The 2015 Dietary Advisory Committee Report: A Summary

Last week, the Dietary Guidelines Advisory Committee released the report containing its recommendations for the 2015 Dietary Guidelines for Americans.   The report is 572 pages long, more than 100 pages longer than the last report, released 5 years ago.  Longer than one of my blog posts, even. Despite its length, and the tortured governmentalese in which it is written, its message is pretty clear and simple. So for those of you who would like to know what the report says, but don’t want to read the whole damn thing, I present, below, its essence:

Dear America,

You are sick–and fat.  And it’s all your fault. 

Face it.  You screwed up.  Somewhere in the past few decades, you started eating too much food. Too much BAD food.  We don’t know why.  We think it is because you are stupid.

We don’t know why you are stupid.

You used to be smart–at least about food–but somewhere in the late 1970s or early 1980s, you got stupid. Before then, we didn’t have to tell you what to eat.  Somehow, you just knew. You ate food, and you didn’t get fat and sick.

But NOW, every five years we have to get together and rack our brains to try and figure out a way to tell you how to eat–AGAIN.  Because no matter what we tell you, it doesn’t work. 

The more we tell you how to eat, the worse your eating habits get. And the worse your eating habits get, the fatter and sicker you are.  And the fatter and sicker you are, the more we have to tell you how to eat. 

DGA - Length & Obesity 1980-2010

Look. You know we have no real way to measure your eating habits.  Mostly because fat people lie about what they eat and most of you are now, technically speaking, fat.  But we still know that your eating habits have gotten worse. How?  Because you’re fat.  And, y’know, sick.  And the only real reason people get fat and sick is because they have poor eating habits.  That much we do know for sure.

And because, for decades now,  we have been telling you exactly what to eat so you don’t get fat and sick, we also know the only real reason people have poor eating habits is because they are stupid.  So you must be stupid.

Let’s make this as clear as possible for you:

sick fat stupid people

And though it makes our hearts heavy to say this, unfortunately, and through no fault of their own, people who don’t have much money are particularly stupid.  We know this because they are sicker than people who have money.  Of course, money has nothing to do with whether or not you are sick.  It’s the food, stupid.

We’ll admit that some of the responsibility for this rests on our shoulders.  When we started out telling you how to eat, we didn’t realize how stupid you were.  That was our fault.

In 1977, a bunch of us got together to figure out how to make sure you would not get fat and sick.  You weren’t fat and sick at the time, so we knew you needed our help.

We told you to eat more carbohydrates–a.k.a., sugars and starches–and less sugar.  How simple is that?  But could you follow this advice?  Nooooooo.  You’re too stupid.

We told you to eat food with less fat. We meant for you to buy a copy of the Moosewood Cookbook and eat kale and lentils and quinoa.  But no, you were too stupid for that too.  Instead, you started eating PRODUCTS  that said “low-fat” and “fat-free.”  What were you thinking?

We told you to eat less animal fat. Obviously, we meant JUST DON’T EAT ANIMALS.  But you didn’t get it.  Instead, you quit eating cows and started eating chickens.  Hellooooo?  Chickens are ANIMALS.

After more than three decades of us telling you how to eat, it is obvious you are too stupid to figure out how to eat.  So we are here to make it perfectly clear, once and for all.

FIRST:  Don’t eat food with salt in it.

Even though food with salt in it doesn’t make you fat, it does raise your blood pressure.  Maybe.  Sometimes.  And, yes, we know that your blood pressure has been going down for a few decades now, but it isn’t because you are eating less salt, because you’re not.  And it’s true that we really have no idea whether or not reducing your intake of salt prevents disease. But all of that is beside the point.

Here’s the deal:  Salt makes food taste good.  And when food tastes good, you eat it.  We’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting salt in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SALT ADDED) and lentils and quinoa in bulk from the food co-op (NO SALT ADDED).  Got it?

Also, we are working on ways to make salt shakers illegal. 

Ban Salt Shakers

 

NEXT:  Don’t eat animals. At all.  EVER.

We told you not to eat animals because meat has lots of fat, and fat makes you fat.  Then you just started eating skinny animals. So we’re scrapping the whole fat thing.  Eat all the fat you want.  Just don’t eat fat from animals, because that is the same thing as eating animals, stupid.

We told you not to eat animals because meat has lots of cholesterol, and dietary cholesterol makes your blood cholesterol go up.  Now our cardiologist friends who work for pharmaceutical companies and our buds over at the American Heart Association have told us that avoiding dietary cholesterol won’t actually make your blood cholesterol go down.  They say:  If you want your blood cholesterol to go down, take a statin.  Statins, in case you are wondering, are not made from animals, so you can have all you want.  

Eggs? you ask.  We’ve ditched the cholesterol limits, so now you think you can eat eggs?  Helloooo?  Eggs are just baby chickens and baby chickens are animals and you are NOT ALLOWED TO EAT ANIMALS.  Geez.

Yes, we are still hanging onto that “don’t eat animals because of saturated fat” thing, but we know it can’t last forever since we can’t actually prove that saturated fat is the evil dietary villain we’ve been saying it is.  So …

Here’s the deal:  Eating animals doesn’t just kill animals.  It kills the planet.  If you keep killing animals and eating them WE ARE ALL GOING TO DIE.  And it’s going to be your fault, stupid.

And especially don’t eat red meat.  C’mon.  Do we have to spell this out for you?  RED meat? 

RED meat = COMMUNIST meat.  Does Vladimir Putin look like a vegan?  We thought not. 

 

 If you really must eat dead rotting flesh, we think it is okay to eat dead rotting fish flesh, as long as it is from salmon raised on ecologically sustainable fish farms by friendly people with college educations. 

FINALLY:  Stop eating–and drinking–sugar.

