Currently browsing posts about: Dietary-Guidelines

Thanks to my colleague Lisa Young for taking this photo at the Magnolia Bakery in Manhattan.

You may recall that one result of the fuss over the highly controversial BMJ article attacking the Dietary Guidelines process was appointment of a committee to review that process.

It has just published the first of its reports, which deals only with the first of the four charges to the committee, which were to determine:

1. How the selection process for the Dietary Guidelines Advisory Committee (DGAC) can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints;
2. How the Nutrition Evidence Library (NEL) is compiled and used, including whether the NEL reviews and other systematic reviews and data analysis are conducted according to rigorous and objective scientific standards;
3. How systematic reviews are conducted on long-standing DGAC recommendations, including whether scientific studies are included from scientists with a range of viewpoints; and
4. How the DGA can better prevent chronic disease, ensure nutritional sufficiency for all Americans, and accommodate a range of individual factors, including age, gender, and metabolic health.

The committee identified values governing the committee selection process:

• Enhance transparency
• Promote diversity of expertise and experience
• Support a deliberative process
• Manage biases and conflicts of interest
• Adopt state-of-the-art processes and methods

Its recommendations:

• Employ an external third party to review the candidate pool for committee members.
• Make the list of provisional appointees open for public comment.
• Publicly disclose nominees’ biases and conflicts of interest; develop a plan for managing them; have them reviewed by a federal ethics officer; document all this in the advisory committee’s report.
• Adopt a system for continuous process improvement in the selection process.

Good recommendations and good luck with them.

I can hardly wait to see this committee’s report on the remaining charges.

In the meantime, it’s about time to start appointing the 2020 Dietary Guidelines Advisory Committee, no?

I’ve just heard about the new Netherlands food guide.  It emphasizes sustainability.  According to an article in National Geographic’s The Plate,

The Netherlands Nutrition Centre says  it is recommending people eat just two servings of meat a week, setting an explicit limit on meat consumption for the first time [but see added comment below].

Here’s what the Netherlands food guide looks like.

Google translator calls this a pyramid, and explains: “Moreover, the Pyramid helps you eat more environmentally friendly broadly.”

Ours, of course, looks like this.  I’m guessing the USDA is working on a new food guide in response to the 2015 Dietary Guidelines.  These do not mention sustainability at all—the S word.

If you want to check out food guides m other countries, see FAO’s pages on food-based dietary guidelines.  You can search the site by regions and countries.  Fun!

Added comment: A reader from Amsterdam, who obviously speaks Dutch better than Google translator, and who also is well versed in the Dutch nutrition scene, writes:

Sustainability is indeed an important concern in the new Dutch food guide. However, the recommendation for meat is not ‘two servings per week’, but two servings of red meat and two servings of white meat (chicken), for a total of four per week. One serving is 100 gram or 3.5 oz. of meat. Diehards may add a third serving of red meat; 300 g of red meat (11 oz) plus 200 g of chicken (7 oz) per week is considered the absolute limit.

The fish advice has been reduced from twice to once a week because environmental concerns were thought to outweigh the small health benefit of a second weekly serving of fish.

You might think that eating is one of those things that comes naturally, but for the next three weeks I’m going to be posting books telling us how.  Here’s the first:

Bee Wilson.  First Bite: How We Learn to Eat. Basic Books, 2015.

Bee Wilson speaks from experience.  She once was a picky eater bordering on having an eating disorder.  Simply eating when hungry and stopping when full is a challenge for many of us.  Wilson explores how food preferences are acquired or made and how culture and environment turn biological needs into obesity-promoting hazards.  Her advice boils down to aphorisms, for example:

• No one is too busy to cook.
• Eat soup.
• Rethink what counts as a main course.
• Regular exercise definitely helps.
• If you want your children to eat better, don’t tell them what to do: eat better yourself.

I’m indebted to Maria Godoy of NPR’s The Salt for pointing out where in the new 2015 Dietary Guidelines you can find advice about cutting down on sugary drinks.  As she puts it, this is easy to miss.

Here’s my wonky analysis.

In my post about the 2015 Dietary Guidelines, I noted that they are unambiguous about the need to reduce added sugars to 10% or less of calories.  But what they say about cutting down on sugary drinks—the leading source of sugars in US diets—is buried deep in the text.  Fortunately, Deborah Noble of slowfoodfast.com has performed a great public service by producing the 2015 Dietary Guidelines in a searchable pdf format.Here’s where to find advice about cutting down on sugary drinks:

The Executive Summary: See under “Cross-Cutting Topics of Public Health Importance:”

Similarly, added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options, such as water in place of sugar-sweetened beverages.

