The recently published 2015–2020 Dietary Guidelines for Americans have received general support from a number of professional organizations, including the American Medical Association,American Diabetes Association, and American Academy of Pediatrics. Nevertheless, they have sparked some minor controversy, as noted below.
The US Department of Health and Human Services and the US Department of Agriculture (USDA) release a new set of dietary guidelines every 5 years to reflect current scientific evidence. These guidelines are reviewed by a 15-member Dietary Guidelines Advisory Committee (DGAC) and are intended to inform the decisions and practices of policymakers and health care providers.
The new guidelines feature a big-picture approach, rather than the compartmentalized approach of previous guidelines.
“The guidelines shift every 5 years to highlight and eliminate certain elements,” said Caroline M. Apovian, MD, professor of medicine and pediatrics at Boston University School of Medicine and director of the Nutrition and Weight Management Center at Boston Medical Center in Massachusetts. “The shift in the new guidelines is toward talking about patterns, which include variety and nutrient-dense foods.”
While previous versions of the guidelines have focused on specific nutrients and food groups, the updated version acknowledges that in reality, people do not consume these foods in isolation but as part of an overall dietary pattern.
“The components of the eating pattern can have interactive and potentially cumulative effects on health,” the guideline authors wrote. “These patterns can be tailored to an individual’s personal preferences, enabling Americans to choose the diet that is right for them.”
Whereas the preceding set of guidelines encouraged weight management via control of caloric intake (and increased physical activity, which is still recommended), the updated version emphasizes an overall healthy eating pattern that includes a variety of vegetables, fruits, grains — of which half should be whole vs refined — fat-free or low-fat dairy, various sources of protein, and oils. The guidelines recommend that added sugars and saturated fat each comprise no more than 10% of an individual’s daily calories and that daily sodium intake be less than 2300 mg. Additionally, it is suggested that women drink no more than 1 alcoholic drink per day and that men limit their intake to 2 drinks daily.
Other changes include encouragement to replace foods high in saturated fats with those high in unsaturated fats, including nuts and avocados, and the removal of the recommendation to limit dietary cholesterol intake. The guidelines still recommend that people “eat as little dietary cholesterol as possible while consuming a healthy eating pattern,” though they now allow for foods that are high in dietary cholesterol, such as eggs and shellfish.
Areas of Concern
Dariush Mozaffarian, MD, DrPH, a cardiologist and dean of the Tufts University Friedman School of Nutrition Science & Policy, considers the new emphasis on overall patterns rather than isolated nutrient targets to be a positive change. However, he is critical of several aspects of the guidelines. “A glaring and shameful omission is the lack of emphasis on reducing refined grains, starchy vegetables, or red meats, especially processed meats,” though suggested limits on these foods were clearly highlighted in the advisory committee’s report, Dr Mozaffarian stated:. There is “little focus anywhere on actually reducing unhealthy foods, just on ‘greater access to healthy choices,’” he said.
The American Cancer Society expressed general support for the updated guidelines but expressly disagreed on the topic of red and processed meats. In its own nutrition guidelines, the American Cancer Society recommends limiting consumption of these foods based on a body of research linking them to an increased risk for cancer, and as I have stated previously, consumption of red meat should be no more than two small portions weekly.
The lack of focus on reducing intake of red and processed meats, refined grains, and starches “is clearly due to the conflicting mandate of the USDA to both protect the public and help the food industry,” said Dr Mozaffarian, who recently published an authoritative review on dietary patterns and their effect on heart disease. “The USDA sacrificed the health of Americans for the benefit of the US and multinational food industry.”
From an endocrinology perspective, Dr Apovian would like to see an increased focus on eliminating processed foods and high-sugar snacks and beverages from the diet. In fact, she believes that sugar-sweetened drinks should be targeted as an item in the food supply that is unnecessary and should be completely eliminated. However, such efforts transcend the scope of individual food choices: “This would need to be done by taxing ‘junk foods’ and subsidizing fruits and vegetables and other costly items so they can be consumed by more Americans who cannot afford them now,” she said. “High-sugar processed foods are usually less expensive than the items recommended by the dietary guidelines.”
Dr Mozaffarian noted that the DGAC recommended such policies, but the “many robust, evidence-based policy recommendations in the 2015 DGAC scientific committee report are greatly watered down,” he said. “In this case, the public was clearly left to suffer at the expense of corporate profit.”
That, my friends, is a sad commentary on our present “political/nutrition complex”, which even seems to invade our dinner tables!