“The Food Pyramid? It’s just wrong.”

June 29, 2017June 29, 2017Adele Hite, PhD MPH RD 24 Comments

“A diet based on food that turns to sugar once it’s in your body was never going to end well.” The last 35 years of dietary advice summed up in one tweet-worthy sentence, and the whole embarrassing public health nutrition fiasco explained in less than 3 minutes.

Hooboy, do I have a treat for you.

Despite the recent nobody-is-listening-so-we’d-better-yell-louder American Heart Association report that encourages everyone to chug soybean oil like it’s cheap beer, butter is baaaaack–and starring in its own video.

My friend, Jenni Calihan at EatTheButter is the mastermind behind this, but I’ll humbly take credit for some “editorial input” here.

Watch first, then we’ll talk:

First of all: I’m still snickering over the “not based on rigorous science” frame:

Next: Maybe you’re a newbie to the world of non-mainstream, it’s-actually-okay-to-eat-animal-fat nutrition, or maybe you are just nutrition-skeptic curious, or maybe you’ve been around all of the various dietary dogma blocks. For whatever reason, if you get a little uncomfortable with all the hyperbole, oversimplification, and finger-pointing about who Made America Fat–the cows! the Snackwells! the stupid lazy gluttonous Americans!–this little video offers a straightforward, easy-to-understand explanation for our current nutrition quandary, without resorting to distortions, exaggerations, and the blame game.

I’m happy to take some credit for that. For me, when you’re talking physiology and biochemistry (crackers turn into sugar, fat doesn’t “make you fat”), things are pretty straightforward. But it gets trickier talking about “good” or “bad” science or what the Food Pyramid did or didn’t do, or cause.

This is one my favorite things about this video: Although the relationship between dietary guidance and outcomes is noted, cause and effect regarding the specifics of the diet is not explicitly stated (although I suspect that various parties will infer what they will).

For example, when the voice-over says “The Food Pyramid? It’s just wrong,” does that mean, “The science behind the Food Pyramid is just wrong” or that “Pyramid-shaped food advice is just wrong”? The first is an argument waiting to happen, but the second just says that the advice we gave out–whether pyramid- or plate-shaped–was, for some reason, the wrong advice for most Americans.

Was it all those starches turning to sugar after few minutes in our stomachs? Did eating less nutrient-dense food, like red meat, mean we ended up eating more food overall in order to be adequately nourished? Did the division of food in to “good” and “bad” categories set up cycles of “good” and “bad” eating? Or, to get all academic on you, did the application of the halo of “healthy” to cheap, convenient, tasty, but nutritionally lacking industrialized food, coupled with a neoliberalist imperative to make health the responsibility of the individual and “solutions” to health a matter of the marketplace, make many Americans–particularly those caught in a widening income gap and increasing economic pressures–more susceptible to eating patterns that exacerbated all of the other toxicities of modern life?

You don’t have to answer that.

My point is that we (really) don’t know what exactly about our dietary advice is the problem, and—as far as I am concerned at this point—it doesn’t matter.

For 20th (and now 21st) century Americans, this kind of dietary advice, provided in this particular political, sociocultural, industrial, and economic context, simply did not—and still does not—“work” to keep Americans healthy. That’s it. We can argue until the grass-fed cows come home about why it didn’t work, but it didn’t work. Acknowledge and move on.

And in the meantime, you can share this video with friends and family and know that it got the “hyperbole-free” stamp of approval from me.

Alternative Fa(c)ts

May 6, 2017May 9, 2018Adele Hite, PhD MPH RD 24 Comments

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.

Will the real Dietary Guidelines please stand up?

April 27, 2016December 30, 2016Adele Hite, PhD MPH RD 37 Comments

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.