Figure 2-10 explains:

The major source of added sugars in typical U.S. diets is beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters.

Reading the Figure tells you that beverages comprise a whopping 47% of added sugars (closer to half if you add in sweetened milks, teas, and coffees).  The text following the Figure says:

Shift to reduce added sugars consumption to less than 10 percent of calories per day: Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars.

Strategies?  How about just saying: “Cut down on sugary drinks” or “Drink water instead of sugary drinks.”

Figure ES-1 in the Executive Summary illustrates the 2015-2020 Dietary Guidelines for Americans at a Glance.  All it says is:

Limit calories from added sugars…Consume an eating pattern low in added sugars…Cut back on food and beverages higher in these components to amounts that fit within healthy eating patterns.

Figure 3.2 shows Implementation of the Guidelines through MyPlate: “Drink and eat less…added sugars,” but nothing about sugary drinks.

This circumspection is weird.  Clear, straightforward advice to cut down on sugary beverages has plenty of historical precedent.

Both Figures ES-1 and 3.2 are most certainly derived from a USDA graphic on the MyPlate website (dated January 2016).  This says flat out:

Drink water instead of sugary drinks.

This statement, in turn, derives from:

• The precepts issued with the 2010 Dietary Guidelines in January 2011
• The statements issued with the MyPlate graphic in June 2011

• The USDA’s May 2012 tip for making better beverage choices.

The 2015 DGAC (Dietary Guidelines Advisory Committee) repeatedly urged limits on consumption of sugar-sweetened beverages.  Statements like this one, for example, appear throughout the document:

To decrease dietary intake from added sugars, the U.S. population should reduce consumption of sugar-sweetened beverages.

Why did the USDA and HHS writing committee choose to waffle about his point?

This cannot be an accident.  It must be deliberate.  And it can have only one explanation: politics.

The 2015 Dietary Guidelines are out.

They are now online in a version that takes up dozens of screens with annoying drop-down boxes.  It’s hard to navigate, and if it’s searchable, I can’t figure out how (OK, it’s searchable but doesn’t work all that well).

First the good news.  These Dietary Guidelines—for the first time—attempt to focus on foods and dietary patterns:

Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. However, people do not eat food groups and nutrients in isolation but rather in combination, and the totality of the diet forms an overall eating pattern.

They almost succeed in this mission.  The Guidelines say:

• Follow a healthy eating pattern across the lifespan [Pattern].
• Focus on variety, nutrient density, and amount [Pattern].
• Limit calories from added sugars and saturated fats and reduce sodium intake [Oops: Nutrients].
• Shift to healthier food and beverage choices [Pattern].
• Support healthy eating patterns for all [Pattern].

A healthy eating pattern, they say:

• Includes foods from various groups [Pattern].
• Limits saturated fats, trans fats, added sugars, and sodium [Oops: Nutrients].

As for (Oops) Nutrients:

• Less than 10% of calories from added sugars [this is new, but consistent with many other reports such as the one from WHO]
• Less than 10% of calories from saturated fats [in the Guidelines since 1990]
• Less than 2,300 mg sodium [no change from 2010]

Why Oops?  Because these Dietary Guidelines, like all previous versions, recommend foods when they suggest “eat more.”   But they switch to nutrients whenever they suggest “eat less.”

In the 2015 Dietary Guidelines,

• Saturated fat is a euphemism for meat.
• Added sugars is a euphemism for sodas and other sugar-sweetened beverages.
• Sodium is a euphemism for processed foods and junk foods.

If the Guidelines really focused on dietary patterns, they wouldn’t pussyfoot.  They would come right out and say:

• Eat less meat [OK, they do but only under the euphemism of “protein” and only for males. “Some individuals, especially teen boys and adult men, also need to reduce overall intake of protein foods (see Figure 2-3) by decreasing intakes of meats, poultry, and eggs and increasing amounts of vegetables or other underconsumed food groups.”  But what about processed meats?  Not a word that I can find.
• Cut down on sugary drinks [OK, it says “drink water instead of sugary drinks,” but good luck finding that statement without knowing where it is].
• Eat less processed and junk food.

Why don’t they?  Politics, of course.

