1
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
UNITED STATES OF AMERICA
+ + + + +
DEPARTMENT OF AGRICULTURE
AND
DEPARTMENT OF HEALTH AND HUMAN SERVICES
+ + + + +
DIETARY GUIDELINES ADVISORY COMMITTEE
+ + + + +
SECOND MEETING
+ + + + +
THURSDAY, JANUARY 29, 2009
The meeting came to order, at
8:00 a.m., in the Jefferson Auditorium of
the USDA South Building, 1400 Independence
Avenue, S.W., Washington, D.C., Dr. Linda
Van Horn, Chairperson, presiding.
2
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
PRESENT:
LINDA V. VAN HORN, PHD, RD, LDCHAIR
CHERYL ACHTERBERG, PHD, MEMBER
LAWRENCE J. APPEL, MD, MPH, MEMBER
ROGER A. CLEMENS, DRPH, MEMBER
NAOMI K. FUKAGAWA, MD, PHD, VICE CHAIR
MIRIAM E. NELSON, PHD, MEMBER
SHARON M. NICKOLS-RICHARDSON, PHD, RD,
MEMBER
THOMAS A. PEARSON, MD, PHD, MPH, MEMBER
RAFAEL PEREZ-ESCAMILLA, PHD, MEMBER
XAVIER PI-SUNYER, MD, MPH, MEMBER
ERIC B. RIMM, SCD, MEMBER
JOANNE L. SLAVIN, PHD, RD, MEMBER
CHRISTINE L. WILLIAMS, MD, MPH, MEMBER
ALSO PRESENT:
CAROLE DAVIS, CO-EXECUTIVE SECRETARY, USDA
KATHRYN MCMURRY, CO-EXECUTIVE
SECRETARY, DHHS
ROBERT POST, ACTING EXECUTIVE DIRECTOR,
CNPP, USDA
RADM PENELOPE SLADE-SAWYER, DHHS
JOAN LYON, CNPP, USDA
3
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S
Opening Remarks . . . . . . . . . . . . . 12
Robert Post . . . . . . . . . . . . . . . 12
Acting Executive Director
Center for Nutrition Policy and Promotion
U.S. Department of Agriculture
Alexandria, VA
Linda Van Horn, Chair . . . . . . . . . . 17
Dietary Guidelines Advisory Committee
Northwestern University
Chicago, IL
Public Oral Testimony . . . . . . . . . . 23
Guy H. Johnson . . . . . . . . . . . . . 23
Executive Director
McCormick Science Institute
Hunt Valley, Maryland
Ann Marie Krautheim . . . . . . . . . . . 26
Registered Dietitian
and Senior Vice President
Nutrition Affairs
National Dairy Council
Rosemont, IL
Ceci Snyder . . . . . . . . . . . . . . . 29
Assistant Vice President for
Consumer Marketing
National Pork Board
Des Moines, Iowa
Susan Levin . . . . . . . . . . . . . . . 32
Registered Dietitian
Physicians' Committee for
Responsible Medicine
Washington, DC
4
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Mary Young . . . . . . . . . . . . . . . 36
Registered Dietitian
and Vice President for Nutrition
National Cattlemen's Beef Association
Centennial, CO
Neal Barnard . . . . . . . . . . . . . . 39
Adjunct Associate Professor
of Medicine
George Washington University
and President, Physicians' Committee for
Responsible Medicine, Washington, D.C.
Jim Hill . . . . . . . . . . . . . . . . 43
Professor of Pediatrics and Medicine
University of Colorado, Denver
and President
American Society for Nutrition
Christina Pirello . . . . . . . . . . . . 46
Host of Christina Cooks
National Public Television
Philadelphia, PA
Stephen Abelman . . . . . . . . . . . . . 50
March of Dimes Foundation, White Plains, NY
Rosa Gonzalez . . . . . . . . . . . . . . 53
Concerned Citizen, Fredericksburg, VA
Pam Popper . . . . . . . . . . . . . . . 55
Executive Director
The Wellness Forum, Columbus, Ohio
Mary Van Elswyk . . . . . . . . . . . . . 59
Representing Martek Biosciences Corporation
Boulder, CO
Nina Gonzalez . . . . . . . . . . . . . . 62
Junior at Stafford High School
Fredericksburg, Virginia.
Part of the Commonwealth Governor's School
5
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Cheryl Leahy . . . . . . . . . . . . . . 64
General Counsel
Compassion Over Killing
Washington, D.C.
Jamie Zoellner . . . . . . . . . . . . . 67
Assistant Professor
and Registered Dietitian
University of Southern Mississippi
Hattiesburg, MS
Lorelei DiSogra . . . . . . . . . . . . . 71
Vice President for Nutrition
and Health
United Fresh Produce Association
Washington, DC
Jennifer McGuire . . . . . . . . . . . . 74
Registered Dietitian
National Fisheries Institute
McLean, VA
Maureen Ternus . . . . . . . . . . . . . 77
Registered Dietitian
and Executive Director
International Tree Nut Council
Nutrition, Research, and
Education Foundation (INC NREF)
Davis, CA
Anne Banville . . . . . . . . . . . . . . 81
USA Rice Federation
Washington, D.C. area
Constance Geiger . . . . . . . . . . . . 84
Registered Dietitian
and President
Geiger and Associates
and Research Associate Professor
University of Utah
Representing the American
Dietetic Association, Chicago, IL
6
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Alex Lewin . . . . . . . . . . . . . . . 87
Center for Science
in the Public Interest
Washington, D.C.
Michael Greger . . . . . . . . . . . . . 91
Director of Public Health
and Animal Agriculture
Humane Society of the United States
Washington, D.C.
Rob Bisceglie . . . . . . . . . . . . . . 94
Executive Director
Action for Healthy Kids
Skokie, IL
Heather Katcher . . . . . . . . . . . . . 98
On behalf of Barbara Wasserman
Physician in Howard County, Maryland
and Chair, Howard County Nutrition
and Physical Activity Coalition
Charles Baker . . . . . . . . . . . . . 101
Executive Vice President
and Chief Science Officer
Sugar Association
Washington, D.C.
Alex Hershaft . . . . . . . . . . . . . 104
Founder and President
FARM
Washington, D.C.
Bernice Deshay . . . . . . . . . . . . 107
Concerned Citizen
Takoma Park, MD
Richard L. Hanneman . . . . . . . . . . 109
President of the Salt Institute
Alexandria, VA
7
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Michelle Matto . . . . . . . . . . . . 112
Registered Dietitian
International Dairy Foods Association
Washington, D.C.
Betsy Faga . . . . . . . . . . . . . . 115
President
North American Millers' Association
Washington, D.C.
Michael McBurney . . . . . . . . . . . 117
Head of Scientific Affairs
DSM Nutritional Products, Inc.
Parsippany, NJ
Suzanne Havala Hobbs . . . . . . . . . 120
Registered Dietitian and faculty member
Gillings School of Global Public Health
University of North Carolina
at Chapel Hill and Nutrition Advisor
Vegetarian Resource Group
Adriane K. Griffen . . . . . . . . . . 124
Director of Health
Promotion and Partnerships
Spina Bifida Association
Washington, DC
Cathy Kapica . . . . . . . . . . . . . 127
Vice President of Global
Health and Wellness
Ketchum
Representing the Canned Food Alliance
New York, NY
Catherine Ruhl . . . . . . . . . . . . 131
Associate Director for Women's
Health Programs
Association of Women's Health,
Obstetric, and Neonatal Nurses
Representing the National
Council on Folic Acid, Washington, DC
8
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Andrew Shao . . . . . . . . . . . . . . 134
Vice President
Scientific and Regulatory Affairs
Council for Responsible Nutrition
Washington, DC
Saurabh Dalal . . . . . . . . . . . . . 137
Registered Dietitian
Representing the Vegetarian Union
of North American
The Vegetarian Society of DC
and the International Vegetarian Union
Washington, DC
Penny Kris-Etherton . . . . . . . . . . 140
Distinguished Professor of Nutrition
and Registered Dietitian
Penn State
Representing the National
Heart Association
State College, PA
Dawn Moncrief . . . . . . . . . . . . . 144
Director
Well-Fed World, Washington, DC
Ilene Smith . . . . . . . . . . . . . . 147
Senior Vice President
and Associate Director
Food and Nutrition Practice
Ketchum, New York, NY
Amie Hamlin . . . . . . . . . . . . . . 151
Director
New York Coalition for
Healthy School Food, New York, NY
Chris Phillips . . . . . . . . . . . . 154
NuVal LLC
Representing Dr. David Katz
Yale University Prevention
Research Center, Boston, MA
9
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Mindy Kursban . . . . . . . . . . . . . 161
General Counsel and
Executive Director
Physicians' Committee for Responsible
Medicine and the Cancer Project
World Nutrition, Washington, DC
Kathy McMahon . . . . . . . . . . . . . 165
Director of Nutrition
and Scientific Affairs
William Wrigley, Jr., Company
A subsidiary of Mars, Incorporated
Chicago, IL
Julie Obbagy . . . . . . . . . . . . . 168
Registered Dietitian
Director of Scientific Affairs
Soy Foods Association of North America
Washington, DC
Eva Rand . . . . . . . . . . . . . . . 172
Registered Dietitian
Team of 20 Primary Care Physicians
Bethesda, MD
David Easley . . . . . . . . . . . . . 176
Louisville, KY
Kathy Hoy . . . . . . . . . . . . . . . 178
Produce for Better Health Foundation
Wilmington, DE
Becky Domokos-Bays . . . . . . . . . . 182
Director of Food and
Nutrition Services
Alexandria City Public Schools
Representing the School
Nutrition Association
Alexandria, VA
10
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Maureen Storey . . . . . . . . . . . . 187
Senior Vice President for
Science Policy
American Beverage Association
Washington, DC
Diana Zuckerman . . . . . . . . . . . . 191
President
National Research Center for
Women and Families
Washington, DC
Joan Lyon . . . . . . . . . . . . . . . 197
Senior Project Manager
Nutrition Evidence Library
Center for Nutrition Policy and Promotion
U.S. Department of Agriculture
Alexandria, VA
Distributions of Usual Intakes . . . . 211
of Nutrients and Food Groups
in the United States
Alanna J. Moshfegh . . . . . . . . . 211
Research Leader
Food Surveys Research Group
Agricultural Research Service
U.S. Department of Agriculture
Beltsville, MD
Questions-and-Answers Period . . . . 221
Susan Krebs-Smith . . . . . . . . . . 234
Chief, Risk Factor Monitoring
and Methods Branch
Division of Cancer Control
and Population Sciences
National Cancer Institute
Rockville, MD
Questions-and-Answers Period . . . . 262
11
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
C-O-N-T-E-N-T-S (CONTINUED)
Trish Britten . . . . . . . . . . . . 288
MyPyramid Technical Project Leader
Center for Nutrition Policy
and Promotion
U.S. Department of Agriculture
Alexandria, VA
Questions-and-Answers Period . . . . 313
Topic Area Discussion: . . . . . . . . 328
Sodium, Potassium, and Water Discussion
Leader: Larry Appel
Water . . . . . . . . . . . . . . . . 329
Questions-and-Answers Period . . . . 332
Potassium . . . . . . . . . . . . . . 334
Questions-and-Answers Period . . . . 336
Sodium . . . . . . . . . . . . . . . 345
Questions-and-Answers Period . . . . 349
Sodium and Blood Pressure in Children 354
Christine L. Williams
Questions-and-Answers Period . . . . 361
12
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 P-R-O-C-E-E-D-I-N-G-S
2 8:08 a.m.
3 DR. POST: Good morning.
4 I would like to introduce myself.
5 I am Robert Post. I'm the Acting Executive
6 Director of the Center for Nutrition Policy
7 and Promotion in USDA.
8 I would like to personally welcome
9 you to the second meeting of the 2010 Dietary
10 Guidelines Advisory Committee.
11 The Center for Nutrition Policy
12 and Promotion has the lead responsibility for
13 managing the process for establishing the
14 Dietary Guidelines for Americans and the
15 Committee's activities.
16 However, the process to produce
17 the 2010 Dietary Guidelines is a joint effort.
18 So I have to tell you that we do, in fact,
19 actively collaborate closely with our partners
20 in this process. The Center works with the
21 Agricultural Research Service of USDA, and
22 also with the Office of Disease Prevention and
13
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Health Promotion of the Department of Health
2 and Human Services.
3 Together, we have a shared
4 commitment to helping Americans of all ages
5 get the information that they need to adopt
6 healthy diets and also encourage activity--
7 physical activity.
8 Ultimately, the Committee's work
9 will result in an advisory report to the
10 Agriculture Secretary, Tom Vilsack, and the
11 Secretary of Health and Human Services, Tom
12 Daschle.
13 We have a new Administration, but
14 the path forward that supports the work of the
15 2010 Dietary Guidelines Advisory Committee
16 remains consistent and committed within USDA
17 and HHS, in line with the Departments' mutual
18 interest in providing dietary guidance for
19 Americans to support health and help reduce
20 the risk for chronic illnesses, such as
21 obesity.
22 I thought I would also recognize
14
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 that, while I am here representing USDA, Rear
2 Admiral Penelope Slade-Sawyer is also
3 representing HHS.
4 Now the role of the Departments is
5 to facilitate the Committee's potential
6 application of their work for federal
7 nutrition policy. This Committee is governed
8 by the Federal Advisory Committee Act, or
9 FACA.
10 FACA was established to assure
11 that the Advisory Committee does certain
12 things, and that is to provide advice that is
13 relevant, objective, and open to the public;
14 act promptly to complete their work, and
15 comply with reasonable cost controls and
16 recordkeeping requirements.
17 Therefore, each public meeting has
18 been and will continue to be announced in The
19 Federal Register through a public notice. As
20 part of the open, transparent process, the
21 meetings of the full Committee are open to the
22 public, and any deliberations that occur
15
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 between meetings-- such as those in topic2
specific subcommittees-- are brought back to
3 the full Committee at a public meeting such as
4 this.
5 The public also has opportunities
6 to participate in the process by providing
7 written comments to the Committee through our
8 online public comments submission database at
9 www.dietaryguidelines.gov. For this meeting,
10 The Federal Register notice also announced the
11 opportunity for the public to present brief
12 oral testimony before the Committee, which we
13 will hear during this morning's session.
