No, Dietary Guidelines Are Not Making Us Sick

Frequently I see the claim that dietary guidelines are the reason we are overweight and sick. It is used to sell books, particular diet strategies, or just to inject doubt about government agencies and nutrition science. This of course rests on the assumption that people are following the recommendations. Some groups have explored the proportion of the population that meets recommendations for various food groups. A good paper is by Krebs-Smith and colleagues from 2010, who used NHANES ’01-’04 data and produced a nice table here. A point of emphasis: overall, about 80% and 89% were below fruit and vegetable recommendations, respectively. Already we know that people aren’t following the guidelines.

I used NHANES ’09-’10 data to do a similar analysis, because I wanted to see if anyone met the guidelines for all food groups, and also to see if we are anywhere close. Since this is the most recent data available, we need to use the MyPyramid recommendations, which was replaced by MyPlate in 2011. The following recommendations (which were designed to meet nutrient needs within calorie limits) were used based on calorie level, except for discretionary calories which I omitted for simplicity.

dailyamounts

Calorie levels were estimated for each person based on age and activity. A section of NHANES asks participants about activity, so I designated active as being physically active for at least 60 minutes a day for at least 5 days per weekdailyamounts2

Results

The proportion of Americans achieving recommendations for fruits, vegetables, grains, meat & beans, milk, and oils: 0.098%Yes, you read that right: it is 1/10th of 1%.

If we add in another recommendation – to make half of all grains whole – 0% of the population meets recommendations. There are additional recommendations for vegetable subgroups that aren’t even worth exploring because nobody is left.

Looking at only the proportion who meet recommendations for both fruits and vegetables, it is 5.5%. The milk group alone is 18.3%. Only 5.9% made half of their grains whole.

Are We Even Close?

To see if we are even on the right track to meet recommendations, I cut them all in half. So at 50% of the recommendations for fruits, vegetables, grains, meat & beans, milk, and oils, 3.3% of the population now reaches them. If we cut the whole grain recommendation to 25% of total grains and include this, we are back below 1%: 0.81%.

Conclusions

The state of the American diet is grim. I previously estimated the proportion of the U.S. population achieving recommendations for 21 micronutrients: 0.5%. The proportion of the population meeting food group recommendations is even lower, and in fact on average, it is 0%. Even being generous and cutting recommendations in half, we are still at less than 1% who meet them.

When someone says our guidelines make us sick, they simply don’t understand the science. Many studies use the Healthy Eating Index, which directly measures how closely each individual adheres to recommendations. For example, Reedy and colleagues published a paper earlier this year associating a higher Healthy Eating Index score with a reduced risk of all-cause, cardiovascular disease, and cancer mortality in the NIH-AARP Diet and Health cohort of 424,662 people. We can also infer from similar healthy consumption patterns (e.g. high fruits and vegetables, whole grains etc) that shifting toward the guidelines would improve population health. An exhaustive review is outside of the scope of this post, but for some additional references, see this nice slide set by Reijo Laatikainen.

Notes & Caveats

This analysis uses one weighted 24-hour recall from NHANES. It is known that self report food intake is not great for some things and some foods may be underestimated while others are overestimated. It would be ideal to use the NCI method to improve estimations of usual food intakes, but for simplicity I have not yet done this. I also did not explore outliers. There is no direct match for “active” as defined for the MyPyramid calorie levels in NHANES, so I used my best judgement of which to use.

  • mem_somerville

    But…but…who can I blame then? THERE MUST BE BLAME!

  • http://honey-guide.com/ Matthew Dalby

    I agree with your point that people do not follow guidelines though I think there may be a grain of truth in the claim, if an indirect one. National dietary guidelines have tended to focus on grams and percentages of dietary components, at least that is how they are often presented. It could be argued that this has unintentionally played into the hands of the industries that make money out of our food and drink, usually not to the benefit of public health. Numerous less than ideal foods are sold on the basis of their content, or lack of, some specific nutritional components. On the other hand my local supermarket now has a traffic light system on their packaging, that results in the almonds and traditional cheeses having prominent red warnings based on their fat, calorie, and salt content. At the same time highly processed breakfast cereals have no red warnings, all based on official nutritional recommendations.

  • Erik Arnesen

    Sadly, it’s not much better in the Nordic countries (Norway, Sweden, Denmark and Iceland). Despite many improvements over the last decades, only 0,3 % of adults and *no* children could be classified as having an “optimal diet” based on the Nordic nutrient recommendations. About 24 % of Norwegians, and 9 % of the Swedes, had a diet classified as “healthy” (but still not optimal) – http://www.norden.org/no/publikasjoner/publikasjoner/2012-552

    • Hafthor Bjornssen

      I want to educate you and CarbSane:

      The sheer numbers of studies ONLY measuring effects MEANS NOTHING. NOTHING. Medicine and nutrition are very guilty of this…

      Science wants and NEEDS deep explanation. CarbSane does not understand science. Why do you follow her blog?

      Correlations do not mean anything UNLESS there is an UNDERLYING PHYSICAL PRINCIPLE WHICH E-X-P-L-A-I-N-S the correlations. :)

      • charles grashow

        Are you RAZZWELL????

        • http://razzwell.blogspot.com/ Razwell

          YES. LOL !!!!!!!!!

        • http://razzwell.blogspot.com/ Razwell

          MORGAN FREEMAN GO POOPY ON YOUR HEAD, WHILST BRUCE LEE PAINTED YOUR BALLSACK BRIGHT PINK. LOL !!!!!!!!!

  • Emma Robertson

    Thanks for crunching those numbers, really great read! Similar numbers for Aussies also.

