The Baneful Consequences of the U.S. Dietary Guidelines Posted on February 02, 2015, 0 Comments
The next set of Dietary Guidelines for Americans (DGA), the public health nutrition policy that directs all federal nutrition activities “including research, education, nutrition assistance, labeling, and nutrition promotion,”1 are due out in 2015. The DGA are meant to address a simple question: What should Americans eat to be healthy?2 As the 2015 Dietary Guidelines Advisory Committee (DGAC) begins to create the report that will advise any possible changes to the DGA, they appear poised to provide the same answer to that question that has proven largely ineffective for the past thirty-five years.
Although the DGAC has retreated from the recommendation that Americans reduce their intake of total fat, limits on saturated fat and cholesterol from animal products remain firmly in place and these levels may be restricted further. Thus despite the superficial movement away from reduced-fat guidance, in terms of which foods are permitted and which are restricted or forbidden, nothing has changed.
According to the 2015 DGAC, eggs, meat, butter and full-fat dairy are still to be limited or eliminated from the diet altogether. Consumption of whole grains, fruits and vegetables, lowfat or no-fat dairy, fish, and lean cuts of poultry are encouraged, and, with restrictions on fat intake relaxed, Americans will now be allowed to consume even more vegetable oil than before.
While the 2015 DGAC has acknowledged that when Americans replaced dietary fat with starches and sugars obesity rates climbed, there has been no recognition of the relationship between this phenomenon and DGA guidance. Rather, the implication remains that high rates of being overweight and obese in America are due to the fact that Americans have simply failed to comply with what the U.S. Departments of Agriculture (USDA) and Health and Human Services (DHHS)―the two government agencies in charge of the DGA―have determined is best for the public. “Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight,”3 not poor dietary recommendations based on inadequate science.
A PRIMARY MISCONCEPTION
In fact, a primary misconception in public health nutrition is that current national nutrition polices are based on scientific agreement about what constitutes a healthy diet. However from the beginning, federal dietary guidance has been based more on ideology, including romantic notions of returning to a “natural” way of eating, than science. Although nutrition science has changed dramatically in the thirty-five years since the first national dietary recommendations were issued, the recommendations themselves have remained virtually unchanged. The historical and cultural influences behind federal dietary recommendations, their controversies and their consequences, warrant a close critical examination. They demonstrate that although science and policy perform very different functions, they can be mutually reinforcing. Though this does serve to make science more political, it does not make policy more scientific.
A cascade of unintended consequences has resulted from those original dietary recommendations, guidance that remains entrenched, held in place by politics, ideology, institutional agendas, and the influence of interested industries.4,5 This entrenchment has resulted in millions of U.S. taxpayer dollars spent on nutrition policies, programs and practices that do not result in good health, while the very same taxpayers are expected to shoulder the blame for these negative outcomes.
HISTORY OF THE DGA
When the first national nutrition recommendations for the prevention of chronic disease, the 1977 Dietary Goals for Americans, were originally proposed, not only was the content of the recommendations hotly debated, the very concept of one-size-fits-all, population-wide dietary advice was itself highly controversial. The 1977 Dietary Goals introduced a diet―high in grains and cereals and low in fat, with few animal products, and vegetable oils substituting for animal fats―that was an extreme departure from what Americans were then eating. Not only was the diet recommended by the 1977 Goals a radical change for many Americans, the very idea that the federal government could know what foods were best for any given individual was a dramatic shift in how public health nutrition was understood and administered.
Before the 1977 Goals were created, the determination of which foods were “good” for you and which were “bad” was located within the family and community, rather than with the government. Packaged food did not carry a nutrition label, and government dietary guidance focused on acquisition of adequate essential nutrition, rather than the avoidance of foods that might cause chronic disease. Despite the lack of government guidance on how to prevent chronic disease through nutrition, heart disease rates had been decreasing in America since 1968,6 and in 1975, less than 15 percent of the population was considered obese.7
In many regards, the health of Americans in the 1970s had never been better. However, concerns about “lifestyle-related” diseases permeated the consciousness of much of middle class America, and food manufacturers responded accordingly. The American Heart Association (AHA) had created a national platform for a theory proposed by a physiologist named Ancel Keys, which asserted that dietary fat—especially saturated fat and cholesterol from animal products—led to heart disease. Responding to these interests, manufacturers of “heart-healthy” margarines and meat substitutes began claiming their products could reduce the risk of heart disease, although the federal government remained unconvinced.
