Commodity, nutrition and health groups are gearing up for the last stretch of the Dietary Guidelines for Americans, using public campaigns and scientific evidence in an attempt to shape the final product in a way that suits their members.
The Dietary Guidelines Advisory Committee released its scientific report July 15, triggering the start of a monthlong comment period that ends Aug. 13. Then the recommendations are in the hands of staff at the Departments of Agriculture and Health and Human Services, and the people above them, Agriculture Secretary Sonny Perdue and Health and HHS Secretary Alex Azar, who are responsible for the final product.
“This is the time to watch,” says Sarah Reinhardt, lead food systems and health analyst for the Food & Environment program at the Union of Concerned Scientists. “In the past, we’ve seen some of the scientific recommendations go in and are nowhere to be found on the other side.”
“We’re definitely on our guard,” says Jessi Silverman, a policy associate and Mark & Sushma Palmer Public Health Advocacy Fellow at the Center for Science in the Public Interest.
Reinhardt and Silverman said the most prominent example of outside influence altering the scientific recommendations occurred after the 2015-2020 DGAC proposed linking environmental sustainability and diet.
“Moderate to strong evidence demonstrates that healthy dietary patterns that are higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods are associated with more favorable environmental outcomes (lower greenhouse gas emissions and more favorable land, water, and energy use) than are current U.S. dietary patterns,” that scientific report said.
The meat industry was strongly opposed to the focus on sustainability, and then-Ag Secretary Tom Vilsack and former HHS Secretary Sylvia Burwell said the DGAs are not “the appropriate vehicle for this important policy conversation about sustainability.”
“We will remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (NNMRRA), which is to provide ‘nutritional and dietary information and guidelines … based on the preponderance of the scientific and medical knowledge,” they said.
Asked whether he received pressure to remove sustainability from the guidelines and what he thought of the perception that “Big Food” or “Big Ag” overly influences them, Vilsack said in an email, “In a sense everything done at USDA involves ‘politics’ because any policy likely matters to a number of folks.
“The DGAs are no exception,” Vilsack, now president and CEO of the U.S. Dairy Export Council, said. “The big difference with the DGAs is that there is a prescribed method for establishing them and there is a scientific threshold that has to be met before a guideline becomes or remains a guideline, which helps to minimize the impact of anyone attempting to force a political position into the DGAs.”
Another former ag secretary said he thinks the influence of the food industry is not what it once was.
Former ag secretary Dan Glickman
Asked about the role of “politics” in the DGA process, Dan Glickman responded, “When you say politics, do you mean, do commodity interests and health interests interface in the process? The answer is yes.”
But he added he thinks the influence of commodity agriculture on these guidelines has waned from when he was at the department during the Clinton administration. “There are more people in the health and nutrition world who are engaged in these issues than there were 25 years ago, and their influence is greater, too.”
“The biggest change in the guidelines is the increasing role that diet, health, nutrition and medicine are playing,” he said. “The whole ‘food is medicine’ area is becoming much more dominant. And that’s infiltrated into the guidelines.”
“I generally followed the advice of our scientists,” Glickman said of his two experiences with the DGA, but added, “If a lobbyist from the meat industry might have had something intelligent to say and I might have agreed with him, yeah, that could happen. Should I have delegated that all to the Food and Nutrition Service? No. Should the White House and the Congress be carefully involved in this process? Should there be congressional hearings on this process? Yeah.”
Marion Nestle, a longtime nutrition advocate, professor at New York University and author of “Food Politics,” who also served on the 1995 DGAC, said she thinks politics plays a “huge” role, but it’s “complicated.”
“Most political influence got exerted right at the beginning and normalized” through the choice of questions posed to the committee, which focus on specific food groups, such as meat and dairy, for what to eat, but switch to nutrients when talking about what not to eat.
“Food companies exert influence behind the scenes,” she says, and committee members can have their own agendas. Since 2005, she noted, the agencies, not the committee, write the guidelines.
Danielle Beck, senior director of government affairs for the National Cattlemen's Beef Association, said “there was lobbying on the front end of the process to make sure the makeup [of the committee] was fair and balanced.” Beck also said that by identifying topics ahead of time, USDA and HHS “really set some guardrails,” so the committee could not “veer off into sustainability.”
Indeed, groups sought to include certain members on the committee, with NCBA, the National Pork Producers Council, and American Beverage Association all pushing for certain researchers before the committee started to meet.
