The U.S. Department of Health and Human Services is “evangelizing real food.” That’s the language used by the agency on its website where it announces that it is “resetting U.S. nutrition policy and putting real food back at the center of health.”
The department says it is “prioritizing protein” and “ending the war on healthy fats.” It encourages people to avoid consuming highly processed foods and refined sugars. The goal is to get people to eat better quality food as a way to improve their health.
"In this last release of the Dietary Guidelines, my head was spinning, because we really had some dramatic changes from the past. In my view, both a few positive changes and some negative changes as well," said Pablo Montivais, a professor in the Nutrition and Exercise Physiology program at WSU’s College of Medicine. He studies the links between diet and health and how what we eat is affected by our environment and social situations.
This interview is lightly edited for clarity and brevity.
Pedro Montivais: Some of the things that we look at in the Dietary Guidelines have to do with some of the concerning nutrients that we know are potentially harmful for health. Americans, for example, tend to consume too much saturated fat. And saturated fat is linked to cardiovascular disease and other adverse outcomes. In this new release of the Dietary Guidelines, the messaging around saturated fat has kind of changed.
And in fact, if you look at the graphic, the new inverted pyramid of the Dietary Guidelines, your eyes are really drawn to the fact that it's prominently displaying red meat, a lot of animal-based proteins, and full-fat and high-fat dairy products, which are major sources of saturated fat in our diets. So that's a really remarkable change, given that the scientific base has been telling us over the last few decades that reducing saturated fat and replacing it with healthier fats is an important way to prevent heart disease, which is really the leading killer in the United States.
Doug Nadvornick: What about protein? Because a lot of people are talking about, we need to take carbs out and replace them in our diet with more protein. What types of protein are we talking about then?
PM: Yes, that's another emphasis area on the new Dietary Guidelines that also marks an important departure, is that they are really, in a sense, talking about ramping up protein to a level that really the science doesn't support.
Let's just start off by saying most Americans get enough protein, and many of us get maybe too much. The protein that we get does come from animal sources. It also, importantly, can come from plant sources. So protein has become kind of an important nutrient, because people are talking about weight management and maybe fitness. And so protein can be an important part of that. Protein can be very satiating, very filling. So it can be important in your diet for that reason.
The potential harm of consuming too much protein is that it can increase your risk of kidney problems, for one. And you have also one thing that is not really mentioned in the Dietary Guidelines, if we bring in too much protein, especially from animal sources, you also have the risk of just increasing your intake of fats, saturated fat especially, and maybe even salt. Because a lot of the foods that are high in protein, animal-based products are also high in sodium.
DN: The Secretary has also emphasized the fact that a lot of those high processed foods bring a lot of sugars. Sugars lead to things like diabetes, which leads to lifelong health problems. What do you feel? Is he on the right track with that?
PM: Yes, this is another important distinction in the new guidelines that I think is a positive step.
This is the first time the Dietary Guidelines have mentioned these so-called ultra-processed or highly processed foods. These are the foods that really, unfortunately, make up the bulk of the American diet today. Some estimates say between 50% to 60% of the calories we eat are based on these ultra-processed foods. These are things that include refined grain, sugars, a lot of salt, and added fat, and maybe additional additives, things that you wouldn't typically have in your own kitchen. That's kind of part of the definition that's used for defining these foods.
There's a lot of research in the last 10 years that has shown that consuming a lot of these foods is linked to higher risk of, you name it, whether it's heart disease, type 2 diabetes, certain types of cancer. There's some remarkable short-term studies that have shown that when given free access to these foods, consumers tend to over-consume calories to the extent that they can consume maybe up to 400 to 500 calories extra per day, leading to, of course, weight gain and, importantly, fat gain, which, of course, is not good for most of us.
DN: You're a co-author of a fairly recent study with one or two of your students regarding "healthy foods" and what the government considers healthy here. Can you tell me a little about that research?
PM: Yes. In a sense, we road-tested a new Food and Drug Administration-based definition that was first floated kind of early in the Biden administration and then went through various iterations with feedback from scientists and industry and was just released really kind of in the middle of last year. So we developed a study to kind of apply this new definition to the American food supply to determine, OK, which of these foods that we're eating in this country qualify? And we found, remarkably, a minority of foods actually qualified. I would say less than 10% of the foods that Americans typically eat qualified under this designation.
