An article published in The New York Times has revealed that scientists in the 1960s were paid by the Sugar Association (then called the Sugar Research Foundation, or SRF) to publish data on the effects of sugar and dietary fat on coronary heart disease (CHD) that apparently downplayed the link between sugar and disease, focusing on saturated fat as the primary culprit. A historical analysis of decades of documents published in JAMA Internal Medicine revealed that while it was suggested as early as in the 1950s that sugar may have an effect on heart disease, it was not reported that the SRF had funded research in the 1960s that suggested that dietary fat — not sugar — is the primary contributor to CHD.
While this news is disappointing, it is not entirely surprising to someone who has practiced as a dietitian for 20 years. It is challenging, yet essential, to keep up with the most recent research so that I can provide my patients with the best possible tools and information to help them manage and prevent chronic disease. As new research is published each year, I must continuously shift gears to help my patients interpret new information and put it into practice. This article confirms my advice to patients that you must constantly look at the source of all published nutrition information, particularly fad diets.
As a dietitian, it is interesting to me that we have come full circle over the past 100 years. In 1916, the first USDA food guide, Food for Young Children, was published primarily to combat malnutrition. It was based on five main food groups: milk/meat, fruits and vegetables, grains, fats, and sugars. In 1956, the USDA published a food guide promoting the “Basic Four:” milk, meat, fruits/vegetables, and grain products, which promoted consuming a minimum number of servings from each food group to ensure a person would get all essential nutrients.
The “Basic Four” recommendations were in place for a number of years, until the Surgeon General’s report on nutrition and health published in the 1980s relied heavily on the recommendation for low-fat food consumption and an overall decrease in total fat, saturated fat, and cholesterol intake. As a result, the USDA Food Guide Pyramid was released in 1992, which encouraged all Americans to consume six to 11 servings of grains (bread, rice, pasta, and cereal) each day. Fats, oils, and sweets had a place at the top of the pyramid, to be used only “sparingly.” As a new dietitian, I had to incorporate these recommendations into practice. What I immediately found was that it was difficult for my patients to interpret these guidelines. They often overestimated serving sizes, consuming more from the pyramid “base” than necessary. Meanwhile, the food manufacturing industry was flooding the market with low-fat and fat-free products. What many consumers did not know is that fat is often replaced by sugar to enhance the flavor of a product. “Fat-free” didn’t necessarily mean “calorie-free,” and many people began to gain weight as a result of their overconsumption of high-sugar, fat-free products.
As a result, The Food Guide Pyramid was replaced by My Pyramid in 2005, which was designed to emphasize moderation and equal portions of food from each food group. I felt that this created even more confusion for my patients, as they could not understand how much from each food group they should be consuming each day.
My Plate was released by the USDA in 2011. It depicts five food groups — fruits, vegetables, grains, protein, and dairy — in relatively equal amounts, reminiscent of the “Basic Four” from 50 years ago, when our country was not faced with the obesity and chronic disease epidemic that we have today. I feel that this is a much easier tool to use for patient education, particularly for explaining proper portion sizes and balance from fresh, unprocessed foods, rather than added fats and sugars.
The bottom line
CHD is still the leading cause of death worldwide. While the consumption of carbohydrates and their role in CHD is still hotly debated, we know that refined carbohydrates in food and sweetened beverages can increase the risk for disease, as reflected in this literature review. As new research unfolds, it will be important to look at the funding sources behind the studies to ensure there is no conflict of interest.
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Carmen is a registered dietitian who specializes in weight management and nutrition therapy for chronic disease. In addition to nutrition counseling at Johns Hopkins in Baltimore, Carmen teaches undergraduate health and wellness courses and provides corporate wellness seminars on exercise and nutrition.