January 8, 2021

Weekly line: Why many scientists were 'stunned' by America's new dietary guidelines

Daily Briefing

    By Ashley Fuoco Antonelli, senior editor

    The Trump administration recently released the 2020-2025 Dietary Guidelines for Americans, and if you thought dietary guidelines couldn't be controversial—think again. Here's what you need to know about the new guidelines and why they've "stunned" many scientists and stakeholders.

    Improve patient access to nutrition-reinforced diets

    Scientists recommend lower limits on added sugar, alcohol consumption for new guidelines

    To understand the controversy over the new guidelines, we first need to look back to last July, when a federal committee of 20 academics and doctors released their recommendations for the new dietary guidelines. The federal government updates its dietary guidelines for Americans every five years, and they guide policies for school-lunch and food-assistance programs, local and state health efforts, and food manufacturing.

    While the panel offered only minimal changes to the federal government's dietary guidelines for American adults overall, two of their suggestions were relatively significant.

    One of those recommendations dealt with alcohol consumption. The United States' alcohol consumption guidelines since 1980 have defined "moderate" drinking as consuming up to two alcoholic drinks per day for men and up to one alcohol drink per day for women. (For reference, "one drink" has long been defined as 12 ounces of beer, five ounces of wine, or one and a half ounces of spirits that are 40% alcohol.)

    The country's alcohol consumption guidelines since 1990 have discouraged heavy drinking, but also claimed that research suggested moderate drinking could improve certain health outcomes. Those guidelines noted that some studies had linked moderate alcohol consumption to fewer heart attacks and a lower mortality rate, and that moderate drinking could help prevent cognitive decline as people age.

    But in July, the advisory panel said there is persistent evidence showing that consuming alcohol is not associated with better health outcomes, and that lower alcohol consumption is healthier than moderate or heavy drinking. As such, the panel recommended that the 2020-2025 guidelines advise both men and women to limit their alcohol consumption to a single serving of beer, wine, or liquor per day.

    Many public health experts lauded the recommendation, noting that Australia, Britain, and France in recent years also had updated their alcohol consumption guidelines in light of research that's linked alcohol consumption with increased cancer risk and other negative health effects. For instance, Thomas Gremillion, director of food policy at the Consumer Federation of America, told the New York Times' Anahad O'Connor, "This is significant because the committee has finally gotten away from this idea that a small amount of alcohol is good for you. … They're really taking a stand and saying drinking less is always better. That's the right message and I think they deserve credit for making that change."

    The panel's second significant recommended change to the new dietary guidelines for American adults related to sugar consumption. Previously, the United States' guidelines recommended that adults limit their consumption of added sugars to no more than 10% of their daily calories. However, the advisory panel recommended that the new dietary guidelines advise U.S. adults to limit their intake of added sugars to no more than 6% of their daily calories.

    The panelists said they suggested the change to address America's growing obesity epidemic, noting that research has shown added sugars—especially those in sweetened beverages—may help drive obesity and related, chronic health conditions such as Type 2 diabetes and heart disease. Elizabeth Mayer-Davis—chair of the nutrition department at the University of North Carolina at Chapel Hill, who chaired the panel's beverages and added sugars subcommittee—told the Wall Street Journal's Andrea Petersen, "One of the biggest health challenges related to nutrition in this country is overweight and obesity."

    Mayer-Davis explained that the panel wanted to lower the added sugar threshold to 6% by modeling diets comprised of healthy foods ranging from 1,000 calories to 3,200 calories per day, and then calculating how many calories those foods would take up at various levels to determine how many co-called "discretionary" calories where left.

    According to Petersen, the panel ultimately determined that, for a U.S. adult with a 2,000-calorie-per-day diet, "1,759 of those calories, or 88%, would be taken up by healthy foods providing essential nutrients … leav[ing] 241 calories to be consumed as added sugars or solid fats." And "[b]ased on how much Americans ordinarily consume, the [panel then] designated 133 calories, or 7%, to solid fats, and 109 calories, or 5%, to added sugars. The [panel] settled on 6% as the general recommendation," Petersen writes, because they "'weren't trying to be unreasonable to how people eat,'" Mayer-Davis said.

    Again, many public health experts praised the panel's recommendation. For example, American Heart Association President Mitchell Elkind in July said the change would "steer the public toward a more heart-healthy path in their daily diets."

    But some in the food industry pushed back on recommended change. For instance, Maia Jack, VP of science and regulatory affairs for the American Beverage Association, in September said the current recommendation to limit added sugars to 10% of Americans' daily calories already is "an ambitious goal," as many Americans regularly exceed that threshold. Further, she said there was "no significant new science" to support lowering the limit.

