I’ve been meaning to blog about this for a while now, but as always: grad school. However, today in my inbox appeared a call to sign a petition sponsored by the Nutrition Coalition to have federal dietary guidance based on sound scientific evidence. Now, I’m all for that–assuming of course, we could agree on what we mean by “sound” and by “scientific” and by “evidence” in the area of nutrition and chronic disease relationships.
Much to my surprise, the first reform that is called for is “to let Americans know that the low-fat diet is no longer officially recommended.” This part makes sense, although it’s kind of old news (see below). The Dietary Guidelines for Americans (affectionately known as the DGA) haven’t recommended a “low-fat” diet since 1995.
But the petition goes on to say that “the DGA have quietly dropped previous limits on total fat.” So what’s my problem?
Walter Willett and Frank Hu say the limits on fat are gone.
Nina Teicholz says the limits on fat are gone.
Great minds think alike, right? Those pesky limits must be gone.
Inconveniently, the folks at the USDA and HHS say this:
An upper limit on total fat intake was not removed from the DGA.
I am less concerned about whether or not the upper limits on fat are officially gone (they aren’t), and more interested in why parties as diverse in their perspectives on diet as the dudes at Harvard and the dudettes at Nutrition Coalition would both agree that they are (when they aren’t). I mean we’re talking about folks who know more than a little about nutrition and policy, and they can’t seem to figure out what the DGA actually say.
Could it be that the USDA and HHS are attempting to rhetorically distance themselves from limits on fat without the policy implications that come with making that official? They’re willing to date the “no more low fat” thinking, but don’t want to put a ring on it?
After all, whether or not you think people followed low-fat guidance, or didn’t follow low-fat guidance, or we can’t tell one way or the other because everybody lies about what they eat anyway, using the authority of the federal government to prescribe a single dietary pattern to everyone over the age of two in the hopes of reducing the risk of every single chronic disease known to mankind–including obesity, which wasn’t even a disease until we made it one–simply did not work out the way we thought it would.
I’m not arguing here about whether or not a low-fat diet is a problem (I suspect it is for a lot of folks and not so much for others), but it seems low-fat dietary guidance is.
The folks who write the DGA seem to have recognized this issue 17 years ago. In 1995, the guidance on fat in the DGA said “Choose a diet low in fat,” and specifically, to limit total fat intake to 30% of calories. But then this happened:
- In 2000, the DGA said, “Choose a diet that is moderate in total fat.” But. The limit on total fat intake remained exactly the same: 30% of calories. So rhetorically, no more low-fat diet; materially, same old, same old.
- In 2005, both the “low fat” and “moderate fat” language are avoided. In the meantime, the total fat intake limit is, quietly, raised, to 35% of calories. Maybe they thought if they shifted the limit on total fat without actually saying anything about it, no one would notice. And, it seems, pretty much no one did.
- In 2010, the range for fat intake remains the same as in 2005: 20-35% of calories.
- In 2015, nothing changes. The range for fat intake is between 20-35% of calories for adults, 25-35% for people younger than 18 years old.
In other words, it does look like the DGA have slowly been modifying–without completely relinquishing–their call for Americans not to eat a lot of fat. At the same time, language in the DGA–and in my correspondence with the USDA/HHS–makes it sound like the fat limits aren’t their fault. They are just following (reinforcing, supporting, and promoting as policy) the limits set by the National Academies.
Which may explain why it did take some persistence on my part to get this info from the government. (If a PhD program has taught me nothing else, it has taught me persistence.)
In my first email, I asked what I thought was a pretty straightforward question:
In the 2015 DGA policy document, is there a recommended limit on the percentage of calories in the diet that should come from fat, and if so, what is it?
I got this response:
Thank you for your email. The 2015-2020 Dietary Guidelines for Americans recommends following a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. Key Recommendations describe the components of a healthy eating pattern and highlight components to limit. Additionally, supporting text acknowledges that healthy eating patterns should be within the Acceptable Macronutrient Distribution Ranges (AMDRs) for protein, carbohydrates, and total fats. For example, page 35 of the PDF states that “healthy eating patterns can be flexible with respect to the intake of carbohydrate, protein, and fat within the context of the AMDR,” and Table A3-1, which outlines the Healthy U.S.-Style Eating Pattern, one example of a healthy eating pattern, states that “calories from protein, carbohydrate, and total fats should be within the AMDRs.”