14 In addition to these rules of
15 FACA, I would like to also review some rules
16 of engagement for the Committee. The Dietary
17 Guidelines Advisory Committee members will
18 refer any individuals who contact them
19 personally to solicit information about their
20 work on the Committee to the Dietary
21 Guidelines Management Team. Committee members
22 are not able to give presentations as a member
16
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of the Committee about the Committee's work or
2 speak as a representative of the Committee, as
3 this would be inconsistent with the Advisory
4 Committee operations and would preclude the
5 requirement that the Committee's work is
6 transparent to the public.
7 At this time, I would like to make
8 a few announcements before turning the floor
9 over to the Committee Chair, Dr. Linda Van
10 Horn.
11 Following the meeting, the meeting
12 minutes will be posted on the
13 dietaryguidelines.gov website.
14 Then, also, I would like to add,
15 as a reminder, please remember to turn off
16 your cell phones during this meeting.
17 Audio and video taping and
18 photography are not allowed, as this would be
19 disruptive to the meeting.
20 There are a number of other
21 housekeeping reminders that have been provided
22 to you at the registration desk on a green
17
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 handout, and I suggest that you look at those.
2 I would like to now turn the
3 proceedings over to Dr. Van Horn, Chair of the
4 Dietary Guidelines Advisory Committee.
5 Thank you. I look forward to a
6 productive and engaging meeting today.
7 Thanks.
8 CHAIR VAN HORN: Thank you, Rob.
9 Good morning to the Committee
10 members of the Dietary Guidelines Advisory
11 Committee, support staff, and the public
12 attendees.
13 Since the first meeting of the
14 Dietary Guidelines group in late October, the
15 Committee began their difficult task of
16 identifying the issues that warrant a
17 scientific review of the literature.
18 I would like to review the
19 subcommittees.
20 First, we have Fluid and
21 Electrolytes, which has been renamed to the
22 Sodium, Potassium, and Water subcommittee, and
18
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 is chaired by Larry Appel.
2 Next, Nutrient Adequacy is chaired
3 by Shelly Nickols-Richardson.
4 Energy Balance and Weight
5 Management is chaired by Xavier Pi-Sunyer.
6 Carbohydrates is now renamed
7 Carbohydrates and Protein subcommittee,
8 chaired by Joanne Slavin.
9 Ethanol is chaired by Eric Rimm.
10 Fatty Acids is chaired by Tom
11 Pearson.
12 Food Safety and Technology is
13 chaired by Roger Clemens.
14 And the Science Review
15 subcommittee is chaired by myself.
16 The goals for each of the topic
17 area subcommittees to accomplish in preparing
18 for this public Committee were to begin
19 formulating scientific review questions and
20 identify questions of high priority, and to
21 propose areas where presentations from outside
22 experts are needed to fill major information
19
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 needs.
2 In working toward these goals, the
3 group has identified several cross-cutting
4 areas as well as areas that require additional
5 discussion to define the scope of the tasks to
6 be undertaken.
7 These cross-cutting issues include
8 macronutrient distribution. This cuts across
9 carbohydrates, proteins, nutrient adequacy,
10 and energy balance. Liquid versus added
11 sugars, which cuts across carbohydrates and
12 protein and energy balance. Alcohol intake,
13 that is including nutrient adequacy and energy
14 balance. Probiotics and prebiotics, which cut
15 across carbohydrates and protein and food
16 safety technology. Fish consumption, which
17 cuts across fatty acids and food safety and
18 technology. Dietary patterns-- again,
19 involving carbohydrates and protein, nutrient
20 adequacy, energy balance, and fatty acids.
21 So we are looking at what
22 randomized trials have been performed, setting
20
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 short-term and long-term benefits, and risks
2 of specific diets such as the Mediterranean
3 Diet, very low fat diets, high protein/low
4 carbohydrate diets, et cetera.
5 Then satiety that cuts across
6 energy balance and carbohydrates and protein.
7 So we are interested in what are
8 the effects of saturated versus
9 monounsaturated versus polyunsaturated fatty
10 acids on satiety, and what are the beneficial
11 or detrimental effects of omega-9 fatty acids
12 as compared with omega-3, omega-6, et cetera.
13 The Science Review subcommittee
14 has been working to provide clarity to the
15 scientific approach, so that each of the
16 subcommittees can proceed forward, reviewing
17 the literature in a consistent, evidence18
based, and transparent way.
19 On the agenda for this meeting, we
20 have public oral testimony which will take
21 place this morning. After lunch, we will hear
22 presentations from Alanna Moshfegh from the
21
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Agricultural Research Service, Sue Krebs-Smith
2 from the National Cancer Institute on data
3 available on distribution of usual intakes of
4 nutrients and food groups in the United
5 States.
6 Those presentations will be
7 followed by updates to the MyPyramid Food
8 Intake Patterns, presented by Trish Britten of
9 the Center for Nutrition Policy and Promotion.
10 After the data presentations, we
11 will begin our topic area discussions with the
12 Sodium, Potassium, and Water subcommittee.
13 Tomorrow we will cover the
14 remaining topics, including the cross-cutting
15 issues.
16 I would like to now begin the
17 public oral testimony section of the meeting.
18 Receiving comments from the public is a
19 significant part of the overall process used
20 for the Committee's work in developing our
21 scientific advisory report, as well as in the
22 federal government's work in developing
22
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 nutrition policy.
2 We received 58 submissions for
3 public oral testimony from individuals and
4 representatives of groups. We have time today
5 to hear the first 45 individuals who submitted
6 testimony, which we have confirmed with them.
7 Numbers 46 through 58 are kindly on standby.
8 Should time permit, we will continue
9 sequentially by number with individuals on
10 standby until 11:30.
11 Individuals providing public oral
12 testimony are asked to come to the front row
13 in groups of five, as instructed by the staff
14 person down in front. Staff will call the
15 presenters to the microphone by number. The
16 presenter should state their name, affiliation
17 if any, and city and state.
18 When the timekeeper says, "Please
19 begin," you will have a green light on the
20 timer, and your three-minute timeframe has
21 begun. When 30 seconds remain, the green
22 light will change to yellow. When the light
23
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 is red, your three minutes are up, indicating
2 that you must wrap up your comments and return
3 to your seat. We are really trying to get
4 those 46 through 58 in today.
5 After providing your comments, you
6 may be seated anywhere within the auditorium
7 dedicated for the public.
8 With that, may we have our first
9 speaker, please?
10 You may begin.
11 DR. JOHNSON: Good morning.
12 I am here to tell you that adding
13 a little spice to your life could add to your
14 life.
15 My name is Guy Johnson. I am
16 Executive Director of the McCormick Science
17 Institute in Hunt Valley, Maryland.
18 We believe that increasing the
19 herb and spice content of the American diet
20 has a potential to contribute to public
21 health. This is hardly a new idea. Herbs and
22 spices have been used for the health benefits
24
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 since antiquity. In fact, Charlemagne in the
2 9th century said, "An herb is the friend of
3 physicians and the praise of cooks."
4 I'm here to tell you that modern
5 science is beginning to confirm those health
6 benefits. For example, in vitro data show
7 that, gram for gram, herbs and spices are by
8 far the most potent antioxidants in the food
9 supply, and clinical studies funded by the
10 McCormick Science Institute are showing that
11 at least some of those spices are beneficial
12 to humans as well.
13 Emerging data show that spices and
14 herbs are concentrated sources of potent
15 bioactives that may reduce inflammation and
16 cardiovascular risk disease.
17 Sounds like a food group to
18 encourage to me.
19 Other guidelines where herbs and
20 spices may come into play are the weight
21 management guideline. There's evidence to
22 suggest that red pepper and capsaicin25
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 containing spices contribute to satiety and
2 may bolster a basal metabolic rate.
3 Herbs and spices have been
4 recommended for years as a way to help people
5 lower the sodium content of the diet.
6 We are funding research to see if
7 herbs and spices can actually increase the
8 acceptability of fruits and vegetables to pre9
schoolers, thereby bolstering the potassium
10 intake. What a gift that would be.
11 Even food safety has places where
12 herbs and spices can contribute. There's
13 evidence to show that the addition of herbs
14 and spices can impede the formation of
15 heterocyclic amines during grilling.
16 In summary, spices and herbs can
17 add to the healthfulness of the diet without
18 adding calories or any nutritional downsides.
19 We believe it is time to add a little zip to
20 the American diet in 2010.
21 Thanks so much.
22 MS. HOWES: Thank you.
26
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Speaker No. 2, would you please
2 come to the microphone?
3 You may begin.
4 MS. KRAUTHEIM: Good morning.
5 My name is Ann Marie Krautheim.
6 I'm a registered dietitian and Senior Vice
7 President of Nutrition Affairs with the
8 National Dairy Council.
9 Thank you for this opportunity to
10 share why dairy is good for life.
11 Today let's focus on three key
12 points.
13 One, why this is an historic
14 opportunity.
15 Two, dairy's unique nutrient
16 package.
17 And, three, why leading health
18 authorities recommend three to four daily
19 servings of dairy.
20 Let's get started.
21 First, this is an historic
22 opportunity to change the course of America's
27
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 dietary patterns by encouraging the
2 consumption of nutrient-dense food first.
3 Why? We have seen a growing increase in the
4 consumption of high-calorie, yet nutrient-poor
5 foods, often at the expense of nutrient-dense
6 foods.
7 This chart from an article in
8 Nutrition Today on the role of dairy foods in
9 the Dietary Guidelines demonstrates this
10 alarming trend. As you can see, adolescents
11 over the age of eight through the age of 18
12 consume less than 8 ounces of milk each day,
13 while consuming over 19 ounces of soft drinks
14 daily. Recommendations that encourage
15 nutrient-dense foods first, including low-fat
16 and non-fat dairy, can help to reverse this
17 alarming trend.
18 This brings us to our second
19 point. Dairy foods offer a unique nutrient
20 package. While calcium is the most recognized
21 dairy nutrient, dairy foods also contain other
22 essential nutrients, including potassium,
28
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 phosphorus, magnesium, zinc, protein, vitamins
2 A, D, and B12, and riboflavin. Simply put,
3 dairy foods are uniquely nutrient-dense.
4 If dairy foods are not included in
5 the diet, calcium and potassium are severely
6 compromised. For those who are lactose7
intolerant, we have dairy options: lactose8
free milk, cheeses, reduced fat and hard
9 cheeses, as well as yogurts.
10 Finally, leading health
11 authorities recommend three to four servings
12 of dairy daily. This is because people have
13 better nutrient intake, better diet quality,
14 and improved bone health and reduced risk of
15 chronic disease.
16 The dietary approaches to prevent
17 hypertension eating plan does recognize
18 dairy's role in blood pressure. Milk supplies
19 the top source of potassium in the American
20 diet. Potassium is known as a blood pressure
21 regulator, but what is not as widely known is
22 that a potassium-rich diet blunts the effect
29
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of sodium on blood pressure. DASH researchers
2 see better results when dairy intake is
3 higher.
4 MS. HOWES: Thank you.
5 MS. KRAUTHEIM: Thank you for this
6 opportunity to talk with you today.
7 MS. HOWES: Speaker No. 3, please.
8 You may begin.
9 MS. SNYDER: Hello, and thank you.
10 My name is Ceci Snyder, Assistant
11 Vice President for Consumer Marketing at the
12 National Pork Board in Des Moines, Iowa.
13 The National Pork Board represents
14 70,000 U.S. pork producers and is funded by
15 the Pork Checkoff Program.
16 As a registered dietitian, I know
17 we all recognize that Americans are eating too
18 many calories and, at the same time, eating
19 too few key nutrients. In order to improve
20 this dilemma, the National Pork Board
21 encourages the Committee to focus on the
22 benefits of choosing a variety of nutrient30
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 dense foods within and among the basic food
2 groups.
3 Americans are not overconsuming
4 meat. Rather, they are underconsuming key
5 nutrients that are found in meat, such as
6 iron, B12, potassium, and phosphorus.
7 Analysis of MyPyramid food group
8 servings using NHANES data shows that less
9 than half of the population consumes the
10 recommended 5.5 ounces of meat or meat11
equivalent.
12 The recent the IOM report on the
13 School Lunch Program states that 75 percent of
14 school-age children are not meeting the
15 MyPyramid recommendations for the meat and
16 beans group.
17 Additionally, recently-published
18 research in The Journal of the American
19 Dietetic Association shows that Americans in
20 general do not consume the most nutrient-dense
21 foods in the basic food groups, offering an
22 opportunity to educate and encourage Americans
31
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 to make smarter food choices.
2 For instance, many people don't
3 realize that a 3-ounce serving of lean beef or
4 pork provides the same amount of protein as a
5 cup and a half of legumes but in half the
6 calories.
7 Calorie-for-calorie, lean red meat
8 is a nutrient-dense choice. A serving of
9 roasted pork tenderloin is an excellent source
10 of protein, thiamin, vitamin B6, phosphorus,
11 and niacin, and a good source of riboflavin,
12 potassium, and zinc.
13 A serving of lean beef is an
14 excellent source of protein, zinc, B12,
15 selenium, and phosphorus, and a good source of
16 choline, niacin, B6, iron, and riboflavin.
17 Both lean beef and pork offer
18 these key nutrients in a single serving with
19 less than 160 calories.
20 And although no one food can
21 remedy our nation's obesity epidemic, research
22 has consistently shown that protein plays a
32
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 unique role in satiety. Recent findings also
2 show that higher protein intake preserves lean
3 mass when calories are restricted. Lean body
4 mass preservation can help sustain basal
5 metabolic rate, which may help in long-term
6 weight maintenance.
7 Protein intake is also essential
8 to help prevent and treat sarcopenia, a
9 disease which will grow in significance as our
10 population ages.
11 While we all agree Americans
12 should eat more fruits and vegetables, there
13 are certain nutrients like iron and zinc which
14 are more easily absorbed from animal foods
15 rather than plants.
16 In summary, the published science
17 supports lean meat's role in a healthy diet.
18 Thank you.
19 MS. HOWES: Thank you very much.
20 Speaker No. 4.
21 You may begin.
22 MS. LEVIN: Okay. Good morning.
33
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 My name is Susan Levin. I'm a
2 dietitian at the Physicians' Committee for
3 Responsible Medicine.
4 Every five years since 1980, the
5 government has given new health and nutrition
6 advice to the American public through the
7 Dietary Guidelines, and every year since then,
8 the American public has become markedly more
9 overweight and obese.
