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Dietary Guidelines for Americans, 2015

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Keith Ayoob EdD, RD Comment ID #441

04/18/2014

To the Dietary Guidelines Advisory Committee:

As a clinician and registered dietitian in practice for 30 years with both general populations and those with special needs, a Dannon Nutrition Advisor, and as a consumer, I am a strong advocate of Americans eating a nutritionally balanced breakfast. While I have long encouraged consumers to drink milk to meet nutrient needs, the declining consumption of fluid milk (1) suggests that Americans are finding it a challenge to comply with such advice. Here,yogurt can play a critical role.

The importance of breakfast

Historically, breakfast has been a meal of habit. People who refuse to eat the same dinner two days in a row will eat the same breakfast for years. Thus the importance of a nutrient-rich breakfast as a vehicle for meeting dietary gaps that would otherwise go unmet.
Adequate dietary calcium and potassium are nutrients of concern. A daily serving of yogurt at a meal of habit such as breakfast, could go a long way towards correcting such a gap.
Protein presents different challenges. The timing of protein consumption appears to be useful for building muscle. Approximately 30 grams of protein at each meal was more effective at stimulating muscle synthesis than skewing protein toward the evening meal (2). Protein at breakfast can be critical to attaining sustained satiety throughout the day, particularly for those needing to restrict energy or lose weight (3,4). Low-fat and fat-free yogurt, especially the concentrated protein of Greek yogurt, can be a significant adjunct or mainstay of a nutrient-rich higher protein breakfast. The brand of yogurt matters not, but the inclusion of yogurt seems to also be associated with better diet quality and lower health risks (5).
Despite these and more advantages of a daily breakfast, up to 75% of Americans frequently skip breakfast (6), thereby potentially missing nutrients at this important meal that will likely not be made up during the day. Twenty to 30% percent of children and 31% of adolescents have been identified as breakfast skippers (7). Children and adolescents who skipped breakfast also tended to have poorer diets and were more likely to be obese.

Dietary Guidelines must be practical and realistic

Dietary recommendations need to be practical or consumers will not follow them. We need to eat well every day and that means recommending foods that are versatile and likeable enough to include every day but also convenient for current lifestyles.

Yogurt is just such a food. Indeed, people who eat yogurt have been found to have better diet quality and fewer health risks (Wang, Livingston, et al). It is ready-to-eat, requires no preparation, and can be savory or sweet in nearly limitless flavors, fat-free, low-fat, or full-fat, sweetened or unsweetened, low in calories and be included as part of a meal or as a stand-alone snack by all ages of Americans. It also provides 2 nutrients of concern: calcium and potassium and is DASH-diet friendly.

The recent addition of yogurt into the approved choices in WIC food packages clearly affirms that the nutritional and practical value of yogurt in the diets of mothers and children deserves strong support. Plus, yogurt is a healthful food that people already like and feel good about eating. Consumers like positive nutrition messages – they want to hear about what they CAN eat, not what they CAN’T eat or should avoid.
Yet despite yogurt’s nutritional assets, 9 out of 10 people eat less than one cup of yogurt per week (8). This is lost nutrition and it shouldn’t be. A recommendation to include one yogurt every day could go a long way towards helping consumers eat healthier diets, meet dietary recommendations, and reduce their health risks.

Conclusion

I respect your mandate to make evidence-based recommendations. A best case scenario combines the benefits of evidence-based research with practical, realistic guidelines that consumers can easily implement. For the reasons stated above, calling out the importance of a higher protein, nutrient-rich breakfast is worthy of a strong recommendation. I hope you will also show support for recommending one yogurt every day for both its nutritional and practical contributions to nutrient-rich diets for Americans.

Thank you again for your time.

