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I write a monthly first-Sunday column for the San Francisco Chronicle. This one is on the latest Dietary Guidelines.

Dietary Guidelines try not to offend food industry

Sunday, February 6, 2011

Q: What do you think of the new Dietary Guidelines that were announced earlier this week? Is there anything very new or different? And how important are these guidelines, anyway?

A: I was stunned by the first piece of the 2010 Dietary Guidelines for Americans that I saw online (dietaryguidelines.gov): “Enjoy your food, but eat less.”

Incredible. The federal government finally recognizes that food is more than just a collection of nutrients? It finally has the nerve to say, “Eat less?”

But this statement and others directed to the public do not actually appear in the guidelines. That document repeats the same principles that have appeared in dietary guidelines for decades.

The 2010 guidelines just state them more clearly. (For the news story on the guidelines, go to sfg.ly/gdgsc0.)

Obesity prevention

Its 23 recommendations are aimed at obesity prevention. They focus on eating less and eating better. “Eat better” guidelines suggest eating more vegetables, fruits, whole grains, low-fat milk, soy products, seafood, lean meats and poultry, eggs, beans, peas, nuts and seeds – all are foods.

But the “eat less” advice is about nutrients: sodium, saturated fat, cholesterol and trans fats. The guidelines even coin a new term for the “eat less” nutrients of greatest concern: “solid fats and added sugars,” annoyingly abbreviated as SoFAS.

Here is one SoFAS guideline: “Limit consumption of … refined grain foods that contain solid fats, added sugars, and sodium.”

Nutrient-based guidelines require translation. You have to delve deeply into the 95-page document to find the food translations. Eat fewer solid fats? This means cakes, cookies, pizza, cheese, processed and fatty meats, and, alas, ice cream. Less sugar? The major sources are sodas, sports drinks, energy drinks and fruit drinks.

Why don’t the guidelines just say so? Politics, of course.

Official policy

Dietary guidelines are an official statement of federal nutrition policy. They influence everything the government says and does about food and nutrition. The guidelines determine the content of school meals, the aims of food assistance programs and the regulation of food labeling and advertising.

But their most powerful effect is on the food industry.

Why? Because advice to eat less is very bad for business.

Banal as their recommendations may appear, dietary guidelines are hugely controversial. That is why I was so surprised by “Enjoy your food, but eat less.”

Consider the history. In 1977, a Senate committee chaired by George McGovern issued dietary goals for the United States. One goal was to reduce saturated fat to help prevent heart disease. To do that, the committee advised “reduce consumption of meat.”

Those were fighting words. Outraged, the meat industry protested and got Congress to hold hearings. The result? McGovern’s committee reworded the advice to “choose meats, poultry and fish which will reduce saturated fat intake.”

This set a precedent. When the first dietary guidelines appeared in 1980, they used saturated fat as a euphemism for meat, and subsequent editions have continued to use nutrients as euphemisms for “eat less” foods.

Then came obesity. To prevent weight gain, people must eat less (sometimes much less), move more, or do both.

This puts federal agencies in a quandary. If they name specific foods in “eat less” categories, they risk industry wrath, and this is something no centrist-leaning government can afford.

Eat less, move more

So the new guidelines break no new ground, but how could they? The basic principles of diets that protect against chronic disease do not change. Stated as principles, the 2010 dietary guidelines look much the same as those produced in 1980 or by the McGovern committee.

In my book, “What to Eat,” I summarize those basic principles “eat less, move more, eat plenty of fruits and vegetables, and don’t eat too much junk food.” Michael Pollan manages this in even fewer words: “Eat food. Mostly plants. Not too much.”

Everything else in the guidelines tries to explain how to do this without infuriating food companies that might be affected by the advice. And the companies scrutinize every word.

The soy industry, for example, is ecstatic that the guidelines mention soy products and fortified soy beverages as substitutes for meat and as protein sources for vegetarians and vegans.

The meat industry is troubled by the suggestion to increase seafood, even though the guidelines suggest meal patterns that contain as much meat as always.

