What should Americans eat? The 2010 dietary guidelines

The advice on what to eat for optimal health is reevaluated and dispensed by the government every five years and we’ll be seeing new guidelines published later on this year.

The foundation for the guidelines is an independent, evidence-based report, prepared by the Dietary Guidelines Advisory Committee, which is comprised of independent experts—mostly academics in the fields of nutrition and health. The advisory committees have been giving, in essence, pretty much the same advice for the past thirty years: Eat less solid fats, salt, and added sugars and more fruits, vegetables, and whole grains. Move more. The devil’s in the details—wording, upper and lower limits for nutrients, emphasis on food groups—and this document is usually not received without debate by the food industry and other players.

Yet not much happens. Guidelines aside, obesity rates have continued to climb, and the fast- and processed-food diet is still the most prevalent food pattern observed by Americans.

The Dietary Guidelines Advisory Committee Report of 2010 issued its recommendation recently, the report is now open for comments, and following the public comment period the USDA and US Department of Health and Human Services will take in the comments—let’s hope politics won’t be thrown into the mix—and translate the Advisory Report into the 2010 Dietary Guidelines for Americans.
So what’s new in the 2010 Advisory Committee Report guidelines?

Cut Salt. By a lot.

The 2005 guidelines recommended a daily sodium upper limit of 2,300 mg sodium for the general adult population, and a 1,500 mg per day sodium limit for people with hypertension, African-Americans and older Americans. Since these latter groups comprise 70 percent of US adults, the new 2010 guidelines recommend 1,500 mg per sodium day upper-limit for the general population. It’s quite a challenge, given the vast amounts of salt processed foods contain, and the high levels of salt most people are accustomed to. Most Americans consume more than twice the 2,300 mg “old” upper-limit.

Food patterns: Plant centered patterns promote health, and vegetarian diets get the nod

The new report realizes that people eat food, not isolated nutrients, and counting grams of fats, servings of carbs and milligrams of salt isn’t a tempting lifestyle for most—who wants to walk around with reading glasses and a calculator? Many experts believe that total diet and food patterns are better guides to what we should be eating. The 2005 report mentioned two eating patterns recommended for their health benefits, the DASH (Dietary Approaches to Stop Hypertension) eating plan, and the USDA food guide eating plan—yet these two plans still resemble a diet recipe and not a dietary pattern—they’re still more about counting servings rather than providing food rules and a framework for a healthy diet.

The new proposed guidelines go further, and suggest two eating patterns proven to promote health: the Mediterranean-style and vegetarian-style diets. What these patterns have in common is emphasis on plant-foods. If the vegetarian style diet indeed gets an endorsement in the final guidelines this is going to be quite a shift—the guidelines and pyramids of past were big promoters of animal protein, and vegetarians and vegans seemed like poor step-kids living a life of compromise on inferior substitutions. (Full disclosure: I am a vegetarian, mainly for ethical reasons.)

Here’s the report’s recommended diet in a nutshell:

“Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.
Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium.”

I guess this is as close as we can get to spelling out how we should eat without offending any food industry. May I offer my interpretation in plain-speak?

There are many ways to eat healthy, all of which emphasize plenty of plant foods—fruits, vegetables, whole grains and such—and moderation in pretty much everything else. There’s one food pattern that clearly doesn’t work: the processed- junk- and fast-food diet tends to make people fat and unhealthy. Eat that stuff only on special occasions.

The food environment: We all need to work together to improve it

The guidelines acknowledge that although personal food choices play a central role in the obesity epidemic, our food environment is also a key-player that needs to be addressed urgently:

“In order to reduce the obesity epidemic, actions must be taken to improve the food environment. Policy (local, state, and national) and private-sector efforts must be made to increase the availability of nutrient-dense foods for all Americans, especially for low-income Americans, through greater access to grocery stores, produce trucks, and farmers’ markets, and greater financial incentives to purchase and prepare healthy foods. The restaurant and food industries are encouraged to offer foods in appropriate portion sizes that are low in calories, added sugars, and solid fat. Local zoning policies should be considered to reduce fast food restaurant placement near schools.”

Is there hope for change?

Absolutely. I think the guidelines provide an evidence-based framework on which policies, action and choices need to be made. Although the advice is basically the same over many decades, there are more people listening, a first lady dedicated to the cause, a strong and growing crowd of people who care about this issue, and are eager for change, a health-care system threatening to collapse under the rising costs of obesity-related disease and a food movement rising.

I’m hopeful (as a matter of principle and as a way of life). Are you?

Dr. Ayala

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