Evidence that dietary fat and cholesterol had significant effects on heart disease was elusive, and the Federal Trade Commission repeatedly warned manufacturers not to make false and misleading claims linking food products to the prevention of heart disease.8 Although the AHA primarily aimed its fear-of-fat message at businessmen who might be lucrative donors,8 the counter-culture thinking that emerged from the social upheavals of the 1960s picked up the refrain, marrying concerns about chronic disease to anxiety about the environment and world hunger.
Earlier in the decade, a popular vegetarian cookbook by Frances Moore Lappé, Diet for a Small Planet, suggested that a meat-free diet would be low in saturated fat and cholesterol, thus reducing risk of obesity, heart disease and cancer; furthermore, Lappé asserted, a vegetarian way of life would reduce world hunger, energy costs, and environmental impacts of agriculture.9
While Frances Moore Lappé’s Diet for a Small Planet popularized vegetarian ideology, then-Secretary of Agriculture Earl Butz, an economist with many ties to large agricultural corporations, was enacting policies that encouraged the planting of large-scale, monoculture crops on all arable land.10
The “fencerow to fencerow” policies Butz initiated helped to shift farm animals from pasture land to feed lots. Making room for government-subsidized corn and soybeans would increase efficiency of food production; what didn’t go into cows could go into humans, including the oils that were a by-product of turning crops into animal feed.
The agenda of vegetarians and health reformers who urged Americans to consume fewer animal products, eat more grain and cereal products, and to substitute polyunsaturated oils found in corn and soybean oil for saturated animal fats like butter and lard, fit neatly into large agribusiness efforts to increase the market for processed foods that have a wider profit margin than eggs and meat.11
These cultural forces coalesced around Senator George McGovern’s Senate Select Committee on Nutrition and Human Needs, which was first created in order to address malnutrition in America. The work of the Select Committee had been so successful that it shifted its attention from malnutrition to “overnutrition” and focused on the creation of a report that was meant to do for diet and chronic disease what the 1964 Surgeon General’s Report had done for cigarettes and cancer.12 This work took on renewed urgency and significance as the committee’s tenure seemed about to come to an end.13 Such a report would address the public’s growing fears about obesity and chronic disease and policymakers’ concerns about rising health care costs―and perhaps extend the lifespan of the committee itself.14
During the summer of 1976, the committee conducted a series of hearings, entitled “Diet Related to Killer Diseases,” from doctors and scientists specifically chosen for their willingness “to talk about eating less fat, eating less sugar, eating less meat.”15 The title of the hearings and the experts chosen to testify set the direction for their findings. In early 1977, the committee released the Dietary Goals for Americans, blaming what they saw as an “epidemic” of killer diseases—obesity, diabetes, heart disease and cancer—on changes in the American diet that had occurred in the previous fifty years, specifically the increase in “fatty and cholesterol-rich foods.”16
The report claimed that in order to reduce their risk of chronic disease, Americans should reduce their intake of food that contained fat, particularly saturated fat and cholesterol from animal products like meat, whole milk, eggs and butter, and instead consume more grains, cereals, vegetable oils, fruits, and vegetables. These particular recommendations reflected not only concerns related to health, but the “back-to-nature” ideology that was becoming increasingly popular with regard to food and diet. The committee used material from Diet for a Small Planet, along with research on vegetarian diets, to argue that a shift to plant-based protein could reduce intake of calories, cholesterol and saturated fat, as well as reduce blood pressure, risk of cancer, use of natural resources, and food costs.16 This message gave official sanction to the romantic notion that a plant-based diet could not only prevent chronic disease, but feed the hungry and save the planet.
