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Building a New Pyramid

Oct. 26, 2004
Whether they take the form of a pyramid, a plate or whatever, the 2005 USDA Dietary Guidelines are on their way with more than the recommended allowance of controversy.
By David Feder, R.D., EditorThe rebuilding of the U.S. Dept. of Agriculture’s Dietary Guidelines is generating nearly as much contentiousness as the upcoming presidential election. The framework for the guidelines has been under construction for the past year, with plenty of sweat equity already invested by the individual experts and groups attached to the Dietary Guidelines Advisory Committee. Now, in the several months since the public comment period began (and just closed), interest groups from all sides are weighing in with what they believe to be the best way for Americans to eat healthier. More Pyramids Than EgyptWhen the USDA, along with the National Institutes of Health, sat down to create a basic platform for educating people on the best way to eat more healthfully, they sought to build something simple, easily understood and, most importantly, effective. Hence the introduction of the Dietary Guidelines and their companion pyramid. But it’s not just about rebuilding the iconic pyramid. The undercurrent of political intrigue and influence in creating the guidelines gets more overwhelming each time they are revamped.The shifting foundations of what experts believe to be the picture of a healthful diet first showed in the mid to late 1990s when a crowd of customized and individualized pyramids popped up. In the, “Oh yeah? Well two can play at that game” model, vegetarian, Mediterranean, soul food, Asian, Mexican and every other food type had its own eating edifice erected and presented it to the public with panaceaic fanfare. All were designed to complement at least, and compete at most, with the USDA version. Driving TrendsThe USDA guidelines and their offspring drive health trends, directly or indirectly, with far-reaching effects. Mediterranean cuisine is just one case in point: Although its explosion on the restaurant scene predated the first guidelines by more than a decade, it wasn’t until the creation of the Mediterranean Diet Pyramid in 1996 as a counter to the USDA’s version that the positive association of an ethnic cuisine with heart health gave food manufacturers a boost. The cuisine was a vehicle to create and purvey billions of dollars worth of Mediterranean-influenced prepared foods. One would be hard put today to find a pantry without olive oil and balsamic vinegar in it. There are numerous other examples of health trends driving industry profits. In the 1970s and 1980s, oat bran was such a prominent health food it ended up in hundreds of products. This was just one massively profitable segment of the low cholesterol obsession, which began in the early 1970s and plays with relevance even today. (Fortunately, more rational use of “low cholesterol” now prevails versus 20 years ago, when the term was slapped on nearly every manufactured product short of building materials.) The process works in reverse, too. When millions of people were seized by the high-protein/low-carbohydrate diet craze, industry stepped up to the dinner plate and within months thousands of low-carbohydrate products were on the shelves. That fad is finally starting to abate, but it had enough impact to influence the discussions for this current set of guidelines in production. After extensive debate and a vociferous public lobbying campaign by Atkins Nutritionals Inc., the committee felt it necessary to address the low-carb diet trend by not recommending a restriction of carbohydrates. Hardly the answer desired by the late Dr. Atkins’ disciples but a reaction nonetheless. How to Make a GuidelineOstensibly, the guidelines are a review and reapplication of current nutrition science. But the fact is much of nutrition research is generated and funded by groups with some sort of vested interest. Case in point: Producers of such big-money commodities as beef, dairy and sugar have been subjected to, or threatened with, legal actions for exerting a perceived undue influence on the guidelines. This created a set of hurdles for the new committee from the get-go.

Nine "major messages" from the Dietary Guidelines Committee:

