Search results: dietary guidelines

This morning’s Politico Pro Morning Agriculture says that FDA menu labeling (see Monday’s Post) is not the only food rule being held up by the White House.

The issue: The White House is supposed to sign off or reply within 90 days, or formally request an extension.  That’s not happening with menu calorie labeling or four others:

• The Common or Usual Name for Raw Meat and Poultry rule: this refers to what you can call meat and poultry with added water, salt or other ingredients.  The White House has been sitting on rule for review since April 30.   Chicken producers love it.  Some meat producers don’t.  Here’s the initial proposal.  It’s not clear whether or how it’s been altered.
• Child Nutrition Program Integrity and Child and Adult Care Food Program proposals: these rules, also sent in April, deal with USDA’s implementation of the Healthy Hunger Free Kids Act. The integrity rule deals with mismanagement.  The other one requires USDA to update the meals to comply with dietary guidelines every 10 years.
•  USDA’s catfish inspection rule: Sent to the White House on May 30, this would implement a section of the 2014 farm bill that puts USDA, not FDA, in charge of catfish inspections (see previous post on this).
• EPA’s Renewable Fuel Standard for 2014: This was sent August 22.  The White House has not extended the review period.  f the administration does take more time to officially complete its review, it could push the release of the rule governing how much ethanol needs to be mixed into gasoline for 2014 into 2015.

What’s going on?  Politics, of course.  But I can only speculate on what they might be.

Yesterday, the fabulous Representative Rosa DeLauro (Dem_CT) introduced the Sugar-Sweetened Beverages Tax Act of 2014 (SWEET Act).  Here’s a quick summary of the bill. The SWEET Act (you have to love the name) would put an excise tax of one cent per teaspoon of sugars (a teaspoon is about 4 grams). The bill is clearly aimed at sugary drinks, which account for about half of total sugar intake.  According to the 2010 Dietary Guidelines (page 29),

• Sodas, energy, and sports drinks account for 35.7% of total sugars
• Fruit drinks—a category that does not include 100% juices—account for another 10.5%.
• Sugar-sweetened teas account for 3.5%.

The tax ought to raise about $10 billion a year, and is earmarked for programs to combat soda-related disease. It also ought to further reduce consumption of sugary drinks, as is already happening in Mexico. If you would like to endorse this legislation, contact Kelly.Horton@mail.house.gov in Representative DeLauro’s office. References

• DeLauro Press Release
• CSPI’s Press Release
• Mark Bittman’s July 30 discussion of the bill in the New York Times
• The Prevention Institute’s endorsement
• Reuters’ report
• Food-Navigator.com’s report
• The Hill’s story plus video
• The American Beverage Association statement

The FDA is taking comments on its proposals to revamp the food label until August 1, 2014.

It has two sets of proposed changes:

• Nutrition and Supplement Facts Labels
• Serving Sizes

Here is the first of my comments on several food label items.  Feel free to copy, edit, or file your own (see directions below).

July 16, 2014

TO:  FDA

FROM:  Marion Nestle, Professor, New York University

RE:  Nutrition Facts panel: ADDED SUGARS

1.  Retain the line for Sugars but call it Total Sugars

2.  Add a line for Added Sugars

Rationale:

• Excessive intake of dietary sugars is well established to raise the risk of obesity and type-2 diabetes.[i]
• Americans on average twice as much as is generally recommended.[ii]
• The amount typically consumed comes close to the upper limit recommended by the Institute of Medicine on the basis of increased risk of nutrient deficiencies.[iii]
• Sugars intrinsic to foods are accompanied by nutrients; added sugars are not.
• Although there is no biochemical difference between intrinsic and added sugars, food and beverage companies know exactly how much sugar they add as part of the recipes for their products.
• Listing the amount of added sugars on food labels would inform consumers about how much sugars are added to the foods they buy.
• Randomized, controlled clinical trials to test the hypothesis that added sugars increase disease risk would violate ethical standards and, therefore, are impossible to conduct.