Recall that Congress weighed in with an Appropriations Bill that called for an investigation of the scientific basis of the Guidelines and granted $1 million to the National Academy of Medicine to take them over.

Recall also that the secretaries of USDA and HHS said that the Guidelines would not say anything about sustainability as a rationale for advising eating less meat.

So let’s count the 2015 Guidelines as a win for the meat, sugary drink, processed, and junk food industries.

Other concerns, nutritional and otherwise:

• Calories: The Guidelines deemphasize calories.  They dropped the information about food sources of calories from the 2010 edition, even though calorie balance remains a—if not the—major public health nutrition problem (an Appendix gives calorie needs).
• Portion sizes: the best way to control calorie intake is by eating smaller or moderate portions. If the Guidelines talk about portion size, it must be well hidden.
• Cholesterol: the recommendation to limit cholesterol has been dropped, but the document says, confusingly, that “this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”  Could the dropping of the limit have anything to do with egg-industry funding of research on eggs, the largest source of dietary cholesterol, and blood cholesterol?  The Physicians Committee for Responsible Medicine has just filed a lawsuit on that very point.
• Protein: My pet peeve.  The Guidelines use this as yet another euphemism for meat.  “Protein” lumps meat together with seafood, poultry, eggs, nuts, seeds, and soy.  But grains and dairy also have protein, so using this term makes no nutritional sense and obfuscates the message to eat less meat.
• Seafood: the document recommends 8 ounces a week of seafood high in omega-3s but low in methylmercury. That pretty much means salmon and sardines (anchovies are too salty).

I might have more to say when I can look at a document that is easier to read.

Full disclosure: I was a peer reviewer on an earlier version of this document.

Documents and commentary

• The HHS press release and the government’s digital press kit
• The Dietary Guidelines Advisory Committee Report
• USDA’s MyWins food guide
• Dietary Guidelines version of MyWins
• My Rogue Dietary Guidelines (with Tamar Haspel)
• CSPI’s press release and materials
• CSPI’s summary of the Guidelines’ major points
• The New York Times take (I’m quoted)
• Politico’s take (I’m quoted)
• Friends of the Earth (with a good summary of public input)
• Julia Belluz in Vox (comparison to Swedish guidelines)
• The official HHS version in JAMA Cardiology
• The Sugar Association’s predictable complaints
• The American Cancer Society’s complaints (no clear guidance on red and processed meats)
• The Distilled Spirits Council’s statement
• Time Magazine’s collection of reactions (including mine)
• The Washington Post on the confusion (I’m quoted)
• Food-Navigator’s take: a marketing opportunity
• The American Beverage Association’s reaction

While we are endlessly waiting for the release of the 2015 Dietary Guidelines, Tamar Haspel and I thought we would jump the gun and write up for the Washington Post what we think most makes sense: How to eat more healthfully, in 6 easy steps.

Here are our Rogue Dietary Guidelines:

Go through the fine print of the omnibus spending bill just passed by Congress, and you’ll see that the 2015 Dietary Guidelines, scheduled for release in — you guessed it — 2015, have been pushed out to 2016. You wouldn’t think that the government’s efforts, every five years, to help Americans eat more healthfully would turn into a political football. But when its appointed scientists reviewed the literature on meat and health, for example, they did something quite radical. They said what they meant with no equivocations: Americans should eat less meat.

As if that were not radical enough — previous committees had pussyfooted with such euphemisms as “choose lean meats to reduce saturated fat” — this committee insisted on an additional reason beyond health: environmental considerations.

The result? Uproar.

Arguments like the ones over the Dietary Guidelines, fueled by lobbyists, politicians and agenda-driven groups, make diet advice seem maddeningly inconsistent, but the fundamentals haven’t changed much at all.

It’s time to take back the process, so we’re going rogue and issuing our own Dietary Guidelines, untainted by industry lobbying, unrestricted by partisan politics. Here, in six easy steps, is our advice for the new year: what we think dietary guidelines ought to say.

1. Eat more plants. You heard it from your grandmother. You heard it from Michael Pollan. Now you hear it from us: Eat your vegetables. Add fruits, beans and whole grains, and the wide-ranging plant category should make up most of your diet. Variety is the key. Plants offer us such an astonishing range of roots, stems, leaves, flowers, buds and seeds that there is bound to be something even the most jaded vegetable skeptic can love.
   Vegetables, fruits, beans and whole grains: Plants should make up most of our diet. (J. Scott Applewhite/Associated Press)
2. Don’t eat more calories than you need. Although on any given day it’s hard to tell whether you’re doing that, over the long term, your scale is a sure-fire indicator. If the pounds are going up, eat less.

