2015-2020 Dietary Guidelines for Americans: Content & Controversies

by Emily Finnan

With the next five years of Americans’ nutritional recommendations at stake, a hot debate surrounding the Dietary Guidelines is a guarantee!

As you’re probably well aware, the 2015-2020 Dietary Guidelines (DG) for Americans were released! Every five years, this report, a joint venture of Department of Health and Human Services and the United States Department of Agriculture (USDA), aims to provide food and beverage recommendations to promote health, prevent chronic disease, and help people reach and maintain a healthy weight.

The final Dietary Guidelines aren’t just lofty recommendations. They’re the basis of food/nutrition policy and federal nutrition programs like WIC, national school meals, meal programs for the elderly, and others. Organizations, industry, health professionals, and individuals all use these guidelines.

The guidelines were formed over a long, two-in-half-year process detailed in this month’s Sprout article by Connie Ray, the “Process & Politics,” of the DG. A team of scientists starts the process with the Scientific Report of the Dietary Guidelines Advisory Committee (DGAC) that aims to inform the DG.

The Dietary Guidelines are a pretty big deal. We can expect contention. This edition seemed to generate even more disputes, however, starting with the release of the DGAC report. Debates even took to the congressional floor! Ray’s article explores the congressional controversy that happened before the guidelines were even released.

It is important to note that the DG actually don’t change much with each new edition despite a media portrayal of fickle nutrition recommendations (remember when one day kale was a “superfood,” the next filled with toxic thallium?). Overall, what we know to be a healthy diet, and what dietary changes Americans should make, holds true.

We still need to eat more vegetables and fruits (especially whole fruits). We fall way behind on the recommendation to make “half your grains whole.” The majority of us aren’t meeting dairy goals with most of the dairy we eat being saturated fat-rich cheese versus low-fat milk and yogurt. Most of us are way over the recommended maximum 2,300 milligram of sodium a day.

Though not everyone agrees on even those unchanging recommendations, they were largely accepted without major controversy. Scientists and organizations were quick to sound off within hours of the release on what did change—or, alternatively, did not change—in the 2015 DG.

For cholesterol there isn’t a new or different recommendation, but rather a lack of a recommendation in the 2015 DG. It was removed from the list of nutrients to limit. In 2010, Americans were over-consuming the recommended 300-milligram limit on cholesterol.

Per the 2015 DG, “Adequate evidence is not available for a quantitative limit for dietary cholesterol.” The guidelines confusingly add, “but this change does not suggest that dietary cholesterol is no longer important…individuals should eat as little dietary cholesterol as possible.” The DG go on to cite the high saturated fat content of many cholesterol-containing foods. Eggs and shellfish get special mention for being high in cholesterol but low in saturated fat.

It seems most media outlets took the lack of cholesterol recommendation as vindication, concluding that cholesterol is not the artery-clogging nutrient it was once thought of. The Physicians Committee for Responsible Medicine, a group that advocates for vegan diets, filed a lawsuit against the DG (they also did this in 2011 with the 2010 DG). They questioned if a conflict of interest from the egg industry led to the deletion of a cholesterol limit. However, overall, the group praised the guidelines, focusing on the “eat as little as possible” phrasing.

And despite some heavy media coverage and significant controversy, butter is NOT back. The recommendation to eat less than 10% of total calories from saturated fat remained, with continued encouragement to replace solid, saturated fats with unsaturated plant oils.

We are still eating too much added sugar. We are down from on average 16% of total calories to 13%, with most of that added sugar still coming from beverages. New in this version of the Dietary Guidelines is a calorie limit on added sugar: less than 10% of total calories. By distinguishing added sugar from sugar naturally present in food, the sugar in fruit and milk gets a pass. The proposed re-vamped nutrition facts panel would have added sugars listed separately, with a corresponding daily value, making this recommendation easier for individuals to implement.