In other words, wtf?
I tried again:
Thank you so much for your reply. But I’m not sure it answers my question in that the information that you point to seems to have been interpreted different ways.
The heading for the table which references the AMDR in the DGA document says this: “Daily Nutritional Goals for Age-Sex Groups Based on Dietary Reference Intakes and Dietary Guidelines Recommendations.” Beneath that it indicates that, except for children under the age of three, total dietary fat should be limited to no more than 35% of calories. This, to me, sounds like a limit on total fat calories as as part of the official policy document that is the DGA.
But, the parts of the text you reference that point to the AMDR seem to have been interpreted by others as the AMDR recommending one thing, while the DGA recommend something else.
Dr. Frank Hu has said about the 2015-2020 DGA that, “Another important positive change is the removal of an upper limit for total dietary fat …” Dr. Walter Willett has said, “The 2016 Dietary Guidelines are improved in some important ways, especially the removal of the restriction on percentage of calories from total fat …”
So, to put it quite simply, have the upper limits on percentage of calories from total fat been removed? Would it be possible to get an official “yes” or “no” answer to that question?
And this is what I got back:
Thank you for your email. The 2015-2020 DGAs recommends total fat intake within the AMDRs. As you know, the AMDRs are set by the Health and Medicine Division (formerly the Institute of Medicine), not through the Dietary Guidelines process.
An upper limit on total fat intake was not removed from the DGA.
The AMDR for total fats for adults is 20-35% of total kcal.
So, long story long: Have the “official” upper limits on total fat intake been lifted? No.
Do the officials in charge of the “official” limits want to come right out and say this? Um, well, uh … hmmm … perhaps maybe not in so many words.
And every 5 years. There are. So. Many. More. Words.
Speaking strictly in terms of association, we could say that the number of words in the Dietary Guidelines are directly and strongly related to increases in rates of obesity.
Maybe the problem isn’t the fat that is or is not in the diet. Maybe the problem is the words about fat that are–or are not, depending on your version of reality–in the guidelines.
And if you’ve made it this far and are interested in still more words on nutrition and rhetoric, I’ve had the pleasure of getting to chat with a number of different folks about my studies and where they are taking me. If you want to know what I’m reading, writing, and thinking about in that never-ending PhD program I’m in, here it is:
Diana Rogers at Sustainable Dish: We do a deep dive into social and political history behind the Dietary Guidelines, the price of meat in the 1970s, and how Diet for a Small Planet is not a low-fat cookbook. Tune in and you can hear me talk about the “dietary imaginary” and how we’ve lost the ability to think for ourselves about food.
Peter Defty at Optimal Fat Burning: We chat about the Dietary Guidelines, calories, and changing body size norms. Tune in and you can hear me talk about how a post-menopausal body can turn even the best diet into body fat and a bad attitude.
Laura and Kelsey at The Ancestral RDs: We talk about ethical problems associated with the Dietary Guidelines and how a feisty little start-up in Canada is working to make them irrelevant.
Speaking of that feisty little start-up in Canada, Approach Analytics, here’s some more about them and their work to “democratize the nutrition knowledge-making process.”
Please join me at AHS 2017, where–surprise–I’ll just keep on talking! I’m looking forward to discussing the ideas behind democratizing nutrition knowledge-making and more about how “n of 1” nutritional approaches, together with the power of population-based information, can sidestep an information-gathering system that serves to maintain the status of mainstream dietary guidance, but does little to help the public.
Finally, if you missed AHS 2016 and you haven’t heard me yammer on enough about the 2015 Dietary Guidelines, now’s your chance. Pull this up on YouTube and you’ll get see me do a couple of different versions of happy dance.
Eathropology 
And already the dogma strikes back.
http://www.medscape.com/viewarticle/881689
(still psyching myself up to read the actual article). When David “where’s my cheque?” Katz is involved you know it isn’t going to end well. Some of the responses are deliciously acerbic.