10 The Guidelines were originally
11 written with healthy people in mind, but today
12 only a minority of Americans fit this
13 description. That is largely because our
14 ever-growing appetites for cheap, fatty foods
15 have made us one of the most overweight and
16 chronically-ill countries in the world.
17 Almost 81 million Americans have
18 at least one form of cardiovascular disease,
19 and diabetes rates have gone through the roof.
20 One in three children born in 2000 will
21 develop diabetes at some point in his or her
22 lifetime. The NIH stated earlier this week
34
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 that 13 percent of adults have diabetes.
2 The average American now eats more
3 than 200 pounds of meat per year,
4 approximately the double global norm. We eat
5 about 30 pounds of cheese per year, three
6 times as much as we did in 1970.
7 Both of these animal products are
8 high in total fat, saturated fat, and
9 cholesterol, and completely devoid of fiber,
10 all areas to be focused upon, according to
11 previous Dietary Guidelines.
12 It is time for the Guidelines to
13 take direct aim at the diet-related diseases
14 that claim millions of American lives each
15 year. To do that, they should support low-fat
16 diets-- about 10 percent of calories from fat-
17 - for the prevention and treatment of disease.
18 They also need to include more
19 information on the benefits of plant-based
20 diets. Vegetarian diets should be touted as
21 the ideal, and let people deem how they want
22 to adapt this healthful way of eating to their
35
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 own lifestyles.
2 Science supports a low-fat, plant3
based diet for optimal health. In fact, the
4 ADA states that well-planned vegan and other
5 types of vegetarian diets are appropriate for
6 all stages of the life cycle and offer a
7 number of nutritional benefits.
8 The ADA's position paper was
9 published in 2003 and references over 250
10 studies and papers. The studies continue and
11 show that these types of diets still prevent
12 type 2 diabetes, cardiovascular disease, and
13 some types of cancer.
14 Guidelines should rely solely on
15 evidence-based research and disregard any
16 special interest groups. It is possible to
17 set the bar as high as the science dictates,
18 and it is critical that the USDA acknowledge
19 America's current state of health and rewrite
20 the Dietary Guidelines for the majority of
21 Americans-- those who are overweight or obese.
22 Making these revisions will not be
36
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 easy. Real innovation never is.
2 Thank you.
3 MS. HOWES: Thank you.
4 Speaker No. 5, please.
5 You may begin.
6 MS. YOUNG: Good morning.
7 I am Mary Young, a registered
8 dietitian and Vice President for Nutrition
9 with the National Cattlemen's Beef
10 Association, funded by America's beef farmers
11 and ranchers.
12 We thank you for the opportunity
13 to participate today.
14 For nearly three decades, public
15 health and government guidance have called for
16 Americans to reduce their total fat, saturated
17 fat, and cholesterol. Improvements in food
18 industry practices are central to achieving
19 these goals, and the red meat industry has met
20 this challenge.
21 Today lean red meat is widely
22 affordable, available, and popular with
37
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 consumers. Quite simply, today's red meat may
2 not be what you think it is. In fact, today's
3 pork is 30 percent leaner than 30 years ago,
4 and beef is 20 percent leaner than 14 years
5 ago.
6 Beef and pork producers have
7 utilized feeding and breeding techniques to
8 produce leaner animals, and recently market
9 basket research reveals that beef and pork in
10 the meat case have less than zero inch fat
11 trim, practically devoid of external fat.
12 This is a dramatic improvement since the 1980
13 edition of the Dietary Guidelines, when
14 average fat trim was half-inch. These
15 significant changes in the industry have
16 resulted in at least 35 cuts of red meat that
17 meet government guidelines for lean.
18 Frankly, there is a common
19 misperception that only poultry provides lean
20 options, but here's a fact you may not
21 realize: when comparing lean protein options
22 such as pork tenderloin, sirloin steak, and a
38
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 skinless chicken breast, all have less than 2
2 grams of saturated fat per 3-ounce serving,
3 demonstrating that both white and red meat
4 provide lean options. In fact, all of the
5 numerous lean beef and pork cuts, on average,
6 have only one more gram of saturated fat than
7 the leanest chicken cut, a skinless chicken
8 breast.
9 These are not obscure cuts hidden
10 in the meat case. In fact, consumers are
11 choosing leaner cuts in the grocery aisle.
12 Fifty-five percent of pork sales and 65
13 percent of all beef muscle cuts sold at retail
14 meet government guidelines for lean.
15 Red meat's fatty acid profile also
16 requires clarification. Despite the common
17 reference that animal fats are saturated,
18 nearly 50 percent in red meat are
19 monounsaturated, and one-third of the
20 saturated fat in beef and pork is stearic,
21 which have a neutral or cholesterol-lowering
22 effect.
39
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 A serving of lean red meat is a
2 good or excellent source of 10 essential
3 nutrients and only 154 calories and 2 grams of
4 saturated fat. Given this nutrient
5 contribution and the dramatic changes in the
6 leanness of the product, it is essential to
7 rethink red meat's important contribution to
8 healthy diets.
9 Thank you.
10 MS. HOWES: Thank you.
11 Speaker No. 6, please.
12 You may begin.
13 DR. BARNARD: Good morning.
14 I am Neal Barnard, Adjunct
15 Associate Professor of Medicine at the George
16 Washington University and President of the
17 Physicians' Committee for Responsible Medicine
18 here in Washington.
19 As nursing babies taste their
20 first solid foods, rice cereal goes down well
21 and fruit is well-accepted, too. But,
22 eventually, well-meaning parents put a little
40
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 chunk of meat into the baby's mouth, and the
2 infant promptly pushes it back out, and it
3 rolls down the baby's bib. The parents push
4 the meat back in, and the baby spits it out
5 again. And the battle of wills continues
6 until the baby relents and meat becomes a
7 permanent part of the diet, in much the same
8 way previous Dietary Guidelines have pushed
9 meat into our collective mouths and scientific
10 studies keep pushing it back out again.
11 Prospective studies, including the
12 Adventist Health Study and others, show that
13 controlling for other lifestyle factors,
14 people who eat meat have shorter lifespans and
15 greater risk of common illnesses, particularly
16 cardiovascular disease, compared with
17 vegetarians.
18 But past Dietary Guidelines have
19 suggested instead that choosing lean meat is
20 as healthful as avoiding meat completely, and
21 every five years the Committee has shoved meat
22 back into our Guidelines, and research is
41
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 spitting it out again.
2 Clinical trials confirm that
3 people who merely limit meat intake following
4 the National Cholesterol Education Program
5 Guidelines, for example, reduce their LDL
6 cholesterol levels by only about 5 percent.
7 A vegetarian or vegan diet reduces LDL by
8 anywhere from 13 to 37 percent, depending on
9 the overall makeup of the diet.
10 The preventive power of a meatless
11 diet against heart disease, weight problems,
12 diabetes, and other conditions exceeds that of
13 other diets. The same is probably true for
14 cancer. The AICR report indicated that red
15 meat is a convincing cause of colorectal
16 cancer, with no entirely safe intake level.
17 Similar issues apply to dairy
18 products. Certainly, people who get less
19 than, say, 600 milligrams of per day, do well
20 to increase calcium intake. But green
21 vegetables, beans, and other foods provide
22 highly-absorbable calcium, and they deserve
42
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 emphasis.
2 Prospective studies confirm that
3 milk-drinkers have no better bone development
4 early in life and no fewer hip fractures later
5 in life.
6 If we were to skip meat and dairy
7 products, what would happen to our overall
8 nutrition? Well, studies show that omnivores
9 who switch to vegan diets improve their
10 nutrition, reducing their intake of fat and
11 saturated fat and cholesterol, increasing
12 fiber and many important nutrients.
13 So let me suggest two points that
14 should be emphasized in the Guidelines.
15 First, individuals who avoid meat
16 enjoy health benefits compared to those who
17 include even lean meat.
18 Second, making vegetarian and
19 vegan foods part of children's routines,
20 including school lunches, is an important way
21 to reduce saturated fat, increase fiber, and
22 improve overall nutrition.
43
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. HOWES: Thank you.
2 DR. BARNARD: Thank you.
3 MS. HOWES: We appreciate your
4 comments, Doctor.
5 Speaker No. 7.
6 You may begin.
7 DR. HILL: Good morning.
8 My name is Jim Hill. I am
9 Professor of Pediatrics and Medicine at the
10 University of Colorado, Denver. I'm currently
11 serving as the President of the American
12 Society for Nutrition, or ASN, and I am
13 pleased to be representing the Society here
14 today in presenting its initial thoughts to
15 this Committee.
16 With a membership of more than
17 3500 scientists, ASN is the premiere research
18 society dedicated to improving the quality of
19 life through the science of nutrition. We are
20 proud of our members who are serving on this
21 Committee and those who have served on past
22 committees.
44
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 First of all, ASN would like to
2 offer itself and its members as a resource for
3 you as you move forward with your evaluation
4 of the science. Our members have a wealth of
5 experience from molecular biology to clinical
6 nutrition research. We can assist in
7 identifying subject matter experts to brief
8 you on topics as necessary.
9 In May 2007, Dr. Janet King, Chair
10 of the 2005 Dietary Guidelines Committee, and
11 other members of that group, sent a letter to
12 HHS and USDA. ASN endorses the following
13 recommendations set forth in this letter:
14 The translation of the Advisory
15 Committee's report into the government Dietary
16 Guidelines report should be transparent. The
17 Committee should be informed about the
18 translation and the content in the final
19 report before it is released and given an
20 opportunity to review it.
21 Food accessibility, marketing,
22 economics, and culture should be considered
45
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 when reviewing the science supporting the next
2 set of guidelines. These factors have a
3 significant influence on food intake and
4 health behaviors, and lack of sufficient
5 consideration of them in previous Dietary
6 Guidelines may, in part, explain why so few
7 Americans follow them.
8 A focus group of guideline users
9 from such sectors as the food industry,
10 medical, and public communities, as well as
11 the general public, could be convened to
12 review the Guidelines before they are released
13 and provide input.
14 Non-evidence-based approaches must
15 supplement the systematic review that is
16 critical to evaluating the science. Such
17 approaches should include food modeling. This
18 is necessary for adopting the recommendations
19 to fit the needs of subpopulations such as
20 vegetarians, those with lactose-intolerance,
21 children, older adults.
22 The following areas should be
46
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 addressed: nutrient density, especially
2 beverage; health-effective protein sources;
3 nutritional supplements; specific functional
4 foods or food components.
5 Lastly, we endorse the Physical
6 Activity Guidelines for Americans that are an
7 important accomplishment and one we applaud.
8 However, we would love to see a unique set of
9 guidelines that encompasses both dietary and
10 physical activity recommendations. To
11 separate the two not only diffuses the
12 message, but could confuse the public.
13 Thank you for this opportunity.
14 MS. HOWES: Thank you.
15 Speaker No. 8.
16 You may begin.
17 MS. PIRELLO: Good morning.
18 I'm Christina Pirello. I host
19 Christina Cooks on National Public Television,
20 and I hold a master's degree in food science
21 and nutrition, and I'm frustrated.
22 After more than 20 years of
47
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 teaching healthy lifestyle classes, I have
2 seen our country grow fatter, less healthy,
3 and certainly less fit.
4 Healthcare is on everyone's mind
5 these days. Costs are out of control, but
6 they're right in line with our out-of-control
7 decline in health. The simple truth is, if
8 people changed their diets, healthcare would
9 reform itself. With cancer, diabetes, heart
10 disease, and obesity on the rise, we need to
11 wake up and smell the toast.
12 Industrial food production has
13 created a global desire for cheap, empty
14 calories. The stranglehold that certain
15 advertisers hold over consumers has made
16 shopping a shell game that nobody can win.
17 America's health will only get
18 worse as they grow more brainwashed and more
19 confused. Advertisements show slim, fit
20 people eating the very foods that we all know
21 will turn them into overweight, sick,
22 pharmaceutical-dependent wrecks.
48
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Decades of inappropriate
2 information, given in the name of market, have
3 literally murdered Americans' health for
4 profit, and it's impossible to present
5 objective guidelines when that information is
6 sponsored by special interest groups who do
7 not have the health of America in mind.
8 It's time to stop kidding
9 ourselves. Honey Nut Cheerios are not natural
10 whole grain, Coca-Cola is in no way
11 nutritious, and hormone-fed animals are in no
12 way natural meat sources.
13 Truly healthy guidelines are
14 necessary to meet the urgent challenges of our
15 time. With rising energy costs, climate
16 change, food costs rising, diminishing water
17 supplies, and an exploding population,
18 quality, not just quantity, have to rule the
19 Guidelines.
20 We must encourage the consumption
21 of vegetables, fruits, beans, and whole
22 unprocessed grains, and discourage the
49
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 consumption of saturated fats, sugar, and junk
2 food.
3 The new Dietary Guidelines must
4 reflect our commitment to reverse the
5 catastrophic epidemic of disease we face,
6 including more information on the benefits of
7 vegetarian and vegan diets, and placing the
8 focus on them for the role they play in the
9 prevention and even treatment of many
10 conditions.
11 While other things have been
12 linked to Americans' sort of loss of health,
13 the frequent consumption of plant foods has
14 also been identified as a factor for increased
15 longevity. Loma Linda, California, has been
16 declared an official blue zone, an area where
17 people live long, healthy, and productive
18 lives, and where the lion's share of the
19 Seventh-day Adventist population eat a
20 nutrient-rich vegan diet.
21 And finally, the most inconvenient
22 truth of all: rising animal costs for food
50
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 take 10 times the water to produce animal
2 protein versus vegetable, so our environment
3 can't take it.
4 It's up to you to help us create
5 guidelines that will make America healthy.
6 Thank you.
7 MS. HOWES: Thank you very much.
8 Speaker No. 9, you may begin.
9 MR. ABELMAN: Good morning.
10 Steve Abelman from the March of
11 Dimes.
12 Madam Chairperson, members of the
13 Committee, we appreciate the opportunity to
14 speak before you as you deliberate over the
15 content of the advisory report for the 2010
16 Dietary Guidelines for Americans.
17 The mission of the March of Dimes
18 is to improve the health of babies by
19 preventing birth defects, prematurity, and
20 infant mortality. Thus, we promote healthy
21 nutrition for women of child-bearing age to
22 help have a healthy baby.
51
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Since the early 1990s, the U.S.
2 Public Health Service and the Institute of
3 Medicine have recommended that all women of
4 child-bearing age consume 400 micrograms of
5 folic acid daily to reduce the incidence of
6 neural tube defects, such as spina bifida.
