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Thursday, July 23, 2015

Let's Do Away With The Dietary Guidelines

Blogstress Note:  This post has been in the draft bin for some time, most of it written very shortly after the JAMA article that sparked it.  As you'll see, it's more ranty than usual ;-)   I thought about toning it down or adding to it from the NYT editorial, but have just gotten too busy.  So I'm publishing it up -- as is -- before it exceeds it's blog by date by too much!  There's probably some repetition with the Percentages post published up in the interim.  Please forgive typos, dropped sentences, incomplete thoughts, etc.  Dunno how many there may be, so here goes ...

Let's Do Away With The Dietary Guidelines 


The true cause of the
childhood obesity epidemic
... if this is what it takes to save me from being bombarded with one more idiotic editorial in a peer review journal -- like the recent one in JAMA by Dariush Mozaffarian MD,DrPH and David S. Ludwig MD,PhD -- I'm jumping on board.  Oh!!  And this rank stupidity is so important to ad revenue for JAMA that in the past few days, it has been "upgraded" to free!  The 2015 US Dietary Guidelines:  Lifting the Ban on Total Dietary Fat.  All excerpts from this putrid pontification will be in purple.


With all the lying, scamming, dishonest rhetoric flying around the DGAC Report issued early this year, it was quite a feat for Mozaffarian and Ludwig to accomplish these new depths of nutfoolery.  Let's begin with the title.  A BAN???   No, there was NEVER any ban in the Guidelines.  For starters, they aren't called Guidelines for nothing!  Let's also get our facts straight, can we?  
In 1980, the Dietary Guidelines recommended limiting dietary fat to less than 30% of calories. This recommendation was revised in 2005, to include a range from 20% to 35% of calories. 
No.  The 30% value was suggested in the 1977 McGovern report, but never adopted until 1990.  

Left:  1977 Goals           Right:  1980 Guidelines (summary)


The 1980 Guidelines were a wishy-washy compilation of inconsequential statements.  But let us NOT forget that there has been a call for sugar's head in far more draconian fashion.  While the fat reduction was modest 25% from current levels of the day (actually would have been even less according to NHANES - yes, flawed), sugar was to be cut by 40%.   Often overlooked in the 1977 Goals is that BEFORE the Guidelines supposedly caused obesity,  we were ostensibly getting 25% of our calories from sugar.  (A 40% reduction to 15% means baseline was 25%)   

Everyone knows by now what actually happened with fat intake, right?


source

This is why I'm going to call Mozaffarian and Ludwig flat out liars.  What the every-expletive-known-to-man are you two thinking?????   Have you actually looked at the data at any time during your entire distinguished careers?  Apparently not.  This is unconscionable at this point.  Well, long before this point, but come on!!!  

Americans -- as a population -- have never followed the Guidelines.  NEVER.     Blaming a decrease in fat intake is a LIE

There is not even a scintilla of evidence that in pockets of the population who have  eaten a Guidelines-style diet, obesity has ensued, nor is there a scintilla of evidence that adherence is higher in segments of the population most impacted by the obesity epidemic.  Nevermind that self-reported intake is so danged absurdly "off".   But this editorial is not even your usual "Americans used to snack on hardboiled eggs dunked in butter atop porkbelly on a bed of spinach" crap.  No, this is an especially infuriating alternate dimension of nutritional lies.
These complexities explain why substitution of saturated fat with carbohydrate does not lower cardiovascular risk.1,2 Moreover, a global limit on total fat inevitably lowers intake of unsaturated fats, among which nuts, vegetable oils, and fish are particularly healthful.1,2 Most importantly, the policy focus on fat reduction did not account for the harms of highly processed carbohydrate (eg, refined grains, potato products, and added sugar)—consumption of which is inversely related to that of dietary fat.

Oh really.  First of all, Ludwig, your Glycemic Index petticoat is showing here.  On no planet  but your dogmalternate orb is the potato some nutritional demon.  Furthermore, if we're going to pin any increase in refined grains on anyone, how about you step on forward and take "credit" for instilling the fear of a plain baked or boiled potato or freaking carrots for crying out loud!!!  Another $4+ million to study GI coming down the pike .... SIGH.  While on that topic, no mention of GI in this editorial?  You know, that index that makes potato chips (GI = 51) a better choice than French fries (GI = 75), better than a boiled potato (GI = 82), instant mashed potatoes (GI = 87)  or [gasp!!!] a baked potato (GI = 111).    Talk about a failed paradigm for fostering healthy, weight normalizing, food choices!!!