Keeping it Simply Stupid: Marion Nestle’s “Rogue Guidelines”

January 21, 2016January 23, 2016Adele Hite, PhD MPH RD 58 Comments

One of the things I do to irritate myself into a state of incoherence is read the comments section on interwebz articles that propose to address our national concerns about food and health. A constantly recurring theme about eating a “healthy diet”–100% guaranteed to appear in any comment section–is “It’s so simple. Just [do this thing].”*

I blame the Dietary Guidelines (but then I blame the Dietary Guidelines for everything–when my car won’t start, it’s those damn Guidelines again). They began the long proud tradition of over-simplifying nutrition guidance to the point of uselessness, a tradition that Michael Pollan, and now Marion Nestle, has taken to new levels of banality. This oversimplification not only displays an unholy disregard for any sort of cultural, economic, or metabolic differences between humans, but–when you get down to the details (the main ingredients of which are always devilish)–it “simply” doesn’t say much of anything.

Marion Nestle and Tamar Haspel wrote a whole long article about the “6 easy steps” to eating better, reproduced in the boxes below. Ranting in regular type? That’s me.

Go through the fine print of the omnibus spending bill just passed by Congress, and you’ll see that the 2015 Dietary Guidelines, scheduled for release in — you guessed it — 2015, have been pushed out to 2016. You wouldn’t think that the government’s efforts, every five years, to help Americans eat more healthfully would turn into a political football. But when its appointed scientists reviewed the literature on meat and health, for example, they did something quite radical. They said what they meant with no equivocations: Americans should eat less meat.

In order to keep things simple, it’s best if you ignore any historical facts that might add nuance–or reality–to your story. Like the fact that this 38-year-old “radical” idea to “eat less meat” arrived in the first edition of the 1977 Dietary Goals. Yes, this statement was changed in the 2nd edition of the 1977 Goals, but not–as Marion Nestle and Michael Pollan would have it–due to the fact that Evil Meat ran roughshod over the science. Of course the meat folks were upset; this call to “eat less meat” had about as much science behind it as similar suggestions at the time that vegetable oil could cause health problems, which is to say, not enough to justify public health policy. Yet, due to reasons more social, political, and economic than scientific, the prohibitions about meat are still with us, while concerns about vegetable oil have faded out of mainstream nutrition

Numerous physicians and scientists represented in the 1977 Dietary Goals for the United States: Supplemental Views, point out that (as McGovern himself and one of his primary supporters, Dr. Mark Hegsted, admit) the case against meat had never been proven. They go on to argue that suggesting that Americans remove/reduce an important source of nutrition in their diet (meat) may have unforeseen negative consequences. Norton Spritz (NYU School of Medicine) states: “… there are serious nutritional problems that affect many Americans that are clearly related to dietary inadequacies particularly of high quality protein …” George M. Briggs (Professor of Nutrition at UC-Berkeley) states: “There is good evidence that those who consume meat at the average level or more have as good health records and freedom from chronic disease as those who do not.”

The switch in language in the 2nd edition of the 1977 Goals to decreasing “saturated fat” intake rather than “meat” in general was not because there was more conclusive science to support that approach, but because it was politically more tenable. Meat producers could try to–and did–breed animals with a reduced amount of the ostensible evil food component, saturated fat, in their product. But saturated fat wasn’t really the problem now, was it?

F.A. Kummerow (Director, The Burnsides Research Laboratory, University of Illinois, Urbana-Champaign) points out: “Your data indicates that animal fat consumption has decreased 24 pounds and vegetable fat consumption has increased 34 pounds/capita from 1940 to 1974. Yet, coronary disease has increased during a time period that this change took place. Why blame animal fats?” (See Nina Teicholz’s neato graph for a visual of the trend.) Well, because they come from animals, and there are all sorts of social and cultural reasons that some people are opposed to eating animals, that’s why. Why these people got to make the rules for the rest of us is a story for a different day.

Scientists voiced a number of valid concerns about the wisdom of telling Americans to eat less meat in 1977, many of which are still valid today: over 40% of Americans, mostly females, have inadequate protein intake. But that complicates the narrative, doesn’t it?

As if that were not radical enough — previous committees had pussyfooted with such euphemisms as “choose lean meats to reduce saturated fat” — this committee insisted on an additional reason beyond health: environmental considerations.

