by Marion Nestle

Currently browsing posts about: Dietary-Guidelines

Feb 23 2015

Dietary guidelines shouldn’t be this controversial

The uproar caused by the release of the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC) has been even noisier than I predicted, so noisy that USDA Secretary Vilsack appears to have pulled back on it.  He told Jerry Hagstrom (HagstromReport.com) that:

He wants people to realize that the process of writing the dietary guidelines “is just beginning today,” and that he and [HHS Secretary] Burwell will consider input from federal agencies and the general public. He said he wants to be sure that people “know that I know my responsibility.”

In this, Vilsack was referring to the directive by Congress in the 2015 appropriations bill blocking him from considering sustainability in the guidelines.

As for the DGAC report: It concluded:

…the U.S. population should be encouraged and guided to consume dietary patterns that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and beverages and refined grains.

Predictably, this did not go over well with the meat industry or, for that matter, other industries affected by such advice or groups funded by such industries.

Less predictably, the New York Times published an Op-Ed by Nina Teicholz, the journalist author of “The Big Fat Surprise,” a work based on her own review of the science of fat.  In her view, mainstream nutritionists have badly misinterpreted this science to the great detriment of public health.

Her conclusion:

…we would be wise to return to what worked better for previous generations: a diet that included fewer grains, less sugar and more animal foods like meat, full-fat dairy and eggs.

But Teicholz’ book has been the subject of a line-by-line analysis by Seth Yoder (whom I do not know personally).  Mr. Yoder did what graduate students in science are trained to do: read the references.

He looked up and examined the references Teicholz cites in the book as the basis of her views.  He documents an astonishing number of situations in which the references say something quite different from what Teicholz gets out of them.  At the very least, his analysis raises serious questions about the credibility of her views on the science of fat.

Let’s grant that the science of nutrition is difficult to do and complicated.  The New York Times should know this, which is why I’m surprised that it would give Teicholz so prominent a platform without countering them with point-counterpoint views of a respected nutrition scientist.

It does little to foster the health of the public to make nutrition science appear more controversial than it really is.

The basic advice offered by 2015 Dietary Guidelines Advisory Committee boils down to plain common sense:

  • Eat plenty of foods from plant sources
  • Eat foods from animal sources in moderation
  • Balance calories
  • Avoid overeating junk food

Unfortunately, this kind of advice doesn’t make headlines or, apparently, merit op-ed space in the New York Times.

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Feb 20 2015

The 2015 Dietary Guidelines Advisory Committee releases its courageous report

The 2015 Dietary Guidelines Advisory Committee (DGAC) issued its more than 500-page report yesterday.

Before I say anything about it, please note that this report informs, but does not constitute, the Dietary Guidelines. The agencies—USDA and HHS—write the actual Guidelines and are not expected to do so until the end of this year.

Here are what I see as the highlights (these are direct quotes)

  • A healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and drinks and refined grains.
  • A diet higher in plant-based foods…and lower in calories and animal-based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.
  • It will take concerted, bold actions…to achieve and maintain the healthy diet patterns, and the levels of physical activity needed to promote the health of the U.S. population. These actions will require a paradigm shift to an environment in which population health is a national priority and where individuals and organizations, private business, and communities work together to achieve a population-wide “culture of health” in which healthy lifestyle choices are easy, accessible, affordable, and normative.

Some facts and statements from the report (not direct quotes).

  • Half the energy intake in U.S. diets comes from a combination of burgers and sandwiches (~14%), desserts and sweet snacks (8.5%), sugary beverages (6.5%), mixed dished made with rice, pasta, and other grains (5.5%, savory snacks (~5%), pizza (4.3%), and meat, poultry and seafood mixed dishes (~4%).
  • Nearly half of total sugar intake comes from beverages other than milk and 100% fruit juice

The report comments on issues under current debate.