These recommendations were met with vehement objections from scientists, doctors, and public health professionals, who argued that the recommendations were scientifically unsound and potentially harmful.17 Those who supported the Dietary Goals felt the proposed radical change in the American diet presented no risk to the health of the American people.16 In contrast, the American Medical Association said, “The evidence for assuming that benefits to be derived from the adoption of such universal dietary goals . . . is not conclusive and there is potential for harmful effects from a radical long-term dietary change as would occur through adoption of the proposed national goals.”18 Yet this warning went unheeded, and the controversy over the Dietary Goals had little effect on future USDA/ DHHS recommendations. With few changes, the 1977 Goals became the first Dietary Guidelines for Americans in 1980. The DGA have since become a powerful policy document, although the limitations that have afflicted them since the beginning have resulted in several unintended negative consequences.
The controversy surrounding the original 1977 Dietary Goals took shape along several lines. Critics raised doubts regarding the appropriateness of a single, population-wide dietary prescription, applied to all individuals regardless of level of risk, to prevent diseases that were not established as nutritional in nature.19 In addition, they made strenuous objections to the fact that these recommendations had not been tested for safety or efficacy and would be the equivalent of conducting a population-wide dietary experiment.20
Critics of the report pointed to the report’s “new age, neo-naturalist” stance, noting that the nutrition scientists at the Department of Health, Education, and Welfare (now the DHHS), who urged caution in the face of the limited science on nutrition and chronic disease, could not compete with this popular ideology either for public support or for government funds for additional research.21
That the creators of the 1977 Goals had used a thin veneer of science to support their preconceived notions of what diet was best for Americans was evident in the contradictory nature of the report’s own data. For example, the 1977 Goals suggested consumers should increase vegetable oil consumption. However, dissenting scientists pointed out that increased consumption of vegetable oils and decreased consumption of saturated fats were, according to data supplied by the 1977 Goals themselves, associated with increased levels of heart disease.17 As a result of this shaky scientific foundation, significant scientific controversy continues about some of the original and current assertions upon which the DGA recommendations are built. These can be seen generally as an on going inability to firmly establish the connections between dietary patterns and chronic disease with available methodology. More specifically, controversy continues to surround the theories that 1) dietary fat, saturated fat, and cholesterol cause heart disease, obesity, diabetes and cancer and should be replaced in the diet with polyunsaturated vegetable oils; 2) a diet high in carbohydrates will reduce the risk of chronic disease; and 3) excessive sodium intake is the primary variable in the etiology of hypertension, a risk factor for heart disease.
The case against saturated fat and cholesterol has been particularly difficult to maintain in the face of evidence to the contrary that has accumulated in the past three decades. When the first DGA were created, there was no agreement regarding the relationship of diet to blood lipids and atherosclerosis. The reasons given then for the difficulty in clarifying the relationship were “the complicated nature of this disease, as well as the multitude of contributing factors and their relationships.”22 Large observational and intervention studies conducted early in the history of the DGA, such as the Framingham study, Multiple Risk Factor Intervention Trial, and the National Diet-Heart Study, are frequently cited as proving that a lowfat, low-cholesterol diet reduces risk of heart disease, yet the results from these studies are weak or inconclusive with regard to the relationship between diet and the development of heart disease.23-26 The science since that time remains inconsistent, limited, and open to question.
