Archive for the ‘USDA Dietary Guidelines’ Category

MedicineBall*: Harvard School of Public Health steps up to the Plate.

Posted: October 3, 2011 in Dietary Fiber, Evidence Based Medicine, Lipophobes, low-carbohydrate diet, Observational Studies, Protein, The Nutrition Story, Uncategorized, USDA Dietary Guidelines
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First published in October of 2011, this post announced a Q&A on line with Harvard’s Eric Rimm to answer question about the School of Public Health’s new  “Healthy Eating Plate,” its own version of nutritional recommendations to compete with the USDA’s MyPlate. A rather  limited window of one hour  was allotted for the entire country to phone in our questions.  Unfortunately HSPH was not as good at telecommunications as it is at epidemiology and the connection did not start working for a while.  The questions that I wanted to ask, however, still stand and this post is a duplicate of the original with the notice about the Q&A removed.  Harvard has been invited to participate in a panel discussion at the Ancestral Health Symposium, and we will see how these questions can be answered.

— adopted from Pops (at Louder and Smarter), the anonymous brilliant artist and admitted ne’er do well.

One of the questions surrounding USDA Nutrition Guidelines for Americans was whether so-called “sunshine laws,” like the Freedom of Information Act, were adhered to. Whereas hearings were recorded, and input from the public was solicited, there is the sense that if the letter of the law was followed, the spirit was weak.  When I and colleagues testified at the USDA hearings, there was little evidence that their representatives were listening; there was no discussion. We said our piece and then were heard no more.  In fact, at the break, when I tried to speak to one of the panel, somebody came out from backstage, I believe unarmed, to tell me that I could not discuss anything with the committee.

Harvard School of Public Health, home of  “odds ratio = 1.22,” last month published their own implementation of the one size-fits-all approach to public nutrition, the”Healthy Eating Plate.”  Their advice is full of  “healthy,” “packed with” and other self-praise that makes this mostly an infomercial for HSPH’s point of view. Supposedly a correction of the errors in MyPlate from the USDA, it seems to be more similar than different. The major similarity is the disdain for the intelligence of the American public. Comparing the two plates (below), they have exchanged the positions of fruits and vegetables.  “Grains” on MyPlate is now called “Whole Grains,” and “Protein” has been brilliantly changed to “Healthy Proteins.”  How many NIH grants were required to think of this is unknown.  Harvard will, of course, tell you what “healthy” is:, no red meat and, of course watch out for the Seventh Egg.

 

 

 

 

 

 

 

So here are the  questions that I wanted to ask:

  1. Dr. Rimm, you are recommending a diet for all Americans but even within the pattern of general recommendations, I don’t know of any experimental trial that has tested it.  Aren’t you just recommending another grand experiment like the original USDA recommendations which you are supposedly improving on?
  2. Dr. Rimm, given that half the population is overweight or obese shouldn’t there be at least two plates?
  3. Dr. Rimm, I think the American public expects a scientific document.  Don’t you think continued use of the words “healthy,” “packed with nutrients,” makes the Plate more of  an informercial for your point of view?
  4. Dr. Rimm, the Plate site says “The contents of this Web site are not intended to offer personal medical advice,” but it seems that is exactly what it is doing. If you say that you are recommending a diet that will “Lower blood pressure; reduced risk of heart disease, stroke, and probably some cancers; lower risk of eye and digestive problems,” how is that not medical advice?  Are you disowning responsibility for the outcome in advance?
  5. Dr. Rimm, more generally, how will you judge if these recommendations are successful? Is there a null hypothesis? The USDA recommendations continue from year to year without any considerations of past successes or failures.
  6. Dr. Rimm, “healthy” implies general consensus but there are many scientists and physicians with good credentials and experience who hold to different opinions. Have you considered these opinions in formulating the plate? Is there any room for dissent or alternatives?
  7. Dr. Rimm, the major alternative point of view is that low-carbohydrate diets offer benefits for weight loss and maintenance and, obviously, for diabetes and metabolic syndrome. Although your recommendations continually refer to regulation of blood sugar, it is not incorporated in the Plate.
  8. Dr. Rimm, nutritionally, fruits have more sugar, more calories, less potassium, fewer antioxidants than vegetables.  Why are they lumped together? And how can you equate beans, nuts and meat as a source of protein?
  9. Dr. Rimm, looking at the comparison of MyPlate and your Plate, it seems that all that is changed is that “healthy” has been added to proteins and “whole” has been added to grains.  If people know what “healthy” is, why is there an obesity epidemic? Or are you blaming the patient?
  10. Dr. Rimm, you are famous for disagreeing on lipids with the DGAC committee yet your name is on their report as well as on this document is supposed to be an alternative.  Do we know where you stand?
  11. Dr. Rimm, the Healthy Plate “differences” page says “The Healthy Eating Plate is based exclusively on the best available science and was not subjected to political and commercial pressures from food industry lobbyists.” This implies that the USDA recommendations are subject to such pressures.  What is the evidence for this? You were a member of the USDA panel. What pressures were brought to bear on you and how did you deal with them
  12. Dr. Rimm, the Healthy Plate still limits saturated fat even though a study from your department showed that there was, in fact, no effect of dietary saturated fat on cardiovascular disease.  That study, moreover, was an analysis of numerous previous trials, the great majority of which individually showed no risk from saturated fat. What was wrong with that study that allows you to ignore it?