7 We have encouraged women capable
8 of having a baby to consume a multivitamin
9 containing folic acid, and to eat foods that
10 have folic acid in them. But according to the
11 latest findings from a March of Dimes survey
12 conducted by the Gallup Organization, less
13 than 40 percent of women of child-bearing age
14 say they take a daily multivitamin supplement
15 containing folic acid.
16 Other studies show that most women
17 do not achieve the recommended amount of 400
18 micrograms of folic acid by eating naturally19
folate-rich foods. Therefore, enriched grain
20 products like breads, cereals, pasta, and rice
21 offer a viable option for women to help them
22 get the folic acid they need, enriched grain
52
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 products that are fortified with folic acid,
2 which helps to prevent these serious birth
3 defects of the spine and brain.
4 While we agree that 100 percent
5 whole grains are important and an excellent
6 source of micronutrients and fiber, the
7 current Dietary Guidelines suggest that half
8 of grain consumption should be in the form of
9 whole grains. These Guidelines also say that
10 the remaining servings can come from enriched
11 or other grain products.
12 Since the FDA in 1998 mandated
13 that any grain and cereal product containing
14 the label enriched be fortified with folic
15 acid, the CDC has reported that the incidence
16 of these birth defects dropped by 26 percent.
17 This is still well short of the 2010 national
18 health objective of reducing the occurrence of
19 spina bifida by 50 percent.
20 The FDA's decision to add folic
21 acid was a victory for mothers and babies.
22 It's rare that we get the opportunity to
53
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 prevent thousands of babies being born with
2 disabling or fatal birth defects with such a
3 low-tech means.
4 Therefore, the March of Dimes
5 Foundation encourages the Dietary Guidelines
6 Advisory Committee to maintain the current
7 balance between the whole grains and enriched
8 grains in the 2010 Dietary Guidelines for
9 Americans.
10 Thank you.
11 MS. HOWES: Thank you. Speaker
12 No. 10, you may begin.
13 MS. ROSA GONZALEZ: Good morning.
14 My name is Rosa Gonzalez, and I am
15 a concerned citizen from Fredericksburg,
16 Virginia.
17 A couple of months ago, I was
18 diagnosed with metabolic syndrome. I weighed
19 over 225 pounds, and I was told I had
20 diabetes, high blood pressure, and I was on
21 the verge of taking five different pills.
22 I was assigned to meet with a
54
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 dietitian, who told me I had to follow the
2 Dietary Guidelines that included dairy, meat,
3 and, of course, fruits and vegetables. I
4 indicated to her that I was interested in
5 following an alternative diet, which was
6 vegetarian, that I had read could improve my
7 diabetes.
8 With her mixed blessings, I
9 followed this diet, and was able to lose
10 almost 100 pounds. I improved my diabetes.
11 My A1C went from 15 to 5.4. I am no longer
12 diabetic. My diabetes is in remission.
13 My cholesterol went from 215 to
14 137. My vision changed. I had to get new
15 eyeglasses. My thyroid, which I had suffered
16 from for numerous years, reduced three
17 different times. My dosage is down three
18 times. My blood pressure, which was 140 over
19 80, is now 102 over 63.
20 So I'm living proof that Americans
21 can do this if the Dietary Guidelines are
22 there that provide alternatives.
55
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I was very disappointed that my
2 dietitian did not support me, and now she's
3 all for it, and is proud of the fact that I
4 was able to accomplish this.
5 Thank you.
6 MS. HOWES: Thank you.
7 Speaker No. 11, please. You may
8 begin.
9 DR. POPPER: Thank you for
10 inviting me today.
11 My name is Pam Popper. I'm the
12 Executive Director of the Wellness Forum in
13 Columbus, Ohio. I'm a naturopath and
14 nutritionist, and we help people to reverse
15 degenerative disease by making diet and
16 lifestyle recommendations, and helping them to
17 accomplish change. We also operate a
18 foundation that goes into schools and works on
19 improving school food and children's health.
20 It is quite clear to me that the
21 reason we have such a health crisis in this
22 country is based on food intake. When people
56
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 come into our office, we put them on a near2
vegetarian or vegan diet, and their health
3 issues start to resolve and they lose weight.
4 And I'm talking about serious conditions:
5 multiple sclerosis, coronary artery disease.
6 And I'm not the only practitioner
7 accomplishing these types of results. I have
8 provided numerous references in the packet
9 that I gave to the lady at the desk.
10 The problem, and the one that
11 we're here to discuss today, is the current
12 Dietary Guidelines really don't make
13 recommendations consistent with the diet that
14 produces these outcomes. There's too much
15 allowance for animal foods and dairy products
16 and fats and oils and refined foods, which we
17 know lead to the creation of degenerative
18 disease.
19 I would ask the Committee to
20 really think about looking at some of the
21 myths that perpetuate bad diets, one of which
22 is that we don't know what really constitutes
57
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the best diet for humans, but I think the
2 research is quite clear: plant-based diets
3 are better for human health.
4 Another is that people won't adopt
5 this type of diet, so why bother to tell them
6 about it? But my experience is completely
7 different. When we talk to people about the
8 dangers of the American diet, and we show them
9 how to adopt a near vegetarian and vegan diet,
10 a lot of them do it.
11 And this may sound
12 counterintuitive, but the bigger changes they
13 make, the more likely they are to be
14 compliant, because big dietary changes result
15 in big health changes, and that's a motivating
16 factor for people to continue their good
17 dietary habits.
18 Still another myth is that
19 children won't adopt this kind of diet, but
20 they will. When we educate kids in schools,
21 and we do staff and teacher training, and we
22 educate parents, kids make healthier choices,
58
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 even when bad choices are available.
2 Last but not least, I'd like to
3 address a very important myth, which is that
4 little changes result in health change, and
5 they don't. People come into my office,
6 they've been trying to change their diet for
7 a long time without success, but when we
8 address the totality of their diet, the good
9 changes in health status begin to emerge.
10 So in closing, I'd like to propose
11 that the revision of the Dietary Guidelines
12 for Americans be based on the preponderance of
13 the scientific evidence, which is that a
14 plant-based diet is best for humans, and that
15 those be translated into clear recommendations
16 to adopt such a diet, and we ignore a lot of
17 the special interest groups that I'm sure will
18 be hurt, in the interests of public health,
19 which is being hurt daily by the current state
20 of affairs.
21 Thank you very much for the
22 opportunity to talk to you today.
59
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. HOWES: Thank you.
2 Speaker No. 12, please. You may
3 begin.
4 MS. VAN ELSWYK: Good morning.
5 My name is Mary Van Elswyk, and
6 I'm representing Martek Biosciences.
7 Thank you to the Committee for
8 this opportunity.
9 As the Committee considers the
10 Dietary Guidelines, it will be important to
11 recognize the availability, sustainability,
12 and quality of various food sources. This
13 will be particularly important with regard to
14 rich sources of long-chain omega-3 fatty acids
15 or n-3 LCPUFA.
16 The current Dietary Guidelines
17 suggest that consuming two fish meals per week
18 can help reduce the risk of cardiovascular
19 disease mortality in at-risk adults. Data
20 from cardiovascular studies published since
21 the 2005 Dietary Guidelines now provide strong
22 evidence for the primary prevention of
60
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 cardiovascular disease, as well.
2 Additional data from RCTs further
3 suggests that n-3 LCPUFA equal to or greater
4 than 500 milligrams per day may significantly
5 reduce blood pressure and heart rate in the
6 general population.
7 In addition, the evidence in
8 support of DHA omega-3 for neurocognitive
9 health continues to grow. The 2005 report
10 recognized the increased need for various
11 nutrients in population subgroups, but failed
12 to recognize the importance of DHA omega-3
13 among pregnant and nursing women, women of
14 child-bearing age, young children, and the
15 elderly.
16 Evidence published since the 2005
17 Dietary Guidelines provide strong
18 observational support indicating that n-3
19 LCPUFA may increase the cognitive function of
20 adults over the age of 50, and overwhelming
21 support from both RCTs and observational
22 studies regarding DHA supplementation during
61
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 pregnancy, and increased gestational duration
2 and improved neural development of infants and
3 young children, particularly with regard to
4 vision-related outcomes.
5 Current expert group
6 recommendations include consumption of at
7 least 200 milligrams of DHA per day during
8 pregnancy and nursing from low-risk sources
9 such as low-methylmercury fish and dietary
10 supplements from marine algal oil.
11 Meeting this recommended intake in
12 theory is achievable and safe if women are
13 knowledgeable about high-DHA, low-toxin fish,
14 and are willing and financially able to
15 consume fish. In reality, this becomes
16 difficult, requiring a high level of knowledge
17 and competence regarding seafood sources, and
18 the willingness to incorporate these sources
19 in the diet on a regular basis.
20 As we look to expand our
21 consumption of DHA omega-3, it will also be
22 important to consider the sustainability of
62
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 fish. According to recent figures from the
2 FAO, more than half of all fisheries worldwide
3 are being fished at or beyond their maximum
4 biological capacity.
5 Recognizing the intakes of even
6 just two fish meals per week may be difficult
7 to achieve or sustain, the Dietary Guidelines
8 should consider fortified foods and dietary
9 supplements as part of their recommendations.
10 Thank you.
11 MS. HOWES: Thank you.
12 Speaker No. 13, please. You may
13 begin.
14 MS. NINA GONZALEZ: Okay. My
15 name is Nina Gonzalez, and I'm a junior at
16 Stafford High School in Fredericksburg,
17 Virginia. I'm part of the Commonwealth
18 Governor's School, which is kind of a magnet
19 program of the school.
20 And as part of our research, we
21 enact culminating regulation, which is where
22 you take four years of your high school career
63
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 and you dedicate it to a study. So I
2 dedicated mine to finding vegetarian options
3 in our cafeteria.
4 I became a vegetarian about three
5 years ago. And I noticed that at our
6 cafeteria we didn't have meatless options.
7 And I talked to a bunch of my fellow peers,
8 and there was a need for it. So I met with
9 the County Nutrition Director, and he was a
10 little bit hesitant, but I encouraged him to
11 look into it because there was a need.
12 So we had a meeting at our school,
13 and we had about 30 kids who were interested.
14 And so we talked, and we had taste testings.
15 And fortunately, I succeeded and we got
16 vegetarian options into our menu.
17 And I encourage you to look into
18 this because, as part of when you add food to
19 the lunches, you have to go through the
20 Pyramid, and they have to meet several
21 regulations. So I see that there is wide
22 acceptance of this, and I had kids stop me in
64
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the hallway thanking me for this, because it
2 was something that they really had -- it was
3 a variety.
4 So I encourage you to evaluate
5 this and look into various additions to the
6 Food Pyramid, and perhaps at least just
7 mention that a vegetarian option is an option,
8 and that it should be included in there and
9 mentioned.
10 Thank you.
11 MS. HOWES: Thank you.
12 Speaker No. 14, please. You may
13 begin.
14 MS. LEAHY: Good morning.
15 My name is Cheryl Leahy. I'm the
16 General Counsel at Compassion Over Killing,
17 which is based here in Washington.
18 I believe the Dietary Guidelines
19 for Americans should promote a more vegan diet
20 or plant-based diet. The benefits of
21 especially low-fat, plant-based diets include
22 lower rates of heart disease, certain cancers,
65
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 diabetes, obesity, that some of the other
2 speakers have mentioned today, and other
3 killers which are all epidemics and increasing
4 with the decreasing health of the American
5 public.
6 Just to take a few examples,
7 plant-based diets strongly correlate with
8 dramatically lower heart attack risk. A study
9 published in Nutrition Today on endurance
10 showed that the average endurance was nearly
11 three times higher when the subjects were fed
12 a plant-based diet than when they were fed a
13 high meat diet, and nearly 1.5 times better
14 than a mixed diet from plant and animal
15 sources.
16 Plant-based diets have no
17 cholesterol, and a significantly lower amount
18 of saturated fat than the current Guidelines
19 allow and current actual diet consumption
20 reflects. Cholesterol rates are directly
21 correlated with consumption of saturated fat,
22 as well, and blood cholesterol, of course.
66
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 And in addition, public sentiment
2 is moving more and more toward plant-based
3 diets, for reasons of health. Also
4 environmental protection and animal
5 mistreatment issues.
6 Animal agriculture, from the
7 environmental side, is the largest consumer
8 and polluter of water, for example. It's also
9 extremely inefficient, requiring seven to 10
10 times the amount of grain and water per unit
11 of meat than if you were to feed the grain
12 calories directly.
13 Pesticides are more concentrated
14 in typical animal flesh products than in
15 plant-based products, which is obviously also
16 a major concern for health.
17 And the public has become
18 concerned with the cruelty endemic in the way
19 modern agriculture chooses to raise and kill
20 animals. Investigation video footage has
21 shown numerous instances of severe neglect and
22 abuse, painful and improper slaughter, and
67
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 other problems which have increased public
2 awareness of this issue.
3 So the popularity of vegetarian
4 and vegan diets has only been increasing and
5 will likely continue to increase. Just this
6 month, a study was published saying one in 200
7 kids are vegetarian, which that number may be,
8 in fact, significantly higher.
9 Current subsidy programs really
10 don't reflect any priority on eating plant11
based diets. And so eating vegetarian and
12 vegan should be actively promoted in the
13 Guidelines to help encourage policy changes in
14 that direction and practical changes among the
15 public in that direction as well.
16 Thank you.
17 MS. HOWES: Thank you. Speaker
18 No. 15, please.
19 You may begin.
20 MS. ZOELLNER: Good morning.
21 My name is Jamie Zoellner, and I'm
22 an assistant professor and registered
68
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 dietitian from the University of Southern
2 Mississippi.
3 I'm here today to represent the
4 voice of residents who live in the Lower
5 Mississippi Delta Region. As many of you may
6 be aware, the Delta is a rural area, one of
7 the most impoverished regions in the United
8 States, with extensive health and nutritional
9 disparities that have been documented.
10 My research efforts have focused
11 on exploring issues related to health and
12 nutrition literacy in this area. About two
13 years after the 2005 Dietary Guidelines and
14 MyPyramid were released, we conducted a cross15
sectional study in the Mississippi Delta. Our
16 objective was to examine the nutritional
17 literacy status.
18 When provided with four graphics
19 and asked to identify the most recent picture
20 promoted by the 2005 Dietary Guidelines, only
21 12 percent could identify the newest
22 mypyramid.gov. So 12 percent could identify
69
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 that graphic two years after its release.