3.  Establish a Daily Reference Value for Added Sugars of 10% of total calories

Rationale:

• Since the 1977 Dietary Goals, health officials have consistently recommended an upper limit of 10 percent of calories from added sugars.[iv]
• The 1992 USDA Food Guide Pyramid suggested an upper limit of 6, 12, and 18 teaspoons of sugars, respectively, for daily diets of 1,600, 2,200, and 2,800 calories, respectively.  This works out to 7, 10, and 13 percent of calorie intake, respectively, for an average of 10 percent.[v]
• By 1992, health officials in several European countries had recommended much the same.[vi]
• The Institute of Medicine’s 2002 upper safety limit of 25% of calories was based on risk for nutrient deficiencies, not obesity and chronic disease.[vii]
• In 2009, the American Heart Association recommended that women consume no more than 100 calories per day from added sugars (25 grams), and men no more than 150 calories per day (38 grams).  These come to 5 percent and 7.5 percent, respectively, of a 2000-calorie daily diet.[viii]
• The 2010 Dietary Guidelines for Americans state that no more than 5 to 15 percent of calories should come from a combination of solid fats and added sugars.  This implies that added sugars should be less than 10% of calories.^[ix]
• Dr. Robert Lustig says that a “dose” of added sugars up to 50 grams a day poses little risk for metabolic or chronic disease.  This amounts to 200 sugar calories and 10% of a 2,000-calorie daily diet (he says twice that much, the amount commonly consumed by Americans, is toxic.[x]
• The World Health Organization in 2014 said that added sugars should make up less than 10 percent of total calories per day, and less than 5 percent would be even better,[xi] based on two research reviews, one on sugars and obesity[xii]  and one on sugars and tooth decay.[xiii]
• Added sugars as 10% of calories represents about half the amounts currently consumed and comes close to consensus.

References

[i] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohttp://steinhardt.nyu.edu/nutrition/hort studies. BMJ 2012;345:e7492.  doi: 10.1136/bmj.e7492.

[ii] USDA.  Loss-adjusted food availability documentation.  March 11, 2014.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/loss-adjusted-food-availability-documentation.aspx#.UzlzcfldU6w.   USDA.  Food availability documentation: added sugar and sweeteners.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/food-availability-documentation.aspx#sugar.   The tables used to construct figure 3D are at: Refined Sugar, Corn Syrup, Other Sweeteners.

[iii] Institute of Medicine (IOM) of the National Academies. “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), Chapter 6: Dietary Carbohydrates: Sugars and Starches”, Washington, DC: National Academies Press; 2002.

[iv] U.S. Senate Committee on Nutrition and Human Needs.  Dietary Goals for the United States, December 1977.

[v] USDA.  Food Guide Pyramid, 1992.

[vi] Cannon G:  Food and Health: The Experts Agree.  London:  Consumers’ Association, 1992.

[vii] USDA.  Is intake of added sugars associated with diet quality?  Nutrition Insights, Insight 21, October 2000.

[viii] Johnson RK, Appel LJ, Brands M, et al.  Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.  Circulation. 2009;120(11):1011-1120.  doi: 10.1161/CirculationAHA.109.192627.

[ix] USDA and USDHHS.  Dietary guidelines for Americans, 2010.  http://www.cnpp.usda.gov/dgas2010-policydocument.htm.

[x] Lustig RH.  Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.  Hudson Street Press, 2012.

[xi] WHO.  Draft guideline: Sugars intake for adults and children, March 2014. http://www.who.int/nutrition/sugars_public_consultation/en/.

[xii] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2012;345:e7492 doi: 10.1136/bmj.e7492.

[xiii] Moynihan PJ, Kelly SAM.  Effect on Caries of Restricting Sugars Intake. Systematic Review to Inform WHO Guidelines.  JDR 2014;93:8-18.  doi:10.1177/0022034513508954.

The FDA makes it easy to file comments. It provides:

• All necessary information in one place.
• A short guide and checklist
• Nutrition and Supplement Facts Label: Docket FDA-2012-N-1210  Comment here now
• Serving Sizes: Docket FDA-2004-N-0258  Comment here now

Eating fish presents difficult dilemmas (I evaluate them in five chapters of What to Eat).