I had to repost this one. It’s priceless:
From : Dr. robin tager
http://www.medscape.com/viewarticle/881576
On the 14th of June 2017 we read that high LDL is neuroprotective in men. We also know that the incidence of Parkinson’s has increased dramatically in men over the last 30 years – roughly the same period over which the consumption of saturated fat decreased and statin use increased.
On the 15th of June, once again, we read that the AHA is trying to push their low saturated fat and statin agenda.
Also on the 14th of June we read on medscape (published in Lancet 13 June) about the marked increase in risk of haemorrhagic stroke in older patients on aspirin for secondary prevention. The well documented inverse correlation between LDL and risk of haemorrhagic stroke is beyond dispute.
Well, a conspiracy theorist could be forgiven for thinking that perhaps the AHA is trying to destroy people’s brains so that we have no way of understanding what nonsense this is that they are proposing.
However, it would be unforgivable for a medical doctor (with his faculty of logic intact) concerned about the wellbeing of his patients to be expected to accept this nonsense.
Is it just that cardiologists are so arrogant that they don’t care about the effects of their advice on other organs and the general well being of people? As long as the patient doesn’t have an MI the cardiologists job is done – so let’s lower the patients LDL which dramatically increases the risk of a haemorrhagic stroke and then just for good measure let’s add a little Aspirin? Unbelievable. Oh, and then just to protect those same patients against a GI bleed, let’s put them all on PPIs (and not say a word about H2 blockers – which are cardioprotective), a class of drugs known to increase the risk of MI in the general population – and then when we see MI risk going up again, we can add in thienopyridines on the pretext of reducing MI risk, although we know that PPIs reduce the efficacy of these drugs …….. and so the mess continues and who benefits? Not our patients, that’s for sure.
Long ago, probably well over a decade now, the ADA (Diabetes) stated that every diabetic should eat three meals of 45 – 60g carbs and three snacks of 15 – 30g per day. They also had a page called “Eat More Starch!” and they used to have one called “Make Starch The Star!” (They did helpfully point out that eating more starch required an “adjustment” in medication without pointing out that this would be in an upward direction.)
Then they retired their overt recommendations. The “Eat More Starch!” page remained for several years but was no longer linked to, so you could only find it if you knew where to look. They stopped listing absolute requirements for carbs, but retained absolute requirements for protein and fats, and surprise surprise if you subtracted these from their recommended calories you ended up with EXACTLY the same quantity of carbs.
When John Buse was in charge, they actually did reduce their carb recommendations to an absolute minimum of 135g/day, to be used only for weight loss and for a maximum of a year. At this time they changed their suggestion that “Medical Nutrition Therapy” could reduce HbA1c by 0.9 – 1,9% to 2.9%
Then some of their biggest sponsors went away, and so did Buse.
Meanwhile on their very own forums, patients were routinely reporting 5 – 8% reductions in HbA1c, and even over 13%. But obviously since none of these patients were following their dietary advice, they chose to put their fingers in their ears and continued to claim that low carb diets could not be recommended as there were “no long term studies”. If they had looked at the contents of their own forum they could by now have had studies well over a decade in length. Not to mention thousands more well controlled diabetics on no or minimal medication.
I stopped using their forums when it was taking longer than a day to read a day’s worth of posts, and I stopped looking at their website after the constant blows from my head had damaged my desk, so I don’t know how they have continued to muddy the waters as to whether or not their recommendations have changed
I suspect none of these organisations DARE to overtly change their recommendations, and the most you will get is a slow and careful step change which they hope no-one will notice for fear of legal reprisals. See the recent Noakes farce for details – and unbelievably since the ADSA/HPCSA axis was roundly trashed in the trial they are going for an appeal. Meanwhile the low fat/vegan axis is all over Twitter, blogs and of course the mainstream media, and I suspect they will mount further legal challenges should anyone dare to defy them. Backed by the huge profits to be made from keeping the population poorly fed and unwell. Science comes a poor third.
I suspect that you are right, any change in the DGA recommendations will be slow and unremarked upon, as with the ADA.
