Health Insite

The War of the Pyramids

December 2002

Remember the "Food Guide Pyramid"? Every grade-schooler does. The latest version was introduced ten years ago, in 1992, and hasn't been revised since. The underlying guidelines have been updated, elaborating on the image, but the image itself is now ten years old. Does it still represent what science tells us is a healthy diet? Are the underlying guidelines accurate? These questions are at the heart of a debate now taking place among scientists, government, and industry across the nation. But the most important question of all is what does this mean to your diet.

Dr. Stempher's Dissention

Every five years the United States Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) get together to release the "Dietary Guidelines for Americans" that elaborate on the basic message of the pyramid. They invite a committee of experts to offer suggestions for changes based on new research findings. The departments then review the recommendations and make adjustments to the pyramid guidelines as they see fit. When this process was last completed in 2000, Dr. Meir Stampher was asked to serve on the committee. Dr. Stampher was then a professor in the Departments of Epidemiology and Nutrition and Chair of the Department of Epidemiology at the Harvard School of Public Health.

Though Dr. Stampher agreed with many of the 2000 recommendations, he was clearly upset by the government's disregard for many experts' recommendations and the studies upon which they were based. He believes that the government is overlooking evidence due to a fear of confusing the public by contradicting their own longstanding recommendations. Dr. Stampher expressed these concerns to reporters for Nutrition Source, a website maintained by the Harvard School of Public Health. In response to the government's guidelines, he and his colleague, Dr. Walter Willett (Chair of the Department of Nutrition), set out to develop their own recommendations to challenge the pyramid.

Eat, Drink, and Be Healthy

In 2001, Dr. Willett published the early results of their research, and a new pyramid, in his book Eat, Drink, and Be Healthy. It emphasizes the importance of protein and produce, while de-emphasizing carbohydrates. Most importantly, it distinguishes the difference between good protein sources and bad, good carbohydrates and bad; and it establishes the importance of healthy fats. Now, a year after publication of the book, the American Journal of Clinical Nutrition is publishing definitive proof that the Harvard guidelines make sense.

Dr. Willett's research team at Harvard chose 100,000 men and women from the Health Professionals Follow-Up Study and the Nurses' Health Study, two of the longest-running, most comprehensive general health assessment projects ever developed. The men and women were sent detailed questionnaires designed to critically evaluate their consumption of various foods—something both study groups had been doing for some time as part of their participation in their respective studies. The critical assessment of these 100,000 people clearly showed that the researchers' ideas were correct, and that the food pyramid needs to be turned on its tip.

What is "Healthy Eating"?

When revising the Dietary Guidelines for Americans, the government looks at their "Healthy Eating Index" (HEI), which establishes point values for foods that are recommended and consumed. But like the pyramid, the HEI does not distinguish between sources of nutrients. Therefore, when beginning their research, Dr. Willet's team designed what they call the "Alternative Healthy Eating Index" (AHEI), which does consider the quality of nutrient sources and food choices.

The results of their research are nothing short of amazing. By following the AHEI, men reduced their overall risk of chronic disease by 20 percent; women lowered their risk by 11 percent. Compare this to the reductions of 11 percent and 3 percent, respectively, garnered by following the government's old HEI, and it's clear which guidelines are the best for maintaining good health. For cardiovascular disease alone, following the AHEI reduced men's risk by 39 percent and women's risk by 28 percent.

The AHEI is represented by the new "Healthy Eating Pyramid" Dr. Willett published in Eat, Drink, and Be Healthy (shown below), an image that takes into consideration the sources of nutrients like protein, carbohydrates and fats, distinguishes the difference between good and bad, and includes items such as alcohol and multivitamins not even represented on the government's pyramid. Commenting on the research, Dr. Willett said, "The current USDA dietary pyramid misses an enormous opportunity for improving the health of Americans. It's clear that we need to rebuild the pyramid from the ground up. Every American deserves it."

The Government Responds

The USDA has been fielding criticism of their pyramid since its inception, but it appears that the new push is making waves. Acting director for the agency's Center for Nutrition Policy and Promotion recently told USA Today that they are "looking to make sure the recommendations are consistent with the most recent science, and that it (the pyramid) is better interpreted by the public.

One problem, he says, is that the pyramid has become a stand-alone image and is not readily understood as a brief representation of the full-text guidelines that accompany it. Dr. Willett's pyramid, however, attempts to explain the recommendations further within the pyramid itself, so that those who do not study the underlying text will still get the message.

Another challenge for the government is balancing the advice of academia against the interests of industry, which has deep pockets and influential lobbyists by the thousands. Even the Wheat Foods Council, which represents the grain industry, is wary of agreeing with the changes the Harvard studies suggest because these changes promote whole grains at the expense of refined grains, which make up the majority of consumer grain products in America. The Cattlemen's Beef Association, not surprisingly, says that any changes to the meat group would "concern them." And so the debate continues.

Still, the USDA assures us that they are looking at revisions to the pyramid, including new recommendations from the Office of Medicine at the National Institutes of Health, which has released new recommendations for foods like fiber and essential fatty acids. But don't look for a change in the shape. "It's probably the most recognized nutrition symbol ever developed," says the government.

What to Do

It's clear that proper human nutrition is too complex to be illustrated in a simple graphic symbol; and that no matter what the symbol includes, it must be updated regularly. While the USDA takes a hard look at its recommendations and the accompanying pyramid, perhaps the best advice is for us all to take a hard look at our diets.

We've included links to the sources used for this article, as well as to other useful information sites online, to help you make informed decisions for your family's eating habits. Take some time to browse them, think about what you eat on an average day or an average week, and see how you measure up. More importantly, consider how you feel, how much energy you have and how often you feel sick, and think about how the foods you eat might play a role in your quality of life. If the old maxim is true—that you are what you eat—perhaps the secret to living a healthier, happier life is as close as the refrigerator.

References and Further Reading

"Food Pyramids," Nutrition Source Website (Harvard School of Public Health), www.hsps.harvard.edu/nutritionsource/, 2002.

Press Release, Harvard School of Public Health, November 21, 2002.

Hellmich, N: Scales tip in favor of new food pyramid.USA Today, November 4, 2002.

USDA's Center for Nutrition Policy and Promotion. Includes the Food Guide Pyramid, the 2000 Dietary Guidelines for American's, and more. www.usda.gov/cnpp

USDA's Food and Nutrition Services. www.usda.gov/fns

The American Journal of Clinical Nutrition. www.ajcn.org

The Health Professionals Follow-Up Study. www.hsph.harvard.edu/hpfs

The Nurses' Health Study. www.channing.harvard.edu/nhs

The American Dietetic Association. www.eatright.org

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