  • Rudi Lambert

    Nice opinion, but you obviously haven’t done your homework…. at least read the arguments of the people who you think are wrong, so you know what and why they think exactly, rather than assuming they most be wrong because they have a different opinion.
    Reed Techoldz ‘Big Fat Surprise’, Taubes’ ‘Why we get fat’ and Tim Noakes websites. At least you’ll know what your talking about.

  • Dan

    and here I thought we needed sugar at each meal / seems sugar is a toxin and we need all these aminos at each meal /// They’re distinguished by their chemical structures. Proteins are compounds which are made up of amino acids, which all contain an amino (nitrogen-containing) and carboxyl (like carbon dioxide) group. Proteins are made when these amino acids are strung together and (often) folded into complex shapes. They can be structural proteins, like the keratin in our fingernails or the actin in our muscles, or they can be chemically functional, like enzymes. Proteins can also be very important in communication in the body – insulin, for example, is a protein. In fact, if you take away the water, 75% of our bodies are protein. All of these proteins require the right amino acids found in our bodies and our diets to be made. Watch this video to understand how they are made:
    While most microorganisms and plants can produce whatever amino acids they want, animals, including us, have lost the ability to produce certain amino acids. These amino acids are called the “essential” amino acids, or the ones we must intake in our diet. Without enough of a dietary source of these essential amino acids (of which, in humans, there are about 8, with 4 others needed by children), our bodies can have trouble making the proteins needed for ordinary functioning, and we can end up malnourished. On top of this, our bodies don’t store amino acids like they do fats or carbohydrates. To ensure we have the amino acids we need, we have to get them daily.
    It would be easy to attain the amino acids we need if all we had to do was eat enough of them as needed to make proteins, but alas, as always, our bodies are far more complicated. As the body digests protein, a large portion of the amino acids that result are deaminated and are used for fuel instead of as protein building blocks. This is done by a two processes, either gluconeogenesis where proteins are converted to glucose directly or an alternate pathway where they are fed into the natural energy cycle (the citric acid cycle) at a later point to produce even less fuel. This particularly occurs under starvation conditions, where the body will actually start breaking down its own muscle and other protein sources for fuel. As far as energy goes, protein is a poor source of it, containing only 4 kilocalories per gram as opposed to the 9 in fats.
    Our bodies don’t fluctuate in amino acid concentrations like they do with other molecules. Levels of amino acids in the blood are almost constant, regardless of diet. However, that’s not because diet isn’t important, it’s because the body will begin to attack itself and break down muscle and other tissue to keep amino acid concentrations level. This can be why some extreme dieters seem to lose weight but feel lethargic or unable to exercise – by massively cutting calories, they probably cut a lot of protein out of their diets, too, and their bodies are basically eating their muscle tissue to get amino acids for more essential uses like cell signaling. Therefore, to get the total amount of amino acids we need on a daily basis, we actually have to eat a high amount of excess amino acids.
    When it comes to dietary intake, the weakest link is the most important. The most limited essential amino acid in our diet affects how well our bodies uptake the rest of them, so balance is key. In other words, whatever amino acid we’re most lacking in will set the bar for how our bodies intake all the others, and so to have healthy levels of all amino acids we have to have good balance and enough of each.
    The Essentials and Our Diets
    There are roughly 20 common amino acids, with 8 of them considered essential for adults and another 4 essential for children and infants. The essential ones for adults are:
    isoleucine
    leucine
    valine
    methionine
    phenylalanine
    threonine
    tryptophan
    lysine.
    Additionally, cysteine, tyrosine, histidine and arginine are required by infants and young children. It’s rare that a person needs to supplement their diet with any form of pill or powder to get enough amino acids, and doing so can be dangerous if not closely watched. For example, body-building supplements contain a high concentration of the first three amino acids mentioned, but over time, extreme excess of these acids can lead to nerve degeneration or even liver and kidney toxicity. In general, extreme excess of any amino acid is bad for the body. It’s hard to get that kind of excess from eating – our bodies naturally just turn most excess deitary protein into fuel, but you can over-supplement.
    Impact of Protein Deficiencies
    Because of the many uses and importance of amino acids in our bodies, it’s key that we get enough and a balanced amount of the essentials, which is far more often the problem than excess amino acids. Protein deficiency is a huge medical issue in developing nations, with protein-energy malnutrition affecting 500 million people every year and killing 10 million of them. Severe cases tend to include complete loss of immune function and thus increased risks from other diseases. While it’s fairly rare in developed nations, protein deficiency can affect the poor and often occurs in those who are crash dieting to lose weight or in older adults, particularly leading to conditions like osteoporosis, as protein is key when it comes to bone health. Those recovering from surgery, trauma or illness can also be protein deficient if they don’t increase their dietary intake to match their increased needs. Our bodies use protein when we’re healing, so its important to eat lots of it when we’re sick or recovering.

    It’s even possible that protein deficiency is a far more common problem than we think, and that many simply suffer from very mild affects. There are studies which have shown lower protein intake in certain minorities. Some biologists, like Bob Lanier, a biology professor at Jesuit College Preparatory School of Dallas, have argued that a very slight protein deficiency might actually explain some of the variance in academic performance between poor minority and richer majority students. Since so much of brain function is tied to proper nutrition and protein intake, it’s entirely possible that even smaller changes in protein consumption, like that of crash dieters, could have an impact on mood and cognition, though few studies have looked deeper into this idea in adults. In children, however, a deficit in dietary protein as infants can have a marked affect on intelligence as older children, especially for boys.