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?
27 thoughts on “What if there were no Dietary Guidelines?”
I’ve just discovered your blog – lots of interesting food for thought! What do you think the role of drug treatment (especially statins) has had in the reduction of serum cholesterol, hypertension and heart disease mortatlity? I would think that has to be a factor that has to be considered. I am a RD in a long-term acute care hospital and see that the vast majority of patients admitted are on statin therapy – even the 90 yr olds.
Reductions in serum cholesterol and hypertension are supposedly independent of medication use. My guess is that they track very closely with reductions in smoking as does heart disease mortality. In fact, according to Walter Willett himself, circa 1999, our efforts at prevention of heart disease have been a failure: “If there had been a true decline in incidence–we know that a number of treatments have improved over time, there–we should have seen an acceleration in the rate of decline if there were a true decline in incidence.” But we didn’t.
I think the biggest issue with statin use is that it may very well address the serum markers that we use to identify CVD risk, but–particularly for low-risk patients–we don’t have nearly enough information about what else may be adversely affected. Statin manufacturers have been less than willing to share their data openly, as the recent dust-up in the BMJ between Rory Collins and John Abramson demonstrates.
FINALLY someone has said it! FINALLY someone has the guts to say it! FINALLY someone is standing up to the government central planners who co-opted control of nutritional science decades ago and destroyed our public’s health. FINALLY someone has put into words the command to throw the bums “out altogether.”
You cannot make a silk purse out of a sow’s ear; you cannot make truth out of pseudoscience. That the Dietary Guidelines for Americans were based on bastard epidemiology and fostered by fraud was well document by Taubes in Good Calories, Bad Calories almost a decade ago and now by Teicholz in The Big Fat Surprise.
We assumed that with Taubes, the deadly public experiment would finally meet its demise, but enthusiasm for the effort gradually diminished. Now Teicholz has revived the eagerness for righting the grievous wrong. Will the Teicholz’ fervor slowly fade away like that of Taubes? How many more times must our noses must be rubbed in the mierda?
The only way for the enthusiasm engendered by GCBC and BFS to produce the mandatory result of elimination of government control of nutritional science is to arouse public ire and create an active and vocal rebellion. Remember the anti-smoking campaign??? Taubes and Teicholz and bloggers Adele and Amy have done their job, but the public sits back and just says, “Yes, yes.” Who is to lead the charge???
We no longer have an independent and competent Surgeon General who is free from political manipulation. The success of the mid-1960s antismoking campaign in changing legislation, the economy, and improving the health of millions of Americans was due to the public and political storm created by Surgeon General Luther Terry’s landmark report on smoking and health. The antismoking campaign was a major public health success with few parallels in the history of public health (1, p.258).
Any well known and respected scientist in biological sciences could lead a successful campaign to remove nutritional science from government jurisdiction, but at what price. The story of the emasculation of the Surgeon General (1, p.257) plus the tales from Taubes and Teicholz would be sufficient to dissuade even the most dedicated and devoted public servant from undertaking such a project. The public MUST rise up and protect itself. We cannot wait!
Wow. Thanks for the response. The key to what I see happening is here: “You cannot make a silk purse out of a sow’s ear.” So far, calls for reform have been about making a really bad idea a better one by rearranging the deck chairs on the Titanic. But even Guidelines that are better grounded in biochemistry are still top-down, one-size-fits-all, remotely administered “food rules” that will always find their audience with food manufacturers first, and with the public afterwards. As long as the Guidelines say “don’t eat this,” food manufacturers will be there to provide the public with a way of not eating “this” (whatever it is–fat, cholesterol, or carbs), by creating foods that replace “this” with something else. Enough already.
Alice and Fred, Wow, indeed. I love the passion of this comment. It’s all too easy for us to forget that people are being harmed all day, every day, by bad nutrition advice.
Perhaps the Dietary Guidelines should at least have black box warnings like those on prescription drugs. Something warning everyone of the adverse effects, like weight gain, dry skin, bloating, unnatural hunger, and the list goes on.
Adele and Kenny, thank you so much for your wisdom. Let us add another maxim or two. We are sure you can add more.
1. There is NO drug that can cure a nutritional disease!
2. Disease is the absence of healing (the human body is the most marvelous creation
imaginable; it self-heals IF given the proper food) Bless your great work and drive to attain
Good article, Adelle, This paragraph is important. “…the DGA are far more than health prescriptions that Americans do or do not follow. They are a powerful political document, and they regulate a vast array of federal programs and services, influence health-related research, and direct how food manufacturers respond to consumer demand. Virtually no aspect of our food environment is unaffected by the DGA.”
Arguably, the worst aspect of the DGA is the advice to replace saturated fats with polyunsaturated oils. But that advice originated with a 1961 American Heart Association (AHA) advisory.
Ironically, while health agencies and health promotion organizations continue to advise Americans to replace saturated fats with polyunsaturates, the edible oils industry is quietly reducing the omega-6 linoleic acid content of the food supply. High oleic acid versions of soybean oil, corn oil, canola oil, peanut oil, sunflower oil, and safflower oil are increasingly available to food manufacturers, restaurants, and consumers. As the omega-6 content of the food supply drops, we’ll likely see a noticeable improvement in the public health.
Which is why I think we need to turn our attention to the food supply and quit trying to micromanage every American’s diet.
Thanks for the kind words–and I agree, the most important aspects of the DGA are the ones we seldom talk about, how they have changed our food environment, and even how we think about food.
Adele, I really enjoyed this piece. Really well done fitting so many important points into a short article.
At the end you wonder if we’d start eating better. I think if the DGA disappeared we’d first exhale, relax, binge out for a while, feel terrible, then heuristically learn how to eat what works for each of us.
