Digesting the new dietary guidelines
Posted April 15, 2016
If “what’s for dinner?” is the most common question in your home, the U.S. government thinks it has the answer.
After more than two years of study and debate, federal officials have released new dietary guidelines, the underpinning of its controversial food pyramid (now morphed into a food plate) and the driver of what’s served for breakfast and lunch in school and the military.
They contain many clichéd and predictable directives, including a plea for Americans to consume fewer pastries and cookies, more fruits and vegetables. But boiling behind the seemingly benign report is a crockpot of controversy, stirred by accusations that the government ignores evidence of the nutritional dangers in order to bolster U.S. agricultural interests.
Behind that lurks an even larger question: Why does the government tell us what to eat anyway? Or, for that matter, why should anyone?
As prolific food writer Michael Pollan asked in his 2008 book “In Defense of Food,” “What other animal needs professional help in deciding what it should eat?”
The guidelines released in early January were the eighth since 1980. All have drawn criticism, but this year's response was particularly harsh, with one Yale professor calling them a “national embarrassment” and others accusing the government of ignoring the recommendations of a respected advisory committee to placate the meat and dairy industries, and processed-food manufacturers.
“The only real win for public health was the recommendation that sugar consumption be limited to 10 percent of calories,” said Michele Simon, a public-health lawyer and author of “Appetite for Profit.”
While the intended audience is comprised of policymakers and nutrition and health professionals, the guidelines have the potential to impact the overall health of the nation – and therefore, its families – because they influence everything from school lunches to what food-stamp recipients can buy with their benefits, from meals served to senior citizens to those serving in the Armed Forces.
Their impact is less pronounced, however, on the meals individuals and families consume at home — which, the guidelines note, is 67 percent of what Americans eat.
“It’s true that the dietary guidelines have relatively little impact in the day-to-day of how people eat," Simon said. “But my measure of how much these things matter is how much the food industry fights against them. If they didn’t matter, we wouldn’t see the kind of outcry that we did.”
And the epidemiologist who chaired the advisory committee said individuals and families can learn from the guidelines, as well. All Americans, Barbara Millen said, should know how many calories they need each day, relative to their age, gender and activity level, and what risks are associated with their current diet.
Then they should choose the best healthy eating pattern and begin to incorporate it, with the goal of incorporating its principles for life. The guidelines contain charts and tables that families can print and put on their tables to help them as they make changes, Millen said.
What they say
The guidelines, issued in January, begin by chiding Americans for eating much and exercising too little over the past two decades, resulting in a population in which two-thirds of adults (and one-third of children) are overweight or obese.
“About half of all American adults — 117 million individuals — have one or more preventable diseases chronic diseases, many of which are related to poor quality eating patterns and physical inactivity,” the report says.
Slightly more than half of Americans have diets aligned with previous dietary guidelines, the report says, and only 20 percent meet the guidelines for physical activity.
Our poor diets, the report says, are the result of eating too little of what’s good for us and too much of everything else. Three-quarters of Americans don’t eat enough vegetables, fruits, dairy products and healthy oils, while half of us meet or exceed the recommended intake of protein and grain — though too often, the wrong types of meat and grains.
And nearly all of us eat too much sugar, sodium and saturated fats, the report says, recommending that Americans cut sodium consumption from 3400 to 2300 milligrams (about a teaspoon a day) and limit sugar consumption to 10 percent of all calories (as opposed to the 13 percent it is now), which for an adult on a 2,000-calorie diet, amounts to about 12 teaspoons per day.
Despite this gloomy assessment, the government does not recommend radical and sweeping changes on the dinner table, but urges Americans to make incremental changes, “small shifts in good choices,” with the goal of developing a healthy eating pattern to last a lifetime. And instead of pointing down one path, the guidelines offer three styles of healthy eating patterns from which to choose: vegetarian, Mediterranean and “healthy U.S.”
While all are heavy with fruits and vegetables, the Mediterranean pattern contains more fruits and seafood and fewer dairy products than the U.S. plan; and the vegetarian pattern suggests more soy, legumes, nuts, seeds and whole grains to make up for the loss of meat. The "healthy U.S." plan is the standard American diet, largely shorn of processed foods and excessive salt and sugar. It suggests, among other things, that half of all grain products be whole-grain, that dairy products be low-fat or fat-free, and that nuts and seeds be unsalted and meat be the leanest cuts available.
