Bonnie's Critique of 2010 Dietary Guidelines for Americans

Bonnie - 700 pages for this? Nothing in this report is groundbreaking for our clientele except that the committee acknowledged the presence of not just food allergy, but food intolerance as a major issue affecting Americans which needs to be recognized. Most of the recommendations support what is already known. Other recommendations are clearly meant to placate food industry groups. Here is what we found to be meaningful.

-Gradually reduce total sodium intake to 1500 mg/day.

-Dietary monounsaturated fatty acids (MUFA) are associated with improved blood lipids related to both CVD and T2D, when MUFA is a replacement for dietary saturated fats. Increased MUFA intake, rather than high carbohydrate intake, may be beneficial for persons with T2D. High MUFA intake, when replacing a high carbohydrate intake, results in improved biomarkers of glucose tolerance and diabetic control. Bonnie - monounsaturated fats come from sources such as olive oil.

-Saturated fat is positively associated with intermediate markers and end point health outcomes for two distinct metabolic pathways: 1) increased serum total and LDL cholesterol and increased risk of CVD and 2) increased markers of insulin resistance and increased risk of Type 2 Diabetes. The evidence shows that 5 percent energy decrease in SFA, replaced by MUFA or PUFA, decreases risk of CVD and T2D in healthy adults and improves insulin responsiveness in insulin resistant and T2D individuals. Bonnie - the committee went after saturated fats in a big way, while mostly ignoring grain carbohydrates.

-Consumption of one egg per day is not associated with risk of CHD or stroke in healthy adults, although consumption of more than seven eggs per week has been associated with increased risk.

-Consumption of two servings of seafood per week (4 oz per serving), which provide an average of 250 mg per day of long-chain n-3 fatty acids, is associated with reduced cardiac mortality from CHD or sudden death in persons with and without CVD.

-Increased maternal dietary intake of long chain n-3 PUFA (EPA/DHA), in particular docosahexaenoic acid (DHA) from at least 2 servings of seafood per week, during pregnancy and lactation is associated with increased DHA levels in breast milk and improved infant health outcomes, such as visual acuity and cognitive development.

-Unsalted peanuts and tree nuts, specifically walnuts, almonds, and pistachios, in the context of a nutritionally adequate diet and when total calorie intake is held constant, has a favorable impact on cardiovascular disease risk factors, particularly serum lipid levels.

-Avoid trans fatty acids from industrial sources in the American diet, leaving small amounts from trans fatty acids from natural (ruminant) sources. Bonnie - some dairy products and meats contain conjugated linoleic acid, a natural form of trans fat which is not harmful.

-When stearic acid is substituted for other saturated fats or trans fatty acids, plasma LDL cholesterol levels are decreased; when substituted for carbohydrates, LDL cholesterol levels are unchanged. Bonnie - stearic acid is often used as an excipient in dietary supplements.

-Added sugars, including sugar-sweetened beverages, are no more likely to cause weight gain than any other source of energy. Bonnie - this is hilarious. An obvious placation of the soft drink lobby.

-Individuals who use non-caloric sweeteners are more likely to gain weight or be heavier. This does not mean that non-caloric sweeteners cause weight gain rather that they are more likely to be consumed by overweight and obese individuals. Bonnie - the second comment is them covering for the first comment, which is the most provocative statement so far.

-Gut microflora play a role in health, although the research in this area is still developing. Foods high in prebiotics (wheat, onions, garlic) may be consumed, as well as food concentrated in probiotics (yogurt), within accepted dietary patterns.

-Total grains servings are typically over-consumed in the US, so recommendations to consume more grains are not supported by this review. Bonnie - while encouraged by not recommending an increase, there should have been a reduction, to be replaced by vegetables.

-The DRI committee concluded that evidence was insufficient to set a Tolerable Upper Intake Level (UL) for carbohydrates. However, a maximal intake level of 25 percent or less of total calories from added sugars was suggested by the panel. Bonnie - this report is full of double talk, as seen here. This statement contradicts the "no increase in carbs" from above. 25 percent of carbs from added sugars (empty calories)? How will that help the obesity epidemic?

-Strong evidence demonstrates that intake of milk and milk products provide no unique role in weight control. Bonnie - The Dairy Council is probably fuming over this statement.

-Glycemic index and/or glycemic load are not associated with body weight and do not lead to greater weight loss, better weight maintenance, or cancer. While a relationship between high glycemic index and type 2 diabetes exists, there is little association between glycemic load and type 2 diabetes. No conclusion can be drawn to assess the relationship between either glycemic index or load and cardiovascular disease. Bonnie - this is hogwash. There is a plethora of evidence supporting glycemic load/index. This is protection for Big Sugar and Big Grain

-For both adults and children: vegetables, fruits, whole grains, fluid milk and milk products, and oils are underconsumed.

-For both adults and children: vitamin D, calcium, potassium, and dietary fiber are underconsumed.