Please go read the FOOD recommendations from the 1977 Committee before reading further.  OK, I'll repeat them here:



Tell me again how they "did not account for the harms of highly processed carbohydrate (eg, refined grains, potato products, and added sugar)".  Cosumption of processed crap is NOT inherently "inversely related to that of dietary fat".   

Hello, but in your mind-bogglingly blinkered abdication of integrity here (can you tell I'm kinda annoyed?) you forgot about real food sources of carbohydrate:  potatoes and other root veggies, legumes,  real whole grains such as rolled oats, brown rice, corn-on-the-cob, and so-called pseudograins like buckwheat and quinoa.  Sure, the lattermost offering is relatively new to the States, but there are many starchy seeds that have well nourished billions of humans the globe over for millennia.  Stop the crap.  Number 4 in the Guidelines is perhaps the only rather misguided recommendation, though the reduced fat versions (2% IS pretty popular) are perfectly acceptable and what reality has spawned anyway.  Number 5 is fine too, even if dietary cholesterol may not be the bogeyman for the entirety of the population (most likely, dietary cholesterol per se is irrelevant for most, but rather important for some).  Pretty much nobody in the so-called First World, however, is negatively impacted by REDUCING consumption of these foods, as we consume plenty enough of them and have continued to do so despite government warnings not to.  Undernourished humans are a different story in terms of recommendations, let's be honest about this, OK?  But telling an impoverished person to eat meat and eggs when they only have beans available is also a moot point.  

Importantly, the Guidelines DID NOT say to:
  • Add more carbohydrates of ANY sort to the baseline total energy intake of the day 
  • Substitute sugar and white flour, or products made with them,  for saturated fat

THE 1990 GUIDELINES



Sooooo strict and confusing I tell ya!  And so, let's continue on ... we've only just begun ...
As with other scientific fields from physics to clinical medicine, nutritional science has advanced substantially in recent decades. 
No it hasn't.  Not in the way they are implying anyway.  Exhibit A:  THIS IDIOTIC EDITORIAL in JAMA!  Flashback to this:
Moreover, a global limit on total fat inevitably lowers intake of unsaturated fats, among which nuts, vegetable oils, and fish are particularly healthful.
Ahhhh yes.  The recommendations of the originally convened dietary panel to eat more fish has resulted in eating less fish for fear of hitting the dreaded fat ceiling.  Gotcha.  Scroll up ... the actual recommendation was to choose Mozaffarian's fave veggie oils *most often* as they are lower in saturated fat.  Ahem ...
For decades, carbohydrates were considered a foundation of a healthful diet, as evidenced by placement of grain products (including many highly processed items) at the base of the Food Guide Pyramid of 1992. However,  by  2005, the Dietary Guidelines called for restriction of refined grains and added sugars due to growing evidence that refined carbohydrates increase metabolic dysfunction, obesity, and cardiovascular disease.  {emphasis mine}
Seriously?  How did these two get their letters after their names.  "BY" 2005?  How about way back in 1977 and likely long before ....  If Big Food was allowed to bastardize and distort "whole grains" to sell refined junk, that blame cannot be placed at the feet of those promoting true whole grains.  Neither can the shenanigans of using concentrated fruit juices and such to sweeten items in place of sugar be construed as an indictment of a recommendation to eat more apples.  These people have NO shame.   What follows is the rest of the above paragraph:
Presently, US consumption of sugar-sweetened beverages is declining, likely related to both scientific research and associated publicity confirming their adverse health effects. Yet added sugar in other foods and, perhaps more importantly, refined grain products—including white bread, white rice, chips, crackers, cereals, and bakery desserts—continue to represent major sources of calories in the US food supply. {emphasis mine}
Give me a break.  The American people started drinking soda a lot because of Big Gulps and unlimited refills associated with the economics of the soda industry in fast food restaurants.   

Repeat after me ... 1977:  Reduce sugar intake by about 40 percent.  White rice?!  Alert Japan and Jaminet!!  Cereals, someone ought to tell the Pukapukans but quick!!  Oh those evil Charles people.

