Are the new US diet guidelines unrealistic?

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Hi All,

Are the new US diet guidelines unrealistic?

See:

Experts Charge New US Dietary Guidelines Pose Daunting Challenge for

the Public

Bridget M. Kuehn

JAMA. 2005 Feb 23;293(8):918-20. No abstract available.

With recommendations calling for 9 servings of fruits and vegetables

per day, a limit of 2300 mg of sodium per day, and 60 to 90 minutes

of exercise on most days to lose weight, the 2005 US Dietary

Guidelines released last month set ambitious goals for weight loss

and healthy eating. But some experts say the recommendations may be

too complicated for the average person to understand—or simply

unattainable.

Past editions of the guidelines, which are revised every 5 years,

targeted the public, but the new edition is intended for use by

public policy makers, nutritionists, and health educators. The more

than 40 recommendations are peppered throughout a 70-page document

(posted online at http://www.healthierus.gov/dietaryguidelines/). The

guidelines are based on a report by the Dietary Guidelines Advisory

Committee, a panel of nutrition experts who reviewed the relevant

literature. (The committee's report is also available online at

http://www.health.gov/dietaryguidelines/dga2005/report/.)

The guidelines suggest that individuals follow the US Department of

Agriculture Food Guide or the Dietary Approaches to Stop Hypertension

Eating Plan, which the report concludes is applicable to the general

public. The federal government also released a companion pamphlet

intended for the public, but it contained less specific

recommendations.

PERSONAL CHOICE

A key tenet of the guidelines is making personal choices about

physical activity and diet.

" The dietary guidelines are a prescription we can write for

ourselves, fill in ourselves, and be happier and healthier for it, "

said then US Health and Human Services Department Secretary Tommy

, during a press conference. Some nutrition experts, however,

expressed concern that the guidelines are not easy for the average

person to understand or apply to their lives.

Some of the key recommendations include

3 oz or more of whole grain products per day

3 cups of fat-free or low-fat dairy products per day

total fat intake between 20% and 35% of calories

limited consumption of saturated fats and trans-fatty acids

foods and beverages with little added sugar or caloric sweeteners

to reduce disease risk, at least 30 minutes daily of moderate-

intensity physical activity, beyond usual activities at home and at

work

to lose weight and prevent gradual weight gain, 60 minutes of

moderate- to vigorous-intensity activity on most days

to keep off lost weight, 60 to 90 minutes of moderate-intensity

activity.

The Center for Science in the Public Interest, a public advocacy

group, and several health organizations, including the American

Dietetic Association (ADA), the American Heart Association, the

American Cancer Society, and the American Diabetes Association

applauded the new guidelines for their specificity and emphasis on

disease prevention. Previous guidelines did not set specific limits

or goals for most food categories, but offered vague statements such

as " Aim for a healthy weight, " and " Let the food pyramid guide food

choices. "

ADDED SUGARS DISCOURAGED

n Nestle, PhD, MPH, the ette Goddard Professor of Nutrition,

Food Studies, and Public Health at New York University and critic of

the strong influence of the food industry on public nutrition policy,

said she is pleased that the government included in the guidelines a

recommendation that individuals " choose and prepare foods and

beverages with little added sugar or caloric sweeteners, " despite an

intense lobbying effort by the sugar industry and a weak

recommendation from the Dietary Guidelines Advisory Committee that

helped prepare the document.

" The fact that they used the word `added' is very dramatic because

the sugar lobbying groups did everything they could to keep that out

of there, " Nestle said.

The committee recommended that " a reduced intake of added sugars,

especially in sugar sweetened beverages, may be helpful in achieving

recommended intakes of nutrients and in weight control. "

A 2003 World Health Organization (WHO) scientific report made a

stronger recommendation. It concluded that added sugars should make

up less than 10% of the total caloric intake. For a person on a 2000

calorie per day diet, one 20-oz soft drink would exceed the

recommended intake. During the development of the WHO strategy to

combat obesity, the US delegation to the WHO lobbied vigorously and

successfully on behalf of the US sugar industry against including

these explicit limits in the strategy.

