Will the real Dietary Guidelines please stand up?

I don’t say this very often (or ever).  I was wrong.  I think.

Here I’ve been laboring under the assumption that the 2015 Dietary Guidelines tell the American public to eat a diet lower in fat (because we eat “too much” of it now) and higher in carbohydrate (especially from whole grains like whole wheat–because we don’t eat “enough” of those now), to eat less salt, and to “eat as little dietary cholesterol as possible.” But according to a document recently released from a source at the Center for Nutrition Policy and Promotion (CNPP) that isn’t what the Guidelines say.  Or at least not exactly. Maybe.

The good folks at CNPP were asked to respond to Kris Gunnar’s list of  “20 Mainstream Nutrition Myths (Debunked by Science)”  with the idea being that the Guidelines are about as “mainstream” as nutrition advice gets.  The hope was that, if the good folks at CNPP could explain why their advice is ostensibly “backed by science” and yet is “debunked by science,” we would all sleep a little better at night, even if we still insisted on eating bacon and eggs in the morning.

The good folks at CNPP rose to the challenge and cleared things right up.  But, to quote the inimitable if soporific Crosby, Stills and Nash, “just beneath the surface of the mud, there’s more mud.  Surprise.”

Below, I’ve restated their responses as dietary guidance arranged in an order that I found amusing.  The number of the corresponding “Myth” from Kris Gunnars is given as well, so that those of you with split screens or dual monitors can play along at home.

According to the good folks at CNPP, the 2015 Dietary Guidelines for Americans:

  • do not recommend Americans eat a diet low in total fats or high in carbohydrates, particularly from grains. (Myth 1)
  • do not encourage eating low-fat foods. (Myth 12)
  • do not suggest avoiding saturated fat.(Myth 16)1
  • do not say saturated fat raises LDL cholesterol. (Myth 6)2
  • do not suggest Americans should avoid egg yolks, nor do they suggest that dietary cholesterol is linked to heart disease. (Myth 4)3
  • do not suggest eating red meat raises risk of disease. (Myth 13)4
  • do not say seed and vegetable oils lower cholesterol levels. (Myth 20)5
  • do not recommend the population restrict sodium intake (Myth 2)6
  • acknowledge there may be more to weight management and diet-related diseases than calories in-calories out. (Myth 15) 7
  • do not state sugar is harmful. (Myth 19)8

I know what you’re thinking.   Adele’s mind has finally blown a gasket from reading all those big words they have in grad school.  I’m not going to argue that point, but you can check the CNPP’s response for yourself right here.

This response also acknowledges that current scientific evidence regarding the reduction of full-fat dairy is contradictory (Myth 10) and that a variety of eating patterns can produce weight loss (Myth 8).  It also says that  3-5 cups of coffee a day can be part of a healthy diet (Myth 7)–hallafreakinlujah– but whole wheat products?  Meh (Myth 5).

I can see the helpful public health messages now:

You should not avoid egg yolks, but you should eat as little dietary cholesterol as possible, even though dietary cholesterol consumption is not linked to heart disease.

You don’t need to choose low-fat foods, just choose fat-free or low-fat milk, yogurt, and cheese even though it might not actually help you avoid chronic disease .

You should shift to lower sodium consumption without restricting your intake of sodium.

What’s going on here?

Good question.  Perhaps the good folks at CNPP didn’t actually read the Dietary Guidelines this time around.  Who, except for me, has that kind of time?  Or maybe they had a hard time finding them. Once you get to the health.gov/dietaryguidelines/ site, you have to click through 3 menus or links before you get to the actual guidelines (try it), which are a swarm of footnotes and “see more” hyperlinks.  Even Marion Nestle complained about how hard all those “annoying drop-down boxes” are to navigate.  It’s possible the good folks at CNPP just assumed that the other good folks over at DHHS–responsible for Guidelines online labyrinth–were paying attention so they didn’t have to.

Or maybe it means that it’s actually really hard to get words to say what you want them to say without them saying other things that you don’t want them to say.  And this is especially difficult when you are asked to make sweeping recommendations based on a weak scientific evidence base that both supports and contradicts past guidance, which you can’t contradict even when you can’t support it, because, then what?

No wonder the good folks at CNPP are having a hard time getting their story straight.

To tell the truth, I have a lot of sympathy for the message-makers there at the USDA.  We created the Dietary Guidelines 35 years ago assuming zero potential negative consequences.  True, the scientific evidence didn’t strongly support the recommendations, but whatever.  Whether they followed the recommendations or not, hey, the health trajectory of Americans couldn’t get any worse, could it?  We knew the Guidelines would significantly impact the food industry, but that could only be a good thing, right?  And we meant for Guidelines to set the direction for nutrition research, but since science is only about facts and never about politics or funding, any errors or biases in our original rationale would be quickly discovered and corrected, no?

Now it seems pretty clear that we might have spent a little more time thinking through the whole “Let’s make sweeping dietary recommendations that are meant to apply to every single American alive over the age of 2 as a method of preventing every single major chronic disease known to humankind “ thing before shrugging our shoulders and saying “Oh, no worries.  It will all work out.”  Now the folks at the USDA have used up their wishes and are left trying to stuff the genie back in the bottle with nothing but semantics and poor website design.

