STRAIGHT TALK
ANDREW M. FREEMAN, MD
U.S. Dietary Guidelines for Adults
2015: Confusion or Clarity?
W
e’ve known for years that eating “right,”
combined with exercise and stress relief
or mindfulness, can have profound effects on cardiovascular health and disease. The problem, of course, is what constitutes “eating right?”
Over the years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health
and Human Services (HHS) have attempted to
help answer this question through the development of dietary guidelines that are updated at
regular intervals, as well as public campaigns
using visual imagery like pyramids and plates.
While these efforts are laudable, the downside is
that every revision of these guidelines and every
new iteration of informative graphics results in a
lobbying free-for-all by industry and special interest groups on what should be included or not
included. As such, it is difficult to know if new
guidelines and related tools are really based on
what is or is not healthy or the financial or political interests of certain groups.
As you can imagine this leads to massive con-
The important
point for many of
our patients is not
to simply increase
these beneficial
foods, but to
replace some
or all of the less
good choices with
them.
48 CardioSource WorldNews
sumer confusion and, even further, massive confusion among health care providers. Given that
most of us have had little to no nutrition training
during medical school, residency, and fellowship,
we as clinicians tend to be ineffective at delivering this type of much needed instruction.
This year’s dietary guideline release is no
exception. There was some clarity on the dietary
cholesterol issue. The guidelines note that “people
do not need to obtain cholesterol through foods”
and recommend limiting cholesterol intake, stating that people “should eat as little dietary cholesterol as possible.” Further, the guidelines now
“wholeheartedly” endorse more fruits, vegetables,
and whole grains in nearly every section—a big
win for cardiovascular disease.
However, there are some definite areas of
confusion. First, the dairy section includes not
just standard animal milk products but also soy
“milk,” which is not a dairy product at all. Soy
and nut “milks” are not animal-based and do not
contain cholesterol. Further, while the cholesterol section discussed above says “eat as little”
cholesterol as possible, there are whole sections
suggesting that dairy, meat, eggs, and other
cholesterol-laden products should be consumed
regularly, making it difficult for consumers to
know how much of anything to really eat.
Finally, it is all well and good to suggest eating certain foods, but there was essentially no
discussion in the final guidelines on sustainability of food. Obviously, if food is not available, it
cannot be consumed. It has been well established
that current meat, dairy, fish, and egg production is not only non-sustainable for the entire
world population, but it is also detrimental to our
environment. As such , if guidelines make recommendations to eat these resource intensive foods,
there should be a statement with suggested solutions on sustainability. In the U.S. alone, suggesting regular meat, cheese, or dairy consumption
in key states like California—where agricultural
production is being hit by a multi-year drought—
seems counterintuitive given that the water footprint required to produce these foods is significantly higher than most plant-based foods.
In short, the key takeaways from the new di-
etary guidelines are to eat more fruits, vegetables,
whole grains, and legumes, and less meat, dairy,
and cholesterol. This is indeed clearer. However,
the guidelines have woven in some other statements making the specifics of how one should
implement healthy eating a bit more nebulous.
For our patients (and for our own sakes) we
should aim to reduce or eliminate added sugars,
salts, and saturated and trans fats and trade out
higher fat and cholesterol foods for lower fat,
low-to-no cholesterol foods and markedly increase unprocessed, whole, plant-based foods.
The important point for many of our patients
is not to simply increase these beneficial foods,
but to replace some or all of the less good choices
with them. So, no, the cheeseburger piled high
with veggies isn’t healthy! ■
Andrew M. Freeman, MD, is a cardiologist and
co-lead of the Nutrition Working Group for the ACC
Prevention Council.
February 2016