RTTP Workshop, January 21 Notes for my role as "Elaine Arkin" * I worked as a contractor with the USDA staff in developing the "Food Pyramid" recommendations. So my point of view should be more in line with that of the other USDA staff members and *not* with that of the new Secretary of Agriculture (who decided in 1991 to withdraw the Pyramid under pressure from meat and dairy interests, and to study it further before making a new set of nutritional recommendations) * In other words, I should be working to convince the Congressional Committee that the science behind the Food Pyramid recommendations is strong and that, the further study is really unnecessary (maybe even that the Food Pyramid recommendations don't make really huge changes in any case -- they just give people -- the target audience with 12th grade reading skills, etc. a new and superior way to think about priorities for diet choices). This will involve walking a fine line -- not being too confrontational with the "new boss" of the USDA (the new secretary), but also being firm that 1) the Food Pyramid recommendations are essentially right -- in line with the best science we have, e.g. from the Surgeon General's Report -- and that it should be disseminated 2) the development of the Food Pyramid was a careful and well-done process [see Welsh-Davis-Shaw article for details]; new recommendations different from 1946 USDA "Basic Four" necessary because of new situation: "eat more" to avoid malnutrition is not needed any more, and new science indicates "eat less of some food types" will improve health Pyramid graphic yielded best results -- even in additional testing after the 1991 decision by the Secretary of Agriculture -- (p. 35-37). * At the same time, my "victory goals" for the game indicate that I should *not* advocate relieving the USDA of resposibility for making nutritional recommendations, even though the traditional role of the USDA as an advocate for farming (especially meat and dairy) interests is creating a possible conflict of interest for the USDA in the light of new understanding of the health effects of diets high in fat from meat and dairy products. Possible rationale to use for this: One key aim of the USDA is to "improve nutrition and health by providing food assistance and nutrition education and promotion." This is done by sections of the agency that are not directly connected with the regulatory and promotional offices. But the USDA also indeed has long-established regulatory power over, and close ties with, the meat, dairy, and other food production industries. Who is better situated to try to mediate with/influence those industries to work to address the links between diet and newly-understood public health issues (high-fat diets and links to cardiovascular disease, cancer, diabetes, ... )? We're in this together and we don't want this to become a destructive confrontation between the food producers and those charged with making recommendations about diet for public health. So keeping this role for the USDA makes practical sense. i.e. joint role for USDA and DHHS is OK, and preferable to relieving USDA entirely * The scientific evidence Surgeon General's Report: reduction in dietary fat, and limit total calories -- would reduce risk of heart disease, cancer, stroke, diabetes, GI increase starch, fiber -- reduce risk of cancer, diabetes, GI reduce sodium -- reduce heart disease, stroke reduce alcohol -- reduce cancer, stroke, GI extensive vetting process by 200 scientists over 4 years by Public Health Service, NIH highest priority is to reduce consumption of fat and saturated fat Recommendations: 1) Reduce fat and cholesterol by adding fruits, vegetables, whole grains, fish, poultry, lean meats, low-fat dairy 2) Maintain healthy body weight (control calories and regular exercise) 3) Increase whole grains, vegetables, fruits, dried beans -- more complex carbohydrates (fiber) 4) limit sodium 5) alcohol only in moderation More details on connection diet -> heart disease (CHD) CHD is directly linked to high total serum cholesterol LDL "bad" + HDL "good" dietary saturated fats and cholesterol raise total and LDL polyunsaturated fats lower total and LDL exercise, weight loss, estrogen (women) raise HDL BUT ... "It has been difficult to demonstrate a connection between dietary fat and serum cholesterol" by studies within populations, with controlled diets different fats have different effects (omega-3's "good", omega-6's "not as good") obesity associated with increased CHD alcohol use seems to give a moderate benefit (reduce CHD) but must be in moderation, and other problems make it not wise to recommend increasing alcohol consumtion high fiber diets associated with reduced CHD changing diet for those who already have heart disease gives definite benefits if total serum cholesterol is reduced, HDL increased. More details on connection diet -> cancer Cancers result from a complicated interaction of factors -- diet, lifestyle, genetics, environment diet can influence development of tumors at several stages and in different ways (not entirely understood) Ecological studies (weak) indicate positive correlation between dietary fat intake and incidence of breast cancer other studies have indicated other connections "In spite of the many limitations noted for these studies, there is a clear consensus that changing diet can reduce risk of cancer." Table 14 (p. 49) summarizes associations between diet and cancer according to this consensus. National Cancer Institute has made dietary recommendations in line with what was incorporated into the Food Pyramid: Fat intake < 30% of total calories > 20g fiber per day <- esp. for link w/ colon cancer Variety of fruits and vegetables every day Maintain proper weight Alcohol only in moderation Limit smoked, salted, pickled foods <- link with esophageal, stomach cancers Even if causal mechanisms aren't completely understood,