*Medicineball, (colloq) a game that derives from Moneyball, in which an “unscientific culture responds, or fails to respond, to the scientific method ” in order  to stay funded.

Portion Control and the Language of Food.

Posted: September 5, 2011 in Dietary Fiber, Intention to Treat, low-carbohydrate diet, The Nutrition Story, USDA Dietary Guidelines
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“Portion Control” is a popular buzz-word in nutrition. It has a serious and somewhat quantitative sound as if it were recently discovered and transcends what it really means which is, of course, self-control. Self-control has been around for long time and has a poor history as a dieting strategy.  Lip service is paid to how we no longer think that overeating means that you are a bad person but “portion control” is just the latest version of the moralistic approach to dieting; the sense of deprivation that accompanies traditional diets may be one of the greatest barriers to success. Getting away from this attitude is probably the main psychological benefit of low-carbohydrate diets.  “Eat all the meat you want” sounds scary to the blue-stockings at the USDA but most people who actually use such diets know that the emphasis is on “want” and by removing the nagging, people usually find that they have very little desire to clean their plate and don’t eat any more meat than they ever did.  Coupled with the satiety of fat and protein compared to carbohydrate, this is surely a major factor in the success of carbohydrate restriction.  In the big comparison trials, the low-fat trials are constrained to fix calories while the low-carbohydrate group is allowed to eat ad-libitum, and the two groups usually come out about the same total calories.

On the other hand, there is an obvious benefit to having a lean and hungry feel if not look and, as Woody Allen might have put it: eating less is good if only for caloric reasons.  So, one tactic in a low carbohydrate diet is to eat a small portion — say, one fried egg, a small hamburger — and then see if you are still hungry before having the second or third portion which while not forbidden, is also not required. The longer you wait between portions, the more satiety sets in.

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The Warshaw-Diabetes Health Thing – Invitation to Discuss.

Posted: July 8, 2011 in low-carbohydrate diet, The Nutrition Story, USDA Dietary Guidelines
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The whacko suggestion by Hope Warshaw on DiabetesHealth that people with diabetes should increase their carbohydrate intake — I don’t know whether she was serious or just trying to infuriate — obviously generated a rather large response, especially on the DiabetesHealth website itself.  I was writing my own post on the issue when the editor Nadia Al-Samarrie published a piece which seems to have added to the discord. I decided to bypass the argument and I posted the following letter to her suggesting a way to introduce more information and fewer bad vibes.

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Dear Nadia,

I understand that publishing a popular site requires one to be provocative and I think you can see that many people had a strong response to Hope Warshaw’s article and your response.  I think you will agree however that this is a serious matter and I want to suggest a mechanism for bringing the science out for the general public.  I am suggesting a discussion between opposing points of view, less a debate that than a presentation of facts although one implementation might be to have a kind of jury of impartial scientists to present summaries.  I would suggest that you and I be organizers and if DiabetesHealth would be one of the sponsors, I feel sure that I would be able to provide other sponsors. It would, of course, be imperative for the American Diabetes Association and the USDA Advisory committee to participate (send or endorse discussants) to establish that recommendations for people with diabetes conform to some kind of “sunshine law.”

The details of such a meeting could be worked out but as a starting point, I would suggest something along the lines of the following.

There would be two panels, one who maintains that a low-carbohydrate diet (definitions to be agreed upon in advance) is the default diet, that is, the one to try first, for both type 1 and type 2 diabetes and metabolic syndrome.  The other would conform to the very restricted view on such diets (only for weight loss, concerns about heart disease or kidney disease or whatever).