The recommendation that individuals in the United States should

increase their dairy product intake from 2 to 3 cups per day was met

with skepticism by some nutritionists, who said the measure is

clearly a " gift " to the dairy industry. An article published in the

Wall Street Journal on August 30, 2004, detailed dairy industry

lobbying efforts to raise the recommendation to 3 to 4 servings per

day and identified potential conflicts of interest among several

Dietary Guidelines Advisory Committee members who had received

National Dairy Council funding in recent years.

The committee report said daily consumption of 3 cups of fat-free or

low-fat dairy products can reduce the risk of low bone mass and that

they contribute (in addition to calcium) important nutrients such as

potassium, magnesium, vitamin D, and vitamin A.

Nestle said that research findings on the health benefits of milk

have been contradictory.

" There are many reasons to be suspicious of the `need' to have 3 cups

of milk a day, " she said.

TRANS-FATS

Gerbstadt, MD, MPH, RD, a national spokesperson for the

ADA, said the guidelines' message to limit trans fats is an important

step toward raising awareness of trans-fat intake, even though no

specific limits were set.

" The fact that they addressed [trans fat] at all is really a

breakthrough, " Gerbstadt said.

The Dietary Guidelines Advisory Committee recommended that the intake

of fatty acids should be kept as low as possible, about 1% of total

energy.

The recommendation echoes a recommendation in the 2003 WHO report,

and a statement made by a Food and Drug Administration Food Advisory

Committee in April 2004, " Although current scientific evidence does

not indicate a specific acceptable daily intake for trans fatty

acids, it is consistent with reducing trans fatty acid intake to a

level less than 1% of energy [2 g per day for a 2000-calorie diet]. "

Meat and dairy products and vegetable oils contain some fatty acids,

but the majority of trans-fat in the US diet comes from prepared

foods and snack foods, in which trans-fats are used as a

preservative. A new federal law requiring companies to label the

trans-fat content of food products may make limits on trans-fats a

nonissue. Nestle said that most food companies will have removed it

from their products by the time the law goes into effect. Some

companies have already begun marketing their products as trans-fat-

free.

While even critics of US nutrition policies joined health

organizations in applauding the new guidelines' strong messages on

physical activity; reducing added sugar and trans-fat intake; and

increasing fruit, vegetable, and whole grain consumption;

nutritionists caution that without explicit instructions on which

foods to eat and which to avoid, individuals may be not be able to

put the new guidelines to use.

" It's a step in the right direction, but I still think we need to

realize a lot more education and information for specific food

changes would help the average person make these changes toward a

more healthful diet, " Gerbstadt said.

The recommendation to limit sodium intake to 2300 mg/d may be

difficult for busy individuals and families who rely on prepared

foods, which are notoriously high in sodium. A can of condensed

chicken soup, for instance, may contain more than 2000 mg of sodium.

" It's certainly an achievable goal, if you reduce the amount of

prepared foods and make low sodium choices. " Gerbstadt said. She

noted that the ADA advises individuals to avoid prepared foods,

refined sugars and flours, and products with added sugars.

Gerbstadt also noted that any reduction in sodium intake would be a

positive step; individuals can benefit from reducing dietary salt

intake even if they don't achieve the recommended daily level of 2300

mg.

BURDEN ON CONSUMER

Nestle criticized the guidelines' emphasis on individuals making food

choices based on reading food labels, with no commitment from the

government and the food industry to help make healthy choices easier

for consumers.

" It's left entirely up to individuals to figure out how to read food

labels, " Nestle said. " It's really not easy. " She noted that the Food

and Drug Administration's guide on how to read food labels is 10

pages long.

