National Dietary Guidelines Called Sound--the Second Time Around : Earlier Goals Met With Resistance by Dietitians; The Second Edition Outlines Seven Principles of Sound Diet

The second edition of the national Dietary Guidelines, which were released recently by Secretary of Agriculture John R. Block, has officially met the approval of the American Dietetic Assn. after controversial bantering over early dietary guidelines.

Early dietary goals, which gave percentages of fats, carbohydrates and protein recommendations, met with resistance by dietitians, who argued that the national Dietary Guidelines cannot set definite figures for an individual’s consumption of a dietary component.

This time, the seven guidelines outline the basic principles of a sound diet without giving the percentages of the dietary components. However, the dietitians throw in a veiled criticism, in effect, implying that the guidelines need interpretation if they are to be adopted by the general public. And who should help interpret? Registered dietitians, of course.

“If more precise guidelines are needed, the individual should consult a federally registered dietitian (known as an RD) or licensed nutritionist, who works in conjunction with the individual’s physician,” states the official American Dietetic Assn. policy statement on the Dietary Guidelines for Americans.

Still, the guidelines have been pronounced as sound and seem to emphasize certain concerns that have come into clearer focus since the last guidelines were published. These issues include eating a variety of foods, watching calories and exercising more.

The recommendations are based on a review of all the research data and reports on key health issues, such as cancer, heart disease, osteoporosis, obesity and dental cavities, since 1980 when the last Dietary Guidelines were issued. Included are the report of the National Academy of Sciences-National Research Council Committee on Diet, Nutrition, and Cancer; the National Institutes of Health Consensus Development Conference statements on osteoporosis; the health implications of obesity and on lowering blood cholesterol to prevent heart disease; the American Heart Assn. recommendations for treatment of hyperlipidemia in adults, and the American Dental Assn. statement on diet and dental cavities.

The guideline committee stressed that the recommendations are designed only for healthy Americans and do not apply to “people who need special diets because of diseases or conditions that interfere with normal nutritional requirements. These people may need special instruction from registered dietitians, in consultation with their own physicians.”

The dietitians argue that the implementation of the guidelines for healthy people also requires the help of dietitians.

“While the guidelines are important, their value will be maximized only if they are appropriately distributed and used,” the ADA statement says.

Among the seven recommendations for Americans to follow are:

--Eat a variety of foods.

--Maintain desirable weight.

--Avoid too much fat, saturated fat and cholesterol.

--Eat foods adequate in starch and fiber.

--Avoid too much sugar.

--Avoid too much sodium.

--If you drink alcoholic beverages, do so in moderation.

According to Bernard S. Schweigert of the University of California at Davis, who chaired the Dietary Guidelines Advisory Committee, the most touchy issue was that of saturated fat and cholesterol, which drew divided camps within the committee.

“When there is insufficient evidence, it’s hard to come to uniform agreement. Until all the evidence is in, we felt that a call for moderation in the intakes of fats and cholesterol would still be the best answer today,” Schweigert said at a teleconference after the release of the guidelines.

Meanwhile, the emphasis on eating a variety of foods, which will ensure a full range of nutrients needed for optimum health, will stand until the next guidelines appear. “Eating a variety of foods is an important key to a healthful diet,” Schweigert said.

The American Dietetic Assn. concurs, with some qualification, however. “Eating patterns are based on cultural, social and economic factors. The American Dietetic Assn. believes that implementation of a recommended pattern of eating will be attained by the American public only if a suitable variety of foods is available at a reasonable price.”

It’s also vitally important for Americans to watch calories for maintaining appropriate body weight for their height and weight. Control of body weight should involve some measure of exercise in order to balance energy expended with energy from calories consumed.

Among the issues that have gathered more awareness since the 1980 guidelines is the question of calcium intake, especially in light of the recommended changes expected should new Recommended Dietary Allowances be released.

“Increased awareness of osteoporosis, a disease of bone depletion among the elderly, has raised questions about amounts necessary for good health,” said Schweigert. So far, however, the only recommendation has been to consider increasing intake of food sources high in calcium, such as dairy group foods. Further recommendations will occur as scientists learn more about this mineral in relation to humans, according to Schweigert. The National Institutes of Health Consensus Development Conference Statements on Osteoporosis was an important validation of the calcium recommendation, Schweigert pointed out.

Sodium recommendations were based on the known data. However, Schweigert pointed out that whereas salt is associated with hypertension, it is an important flavoring and preservative constituent in the nation’s food supply because of dangers of bacterial growth without it. Schweigert pointed to the need for further research before the tally is in on sodium.

Food sources high in fiber are listed in the new guidelines, but insufficient data on this non-nutritive substance have toned down the recommendation for increasing fiber and starch. Instead, guidelines call for eating foods “adequate” in starch and fiber. These are “exciting areas of current research,” Schweigert pointed out, but scientists have yet to come up with conclusions about fiber.

The recommendation to avoid too much sugar also comes with a warning to watch food labels, according to Schweigert. “Sugar is present in many foods so we stress total sugar intake in the diet,” he said.

The American Dietetic Assn. would like the guidelines to include federal nutrition education and information programs and to have recognized nutrition authorities review the dietary guidelines for scientific accuracy and appropriateness in a five- to 10-year cycle. Recommendations for periodic review have been made by the committee, according to Schweigert.

“By augmenting the guidelines with individually tailored counseling by a registered dietitian to quantify the guidelines and/or adapt them for special diets, the Dietary Guidelines can be the basis of a sound diet for individual health promotion and disease prevention,” the ADA policy statment says.

How to Use Guidelines

For a list of materials on how to use the Dietary Guidelines, write to Human Nutrition Information Service, U.S. Department of Agriculture, Room 325-A Federal Building, Hyattsville, Md. 20782.

For additional help with diet and health questions, write to Consumer Inquiries, Food and Drug Administration, 5600 Fishers Lane, Rockville, Md. 20857 or contact a dietitian, home economist or nutritionist in one of the following groups:

--Public health department

--County extension service

--State or local medical society

--Hospital outpatient clinic

--Local American Red Cross chapter

--Local dietetic association

--Local diabetes association

--Local heart association

--Local health center or clinic.