Monthly Archives: February 2015

Are the Dietary Guidelines Keeping Us Down? Lessons from Brazil

Last week, the Dietary Guidelines Advisory Committee (DGAC) released their report detailing their recommendations for the 2015 Dietary Guidelines for Americans (DGA). The DGA are updated every 5 years, and they target the general, healthy public, adults and children aged 2 and older. They are used to inform nutrition policy, public health initiatives, physicians, and nutrition professionals. They are used to create nutrition education materials for community programs, clinical practices, and school nutrition programs.

This is just the report, and the actual DGA will be released later this year after a few months of open forum comments and raging food industry lobbying.

The report summarizes the committee’s plans to continue some of 2010’s recommendations (limiting saturated fat to 10% of energy intake, for example), but also introduces some very interesting new ones – lifting the taboos on cholesterol (eggs! shrimp!) and coffee (3 – 5 cups per day is a-OK). This year’s report is more anti-red meat than every preceding DGAC report, and takes a strong stance against added sugars. Plus, this is the first time that advice to restrict fat to a certain percentage of calorie intake is absent from the guidelines. Whether these recommendations weaken a bit before the guidelines are published later this year is dependent on how successful the soda and meat lobby groups are in the coming months.

Although the food industry will reach the highest decibel level when attacking the guidelines, they’re not the only corner from which protests can be heard.  Some health and nutrition experts and writers have had bones to pick with just about every incarnation of the DGA since their birth in 1980. Despite the guidelines being evidence-based and written by a group of nutrition and public health experts (RDs, PhDs, MDs), many believe that they are misguided and murky . One common argument is that the DGAC’s  perennial recommendation to cut fat from the diet (based largely on observational studies as opposed to randomized, clinical trials) has led to the overconsumption of calories from nutrient-poor refined carbohydrates and sugars, making our obesity worse and our chronic disease more prevalent (Nina Teicholz contributed a somewhat-biased op-ed piece to the New York Times saying exactly this*).

Others have a problem with the inherent conflict of interest present when the government’s Department of Agriculture is responsible for both boosting sales of farmed foods and livestock and promoting our nation’s health.

I get why people in the nutrition world have a problem with the whole DGA process. Big Food’s influence on the guidelines disturbs me, as does the aforementioned conflict of interest. Plus, nutrition science is continuously evolving and no, observational data aren’t the best way to inform our nutrition policies, but clinical trials don’t always work either; there’s a plethora of confounding variables that are present when asking groups to follow a specific diet over a long period of time.

But my big problem with the DGA is the very palpable sense that the DGAC has a deep distrust of Americans’ ability to properly care for themselves.  When I read the guidelines, I feel like I’m being reprimanded for my life choices. I’m told that we Americans are fat and lazy, controlled by our sugar and fat addictions, will inevitably develop one or more chronic diseases, and will die an early death. And all of this will cost the country billions of dollars in healthcare costs. And it’s All. My. Fault.

What I’m saying is, I feel like a child. Even the visual presentation of the 2010 Guidelines (remember the actual 2015 guidelines won’t be released until later this year) is elementary; it looks like a fifth grade text book.

diet guidelines2 diet guidelines1

(taken from PDF copy of 2010 Dietary Guidelines for Americans)

Take the low fat recommendations, for example. Previous DGACs recommended low fat diets, or more specifically, low fat diets where saturated fats are substituted by unsaturated fats. These recommendations were based on what has been considered sound science – evidence supporting a link between fat intake and heart disease.  The fact that Americans replaced fat with refined carbohydrates in their diets is unfortunate, but that was never the intent (explicit or implicit) of the guidelines. The DGAC never said, “Stop eating red meat, dairy, and butter, and eat pre-packaged, low fat cakes, cookies, and candies instead.”

And that is the problem.

