A set of dietary guidelines issued by the federal government more than three years ago is still generating controversy. An advisory committee appointed by the U.S. Department of Agriculture to review and update the guidelines met for the first time this month, and it was clear after the two-day meeting that the issue will continue to sizzle for months to come.
The guidelines consist of seven strictures, whose apparent basis in common sense has led some people to wonder what all the fuss is about. But meat, egg and dairy producers have fussed plenty since the guidelines were issued by USDA and the Department of Health and Human Services. Their biggest complaint has been with the recommendation to moderate consumption of fat, saturated fat and cholesterol; their biggest fear that it would dampen people's enthusiasm for eating red meat, eggs and dairy products. The industry clamored for changes in the guidelines, and late last year, following a 2-year-old request by a Senate committee, USDA announced the formation of an advisory committee to take another look at the guidelines.
But when the names of the appointees to the panel were announced, the fuss came from consumer groups, who charged that five of the nine nominees were scientists who had financial ties to the food industry and whose views on fat and cholesterol consumption were contrary to the prevailing view of the scientific community.
At the July 20-21 meeting it was clear those views are still held by some of the panel members. Robert Olson, a biochemist from the University of Pittsburgh School of Medicine, contended that studies have not yet established a link between high fat diets and cardiovascular disease. Olson was the primary author of a 1980 report by the Food and Nutrition Board, an arm of the National Academy of Sciences, which caused a furor because it failed to recommend that Americans cut their intake of fat and cholesterol.
At the meeting, Frederick Stare, a professor emeritus of nutrition at the Harvard School of Public Health, called for junking entirely the guideline advocating a lower fat diet. Stare is cofounder of a nonprofit, industry-supported group called the American Council on Science and Health, which seeks to allay people's fears about public health hazards. Stare said the guideline should be replaced with one that advises people to adjust total caloric input to caloric output, commenting, "It doesn't make a lot of difference if you eat a lot of fat or a little fat, or a lot of sugar or a little sugar, as long as you have the correct caloric intake."
"I would have a problem agreeing with that," replied panel member Lester Salans, director of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases at the National Institutes of Health in Bethesda.
Both Salans and panel member Robert Levy, former director of the National Heart, Lung and Blood Institute and now with Columbia University, expressed support for the fat and cholesterol guideline. The nomination of Levy, a leading cardiovascular expert, was endorsed by the American Heart Association. But observers at the meeting wondered whether his expertise would be put to use when it was revealed that Levy had not been assigned to the subgroup in charge of drafting a new fat and colesterol recommendation. Committee chairman Bernard Schweigert, a food technologist at the University of California at Davis who assigned panel members to subgroups, said he tried to match expertise with subject area but that the assignments were "somewhat arbitrary."
At the close of the two-day meeting, Levy expressed unhappiness with the subcommittee assignments and was included in the fat and cholesterol subgroup. He will work with Olson and David Kritchevsky, associate director of the Wistar Institute in Philadelphia, who has also questioned the benefit of a low-fat diet. "The data suggest everything in the diet can affect serum cholesterol levels, not just fat," he told the other panel members at the meeting.
When the guidelines were drawn up in 1980 by USDA and HHS officials, they studiously avoided defining how much was "too much" fat, sodium and sugar for a general population. At the July meeting, Olsen noted that one of the issues the panel will have to deal with is whether quantitative amounts for these macro-nutrients should be inserted in the guidelines. Other panel members were concerned that this would cause furthur controversy.
The guideline to avoid too much sugar, which primarily discusses the problem of tooth decay, also appears to be in danger. Olson complained the recommendation "plays into the hands of food faddists." He added, "The inference from this guideline is that anything white is not natural."
Stare agreed the guideline should be eliminated, suggesting it be replaced with a recommendation to drink fluoridated water whenever possible. There are no dental experts on the panel.
There was less disagreement among the nine committee members about the guidelines recommending that a variety of foods be eaten, that ideal weight be maintained and that alcohol be taken in moderation. And there was surprisingly little opposition to the guideline to avoid too much sodium. However, some changes will probably be recommended by the committee in all the guidelines.
The two-day discussion left the distinct impression that many committee members believe the present American diet has served the public well and that any recommendation for change should be approached with caution. Henry Kamin, a biochemist at Duke University, called for a new guideline that would say, "Please don't louse up your diet." He remarked, "I'm very reluctant to abandon the American diet to one that's overly austere. Let's be very cautious and not go overboard." But Levy replied, "These guidelines are moderate and conservative and don't recommend austerity or deprivation."
The committee is supposed to look at any new studies that would suggest changes in the present guidelines. Recent studies discussed at the meeting indicate that:
* A diet high in fat may act as a promoter of various kinds of cancer, such as breast cancer.
* Men with low blood cholesterol may have a higher risk of cancer.
* The complex carbohydrates found in different starchy foods, such as rice, bread, corn or potatoes, may exert different effects on blood sugar and lipid levels.
* The body may react to fiber in a variety of ways, depending on the type of fiber consumed.
* Alcohol consumption during pregnancy may pose a risk to the fetus, no matter what the level consumed.
Schweigert said he expects the committee to complete its recommendations for changes to the guidelines within a year. The changes will be sent to USDA and Health and Human Services officials, who will have to make the ultimate decision about whether to revise the guidelines.
A copy of the 1980 "Dietary Guidelines for Americans" can be obtained from the U.S. Government Printing Office for $2.25. Comments on the guidelines will be considered by the advisory committee and should be sent to Isabel Wolf, Administrator, Human Nutrition Information Service, 6525 Belcrest Rd., Room 522, Hyattsville, Md. 20782, by Sept. 1.