Added sugar in refined grain products -- like, oh, a cupcake or a donut?  Say it isn't so.  I had noooooooooooo idea as a kid growing up in the 60-70s that there was sugar in that there flour based donut (forget what it's fried in).  Note to Mozaffarian:  Vegetable oils are highly refined "empty calories".  
The DGAC report highlights that more than 70% of the US population consumes too many refined grain products. Many of these foods enjoy a lingering health halo or at least a benign reputation, based on years of government guidelines and industry promotion.
Can you name just a few of these foods for me?  Frosted Flakes?  Coke?  Oh I know ... Raisin Bran?  Minute Rice maybe?   I'm kinda racking my brain out here trying to think of these refined grain products with their health halos.  Cup o Noodles?  Cheerios!  That's it.  The dreaded Cheeriobesity!    What government guidelines are they talking about?  The manufacturing/marketing guidelines that allow a company to slap a "whole grain" label on a product if it contains 25% whole grain*?    (*I don't know the exact rule, and I'm not sure if it has changed, but lots of "whole wheat" products were anything but whole grain.)
Recognizing this widespread misunderstanding, the 2015 DGAC report specifies that, “consumption of ‘low-fat’ or ‘nonfat’ products with high amounts of refined grains and added sugars should be discouraged.”
Where did this widespread misunderstanding come from?  Is there some epidemic of chubby school kids chugging fat free dressings that I'm unaware of?  Has the government been encouraging the consumption of white flour and sugar?   Maybe Ludwig is mad that the government didn't adopt his useless Low GI seal, and therefore they're promoting high GI refined grains by default.  Is that right?   If only they hadn't told us not to eat as much fat.

The elimination of the upper limit on total fat would make it easier for industry, restaurants, and the public to increase healthful fats and proteins while reducing refined grains and added sugar.
Bahahahahahahahahahahahahahahahahaha.  Seriously, there should be some sort of means by which making dumb ass statements in public results in loss of academic credentials.    Alrighty then, poor Olive Garden, right?  Pasta and breadstick restaurant.  Serving up refined carbs up the wazoo while shackled by the government low fat cuffs.


I'm sure the 52 grams of carbohydrate -- including 6 grams of sugar ... gasp!! -- is the big problem in the "lighter Italian fare" Ravioli di Portobello.  Because they had to put that in there to keep the fat under 35% 50%!!   Thankfully they don't listen to the government then, right?  Because thankfully there's plenty of fat in the Garden Primavera (39% fat) add shrimp and we're down to 37%, add chicken instead and we're down to 36%.  It's surely the refined carbs in the over 1000 calorie Chicken Alfredo that will do you in, not the 61% fat!?!  Look at all that sugar they have to add to their meals, and everyone flocks to Olive Garden to chug their fat free salad dressings.  Whatever you do, don't order the 410 calorie Citrus Chicken Sorrento -- it's got 35g carb of which 22g are sugar.  Yep!   Ahhh but surely the desserts will carb you up.  Why yes they will!!


Oh hey look!  The Zeppoli is loaded with sugar, 5X the amount in your bloodstream, and almost 120 grams total carbs (that's 24X the amount in your bloodstream ya know).  Oooh oooh and it's low fat!  Well, since 2005 anyway, for 1990 you'd have to add chocolate or raspberry sauce to bring the dessert down below 30% fat.  I'm sure the US government always intended it that way and weight conscious Americans think over 1000 calories on dessert is a great idea!  Much better to choose the mini desserts where options range from 52% to 68% fat.

Look at any of these family restaurant type places, it's pretty much the same.  But it's actually easier to stick to a reasonably low carb diet -- say under 50 grams in a meal -- than "low fat" at say under 25 grams (one third of ~30% of 2000 cal/day) ... at the Olive Garden!