Okay, we know we told you to eat more carbohydrate food.  And, yes, we know sugar is a carbohydrate. But did you really think we were telling you to eat more sugar?  Look, if you must have sugar, eat some starchy grains and cereals. The only difference between sugar and starch is about 15 minutes in your digestive tract.  But …

Here’s the deal:  Sugar makes food taste good.  And when food tastes good, you eat it.  Like we said, we’re opposed to that.  But since you are too stupid to actually stop eating food, we are going to insist that food manufacturers stop putting sugar in their products.  That way, their products will grow weird microorganisms and spoil rapidly–and will taste like poop.

This will force everyone to stop eating food products and get kale from the farmer’s market (NO SUGAR ADDED) and lentils and quinoa in bulk from the food co-op (NO SUGAR ADDED).  Got it?

Ban cupcakes

 

Hey, we know what you’re thinking.  You’re thinking “Oh, I’ll just use artificial sweeteners instead of sugar.”  Oh NOOOO you don’t.  No sugar-filled soda.  No diet soda.  Water only. Capiche?

 So, to spell it all out for you once and for all:

DO NOT EAT food that has salt or sugar in it, i.e. food that tastes good.  Also don’t eat animals.

DO EAT kale from your local farmers’ market, lentils and quinoa from your local food co-op,  plus salmon. Drink water.  That’s it. 

And, since we graciously recognize the diversity of this great nation, we must remind you that you can adapt the above dietary pattern to meet the your own health needs, dietary preferences and cultural traditions. Just as long as you don’t add salt, sugar, or dead animals.

Because we have absolutely zero faith you are smart enough to follow even this simple advice, we are asking for additional research to be done on your child-raising habits (Do you let your children eat food that tastes good?  BAAAAD parent!) and your sleep habits (Do you dream about cheeseburgers?  We KNOW you do and that must stop!  No DEAD IMAGINARY ANIMALS!)

And–because we recognize your deeply ingrained stupidity when it come to all things food, and because we know that food is the only thing that really matters when it comes to health, we are proposing  America create a national “culture of health” where healthy lifestyles are easier to achieve and normative.

“Normative” is a big fancy word that means if you eat what we tell you to eat, you are a good person and if you eat food that tastes good, you are a bad person. We will know  you are bad person because you will be sick. Or fat. Because that’s what happens to bad people who eat bad food.

We will kick-off this “culture of health” by creating an Office of Dietary Wisdom that will make the healthy choice–kale, lentils, quinoa, salmon, and water–the easy choice for all you stupid Americans.  We will establish a Food Czar to run the Office of Dietary Wisdom, because nothing says “America, home of freedom and democracy” like the title of a 19th century Russian monarch.*

The primary goal of the “culture of health” will be to enforce your right to eat what we’ve determined is good for you. 

This approach will combine the draconian government overreach we all love with the lack of improvements we expect, resulting in a continued demand for our services as the only people smart enough to tell the stupid people how to eat.**

 Look.  We know we’ve been a little unclear in the past.  And we know we’ve reversed our position on a number of things. Hey, our bad.  And when, five years from now, you stupid Americans are as sick and fat as ever, we may have to change up our advice again based, y’know, on whatever evidence we can find that supports the conclusions we’ve already reached.

But rest assured, America.

No matter what the evidence says, we are never ever going to tell you it’s okay to eat salt, sugar, or animals.  And, no matter what the evidence says, we are never ever going to tell you that it’s not okay to eat grains, cereals, or vegetable oils.  And you can take that to the bank.  We did.

Love and kisses,

Committee for Government Approved Information on Nutrition (Code name: G.A.I.N.)

***********************************************************************************

*Thank you, Steve Wiley.

**Thank you, Jon Stewart, for at least part of this line.

 

Figure out Food: Eat what works!

No, that’s not the name of my new blog (although it is awfully catchy, isn’t it?), but it sure does capture the spirit of my own approach to nutrition these days.

It’s the name of what I think will be the future of nutrition–an app that helps you figure out what to eat to be healthy by connecting what you eat to how you feel.  Can I get an “It’s about damn time”?

Kenny's app

Wading through the muck of nutrition science and public health, I’ve learned just a few things that I can say with assurance:

1) We know very little about the relationship between diet and prevention of chronic disease.  Somebody tells you that they have a scientifically proven diet for preventing chronic disease?  This person may have a diet, it may even work (as far as we can tell at the moment), but it not going to be scientifically proven because we simply don’t have the science to prove it.  As they say in the biz, our methodology sucks green tomatoes.

2) The focus in public health (and private care) on weight loss is misguided.  Weight loss does not equal health and even if it did, we’re really bad at helping people do it successfully and long-term.  Does weight loss result in better health?  Sometimes.  But is that due to the weight loss per se, or due to whatever metabolic changes had to happen in order for weight loss to occur?  And, truth is, sometimes attempts at weight loss compromise health.  Loss of muscle mass, disordered eating patterns, nutritional deficiencies, restricted lifestyle, hunger, fatigue, general misery and bitchiness–all of these can accompany attempts at weight loss & may cause more problems than they solve.

BUT–and it’s a big but, like it always is–food is really important.  Some foods make us feel satisfied and full of energy and ready to leap over tall buildings with nary a second thought.  Other foods make us Sleepy and Sneezy and Dopey and a few other dwarves that Snow White didn’t meet:  Cranky, Burpy, and Farty.

And foods that make my body happy are not necessarily the ones that make yours happy.

How do we know which foods are which?  

Ta-da!  Kenny Gow to the rescue with a totally cool app that he’s been working on for a while now.

The main thing to know about this app is that it’s about having health now (not about weight loss or disease prevention–see above) and it’s about you (not an aggregate of information from datasets full of people who aren’t you).