There would be, say, four representatives on each panel endorsed, again, by the ADA and USDA, DiabetesHealth and by the Nutrition and Metabolism Society.

Because of the voluminous literature, each side would specify ten papers in the literature, popular writings or book sections (max 30 pages each).  Discussion would be restricted to these sources.

Participants would meet before hand to set up preliminary procedures to avoid a free-for-all or any “defenestration.”

Variations might include a second day in which both panels took questions from the public or press.

I feel sure that such a meeting would go a long way towards reducing the palpable bad feelings and I am sure you agree that the enemy is diabetes and related diseases and not people with other opinions.  I would be glad to discuss, on the phone, how we can get started.

Best Regards,

Richard David Feinman

Darwin and the USDA Dietary Guidelines: Nutrient Dense or Just Dense.

Posted: March 24, 2011 in The Nutrition Story, USDA Dietary Guidelines
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Charles Darwin, in his autobiography described

“the oddest case which I have known. A gentleman (who, as I afterwards heard, is a good local botanist) wrote to me from the Eastern counties that the seed or beans of the common field-bean had this year everywhere grown on the wrong side of the pod. I wrote back, asking for further information, as I did not understand what was meant; but I did not receive any answer for a very long time. I then saw in two newspapers, one published in Kent and the other in Yorkshire, paragraphs stating that it was a most remarkable fact that ‘the beans this year had all grown on the wrong side.’ So I thought there must be some foundation for so general a statement.”

I had read this passage a while ago but it suddenly popped up in my mind on reading the new USDA Dietary Guidelines. The Guidlines have a strong recommendation to choose “nutrient dense” food.  Since all the food you ingest contains some kind of macronutrient or micronutrient  and having a food dense in one or another would depend on how much you thought was good I could not really understood what was meant.  I pretty much forgot about it until I saw in a video from a TV broadcast making the same recommendation suggesting that it was intelligible to the general population. I still couldn’t understand what could be meant. The guidelines say, on page 3, “Energy-dense forms of foods, especially foods high in SoFAS, should be replaced with nutrient-dense forms of vegetables…” SoFAs stands for “solid fats and added sugars.” It would be hard to find two more nutrient dense but different substances. So at least nutrient dense is not calorie dense but it is not obvious what it is.  Note added in 2013:when I first posted this, I genuinely did not know that nutrient-dense now means micronutrient-dense but I think the critique of the USDA still stands and for a description of currency of an idea that has no real meaning at all, Darwin’s story is still the best. (And, of course, vitamin deficiencies may be the least of our nutritional problems).

Darwin described how he

“went to my gardener, an old Kentish man, and asked him whether he had heard anything about it, and he answered, ‘Oh, no, sir, it must be a mistake, for the beans grow on the wrong side only on leap-year, and this is not leap-year.’ I then asked him how they grew in common years and how on leap-years, but soon found that he knew absolutely nothing of how they grew at any time, but he stuck to his belief. After a time I heard from my first informant, who, with many apologies, said that he should not have written to me had he not heard the statement from several intelligent farmers; but that he had since spoken again to every one of them, and not one knew in the least what he had himself meant. So that here a belief–if indeed a statement with no definite idea attached to it can be called a belief–had spread over almost the whole of England without any vestige of evidence.”

(In case you think that there is any botanical meaning at all: it is not just the leap-year. It is that there is no right or wrong side of the pod at all).  Is it possible that the USDA guidelines, put together by the famous 13 experts have made a recommendation that was completely devoid of meaning?  Page 11 says that “A nutrient-dense total diet has multiple health benefits and can be implemented in various ways” but what is nutrient-dense?  Although never defined, examples are given on pages 19-20.

• Vegetables, fruits, high-fiber whole grains

• Fat-free or low-fat fluid milk and milk products

• Seafood, lean meat and poultry, eggs, soy products, nuts, seeds, and oils

• Very low in solid fats and added sugars (SoFAS)

• Reduced in sodium

The remarkable thing is that in five out of six, the nutrient density is attained by absence of nutrients: fat-free, low-fat, lean, very-low SoFAS, reduced sodium — and is there anything less dense than skim-milk?  Paraphrasing Darwin, then, here is a dietary recommendation –if indeed a statement with no definite idea attached to it can be called a recommendation — will be spread over almost the whole of the country without any vestige of evidence.