New U.S. Dietary Guidelines: Progress, Not Perfection

Dietary Guidelines 2010: Progress, Not Perfection (dietary-guidelines.jpg)The long-awaited new U.S. dietary guidelines are a step in the right direction, but they don’t go quite far enough to spell out what Americans need to do to stay healthy—not a surprise, some critics say, given the strong influence of the food industry on U.S. food policy.

The 2010 Dietary Guidelines for Americans, released on January 31, 2011, are used to direct federal nutrition and education programs that reach tens of millions of Americans, including school lunch and food assistance programs. The 95-page document is the culmination of a two-year process of scientific evidence review and public hearings that drew thousands of comments from individuals and public health experts, as well as from powerful food industry groups—the Grocery Manufacturers Association, the Sugar Association, the National Milk Producers Federation, and the National Cattleman’s Beef Association, among them.

Eat Less Red Meat (eat-less-red-meat.jpg)

The Dietary Guidelines for Americans 2010 has two pages of “Key Recommendations” that spell out specific food components that Americans need to cut back on—among them, sodium, saturated and trans fat, added sugars, and refined grains. But the document could have been much more direct, telling people which foods to avoid—for example, to cut sugary soft drinks, red meat, white bread, French fries, and other American staples.

Interestingly, the same two page section of the report very clearly spells out what foods to increase—vegetables, fruits, whole grains, seafood, and low-fat or fat-free milk and milk products.

It’s possible that the yet-to-be-launched consumer education materials will be more user-friendly and direct. A separate handout with “Selected Messages for Consumers,” provided on the Dietary Guidelines website, does tell people to “drink water instead of sugary drinks,” but it is silent on red meat.

As expected, based on a report of the Dietary Guidelines Scientific Advisory Committee last summer, the new guidelines encourage Americans to eat more foods that deliver healthful nutrients and fewer foods chock full of empty calories and salt, to exercise more and curb screen time, and to maintain healthy weights. In some places, though, the healthy eating messages are obscured. And, critics say, the guidelines still don’t go as far as they could to promote eating patterns that lower heart disease, diabetes, and other chronic disease risk. (Read about the problems with 2005 Dietary Guidelines for Americans.)

An ongoing complaint of public health experts is that the guidelines, which are updated every five years, come not just from the agency responsible for promoting the nation’s health—the U.S. Dept. of Health and Human Services—but also from the U.S. Dept. of Agriculture (USDA), which is responsible for promoting and marketing agricultural products.  

“I had hoped that the USDA would be able to give Americans the clear advice about diet that they deserve,” says Dr. Walter Willett, Fredrick John Stare Professor of Epidemiology and Nutrition, and chair of the Dept. of Nutrition at Harvard School of Public Health. “However, the continued failure to highlight the need to cut back on red meat and limit most dairy products suggests that ‘Big Beef’ and ‘Big Dairy’ retain their strong influence within this department. Might it be time for the USDA to recuse itself because of conflicts of interest and get out of the business of dietary advice?”

While the 2010 guidelines’ development was informed by an expert panel of nutrition scientists (including Dr. Eric Rimm, Associate Professor in the Dept. of Nutrition at Harvard School of Public Health), the scientists do not have any say in the wording of the final document.

“We wanted our messages to be as food and diet based as possible, as opposed to focusing on nutrients,” Rimm says. “We still have a huge obesity problem in children and adults, so it’s clear that our previous messages were not getting out to the public. We hope that the planned consumer education materials based on the new Dietary Guidelines will be much easier to interpret.”

Encouragingly, the new Dietary Guidelines acknowledge for the first time that overweight and obesity are social—not individual—problems. Although brief, one chapter of the guidelines offers strategies that schools, communities, health-care providers, policy makers, and food producers can use to make it easier for individuals and families to eat right and stay active.

Some of the nutrition recommendations in the new Dietary Guidelines represent important steps in the right direction:

  • Eat more foods from plants. The guidelines emphasize eating more vegetables, beans, fruit, whole grains, and nuts, and they highlight healthful plant-based eating patterns, including the DASH diet and the Mediterranean diet, as well as vegetarian and vegan eating plans.

Read more about the health benefits of eating fish and omega 3 fatty acids.

  • Eat more fish. Recognizing the role of omega 3 fatty acids in preventing heart disease, the guidelines encourage Americans to eat more seafood—two servings (8 ounces) per week—in place of red meat or poultry. 
  • Not all protein packages are the same. The document notes that some protein foods, such as meat, poultry, and eggs, are higher in so-called “solid fats”—the saturated and trans fats that Americans need to cut back. It recommends replacing them with protein foods that contain healthy oils, such as fish and nuts, or choosing leaner forms of meat.
  • Read more about how to include healthy fats in your diet.

    Total fat is fading away as a focus.  This version of the guidelines appropriately emphasizes total calories in the diet, rather than the percentage of calories from fat in the diet. And it is appropriately focused on replacing bad fats with healthful fats from plant sources and fish.

