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In response to the American Heart Association’s Updated Dietary Guidance
DECEMBER 3, 2021
We support the American Heart Association’s updated dietary guidance and believe that these recommendations are a timely development to help clarify nutrition confusion and improve public health.
As in previous iterations, we are pleased to see that the American Heart Association’s guidance continues to reﬂect the importance of healthy foods such as whole grains, fruits, vegetables, and lean proteins. Additionally, in a welcome reﬂection of what hundreds of nutrition studies have revealed over the past 15 years, we concur with the two new recommendations not seen in the 2006 version (choosing healthy sources of protein from mostly plant sources and choosing minimally-processed foods instead of ultra-processed foods). Both of these updates are a wise reﬂection of where nutrition science stands today.
In order to help a greater number of people comply with a heart-healthy diet, it is essential to recognize and overcome existing obstacles. We applaud the American Heart Association for identifying barriers to a heart-healthy diet, such as “targeted marketing of unhealthy foods and beverages, structural racism, neighborhood segregation, and food and nutrition insecurity.” We also support innovative ideas to make the food environment more conducive to healthy eating, such as policies that “encourage healthier default options such as making whole grain rather than reﬁned grain products available and minimizing the sodium and sugar content in products.”
Finally, we agree with both the American Heart Association and the 2020-2025 Dietary Guidelines for Americans that nutrition guidance must take a whole diet approach, rather than narrow in on individual foods or nutrients. As our 30-year history in the nutrition education space has taught us, dietary patterns, including cultural models of healthy eating (like the Mediterranean diet, the African Heritage diet, the Asian Heritage diet, and the Latin American Heritage diet) are practical guides for showing people how to incorporate nutritious, heart-healthy foods into a balanced diet.
DECEMBER 30, 2020
One of the most exciting updates in the 2020-2025 Dietary Guidelines for Americans is the focus on cultural diets. According to the Guidelines, “customizing the Dietary Guidelines framework to reﬂect speciﬁc cultures and traditions is an important strategy to help communities across the country eat and enjoy a healthy dietary pattern.” We are pleased that the 2020-2025 Dietary Guidelines for Americans aﬃrm the work that Oldways has been doing for the past 30 years to inspire people to embrace the healthy and sustainable joys of the old ways of eating. As stated in the new Dietary Guidelines, “relying on the expertise of professionals in nutrition and in speciﬁc cultural foodways can help people prepare foods healthfully while retaining heritage.”
The Guidelines also note the importance of herbs and spices, a mainstay of Oldways’ traditional diet pyramids for many years. “Spices and herbs can help ﬂavor foods when reducing added sugars, saturated fat, and sodium, and they also can add to the enjoyment of nutrient-dense foods, dishes, and meals that reﬂect speciﬁc cultures.” Additionally, we are also pleased with the continued emphasis on dietary patterns, such as the Mediterranean diet and vegetarian diet, as well as the continued recommendation to make at least half of your grains whole.
Another momentous update in the new Dietary Guidelines is the guidance on infant and toddler nutrition. The particular importance of whole grains for children 12-24 months (making upwards of ⅔ of the total grain intake whole) is essential in setting the stage for healthy habits down the road, and encouraging parents and caregivers to oﬀer foods that will best help support growing brains and bodies during this important developmental stage.
In such an ambitious undertaking there is almost always room for improvement, and the Dietary Guidelines are no exception. Like many, we are disappointed that the 2020-2025 Dietary Guidelines for Americans did not carry forward the recommendation to reduce sugar to only 6 percent of calories. We concur with the National Academies, that “If the DGA omits or only accepts parts of the conclusions in the DGSAC report, a clear explanation has to be given as to why.”
The 2020-2025 Dietary Guidelines for Americans reminds us that “the U.S. Government uses the Dietary Guidelines as the basis of its food assistance and meal programs,” such as the National School Lunch program. And yet just one day before these guidelines were released, the public comment period closed on a proposed rule from the USDA intended to weaken school nutrition standards.
A recent Food4Health Alliance report found that more than 90% of the reviews conducted for the Dietary Guidelines did not amount for race, ethnicity, and/or socio-economic status. We applaud the focus on cultural food traditions in the 2020-2025 Dietary Guidelines for Americans, and we urge the government to invest in scientiﬁc research on traditional diets to help prevent bio-ethnocentrism in the Dietary Guidelines and help reduce racial and ethnic health disparities.
