Thursday Thoughts: 2010 Dietary Guidelines for Americans.

It's Thursday, so you know what that means...

Thursday Thoughts

If you are new to my blog, or haven't been reading on Thursdays, this is a segment where I post my thoughts about various nutrition and health related topics, or maybe even something else if it is really an intriguing topic.  Most of my current views and opinions come from experience working as a dietitian and as college instructor in nutrition courses.  Most of that learning is science based or observational from the clinical setting.  In general, I hate over-generalizations, so for many of the things I post, I expect there is one or two exceptions because broad sweeping generalizations are always bound to miss out on something. 

I know last week I was just having one of those days and I did not get around to reviewing the 2010 DGAs so I deferred this post until this week.  Normally I make 5 points, but I see there are 6 chapters and I wanted to just make a few comments on each chapter.

1) Introduction: I really like that this sets the tone for the need for guidelines that are science based because of the toll that chronic diseases take on Americans each year.  It is great that this information is included because anyone reading can see the reason why we put an effort into the DGA.  I also really liked the last part where the document is being explained as a set of guidelines to be used for educational materials, nutrition related programs and authoritative statements.  What this says to me is that these are not designed to be utilized by individuals, so if not everyone can understand what is being stated in the document, there is no need to worry.  This is a set of guidelines for professionals to use in guiding them to make education materials and teach people in the community.  It can help agencies make food and nutrition related decisions.  In other words, professionals need to understand what is best for the health of the public and we need to determine how best to implement the guidelines.  The public should not be going at this alone.

2) Balancing Calories to Manage Weight: Right away I liked the review of BMI and obesity related terms.  Then I look more closely and my heart stopped for just a second.  I am not so sure I think that the description is enough to say that BMI is an indication of weight status.  Weight status doesn't always mean that weight is bad weight.  BMI is a really good indicator for disease risk.  At least the risks are described as weight related conditions, but I think that within the table on BMI this should be made clear.  Let's face it, people zone in on boxed off tables.  

Here are the key recommendations:

-Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.

-Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.

-Increase physical activity and reduce time spent in sedentary behaviors.

-Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

For starters, these are good goals or recommendations.  I think standing alone, these could appear tough for some people to grasp because what does it really mean to "maintain appropriate calorie balance".  The guidelines do go on to mention what this means and there is also a chart to give the basics to what would be appropriate for each person.  I did also notice that there is a reference to everyone have different needs and these are based on a variety of factors.  I think the benefit here being these guidelines applied to nutrition education materials.  One thing that is most important to remind people is that when it comes to energy balance, the best indicator if you are doing this is to actually be maintaining your weight.  Calculations only get us so close.  Oh, and I like the emphasis on physical activity.  You can't go wrong with a topic like this and these key recommendations, but I can see how they might be seen as vague or not well defined.

Other key pieces of advice I wanted to mention:

-Focus on the total number of calories consumed (of course you need to know what is appropriate for you)

-Monitor food intake (be aware of what you are consuming...little bits add up over the course of the day)

-When eating out choose smaller portions or lower calorie options (good to mention because I doubt people will just stop eating out because new guidelines we released)

-Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories (simple enough, but what constitutes high in calories?  This could differ in the opinions of various people)

-Eat a nutrient dense breakfast (I love this recommendation)

-Limit screen time (this is another great issue addressed)

3) Foods and Food Components to Reduce: I think this is what everyone wants to know, but telling people what not to do always sounds so negative and I think often times backfires.  You say no and all of the sudden everyone wants to do it.  But, for health professionals to know, this is perfect information.  We can always spin this to a more positive message.  The focus here is to reduce the impact of chronic diseases, and so many of those are food related.  By cutting back on certain foods, weight can be better managed and disease risk can be reduced.

Here are the key recommendations:

 -Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

-Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.

-Consume less than 300 mg per day of dietary cholesterol.

-Keep trans fatty acid consumption as low as possible, especially by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.

-Reduce the intake of calories from solid fats and added sugars.

-Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.

-If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age.

The focus really does not change and still targets the major offenders of saturated fats, sugars and sodium.  Nothing new here, excepted the major reduction of sodium to 1,500 mg.  I have already posted about this specific topic, but I think the main take home message would be pressing to apply this in policy and education in hopes to get food companies and restaurants to cut back because without that we will not be able to get people to reach this goal for sodium.  I think the recommendation of limiting refined grains and those with added fats, sugar and sodium is great, but lacking on a definition for refined, just in case someone not educated in this area is reading.  I know there is no other way to do it, but percentages can get confusing, especially with %DV on the food label, which is not really a designated term people are educated on.  This takes the arbitrary 2000 calories and I find many people have no idea how to find a percent from their diet.  Even worse, I find some students who are not strong in math have trouble with this as well.  The problem is that this is not just one calculation, but requires a few steps. This can be a turn off for some people.  I am not sure if I have a better suggestion, but this should be taken into consideration by professionals when creating education materials or working one-on-one with a client.  Otherwise, like I said, the saturated fats and cholesterol recommendations remain unchanged.

I really like the review of added sugars and the explanation, plus the list of all added sugars to include HFCS, white sugar and brown sugar.  I was a little disappointed to see that the same sugars in their organic forms were not listed.  They are by no means healthier and the word organic often gives it a false appearance.  The calories are the same, although depending on the sweetener (not organic or non-organic) some may require less of the product for the same effect meaning less calories overall.  I did think it was great to include the reminder on the sugar in fruit not being any different health-wise than the added sugars, but that with fruit it was part of the total package and provided a nutritional benefit.

