Jay's World of Abstracts 00027

Jay's Introduction

Since the time I was the area WIC nutritionist (1995-1997), the Food Guide Pyramid put out by the USDA was considered the most sensible exposition on nutritional needs, oft copied by nations around the world. There were always certain problems with it, often because of the need to keep it simple enough for "regular" people to understand and use.

There is a growing desire to update the Pyramid or do away with it in favor of recommendations that are based more strongly on nutritional research. This article is another proposal for how new nutritional guidelines should look.

Abstracts

In 1992 the U.S. Department of Agriculture officially released the Food Guide Pyramid, which was intended to help the American public make dietary choices that would maintain good health and reduce the risk of chronic disease. The recommendations embodied in the pyramid soon became well known: people should minimize their consumption of fats and oils but should eat six to 11 servings a day of foods rich in complex carbohydrates--bread, cereal, rice, pasta and so on. The food pyramid also recommended generous amounts of vegetables (including potatoes, another plentiful source of complex carbohydrates), fruit and dairy products, and at least two servings a day from the meat and beans group, which lumped together red meat with poultry, fish, nuts, legumes and eggs.

Unfortunately, many nutritionists decided it would be too difficult to educate the public about these subtleties [saturated vs. unsaturated fats; red meat vs. poultry/fish]. Instead they put out a clear, simple message: "Fat is bad." Because saturated fat represents about 40 percent of all fat consumed in the U.S., the rationale of the USDA was that advocating a low-fat diet would naturally reduce the intake of saturated fat. This recommendation was soon reinforced by the food industry, which began selling cookies, chips and other products that were low in fat but often high in sweeteners such as high-fructose corn syrup.

When the food pyramid was being developed, the typical American got about 40 percent of his or her calories from fat, about 15 percent from protein and about 45 percent from carbohydrates. Nutritionists did not want to suggest eating more protein, because many sources of protein (red meat, for example) are also heavy in saturated fat. So the "Fat is bad" mantra led to the corollary "Carbs are good." Dietary guidelines from the American Heart Association and other groups recommended that people get at least half their calories from carbohydrates and no more than 30 percent from fat. This 30 percent limit has become so entrenched among nutritionists that even the sophisticated observer could be forgiven for thinking that many studies must show that individuals with that level of fat intake enjoyed better health than those with higher levels. But no study has demonstrated long-term health benefits that can be directly attributed to a low-fat diet. The 30 percent limit on fat was essentially drawn from thin air.

Finally, one must consider the impact of fat consumption on obesity, the most serious nutritional problem in the U.S. Obesity is a major risk factor for several diseases, including type 2 diabetes (also called adult-onset diabetes), coronary heart disease, and cancers of the breast, colon, kidney and esophagus. Many nutritionists believe that eating fat can contribute to weight gain because fat contains more calories per gram than protein or carbohydrates. Also, the process of storing dietary fat in the body may be more efficient than the conversion of carbohydrates to body fat. But recent controlled feeding studies have shown that these considerations are not practically important. The best way to avoid obesity is to limit your total calories, not just the fat calories. So the critical issue is whether the fat composition of a diet can influence one's ability to control caloric intake. In other words, does eating fat leave you more or less hungry than eating protein or carbohydrates? There are various theories about why one diet should be better than another, but few long-term studies have been done. In randomized trials, individuals assigned to low-fat diets tend to lose a few pounds during the first months but then regain the weight. In studies lasting a year or longer, low-fat diets have consistently not led to greater weight loss.

Carbo-Loading
Now let's look at the health effects of carbohydrates. Complex carbohydrates consist of long chains of sugar units such as glucose and fructose; sugars contain only one or two units. Because of concerns that sugars offer nothing but "empty calories"--that is, no vitamins, minerals or other nutrients--complex carbohydrates form the base of the USDA food pyramid. But refined carbohydrates, such as white bread and white rice, can be very quickly broken down to glucose, the primary fuel for the body. The refining process produces an easily absorbed form of starch--which is defined as glucose molecules bound together--and also removes many vitamins and minerals and fiber. Thus, these carbohydrates increase glucose levels in the blood more than whole grains do. (Whole grains have not been milled into fine flour.)