Respectfully submitted,

Keith Ayoob, EdD,RD,FAND

References:
(1)http://www.ers.usda.gov/media/1118789/err149.pdf. Accessed March 13, 2014.
(2)Mamerow, MM et al. http://www.ncbi.nlm.nih.gov/pubmed/24477298
(3)Leidy et al. (2013) http://www.ncbi.nlm.nih.gov/pubmed/23446906
(4)Wang et al. (2013) http://www.ncbi.nlm.nih.gov/pubmed/?term=wang+and+troy+and+rogers
(5)http://appliedresearch.cancer gov/diet/usualintakes/pop/yogurt.html
(6)http://www.ncbi.nlm.nih.gov/pubmed?term=leidy+and+racki
(7)http://www.ncbi.nlm.nih.gov/pubmed/?term=deshmukh+and+niklas+and+oneil+and+keast
(8)http://appliedresearch.cancer.gov/diet/usualintakes/pop/2001-04/yogurt.html

Affiliation: Industry/Industry Association Organization: Dannon
Topic:
  • Eating Patterns-Diets (USDA Food Patterns, DASH, Vegetarian, Low Carb, Hi-Protein, etc.)
  • Food industry approaches to reducing sodium, added sugars, and fats
  • Protein (Plant, Animal)

David Wallinga MD, MPA Comment ID #440

04/18/2014

David Wallinga, MD, MPA
04/17/2014

Comments on Aspects of the 2015 Dietary Guidelines Related to Seafood Consumption; Balancing Nutritional Benefits with Longer-Term Risks Due to Methylmercury Exposure

Dear Dietary Guidelines Advisory Committee:

The literature on risks associated with methylmercury exposure at levels known to exist in seafood is voluminous. As a clinician, the greater challenge is how to communicate to patients the win-win of eating some seafood for its nutritional benefits while avoiding or reducing the mercury risks through smarter seafood choices.

The topic of benefits and risks of seafood consumption has been flagged for a coordinated evaluation by DGAC Work Groups 1 and 3. In fact, the 2015 Dietary Guidelines must give equal weight to both important public health goals: Promoting some fish consumption for the nutritional benefits it confers, but also guiding consumers in choosing low-mercury fish so as to minimize methylmercury exposure, particularly in more vulnerable populations. Here are the thought steps underlying this approach:

1. Methylmercury effects on the developing brain are clearcut, and known to occur at levels of exposure an order of magnitude lower than was recognized when fish consumption advice was first developed (in 2003) that later came to be incorporated into the preceding 2010 Dietary Guidelines was initially developed.

2. Yes, women of childbearing age and young children are at risk of excessive methylmercury exposure. However, several additional subpopulations can be identified that are at heightened risk, and therefore need and deserve guidance to choose low-mercury fish. These include frequent fish consumers, of all ages and genders. Certain ethnic minorities, including here in Minnesota, such as Hmong Americans and Native Americans, consume high fish diets, as do sushi lovers. Many health-conscious individuals have chosen fish as their primary protein source.

3. The type of fish consumed drives both the nutritional benefits (PUFA intake) and risks (methylmercury dose). To optimize the balance between the two, consumers need advice that guides them to choose specific high-PUFA, low-mercury varieties of seafood most often.

To summarize, the Committee should highlight the need for balanced, clear health messages that stress both benefits and risks. We urge it to craft layered, nuanced advice -- advice that includes details of the PUFA and methylmercury content of all popular seafood choices, so that consumers can choose wisely.

Thank you for your consideration.

David Wallinga, MD, MPA
Director, Healthy Food Action
St. Paul, MN 55105

Affiliation: Other Organization: Healthy Food Action
Topic:
  • Fats (Total Fat, Solid Fats, Oils, Fatty Acids, Cholesterol)
  • Food Environment
  • Food Safety

Thomas R Blakeslee engineer Comment ID #439

04/15/2014

Dear Dr. Millen and 2015 Dietary Guidelines for Americans Advisory Committee Members:

The existing USDA dietary recommendations regarding fat have created a $30 billion “low fat” food industry and caused an alarming increase in carbohydrate and PUFA consumption. Since these changes, the incidence of obesity, CVD, CHD, diabetes, cancer and chronic autoimmune diseases has increased dramatically. This committee has a golden opportunity to make recommendations that will restore the health of the people and save billions in future medical costs. But admitting an embarrassing mistake is difficult because we all unconsciously filter our perception through a lens that distorts reality in a way that justifies previous actions. Denial and groupthink produce the “Semmelweis reflex” which causes leading experts to ignore information that contradicts established conclusions.

