On Nutrition

It’s 2020, which means it’s time for another update to the Dietary Guidelines for Americans (DGA). Before we see a finished product sometime in December, we get to peruse the scientific report of the Dietary Guidelines Advisory Committee (DGAC), the committee’s official recommendations to the federal government. Every five years, the DGAC report is based on a review of new science in key areas, as it adds to or evolves our understanding of the science that came before. Unlike the final guidelines, which are influenced by food politics, the scientific report itself is based on nutrition science. Here are a few highlights.

Alcohol and added sugars

While many recommendations stay the same for years, sometimes the report offers a surprise. For example, the 2015-2020 guidelines dropped the recommendation that healthy Americans limit intake of dietary cholesterol to 300 milligrams per day. This time around, it’s the tightening of recommended alcohol limits for men — from two drinks per day down to one drink per day, the level currently recommended for women — and cutting back more than ever before on added sugars. To limit empty calories and reduce disease risk, the DGAC suggests limiting added sugars to 6% of calories, instead of the 10% recommended in 2015. For people eating 2,000 calories per day, that’s 30 grams of added sugar. Note that added sugar is not the same as the natural sugars found in fruit, dairy and whole grains, a distinction that’s easier to make now that food labels include added sugar in the nutrition facts panel.

“Added sugars labeling only went into effect recently, yet Americans have been steadily reducing their consumption of added sugars for the last two decades,” said registered dietitian Kris Sollid, senior director of nutrition communications at the International Food Information Council (IFIC). “Currently, added sugars make up about 13% of the calories we consume. The new 2020 DGAC recommendation essentially says that we should cut that number in half.” He pointed out that having added sugars listed on food labels supports this goal, it’s not enough make it achievable for the average American.  

Maternal and early childhood nutrition

Perhaps the biggest change in the DGAC report is the inclusion of nutrition recommendations for children from birth to 24 months, as well as for pregnant and breastfeeding women. The addition reflects the growing research about the importance of nutrition during pregnancy and early childhood for not just child health, but for its influence on health and risk of chronic disease decades later in adulthood.

“Focusing on the prenatal and early childhood periods is significant because this time influences a child’s future health. For example, early food preferences influence our food choices throughout our lives, so it is critical that we start with exposure to proper nutrition early in life,” Sollid said. 

This inclusion is good news, especially because the U.S. government uses the DGA as the basis for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and other food assistance programs. Related to these new recommendations, the DGAC has also highlighted choline as a nutrient that most Americans don’t get enough of, and that this is especially concerning among infants, toddlers and pregnant and breastfeeding women. The report points out that eggs are a primary food source of choline, which can feel like a bit of nutritional whiplash given that until five years ago all Americans were told to limit dietary cholesterol, which meant limiting eggs.

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“Since the 2015-2020 Dietary Guidelines were published, research on choline’s effects on human health has progressed significantly, which made more evidence available to the Committee for consideration in this newest set of recommendations,” Sollid said. “Changes in dietary recommendations can be difficult for people to understand because they can seem like they come suddenly and from out of left field, even though this is not the case. Science progresses slowly over time, yet some previous, now outdated, recommendations can be hard for our minds to let go — like limiting eggs due to their high cholesterol content. Eggs are also rich in choline, and diets that avoid eggs or don’t include a dietary supplement are often deficient in choline.”

Continued lack of diversity

The DGAC continues to recommend three dietary patterns: the Healthy Mediterranean-Style Pattern, the Healthy Vegetarian Pattern and the Healthy U.S.-Style Pattern, none of which reflect the cultural heritage of many Americans. If you are Black, brown or Indigenous and want to reduce your chronic disease risk while also eating foods and flavors that connect you to family and community, you won’t get guidance from the DGA. This omission has received criticism for years, and is more glaring than ever in light of ongoing protests over racial equity.

As I wrote about back in June, “good nutrition” can’t solve the tragic fact that Black and brown Americans are disproportionately affected by not just COVID-19, but many chronic health problems. However, the fact that the DGA reflects white, middle-class households is just one more way of saying “we don’t see you” to communities of color. Healthful interpretations of cultural diets could fit within the framework of the DGA’s chosen patterns, yet the guidelines continue to fail to bridge that gap. At the very least, MyPlate, the graphic representation of the guidelines, should translate the DGA into culturally specific plates. Currently, MyPlate’s only nods to diversity are the odd reference to collard greens or taco (both of which have already been mainstreamed into white culture), the inclusion of photos of Black and brown folks on the website, and translation of the logo and a generic circa 2010 “10 Tips” flyer into several languages.

For example, Oldways, a nonprofit best known for its Mediterranean diet pyramid, has developed African heritage, Latin American and Asian heritage diet pyramids, and Canada incorporated Indigenous foods into it’s updated food guide last year, and is working on specific guides for different Indigenous populations. Our official dietary guidelines can, and should, do better, too.