Since you are a “recovering-almost-epidemiologist” I thought you might be interested in this Twitter dustup last summer. Your piece reminded me of it. It started when Dr. Alice Roberts, one of my favorite science presenters in the UK, wrote a personal piece in The Guardian newspaper about her experiences (side effects) with the pill versus the accepted evidence base.
Dr. Alice wrote the single greatest Tweet I’ve ever seen encapsulating my feelings about epidemiology vs real life.
If you want to see the context, and when the epidemiologists attack, see the Twitter conversations:
Fascinating conversation, and yes, individuals are individuals, not aggregates or averages.
I deliberately used the word “better” at the end, because I think that stepping away from the “good food” vs. “bad food” paradigm is the beginning of restoring food-health relationships. And after that, there’s Kenny’s app–which everyone should check out and support!
Thanks. You say near the end of the article: “Finally, the DGA assert that science has unquestionably established links between diet and chronic disease. It hasn’t”
I pulled the following clip out of the first DGAC 2015 meeting. McGinnis, one of the architects of the original 1980 DGA, admits they didn’t have the science base, and moved forward anyway, calling them guidelines instead of goals. Wow! Only in nutrition science….
And we still don’t have the science base!
OMG, that is too wonderful that he says that! I can’t thank you enough for that find. One of the things that I’m doing research on is exactly this: although we didn’t really have an answer, we had to provide some food rules anyway (or in the case of Marc Lalonde’s 1974 report, general behavior rules). What allowed this sort of perspective? And more, what is so interesting is this sort of “confession” that we don’t really have the answer, but that there is nevertheless an overriding imperative that we provide one anyway. What compels that confession? Crazy, wonderful stuff.
Loved the article. Thought provoking. I’m on board with you. Be gone with the guidelines. Their system is so corrupt!
Which is what makes them REALLY bad policy. The science is weak, they are not adhering to their legal mandate, the process is not transparent nor does it meaningfully engage the public (despite what USDA/DHHS say), and there’s no evaluation process–all of that is bad policy. But TERRIBLE policy is when all of that is true AND they don’t do what they say they are going to do, which is improve the health of the public.
Thanks for the kind words. I’m so glad you enjoyed the article. I’m honing my ranting skills to a fine point.
This is what struck me the most: ‘From the beginning, the DGA created clear “winners” and “losers” in our food system.’ And THIS: ‘the DGA’s list of “good” and “bad” foods implies chronic disease is entirely under the control of the consumer.’
Every time you write an article or a blog post, I feel like my brain is exploding with new (to me) perspectives on the context in which the DGA exist, their political ramifications, their faulty science…
I am SO going to eat a chair now.
Great post! Hang in there in your studies!
Thanks! The workload is killing me but the stuff I’m learning is amazingly relevant to understanding how the Dietary Guidelines “work” in America. The big light bulb moment for me–for which I have a number of professors to thank–was the realization that this is not just about whether or not people “follow” the Dietary Guidelines, but how their existence has affected our ways of thinking about ourselves. Dissertation here I come!!!
Thought-provoking piece Adele.
I agree the guidelines are restricting our ambitions in important areas of public health, namely research and funding.
Unfortunatrly the guidelines here in Australia are much the same as the US.
Thanks for your time writing all these Great articles.
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I have a FB friend Down Under (hi Stewie!) who keeps me up to date with all the nutrition politics going on there. Whew! It’s a little crazy, isn’t it? The Catalyst shows and that paleo chef? It may be the sound of paradigms shifting, perhaps.
Things have certainly escalated quickly down here, you’re right!
What do you say to those who quote stats saying that only 5% (or some other small number) actually follow the guidelines, and therefore guidelines cannot be held accountable for health outcomes?
Although my knowledge is strictly limited to the U.S., there are a number of ways to think about that. Take your pick:
1) Public health nutrition experts point to the fact that deaths from heart disease have declined since 1980 as an indication that Americans have followed their advice and switched to a “healthier” diet. (Public health nutrition experts also point to the skyrocketing rates of obesity and diabetes as evidence that Americans have not followed their advice. What this tells me is that public health nutrition experts want to credit the Guidelines for positive outcomes and blame the public for negative ones. Which tells me we should stop listening to them.)
2) If, after 35 years of Dietary Guidelines, Americans still don’t follow them, then they are a failed policy and should be abandoned for something Americans can/will follow–or just abandoned.
3) All available data (food supply/disappearance data, as well as reported intake 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 the Guidelines exactly as public health experts intend does not absolve these experts from ensuring that the dietary guidance provided to Americans first and foremost does no harm.Here’s some food supply data that show we have certainly shifted our diets in the direction of the guidance we’ve been given.
4) There’s a way of thinking about the guidance given to participants in clinical trials called “intention to treat.” In an intention-to-treat framework, you are addressing “the public health question of what happens when a recommendation is made to the general public and the public decides how to implement it,” apart from whether or not the recommended intervention works under controlled circumstances. When you look at the Guidelines from this framework, it is difficult to argue that they have–overall–improved the health of Americans.
5) The Dietary Guidelines are implemented through the food industry, and many choices about what we would like in our food have been made for us before we enter the grocery story. Food supply data reflect this.
It doesn’t matter whether the Guidelines don’t work because we haven’t followed them, or they don’t work because we have. Either way, they don’t work.
Many, many thanks for sending us this. We are very anxious to read it (we KNOW it will be good) and reply. God Bless you, Adele, for your time and dedication.
I do hope you enjoy it. It’s been a tough idea for me to consider seriously (all that dietetics training), but the worse the Guidelines get, the more reasonable it seems to get rid of them altogether.
Well done, Adele!
Thanks so much. It was fun to write 🙂