentations, the speakers will entertain questions from the press, stakeholders, students and others in attendance.

 Monday, January 31, 2011, 10 a.m. – 11 a.m. EST

The George Washington University

Jack Morton Auditorium

Media and Public Affairs Building

805 21st Street, NW

Washington, DC 20052

Stakeholders are invited to attend this event in person. Seating is limited and RSVP is required by 5 p.m. on Wednesday, January 26, by registering here.

Stakeholders may also view the event via webcast at www.usda.gov/live

Copies of the 2010 Dietary Guidelines for Americans will be available at www.DietaryGuidelines.gov immediately following the press conference.

Can’t wait!

My first San Francisco Chronicle “Food Matters” column for the new year deals with some predictions:

Q: Whatever you used as a crystal ball last year turned out to be a pretty good predictor of the most prominent food issues of 2010. How about trying again: What food matters will we be hearing about in 2011?

A: It doesn’t take a crystal ball to figure out what’s coming up with food issues. I’m happy to make predictions, especially since most seem fairly safe.

Dietary guidelines will be released this month. By law, they were due last year and are already late. What will they say? The 2010 guidelines advisory committee recommended eating more fruits, vegetables and whole grains, but introduced a new euphemism – SOFAs, or Solid Fats and Added Sugars – for the “eat less” advice. SOFAs really mean “cut down on fatty meat and dairy products” and “avoid sugary sodas.”

Will government agencies have the nerve to say so? Let’s hope.

The U.S. Department of Agriculture will issue a new food guide. The 2005 pyramid’s rainbow stripes proved impossible to teach and useless to anyone without a computer. I’ve heard a rumor that I will love the new design. I’m skeptical. I liked the original 1992 pyramid. It showed that bottom-of-the-pyramid foods were healthiest, making it unpopular with companies selling top-of-the-pyramid products. But it is healthier to eat some foods than others (see: dietary guidelines).

Will the USDA improve on the 1992 design? We will soon find out.

The fights over food safety will continue. At the last possible moment, Congress passed the food safety bill by a large majority. Now the fights really begin.

Funding will be most contentious, with the actual regulations not far behind. The Congressional Budget Office absurdly considered the bill’s provisions to be “budget neutral.” They are anything but.

The bill’s provisions require the Food and Drug Administration to hire more inspectors just at a time when Republican lawmakers have sworn to cut domestic spending. The FDA also must translate the bill’s requirements and exemptions for small farmers into regulations.

Rule-making is a lengthy process subject to public comment and, therefore, political maneuvering. Watch the lobbying efforts ratchet up as food producers, large and small, attempt to head off safety rules they think they won’t like.

Expect more lawsuits over the scientific basis of health claims. The Federal Trade Commission just settled a $21 million claim against Dannon for advertising that yogurt protects against the flu. The agency also has gone after scientifically unsubstantiated claims that omega-3s in kiddie supplements promote brain development and that pomegranate juice protects against prostate problems. POM Wonderful has already countersued the FTC on grounds that the First Amendment protects commercial speech. I’ll be watching this case carefully.

The FDA will issue new front-of-package label regulations. The FDA has promised to propose an at-a-glance symbol to indicate the overall nutritional value of food products. Food companies like the Guideline Daily Amount spots they are using in the upper corners of food packages because the symbols are factual but nonjudgmental. The FDA, however, is considering red, yellow and green traffic-light symbols that do convey judgments. Food companies say they will not voluntarily use a symbol that tells people to eat less of their products.

Will the FDA have the courage to make traffic lights mandatory? It will need courage. The new British government dealt with the traffic-light idea by summarily dismantling the food agency that suggested it.

Corporations will seek new ways to co-opt critics. Under the guise of corporate social responsibility, food companies have been making large donations to organizations that might otherwise criticize their products. The most recent example is the decision by Save the Children, formerly a staunch advocate of soda taxes, to drop that cause coincidentally at a time when its executives were negotiating funding from Coca-Cola.

Such strategies remind me of how the Philip Morris cigarette company distributed grants to leading arts groups. Expect food companies to use generosity to neutralize critics and buy silence.

School meals will make front-page news. Congress passed the Healthy, Hunger-Free Kids Act last month. Now the USDA must implement it by setting nutrition standards, adding fresh fruits and vegetables (some locally grown) and expanding eligibility.

