The 2015-2020 Dietary Guidelines for Americans (DGA) have finally been released and I’m sure that most of you could care less what they say. You may think that they can’t be trusted because you believe the original science-based recommendations have been altered by political, food and agribusiness forces. Perhaps you don’t trust science to guide us in food choices. Perhaps, like the skeptical cardiologist, you realize that the DGA has created, in the past, more problems than they have corrected.
This time, the skeptical cardiologist believes they have made a few strides forward, but suffer from an ongoing need to continue to vilify all saturated fats.
As such, the DGA no longer lists a recommended limit on daily cholesterol consumption (step forward) but persists in a recommendation to switch from full fat to non fat or low fat dairy products, which is totally unsubstantiated by science, (see my multiple posts on this topic here).
By now you should have gotten the message that a healthy diet consists of lots of fruits, vegetables, nuts, legumes, fish, olive oil and whole grains. The DGA emphasizes this.
There is general consensus that processed foods and added sugar should be limited.
Most of the controversy is about what to limit and how much to limit foods that are considered unhealthy.
Red meat and processed meat remain in the crosshairs of the DGA (although not stated explicitly), but eggs and cholesterol have gotten a pass, something which represents a significant change for the DGA and which I have strongly advocated (here and here).
But hold on, my professional organization, the American College of Cardiology says otherwise.
Misleading Information From the American College of Cardiology
The American College of Cardiology sent me an email and posted on their website the following horribly misleading title:
The first paragraph of the ACC post reads as follows:
“Physiological and structural functions of the body do not require additional intake of dietary cholesterol according to the 2015 Dietary Guidelines released on Jan. 7 by the U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA). As such, people should practice healthy eating patterns consuming as little dietary cholesterol as possible. – ”
While technically these statements can be found in the document (by digging way down) the executive summary (infographic below) says nothing about limiting cholesterol.
The “Key Recommendations” list eggs as included under a “healthy eating pattern” along with other protein foods.
In addition, there is no mention of cholesterol under what a healthy pattern limits.
In the same section on cholesterol that the ACC inexplicably has chosen to emphasize, is this sentence:
“More research is needed regarding the dose-response relationship between dietary cholesterol and blood cholesterol levels. Adequate evidence is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines.”
So the DGA recommends no specific limit on dietary cholesterol.
This is consistent with what the DG advisory committee recommended when they wrote “dietary cholesterol is no longer a nutrient of concern.”
The DGA goes on to state:
“A few foods, notably egg yolks and some shellfish, are higher in dietary cholesterol but not saturated fats. Eggs and shellfish can be consumed along with a variety of other choices within and across the subgroup recommendations of the protein foods group.”
The Vegan Agenda
I have a theory on why the ACC went so wildly astray in reporting this information: they are led by a vegan.
The current president of the ACC, Kim Williams, is an evangelical vegan, unrepentant, as this NY times article points out. Apparently, he tries to convert all his patients to the “plant-based diet.”
He is quoted extensively in the ACC blurb on the DGA and is clearly attempting to put a bizarre vegan spin on the new guidelines, ignoring the evidence and the progressive shift from the 2010 guidelines.
Can any information from the ACC be trusted if such basic and important science reporting was so heavily distorted by its President?
No wonder Americans tune out dietary advice: it can so easily be manipulated by those with an agenda.
These are pretty simple and strait-forward and sound a lot like Michael Pollan’s dictum to “eat food, mostly plants, not too much.”
She points out that much of the controvery over the (hopefully) soon to be published 2015 (I know, it’s no longer 2015) Dietary Guidelines for Americans are “fueled by lobbyists, politicians and agenda-driven groups” and “make diet advice seem maddeningly inconsistent.”
Despite this, she maintains “the fundamentals haven’t changed much at all.”
Actually, a lot of the “fundamentals” have changed: we don’t worry about dietary cholesterol now, total dietary fat is not of concern, and we know now that replacing saturated fat with carbohydrates is not a good thing.
However, I can endorse her six fundamental recommendations as follows:
“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.
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.
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.
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:
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.
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.”
These six guidelines are a lot easier to digest than the hundreds of pages that will emerge ultimately from the dietary guidelines for Americans later on this year.
Marion Nestle is Paulette Goddard Professor in the Department of Nutrition, Food Studies, and Public Health at New York University, which she chaired from 1988-2003. She is also Professor of Sociology at NYU and Visiting Professor of Nutritional Sciences at Cornell. She holds an honorary degree from Transylvania University in Kentucky. She earned a Ph.D. in molecular biology and an M.P.H. in public health nutrition from the University of California, Berkeley.
