Experts Eager to Review the New Dietary Guidelines: The Good and the Not-So-Good
Let’s go back a week, a time of mixed anticipation and dread for many health experts. On January 7, 2016, nutritional and integrative health gurus eagerly waited to review the newly released, fresh off the presses, 2015-2020 Dietary Guidelines for Americans. In February 2015, The 2015 Dietary Guidelines Advisory Committee (DGAC), submitted for assessment and review their Scientific Report of the 2015 Dietary Guidelines Advisory Committee (Advisory Report) to the Secretaries of U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA). Although the report did not serve as a draft of the Dietary Guidelines, it was a resource for them.
Why were these nutritional authorities so excited? There were many updates in the DGAC’s advisory report that were in alignment with integrative, holistic, and whole-food nutritionists, practitioners, and doctors. Probably, most notably, was the suggestion to take cholesterol off the “nutritional enemy list.” Would this and other positive changes that reflected the science, opinions, and new understandings of the time be upheld? Let’s review what the recommendations were and later discuss some of the controversial suggestions that were upheld, ignored, or dismissed.
From Report to Recommendations
The DGAC’s Advisory Report consisted of a compilation of the latest scientific and medical evidence in nutrition in order to adequately advise experts and the public about optimizing diet. The end result is to have guidelines that “promote health,” “prevent chronic disease,” and to “help people reach and maintain their optimal weight.”
As stated in the executive summary of this 8th edition of Dietary Guidelines, “The statute (Public Law 101-445, 7 U.S.C. 5341 et seq.) requires that the Dietary Guidelines be based on the preponderance of current scientific and medical knowledge.” The guidelines are reevaluated and updated every five years to reflect the latest findings and research. Constructing them on current evidence is of utmost importance, as these guidelines have a strong impact on guiding federal nutrition policy and programs, public health agencies, health care providers, educational institutions, local, state, and national initiatives, and various industries.
According to the U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA) press release (bold emphasis mine):
Secretary of Health and Human Services Sylvia M. Burwell and Secretary of Agriculture Tom Vilsack today released updated nutritional guidelines that encourage Americans to adopt a series of science-based recommendations to improve how they eat to reduce obesity and prevent chronic diseases like Type 2 diabetes, hypertension, and heart disease. The 2015-2020 Dietary Guidelines for Americans is the nation’s trusted resource for evidence-based nutrition recommendations and serves to provide the general public, as well as policy makers and health professionals with the information they need to help the public make informed choices about their diets at home, school, work and in their communities.
The five overall themes of the recommendations in the latest version were summarized as follows:
- Follow a healthy eating pattern across the lifespan. Eating patterns are the combination of foods and drinks that a person eats over time
- Focus on variety, nutrient-dense foods, and amount
- Limit calories from added sugars and saturated fats, and reduce sodium intake
- Shift to healthier food and beverage choices
- Support healthy eating patterns for all
The guidelines also emphasize eating a variety of vegetables, legumes, fruit, grains (half consisting of whole grains), fat-free or low-fat dairy, a variety of proteins (including eggs, lean meats, seafood, legumes, nuts, soy), oils from plants (canola, corn, olive, peanut, safflower, soybean, and sunflower), and those oils found in nuts, seeds, seafood, olives, and avocados.
As far as reducing “harmful nutrients,” the Dietary Guidelines emphasized keeping upper limits of added sugars and saturated fat to less than 10 percent of calories a day and sodium to less than 2,300 mg/day for people 14 years and older… less for younger. Alcohol was also recommended to be consumed in moderation, one glass a day for women and two a day for men tops.
You can read the full version of the guidelines here. Now let’s look at some of the good, bad, and ugly.
The Four Good Guidelines
1. Food as Medicine
The Dietary Guidelines support what naturopathic and functional medicine doctors have been advocating for years, food and positive lifestyle habits are powerful medicine. The current Dietary Guidelines state, “A growing body of research has examined the relationship between overall eating patterns, health, and risk of chronic disease, and findings on these relationships are sufficiently well established to support dietary guidance.”
Three recent studies, all released in December 2015, provided more evidence of how lifestyle habits can impact health outcomes for individuals. The first study, published in Circulation, found that seven healthy heart habits, which included diet, could decrease risk of heart failure. Another study, published in PLOs One consisting of a large Australian cohort, also demonstrated that those who had less risky lifestyle factors had lower overall mortality risk. Finally, the third study was reported in International Journal of Epidemiology. It included over 1.3 million Swedish men who were followed for 29-years. Its concluded there was an association between those with the highest level of fitness from adolescence to lower all mortality risk from any cause, with obesity modifying risk.
With over half of Americans struggling with one chronic disease, as reported by the CDC, and a quarter with more than one chronic disease. The impact of changing diet and supporting healthy behaviors could be extraordinary, especially considering the high cost of healthcare today in the United States with dismal healthcare outcomes compared to other industrialized nations.