Will the real Dietary Guidelines please stand up?

If only they had a leg to stand on.

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

 

 

1.  They just want you to reduce your intake of saturated fat without actually avoiding it.

2. They do recommend limiting saturated fats based on the notion that somehow this will reduce risk of heart disease. But let’s leave LDL cholesterol levels out of this. What did they ever do to you?

3.  But Americans still should eat as little dietary cholesterol as possible, just fyi.

4.  Eating red meat does not raise risk of disease, but not eating red meat lowers it. Um.  Weird, right?

5.  But you should eat vegetable oils instead of animal fats, because, well, because.

6. They do want you to shift to lower sodium consumption, just not by restricting your intake.

7.  Although they remain singularly obsessed with calories in and out, there’s apparently no need for you to be.

8.  But you shouldn’t eat very much of it anyway, because, well, because.

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37 thoughts on “Will the real Dietary Guidelines please stand up?

  1. Hi Adele,

    The dietary guidelines is not a guide at all. Its full of ambiguous and equivocal rules that serves only to confuse those who wants to follow its advice.

    The guidelines serves to defend itself using its equivocal tone.

    1. I agree. Case in point is that so many of the nutrition cognoscenti–from Walter Willett to Nina Teicholz–declared that the 2015 DGA removed the cap on dietary fat, so that calories from fat in the diet are no longer restricted. This is not the case, but it took a couple of emails to HHS/USDA to get them to actually say so in plain language. Maybe another blog post on that soon …

  2. Ever hopeful, I listened to the NAM’s first meeting on the DGA procedures. I came away a little depressed as the amount of work still needed sank in. (And, yes that bureaucratic Moebius strip was followed to a large degree.) But for some reason, I thought of your spoken comments to the DGAC last year. So, I listened to it again on You Tube and I was smiling again. Thanks.

    1. Thanks so much for this! As I head into the final stretch before my written exams and (to borrow your words) as the amount of work still needed for me to finish my PhD sank in, your comment totally made my day! Despite my current sense of being overwhelmed, I am working a letter to the NAM committee, in an ever-hopeful-but-likely-futile effort to get them to think about the broader (and specifically ethical) implications of these guidelines.

      1. FYI. The NAM meeting webpage now has links to the audio and presentations of the first meeting. I actually found some of the questions by the panelist to offer some hope that the review will be productive and not just a rubber stamp. I need to listen to the meeting again before I submit any comments.

        http://www.nationalacademies.org/hmd/Activities/Nutrition/DietaryGuidelinesforAmericans/2016-SEP-01.aspx

        the links are on the upper right under “Other Meeting Resources”

        1. Thanks again–exams at the end of this week … It actually sounds a little sad to say that when my exams are done (whew!) I’m going to celebrate by listening to a NAM meeting on dietary guidelines process reform.

  3. The National Academy of Medicine is about to appoint a slew of calories in, calories out people to review the science behind the 2015 Dietary Guidelines. See: http://www.nutrition-coalition.org/stop-the-national-academy-of-medicine-from-stacking-the-panel-on-dietary-guidelines-with-government-insiders/

    Where is everyone? Why are the American LCHF gurus not sounding the alarm? Do you guys not remember how we even got the US Congress to spend a million dollars to investigate the USDA’s Dietary Guidelines? Congress members don’t know how our money is being spent. We need to tell them.

    Short story about my Easter ham. Tyler Jones learned to farm by being an intern at Polyface Farm with Joel Salatin. One year Tyler’s Easter hams were confiscated by the USDA. (The reason was due to some miscommunication between the new USDA inspector and the previous one.) As it happened, Joel Saladin gave a talk where I lived and I got to ask him how best to get my ham back and the rest of Tyler’s hams. He said call and write your Congress person. I did that. Sure enough it took only a few weeks and we got all of the hams back.

    Every American LCHF eater should be writing NAM and their Congresspeople. Why is not every American blogger on the Diet Doctor page not commenting and rallying the troops?

      1. No, well, not until I got your comment. So thanks!!! I am registered now. I’m smack in the middle of prepping for written exams (in about 2 weeks), so I’ve got zero bandwidth right now, but hopefully I can catch at least part of it.

  4. There are a lot wrong with the DGA. As you probably know, there is a Congress mandated NAM review of the DGA process which will hopefully improve the credibility of the 2020 DGA. The NAM review has not been widely publicized, so your readers may not know that the review has finally started, with this post on the NAM website on 8/8/16,
    http://www.nationalacademies.org/hmd/Activities/Nutrition/DietaryGuidelinesforAmericans.aspx

    It names the members of the committee that will review the DGA process and asks for comments on member selection, due by 8/28/16. I have followed your criticism of the DGA and I share your sentiment. I would appreciate any comments that you have on the NAM review.