I would love to know if you have links or screen shots of the ADA “Eat more starch” pages! Maybe Internet Archive Wayback Machine pages?
Nearest I could find
https://web.archive.org/web/20040203222331/http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp
I blew away a lot of dead bookmarks before realising they would still work via the Wayback Machine
I will probably be dead, but you may live long enough to see Willett and Hu claiming that saturated fats were never a problem and they never said they were . . .
Thanks! This is terrific. And geez, who wrote this gibberish anyway?
I’m pretty sure Willett will be carried out clutching his bottle of EVOO. Hu may end up living long enough to have to quietly shift position. My prediction is that there will be no recanting; it will simply no longer be discussed.
And, yes, hooray for the Wayback Machine! Remember, dear readers, if there’s a webpage you want a permanent link for, visit the Internet Archive site and help them capture the internet as it happens.
The archive now has evolved working links so you can wade about in it a bit
https://web.archive.org/web/20040203184749/http://www.diabetes.org:80/nutrition-and-recipes/nutrition/foodpyramid.jsp
as to where the recommendations emanate
https://web.archive.org/web/20040203144056/http://www.diabetes.org:80/support-the-cause/corporate-friends/recognizing-our-corporate-sponsors.jsp
Probably some of the same companies sponsor Willett & Hu hence their total failure to discern the differences between Omega 6 and Omega 3 oils even after all these decades. They haven’t bought Joe Hibbeln though
http://www.meandmydiabetes.com/2013/03/10/vegetable-oil-associated-with-more-heart-deaths-nih-scientist-joe-hibbeln/
Oh, the precious Diabetes Food Pyramid [says Adele, taking screenshots]. Generations from now they will wonder what the hell we were thinking.
Thanks for passing these along!
Simple! “Everyone knows” that diabetes is caused by being fat (or eating meat). You can only get fat by eating fat. Therefore diabetics must eat less fat and protein, which just leaves carbs – and drugs. Plus they die of CVD which is also caused by eating fat.
Scary that even today too many doctors, nurses and especially dieticians still believe this – “of course insulin can’t make you fat, it has no calories!” – a dietician explains her grasp of modern science.
The folks who can remember a time before there were “epidemics” of obesity, diabetes and other metabolic diseases are dying now (often at an advanced age which many younger people simply will not reach) leaving the world in the hands of the New Young Narcissists and their dogma. Meanwhile I have written my epitaph
“See? We told him fifteen years ago that dangerous low carb diet would kill him!”
Love your blog! And good luck with your PhD studies!
I am a former low carb guy, middle-aged male, reasonably active. But I am now somewhat agnostic about specific macronutrient %s, and prefer to just focus on eating fresh, relatively unprocessed, well-seasoned foods. Approximately a “whole foods omnivorous diet.”
I do have success with reducing wheat products — I generally avoid bread, pasta, cereals, and pastries, which has produced body fat loss and enormous improvements in digestion. Not sure if these benefits are due to avoiding wheat specifically or to avoidance of refined carb foods in general. But it works for me.
Thanks for the kind words. I survived a compassionate, and very helpful, grilling by my co-chairs today on my prospectus, so unbridled enthusiasm for my writing is a welcome note 🙂 Onward and more words.
And speaking of words, “works for me” are magic ones! Although it would be fun to know, it is less important as to what it is about reducing wheat products–gluten, carbs in general, some other mysterious factor–than for you to know what you can do to help yourself feel better on a day to day basis.
I have a friend who is (mostly) vegan. She eats fish every now and then, but meat and other animal products make her feel lousy (and no, it’s not because she is not “used” to eating meat; she says she’s been like this as long as she can remember). When she stays away from animal products, she feel good. She is a busy working mom with two (smart, lively & omnivorous) youngsters, is happy and healthy. Her diet wouldn’t work for me, but it works for her. If we could be content with “works for me” and not insist that what “works for me” should work for everyone on earth, I’d be out of job, but the world, in my view, would be a much lovelier place.