2. Cholesterol No Longer Public Enemy Number One
As mentioned above, one of the major changes in the initial advisory report that caused a huge outcry, both positive and negative, in the press and medical world was the ease of cholesterol guidelines, removing it from being a “nutrient of concern.” This was upheld in the current dietary guidelines to many experts’ relief. There’s now new meaning and a lot of science to the healthful impact of the “incredible, edible egg.”
According to an article in Medscape regarding the initial report released in December, “In practice, these new recommendations are perfectly in line with current scientific knowledge. They relativize the impact of dietary cholesterol on CV risk and will probably bring eggs back into favor, which, as has long been known, can be safely included in a balanced diet (with one possible exception, however, for diabetics).”
In fact, one review even reported that eggs may assist with healthy cholesterol pattern shifts (bold emphasis mine):
The lack of connection between heart disease and egg intake could partially be explained by the fact that dietary cholesterol increases the concentrations of both circulating LDL and high-density lipoprotein (HDL) cholesterol in those individuals who experience an increase in plasma cholesterol following egg consumption (hyperresponders). It is also important to note that 70% of the population experiences a mild increase or no alterations in plasma cholesterol concentrations when challenged with high amounts of dietary cholesterol (hyporesponders). Egg intake has been shown to promote the formation of large LDL, in addition to shifting individuals from the LDL pattern B to pattern A, which is less atherogenic. Eggs are also good sources of antioxidants known to protect the eye; therefore, increased plasma concentrations of lutein and zeaxanthin in individuals consuming eggs are also of interest, especially in those populations susceptible to developing macular degeneration and eye cataracts.
3. A Focus on Dietary Patterns Over Individual Food Components
A welcome change to non-reductionists was the shift from focusing on individual food groups and components and into overall eating patterns. This “real world” application is meant to provide more choices in types of healthy diets and is based on the recognition that, according to the Dietary Guidelines Executive Summary “people do not eat food groups and nutrients in isolation but rather in combination, and the totality of the diet forms an overall eating pattern. The components of the eating pattern can have interactive and potentially cumulative effects on health. These patterns can be tailored to an individual’s personal preferences, enabling Americans to choose the diet that is right for them.”
I’ve discussed in the past the issue of basing diets on one dietary theory verses what is right for the individual at different points in time. This can lead to dietary wars that say one way is right for everyone when, in reality, genetics, current health status, and digestive capacities all determine if certain foods will be helpful or harmful to individuals.
For example, it’s a popular belief that high protein diets help with satiety and can assist with weight loss. However, the exact amount to recommend can be hard to determine due to some scientific inaccuracy issues in measurement. Furthermore, low carbohydrate and higher fat diets do have evidence to support weight loss (along with most diets); but have been shown to effect thyroid hormonal output. Therefore, dietary recommendations should change with an individual’s changing health status.
4. Sugar and Sugary drinks
That’s a no brainer. Sugar and sugar substitutes just aren’t good for you. Period.
Now, click here for the not-so-good Dietary Guidelines Recommendations including:
- The Saturated Fat Attack
- The Oil Dilemma
- The Dairy Controversy
- The Biases
- More Need for Individualizing Nutrition (see below)
Bonus read: Why Consider Personalized Nutrition?
The New York Times recently discussed a personalized approach to nutrition. Here is an excerpt:
Research increasingly suggests that each of us is unique in the way we absorb and metabolize nutrients. This dawning realization has scientists, and entrepreneurs, scrambling to provide more effective nutritional advice based on such distinguishing factors as genetic makeup, gut bacteria, body type and chemical exposures.
“The same dietary advice cannot be good for everyone, because we are all different,” said Eran Elinav, an immunologist at the Weizmann Institute of Science in Rehovot, Israel. “This is why we have failed so miserably at controlling the obesity epidemic.”…
Scientists are beginning to tease out the connections. Studies have linked at least 38 genes to nutrient metabolism — variants of which are thought to hinder or help absorption or the efficient use of nutrients in foods. Depending on your genetic makeup, studies suggest you might want to consume more or less folate, choline, vitamin C, fatty acids, starches and caffeine.
Click here to read more about a truly individualized approach to nutrition.
References:
U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
U.S. Department of Health and Human Services. Press Release: HHS and USDA Release New Dietary Guidelines to Encourage Healthy Eating Patterns to Prevent Chronic Diseases. January 7, 2016. Available at: http://health.gov/dietaryguidelines/2015/
Thompson D. New U.S. Dietary Guidelines: Limit Sugar and Salt, Boost Fruit and Veggie Intake. Health Day: Consumer News. January 7, 2016. http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/new-u-s-guidelines-limit-sugar-and-salt-boost-fruit-and-veggie-intake-706832.html
Office of Disease Prevention and Health Promotion (ODPHP). 2015 Dietary Guidelines. Advisory Committee. Health.gov Web site. Available at: http://health.gov/dietaryguidelines/2015-scientific-report/
Sifferlin A. Read the Government’s New Dietary Advice for Americans. Time. January 7, 2016. http://time.com/4142859/2015-us-dietary-guidelines/
Center for Disease Control and Prevention. Chronic Disease Overview: Chronic Diseases: The Leading Causes of Death and Disability in the United States. CDC Web site. August 15, 2015. http://www.cdc.gov/chronicdisease/overview/
Seven Healthy Habits May Reduce Heart Failure Risk. Reuters. December 23, 2015.
Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort. PLOS One. December 8, 2015
American Heart Association. My Life Check – Life’s Simple 7. http://www.heart.org/HEARTORG/Conditions/My-Life-Check—Lifes-Simple-7_UCM_471453_Article.jsp#
Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men. Int. J. Epidemiol. December 20, 2015. doi: 10.1093/ije/dyv321
Hansel B. Why Dietary Cholesterol Is No Longer Enemy Number One. Medscape Diabetes & Endocrinology. March 19, 2015.
Fernandez ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care. 2006 Jan;9(1):8-12.
Ebbeling CB, Swain J, Feldman HA, et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607.
National Institute of Health. NIH study finds cutting dietary fat reduces body fat more than cutting carbs. August 13, 2015. http://www.nih.gov/news-events/news-releases/nih-study-finds-cutting-dietary-fat-reduces-body-fat-more-cutting-carb
Heid M. Experts Say Lobbying Skewed the U.S. Dietary Guidelines. Times. January 8, 2016. http://time.com/4130043/lobbying-politics-dietary-guidelines/
Harcombe Z, Baker JS, Cooper SM, et al. Evidence from randomized controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart 2015; DOI:10.1136/openhrt-2014-000196.
Ward, T. Saturated Fat and CAD: It’s Complicated. theheart.org on Medscape. February 9, 2015. http://www.medscape.com/viewarticle/839360?src=wnl_edit_specol&uac=146852BY#vp_4
O’Riordan. No Evidence to Support Dietary Fat Recommendations, Meta-Analysis Finds. February 12, 2015. http://www.medscape.com/viewarticle/839708?src=wnl_edit_specol&uac=146852BY#vp_2
Kuetipers RS et al. Saturated fat, carbohydrates and cardiovascular disease. Neth J Med. 2011 Sep;69(9):372-8.
Gunnars K. 10 Proven Health Benefits of Coconut Oil (No. 3 is Best). Authority Nutrition. December, 2015
International Agency of Research on Cancer. IARC Monographs evaluate consumption of red meat and processed meat. Press Release. October 26, 2015. http://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf
Foster R. Processed Meat Can Cause Cancer: WHO. Health Day. October 26, 2015. http://consumer.healthday.com/cancer-information-5/colon-cancer-news-96/processed-meat-can-cause-cancer-who-704606.html
NRDC. Meat + Drugs= Superbugs. http://www.nrdc.org/food/saving-antibiotics.asp
CDC. Understanding CAFOs and their Impact on Communities. Accessed at: http://www.cdc.gov/nceh/ehs/Docs/Understanding_CAFOs_NALBOH.pdf
Graham M, Crooke R, Edwards PA, Hazen SL, Lusis AJ. Trimethylamine-N-oxide, a metabolite associated with atherosclerosis, exhibits complex genetic and dietary regulation (abstract). Cell Metab. 2013 Jan 8;17(1):49-60. doi: 10.1016/j.cmet.2012.12.011.
Turning Down The Heat When Cooking Meat May Reduce Cancer Risk: http://www.npr.org/sections/thesalt/2015/11/23/456654768/turning-down-the-heat-when-cooking-meat-may-reduce-cancer-risk?utm_medium=RSS&utm_campaign=health
Melkonian, S. C., Daniel, C. R., Ye, Y., Tannir, N. M., Karam, J. A., Matin, S. F., Wood, C. G. and Wu, X. (2016), Gene-environment interaction of genome-wide association study-identified susceptibility loci and meat-cooking mutagens in the etiology of renal cell carcinoma. Cancer. 122: 108–115. doi: 10.1002/cncr.29543
Hibbeln JR, et al. Healthy intakes of n?3 and n?6 fatty acids: estimations considering worldwide diversity. Am J Clin Nutr. June 2006; 83(6): S1483-1493S
Kris-Etherton PM, et al. Polyunsaturated fatty acids in the food chain in the United States. Am J Clin Nutr. January 2000; 71(1): 179S-188S.
Kresser C. How too much omega-6 and not enough omega-3 is making us sick. Chris Kresser Web site. May 8, 2010.
Russo G. Dietary n-6 and n-3 polyunsaturated fatty acids: from biochemistry to clinical implications in cardiovascular prevention. Biochem Pharmacol. 2009 Mar 15;77(6):937-46. doi: 10.1016/j.bcp.2008.10.020. Epub 2008 Oct 28.
Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6015 (Published 28 October 2014)
The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. European Journal of Nutrition. February 2013; 52(1): 1-24.
Mercola J. Is Whole Milk Dairy Better Than Low Fat? Mercola Web site. November 18, 2015.
Dallas ME. Report: DASH Diet Best Overall Eating Plan. Health Day Web site. January 5, 2016.
Chiu S, et al. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. Am J Clin Nutr. December 30, 2015, doi: 10.3945/?ajcn.115.123281