Consume a variety of foods within and among the basic food groups while staying within energy needs.Control calorie intake to manage body weight.Be physically active every day.Increase daily intake of fruits and vegetables (from the current five to nine servings to five to 13), whole grains and nonfat or low-fat milk and milk products.Choose fats wisely for good health.Choose carbohydrates wisely for good health.If you drink alcoholic beverages, do so in moderation.Keep food safe to eatThe USDA and the Dept. of Health and Human Services asked that we take a different approach from that of previous Dietary Guidelines Advisory Committees,” says Connie M. Weaver, Ph.D., chair of the nutrient adequacy subcommittee for the 2005 guidelines. “Rather than just considering how the 2000 Dietary Guidelines should be changed, we were asked to conduct an evidence-based review of diet and health. Thus, we initially posed over 40 specific questions related to dietary guidance. We then thoroughly reviewed the scientific literature pertaining to those questions, analyzed national data sets, sought additional information from invited experts and deliberated on the results.” After dropping some questions because of incomplete or inconclusive data, the committee drafted a set of conclusive statements with comprehensive rationales. Then, using evidence-based analysis of the science, they established nine “major messages” the committee believes should be conveyed in the 2005 Dietary Guidelines of Americans. Too Many PharaohsAs usually happens when so many disparate voices strive to be heard, compromises -‑ and compromises of the compromises -‑ became the rule of the day. Typical of the previous guidelines, the final results are simple, and nearly every interest’s issue gets addressed. Of course, not everybody will be satisfied. This first version for the new millennium is thus well under way and scheduled to be released mid-next year. However, controversy is also fractioning the attention from content -‑ what the next Food Guide Pyramid should contain -‑ to the question of whether a pyramid has ever really been the best descriptor of needs or if any of it really makes a difference at all. (Not only are other shapes being discussed, it’s been proposed the best and most utilitarian visual representation would be a dinner plate. Something to think about.) One of the more curious arguments to come along is that the Pyramid should be retained because nearly every adult in American recognizes it. The problem, however, is about an equal number of people surveyed confess to not being able to understand it. Recognition seems a poor argument for keeping something so tainted by the perception of failure; everybody recognizes a jumbo jet but only a few people can fly one. Does something as generalized as the Food Guide Pyramid really have any effect on the food business? Absolutely. Not only do the guidelines essentially tell food manufacturers what direction health trends may be headed, they also are a guideline of how foods can be labeled and marketed. According to Weaver, “Some of the main questions we addressed were: What nutrients are most likely to be consumed by the general public in amounts low enough to be of concern, what dietary pattern is associated with achieving recommended nutrient intakes and what are the effects of salt and potassium intake on health?” The conclusions reached were that for adults vitamins A, C, E and K, minerals calcium and magnesium and the dietary component fiber were low enough to be of concern for adults. For children, vitamins and minerals of concern were E, K, calcium and magnesium. “We concluded two major aspects of the USDA dietary pattern would contribute to meeting nutrient intake recommendations: consumption of foods from each of the basic food groups (fruits; vegetables; grains; milk, yogurt, and cheese; meat, poultry, dry beans, eggs and nuts) and consumption of a variety of foods within each of those groups,” Weaver continues. She explains since higher energy intake is ideally strongly associated with greater variety and higher nutrient intake, attention also should be given to food group choices that maintain appropriate energy balance. “Implications for the food industry,” says Weaver, “are these nutrients need to be increased in the food supply or choices of foods rich in these nutrients need to improve.” Implications for IndustrySpecial nutrient recommendations were warranted for the following subgroups: adolescent females and women of childbearing age for iron and folic acid; persons over age 50 for vitamin B12; and the elderly, persons with dark skin and persons exposed to insufficient sunlight for vitamin D. Take with a Grain of SaltOdd things persist in the proposed guidelines. Take salt, for instance. The guidelines purport to serve all Americans, yet salt intake is persistently recommended for restriction. This even though all the available science indicates only a small percentage of the population needs to do so.

“The research shows lower sodium diets have a miniscule long-term effect on the blood pressure of healthy individuals,“ asserts Richard Hanneman, president of the Salt Institute, (www.saltinstitute.org), Alexandria, Va.

“For many years, the intense controversy that has characterized the public policy debate over health recommendations on salt intake has focused on the wrong question,” Hanneman continues. “Medical experts, public health policy-makers and the public focused on the relationship of sodium intake to blood pressure instead of the relevant question of whether changing intake levels of dietary sodium results in improved health outcomes. Insufficient work has been done to evaluate the risks.”

Even among persons with high blood pressure, the number who are “salt-sensitive” is estimated at less than 30 percent. Quoted in a Salt Institute report, Lawrence Resnick, M.D., executive editor of the American Journal of Hypertension, stated, "A fair discussion of the data does not allow us to come to a universal recommendation about dietary sodium for the population as a whole."