  • Saturated fat: “replacing SFA with unsaturated fats…significantly reduces total and LDL cholesterol…Strong and consistent evidence…shows that replacing SFA [saturated fatty acids] with PUFA [polyunsaturated fatty acids] reduces the risk of CVD [cardiovascular] events and coronary mortality…For every 1 percent of energy intake from SFA replaced with PUFA, incidence of CHD [coronary heart disease] is reduced by 2 to 3 percent. However, reducing total fat (replacing total fat with overall carbohydrates) does not lower CVD risk.”
  • Sugars: “Strong and consistent evidence shows that intake of added sugars from food and/or sugar sweetened beverages are associated with excess body weight in children and adults…Strong evidence shows that higher consumption of added sugars, especially sugar-sweetened beverages, increases the risk of type 2 diabetes among adults and this relationship is not fully explained by body weight.[Theae findings are] compatible with a recommendation to keep added sugars intake below 10 percent of total energy intake.”
  • Food labels: “Consumers would benefit from a standardized, easily understood front-of-package (FOP) label on all food and beverage products to give clear guidance about a food’s healthfulness.” [This refers to the recommendations of the Institute of Medicine that I’ve written about previously; they disappeared without a trace.]
  • Soda taxes: “Economic and pricing approaches, using incentives and disincentives should be explored to promote the purchase of healthier foods and beverages. For example, higher sugar-sweetened beverage taxes may encourage consumers to reduce sugar-sweetened beverage consumption.”
  • SNAP: “Policy changes within the federal Supplemental Nutrition Assistance Program (SNAP), similar to policies in place for the WIC program, should be considered to encourage purchase of healthier options, including foods and beverages low in added sugars. Pilot studies using incentives and restrictions should be tested and evaluated.”

The DGAC recommends (these are direct quotes but not necessarily complete):

  • Establish local, state, and Federal policies to make healthy foods accessible and affordable and to limit access to high-calorie, nutrient-poor foods and sugar-sweetened beverages in public buildings and facilities.
  • Set nutrition standards for foods and beverages offered in public places.
  • Improve retail food environments and make healthy foods accessible and affordable in underserved neighborhoods and communities.
  • Implement the comprehensive school meal guidelines (National School Lunch Program) from the USDA that increase intakes of vegetables (without added salt), fruits (without added sugars), and whole grains.
  • Limit marketing unhealthy foods to children.
  • Make drinking water freely available to students throughout the day.
  • Ensure competitive foods meet the national nutrition standards (e.g., Dietary Guidelines for Americans).
  • Eliminate sugar-sweetened beverages [from schools].
  • Nutrition Facts label should include added sugars (in grams and teaspoons).

And for all federal nutrition programs, the DGAC recommends:

  • Align program standards with the Dietary Guidelines for Americans so as to achieve the 2015 DGAC recommendations and promote a “culture of health.”

Congratulations to this committee for its courageous recommendations.

Why courageous?  See my previous comments on the objections to such advice.

The next step: public comment:

The public is encouraged to view the independent advisory group’s report and provide written comments at www.DietaryGuidelines.gov for a period of 45 days after publication in the Federal Register. The public will also have an opportunity to offer oral comments at a public meeting in Bethesda, Maryland, on March 24, 2015. Those interested in providing oral comments at the March 24, 2015, public meeting can register at www.DietaryGuidelines.gov. Capacity is limited, so participants will be accepted on a first-come, first-served basis.

Here’s your chance to support this committee’s excellent ideas and demonstrate public approval for diets that promote the health of people and the planet.

Note: the reactions to the report are pouring in and I will deal with them next week.  Enjoy the weekend!

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Feb 12 2015

What’s up with the cholesterol guideline?

The Washington Post says that the 2015 Dietary Guidelines Advisory Committee is about to drop the long-standing guideline about restricting dietary cholesterol.

The 2010 Dietary Guidelines said “Consume less than 300 mg per day of dietary cholesterol.”

This is about the amount in one egg.

I have no idea what’s going on.  The Advisory Committee report has not yet been released so I don’t know what it says (I’ve heard rumors that it is to be released this week, which could mean late Friday afternoon on a holiday weekend).