This one is about asking pregnant women to weigh the benefits of fish-eating against the hazards of their toxic chemical contaminants to the developing fetus.

The Dietary Guidelines tell pregnant women to eat 2-to-3 servings of low-mercury fish per week (actually, it’s methylmercury that is of concern, but the FDA calls it mercury and I will too).

But to do that, pregnant women have to:

• Know which fish are low in mercury
• Recognize these fish at the supermarket, even if they are mislabeled (which they sometimes are).

Only a few fish, all large predators, are high in mercury.  The FDA advisory says these are:

• Shark
• Swordfish
• King Mackerel
• Tilefish

What?  This list leaves off the fifth large predator: Albacore (white) tuna.  This tuna has about half the mercury as the other four, but still much more than other kinds of fish.

The figure below comes from the Institute of Medicine’s fish report.  It shows that fish highest in omega-3 fatty acids, the ones that are supposed to promote neurological development in the fetus and cognitive development in infants, are also highest in mercury.

White tuna is the line toward the bottom.  The ones in the blue boxes are all much lower in omega-3s and in mercury except for farmed Atlantic salmon (high in omega-3s, very low in mercury).

What’s going on here?

• Tuna producers know you can’t tell the difference between white and other kinds of tuna and don’t want you to stop eating tuna during pregnancy.
• The data on the importance of eating fish to children’s cognitive development are questionable (in my opinion).  The studies are short term and it’s difficult to know whether the small gains in early cognitive development that have been reported make any difference a few months later.
• The FDA must be under intense pressure to promote fish consumption.

I think it is absurd to require pregnant women to know which fish to avoid.  In supermarkets, fish can look pretty much alike and you cannot count on fish sellers to know the differences.

Other dilemmas:

• Even smaller fish have PCBs, another toxin best avoided by pregnant women, if not everyone.
• The world’s seafood supply is falling rapidly as a result of overfishing.
• Half of the mercury in seafood derives from emissions from coal-burning power plants.  The best way to reduce mercury in fish is to clean up the emissions from those plants, but plant owners want to avoid the expense.

That’s fish politics, for you.

The FDA documents:

• Press Release: FDA and EPA Issue Draft Updated Advice for Fish Consumption
• FDA and EPA Draft Updated Advice for Fish Consumption (open for public comment)
• Federal Register Notice – Environmental Protection Agency and Food and Drug Administration Advice About Eating Fish: Availability of Draft Update
• Consumer Update: New Advice: Some Women and Children Should Eat More Fish
• Dietary Guidelines for American’s 2010
• Quantitative Assessment of the Net Effects on Fetal Neurodevelopment from Eating Commercial Fish

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.

Nicholas Kristof of the New York Times recently devoted a column to an analysis of who really gets welfare in the United States.  He listed policies that favor not only the wealthy, but the fabulously wealthy:

• Subsidies for private airplanes via tax write-offs and deductions
• Tax deductions for private yachts
• Tax deductions for hedge funds and private equity
• Bank rescues
• Incentives to operate locally

His column reminded me of one written in 2005 by Sean Faircloth, then a Maine State representative, “Six ways government promotes obesity and what to do about it.”

No government, Faircloth said, could have devised more effective policies for reducing physical activity and promoting junk food.  Taxpayers, he pointed out:

• Subsidize oil companies and cars to the detriment of trails and sidewalks.
• Make it impractical to get basic information in foods and restaurants (menu labeling regulations: where are you?).
• Give large corporations free reign to market to children.
• Allow soda and snack-food companies to market products in schools (USDA is trying to change this).
• Direct billions in subsidies toward processed foods while neglecting fresh produce.
• Promote high-calorie foods in programs for poor people.

I thought this was an interesting way of thinking about obesity policy and over the years have added these:

• Allowing marketing costs to be deducted from taxes as business expenses
• Bans on lawsuits against food companies
• Ambiguous and obfuscating dietary guidelines (e.g. SoFAS in the 2010 edition)

No doubt there are others.