Critics of the status-quo are often ignored without careful reading because established leaders have dismissed and even mocked them. I would like to suggest that members of the committee make a conscious effort to reread, with an open mind, some 2014 references. Please resist the groupthink tendency to dismiss because you have heard negative comments about the authors. It is natural for peer groups to “shoot the messenger” when the conclusions are embarrassing.

Fat and sugar consumption are highly correlated, so many of the conclusions about fat consumption may have blamed fat when the real culprit was sugar and flour. Another source of confusion is that the word “fat” includes trans fats, which are clearly harmful and also healthy low and medium density saturated fats like coconut, avocado, nuts and cheese. “Saturated fat” is a term that includes good and bad fats, so studies that lump them all together are meaningless.

2014 has seen a major shift in establishment thinking with important publications finally recognizing that a mistake has been made. I encourage the committee to review the April 2014 Mayo Clinic Proceedings paper titled “The questionable benefits of exchanging saturated fat with polyunsaturated fat.” It concludes: “The benefits of replacing SFAs with PUFAs are questionable. There is no evidence that a lower intake of SFA can prevent CVD and a high intake of PUFAs without specification may result in a high intake of omega-6, which is associated with many adverse health effects.Because there is much evidence that saturated fat may even be beneficial, we urge the American Heart Association, the American Diabetes Association, and the National Institute of Clinical Excellence to consider the aforementioned evidence when updating their future guidelines.”

In the March 2014 issue of The Annuls of Internal Medicine, Chowdhurry et al examined 59 trials with over half million participants and concluded that “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

The March 2014 issue of BMJ has an article by Wise titled “Evidence does not support guidelines on saturated fat”

The Jan 2014 issue of BMJ Open Heart has an editorial by DiNicolantonio called, “The cardiometabolic consequences of replacing saturated fats with carbohydrates or O-6 polyunsaturated fats: Do the dietary guidelines have it wrong?”

Siri-Turano et al reached similar conclusions in a 2010 study published in the American Journal of Clinical Nutrition. They concluded, “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD stroke or CVD.”

Sometimes a consensus is reached prematurely but experts are embarrassed to admit that a mistake was made. Ultimately the “elephant under the rug” becomes impossible to ignore and reality must be faced. The staggering expense and pain caused by the “low-fat” campaign is so great that I urge this committee to carefully reconsider the evidence on saturated fats with an intentionally open mind. The rush to judgement of the 1977 Senate committee has done incalculable damage.

request 2-1

Affiliation: Individual/Professional Organization: Clearlight Foundation
Topic:
  • Energy Balance (Weight Loss, Weight Maintenance, Calorie Intake, Physical Activity)
  • Fats (Total Fat, Solid Fats, Oils, Fatty Acids, Cholesterol)
  • Food industry approaches to reducing sodium, added sugars, and fats

Anonymous Comment ID #438

04/14/2014

Please see the attached letter and supporting research. There are five attachments.

Thank you.

Affiliation: Industry/Industry Association Organization: USA Rice Federation
Topic:
  • Carbohydrates (Added Sugars, Fiber, Glycemic Index, Whole Grains)
  • Energy Balance (Weight Loss, Weight Maintenance, Calorie Intake, Physical Activity)
  • Micronutrients (Sodium, Potassium, Vitamin D, Calcium, Iron)

Anonymous Comment ID #437

04/13/2014

Hello,
I've been interested in finding an example meal log for the duration of about a week (the longer the better) that strictly includes & itemizes the perfect nutritional meals.