It seems most were happy with the “sugar cap.” The World Health Organization has said since 1989 to keep added sugars less than 10% of total calories. More recently in 2015, a further reduction was recommended for dental health: keep sugars to less than 5% of total calories. Unsurprisingly, The Sugar Association rejects the sugar limit, describing it as an, “agenda based, not science based” recommendation, claiming a lack of scientific evidence to justify the cap.

Nutritionist and food industry critic Dr. Marion Nestle criticized the DG for not outright recommending to “drink less soda.” Indeed, just one 16-ounce soda can put a person over the recommended sugar limit. Nestle and quite a few others, including Friedman Dean Dr. Dariush Mozaffarian, note the DG switch from talking about food (i.e., eat more green leafy vegetables), to talking about nutrients when they want us to eat less of something (i.e. eat less sugar, instead of drink less soda). Nestle blames “food politics.”

The DG do suggest cutting down on sugar by drinking no-added sugar beverages, but do not recommend diet drinks. In fact, this was the first time the DG mentioned diet drinks: “Replacing added sugars with high-intensity sweeteners may reduce calorie intake in the short-term, yet questions remain about their effectiveness as a long-term weight management strategy.” Caffeine also gets a first time mention. Moderate caffeine consumption is OK, but if you don’t drink caffeine, there’s no reason to start.

For the first time, the scientific report considered sustainability. The DGAC recommended a diet that limited animal products. This drew intense industry criticism and even a Change.org petition, titled “Hands Off My Hot Dog.” The Secretaries of Health and Human Services and Agriculture decided not to include sustainability in the DG. Ray’s article further explores the controversy behind the influence industry had on the exclusion.

The scientific report’s main finding—what constitutes a healthy diet—is as follows: “higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat.” This pescatarian-esque diet recommendation drew harsh criticism from the North American Meat Institute, which called removal of “lean meat” as part of a healthy diet “arbitrary and capricious,” publicly questioning the scientific rigor and transparency of the DGAC.

The 2015 DG recognized the scientific evidence regarding meat and health, stating, “Strong evidence…has shown that eating patterns that include lower intake of meats as well as processed meats and processed poultry are associated with reduced risk of CVD in adults. Moderate evidence indicates that these eating patterns are associated with reduced risk of obesity, type 2 diabetes, and some types of cancer in adults.”

However, the recommendation to eat, per week, 26-ounce equivalents of meat, poultry, and egg goes unchanged from 2010. The 2015 DG do sort of recommend you eat less meat, particularly red and processed meat, if you read between the lines.

For protein, the big take home is to increase variety. Since Americans get most of their protein from poultry, meat, and eggs, the recommendation to increase variety by eating more seafood, nuts/seeds, and legumes can be interpreted as “eat less meat.” Teen and adult men generally overconsume protein, so it is recommended they decrease protein intake by eating less of the common protein foods like meat, chicken, and eggs. Recommendations to limit saturated fat can lead someone to eat less red meat, and recommendations to eat less sodium could lead someone away from typically high-sodium processed meat. The DG do green light lean, low-sodium processed meats.

The tiptoeing around processed and red meat yielded perhaps the largest criticism of the Dietary Guidelines. In an interview with NPR, Mozaffarian said, “A challenge here is that the Dietary Guidelines come from USDA, which is inherently conflicted. It wants to improve the health of Americans yet it also wants to promote farming and food industry.”

The American Institute of Cancer Research had some harsh feedback: “We are dismayed to see that the Dietary Guidelines have allowed lobbying efforts to supersede the scientific evidence, when it comes to meat and cancer risk.” The American Cancer Society Cancer Action Network echoed this sentiment, calling the DG a “missed opportunity to reduce death and suffering.”

It will be interesting to see if the discord surrounding the 2015 DG fizzles out or creates serious change in how the Dietary Guidelines are created and disseminated. But, if you are unhappy with the guidelines, sit tight. Only five more years and we can debate once again!

Emily Finnan is a second-year Biochemical and Molecular Nutrition MS student and registered dietitian. When she’s not reading lengthy government documents, she’s tweeting: follow her @emilyyfin.

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