I think it’s pretty cool & when I eventually get back to working with patients, I hope this app is there to help me help them.  But–for that to happen, he needs some support from us.

With that in mind, check out his Indiegogo campaign, which I’m about to donate to, as soon as I finish this blog post.

Fist-bump to Gingerzini who beat me to it.

 

 

 

 

What if there were no Dietary Guidelines?

I don’t get excited about much these days.  Mostly because I’m too sleep deprived from studying until 2:00 AM.  But I’m pretty excited about this.

I’ve been wanting to write this piece for a long time.  The wonderful folks at Examine.com encouraged me to go ahead and do it.

Check it out:  What if there were no Dietary Guidelines?  

 

Examine com pix

Changing the Dietary Guidelines

If you have been following any of the Dietary Guidelines Advisory Committee’s meetings (who does that anyway? I mean, unless you are a total geek like I am), then you might have noticed that the next Guidelines seem very likely to continue to promote the same nutritional advice that has proven largely ineffective for more than 35 years.

In my other, not-quite-so-snarky, life, I am not Wonder Woman (but oh, what I wouldn’t give for a pair of bracelets of submission). However, I am director of the Healthy Nation Coalition, a loose affiliation of healthcare and public health professionals, scientists, and concerned citizens who think it is time we did nutrition a little differently. Right now, we are creating a coalition of supporters to speak out against the direction the current 2015 Dietary Guidelines are taking and to offer an alternative approach.

This letter will be delivered to the Secretaries of the U.S. Departments of Agriculture and Health and Human Services, selected policymakers, and interested media outlets. We hope to add to the momentum that has been building in the national media calling for a change in our national dietary guidance (see Nina Teicholz’ book, Big Fat Surprise, and her recent op-ed in the Wall Street Journal).

The letter is copied below (or you can use this link to the pdf–the pdf is where all the citations are, because I know how you love citations).

If you wish to sign on, you can use this quick form to add your information to the letter. If you’re interested, but don’t want to read the whole boring letter, check out Mark Sisson’s blog post about it.  It’s lots more fun.

In a nutshell, we are asking for Dietary Guidelines that are geared toward the general public and focused on adequate essential nutrition.

This is not a call for low-carb, high-fat dietary recommendations, or paleo ones, and it takes no stance on the whole “calories in, calories out” versus hormonal regulation etc. etc. issue.  So if you want to criticize this approach, don’t start bitching about low-carb diets or CICO, or I’ll know that you haven’t bothered to actually read this and I won’t feel guilty about deleting your comments.  Beyond that, if you have genuine objections to this approach, suggest a better one–or go away.   What we are doing now isn’t working.  What we need is productive conversation about what to do differently.

Healthy Nation Coalition Letter – 2015 Dietary Guidelines for Americans

Dear Secretary Burwell and Secretary Vilsack,

At the conclusion of the sixth meeting of the 2015 Dietary Guidelines Advisory Committee (DGAC), we write to express concern about the state of federal nutrition policy and its long history of failure in preventing the increase of chronic disease in America. The tone, tenor, and content of the DGAC’s public meetings to date suggest that the 2015 Dietary Guidelines for Americans (DGA) will perpetuate the same ineffective federal nutrition guidance that has persisted for nearly four decades but has not achieved positive health outcomes for the American public.

We urge you to adhere to the initial Congressional mandate that the DGA act as “nutritional and dietary information and guidelines for the general public” and are “based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared.”

Below we lay out specific objections to the DGA:
· they have contributed to the increase of chronic diseases;
· they have not provided guidance compatible with adequate essential nutrition;
· they represent a narrow approach to food and nutrition inconsistent with the nation’s diverse cultures, ethnicities, and socioeconomic classes;
· they are based on weak and inconclusive scientific data;
· and they have expanded their purpose to issues outside their original mandate.

As you prepare to consider the 2015 DGAC’s recommendations next year, we urge you to fulfill your duty to create the dietary foundation for good health for all Americans by focusing on adequate essential nutrition from whole, nourishing foods, rather than replicating guidance that is clearly failing.

The DGA have contributed to the rapid rise of chronic disease in America.

In 1977, dietary recommendations (called Dietary Goals) created by George McGovern’s Senate Select Committee advised that, in order to reduce risk of chronic disease, Americans should decrease their intake of saturated fat and cholesterol from animal products and increase their consumption of grains, cereal products, and vegetable oils. These Goals were institutionalized as the DGA in 1980, and all DGA since then have asserted this same guidance. During this time period, the prevalence of heart failure and stroke has increased dramatically. Rates of new cases of all cancers have risen. Most notably, rates of diabetes have tripled. In addition, although body weight is not itself a measure of health, rates of overweight and obesity have increased dramatically. In all cases, the health divide between black and white Americans has persisted or worsened.

While some argue that Americans have not followed the DGA, all available data show Americans have shifted their diets in the direction of the recommendations: consuming more grains, cereals, and vegetable oils, while consuming less saturated fat and cholesterol from whole foods such as meat, butter, eggs, and full-fat milk. Whether or not the public has followed all aspects of DGA guidance does not absolve the U.S. Departments of Agriculture (USDA) and Health and Human Services (DHHS) from ensuring that the dietary guidance provided to Americans first and foremost does no harm.

The DGA fail to provide guidance compatible with essential nutrition needs.

