Currently browsing posts about: Dietary-Guidelines

The American Heart Association (AHA) has just issued its latest set of dietary guidelines aimed at preventing the leading cause of death in the United States: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Because AHA guidelines apply not only to coronary heart disease but also to all other chronic disease conditions—and sustainability issues—influenced by dietary practices, they deserve special attention.

Most of these repeat and reinforce the 2020-2025 Dietary Guidelines for Americans.

The two big differences in the recommendations:

• Clarifying protein recommendations: these include all sources but emphasize plant sources (#4)
• Including a new one: minimize ultra-processed foods (#6)

These recommendations are way ahead of the US Dietary Guidelines in recognizing how much ultra-processed foods contribute to poor health, and how important it is to minimize their intake.

Also unlike the US guidelines, these are unambiguous and easily summarized.

The statement is worth reading for its emphasis on two other points.

• This dietary pattern addresses problems caused by other chronic conditions and also has a low environmental impact.
• Following this dietary pattern requires much more than personal responsibility for food choices.  It requires societal changes as well.

The press release summarizes the problems in society that make following healthy diets so difficult, if not impossible:

• Widespread dietary misinformation from the Internet;
• A lack of nutrition education in grade schools and medical schools;
• Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
• Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
• Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

As the statement concludes: “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”

Amen to that.

Comment: From my perspective, this statement thoroughly supersedes the 2020-2025 Dietary Guidelines for Americans, which—because they say nothing about ultra-processed foods , differential protein sources, sustainability, or doing anything to counter societal determinants of poor diets—were out of date the instant they appeared.

Some of the details of the AHA statement will be debated but its overall approach should not be.

The committee that put these guidelines together deserves much praise for basing its advice on today’s research and most pressing societal needs.

Additional AHA Resources:

• Spanish news release 
• Available multimedia is on right column of release link: https://newsroom.heart.org/news/new-look-at-nutrition-research-identifies-10-features-of-a-heart-healthy-eating-pattern?preview=288ef57763869cab946e725d341dbb63
• After Nov. 2, 2021, view the manuscript online.
• What kind of diet helps heart health?
• Eating walnuts daily lowered bad cholesterol and may reduce cardiovascular disease risk
• Eating more plant foods may lower heart disease risk in young adults, older women
• Sugar 101
• Follow AHA/ASA news on Twitter @HeartNews

I saw this in a tweet from the Politico cartoonist, Matt Wuerker.  It’s too good not to share.

A dietitian colleague forwarded this message from Today’s Dietitian.

Honey may be made by bees, but it is mainly glucose and fructose just like any other sugars.

A few “food-for-thought” questions:

• Should dietetic publications be promoting sugars of any kind?
• Should dietitians be recommending honey to their clients?
• Should dietitians allow their publications to accept ads like this?

This report documents how government policies—in the U.S. and internationally—promote and protect makers of booze, wine, and beer, despite the demonstrably harmful effects of those products on health and society.

How do governments do this?

• Development assistance
• Tax breaks
• Tax rebates
• Marketing deductions
• Production subsidies
• Trade agreements

Why do they do this?  Lobbying and tax revenues.

If you want to understand why the USDA and HHS “found no evidence” for reducing the alcohol recommendation in the 2020 Dietary Guidelines, read this report.

I only have a few more comments about the Dietary Guidelines beyond what I posted last week.

One is my surprise that the USDA did not do a new food guide.  The existing one, after all, dates from the Obama administration.  It has not changed.

Here’s how it is explained in the new guidelines:

My translation: Eat more plant foods, eat less meat, avoid ultraprocessed foods (including sugary beverages).

This requires a translation because the guidelines say nothing about ultraprocessed junk foods, and they try hard to avoid singling out foods to avoid.

These guidelines are similar to those in 2015 and are, therefore, woefully out of date.

They do mention the pandemic, once:

The importance of following the Dietary Guidelines across all life stages has been brought into focus even more with the emergence of COVID-19, as people living with diet-related chronic conditions and diseases are at an increased risk of severe illness from the novel coronavirus (p. 4).

They do mention food insecurity several times, for example:

In 2019, 10.5 percent of households were food insecure at least some time during the year. Food insecurity occurs when access to nutritionally adequate and safe food is limited or uncertain. Food insecurity can be temporary or persist over time, preventing individuals and families from following a healthy dietary pattern that aligns with the Dietary Guidelines. The prevalence of food insecurity typically rises during times of economic downturn as households experience greater hardship. Government and nongovernment nutrition assistance programs help alleviate food insecurity and play an essential role by providing food, meals, and educational resources so that participants can make healthy food choices within their budget (p. 50).

And they do mention food assistance programs (on page 81), although they do not discuss how the USDA has been relentless in trying to cut those programs.

Nothing about food systems.  Nothing about the effects of food production and consumption on climate change and sustainablity.

Nothing about eating less meat other than implying that eating less processed meat might be a good idea.

One other point: the complexity is increasing.  Here is the history of the page numbers:

As I’m fond of saying, Michael Pollan can do all this in seven words: “Eat food.  Not too much.  Mostly plants.”