The sustainability issue isn’t going away. The current report says USDA and HHS need to look more closely at the relationship between diet and sustainability of the food system. Public comments “identified the importance of evaluating sustainability of recommended dietary patterns, addressing the social and economic aspects of access to foods that are components of healthy dietary patterns, and considering systemic changes to encourage behavior change consistent with the guidelines,” DGA Committee Chair Barbara Schneeman and Vice Chair Ronald Kleinman said in their letter transmitting the report to USDA and HHS.
Areas to watch in the coming months include the committee’s recommendations on alcohol and added sugars, as well as its consideration of carbohydrates in Americans’ diets.
The alcohol industry is concerned about the committee’s lowering of the recommendation in the current guidelines from two drinks a day for males and one for females to one drink for both, on days when alcohol is consumed.
“Among those who drink, consuming higher average amounts of alcohol is associated with increased mortality risk compared to drinking lower average amounts,” the committee said, agreeing with the recommendation in the 2015-2020 Dietary Guidelines for Americans “that those who do not drink should not begin to drink because they believe alcohol would make them healthier.”
The Wine Institute is pushing back against the one-drink advice.
“The recommendation … to alter the guidance by redefining moderate consumption as no more than one drink per day for men and women is a sudden change that contradicts the draft conclusions” released by the DGAC’s Subcommittee on Beverages and Added Sugars Subcommittee in late May following a systematic review of 60 research studies on all-cause mortality, it said. “Those studies clearly support maintaining the current guidance.”
A Harvard researcher critical of the alcohol recommendations says “if you take the best studies out there, there’s no question that men who drink two drinks a day live longer.”
“We know it lowers the rate of heart attack,” said Eric Rimm, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health and a 2010 DGAC member.
But Tim Naimi, a DGAC member who is a doctor and alcohol epidemiologist at Boston Medical Center and a professor at the Boston University Schools of Medicine and Public Health, said “the recommendations didn’t change as far as I know. They do sometimes but did not for alcohol.”
The “bottom line,” he said, is that “the evidence is clear that drinking two drinks per day among men has a higher risk than one drink per day, which is the reason for the recommendation.” He added that “this was the first time evidence on alcohol and total mortality was reviewed” by the DGAC.
Another issue to watch is added sugars. The committee specifically said Americans should get no more than 6% of their calories from that category, lowering the recommendation from 10%.
“I haven’t heard much coming from sugar. Maybe they’ve accepted the science is so strong that they can’t make a good case,” says CSPI’s Silverman.
The Sugar Association, however, which didn’t issue a public statement after the release of the scientific report, said it’s been watching the process closely. In a statement, the association’s president and CEO, Courtney Gaine, said the association is concerned by “the lack of scientific justification for many of the committee’s conclusions, particularly those around added sugars” and said it would make its objections clear in its comments.
And the American Beverage Association, which also stayed silent publicly (but not at Tuesday’s meeting), promised the same, with a twist. “We agree that too much sugar isn’t good for anyone, which is why America’s beverage companies are supporting consumers’ efforts to reduce the sugar they get from beverages by providing more choices with less sugar or zero sugar, smaller package sizes and clear calorie information right up front. As a result, more than 50% of all beverages purchased today have zero calories.”
Glickman, however, says, “We spend hundreds of billions of dollars a year treating people with chronic disease. Most of the cause of that is bad diet — not all, but most, and a lot of that has to do with sugars in the diet.”
The value of carbs in the diet also is being debated, with a relatively new group, the Low-Carb Action Network, leading the way in arguing that the DGAC excluded relevant studies on low-carb diets from its review.
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"L-CAN has identified a total of 66 trials of a true low-carb diet that the [DGAC] ignored," says Jessica Wharton of L-CAN.
"The Dietary Guidelines Advisory Committee did no analysis of these studies... how can they then make statements that the effects of low-carb/keto diets cannot be sustained?" Wharton asks.
UCS's Reinhardt, however, counters that "when it comes to research on low-carbohydrate diets, the committee found very few studies that were rigorous enough to make the cut" for consideration, Reinhardt said. "For example, studies would be excluded if they were designed specifically for weight loss."
But, she adds, "Even when it comes to weight loss, there are a lot of studies out there — including those touted by low-carb advocacy groups — that might show promising results early on, but the effects either diminish as time goes on, or the study doesn’t follow participants long enough to know whether those results can be sustained."
The guidelines are expected to be finalized by the end of the year.
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