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Diets

A History of Nutrition Guidelines

            The history of Government recommended nutrition guidelines in the United States now spans over 100 years.  During this time, the United State Department of Agriculture’s (USDA) nutrition guides promoted at various times from 4 to 11 food groups.  For most, these guidelines became the basis of what they were taught about nutrition and quite likely many of their food preference.

            In recent years, the Government’s nutrition guides have been criticized for not accurately representing the best scientific information and for being overly influenced by agribusiness interest.  With the Department of Agriculture having conflicting mandates for providing nutrition guidelines and for promoting agribusiness it’s not difficult to see why nutrition policy might have run off the tracks.

            The Government’s first nutrition guidelines were published in 1894 as a farmers’ bulletin.  These guidelines advocated measuring calories, variety, proportionality, and moderation.  An efficient and affordable diet was described as one that focused on nutrient-rich foods, less fat, less sugar and less starch.  While well intended, this early guide advised against vegetables.  At that time the science of nutrition was in its infancy with the discovery of the first vitamin still sixteen years away.

            In 1916, a new recommendation was issued that categorized foods into five food groups:  milk and meat, cereals, vegetables and fruits, fats and fatty foods, and sugary foods. These guidelines remained through the Great Depression years with several variations based on affordability.  By 1941 the guidelines were updated to include a few vitamins and minerals.

            In 1943, a graphic nutrition guide called the ‘Basic 7’ food groups was issued as part of helping maintain nutritional standards under WWII food rationing.  The Basic 7 food groups included:

  1. Green and yellow vegetables
  2. Oranges, tomatoes, grapefruit, cabbage and salad greens
  3. Potatoes, vegetables, and fruits
  4. Milk, cheese, and other milk products
  5. Meat, poultry, fish, eggs, dried beans, peas, nuts, and peanuts
  6. Bread, flour, and cereals
  7. Butter and fortified margarine

            In 1956 the Government began promoting a new nutrition guideline called the “Basic Four” food groups.  Until 1992, the ‘Basic Four’ remained the standard for nutrition education in public schools.  

            Recommendations for minimum servings from the ‘Basic Four’ food groups included:

  • Vegetables and fruits (four or more servings daily).
  • Milk and milk products (four servings for teens and two for adults).
  • Meat, fish, or beans (two servings daily).
  • Cereals and bread (Four servings daily)

            Other foods were suggested to round out the ‘Basic Four’ meals and satisfy appetites. These included additional servings from the ‘Basic Four’ or foods like butter, margarine, oils, jellies, syrups, etc.  To promote the ‘Basic Four’ nutrition recommendation, a food guide pyramid was introduced.   Interestingly, the first ‘Basic Four’ chart suggested by nutritional experts featured fruits and vegetables as the biggest group, not bread.  The original chart also emphasized eating less meat, salt, sugary foods, bad fat, and additive-rich factory foods. Unfortunately, the proposed chart was overturned at the hand of special interests in the grain, meat, and dairy industries.  The final guidance included more refined grains, meat, commercial snacks and fast foods.

            Twelve years later the ‘Basic Four’ pyramid was updated with a guide called MyPyramid.  The somewhat abstract design depicted a nutrition recommendation in which grains narrowly edged out vegetables and milk in equal proportions. Fruits were next in proportional serving size, followed by a narrower wedge for protein and a small sliver for oils. An unmarked white tip represented discretionary calories for items such as candy, desserts, etc.  Stairs were added up the left side of the pyramid with an image of a climber to represent a push for exercise.

            In June 2011 after 19 years of the food pyramid recommendations, the MyPlate nutrition guide was issued.  In the MyPlate scheme, a plate and glass depict five food groups.