The result? Uproar.

Why have an uproar about a group of nutrition scientists (for the rigors of nutrition science, see below) making declarations about environmental issues? Perhaps next year, we can have the EPA make dietary recommendations.

Arguments like the ones over the Dietary Guidelines, fueled by lobbyists, politicians and agenda-driven groups, make diet advice seem maddeningly inconsistent, but the fundamentals haven’t changed much at all.

Sigh. “Fundamentals”? Really? Which fundamentals would you be talking about now? The “fundamentals” of 1955 when more than half of our calories came from meat, eggs, milk, cream, fats and oils? Oh, and adult diabetes was virtually unheard of.

It’s time to take back the process, so we’re going rogue and issuing our own Dietary Guidelines, untainted by industry lobbying, unrestricted by partisan politics. Here, in six easy steps, is our advice for the new year: what we think dietary guidelines ought to say.

Really? Untainted by industry lobbying? Because wheat and vegetable oil interests never lobby–only Evil Meat. That’s why the bottom of Marion Nestle’s beloved Food Pyramid ended up being ALL MEAT. Wait? No? Nevermind.

1. Eat more plants. You heard it from your grandmother. You heard it from Michael Pollan. Now you hear it from us: Eat your vegetables. Add fruits, beans and whole grains, and the wide-ranging plant category should make up most of your diet. Variety is the key. Plants offer us such an astonishing range of roots, stems, leaves, flowers, buds and seeds that there is bound to be something even the most jaded vegetable skeptic can love.

It’s just so simple. Eat more plants. The biggest increase in calories during the rise in obesity and diabetes in America came from flour, cereal, and vegetable oils. That’s right. Plants.

As for your grandmother (or great-grandmother), she ate at least 10% of her calories from vegetables and fruit, and so should you (see above).

2. Don’t eat more calories than you need. Although on any given day it’s hard to tell whether you’re doing that, over the long term, your scale is a sure-fire indicator. If the pounds are going up, eat less.

It’s just so simple. Don’t eat more calories than you need, whatever that means. You can’t really tell when you’ve overeaten–until after the fact–at which point you should eat less. If you’re hungry when you “eat less,” tough luck. Suck it up, you wuss, you’ve already had more calories than you “need.”

Let’s pause here for the good news. If you follow our first two guidelines, you can stop worrying. Everything else is fine-tuning, and you have plenty of leeway.

That was the “good news”?

3. Eat less junk. “And what’s junk?” we hear you asking. We have faith that you know exactly what junk is. It’s foods with lots of calories, plenty of sugar and salt, and not nearly enough nutritional value. It’s soda and sugary drinks. It’s highly processed, packaged foods designed to be irresistible. It’s fast food. You know it when you see it. When you do, don’t eat too much of it.

It’s just so simple. Eat less “junk.” And since we know that it’s really mostly minorities and poor people who eat all the “junk” food, we should start by eliminating all the poor people by giving them more money so they don’t go around being poor. After that we should encourage a massive influx of people of color into the U.S. so minorities won’t be minorities anymore and will therefore stop eating junk food. Problem solved.

4. Eat a variety of foods you enjoy. There is research on the health implications of just about any food you can think of. Some — such as fish — may be good for you. You should eat others — such as meat and refined grains — in smaller amounts. The evidence for most foods is so inconsistent that you should never force yourself to eat them if you don’t want to, or deny yourself if you do. If you love junk foods, you get to eat them, too (in moderation, of course). You have bought yourself that wiggle room by making sure the bulk of your diet is plants and by not eating more than you need.

It’s just so simple. And by plants you mean flour, cereal, and vegetable oil, right? And by “not eating more than you need” you mean, well, you don’t know what you mean and neither do we.

This is an appropriate place to talk about a phrase that has been thrown around a lot in the Dietary Guidelines brouhaha: “science-based.”

As a journalist (Tamar) and a scientist (Marion), we’re very much in favor of science. But in this situation, the food industry’s frequent calls for “science-based” guidelines really mean, “We don’t like what you said.”