The salt recommendation – a teaspoon or less per day, and even less for people at risk for high blood pressure – is unchanged since 2005, but stated more explicitly. The salt industry reacted predictably: “Dietary guidelines on salt are drastic, simplistic and unrealistic.”

In a few months, a new food guide will replace the old pyramid. Thanks to a law Congress passed in 1990, dietary guidelines must be revisited every five years. Expect the drama over them to continue.

But for now, enjoy your food.

Marion Nestle is the author of “Food Politics,” “Safe Food,” “What to Eat” and “Pet Food Politics,” and is a professor in the nutrition, food studies and public health department at New York University. E-mail her at food@sfchronicle.com, and read her previous columns at sfgate.com/food.

This article appeared on page H – 3 of the San Francisco Chronicle

In an article about fast food marketing, the Los Angeles Times explains as clearly as could be why Dietary Guidelines matter so much.  The article is titled “Eat less, U.S. says as fast-food chains super-size their offerings.”

Why would fast food chains want to offer hot dogs, hamburgers, and burritos ranging from 800 t0 1,600 calories each?  How’s this for a candid answer:

The bottom line is we’re in the business of making money, and we make money off of what we sell,” said Beth Mansfield, spokeswoman for CKE Restaurants Inc., which owns the Carl’s Jr. and Hardee’s chains. “If we wanted to listen to the food police and sell nuts and berries and tofu burgers, we wouldn’t make any money and we’d be out of business.

You want to help people stay healthy?  That makes you food police.

If you care about public health, you can expect to be called names.  But that shouldn’t stop you from trying to create a healthier food system.

And thanks to Sheila Viswanathan of the GoodGuide for sending the article.

I have now had time to look at the full report of the 2010 Dietary Guidelines–all 95 pages of what they are calling “the policy document.”

Oh no!  What happened to the Selected Messages for Consumers that I posted yesterday?  “Enjoy your food” is not in it and neither are any of the other clear, straightforward messages.  This is a big disappointment.

Nevertheless, the document is well worth reading.

It addresses my complaints about the executive summary.  It explains the meaning of the annoying SOFAS (solid fats and added sugars).  It discusses the need to improve the food environment.

Let me share a few thoughts about selected issues.

SOFAS

The report translates its advice (pages 62-68).   It translates  “Cut back on foods and drinks with added sugars,” a nutrition euphemism, as:

Drink few or no regular sodas, sports drinks, energy drinks, and fruit drinks.  Eat less cake, cookies, ice cream, other desserts, and candy.  If you do have these foods and drinks, have a small portion.

But it translates “Cut back on solid fats” in yet another euphemism:  “Select lean meats and poultry, and fat-free or low-fat milk and milk products.”  This, no doubt, is to avoid the politically impossible “eat less meat.”

Added sugars

The report lists synonyms for added sugars that you might find on a food label (page 75).  The 2005 Dietary Guidelines included “fruit juice concentrates” on that list.  The 2010 guidelines do not.  The Table lists “nectars” but not fruit juice concentrates.  How come?  It doesn’t say.

Food group patterns

The report describes healthy patterns for diets ranging from 1,000 to 3,200 calories a day.  For a diet containing 2,000 calories, you are only allowed 258 calories a day from SOFAS.  That’s all? One 20-ounce soft drink contains more than that and so does  one tablespoon of butter and a 12-ounce soft drink.  No wonder the guidelines don’t want to be specific about foods when they mean “eat less.”

Sodium

The recommendation to reduce sodium intake to 2,300 or 1,500 mg per day is addressed to the wrong people.  Individuals cannot do this on their own since most salt is already added in restaurant and processed foods.  The report recognizes this:

• Consume more fresh foods and fewer processed foods that are high in sodium.
• Eat more home-prepared foods, where you have more control….
• When eating in restaurants, ask that salt not be added….
  

Vegetarian and vegan diets

The report includes diet plans for lacto-ovo vegetarians and vegans (pages 81 and 82).  Applause, please.  When I was on the dietary guidelines advisory committee in 1995, we tried to say something useful about vegetarian diets but were forced to add something about the nutritional hazards of such diets, minimal as they are.  Not having to do this is a big improvement.  But you too only get 258 calories for SOFAS.

