Currently browsing posts about: Dietary-Guidelines

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).

Secretary Sonny Perdue has released his blueprint for the 2018 farm bill.

Its goal is to “improve services while reducing regulatory burdens on USDA customers” [translation: Big Ag].

USDA, he says, supports legislation that will do a great many things for farm production, conservation, trade, food and nutrition services, marketing, food safety, research and education, and natural resources.

There are a lot of words here and it’s hard to know what they mean, even reading between the lines.

For example, here are USDA’s principles for SNAP (food stamps), with my [translations and questions]:

• Harness America’s agricultural abundance to support nutrition assistance for those truly in need.  [This sounds like a food distribution program, but I’m wondering how “truly in need” will be defined.]
• Support work as the pathway to self-sufficiency, well-being, and economic mobility for individuals and families receiving supplemental nutrition assistance.  [This means work requirements, but where will the jobs come from?]
• Strengthen the integrity and efficiency of food and nutrition programs to better serve our participants and protect American taxpayers by reducing waste, fraud and abuse through shared data, innovation, and technology modernization. [This means spending hundreds of millions a year on fraud prevention].
• Encourage state and local innovations in training, case management, and program design that promote self-sufficiency and achieve long-term, stability in employment.  [The jobs?]
• Assure the scientific integrity of the Dietary Guidelines for Americans process through greater transparency and reliance on the most robust body of scientific evidence.  [Weren’t they always based on the available science?  This sounds like a way to prevent the guidelines from suggesting eating less of junk foods].
• Support nutrition policies and programs that are science based and data driven with clear and measurable outcomes for policies and programs. [This one translates to you can’t set nutrition policies unless you can demonstrate beneficial outcomes—fine in theory, but policy-blocking in practice].

Reading through the other sections is equally non-reassuring.  Where is a vision for a farm bill that promotes health, sustainable agriculture, and small or mid-size farms, protects farm workers, and reduces greenhouse gases?

Maybe the next one?

Thanks to my colleague Lisa Young for taking this photo at the Magnolia Bakery in Manhattan.

You may recall that one result of the fuss over the highly controversial BMJ article attacking the Dietary Guidelines process was appointment of a committee to review that process.

It has just published the first of its reports, which deals only with the first of the four charges to the committee, which were to determine:

1. How the selection process for the Dietary Guidelines Advisory Committee (DGAC) can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints;
2. How the Nutrition Evidence Library (NEL) is compiled and used, including whether the NEL reviews and other systematic reviews and data analysis are conducted according to rigorous and objective scientific standards;
3. How systematic reviews are conducted on long-standing DGAC recommendations, including whether scientific studies are included from scientists with a range of viewpoints; and
4. How the DGA can better prevent chronic disease, ensure nutritional sufficiency for all Americans, and accommodate a range of individual factors, including age, gender, and metabolic health.

The committee identified values governing the committee selection process:

• Enhance transparency
• Promote diversity of expertise and experience
• Support a deliberative process
• Manage biases and conflicts of interest
• Adopt state-of-the-art processes and methods

Its recommendations:

• Employ an external third party to review the candidate pool for committee members.
• Make the list of provisional appointees open for public comment.
• Publicly disclose nominees’ biases and conflicts of interest; develop a plan for managing them; have them reviewed by a federal ethics officer; document all this in the advisory committee’s report.
• Adopt a system for continuous process improvement in the selection process.

Good recommendations and good luck with them.

I can hardly wait to see this committee’s report on the remaining charges.

In the meantime, it’s about time to start appointing the 2020 Dietary Guidelines Advisory Committee, no?

I’ve just heard about the new Netherlands food guide.  It emphasizes sustainability.  According to an article in National Geographic’s The Plate,

The Netherlands Nutrition Centre says  it is recommending people eat just two servings of meat a week, setting an explicit limit on meat consumption for the first time [but see added comment below].

Here’s what the Netherlands food guide looks like.

Google translator calls this a pyramid, and explains: “Moreover, the Pyramid helps you eat more environmentally friendly broadly.”

Ours, of course, looks like this.  I’m guessing the USDA is working on a new food guide in response to the 2015 Dietary Guidelines.  These do not mention sustainability at all—the S word.