Implications for the food industry are familiar: Folic acid should be supplied in whole grain products as well as enriched products, and since it is too difficult to obtain adequate amounts of vitamin D in foods for many at-risk groups, more fortified food options need to be available. The same holds for iron (as well as zinc) and B12. Related to this, the Dietary Guidelines committee studied which food groups were likely to be consumed in inadequate amounts and what amounts were associated with health and disease prevention. “We concluded most Americans need three cups of milk or equivalent milk products, three servings of whole grains, and five to 13 servings (2.5 to 6.5 cups) depending on calorie needs of fruits and vegetables each day,” explains Weaver. This means all these foods need to be more available to consumers, especially where access to options are limited. “These foods need to be available in vending machines, school food stores -- all food service establishments,” Weaver declares. Another aspect of the new recommendations is an increased daily recommended intake (DRI) for the mineral potassium. Weaver explains, “Being so much higher than current intakes, and this being a featured question addressed by the Dietary Guidelines committee, this nutrient is likely to be a focus of the immediate future.” Diets rich in potassium can lower blood pressure, may reduce the risk of developing kidney stones and possibly decrease bone loss. In view of the health benefits of potassium and its relatively low intake by the general population, a daily potassium intake of at least 4,700 mg is recommended. African Americans are especially likely to benefit from an increased intake of potassium. Industry will do well to be aware of the potassium contributions of their products and think about marketing their products with high levels or improving the potassium content of their products. Points of ContentionSugar is still the sweet spot for critics deeming the guidelines as tainted by industry. And although the committee acknowledged a link between soft drinks and weight gain, it backed down from recommending less sugar. Trans fatty acids are also having their time under the hot light. A byproduct of partial hydrogenation, the research of the past decade linking trans fatty acid consumption to heart disease is strong enough that for the first time the guidelines will recommend people restrict their intake of trans fatty acids. We already have seen manufacturers of foods typically containing trans fats, such as margarines and partially hydrogenated oils, curtailing trans fat content and boasting about it on the label. There will only be more such labeling once the guidelines go public. For the first time, food safety takes a featured role in the guidelines. Although about 80 to 90 percent of foodborne illnesses occur in the home, there is no denying food safety is moving to a pole position on the back of an unprecedented increase in contamination instances, especially by E. coli, in food processing. View from the Ivory Tower“When we look at the Dietary Guidelines, it is critical to look at a whole dietary pattern approach,” says Kathy McManus, director of the Dept. of Nutrition at Brigham and Women’s Hospital/Harvard Medical School. “People eat ‘food,’ not ‘nutrients.’ Foods are recommended to describe a healthy dietary pattern. The emphasis is on eating healthy foods rather than restriction.”Harvard, the source of the competing “Healthy Eating Pyramid” developed by Walter Willett, M.D., Ph.D., took a more aggressive approach in looking at literature and research about disease, history, and populations as they pertain to eating and health. Physical activity, along with a healthy weight, are the foundations for the Harvard pyramid (and are now included in the USDA revamp). “Overall, healthy diets are plant-based and balanced and include a variety of foods,” says McManus, “but whole grains are also a critical component. Numerous studies support the benefits of diets rich in fiber and healthy carbohydrates -‑-those low in glycemic load -‑ to reduce risk of chronic disease including cardiovascular disease and diabetes. These foods include whole grain bread, brown rice, whole wheat pasta, whole grain crackers and cereals such as oatmeal and shredded wheat. “It is also important to reduce use of sugar sweetened beverages,” she continues. “My hope is the released guidelines will address refined carbohydrates and high fructose containing beverages.” According to most experts today, unsaturated fats are an important part of healthy dietary patterns. Monounsaturated fats (such as olive and canola oils, many nuts and peanut butter) show reduction in low density lipoproteins and cardiovascular disease risk when substituted for less healthy saturated fats and trans fats. How About a “Hunger Guide Pyramid?” By Mark Anthony, Ph.D.As USDA decides whether the symbol for the next food guide should remain a pyramid or take on some other shape, one hopes the agency will consider an illustration for the guidelines people can really use, not just identify. A balanced, healthy diet can’t happen without recognizing the necessity for hunger to guide healthy eating. The most useful hunger-based guide would begin by reapproaching how we look at macronutrients, especially carbohydrates. The body hungers for five basic components: sugar, starch, fat, protein and fiber. By simply recognizing and defining the most effective staples for each of these “hungers,” we may be able to avoid a formula-based guideline and opt for a “quality staples guide” instead. To make this transition easier, it is necessary to correct the most common oversight in nutrition‑an oversight that has culminated much confusion regarding the use of carbohydrates. Method of preparation is critical to the definition of a complex carbohydrate. Simply put, when starches are boiled or steamed they act as efficient complex carbohydrate staples, irrespective of their glycemic index. These staples have sustained diverse populations for generations, and have only recently fallen out of favor due to the preponderance of baked and fried counterparts in the American diet. A hunger-based quality staples guide would go a long way to gently educate consumers without imposing a rigid set of rules. ‑-Dr. Mark Anthony, retired University of Texas at Austin nutrition scientist, is author of Gut Instinct: Diet’s Missing Link. To find out more about his hunger-based guide to diet and health, visit the web site: www.dietsmissinglink.com.

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