The 1977 Dietary Goals marked a radical shift in federal dietary guidance. Before then, federal dietary recommendations focused on foods Americans were encouraged to eat in order to acquire adequate nutrition; the DGA focus on specific food components to limit or avoid in order to prevent chronic disease. The DGA have not only failed to prevent chronic disease, in some cases, they have failed to provide basic guidance consistent with nutritionally adequate diets.
· Maillot, Monsivais, and Drewnowski (2013) showed that the 2010 DGA for sodium were incompatible with potassium guidelines and with nutritionally adequate diets in general.
· Choline was recognized as an essential nutrient in 1998, after the DGA were first created. It is crucial for healthy prenatal brain development. Current choline intakes are far below adequate levels, and choline deficiency is thought to contribute to liver disease, atherosclerosis and neurological disorders. Eggs and meat, two foods restricted by current DGA recommendations, are important sources of choline. Guidance that limits their consumption thus restricts intake of adequate choline.
· In young children, the reduced fat diet recommend by the DGA has also been linked to lower intakes of a number of important essential nutrients, including calcium, zinc, and iron.

Following USDA and DHHS guidance should not put the most vulnerable members of the population at risk for nutritional inadequacy. DGA recommendations should be emphasizing whole foods that provide essential nutrition, rather than employing a reductionist approach based on single food components to exclude these foods from the diet.

The DGA’s narrow approach to food and health is inappropriate for a diverse population.

McGovern’s 1977 recommendations were based on research and food patterns from middle class Caucasian American populations. Since then, diversity in America has increased, while the DGA have remained unchanged. DGA recommendations based on majority-white, high socioeconomic status datasets have been especially inappropriate for minority and low-income populations. When following DGA recommendations, African American adults gain more weight than their Caucasian counterparts, and low-income individuals have increased rates of diabetes, hypertension, and high cholesterol. Long-standing differences in environmental, genetic and metabolic characteristics may mean recommendations that are merely ineffective in preventing chronic disease in white, middle class Americans are downright detrimental to the long-term health of black and low-income Americans.

The DGA plant-based diet not only ignores human biological diversity, it ignores the diversity of American foodways. DGA guidance rejects foods that are part of the cultural heritage of many Americans and indicates that traditional foods long considered to be important to a nourishing diet should be modified, restricted, or eliminated altogether: ghee (clarified butter) for Indian Americans; chorizo and eggs for Latino Americans; greens with fatback for Southern and African Americans; liver pâtés for Jewish and Eastern European Americans.

Furthermore, recommendations to prevent chronic disease that focus solely on plant-based diets is a blatant misuse of public health authority that has stymied efforts of researchers, academics, healthcare professionals, and insurance companies to pursue other dietary approaches adapted to specific individuals and diverse populations, specifically, the treatment of diabetes with reduced-carbohydrate diets that do not restrict saturated fat. In contradiction of federal law, the DGA have had the effect of limiting the scope of medical nutrition research sponsored by the federal government to protocols in line with DGA guidance.

The DGA are not based on the preponderance of current scientific and medical knowledge.

The science behind the current DGA recommendations is untested and inconsistent. Scientific disagreements over the weakness of the evidence used to create the 1977 Dietary Goals have never been settled. Recent published accounts have raised questions about whether the scientific process has been undermined by politics, bias, institutional inertia, and the influence of interested industries.

Significant scientific controversy continues to surround specific recommendations that:
1. Dietary saturated fat increases the risk of heart disease: Two recent meta-analyses concluded there is no strong scientific support for dietary recommendations that restrict saturated fat. Studies cited by the 2010 DGAC Report demonstrate that in some populations, lowering dietary saturated fat actually worsens some biomarkers related to heart disease.
2. Dietary cholesterol increases the risk of heart disease: Due to a lack of evidence, nearly all other Western nations have dropped their limits on dietary cholesterol. In 2013, a joint panel of the American Heart Association and the American College of Cardiology did the same.
3. Polyunsaturated vegetable oils reduce the risk of heart disease and should be consumed as the primary source of dietary fat: Recent research renews concerns raised in response to the 1977 Dietary Goals that diets high in the omega-6 fatty acids present in vegetable oils may actually increase risk of chronic disease or death.
4. A diet high in carbohydrate, including whole grains, reduces risk of chronic disease: Clinical trials have demonstrated that diets with lower carbohydrate content improve risk factors related to heart disease and diabetes. Janet King, Chair of the 2005 DGAC, has stated that “evidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health.”
5. A low-sodium diet reduces risk of chronic disease: A 2013 Institute of Medicine report concludes there is insufficient evidence to recommend reducing sodium intake to the very low levels set by the DGA for African-Americans of any age and adults over 50.

In all of these cases, contradictory evidence has been ignored in favor of maintaining outdated recommendations that have failed to prevent chronic disease.

More generally, “intervention studies, where diets following the Dietary Guidelines are fed long-term to human volunteers, do not exist,” and food patterns recommended by the DGA “have not been specifically tested for health benefits.” The observational research being used for much of the current DGAC activities may suggest possible associations between diet and disease, but such hypotheses must then be evaluated through rigorous testing. Applying premature findings to public health policy without adequate testing may have resulted in unintended negative health consequences for many Americans.

The DGA have overstepped their original purpose.

The DGA were created to provide nutrition information to all Americans. However, the current 112-page DGA, with 29 recommendations, are considered too complex for the general public and are directed instead at policymakers and healthcare professionals, contradicting their Congressional mandate.

Federal dietary guidance now goes far beyond nutrition information. It tells Americans how much they should weigh and how to lose weight, even recommending that each American write down everything that is eaten on a daily basis. This focus on obesity and weight loss has contributed to extensive and unrecognized “collateral damage”: fat-shaming, eating disorders, discrimination, and poor health from restrictive food habits. At the same time, researchers at the Centers for Disease Control have shown that overweight and obese people are often as healthy as their “normal” weight counterparts. Guidance related to body weight should meet individual health requirements and be given by a trained healthcare practitioner, not be dictated by federal policy.