In addition to urging Americans to trade sweets and salty snacks for nutrient-dense foods, the guidelines advocate a more diversified menu. They note that when Americans eat vegetables, they’re most likely to be eating potatoes and tomatoes, which account for 21 and 18 percent of all vegetable consumption, respectively. (Lettuce and onions are only other vegetables consumed in notable quantities.)
A variety of vegetables is important because they offer widely different nutrients. "For example, dark-green vegetables provide the most vitamin K, red and orange vegetables the most vitamin A, legumes the most dietary fiber, and starchy vegetables the most potassium," the report says.
Similarly, two types of dairy — milk and cheese — comprise the bulk of dairy consumed in the U.S. currently, at 51 percent and 45 percent, respectively. Only 2.6 percent of dairy is yogurt, and 1.5 percent soymilk. The guidelines advocate more consumption of fat-free or low-fat milk and yogurt.
And, reversing previous warnings, the guidelines say eggs are okay again since Americans largely have their cholesterol in check.
Critics weigh in
Given a cursory glance, the report seems benign, even boring. As Michael Pollan wrote in "In Defense of Food," "Who wants to hear, yet again, that you should 'eat more fruits and vegetables'?"
Yet it has ignited a firestorm among various advocacy groups and commentators, both for what it includes and what it leaves out.
Much of the criticism concerns the differences between the February 2015 report of the advisory committee and the final product. The advisory committee, comprised of 14 highly regarded doctors, scientists and health-care professionals, considered more than 4,000 scientific studies in making its recommendations. The official guidelines are a hybrid product of that report, a congressional hearing, the U.S.Department of Agriculture and the Health and Human Services Department, and, some say, lobbyists for the meat and dairy industries.
They should have been called "Guidelines to Balance Public Health and Corporate Profit," groused Dr. David Katz of Yale University, who started an online petition to change the name because "our government should not be in the business of false advertising." Katz believes the report of the advisory committee was excellent, but it was watered down to make it more palatable to the nation's farmers.
For example, the advisory committee wanted strong language telling Americans to eat less red and processed meat. While the final report said men and teenaged boys should consume less protein, it did not urge a decrease in meat eating overall, saying blandly that "some" healthy diets contain less red meat.
"There is a disgraceful shoehorning in of advice to keep consuming 'all food groups,' clearly a bow to the industry and effective lobbying," Katz told TIME magazine.
Equally unhappy is Dr. Walter Willett, chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health in Boston, who said the guidelines “seriously distort” the conclusions of the advisory committee.
“Most importantly, after an in-depth review of the scientific evidence, the committee concluded that red-meat consumption should be limited for both human health and planetary health. The final guidelines completely discarded this and actually promoted consumption of lean red meat,” Willett said.
Willett also noted that the advisory committee specifically urged the reduction of soda and other sweet beverages, while the guideline only address a reduction in “added sugars” across the board. The guidelines do note that sweetened beverages account for 47 percent of sugar intake. But they should have said forcefully that Americans should drink fewer soft drinks, Willett said.
“Of course, the influence of the beef and soda industries is crystal clear, and Americans pay the price in terms of increased premature death and morbidity because these guidelines serve as the base for federal policies and food programs, not just recommendations," he said.
The United States is the world’s largest producer of beef, and its cattlemen are well represented in Washington, with three major advocacy groups. Their influence often results in vague language in nutrition policy statements, as happened in 1977, when the Senate was considering a proposal to recommend that Americans eat less meat and eggs.
As reported by Quartz, one industry representative, in an exchange with Kansas Sen. Bob Dole, said, “Decrease is a bad word, Senator.”
The official recommendation later urged to urge Americans to eat less “animal fat”, not meat.
Most often, the language is changed from a negative to a positive, according to Marion Nestle, a prolific author and critic of American food policy, who notes that guidelines never say "eat less" but instead say "eat two or three servings a day."
According to the watchdog website Opensecrets.org, in 2015, the meat processing industry, including the American Meat Institute and Agri Beef, spent $4.5 million on lobbyists.
For its part, the meat industry, which grumbled after the release of the advisory committee's report last year, was satisfied with the final product.
