Report to USDA: “Americans Should Eat More Plant-Based Foods, Less Sugar”

When the USDA releases its recommended dietary guidelines every five years, you can expect a food fight of epic proportions. This year's scientific report–essentially the paper that is submitted to the Secretaries of Agriculture and Health and Human Services in advance of the guidelines–states clearly that we should all be eating more plant-based foods and less added sugar, and do so as if our lives depended on it.

As well as promoting plant-based foods, the report also says Americans should avoid saturated fat, cholesterol, and red and processed meat. If followed, the recommendations send a powerful message during a pandemic that more plant-based foods including fruit, vegetables, whole grains, nuts, seeds, and fewer animal products, processed foods, and sugar are essential changes to our nutrition now, and essential for the health of Americans.

"A noteworthy difference from the 2015 Committee report is that whole grains are now identified with almost the same consistency as vegetables and fruits as beneficial for the outcomes examined, suggesting that these three plant-based food groups are fundamental constituents of a healthy dietary pattern."

The report, by doctors, RDs, data scientists, behavioral experts, and others in the human nutrition field,  recommends replacing saturated fat, found mostly in animal products, with unsaturated fats, found mostly in plant-based foods, and increasing our fiber intake, while reducing added sugars and adding whole grains, as a way of lowering obesity, type 2 diabetes and risk of cardiovascular disease.

The context of the report being delivered during the pandemic was cited as one reason to recommend Americans eat more plant-based foods, since the scientists noted that the coronavirus has significant nutritional implications, given the fact that America is suffering from "parallel epidemics," one non-infectious, meaning obesity, and the other infectious, meaning the virus. The overlap between these two epidemics in America obesity and COVID-19 means that the more whole plant-based food you eat, the better off you are likely to fare.

"The Committee began its work in March 2019. As the 2020 Committee submits its report and the 2020-2025 Dietary Guidelines for Americans are prepared, we are in the midst of the COVID-19 epidemic. As more is learned about infection by SARS-Co V-2 and the development of COVID19, it is clear that it has significant nutritional implications. These parallel epidemics, one noninfectious ( obesity and diet-related chronic diseases) and one infectious (COVID-19) appear to be synergistic. Those at most risk for the most serious outcomes of COVID-19, including hospitalization and death, are people afflicted by diet-related chronic diseases ( obesity, type 2 diabetes, and cardiovascular disease).

One aspect the report addressed is the importance of food in the treatment of chronic diseases and food insecurity and ready access to healthy food choices that are "outside" the report's ability to address as they assess the need for new guidelines.

"For example, comments identified the need to evaluate dietary patterns that are effective in the management, support, and treatment of those with chronic diseases and disabilities to determine their value in clinical practice. In addition, comments identified the importance of evaluating the sustainability of recommended dietary patterns, addressing the social and economic aspects of access to foods that are components of healthy dietary patterns, and considering systemic changes to encourage behavior change consistent with the guidelines. These comments point to areas that are important for USDA and HHS to address through appropriate mechanisms, and their consideration may provide useful approaches for implementing the recommendations in the Dietary Guidelines for Americans."

The nutrition position paper, which will inform the next five years of federal dietary guidance, is being praised for encouraging the consumption of plant-based foods.

The Dietary Guidelines Advisory Committee's (DGAC) scientific report, which was compiled by the Committee's 20 top health experts, reviews the latest dietary and nutrition research and current state of American health as it relates to nutrition. It will be used by the USDA and the Department of Health and Human Services (HHS) to develop the 2020 Dietary Guidelines. One criticism so far is that it sidesteps the question of whether milk and dairy should be avoided, but it does specifically say stay away from saturated fat, which is in dairy foods.

The doctors and scientists noted that most chronic illness in America is tied to poor diet:

"More than 70 percent of Americans have overweight or obesity and the prevalence of severe obesity has increased over the past 2 decades. The increasing prevalence of overweight and obesity at young ages is of particular concern because of their effects on the current health of the child as well as the risks of persistent overweight or obesity into adulthood," the report noted.

"The high rates of overweight and obesity are an important public health problem in and of themselves, and they are a driver for prevalent diet-related chronic diseases, such as cardiovascular disease (CVD), type 2 diabetes, and some types of cancer. At present, 6 in 10 Americans have a chronic condition and 4 in 10 Americans have 2 or more chronic conditions. Various factors contribute to the prevalence of these chronic diseases. Prominent among these are unhealthy dietary patterns and a lack of physical activity." it added.

"Food insecurity and lack of access to affordable healthy food is a persistent problem. In 2018, more than 37 million people, including 6 million children, lived in households that were uncertain of having, or unable to acquire, enough food to meet their needs. Certain populations are disproportionately affected, including low-income, Black non-Hispanic, and Hispanic households, households with young children, and households headed by a single woman or man," states the report.

"Most Americans have 1 or more chronic diet-related health conditions, including overweight and obesity, heart disease, stroke, type 2 diabetes, hypertension, liver disease, certain types of cancer, dental caries, and/or metabolic syndrome," the scientists found.

"The Committee’s review of current dietary intakes shows that the American dietary landscape has not changed appreciably over time. Across the lifespan, the typical diet Americans consume result in overconsumption of...  saturated fats, sodium, added sugars, and for some consumers, alcoholic beverages."

Meanwhile, the report states:  Intakes of fruits, vegetables, and whole grains are lower than current recommendations. Something has to change, they concluded.

