* On Independence Day, we’re looking at what Americans eat.
* An official (United States Department of Agriculture) publication estimated food consumed by the average American, after adjusting for food lost/wasted etc. The report opened with rates of obesity and overweight in the US, as background to the dietary examination.
* The summary of the report was that, on average, Americans are eating too much added fat, too many refined grains, added sugars and sweeteners, and not enough fruit, vegetables, whole grains, seafood, and low-fat dairy products.
* The report compared food intake in 1970 and 2014 for fruits, vegetables, grains, meat/eggs/nuts, dairy, added fats and oils and added sugar and sweeteners. In 2014, Americans were eating more of everything except dairy products.
* The biggest single increase between 1970 and 2014 was for added fats and oils, where consumption almost doubled.
* The report was focused on whether Americans achieved the Dietary Guidelines. It didn’t question whether the guidelines, or actual food consumption, met nutritional requirements. It didn’t question whether the guidelines played any part in the incidence of obesity and overweight.
As this Monday note falls on American Independence Day, I thought we could look at what Americans eat. I asked Nina Teicholz, founder of the Nutrition Coalition, for the best data on food intake. Nina explained that the data are not ideal or particularly current, but the best document is probably “U.S. Trends in Food Availability and a Dietary Assessment of Loss-Adjusted Food Availability, 1970-2014” by Jeanine Bentley, published in January 2017 (Ref 1).
This document is a USDA (United States Department of Agriculture) publication. The approach taken was as follows. Food available for consumption was assessed using the data in the US Department of Agriculture (Economic Research Service’s Food Availability) system. This was adjusted for food lost (food spoilage, plate waste and other losses) to give an estimate of food consumption per person. The loss-adjusted food availability was then compared with the recommendations in the 2015-2020 Dietary Guidelines for Americans. The document then reported whether Americans are, on average, at, above or below dietary recommendations for fruit, vegetables, grains, protein foods, dairy, added fats and oils, and added sugars and sweeteners.
The report opened with a number of statistics related to overweight and obesity. The first sentence of the introduction was “Since the 1970s, the U.S. obesity rate among adults has almost tripled, from 16 percent in 1971-74 to 46 percent in 2013-14” (Ref 2).That was adults. A couple of sentences later, the position for younger people was summarised: “Among children and adolescents (ages 2 to 19 years old), the obesity rate more than tripled from 5.2 percent in 1971-74 to 17.2 percent in 2013-14” (Ref 3).
Given that this was the context for the report, it was frustrating from the outset that the report aim was to use loss-adjusted food availability data to assess whether Americans are following the dietary guidelines. i.e., there was no examination of the possibility that the dietary guidelines (introduced in the 1970s) could have contributed to the substantial increase in overweight and obesity – just an examination of whether or not people were following them.
The summary conclusion of the report was: “The findings indicate that Americans’ consumption, on average, is below the dietary recommendations for fruit, vegetables, and dairy and above the recommendations for grains, protein foods, added fats and oils, and added sugars and sweeteners on the basis of a 2,000-calorie-per-day diet. To meet these recommendations, Americans would need to lower their consumption of added fats, refined grains, and added sugars and sweeteners, and increase their consumption of fruit, vegetables, whole grains, seafood, and low-fat dairy products.” I have had the privilege of seeing Nina present several times and she makes the point that, since the 1970s, Americans have shifted their eating habits in the direction advised by the guidelines in every category of food measured. The loss-adjusted food report concluded that Americans aren’t meeting the guidelines. It doesn’t report how far they have come.
Page 2 of the report contained a summary of the recommended intakes of fruits, vegetables, grains, protein foods, dairy, oils and discretionary calories (for junk, basically). I must always point out that those are ignorant food groups. Protein is in everything other than sucrose and oils – it is a macronutrient not a food group. Using "protein" as a food group enables three of the four most nutritious food groups (meat, fish and eggs) to become one group (dairy being the fourth). That’s three animal groups marginalised with the choice of the word “protein”.