-Strong and consistent evidence demonstrates a large reduction in the incidence of neural tube defects (NTDs) in the US and Canada following mandatory folic acid fortification.

-Substantial numbers of adolescent girls and women of reproductive capacity have laboratory evidence of iron deficiency.

-A substantial proportion of individuals older than age 50 years may have reduced ability to absorb naturally occurring vitamin B12 but not the crystalline form.

-For the general, healthy population, there is no evidence to support a recommendation for the use of multivitamin/mineral supplements in the primary prevention of chronic disease. Limited evidence suggests that supplements containing combinations of certain nutrients are beneficial in reversing chronic disease when used by special populations; in contrast, certain nutrient supplements appear to be harmful in other subgroups. Bonnie - obviously, we vehemently disagree with these statements. The head of the DGA committee is also the head of the American Dietetic Association, which came out earlier this year supporting a multivitamin/mineral. So where is the disconnect?

-Maternal weight gain during pregnancy outside the recommended ranges is associated with suboptimal maternal and child health. Women who gain weight excessively during pregnancy retain more weight after delivery, are more likely to undergo a cesarean section and to deliver large-for-gestational age newborns, and their offspring may be at increased risk of becoming obese later on in life.

-Moderate, consistent evidence shows that US consumers do not clean their refrigerators following available guidance, which impacts food safety. Bonnie - this is something that we should all do at least once or twice per year.

-Moderate, consistent evidence shows that health benefits derived from the consumption of a variety of cooked seafood in the US in amounts recommended by the Committee outweigh the risks associated with methyl mercury (MeHg) and persistent organic pollutants (POPs) exposure, even among women who may become or who are pregnant, nursing mothers, and children ages 12 and younger. Overall, consumers can safely eat at least 12 oz. of a variety of cooked seafood per week provided they pay attention to local seafood advisories and limit their intake of large, predatory fish. Women who may become or who are pregnant, nursing mothers, and children ages 12 and younger can safely consume a variety of cooked seafood in amounts recommended by this Committee while following Federal and local advisories.

-On average, Americans of all ages consume too few vegetables, fruits, high-fiber whole grains, low-fat milk and milk products, and seafood and they eat too much added sugars, solid fats, refined grains, and sodium. SoFAS (added sugars and solid fats) contribute approximately 35 percent of calories to the American diet. This is true for children, adolescents, adults, and older adults and for both males and females. Reducing the intake of SoFAS can lead to a badly needed reduction in energy intake and inclusion of more healthful foods into the total diet. Bonnie - the devil is in the details. The total reduction the committee suggests is only 3 percent (if maximum 25 percent from added sugars and 7 percent from saturated fats = 32 percent). How is that going to make a difference?

-Patterns of eating that have been shown to be healthful include the Dietary Approaches to Stop Hypertension (DASH)-style dietary patterns and certain Mediterranean-style dietary patterns.

-Improve the availability of affordable fresh produce through greater access to grocery stores, produce trucks, and farmers’ markets.

-Increase environmentally sustainable production of vegetables, fruits, and fiber-rich whole grains.

-Develop safe, effective, and sustainable practices to expand aquaculture and increase the availability of seafood to all segments of the population. Enhance access to publicly available, user-friendly benefit/risk information that helps consumers make informed seafood choices.

-Encourage restaurants and the food industry to offer health-promoting foods that are low in sodium; limited in added sugars, refined grains, and solid fats; and served in smaller portions.

-Selected behaviors that lead to a greater propensity to gain weight include too much TV watching, too little physical activity, eating out frequently (especially at Quick Service Restaurants [i.e. fast food restaurants]), snacking on energy-dense food and drinks, skipping breakfast, and consuming large portions. Self-monitoring, including knowing one’s own calorie requirement and the calorie content of foods, helps make individuals conscious of what, when, and how much they eat. Mindful, or conscious, eating is an important lifestyle habit that can help to prevent inappropriate weight gain, enhance weight loss in those who should lose weight, and assist others in maintaining a healthy weight.

-Individuals also should increase their consumption of dietary potassium because increased potassium intakes helps to attenuate the effects of sodium on blood pressure.

-An average daily intake of one to two alcoholic beverages is associated with the lowest all-cause mortality and a low risk of diabetes and coronary heart disease among middle-aged and older adults. Despite this overall benefit of moderate alcohol consumption, the DGAC recommends that if alcohol is consumed, it should be consumed in moderation, and only by adults. Moderate alcohol consumption is defined as average daily consumption of up to one drink per day for women and up to two drinks per day for men, with no more than three drinks in any single day for women and no more than four drinks in any single day for men. One drink is defined as 12 fl. oz. of regular beer, 5 fl. oz. of wine, or 1.5 fl. oz. of distilled spirits.

Written comments to the USDA will be accepted from June 15, 2010, to July 15, 2010.