Currently browsing posts about: Dietary-Guidelines

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

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!

My first San Francisco Chronicle “Food Matters” column for the new year deals with some predictions:

Q: Whatever you used as a crystal ball last year turned out to be a pretty good predictor of the most prominent food issues of 2010. How about trying again: What food matters will we be hearing about in 2011?

A: It doesn’t take a crystal ball to figure out what’s coming up with food issues. I’m happy to make predictions, especially since most seem fairly safe.

Dietary guidelines will be released this month. By law, they were due last year and are already late. What will they say? The 2010 guidelines advisory committee recommended eating more fruits, vegetables and whole grains, but introduced a new euphemism – SOFAs, or Solid Fats and Added Sugars – for the “eat less” advice. SOFAs really mean “cut down on fatty meat and dairy products” and “avoid sugary sodas.”

Will government agencies have the nerve to say so? Let’s hope.

The U.S. Department of Agriculture will issue a new food guide. The 2005 pyramid’s rainbow stripes proved impossible to teach and useless to anyone without a computer. I’ve heard a rumor that I will love the new design. I’m skeptical. I liked the original 1992 pyramid. It showed that bottom-of-the-pyramid foods were healthiest, making it unpopular with companies selling top-of-the-pyramid products. But it is healthier to eat some foods than others (see: dietary guidelines).

Will the USDA improve on the 1992 design? We will soon find out.

The fights over food safety will continue. At the last possible moment, Congress passed the food safety bill by a large majority. Now the fights really begin.

Funding will be most contentious, with the actual regulations not far behind. The Congressional Budget Office absurdly considered the bill’s provisions to be “budget neutral.” They are anything but.

The bill’s provisions require the Food and Drug Administration to hire more inspectors just at a time when Republican lawmakers have sworn to cut domestic spending. The FDA also must translate the bill’s requirements and exemptions for small farmers into regulations.

Rule-making is a lengthy process subject to public comment and, therefore, political maneuvering. Watch the lobbying efforts ratchet up as food producers, large and small, attempt to head off safety rules they think they won’t like.

Expect more lawsuits over the scientific basis of health claims. The Federal Trade Commission just settled a $21 million claim against Dannon for advertising that yogurt protects against the flu. The agency also has gone after scientifically unsubstantiated claims that omega-3s in kiddie supplements promote brain development and that pomegranate juice protects against prostate problems. POM Wonderful has already countersued the FTC on grounds that the First Amendment protects commercial speech. I’ll be watching this case carefully.

The FDA will issue new front-of-package label regulations. The FDA has promised to propose an at-a-glance symbol to indicate the overall nutritional value of food products. Food companies like the Guideline Daily Amount spots they are using in the upper corners of food packages because the symbols are factual but nonjudgmental. The FDA, however, is considering red, yellow and green traffic-light symbols that do convey judgments. Food companies say they will not voluntarily use a symbol that tells people to eat less of their products.

Will the FDA have the courage to make traffic lights mandatory? It will need courage. The new British government dealt with the traffic-light idea by summarily dismantling the food agency that suggested it.

Corporations will seek new ways to co-opt critics. Under the guise of corporate social responsibility, food companies have been making large donations to organizations that might otherwise criticize their products. The most recent example is the decision by Save the Children, formerly a staunch advocate of soda taxes, to drop that cause coincidentally at a time when its executives were negotiating funding from Coca-Cola.

Such strategies remind me of how the Philip Morris cigarette company distributed grants to leading arts groups. Expect food companies to use generosity to neutralize critics and buy silence.

School meals will make front-page news. Congress passed the Healthy, Hunger-Free Kids Act last month. Now the USDA must implement it by setting nutrition standards, adding fresh fruits and vegetables (some locally grown) and expanding eligibility.

President Obama has promised to restore the $4.5 billion “borrowed” from the SNAP (food stamp) program to fund this act. The scrambling over the regulations and financing should make excellent spectator sport.

