Very soon the Department of Health and Human Services will be releasing the 2015 version of the Dietary Guidelines for Americans (DGA or Dietary Guidelines). When it happens sometime this month (December 2015), I can guarantee you the occasion will be much in the news. So unless you’re living in a cave somewhere in the wilds of some primitive area, you will hear about it.
Most people have no idea what goes into the creation of the Dietary Guidelines. I’ll provide a high-level overview of what they are, how they’re created and what they really mean. And why now they have become so newsworthy.
Before we get started, for whatever it’s worth, I don’t think the government should be in the nutrition business, but it is. And barring some sort of revolution, the government will doubtless continue to be in the nutrition business (as well as countless other endeavors they have no business in) for the foreseeable future, so I’ve got to live with it. And deal with it.
What are the Dietary Guidelines for Americans?
The Dietary Guidelines for Americans have been around in one form or another since the first ones were issued in 1980. As their name implies, these guidelines are supposed to be recommendations as to what we should all eat based on the latest, most up-to-date nutritional research. By Public Law 101-445, Title III, 7 U.S.C. 5301 et seq (a real snoozer) these guidelines undergo revision every five years.
Every five years when revision time comes around, people in the food industry and academia pay close attention. The average Joe on the street, however, could not care less. But it’s not just the average Joes (and Janes) who don’t give a flip; even wealthy, famous people don’t pay attention. (See my exchange with Bill O’Reilly from 15 years ago about this very issue re the 2000 guidelines.) Public apathy aside, these guidelines — though far from most up to date nutritional science — are, in fact, important.
Why are the Dietary Guidelines for Americans important?
The Dietary Guidelines for Americans are enormously important, not so much in terms of the impact on the average guy going to the grocery store, but in what they do in terms of US Government policy decisions.
The DGA basically sets the federal government’s official nutrition policy. Since the government feeds about a quarter of the US population, that means about 79 million people (up from 53 million people when I did my interview with O’Reilly) get some or all of their daily fare courtesy of Uncle Sam. And what those 79 million people get to eat must conform to the DGA. Plus, many countries throughout the rest of the world accept the DGA and apply them to their own populations. So these guidelines affect many more people than just those living in America.
By any estimation 79 million is a lot of mouths to feed, even if only one meal per day. If the DGA were to come out and demonize sugar, for instance, what do you think the reaction of the sugar lobby would be, when confronted by the loss of 79 million customers? Which would happen if the government followed the DGA in all its feeding programs. Which is why industry is seriously concerned about what shows up in the DGA.
What with the large contributions industry makes to politics, you can be sure that if any one part of Big Food or Big Agra worries about getting pinched, the squealing will begin. And the politicians, who are recipients of funding from Big Food and/or Big Agra will listen.
But now, it’s not just industry listening. Unlike previous versions, the current 2015 revision, which is in process, has gotten a lot of people agitated. I’ve got a few theories as to why that I’ll lay out in due course. Before I do, however, let’s take a look at how the DGA are created and revised.
How are the Dietary Guidelines for Americans created?
Like any other official federal government recommendation or regulation, the process by which the DGA are put together is labyrinthine. With a lot of cooks in the kitchen. And you know what they say about too many cooks…
Here is what happens.
A group of experts spends two years submitting the most up-to-date scientific evidence available to rigorous critical review. This group, called the DGA Advisory Committee (DGAC), then collaborates to compose the Scientific Report of the DGAC, called the Advisory Report for short, and submits it to the Secretaries of the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA). This Advisory Report is not the Dietary Guidelines or even a draft of the ultimate policy. It is simply a report advising the various governmental agencies (and the public) what the scientific consensus of the DGAC is.
As I write this, the powers that be are at this precise point of the process of formulating the 2015 DGA: the DGAC has put forward its Advisory Report.
Next the public will weigh in on the Advisory Report as will industry, academia, lobbying groups, the HHS, the USDA, and ultimately Congress. After everyone has fiddled with it, the final document, the actual 2015 Dietary Guidelines for Americans will be released jointly by the HHS and USDA this month (December 2015).
Where do these experts come from who put together the Advisory Report?