The DGA began as an unmandated consumer information booklet. They are now a powerful political document that regulates a vast array of federal programs and services, dictates nationwide nutrition standards, influences agricultural policies and health-related research, and directs how food manufacturers target consumer demand. Despite their broad scope, the DGA are subject to no evaluation or accountability process based on health outcomes. Such an evaluation would demonstrate that they have failed to fulfill their original goal: to decrease rates of chronic disease in America.

Despite this failure, current DGAC proceedings point to an expansion of their mission into sustainable agriculture and environmental concerns. While these are important issues, they demonstrate continued “mission creep” of the DGA. The current narrow DGA focus on plant-based nutrition suggests a similarly biased approach will be taken to environmental issues, disregarding centuries of traditional farming practices in which livestock play a central role in maintaining soil quality and ecological balance. Instead of warning Americans not to eat eggs and meat due to concerns about saturated fat, cholesterol, and obesity, it is foreseeable that similar warnings will be given, but for “environmental” reasons. This calls for an immediate refocusing of the purpose of the DGA and a return to nutritional basics.

Solution: A return to essential nutrition guidance

As our nation confronts soaring medical costs and declining health, we can no longer afford to perpetuate guidelines that have failed to fulfill their purpose. Until and unless better scientific support is secured for recommendations regarding the prevention of chronic disease, the DGA should focus on food-based guidance that assists Americans in acquiring adequate essential nutrition.

Shifting the focus to food-based guidance for adequate essential nutrition will create DGA that:
· are based on universally accepted and scientifically sound nutritional principles: Although more knowledge is needed, the science of essential nutrient requirements is firmly grounded in clinical trials and healthcare practice, as well as observational studies.
· apply to all Americans: Essential nutrition requirements are appropriate for everyone. Lack of essential nutrients will lead without exception to diseases of deficiency.
· include traditionally nourishing foods: A wide variety of eating patterns can provide adequate essential nutrition; no nourishing dietary approaches or cultural food traditions would be excluded or discouraged.
· expand opportunities for research: With dietary guidance focused on adequate essential nutrition, researchers, healthcare providers, and insurance companies may pursue dietary programs and practices tailored to individual risk factors and diverse communities without running afoul of the DGA and while ensuring that basic nutrition needs are always met.
· direct attention towards health and well-being: Focus will be directed away from intermediate markers, such as weight, which may be beyond individual control, do not consistently predict health outcomes, and are best dealt with in a healthcare setting.
· are clear, concise, and useful to the public: Americans will be able to understand and apply such guidance to their own dietary patterns, minimizing the current widespread confusion and resentment resulting from federal dietary guidance that is poorly grounded in science.

It is the duty of USDA and DHHS leadership to end the use of controversial, unsuccessful and discriminatory dietary recommendations. USDA and DHHS leadership must refuse to accept any DGA that fail to establish federal nutrition policy based on the foundation of good health: adequate essential nutrition from wholesome, nourishing foods. It is time to create DGA that work for all Americans.

 

Dietary Guidelines for Americans: We don’t need no stinkin’ science

I know, I know. I never post. I never call. I don’t bring you flowers. It’s a wonder we’re still together. I have the usual list of excuses:

1) GRADUATE SCHOOL

But before I disappear off the face of the interwebz once again, I thought I share with you a quickie post on the science behind our current Dietary Guidelines. Even as we speak, the USDA and DHHS are busy working on the creation of the new 2015 Dietary Guidelines for Americans, which are shaping up to be the radically conservative documents we count on them to be.

For just this purpose, the USDA has set up a very large and impressive database called the Nutrition Evidence Libbary (NEL), where it conducts “systematic reviews to inform Federal nutrition policy and programs.” NEL staff collaborate with stakeholders and leading scientists using state-of-the-art methodology to objectively review, evaluate, and synthesize research to answer important diet-related questions in a manner that allows them to reach a conclusion that they’ve previous determined is the one they want.

It’s a handy skill to master. Here’s how it’s done.

The NEL question:

What is the effect of saturated fat intake on increased risk of cardiovascular disease or type 2 diabetes?

In the NEL, they break the evidence up into “cardiovascular” and “diabetes” so I’ll do the same, which means we are really asking: What is the effect of saturated fat (SFA) intake on increased risk of cardiovascular disease?

Spoiler alert–here’s the answer: “Strong evidence” indicates that we should reduce our intake of saturated fat (from whole foods like eggs, meat, whole milk, and butter) in order to reduce risk of heart disease. As Gomer Pyle would say, “SUR-PRIZE, SUR-PRIZE.”

Aaaaaaaand . . . here’s the evidence:

The 8 studies rated “positive quality” are in blue; the 4 “neutral quality” studies are in gray. The NEL ranks the studies as positive and neutral (less than positive?), but treats them all the same in the review. Fine. Whateverz.

According the exclusion criteria for this question, any study with a dropout rate of more than 20% should be eliminated from the review. These 4 studies have dropout rates of more than 20%. They should have been excluded. They weren’t, so we’ll exclude them now.

Also, according to NEL exclusion criteria for this question, any studies that substituted fat with carbohydrate or protein, instead of comparing types of fat, should be excluded. Furtado et al 2008 does not address the question of varying levels of saturated fat in the diet. In fact, saturated fat levels were held constant–at 6% of calories–for each experimental diet group. So, let’s just exclude this study too.

One study–Azadbakht et al 2007–was conducted on teenage subjects with hypercholesterolemia, a hereditary condition that affects about 1% of the population. Since the U.S. Dietary Guidelines are not meant to treat medical conditions and are meant for the entire population, this study should not have been included in the analysis. So let’s take care of that for those NEL folks.

 

In one study–Buonacorso et al 2007–total cholesterol levels did not change when dietary saturated fat was increased: “Plasma TC [total cholesterol] and triacylglycerol levels were NS [not significantly] changed by the diets, by time (basal vs. final test), or period (fasting vs. post-prandial) according to repeated-measures analysis.” This directly contradicts the conclusion of the NEL. Hmmmm. So let’s toss this study and see what’s left.