Farm bill advocates will be mobilizing. You might think it too early to be worrying about the 2012 Farm Bill, but I’ve already gotten position papers analyzing commodity and food-assistance issues from groups gearing up to lobby Congress to bring agricultural policy in line with nutrition and public health policy.

I have a personal interest in such papers. I will be teaching a course on the Farm Bill at New York University next fall. Please get busy and write more of them!

Happy new year, and let’s see how my guesses play out.

After a snow-induced stranding in Miami, the vacation ends, and FoodPolitics.com resumes by catching up on missed events.

Other missed events will follow, but let’s start with USDA’s announcement that it is requiring Nutrition Facts labels on meat and poultry products.

In the Final Rule published on its website, USDA says it will require labeling of fat and calorie content on all industrially packaged intact or ground, single-ingredient, raw meat and poultry by January 1, 2012.  USDA’s rule exempts small producers, however.

Nutrition Facts on meat and poultry have been a long time coming. USDA seriously considered such labels in 1990 when Congress passed the Nutrition Labeling and Education Act.  That act only required Nutrition Facts labels on FDA-regulated foods, which include pretty much everything except USDA-regulated meat and poultry.

By the time the USDA finally got around to proposing its own version in 2001, the agency made labeling voluntary.

You can guess what happened.  Meat and poultry producers happily volunteered not to label their products.

Why not?  Meat producers greatly prefer that you remain ignorant of the amount of fat and calories meat contains.

As is evident from this label example, meat labeling raises issues related to calories, fat, saturated fat, and serving size.

Calories: this particular ground meat contains 21 grams of protein and 11 grams of fat.  These provide 190 calories, per serving.

Fat: Fat is the major determinant of calories (9 per gram as compared to 4 per gram for protein). That is why more than 50% of the calories in this ground beef come from fat.

Saturated fat: The 4.5 grams of saturated fat in this meat account for 22% of the Daily Value, a lot or a little depending on what else you eat.

Serving size: The serving size is a quite reasonable 4 ounces (like a quarter-pounder).  It represents, however, a substantial increase over previous USDA serving size suggestions.  Since 1958, the USDA has considered a meat serving to include just 2-to-3 ounces.

As I discuss in Food Politics, pressures from meat producers over the years induced government agencies to steadily increase the amount of meat (or meat substitutes) recommended for daily intake.

• 1958 to 1989 (USDA food guides): two daily servings of 2-3 ounces for a total of 4-to-6 ounces
• 1990 (Dietary Guidelines): two daily servings of 2-3 ounces for a total of 6 ounces
• 1992 (Food Guide Pyramid): two-to-three daily servings for a total of 5-to-7 ounces
• 1995-2005 (Dietary Guidelines): two-to-three daily servings for a total of 4-to-9 ounces

If advice to consume two-to-three daily servings of meat (or meat substitutes) still holds, the recommendation will now be 8-to-12 ounces.

The 2010 edition of the Dietary Guidelines is overdue and should be released any day now.   In its report last June, the Dietary Guidelines Advisory Committee said:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

What will the new guidelines say about the amount of meat we should all be eating?  I can’t wait to find out.

Happy new year to all!

Addition, 1-1-11: I forgot to cite the USA Today story on this (I’m quoted).

This month’s San Francisco Chronicle column evolved in answer to a question from a former colleague at the UCSF School of Medicine.

Q: What do you think doctors should be telling patients about how best to care for themselves and their families, nutritionally?

A: I had my chance when, long ago, I ran a nutrition education program for medical and other health professions students and practitioners at UCSF.

Then, as now, it was obvious that just about every patient who landed in the hospital needed nutrition intervention. Practically everyone who visited the outpatient clinic either wanted or needed nutrition advice.

Then, as now, few doctors were taught anything about nutrition, let alone the details of what they needed to know to help patients address dietary concerns.