In 1997, Ancel Keys, the scientist whose theories about dietary cholesterol and heart disease first warned Americans away from meat and eggs, acknowledged, “There’s no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along.”27 Studies cited by the 2010 DGAC Report demonstrate varied metabolic responses to lowered dietary saturated fat, with certain subpopulations exhibiting adverse rather than improved health outcomes.3 Two recent comprehensive meta-analyses indicate that saturated fat is not linked to heart disease.28,29 In fact, in a definitive review of forty-eight clinical trials, with over sixty-five thousand participants, the reduction or modification of dietary fat had no effect on mortality, cardiovascular mortality, heart attacks, stroke, cancer, or diabetes.30 Yet, avoiding saturated fat remains a cornerstone of national dietary guidance. Surveys show that the vast majority of Americans have come to believe that consuming animal fats increases one’s risk of heart disease, and many try to limit their intake of foods that contain these fats.31
UNDERMINING INDEPENDENT FARMERS
The 1977 Dietary Goals did more than change the health beliefs of Americans. They affected all aspects of the food environment. That the 1977 Goals would have a powerful effect on the food industry was apparent even before they were finalized, but it is unlikely that the result was the intended one. While the initial hearings were being held, members of McGovern’s committee were warned that the food industry would respond with an explosion of products designed to meet whatever new dietary standards were established.32 With the creation of the 1977 Goals, the federal government had unmistakably designated who the “winners” and “losers” in the food sector would be. The “winners” would be manufacturers of breads, cereals, margarine, cooking oils, and soy products; “losers” would be producers of meats, butter, eggs and cheese.
Experts recognized at the time that many processed food manufacturers could “reformulate existing products to remove their allegedly deleterious nutritional effects,” something that would be very difficult for farmers who produced eggs and meat.33 To compound the advantage, for “food producers and processors whose product categories are favored by the goals, greater promotional emphasis on the nutrition value of these products may be expected. In effect products can be promoted using the national dietary goals as a ‘stamp of approval’ to gain greater acceptance in an increasingly nutrition-conscious marketplace.”33 The group most likely to be hurt by the new paradigm was not food processors but farmers: “The farmers feel especially threatened . . . because their livelihood could be most directly affected by the recommended changes. As the primary element in the food chain, farmers tend to be the most specialized and do not enjoy the flexibility and insulation of a multi-product line food processor.”33
Indeed, since the advent of the first DGA, the amount of money farmers receive for food produced has fallen by half.34 As consumers adopted eating patterns recommended in the DGA, a much larger share of their food dollar went to increased processing and marketing and the labor costs associated with these activities. Since the DGA encourages Americans to consume fewer of the products that generate a higher farm value―in other words, what the farmer is paid for the product that leaves the farm―and more of the products that generate a lower farm value, farmers overall receive less of each dollar spent on food in America. For example, the farm value of eggs, a food the DGA tells Americans to limit, is worth 54 percent of the consumer’s dollar. Instead, the DGA recognizes cereal as a preferred “healthy” breakfast; its farm value is worth only 8 percent of the consumer’s dollar.
Conventional arguments that promote plant-based diets as the most beneficial for health, the environment, and feeding the world neglect to address the way in which those diets are compatible with the agricultural policies that benefit large agricultural corporations and undermine the interests of farmers. Creating a more “democratic, socially and economically just, and environmentally sustainable” food system that supports farmers may need to begin with a reassessment of what foods may be considered nourishing.35
INCREASING CHRONIC DISEASES
With federal nutrition directives to avoid saturated fat and cholesterol driving food manufacturing and consumer demand, eating patterns in America have changed dramatically since the first DGA were created. Consumers, whether they were interested in reducing the saturated fat content of their diet or not, were faced with food choices that had changed according to the DGA. As a result, despite accusations that they have ignored federal dietary advice, Americans have increased their intake of flour and cereal products and the vegetable oils that could be added to them, changes that are in line with DGA recommendations. Consumption data gathered from national health surveys indicate that virtually all of the increase in calories in the past 30 years has come from carbohydrate foods (starches and sugars such as would be found in flour and cereal products), while calories from saturated (animal) fats have decreased.36 While these changes are in line with recommendations from the DGA, they may have transformed the American diet in ways incompatible with good health.
In 1988, a vegetarian-oriented food activist group, Center for Science in the Public Interest (CSPI), warned the American public against the dangers of saturated fat and campaigned for the food industry to switch from beef tallow and lard to partially hydrogenated vegetable oil—specifically soybean oil. This is the kind of oil that is now associated with harmful trans fats. But in 1988, CSPI insisted trans fats were an improvement over saturated fat from animals.37 Oil seed companies were prepared with the technology to make this switch; Earl Butz’s agricultural policies provided plenty of the soybeans needed to create the oils that would be partially hydrogenated. Thus, far from resisting this change, “nearly all targeted firms responded by replacing saturated fats with trans fats.”37 For consumers, CSPI’s successful campaign meant that natural animal fats that cause no danger to health were replaced with highly-processed and harmful trans fats―whether t he public w anted t hose changes or not.