Let’s pause here for the good news. If you follow our first two guidelines, you can stop worrying. Everything else is fine-tuning, and you have plenty of leeway.

3. Eat less junk. “And what’s junk?” we hear you asking. We have faith that you know exactly what junk is. It’s foods with lots of calories, plenty of sugar and salt, and not nearly enough nutritional value. It’s soda and sugary drinks. It’s highly processed, packaged foods designed to be irresistible. It’s fast food. You know it when you see it. When you do, don’t eat too much of it.
4. Eat a variety of foods you enjoy. There is research on the health implications of just about any food you can think of. Some — such as fish — may be good for you. You should eat others — such as meat and refined grains — in smaller amounts. The evidence for most foods is so inconsistent that you should never force yourself to eat them if you don’t want to, or deny yourself if you do. If you love junk foods, you get to eat them, too (in moderation, of course). You have bought yourself that wiggle room by making sure the bulk of your diet is plants and by not eating more than you need.

This is an appropriate place to talk about a phrase that has been thrown around a lot in the Dietary Guidelines brouhaha: “science-based.”

As a journalist (Tamar) and a scientist (Marion), we’re very much in favor of science. But in this situation, the food industry’s frequent calls for “science-based” guidelines really mean, “We don’t like what you said.”

Arriving at truths about human nutrition isn’t easy. We can’t keep research subjects captive and feed them controlled diets for the decades it takes many health problems to play out. Nor can we feed them something until it kills them. We have to rely on animal research, short-term trials and population data, all of which have serious limitations and require interpretation — and intelligent people can come to quite different opinions about what those studies mean.

Which is why “eat some if you like it” isn’t a wishy-washy cop-out. It acknowledges science’s limitations. We do know that plants are good, and we do know that junk foods aren’t, but in between is an awful lot of uncertainty. So, eat more plants, eat less junk, and eat that in-between stuff moderately. That is exactly the advice science demands.

What we eat and how we eat go hand in hand. We’ve all been there, sitting in front of a screen and finding that, all of a sudden, that bag, box or sleeve of something crunchy and tasty is all gone. We’re so focused on what to eat that how to eat gets short shrift. So:

5. Find the joy in food. Eat mindfully and convivially. One of life’s great gifts is the need to eat, so don’t squander it with mindless, joyless consumption. Try to find pleasure in every meal, and share it with friends, relatives, even strangers.

6. Learn to cook. The better you cook, the better you eat. There are days when cooking feels like a chore, but there are also days when you find profound satisfaction in feeding wholesome homemade food to people you love. And foods you make at home are worlds apart from foods that manufacturers make in factories. No home kitchen ever turned out a Lunchable.

If you go out in the world armed only with these guidelines, you’ll do great. Sure, there’s much more to know, if you want to know it. We’ve forged careers writing about food and nutrition, and either one of us could talk micronutrients until your eyes glaze over. But these few basics are all you need to make good food decisions. Choose foods you like, cook them and enjoy them.

It really is that simple.

Haspel is the James Beard award-winning writer of Unearthed, a Washington Post column devoted to finding out what’s actually true about food.

Nestle is professor of nutrition, food studies and public health at New York University and is the author, most recently, of “Soda Politics: Taking on Big Soda (and Winning).”

Jason Huffman, Helena Bottemiller Evich, and Jenny Hopkinson of Politico Pro Agriculture have published their end-of-year assessment of game-changing events in food and agriculture policy last year.  Here’s their list:

• Avian flu blew up the U.S. egg industry.
• The Trans-Pacific Partnership deal got done.
• The battle over the Dietary Guidelines turned even nastier.
• The FDA banned most uses of trans fat.
• The FDA said a genetically engineered fish is safe to eat.
• The EPA released its final Waters of the U.S. rule, inciting the wrath of multiple industries, states and lawmakers.
• A federal judge sent peanut company executives to jail for decades for their part in a giant salmonella outbreak.
• The FDA released major rules to promote the safety of produce and imports.
• The FDA doubled down on added sugars on food labels, proposing daily values for the listings.

I’ve discussed most of these on this site (all except Waters of the US).

I can’t wait to see what this year brings—more of the same, for sure, but what else?  Stay tuned.