Although the report is packed with useful tables identifying the

major food sources of nutrients, including added sugars and trans-

fats, Nestle said that the information that would be helpful to

individuals trying to make sense of food labels is buried and is not

included in the companion pamphlet targeting the general public.

" It's there for anyone who wants to see that soft drinks and juice

drinks are the biggest sources of sugars in the American diet, " she

said. " I loved the table with euphemisms for sugar. It lists 20 or 30

names under which sugar appears on food labels. The one I like best

is fruit juice concentrate. I think it's about time somebody admitted

that those were just sugars, that all semblance of fruit juice has

been removed, " she said.

" The emphasis on the need for people to be more physically active is

also helpful, although the amount of time recommended is so

unrealistic for most people that I think it will be laughed off, "

Nestle said.

A SEA OF ADVERTISING

The Center for Science in the Public Interest, the ADA, and many

other groups are urging the government to develop marketing campaigns

to publicize the guidelines and to work with the food industry to get

the message out. However, there is no money set aside to market the

guidelines to the general public. The Department of Agriculture

spends about $500 million per year on nutrition education through

Food Assistance Programs, School Meal programs, the Food Stamp

Program, and the Women, Infants, and Children program, according to

Agriculture Secretary Ann M. Veneman. But these efforts, aimed at

participants in these programs, are dwarfed by the multibillion

dollars of food advertising that reaches virtually every US resident,

including children, each year.

" You have this little pamphlet or pyramid with no money behind it to

publicize it or to explain to people how it works, " Nestle said. " And

you're up against $34 billion worth of food and beverage marketing

that uses health claims like they are going out of style. "

2000 2005

Table: Weight Management

Aim for a healthy weight. Evaluate weight using body mass index.

Balance calories from food and beverages with calories expended.

Follow food guide for appropriate calorie requirements based on age

and physical activity level.

Adequate Nutrients

Let the pyramid guide food choices. Consume a variety of nutrient-

dense foods and beverages. Follow a balanced eating pattern such as

the USDA Food

Guide or DASH Eating Plan.

Food Groups to Encourage

Consume 2 to 4 serving of fruits, 3 to 5 servings of vegetables.

Consume enough fruits and vegetables while staying within energy

needs. Two

cups of fruit and 2 1 /2 cups of vegetables per day for a reference

2000-calorie

intake. Make adjustments for various calorie levels.

Choose a variety of grains, especially whole grains.

Include 3 ounces or more of whole grains with at least half of grains

from whole

grains.

Consume 2 to 3 cups of milk or equivalent. Consume 3 cups per day of

fat-free or

low-fat milk or equivalent.

Fat

Choose a diet low in saturated fat and cholesterol and moderate in

total fat.

Keep total fat between 20% to 35% of calories, with most fats coming

from sources of polyunsaturated and monounsaturated fats.

Salt

Choose and prepare foods with less salt. Consume less than 2300 mg of

salt per

day and include potassium-rich foods such as fruits and vegetables.

Sugar

Choose beverages and foods to moderate intake of sugars.

Choose and prepare foods with little added sugars or caloric

sweeteners.

Physical Activity

Be physically active each day. Aim to accumulate 30 minutes of

activity per day.

Engage in at least 30 minutes of moderate physical activity on most

days of the week.

To help manage weight, engage in about 60 minutes of moderate to

vigorous activity on most days of the week while not exceeding

calorie requirements.

• Discretionary calorie allowance in the US Department of Agriculture

(USDA)

Food Guide and Dietary Approaches to Stop Hypertension (DASH) Eating

Plan

• Recommendations for special population groups

• Calorie requirements based on gender, age, and level of physical

activity

----------------------------------

New Items in 2005 Dietary Guidelines

• Discretionary calorie allowance in the US Department of Agriculture

(USDA) Food Guide and Dietary Approaches to Stop Hypertension (DASH)

Eating Plan

• Recommendations for special population groups

• Calorie requirements based on gender, age, and level of physical

activity

Source: American Dietetic Association