So, let me see if I understand this? When the food industry calls for “science-based” guidelines, that’s a bad thing? But if a bunch of (mostly) scientists call for “science-based” guidelines** that’s a good thing? This is getting a little confusing.

Arriving at truths about human nutrition isn’t easy.

But wait, you said these are “6 easy steps”? Ooooooh. Light bulb moment. You’re not actually planning on telling us any “truths about human nutrition,” are you? Ah, this is all beginning to make sense.

We can’t keep research subjects captive and feed them controlled diets for the decades it takes many health problems to play out. Nor can we feed them something until it kills them. We have to rely on animal research, short-term trials and population data, all of which have serious limitations and require interpretation — and intelligent people can come to quite different opinions about what those studies mean.

Which is why “eat some if you like it” isn’t a wishy-washy cop-out. It acknowledges science’s limitations. We do know that plants are good, and we do know that junk foods aren’t, but in between is an awful lot of uncertainty. So, eat more plants, eat less junk, and eat that in-between stuff moderately. That is exactly the advice science demands.

“We do know that plants are good.” Which plants are you talking about? Corn, wheat, soy = plants, right? And how do we know these plants (whichever plants you mean) are “good”? Surely not through the vagaries of nutrition science, with all of its “serious limitations.” You’ve just made the case that nutrition science is a poorly disciplined loudmouth whose “demands” we might very well ignore. Oh wait. Right. This is the part about not exactly telling us any “truths about human nutrition.”

What we eat and how we eat go hand in hand. We’ve all been there, sitting in front of a screen and finding that, all of a sudden, that bag, box or sleeve of something crunchy and tasty is all gone.

We’re so focused on what to eat that how to eat gets short shrift. So:

5. Find the joy in food. Eat mindfully and convivially. One of life’s great gifts is the need to eat, so don’t squander it with mindless, joyless consumption. Try to find pleasure in every meal, and share it with friends, relatives, even strangers.

Just remember that your mindful, joyful consumption should be Mostly Plants. Thank goodness flour, cereal, and vegetable oils are Mostly Plants, so that I may mindfully and joyfully eat those Strawberry PopTarts. It’s just so simple.

Learn to cook. The better you cook, the better you eat. There are days when cooking feels like a chore, but there are also days when you find profound satisfaction in feeding wholesome homemade food to people you love.

“Learn to cook.” It’s just so simple.

First, use your copious spare time to chillax with some Ina Garten YouTube videos.
Once you “know” how to cook, assemble some easy-to-prepare menu ideas that will meld seamlessly with your work schedule, your workout schedule, your partner’s work schedule, your partner’s workout schedule, and your kids’ soccer/ trombone/tap dancing schedule. Or maybe your two-jobs and day-care and public transportation schedule. Or any variation on the above in your oh-so-simple life.
Then go shopping and buy all the stuff you need (this step requires money, just FYI). Don’t forget to take your reusable hippie bags.
Carry all the stuff home in the back of your Prius, or on the bus, or if the scale is telling you that you’ve had more calories than you “need,” you can just hoof it home, fatso.
Put all of your groceries away. Try to find a place where the food won’t spoil, and your kids/partner/roommate won’t eat it before it becomes dinner. Recycle your plastic bags since your forgot to use your hippie ones.
At the appointed hour, begin. Chop. Stir. Sauté. All the things.
Call those “people you love” to the table.
Search your soul for that “profound satisfaction” you’ve been promised when the “people you love” use this opportunity to gripe about flavor, color, consistency, and smell of the lovingly prepared food that sucked up hours of your life, which they then proceed to snarf down in 7 minutes flat before bolting from the table in order to escape your nonstop bitching about what a thankless task cooking is.

[Snarky aside: This advice about cooking? It just applies to poor slobs like you and me. As for Marion Nestle herself, she’d prefer not to: “I eat out a lot and don’t cook much for myself.” ]

And foods you make at home are worlds apart from foods that manufacturers make in factories. No home kitchen ever turned out a Lunchable.