President Obama has promised to restore the $4.5 billion “borrowed” from the SNAP (food stamp) program to fund this act. The scrambling over the regulations and financing should make excellent spectator sport.

Farm bill advocates will be mobilizing. You might think it too early to be worrying about the 2012 Farm Bill, but I’ve already gotten position papers analyzing commodity and food-assistance issues from groups gearing up to lobby Congress to bring agricultural policy in line with nutrition and public health policy.

I have a personal interest in such papers. I will be teaching a course on the Farm Bill at New York University next fall. Please get busy and write more of them!

Happy new year, and let’s see how my guesses play out.

After a snow-induced stranding in Miami, the vacation ends, and FoodPolitics.com resumes by catching up on missed events.

Other missed events will follow, but let’s start with USDA’s announcement that it is requiring Nutrition Facts labels on meat and poultry products.

In the Final Rule published on its website, USDA says it will require labeling of fat and calorie content on all industrially packaged intact or ground, single-ingredient, raw meat and poultry by January 1, 2012.  USDA’s rule exempts small producers, however.

Nutrition Facts on meat and poultry have been a long time coming. USDA seriously considered such labels in 1990 when Congress passed the Nutrition Labeling and Education Act.  That act only required Nutrition Facts labels on FDA-regulated foods, which include pretty much everything except USDA-regulated meat and poultry.

By the time the USDA finally got around to proposing its own version in 2001, the agency made labeling voluntary.

You can guess what happened.  Meat and poultry producers happily volunteered not to label their products.

Why not?  Meat producers greatly prefer that you remain ignorant of the amount of fat and calories meat contains.

As is evident from this label example, meat labeling raises issues related to calories, fat, saturated fat, and serving size.

Calories: this particular ground meat contains 21 grams of protein and 11 grams of fat.  These provide 190 calories, per serving.

Fat: Fat is the major determinant of calories (9 per gram as compared to 4 per gram for protein). That is why more than 50% of the calories in this ground beef come from fat.

Saturated fat: The 4.5 grams of saturated fat in this meat account for 22% of the Daily Value, a lot or a little depending on what else you eat.

Serving size: The serving size is a quite reasonable 4 ounces (like a quarter-pounder).  It represents, however, a substantial increase over previous USDA serving size suggestions.  Since 1958, the USDA has considered a meat serving to include just 2-to-3 ounces.

As I discuss in Food Politics, pressures from meat producers over the years induced government agencies to steadily increase the amount of meat (or meat substitutes) recommended for daily intake.

• 1958 to 1989 (USDA food guides): two daily servings of 2-3 ounces for a total of 4-to-6 ounces
• 1990 (Dietary Guidelines): two daily servings of 2-3 ounces for a total of 6 ounces
• 1992 (Food Guide Pyramid): two-to-three daily servings for a total of 5-to-7 ounces
• 1995-2005 (Dietary Guidelines): two-to-three daily servings for a total of 4-to-9 ounces

If advice to consume two-to-three daily servings of meat (or meat substitutes) still holds, the recommendation will now be 8-to-12 ounces.

The 2010 edition of the Dietary Guidelines is overdue and should be released any day now.   In its report last June, the Dietary Guidelines Advisory Committee said:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

What will the new guidelines say about the amount of meat we should all be eating?  I can’t wait to find out.

Happy new year to all!

Addition, 1-1-11: I forgot to cite the USA Today story on this (I’m quoted).

This month’s San Francisco Chronicle column evolved in answer to a question from a former colleague at the UCSF School of Medicine.

Q: What do you think doctors should be telling patients about how best to care for themselves and their families, nutritionally?

A: I had my chance when, long ago, I ran a nutrition education program for medical and other health professions students and practitioners at UCSF.

Then, as now, it was obvious that just about every patient who landed in the hospital needed nutrition intervention. Practically everyone who visited the outpatient clinic either wanted or needed nutrition advice.

Then, as now, few doctors were taught anything about nutrition, let alone the details of what they needed to know to help patients address dietary concerns.

In today’s health care environment, even doctors with advanced nutrition training do not have time to use it. Blame this on how our health care system systematically rewards doctors for treatment of disease, not its prevention.

What doctors need to tell patients about nutrition depends on who the patients are. If people are sick, doctors need to talk to them about how dietary changes and improvements will help them recover and prevent further illness.

But I’m guessing that your question refers to healthy patients who want to stay that way. With these people, what doctors do and say can have profound effects. Doctors are authority figures and their advice is taken seriously.