4) Foods and Nutrients to Increase: Hooray for the positive message.  At least they started with the Don'ts and moved to the Do's instead of going "downhill".  These are the standard basics with increasing fruits and veggies.

Here are the key recommendations:

-Individuals should meet the following recommendations as part of a healthy eating pattern and while staying within their calorie needs.

-Increase vegetable and fruit intake.

-Eat a variety of vegetables, especially dark- green and red and orange vegetables and beans and peas.

-Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.

-Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.

-Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds.

-Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.

-Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils.

-Use oils to replace solid fats where possible.

-Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products.

Wow, there are a lot of those recommendations.  I like that these are recommended, but only as long as you stay within the recommended calorie range.  Otherwise, even "healthy" foods can lead to weight gain.  An excess is an excess anyway you look at it.  I think these are some good recommendations but I would like to see some emphasis on those fruits and vegetables less commonly mentioned.  We have the basics, but I think we need to start expanding the horizons of the general public.  Good suggestion on cutting back on saturated fat containing meats and looking for lower fat proteins.  As always, you can see all the standard food groups mentioned, which we all know is political, but you can't deny the fact that they exist and all have research completed on them (the good, the bad and the inconclusive), AND all have their own groups (which helps in lobbying and financial backing).  The DGAs are also used for the USDA food guide pyramid so it is no shock that the guidelines would continue to use these food groups.  We know that not everyone eats from these groups as currently listed, and that those people can be healthy too (think vegetarians and those who are lactose intolerant).  The key is still get a variety of what you DO eat so that you can meet your needs for all nutrients.  You do not need milk for calcium (although it can be a good source if you can tolerate dairy) and you do not need meat for protein, but the food guide pyramid is still a basis for planning a diet.  In the end, the message is for the professionals to educate each person as appropriate.  Nothing is ever one size fits all, but the key recommendations can stay the same for everyone...more fiber, more fruits and veggies, less saturated fat from meats.

As I mentioned before, people really do zone in on boxed off information, so I was pleased to see the topics of fruit juice, whole grains and legumes highlighted in this section.  If a lay person were to be reading this document, those sections really provide some good information.  They are brief, but they contain good topics, and that is really important.

5) Building Healthy Eating Patterns: Seems like a logical flow from the what to eat and what not to eat sections.  I like the use of the word research to show that the guidelines are coming from science.  I especially like that the Mediterranean diet was mentioned and the science behind this was mentioned.  Plus, they included the science for the benefits of a vegetarian diet.  From what it looks like, science has demonstrated in a variety of studies that the key guidelines here are all supported and previously demonstrated.  In other words, this is the body of evidence that led to the determination of the DGAs.  Now, this is science that we have used for some time and some guidelines have not changed.  I am unsure if there is just not new research on this, or the new research shows the same things.

Here are the key recommendations: 

-Select an eating pattern that meets nutrient needs over time at an appropriate calorie level.

-Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern.

-Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses.

Again, the issue of the appropriate calorie level is addressed.  I know it is mentioned what is appropriate, but this will likely be an area of confusion for many people.  I think there are some appendices and this is covered there in more detail.  If you are overweight, there is a good chance you are consuming at a level higher than your needs, but there is a chance this is not the case (could be a medical issue or something else like that).  But, there is a good chance you are consuming too much, so that should be an indicator to cut back by finding places where you can easily cut back.  This goes along with that second recommendation here.  You need to be mindful and aware of all foods and beverages you consume.  I think the inclusion of food safety is necessary, not to mention that food allergies are addressed.  It would have been nice to see some mention of gluten here as this is a major fad (eliminated for many things that are not necessarily shown to be "cured" but removing it) that does not seem to be going away.

6) Helping Americans Make Healthy Choices: I must say the resource list and the Social Ecological Framework chart are my favorite parts.  It is impossible to help people make the right food choices without recognizing all of the factors that influence our food choices.  There is never just one factor or variable, so it is important that all professionals in health and wellness address these factors as they are interrelated.  

Here are the principles for the Call to Action:

The 2010 Dietary Guidelines’ Call to Action includes three guiding principles:

1. Ensure that all Americans have access to nutritious foods and opportunities for physical activity.

2. Facilitate individual behavior change through environmental strategies.

3. Set the stage for lifelong healthy eating, physical activity, and weight management behaviors.

Overall, these set a good tone for the future of Americans, but there is some ambiguity, I think, with some of the guidelines, meaning more wiggle room for education materials, educational programs and government programs to meet the guidelines.  Almost like I could see some loop holes coming about when these guidelines are applied to certain food related programs.  I am sure everyone has their own thoughts and opinions, and I would love to hear them.  I could have gone on all day, but I know this post is long already, so I won't say too much more.  

The end message is that based on science and data collected, Americans have a ways to go to get to goals.  Lowering them before we get there does not seem reasonable, but a push needs to be given to food companies and restaurants.  People are responsible for their own choices, but they need education and product availability to make the right and most nutritious choices.

QUESTIONS:  What are your thoughts on the new 2010 Dietary Guidelines for Americans?  What do you think is the easiest guideline for you to reach personally?  What do you think is the hardest guidelines for you to reach personally?