In these four studies, higher levels of saturated fat in the diet made some heart disease risk factors get worse, but other risk factors got better. So the overall effect on heart disease risk was mixed or neutral. As a result, these studies do not support the NEL conclusion that saturated fat should be reduced in order to reduce risk of heart disease.

 

That leaves one lone study. A meta-analysis of eleven observational studies. Seeing as the whole point of a meta-analysis is to combine studies with weak effects to see if you end up with a strong one, if saturated fat was really strongly associated with heart disease, we should see that, right? Right. What this meta-analysis found was that among women over 60, there is no association between saturated fat and coronary events or deaths. Among adult men of any age, there is no association between saturated fat and coronary events or deaths. Only in women under the age of 60 is there is a small inverse association between risk of coronary events or deaths and the reduction of saturated fat in the diet. That sounds like it might be bad news—at least for women under 60—but this study also found a positive association between monounsaturated fats—you know, the “good fat,” like you would find in olive oil—and risk of heart disease. If you take the results of this study at face value–which I wouldn’t recommend–then olive oil is as bad for you as butter.

So there’s your “strong” evidence for the conclusion that saturated fat increases risk of heart disease.

 

Just recently, Frank Hu of the 2015 Dietary Guidelines Advisory Committee was asked what we should make of the recent media attention to the idea that saturated fat is not bad for you after all (see this video at 1:06:00). Dr. Hu reassured us that, no, saturated fat still kills. He went on to say that the evidence to prove this, provided primarily by a meta-analysis created by USDA staffers (and we all know how science-y they can be), is MUCH stronger than that used by the 2010 Committee.

Well, all I can say is:  it must be.  Because it certainly couldn’t be any weaker.

 

 

Why care about calories?

After the last blog post on calorie magic, my husband–whose intellectual response to people challenging me on the internet is to want to give them a virtual wedgie–asked me why I didn’t just engage those cute little white dude-o-scientists who are so pumped about how IT JUST MUST BE CALORIES CALORIES CALORIES CALORIES in some sort of PubMed duel to the finish.

My explanation:  I don’t do PubMed duels. PubMed is a wonderful thing, and the internet has given us tremendous access to a great deal of information, much of which is used to confirm our own preconceived notions, even if (especially if?) we don’t fully understand what those notions actually are. As I’ve said before, a pastiche of  PubMed citations frequently boils to a bunch of snapshots taken out of context of the larger literature–and out of context of a full understanding of physiological and biochemical realities, not to mention social and cultural ones–that may or may not express a physiologically significant or practically useful concept.

And this is problem: I’m not convinced that calories express a physiologically significant or practically useful concept. Here’s what I figure. If calories were so FREAKIN important, then my biochemistry books should be rife with information about them. But that does not seem to be the case.

[I took my first biochem class at age 45, weeping my way through one excruciatingly difficult exam after another. I emerged–bloodied by unbowed–to joyfully sign up for 3 more semesters. I don’t consider myself an expert by any stretch; I just feel that biochemistry is sort of the key to the universe, certainly the universe of nutrition. If something doesn’t make sense from a biochemical perspective–which would apply to about 90% of the Dietary Guidelines–it shouldn’t be part of nutrition policy.]

I did this a while back, just for my own peace of mind, and I don’t know how useful it will be to any of you, but here’s what my collection of biochem books has to say about calories. Spoiler alert: Not much. [So you can stop here if you have a life.]

My biochemistry books, in order of how much I love them, least to most:

Advanced Nutrition and Human Metabolism (3rd Edition), 2000

James Groff & Sareen Gropper

I don’t know why I have this book.

–“Calorie” is indexed to a passage on units of energy in a discussion of thermodynamics. Calories are not mentioned again.

–“Calorimetry, direct” and “calorimetry, indirect” are indexed to passages discussing the measurements of energy expenditure. It contains this notable summary:

” Although changes in energy balance produce weight changes, the extent of these changes varies from person to person.”

 


Functional Biochemistry in Health and Disease, 2009

Eric Newsholme & Tony Leech

I got this book with great anticipation, as it seemed to promise a better integration of biochemistry and physiology than most biochem texts. But like some sort of weird Asian-fusion spicy wonton Alfredo dish, I guess it is just trying to do too much. There is not enough detail here for me, and the reader is left to sort of assume “magic elves in a box” in too many places, which–as far as I am concerned–defeats the whole point of learning biochemistry.

–“Calorie” is not indexed.

–“Calorimetry” is indexed. This couple of pages highlights the limitations of measuring calorie expenditure in the human body.


Biochemistry (4th Edition), Lippincott’s Illustrated Reviews, 2008

Pamela Champe, Richard Harvey, & Denise Farrier

This is the boy-toy of my biochem texts. I don’t love this book, but it is much more portable than my other biochem texts, so I can take it out in public without too much embarrassment.

–“Calorie” is not indexed.

–“Caloric consumption,” “caloric restriction, weight reduction and,” and “calorimeter” are indexed.

“Caloric consumption” addresses the fact that the source of the increase in calories consumed by Americans since 1971 is carbohydrates.

“Caloric restriction, weight reduction and” is indexed to a page includes the following helpful information:

 “Caloric restriction is ineffective over the long term for many individuals.”

 


Biochemistry (2nd Edition) , 1995

Donald Voet & Judith Voet

I approach the Voets with the reverence and respect due a giant doorstop of a book like this. Like that scary old professor who knows everything, it is intimidating, but, well, it knows everything.