How about changing the food environment?

The report makes it clear that the food environment strongly influences the food choices of individuals, and it urges efforts to

• Improve access to healthy foods
• Empower people with improved nutrition literacy, gardening and cooking skills
• Develop policies to prevent and reduce obesity
• And for kids, fix school meals, encourage physical activity, and reduce screen time

In short, there is plenty to work with here.  You just have to look hard and dig deep to find it.

What is the food industry’s reaction?

Just for fun, I’ve been tracking some of the industry reactions.  The soy people love it.  The report mentions soy along with nuts and seeds in the USDA’s meal patterns (page 79), and soy has its own category in the vegetarian and vegan diets (page 81 and 82).

The meat people don’t love it so much.  They are a little worried that seafood is pushed more than meat, but the American Meat Institute is giving it a nice spin, pointing out that the overall meat recommendation has not changed since 2005.

And the Salt Institute?  “Dietary Guidelines on Salt Drastic, Simplistic, Unrealistic.”

I rest my case.

The 2010 Dietary Guidelines for Americans were just released.  Here are the take-home messages:

Balancing Calories

• Enjoy your food, but eat less.

• Avoid oversized portions.

Foods to Increase

• Make half your plate fruits and vegetables.

• Switch to fat-free or low-fat (1%) milk.

Foods to Reduce

• Compare sodium in foods like soup, bread, and frozen meals—and choose the foods with lower numbers.

• Drink water instead of sugary drinks.

I’m in shock.  I never would have believed they could pull this off.  The new guidelines recognize that obesity is the number one public health nutrition problem in America and actually give good advice about what to do about it: eat less and eat better. For the first time, the guidelines make it clear that eating less is as priority.

My two quibbles:

Quibble #1: They still talk about foods (fruits, vegetables, seafood, beans, nuts) when they say “eat more.”   But they switch to nutrient euphemisms  (sodium, solid fats and added sugars) when they mean “eat less.”

They say, for example: “limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.”

This requires translation: eat less meat, cake, cookies, sodas, juice drinks, and salty snacks.

That’s politics, for you.

Let’s give them credit for “drink water instead of sugary drinks.”  That comes close. But I listened in on the press conference and conference call and several people pushed federal officials about why they didn’t come out and say “eat less meat.”  The answers waffled.

Quibble #2: This is all about personal responsibility.  What about the “toxic” food environment?  Shouldn’t these guidelines be directed at the food and restaurant industries?  The Dietary Guidelines Advisory Committee made a big point of that.  Apparently, that’s in the full dietary guidelines report but I’ve only seen the executive summary.

For background, see my previous posts, one on the politics of this report, and one on the science of the dietary guidelines.

Overall, the new guidelines aren’t perfect but they are a great improvement.

Next: let’s see what they do to improve the implementation guide—the pyramid or its equivalent.  This, they say will come out in a few months.  Stay tuned.

Here’s what I’m going to be doing on Monday morning:

INVITATION TO KEY STAKEHOLDERS TO JOIN IN THE NATIONAL RELEASE OF THE 2010 DIETARY GUIDELINES FOR AMERICANS

The U.S. Departments of Agriculture and Health and Human Services Will Release the 2010 Dietary Guidelines for Americans at a Joint Press Conference Monday, January 31, 2011

On Monday, January 31, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) will hold a joint press a conference at The George Washington University Jack Morton Auditorium to release the new 2010 Dietary Guidelines for Americans.

Agriculture Secretary Tom Vilsack and HHS Secretary Kathleen Sebelius will discuss the Guidelines and provide key insights into the new recommendations. Joining the Secretaries will be Dr. Robert Post, Deputy Director of USDA’s Center for Nutrition Policy and Promotion and Rear Admiral Penelope Slade-Sawyer, HHS Deputy Assistant Secretary for Health Disease Prevention and Health Promotion. Immediately following the presentations, the speakers will entertain questions from the press, stakeholders, students and others in attendance.