But ...
The elimination of the upper limit on total fat would make it easier for industry, restaurants, and the public to increase healthful fats and proteins while reducing refined grains and added sugar.
Okey dokey!  In 1991, a year after the 30% fat "limit" was included in the Guidelines,


Who remembers this short-lived item?  They were actually pretty good.  A slice of tomato and lettuce ... and since they were rarely ordered, they were prepared fresh (read:  hot, and not warmed over either).  Other fast food joints had low fat items, Taco Bell had a complete menu.  Remember?  None of it lasted.  Because Americans were simply NOT eating low fat.  In the face of daunting low fat edicts, what did McD's come out with?  More bun to patty ratio?  Leaner beef?  Hardly!  The standby Big Mac clocks in at 33g fat and only 44g carb (and personally, I'd ditch the center bun thing if anything!).

But let's not pick on just McD's here.  Both the fast food and family restaurants have been making MORE burger to bun, with the only slightly opposing trend I can think of being the slider trend.  Still, Burger King took the slider and stacked up the meat up to 4 patties!!   No longer available I suppose, no doubt due to the 2005 35% fat ceiling.  These have been replaced by the quarter-thin patty between a regular bun.  Yep!

Doubles, triples, add cheese, 5 oz, 6 oz, half-pound burgers ... It's more meat and more fat.  These burgers are 80:20 at the leanest.  A plain hamburger at BK does squeak in at just under 35% fat.  Phew!  If we could add a small fries to that it would be a USDA approved meal, right?  Because potatoes are a vegetable.  Nope, that actually ups the combined fat percentage to almost 37%.  Yeah, fries are pure carbs.

Who would have thunk that the fast food joints might be a best option?!  Five Guys' most calorie frugal "Little Hamburger" runs almost 500 calories, exactly 50% fat.  If you splurge on the highest cal burger, the over 900 calorie Bacon Cheeseburger, you're in for a whollop of refined carbs, right?  Wrong.  This one clocks in at 61% fat.  You get around 40 grams carb in all of their burgers.  A bit more protein of course, but the big difference is the extra 36  grams of fat (38% more fat than in the whole of the Little Hamburger) in that Bacon Cheeseburger -- total fat = 62 grams = ~30% of a 2000 cal/day diet.  But that ain't nothin!!!  You're not getting out of TGIFridays with a beef hamburger for under 1000 calories!

You can eek it out with a turkey burger, but the rest begin at 1250 and go up from there, topping at a whopping 1630 -- that's more than the average American woman reported eating in an entire day in 1970!!  Carbfests?  Nah.  Well, that Jack Daniels clocks in at 151 grams working out to a nice "moderate carb" 40% of calories, while the 74 grams of fat make for 44% fat.  (For those doing the math, that leaves 16% protein).  The Smoke-Stacked is a nice 56% fat and flirting with original Perfect Health standards at only 25% carbs!!   I'll note that a TGIF's burger has more fat in it than the average American reports consuming for the past four decades.   (I'm still hoping these numbers include a side of fries, but there's no indication of this in the descriptions.)

Last one, but I could go on with all of these family restaurants.  It's a good thing they are so "constrained" by the "ban" on fat that Carrabba's manages to make a bean and noodle soup -- aka Pasta Fajioli, one recipe here -- a high fatty fat fat item  Come on!  This is typically a vegetarian soup, sometimes with cheese or a chicken or beef broth base, virtually no fat in your basic ingredients, so it's mostly what's added.  But good thing we have the USDA telling restaurants what to do or else they might make this too low fat I guess?  Carrabba's version is freakin 72% fat???!!!   If it weren't for the fact that scarce few items on that menu clock in under 50% I'd presume that's a typo, but ...  You really need to AVOID cutting and/or DELIBERATELY add fat to "formulate" these menu items.  Every time I write one of these posts, I develop greater respect for Jared Fogle.  At least Subway -- while still offering plenty of fat for folks who want it -- includes several lowfat options -- and, after all, you can always add fat to a salad or sandwich!

Mozaffarian and Ludwig are either incredibly ignorant men, or their integrity has been compromised.   I know that is harsh, but there can be no other explanation for the absurdity that is this editorial.  I'm going to have to go with the compromised integrity here because nobody that learned can be that ignorant.  Mozaffarian's main "conflict of interest" listed in journal disclosures these days is Bunge.


Ludwig is the biggest recipient of NuSI funding which is ANYTHING but independent.

This duo has followed up the article with an editorial in the NYT.  I blogged on that a bit in response to tweets by Mozaffarian here:  Percentages are Often Meaningless II

Probably the last on this unless they come up with more nonsense.

/ RANT





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