Surplus corn provided another substitute for saturated fats in the form of high-fructose corn syrup (HFCS). As Dr. Robert Lustig, an endocrinologist specializing in obesity has noted, “When you take the fat out of a recipe, food tastes like cardboard, and you need to replace it with something— that something being sugar.”38 HFCS offered a cheap, plentiful, sugary replacement for the animal fats that Americans were now told to avoid. For example, “fat-free” yogurt, sweetened with HFCS, appeared on grocery store shelves, as a “healthy” alternative to full-fat yogurt.
In time, scientists on the 2000 DGAC realized that the emphasis on reducing fat in the diet could lead to “adverse metabolic consequences” resulting from a high intake of sugars and starches.39 They went on to note that “an increasing prevalence in obesity in the United States has corresponded roughly with an absolute increase in carbohydrate consumption.”32 At least some of that increase in carbohydrate consumption came from the HFCS that replaced saturated fats in food.
Obesity was not the only thing that increased in prevalence since the creation of the first DGA. In fact, trends indicate that, since 1980, the rates of many chronic diseases have increased dramatically. Prevalence of heart failure and stroke has increased significantly.6 Rates of new cases of all cancers have gone up.40 Rates of diabetes have tripled.41 In addition, although body weight is not in itself a measure of health, as the 2000 DGAC noted, rates of overweight and obesity have increased as Americans have adopted the eating patterns recommend by the DGA.7
In all of these categories, the health divide between black and white Americans has persisted or worsened, with black Americans especially negatively affected by the increase in diabetes. When following DGA recommendations, African-American adults gain more weight than their Caucasian counterparts, and low-income individuals have increased rates of diabetes, hypertension, and high cholesterol.42,43 Despite adherence to healthy eating patterns as determined by the DGA, studies have shown that African-American children remain at higher risk for development of diabetes and prediabetic conditions.44 African-Americans are almost twice as likely to have diabetes as non- Hispanic white Americans, and these differences in health outcomes have not been adequately explained by social and economic disparities in these populations.45 Long-standing differences in environmental, genetic and metabolic characteristics may mean recommendations that are merely ineffective in preventing chronic disease in white, middle-class Americans and are in fact detrimental to the long-term health of black and low-income Americans.
ADEQUATE ESSENTIAL NUTRITION
While on the one hand the DGA have failed to prevent chronic disease, on the other hand they have also failed to provide Americans with guidance in accordance with obtaining adequate essential nutrition. Before the 1977 Dietary Goals were created, federal dietary recommendations focused on foods Americans were encouraged to eat in order to acquire adequate nutrition, not on food components to limit or avoid in order to prevent chronic disease.46 Meat, eggs, butter and whole milk were considered important sources of essential nutrients, and avoiding saturated fat in food was considered a “questionable dietary practice” adopted by “food faddists.”47 During World War II, meat and fats were considered such valuable sources of nutrition that Americans back home were asked to save them for the troops and eat fish and vegetables instead. In fact, prior to the creation of the DGA, Americans got about 36 percent of their calories from grains, fruits, and vegetables and over 50 percent of their calories from meat, eggs, cream, cheese, and fat.48
From the beginning, scientists were concerned that recommendations warning people to limit their intake of foods that were traditionally considered to be highly nutritious would adversely affect intake of essential nutrients. In response to the 1977 Dietary Goals, one scientist argued that “there are serious nutritional problems that affect many Americans that are clearly related to dietary inadequacies, particularly of high-quality protein . . . implementation of your recommendations could have a negative effect on these problems.”17
In fact, research has found that following DGA recommendations can have a detrimental impact on intake of essential nutrition. A 2013 study demonstrated that sodium restrictions in the 2010 DGA are “incompatible with potassium guidelines and with nutritionally adequate diets, even after reducing the sodium content of all foods by 10 percent.”49 The reduced-fat diet recommended by the DGA has also been linked to lower intakes of several important essential nutrients. In one study, lower fat intake was associated with lower intake of nine out of fourteen important micronutrients, independent of calorie intake.50
Choline, which was not recognized as an essential nutrient until after the first DGA were created, plays an important role in brain development in fetuses, and adequate amounts are important for the prevention of liver disease, atherosclerosis, and neurological disorders.51 Current average intakes of choline are far below established adequate levels.40 Scientists have suggested that, “Given the importance of choline in a wide range of critical functions in the human body, coupled with the less than optimal intakes among the population, dietary guidance should be developed to encourage the intake of choline-rich foods.”40 However, consumption of eggs and meat, two foods that are rich in choline, is restricted by current DGA recommendations that limit intake of cholesterol and saturated fat.
