U.S. Dietary Guidelines for Adults 2015: Confusion or Clarity?
We’ve known for years that eating “right,” combined with exercise and stress relief or mindfulness, can have profound effects on cardiovascular health and disease. The problem, of course, is what constitutes “eating right?”
Over the years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) have attempted to help answer this question through the development of dietary guidelines that are updated at regular intervals, as well as public campaigns using visual imagery like pyramids and plates. While these efforts are laudable, the downside is that every revision of these guidelines and every new iteration of informative graphics results in a lobbying free-for-all by industry and special interest groups on what should be included or not included. As such, it is difficult to know if new guidelines and related tools are really based on what is or is not healthy or the financial or political interests of certain groups.
As you can imagine this leads to massive consumer confusion and, even further, massive confusion among health care providers. Given that most of us have had little to no nutrition training during medical school, residency, and fellowship, we as clinicians tend to be ineffective at delivering this type of much needed instruction.
This year’s dietary guideline release is no exception. There was some clarity on the dietary cholesterol issue. The guidelines note that “people do not need to obtain cholesterol through foods” and recommend limiting cholesterol intake, stating that people “should eat as little dietary cholesterol as possible.” Further, the guidelines now “wholeheartedly” endorse more fruits, vegetables, and whole grains in nearly every section—a big win for cardiovascular disease.
However, there are some definite areas of confusion. First, the dairy section includes not just standard animal milk products but also soy “milk,” which is not a dairy product at all. Soy and nut “milks” are not animal-based and do not contain cholesterol. Further, while the cholesterol section discussed above says “eat as little” cholesterol as possible, there are whole sections suggesting that dairy, meat, eggs, and other cholesterol-laden products should be consumed regularly, making it difficult for consumers to know how much of anything to really eat.
Finally, it is all well and good to suggest eating certain foods, but there was essentially no discussion in the final guidelines on sustainability of food. Obviously, if food is not available, it cannot be consumed. It has been well established that current meat, dairy, fish, and egg production is not only non-sustainable for the entire world population, but it is also detrimental to our environment. As such, if guidelines make recommendations to eat these resource intensive foods, there should be a statement with suggested solutions on sustainability. In the U.S. alone, suggesting regular meat, cheese, or dairy consumption in key states like California—where agricultural production is being hit by a multi-year drought—seems counterintuitive given that the water footprint required to produce these foods is significantly higher than most plant-based foods.
In short, the key takeaways from the new dietary guidelines are to eat more fruits, vegetables, whole grains, and legumes, and less meat, dairy, and cholesterol. This is indeed clearer. However, the guidelines have woven in some other statements making the specifics of how one should implement healthy eating a bit more nebulous. For our patients (and for our own sakes) we should aim to reduce or eliminate added sugars, salts, and saturated and trans fats and trade out higher fat and cholesterol foods for lower fat, low-to-no cholesterol foods and markedly increase unprocessed, whole, plant-based foods.
The important point for many of our patients is not to simply increase these beneficial foods, but to replace some or all of the less good choices with them.
The important point for many of our patients is not to simply increase these beneficial foods, but to replace some or all of the less good choices with them. So, no, the cheeseburger piled high with veggies isn’t healthy!
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