As an example, a person with a 2,000 calorie a day requirement is recommended to consume the following each day: 2 cup equivalents of fruit; 2.5 cup equivalents of vegetables; 6oz grains; 5.5oz of protein foods; 3 cup equivalents of dairy (low-fat of course); and 27g of fats and oils. Apologies dear American friends, but the use of cups is the least accurate measurement imaginable. First, there are rules on what counts as a cup equivalent (raw vs dried fruit, for example). Second, the conversion to a precise measurement (e.g., grams) is different for every food. This is explained in the reference here (Ref 4). There are 270 calories allocated for "added sugars, added refined starches, solid fats, alcohol, or to eat more than the recommended amount of food in a food group."
Summary of intakes & recommendations
Page 6 of the report contained an excellent image to capture calories consumed by food category for 1970 (the inner ring) and 2014 (the outer ring). I’ve reproduced it here:
That image presented consumption between the two years being compared – 1970 and 2014. This was in calories, while recommendations for intakes are primarily in cups, oz and grams. To compare actual volume (cups) and weight (oz and grams) intake against recommended volume and weight intake, I went through the report and extracted the loss-adjusted food availability figure for each of the seven categories for the two dates that the report compared: 1970 and 2014. The recommended column is the intake for someone needing 2,000 calories a day. The 1970 and 2014 columns are the loss-adjusted average intake per person. This is the simplest summary of the entire report.
1) The cup intakes for fruit and vegetables included total amounts of fruit & veg consumed – fresh, frozen and processed.
2) The “other calories” includes “added sugars, added refined starches, solid fats, alcohol, or to eat more than the recommended amount of food in a food group." However, the report only contained data for added sugars & sweeteners. The other calories that were consumed in this category were not reported. Within the “added sugars and sweeteners” category, I included only those sugars with calories in the bottom line of the table above. In 1970, 20.8 teaspoons of added sugars and sweeteners were consumed. In 2014, this figure was 22.9. Intake of table sugar declined between the two dates, while intakes of corn sweeteners more than tripled. Americans have been opting for calorie-free sweetness, while overweight and obesity has increased fewfold.
Observations from the table
As the report concluded, intakes of fruits, vegetables and dairy were below recommendations, intakes of grains, protein foods, fat & oils and added sugars & sweeteners were above recommendations. Other findings could have been highlighted:
1) Between 1970 and 2014, average intakes per person of fruits, vegetables, grains, protein foods, fats & oils and sugars & sweeteners all increased. Dairy was the only category with lower consumption in 2014 compared to 1970.
2) Spot the culprit – intake of fats & oils almost doubled from 1970 to 2014 and, in 2014, intake was more than double the recommended 27g per person per day (and that’s for the mid-range 2,000 calorie a day person). That’s nearly 600 calories of fats & oils a day being consumed by the average American. Those are largely empty calories. Fats and oils contain some fat soluble nutrients – butter tends to have vitamins A and D; seed oils tend to have vitamins E and K, but they are poor for, or void of, minerals and incomparable to meat, fish, eggs and dairy for nutrients overall.
Observations from the report
There were interesting points in the 38-page report related to each category. I’ve summarised them below:
Fruit: Fruit was described in the report as "relatively low in calories and high in nutrients." It is relatively low in calories but compared to meat/fish/eggs/dairy it is also low in nutrients. Approximately half of fruit intake in both years was described as “processed.”
Vegetables: Potato chips and dehydrated vegetables were included in total vegetables. Potatoes were the single biggest vegetable for intake. "Almost half of potato availability was segmented in the frozen market (46.3 pounds)." That’s oven chips. Tomatoes, onions and head lettuce were three of the other major vegetables by intake – driven by things put in burger buns, I hypothesise.
Legumes were included in total vegetables – not protein foods. Half of all vegetables consumed in 1970 and 2014 were described as "processed."
Grains: Wheat accounted for 81% of all grain intake in 1970 and 73% in 2014. Corn accounted for 11% of all grain intake in 1970 and 25% in 2014. These two grains thus accounted for 92% and 98% of grain intake in 1970 and 2014 respectively.
Protein foods: These included red meat (beef, pork, lamb), poultry, fish & shellfish, eggs and nuts (excluding peanut butter, which was counted as a legume and thus a vegetable).