            While the MyPlate recommendation is an improvement, it is still not the best recommendation based on current research. Numerous research findings demonstrate that the US Dietary Guidelines still fall short of needs for health.  For now, special interest groups from agribusiness maintain a stronger influence through the revolving door of agribusiness and Government than do experts from the science of nutrition. Of additional concern is the Government’s reliance on advice from professional bodies such as the American Heart Association, the American Diabetes Association, and the American College of Cardiology, which in the past have been suspected of influence by agribusiness.  On a positive note, the Government’s 2015 report found that a healthy diet should comprise higher quantities of plant-based foods and lower quantities of animal-based foods.  It also reported that a plant-based diet was better for the environment than one based on meat and dairy.  While these recommendations are encouraging, progress in realizing the best guidelines will remain a contest between the need for public health information that provides the best advice and defenders of agribusiness.

            In 2020, the Government will publish a new set of nutrition guidelines based on a review of current scientific findings, inputs from industry and public comment. Once again, the battle for influence over the national diet will begin in earnest with agribusiness having the financial upper hand, science having an essentially unfunded seat at the table, and the public generally unaware of plans for their future.

            Given that a significant percentage of all chronic diseases in this country are attributable to lifestyle choices with poor dietary habits being the major culprit, healthful eating must be promoted as a public health priority.  Without this national priority, the cost of healthcare will continue to rise and will in time exceed the limits of affordability causing significant reductions in availability and quality of service.

            The progression of preventable chronic conditions like type 2 diabetes and Alzheimer’s clearly points to the failure of existing national policies.  Fifty years ago, there were about two million Americans with type 2 diabetes.  Today diabetes is estimated to impact 160 million Americans diagnosed with diabetes or pre-diabetes.  In both cases, lifestyle is the most common cause of a national epidemic that is preventable, treatable and for type 2 diabetes often, reversible through dietary and other lifestyle modifications.

            If the future cost of healthcare is a concern to you then let your elected representatives know that you favor having the Government promote nutrition guidelines that reflect the most healthful choices.

            To the extent that my voice can be heard, I will continue to argue that the best diet for disease prevention and optimal health for most people is one that consists predominantly of plant-based whole foods.

            You can also play an important role in the 2020-2025 Dietary Guidelines development process by expressing concern to your elected officials.  Below you will find a statement that supports needed objectives for the 2020-2025 nutrition guidelines.  You can be sure the voice of agribusiness will be heard.  By 2020 we will know if the best evidence for health has become national policy that can help influence what children are taught in school.  With over two generation taught poor dietary habits, getting back on track could take some time.

            About getting back on track, do you have daily walks in your plan?  If not, set the clock for a morning walk.  The cool Spring mornings are near perfect for a walking meditation.  A morning walk along one of our greenways before 7:00 am is good medicine for the body and soul.

            Nancy Neighbors, MD

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Statement of Objective for the 2020-2025 Dietary Guidelines

            Feel free to use the statement below in advising your elected representatives about your preferences for meaningful national dietary guidelines.  National guidelines are important because they flow into a wide range of educational materials including public school instruction.  Without a positive influence early in life, dietary habits can be quite difficult to change.

“The 2020-2025 Dietary Guidelines must be updated to reflect the evidence and speak to the power that individuals have to prevent, treat and reverse chronic disease through whole food, plant-based nutrition. Plant-based nutrition has the power to mitigate obesity, hypertension, high cholesterol and dyslipidemia, insulin resistance in diabetes and much more.  Considering that the number one prescribed medication in the US is statins (to treat high cholesterol and inflammation), Americans should be made aware that cholesterol is found ONLY in animal foods (meat, poultry, fish, dairy).  By replacing cholesterol-containing foods with whole plant foods, they are able to dramatically reduce their cholesterol, reduce inflammation, and reduce their need for medications.  Whole food plant-based nutrition is also typically very low in sodium, high in fiber, nutrients, and phytochemicals and provides more than sufficient amounts of protein – a macronutrient that is typically correlated with meat.  The US public on average consumes nearly twice as much protein as needed. Minimally processed, whole food plant-based nutrition diets, high in vegetables, fruits, whole grains, beans and other legumes, nuts and seeds with minimal (or no) animal products, added oil, and refined sugar defines the concept of “food as medicine” and must be both addressed and included in the 2020-2025 Dietary Guidelines.”

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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