JANUARY 21, 2020
We are extremely disappointed by the recent USDA announcement to further weaken school nutrition standards, by removing the daily grain requirements at breakfast, reducing the amount of fruit required to be served at breakfast outside of the cafeteria, and signiﬁcantly reducing the amount of red and orange vegetables required in lunches each week in the National School Lunch Program (NSLP), among other changes. The proposed rule would also remove ﬁnes for schools that repeatedly violate milk and vegetable requirements, sending a clear signal to schools that they needn’t worry about nutrition.
Both common sense and the USDA’s own reports tell us that healthier school nutrition standards lead to healthier school lunches. According to the School Nutrition and Meal Cost Study, published by the USDA FNS in April 2019, “updated nutrition standards for school meals have had a positive and signiﬁcant inﬂuence on nutritional quality.” Speciﬁcally, the nutritional score of school lunches “increased 41 percent—from 57.9 to 81.5 out of a possible 100” between the 2009-2010 school year and the 2014-2015 school year.
While cost is often cited as a perceived barrier to oﬀering healthier lunches, the USDA study found that “there was no signiﬁcant association between revenue as a percentage of reported cost and compliance with updated nutrition standards for NSLP lunches.” In fact, there was no signiﬁcant diﬀerence in costs per lunch in schools with more versus less nutritious meals.
The new draft guidance cites lower participation and increased food waste as reasons for eroding current nutrition standards. However, the USDA’s own data fail to support these widely repeated mischaracterizations. The School Nutrition and Meal Cost Study found that students were signiﬁcantly more likely to participate in the NSLP in schools that served the healthiest lunches. Further, while the School Nutrition and Meal Cost Study did not compare plate waste before and after the nutrition standards were changed, the study did report that other “studies that examined plate waste before and after implementation of the updated nutrition standards found that levels of plate waste were reduced or unchanged.”
School lunch oﬀerings have the power to shape students’ preferences and build healthy habits for the long-term. Studies show that it can take 8-15 exposures to a food before children begin to accept it, meaning what ends up in the wastebasket today may very well become a dietary staple down the road. We can’t help support children build healthy habits for the long-term if we’re not giving them a chance to try these healthy foods in the ﬁrst place. Further, widespread evidence indicates that healthier school meals have actually reduced plate waste without reducing school meal participation in many districts.
Our lunchrooms are a place to nurture students’ appetites for healthy food and properly fuel their growing brains and bodies. Thus, we urge policy makers to prioritize the health and wellbeing of the next generation, and to not backpedal on existing successes.
OCTOBER 1, 2019
We are very disappointed by the Annals of Internal Medicine article suggesting that red and processed meat are not linked with poor health outcomes. In fact, the opposite is true, as the very studies cited to support this claim indicate that red and processed meats are linked with all-cause mortality, as well as heart disease, cancer, and diabetes.
How can such clear evidence be so poorly misconstrued? In this case, the authors of the article analyzed nutritional studies using an analysis tool (GRADE) meant for drug trials—not for nutrition studies. Further, they conveniently dismissed the wealth of observational studies linking red and processed meats with poor health outcomes. Observational studies are an important research tool that have helped identify life-saving behaviors (such as the link between smoking and cancer).
It is very diﬃcult to prove cause-eﬀect relationships in scientiﬁc studies, especially in nutrition studies. After all, unlike drug trials (in which you either take the drug or you don’t), humans eat all day, creating endless food choices and lifestyle decisions. Studying the lifetime eﬀects of every eating pattern simply isn’t feasible. Nonetheless, the current body of research shows very strong relationships between certain eating patterns (more fruits, vegetables, and whole grains, and limited red and processed meats) and good health.
We at Oldways are dedicated to improving public health using the weight of evidence from all relevant research methods. Unfortunately, the Annals of Internal Medicine article seeks to sow confusion, rather than consensus. This is especially harmful, as confusion gives us a reason not to change our engrained habits. Take a minute today to pause and ask yourself what you can change for the sake of your health and that of the planet.
