2015 Dietary Guidelines Call for Less Added Sugar, But Advice on Meat Takes a Detour

Last February, the Dietary Guidelines Advisory Committee trumpeted its recommendations to promote sustainability and curtail consumption of red and processed meat. After a year of intense lobbying, neither item made survived the final cut in the 2015 report released today.

Americans should eat less added sugar, saturated fat and salt, according to the final version of the 2015 Dietary Guidelines for Americans, the official nutrition policy issued once every 5 years by the US Departments of Health and Human Services and Agriculture.

Tweaks to the final report appear to have pulled back on aggressive recommendations to limit red and processed meat, made by the Dietary Guidelines Advisory Committee (DGAC) in Februrary. However, federal administration officials who briefed reporters on the guidelines insisted the final document was consistent with those findings, as well as the 2010 report.

More so than in most years, this process was highly political and closely watched—and criticized even before the final guidelines were released this morning as being more of the same. Groups opposed to the 2015 version say it places too much emphasis on carbohydrates and is too harsh on butter, cheese, and whole milk, and will continue the patterns that have resulted in rising obesity rates.

The final guidelines were a few weeks behind schedule, after Congress intervened in its spending bill in late 2015 to require that the guidelines be based on scientific evidence and reviewed by the National Academy of Medicine, even after HHS Secretary Sylvia Mathews Burwell and USDA Secretary Tom Vilsack said they would overlook DGAC’s recommendation to take sustainability into account when setting nutrition policy.

Burwell’s announcement today emphasized the theme of not rocking the boat, in sharp contrast to 2010, when the administration rolled out the new “MyPlate” logo and kicked off the effort to overhaul the National School Lunch Program, which has been an ongoing source of controversy. (Today’s announcement comes with an enhanced version of MyPlate and no plans to tinker with school lunches.)

“By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable,” she said in a statement. “The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control and prevent chronic conditions, like type 2 diabetes, hypertension, and heart disease.”

Specifically, the final guidelines say Americans should eat:

· A diet rich in vegetables, including dark green, red and orange, starchy and other vegetables.

· Fruits, especially whole fruits, are encouraged.

· Grains, at least half of which are whole grains.

· Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or soy beverages.

· Oils from selected plants: canola, corn, olive, peanut, safflower, soybean, and sunflower. The guidelines note that oils are naturally present in advocados, seafood, nuts and seeds.

The guidelines further recommend:

· Lifting longtime limits on cholesterol in food, although officials note that limits on saturated fat will have this effect, and that monitoring cholesterol is part of a healthy diet. Certain foods like eggs and seafood have naturally occurring cholesterol but can be part of a healthy diet. The discussion to drop cholesterol limits was among the more controversial recommendations from DGAC.

· Asking Americans to eat less than 10% of their calories per day from saturated fats. This would require limiting consumption of meats not labeled as lean, as well as butter, whole milk, and tropical oils.

· Limiting sodium consumption to less than 2300 mg per day for persons over age 14 and less for children 13 and younger. This will require most Americans to limit consumptions of processed foods like pizza, and to read labels on foods like soups and pasta sauces.

· Consuming less than 10% of calories per day from added sugars. Today’s announcement states that a long-awaited updated Nutrition Facts label that separately lists added sugars will be forthcoming.

· Shifting to healthier food and beverage choices.

The guidelines, which affect everything from school lunches to nutrition assistance to military meals, have become increasingly political as food industry lobbyists go directly to Congress when they are unhappy with recommendations from DGAC, the panel of scientists and nutritionists that this cycle spent more than 15 months going through studies before issuing its report. For the first time, the panel specifically looked at evidence about how dietary patterns can affect cancer, in addition to chronic conditions like diabetes.

This cycle, the group was especially interested in examining dietary patterns, rather than individual nutrients, because it wanted to make policies based on the ways people actually eat. Besides recommendations based on a typical US diet, it examined dietary patterns for vegetarians and a Mediterranean diet, which has been well-studied in recent years.

The decision to address issues such sustainability drew fire, however, despite timely events such as the severe drought in California, which grew worse after the panel issued its findings.

The guidelines were widely praised by the Center for Science in the Public Interest (CPSI), except for the recommendation on cholesterol. It highlighted the recommendations on sodium and noted that those with hypertension or prehypertension were urged to consume less than 1500 milligrams per day.

The Nutrition Coalition, a privately funded group opposed to the guidelines, released this statement from its chair, journalist Nina Tiecholz, the night before the final document was issued: “With the exception of the cap on sugar, these DGAs are virtually identical to those of the past 35 years, during which time obesity and diabetes have skyrocketed. Given the same advice, it’s not clear why we should expect different outcomes,” especially when Americans have cut back on butter, whole milk, and red meat and replaced these calories with carbohydrates.

Teicholz was the center of controversy in late September when she published an article in BMJ highly critical of the science behind the DGAC report. Her article was criticized by other nutrition experts, who demanded a correction—and got one a month later. But others have been critical of the guidelines over the years, especially the old “food pyramid” that encouraged grain consumption. Among these critics is Joslin Diabetes Center’s Osama Hamdy, MD, PhD, who told Evidence-Based Diabetes Management this fall that bad nutrition science over the years had done lots of damage.

While critics of the guidelines blame them for the nation’s obesity problem, CPSI lays the blame on the food industry and its marketing of unhealthy foods to the American public, especially children. “These sophisticated marketing campaigns make it harder for Americans to eat diets that will protect against obesity, diabetes, heart disease, cancer, and other serious diet-related problems,” said Michael F. Jacobson, president of CPSI.

In the conference call with reporters, officials from HHS and USDA deflected suggestions about industry lobbying on the portion of the report about meat, with one official saying final recommendations did not reflect outside influences before she was even asked.

During an April presentation to the meeting Patient Centered Diabetes Care, sponsored by The American Journal of Managed Care, DGAC member Frank B. Hu, MD, MPH, PhD, described the recommendations to reduce red meat consumption and ensure that food sources were sustainable as “groundbreaking.” Both are gone from the final report.

Instead, the final report says recommends the equivalent of 26 ounces a week of meat, poultry and eggs for persons following a 2000 calorie diet on the US-style eating pattern (not the only one covered in the report). “Choices within these eating patterns may include processed meats and processed poultry as long as the resulting eating pattern is within limits for sodium, calories from saturated fats, and added sugars, and total calories,” the report states.