As part of its focus on healthy dietary patterns that include nutrient-dense foods consumed at appropriate energy levels, the 2015-2020 Dietary Guidelines for Americans recommended that Americans consume less than 10 percent of energy from added sugars. That number has gone up, and now represents twice the current guidelines of added sugar.

"The 2020 Committee examined the impact of added sugars ... and found: "For Americans ages 1 year and older, the average consumption of added sugars represent 13 percent of daily energy intake," meaning that most Americans consume more than double the current recommendation for added sugar.

"Nearly 70 percent of intake comes from 5 food categories: Sweetened beverages, desserts and sweet snacks, coffee and tea (with their additions), candy and sugars, and breakfast cereals and bars. Evidence suggests that adverse effects of added sugars, particularly from SSB, may contribute to unhealthy weight gain and obesity-related health outcomes. Reducing the amount of added sugars in the diet, either through changes in consumer behavior or in how food is produced and sold, is an achievable objective that could improve population health.

"Reducing the amount of added sugars in the diet, either through changes in consumer behavior or in how food is produced and sold, is an achievable objective that could improve population health. After considering the scientific evidence for the potential health impacts of added sugars intake, along with findings from model-based estimations of energy available in the dietary pattern after meeting nutrient requirements, the Committee suggests that less than 6 percent of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10 percent energy from added sugars.

The scientists who worked on the report divided their recommendations into life stages to better suggest how infants, children, young adults and others (pregnant women for instance) should eat to be healthiest. They suggest reducing animal proteins and getting more fiber, from plant-based foods:

"For infants fed human milk, during the period of complementary feeding, patterns that include iron- and zinc-rich foods (e.g., meats, fortified cereals) and that also provide adequate protein and other minerals and vitamins, are essential to healthy growth and development.

• "Added sugars is a food component to limit in the diet. However, the connection to a healthful dietary pattern is the evidence on limiting the foods in the diet that are the top sources of added sugars (e.g., sweetened beverages, including additions to coffee and tea, and sweet snacks and desserts).

• "Few Americans achieve or exceed the Adequate Intake for dietary fiber, and a dietary pattern that encourages the intake of fiber-rich foods, including whole grains, fruits, vegetables, nuts and legumes, and other plant-based foods would be beneficial to increase fiber intakes.

• To reduce saturated fat intake, the dietary pattern should replace sources of saturated fat with sources of polyunsaturated fats by substituting certain animal-source foods, especially processed meats and certain high-fat dairy products, with sources of polyunsaturated fats, such as seafood, seeds, nuts, legumes, and appropriate vegetable oils. In addition, if meat and dairy foods are included in the dietary pattern, choosing lean cuts and lower fat dairy options is preferred.

The scientists included in their recommendations to the Secretaries of Agriculture and Health and Human Services several ways to help people source, afford, prioritize and eat a diet of healthier food choices. Their recommendations include these:

1. Follow a healthy eating pattern across the lifespan. Suggested Update for 2020-2025: This guideline should introduce the importance of a healthful dietary pattern to support each life stage and of maintaining healthful dietary patterns across each life stage. For the 2020-2025 Dietary Guidelines for Americans, the life stages include pregnancy and lactation, birth to age 24 months, children ages 2 years and older, adolescents, and adults.

Concepts that the Committee recommends be included in the overarching guidelines: a. Initiate a healthful dietary pattern early in life for infants and young children. b. Follow a healthful dietary pattern appropriate for the nutritional needs of each life stage. c. Modify the dietary pattern over the lifespan to meet the nutritional needs of each life stage.

2. Focus on variety, nutrient density, and amount. Suggested Update for 2020-2025: The Committee’s review focused on the core elements of healthful dietary patterns, including the nutritional quality of food choices when incorporating variety.

The review also focused on frequency of eating, as determinants of the amount of food consumed. Concepts that the Committee recommends be included in the overarching guidelines: Part B. Chapter 2: Integrating the Evidence Scientific Report of the 2020 Dietary Guidelines Advisory Committee

a. Focus on nutritional quality of food choices, portion size and frequency of eating.

b. For the earliest life stage, focus on breastfeeding and human milk for optimal nutrition and gradual introduction of a variety of nutrient-rich complementary foods during the second half of infancy.

3. Limit calories from added sugars and saturated fats and reduce sodium intake. Suggested Update for 2020-2025: The Committee’s review emphasized the importance of identifying the foods to limit or replace in the diet to limit intake of certain food components. For those who consume alcoholic beverages, current evidence indicates that lower intakes are better than higher intakes and some groups should not drink alcoholic beverages. Concepts that the committee recommends be included in the overarching guidelines:

a. Limit foods and beverages that are sources of added sugars, saturated fats, alcohol, and salt to reduce intake of excess energy, solid fats, and sodium.

b. Replace foods and beverages that are sources of added sugars, saturated fats, alcohol, and sodium with more healthful choices.

c. In the first 2 years, foods such as sugar-sweetened beverages should be avoided.

4. Shift to healthier food and beverage choices. Suggested Update for 2020-2025: The Committee’s review found that this approach is linked to achieving the first guideline. In addition, this approach can help individuals understand that it is never too late to start making improvements in their dietary pattern.

To use this approach effectively, an individual will need to recognize what food and beverage choices are most important to shift. Concepts that the Committee recommends be included in the overarching guidelines:

a. Shift eating patterns to food and beverage choices that have a higher nutrient-to-energy ratio

b. Shift to higher quality food and beverage choices at every age to achieve a more healthful dietary pattern.