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The scientific report guiding the US dietary guidelines: is it scientific?

BMJ 2015; 351 doi: (Published 23 September 2015) Cite this as: BMJ 2015;351:h4962

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Re: The scientific report guiding the US dietary guidelines: is it scientific?

Statement of CSPI Nutrition Director Bonnie Liebman

September 23, 2015

Today’s “feature” in the BMJ by journalist Nina Teicholz continues her distorted and error-laden campaign against the Dietary Guidelines Advisory Committee report.[1] Earlier this year, she wrote a similar mistake-filled op-ed for the New York Times.[2] Teicholz is author of a book urging the public to eat more red meat, cheese, butter, and eggs.

In fact, the DGAC’s advice is consistent with dietary advice from virtually every major health authority, including the American Heart Association, the American College of Cardiology, the American Diabetes Association, the American Cancer Society, World Health Organization, and the Obesity Society.[3][4][5][6][7] Teicholz would have us believe that only she, not the dozens of experts who systematically reviewed the evidence for these health authorities, has the smarts to accurately interpret this evidence. In fact, she makes many glaring errors in her BMJ piece. Among them:

Teicholz criticizes the DGAC for ignoring “a meta-analysis and two major reviews (one systematic) that failed to confirm an association between saturated fats and heart disease.”[1] In fact, the systematic review to which she refers concluded that “reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14 percent.”[8] (That figure was increased to 17 percent in a 2015 update.[9]) The meta-analysis[10] and second review,[11] whose senior author[12] has been heavily funded by the dairy industry,[13] had serious flaws.[14][15][16]

Teicholz notes that the Women’s Health Initiative found no drop in heart disease deaths after “nearly 49,000 women followed a diet low in fat and high in fruits, vegetables, and grains for an average of seven years.”[1] Yet the eight-year trial was never designed to lower cardiovascular disease. As the authors note, the drop in LDL (“bad”) cholesterol measured in the women “would be predicted to produce only a small (2 percent to 4 percent) decrease in CVD risk, a value far below the power for detection in the current study.”[17] (Note that the women averaged an increase of only one serving of fruits and vegetables and only half a serving of grains per day.)

Teicholz claims that “large government funded randomized controlled trials on saturated fats and heart disease from the 1960s and ‘70s…showed mixed outcomes for saturated fats but early critical reviews, including one by the National Academy of Sciences, which cautioned against the inconclusive state of the evidence on saturated fats and heart disease, were dismissed by the USDA when it launched the first dietary guidelines in 1980.”[1] In fact, a meta-analysis of many of those trials concluded that replacing saturated fats with polyunsaturated fats led to a 19 percent reduction in heart disease.[18] Furthermore, that National Academy of Sciences review was roundly criticized, in part because some of its authors had strong ties to the egg, dairy, and meat industries.[19] [20] The Academy was so embarrassed by those disclosures that it reorganized its Food and Nutrition Board to include fewer members with food industry ties.[21]

Finally, Teicholz adopts the latest defense by a growing number of scientists who are heavily funded by the food or soda industries. They charge that scientists who do not take industry funding have a “white hat bias.” How convenient.

Like other health authorities, the DGAC report advised Americans to “consume dietary patterns that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar sweetened foods and beverages and refined grains.”[22] Nina Teicholz’s latest salvo on behalf of saturated-fat-laden meat and dairy foods is a hodge-podge of fact and fiction and will only confuse a confused public even more.

1 Teicholz N. The scientific report guiding the US dietary guidelines: is it scientific? BMJ. 2015;351:h4962.
2 Jacobson MF. Distorting Nutrition Facts to Generate Buzz. The Huffington Post. 2015. Accessed September 2015.
3 Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Circulation. 2014: 129:S76–S99. doi: 10.1161
4 Fox CS, Hill Golden S, Anderson C, et al. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence. Circulation. 2015;132:691–718. doi: 10.1161
5 Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. CA. 2012;62(1):30–67. doi: 10.3322
6 World Health Organization. Diet, Nutrition and the prevention of chronic diseases. 2003. Accessed September 2015.
7 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129:S102–S138. doi: 10.1161
8 Hooper L, Summerbell CD, Thompson R, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2012:16: :CD002137. doi: 10.1002/14651858.CD002137.pub3.
9 Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015:6:CD011737. doi: 10.1002
10 Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010:91(3):535–46. doi: 10.3945/ajcn.2009.27725.
11 Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010;91(3):502–209. doi: 10.3945
12 World Congress On Insulin Resistance, Diabetes, & Cardiovascular Disease. Curriculum Vitae: Ronald M. Krauss, M.D. Accessed September 2015.
13 The Liver Center at the University of California, San Francisco. Members: Ronald M. Krauss. Accessed September 2015.
14 Katan MB, Brouwer IA, Clarke R, et al. Saturated fat and heart disease. Am J Clin Nutr. 2010:92(2):459–460. doi: 10.3945
15 Stamler J. Diet-heart: a problematic revisit. Am J Clin Nutr. 2010;91(3):497–9. doi: 10.3945
16 Scarborough P, Rayner M, van Dis I, et al. Meta-analysis of effect of saturated fat intake on cardiovascular disease: overadjustment obscures true associations. Am J Clin Nutr. 2010;92(2):458–9. doi: 10.3945
17 Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–66.
18 Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252. doi: 10.1371
19 Brody J. Experts Criticize Report Declaring Curb on Cholesterol Is Not Needed. The New York Times. June 1, 1980.
20 Cohn V. 2 on Food Panel Are Advisers. The Washington Post. May 31, 1980; Page A1.
21 Nestle M. Food Politics. Berkeley and Los Angeles, California: University of California Press. 2007;132–135.
22 Dietary Guidelines Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. 2015. Accessed September 2015.

Competing interests: No competing interests

23 September 2015
James A. O'Hara
Director, Health Promotion Policy
submitted on behalf of Bonnie Liebman, CSPI Nutrition Director
Center for Science in the Public Interest
1220 L Street NW, Washington, DC 20005