We Eat; Therefore, They Are

BETHESDA, Md. —  Inside a packed ballroom at the local Holiday Inn, 13 government-appointed scientists sat regally around a table, debating servings of fish.

“What do we want to recommend for children? Fish twice a week?” asked chairwoman Janet King.

“Small fish,” another panel member said.

“Children are advised to eat smaller portions of fish than adults?”

“Can we defer a vote on that?” pleaded another.

The august panel of nutrition researchers had been talking this way for 45 minutes. The ballroom was filled with silent listeners scribbling away on notepads.

Some of the listeners were looking a little haggard. They had already witnessed exhaustive discussions on protein, sugar, fat, grains, breakfast, exercise and a record-breaking 2 1/2 -hour standoff on vitamin D.

“Mind-numbing isn’t the half of it,” said a woman in line for the restroom. “I want to strangle them.”

After a year’s work, the Dietary Guidelines Advisory Committee is in the final stages of overhauling the Dietary Guidelines for Americans, which will be formally adopted next year.

Since 1980, the guidelines -- consisting of seven to 10 short statements and an accompanying booklet -- have been issued every five years by the departments of Agriculture and Health and Human Services.

School menus must comply with the guidelines; so must the Women, Infants and Children program, which provides food to low-income mothers. The food pyramid, currently receiving its own overhaul, is also based on the guidelines.

America now waits hungrily for the latest update.

Do these scholars think we should still “choose a variety of fruits and vegetables daily” as the guidelines currently decree?

Should we continue to “choose and prepare food with less salt,” and “aim for a healthy weight?”

Would it remain wise to “choose beverages and foods to moderate your intake of sugars”?

To reach their conclusions, committee members -- unpaid volunteers generally drawn from academia -- have waded through thousands of pages of studies on fat, heart disease, television watching, obesity and the effect of fiber on stool weight.

They have investigated the best way to wash broccoli and argued bitterly on the matter of sugar.

They have been aided by testimony and letters from hundreds of groups and individuals, including the Sugar Assn., the Grocery Manufacturers of America, the American Heart Assn., People for the Ethical Treatment of Animals, the Bible-based Hallelujah Diet and scads of disciples of Dr. Joseph Mercola, author of “The No-Grain Diet.”

The job is “enormous -- probably one of the most difficult jobs I ever had,” said Dr. Cutberto Garza, director of the division of nutritional sciences at Cornell University and chairman of the 2000 Dietary Guidelines Advisory Committee.

He didn’t get paid, but he had some exciting times.

Before the job was done, his committee sparked a lawsuit by an advocacy group claiming the panel had a pro-milk bias, was challenged by one senator for being too positive about alcohol and castigated by 30 other senators for being too negative about sugar.

Writing the dietary guidelines is honor, toil, aggravation and tedium -- in unequal measure.

The results of the group’s work are bland and seemingly obvious bits of advice that most Americans have never read.

“It is interesting to see how they put it all together,” whispers one audience member. “It is a little bit boring, of course.”

*

The committee has held four public meetings to discuss the ideal American diet. The panel will hold its fifth -- and supposedly last -- public meeting on the issue Wednesday.

The third meeting, which took place in March, attracted as usual a veritable Who’s Who of the food world.

The National Dairy Council’s representative sat up front. Further back was an employee from the Center for Science in the Public Interest, a consumer advocacy group.

There were cheerleaders for seemingly every foodstuff: walnuts, soybeans, sugar, alcohol, crackers, jellies and vegetables.

They listened intently and dashed off during breaks to inform headquarters of critical twists in the committee’s deliberations.

Where were the scientists heading on trans fats? What were they saying about breakfast?

“These issues affect everything we do,” said Richard Cristol, senior vice president with the Atlanta-based Kellen Co., which manages trade associations, including those for margarine, dressings and sauces.

Committee chairwoman King, a nutrition researcher at the Children’s Hospital Oakland Research Institute, announced that there would be reports from the carbohydrates subcommittee, the fatty acids subcommittee and the macronutrients subcommittee.

“I think we will have a real dynamic afternoon addressing those three topics,” she said to a few snickers from the audience.

The committee first heard from two experts who were brought in to straighten out an issue to do with appetite.

Expert No. 1, Barbara Rolls, professor of nutrition and biobehavioral health at Pennsylvania State University, explained that studies showed that people felt fuller and consumed fewer calories when they ate energy-dilute foods like soups instead of, say, potato chips.

Expert No. 2, Richard Mattes, professor of foods and nutrition at Purdue University, began by smashing some potato chips, then explained how studies show that people consuming food and drink that isn’t dense in calories can end up eating more, not less.

King thanked Rolls and Mattes for their helpful presentations.