If we can’t do better than this 164 pages of obfuscation, isn’t it about time to stop requiring these things every five years?

Here’s what other people are saying about them

• New York Times report (I’m quoted)
• Wall Street Journal (quotes American Beverage and Beer Associations)
• New York Daily News (I’m quoted)
• CNN (I’m quoted)
• Bipartisan Policy Center [Dan Glickman (Dem) and Ann Veneman (Rep), former USDA secretaries]
• Physicians Committee for Responsible Medicine (accuses guidelines of racial bias)
• USA Today
• National Fisheries Institute 
• Produce for Better Health Foundation

So much for my plan to take the week off.

The new 2020-2025 Dietary Guidelines came out today.  See them at DietaryGuidelines.gov.  The new guidelines are much the same as the ones in 2015.

The big news: They paid no attention to the recommendations of the Dietary Guidelines Advisory Committee (I covered this in a previous post).

USDA and HHS overrode the scientific decisions of the DGAC.  So much for “science-based” dietary guidelines.

I would love to know what the members of the DGAC think of this.

More later.  These come from the USDA’s press release.

• Dietary Guidelines for Americans, 2020-2025 along with companion pieces:
• Executive Summary of the Dietary Guidelines for Americans, 2020-2025
• The Top 10 Things You Need to Know About the Dietary Guidelines
• Make Every Bite Count with the Dietary Guidelines video
• The Dietary Guidelines Consumer Brochure: Small Changes Matter. Start Simple with MyPlate Today
• Dietary Guidelines infographic series on topics like:
  • Making Every Bite Count with the Dietary Guidelines
  • The Dietary Guidelines Can Help You Eat Healthy to Be Healthy
  • Public Engagement Strengthens the Process
  • USDA-HHS Process to Develop the Dietary Guidelines
  • What’s the Difference between the Dietary Guidelines Advisory Committee Report & the Dietary Guidelines for Americans
• Video of the Dietary Guidelines for Americans, 2020-2025 virtual event
• Press release announcing the Dietary Guidelines for Americans, 2020-2025

And here’s the USDA’s explanation, such as it is, of why it overrode the decisions of the DGAC on sugar and alcohol

The report of the 2020 Dietary Guidelines Advisory Committee is now available in online preprint.

It sets a record at 835 pages.

Its conclusions are highly consistent with those of previous Dietary Guidelines.

It recommends eating more of these foods:

Common characteristics of dietary patterns associated with positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or nonfat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils.

It recommends eating less of these foods:

The Committee found that negative (detrimental) health outcomes were associated with dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains.

It retained the recommendation: Eat less red and processed meats

It retained the recommendation to eat less saturated fat (replace with polyunsaturated or monounsaturated)

Thus, the Committee recommends that dietary cholesterol and saturated fat intake be as low as possible within a healthy dietary pattern, and that saturated fat intake be limited to less than of 10 percent of total energy intake, as recommended by the 2015-2020 Dietary Guidelines for Americans. This recommendation applies to adults and children ages 2 years and older.

It tightened up restrictions on alcoholic beverages from 2 drinks a day for men to 1 drink:

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.

It tightened up restrictions on added sugars, from 10% of calories to 6%:

After considering the scientific evidence for the potential health impacts of added sugars intake, along with findings from model-based estimations of energy available in the dietary pattern after meeting nutrient requirements, the Committee suggests that less than 6 percent of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10 percent energy from added sugars.

What’s missing?

• Salt: The report says remarkably little about sodium beyond that it is overconsumed and people should “reduce sodium intake.”  It’s possible that I missed it, but I could not find suggestions for quantitative limits.
• Ultraprocessed: The word does not appear in the report except in the references.  A large body of evidence supports an association of ultraprocessed foods to poor health.  If the committee considered this evidence, it did not spell it out explicitly.
• Sustainability: This was off the table from the beginning but this committee recommends that it be considered next time in the context of a food systems approach to the Dietary Guidelines (p.771).

Comment

This is an impressive, solid, conservative review of the existing science highly consistent with previous Dietary Guidelines but with mostly stronger recommendations.

This committee was up against:

• A tight time frame
• A first-time mandate to review literature on infancy, pregnancy, and lactation in addition to that for adults
• A first-time process in which the agencies set the research agenda, not the committee
• The Coronavirus pandemic

At the outset, I was concerned that the committee members might be heavily biased in favor of food industry interests.  If they were, such biases do not show up in the final report.  I think this committee deserves much praise for producing a report of this quality under these circumstances.

Want to weigh in on it? 

The agencies are taking public comments until August 13.  On August 11, there will be an online public meeting for even more comments.

What’s next?

This report is advisory, only.  USDA and HHS must boil this down to the actual 2020 Dietary Guidelines.  Whereas the committee process was transparent, the boiling down process is highly secretive, or was in 2015.  It will be interesting to see what the agencies do, especially given the heavy lobbying by proponents of meat, saturated fat, and low-carbohydrate diets.