Well, a notice appeared in the October 26, 2012 Federal Register seeking nominations for prospective members of the DGAC. Did you see that notice in the Federal Register? Don’t feel bad. I didn’t see it either. I doubt seriously that many, if any, members of the committee come from nominations from the public. Rather, here is where they come from:
The Secretaries of USDA and HHS jointly appointed individuals for membership to the 2015 DGAC. The chosen individuals are highly respected by their peers for their depth and breadth of scientific knowledge of the relationship between dietary intake and health in all relevant areas of the current Dietary Guidelines.
The DGAC, once chosen, has two years to complete its work of upgrading and modifying the previous version of the DGA. The DGAC pursues a rigorous science-based evaluation of all new data to determine these modifications.
Fifteen people received appointments to the DGCA; one had to drop out due to other obligations, leaving 14 members to review the science and put together the Advisory Report.
As reported by a member of the DGCA for the 2010 Dietary Guidelines, the members of the DGCA don’t do most of the heavy lifting to create the Advisory Report, but instead oversee staffers who do most of the work.
…the scientific experts serving on the committee are often not involved in analyzing the latest studies. Reviewing the previous five years of science — which is every committee’s mandate – is an enormous undertaking, and experts appointed to the committee are usually academics who already have full-time jobs. As a result, the responsibility falls to government staff, reviewing scientific literature alongside a network of volunteers and professionals. Although committee members do their best to be directly involved, they are often limited to simply accepting the analysis without time for questioning.
How does the DGAC determine which studies to use to formulate the Advisory Report?
If you know anything about the scientific literature, you know that an enormous amount of it is published every day. And you should know, if you don’t already, that most of it is dreck. Given the amount of material churned out, you would be surprised at how little of it is even worth reading.
So, the question becomes how to know what to include and what to ignore in the mountain of reports published over the past five years since publication of the 2010 Advisory Report.
The DGAC assembled for the 2010 Advisory Report put in place a rigorous process to winnow the giant mass of scientific reports to a more manageable number by running them through an exacting checklist designed to assess the strength and validity of individual studies. Those making the cut became a part of what is called the Nutrition Evidence Library (NEL), housed at the Department of Agriculture.
As we shall explore in a bit, one of the many complaints people have about the 2015 DGAC is that the members did not make full use of the NEL.
To summarize: the government mandates the creation of a set of Dietary Guidelines for Americans every five years. The USDA and HHS appoint 15 people to review the new scientific data generated since the last go round and use it to make recommendations to be incorporated into the new Dietary Guidelines. Then the public weighs in, lobbyists weigh in, activists groups weigh in, government bureaucrats weigh in, and ultimately Congress weighs in. At the end of all the weighing in, the actual Dietary Guidelines for Americans emerge.
All in all, it’s the typical government sausage factory. Millions spent to produce a document that few people will read.
But unlike most government guidelines, which few ever see and even fewer care about, the Dietary Guidelines seem to garner a lot of attention. And the 2015 version has gotten more public attention than any version before it.
Why so much interest in the DGA this time around?
There has been an exponential increase in interest in the making of the 2015 Dietary Guidelines. For instance, Nina Teicholz, author of The Big Fat Surprise, wrote a feature article in The BMJ (formerly the British Medical Journal) about this year’s guidelines (more about which later). At the time her article was published, members of the public had already voiced their opinions by submitting 29,000 comments as compared to only 2,000 such comments in 2010.
Why all the interest now? Probably because more people are aware of the Dietary Guidelines and what they mean because of the rise of blogging and other social media. And because the internet has made it much easier to dash off a comment. Especially since many bloggers and other advocacy groups give explicit instructions as to how to do so, hoping, of course, that you will see things the same way they do. Sometimes it doesn’t work out as expected.
When large segments of the public show an interest in some sort of government regulation, you can be sure that politicians won’t be far behind. They weren’t. They, too, jumped on the bandwagon and began badgering those in charge.
Then, in the midst of this unexpected chaos, The BMJ, a prestigious scientific journal, weighs in with an article openly asking if the Advisory Report is really based on science.