 Monday, January 31, 2011, 10 a.m. – 11 a.m. EST

The George Washington University

Jack Morton Auditorium

Media and Public Affairs Building

805 21st Street, NW

Washington, DC 20052

Stakeholders are invited to attend this event in person. Seating is limited and RSVP is required by 5 p.m. on Wednesday, January 26, by registering here.

Stakeholders may also view the event via webcast at www.usda.gov/live

Copies of the 2010 Dietary Guidelines for Americans will be available at www.DietaryGuidelines.gov immediately following the press conference.

Can’t wait!

The Dietary Guidelines Advisory Committee held a hearing yesterday on its recent report (see my posts of June 28 on the politics of this report, and June 29 on its science).  I could not attend the hearing but am collecting second-hand reports from people who attended or testified.

Philip Brasher, who blogs at GreenFields.com, summarizes lobbyists at work:

• National Pork Producers: “Lean meat is a vital source of high-quality protein and certainly should not be framed as a food to limit in the American diet….Urging Americans to shift to a more plant-based diet and consume only moderate amounts of lean meat implies they should decrease consumption of this vital, complete protein.”
• Egg producers: “The average American could increase egg consumption and still be within the egg-a-day limit.”
• The Sugar Association: Advice to reduce sugar is “impractical, unrealistic and not grounded in the body of evidence.”
• The Salt Institute:  “Encouraging consumption of low-salt foods will encourage Americans to eat excessively to make up for the lack of taste….The guidelines have become far more a reflection of ideology than sound science.”

The Organic Trade Association testified that the scientific review, which found no significant nutritional differences between organic and conventionally produced foods, is:

Neither grounded in current science nor relevant to the mandate of the Dietary Guidelines….[it is] in direct conflict with the advice put forth by the recent President’s Cancer Panel report regarding ways to reduce environmental cancer risk….It is inconceivable and alarming that the very document that is the underpinning of our nation’s policies regarding food and nutrition would include a statement that directly contradicts these recommendations….As released, the guidelines confuse the consumer, contradict the President’s own Cancer Panel, and do not enhance dietary recommendations.

To repeat: The committee report is simply advisory.  So is the lobbying.  The sponsoring federal agencies, USDA and DHHS, now must deal with both as well as with written comments on the report’s statements and recommendations.

The agencies write the final guidelines. Will they include advice to cut down on added sugars and fatty meats?  Will they say anything positive about organic foods?

Maybe, if enough people weigh in with such opinions.  Comments are due by July 15.  Here’s how.

Addition, July 10: Amber Healy’s terrific account in Food Chemical News (July 12) summarizes the hearings as “largely boiling down to a single question: Is meat good or bad?” For example:

• People for the Ethical Treatment of Animals, the Physician’s Committee for Responsible Medicine (PCRM), the Soyfoods Association of North America and Christina Pirello, the host of a cooking show on PBS: the guidelines should more clearly spell out the benefits of reducing meat consumption and take a stronger position on the need to reduce intake of processed meats.

• Sally Fallon Morell, president of the Weston A. Price Foundation: the recommended reduction in intake of lean meat and protein from animal sources could “perpetuate the kind of nutrient deficiencies” that the guidelines try to avoid and even lead to lower fertility rates.
• Betsy Booren of the American Meat Institute: If people try to consume the same amount of protein from plant-based foods, people could end up consuming more calories than if they had simply eaten some lean meat or poultry.

And, the National Dairy Council and the International Dairy Foods Association approved of the recommendation for three daily servings of low-fat or fat-free milk or dairy foods, but asked that the final guidelines acknowledge that flavored low-fat milk [i.e. chocolate] can encourage consumption among children.

With the politics out of the way (see yesterday’s post), let’s talk about what’s superb in the Dietary Guidelines Advisory Committee Report: the scientific review and analysis.

This was based on reviews produced by the Nutrition Evidence Library (NEL), which apparently recruited dozens of people to identify articles, assess their quality by uniform criteria, and rank the overall evidence as limited, moderate, or strong and consistent or inconsistent.

