Roger Berkowitz

Then came a meeting of the HSPH Nutrition Roundtable, a group of people who share a common interest in advancing public nutrition. Berkowitz attended.

"I didn’t know trans fats from avocados," Berkowitz said. Once he learned the health risks of trans fatty acids found in hydrogenated vegetable oil, Berkowitz embarked on a successful and ongoing campaign to replace the trans fats in Legal Sea Foods with beneficial oils.

Walter Willett at the forum

The US Department of Agriculture (USDA) Food Guide Pyramid has not been updated since its 1992 public release. The pyramid was intended to serve as a tool to help consumers implement the Dietary Guidelines for Americans, published jointly by the USDA and the US Department of Health and Human Services. The guidelines have been updated twice since 1992 and are being revised again for 2005.

Coincidentally, the USDA published proposed revisions to the Food Guide Pyramid a few days after the forum at HSPH, opening a public comment period on the proposals. (See sidebar below.)

"The Healthier Food Guide Pyramid" forum was sponsored by the Departments of Nutrition at HSPH and Brigham and Women’s Hospital.

A Flawed Pyramid

"We want to initiate a public dialogue about why and how the USDA Food Guide Pyramid needs to be revised based on science," explained forum co-chair Lilian Cheung, describing the event's purpose in a later follow-up by HPH NOW. "The USDA Pyramid is seriously outdated," she continued. "Many new research findings have emerged that justify the need for revision. Besides examining it from the scientific angle, we also want to learn from practitioners in the field to explore how the science-based recommendations for a healthier pyramid can be implemented." Cheung is a lecturer and director of health promotion and communication in the Department of Nutrition. She co-chaired the forum with Kathy McManus, director of nutrition at Brigham and Women's Hospital.

Alice Lichtenstein

One of the big problems with the old USDA pyramid is that it ignores critical differences in the effects that various types of dietary fat have on disease risk, even though that research goes back 30 years, said Walter Willett, chair of the Department of Nutrition.

Other modifications should be considered, he asserted, such as distinguishing whole-grain carbohydrates from refined grains and sugars and emphasizing nuts, fish and soy as protein sources.

Willett has been a vocal proponent of changing the USDA pyramid. Last year, he was part of a research team that developed an Alternative Healthy Eating Index and food guide pyramid emphasizing quality of food choices. The team included Marjorie McCullough, an epidemiology researcher at the American Cancer Society who formerly worked in and received her doctorate from the Department of Nutrition at HSPH, as well as researchers from the ongoing Harvard-based Health Professionals Follow-Up Study and the Nurses’ Health Study. They found in studies that men and women who followed the healthier alternative to the USDA pyramid–but not the USDA pyramid itself–significantly reduced their risk for major chronic diseases. The results were published in the December 2002 issue of the American Journal of Clinical Nutrition. McCullough was first author on the paper.

A Chance to Make Changes

Willett and colleagues have calculated that the risk of premature heart disease, type 2 diabetes and colon cancers can be reduced by 70 to 90 percent with modest changes in diet and lifestyle.

	Stephanie Smith-Warner

	Frank Hu

High protein diets remain controversial, but moderately high protein diets may have beneficial effects on blood lipids and coronary heart disease, said Frank Hu, associate professor of nutrition and epidemiology in the Department of Nutrition. Dieticians can safely recommend that about 20 to 25 percent of daily calories come from healthy sources of protein such as fish, poultry, low-fat dairy, egg whites, nuts and legumes, especially if they replace refined grains and sugar.

Consumers need to be made more aware that foods lumped together in traditional categories of carbohydrates, proteins, dairy products and even fruits and vegetables can have very different impacts on health.

Frank Sacks

For example, complex, slowly digested carbohydrates (also known as having a low glycemic index) appear to help people lose weight and control their appetites compared to quickly digested starches that send insulin levels on a rollercoaster ride, first soaring and then plummeting, said David Ludwig, assistant professor of pediatrics at Children’s Hospital Boston. But Ludwig cautioned against adopting too rigid an approach to following a low glycemic index or any other single dietary idea.

