Dietary Guidelines for Americans 2015

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;

–      Oils.

“A healthy eating pattern limits:

–      Saturated fats and trans fats, added sugars, and sodium

“Quantitative recommendations:

–      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.”

Be wise!

References:

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.

21 thoughts on “Dietary Guidelines for Americans 2015

  • Pingback:How Nutrition Politics Hid the Health Benefits of Saturated Fat

  • avatar
    February 10, 2016 at 10:55 am
    Permalink

    The writer of the linked article is a gastroenterologist “with expertise in nutrition, integrative gastroenterology and women’s health” but oddly is not up to speed even with these latest Guidelines dropping of the cholestrol myth, when she writes in her latest article about hospital food, of “catered meals that were loaded with sugar, salt, and cholesterol” and “The food served in regular hospital cafeterias often isn’t much better; in the same 2015 report, PCRM analyzed cafeteria menus and patient meal plans, and found that they often included processed meats and items high in sugar, salt, and cholesterol.” (leave aside her comments re meat.)
    http://www.theatlantic.com/health/archive/2016/02/unhealthy-hospital-food/461898/?utm_source=SFFB

    Reply
    • avatar
      February 10, 2016 at 11:04 am
      Permalink

      Coincidentally, I have just seen this in the comments to the above Atlantic link, where a commenter links to your post about meat!

      “PCRM is a vegan advocacy group. They won’t be happy until they impose a vegan diet on everyone else.

      We have never established as “fact” that a plant-based diet is healthier than a meat-heavy diet. We have observational studies based on self-reported food surveys, where people who are eating a lot of meat, lower quality processed meats, more processed foods in general, more carbohydrates and sugars, fewer vegetables, getting less exercise, etc, are less healthy than populations who are eating the opposite of all those trends. To blame this solely on “meat” ignores both types and qualities of meats, as well as ignores all those other dietary factors (carbohydrates, processed oils, etc) and ignores the numerous populations who have enjoyed excellent cardiovascular health while eating diets rich in meats, fats, and saturated fats. Humans are adapted to be omnivores, and quality animal foods are both satiating and nutrient dense.

      We also have numerous clinical trials, with human subjects, where people eating high(er) fat, low(er) carb diets both lose weight and improve their cardiovascular risk factors relative to those eating low-fat or standard dietary advice. In short, it was likely the chocolate cake, soda, and the breading on those chicken wings doing the damage to Dr. Ravella’s patient, the chicken inside the breading was most nourishing part of that meal.

      As a doctor, a gastroenterologist, Dr. Ravella should know that dietary cholesterol has little to no effect on blood serum cholesterol, and that a breakfast of eggs is one of the most nutritionally dense and satiating breakfasts that one can eat.

      Finally, some sanity on the WHO red meat report, which is also based on self-reported food surveys, and uses relative risk numbers to make a tiny absolute risk sound scarier:
      http://www.zoeharcombe.com/201
      http://chriskresser.com/red-me
      http://www.marksdailyapple.com

      Reply
      • avatar
        February 10, 2016 at 11:43 am
        Permalink

        Go Amie! x

        Reply
  • avatar
    January 19, 2016 at 1:05 pm
    Permalink

    Zoe, Can you say whether the standard low fat advice sheet that NHS doctors issue to patients they have deemed to have too high cholestrol, has changed? My husband has been getting these for several years after his annual blood tests. (He has ignored these, as well as the urging to take statins, for the past few years since we changed to a more LCHF diet after he had AF related TIAs, and his trigs and ratios are just fine.) It seems to me that the latest sheet he has just received has changed for the worse:
    Under the column: Choose from these foods daily, it has fruit juice (unsweetened)!! Sweetened fruit juice is under the Eat in moderation once a week or less. Even where the word is now out on TV programmes and tabloids re the damage caused by the high levels of fructose in so called “unsweetened” “healthy” fruit juices! I don’t recall this advice in the previous sheets, but I may be wrong.
    All whole milk dairy still a total no no, as is butter; the only oil that is acceptable is rapeseed: you can have deep fried chips as long as fried in rapeseed. The only acceptable “nuts” are chestnuts.
    Total ban on “visible fat on meat” and goose (!) Also coconut banned, and no more than 3 eggs a week, inclusive of eggs in baked goods! Liver, not more than once a week or less, as is duck (without skin.)
    Whole grains tofu, soya, recommended daily, White grains, 2-3 times a week.
    Yikes!!!

    Reply
    • avatar
      January 20, 2016 at 9:04 am
      Permalink

      Hi Amie
      I don’t know what gets handed out – probably just as well or my BP would go up! That sound truly dreadful advice – do you blog? Can you post it up somewhere for the world to see?!
      Let me know if you do and I’ll share it on twitter/Facebook etc
      Best wishes – Zoe

      Reply
      • avatar
        January 20, 2016 at 12:38 pm
        Permalink

        Hi
        The site I blog for does mainly political stuff. I have a moribund blogsite I can maybe use. I agree it is worth sharing more widely. Will be in touch.

        Reply
      • avatar
        January 27, 2016 at 12:13 pm
        Permalink

        The diet sheet was sent to you on twitter by DIL. I love your response.

        Reply
        • avatar
          January 27, 2016 at 1:51 pm
          Permalink

          Ha ha – many thanks :-)

          Reply
  • avatar
    January 15, 2016 at 6:25 pm
    Permalink

    Thanks for the post. I especially like taking the long view back to the original DG.

    But I have a question about the last item in your following sentence. “We need to prioritise meat, fish, eggs, dairy, non-starchy vegetables and sunflower seeds.”
    Instead of sunflower seeds by themselves, I would have guessed you would have written all seeds and nuts. Why just sunflower seeds?

