Jettisoning the National Dietary Guidelines

-- By ShawnFetty - 12 Apr 2010

--Introduction

The impact of obesity on both individual and public health is well understood. http://en.wikipedia.org/wiki/Obesity_associated_morbidity, http://en.wikipedia.org/wiki/Obesity_in_the_United_States#Medical_costs , http://www.youtube.com/watch?v=RTIY66IPjdY . Governments have reacted by adopting dietary guidelines, and these guidelines are mostly consistent across the globe. http://www.tropicanafruitnutrition.com/eng/FruitWellness/DietaryGuidelines.aspx . In the United States, the national guidelines serve as a starting point for both nutrition policy (for example, in the design of National School Lunch Program meals) and for diet advice from medical professionals, whether in clinical consultations or the preparation of hospital meals. Additionally, the guidelines are meant to steer individual consumers towards healthier food choices via food labeling. Thus, within American obesity discourse, the guidelines hold a highly privileged place. This is regrettable because the guidelines are seriously flawed.

--The guidelines rest on shaky theoretical grounds and should not be considered a credible source of health advice.

The guidelines are premised on several theories of health, many of which are taken axiomatically. For example, consider the theory of cardiovascular disease we all grew up with: saturated fat and cholesterol from our diet clogs our arteries, eventually cutting off the heart’s own blood supply or else resulting in stroke. Consequently, the guidelines today recommend that saturated fat amount to less than 10% of overall calories, that carbohydrates account for 50-60% of overall calories, and that cholesterol be restricted to less than 300mg/day. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf .

Recent studies suggest that this advice is either meritless or harmful. See, http://jama.ama-assn.org/cgi/content/abstract/281/15/1387 (daily consumption of eggs is unlikely to increase risk of coronary heart disease in spite of high cholesterol), http://www.ajcn.org/cgi/content/abstract/91/3/535 (no evidence that saturated fat is associated with an increased risk of cardiovascular disease), and http://www.ajcn.org/cgi/content/abstract/91/3/502 (replacing dietary fat with carbohydrates IS associated with an increased risk of cardiovascular disease and diabetes). See also, http://www.ncbi.nlm.nih.gov/pubmed/17341711 (the high-carb, low-fat diet advocated by the guidelines performs worse both in terms of weight loss AND risk indicators of cardiovascular disease compared to the much maligned high-fat/protein, low-carb Atkins Diet; video explanation here: http://www.youtube.com/watch?v=eREuZEdMAVo).

These are not revolutionary new findings. Studies almost sixty years ago reached similar conclusions. See, http://www.ajcn.org/cgi/reprint/17/5/281.pdf and http://jn.nutrition.org/cgi/content/abstract/59/1/39 . Even if this theory of cardiovascular disease, on which the guidelines remain significantly based, was at all persuasive when the guidelines were originally promulgated (in spite of evidence to the contrary), it is not persuasive today.

Because they are produced by an organ of the state, the guidelines are uncritically accepted as firm science when they are naught. My father, his doctors, and millions similarly situated rely on the national guidelines to make decisions about their health and the health of others. They are acting to their detriment.

--Yet, focusing our efforts on revising the guidelines is a mistake.

The nature of our political system prevents the guidelines from ever developing into a locus of positive change. So long as nutrition science remains in its infancy, vigorous debate will surround any attempt to replace the current guidelines with a new standard. Because of the large financial interests at stake, the food industry will undoubtedly participate in that debate. See, http://online.wsj.com/article/SB109104875075676781.html?mod=health_hs_policy_legislation (charting the food industry’s efforts during last update to the national guidelines in 2005), http://www.commondreams.org/headlines03/0421-06.htm (discussing the food industry’s response to a WHO report recommending decreased sugar consumption) , and http://www.indiaresource.org/news/2005/1095.html (discussing the food industry’s success in defeating proposed regulations). The food industry has unquestionably been successful in asserting its interests in the past, and given the record so far, chances are good that the food lobby will triumph again.

There’s no way to eliminate industry lobbying as a barrier. First, the idea has no political currency. Second, the current Supreme Court would likely uphold lobbying as constitutionally protected free speech. http://www.nationaljournal.com/njonline/rg_20100121_2456.php http://en.wikipedia.org/wiki/Citizens_United_v._Federal_Election_Commission . Anyway, it’s not worth the fight until we know what the guidelines should say. Consider the difficulty we have instituting environmental regulations. At least in that case, there is broad scientific support and consensus behind the regulations in question. There is no such consensus regarding what we should and should not eat.

Instead, our approach should be based on what we know works.

As is evident from the body of conflicting health studies, we are still fumbling in the dark when it comes to our own biology. We don’t adequately understand the relationship between what we eat and how it leads to disease. Institutionalizing a singular theory of optimal human nutrition on the basis of that inadequate understanding is poor public policy. In doing so, we’ve allowed moneyed interests to usurp nutrition discourse, made no significant inroads towards curbing obesity, and convinced two generations that fat, a macronutrient essential to good health, is the devil. The net result has been a negative impact on the eating habits and health of Americans.

The need to eat grounds us in mortality, gives us pleasure, and is among the most common reasons people have for gathering. Food is thus at the center of our interactions with each other and the world. For that reason, we should avoid pathologizing it carelessly. I do not mean that we should abandon all attempts to regulate nutrition, but perhaps we should stop officially promoting newly fashioned diets until we know more. In the mean time, the best solution might be to go back to those diets that have empirically proven themselves practical, sustainable, and effective over many generations--and for which there is renewed scientific support. See, http://www.ajcn.org/cgi/content/abstract/53/6/1647S , http://jn.nutrition.org/cgi/content/abstract/134/12/3355 , http://www.globaleat.org/~imada/shiryou_okiba/EastAsia_papers/The%20unique%20aspects%20of%20the%20nutrition%20transition%20in%20South%20Korea.pdf . This would go a long way towards re-establishing a workable food culture.

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