This post was originally written for the Chicago Academy of Nutrition and Dietetics. I'm the "blog master" over there, with about 10-15 dietitians contributing. Be sure to check it out! So many great bloggers, with different perspectives and interests. I made a couple of edits, since most people reading this blog are not nutrition professionals. Hope you enjoy.
ICYMI, the 2015 Dietary Guidelines for Americans were released on January 7. If you’re like most people, the details of the who, how and why of the Guidelines are super fuzzy. Let’s review…
The Guidelines are required under the 1990 National Nutrition Monitoring and Related Research Act. Basically, this says every 5 years the US Departments of Agriculture (USDA) and Health and Human Services (HHS) must work together to publish a research-based report on nutritional info and dietary guidelines for the general public.
The public (I’m going to include the media in that statement) has been a little up in arms with this news. Critiques and frustrations abound, but those that I find most interesting are “why should I care?” and “how is this different?”.
The reality is that the Guidelines are super confusing to the general public. But here’s the thing – the Guidelines aren’t meant for the general public. They’re meant for other government agencies (think: food assistance programs like SNAP and school food) and for health professionals. It’s actually our job as dietitians to translate the Guidelines for public consumption (pun intended).
As a dietitian, then, I want to make sure that I really understand what's going on. How are the 2015 Guidelines different from the 2010 Guidelines? What's really changed? Here are my top 5 things you should know.
1. Individualized Nutrition
The Guidelines clearly acknowledge the importance of individualizing any eating plan. This is both encouraging and frustrating. It’s frustrating because there are fewer specifics that work on a population level. To the average person reading along, it even seems like the Guidelines are just being vague, not saying much or otherwise back-peddling from past recommendations.
But it’s encouraging because personalizing recommendations to the individual is nothing new. Dietitians have been doing this for a long time. The role of genetics and epigenetics is making our field more interesting and nuanced by the day. Are you salt sensitive (not everyone is!)? That’s going to lead to very different sodium recommendations – no matter what your blood pressure is. Same goes with cholesterol.
I’m also encouraged to see that there’s no one way to eat healthy from the Guidelines. The message becomes “Find what works for you, and stick with it”. It reminds me of Dr. Katz’s presentation at our annual dietitian conference this year. Health professionals and most popular diets agree on more than we disagree. There are some basic principles we should all adhere to, and past that, it’s all about finding a way to make it work for your life.
2. Added Sugar
Whoa, the media loved this one. This is the big topic that everyone was talking about. Of course, it’s not really new, but the Guidelines took a firmer stand than in the past. In 2015, they recommend no more than 10% of calories should come from added sugar. This is consistent with the World Health Organization (WHO) guidelines.
I loved the messaging around this. The Guidelines state this recommendation is not based on cause and effect research of added sugar. Rather, that 10% of calories is the level of consumption that still leaves room for key nutrients at appropriate calorie levels.
This means that sugar isn’t demonized. Rather, there is an emphasis on getting your nutrients first. It’s a good reminder that there’s room for a treat, but that treat doesn’t come three or four times a day. There are lots of ways to tackle added sugar, and of course is client specific. While sugar-sweetened beverages are a major issue for our country, there is plenty of sugar in “healthy” foods like yogurt and pasta sauce. Many people know where the issue is, and just need the encouragement and skills to cut back. Others need to up their awareness of where added sugar is lurking in their diets.
3. Coffee and Caffeine
Zero mentions in 2010, but 205 mentions of caffeine and 209 mentions of coffee in 2015. In other words, start paying attention to this. Most of the research on caffeine comes from coffee, so these terms are somewhat interchangeable in the Guidelines. However, it is important to note that caffeine is increasingly being added to both food and drink, and I’m guessing the terms will become more distinct in the future.
The research indicates that up to 400 mg/day of caffeine can be incorporated into healthy eating patterns. Coffee drinking is associated with reduced risk of type II diabetes and cardiovascular disease. Caffeine may have a protective role against Parkinson’s. That said, the Guidelines do not encourage caffeine consumption – similar to recommendations on the health benefits of alcohol.
An important conversation is what that 400 mg/day looks like. Some of the messaging I’ve read indicates that 3-5 cups of coffee is considered moderate coffee consumption. What do you consider a cup? Is it 6 oz (coffee pot measurement), 8 oz (1 cup) or 16 oz (a large mug)?
The amount of caffeine in coffee definitely ranges based on how strong the brew is. At Starbucks, a grande coffee (16 oz) contains about 330 mg of caffeine. At Dunkin Donuts, that would be about 200 mg of caffeine. So all of the sudden, 400 mg doesn’t seem like that much.
The clear-cut cholesterol limit of 300 mg/day has been removed. This is because cholesterol is no longer seen as a nutrient of concern. When the 2010 Guidelines were written, the average American was consuming 360 mg of cholesterol each day. The latest data shows the average American consuming closer to 260 mg of cholesterol. Thus, it’s not an area we need to focus on any more. Also, research has shown that dietary cholesterol isn’t as important to blood cholesterol as saturated fat.
Some of this goes back to the genetics of the client. Just because the Guidelines don’t call it out, doesn’t mean that it’s not an important nutrient for an individual. Also, I wonder what will happen as the restriction is lifted. Will our intake jump back up? Will it make a difference in cardiovascular health?
Before you make yourself a nice 3-egg omelet to celebrate, the Guidelines are not intended to be a green light on cholesterol-containing foods. “This change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the [Institute Of Medicine], individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”
In other words, don’t read the headlines the media has chosen. Read the fine print. You still want to be mindful of how much cholesterol you consume.
5. Small Changes
The Guidelines really emphasize the fact that small changes can really add up when it comes to creating a healthy lifestyle. This is great. It de-emphasizes fad diets, it increases self-efficacy, and promotes doing something instead of nothing. For Americans without any chronic diseases, this is probably the best thing they can hear.
However, half of Americans do have at least one chronic disease, according to the Centers for Disease Control. Obesity is a major factor in and of itself and as a co-morbidity with other chronic diseases. Many people truly need an overhaul of their diet.
Unfortunately, I have seen too often that people hear the opposite message of what they need most. In other words, those without the chronic disease think they have to suddenly change everything, and those that struggle with obesity and chronic diseases think they can just make a couple small changes. One of most important roles is to help people strike that healthy balance
There have been plenty of other reviews on the Guidelines. Some significant controversy has come due to differences in the original draft as compared to the final guidelines. Sustainability was a key element in the original draft, including a recommendation to reduce or eliminate meat (especially red and processed).
Many in the cancer community are upset, given the International Agency for Research on Cancer report on the connection between red and processed meat and colo-rectal cancer.
Dr. Katz issued a very strong statement against the Guidelines, indicating that politics had more to do with the final report than the research.
What are your thoughts on the Guidelines? What questions have come to mind? What changes are you considering?