The information in the DGA isn’t necessarily flawed, it’s just incomplete. It is rudimentary and basic. It boils complex concepts down to vague one-liners and doesn’t consider the whole picture.  If we want Americans to make informed decisions about their food choices, we need to stop dumbing down our messages. We can’t just say stop eating solid fats and added sugars. Because we never taught the public where solid fats and added sugars are found in their food supply, why they are added and at what expense. And we never told them what to eat instead.

Another example: Americans are told we should eat less refined grains and less processed foods.  But what does that even mean?  Cleaning, removing inedible parts, and pasteurizing are all examples of processing undertaken by farmers and food companies before making food available for purchase. One would hardly consider these processes detrimental to our health. The processing behind refining grains, however, does result in a less-nutritious product. But our guidelines don’t differentiate these concepts, leaving Americans confused instead of informed.

Our guidelines are so focused on the negative consequences of our diet that they fail to address the fact that food and eating is about so much more than physical health. The experience of eating touches cultural, social, emotional, and environmental realms.

I didn’t fully realize this void until I read Brazil’s dietary guidelines, the most recent version introduced last year. Granted, Brazil is culturally, economically, and politically different than the US , but as the country continues to make forward progress in the global economy, their diet is unfortunately starting to resemble ours. And the great thing about food and nutrition is that it’s universally important, and adequate access to food is considered a basic human right.

The reason Brazil’s guidelines are so great is because they delve into a comprehensive rationale for eating a diet based in whole, minimally processed foods. They talk about the entire eating experience. Not just specific nutrients and foods, but how they can be prepared and incorporated into meals, with whom they are eaten, how quickly, and how mindfully. They actually have multiple photos of examples of healthful meals (breakfasts, lunches, and dinners, and snacks). There’s a chapter called “Modes of Eating” that discusses the time and attention devoted to eating, the environment in which it occurs, and the people with whom meals are shared.

brazil meals 2

(taken from PDF copy of Dietary Guidelines for the Brazilian Population)

When they advise against eating ultra-processed foods, they go beyond the obvious reasons (they are nutrient poor but calorie dense, laden with fat, sugar, and sodium). They cite their impact on a society’s culture, social life, and environment. Marketing campaigns behind processed foods like soda and snack foods are credited with a lost sense of cultural belonging (especially among children) and processed foods’ ease of consumption promote mindless, isolated eating and prevent meal-sharing and socializing.

Their guidelines are relevant for Brazilian families, traditions, routines. They acknowledge that eating is about so much more than getting adequate nutrients to sustain life (despite the fact that not so long ago, this was a major concern for Brazilians). They look at food comprehensively and holistically. And they tackle barriers to healthy eating – time, cooking skills, cost, the availability of sound nutrition information, and the food industry’s advertising campaigns. Acknowledging that barriers exist, let alone offering suggestions for overcoming them, is something the US guidelines don’t do at all.

Brazil’s guidelines are inspiring, where as ours feel like homework.

It’s not that Brazil “gets” something that America doesn’t. But Brazil gives its citizens much more credit than the DGA committee gives Americans.  Our guidelines need to stop talking to Americans like they’re in preschool. Americans are resourceful and capable of change, especially if they’re given a tool that’s optimistic about the future of their health and embraces the full complexity of the human relationship to food.

Dietary Guidelines for Americans 2010:

http://www.cnpp.usda.gov/dietary-guidelines-2010

Scientific Report of the 2015 Dietary Guidelines Advisory Committee: http://www.health.gov/dietaryguidelines/2015-scientific-report/

Dietary Guidelines for the Brazilian Population: http://189.28.128.100/dab/docs/portaldab/publicacoes/guia_alimentar_populacao_ingles.pdf

Interesting reads:

http://www.foodpolitics.com/2014/02/brazils-new-dietary-guidelines-food-based/

http://www.vox.com/2015/2/20/8076961/brazil-food-guide

*Regarding Ms Teicholz’s piece: my opinion is that this piece is misguided, but I wanted to include it to show that criticisms of the government’s dietary advice are as mainstream as the New York Times.

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