I particularly like the way the report organizes the research review by questions (of which there are 56, if I counted right).  The questions cover a great range of topics.  Examples:

• What nutrients and dietary components are overconsumed by the general public?
• Can a daily multivitamin/mineral supplement prevent chronic disease?
• What is the role of prebiotics and probiotics in health?
• What are health effects related to consumption of nuts?
• What are the health effects related to consumption of chocolate?
• How do the health outcomes of a vegetarian diet compare to those of a diet which customarily includes animal products?
• How are non-caloric sweeteners related to energy intake and body weight?
• What amount of water is recommended for health?

Questions are followed immediately by Conclusions, Implications, and Review of the Evidence. All of this is written with great clarity, accompanied by thoughtful comments, and packed with useful information.

Here is just one example (I’ve emphasized the evaluative words):

What is the Relationship between Vegetable Protein and/or Soy Protein and Selected Health Outcomes? Few studies are available, and the limited body of evidence suggests that vegetable protein does not offer special protection against type 2 diabetes, coronary heart disease, and selected cancers. Moderate evidence from both cohort and cross-sectional studies show that intake of  vegetable protein is generally linked to lower blood pressure. Moderate evidence suggests soy protein may have small effects on total and low density lipoprotein cholesterol in adults with normal or elevated blood lipids, although results from systematic reviews are inconsistent. A moderate body of consistent evidence finds no unique benefit of soy protein on body weight. A limited and inconsistent body of evidence shows that soy protein does not provide any unique benefits in blood pressure control.

Readers may disagree with the committee’s research interpretations, but its conclusions deserve serious consideration.

And, if anyone wants to know the state of the available science on any of a large number of questions in nutrition, this report is the place to look first.

Student alert: I will be using this report in classes.

I’ve heard rumors that some members of the Dietary Guidelines Advisory Committee (DGAC) believe that commentators did not give a fair shake to their recently released report (see previous post).

I complained that the DGAC report is difficult to read because its pieces are presented online in a great many individual pdf files that must be downloaded separately.  Fortunately, Cornell student Daniel Green created a single Web-based file.

I have now read the report, or at least browsed through its 699 pages, and I agree that it is better than it first appeared and deserves a revisit (which I am doing in two parts, the second tomorrow).

As with previous Dietary Guidelines, both politics and science underlie this report.  The science components of this report are stunning—as good as such things get—and make this document an invaluable resource.

Why did everyone, including me, miss this?  Politics, of course.  The politics appear unchanged from previous versions (for that, see Food Politics).

The science in this report gives clear guidance for action.  But the report obfuscates its most important messages.

The Executive Summary makes the advice seem dull. The Summary is the part everyone reads first and often the only part anyone reads.  Try this:

The 2010 DGAC report concludes that good health and optimal functionality across the life span are achievable goals but require a lifestyle approach including a total diet that is energy balanced and nutrient dense…SoFAS (added sugars and solid fats) contribute approximately 35 percent of calories to the American diet….Reducing the intake of SoFAS can lead to a badly needed reduction in energy intake and inclusion of more healthful foods into the total diet.

Obesity, it says, is a big problem.  The food environment is a big problem.  What to do about them?  SoFAS.

The report introduces a new euphemism, SoFAS (Solid Fats and Added Sugars).  The meaning of added sugars is obvious.  But what are solid fats?  For that, you must wait until page 183 (on the Daniel Green file):

Solid fats are fats that are solid at room temperature. Solid fats come from many animal foods and can be made from vegetable oils through hydrogenation. Some common solid fats are butter, beef tallow (tallow, suet), chicken fat, pork fat (lard), stick margarine, and shortening. Foods high in solid fats include many cheeses, creams, ice cream, well-marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked goods (such as cookies, crackers, donuts, pastries, and croissants).