"We need to avoid coming up with another Holy Grail that becomes obsessive in the long run," he said, referring to the low-fat mantra espoused for years by nutritionists and food industry representatives that seems to have backfired. Not all fats are bad, and many so-called low-fat or no-fat products are packed with sugar. Or, people simply eat too many of them, assuming that a lack of fat alone will help them avoid gaining weight.

A Starting Point at Schools

Kathy McManus

Forum speaker and Massachusetts State Representative Peter Koutoujian described a proposed bill, HB3519, to ban soft drinks, high-fat chips and candy from vending machines in schools during regular hours and replace them with water, healthier drinks and healthier food. Koutoujian is Massachusetts House Chair of the Joint Committee on Health Care.

"A wave is when public sentiment and science align at a time when you can get something done, and we’ve got one now with childhood obesity," he said.

A Pie-Shaped Pyramid?

A future, revised food pyramid may not be in the shape of a pyramid at all. Tufts’ Lichtenstein said she is not sure that a pyramid is the best graphic to use when disseminating nutritional advice.

"From what I understand, the Food Guide Pyramid is one of most recognizable nutrition symbols, but there is no evidence that people are interpreting it correctly," she said. Lichtenstein recommended a new graphic for the next generation of diet advice that will have enough flexibility to provide more tailored information.

To start people thinking more creatively, she suggested a plate shape or pie shape so people are not

confused about whether the best or worst foods are at the bottom or at the top of the pyramid.

"Something new may shake people up a little and get them to pay more attention," she said in a follow-up phone interview.

A webcast of "The Healthier Food Guide Pyramid: From Science to Practice" is archived at the web site www.hsph.harvard.edu/nutrition/foodpyramid.

Lilian Cheung

Lilian Cheung, co-chair of "The Healthier Food Guide Pyramid: From Science to Practice," (see above) is encouraging people to respond. "It is important for scientists, practitioners, dietitians, clinicians, public health experts, to speak up and offer their critique to the USDA," Cheung said. "We are in the process of creating a joint statement from members of the faculty in the Department of Nutrition."

The USDA wants to hear input about how much fruit, vegetables, grains, meat and beans, fats and additional sugars it should recommend for daily consumption. Other areas include daily calorie targets, nutritional goals for proposed food intake patterns, and how to measure serving size.

The graphic presentation of the revised information, be it a pyramid or something else, will be presented for public comment in 2004.

The USDA Pyramid revisions are being coordinated with the planned 2005 update of the Dietary Guidelines for Americans. Carlos Arturo Camargo Jr., assistant professor of epidemiology at HSPH and president of the American College of Epidemiology, is one of 13 individuals on the Dietary Guidelines Advisory Committee.

Submit comments to the Food Guide Pyramid Reassessment Team, USDA Center for Nutrition Policy and Promotion, 3101 Park Center Dr., Room 1034, Alexandria, VA 22302. Comments must be received on or before October 27, according to the notice in the Federal Register.

--Carol Cruzan Morton

Kosher and Other Meals for HSPH Members with Dietary Considerations Available at Sebastian’s

Sebastian’s chef Patricia Gregory orders the meals.

"Sebastian’s is a place where comfort is provided, where people can take a break from their busy days," noted general manager Jeanne Tappan. "People should feel like they can come here and find food that will satisfy them."

Today, Sebastian’s offers not only kosher meals by request but also meals for people who have special dietary considerations, such as food allergies. There are usually several frozen meals from which to choose, such as roast chicken or pasta, and a vegetarian option. The meals cost on average $6 each.

The meals are microwaveable, and there is a microwave available to students near the entrance to Sebastian’s by the vending machines.

For more information about ordering kosher or special dietary meals, contact Tappan at jtappan@camail2.harvard.edu.