As a standard part of patient care, doctors routinely ask about drugs, cigarettes and alcohol. Even if they only have a minute, adding one more question about diet can do much good. If nothing else, it conveys that diet matters to health.

Given the reality of time constraints, my wish list for what to do next is necessarily short.

Tell patients that healthy eating simply means three things: variety, minimal processing and moderation.

Variety means choosing many different kinds of foods from the various food groups: meat, dairy, fruits, vegetables, grains. It counts because foods vary in nutrient content. Varying foods within and among food groups takes care of needs for nutrients without having to think about them. People who consume adequate amounts of varied diets rarely exhibit nutrient deficiencies. It’s the most restrictive diets that are likely to be deficient in one or another nutrient.

Minimal processing means that the foods should be as close as possible to how they came from the animal or plant. The greater the level of processing, the less the foods resemble their origins, the less nutritious they may be, and the more salt, sugar and calories get added to disguise the changes.

Minimal processing excludes foods high in salt and sugars and low in fiber, as well as sugary sodas and juice drinks, those popularly known as junk foods.

My definition of minimal processing is only slightly facetious: Don’t eat anything with more than five ingredients or an ingredient you can’t pronounce.

Moderation is about balancing calorie intake with expenditure and maintaining a healthy weight through food choices and physical activity.

These are general principles. Beyond them, nutrition advice must be personalized to the particular individual or family. To do that quickly:

• Ask patients what they and their children eat. You can start with a waiting-room questionnaire that probes typical intake of foods and supplements.
• Screen the responses for variety, minimal processing, moderation and excessive or unusual supplement use. Note whether body weights are within healthy ranges.
• Reassure patients whose diets are varied, minimally balanced and moderate that they are doing wonderful things for their health and should keep doing what they are doing.
• Refer observations that need further discussion to a nutritionist.

Doctors: You don’t have to do it all. Making it clear that diet matters is often enough to encourage patients to make better dietary choices. Use the services of a nutritionist. Nutritionists are professionally trained to answer patients’ questions about diet and health and to counsel them on dietary interventions.

Patients (meaning everybody): Tell your doctors that you want their advice about diet and health and expect them to know something about it.

How can food producers become more sustainable? Use less meat in their products.

Rita Jane Gabbett writes today on Meatingplace.com, a meat industry site, about a talk given by Cheryl Baldwin of Green Seal at a recent meeting of the Institute for Food Technologists.

She told Meatingplace that meat producers should better understand “the production methods used to feed and raise animals, making sure they are treated humanely and looking for ways to reduce the carbon footprint of processing methods.” She also said that “grass-fed animals created a lower carbon footprint than those that were grain fed.”

One can only imagine the reaction of meat producers to her comments.

Meatingplace noted:

Earlier this year, however, a study by the University of New South Wales published in the journal Environmental Science and Technology indicated beef produced in feedlots had a slightly smaller carbon footprint than meat raised exclusively on pastures. (See Feedlot beef could be “greener” than grass-fed: study on Meatingplace, Feb. 8, 2010.)

More recently, Washington State University scientists concluded that improvements in U.S. beef industry productivity have reduced the environmental impact of beef production over the past decade. (See Better beef industry practices have reduced carbon footprint on Meatingplace July 15, 2010.

This follows soon after the Dietary Guidelines Advisory Committee report’s advice to:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

To the meat industry, advice about health and sustainability must come as a serious challenge. Keep an eye on the “eat less meat” theme. My guess is that we will be hearing a lot more about it.

The Dietary Guidelines Advisory Committee held a hearing yesterday on its recent report (see my posts of June 28 on the politics of this report, and June 29 on its science).  I could not attend the hearing but am collecting second-hand reports from people who attended or testified.

Philip Brasher, who blogs at GreenFields.com, summarizes lobbyists at work:

• National Pork Producers: “Lean meat is a vital source of high-quality protein and certainly should not be framed as a food to limit in the American diet….Urging Americans to shift to a more plant-based diet and consume only moderate amounts of lean meat implies they should decrease consumption of this vital, complete protein.”
• Egg producers: “The average American could increase egg consumption and still be within the egg-a-day limit.”
• The Sugar Association: Advice to reduce sugar is “impractical, unrealistic and not grounded in the body of evidence.”
• The Salt Institute:  “Encouraging consumption of low-salt foods will encourage Americans to eat excessively to make up for the lack of taste….The guidelines have become far more a reflection of ideology than sound science.”

