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All in Favor of Changing the US Dietary Guidelines and MyPlate?

3/2/2014

10 Comments

 
Picture

March is National Nutrition Month, and March 12 is National Registered Dietitian Nutritionist Day. So around this time of year, I get a lot of emails offering special deals on promotional items like nutrition posters, handouts, food models, games, books, etc. I rarely purchase them because their message is so far removed from my own nutrition philosophy, but I still look at them. One of the "teaching tools" promos I received this week was the banner to the left. It's the USDA MyPlate logo covered with specific foods from each of the categories: grains, fruits, vegetables, protein, and dairy. 

I've never been a fan of MyPlate and wasn't a fan of MyPyramid either (really the same information in a different graphic), and it upset me to see the possible combinations of food I"m supposed to be promoting as a "healthy meal" for individuals across the board with few exceptions (i.e., less protein and sodium for people with renal disease). To anyone who argues that MyPlate does not constitute a high-carbohydrate diet (I've seen this argued by dietitians and CDEs many times), I take issue with that claim. Half the plate is automatically made up of high-carb food from the fruit and grains sections. The vegetables could be low in carbohydrates, but not if corn, carrots, and peas are chosen. (Quick aside: At a local restaurant, I recently ordered steak tips without the noodles. My server asked if I wanted extra vegetables. Instead of asking what the vegetables were (always ask!), I said yes. Of course, I was served corn and peas.)  Most protein options are low-carb, but legumes are listed as being interchangeable with meat, poultry, and fish. The dairy on the side of the plate could be cheese, but most people looking at the blue circle would probably believe that milk is the best choice. And really, who could blame them? Also, fat isn't anywhere on the plate at all. At least the Food Pyramid used to have a tiny sliver of yellow to represent fats and oils. And according to MyPlate, cheese is considered empty calories because it contains solid fat. 

I understand that some people can eat according to MyPlate and stay healthy; several members of my own family can and do eat a large portion of their diet as carbohydrates and maintain a good weight, normal blood sugar, and good energy levels. But for many others, including people with diabetes and other metabolic issues, this plate just isn't appropriate. When I read diabetes magazines, the recommendation most CDEs make is to follow MyPlate or to "eat the same balanced diet recommended for everyone else" -- essentially, to follow MyPlate. 

MyPlate is based on the USDA's Dietary Guidelines, which are set to be revised in 2015 by the Dietary Guidelines for Americans Committee. So far, I've heard that they will likely place an emphasis on plant-based diets, the Mediterranean Diet, and the Dash Diet. From the evidence I've reviewed (both anecdotal and many well-designed studies), these three diets are too high in carbohydrates for many people, with the exception of a low-carb version of the Mediterranean Diet such as Dr. Steve Parker's Low Carb Mediterranean Diet and Ketogenic Mediterranean Diet. So why isn't carbohydrate restriction being given consideration as well in formulating the nutrition guidelines designed for the entire US population?

Dr. Richard Feinman and Judy Barnes Baker have drafted a petition to change the way the Dietary Guidelines are created by having independent experts review all available nutrition-related studies in order to formulate guidelines that are truly evidence based. The petition needs 100,000 signatures by March 20. As of today, it has only 943. I'd like to ask all of my readers to please sign the petition (if you haven't done so already) and share the link with others who disagree with the one-size-fits-all recommendations in the US Dietary Guidelines and MyPlate. It only takes a couple of minutes to register and sign, so please do it. The only way we can change nutrition policy for the better is by taking action like this. Thank you very much.


10 Comments
Dan Brown link
3/2/2014 09:53:24 pm

Q. 1: Are we (you and I and other like-thinkers) mostly "preaching to the converted"? Q. 2: How can we extend our outreach through our blogs?

Reply
Franziska Spritzler link
3/2/2014 10:59:49 pm

Hi Dan,

A.

1. Probably

2. Good question, and I wish I had a good answer. I posted this to Facebook and Twitter; hopefully people will share and reach others who aren't aware of the problems with the guidelines. I'm also planning to speak about this with Dr. Feinman next week at the Nutrition and Metabolism Society conference in Philadelphia.

Reply
Eddie Mitchell link
3/4/2014 03:30:07 am

Hi Franziska this article will interest you. Only a very small study but reflects the experience of the many diabetics I know and have worked with over the last six years.

Published yesterday in Practical Diabetes - A low carb approach in General Practice.

Abstract

Patients with diabetes have long been exhorted to give up sugar, encouraged instead to take in fuel as complex carbohydrate such as the starch found in bread, rice or pasta (especially if ‘wholemeal’). However, bread has a higher glycaemic index than table sugar itself. There are no essential nutrients in starchy foods and diabetics struggle to deal with the glycaemic load they bring. The authors question why carbohydrate need form a major part of the diet at all? The central goal of achieving substantial weight loss has tended to be overlooked. The current pilot study explores the results of a low carbohydrate diet for a case series of 19 type 2 diabetics and pre-diabetics over an 8 month period in a suburban general practice.

A low carbohydrate diet was observed to bring about major benefits. Blood glucose control improved (HbA1c 51±14 to 40±4mmol/mol; p<0.001).By the end of the study period only 2 patients remained with an abnormal HbAic (>42mmol/mol), even these two had seen an average drop of 23.9mmol/mol. Weight fell from 100.2±16.4 to 91.0±17.1kg (p<0.0001) and waist circumference decreased from 120.2±9.6 to 105.6±11.5cm (p<0.0001). Simultaneously, blood pressure improved (systolic 148±17 to 133±15; p<0.005; and diastolic 91±8 to 83±11 mmHg; p<0.05). Serum gamma GT decreased from 75.2±54.7 to 40.6±29.2 U/l (p<0.005). Total serum cholesterol decreased from 5.5±1.0 to 4.7±1.2mmol/l (p<0.01). This approach is easy to implement in general practice, brings rapid weight loss and improvement in HbA1c. The great majority of patients find a low carbohydrate diet easy to live with.