Other recommendations do not go far enough to reflect the latest nutrition science—or bury key messages:

  • Continued fixation on 35 percent of calories from fat.  Although the new guidelines appropriately decrease the emphasis on percentage of calories from fat, they still set 35 percent as the upper limit—a problem, especially given the way that the guidelines are used to set standards for schools and other federal food programs. The cap on fat can distort menus, since it means that a large intake of refined grains is still allowed. And often this cap on fat is wrongly applied to individual foods or meals, so that broccoli with olive oil would be seen as too high in fat, whereas mashed potato with butter would not.
  • Too lax on refined grains. Though the new guidelines encourage Americans to cut back on refined grains and replace them with whole grains, they still suggest that it is okay to consume up to half of our grains as refined grains. That’s unfortunate, since there’s been even more research evidence in the past five years that refined grains, such as white bread, white rice, and white pasta, have adverse metabolic effects and increase the risks of diabetes and heart disease. (1,2) The Healthy Eating Pyramid, from the Dept. of Nutrition at Harvard School of Public Health, puts refined grains in the tip, meaning that they should be used sparingly, if at all.
  • Too lenient on red meat. The guidelines still continue to lump red meat together with fish, poultry, eggs, nuts, seeds, beans, and soy products in one food group, newly termed the “protein foods” group. Though they highlight the benefits of replacing some meat or chicken with fish, they gloss over the substantial evidence that replacing red meat with poultry, beans, or nuts, could help prevent heart disease, and that lowering red meat can lower the risk of diabetes. (3,4) The Healthy Eating Pyramid, in contrast, puts red meat in the “use sparingly” tip, to emphasize that it’s better to get proteins from more healthful sources, such as nuts, seeds, beans, fish, poultry, and eggs.  The guidelines also don’t provide adequate warning about processed meats, which have been most strongly linked with cardiovascular disease and diabetes, at least in part due to their high added sodium content.
  • Too much dairy. The guidelines recommend increasing intake of low-fat milk and dairy products—recommendations that don’t reflect the evidence. There is little, if any, evidence that eating dairy prevents osteoporosis or fractures, and there is considerable evidence that high dairy product consumption is associated with increased risk of fatal prostate and ovarian cancers. To be sure, calcium is an important nutrient, but we don’t need as much calcium as these guidelines recommend—and milk and dairy are not the only, or best, sources of calcium. Also, while the guidelines are clear about low-fat dairy, they are notably vague about regular fat dairy products such as cheese and ice cream.  Based on the scientific evidence, the Healthy Eating Pyramid recommends limiting dairy products to one to two servings per day, or consuming a vitamin D and calcium supplement instead.
  • Read why the IOM’s recommendations are too low on vitamin D and too high on calcium.

    Too little vitamin D. The guidelines, as expected, follow the lead of the Institute of Medicine (IOM) and recommend 600 IU of vitamin D a day for children and most adults, and 800 IU for adults over age 70—a recommendation that’s too low. There’s ample evidence that to reach adequate blood levels of vitamin D, most Americans need at least 1,000 IU of vitamin D per day—an amount that is hard, if not impossible to achieve, from food alone. 

  • Stopping short on sodium. Given that nearly 70 percent of U.S. adults should consume no more than 1,500 milligrams of sodium per day, (5) it’s a shame that the Dietary Guidelines does not make 1,500 milligrams the daily sodium max for all Americans. Instead, the guidelines keep 2,300 milligrams as the upper limit for everyone except people in high risk groups. 
  • Lack of clarity. While the guidelines are clear about foods that should be increased, such as fruits, vegetables, and whole grains, the guidance becomes vague when discussing foods to reduce.   Instead of talking about reducing “solid fats” the guidelines should emphasize reducing red meat and dairy products, such as butter, regular milk, cheese, and ice cream. A table in the Appendix does list more specific strategies for consumers, so perhaps the planned consumer education materials will be more direct than the Dietary Guidelines themselves.

It remains to be seen how these new Dietary Guidelines will be turned into nutrition messages for the general public. Typically, the scientists who help inform the guidelines’ development are not involved in the communication effort—and their science-based guidance sometimes gets lost in translation. Take the MyPyramid logo, which became the public face of the 2005 guidelines. Vague and abstract, it doesn’t clearly illustrate what foods are healthier choices than others; you need to visit the USDA’s website for those details. The MyPyramid website is cited frequently throughout the new Dietary Guidelines report, but there are no pictures of MyPyramid itself, so perhaps the much-maligned logo is in for a face lift? Stay tuned.

References

1. Sun Q, Spiegelman D, van Dam RM, et al. White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med. 2010;170:961–9.

2. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010;91:502–9.

3. Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122:876–83.

4. Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia. 2009;52:2277–87.

5. Application of lower sodium intake recommendations to adults—United States, 1999-2006. MMWR Morb Mortal Wkly Rep. 2009;58:281–3.

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