2 Participants trusted information
3 from doctors and the television the most, and
4 the internet the least. Overall, the internet
5 was the least trusted and least used source
6 for seeking nutrition information.
7 We found rates of limited health
8 literacy among Delta adults were higher
9 compared to other national surveys. Results
10 also suggested that nutrition literacy status
11 had important implications for acquiring and
12 trust of nutrition information.
13 So while the dietaryguidelines.gov
14 and mypyramid.gov are fabulous websites, and
15 for the mainstream population, electronic
16 health communication is very exciting, please
17 remember that you and I may live in a world of
18 Wi-Fi and Blackberries, but people in the
19 Delta don't. As a matter of fact, many of
20 them don't have computers in their homes, or
21 in their schools, or have infrastructure in
22 their communities to support internet access.
70
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 The most basic component of
2 nutrition literacy is the ability to obtain
3 nutrition information. If we are
4 concentrating our efforts on putting these
5 messages in places that aren't accessed or
6 trusted by those who may need them the most,
7 then we're fighting a losing battle.
8 As an advisory committee, I know
9 you have many difficult tasks in front of you.
10 I hope one of your priorities is considering
11 this need to better disseminate culturally12
appropriate dietary guidance messages in hard13
to-reach, health disparate populations, which
14 includes culturally-appropriate communication
15 channels.
16 Based on our research in the
17 Delta, I'm fearful that relying on the
18 internet as a central mode of nutrition
19 communication will only widen the nutritional
20 disparity gaps in this region.
21 Thank you.
22 MS. HOWES: Thank you. Speaker
71
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 No. 16, please. You may begin.
2 MS. DiSOGRA: Sure. Good morning.
3 I'm Lorelei DiSogra. I'm the Vice
4 President for Nutrition and Health at United
5 Fresh Produce Association. We're located here
6 in Washington, D.C.
7 I'm sure this committee is well
8 aware of the health benefits of a diet rich in
9 fruits and vegetables. So I won't go there.
10 I would say that our organization
11 strongly supports the fruit and vegetable
12 recommendations from the 2005 Dietary
13 Guidelines. However, I do want to make three
14 recommendations to this Committee.
15 The first one is to please provide
16 very clear and strong - stronger - advice that
17 might motivate people to actually change their
18 behavior and eat more fruits and vegetables
19 than what we saw in the 2005 version. Terms
20 like, make wiser food choices, and, foods to
21 encourage, are very, very vague, and just
22 don't do anything in terms of motivating
72
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 anybody, including policymakers, to pay
2 attention to this. So I encourage you to make
3 strong, clear recommendations that are going
4 to motivate the public to make some changes.
5 Secondly, in preparation for the
6 2005 Dietary Guidelines, a team of us at the
7 National Cancer Institute in the Five-A-Day
8 Program worked for quite a long time to come
9 up with some overarching statements that could
10 apply to fruits and vegetables, and I would
11 ask this committee -- and I'm sure you've
12 already looked at it -- but I would ask this
13 committee to look at Table A2 in the 2005
14 Dietary Guidelines, and see how anybody could
15 make any sense out of fruit and vegetable
16 recommendations.
17 So I'm asking you, at the end of
18 your deliberations on 2010, is to take a look
19 at this, and see if you can't make any
20 overarching recommendations about fruits and
21 vegetables. The statement that we came up
22 with at the National Cancer Institute back in
73
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 2005 was, half your plate should be fruits and
2 vegetables. So think about something like
3 that. That considers that the glass of milk
4 is off to the side. So half your plate, I
5 would ask you to consider something like this.
6 Thirdly, I would like to say that,
7 where you're operating right now in your
8 recommendations, you're going to come into a
9 whole different arena in terms of nutrition.
10 Nutrition, the importance of nutrition, the
11 importance of nutrition in prevention, has
12 changed in this town in the last eight days.
13 You know, it's amazing that you
14 could have Secretaries Daschle and Vilsack
15 meeting before they get confirmed to talk
16 about nutrition and prevention and the role in
17 health reform.
18 So I would ask this committee to
19 think about the policy implications of your
20 recommendations, and again speak very strong
21 and clear and loudly to the policymakers in
22 this town.
74
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thanks very much.
2 MS. HOWES: Thank you. Speaker
3 17, please. You may begin.
4 MS. McGUIRE: Good morning.
5 I'm honored to have the
6 opportunity to speak to the committee today.
7 My name is Jennifer McGuire, and I
8 am a registered dietitian with special
9 expertise in nutrition communication. I work
10 for the National Fisheries Institute, McLean,
11 Virginia, and spend much of my time following
12 the steady stream of scientific studies about
13 fish and its health benefits. But this
14 science will be submitted to the Nutrition
15 Evidence Library and speak for itself.
16 Instead, today I am going to focus
17 on nutrition communication, because scientific
18 studies are meaningless to the average
19 consumer unless their findings are clearly
20 communicated via simple and caveat-free
21 recommendations about what to eat.
22 The amount of seafood Americans
75
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 eat is low. While the average person eats
2 more than enough total protein, fish
3 contributes only 3.5 percent to this total.
4 For perspective, meat contributes 24 percent,
5 and cheese alone contributes 8.6 percent.
6 Worse, there are subpopulations that eat even
7 less than average fish. Pregnant women in
8 this country eat just 1.89 ounces of seafood
9 per week.
10 The most popular and often least
11 accurate source of information about seafood
12 is the media. Here are two examples of
13 scientifically-incorrect statements countless
14 Americans heard or read in the last month:
15 First, in The LA Times, from an
16 article about the effect of eating fish on
17 brain development, a physician explains that,
18 "Fish are not the only good source of omega-3
19 fatty acids. Significant plant sources of the
20 nutrient include flaxseed, walnuts, pecans,
21 cauliflower, broccoli, et cetera." -- with no
22 differentiation between short- and long-chain
76
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 omega-3s.
2 Next from Good Morning, America,
3 as part of a story about the effects of eating
4 fish on a middle-aged man, Diane Sawyer
5 explains, "Albacore tuna should be limited to
6 one meal a week. Fish lower in mercury,
7 shrimp and salmon, two meals a week." -- with
8 no mention that this FDA advice is not for
9 middle-aged men, but for pregnant and nursing
10 women and young children.
11 Clear, unequivocal recommendations
12 in the Dietary Guidelines are needed to combat
13 this type of misinformation about eating fish.
14 To end up with these explicit recommendations,
15 the Committee must keep these three points in
16 mind:
17 First, the Committee's
18 recommendations must be based on science and
19 scientifically-measured outcomes.
20 Second, FDA released just last
21 week a draft report on the net effect of
22 eating fish. I implore you to adopt FDA's
77
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 holistic approach in your own review of
2 seafood science, because when we talk about
3 whole foods, nutrients like omega-3s and
4 elements like mercury don't exist in a vacuum.
5 The Committee must understand that studies
6 calculating the effect of eating fish on the
7 brain or heart include a built-in risk/benefit
8 equation. This liberates you to communicate
9 using net, outcome-based recommendations
10 without caveats.
11 Lastly, please consider the
12 challenge posed to you at your first meeting
13 to identify two or three dietary changes that
14 Americans could make immediately that would
15 most greatly benefit your health. Fish
16 certainly qualifies as one of these changes.
17 Thank you.
18 MS. HOWES: Thank you. Speaker
19 No. 18, please. You may begin.
20 MS. TERNUS: Thank you. Good
21 morning.
22 I'm Maureen Ternus. I'm a
78
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 registered dietitian and Executive Director of
2 the International Tree Nut Council, Nutrition,
3 Research, and Education Foundation, or INC
4 NREF, in Davis, California.
5 And on behalf of INC NREF, I'd
6 like to thank you for the opportunity to
7 provide comments today on the health benefits
8 of nuts.
9 INC NREF is a non-profit
10 organization. We represent nine different
11 tree nuts.
12 While the FDA-qualified health
13 claim for nuts and heart disease recommends
14 one-and-a-half ounces of nuts per day, few
15 people actually consume this amount. In the
16 2001/2004 What We Eat in America NHANES
17 survey, 34 percent of those surveyed consumed
18 nuts, but most only ate about three-quarters
19 of an ounce, roughly half of the recommended
20 amount.
21 Why should we consume more? Since
22 the publication of the 2005 Dietary
79
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Guidelines, there has been a dramatic increase
2 in the number of studies showing the positive
3 role of nuts in reducing the risk of
4 cardiovascular disease and diabetes and their
5 positive effect on weight and satiety.
6 Thirty-one randomized clinical
7 trials have provided further evidence that
8 nuts can help reduce the risk of heart
9 disease. In 25 of these studies, nuts
10 significantly lowered both total and LDL
11 cholesterol, and in 13 studies increased HDL.
12 In a pooled analysis of four U.S.
13 epidemiologic studies, those who ate the most
14 nuts, about one ounce five or more times per
15 week, had about a 35 percent reduced risk of
16 coronary heart disease.
17 When it comes to diabetes,
18 emerging research suggests nut consumption may
19 have a significant impact. The Nurses' Health
20 Study indicated that frequent nut
21 consumption - again, about an ounce five or
22 more times per week - was associated with a 27
80
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 percent reduction in relative risk of
2 developing diabetes compared to those who
3 rarely or never ate nuts.
4 Acute feeding studies have
5 demonstrated the ability of nuts, when eaten
6 with carbohydrates such as bread, pasta, and
7 rice, to depress post-prandial glycemia.
8 With regard to weight and satiety,
9 more than 12 epidemiologic and clinical
10 studies show that nut consumption is not
11 associated with higher body weight. In fact,
12 in a recent NHANES analysis which is being
13 prepared for publication, nut consumers had
14 lower BMIs than non-nut consumers.
15 Possible reasons: the satiety
16 value of nuts, incomplete fat absorption - the
17 fat in nuts doesn't appear to be fully
18 absorbed - and a potential increase in resting
19 expenditure with chronic nut consumption may
20 contribute to the less-than-predicted weight
21 gain.
22 Approximately 60 percent of nuts
81
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 are consumed as snacks, and data show that
2 many people obtain about a quarter of their
3 calories from snacks.
4 Finally, if we could just replace
5 some snacks high in refined carbohydrates with
6 nuts, we could have a positive impact on the
7 nutrient density of the diet, and on reducing
8 risk of chronic illness.
9 Thank you.
10 MS. HOWES: Speaker 19, please.
11 MS. BANVILLE: Good morning.
12 My name is Anne Banville, and I'm
13 with the USA Rice Federation, a trade
14 association representing producers and millers
15 of U.S.-grown rice. We're here in the
16 Washington area.
17 We appreciate the opportunity to
18 make three points today.
19 First, USA Rice's consumer
20 education promotes increasing daily whole
21 grain consumption. The popularity of brown
22 rice has grown dramatically in the past five
82
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 years.
2 We believe the focus on whole
3 grain consumption, as important as it is,
4 should not come at the expense of enriched,
5 fortified grains, since they are a primary
6 source of folic acid in the diet. Folic acid
7 fortification has produced dramatic results,
8 and the rice industry is proud to participate
9 in a program that has vastly improved infant
10 health.
11 The National Council on Folic Acid
12 believes that the risk of serious birth
13 defects can be reduced by up to 70 percent if
14 women of child-bearing age were consuming 400
15 micrograms of folic acid each day. What a
16 victory that would be, 70 percent.
17 Having required the grain
18 companies to enrich and fortify their
19 products, it would be a disservice to both the
20 public and grain companies to in any way imply
21 that those products are to be avoided. It
22 also would not serve the goal of harmony of
83
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 food guidance between USDA and HHS that the
2 2005 Dietary Guidelines helped address.
3 My second point: in our
4 experience, the role and benefit of
5 carbohydrates in the diet is still
6 misunderstood by the majority of consumers,
7 and most don't know the difference between
8 simple and complex carbs. We urge that the
9 2010 Dietary Guidelines include education on
10 why the body and brain need carbs to function,
11 and also that not all carbs are created equal.
12 It's added fats and sugars, not carbs, that
13 are the issue.
14 Finally, knowing the number of
15 calories needed each day is an important part
16 of healthy eating and weight management. We
17 urge a Know Your Numbers campaign in the 2010
18 Dietary Guidelines. The goal would be for
19 consumers to be aware of daily calories he or
20 she needs. This surely would be an important
21 step in the right direction for healthier
22 eating.
84
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you.
2 MS. HOWES: Thank you. Speaker
3 No. 20, you may begin.
4 DR. GEIGER: Good morning.
5 My name is Constance Geiger, and
6 I'm a registered dietitian and President of
7 Geiger and Associates, and a Research
8 Associate Professor at the University of Utah.
9 I'm here representing the American
10 Dietetic Association. I'm a Director-at-
11 Large, ADA's Board of Directors, based in
12 Chicago, Illinois, and I am presenting these
13 comments on behalf of ADA and my fellow
14 members, 68,000 food and nutrition
15 professionals.
16 The American Dietetic Association
17 is the world's largest organization of food
18 nutrition professionals. We are committed to
19 improving the health of Americans through food
20 and nutrition strategies. We seek to advance
21 the scientific basis of the Dietary
22 Guidelines, and to facilitate consumer
85
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 communication and implementation of your core
2 messages.
3 Today I am discussing three
4 points:
5 First, ADA recommends 10-year
6 intervals for issuing the Dietary Guidelines,
7 which is consistent with the issuance of other
8 public health guidance. Issuing the Dietary
9 Guidelines every five years does not provide
10 adequate time to conduct and review emerging
11 nutrition research, nor does it provide enough
12 time to effectively roll out and communicate
13 key information about the Guidelines to
14 consumers. It seems like we were just here
15 for the 2005 Guidelines. So a 10-year
16 interval would strengthen the research basis,
17 the implementation and communication, and the
18 impact and evaluation of the Guidelines.
19 Secondly, the Guidelines should
20 focus on food-based recommendations and meal
21 patterns. While it's technically true all
22 foods can fit with careful planning, some fit
86
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 more often than others, and some fit very
2 infrequently, especially when you get to my
3 age.
4 Overweight and obesity continue to
5 be major health concerns for our population.
6 These conditions are often accompanied by
7 inadequate nutrient intake.
8 So we really need to consider
9 research on meal patterns. Nutrient density
10 and physical activity need to reviewed and
11 reflected in the Dietary Guidelines, and the
12 recommendations should provide guidance on the
13 types and amounts of food people should
14 consume and should limit as the basis of their
15 dietary intake.