Before we go on, let me give you my view of it all after 30 plus years of observation. Of course the Advisory Report is not scientific. And the Dietary Guidelines themselves are even less scientific. They are a gumbo of consensus reporting by mainstream academicians, political fiddling, Big Agra diddling, and a huge amount of lobbying by a horde of disparate interests, all of whom stand to gain or lose by what’s ultimately published in the Dietary Guidelines.
Like almost all solutions derived by committee, what results is something designed to appease as many interests as possible. And if these guidelines were described this way, I wouldn’t have a problem with them. But they are not. They are presented as the latest and best that nutritional science has to offer. Which, sadly, is far from the case.
Which is what got Nina Teicholz worked up. As an investigative journalist having just written a book about shoddy nutritional research, she was charged with reviewing the Advisory Report and commenting on what she considered the deficiencies in the studies selected (or ignored) to serve as the scientific basis for the committee’s recommendations.
What happened when The BMJ published the editorial?
Well, let’s put it this way: A lot of panties got wadded. An especially large pair of panties worn by a certain blogger got really wadded, and the owner of said panties tried desperately (and futilely, as it turned out) to brand Teicholz as a hare-brained zealot without scientific training, who had no business meddling in the work of true scientists.
You can read The BMJ article in full to see what all the fuss is about, but in it Teicholz basically points out that the committees ignored a lot of current research while continuing to rely on a lot of old research, some of which has been superseded by newer and better work. Not only did it ignore much of the new scientific publication, the committee made sparing use of the NEL, the very library of studies deemed by the government to be of great value. Instead, the committee relied a great deal on studies published in various specialty group journals, which often show a bias. In short, she made the case that much of the newer research was ignored. Especially research showing that saturated fat isn’t harmful and that low-carb diets typically perform better than low-fat diets to help people lose weight and improve their blood sugars, blood lipids and a host of other health parameters. Plus Teicholz made the case that the members of the committee did not disclose any potential conflicts of interest.
Much has been written about how industries try to influence nutrition policy, so it is surprising that unlike authors in most major medical journals, guideline committee members are not required to list their potential conflicts of interest. A cursory investigation shows several such possible conflicts: one member has received research funding from the California Walnut Commission and the Tree Nut Council, as well as vegetable oil giants Bunge and Unilever. Another has received more than $10,000 (£6400; €8800) from Lluminari, which produces health related multimedia content for General Mills, PepsiCo, Stonyfield Farm, Newman’s Own, and “other companies.”And for the first time, the committee chair comes not from a university but from industry: Barbara Millen is president of Millennium Prevention, a company based in Westwood, MA, that sells web based platforms and mobile applications for self health monitoring. While there is no evidence that these potential conflicts of interest influenced the committee members, the report recommends a high consumption of vegetable oils and nuts as well as use of self monitoring technologies in programs for weight management.
When The BMJ editorial appeared, the CICO (calories in vs calories out) diehards were annoyed (to put it mildly) with Teicholz for daring to suggest that the academicians making up the DGAC might not have done the best job possible. The root of their annoyance, I suspect, is that the Advisory Report confirmed their biases, and Teicholz’s scathing article threw them into not just a little cognitive dissonance. They were not shy about their attacks. If you haven’t read any of the literature out there debating this issue, you can take a look here, here, here, here, here and here. And this just scratches the surface of the molten brew of agitation out there.
A recurrent theme through these pieces is that Nina Teicholz is a journalist, not a scientist; therefore she has no standing to attack the work of true scientists, i.e., the Dietary Guidelines Advisory Committee. I say: What difference does it make? A valid argument is a valid argument, no matter who makes it. And investigative journalists investigate. And write about the results of their investigations. That’s what they’re paid to do.
Another point of attack is that Teicholz has written a book, and therefore she, like the members of the DGAC she criticizes, has her own biases. And her own conflict of interests. As I never tire of pointing out, everyone has biases. The only people who don’t have biases and have completely open minds are those who are completely clueless about the situation in question.
Since the DGAC is so biased in one direction, it takes someone with an opposing bias to question them and their motives. The confirmation bias is so powerful that I would assume the DGAC actually believes their own conclusions because they fit so comfortably with what they are absolutely convinced is correct. It takes a person with an opposing point of view to dissect their arguments. You never have debates in which both sides believe the same thing. What’s the point? You want an opposing viewpoint, which is what Teicholz brings to the table.