NARROW APPROACH TO NUTRITION AND HEALTH
In 1977, the Dietary Goals acknowledged that “genetic and other individual differences mean that these guidelines may not be applicable to all.”16 However, this qualification has been muted in subsequent DGA. Although it is clear that good nutrition plays an important role in long-term health, when the first DGA were created the particular dietary pattern that would be optimal for achieving lifelong health was unclear; that is still the case today. Early critics of the Guidelines felt that the scientific model used to address nutrient deficiencies did not apply to chronic diseases such as heart disease and cancer.52 Scientists thirty years later express similar concerns, adding that “nutrient-based metrics [of current recommendations] are hampered by imprecise definitions and inconsistent usage,” and “few individuals can accurately gauge daily consumption of calories, fats, cholesterol, fiber or salt.”53 However, current Guideline recommendations urge Americans to track food and calorie intake as means of achieving a healthy diet.3
Furthermore, the DGA have institutionalized the idea that overweight and obese people are different from “normal”—establishing, as part of national dietary policy, the notion that they are less likely to accurately or honestly report on their own eating habits. The 2010 DGA indicate that, on the basis of national survey data, Americans do not seem to be consuming excessive amounts of calories. Thus the inexplicably high rates of obesity in America must be due to the fact that people who are overweight or obese lie about how much they eat: “[T]he numbers are difficult to interpret because survey respondents, especially individuals who are overweight or obese, often underreport dietary intake.”3
This moralistic approach to obesity and weight loss has contributed to extensive and unrecognized “collateral damage” in the form of fat-shaming, eating disorders, weight discrimination, and poor health from restrictive food habits. At the same time, researchers at the Centers for Disease Control have shown that overweight and obese people are often as healthy as their “normal” weight counterparts.54
Finally, the emphasis on plant-based nutrition and the demonization of animal-based foods is a culturally biased perspective. Although the 2010 DGA claim that the recommendations they contain “accommodate the varied food preferences, cultural traditions and customs of the many and diverse groups who live in the United States,”27 this is most certainly not the case. Animal products containing saturated fat are an important part of many food cultures: sausages of Eastern European and Chinese cuisine; ghee, the clarified butter of Indian cuisine; chorizo and eggs from Latin America; liver patés eaten by Jewish Americans; greens and fatback of Southern and soul food traditions.
As a dietitian, I was taught to respect the preferences of those who choose vegetarian or vegan diets. However, when it comes to animal products, dietitians, in accordance with the DGA, are encouraged to engage in “pork-shaming,” counseling people on how to eliminate, limit, or modify traditional foods in order to avoid saturated fat and cholesterol. As a dietitian, I found that people who were told to give up their traditional dishes, or to change them in ways that reduced saturated fat and cholesterol, were very likely to give up those dishes altogether; substitutions were not as good as the “real thing” and for a reason. For example, in Southern U.S. cooking, salt pork cuts the bitter taste of greens and fatback provides a vehicle for flavor as well as for fat-soluble vitamins. Greens made with little or no fat may actually be less nutritious; certainly they are if people don’t eat them.