“Calorie (cal)” and “Calorie, large (Cal)” are indexed to the same place. The indexing refers to a table that compares thermodynamic units and constants as an adjunct to a passage on the First Law of Thermodynamics. This passage contains a little nugget of joy for those of us who insist that conversations about weight management may need to consider more than just how many calories go “in” and how many calories go “out.” Unless you are a fully registered and certified geek, you may want to just skip ahead:

“Neither heat [i.e. what is measured by calories] nor work is separately a state function [i.e. quantities that depend only on the state of the system] because each is dependent on the path followed by a system in changing from one state to another . . . If [the First Law of Thermodynamics] is to be obeyed, heat must also be path dependent. It is therefore meaningless to refer to the heat or work content of a system (in the same way that it is meaningless to refer to the number of one dollar bills and ten dollar bills in a bank account containing $85.00).”

This is why when someone talks about a person storing “800 calories of energy as fat,” I hear something that makes about as much sense to me as saying a person can store “$85 dollars worth of money in his bank account as four twenties and a fiver.”

Calories are otherwise never mentioned again in the rest of the 1,310 pages of this book.

 

Biochemistry (6th edition), 2009

Mary Campbell & Shawn Farrell

Campbell y Farrell is my warm fuzzy teddy-bear of a biochem book. I LUV it. Cuddle up with C&F for a well-written, easy-to-understand (as these things go) romp through the wonders of biochem.

–“Calorie” is not indexed.

–“Caloric restriction” is indexed to a discussion of longevity and sirtuins, not weight loss or obesity.


Lehninger’s Principles of Biochemistry (4th Edition), 2005

David L. Nelson & Michael M. Cox

This is my favorite biochemistry book ever. If it were available and I were single, I would marry it in a hot second.

–“Calorie” is not indexed. Nor is “kilocalorie.” Nor anything else that I could think of having to do with “calories.”

There you have it.   Seems to me that all those broscientists want to talk about is something that doesn’t have a lot to do with the keys to the universe of nutrition.  I don’t mind talking biochemistry, but the basic biochemistry that I’m familiar with has virtually nothing to say about calories.

And if biochemistry isn’t too concerned with calories, why should you be?

 

 

The Magic of Calories

There have been a couple of interesting conversations on the interwebz involving calories lately. I don’t normally pay attention to these things because I am so busy napping being, well, busy, but I am paying attention to these conversations because they are both starring–ME!!!

Let’s face it, the whole “only calories matter, period” vs. “calories, shmalories” debate tends to be an oversimplification on both sides. But, the truth is, only one of these sides has been the primary focus of many decades of unsuccessful public health nutrition intervention. In that regard, the “all you have to do to lose weight is make sure your calories out exceed your calories in” stance deserves to be questioned.

To this end, Adam Kosloff has gathered a useful compendium of calories in-calories out naysayers (including yours truly):

Then, a different Adam, does some naysaying about the naysayers:

While it would be fun to naysay all the naysaying about the naysayers, rather I will just address the part starring ME!!!

In reference to my scientific-y calorie calculations about how long it would take me to “disappear altogether,” Adam the Second had this to say:

“Yes, If she were to drop her calories in by 500 a day and increase her calories out by 500, she would lose a shit load of weight after 6 months.”

Um, no I wouldn’t. I would lose about 30 pounds, then I would begin to regain. Because that’s what happened to me in my real life. Oh wait, but it probably didn’t happen to me in real life because I was a fat person then, and everybody knows that fat people lie about how much they really eat, and because everyone knows that scientific-y calculations are more real than anybody’s actual life.

Adam the Second:

“She just has to remember that metabolism will vary over that time span, so her calories will also have to. This is due to the body naturally requiring less calories [sic] as a smaller vessel, and also the body will lower non exercise energy expenditure (general fidgeting, moving around etc).”

WHAT? My metabolism is going to change over time because I’ve changed my eating patterns? That’s in direct contradiction to the whole “calories in, calories out” premise. There are no differentiated calorie labels that say “This low-fat yogurt contains 250 calories for those of you who haven’t been on a diet for 6 months, BUT it contains 5,680 calories for those of you who have.”

Yes, in more sophisticated venues, calorie calculators for “energy out” change with weight, but the overall premise stays the same and leads to the same conclusion.


So if I weigh 205 pounds, walking at a moderate pace for an hour burns 307 calories. Once I diet & exercise down to 180 pounds, I can burn only 270 pounds doing that same amount of exercise. Which means that now I have to eat EVEN less and move EVEN more to continue to lose weight (regardless of how little I was eating or how much I was moving in order to get to 180 pounds in the first place)? When does the madness stop???

Lucky for you, dear reader, I will now demonstrate, due to the magic of calories, that the whole “eat less, move more” ad infinitum ad nauseum ad starvatium ad exhaustium does stop and in fact–this is the magic part–even reverses itself.   All for the low low price of free.

Let’s take this whole calorie calculation/deficit/mumbo jumbo out for a “brisk pace” walk, shall we? One of the reasons I think that some folks are such diehard supporters of calories in-calories out, it that they’ve never actually been a fat person trying to navigate the terrain of the whole calorie-counting experience.  So let’s hold hands & try it together.

Let’s say I’m a big fat newbie. Let’s say I’m a 35-year-old, 5’10” OBESE female who weighs 240 pounds (not my current age or weight, but that’s approximately where I started in my own weight loss journey). I already know that I need to “eat less and move more” in order to lose weight, because that’s what my doctor told me. I go to a trusted source, the Mayo Clinic, for guidance (for those of you who want to play along at home, here’s the Mayo Clinic calculator).

First I need to know how many calories I actually require (so I can reduce them). I start off with a estimated energy requirement for my activity level, which I will calculate as “inactive” (“never or rarely include physical activity in your day”), because we all know that the reason that fat people are fat in the first place is because they are lazy slugs.