These recommendations were not supported by the science at the time, and were hotly debated, but led to dramatic changes in the diet of Americans who were taught that anything with low fat and low cholesterol levels was “heart-healthy.”
Some mistakes in the original guidelines have been corrected over time (yay! Now we can eat egg yolks and avocados), but as late as 2010, major recommendations of the committee were not supported by scientific evidence (as I have pointed out here and here).
There is now a congressional mandate for the Departments of Agriculture and Health and Human Services to convene a committee of experts every 5 years to review the current guidelines and the scientific evidence on nutrition and make new “Dietary guidelines for Americans (DGA).”
This DGA committee (DGAC) issued its draft report earlier this year and it has led to considerable controversy.
A major criticism has been its recommendations to cut down on meat consumption. An editorial in the BMJ by Nina Teicholz suggested that the committee members had not appropriately considered recent evidence suggesting that saturated fat had been exonerated as a cause of obesity or heart disease and that low carb diets may be more beneficial in preventing obesity and diabetes than low fat diets. This editorial suggested that many of the DGAC members were biased toward keeping old dietary recommendations, and demanded an independent review of the recommendations by another scientific committee.
The pushback from various interest groups and some scientists has, in fact, been so intense, that the HHS and Agriculture secretaries were grilled on the science behind many of their recommendations by a House committee last week.
Sustainability of Dietary Recommendations
The most controversial portions of the DGAC recommendations were a sustainability measure that suggested Americans consider the environment when deciding which foods to eat, and a soda tax to promote the reduction of added sugar consumption (my thoughts on soda tax are here).
The Obama administration indicated, during the House interrogations, that neither of these recommendations would be in the final guidelines.
The original DGAC report highlighted the connection between environmental impact and healthy eating, stating: “access to sufficient, nutritious, and safe food is an essential element of food security for the US,” and “a sustainable diet ensures this access for both the current population and future generations.”
In a statement posted Tuesday on the USDA website, Agriculture Secretary Tom Vilsack and Health and Human Services Secretary Sylvia Burwel, announced that the guidelines will not include recommendations about how to choose foods with the lightest impact on the planet. The dietary guidelines, they wrote, are not “the appropriate vehicle for this important policy conversation.”
Whereas the original report thrilled environmentalists, it enraged the beef and livestock industry in the US, and clearly the backlash from this industry influenced the final decision.
This has been portrayed as an example of politics trumping science, but I believe that, currently, all of food policy is being influenced by politics.
It is way beyond my capability to assess the science behind issues of sustainability, but environmentalists believe we can substantially lessen the negative impact of food production on the planet by consuming less meat.
by cutting back on red meat consumption by just a little, we can have an outsized, positive impact on our health and our environment, too. NRDC estimates that if each of us skipped just a single quarter-pound serving of beef a week, then nationwide we’d have pollution-cutting power of converting 4 to 6 million cars into zero-emission vehicles!
For an in-depth discussion of the environmental impact of meat consumption over veggie consumption, check out this excellently referenced article at thinkprogress.org:
Should Sustainability Be A Consideration In National Dietary Guidelines
I have to say that I don’t incorporate issues of sustainability into my own dietary choices. If I want a grass-fed beef burger from Winslow’s Home or a Smoked Beef Brisket plate from Salt and Smoke, I just order it and let the planet be damned.
Even after reading all the arguments of the environmentalists, I’m going to eat a grass-fed sirloin steak once every couple of weeks if the mood strikes me.
I will be making dietary choices based on what is good for me, and I see no need to restrict red meat or dairy consumption. I don’t think the science has proven that this is deleterious to my health.
This is probably selfish. In most other respects I do what I can to help the planet. I even drive a Camry hybrid.
But somehow the concept of me eating one less burger per week, while billions of people in developed countries are ramping up their beef and pork consumption, seems futile.
Consequently, I think it was appropriate for the sustainability issues to be taken out of the DGA report.
Let’s try to tell people what diet is best for their health, and let them make their own moral decisions on how to save the planet or be kind to animals.