“It’s a thankless job,” Mattes said later. “These are intelligent people doing their best with the knowledge as it is -- and that knowledge is constantly changing. People will get angry with them almost no matter what they do.”

*

Complaints surfaced from the moment the committee was appointed last year.

The Center for Science in the Public Interest pointed fingers at seven of the 13 selected committee members for having financial relationships with industry groups, including the Sugar Assn., the Campbell Soup Co. and the American Cocoa Research Institute.

How, asked the consumer group, could Americans be sure the scientists were unbiased?

Richard Hanneman, president of the Salt Institute, was pretty ticked too.

He has peppered the committee with letters complaining about the unfair and unscientific treatment given to salt in the 2000 guidelines, which told Americans to “choose and prepare foods with less salt.”

“We could not accept that,” said Hanneman, who hasn’t missed a dietary guideline meeting since 1990. “We don’t think there’s evidence that the public should consume less salt.”

The Sugar Assn. and the Grocery Manufacturers of America both wrote to say that the guidelines don’t focus enough on physical activity -- just on what people eat. The grocery manufacturers have suggested that the name of the guidelines be changed to the Dietary and Physical Activity Guidelines.

Such intensity about eating advice did not exist a century ago when the government began issuing guidelines, said Marion Nestle, a professor of nutrition, food studies and public health at New York University and author of the 2002 book, “Food Politics: How the Food Industry Influences Nutrition and Health.”

In the early days, the Department of Agriculture advised people to eat widely and plentifully, in keeping with its role promoting American agriculture.

The advice has changed through the years -- there were five food groups in 1917, 12 in 1933, eight in 1942 and either seven or 11 in 1943, depending on which pamphlet you consulted.

The tips were at times on the tepid side: The 1979 “Hassle-Free Guide to a Better Diet” told readers that many scientists felt diet contributed to chronic disease, but others did not, “so the choice is yours.”

The trouble began when the government started advising people to start eating less of certain foods, Nestle said.

One flap erupted in 1977 after a Senate committee report suggested Americans cut back on saturated fats, sugar, cholesterol and salt.

The cattle, dairy, egg and sugar industries protested -- and the report was revised, easing up on salt and cholesterol and dumping the phrase “reduce consumption of meat” for a friendlier “choose meats, poultry and fish which will reduce saturated fat intake.”

The food pyramid also drew ire upon its completion in 1991 because its pointed shape indicated that some foods should be eaten less than others.

Strenuous objections from the National Cattlemen’s Assn. and National Milk Producers Federation -- both of whose products were nearer the top of the pyramid -- caused a one-year delay in the pyramid’s release.

Creating the guidelines is still “political -- from start to finish,” said Nestle, who was on the 1995 Dietary Guidelines Committee. “It’s science politics. It’s politics politics. It’s corporate politics.”

She recalled tensely standing her ground to ensure that a phrase she hated -- “there is no such thing as a good or bad food; all foods are part of a healthy diet” -- was not included in the 1995 guidelines.

She bemoaned the fact that even as Americans fatten up, no one is ever told to eat less of any specifically identified food -- not even a candy bar or soft drinks.

And she snorted at the guideline about sugar, which as far as she’s concerned has been infected by a creeping blight of wishy-washiness.

In 1980, people were flatly told to “avoid too much sugar.”

By 2000, the committee was going to tell Americans to “choose beverages and foods to limit your intake of sugar” -- but the word “limit” was tossed out at the last minute by the government (after industry protests) and replaced with the weaker word “moderate.”

This time, people are holding their breath to see if there will be a sugar guideline at all.

*

The fourth meeting of the committee was held in May. It was supposed to be the last, but a rollicking debate about vitamin D threw everything off schedule. No one was certain when the meeting would end.

“I’m figuring midnight,” said a USDA employee, placidly stitching away on a patchwork quilt to pass the time.

Fresh science, it seemed, had emerged since 2000, revealing that many people are deficient in the vitamin. But some committee members were nervous about recommending a big jump in intake.

Brisk progress was made on some subjects: Eight draft guidelines were crafted, advising Americans, for instance, to “keep food safe to eat,” “monitor your body weight to achieve health,” “choose and prepare foods with less salt” and “be physically active every day.”

For the first time, the committee planned to recommend Americans slash their intake of trans fats, those hardened, partially hydrogenated vegetable oils found in stick margarines and many baked goods.

But sugar was a sticky mess. As the committee took up the issue again, an excited rustle went through the audience like so many candy bars being unwrapped.

Dr. Carlos Camargo, assistant professor of medicine and epidemiology at Harvard University, cited three recent studies reporting that kids drinking the greatest number of sugary soft drinks ended up plumper later on.

