What's That Smell? That Which We Call 'Dietary Guidelines'...

What's That Smell? That Which We Call 'Dietary Guidelines'...
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Since the release last week of the current Dietary Guidelines for Americans, and in my case at least, a resulting bout of projectile vomiting, the nutrition community has been all atwitter. These days, some of that is far more literal than originally denoted, with a high volume of those 140-character commentaries. Much of it, however, has played out in exchanges amongst ourselves, comparing reactions, and considering options.

Some, like me, have been mostly inclined to express extreme disappointment in how the political process so thoroughly coopted what begins as science. Some are feeling defeated, hunkered down, licking wounds. Others have chosen to look on the bright side, and emphasize the little bit of good -- most notably guidance to limit intake of added sugars and saturated fat -- preserved from the excellent Dietary Guidelines Advisory Committee Report. Some, representing industry, are already perkily exploiting the distortions in the final document to peddle some product. So, for instance, we are getting very helpful tips on how to eat more beef and bacon in satisfaction of the Dietary Guidelines recommendation to eat "a variety of nutrient-dense foods across and within all food groups."

Some, with particularly good intel, are very worried about 2020, and rumblings that large sums of money are already being spent to build on the effectiveness of lobbying in 2015, and further take over the final product next time. We all know what happens when there is blood in the water; ever more hungry sharks start showing up. It's on display now that dietary guidance in America is, more or less, for sale -- and the bids for the next auction are starting to come in.

But last week is done, and 2020 is still a game of anxious guessing. The present is for pragmatists. What can we do with what we've got? How do we fix the Dietary Guideline debacle? I have ideas, refined after conferring with my very knowledgeable colleagues.

First, many have asked, in response to my earlier column, what is the best current dietary guidance? If the Dietary Guidelines do not provide a concise summary of best, current expert thinking- what does?

That one is easy. For starters, the 2015 Dietary Guidelines Advisory Committee Report, which will remain publicly accessible even now that it has been supplanted by the official Dietary Guidelines, is outstanding. See the executive summary here for a concise overview of the clearly articulated, salient aspects of healthy, sustainable eating. This same basic theme, and its same basic particulars, were espoused by an illustrious gathering of scientists at the Oldways Common Ground Conference in Boston in November; that consensus statement is available for you here. I was charged a couple of years ago, by Annual Review of Public Health, with answering just this question based on a review of the evidence, and my answers are here. Dr. Frank Hu, a member of the 2015 Dietary Guidelines Advisory Committee, and I joined ranks to express our answer here, with a respectful nod to the pithy wisdom of Michael Pollan.

Finally, and perhaps most noteworthy, is a global coalition of over 250 highly influential voices from 30 countries. This veritable who's who in worldwide public health, nutrition, preventive medicine, lifestyle medicine, sustainability, and even the culinary arts, has come together to say "we agree" about the fundamentals of healthy, sustainable eating, spelled out here.

So, as noted, addressing that first question is easy. We are not clueless about the basic care and feeding of Homo sapiens, nor about the important influence of human dietary patterns on the climate and the planet. The best thinking of the world's leading experts is clear, actionable, and available to us all.

But that still leaves us with the second question: What do we do about the obvious politicization of the U.S. Dietary Guidelines?

Just in case you don't already know this, the current process involves a Dietary Guidelines Advisory Committee Report, put together over two years based on an expansive review of evidence by leading scientists, carefully and transparently selected. Then, that committee is disbanded entirely, and their report is turned over to the USDA, where the official Dietary Guidelines are drafted by federal employees. The latter effort is informed by the scientist's report, but also subject to instructions from Congress, in turn subject to the tender machinations of well-financed lobbyists.

So, the obvious answer jumps out at us all: Why not take away the political step and just let public health scientists generate the Dietary Guidelines directly? My well-informed colleagues, both inside government and out, tell me that will never happen. The U.S. Dietary Guidelines directly inform a number of government programs, from school meals, to WIC, to SNAP. The government, as the principle implementer of the guidelines, will simply not relinquish the final word about the final wording.

Well, then, in the spirit of not making the perfect we cannot achieve an enemy to the good we can, what might we do?

There has been a certain amount of fussing, most of it dubious, misguided, and self-serving, about the propriety with which the government empaneled the Dietary Guidelines Advisory Committee in the first place. Looking at the caliber of the committee, I don't see anything broken here, and you know what they say: If it ain't broke, don't fix it. Still, the assaults on the process attenuate trust, and there is an easy solution. A fully independent entity, such as the illustrious National Academy of Medicine (until recently, the Institute of Medicine) could populate and authorize the committee, and then commission it to generate its report, as it now does, working with support staff and drawing on resources of the USDA.