Recall: no matter what the Advisory Committee says in its report, it does not write the Dietary Guidelines.  The agencies—USDA and HHS—do whatever they choose with the committee’s research report.

If the Committee really is dropping the guideline, I’d like to see its research rationale.

I’m wondering if research sponsored by the egg industry could have anything to do with this.

See, for example, this recent study concluding that people with coronary heart disease don’t have to worry about eating eggs.

We found no evidence of adverse effects of daily egg ingestion on any cardiac risk factors in adults with CAD over a span of 6 weeks.

You have to read the study carefully to find the funding source (these are usually at the end of articles, but this one is in the middle):

Disclosures. This study was conducted with funding from the Egg Nutrition Center/American Egg Board and the Centers for Disease Control and Prevention (Grant
No. 5U48DP001945-05).

And you have to read the tables carefully to find out that 90.6% of the subjects in this study were taking statins, nearly 90% were taking drugs to lower blood pressure, and nearly 80% were taking aspirin.  The discussion, however, does not mention this point making this study a classic example of the problems with conflicts of interest in research.

If the Advisory Committee is dropping the cholesterol recommendation, could it be because so many people are taking statins that dietary cholesterol doesn’t appear to matter so much anymore?

This story is getting a lot of press.  Here’s one from USA Today that quotes me and changes my name as it goes along (they have now fixed that).

Can’t wait to see what the report really says.

 

 

 

 

 

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Feb 9 2015

Red meat politics

I was interested to read Clare Foran’s piece in The National Journal on The Political Battle Over Red Meat.   It nicely summarizes the lobbying to stop the 2015 Dietary Guidelines Advisory Committee from saying that diets would be healthier and more sustainable if they included less red meat.

Her piece includes this illustration of why the meat industry objects to such ideas.

Infographic

Since 2000, the meat industry has been relatively quiet over the Dietary Guidelines, mainly because—as I discussed in Food Politics—this industry had won most of the political battles.

The 2000 Dietary Guidelines recommended 2-3 servings a day of 2-3 ounces of meat for a total of 4-9 ounces a day—an increase over previous recommendations.

But then:

  • The 2005 Guidelines folded meat in with other sources of protein: “When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.”
  • The 2010 Guidelines said “Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds.”

If current trends in Guidelines continue, the meat recommendation might disappear entirely.

Meat industry lobbyists want to make sure meat maintains its historic place in the center of American plates.

What will the Dietary Guidelines Advisory Committee say?  Its report is due out soon.  Stay tuned.

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Dec 18 2014

The Healthy Nation Coalition doesn’t like the Dietary Guidelines. But what does it want?

This is my week to be talking about the Dietary Guidelines, apparently.  Yesterday’s Politico Morning Agriculture, a news source on which I greatly depend, noted yet another attack on the Dietary Guidelines, this one from a group called  The Healthy Nation Coalition.

The Coalition wrote a letter to the secretaries of USDA and HHS, the agencies sponsoring the Guidelines, with many complaints about process and ineffectiveness.

I had never heard of this group, so I went to its website and laughed when I saw this graph—a terrific example of why epidemiologists insist that association does not necessarily say anything about causation.

Screenshot 2014-12-17 10.46.00

 

The implication here is that the Dietary Guidelines either cause obesity (something patently absurd) or have had no effect on its prevalence (something only to be expected given the other changes in society that predisposed to obesity beginning in the early 1980s).

If anything, the Dietary Guidelines are a result of those forces in society, not their cause.

I have my own issues with Dietary Guidelines (see Fo0d Politics), mainly about the use of advice that is euphemistic (“choose lean meats”) or incomprehensible (reduce SoFAS—solid fats and added sugars), and their focus on nutrients (fat, sugar, salt) rather than foods.

But I can’t understand what this Coalition is about or what it wants.

Its website says the Coalition formed because

A sense of community has arisen around questioning our current approach to food and nutrition. Healthy Nation Coalition has its beginnings in the ancestral health, Weston A. Price Foundation, and low-carbohydrate nutrition communities.

