The Public Health Implications of the 2010 Dietary Guidelines

An Expert Interview With David L. Katz, MD, MPH

Janet Kim, MPH

Disclosures

February 15, 2011

In This Article

Meat and Dairy

Medscape: You criticized the continued inclusion of recommended intakes of dairy and various meats in the updated policy document. Are you concerned that the guidelines do not specifically recommend reducing red meat intake, and why do you think this recommendation has not been made in any of the previous reports?

Dr. Katz: I am somewhat concerned that the guidelines don't recommend a willful reduction in red meat or beef intake. I know exactly why this recommendation has not been made in any of the previous guidelines and why resistance [persists in the new guidelines]. We need to make perfectly clear that a science-based dietary guidelines advisory committee is asked to generate recommendations on the basis of their perspective of the best available nutrition science, but they are, at the end of the day, an advisory committee. They don't get to issue the dietary guidelines; they just advise the federal authorities on what they think the guidelines should say.

To be fair, the federal authorities seriously consider the advisory committee's recommendations and try to come pretty close to their recommendations, but the federal authorities, notably the USDA, are concerned about other constituencies. The USDA represents the agriculture sector of the economy and consequently is concerned not to step on the toes of large business entities in that sector; those responsible for raising, producing, and contributing beef to the food supply are part of that equation, and so is the dairy industry. Any entity that is making a major contribution to the food supply is going to get some respect in the way the dietary guidelines are put together.

A specific recommendation to reduce beef intake would be very much at odds with what we've ever seen in the dietary guidelines. They tend to be quite circumspect when it comes to reducing the intake of any given food. They can be quite explicit about what we should eat more of, but they tend to be a bit cagey when it comes to offering advice about what we should eat less of, and that's because the guidelines ultimately are a reconciliation between science-based public health and the relationship between the federal government and large food suppliers.

Essentially, what I think is going on here is that we have the ghosts of dietary guidelines past haunting the current dietary guidelines. When dietary guidelines began, we were thinking in terms of major food groups. We had meat and dairy groups, and we have never completely abandoned the notion that a healthy balanced diet should include all of these food groups. You can have an optimal diet without consuming meat or without consuming dairy.

That said, you can also have an optimal diet that includes 1 or both of these, but only if you get it right! First, not all meat is created equal. If we look at the average serving of beef, for example, in the United States today, as much as 35% of the calories come from fat, mostly saturated and certainly absent of omega-3 fatty acids. If you compare that with game, which is the kind of meat that our Stone Age ancestors ate, such as antelope meat, approximately 7% of the calories come from fat; almost all is unsaturated and a fair portion is omega-3 -- both meat, but totally different. It's not that meat, per se, is bad, but the dietary guidelines could do a better job of distinguishing between the kinds of meat that are better for health and the kinds of meat that are less good for health, as well as the environment. (By the way, I'm not suggesting that we all start eating antelope! But less beef overall, and grass-fed rather than grain-fed beef, would be moves in the right direction. Grass-fed cattle have a different composition to their meat than grain-fed cattle and are better for the environment.)

In terms of dairy, a number of populations around the world manage to have an optimal diet and exclude dairy altogether, but I think it is reasonable to note an argument for including dairy on the basis of the DASH (Dietary Approaches to Stop Hypertension) diet, which includes low- and nonfat dairy. It has been decisively shown to lower blood pressure and to be associated with improvements in overall cardiovascular health.[4,5] It's uncertain whether a net benefit is gained from including dairy in the diet if you otherwise are practicing a mostly plant-based diet that's well balanced and close to nature. But the addition of low- and nonfat dairy to the typical American diet generally results in overall improvement.

You get hints of the political agenda that mitigate the science-based nutrition guidance that we hope to see, and that dampens my enthusiasm for the dietary guidelines and probably has the same effect on anyone whose exclusive concern is guidance for the consumer and the public's health, and not an interest in advancing the business side of the equation.

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