Nutrition researchers Teresa Nicklas, professor of pediatrics at Baylor College of Medicine, and Joanne Lupton, professor of nutrition at Texas A&M; University, lobbed back other types of studies that didn’t find that link.

Camargo, noting his position as president of the American College of Epidemiology, said that the other types of studies were inferior in design.

Well, Lupton said, if we’re going to ignore them for sugar, we have to ignore those kinds of studies for other issues too.

“We’re here to make a difference,” Camargo said.

“I don’t think we are here to make a difference,” Lupton said. “I think we are here to evaluate the science.”

*

The mood began to lighten when sugar was put off again and matters drifted on, past cholesterol and fish to a discussion of alcohol, in which nothing, as usual, was left unquestioned.

The panel debated a recommendation that alcohol be avoided by children and those operating heavy machinery. One committee member asked for the pertinent data.

They forged ahead, moving on to fiber’s impact on heart disease and bowel motion.

Lupton explained that there had been more than 100 studies on the effect of fiber on stool weight and its consequent speedier passage through the bowel.

“So there is a very strong ... are you laughing at me for talking about this?” she said.

Some committee members were giggling.

“It is interesting where we, as a society, have placed our research efforts ... 100 trials on stool,” Camargo said.

Lupton tried to explain that constipation is one of the most common disorders in Western countries, affecting up to 10% of children and maybe 20% of people aged 65 and older.

A blond woman five rows back was laughing so hard she was crying.

Some people in the audience took advantage of the uproar and sneaked out for an evening snack.

*

(BEGIN TEXT OF INFOBOX)

Eating better

A federal panel of nutrition researchers is in the process of drafting new dietary guidelines, which are updated every five years.

2000:

Aim for a healthy weight.

Be physically active each day.

Let the Food Guide Pyramid inform your choices.

Choose a variety of grains daily, especially whole grains.

Choose a variety of fruits and vegetables daily.

Keep food safe to eat.

Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.

Choose beverages and foods to moderate your intake of sugars.

Choose and prepare foods with less salt.

If you drink alcoholic beverages, do so in moderation.

*

Draft 2005 guidelines:

Monitor your body weight to achieve health.

Be physically active each day.

Choose a variety of foods with, and among, the basic food groups, while not exceeding your daily calorie limit.

Increase daily intake of fruits and vegetables, whole grains, and non-fat or low-fat milk and milk products.

Keep food safe to eat.

Decrease intake of saturated fat, trans fat and cholesterol while increasing foods rich in omega-3 fatty acids (fish).

Choose and prepare foods with less salt.

If you drink alcohol, do so in moderation.

Sources: U.S. Department of Agriculture; Department of Health and Human Services; Times staff research

*

The food pyramid

The government’s Food Guide Pyramid, which is based on the dietary guidelines above, will be overhauled this year. The current pyramid:

Milk, yogurt and cheese group: 2 to 3 servings

Vegetable group: 3 to 5 servings

Bread, cereal, rice and pasta group: 6 to 11 servings

Fruit group: 2 to 4 servings

Meat, poultry, fish, dry beans, eggs and nut group: 2 to 3 servings

Fats, oils and sweets (not a food group): Use sparingly

*

(BEGIN TEXT OF INFOBOX)

Dietary advice through the ages

1917: The Department of Agriculture releases a 14-page pamphlet, ‘How to Select Foods,’ encouraging Americans to eat from five food groups: milk and meat; cereals; vegetables and fruits; fats and fat foods; sugars and sugary foods.

1941: First recommended daily allowances released by the National Academy of Sciences.

1959: Nutrition researcher Ancel Keys and wife Margaret publish guidelines for avoiding heart disease, including ‘do not get fat; if you are fat, reduce’; ‘restrict saturated fats’; and ‘be sensible about cigarettes, alcohol, excitement, business strain.’

1977: Dietary Goals for the United States -- a report from the Senate Select Committee on Nutrition and Human Needs -- recommends cutting back on salt, saturated fat, sugar and cholesterol. Food industry groups protest, as do some scientists and doctors.

1980: First edition of the Dietary Guidelines for Americans. People are told to avoid too much sugar, sodium, fat, saturated fat and cholesterol; to maintain an ideal weight; eat a variety of foods; and drink alcohol only in moderation.

1991: The Food Guide Pyramid is completed, sparking food industry protest. Agriculture Secretary Edward R. Madigan withdraws the pyramid, claiming it is confusing to children.

1992: The Food Guide Pyramid is released to the public.

Sources: ‘Food Politics’ by Marion Nestle, 2002; U.S. Department of Agriculture; Department of Health and Human Services. Researched by Times staff writer Rosie Mestel