16 Third, consumer research should be
17 considered along with scientific diet and
18 nutrition studies. Fewer than five percent of
19 Americans consume diets consistent with the
20 Dietary Guidelines.
21 So in conclusion, a 10-year
22 interval would allow for a full analysis of
87
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the data, and then systematic reviews of
2 literature and evidence analysis of key
3 questions from both scientific and consumer
4 research are vital for a strong Committee
5 report.
6 We commend USDA and HHS for their
7 commitment to the Nutrition Evidence Library
8 and their support of Evidence Analysis System
9 as the basis of the Dietary Guidelines for
10 Americans.
11 Thank you.
12 MS. HOWES: Thank you. Speaker
13 21, please. You may begin.
14 DR. LEWIN: Good morning.
15 My name is Alex Lewin with Center
16 for Science in the Public Interest here in
17 Washington, D.C.
18 We congratulate the great work
19 USDA and HHS did on the 2005 Dietary
20 Guidelines, and recommend seven ways the
21 Committee could strengthen the current
22 recommendations.
88
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 First, the salt guideline, while
2 currently quite good, should do even more to
3 alert Americans to the risk of consuming
4 excess amounts of sodium, how much sodium is
5 in processed and restaurant foods, and the
6 daily limit for sodium.
7 Second, the Dietary Guidelines
8 should continue to encourage Americans to
9 switch from refined grains to whole grains.
10 The Committee should do more to clearly steer
11 consumers towards whole grains, and away from
12 foods that only appear to be whole grain.
13 Third, the Committee should
14 provide strong advice about three crucial
15 contributors to excessive calorie intake:
16 soft drinks, large portion sizes of calorie17
dense foods, and restaurant foods.
18 Soft drinks are the No. 1 source
19 of calories in Americans' diets, and the only
20 individual food linked with obesity. The
21 Dietary Guidelines should provide clear and
22 practical advice for how to limit the intake
89
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of sugary beverages.
2 Portion sizes have grown over
3 time, especially at restaurants, and studies
4 show that, when adults and children are served
5 more, they eat more. The Dietary Guidelines
6 should include strong advice about why and how
7 to choose sensible portions.
8 Studies link eating away from home
9 with higher calorie intakes and obesity.
10 Americans are eating out about twice as much
11 as in 1970, providing about a third of the
12 calorie intake for the average adult or child.
13 The 2010 Guidelines should include a separate
14 guideline on the importance of healthy eating
15 when eating out, and give clear advice for
16 helping people limit their intake of calories,
17 saturated and trans fats, sugars and sodium at
18 restaurants.
19 Fourth, the sugars guideline
20 should provide a quantitative recommendation
21 for added sugars intake using the MyPyramid
22 quantitative limits for refined sugars intake.
90
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 For example, for a 2,000-calorie-a-day diet,
2 people should consume no more than about 40
3 grams of refined sugars per day.
4 Fifth, the Guidelines should
5 establish a quantitative recommendation for
6 trans fat. Now that the nutrition facts
7 labels are required to list trans fat,
8 consumers need to be able to use the updated
9 label to better understand how much of their
10 daily maximum for trans fat is contained
11 within a food.
12 Seventh, we also recommend that
13 the Committee evaluate the evidence linking
14 food dyes and behavior. A meta-analysis done
15 in the U.S. and two British studies provide
16 evidence that dyes impair children's health.
17 Given the sky-high rates of
18 obesity and widespread prevalence of diet19
related health problems, the agencies need to
20 undertake a much stronger and comprehensive
21 effort to support Americans' efforts to eat
22 healthily.
91
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you for the opportunity to
2 share our views today.
3 MS. HOWES: Speaker 22, please.
4 You may begin.
5 DR. GREGER: Hello.
6 My name is Michael Gregor. I'm
7 the Director of Public Health and Animal
8 Agriculture at the Humane Society of the
9 United States here in D.C.
10 Thank you for this opportunity,
11 and thank you for the important work that
12 you're doing.
13 I'd like to just highlight three
14 recently-published studies in the peer15
reviewed literature.
16 The first, last April, egg
17 consumption in relation to cardiovascular
18 disease and mortality. The Harvard physicians
19 studied 20,000 male physicians, followed for
20 an average of 20 years, and those eating just
21 a single egg a day or more was associated with
22 significantly increased total all-cause
92
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 mortality, meaning eating one egg a day or
2 more significantly associated with living on
3 average a shorter life.
4 Eggs are, of course, a primary
5 source of dietary cholesterol in the American
6 diet, and the CDC estimates that more than
7 100,000 Americans are sickened every year by
8 egg-borne salmonella. Yes, the 2005
9 Guidelines warn against raw eggs, but common
10 preparation methods, over-easy, scrambled, and
11 sunny-side-up, according to a recent article
12 in the August issue of Poultry Science, are
13 insufficient to eliminate the salmonella
14 threat.
15 The second study I would like to
16 highlight, published last month in the
17 Proceedings of the National Academy of
18 Science, Hedlund's Group at UC-San Diego
19 concluded that the incorporation of
20 N-glycolylneuraminic acid into human colon
21 cancers, retinal and skin cancers, and breast
22 cancers, facilitates tumor progression. The
93
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 only source of this carcinoma-promoting
2 substance is the consumption of meat and dairy
3 products.
4 So I think the Committee should
5 consider promoting legumes as the preferred
6 source of protein, lacking dietary cholesterol
7 and animal fat, obviously, and as a bonus, the
8 fiber, folate, and phytonutrients.
9 And finally, the last study,
10 another 2008 study, in light of the obesity
11 epidemic here in the United States, a study
12 co-authored by a Cornell Professor Emeritus of
13 nutritional biochemistry, T. Colin Campbell.
14 These were patients, overweight patients,
15 encouraged to eat a diet of whole plant foods,
16 and they achieved a weight loss of 24
17 kilograms at the two-year follow-up point. So
18 that is unprecedented, more than 50 pounds of
19 healthy sustained weight loss, one of the
20 reasons perhaps why the longest-running study
21 on vegetarians in history, the California
22 Seventh Day Adventist study, found that those
94
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 eating vegetarian lived, on average, 10 years
2 longer than the general population, in fact,
3 the longest-living formally-studied population
4 in the world.
5 So I encourage the Committee to
6 continue to extend their recommendations
7 toward an even more plant-based diet.
8 Thank you.
9 MS. HOWES: Thank you.
10 Speaker No. 23.
11 You may begin.
12 MR. BISCEGLIE: Good morning.
13 My name is Rob Bisceglie, and I am
14 the Executive Director of Action for Healthy
15 Kids, a national, grassroots, non-profit
16 organization focused on addressing the
17 epidemic of overweight, undernourished, and
18 sedentary youth by improving nutrition and
19 physical activity in schools, funded by former
20 Surgeon General Dr. David Satcher.
21 I will confine my remarks today to
22 two primary points. The first is related to
95
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the importance of nutrition, specifically
2 breakfast, as well as physical activity, to
3 learning, and the second to the importance of
4 stressing foods of high-nutrient density.
5 First, there is a growing body of
6 evidence demonstrating that children who eat
7 poorly or who engage in too little physical
8 activity do not perform as well as they could
9 academically. In a study published just last
10 year of more than 5,000 children, an
11 association was observed across multiple
12 indicators of diet quality with academic
13 performance. That's from The Journal of
14 School Health.
15 We urge this Committee to consider
16 incorporating a recommendation that encourages
17 school-age children to eat a healthy breakfast
18 each day. We at Action for Healthy Kids have
19 demonstrated that participation in such
20 programs can be enhanced with relatively small
21 financial investments.
22 For example, the Ohio Action for
96
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Healthy Kids team has distributed $25,000
2 annually in school breakfast mini-grants,
3 ranging from $500 to $1,000, to provide
4 schools with funds for school breakfast
5 program startup, expansion, marketing, and
6 promotion.
7 As a result of the mini-grant
8 funds and the associated technical assistance,
9 school breakfast participation in Ohio
10 increased 15 percent in 13 months.
11 In our experience, the return on
12 investment for breakfast initiatives makes
13 them a wise dedication of time, energy, and
14 resources.
15 We believe that this Committee
16 will have a tough time identifying other
17 simple, actionable, affordable pieces of
18 dietary guidance that have the potential
19 impact of this simple recommendation.
20 Everyone should eat a good breakfast.
21 Similarly, we hope that this group
22 will reinforce the position of the 2005
97
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Dietary Guidelines Committee and, more
2 recently, the 2008 Physical Activity
3 Guidelines for Americans, that physical
4 activity plays a profound role in health.
5 My second main point relates to
6 the continued need to encourage consumption of
7 nutrient-dense foods. We are particularly
8 concerned about the disproportionate effect of
9 poor nutrition on low-income communities. We
10 continue to seek best practices on ways of
11 reaching through schools, communities, and
12 parent groups, youth who are malnourished,
13 sedentary, and overweight.
14 To the extent that we can deliver
15 positive messages about foods to encourage
16 specifically fruits, vegetables, whole grains,
17 and low-fat and non-fat dairy, and that we can
18 deliver culturally-appropriate and good19
tasting foods from those categories to youth
20 in these settings, we believe we can make a
21 meaningful difference in lifelong eating
22 patterns.
98
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you so much.
2 MS. HOWES: Thank you.
3 Speaker 24, please.
4 You may begin.
5 MS. KATCHER: Hi. My name is
6 Heather Katcher. I work with the Washington
7 Center for Clinical Research, but I was asked
8 to speak today on behalf of Barbara Wasserman,
9 who was unable to be here due to icy road
10 conditions. She is a doctor in Howard County,
11 Maryland, and Chair of the Howard County
12 Nutrition and Physical Activity Coalition.
13 As the Committee is aware, 16
14 percent of children and adolescents are
15 overweight or obese, and in Howard County,
16 Maryland, where Dr. Wasserman is from, 31
17 percent of children and adolescents are
18 overweight or obese.
19 So she sees to a higher degree the
20 medical problems related to obesity, including
21 cardiovascular disease, high blood pressure,
22 type 2 diabetes, and certain types of cancer.
99
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Dr. Wasserman urges the HHS and
2 Department of Agriculture to incorporate into
3 their policies the many scientific studies
4 that demonstrate the benefits of plant-based
5 diets and the dangers associated with high
6 consumption of animal-related foods, meaning
7 meat and dairy.
8 She says that now is the time for
9 a groundbreaking 2010 Dietary Guidelines
10 similar to the 1954 Surgeon General's report
11 on the danger of tobacco use. Further delay
12 is putting millions of Americans at risk of
13 various chronic diseases.
14 She urges the Committee to
15 consider a few scientific publications. One
16 is the China study by Dr. Colin Campbell that
17 has epidemiologic evidence of lower colorectal
18 cancer with a plant-based diet.
19 A second is a low-fat vegan diet
20 improves glycemic control and cardiovascular
21 risk factors in individuals with type 2
22 diabetes. This is by Bernard, et al., in
100
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Diabetes Care 2006.
2 The study showed that glycemic and
3 lipid control in type 2 diabetes improved with
4 a vegan diet and ADA diet, but improvements
5 were greater with a low-fat vegan diet.
6 Third are studies by Caldwell
7 Esselton in Preventive Cardiology 2001,
8 showing that a plant-based diet was able to
9 prevent, arrest, and reverse coronary artery
10 disease.
11 And fourth is the report by the
12 American Institute of Cancer Research and
13 World Cancer Fund that demonstrate that excess
14 body fat increases risk of numerous cancers.
15 So just to conclude, Dr. Wasserman
16 says, as a physician concerned with the
17 obesity epidemic in my community and the
18 rising rates of obesity-related chronic
19 disease, I request the Dietary Guidelines
20 Committee to prepare guidelines that address
21 the needs to reverse obesity by focusing on a
22 low-fat, plant-based diet and minimizing
101
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 intake of animal-based foods and processed
2 foods high in fat and sugar.
3 Thank you.
4 MS. HOWES: Thank you.
5 Speaker No. 25.
6 You may begin.
7 MR. BAKER: Good morning.
8 My name is Charles Baker,
9 Executive Vice President and Chief Science
10 Officer at the Sugar Association, a non-profit
11 organization headquartered here in Washington,
12 D.C.
13 The Sugar Association represents
14 U.S. sugarcane and sugar beet growers and
15 processors. It was established in 1943 to
16 educate the public about sugar and its role in
17 nutrition, balanced diets, and healthy
18 lifestyles.
19 Based on the sum of the scientific
20 evidence, we support sugar as a safe, natural,
21 beneficial food ingredient. We welcome this
22 opportunity to present these remarks.
102
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 The Association shares the
2 Committee's concern about the rising rates of
3 obesity and its detriment to overall health,
4 especially among children. The Association
5 respectfully reminds the Committee that a
6 focus on restricting dietary sugars as the
7 remedy is as flawed as a singular focus on
8 dietary fads of the 1990s.
9 The Association's written comments
10 document published evidence showing body
11 weight is independent of sugar's intake in
12 young children, adolescents, and adults.
13 Targeting one nutrient class is not the magic
14 bullet for achieving the true remedy, which is
15 caloric balance.
16 The Association also respectfully
17 reminds the Committee that nutritional
18 adequacy is determined by the totality of
19 one's diet, not how much or how little a
20 single diet component like sugar is present.
21 The Association's written comments
22 also cite a body of peer-reviewed evidence
103
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 confirming the ineffectiveness of applying a
2 simplistic, a priori mathematical construct
3 like micronutrient displacement as a
4 comprehensive measure of dietary quality.
5 Taken as a whole, our grandmothers
6 had it right. Their advice to eat a little
7 bit of everything, then go outside and play,
8 recognized the central importance of
9 moderation, portion control, and daily
10 activity and healthy lifestyles. Their common
11 sense recognized all calories are
12 discretionary.
13 In conclusion, the Association
14 acknowledges the enormous responsibility of
15 providing Americans with nutrition advice.
16 The Association respectfully asks the
17 Committee to maintain the scientific integrity
18 of the Dietary Guidelines for Americans
19 process by de-emphasizing an inordinate focus
20 on a single nutrient like sugar.
21 Please remain committed to basing
22 dietary recommendations solely on a critical
104
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 analysis of the body of peer-reviewed,
2 published data. Translating basic dietary
3 data into effective policy and successful
4 consumer education materials requires complete
5 objectivity.