Earlier (p. 24), the report listed the principal food sources of SoFAS:

Solid fats (percent of solid fat intake)

• Grain-based desserts, including cakes, cookies, pies, doughnuts, and granola bars (10.9%)
• Regular cheese (7.7%)
• Sausage, franks, bacon, and ribs (7.1%)
• Pizza (5.9%)
• Fried white potatoes, including French fries and hash browns (5.5%)
• Dairy-based desserts, such as ice cream (5.1%)

Added sugars (percent of added sugars intake)

• Soda (36.6%)
• Grain-based desserts (11.7%)
• Fruit drinks (11.5%)
• Dairy-based desserts (6.4%)
• Candy (6.2%)

The report does not say to eat less of these foods; it talks about nutrients.  In various places in the report, the report says [with my comments in brackets]:

• Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium. [Nutrients, not foods].
• Eat less of these: calories from SoFAS, added sugars, solid fats, refined grains, sodium, saturated fat. [Ditto]
• Significantly lower excessive calorie intake from added sugars, solid fats, and some refined grain products. [Ditto]
• Strategies to prevent childhood obesity should include efforts to reduce surplus energy intake, especially energy from foods and beverages that provide empty calories from added sugars and solid fats. [Ditto]
• Intake of caloric beverages, including SSB [sugar-sweetened beverages], sweetened coffee and tea, energy drinks, and other drinks high in calories and low in nutrients should be reduced in consumers needing to lower body weight.  [Only overweight people need to worry about these foods?]

Only once does the report say the clear and simple: “Avoid sugar-sweetened beverages” (p. 65).  Nowhere does it explicitly say to eat less steak, hamburger, French fries, pizza, cookies, or ice cream.

Like previous editions of the Dietary Guidelines, this one talks about foods in the context of eat more (fruits and vegetables).  For eat less advice, it switches to nutrients.  I’d call this obfuscation (and politics).

But the report—for the first time—emphasizes environmental influences on obesity:

The 2010 DGAC recognizes that the current food environment does not adequately facilitate the ability of Americans to follow the evidence-based recommendations outlined in the 2010 DGAC Report. Population growth, availability of fresh water, arable land constraints, climate change, current policies, and business practices are among some of the major challenges that need to be addressed in order to ensure that these recommendations can be implemented nationally.

What business practices?  It doesn’t say.  It does, however, recommend:

• Improve foods sold and served in schools, including school breakfast, lunch, and afterschool meals and competitive foods so that they meet the recommendations of the IOM report on school meals….
• Increase comprehensive health, nutrition, and physical education programs and curricula in US schools and preschools, including food preparation, food safety, cooking, and physical education classes and improved quality of recess….
• Remove sugar-sweetened beverages and high-calorie snacks from schools, recreation facilities, and other places where children gather.
• Develop and enforce responsible zoning policies for the location of fast food restaurants near schools and places where children play….

This is excellent advice.  But how about some suggestions about what individuals might do about it?

The report says little about food marketing.  Beyond “Develop and enforce effective policies regarding marketing of food and beverage products to children…,” the report says virtually nothing about the well documented impact of food marketing on children’s food choices, dietary intake, and health.  Unless I missed it someplace, the research review does not cite the Institute of Medicine’s 2006 landmark report, Food Marketing to Children and Youth: Threat or Opportunity.

It buries the need for policy changes in long wordy lists.  It states the needs for low-income Americans to have access to and afford healthier foods; to produce fruits, vegetables, and grains sustainably; to ensure household food security; to promote sustainable aquaculture; and to encourage the food service industry to serve healthier foods and smaller portions.  It does not—and perhaps cannot—recommend policy changes to achieve these important goals.

Overall, the report contains plenty of material for food, nutrition, and health advocates to work with, but you have to read between the lines to find it.

Recall the process.  This committee’s report is advisory. From 1980 through 2000,  dietary guidelines advisory committees actually wrote the final Dietary Guidelines.   No more.  Since 2005, the sponsoring agencies decide what the Dietary Guidelines will say.

The report is open for public comment until July 8.  If you think the Dietary Guidelines should provide clear, unambiguous advice about how people should eat to avoid obesity and how we can create a healthier food environment, now would be a good time to express your opinion.  Here’s how.

Tomorrow: The reason why this report is an invaluable resource—its science review.