I understand what the Coalition does not want.  It

suggests that the 2010 Guidelines are not appropriate for population-wide diet recommendations, especially with regard to restrictions on dietary fat, saturated fat, cholesterol and salt.

indicates that the 2010 Guidelines may lead to increased risk of weight gain, diabetes, and chronic disease in many populations.

indicates that reducing intake of sugars and starches has health benefits.

indicates that adequate, complete protein is a critical part of the adult diet and that many adults benefit from intakes above current minimum recommendations.

Here’s what it says it wants

the Healthy Nation Coalition proposes that this process be removed from the USDA and HHS and given to one or more independent agencies, offices, or entities that can create dietary guidance that is without bias and responsive to the needs of the people of America.

Really?  Like what?

The “ask” in the letter is this:

It is the duty of USDA and DHHS leadership to end the use of controversial, unsuccessful and discriminatory dietary recommendations. USDA and DHHS leadership must refuse to accept any DGA that fail to establish federal nutrition policy based on the foundation of good health: adequate essential nutrition from wholesome, nourishing foods. It is time to create DGA that work for all Americans.

But what would they look like?

I don’t recognize any of the names of the individuals listed as part of the Coalition.

Can anyone explain to me what this group wants and is about?

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Dec 16 2014

More pressures on Dietary Guidelines: The “Back to Balance” Coalition

I had to laugh when I read Andy Bellatti’s blog post on the latest food industry front group, the Back to Balance Coalition.

A few years ago, Andy started a group called Dietitians for Professional Integrity to advocate for greater financial transparency and ethical sponsorships within the Academy of Nutrition and Dietetics.

Dietitians for Professional Integrity does not believe that it’s a good idea for the country’s largest organization of nutrition professionals to be sponsored by Coca-Cola, PepsiCo, Kellogg’s, and other Big Food giants.

I could not agree more.  And the same could be said of the American Society for Nutrition.  See, for example, one of its recent sponsored sessions.

Friday, December 5, 7:00 am – 8:45 am

Sponsored Satellite Program and Breakfast:

Defining Moderation: Should There Be Dietary Guidance for Chocolate?

Sponsored and organized by the National Confectioners Association

As I keep pointing out, you can’t make this stuff up.

But to return to the Back to Balance Coalition.

The Back to Balance Coalition brings together food and beverage organizations, health advocacy groups, and nutrition professionals who are supporters of balance, variety and moderation in dietary guidelines. The group aims to bring forward common sense, practicality, economic, and cultural relevance into dietary guidance.

As Andy puts it, “Leave it to the food industry to appoint itself as the sole definer of what constitutes balance, variety, and moderation.”

The beleaguered 2015 Dietary Guidelines Advisory Committee, as I explained yesterday, is under pressure from Congress to avoid saying anything about how food production and consumption might affect the environment, despite estimates that agriculture accounts for 15% to 20% of greenhouse gas emissions.

The Back to Balance Coalition has a different agenda.  It does not want the Dietary Guidelines to say a word about eating less of any foods its members sell.

Instead, it wants the Guidelines to talk about choice [my translations follow]:

  • Empowering choice is more effective than restricting it [so you will keep choosing our highly profitable junk foods].
  • All foods can fit within a healthful, overall dietary pattern if consumed in moderation with appropriate portion size and combined with physical activity [please ignore the amounts of money we spend to market our unhealthiest products].
  • Restricting food choices by classifying specific foods as “good” or “bad” is often overly simplistic and may foster unhealthy eating behaviors [you might not buy our products!].
  • Guiding Americans on which nutrient rich food choices to make versus not to make, and focusing on portion guidance to provide “how to” practical advice, can help people make wise food choices within the context of the total diet [never mind the fortunes we sink into promoting supersize junk foods].

To the Dietary Guidelines Advisory Committee: Courage!

 

 

 

 

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Dec 15 2014

2015 Dietary Guidelines: more congressional micromanagement

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.

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Nov 17 2014

Brazilian dietary guidelines are based on foods, food patterns, and meals, not nutrients

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).

Screenshot 2014-11-16 20.47.15 - Copy (2)

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.

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