See comments in history. Update 7/7: Tweaked ever so slightly

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Edited paper:

Walking Away from the National Dietary Guidelines

-- By ShawnFetty - 12 Apr 2010

--Introduction

For half a year my father lay on his back in a hospital bed following a heart attack and its complications. He had been big, strong man--able to lift cars, even--and for as long as I could remember, he had dwarfed me in every meaningful respect. Within six months, however, the muscle he had built up through so many years of hard labor had atrophied, and his body had turned to jelly. The weight of his chest compressed his lungs, so a machine breathed for him. My father lives yet, but I have written his eulogy. Oh how he loves to eat.

The impact of obesity on both individual and public health is well understood. As part of an effort to improve nutritional habits and combat obesity, governments have implemented national dietary guidelines. In the United States, the national guidelines serve as a starting point for both nutrition policy (for example, in the design of National School Lunch Program meals) and for diet advice from medical professionals, whether in clinical consultations or the preparation of hospital meals. Additionally, the guidelines are meant to steer individual consumers towards healthier food choices via food labeling. Thus, within American obesity discourse, the guidelines hold a highly privileged place. This is regrettable because the guidelines are seriously flawed.

-- Many of the guidelines rest on shaky theoretical grounds and should not be accepted uncritically

The guidelines are premised on several theories of health, many of which are taken axiomatically. For example, consider the theory of cardiovascular disease with which we all grew up: saturated fat and cholesterol from our diet clogs our arteries, eventually cutting off the heart’s own blood supply or else resulting in stroke. Consequently, the guidelines today recommend that saturated fat amount to less than 10% of overall calories, that carbohydrates account for 50-60% of overall calories, and that cholesterol be restricted to less than 300mg/day.

However, recent studies suggest that this advice is either meritless or harmful. For example, the daily consumption of eggs is unlikely to increase risk of coronary heart disease in spite of high cholesterol). Additionally, there is no evidence that saturated fat is associated with an increased risk of cardiovascular disease while replacing dietary fat with carbohydrates IS associated with an increased risk of both cardiovascular disease and diabetes. Further, the high-carb, low-fat diet advocated by the guidelines performs worse both in terms of weight loss AND risk indicators of cardiovascular disease compared to the much maligned high-fat/protein, low-carb Atkins Diet; video explanation here.

These are not revolutionary new findings. Studies almost sixty years ago reached similar conclusions. Even if this theory of cardiovascular disease, on which the guidelines remain significantly based, was at all persuasive when the guidelines were originally promulgated (in spite of evidence to the contrary), it is not persuasive today.

Because they are produced by an organ of the state, the guidelines are uncritically accepted as firm science when they are not. My father, his doctors, and millions similarly situated rely on the national guidelines to make decisions about their health and the health of others. They are acting to their detriment.

--Yet, focusing our efforts on revising the guidelines is a mistake.

So long as nutrition science remains in its infancy, vigorous debate will surround any attempt to replace the current guidelines with a new standard. Because of the large financial interests at stake, the food industry will undoubtedly participate in that debate. See, here (charting the food industry’s efforts during last update to the national guidelines in 2005), here (discussing the food industry’s response to a WHO report recommending decreased sugar consumption), and here (discussing the food industry’s success in defeating proposed regulations). The food industry has unquestionably been successful in asserting its interests in the past, and given the record so far, chances are good that the food lobby will triumph again.

There’s no way to eliminate industry lobbying as a barrier. First, the idea has no political currency. Second, the current Supreme Court would likely uphold lobbying as constitutionally protected free speech. Anyway, it’s not worth the fight until we know what the guidelines should say. Consider the difficulty we have instituting environmental regulations. At least in that case, there is broad scientific support and consensus behind the regulations in question. There is no such consensus regarding what we should and should not eat.

The nature of our political system prevents the guidelines from ever fully reflecting the best nutrition science.

--Instead, our approach should be based on what we know works.

As is evident from the body of conflicting health studies, we are still fumbling in the dark when it comes to our own biology. We don’t adequately understand the relationship between what we eat and how it leads to disease. For this reason, we should be skeptical when government institutions carelessly pathologize food groups such as fats. While it is likely necessary for the government to have some institutionalized guidelines around which to organize national food policies, individuals would do well to recognize that the process by which sound science is distilled into national guidelines is highly imperfect.

The government is trying to move the nation towards a healthier food culture, but the mistakes it makes along the way are not without costs. In the mean time, while the government attempts to turn complex science into workable policy, it may be wise for individuals to stick to those diets that have empirically proven themselves practical, sustainable, and effective over many generations--and for which there is renewed scientific support.

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