In her “home kitchen,” my mom used to make us bologna and processed cheese food sandwiches on Wonder Bread. As a special treat, she would sometimes leave the red plastic strip on the bologna. Extra fiber. But, most assuredly, not a Lunchable.

If you go out in the world armed only with these guidelines, you’ll do great. Sure, there’s much more to know, if you want to know it. We’ve forged careers writing about food and nutrition, and either one of us could talk micronutrients until your eyes glaze over. But these few basics are all you need to make good food decisions. Choose foods you like — heavy on the plants, light on the junk — cook them and enjoy them.

It really is that simple.

Simple. Simply useless. And not exactly “rogue” either. The 2010 Dietary Guidelines include some form of every single one of these “rogue” guidelines–including the directive to cook and eat at home, preferably with your family, whether you like them or not–even if the 2015 ones don’t.

The only truly “rogue” statement Haspel and Nestle make is in the headline, and it is one with which I concur:

Forget government guidelines.

Simple.

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*Nowadays, when I see an online nutrition article with a comment section, I get out my FATSO card & see how many comments it takes for me to score a FATSO. FATSO is like BINGO, only renamed in honor of America’s moral panic over body size.

**But not too science-based. According to the two letters sponsored by Center for Science in the Public Interest (motto: “Trans~~fatting~~forming the American diet”), the members of the Dietary Guidelines Advisory Committee and a number of other nutrition-related organizations both opposed the notion that “Any new recommendations or changes to the 2010 Guidelines must be based on conclusions rated “Grade 1: Strong” by the Nutrition Evidence Library (NEL) rubric.” In other words, the scientists–not the food industry–would like to have Guidelines based on weak conclusions from a scientific field whose methodology is already pretty weak. Nice one, scientists.

The slick “new” Dietary Guidelines

January 14, 2016May 17, 2018Adele Hite, PhD MPH RD 29 Comments

Because never changing the recommendations means never having to say you’re sorry for 35 years of crappy advice, the 2015 (really 2016, but who’s counting?) Dietary Guidelines repeat the same old-same old “whole grains, fruitsandvegetables, low-fat/fat-free dairy, fish, nuts, and (if you must) lean meat” guidance from years past. Only difference: The new Guidelines are now oozing with vegetable oil.

In the list of recommended foods to include in “a healthy eating pattern,” “oils” now have their own category.

For the most part, we are talking Big Oil: canola, corn, peanut, safflower, soybean, and sunflower. Oils that have been chemically extracted, de-gummed, bleached, and deodorized (y’know, stuff you do to dirty diapers). And good luck finding them at your local farmers market.

Big Oil is big business for the U.S. agricultural economy and for the nutrition science academic industry. Alice Lichtenstein, of the 2015 Dietary Guidelines Advisory Committee, has found more creative ways to feed all kinds of oil to hamsters, rats, and people than probably anybody on earth. Corn, canola, soybean, safflower, sunflower, margarine and shortening, even rice bran oil–you name the oily food substance and Alice Slicktenstein has built her career on getting funding for studying it. Most of her work is done at–and funded through–the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts, which is supported by money from, you guessed it, the USDA. Her research is also supported by numerous grants from the NIH branch of HHS. However, this has nothing to do with the shiny new prominence of oily stuff in the USDA’s and HHS’s new Dietary Guidelines.

To be sure, oil oil everywhere is not the only thing slick about the new Guidelines. The language is pretty slippery too. There’s been a lot of cheering from the press about the “new” direction of the Guidelines, and indeed, some of the things being reported are actually in the Guidelines: The Guidelines have gotten rid of the ridiculous (and possibly dangerous) “1/2 teaspoon of salt a day” limits on sodium for some subpopulations–although the no-more-than 2300 mg (yes, a Whole Teaspoon!) limit should still be–wait for it–taken with a grain of salt.