IN RESPONSE TO “WHAT WE KNOW ABOUT DIET AND WEIGHT LOSS” BY GINA KOLATA (NEW YORK TIMES, DECEMBER 2018)
DECEMBER 18, 2018
We were troubled by Gina Kolata’s December 10, 2018 New York Times article claiming that “after decades of research, there are shockingly few ﬁrm conclusions” about diet. There is no “one-size-ﬁts-all” approach to diet, and searching for a magic bullet eating plan can only lead to disappointment and frustration. That said, decades of research from distinguished scientists across a wide spectrum of dietary philosophies do in fact reveal a number of ﬁrm conclusions about what constitutes a healthy diet. One reason people give up on eating well is the public perception that nutrition experts all disagree and that there’s no clear message on how to eat well. While this perceived conﬂict might make for a more interesting headline, in reality, nutrition research is not as muddled as many journalists lead readers to believe. In 2015, Oldways gathered the leading researchers across a wide spectrum of dietary philosophies (from Paleo to vegan, from low fat to Mediterranean, and many more) to ﬁnd common ground on what constitutes a healthy diet, and the group reached numerous actionable points of consensus. Since then, the academic community has continued to pursue clarity amidst the confusion and controversy that dominate headlines. Just last month, scientists with widely varying perspectives published a review on low-fat and low-carb diets, identifying areas of consensus between the two approaches. Science by its nature encourages us to continue probing for new information – and yet in the meantime, we all need to eat three times a day, so it’s imperative that people understand we have plenty of evidence already for what kind of food choices support good health.
DECEMBER 6, 2018
We are extremely disappointed by the recent USDA announcement that the ﬁnal rule on school meal ﬂexibilities will weaken school nutrition standards, particularly with regards to whole grains. The announcement that only half of the weekly grains served in the school lunch and breakfast programs will be required to be “whole grain rich” is a euphemism for making a meager 25% of the grains whole. This is because “whole grain rich” simply means that at least half of the grains in a food are whole — NOT that the food is 100% whole grain.
The rollback of whole grains in the upcoming ﬁnal rule is a disconcerting departure from the interim ﬁnal rule, which required 100% of grains to be whole grain rich, but allowed schools to ﬁle for exemptions as needed. According to the interim ﬁnal rule, published on November 30, 2017, fewer than 15% of schools request waivers for whole grains. The interim ﬁnal rule also noted that “The availability of whole grain-rich products through USDA Foods and the commercial market has increased signiﬁcantly since the implementation of the meal standards and continues to progress, providing new and aﬀordable options for local operators to integrate into menus.”
This rollback is an unnecessary threat to children’s health, given that widespread evidence indicates that healthier school meals have actually reduced plate waste without reducing school meal participation in many districts. Despite Secretary Perdue’s comments to the contrary, students today are eating, and enjoying, whole grain foods. Relaxing nutrition guidelines that are already being met is a pointless exercise, and September 2016 data from the USDA show that the vast majority of school districts are certiﬁed as complying with the school nutrition standards. This includes 100% certiﬁcation in states such as Alabama, Kentucky, and Mississippi — states that often don’t receive acknowledgement for meeting nutritional guidelines.
This announcement comes at a particularly troubling time, as a 2017 study published in the New England Journal of Medicine estimates that 57% of today’s children will be obese by age 35. Our lunchrooms are a place to nurture students’ appetites for healthy food and properly fuel their growing brains and bodies. Thus, we urge policy makers to prioritize the health and wellbeing of the next generation, and to not backpedal on existing successes.
AUGUST 27, 2018
The Lancet article did in fact ﬁnd protective eﬀects of moderate alcohol consumption in heart disease and diabetes, but argues that the increased risk of certain cancers and car accidents outweighs the beneﬁts. Given that heart disease is the number one killer in the US, alcohol’s potential beneﬁcial relationship with cardiometabolic health should not be dismissed. However, the overall lifestyle that alcohol is a part of can reveal far greater information about health risks and beneﬁts than simply analyzing alcohol in isolation. Moderate alcohol intake (particularly wine) is a characteristic component of a traditional Mediterranean diet, enjoyed in populations made famous for their longer lives and lower rates of chronic disease. When alcohol is consumed as part of a balanced meal, and coupled with daily movement and social connections, as in the Mediterranean, studies ﬁnd a net health beneﬁt. However, when alcohol intake is accompanied by unhealthy habits, like smoking or poor diet, or unsafe habits, like driving, obvious health risks present themselves. There’s no reason to start taking up drinking if you don’t already, particularly if you have a family history of alcohol dependency. However, the Mediterranean diet and other traditional diets present examples of how to safely enjoy alcohol in moderation (up to one 5-ounce glass of wine per day for women, or up to two 5-ounce glasses daily for men), in a way that may support cardiometabolic health and help to foster positive social connections.