It was, after all, writes Pollan, the government that fostered the current system:
“In an effort to combat a spike in food prices, the Nixon Administration abandoned supply controls and used the policy tools at its disposal to boost farm production by subsidizing, and encouraging, the industrialization and consolidation of commodity agriculture. This “productivist paradigm” — heavily dependent on fossil fuel inputs and a small number of crops grown in monoculture — succeeded in producing an abundance of cheap calories. But this was achieved at a price to the health of the population, the environment and rural economy that is no longer sustainable….
these various issues are currently addressed through piecemeal and often contradictory approaches, whereas they are interlocking problems that can best be addressed through a unified and coordinated policy focused on their common denominator: the food system.
A NFP would, as Pollan terms it, “resolarize” the production system:
Develop a roadmap to “re-solarize” the production system. There are many moving parts to this agenda, but this core idea unifies most of them: To the extent that we wean American agriculture from its heavy 20th-century diet of fossil fuel and put it back on one of contemporary sunshine captured through photosynthesis, we can solve several problems at once, including improving the American diet and mitigating climate change. The problem, in a nutshell, is that we grow too much of our food in vast monocultures, which depend on applications of fossil fuel fertilizer, fossil fuel pesticides, and energy-intensive processing and transport. These monocultures produce more calories per farmer, yet they survive only as long as fossil energies are available and cheap, and only because society is willing to let those farmers externalize heavy environmental, health, and socioeconomic costs. They also lead directly to a fast-food diet based on the building blocks of commodity corn (for cheap sweeteners and meat) and commodity soy (for cheap oil and meat). The more diversified a farm production system is, the more it relies on free contemporary sunlight rather than fossil fuels and fertilizers. A more diversified agriculture would at the same time help diversify the American diet and sequester significant amounts of carbon in the soil. Relocalizing the food system contributes to this objective. This will reduce energy consumption and improve food safety and security, while at the same time improving the quality of calories produced, since the less food is processed for national distribution the fresher and more nutritious it is.
This seems like a great approach, and I hope it comes soon.
When the 2015 Dietary Guidelines for Americans (DGA2015) are finally issued they will likely follow the recommendations of the DGA committee. The DGA report (available here) has made giant strides in reversing four decades of bad advice coming from the government and the American Heart Association (AHA.)
Namely, as I discussed in detail here they no longer consider cholesterol a nutrient of concern and recommend lifting any specific limit on dietary cholesterol.
In addition, as a recent article in JAMA suggested they have finally lifted any recommended limit on percent daily intake of fat and we should celebrate and encourage this.
As we have pointed out multiple times, higher fat intake is not associated with heart disease or obesity and it makes no sense, therefore to impose limits on its consumption.
In fact, replacement of fat with carbohydrates is the worst dietary change you can make (with the exception of exchanging butter for industrial processed oils containing trans-fats).
Arguably, thanks to four decades of government and AHA advice to cut fat and cholesterol we have seen the rise of sugar consumption and obesity as food manufacturers have agreeably made products that fulfill requirements for low fat but still taste good.
The new analysis and report from the DGAC 2015 will hopefully reverse this as they seem to have gotten most of the science right.
Non fat or Low-Fat Dairy Still Recommended
However, they have, inexplicably, left in recommendations for non-fat or low fat dairy.
As I have written about here and here there is no scientific evidence that supports the concept that dairy processed to remove dairy fat is healthier than the original unadulterated product.
In fact, evidence suggests full fat dairy reduces central obesity, diabetes and atherosclerosis in general.
It is virtually impossible in most grocery stores to find full fat yogurt or milk. The vast majority of the dairy aisle is devoted to various low or non fat concoctions which have had loads of sugar and chemicals added and are arguably worse than a Snickers bar.
Flawed Reasons for Low Fat Dairy Recommendations
I believe there are three reasons for this failure of the DGA 2015 and nutritional experts to correct the flawed advice to eat non or low-fat dairy over full fat:
1. In few randomized dietary studies showing benefits of a particular diet over another, non fat or low fat dairy was recommended along with a portfolio of other healthy dietary changes.
The overall benefit of the superior diet had nothing to do with lowering the dairy fat but was due to multiple other changes.
2. The dairy industry has no motivation to promote full fat dairy. In fact, they do better financially when they can take the fat out of milk and sell it for other purposes such as butter, cheese, and cream.
3. Saturated fat is still mistakenly being treated as a monolithic nutritional element. Although dairy fat is mostly saturated, the individual saturated fats vary widely in their effects on atherogenic lipids and atherosclerosis. In addition, the nature of the saturated fat changes depending on the diet of the cow.
If the DGA 2015 doesn’t get this issue right we risk another decade of the public consuming high sugar, low fat yogurt in the mistaken belief that they are engaging in healthy behavior.