A slightly more meaningful redirect proves to be a case of "back" to the future. Not all that long ago, I am told by an expert colleague in the know, the Dietary Guidelines Advisory Committee was NOT disbanded after issuing their scientific report. Rather, their report was reviewed and marked up by the federal agencies, and then turned back over to the scientists themselves to write the official Dietary Guidelines. The agencies still had final editorial control, of course, but the language, at least, emanated from actual experts, devoted to public health. This is not ancient history; it was standard operating procedure until changed during the second Bush administration, only about 10 years ago. Since it has already proven to be a viable approach, and is superior to what we have now, why not return to it?

Yet another option is a stripped-down version of the above. If, for whatever reason, we have lost the stomach to let actual experts in dietary guidance draft the dietary guidelines, and if political functionaries are going to do that, we might at least summarize the gulf between science-based and politics-based guidance. We might, specifically, retain the Dietary Guidelines Advisory Committee until after completion of the official Dietary Guidelines, and ask them to summarize, for public viewing, an inventory of the differences between their recommendations, and the final product. I have had many people ask for exactly that this time, and there is no single, decisively authoritative source. Why not provide one?

And, finally, we have recourse to a remedy I think potentially the simplest, and practicable for all concerned. Let's just change the name.

My writing above may suffice to show why the name -- Dietary Guidelines -- matters. The difference between "Dietary Guidelines Advisory Committee Report" and "Dietary Guidelines" is hard to say, let alone understand. They sound more alike than different. It certainly sounds as if the latter is the final, official, "better" version of the former. And because the first is "advisory," it is clearly subordinate. The nomenclature is designed to make us think of the DGAC report as a "draft," and the DGs as the finished product. That's not true; they really are two separate products of two separate processes. We have cause to suspect that confusion born of muddled nomenclature -- DGAC vs. DGs -- is by design.

"Dietary Guidelines for Americans" sure sounds like: Here is what experts think Americans should eat. But that is not true. The Dietary Guidelines Advisory Committee Report is what experts think Americans ought to eat. The DGs are what politicians think the American Public ought to be told, and do, about what the scientists actually think.

In other words, the so-called "Dietary Guidelines for Americans" are not dietary guidelines for Americans at all. They are "Guidelines to Balance Public Health and Corporate Profit." That is literally true, but maybe a bit long and cumbersome. We might get by with: Food Policy Guidelines.

That, quite literally, is what the DGs really are. They are informed by public health science and expertise, but equally focused on the economy, and monetary advantage for large food industry elements, from agriculture to manufacturing. Here is the real epiphany: That, per se, is not a bad thing!

Passionate crusader for public and planetary health that I am, I can accept government devotion to economic matters -- provided there is truth in advertising. Why not have the report of a Dietary Guidelines Advisory Committee Report that is all about the science of sustainable, healthy eating inform a final report that is honestly, and transparently about something else? I believe most of my colleagues could accept that the government has priorities other than public, or even planetary health -- however shortsighted we may consider some of them. What we object to most vigorously is the costly deception that what are, truly, guidelines to balance public health with corporate profit in America, are misrepresented as the best thinking on dietary practices for Americans. If not a lie, the nomenclature is a long way from honest. It is, quite simply, false advertising -- and that's supposed to be against the law.

I say it is costly. It allows for diatribes against the official Dietary Guidelines to be conflated with diatribes against nutrition expertise in general. It propagates distrust at best, disgust at worst. The result is an unending parade of dietary boondoggles, as we get fatter and sicker, and ever more irrevocably soil the one and only nest that is our planet.

Apparently we cannot take the Dietary Guidelines out of government hands, nor take the government's priorities out of the guidelines. But we should be able to tell the truth about what these are guidelines for.*

They are not what the best experts think is best for Americans and the world to eat for personal health, public health, and planetary health. They are what policy makers think should be done with what experts think. I say it is a partial, yet still meaningful, solution to the current crisis to tell the truth about that. These are "Food Policy Guidelines for America," not Dietary Guidelines for Americans. If you agree, please sign my petition for a name change. If enough of you do, I promise to take it to my friends in Congress.

For government documents, if, famously, not the garden, names really do matter. Misleading nomenclature stinks. That which we call "Dietary Guidelines," by other words that tell it like it really is -- would smell a whole lot sweeter.


*If ending a sentence with a preposition, do it with flare, I say!

Director, Yale University Prevention Research Center; Griffin Hospital

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