JULY 10, 2018
A recent article with the headline, “Fatty foods don’t cause heart diease, bread and pasta do,” is another disappointing focus on a study that has been discounted by most nutrition scientists and other health professionals.
As the Harvard School of Public Health wrote in the week after the study was published in the Lancet: “results from the Prospective Urban Rural Epidemiology (“PURE”) study made headlines, but the ﬁndings are not as novel or disruptive as these sensational headlines suggest.”
Oldways weighed in at the time the PURE Study was published, also citing methodological problems, such as the fact that carbohydrate quality was not considered, and that the diet described in the article (50-55% carbohydrates, 35% fat, and (by diﬀerence) 10-15% protein) actually resembles a Mediterranean diet more than a low-carb Atkins diet.
For more information on why the PURE study’s press coverage does NOT represent Common Ground agreed to by leading scientists, read what the experts have written about this study:
- Harvard School of Public Health
- David Katz in the Huﬃngton Post
- James Hamblin in the Atlantic
And then, take a deep breath and remember that one study does not change years of solid nutrition science research. High quality pasta and bread are part of a healthy diet.
JUNE 14, 2018
The PREDIMED study, ﬁrst published in The New England Journal of Medicine in 2013, was a landmark clinical trial demonstrating the Mediterranean diet’s role in major cardiovascular events (like stroke or myocardial infarction). The republished PREDIMED data, which has stronger randomization protocols in place, further strengthens the evidence base on the health beneﬁts of a Mediterranean diet.
Despite the imperfections of the original PREDIMED study, its results continue to withstand scrutiny. The republished analysis, which excludes 1,588 of the original 7,447 participants due to randomization protocol, comes to the same ﬁndings as the original PREDIMED study, with an approximately 30% lower risk of major cardiovascular events. The participants that were omitted from the republished study were excluded because they shared a household with a previously enrolled participant and were therefore assigned the same diet without randomization, and because one of the eleven study sites assigned participants to diets by clinic, rather than individually. Even without these participants included, the sample size of PREDIMED remains large compared with other randomized controlled trials of diets and adds to the large body of literature demonstrating the health beneﬁts of a Mediterranean diet.
Dietary beliefs should not be shaped on one single paper. Leading nutrition researchers across the full spectrum of dietary philosophies emphasized at Oldways Finding Common Ground Conference that “representations of new diet studies to the public should be made in the context of the prevailing consensus,” and that “new evidence should be added to what was known before, not substituted for it sequentially.”
But here again, the Mediterranean Diet has science on its side. The PREDIMED study is hardly the only time researchers have made links between the Mediterranean Diet and good health. The Mediterranean diet is one of the most well-researched eating patterns in the world, with more than 5 decades of epidemiological and clinical research supporting its beneﬁts. The evidence supporting the Mediterranean Diet is so robust, that even the Dietary Guidelines for Americans recommend a Mediterranean style diet.
It’s easy to get caught up in the chaos when reputable journal like the New England Journal of Medicine retracts and republishes a study. But read beyond the headlines and you’ll ﬁnd that the beneﬁts of a Mediterranean diet are just as promising as researchers suspected, perhaps even more so. As PREDIMED study author Miguel A. Martínez-González tells the Washington Post, “no previous trial has undergone such intense scrutiny.”
Response to Recent Guardian Articles on the Status of the Mediterranean Diet in the Mediterranean Region
MAY 29, 2018
The recent Guardian article titled, “’People just have less time now’: is the Mediterranean diet dying out?” doesn’t accurately reﬂect the data in WHO’s own Childhood Obesity Surveillance Initiative. The 2018 COSI report actually says that, comparing initial 2007 COSI data with the most recent 2017 data, “a signiﬁcant decrease in the prevalence of both overweight and obesity was recorded in Greece, Italy, Portugal and Slovenia…[and] a decreasing tendency was also observed in…Spain.”
Yes, children in countries around the Mediterranean are eating more fast food and highly processed food, just as American children have done, and are thereby becoming more overweight and less healthy, like their American cousins. Educating kids (and their parents) about healthy food choices (and how to put them on the table quickly) is essential. Many traditional Mediterranean meals – such as pasta topped with vegetables and beans or a little ﬁsh – take less time to prepare than visiting the mall food court or picking up takeout, while saving money too.