    Similarly, the National Confectioners Association in September said "[t]here was no new data" to support lowering the 10% threshold.

    Still, the advisory panel sent their recommendations to the U.S. Department of Agriculture and HHS, which were responsible for reviewing and publishing the finalized 2020-2025 Dietary Guidelines for Americans.

    Trump admin releases new guidelines—without recommended changes

    USDA and HHS released the finalized guidelines last month, and to many scientists' and experts' surprise, they did not include the panel's recommended changes for added sugar and alcohol intake.

    Instead, the new guidelines maintain the 10% threshold for added sugar consumption, though they also acknowledge that added sugars can lead to weight gain.

    For alcohol, the guidelines state that adults "can choose not to drink or to drink in moderation by limiting intake to two drinks or less in a day for men and one drink or less in a day for women, when alcohol is consumed. But they also note that recent research has linked alcohol consumption to some forms of cardiovascular disease and cancer. In addition, the new guidelines note that research "suggests … even drinking within the recommended limits may increase the overall risk of death"—marking a departure "from the once popular notion that moderate drinking is beneficial to health," the Times' Roni Caryn Rabin writes.

    In a release, the departments said they "carried forward the committee's emphasis on limiting these dietary components, but did not include changes to quantitative recommendations, as there was not a preponderance of evidence in the material the committee reviewed to support specific changes, as required by law."

    Instead, the new guidelines in general encourage American adults to "Make Every Bite Count" by:

    • Customizing their nutrient-dense food and beverage choices to reflect their own budgets, cultural traditions, and preferences;
    • Focusing on meeting dietary needs from all five food groups and staying within their own calorie limits;
    • Following a healthy dietary pattern; and
    • Limiting foods and beverages that have comparatively higher amounts of added sugars, saturated fat, and sodium, as well as alcoholic beverages.

    Scientists, public health experts 'stunned' that new guidelines lack panel's recommendations

    Many researchers and public health experts were surprised and disappointed that the new guidelines don't include the panel's recommended changes for added sugar and alcohol consumption.

    Elkind, for instance, said AHA was "disappointed that USDA and HHS did not accept all of the Dietary Guidelines Advisory Committee's science-based recommendations in the final guidelines for 2020, including the recommendation to lower added sugars consumption to less than 6% of calories."

    Jessi Silverman, a policy associate at the Center for Science in the Public Interest, said, "There is no question that individuals would benefit from reducing their intake of added sugars to less than 10%, but they would benefit more by consuming less than 6%."

    The American Institute for Cancer Research accused USDA and HHS of submitting to "industry pressure" by not lowering alcohol consumption recommendations for men. "The scientific report from the Dietary Guidelines Advisory Committee found that the current evidence justifies tightening the alcohol guideline for men to no more than one drink per day, to match the recommended limit for women." The group added that it "recommends … for cancer prevention" that the guidelines advise people "not to drink alcohol."

    Marion Nestle, a professor emerita of nutrition and food studies at New York University, told Caryn Rabin that she was "stunned" the panel's recommended changes weren't included in the new guidelines.

    "Those were big changes, and they got all the attention when the report came out last summer for very good reasons—and they were ignored in the final report," Nestle said. But "[d]espite repeated claims that the guidelines are science-based, the Trump [administration] ignored the recommendation of the scientific committee they had appointed, and instead reverted to the recommendation of the previous guidelines," she added.

    The Washington Post's editorial board in an opinion piece expressed a similar sentiment, writing that the Trump administration "responded" to the panel's recommendation "as it often does when science is involved: It spurned the advice of the experts as it established policy that touches the lives of Americans."

    Some experts eye incoming Biden administration for more robust changes

    In response, some public health experts and industry stakeholders are hoping President-elect Joe Biden's administration will take more action to guide Americans toward healthy eating.

    "People in the U.S. ultimately need much more than advice" to change their eating habits, Silverman said, and she called on the "incoming administration to remove barriers to healthy eating in our stores, restaurants, and institutions, and to implement policies that actually help Americans eat according to the guidelines."

    It remains to be seen whether Biden's administration will act on those calls, but one thing is clear: Even routine and seemingly mundane government operations can spark controversy.

    Learn more: Improve patient access to nutrition-reinforced diets

    Provider-Led Strategies to Address Food Insecurity

    Explore best practice models for implementing programs to address food insecurity, learn from seven provider organizations that represent a broad range of food insecurity interventions, and get action steps for improving patient access to nutrition-reinforced diets.

    Download Now

    Have a Question?

    x

    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.

    X
    Cookies help us improve your website experience. By using our website, you agree to our use of cookies.