Adele and Chuck W: Thoroughly sensible words and eating. I’ve done dietary self-experimantation for a dozen years or so, and have found what works for me, too. I eat almost entirely meals I prepare myself. Lots of garden vegetables and some fruit, pastured animal foods including lots of eggs, high-quality seafood, and occasional starchy vegetables. What made a big difference for me was entirely giving up grains (I was a forty-year maker of sourdough, mainly rye). Recently, after suffering a bout of sinus congestion I decided to give up fluid milk (homemade raw-milk kefir). After years of waking up in the morning with congestion, it’s gone! I have no trouble with cheese, cream or butter. Nor do I have any trouble digesting all the fat I can fit in the pie hole, and I relish it, especially animal fat. So experiment, I say, and choose mostly real foods. And abolish the USDA (just kidding; trim it down to size).
Hi Gary, Thanks for sharing your story. As these collect–on my blog and in my “real life”–there’s a common pattern. My good buddy, Dave Boothman, gave me the analogy of rocks appearing in a creek bed as the dry weather of summer progresses as a way to think about how the “insults” to the body that we tolerated well (or didn’t even notice) when we were younger have to be addressed as we get older (tolerance in general being something I certainly have less of as time goes on). It is possible that these sensitivities were just there, waiting to be uncovered (like rocks in a creek bed that were there all along) or it’s possible that these develop according to individual exposures to other stressors in addition to the food we eat (like rocks in a creek bed rolled there due to erosion or flooding). Either way, there are times in our lives when we care more–or less–about our diet.
I’m okay with either, as long as we don’t lose sight of the fact that what food is supposed to do is nourish the body. And one of the things that we gave up when the low-fat, high-carb guidelines took over is food that is nutrient dense (such as all the foods you listed Gary!). I’ve yet to see convincing evidence that grains and cereals qualify for that term, unless they are fortified/enriched or unless, like the USDA, you talk about nutrient density in terms of what a food doesn’t have in it, instead of what it does.
Adele: Also instructive to consider the anthropological evidence of the shift from hunter-gatherer to settled agriculturalist, which was accompanied by a reduction in stature and dental and skeletal health, and no doubt other parameters. But it allowed the development of villages, towns and cities, for expanded trading relationships, for the marshaling of labor for construction and for warfare. So it was a trade-off. I guess one could say that agriculture was the beginning (or end) of civilization. But we know better today; we needn’t eat many, or any, grains unless we like them and digest them well. If only Luise Light hadn’t been completely shafted the nation’s waistlines would look very different.
Life–and civilization–is one big long trade-off 🙂
Luise Light’s story is a fascinating one. I’ve been keeping track of her work for a bit now & she seems to have shifted her position a bit on fats. Here’s what she had to say in 2004:
In contrast, her 2006 book refers to the Weston A. Price Foundation with regard to fats; she makes it clear she’s not a fan of veg oils. On the other hand, her second rule for “healthy eating” is “Eat whole grain pasta, rice, breads, and cereals” (after Rule 1: “Eat a variety of fresh fruits and vegetables.”)
The other thing to remember is that the Food Pyramid did not make its way to the public (in any form) until 1992, at which point in time researchers had already begun to notice a dramatic jump in rates of obesity in the U.S. In some regards, the Food Pyramid was a response to this, not a cause.
Adele: Thank you so much for this post. I was particularly interested in your comments about protein in the interview with Laura and Kelsey. At 65 I began biweekly strength-training through body-weight exercises. After three years I went from being being unable to complete a pull-up, to being able to do four sets of seven, but the muscle mass growth was pretty meager, and recovery took a minimum of 72 hours. Then 6 months or so ago Mark Sisson wrote a post about how inadequate the guidelines for protein are for those doing strength training, that they should be two to three times the guidelines. I added isolated whey protein (26-52g/day) to my routine the day of and after my workout, and my recovery time is less (I work out three times a week now), I can add repetitions at a faster pace, and the upper body muscles seem to be growing faster. Your comments add further validation to this strategy. I only take the extra protein when my body tells me it needs it, so it’s not every day. I eat two eggs and 5-8 oz of meat or seafood, plus cheese and nuts, every day, but this wasn’t quite enough. The best take-home message from this post, though, is that we are all different in how we can meet our nutritional needs (and the DGA have nothing to do with nutritional needs!).