    Reply
    • avatar
      January 20, 2016 at 9:01 am
      Permalink

      Hi Nate
      Because they are uniquely rich in vitamin E – to the extent that I wonder how humans get sufficient vit E without them!
      Best wishes – Zoe

      Reply
      • avatar
        January 25, 2016 at 3:22 pm
        Permalink

        Thanks, I’ve put them on my salads, so I’ll do that a little more often, now. And just plain eat a handful.

        Reply
  • avatar
    January 14, 2016 at 6:51 pm
    Permalink

    Nice to see you back! I got worried that you had been kidnapped by dieticians and rendered to a secret prison camp on Carb Island where you were waterboarded with sunflower oil and force-fed tofu until you agreed to say “Yum yum!”

    Well it could happen, do you think Aseem Malhotra or Rangan Chatterjee will be their victim in a show trial a la Annika Dahlqvist (that didn’t end too well for them), Tim Noakes and Jennifer Elliott. They seem a tad upset that these guys are improving the health of their patients.

    Reply
  • avatar
    January 13, 2016 at 10:23 pm
    Permalink

    Well, they’re still recommending “low fat” and “non fat” dairy products. That’s not real food, and if you’re not going to eat proper dairy products how they appear in nature, why eat them at all? And I notice they seem to recommend soy a lot as part of a “healthy diet”; I have a lot of quibbles about that, soy is a highly processed non-food. Although they’ve “lightened up” slightly on their dietary cholesterol recommendations, there’s still a caveat where they claim that foods that are high in cholesterol “are also generally high in saturated fat”, and therefore should be limited. They’re still recommending low sodium diets, when some of us (like me) have low blood pressure and need to make sure we eat *enough* sodium- (reducing sodium only minimally reduces blood pressure anyway, whereas reducing sugar and carbohydrates has more effect). They seem overly concerned with caloric intake, as if to imply that each and every one of us are fat. I could go on and on…..

    So many things wrong with this one-size-fits-all advice!

    Reply
  • avatar
    January 11, 2016 at 9:54 pm
    Permalink

    This may be a stupid question, buy why are governments giving us nutritional advice to begin with? After all we managed for several thousand years without their benevolent oversight. Looking at what’s happened to us in the 50 or so years since they started telling us what’s good for us, it’s become quite the train wreck.

    Would the hyper-processed food industry have made such inroads if they hadn’t had tacit government approval?

    Reply
  • avatar
    January 11, 2016 at 1:55 pm
    Permalink

    Hi Zoë,
    Well said! Official advice is never going to amount to much as it is the result of vested interests and agenda driven politics (especially in the US which must be regarded as a lost cause when it comes to diet). The problem is finding genuinely good advice, such as you and relatively few others provide, vs. the dogma driven rubbish that so many people (including celebrity doctors) who should know better continue to spout. Bad diet advice from doctors is particularly damaging because far too many assume that a doctor knows what he/she is talking about when it comes to diet. Additionally the voice of reason is heavily outgunned by the voice of stupidity especially when it is backed up by what appears to some as obvious knowledge (the “everybody knows” syndrome) such as fat makes you fat and the “eat less move more” brigade. Note that I’m not anti-exercise but it is not the most efficient or comfortable way to lose weight.
    It is beyond obvious that the depressingly poor health of many is a direct result of flawed dietary advice (ignoring the minefield that is the quality and nutritional content of food even if you consume the right type of food) and the damage resulting from a poor diet is compounded by unnecessary medication rather than correcting diet deficiencies.
    Corruption aside I cannot understand how intelligent people fail to see what is wrong with current diet advice when it has so clearly failed so many for so long. Even a basic knowledge of biochemistry provides enough understanding to uncover the fundamental flaws.
    Please keep up the good work!

    Reply
  • avatar
    January 11, 2016 at 11:39 am
    Permalink

    The 1980 guidelines were the product of that famous Senate committee. Replying to one of the actual scientists’ plea that not enough was known to provide useful guidelines, Senator McGovern replied that senators, unlike scientists, didn’t have the luxury of waiting until every last piece of evidence was in.

    What he really meant was, “until we have any reliable evidence at all”. This was an outstanding early example of what has since become known in political circles as “policy-led intelligence”.

    Reply
  • avatar
    January 11, 2016 at 11:36 am
    Permalink

    Also, they kept the (very low) salt intake the same, even though there’s quite a bit of evidence that that low of salt intake can cause disease. There are many conflicting studies on salt intakes and disease. If that’s the case, the guidelines should say “We think there might be upper and lower limits for salt, but we have no idea what they are.” Instead, they may rules, which may cause more harm than good.

    The only point about your article where I have a possible quibble is in resistant starch. I’m not sure about resistant starch. I’ve been experimenting with it lately because I was experiencing irritable-bowel type symptoms (basically, you have to go to the bathroom IMMEDIATELY or it feels for hours like you have to go but don’t). Resistant starch, though, often means increased calories from carbs. Since I’m insulin resistant, it’s a challenge to balance the carb intake with the (purported) benefits of resistant starch. I should note studies with resistant starch, even for diabetics, show no increase in blood sugars for resistant starch (not sure about the effects of insulin, though — I’ll see if I can look into this). It’s unclear to me whether resistant starch is helping, as I’ve also been performing intermittent fasting (first week of the year was a five day fast), and only have been trying a little over a month, with the holidays thrown in. My initial impression is that using resistant starch seems to help. A side issue for me is why we (the human race) involved to need resistant starch — why aren’t vegetables good enough? Why do we also need plantains, potato starch, etc.?

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.