FAILURE TO FULFILL THE ORIGINAL MANDATE
The first DGA, created in 1980 without a specific legislative mandate, began as a very simple twenty-page, one-column booklet directed at consumers. However, it became apparent in the decade following the release of the first DGA that obesity rates in America had increased, despite the fact that Americans were making alterations to their diets in line with their recommendations.55,56 In light of these circumstances, the DGA needed not only to explain the noted discrepancies between behavior and outcome, but should attempt to prevent further negative changes in the health of Americans. In 1990, Congress passed a law indicating that DGA should be reviewed and reissued every five years, emphasizing that: “Each such report shall contain nutritional and dietary information and guidelines for the general public,. . . and shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared [emphasis mine].”57
However, the DGA have never been able to overcome their original shaky scientific foundations. They have grown in size, right along with the waistlines of Americans, but have failed to improve health outcomes. Over the years, the seven recommendations from the 1980 DGA became twenty-three complicated instructions to micromanage food components in the 2010 DGA. As a result, the DGA are considered too complex for consumers to use and are instead meant for policymakers and healthcare professionals, who “translate” the DGA for consumers.
Both the lack of science and the lack of simplicity that current DGA exhibit are violations of their legislative mandate. At the same time, the DGA have become a powerful and influential document that goes far beyond providing information to consumers. These recommendations shape all government dietary guidance, dictate nationwide nutrition standards, influence agricultural policies and nutrition research protocols, direct how food manufacturers target consumer demand, guide healthcare practices, and affect how the American public thinks about diet, weight, and health. They can be considered the most influential health-related pronouncements in the world.
The 2015 DGAC has made sustainability and environmental concerns part of its agenda, indicating that one of their goals is to “develop dietary guidance that supports human health and the health of the planet.”58 There is no mistaking the fact that protecting the environment and ensuring a sustainable food supply are important issues. In fact, they are far too important to be entrusted to a committee of nutrition scientists with little knowledge or expertise in the vast and complex interactions that make up the American agriculture and food production system. The American public has already been subject to the unintended effects of policy established by the USDA and DHHS without the support of sufficient evidence. The world simply cannot withstand the consequences if the DGA’s impact on the environment is similar to its impact on obesity and chronic disease.
WHAT CAN BE DONE INSTEAD?
In 1977, the Dietary Goals presented a single perspective on food and health to the public as if it were a commonsense approach to nutrition grounded firmly in science and applicable to all Americans. This was not the case. However, there is such an approach available to the leadership at USDA and DHHS. Dietary recommendations that focus on a food-based guidance that assists Americans in acquiring adequate essential nutrition is based in solid, non-controversial science and is equally applicable to all Americans. Although scientific understanding of essential nutrition is not complete by any means, it is nevertheless supported by evidence that has stood the test of time with little controversy. All Americans require essential nutrition; without exception, inadequate intake results in diseases of deficiency. It is not necessary to eliminate, restrict or modify culturally traditional foods under the essential nutrition paradigm.
Focusing on essential nutrition is an approach that includes and celebrates a wide variety of food traditions. Such guidance would shift the focus of public health nutrition towards general health and wellness, and away from weight and other surrogate markers like cholesterol levels and blood pressure, leaving those areas of concern for the healthcare setting. Importantly, guidance that emphasizes adequate essential nutrition would be clear, concise, and useful to the general public. Contradictory messages about nutrition―unavoidable when most dietary guidance lacks a strong scientific basis because it simply echoes the DGA―have led to widespread general confusion and a lack of confidence in the science of nutrition.59 The proliferation of “food rules” that stem from DGA guidance have left many consumers frustrated by the feeling that the standards for “healthy eating” are unreachable, even as they strive to meet those standards.60 DGA recommendations based on adequate essential nutrition from wholesome, nourishing foods would not only provide the foundation for good health, they would finally provide what has been missing from the past thirty-five years of federal nutrition policy: dietary guidance that works―for all Americans.