Can you think of any others?  Thanks.

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.

On Friday, President Obama signed the Agriculture Act of 2014, a.k.a. the farm bill.

 The green object on the left is a John Deere tractor.  Why is it there?

The John Deere company:

• Sells crop insurance.
• Is one of the 18 insurance companies that benefit handsomely from the newly revised law.
• Gives widely to members of Congress (both parties).

The bill has 12 titles or sections:

1. Commodities
2. Conservation
3. Trade
4. Nutrition
5. Credit
6. Rural Development
7. Research, Extension, and Related Matters
8. Forestry
9. Energy
10. Horticulture
11. Crop Insurance
12. Miscellaneous

I took a quick look at what’s new in Title 4: Nutrition—the part that deals with SNAP.  Here are a few of its details [with my comments]:

Sec. 4001. Preventing payment of cash to recipients of supplemental nutrition assistance benefits for the return of empty bottles and cans used to contain food purchased with benefits provided under the program.  [This closes a loophole but hardly seems worth the trouble—how much cash is involved here?  And won’t it be impossible to enforce?]

Sec. 4018.  No funds authorized to be appropriated under this Act shall be used by the Secretary for recruitment activities designed to persuade an individual to apply for supplemental nutrition assistance program benefits. [This one is especially troubling, as it eliminates USDA outreach activities to people who might be eligible for benefits but don’t know about them.]

Sec. 4028. Nutrition education is to include physical activity in addition to healthy food choices.  [Translation: Focus obesity-prevention efforts on activity, not on making fewer purchases of junk foods and sodas.]

Sec. 4202.  The Secretary [of USDA] shall conduct a pilot project…[to] facilitate the procurement of unprocessed fruits and vegetables in not more than 8 States. [It’s only a pilot program but it’s to promote local farm-to-school programs! Score this one as a small win.] 

Sec. 4204.  Not later than the 2020 report [on the Dietary Guidelines for Americans] and in each report thereafter, the Secretaries [of USDA and HHS] shall include national nutritional and dietary information and guidelines for pregnant women and children from birth until the age of 2.  [I’m baffled by this one.  Current Guidelines apply to everyone over the age of 2 and already contain advice for pregnant women.  I doubt this is meant to make sure that the Guidelines advise parents to avoid giving sodas to kids under the age of 2.]

Sec. 4208. Food Insecurity Nutrition Incentive.  This provides for competitive matching grants to increase the purchase of fruits and vegetables by SNAP participants.  [As discussed by Michele Simon and Daniel Bowman Simon, the bill does not necessarily favor local foods or purchases at farmers’ markets, and the size of the incentive is unclear.]

Sec. 4209.  Food and agriculture service learning program…to increase capacity for food, garden, and nutrition education within host organizations or entities and school cafeterias and in the classroom.  The USDA is to award competitive grants to entities that have a proven track record; work in underserved rural and urban communities; teach and engage children in experiential learning about agriculture, gardening, nutrition, cooking, and where food comes from; and facilitate a connection between elementary schools and secondary schools and agricultural producers in the local and regional area. [This must mean Food Corps.  The bill authorizes $25 million until spent, but the funding is not mandatory.  Will it be funded?  Fingers crossed.]

Sec. 4213.  Pulse crop products.  The [USDA] Secretary shall purchase eligible pulse crops and pulse crop products for use in the school lunch program…[and] the school breakfast program. [Bean growers—soybean growers?—must be doing some effective lobbying.]

Sec. 4214. The Secretary shall carry out a pilot project in schools participating in the Fresh Fruit and Vegetable Program…in not less than 5 States, to evaluate the impact of allowing schools to offer canned, frozen, or dried fruits and vegetables.  [It looks like the frozen food industry is also doing some effective lobbying.  Frozen vegetables are fine, but not if they mean giving up fresh ones.]

—Thanks to Daniel Bowman Simon for pointing out some of these issues and for providing links to relevant sources.