In the context of intake of almost everything increasing between 1970 and 2014, red meat declined from an average of 4.2oz per person per day in 1970 to 3oz in 2014. Poultry intake doubled from 1.16oz to 2.44oz (KFC etc) per person per day. Fish and shellfish intake increased from 0.17oz to 0.26oz per person per day – that’s too low to secure required intakes of vitamin D and omega-3 fatty acids. Egg intake declined. Nut intake increased (the table on p19 of the report summarised all this).
Dairy: In the dairy category, milk intake declined, cheese intake increased (cheeseburgers?). Frozen dairy intake (ice cream and frozen yoghurt) was lower than I expected – 0.11 cups a day in 1970 and 0.09 cups a day in 2014.
Fats & oils: As shared in the summary observations from the table, fats & oils were the big increase items. This was not driven by animal fats (butter, lard and tallow). These declined from 8.33g/day to 5.85g/day between 1970 and 2014. Vegetable fats & oils (salad and cooking oils and margarine) increased from 27.85g/day to 57.14g/day between 1970 and 2014. Americans were told to ditch animal fats for vegetable oils, and they’ve done what they were told. We can’t blame butter for what has happened to American health since 1970.
The report barely mentioned vitamins and minerals, other than to make statements such as “Vegetables are a good source of vitamins, minerals, and dietary fiber…” The report did not, therefore, assess the nutrient intake of Americans to see if the average consumption meets requirements.
The most recent Dietary Guidelines for Americans (DGAs) summary report contains tables at the back setting out nutritional goals for all age/sex groups for calories, macronutrients, minerals (calcium, iron, magnesium, phosphorus, potassium, sodium and zinc) and vitamins (A, D, E, K, C and the B vitamins) (Ref 5). That document doesn’t contain an assessment of the average American sufficiency, or deficiency, of vital nutrients.
The scientific report underpinning the DGAs does admit that the guidelines are nutritionally deficient (Ref 6). The Nutrition Coalition posted a short but important article citing the following passage from within the 835 page report: “The nutrients for which adequacy goals are not met in almost all [recommended dietary patterns] are potassium, vitamin D, vitamin E, and choline” (Ref 7). Hence, even if Americans meet the dietary guidelines, the creators of those guidelines know that they do not provide what is needed.
I have analysed one of the diets being recommended for Americans. In this post, I analysed the "healthy vegetarian dietary pattern for ages 2 and older" as recommended in Table A3-4 on page 148 of the 2020-2025 DGAs (Ref 8). The diet did not meet the RDAs for retinol, B3 (niacin), B6, vitamin C (surprisingly), vitamin D, vitamin E and Vitamin K (and that’s before getting into D3 vs D2 or K2 vs K1 and what the body actually needs). The diet fared better for minerals (these come from the ground, so you would expect that in a plant-based diet) but it was still woefully deficient in iron – delivering 11.5mg out of a target of 18mg. And much of the iron was reported as coming from plant foods and is thus not as bioavailable as the iron provided by the eggs. Table A1-2 did not include essential fatty acids and there was only one mention of EPA/DHA in the report (this is the form in which we need omega-3 essential fatty acids). It is unlikely that the diet met EPA/DHA requirements and would likely be high in omega-6 to omega-3 as a ratio of essential fatty acids.
The macronutrient composition was 267g carbohydrate, 77g protein and 45g fat. The targets set in the AMDR table were 130g for carbohydrate, 46g for protein and no grams were given for fat, but a percentage range of 20-35% was given instead. The fat percentage turned out to be 23%, so the actual intake from our example diet was at the low end of the AMDR. The carbohydrate intake was a whopping 60% and protein made up the 17% remainder.
