What you need to know about the new dietary guidelines

Ever wonder how the Food Pyramid gets created?

Well sit back and relax, cause this is an interesting story.

Every five years, both the USDA and the Department of Health and Human Services are required by law to jointly update and publish the “Dietary Guidelines for Americans”. The first thing they do is to convene an expert panel (The Dietary Guidelines Advisory Committee) which makes recommendations based the available science.

Or at least the science they agree with. (More on that in a moment.)

After the Report is released, “interested parties” are encouraged to submit written comments, and there is a public meeting to solicit oral comments as well. Ultimately, we get the “Dietary Guidelines for Americans” and eventually, a new Food Pyramid based on those guidelines.

The Report of the Dietary Guidelines Advisory Committee recently came out, and it did not make many of us in the nutrition community very happy—particularly those of us who believe that rampant consumption of carbohydrates is driving the obesity epidemic.

This is important, because the Report ultimately forms the basis of the Dietary Guidelines for Americans (and, ultimately, the Food Pyramid).

When a Food Pyramid comes out that recommends 11 servings from the “Breads, Cereal, Rice and Pasta” group, as well as recommending that you consume as little fat as possible (exactly what the God-awful 1992 Food Pyramid did), you can be sure that the basis of those recommendations was the Report of the Dietary Guidelines Advisory Committee.

That’s the reason this report is so important.

The Report is the basis of what will ultimately become “Official Nutrition Policy”, and the new Food Pyramid. Every dietitian (or at least every “Spokesperson from the American Dietetic Association”) will parrot these recommendations mindlessly (“Low-carb diets are not safe”), every popular magazine will promote diets based on them (“Eat this because it’s low-fat”), and every doctor who never took a nutrition course will use these recommendations to guide their patients. (“Eat a low-fat diet, Mr. Jones, and cut back on the cholesterol.”)

Recently, my esteemed colleague Richard Feinman, PhD, Professor of Biochemistry at SUNY Downstate Medical Center and the president of the prestigious Nutrition and Metabolism Society (of which I am a member) got together a group of distinguished professors and researchers and decided to fight back. They wrote a paper highly critical of the just-released 2010 Dietary Guidelines Advisory Committee Report, pointing out inaccuracies, biases and unsupported conclusions, (such as the same old tired advice about how we should all be eating high-carb diets).

All six of the authors of this critical paper are proponents of controlled carbohydrate eating and they are not exactly intellectual lightweights. They are all professors at various universities and Institutes. Their paper, “In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee” was published in the peer-reviewed journal, Nutrition, and if anyone would like to see it, just e-mail me and I’ll send you a copy.

It’s dense and heavily notated, but here are the important points.

  • The DGAC Report demonstrates several critical weaknesses, including use of an incomplete body of relevant science; inaccurately representing, interpreting, or summarizing the literature; and drawing conclusions and/or making recommendations that do not reflect the limitations or controversies in the science.
  • An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets.
  • It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.
  • The DGAC Report had the opportunity to review and evaluate the emerging science, to distinguish between established principles and ideas that are still areas of research or controversy, and to provide clear, consistent information for Americans. Instead, the 2010 DGAC Report continues to make one-size-fits-all recommendations that are based on evidence that is weak, fragmented, and even contradictory in nature.

Here are some of the most problematic statements in the committee’s report. (Remember, this report is what’s going to be the basis of every mainstream recommendation you hear in the next few years about what “healthy eating” looks like!). These statements are taken directly from the text of the report:

  1. Healthy diets are high in carbohydrates

The committee conveniently ignored the 2005 Institute of Medicine Macronutrient Report, which states:

Compared to higher-fat diets, low-fat, high-carbohydrate diets may modify the metabolic profile in ways that are considered to be unfavorable with respect to chronic diseases such as coronary heart disease (CHD) and diabetes

The Committee says:

2. There is strong and consistent evidence that when calorie intake is controlled, macronutrient proportion of the diet is not related to losing weight. (Translated: as long as calories are the same, it doesn’t matter how many of those calories come from protein, fat or carbohydrates.)

But Fineman and colleagues point out a number of studies demonstrating greater weight loss on a low-carb diet compared with a low-fat diet even when calories are kept the same. (1-4). Did the Committee just ignore these?

