Did you know that, until the final quarter of the twentieth century, public health dietary advice in the US and the UK focused on minimum intakes, to ensure that populations consumed adequate nutrients? The US 1950s-1970s “Basic Four Foundation Diet” recommended four or more bread and cereal portions daily, two cups or more of milk and two or more servings of meat (Ref 1). The UK favoured micro nutrient recommendations; until the first macro nutrient guideline was introduced in 1950 with British Medical Association advice that dietary fat intake should provide a minimum of 25% of daily calories (Ref 2).
The first public health dietary guidelines to set maximum intakes were those announced by the US Select Committee on Nutrition and Human needs in 1977 (Ref 3). These were followed by(Carter, 1977) UK public health dietary advice issued by the National Advisory Committee on Nutritional Education in 1983 (Ref 4). Dietary recommendations in both cases focused on one macro nutrient, fat, and a component part of that macro nutrient, saturated fat. The specific targets were to i) reduce overall fat consumption to 30% of total energy intake and ii) reduce saturated fat consumption to 10% of total energy intake.
As there are only three macro nutrients (carbohydrate, protein and fat), and since protein tends to stay fairly constant in either a plant or animal based diet at approximately 15%, if fat is restricted, carbohydrate increases (and also – if carbohydrate is restricted, fat increases). Fat and carbohydrate are the two most dependent variables in the diet. As human diets restricted fat to c. 30%, therefore, carbohydrate increased to 55-60% of our dietary intake. Since these guidelines were introduced, epidemics of obesity and type 2 diabetes have developed: coincidence or cause?
The 1980 Dietary Guidelines for Americans
The first issue of the famous American publication, issued every five years, came out in 1980. It presented the views of the 1977 Select Committee in a form intended to be digestible (excuse the pun), by all Americans. The 1980 publication, jointly written by the United States Department of Agriculture and the United States Department of Health, Education and Welfare, had seven dietary guidelines as follows:
1) Eat a variety of food;
2) Maintain ideal weight;
3) Avoid too much fat, saturated fat and cholesterol;
4) Eat foods with adequate starch and fiber;
5) Avoid too much sugar;
6) Avoid too much sodium;
7) If you drink, do so in moderation.
All pretty vague and unhelpful, to be honest – “maintain ideal weight” – by doing what exactly?! How much is “too much”?! What is meant by “adequate”?!
The 2015 Dietary Guidelines for Americans
Wind forward 35 years and the Dietary Guidelines are scrutinised like no other American health document. They were published on January 7th 2016, which amused me in itself. The committee know five years in advance that the guidelines are due in 2015 and they have 365 days to publish them and still they were late!
There are five guidelines in the latest edition:
“1) Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease.
“2) Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts.
“3) Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
“4) Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain.
“5) Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.”
Blah, blah, blah… If anything, these are more vague and useless than the original 1980 guidelines. They are certainly more verbose. They are, however, supplemented with specific recommendations, supposedly setting out how to achieve these general guidelines:
“Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.
“A healthy eating pattern includes:
– A variety of vegetables from all of the subgroups – dark green, red and orange, legumes (beans and peas), starchy, and other;
– Fruits, especially whole fruits;
– Grains, at least half of which are whole grains;
– Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages;
– A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products;
“A healthy eating pattern limits:
– Saturated fats and trans fats, added sugars, and sodium
– Consume less than 10 percent of calories per day from added sugars;
– Consume less than 10 percent of calories per day from saturated fats;
– Consume less than 2,300 milligrams (mg) per day of sodium;
– If alcohol is consumed, it should be consumed in moderation – up to one drink per day for women and up to two drinks per day for men – and only by adults of legal drinking age.”
The four interesting things about the latest guidelines:
1) Dietary cholesterol:
The recommendation to limit dietary cholesterol intake to 300 milligrams a day has prevailed in the US since 1977 (Ref 3). This has been dropped from the 2015 guidelines. The Dietary Guidelines Advisory Committee (DGAC) report from February 2015 declared that this recommendation would not be brought forward because available evidence shows no appreciable relationship between consumption of dietary cholesterol and blood cholesterol (Ref 5). All of those years of demonising super-nutritious foods, like eggs and seafood, were all for nothing. There was no evidence.
