Currently browsing posts about: 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.

The press release from the Annals of Internal Medicine arrived last week under embargo, sent to me by several reporters: “New guidelines: No need to reduce red or processed meat consumption for good health.”

The press announcement was accompanied by 5 review papers, a sixth with this recommendation, and an editorial.  These are posted on the website of their publisher, the American College of Physicians, implying this organization’s endorsement of this guideline.

Collectively, these papers challenge dietary advice to eat less processed meat and red meat on the grounds of inadequate science.

These papers argue:

• Eliminating processed and red meat from the diet may reduce disease risks but the effects are small and evidence for them is of low quality and low certainty.
• Omnivores are unwilling to eat less meat.
• If you continue to think eating meat is bad for you in the face of this evidence, you are a victim of the “the less you know, the more you hold to your beliefs” syndrome.
• You can ignore dietary guidelines (regardless of source) and continuing eating meat as you always have.

This is a good example of what I call nutritional nihilism, an approach that insists that because observational studies are based on self-reported information and necessarily flawed, their conclusions are unscientific and should be discounted.  Therefore, because we can’t do more rigorous studies, we should not advise the public about diets best for health or the environment.

I have several concerns about all this:

• Yes, the effects are small but that is true of nutrition studies in general.  The small effects show benefits from eating less meat.  The authors could easily have interpreted their work as suggesting that eating less meat might be useful.  This is an example of interpretation bias.
• The authors took a strictly science-based approach to a problem strongly affected by social, economic, and political factors and values.
• The studies look at previous studies that compared people who eat meat to those who eat less. The authors excluded studies of vegetarians compared to meat-eaters.
• They look at meat outside its context of calories.
• The authors did not look at the totality of the evidence; they excluded laboratory and animal studies that can be more closely controlled.
• They excluded studies of environmental impact, which has a significant bearing on human dietary practices (meat production adds more greenhouse gases than vegetable production).
• The conclusions fall into the category of “everything you thought you knew about nutrition is wrong.”  This rarely happens.  Science usually works incrementally, not in one enormous reversal like this.

Do the authors really believe that all those other committees and commissions urging less meat were wrong and continue to be wrong?   Their strictly science-based approach seems unrealistic.

The papers come across to me as a concerted attack on dietary guidelines (national and international), on nutrition science in general, and on nutritional epidemiology in particular.

The meat industry and its supporters will love them.

Attacks on the quality of nutrition research have been coming from many sources lately: the food industry, of course, but also statisticians (John Ioannidis at Stanford is making a career of this), and some scientists (usually with ties to food companies).  The criticisms themselves are not new.

What is new is the vehemence and level of effort to discredit observational studies, particularly those based on self-reports of dietary intake.  Yes, nutritional epidemiology has flaws, but the methods have been useful in many instances, as argued convincingly by two of its leading practitioners.

In looking at nutrition research, I think it is essential to evaluate the totality of information available: laboratory, animal, human epidemiology and clinical studies—and to do this in the context of what people actually eat and the number of calories they consume, as well as adding in a hefty dose of common sense.

Common sense is what’s missing in these studies.  Do the authors really believe that:

• Meat eaters are healthier than vegetarians?
• Eating more meat is better for health?
• Meat eaters are less obese and have less heart disease and cancer than those who eat less?

If not, the conclusions make no sense.

Most of the authors report no financial ties to the food industry.  I would love to know the back story about why they chose to do these studies and to interpret them in this way.

Reactions (I will be adding to this list as they come in)

• The Harvard School of Public Health Nutrition Department issued a statement
• The True Health Initiative (THI) issued a press release outlining its concerns (the link is here)
• THI council members sent a letter to the journal editor stating objections (the link)
• THI collected quotes from members of its council and others (including mine)
• THI also produced graphics.  Here is one example.

• David Katz weighs in
• New York Times: 5 things you should know
• New York Times coverage: “Eat less meat, scientists said.  Now some believe that was bad advice.”
• From Dean Ornish
• Consumer Reports (I’m quoted)
• From the World Cancer Research Fund
• Vox’s crystal clear explanation
• NPR’s The Salt’s excellent analysis
• Aaron Carroll’s follow-up to his editorial

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.

I’ve saved this for Weekend Reading because it will take a weekend to get through it.  The report is a blockbuster: 37 authors, 47 pages, 357 references.

The Lancet commissioned this report from the EAT Forum, which brought together international experts on diet and health (most of whom I do not know) to define unifying dietary principles that best promote will promote the health of people and the planet.

Fortunately, the diet that is best for health is the same diet as is best for the planet.  The report defines it on page 5.

To summarize:

This report has many strengths:

• It is researched in depth and is now the reference source for information about needed dietary changes.
• It firmly links dietary health to environmental sustainability.
• Its findings are consistent with many previous reports on diet and health, including that of the 2015 Dietary Guidelines Advisory Committee DGAC).
• Its messages are unambiguous.
• The summary report is a big help
• The timing  is excellent; the 2020 Dietary Guidelines advisory committee, if it ever gets appointed, will have to pay close attention to the science reviewed in this report.
• It focuses on food, not nutrients (these meals meet the standards of recommended diets).

Does this report settle the questions?  Hardly.  Remember the fuss over sustainability (the “S-word?”) in the 2015 report of the DGAC?

• The meat industry does not like advice to eat less meat.
• The dairy industry doesn’t like it either.  Its trade associations emphasize its nutritional value and source of livelihood for a billion people.
• The food industry has lots of complaints.

There is lots to read and think about here.  Enjoy!

• The Lancet home page for the report (includes slides, links)
• The Lancet editorial accompanying the report
• The EAT Forum home page for the report (information about EAT, the launch, the commission members, etc)
• The EAT Forum summary report

I was surprised to read a recent paper in the American Heart Association journal arguing that dietary diversity may not be good for health:

“Eat a variety of foods,” or dietary diversity, is a widely
accepted recommendation to promote a healthy, nutritionally adequate
diet and to reduce the risk of major chronic diseases. However, recent
evidence from observational studies suggests that greater dietary diversity is associated with suboptimal eating patterns, that is, higher intakes of processed foods, refined grains, and sugar-sweetened beverages and lower intakes of minimally processed foods, such as fish, fruits, and vegetables, and may be associated with weight gain and obesity in adult populations.

Obviously, eating a variety of junk food is unlikely to improve health.  But the variety recommendation has never been intended to include junk food.

Here’s a summary of the variety recommendations of the Dietary Guidelines from 1980 to 2015:

These have increasingly specified healthy foods.

Eat your veggies!  Enjoy!

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

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).