"The Dietary Guidelines confirm that a variety of dietary patterns can be followed to achieve a healthy eating pattern. Consumers who choose to eat meat and poultry, as 95 percent of Americans do, can continue to enjoy our products as they have in the past," Barry Carpenter, president and CEO of the North American Meat Institute said in a statement.
Dairy producers were equally pleased. A celebratory statement by four dairy groups said the report "affirms the vital, unrivaled contribution made by dairy foods, and reminds Americans that they will continue to benefit from three daily servings of low-fat and fat-free dairy." Americans should consume more dairy products, the statement said, because their government says they should.
'Half the way there'
Then there are those who question why the government is involved in food in any way, from agricultural subsidies to labeling laws to dietary advice.
Daren Bakst, a research fellow in agricultural policy at The Heritage Foundation, says the most common explanation for government’s involvement in nutrition — inadequate information — is bogus.
“In reality, the public already has plenty of information. Restaurants and other businesses respond to consumer demand for nutritional information. Entire industries are built around the public’s demand for dieting and healthy living, from diet sodas to weight-loss programs. The public is inundated with marketing messages regarding health and well-being. When people do not buy the ‘right’ foods, this is not evidence of inadequate information; it is evidence of choices based on complex personal preferences,” Bakst wrote in a policy brief called "Government Control of Your Diet.”
Willett and other critics of the guidelines believe the USDA should not be involved in the guidelines since it also is charged with promoting American agriculture. Among its objectives, detailed in its 2014-2018 Strategic Plan, is to "increase agricultural opportunities by ensuring a robust safety net, creating new markets, and supporting a competitive agricultural system."
Given this, The National Institutes of Health would be a better choice to suggest food choices, some say.
“At a minimum,” Willett said, “members of the advisory committee should be involved in the drafting of the dietary guidelines to minimize corruption of the evidence.”
Barbara Millen, the nutrition epidemiologist who chaired the advisory committee, said that while she was disappointed the final guidelines did not include her panel's position that Americans' health and sustainable agriculture practices are entwined, "by and large, they did a very good job."
“I’m trying to focus on the upside,” she said. “I really like the options given to the American public. I like the language of gradual shifts in dietary behavior. I like the fact that we all have a role in this,” she said.
“The dietary guidelines talk about how, on average, the American diet doesn’t hit the mark about half of the time. That can be a very positive message. I like to think that Americans are half the way there.
“Look at the foods that are being recommended, and look for your favorites. Then add them, and build from there,” she said. “When people understand they don’t have to give up everything they love, they are happier and will be much more successful,” she said.
A spokeswoman for the Department of Health and Human Services noted that the guidelines address only nutrition for adults and children above the age of 2, but that will change within the next decade. The government has become a study of scientific evidence about the best nutrition from birth to 24 months, and for pregnant women, Angie Colson said. "By 2020, the Dietary Guidelines will expand to include additional guidance for these populations," she said.
In the home
While the guidelines are not written specifically for the benefit of families, some mothers do pay attention, like Molly Aubuchon, who lives in Kent, Ohio, and has two children, ages 11 and 13.
Auchubon, 39, is a vegan who was raised as a vegetarian and was “teased and tormented on a daily basis, as were my siblings.”
Although Auchubon believe the dairy and meat industries have too much influence on the guidelines, she believes the guidelines are important and appreciates that they offer a vegetarian option.
“I do pay attention to the guidelines. I know school meals are based off them, and that’s extremely important to me,” she said
As vegans, Auchubon and her children do not eat any animal products, including dairy. (Her husband does, but not in the home.)
The government's promotion of dairy products is another example of the politics behind the process, Simon said. “Dairy is not essential in a diet and can be detrimental for a lot of reasons.”
“My biggest problem with it is that, similar to meat, it displaces the foods we actually need, the plant-based foods with fiber and phytochemicals.
“The most important thing people can do, honestly, is to eat more fruits and vegetables — not pile lettuce on a cheeseburger, but replace the cheeseburger with beans and lentils and so forth," she said.
In other words, follow the Michael Pollan mantra, the creation of which didn't take a government committee, “Eat food. Not Too Much. Mostly Plants"?
Be careful with that, Harvard's Dr. Willett said.
"Pollan’s advice is mostly right, but insufficient; the USDA could interpret this to load up on potatoes."