One of Nina Teicholz’s main gripes about the 2015 Advisory Report is that the DGAC refused to raise the limit on saturated fat that has been in place for decades, while at the same time continuing to recommend 3-5 servings of grains. And this is not to mention that the DGAC has completely ignored the huge body of evidence showing the low-carb diet to be a viable alternative to the low-fat diet for health and weight loss. This after a number of scientific articles published since the 2010 DGA showing saturated fat to be harmless and the low-carb diet to perform better than the low-fat diet. The DGAC chose to ignore those papers.
For far too long the various DGACs have continued to rubber stamp the same old, tired calories in vs calories out, eat less, move more dogma. In my opinion, it’s time someone called them on it.
From the perspective of the members of the DGAC, the previous Dietary Guidelines and the ones before those fit their concept of the state of the art of nutritional science. It’s the confirmation bias writ large. They need to be challenged. They need to be prodded out of their cognitive comfort zone. Which is exactly what The BMJ editorial did. If nothing else, The BMJ piece put future DGAC members on alert that the same old, same old isn’t going to fly under the radar as it has so many times in the past. For that, I am devoutly thankful.
The anti BMJ/Teicholz crowd have been shrill and vociferous, but I don’t think they’ve gotten a lot of traction. And in one case, at least, there has been a casualty. Dr. David Katz, who fancies himself the poet laureate of medicine, came down hard on the notion that Teicholz was not a scientist. Unfortunately for him, his antipathy toward her attracted a little too much attention to himself. Turns out he had written a science fiction novel under a pseudonym and had then given it a rave review under his own name in the Huffington post. And in a long review on Amazon. Which is a big no no. You’re not supposed to write reviews for your own books under another name. Especially not dazzling reviews. To do so, to me, anyway, provides a window into the character hiding under the pseudonym.
Once word got out about the Katz travesty, which probably wouldn’t have happened had he not weighed in on this issue so vociferously, the low-carb advocates kind of followed Napoleon’s maxim of never interrupting your enemy while he is making a mistake. The Huffington Post took down his articles, and even his own institution put his self aggrandizement on display.
Which was all great fun for everyone except Dr. Katz, the victim of his own self immolation. But he appears to be fighting back.
As the time draws near for the final version of the DGA to be released, a number of groups are going into overdrive to get Congress to either change them or leave them alone. I just got an email from none other than Michael Jacobsen, the head of the Center for Science in the Public Interest (CSPI), famous for having inflicted trans fats on America (which they seemed to forget as they mounted a campaign recently to remove trans fats from the food supply). Jacobsen, of course, does not want the DGA to reflect the research showing saturated fat is harmless. He’s worried that the food lobbyists will get to Congress “behind closed doors” and persuade them to change the DGA. Why?
They don’t want consumers to have information how healthy diets – like eating more fruits and vegetables and less meat – can prevent illnesses such as obesity and type 2 diabetes.
Other advocates are desperately trying to force the DGA out early in an effort to keep them free from Congressional meddling, which, obviously, these advocates feel would not be in their best interest.
In urging publication of the guidelines before the spending resolution expires, advocates say they hope to avoid a debate over controversial riders, including one in the House agriculture appropriations bill that would limit the evidence for the recommendations to only the strongest scientific proof.
Why on earth would we not want only the strongest scientific proof? Jesus wept.
And others yet are trying to throw a legal wrench in the works by saying the Dietary Guidelines Advisory Committee was unlawfully selected.
As you can see, there is no lack of interest out there concerning the DGA. Most of it by groups that will one way or another be affected by these guidelines. In other words, their financial well being is at risk.
So, there you have it. A review of the making of the Dietary Guidelines for Americans. If there is a take home message here, it is a repeat of what I said to Bill O’Reilly in my interview with him 15 years ago. Whatever else the Dietary Guidelines are, they aren’t science. There is too much input from industry and too much meddling from Congress. Take them for what they are: a stab at being scientific, but, in the end, a sorry hash of special interest infighting.
If we manage to get a nod toward the acceptance of saturated fat and a nod toward the validity of low-carb diets in the version coming out before the end of December, it will be a triumph. But, still, not pure science. Science isn’t done by consensus.