Despite all arguments otherwise, nutrition–the politics and the science of it–is complicated. In a number of cases, trying to make the ugly stepsister foot of a “consistent public health message” squeeze into the glass slipper of inadequate and contradictory science has the Guidelines talking out of both sides of its oleaginous mouth. Here’s a closer look at what is going on:

1. Limits on cholesterol are gone.
Eh. Sorta kinda not really. It would appropriate to say “numerical” limits on cholesterol are gone, but the language of the DGA is still pretty limiting. As in:

“individuals should eat as little dietary cholesterol as possible”

What’s fun about this is that the Vegamanics are celebrating this as “cholesterol still sucks” while the SatFat Redeemers are all about “Eat them eggs, y’all.” They’re both right. Or wrong. Hey, this is nutrition! You don’t really expect a straight answer now, do you?

2. Red meat gets a pass.

It’s true that [lean] meat has not disappeared altogether, and that language about a “sustainable diet” (whatever that means) is not in the Guidelines. At the same time, the Guidelines recommend “lower intakes of meats, including processed meats,” lumping them in the same category as sugar-sweetened food and refined grains. So like the cholesterol issue above, this is getting played as “Evil meat lobby wins” on one side of the debate, and “Meat justice prevails” on the other.

The meat industry is happy to proclaim its support the Guidelines–as long as its product is still in them. If I were the meat folks though, I’d be working to shut the whole process down. If meat is still in the Guidelines, it is not for lack of 35 years of trying to get it out.

3. Limits on fat are gone.
Nope. Limits on “fat” are still there. If you’ve been hearing rumors that we are at the end of the “low-fat” era, and you thought that meant that the Guidelines were going to give the green light to fats–natural fats, fats that you could find at your local farmers market–you would be sadly, profoundly mistaken.

Just like all squares are rectangles, but only some rectangles are squares, all oils are fats, but only some fats are oils. The new Guidelines have been credited with saying, “Hey we’re okay with rectangles” but they are only okay with those rectangles that are squares. You can eat fat, but only if it’s oil.

So: Fat–as in “saturated fat”– is still evil. For adults, lower limits on “oil” are still 20%–with the exception of a few oils that the DGA folks still don’t like because their fatty acids are mostly saturated. And the upper limit on dietary “oil” as a macronutrient remains at 35% of calories, as it has been since 2005. Only by keeping limits on “oil” low can we manage to cram in the Guidelines’ requisite 45%-65% of calories of carbohydrate into our diets and still have room for protein.

In other words, the USDA hasn’t discarded the “low-fat” diet. They’ve instituted the “low oil” diet. Now you are allowed a whopping 27 grams (about 5 teaspoons) of highly processed and refined, probably not local or within your foodshed, oily oil. Cheers!
4. The DGA limits sugar intake.
Nope. It limits “added sugar” intake. That means that a bottle of orange juice, which “naturally” has as much sugar as a bottle of soda, is “good,” while soda is “bad.” Yeah yeah yeah. I hear you out there: “But but but. Orange juice has Vitamin C.” So add some Vitamin C to soda–same difference. Puh-leeze. Sugar is sugar. (I’ll save my “starch is sugar too” rant for another day.)

And all this talk about how Americans “typically exceed” recommendations for added sugar intake? Go look through the past 35 years of Dietary Guidelines. This is the first time ever that there has been an official numerical limit on sugar in any form–added or otherwise. I’m not sure how we could “exceed” something that wasn’t defined in the first place. However, the “Americans don’t follow the Guidelines” story is the best way to avoid confronting the fact that the Guidelines have not worked as intended. USDA/HHS can pretend that all would have been well if those fat stupid Americans had just done the stuff they were (actually not) told to do! Secretary Burwell suggested at the hearings in October that without the Guidelines the rapid rise in obesity rates might have been even rapider …

“We are on the wrong trajectory, but would the trajectory have been worse?”

… though it is hard to see how. Fat lazy Americans can only cram so many Double Whoppers with Cheese down their gullets at a time, and besides Netflix wasn’t even invented until, like, 1997.