If you want to check out food guides m other countries, see FAO’s pages on food-based dietary guidelines.  You can search the site by regions and countries.  Fun!

Added comment: A reader from Amsterdam, who obviously speaks Dutch better than Google translator, and who also is well versed in the Dutch nutrition scene, writes:

Sustainability is indeed an important concern in the new Dutch food guide. However, the recommendation for meat is not ‘two servings per week’, but two servings of red meat and two servings of white meat (chicken), for a total of four per week. One serving is 100 gram or 3.5 oz. of meat. Diehards may add a third serving of red meat; 300 g of red meat (11 oz) plus 200 g of chicken (7 oz) per week is considered the absolute limit.

The fish advice has been reduced from twice to once a week because environmental concerns were thought to outweigh the small health benefit of a second weekly serving of fish.

You might think that eating is one of those things that comes naturally, but for the next three weeks I’m going to be posting books telling us how.  Here’s the first:

Bee Wilson.  First Bite: How We Learn to Eat. Basic Books, 2015.

Bee Wilson speaks from experience.  She once was a picky eater bordering on having an eating disorder.  Simply eating when hungry and stopping when full is a challenge for many of us.  Wilson explores how food preferences are acquired or made and how culture and environment turn biological needs into obesity-promoting hazards.  Her advice boils down to aphorisms, for example:

• No one is too busy to cook.
• Eat soup.
• Rethink what counts as a main course.
• Regular exercise definitely helps.
• If you want your children to eat better, don’t tell them what to do: eat better yourself.

I’m indebted to Maria Godoy of NPR’s The Salt for pointing out where in the new 2015 Dietary Guidelines you can find advice about cutting down on sugary drinks.  As she puts it, this is easy to miss.

Here’s my wonky analysis.

In my post about the 2015 Dietary Guidelines, I noted that they are unambiguous about the need to reduce added sugars to 10% or less of calories.  But what they say about cutting down on sugary drinks—the leading source of sugars in US diets—is buried deep in the text.  Fortunately, Deborah Noble of slowfoodfast.com has performed a great public service by producing the 2015 Dietary Guidelines in a searchable pdf format.Here’s where to find advice about cutting down on sugary drinks:

The Executive Summary: See under “Cross-Cutting Topics of Public Health Importance:”

Similarly, added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options, such as water in place of sugar-sweetened beverages.

Figure 2-10 explains:

The major source of added sugars in typical U.S. diets is beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters.

Reading the Figure tells you that beverages comprise a whopping 47% of added sugars (closer to half if you add in sweetened milks, teas, and coffees).  The text following the Figure says:

Shift to reduce added sugars consumption to less than 10 percent of calories per day: Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars.

Strategies?  How about just saying: “Cut down on sugary drinks” or “Drink water instead of sugary drinks.”

Figure ES-1 in the Executive Summary illustrates the 2015-2020 Dietary Guidelines for Americans at a Glance.  All it says is:

Limit calories from added sugars…Consume an eating pattern low in added sugars…Cut back on food and beverages higher in these components to amounts that fit within healthy eating patterns.

Figure 3.2 shows Implementation of the Guidelines through MyPlate: “Drink and eat less…added sugars,” but nothing about sugary drinks.

This circumspection is weird.  Clear, straightforward advice to cut down on sugary beverages has plenty of historical precedent.

Both Figures ES-1 and 3.2 are most certainly derived from a USDA graphic on the MyPlate website (dated January 2016).  This says flat out:

Drink water instead of sugary drinks.

This statement, in turn, derives from:

• The precepts issued with the 2010 Dietary Guidelines in January 2011
• The statements issued with the MyPlate graphic in June 2011

• The USDA’s May 2012 tip for making better beverage choices.

The 2015 DGAC (Dietary Guidelines Advisory Committee) repeatedly urged limits on consumption of sugar-sweetened beverages.  Statements like this one, for example, appear throughout the document:

To decrease dietary intake from added sugars, the U.S. population should reduce consumption of sugar-sweetened beverages.

Why did the USDA and HHS writing committee choose to waffle about his point?

This cannot be an accident.  It must be deliberate.  And it can have only one explanation: politics.