Or consider potatoes. Eating a boiled potato raises blood sugar levels higher than eating the same amount of calories from table sugar. Because potatoes are mostly starch, they can be rapidly metabolized to glucose. In contrast, table sugar (sucrose) is a disaccharide consisting of one molecule of glucose and one molecule of fructose. Fructose takes longer to convert to glucose, hence the slower rise in blood glucose levels.

In our epidemiological studies, we have found that a high intake of starch from refined grains and potatoes is associated with a high risk of type 2 diabetes and coronary heart disease. Conversely, a greater intake of fiber is related to a lower risk of these illnesses. Interestingly, though, the consumption of fiber did not lower the risk of colon cancer, as had been hypothesized earlier.

Poultry and fish, in contrast[to red meats], contain less saturated fat and more unsaturated fat than red meat does. Fish is a rich source of the essential omega-3 fatty acids as well. Not surprisingly, studies have shown that people who replace red meat with chicken and fish have a lower risk of coronary heart disease and colon cancer. Eggs are high in cholesterol, but consumption of up to one a day does not appear to have adverse effects on heart disease risk (except among diabetics), probably because the effects of a slightly higher cholesterol level are counterbalanced by other nutritional benefits. Many people have avoided nuts because of their high fat content, but the fat in nuts, including peanuts, is mainly unsaturated, and walnuts in particular are a good source of omega-3 fatty acids. Controlled feeding studies show that nuts improve blood cholesterol ratios, and epidemiological studies indicate that they lower the risk of heart disease and diabetes. Also, people who eat nuts are actually less likely to be obese; perhaps because nuts are more satisfying to the appetite, eating them seems to have the effect of significantly reducing the intake of other foods.

Yet another concern regarding the USDA pyramid is that it promotes overconsumption of dairy products, recommending the equivalent of two or three glasses of milk a day. This advice is usually justified by dairy's calcium content, which is believed to prevent osteoporosis and bone fractures. But the highest rates of fractures are found in countries with high dairy consumption, and large prospective studies have not shown a lower risk of fractures among those who eat plenty of dairy products. Calcium is an essential nutrient, but the requirements for bone health have probably been overstated. What is more, we cannot assume that high dairy consumption is safe: in several studies, men who consumed large amounts of dairy products experienced an increased risk of prostate cancer, and in some studies, women with high intakes had elevated rates of ovarian cancer. Although fat was initially assumed to be the responsible factor, this has not been supported in more detailed analyses. High calcium intake itself seemed most clearly related to the risk of prostate cancer.

More research is needed to determine the health effects of dairy products, but at the moment it seems imprudent to recommend high consumption. Most adults who are following a good overall diet can get the necessary amount of calcium by consuming the equivalent of one glass of milk a day. Under certain circumstances, such as after menopause, people may need more calcium than usual, but it can be obtained at lower cost and without saturated fat or calories by taking a supplement.

Can we show that our pyramid is healthier than the USDA's? We created a new Healthy Eating Index that measured how closely a person's diet followed our recommendations. Applying this revised index to our epidemiological studies, we found that men and women who were eating in accordance with the new pyramid had a lower risk of major chronic disease. This benefit resulted almost entirely from significant reductions in the risk of cardiovascular disease--up to 30 percent for women and 40 percent for men. Following the new pyramid's guidelines did not, however, lower the risk of cancer. Weight control and physical activity, rather than specific food choices, are associated with a reduced risk of many cancers.

Of course, uncertainties still cloud our understanding of the relation between diet and health. More research is needed to examine the role of dairy products, the health effects of specific fruits and vegetables, the risks and benefits of vitamin supplements, and the long-term effects of diet during childhood and early adult life. The interaction of dietary factors with genetic predisposition should also be investigated, although its importance remains to be determined.

Another challenge will be to ensure that the information about nutrition given to the public is based strictly on scientific evidence. The USDA may not be the best government agency to develop objective nutritional guidelines, because it may be too closely linked to the agricultural industry. The food pyramid should be rebuilt in a setting that is well insulated from political and economic interests.