2) Total fat:
The DGAC demonstrated further movement away from the original dietary guidelines by containing no total fat recommendation and a change in position on dietary fat and cardiovascular disease (CVD). The advisory report documented the findings of the meta-analyses by Skeaff, Siri-Tarino, Hooper and Chowdhury (Refs 6-9) and concluded that reducing total fat does not lower CVD risk.
The paper from my PhD from the same month stated the same: there was no evidence whatsoever against total fat for heart deaths or deaths from any cause.
3) Saturated fat:
Alas, the fact that there is also no evidence against saturated fat was a step too far for the 2015 dietary guidelines committee to acknowledge. Hence the saturated fat guideline has been reiterated, with the same recommendation to consume less than 10% of total calories from saturated fat per day.
The consequence of the total fat guideline being conspicuous in its absence, while maintaining the saturated fat guideline is that the consumption of unsaturated fat is free to increase. This is precisely what Unilever and fake food companies want to happen, as they have replaced butter, for example, with cheaper and poor quality vegetable oils. They have reformulated so many junk food products to be rich in cheap vegetable oils and poor in natural ingredients. They have invented the low fat dairy products, endorsed by the guidelines, and replaced the lost taste of fat with cheaper and nutritionally useless sugar. Which brings us to…
4) Added sugar:
It is not widely known that one of the seven original 1980 dietary guidelines was “Avoid too much sugar”. This has largely been missed/ignored – whatever has happened – sugar concern and awareness has really only come to the fore in the past couple of years (albeit as a resurrection of the 1970s work of Professor John Yudkin).
The 2015 guidelines specify that people should have less than 10% of their calorie intake in the form of added sugar. For a typical female, consuming approximately 2,000 calories a day, that would be 200 calories from added sugar – 50 grams of sugar at c. 4 calories per gram. That’s a lot.
Far more importantly however, is the continuation of the nutritional ignorance that has got us in this dietary mess. While recommending less sugar, the Dietary Guidelines are concomitantly advising more fruit, more grains, more beans/pulses, more starch – all things that are, or break down into, sugar. The different forms of sugar are listed here, where fruit is used as an example to show that it is essentially sugar, with far fewer nutrients than people think.
Eat real food!
The only guideline that the US government needed to issue was “Eat real food”! The only debate is then – what should that real food be? If we choose food for the micro nutrients it provides (vitamins and minerals), the answer is obvious. We need to prioritise meat, fish, eggs, dairy, non-starchy vegetables and sunflower seeds. Fruit, grains and starchy vegetables really don’t get a look in.
I suggest that for three key reasons – lobbying by the fake food industry; ignorance on the part of the dietary guidelines panel; and a reluctance to change views, as this would be seen as an admission of previous wrong doing – the 2015 guidelines are what they are. Americans are stuck with bad advice for another 5 years, just as they have been for the 35 years previously. The smart people will ignore these guidelines and work out for themselves that real food is the only choice and some real food is substantially better than others.
As Sally Fallon Morell says “Evolution is no longer the survival of the fittest, but the survival of the wisest.”
Ref 1: Davis C, Saltos. E. Dietary Recommendations and How They Have Changed Over Time,. In: United States Department of Agriculture ERS, editor. Agriculture Information Bulletin No (AIB-750) 494 pp; 1999.
Ref 2: Foster R, Lunn J. 40th Anniversary Briefing Paper: Food availability and our changing diet. Nutrition Bulletin 2007; 32(3): 187-249.
British Medical Association. Summary of dietary allowances based on the recommendations of the British Medical Association. London: HMSO; 1950.
Ref 3: Select Committee on Nutrition and Human Needs. Dietary goals for the United States. First ed. Washington: U.S. Govt. Print. Off.; February 1977.
Ref 4: National Advisory Committee on Nutritional Education (NACNE). A discussion paper on proposals for nutritional guidelines for health education in Britain. 1983.
Ref 5: Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. In: Department of Health and Human Services (HHS), editor.; 2015. p. 571.
Ref 6: Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 2009; 55(1-3): 173-201.
Ref 7: Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition 2010; 91(3): 535-46.
Ref 8: Hooper L, Summerbell CD, Thompson R, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane database of systematic reviews (Online) 2011; (7): CD002137.
Ref 9: Chowdhury R, Warnakula S, Kunutsor S, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med 2014; 160(6): 398-406.