Currently browsing posts about: Dietary-Guidelines

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.

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?

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!

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.

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).

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.

I received an e-mail from the communications director of the Independent Women’s Forum, a group whose mission is to “improve the lives of Americans by increasing the number of women who value free markets and personal liberty.”

Interesting.

The group and its friends have just sent a letter to USDA and HHS complaining that the 2015 Dietary Guidelines Advisory Committee (DGAC) is exceeding its mandate.

Among our most acute concerns is the “mission creep” of the Committee, which has expanded to include non-dietary factors such as “carbon footprints,” “climate change,” “urban agriculture,” and “green cleaning and pest control practices.”

This likely reflects the composition of the Committee, which is nearly all epidemiologists from elite academic institutions with no direct experience in the practical realities of how food is produced and what average Americans may choose to eat.

We need only consider the strongly negative reaction to recent changes to the school lunch rules to understand what is at risk if this Committee attempts to dictate over-reaching changes to the American diet.

This would be funny if it weren’t part of the Republican agenda to roll back improvements in nutrition advice and practice aimed at preventing obesity and its related chronic diseases.

What the IWF is saying is that its members know better about what’s good for health than all those elite epidemiologists, scientists, and other experts on the committee who are worried about what climate change will do to our food supply.

Let’s hope the agencies ignore this letter.

Mal Nesheim and I have an editorial in a recent issue of the American Journal of Clinical Nutrition: “Advice for fish consumption: challenging dilemmas.”

We commented on a research article evaluating blood mercury levels in adults eating seafood.

In it, we point out that

the 2010 Dietary Guidelines for Americans advise Americans to consume 8 ounces (227 g) of seafood per week to reach an average intake of 250 mg/d of the omega-3 fatty acids EPA and DHA.

This recommendation represents a substantial increase over current consumption amounts of ∼3.5 oz/wk. It is based on “moderate, consistent evidence” that the health benefits of increased seafood consumption outweigh the risks associated with methylmercury, a toxic contaminant of large predatory food fish (tilefish, shark, swordfish, king mackerel) and, to a lesser extent, albacore (white) tuna.

To avoid this toxin, the guidelines advise eating seafood typically found to be low in methylmercury, such as salmon, anchovies, sardines, and trout.

Such advice, however, leads to at least 3 dilemmas. Eating more fish might raise methylmercury intake above safe amounts. Pressures to consume more fish might place impossible demands on an already threatened seafood supply. And the obvious solution—fish farming—raises concerns about what farmed fish are fed and how farmed fish affects the environment.

We urge the 2015 Dietary Guidelines committee to take all this into consideration when making recommendations about fish consumption: “We hope that its advice for seafood consumption will help a confused public resolve some of these dilemmas and make wise seafood choices.”

Wise seafood choices may be an oxymoron, alas.

The food movement must be succeeding beyond anyone’s wildest expectations.

Now it’s the Dietary Guidelines Advisory Committee’s (DGAC’s) turn to come under attack.

The Guidelines:  These are principles of healthful diets aimed at policymakers  (not the general public).

The history:  They have been published every five years since 1980, so we are now in round #8 scheduled for publication in 2015.

The process: Two federal departments, USDA and Health and Human Services, appoint an advisory committee of nutrition scientists.  The committee reviews the science and prepares a report.  Since 2005, the agencies have written the guidelines, not the committee.     

Disclosure: I was a member of the advisory committee for the 1995 Guidelines.

The fireworks: According to ProPolitico Morning Agriculture (behind a pay wall, alas), the committee is attracting unusual attention from the right:

• The Washington Examiner, writes that “committee members…are hijacking the guidelines to advance a range of ideological agendas having nothing to do with healthy eating.”
• The Daily Caller asks “Are Progressives Inserting Their Agenda Into Your Diet?” Tuesday.
• The Washington Free Beacon wants you to “Meet the Radicals Creating the New Federal Dietary Guidelines.”

A clue to what is upsetting these folks comes from the committee’s request for public comments.  It is asking for comments that address:

• Elements of a whole food system
• Information on specific food groups or commodities
• Sustainability metrics that have been implemented or are in development

These, apparently, are fighting words.

Yesterday, Fox News asked why “ivory tower types” were in charge of determining food choices for Americans.

Its story particularly singled out Miriam Nelson, a professor at Tufts (not New York University—could Fox be confusing her with me?):

New York University professor Miriam Nelson, said at the committee’s last meeting, “We need to make sure that the guidelines and the policies are promoting those foods … [that] are sustainably grown and have the littlest impact on the environment.”

…The professors of the DGAC may think their job is save the planet by promoting sustainable agriculture and plant-based diets, but if they don’t understand the real-world implications of their work, they’ll be oblivious to the havoc they’ll wreak on the millions of Americans whose diets hinge on their guidelines.

By this time, the Dietary Guidelines are hardly of interest to anyone but policy wonks (really, they never change all that much).  Cheers to the current committee for injecting some life into them.

The 2015 Guidelines will be fun to watch.

What is a poor eater to do?

The latest meta-analysis of the effects of saturated fat on heart disease finds—none.

This study, reported in the Annals of Internal Medicine (doi: 10.7326/M13-1788), examined the results of

• 32 observational studies involving 530 525 participants
• 17 observational studies involving 25 721 participants
• 27 randomized controlled trials involving 103 052 participants

The result?

Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats. 

This meta-analysis follows an editorial in a Mayo Clinic publication (http://dx.doi.org/10.1016/j.mayocp.2013.11.006) by authors who argue that saturated fat is not the problem.  Carbohydrates (e.g., sugars) are the problem.  The authors argue:

• Effects of saturated fat on blood cholesterol are weak and transient.
• Meta-analyses have found a lack of an association between heart disease mortality and saturated fat intake.
• Stroke studies find that patients with stroke had eaten less saturated fat.
• Long-term studies find that people with the highest dairy consumption have the lowest mortality risk, and also low diabetes and heart disease.
• Dietary trials find trivial or no benefit at all from decreasing saturated fat and/or increasing intake of polyunsaturated fat.

On this basis, they say that advice to reduce intake of saturated fat is irrational.

The New York Times asked several experts for comment on the meta-analysis, among them Dr. Frank Hu of Harvard:

The single macronutrient approach is outdated…I think future dietary guidelines will put more and more emphasis on real food rather than giving an absolute upper limit or cutoff point for certain macronutrients…people should try to eat foods that are typical of the Mediterranean diet, like nuts, fish, avocado, high-fiber grains and olive oil.

Dr. Hu was referring to a large clinical trial (not included in the meta-analysis), which concluded that a diet with more nuts and extra virgin olive oil reduced heart attacks and strokes when compared with a lower fat diet with more starches.

The Times story contained a reminder that the American Heart Association issued dietary guidelines last year to “restrict saturated fat to as little as 5 percent of their daily calories, or roughly two tablespoons of butter or two ounces of Cheddar cheese for the typical person eating about 2,000 calories a day.”

How to make sense of this?

I vote with Frank Hu that dietary advice should focus on food, not nutrients.

Focusing on one or another nutrient—fat, saturated fat, cholesterol, or sugar—takes foods out of their caloric as well as dietary context.

My guess: If you balance food intake with physical activity and are not overeating, the specific proportion of fat, carbohydrate, and protein won’t matter nearly as much.

While the arguments about fat v. sugar go on and on:  Eat your veggies, vary the foods you eat, don’t gorge, and enjoy what you eat.