For a bit of perspective, although the 10% cap on “added sugars” is being hailed as some nutrition revolution, the USDA says Americans typically consume 13% of their calories from “added sugars” now. The radical new cap on “added sugars” heralds a (potential) whopping 3% decline in their consumption. To be replaced by “naturally occurring sugars”? Or possibly more artificial sweeteners? Maybe, beer?

One thing is true about the Guidelines, though. Pretty much everyone hates them. Doesn’t matter where on the nutrition dogma spectrum you look–Marion Nestle or Nina Teicholz–everyone’s complaining.

I don’t like them either, but for reasons I don’t hear about in the press:

“All segments of society—individuals, families, communities, businesses and industries, organizations, governments, and others—can and should “align with the Dietary Guidelines.”

What this means: The Guidelines have not worked as intended in the past and haven’t changed significantly in this edition, but this isn’t because the whole idea of having a single dietary prescription that will reduce risk of virtually every chronic disease in all Americans no matter their race, gender, age, genetics, lifestyle, etc. etc. etc. is patently ludicrous. The Guidelines haven’t worked because we haven’t “aligned with” them.

As some snarky person once said, this is all about enforcing your right to eat what the folks behind the Guidelines have determined is good for you.

“Aligning with the Dietary Guidelines by taking these actions is powerful because it can help change social norms and values and ultimately support a new prevention and healthy lifestyle paradigm that will benefit the U.S. population today as well as future generations.”

What this means: Making certain behaviors the “norm” through public health dictum is a tried-and-true way for privileged classes to impose their values on the less-privileged. “Aligning with” the Guidelines will help make eating (and exercising) like rich white people the morally superior choice for everyone.

To paraphrase how one brainless “expert” on public consumption put it many years ago, “Let them eat kale!”

For the rest of us, well, Marion Nestle is right when she says that the Guidelines are a “win” for the processed food industries. She should know. She was managing editor of the 1988 Surgeon General’s Report on Nutrition and Health, which said that processed food created to fit the prevailing definition of “healthy” is exactly what the public needs:

“Food manufacturers can contribute to improving the availability of palatable, easily prepared food products that will help people to follow the [low-fat, high-carbohydrate] dietary principles outlined here.”

The 2015-20120 Dietary Guidelines continue this line of reasoning:

“During the past few decades, food products and menus have notably evolved in response to consumer demands and public health concerns. The food and beverage and food service sectors and settings have a unique opportunity to continue to evolve and better align with the Dietary Guidelines.”

Which means that there is one group that always LUVS the Dietary Guidelines. As Food Navigator-USA puts it:

“The 2015 Guidelines released Jan. 7 create a marketing opportunity for savvy manufacturers and industry stakeholders to promote their products through educational materials that help consumers better understand how to meet the report’s recommendations.”

The Dietary Guidelines have been helping sell “healthy food” to consumers since 1980, just as “healthy food” manufacturers have been helping sell the Guidelines to consumers. But “healthy food” doesn’t always lead to “healthy people.” Moronically enough, the new Guidelines recognize that calls for “healthy processed food” might end badly (flashback to CSPI campaigning to add trans fats to food):

“In [developing and reformulating “healthy” products], care should be taken to assess any potential unintended consequences so that as changes are made to better align with the Dietary Guidelines, undesirable changes are not introduced.”

That means when the onslaught of oily, whole-grain, artificially sweetened and flavored food products fails to improve the health of Americans or (heaven forfend!) makes things worse, we know who to blame.

We can blame the American public for not following the Guidelines. We can blame policymakers for not enforcing them. And we can blame food manufacturers for introducing “undesirable changes” into the food supply. But we can’t blame the Guidelines.

They’re too slick for that.

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

PS. I do plan on continuing the conversation started by Jennifer Calihan’s guest post “Low Fat, High Maintenance: How money buys lean and healthy–plus an alternative path to both.” If you haven’t read it already, you should (and the comments–good stuff there too). But, I just gotta get a couple of Dietary Guidelines rants out of my system.