    1. Thanks so much for sharing this. I am wallowing in pre-exam reading, so this update is much appreciated.

      At first glance, the committee seems to not be full of the typical sort of in-breeding seen on most DGA advisory committees. Of note is the choice of Joanne Lupton, who was not only open-minded enough to join the scientific advisory board of Nina Teicholz’s Nutrition Coalition, but open-minded enough to depart the board when Teicholz’s BMJ article made it clear that, despite the Coalition’s call for nutrition policy “founded upon a comprehensive body of conclusive science,” the group may have some preconceived notions of its own about what constitutes “a healthy diet.”

      I am disappointed that there seems to be a very limited representation of clinicians on this committee; most seem to be academics. I understand that they are to review the “process” behind the policy-making, but perhaps a stronger clinical perspective would make it obvious that the very notion of a one-size-fits-all dietary prescription for the prevention of chronic disease is an outdated (as well as scientifically unsupported) concept. What we have here, it seems to me, is a heroic effort to determine how to put together inadequate evidence in the best possible way. Admirable, but futile.

    1. It didn’t come from the USDA/CNPP website. It came from personal correspondence. I was privileged to be in the email loop, although I did not initiate the conversation, nor was the document generated at my request. I’d be willing to share additional details if you contact me directly: firstname [dot] lastname [at] gmail [dot] com

  5. I read this as carefully as I could, and I believe you have made one mistake here, and I thought I should point it out for you in case, you know, Dr. Willett or somebody comes after you: CSN are not soporific.

    1. LOL. I think my husband made me write that. Sadly, it’s getting to the point where I’m no fun anymore 😉

  6. The fact that the debate around the dietary guidelines seems to have devolved into one of definitions (is recommending 20% fat the same as recommending low fat?) and a narrowing down of who said what, when, reminds me of this post I read yesterday.

    http://www.iayork.com/MysteryRays/2015/07/19/definitions-of-evolution/

    “The legal department at Chrysler may well be deeply interested in the definition of “automobile. Meanwhile, down in the engineering department, the people who are actually contributing to the world instead of trying to distort and profit from it aren’t interested at all.”

    Is CNPP the legal department of the USDA?
    More to the point, are they preparing for a lawsuit?

    1. Excellent questions 🙂 How close is a “communications” department to a legal department?

      And while I don’t think they are necessarily preparing for a lawsuit, I do think they are trying to back very slowly out of the “mistakes were made” room.

  7. Thank you for that. I thought I was going mad, but you saved me in the end. I wonder how we will ever convince people to trust nutritional science again.

    1. Actually I think a lot of people have wised up and are voting with their dollars. Butter sales are up, cereal and soda pop sales down. But I suspect he USDuh has no idea American’s still have functioning brains. On the other hand, it is likely that some of these guideliners are quite aware that they are merely going through the motions-all pays the same.

      1. The problem is that the Guidelines affect a lot more than individual dietary choices–and there are also a lot of individuals who are stuck with DGA-directed policies who might benefit from other choices. I’m thinking particularly of the young (very pregnant) woman in front of me one day at my local farmers market egg stand. She had some WIC coupons that she could use at the farmers market, but they were only for produce so she walked away empty handed. I saw her later with a big bag full of corn–a delicious choice for an NC summertime treat, but she and baby probably could have used the protein (and choline and fat-soluble vitamins) in those eggs.

        1. My god, you’re absolutely right. Profound effects on so many without choices. It is a measure of a society how they treat the children, and the mothers, and I think we don’t even rate a D-. And I’ll never forget seeing the garbage cans in our school lunchroom filled with full cartons of tasteless CAFO low-fat milk that the kids wouldn’t drink, and seeing a stream of white liquid flowing under the fence that enclosed the dumpsters. It is illegal in California to serve full-fat milk in public schools, if you can believe that.

          1. Sadly, it is entirely too easy to believe that. They don’t serve whole milk here in NC either. My son, who could have used the calories & actually really likes milk–if it’s whole milk–refused to drink the low-fat/fat-free stuff sold at school.

            1. It’s the same way in CT. You can get skim or low fat milk or skim chocolate milk, but not full fat milk. My oldest daughter liked to get the pizza and chocolate milk once every two weeks, but we made that an even rarer treat. I personally have a hard time with wheat (causes allergies, chest congestion, many problems), and the entire family has a problem with carbs. For instance, we can “regulate” our oldest daughter’s weight simply by getting her to eat more meat, eggs, and fat and fewer carbs. If we think she’s gaining weight, we just switch her off carbs and she loses it. (And she’s incredibly active: dance, soccer, walking club, etc.; I don’t think she could exercise more if she tried; we certainly couldn’t drive her to any additional after-school activities.) The problem is that low fat and high sugar are everywhere, especially in schools where we can’t control it. If the school has a function, for instance, it’s based around pizza and/or crap food. You can’t serve high fat products, but can serve all the low fat crap you want to serve.

    2. I’m not sure that we should. I’m trying to figure out–actually writing a paper about it now–why we trusted this kind of guidance in the first place.

  8. Do you happen to know the 1976 cartoon “Asterix Conquers Rome” by Uderzo & Goscinny?

    One of the “12 tasks” is to get hold of a certain document in “The Place That Sends You Mad” (a bureaucratic abomination, maybe like the IRS). I see lots of parallels!

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