The Organic Trade Association testified that the scientific review, which found no significant nutritional differences between organic and conventionally produced foods, is:

Neither grounded in current science nor relevant to the mandate of the Dietary Guidelines….[it is] in direct conflict with the advice put forth by the recent President’s Cancer Panel report regarding ways to reduce environmental cancer risk….It is inconceivable and alarming that the very document that is the underpinning of our nation’s policies regarding food and nutrition would include a statement that directly contradicts these recommendations….As released, the guidelines confuse the consumer, contradict the President’s own Cancer Panel, and do not enhance dietary recommendations.

To repeat: The committee report is simply advisory.  So is the lobbying.  The sponsoring federal agencies, USDA and DHHS, now must deal with both as well as with written comments on the report’s statements and recommendations.

The agencies write the final guidelines. Will they include advice to cut down on added sugars and fatty meats?  Will they say anything positive about organic foods?

Maybe, if enough people weigh in with such opinions.  Comments are due by July 15.  Here’s how.

Addition, July 10: Amber Healy’s terrific account in Food Chemical News (July 12) summarizes the hearings as “largely boiling down to a single question: Is meat good or bad?” For example:

• People for the Ethical Treatment of Animals, the Physician’s Committee for Responsible Medicine (PCRM), the Soyfoods Association of North America and Christina Pirello, the host of a cooking show on PBS: the guidelines should more clearly spell out the benefits of reducing meat consumption and take a stronger position on the need to reduce intake of processed meats.

• Sally Fallon Morell, president of the Weston A. Price Foundation: the recommended reduction in intake of lean meat and protein from animal sources could “perpetuate the kind of nutrient deficiencies” that the guidelines try to avoid and even lead to lower fertility rates.
• Betsy Booren of the American Meat Institute: If people try to consume the same amount of protein from plant-based foods, people could end up consuming more calories than if they had simply eaten some lean meat or poultry.

And, the National Dairy Council and the International Dairy Foods Association approved of the recommendation for three daily servings of low-fat or fat-free milk or dairy foods, but asked that the final guidelines acknowledge that flavored low-fat milk [i.e. chocolate] can encourage consumption among children.

With the politics out of the way (see yesterday’s post), let’s talk about what’s superb in the Dietary Guidelines Advisory Committee Report: the scientific review and analysis.

This was based on reviews produced by the Nutrition Evidence Library (NEL), which apparently recruited dozens of people to identify articles, assess their quality by uniform criteria, and rank the overall evidence as limited, moderate, or strong and consistent or inconsistent.

I particularly like the way the report organizes the research review by questions (of which there are 56, if I counted right).  The questions cover a great range of topics.  Examples:

• What nutrients and dietary components are overconsumed by the general public?
• Can a daily multivitamin/mineral supplement prevent chronic disease?
• What is the role of prebiotics and probiotics in health?
• What are health effects related to consumption of nuts?
• What are the health effects related to consumption of chocolate?
• How do the health outcomes of a vegetarian diet compare to those of a diet which customarily includes animal products?
• How are non-caloric sweeteners related to energy intake and body weight?
• What amount of water is recommended for health?

Questions are followed immediately by Conclusions, Implications, and Review of the Evidence. All of this is written with great clarity, accompanied by thoughtful comments, and packed with useful information.

Here is just one example (I’ve emphasized the evaluative words):

What is the Relationship between Vegetable Protein and/or Soy Protein and Selected Health Outcomes? Few studies are available, and the limited body of evidence suggests that vegetable protein does not offer special protection against type 2 diabetes, coronary heart disease, and selected cancers. Moderate evidence from both cohort and cross-sectional studies show that intake of  vegetable protein is generally linked to lower blood pressure. Moderate evidence suggests soy protein may have small effects on total and low density lipoprotein cholesterol in adults with normal or elevated blood lipids, although results from systematic reviews are inconsistent. A moderate body of consistent evidence finds no unique benefit of soy protein on body weight. A limited and inconsistent body of evidence shows that soy protein does not provide any unique benefits in blood pressure control.

Readers may disagree with the committee’s research interpretations, but its conclusions deserve serious consideration.

And, if anyone wants to know the state of the available science on any of a large number of questions in nutrition, this report is the place to look first.

Student alert: I will be using this report in classes.