6 Thank you.
7 CHAIR VAN HORN: Thank you.
8 I would like to thank our first 25
9 speakers for wonderful presentations.
10 We will now take a 10-minute
11 break.
12 (Whereupon, the above-entitled
13 matter went off the record at 9:26 a.m. and
14 resumed at 9:45 a.m.)
15 CHAIR VAN HORN: Presenter 26,
16 please come forward.
17 MS. HOWES: You may begin.
18 DR. HERSHAFT: Good morning.
19 My name is Alex Hershaft. I am
20 the founder and President of FARM, a national
21 non-profit organization based in D.C.
22 advocating for healthful diets since 1976. We
105
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 are funded by public contributions and we have
2 no industry affiliation.
3 Our nation is in the throes of an
4 unprecedented epidemic of obesity and the
5 attendant scourges of heart disease, stroke,
6 cancer, diabetes, and other chronic diseases
7 that each year cripple, then kill, nearly 1.5
8 million Americans.
9 These afflictions have been linked
10 conclusively with consumption of meat and
11 dairy products by more than a dozen scientific
12 panels upon review of hundreds of scientific
13 studies.
14 And it is no wonder as these
15 products are laden with saturated fat,
16 cholesterol, hormones, antibiotics, pathogens,
17 and salt.
18 This appalling diet is shaped
19 largely by the political might and the
20 advertising dollar of the meat, dairy, and
21 other processed food industries. Its impact
22 is particularly acute on our nation's School
106
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Lunch Program, where the fare is driven by the
2 availability of cheap meat and dairy surplus
3 commodities, where early dietary patterns
4 become lifelong addictions.
5 The new administration was voted
6 into office on a platform of change. Dietary
7 Guidelines for Americans 2010 should reflect
8 the spirit of change. They should be based on
9 best science alone, not a mixture of science,
10 dietary traditions, and political expediency.
11 If your interpretation of
12 nutritional science tells you that a diet of
13 vegetables, fruits, legumes, whole grains, in
14 essence, a vegan diet, is best for the health
15 of American people, your guidelines should
16 clearly state that.
17 Please spare us the condescending
18 advice that a properly-planned vegan diet may
19 provide the necessary nutrients when you
20 should be telling the American people that no
21 amount of planning can prevent the health
22 scourges of a meat-and-dairy-based diet.
107
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. HOWES: Thank you very much.
2 We need to move on in the interest of time.
3 We appreciate that.
4 Presenter No. 27, please.
5 You may begin.
6 MS. DESHAY: Good morning.
7 I do not come to you as a
8 scientist or someone with great ability as far
9 as the statistics are concerned. I come as a
10 citizen of the United States, and primarily
11 want to share with you from my own personal
12 experience that a vegan vegetable diet is one
13 that would help our country as far as our
14 total cost of health, as far as maintenance of
15 preventing of diseases, and maintenance and
16 promoting health.
17 I happen to come from a family
18 where my mother is 1 of 13, and we have no
19 other diseases in the family that have been
20 identified other than cardiovascular problems
21 related to hypertension. However, the one
22 person who has chosen to take a vegetarian, a
108
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 vegan diet, has remained living until age 93,
2 whereas the remaining group of the 13 have all
3 died from ages 35 to 40 of cardiovascular
4 problems.
5 The one that is living happened to
6 be my mother, and she became a vegetarian only
7 because I, as her daughter, had read that a
8 vegan diet was best.
9 Now when we look at the global
10 context, having lived in West Africa and most
11 of the continent, we as Americans are
12 transporting to other countries the concept
13 that, to be affluent, one should eat more
14 meat. It is time for us to accept that, if,
15 indeed, we believe the scientific materials
16 that we have developed, if, indeed, we believe
17 that we are the leaders, then it is time for
18 us to insist and make certain that our pyramid
19 says a vegan diet, a vegetarian diet is the
20 diet that will maintain, promote health and
21 prevent diseases.
22 Thank you.
109
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. HOWES: Speaker 28, please.
2 You may begin.
3 MR. HANNEMAN: Good morning.
4 I am Dick Hanneman, President of
5 the Salt Institute. We have a commercial
6 interest here. We represent salt producers.
7 I wanted to share with you,
8 though, our strong embrace of strong science,
9 and had submitted a couple of slides that I
10 intended to illustrate my oral remarks.
11 Unfortunately, I am told we are not going to
12 have a chance to do that. So I will refer to
13 them, and there are handouts I have given to
14 the staff. It is a little less comfortable
15 not talking with the slides.
16 But the point I would make is that
17 evidence-based medicine doesn't mean just
18 finding evidence to support the conclusions
19 that you have, but to start with the rules of
20 evidence and only use those that should apply.
21 We also think it also ought not to
22 be talking about the biomarkers, the
110
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 intermediate variables, but rather health
2 outcomes. So cardiovascular mortality, in
3 this case, and other health outcomes.
4 In that regard, there are a couple
5 of papers that were just produced in the last
6 couple of years, one just last week. It would
7 illustrate what I think is the kind of
8 evidence you ought to look at.
9 Now we have known for 100 years
10 that we would treat high-risk groups with low11
salt diets. Most of you who would be
12 physicians would recognize that a congestive
13 heart failure patient would be, in fact,
14 advised to go on a low-salt diet, but it was
15 on the assumption that that would be healthy.
16 Now we have two studies that examine it, both
17 of them produced by Pontera and Group. I just
18 wanted to quote, although I will leave the
19 studies as well with you, what they said.
20 "In normal sodium diet compared
21 with low-sodium diet in compensated congestive
22 heart failure, is sodium an old enemy or a new
111
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 friend?" The conclusion was, "The results of
2 the present study show that a normal sodium
3 diet -- improves outcome in sodium depletion,
4 has detrimental renal and neural/hormonal
5 effects with worse clinical outcomes in
6 compensated CHF patients. Further studies are
7 required."
8 Yes, further studies are required,
9 but the Dietary Guidelines Advisory Committee
10 recognized that it kind of overreached in
11 1995, and the 2000 Guidelines took a step back
12 on the area of fats. We encourage that to be
13 done here.
14 Also, we have talked about satiety
15 here. It is quite clear now that taste is not
16 the modulating influence, but, rather, salt
17 appetite is, again, hardwired in the brain, a
18 study which we have submitted to you by
19 Geerling and Loewy out of Washington
20 University of St. Louis, which we commend to
21 you.
22 Thank you very much for your
112
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 attention.
2 MS. HOWES: Thank you.
3 Speaker 29?
4 You may begin.
5 MS. MATTO: Good morning.
6 I am Michelle Matto, a registered
7 dietitian with the International Dairy Foods
8 Association, based here in Washington, D.C.
9 IDFA's 220 dairy processing members represent
10 more than 85 percent of the milk-cultured
11 products, cheese, and frozen desserts produced
12 in the U.S.
13 We were pleased that the 2005
14 Dietary Guidelines recommended three servings
15 of dairy per day for most Americans and
16 designated dairy as a food group to encourage.
17 We believe that both of these recommendations
18 should be carried over into the 2010
19 Guidelines. Dairy foods are a nutrient-dense
20 choice and a major source of calcium, vitamin
21 D, phosphorus, riboflavin, vitamin B12,
22 protein, potassium, zinc, magnesium, and
113
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 vitamin A in the American diet.
2 In addition to the role of dairy
3 products in building strong bones, research
4 has also demonstrated benefits of dairy
5 products for hypertension, weight maintenance,
6 insulin-resistance syndrome, and type 2
7 diabetes.
8 Dairy foods provide a unique and
9 diverse nutrient package. Many other
10 substitutes do not provide the same nutrients
11 or with the same bioavailability as dairy
12 products. For people who are lactose13
intolerant, reduced-lactose or lactose-free
14 products are the best option since they will
15 contribute the same nutrients as regular dairy
16 products.
17 In addition to those dairy
18 products that are specially formulated to
19 reduce lactose, there are also dairy products
20 that are naturally low in lactose,
21 particularly cheese and yogurt. Through the
22 processing of yogurt and cheese, the lactose
114
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 content in the finished product is reduced,
2 and many lactose-intolerant individuals find
3 they can consume these foods without
4 discomfort. Since yogurt and cheese are
5 naturally low-lactose dairy foods that provide
6 many of the same nutrients as milk, they are
7 often the best choice for consumers who want
8 to avoid lactose.
9 In the report of the 2005 Dietary
10 Guidelines Advisory Committee, the Committee
11 advised that added sugars could be appropriate
12 when added to nutrient-dense foods such as
13 dairy foods and beverages to increase
14 palatability and consumption of these foods.
15 In conclusion, we would recommend
16 that this Advisory Committee make the
17 following recommendations: recommend at least
18 three servings of dairy per day; encourage
19 consumption of nutrient-dense foods, including
20 dairy products; encourage lactose-reduced
21 dairy products as an alternative for those
22 avoiding lactose; and specifically allow for
115
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 discretionary calories to increase consumption
2 of nutrient-dense foods like flavored milks
3 and yogurt.
4 Thank you.
5 MS. HOWES: Speaker No. 30,
6 please.
7 You may begin.
8 MS. FAGA: Thank you.
9 Good morning.
10 I am Betsy Faga, President of the
11 North American Millers' Association here in
12 Washington, D.C. NAMA is the national
13 association for the wheat, corn, and oat14
milling industry. So, of course, we are
15 interested in the grain-based foods portion of
16 the Dietary Guidelines and know that they have
17 long recognized the importance of grain-based
18 foods in healthy eating, and, more recently,
19 in the 2005 Guidelines, certainly talking
20 about the importance of both enriched and
21 whole grain products -- the enriched grains,
22 for their folic acid, thiamine, riboflavin,
116
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 niacin, and iron, and the whole grains for
2 their fiber and numerous other vitamins,
3 minerals, and phytonutrients.
4 Science continues to support that
5 consuming of both enriched and whole grains is
6 good for you. Each offers a unique set of
7 benefits. It is important to know that
8 enriched grain products represent
9 approximately 92 percent of the total wheat
10 flour that is milled in the United States.
11 Therefore, one cannot be forsaken for the
12 other.
13 The milling, baking, and food
14 processing industry has responded to the
15 recommendations of the 2005 Guidelines with
16 more and better-tasting whole grain foods that
17 are found now on the grocery shelf. Consumers
18 will continue to see new products as
19 innovation continues within our industries and
20 products come to market.
21 As you know, in 1998, the FDA
22 mandated that folic acid be added to enriched
117
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 grain products, and as the gentleman from the
2 CDC indicated, it estimates that about 1,000
3 babies are born each year without neural tube
4 defects, which is about a 26 percent increase
5 in the healthy babies that are born, something
6 that we all pride ourselves in.
7 We encourage consistent messaging
8 as you look at the Guidelines. FDA mandated
9 the inclusion of folic acid, and CDC has a
10 universal flour fortification initiative, so
11 that the 2010 Guidelines, we believe, need to
12 be consistent and looked at in the context of
13 the FDA and CDC initiatives.
14 We appreciate the opportunity to
15 be engaged in the Guidelines process that you
16 are following and the very scientific approach
17 that you are taking.
18 Thank you for this opportunity.
19 MS. HOWES: Thank you.
20 Speaker 31, please.
21 You may begin.
22 MR. McBURNEY: Good morning.
118
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I'm Michael McBurney, head of
2 Scientific Affairs, DSM Nutritional Products,
3 Inc., in Parsippany, New Jersey.
4 Thank you, Committee, for serving
5 and thank you for hearing me. My message is
6 simple. Include fortified foods and
7 supplements in your guidance.
8 With more than two-thirds of
9 Americans overweight and obese, half of them
10 not exercising regularly, the 2005 Dietary
11 Guidelines recommended that people eat fewer
12 calories, be more active, and make wiser
13 choices.
14 Research shows that they are
15 trying to do that, to eat less and reduce
16 their energy intake, but this is challenging
17 to accomplish this and obtain the essential
18 nutrients unless they consume fortified foods
19 or take a daily vitamin.
20 Earlier today, we heard about the
21 importance of breakfast is the most important
22 meal. It is not surprising, given that it
119
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 consists of fortified dairy products,
2 fortified cereals, and orange juices.
3 So I encourage you to really think
4 about leveraging consumer preferences for
5 taste, convenience, and safe foods, and engage
6 the food industry and supplement industry to
7 address those shortcomings. Whether they are
8 a vegan, an omnivore, or a meat-lover, there
9 are solutions. The industry is here to help
10 you, and we can make encouragements so that we
11 address those deficiencies.
12 In my letter that I submitted
13 earlier, I talked about vitamin D and the fact
14 that our status of vitamin D, there's research
15 showing it has declined over the last decade.
16 We can address these. We have an opportunity
17 to do that in the food and supplement industry
18 and, with proper guidance from you, Americans
19 can be better-served.
20 Thank you.
21 MS. HOWES: Thank you.
22 Speakers No. 32 and No. 33 are not
120
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 present. We will move on with speaker No. 34,
2 please.
3 You may begin.
4 MS. HOBBS: Good morning.
5 My names is Suzanne Havala Hobbs,
6 and I'm a registered dietitian and faculty
7 member in the Gillings School of Global Public
8 Health at the University of North Carolina at
9 Chapel Hill. I'm also a nutrition advisor for
10 the Vegetarian Resource Group, a non-profit
11 educational organization that works with
12 individuals, food companies, professional
13 associations, and others to disseminate
14 accurate information to the public about
15 vegetarian diets.
16 Thank you for this opportunity to
17 provide oral testimony today. In considering
18 revisions for the 2010 Dietary Guidelines, I,
19 like so many of the presenters so far this
20 morning -- it seems about half -- encourage
21 you to put more emphasis on choosing a more
22 plant-based diet.
121
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 A plant-based diet is an eating
2 pattern characterized by a foundation of whole
3 grains, dried beans, fruits, vegetables, nuts
4 and seeds. These foods are nutrient-dense and
5 confer significant advantages in the
6 prevention of cardiovascular disease,
7 hypertension, obesity, cancer, and type 2
8 diabetes.
9 A plant-based diet is not
10 necessarily vegetarian, but the majority of
11 research on the health effects of plant-based
12 diets has been conducted on people following
13 vegetarian diets. For example, research in the
14 U.S. and the U.K. found that vegetarians had
15 lower death rates from cardiovascular disease
16 and lower rates of fatal heart attacks than
17 non-vegetarians. Vegetarians had lower blood
18 pressures and lower rates of hypertension than
19 non-vegetarians.