Full article coming soon. Keep up your great work.

Highest respect, Eddie

Reply
Franziska Spritzler link
3/4/2014 07:11:57 am

Hi Eddie,

Thanks so much for sharing this wonderful study with me and my readers! It's a small one, but the results are impressive nevertheless. I look forward to reading the full article to see what type of carb restriction was involved and the individual results.

Thanks also for your continued support and your wonderful work over at The Low Carb Diabetic UK.

Kind regards,
Franziska

Reply
Eddie Mitchell link
3/4/2014 07:23:01 pm

Hi Franziska

This was an instruction sheet given to the participants on the trial. As you can see not overly strict or very low carb, the participants had no trouble sticking to it and I can see why. With the excellent improvements in the markers quoted, it makes me wonder how bad their diets must have been before the trial. Not surprising they became diabetics in my opinion.

Reduce starchy carbs a lot, if possible cut out the ‘White Stuff’ like bread, pasta, rice --though porridge, new potatoes and oat cakes in moderation may be fine. Sugar -cut it out altogether, although it will be in the blueberries strawberries and raspberries you are allowed to eat freely. Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; -they just make you hungrier!! Increase healthy fats as they keep you full for longer and are fuel.

All green veg/salads are fine- eat as much as you can, So that you still eat a good big dinner try substituting veg such as broccoli ,courgettes or green beans for your mash pasta or rice- still covering them with your gravy ,bolognaise or curry ! Tip try home-made soup it can be taken to work for lunch and microwaved. Mushrooms, tomatoes, and onions can be included in this.

Fruit is trickier; some have too much sugar in and can set those carb cravings off. All berries are great and can be eaten freely; blueberries, raspberries, strawberries, apples & pears too, but not tropical fruits like bananas, oranges, grapes, mangoes or pineapples.

Proteins such as in meat, eggs, fish- particularly oily fish such as salmon, mackerel or tuna are fine and can be eaten freely. Plain full fat yoghurt makes a good breakfast with the berries. Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be eaten in moderation

Fats (yes some fats can be fine in moderation) olive oil is very useful, butter may be tastier than margarine and could be better for you!, coconut oil - great for stir fries. Four essential vitamins A, D, E&K are only found in some fats or oils. Try full-fat mayo or pesto. Avoid margarine, corn oil and vegetable oils.

Cheese only in moderation- it’s a very calorific mixture of fat, carbs and protein.

Snacks Avoid, but un-salted nuts such as almonds or walnuts are great to stave off hunger. A hard-boiled egg is another idea. The occasional treat of strong dark chocolate 70% or more in small quantity is allowed
EATING LOTS OF VEG WITH PROTEIN AND FATS LEAVES YOU PROPERLY FULL in a way that lasts.

Finally about sweeteners and what to drink –sweeteners have been proven to tease your brain into being even more hungry making weight loss almost impossible -drink tea, coffee, and water or herb teas. I'm afraid alcoholic drinks are full of carbohydrate- for example beer is almost 'liquid toast' hence the beer belly!! Perhaps the odd glass of red wine wouldn't be too bad if it doesn't make you get hungry afterwards- or just plain water with a slice of lemon.

Where to get more info ?
A book – ‘Escape the diet trap’ by Dr John Briffa - Well researched and easy to read.
Internet - Google 'about.com low carb diet' for loads more info and recipes or look into the closely related PALEO DIET

Kind regards Eddie

Reply
Franziska Spritzler link
3/4/2014 09:18:36 pm

Thanks for sharing this as well, Eddie. Yes, definitely not very strict and probably moderately low carb, which is a great start for people following the SAD. Very reasonable advice.

Reply
David link
3/9/2014 04:35:09 am

Franziska, interesting article!

Eating according to others reccomendation is a bit weird, because different types of foods are influencing differently on our bodies. Especialy carbohydrates..

Thanks!

Reply
Franziska Spritzler link
3/9/2014 10:39:44 pm

Thanks, David!

Reply
Jay
3/20/2014 01:06:18 am

You said: "But for many others, including people with diabetes and other metabolic issues, this plate just isn't appropriate."

Sorry, but this way of eating is just fine for MANY people with Type 1 diabetes, including me (for 40 years). It isn't necessary for diabetics to be afraid of food. It is necessary for diabetics to be SMART about food. Please don't assume that you know what it is like to manage long-term Type 1 diabetes - that comment suggests that you lump all diabetics Type 1 and Type 2 together which you really should not do.

Reply
Franziska Spritzler link
3/20/2014 01:29:07 am

Thanks for your comments, Jay. I'm glad MyPlate works for you. However, there are many people with Type 1 diabetes who aren't able to achieve good BG control eating the way you do. I've heard from dozens over the years who finally experienced normal BG levels as a result of following carbohydrate restriction. I don't lump all PWDs together; I know that some of the lucky ones like you can eat a higher carb diet and do okay. But I'd argue that the majority of Type 1s who follow such a diet have A1cs above 6.5%, indicating frequent BG elevations that could lead to retinopathy, nephropathy, cardiovascular disease,and other serious medical problems. Thanks again for your comments, and I do wish you all the best :)

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