It may be a new year, but in the world of nutrition, not much has changed–yet. If the amount of press dedicated to who gets to say what in the next edition of a document the previous edition of which insisted no American has ever paid one whit of attention to has taught us anything, it’s that “facts” don’t always do what we want them to do, right, Secretary Vilsack? And so, just like David Byrne, we’re stiiiilll waiting on the 2015 Dietary Guidelines, which were due out, like, last year already.

Like the Dietary Guidelines, my life is all about things changing and staying the same. As both of my readers probably already know, I’m smack dab in the middle of a PhD program in communication, rhetoric, and digital media. Quite a switch from my work in nutrition? Not really. The things I work on in my studies now are the same things I was interested in as a PhD student in nutrition epidemiology: dietary recommendations, politics of food, the health gap, methodological issues in nutrition epidemiology of chronic disease, and the ethics of dietary policy. Only now I have a theoretical toolbox that is actually useful for critically examining those things.

Here’s the thing though. I thought that approaching nutrition from the perspective of rhetorical and communication theory would help me take a big step back and take a couple of deep breaths and have a nice cool, calm, totally “academic” attitude about things. Nope. The more I study this stuff, the more ticked off I get. In fact, the more sensitized I am to the rhetoric of nutrition and the better I can identify and understand the structures of privilege and power at work in the discourse surrounding food and health in America, the angrier it makes me. Same as it ever was.

To avoid beginning the year with a full-on, foam-at-the-mouth rant, I am instead hosting a wonderful guest post from my good friend Jennifer Calihan over at EAT THE BUTTER.org. She has a smart, perceptive take on the past 35+ years of nutrition recommendations from a unique perspective. Her post, “Low Fat, High Maintenance,” provides some insight as to why the low fat dietary approach really does “work” for some Americans–and really doesn’t work for many more (and she does this without mentioning “insulin” once). If you haven’t already, you should check out her work.

Her post is the stepping stone to a different direction for my own writing. I’m sick of the diet wars, of “good” science vs. “bad” science, but I still think it is important to try to understand why all the talking heads of nutrition feel compelled to insist that everyone in the known universe can (and should) win at the game of “health through food” and in exactly the same way, despite vast differences in metabolic and genetic characteristics, and more importantly, economic and social contexts (I’m looking at you, Michael Pollan, Marion Nestle, Walter Willett, and–the biggest meat puppet of them all–David Katz). Jennifer not only brings a fresh new voice to the discussion, she directs our attention outside of our own bodies, to how all of us must negotiate our “food worlds” on very different terms.

Stay tuned. Jennifer’s post will be up later this week, followed by some commentary by me. As grad school allows, I’ll return to the regularly scheduled, full-on, foam-at-the-mouth rant already in progress.

Facts are simple and facts are straight
Facts are lazy and facts are late
Facts all come with points of view
Facts don’t do what I want them to
Facts just twist the truth around
Facts are living turned inside out
Facts are getting the best of them
Facts are nothing on the face of things
Facts don’t stain the furniture
Facts go out and slam the door
Facts are written all over your face
Facts continue to change their shape

–The Talking Heads, “Crosseyed and Painless”

New year, same old talking heads

January 4, 2016January 4, 2016Adele Hite, PhD MPH RD 8 Comments

The 2015 Dietary Advisory Committee Report: A Summary

February 23, 2015April 3, 2018Adele Hite, PhD MPH RD 45 Comments

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.

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:

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.

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?

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 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 comes 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 a 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.

What if there were no Dietary Guidelines?

February 5, 2015December 7, 2018Adele Hite, PhD MPH RD 27 Comments

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?

Changing the Dietary Guidelines

November 21, 2014April 24, 2015Adele Hite, PhD MPH RD 28 Comments

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

September 4, 2014December 4, 2018Adele Hite, PhD MPH RD 50 Comments

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 previously 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 to 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. 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. Furthermore, the dietary intervention not only lowered saturated fat content of the diet but cholesterol content too. So it would be difficult to attribute any outcomes only to changes in saturated fat intake. The study should not have been included, 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.

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