I believe this would be helpful if made available to the public along side of the food pyramid. We've all heard the recommendations of "An apple a day, 8 glasses of water, 3 cups of beans a week, etc..", but having these things Incorporated into a visual aid of sample meals could help individuals apply it to their daily lives if not ideally follow it exactly. We know what to eat (fruits, veggies, fiber, omegas... etc) But when and how do we eat it without going over the average 2000 calorie diet?
The suggestions of eating healthy may be useless if we do not know how to apply it (especially with the majority growing up poor and being surrounded with cheap commercialized foods & knowing nothing else). Individuals who do try to apply a healthy diet to their lives may need a little more than just what foods to eat.

I may create such a sample log myself with the proper research from trusted sites as yours. I'd just hate to do so if it already exists. I was imagining 7 photographs of meals (based on the average 2000 cal. diet and what it ideally consists of) laid out like a comic strip with details of what the meals contained (serving size, calories, nutrition details), and having one strip for each meal time (breakfast, lunch, dinner).

Let me know if my requests exists, that'd be very helpful to me.

Thank you so much for your time
-Anita Torres

Affiliation: Individual/Professional Organization:
Topic:
  • Eating Patterns-Diets (USDA Food Patterns, DASH, Vegetarian, Low Carb, Hi-Protein, etc.)

nashoa tawil Comment ID #436

04/12/2014

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Affiliation: Public Health Department Organization: dtk
Topic:
  • Energy Balance (Weight Loss, Weight Maintenance, Calorie Intake, Physical Activity)
  • Fats (Total Fat, Solid Fats, Oils, Fatty Acids, Cholesterol)
  • Lifespan Needs (Infants, Children, Pregnant Women, Older Adults, etc.)

Anonymous Comment ID #435

04/11/2014

At the March 14, 2014 meeting of the 2015 Dietary Guidelines Advisory Committee, the Subcommittee on Food Sustainability and Safety presented “draft key findings” about the safety of the low-calorie sweetener aspartame. The Ajinomoto Company respectfully submits the attached comments on the current scientific evidence that affirms the safety of aspartame.

Affiliation: Industry/Industry Association Organization: Ajinomoto North America, Inc.
Topic:
  • Food Safety

Anonymous Comment ID #434

04/09/2014

The Society for Nutrition Education and Behavior is pleased to provide input to the 2015 DGAC. Please see attached.

Affiliation: Professional Association Organization: Society for Nutrition Education and Behavior
Topic:
  • Behavior
  • Carbohydrates (Added Sugars, Fiber, Glycemic Index, Whole Grains)
  • Eating Patterns-Diets (USDA Food Patterns, DASH, Vegetarian, Low Carb, Hi-Protein, etc.)
  • Energy Balance (Weight Loss, Weight Maintenance, Calorie Intake, Physical Activity)
  • Fats (Total Fat, Solid Fats, Oils, Fatty Acids, Cholesterol)
  • Food Environment
  • Food Groups (Fruits, Vegetables, Grains, Dairy, Protein Foods)

Michael Kelley PhD, RD Comment ID #433

04/04/2014

Wrigley respectfully submits an abbreviated version of our full comments on the oral health benefits of chewing sugar-free gum. The full comments have been filed as #277.

Affiliation: Industry/Industry Association Organization: Wm. Wrigley Jr. Company
Topic:
  • Carbohydrates (Added Sugars, Fiber, Glycemic Index, Whole Grains)

Anonymous Comment ID #432

04/02/2014

RE: Dietary Guidelines Advisory Subcommittee Request SC5-2A: Food Systems Sustainability: Elements of a Whole Food System (Request 5-2)

Please see the attached document for public comments from the The Laurie M. Tisch Center for Food, Education & Policy to the Dietary Guidelines Advisory Subcommittee for sustainability.

Affiliation: Educational Institution: Higher Education Organization: Laurie M. Tisch Center for Food, Education & Policy
Topic:
  • Behavior
  • Sustainability
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