In today’s health care environment, even doctors with advanced nutrition training do not have time to use it. Blame this on how our health care system systematically rewards doctors for treatment of disease, not its prevention.

What doctors need to tell patients about nutrition depends on who the patients are. If people are sick, doctors need to talk to them about how dietary changes and improvements will help them recover and prevent further illness.

But I’m guessing that your question refers to healthy patients who want to stay that way. With these people, what doctors do and say can have profound effects. Doctors are authority figures and their advice is taken seriously.

As a standard part of patient care, doctors routinely ask about drugs, cigarettes and alcohol. Even if they only have a minute, adding one more question about diet can do much good. If nothing else, it conveys that diet matters to health.

Given the reality of time constraints, my wish list for what to do next is necessarily short.

Tell patients that healthy eating simply means three things: variety, minimal processing and moderation.

Variety means choosing many different kinds of foods from the various food groups: meat, dairy, fruits, vegetables, grains. It counts because foods vary in nutrient content. Varying foods within and among food groups takes care of needs for nutrients without having to think about them. People who consume adequate amounts of varied diets rarely exhibit nutrient deficiencies. It’s the most restrictive diets that are likely to be deficient in one or another nutrient.

Minimal processing means that the foods should be as close as possible to how they came from the animal or plant. The greater the level of processing, the less the foods resemble their origins, the less nutritious they may be, and the more salt, sugar and calories get added to disguise the changes.

Minimal processing excludes foods high in salt and sugars and low in fiber, as well as sugary sodas and juice drinks, those popularly known as junk foods.

My definition of minimal processing is only slightly facetious: Don’t eat anything with more than five ingredients or an ingredient you can’t pronounce.

Moderation is about balancing calorie intake with expenditure and maintaining a healthy weight through food choices and physical activity.

These are general principles. Beyond them, nutrition advice must be personalized to the particular individual or family. To do that quickly:

• Ask patients what they and their children eat. You can start with a waiting-room questionnaire that probes typical intake of foods and supplements.
• Screen the responses for variety, minimal processing, moderation and excessive or unusual supplement use. Note whether body weights are within healthy ranges.
• Reassure patients whose diets are varied, minimally balanced and moderate that they are doing wonderful things for their health and should keep doing what they are doing.
• Refer observations that need further discussion to a nutritionist.

Doctors: You don’t have to do it all. Making it clear that diet matters is often enough to encourage patients to make better dietary choices. Use the services of a nutritionist. Nutritionists are professionally trained to answer patients’ questions about diet and health and to counsel them on dietary interventions.

Patients (meaning everybody): Tell your doctors that you want their advice about diet and health and expect them to know something about it.

How can food producers become more sustainable? Use less meat in their products.

Rita Jane Gabbett writes today on Meatingplace.com, a meat industry site, about a talk given by Cheryl Baldwin of Green Seal at a recent meeting of the Institute for Food Technologists.

She told Meatingplace that meat producers should better understand “the production methods used to feed and raise animals, making sure they are treated humanely and looking for ways to reduce the carbon footprint of processing methods.” She also said that “grass-fed animals created a lower carbon footprint than those that were grain fed.”

One can only imagine the reaction of meat producers to her comments.

Meatingplace noted:

Earlier this year, however, a study by the University of New South Wales published in the journal Environmental Science and Technology indicated beef produced in feedlots had a slightly smaller carbon footprint than meat raised exclusively on pastures. (See Feedlot beef could be “greener” than grass-fed: study on Meatingplace, Feb. 8, 2010.)

More recently, Washington State University scientists concluded that improvements in U.S. beef industry productivity have reduced the environmental impact of beef production over the past decade. (See Better beef industry practices have reduced carbon footprint on Meatingplace July 15, 2010.

This follows soon after the Dietary Guidelines Advisory Committee report’s advice to:

Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

To the meat industry, advice about health and sustainability must come as a serious challenge. Keep an eye on the “eat less meat” theme. My guess is that we will be hearing a lot more about it.