First Rule of Dietary Recommendations? First, do no harm

So what is “health” and what actually constitutes a balanced diet? The answer depends, of course, on whom you ask. The World Health Organization defines health as follows:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

bushman family sa tourismThe Gwi Bushmen of the central Kalahari desert, on the other hand, define health in terms of their relationship with the land, making their environment essential not only for physical provisioning of food and shelter, but for spiritual and cultural survival. In other words, their perspective on health and its handmaiden, well-being, is one of econutrition with a dose of mysticism thrown in, just in case.

The Food and Nutrition Board (FNB), as part of the Institute of Medicine of the National Academy of Sciences, has a different take on health and what constitutes a balanced diet—whatever that is. The FNB has been summarizing dietary advice more or less since the 1940s in the form of recommended daily allowances (RDAs), and their report, updated and issued every five years, heavily influences the creation of the U.S. Dietary Guidelines for Americans (think Food Pyramid). In their most recent report in 2002, this massive 900-page report described macro nutrient intake like this:

To meet the body’s daily energy and nutritional needs while minimizing risk for chronic disease, adults should get 45% to 65% of their calories from carbohydrates, 20% to 35% from fat and 10% to 35% from protein . . .

Bizarrely, they also state:

. . . added sugars should comprise no more than 25% of total calories consumed . . . .added sugars are those incorporated into foods and beverages during production [and] major sources include candy, soft drinks, pastries and other sweets.

Yep, none other than the National Academy of Sciences recommends that up to 25% of your daily calories can come from added sugar. Setting aside for the moment which fats, carbs, and proteins should make up the various ranges proposed, you really have to pause a moment and ask yourself what set of morons at the National Academy of Sciences thinks it’s reasonable to get up to 25% of your calories from nutrient-poor, rapidly-digested, insulin-spiking added sugar.

To help you wrap your head around how disastrous these recommendations truly are, a one-day meal plan has been prepared to supply the nutrients in accordance with the FNB’s recommendations. The breakfast, lunch and dinner meal plan (adapted from the China Study) delivers the protein, fat, carbohydrates and sugars within the ranges outlined by this scientific organization on behalf of the American people.

Meal Foods

1 cup Froot Loops
1 cup skim milk
1 package M&M’s
Fiber and vitamin supplements

Grilled cheddar cheeseburger

3 slices pepperoni pizza (from the “other” guys, not nakedpizza)
1 16 oz. Soda
1 serving of cookies

Nutrient                           Sample Menu                         Recommended
Content                            Ranges

Total Calories                       ~1800                                           Varies by height/weight
Protein                                    ~18%                                              10-35%
Fat                                             ~31%                                              20-35%
Carbohydrates                     ~51%                                              45-65%
Added sugars                       ~23%                                              Up to 25%

Even worse, many government sponsored programs (think national school lunch program) are constructed using these same ranges. You don’t need to be a nutrition scientist to predict the outcome. Just look around.

Using the FNBs report as a playbook, the U.S. Department of Agriculture and Department of Health and Human Services updates the Dietary Guidelines for Americans and accompanying Food Pyramid every five years—and has been doing so since their 1980 Congressional mandate. These guidelines are important because they determine, more or less, the composition of meals served as part of the national school lunch program, form the basis of many official nutrition recommendations, and provide cues for food marketers.

In short, the Food Pyramid is designed to “prevent the diseases of dietary excess.” This is interesting when you consider the current issue of Ode magazine which essentially says fat is back and actually good for you, juxtaposed with the 1984 cover of Time magazine that suggested fatty foods cause heart disease and by implication, dietary fat can also make you fat. Oh, how much can change in just 25 short years.

The 1984 Time cover parroted the 1980 dietary guidelines that “recommended reduced intake of all fats” and marked the beginning of the low-fat craze that swept America through the 80s and 90s, sparking our national obsession with processed carbohydrates to replace the calories lost from those fats.


Twenty-five years later, Ode magazine is essentially stating what the science has said all along: fat does not make you fat and fat does not cause heart disease. As bad as it is to base national dietary recommendations on weak science, the idea that “it can’t hurt to reduce fat intake no matter the science” has possibly—though inadvertently—contributed to our modern obesity calamity. Harvard researchers touched upon this emerging unintended consequence in 2001 when they made the following statement in a published this article:

It is now increasingly recognized that the low-fat campaign has been based on little scientific evidence and may have caused unintended health consequences.

What the hell?

What the Harvard researchers were eluding to in 2001, and what has been pointed out by others, is that once the public bought into the low-fat craze, the public assumed that they could consume the newly marketed low-fat or no-fat products flooding the market without concern. As the graph below shows, about the time American females started to heed the less fat is better message per the 1980 dietary guidelines and the accompanying marketing of low-fat products by the food industry, this same group of American females also started to grow in waist size. As a percentage of total calories, fat decreased between 1980 and 2001, but the percentage of overweight and/or obese females skyrocketed.


Interestingly, over this same period, age-adjusted caloric intake for females increased 18 percent, from an average of 1,542 a day in 1971 to 1,877 in 2001. Men show similar patterns. During this same period, females significantly increased carbohydrate intake and, as you may have guessed, most of the carbs were highly processed (easily digested and absorbed). In other words, the majority of the additional calories consumed by females (and males) came in the form of high processed carbs in those low-fat and no fat paroducts.

Ironically, given that obesity is a risk factor for heart disease, the dietary guidelines recommending fat restriction may have worsened the obesity rates in America, and in the final analysis will have the undesired effect of actually increasing rates for heart disease as our current overweight and obese generation ages.

Recent consumer behavior toward the popular 100-calorie “mini-packs” suggests that low-fat or no-fat product offerings may have convinced consumers that they can eat these products with abandon, subsequently contributing to the 18% increase in calories noted above for females from 1971 to 2001. Researchers from Arizona State University found that test subjects consumed more calories when presented with mini-packs versus larger, traditional bags of same snacks. Oops.

The point of all this is that health and a well balanced diet mean different things to different people. Government-sponsored dietary guidelines are often the result of compromise between Congress and powerful lobbies, and not based on the merits of the best science at hand. Marketers and the food industry just make matters worse as they misappropriate dietary guidelines to push products such as low fat Doritos fortified with vitamins and organic Oreo cookies. I could go on for pages.

Dietary guidelines aimed at individual dietary components (e.g., fat) for the potential benefit of individual-level dietary modification (you) can have a net effect on America’s population that can be helpful or harmful. Given this, it is reasonable that government entities and other experts issuing dietary recommendations and advice be guided by the dictum, “first, do no harm.” If this cannot be answered with straightforward and convincing science at hand, do not issue dietary guidelines at all.


2 responses to “First Rule of Dietary Recommendations? First, do no harm

  1. No mobile web, so I just got around to reading your post. 25%!#@! Unbelievable. 0% would be a better target.

  2. In the spirit of “Do no harm,” I’m curious what’s your take on AGEs: Advanced Glycation Endproducts? Should we be limiting our consumption of food cooked above 100C ?

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