The AMA concludes:
The Report suggests that the incidence of heart disease, cancer, hypertension, diabetes, obesity and tooth decay could be reduced by making qualitative and quantitative changes in “the American diet.” The goals are laudable; however, the American Medical Association believes that there are insufficient data to recommend such changes in the diet on a nationwide scale.
Laudable as the goals were, the application of those recommendations has constituted a population-wide dietary experiment that should be brought to a halt. Lack of supporting evidence limits the value of the proposed recommendations as guidance for the consumer or as the basis of public health policy. We ask whether the Dietary Guidelines for Americans process as it stands should continue or whether there might not be better alternatives.
It is time for public health leaders, scientists, and clinicians to stop blaming Americans for not following the recommendations in the Dietary Guidelines for Americans and instead to re-examine the process used to formulate the US dietary guidelines and determine whether or not it is still appropriate for our current needs.
We ask whether it would be preferable to convene an impartial panel of scientists consisting of biochemists, anthropologists, geneticists, physicists, etc., who are not directly tied to nutritional policy. Such a panel would be able to hear all sides in the debate with few preconceived notions.
Recommendations issued by this group would be more likely to be moderate, circumspect, and established on a complete and accurate assessment of available science rather than a narrow perspective of accepted nutritional practice. Public health nutritional policies produced from such recommendations may then serve the honorable intentions of those first dietary goals “to maximize the quality of life for all Americans” [5].
In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee
Abstract
Concerns that were raised with the first dietary recommendations 30 y ago have yet to be adequately addressed. The initial Dietary Goals for Americans (1977) proposed increases in carbohydrate intake and decreases in fat, saturated fat, cholesterol, and salt consumption that are carried further in the 2010 Dietary Guidelines Advisory Committee (DGAC) Report. Important aspects of these recommendations remain unproven, yet a dietary shift in this direction has already taken place even as overweight/obesity and diabetes have increased.
Although appealing to an evidence-based methodology, the DGAC Report demonstrates several critical weaknesses, including use of an incomplete body of relevant science; inaccurately representing, interpreting, or summarizing the literature; and drawing conclusions and/or making recommendations that do not reflect the limitations or controversies in the science.
An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets. The DGAC Report does not provide sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes.
Lack of supporting evidence limits the value of the proposed recommendations as guidance for consumers or as the basis for public health policy. It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.
Although appealing to an evidence-based methodology, the DGAC Report demonstrates several critical weaknesses, including use of an incomplete body of relevant science; inaccurately representing, interpreting, or summarizing the literature; and drawing conclusions and/or making recommendations that do not reflect the limitations or controversies in the science.
An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets. The DGAC Report does not provide sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes.
Lack of supporting evidence limits the value of the proposed recommendations as guidance for consumers or as the basis for public health policy. It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.
Introduction
What is required is less advice and more information.
—Gerald M. Reaven [1]
There is little disagreement that we have a nutritional crisis in the United States. One manifestation is confusion in the mind of the public as to what constitutes sound principles [2], [3]. Recent scientific advances have not led to consensus, but rather to substantial disagreement among experts and further uncertainty for the public. Nutritional health covers a wide range of concerns but foremost in the mind of the public are whether the standing recommendations for lowering fat intake and increasing carbohydrate intake were ever appropriate for the prevention of obesity, diabetes, and cardiovascular disease; whether the regulation of carbohydrates is more important; and what the role of protein, especially from animal sources, should be in the diet. These concerns were raised with the first national dietary recommendations 30 y ago and have yet to be adequately addressed even as the nutritional health of Americans continues to decline.
The 2010 Dietary Guidelines Advisory Committee (DGAC) Report [4], released on June 15, 2010, was expected to address these issues (sections of the report are indicated as part-section number, e.g., B2; pages in the report are denoted, e.g., B2-3.). The DGAC Report had the opportunity to review and evaluate the emerging science, to distinguish between established principles and ideas that are still areas of research or controversy, and to provide clear, consistent information for Americans. Instead, the 2010 DGAC Report continues to make one-size-fits-all recommendations that are based on evidence that is weak, fragmented, and even contradictory in nature.
