By Dr. Geoffrey Modest
The feds just came out with their final dietary guidelines, which are updated every 5 years, with general dietary recommendations. Of note, these guidelines do have real impact: they affect the foods provided in federally-funded school-lunch programs and the WIC program for low-income women, infants, and children. For a review of the draft guidelines including more detail about current eating patterns and obesity, see blog: https://stg-blogs.bmj.com/bmjebmspotlight/2015/02/23/primary-care-corner-with-geoffrey-modest-md-new-nutrition-draft-guidelines/ , which also includes an older blog about the role of potassium in decreasing blood pressure. In general, these new guidelines try to focus more on healthy eating patterns than specific nutrients (though they in fact are not so consistent in this). And, per the NY Times (http://well.blogs.nytimes.com/2016/01/07/new-diet-guidelines-urge-less-sugar-for-all-and-less-meat-for-boys-and-men/?ref=health),
“Last year, an advisory committee of nutrition experts assembled by the government recommended that the dietary guidelines encourage all Americans to consume more plant-based foods and less meat to help promote environmentally sustainable eating habits. That suggestion elicited intense lobbying and criticism from the food and meat industries, leading to a congressional hearing on the topic last year. In December, Congress passed a spending bill that contained a provision calling for a review of the dietary guidelines by the National Academy of Medicine and restricting the scope of the guidelines to nutrition, which essentially eliminated the advice about following an environmentally-sustainable diet.”
A review of the recommendations:
- Follow healthy eating pattern across the lifespan, to achieve and maintain a healthy body weight, support nutrient adequacy and reduce risk of chronic disease
- Esp veges, whole fruits, grains (at least half being whole grains), fat-free and low-fat dairy, proteins (seafood, lean meats/poultry, eggs, legumes, nuts, seeds, soy), oils. [On average we eat about 1/2 the fruits and vegetables recommended and are way below target for dark green veges; are right on target for grains; and for those >13 years old, consume only about 1/2 the dairy recommended; males, esp 19-70 yo, eat more protein than recommended, though are very very low on fish-derived protein; we are also high on solid fat consumption; and are very high on added sugars, esp age 4 to 50 but are high in all age categories]
- Focus on variety, nutrient density, and amount
- Limit calories from added sugars and saturated fats and reduce sodium intake. Cut back on foods and beverages high in these components
- Limit saturated (<10% of calories) and trans fats, added sugars (<10% of calories) and sodium (<2,300 mg/d) and alcohol (up to 1 drink/d for women, 2/day for men) [males from age 14-70 consume average >4000 mg sodium, females 3000 mg/d]
- Shift to healthier food and beverage choices. Consider cultural and personal preferences in making those shifts. [Overall 47% of added sugars come from beverages.]
- Support healthier eating patterns for all, in different settings (home, school, work, communities)
- And, they comment, all should be involved in physical activity, as per the Physical Activity Guidelines for America. Not shockingly, the amount of physical activity decreases pretty dramatically with age (though still only peaks at about 30% for those in those 18-24 yo who do the most physical activity, and less than 20% for pretty much the rest of us, though overall somewhat higher %’s in 2013 than 2008)
So, a few comments:
- There are a few helpful tables, such as Appendix 2 which has estimated calorie needs/day, by age, sex, physical activity level; appendix 4 with Mediterranean-style diet food composition corresponding to different calorie levels, the same for a healthy vegetarian diet (appendix 5). And a general food quantity recommendation for omnivores (appendix 2)
- Other useful appendices (which may be useful to copy and give to patients (if they read and write English) are:
- High potassium foods (appendix 10)
- High calcium foods (appendix 11)
- High vitamin D foods(appendix 12)
- High fiber foods (appendix 13)
- Unlike other guidelines I’ve seen, this one has whole sections on community approaches to having access to healthy, safe, affordable food choices (and noting that 48 milllion!! people in the US have food insecurity), as well as “meeting people where they are” (understanding the individual factors/motivators that determine diet and how to effect interventions).
- As with the draft guidelines, no direct mention of cholesterol consumption (e.g. eggs). It has been mentioned in the press that the egg lobby was active in this, though I should add (from my comments on the draft recs):
- It has long been known that the hypercholesterolemic effect (i.e., increase in serum cholesterol) of eating cholesterol is about 1/3 that of eating saturated fats and about 1/9 of that of eating trans fats. Several very large observational studies have not found that eating foods high in cholesterol is much of a cardiovascular risk factor. Also, as a perspective, only a small minority of circulating cholesterol (about 20%) is from diet, most is from genes….
- Saturated fats: there are some recent data that, in terms of cardiac outcomes, plant-derived saturated fats are much better health-wise than animal-derived ones.
- Trans fats: the worst. Finally, there are significant public health initiatives to decrease their use.
- Sodium: for IOM (institute of medicine) report on sodium intake (which proposes a less-aggressive approach, but still targets much lower than current consumption), see https://stg-blogs.bmj.com/bmjebmspotlight/2013/11/25/primary-care-corner-with-dr-geoff-modest-sodium/
- Potassium: see appended blog in https://stg-blogs.bmj.com/bmjebmspotlight/2015/02/23/primary-care-corner-with-geoffrey-modest-md-new-nutrition-draft-guidelines/. Seems like this is a really important clinical target for intervention
- Caffeine: good news that we don’t have to cut back…