Thanks so much for reading & listening! Yeah, the guidelines for protein are pretty weak. The approximately 50g/day recommendations come from the Institute of Medicine’s 2005 macronutrient report, which means they are also outdated. But (if you take a look at the protein section of that report) it’s pretty clear that we don’t know how to measure or evaluate protein utilization very well & the 50g/day is sort of a “best guess” for avoiding overt protein deficiency.
Another blast from the past you may be interested in is this post from Regina Wiltshire. She makes a number of other arguments, but what is striking to me from the data she’s gathered is the remarkable consistency of levels of protein intake across populations. We eat the protein we need, and it seems, we keep eating until we get it.
When I was at a symposium in D.C. sponsored by the National Academies on nutrition and healthy aging, one of the researchers commented to me (after I voiced a concern that protein recs were too low for old folks, a point that a number of the presenters had made) that she too shared that concern, particularly because the only place we “store” protein in our bodies is in, as she put it, “active muscle tissue.” And I firmly believe, as I get older, that active muscle tissue is my best friend 🙂
In the ABC’s of nutrition, A=Adequate Protein. Like Goldilocks, our protein intake should be “just right” for each of us, not too much and not too little. We should be able to keep the muscle mass we have and build more if we’re doing that. It may take a little tweaking–and as you discovered–variation. Nobody says you have to eat the same amount of protein every day!
The guidelines remind me of someone who wants to change, but is too embarrassed to be open about it. What will people say?
Where exactly are the guidelines on cholesterol? I thought they said dietary cholesterol was now fine, indirectly exonerating fat, but that CSPI and the vegetarian ideologues had waded in with a court case. Fat is bad, it really, really is, because otherwise you might think it’s okay to eat meat. These people regard us as children to be scared this way and that in accordance with their beliefs, whether we share them or not.
The guidelines are tied in ever more complicated knots with endless contradictions. One step forward and half a step back, take from them what you happen to like and someone else can take the opposite. They are locked into the low-fat paradigm, but know that it’s increasingly discredited. This is the mess you get when you mix up selective science and vested interests. If the guidelines had never existed, the world would be a healthier and less confused place. The document gets longer and more complex because they’re trying to serve different masters and hoping that people won’t notice. Only those engaged in a reargard action behave in this way.
“If the guidelines had never existed, the world would be a healthier and less confused place.” Amen to that.
The cholesterol thing is sort of nuts because even Ancel Keys, Mr. Cholesterol himself, disowned that theory decades ago.
I suspect you’re right, the DGA will just keep getting longer and longer and more and more incomprehensible. Perhaps it will simply become a sort of ouija board of nutritional notions. Every 5 years the government will go through the motions of filling up a great deal of space with words and numbers from which readers can cull their own meaning from an otherwise meaningless jumble.
I got in a comments-section tussle with someone over the cholesterol recommendations. I happened to mention that the current recommendations say that dietary cholesterol is OK now, or something along those lines. A very dogmatic commenter attacked me; and I then provided a link to the official website that said so. I was attacked again. Then I found another part of the document that directly contradicted the first one. Both in the same document! Still the other person kept attacking, in a very condescending manner. Not worth the trouble.
I’m wondering if the person having Internet Rudeness was committed to avoiding dietary cholesterol for reasons that have nothing to do with science and dietary guidelines (not that science and dietary guidelines have much to do with each other in the first place). With a few notable exceptions–hello coconut oil!–dietary cholesterol comes almost entirely from animal products and that can be the underlying rationale for strenuous arguments that cholesterol in any form should not be consumed by humans.
But I would agree that comments-section tussles are seldom worth the trouble in any case.
I know that you need to spell out what the DGA states, but as an independent person, I have learned to ignore the DGA entirely. What works for me, may not work for others. I don’t do low carb every day, but I use fasting to go no carb 1 to 4 times every two weeks. I work harder to keep my protein at max 25 percent. That leaves fat as the floating remainder.
Yes, I’m just trying to figure out why the messages are so mixed. But I also like to hear what works for folks in real life! I think one of the most pernicious things about the DGA is that they imply that the same approach to diet will work equally well in all bodies. Your experience is valuable in demonstrating otherwise!