While the WHO report is an important reminder of the stakes involved in instilling good eating habits in our children, the actual WHO data show that perhaps an important corner is being turned as countries that have traditionally followed a Mediterranean Diet and lifestyle are beginning to wake up to the importance of turning back to the old ways of eating. As Antonia Trichopoulou, Europe’s pre-eminent expert on the Mediterranean Diet, said to the Guardian reporter:
I am optimistic that the Mediterranean diet will not die in the next generation,” she said. “There has been a lot of movement in recent years to rediscover traditional foods in Greece, with people moving to villages and producing local food. The Mediterranean diet is seen as sustainable and good for the environment. It can be recovered.”
Since more solid, peer-reviewed data support the health beneﬁts of the Mediterranean Diet than any other way of eating, Guardian readers should be aware that this healthy eating pattern is not on its last legs.
Response to the interim ﬁnal rule, “Child Nutrition Programs: Flexibilities for Milk, Whole Grains, and Sodium Requirements”
NOVEMBER 30, 2017
We are disappointed by the recent USDA rule to relax school nutrition standards. This move is an unnecessary threat to children’s health, given that widespread evidence indicates that healthier school meals have actually reduced plate waste without reducing school meal participation in many districts. Despite Secretary Perdue’s comments to the contrary, students today are eating, and enjoying, whole grain foods. Relaxing nutrition guidelines that are already being met is a pointless exercise, and September 2016 data from the USDA show that the vast majority of school districts are certiﬁed as complying with the school nutrition standards. This includes 100% certiﬁcation in states such as Alabama, Kentucky, and Mississippi — states that often don’t receive acknowledgement for meeting nutritional guidelines.
This announcement comes at a particularly troubling time, as a Harvard study published today in the New England Journal of Medicine estimates that 57% of today’s children will be obese by age 35. Our lunchrooms are a place to nurture students’ appetites for healthy food and properly fuel their growing brains and bodies. Thus, we urge policy makers to prioritize the health and wellbeing of the next generation, and to not backpedal on existing successes.
Response to the National Academies’ reports, Redesigning the Process for Establishing the Dietary Guidelines for Americans (September 2017), and Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process (February 2017)
SEPTEMBER 22, 2017
We wholeheartedly support the National Academies’ suggestions to enhance transparency, manage biases, and promote sound science. That said, we feel it’s important to clarify that the widespread critiques of the DGA do not translate to a critique of the DGSAC (Dietary Guidelines Scientiﬁc Advisory Committee). The 2015 DGSAC report was met with widespread support from those immersed in nutrition research, as well as respected organizations including the Academy of Nutrition and Dietetics, the National WIC Association, the Union of Concerned Scientists, and the Center for Science in the Public Interest. Scientists from vegan to Paleo, and from low-fat to Mediterranean, pushed aside personal interests and lent strong, collective support to the DGSAC report at Oldways’ Finding Common Ground conference.
The National Academies reports devote numerous pages to the need for DGSAC to be free of bias, yet it is the translation from science to policy that deserves the most scrutiny. Although the DGSAC report is intended to serve as the scientiﬁc basis for the DGA, the translation from DGSAC report to DGA has repeatedly watered down the integrity of the ﬁnal report, as the policy writers, more so than the scientists, are subject to the most bias from industry stakeholders. We concur with the National Academies, that “If the DGA omits or only accepts parts of the conclusions in the DGSAC report, a clear explanation has to be given as to why.”
JANUARY 26, 2017
We believe strongly that overall diet determines health, rather than individual foods or speciﬁc nutrients. No matter what combination of nutrient criteria FDA might mandate as healthy, it’s inevitable that a reductionist approach will result in eﬀorts to “game” the system with fortiﬁed manufactured foods, while some whole, natural foods may fail to qualify. For instance, under the “current thinking” outlined in FDA’s September 2016 guidance, brown rice wouldn’t qualify to be labeled healthy – while the highest fat hamburger meat commonly sold (70% lean/30% fat) would qualify, as would the bun typically eaten with it.
In our comments, we advised FDA to follow either of two paths: 1) Don’t allow the use of “healthy” at all on packaging, or 2) Allow it only on whole plant foods. If FDA does allow use of the word “healthy,” Oldways recommends using it to highlight whole or minimally processed plant foods, which are especially encouraged in the 2015-2020 Dietary Guidelines for Americans – instead of tying use of the word “healthy” to a formula of nutrients.