The reason there's an interest in this designation is because, as I mentioned before, a lot of the foods that Americans eat are not whole, unprocessed foods. They're pretty much packaged foods that have some level of processing. So the purpose of this definition is really to help consumers identify, of those processed foods, which are the ones that might be more healthy.
Now, how do you define that? The kind of basic principle of this definition is that healthier products are going to be those that have a higher density of nutrients, given their calorie content. And why is that important? Because most of us get enough calories, or maybe too many calories, and really what we lack are those important vitamins and minerals and fiber that we need more of. This definition is meant to spotlight those foods that are richer in those nutrients. It was a little bit of a discouraging finding, I have to say, that such a minority, such a small percentage of foods actually did qualify.
What we also found in that study was that foods that seemed healthy, that you would have just thought, without any formal definition, looked healthy, sometimes fail the test, for example, beans that you purchase in cans, canned beans that are just black beans, pinto beans. Those foods often failed because the salt content that was in those products invalidated their healthy status.
And so that's one of the problems that we uncovered. Many foods that are available widely to consumers and might be affordable actually ended up being not designated healthy because they fell down on either added salt, added fat, or added sugar, which could then undermine the overall quality of an otherwise healthy product.
DN: So are you essentially saying that less than 10% of our food is worthy of being eaten?
PM: That's the question. I think the definition has its own technical quirks, I have to say.
I think it would be an important next step to say this definition is so restrictive. Does it really need to be this restrictive to identify foods that are truly healthy?
I would say that just from my own view of the study that we did, there were still a lot of foods that I would have designated, based on my own research, as being healthy, but just they fell down for different reasons in the designation, the technicalities of the definition. So we actually made some recommendations about how the definition might need to be updated to better accommodate some of those foods that we know from other studies are healthy.
But also, there's room for the industry to come in, too, to say, look, we're processing all these healthy foods and making them available to consumers in canned products. If we just lower the salt or remove the sugar, we might actually be able to have them be designated as healthy products. And they'd still be affordable to consumers. That's an important point, too.
DN: One of the things that became clear to me when reading the new federal guidelines is when the Secretary says, just eat more real food. Sometimes real food is not available in certain places, food deserts, or it just becomes so expensive that it's really hard, if you have a lower income, to be able to buy that kind of stuff. What are your thoughts about that?
PM: Yeah, that's a very critical point that in the previous at least 20 years of guidelines, and so maybe last four iterations of the dietary guidelines, they've really been more mindful of some of these issues that you raised, the cost of healthier food and access that consumers have to healthy food retailing.
The new dietary guidelines didn't really address that and to just say, hey, spend your money on whole foods and don't eat junk is kind of disingenuous, because a lot of research shows that those whole, healthier foods tend to be more expensive for consumers. And as you point out, in many communities, the kinds of retailing that people have access to, you're not going to see a produce department there. You're going to walk in and see basically a kind of convenience store model where you have a lot of highly processed foods and refrigerated products that are maybe not the healthiest. But this is the way that many people access food. And so there are real structural issues in people's ability to access healthy food, including the price.
If we follow the guidance and move away from ultra-processed foods to these so-called whole foods and unprocessed foods, research suggests that we're going to also need kind of a larger food budget to do that. Consumers will need to spend more.
DN: Three years down the road, we may have a new president who decides something else. Is this a transitory sort of thing?
PM: Yes, that's an important point. I think we are looking at, I guess, a breakdown between the communication of the dietary guidelines and the evolving scientific base. Really, the scientific base has been incrementally growing and improving over the last 30, 40 years. What really is apparent in this last release is really, in a sense, a complete, partial disconnect with that scientific base.
And it might be worth pointing out that this is not the only area where the Department of Health has deviated from scientific evidence, but it is one important area. So what I see in the future is, should we come back to a perhaps less ideologically-driven administration in the coming years, I would hope for more of a return to that incremental approach to communicating nutrition and health, because really, that is how our evidence grows. We don't tend to have radical changes in the science overnight.
We've really evolved in how we understand things like fat and saturated fat and healthy fats. Those are all stories that have all evolved in the last 20 years and are reflected in the dietary guidelines. So to see so much of that thrown out the window is disheartening as a scientist. And I think it does the American public and the consumers a disservice.