My calorie needs as calculated by the Mayo Clinic, by way of the Harris Benedict Equation and the Dietary Reference Intakes, are: 1850 calories/day.

The Mayo Clinic says: “Weight loss comes down to burning more calories than you take in. You can do that by reducing extra calories from food and beverages, and increasing calories burned through physical activity.”  They don’t provide any details about how to do this, but by consulting with the Academy of Nutrition and Dietetics, I find that “A negative energy balance is the most important factor affecting weight loss amount and rate” and that I can achieve this negative energy balance by decreasing my energy intake by about 500 calories/day or increasing my activity by about 500 calories/day–or doing both. Since “adipose tissue, which is mostly fat, contains about 3500 kcals/pound,” if I create a negative energy balance of 1000 calories/day, I’m 7000 calories down–or 2 pounds worth of fat–over the course of a week.

So here goes. I’m going to subtract 500 calories from my Mayo calculation (close your eyes, it’s a mathy part) in order to figure out that I should be eating: 1350 calories/day.

Okay, let’s say I add 500 calories of activity to my day. Using the handy-dandy chart below (also from the Mayo Clinic), I find have to walk for 1 hour and 45 minutes in order to burn 533 calories.

I am now at a caloric deficit of (at least) 1000 calories/day, which according to the super-duper magical 3500 calories = 1 pound of fat formula (Zoe Harcome explores the rigorous scientifically-proven assumptions behind the formula here) means I lose about 2 pounds a week. Not that this would always happen in real life, but okay, fine. Flash forward 5 months, I’m down 40 pounds. I now weigh 200 pounds.  At 200 pounds I am no longer OBESE, I’m just OVERWEIGHT, but I still have more weight to lose. Because my body is naturally going to “require less calories [sic]” because it is a “smaller vessel,” it is time to recalculate my energy needs.  To the Mayo Clinic calculator, Boy Wonder!

(What happened in my own real life when I dieted and exercised my way from 215 pounds to about 185 is that, not only did my weight loss stall, but I started to regain lost weight. Or at least, that’s what would have been happening to me if I hadn’t been lying about it to myself and my hunger and exhaustion weren’t complete figments of my feeble imagination, while in reality I stuffed my face with HoHos and laid around on the couch watching The Young and the Restless).

According to the “smaller vessel” theory, I should require fewer calories, but if I fill out the calculator–WTF??– I end up with more?

I weigh 40 pounds less, and I get to eat 200 more calories/day? I don’t get it, but the Mayo Clinic is a trusted source and I’m just a newbie, so on we go. I subtract my 500 calories/day so I can lose weight, now I am eating:  1550 calories/day

Okay, 1550 calories/day is not a lot, but it’s more than 1350 calories/day I was eating before.* I’m not sure why this is, but I’ll take it, because–even though I am a “smaller vessel”–clearly there must be some calorie magic at work. But while I may be able to eat (a little) more, on the other hand, now I have to exercise even more because my ability to burn calories has decreased (see chart below). Now I have to walk for 2 full hours each day in order to get my 500 calories out.

Following the magic 3500 calories calculation that exists in our magical perfect world, we can flash forward another 5 months. I now weigh 160 pounds, my goal weight. I am now no longer OBESE or even OVERWEIGHT, but thankfully, NORMAL.

But, being NORMAL, I am also now an even smaller “smaller vessel,” and because “the body will lower non exercise energy expenditure (general fidgeting, moving around etc),” it’s time to recalculate. This is really scary because if I could only eat 1850 calories/day as an inactive OBESE 240-pounder, will I even be allowed to eat at all now that I weigh 160 pounds?  Will I have to exercise half the day away in order to be able to “afford” the calories in a low-fat bran muffin?

Oh, I can hardly stand the–wait! Hmmm. Now hold on just a hot second here.

I can see by the calculator that at 160 pounds, I could be inactive and eat 1800 calories/day.

OH THANK YOU CHEESESAUCE!

Because I’ve been eating 1550 calories a day and walking for 2 hours every day, and I am FREAKIN TIRED AND HUNGRY and sick of spending 14 hours a week walking around and getting nowhere.

According to the magic of “calories in, calories out,” I can now eat (even) MORE and move (a lot) LESS and I will NOT gain weight. No matter what I eat–as long as I consume no more than 1800 calories/day, I can sit on my (now slender) ass all day long and never gain an ounce.

HOORAY for CALORIES!!!!

P.S. If you are by any chance wondering why an OBESE inactive female who weighs 240 pounds is only supposed to be eating 50 calories more a day (a 7.7 calorie/pound allotment) than a NORMAL weight inactive female who weighs 80 pounds less (an 11.3 calorie/pound allotment), that’s because NORMAL weight people are more honest and virtuous than OBESE people and therefore deserve more calories per pound body weight.

P.P.S. Dear Adam the Second should you happen by to read this. Not trying to pick a fight. Just trying to illustrate how the calories in-calories out principle–put to work in a real-life example–may be an overly simplistic (if not downright illogical) approach to weight loss for some folks. Hey, if it works for you & your buddies, great! But it doesn’t work for everyone, and the use of this paradigm as the foundation for public health nutrition practice has changed how we think about eating in ways that I would argue have done more harm than good.

P.P. P.S. For more snarkily outraged, or outrageously snarky, commentary on calories, try these calorie-free nuggets of wiseassedness:

Why Calories Count Fo’Shizzle

Calories in, calories out, Would You Please Go Now?

Calories? Again? Already?

*This is where calories in-calories out folks sometimes like to say “But you may have needed more calories.  If you cut your calories too much [whatever that means], you’ll crash your metabolism.” I don’t know. They may be right. But that’s not how the calories paradigm works. There are no “metabolism crashing” exceptions on the Mayo Clinic calculator.