I returned to the ERS (Economic Research Service) website to search for nutrient intakes. A page called “Food Consumption and Nutrient Intakes” looked promising (Ref 9). However, the data spreadsheets available under this heading did not provide the data I was looking for. I wanted all the vitamins and minerals (and in the form that they are needed e.g., retinol, not carotene, for vitamin A). Instead, the only nutrients reported were as follows (with the average for the total population aged 2 and over in brackets): energy (2,048 calories); calcium (956mg); dietary cholesterol (282mg); fiber (16.5g); iron (14mg); fat (81g); saturated fat (27g); and sodium (3,410mg). That’s tells us that, with a couple of exceptions (calcium and iron), the focus was on nutrients perceived to be bad (cholesterol, fat, sodium) and not on nutrients that are vital for optimal health.
That last sentence sums up the Dietary Guidelines for Americans. They are driven by what they don’t want you to eat rather than by what you need to eat. Had they started from the base of what nutrients do we need and where do we find them, they could not have concluded as they did. Instead, they demonised fat and animal foods and inevitably concluded that carbohydrate and plant foods were the options left. Reports, such as Jeanine Bentley’s, then focus on adherence to the guidelines instead of the question of whether the guidelines deliver basic health requirements. The Nutrition Coalition was set up to challenge the dietary guidelines for these very reasons. It is beyond frustrating for all of us working in the field of diet and health to see reports document the huge increase in overweight and obesity and to make no connection with the role that the guidelines might have played.
What do Americans eat? According to official reports, the answer is too much added fat, too many refined grains, added sugars and sweeteners, and not enough fruit, vegetables, whole grains, seafood, and low-fat dairy products. I would agree with the “too much/many” added fat, refined grains, sugars and sweeteners. I would replace the “not enough fruit, vegetables, whole grains, seafood, and low-fat dairy products” with “not enough meat, eggs, fish, seafood, and whole dairy products.” Oh, and not enough nutrients!
Ref 1: Jeanine Bentley. U.S. Trends in Food Availability and a Dietary Assessment of Loss Adjusted Food Availability, 1970-2014, EIB-166, U.S. Department of Agriculture,
Economic Research Service, January 2017. https://www.ers.usda.gov/webdocs/publications/82220/eib-166.pdf?v=6592.4
Ref 2: Fryar et al. 2016a. Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 and Over: United States, 1960-1962 Through 2013-2014, National Health and Nutrition Examination Survey, U.S. Centers for Disease Control and Prevention.
Ref 3: Fryar et al. 2016b. Prevalence of Overweight and Obesity Among Children and Adolescents Aged 2-19: United States, 1963–1965 Through 2013–2014, National Health and Nutrition Examination Survey, U.S. Centers for Disease Control and Prevention.
Ref 4: First, cup equivalents are as follows:
Fruit: In general, 1 cup equivalent is: 1 cup raw or cooked fruit; ½ cup dried fruit; 1 cup fruit juice.
Vegetables: In general, 1 cup equivalent is: 1 cup raw or cooked vegetable; ½ cup dried vegetable; 1 cup vegetable juice; 2 cups leafy salad greens.
Dairy: In general, 1 cup equivalent is: 1 cup milk, fortified soy beverage, or yogurt; 1½ ounces natural cheese (e.g., cheddar); 2 ounces of processed cheese (e.g., American).
Second, examples of cups in grams are as follows:
Fruit: 1 cup of blueberries =148g. (https://nutritiondata.self.com/facts/fruits-and-fruit-juices/1851/2)
Vegetables: 1 cup of raw broccoli = 71g. (https://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2816/2)
Dairy: 1 cup of cottage cheese = 226g. (https://nutritiondata.self.com/facts/dairy-and-egg-products/15/2)
Ref 5: Dietary Guidelines Advisory Committee. Dietary Guidelines for Americans. Ninth edition. In: Agriculture. USDoHaHSaUSDo, ed., 2020:164. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
Ref 6: Dietary Guidelines Advisory Committee. Dietary Guidelines for Americans. Scientific Report of the 2020 Advisory Committee. In: (HHS) DoHaHS, ed., 2020:835
Ref 7: https://www.nutritioncoalition.us/the-guidelines-recommend-diets-that-are-nutritionally-insufficient
Ref 8: https://www.zoeharcombe.com/2021/05/a-healthy-vegetarian-diet/
Ref 9: https://www.ers.usda.gov/data-products/food-consumption-and-nutrient-intakes/