The report also states:

3. A moderate amount of evidence demonstrates that intake of dietary patterns with less than 45 percent calories from carbohydrate or more than 35% calories from protein are not more effective than other diets for weight loss or weight maintenance, are difficult to maintain over the long term, and may be less safe.

Sorry, but this is pure nonsense. The Committee admits to examining 36 articles published since 2004. Twenty of them found no difference in weight loss between diets differing in proportion of fat, carbs and protein. However 13 studies found that low-carb diets out-performed low-fat or high-carb diets when it comes to weight loss, and four more studies found that higher protein diets did the same thing.

In other words, as Fineman and colleagues write, “47% of the cited studies demonstrate that low-carb or high-protein diets … are in fact more effective”.

How does that information get ignored when the Committee writes its final report? Don’t ask me, I’m just the messenger.

The Committee also wrote:

4. “Low-carbohydrate diets are not recommended because they are difficult to maintain over the long term.

Yet Fineman and colleagues present study after study showing that the attrition rates for low-carb diets are, if anything lower than the attrition rates for low-fat diets.

The Committee Report warns that diets that stray from the recommended guidelines “may be less safe”.

Oh really? And the evidence for this is….?  More studies demonstrate that low-carbohydrate diets improve cardiovascular risk markers than demonstrate the opposite. Six studies that demonstrate the reliable increase of HDL (“good” cholesterol) with a low-carb diet as well as the dramatic and reliable drop in triglycerides are ignored. One study (5), that analyzed 13 “low-carb vs. low-fat” diet studies concluded the following:

  • There were significant differences between the groups for weight, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure favoring the low-carbohydrate diet.
  • There was a higher attrition rate in the low-fat as compared with the low-carbohydrate groups suggesting a patient preference for a low-carbohydrate/high-protein approach.
  • Evidence from this systematic review demonstrates that low- carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to one year.

On what planet does that make “straying’ from the high-carb guidelines less safe? None that I live on.

Even on the issue of protein, the committee is all over the map. In one place, the committee writes: “Animal sources of protein, including meat, fish, milk and egg, are the highest-quality proteins”. Yet Americans are advised by the committee to shift to a more “plant-based” diet and “consume only moderate amounts of lean meats, poultry and eggs”.

Hey, listen, I believe in lower-carb eating for weight control and overall health, and I’m still the first to argue that we should also be eating a ton of plant foods like vegetables and fruits. But the report implies that we’d all be better off being vegetarians, something that’s simply not true. What’s more the very evidence examined by the Committee doesn’t support it.

Now I don’t mean to imply that there’s nothing of value in the Report, nor does Dr. Fineman. There are valuable suggestions made regarding improving nutritional literacy and cooking skills; restructuring the food environment, and improving the availability of affordable fresh produce.

But, as Fineman writes: “None of these recommendations makes sense in the context of nutritional guidance that is not based on sound scientific principles and demonstrable results.”

The idea that high-carb low-fat diets are “better” for us than low-carb ones is a myth and based on a misreading or ignoring of the massive evidence to the contrary. As long as those making the recommendations continue to refuse to look objectively at the evidence, we’ll continue to be in the fix we’re in today.

And as long as people who believe this crap are the “gatekeepers” for media outlets, don’t expect to hear the voice of the “loyal opposition” in the mainstream media.

Speaking of which….

I was one of the first bloggers to write about health on the free-wheeling forum known as the Huffington Post, which was originally founded to give those with edgier, out-of-the-mainstream opinions a place to make their arguments without censorship.

Recently, several posts of mine arguing that cholesterol was an overrated health hazard and that low-carb diets had been unfairly portrayed in the press were censored.

I was amazed. Nothing I’ve ever written on the Huffington Post had been censored before.

But my amazement was short-lived.

The newly appointed “Medical Director” of the Huffington Post is none other than the guru of the low-fat philosophy, Dr. Dean Ornish.

1) Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009;44:297309.

2) Buscemi S, Verga S, Tranchina MR, Cottone S, Cerasola G. Effects of hypo- caloric very-low-carbohydrate diet vs. Mediterranean diet on endothelial function in obese women. Eur J Clin Invest 2009;39:33947.

3) Halyburton AK, Brinkworth GD, Wilson CJ, Noakes M, Buckley JD, Keogh JB, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007;86:5807.

4) Keogh JB, Brinkworth GD, Noakes M, Belobrajdic DP, Buckley JD, Clifton PM. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr 2008;87:56776.

5) Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 2009;10:3650.

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