20 Vegans -- and that is vegetarians
21 who avoid all animal products -- had the
22 lowest blood pressures and the lowest rates of
122
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 hypertension compared to lacto-ovo
2 vegetarians, fish-eaters, or meat-eaters.
3 In a Seventh Day Adventist
4 population with a generally healthy lifestyle,
5 type 2 diabetes was twice as common in non6
vegetarians when compared to vegetarians.
7 A study in the U.K. found that
8 overweight or obesity was twice as common in
9 non-vegetarian men and 1.5 times as common in
10 non-vegetarian women when compared to
11 vegetarians.
12 Vegetarian diets with an emphasis
13 on plant foods have been used successfully to
14 treat cardiovascular disease, type 2 diabetes,
15 hypertension, and obesity. These results
16 suggest that, while not every American may
17 choose to follow a vegetarian diet,
18 significant health benefits can be achieved by
19 a movement toward a more plant-based diet.
20 In addition to more explicitly
21 supporting a plant-based diet in the 2010
22 Dietary Guidelines, I urge the Committee to
123
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 clearly present health concerns related to
2 excessive consumption of red meat and
3 processed meats. The AICR recommends that red
4 meat consumption be limited to not more than
5 300 grams per week, little, if any, of which
6 should be processed.
7 Develop new food groupings that
8 don't place plant-based protein sources like
9 dried beans on par with foods like red meat
10 that can be high in saturated fat and devoid
11 of fiber.
12 Similarly, recommendations should
13 emphasize varied and good sources of calcium
14 and other key nutrients, rather than focusing
15 on a single food such as milk and its
16 variations. Milk plus salt equals cheese;
17 milk plus sugar equals ice cream, et cetera.
18 MS. HOWES: Thank you.
19 MS. HOBBS: Thank you.
20 MS. HOWES: In terms of time, we
21 need to move on to the next presenter. Thank
22 you very much.
124
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Presenter No. 35, please.
2 You may begin.
3 MS. GRIFFEN: Thank you.
4 My name is Adriane Griffen. I am
5 the Director of Health Promotion and
6 Partnerships for the Spina Bifida Association.
7 The Spina Bifida Association, or
8 SBA, urges you to consider updating the 2010
9 Dietary Guidelines for Americans by adding a
10 specific recommendation of at least 400
11 micrograms of folic acid for women of child12
bearing age and incorporating messages about
13 the importance of folic acid consumption into
14 the press releases and other collateral
15 materials associated with the release of the
16 new Guidelines.
17 SBA serves 250,000 Americans
18 living with the challenge of spina bifida,
19 which is the nation's most common permanently20
disabling birth defect. Since 1973, the Spina
21 Bifida Association has been the only national
22 voluntary health agency dedicated to both
125
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 promoting the prevention of spina bifida and
2 to enhancing the lives of those affected.
3 One of SBA's most vital functions
4 is to communicate to the 65 million women of
5 child-bearing age the importance of taking
6 folic acid every day to reduce the risk of
7 birth defects like spina bifida by up to 70
8 percent.
9 We are proud that SBA also serves
10 as the administrative agent for the National
11 Council on Folic Acid, which leads the
12 collaborative effort between national health
13 organizations like ours, government, and
14 industry to educate women of child-bearing age
15 about the importance of taking folic acid.
16 Since 1992, the U.S. Public Health
17 Service, the Centers for Disease Control and
18 Prevention, and organizations like SBA have
19 recommended that women who could possibly
20 become pregnant take 400 micrograms of folic
21 acid every day.
22 In 1998, as you have heard from
126
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 others, the FDA added a requirement that folic
2 acid be added to food products like enriched
3 flour, bread, and grain products. These foods
4 were chosen for fortification because they
5 serve as staple products for the U.S.
6 population, and we know that fortification has
7 been effective in reducing the birth defects
8 outcomes for most, for about 26 percent.
9 However, only a third of U.S.
10 women right now are getting the folic acid
11 they need on a daily basis. So, as such, we
12 believe it is imperative that the 2010
13 Guidelines include messages and information
14 about the importance of consuming a variety of
15 folic acid-fortified foods from a varied diet
16 and including the value of taking a daily
17 vitamin for women of child-bearing age.
18 We want to thank the Dietary
19 Guidelines Committee for hearing us today, and
20 we also request these messages about folic
21 acid consumption, again, appear in the
22 collateral materials such as the press
127
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 releases regarding the disseminations of the
2 new Guidelines.
3 Thank you.
4 MS. HOWES: Thank you.
5 Speaker 36, please.
6 You may begin.
7 MS. KAPICA: Hi. I'm Cathy
8 Kapica, Vice President of Global Health and
9 Wellness at Ketchum, providing comments on
10 behalf of the Canned Food Alliance, whose
11 primary mission is to serve as a resource for
12 information on the nutrition, convenience,
13 contemporary appeal, and versatility of canned
14 food, including fruit, vegetables, beans, lean
15 meats, seafood, and poultry.
16 The Canned Food Alliance strongly
17 urges the 2010 Dietary Guidelines for
18 Americans continue to include and promote
19 canned products that are consistent with the
20 overall dietary recommendations. Since the
21 2005 Guidelines were issued, there have been
22 a number of studies confirming the benefits of
128
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 canned foods. Here's a quick summary of some
2 of the information. References are included
3 with the written comments.
4 Consumers want more choices to
5 help them meet their nutrition goals and are
6 relieved to know that canned fruits and
7 vegetables can count toward these goals.
8 Fresh does not always mean more nutritious.
9 All forms -- canned, fresh, and frozen -- of
10 fruits and vegetables provide needed nutrients
11 to the diet.
12 The canning process locks in
13 nutrients at their peak of freshness, and due
14 to the lack of oxygen during the storage
15 period, canned fruits and vegetables remain
16 relatively stable up until the time they are
17 consumed and have a longer shelf life.
18 Studies confirm that canned foods
19 are comparable to cooked, fresh, and frozen
20 varieties in their nutrient contribution to
21 the American diet. Some canned products
22 actually contribute more health-promoting
129
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 antioxidants than their fresh counterparts.
2 Canned blueberries have more
3 anthocyanines compared to the amounts found in
4 fresh and frozen. Half a can of canned
5 tomatoes provides almost three times as much
6 lycopene as one medium, fresh, uncooked
7 tomato.
8 Mild heat treatment of carrots and
9 spinach, as used in commercial canning,
10 enhances the bioavailability of carotene.
11 Canned pumpkin contains higher concentration
12 of betacarotene than fresh pumpkin. The
13 absorption of lutein in corn is also enhanced
14 by the heat of the canning process.
15 The ingredients you choose, not
16 the form of the ingredients, are what really
17 determine a recipe's nutrient content. From
18 a nutrition and sensory standpoint, recipes
19 prepared with canned ingredients and those
20 prepared using fresh and/or frozen ingredients
21 rate comparably.
22 Canned beans, fruits, and
130
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 vegetables provide a number of key nutrients,
2 including potassium, magnesium, folic acid,
3 and iron. Canned seafood provides an
4 excellent source of protein, B vitamins, and
5 omega-3 fatty acids.
6 Canned fruits and vegetables are
7 affordable. Canned fruits and vegetables
8 don't contribute significantly to America's
9 sodium and sugar intake. In fact, all canned
10 fruits and fruit juices contribute less than
11 2 percent of added sugars in most Americans'
12 diets, and vegetables contribute less than 1
13 percent of sodium.
14 Canned fruits and vegetables are
15 safe. In a review of over 5300 foodborne16
related outbreaks and over 150,000 cases of
17 illness, commercially-produced canned fruits
18 and vegetables did not directly account for a
19 single foodborne outbreak, even though the
20 produce category was linked to large numbers
21 of foodborne illnesses.
22 MS. HOWES: Thank you for your
131
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 presentation.
2 MS. KAPICA: Thank you very much.
3 MS. HOWES: Speaker 37, please.
4 You may begin.
5 MS. RUHL: Good morning.
6 My name is Catherine Ruhl. I'm
7 Associate Director for Women's Health Programs
8 at the Association of Women's Health,
9 Obstetric, and Neonatal Nurses. We are
10 members of the Steering Committee of the
11 National Council on Folic Acid, and I
12 represent the National Council today.
13 Folic acid is a B vitamin
14 necessary for proper cell growth. It helps to
15 prevent certain birth defects such as neural
16 tube defects which occur very early in
17 pregnancy, often before a woman knows she is
18 pregnant.
19 The National Council supports the
20 recommendation in the Dietary Guidelines for
21 Americans to consume 400 micrograms of
22 synthetic folic acid daily, either from a
132
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 multivitamin or from fortified foods. As has
2 been mentioned previously, this daily dosage
3 can reduce the risk of having an NTD-affected
4 pregnancy by up to 70 percent.
5 The most common NTDs are spina
6 bifida and anencephaly. Spina bifida is a
7 serious birth defect in which the spinal cord
8 does not form properly, which can result in
9 paralysis and weakness of the lower
10 extremities. Annual medical and surgical
11 costs for those with spina bifida in the U.S.
12 exceed $200 million.
13 Anencephaly is a fatal condition
14 in which the skull does not develop properly
15 or, in some cases, not at all. These infants,
16 if born alive, die soon after birth.
17 The Healthy People 2010 objectives
18 have a target that 80 percent of non-pregnant
19 women of child-bearing age will consume at
20 least 400 micrograms of folic acid daily.
21 This target has not been reached, and it is
22 one reason why it is important that we
133
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 encourage the Dietary Guidelines to continue
2 the folic acid recommendation.
3 Since the 1998 mandate for
4 fortification of certain grain products, as
5 has been mentioned, there has been a threefold
6 increase in American women's blood levels of
7 folate, according to the NHANES data, and
8 neural tube defects have decreased by 26
9 percent.
10 However, it is not thought that
11 this increase is due to supplement use because
12 that has not been reported to have increased.
13 Therefore, NCFA definitely advocates that the
14 recommendation is maintained for the daily 400
15 micrograms of synthetic folic acid.
16 In my personal experience as a
17 nurse midwife for 20 years, I have seen that
18 women readily accept the advice to consume
19 folic acid when educated about its benefits.
20 I have also seen the enormous emotional and
21 financial impact on families. We should take
22 every opportunity to reduce and prevent these
134
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 serious birth defects.
2 Thank you.
3 MS. HOWES: Thank you.
4 Speaker No. 38, please.
5 You may begin.
6 MR. SHAO: Good morning.
7 My name is Andrew Shao. I'm Vice
8 President, Scientific and Regulatory Affairs,
9 for the Council for Responsible Nutrition. I
10 appreciate the opportunity to provide these
11 oral comments to the Committee today.
12 CRN is a Washington, D.C.-based
13 trade association representing the dietary
14 supplement industry. Our members include some
15 of the largest, most well-known manufacturers
16 of dietary ingredients and dietary
17 supplements.
18 First, I want to remind the
19 Committee that dietary supplements, as the
20 name implies, are supplements to, and not
21 substitutes for, a good, healthy diet. Survey
22 after survey after survey, as we have heard,
135
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 have shown that Americans continue to come up
2 short when it comes to achieving the
3 recommended intakes for a variety of
4 nutrients. This is especially true, as we
5 know, for certain subgroups of the population,
6 such as women of child-bearing age, pregnant
7 women, and the elderly.
8 We encourage the Committee to
9 consider the positive public health
10 implications of recommending a simple,
11 inexpensive multivitamin to fill essential
12 nutrient gaps such as for vitamins E, C, and
13 A, where consumers continue to fall short.
14 Americans also have inadequate
15 intakes of calcium, magnesium, potassium,
16 fiber, vitamin D, and long-chain omega-3 fatty
17 acids. Obtaining adequate amounts of vitamin
18 D and long-chain omega-3s from diet alone may
19 be difficult, if not impossible, making
20 supplementation an important and viable
21 option.
22 We encourage the Committee in its
136
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 evidence-based review process to consider the
2 totality of the evidence, including
3 observational data that demonstrates a
4 consistent relationship between adequate
5 intake of these essential nutrients and
6 reduced risk for chronic disease.
7 Observational evidence supporting
8 the appropriate use of dietary supplements to
9 complement a healthy lifestyle that includes
10 a sound diet and plenty of exercise should be
11 given adequate weight by the Committee in the
12 same way observational evidence serves as the
13 basis for recommendations for fruit and
14 vegetable intake.
15 We support the Dietary Guidelines.
16 We are pleased that the current 2005 edition
17 recognizes the important role of dietary
18 supplements as a tool for helping people
19 improve nutrient intake.
20 We encourage the 2010 Committee to
21 consider some modifications that would further
22 clarify the important role of dietary
137
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 supplements.
2 Thank you.
3 MS. HOWES: Thank you.
4 Speaker 39, please.
5 You may begin.
6 MR. DALAL: Good morning.
7 I am Saurabh Dalal from the local
8 area. I thank you for the opportunity to
9 provide testimony.
10 These comments are presented on
11 behalf of three non-profit, volunteer-driven
12 organizations: the Vegetarian Union of North
13 American, the Vegetarian Society of D.C., and
14 the International Vegetarian Union. So
15 there's no surprise what the theme of my
16 comments is going to be.
17 Vegetarian foods offer powerful
18 advantages for humans and can be nutrient19
dense. A large number and wide variety of
20 scientific studies have shown that well21
planned vegetarian diets support good health
22 for all stages of the life cycle.
138
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Many nutritionists and other
2 health professionals recognize that a well3
planned, low-fat vegetarian diet, and
4 preferably a vegan diet that consists of no
5 animal products, is the best diet for humans.
6 Animal products are the main source of
7 saturated fats, as you know, the only source
8 of dietary cholesterol, and contain no fiber,
9 often resulting in high cholesterol levels and
10 variety of diet-related diseases.
11 Preventing and sometimes reversing
12 heart disease as well diabetes, preventing
13 several types of cancer, lowering blood
14 pressure, and helping manage weight are among
15 the many successes of such a diet.
16 We urge the Advisory Committee to
17 clearly emphasize plant foods and alternatives
18 to meat, dairy, and eggs. A wide variety of
19 plant foods consisting of whole grains, whole
20 fruits, vegetables, legumes, nuts, seeds, and
21 fortified cereals, and fortified plant milks
22 can ensure a healthy, well-balanced diet.
139
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Naturally and strongly-colorful
2 vegetables and fruits should also be
3 emphasized for their antioxidant and
4 phytonutrient value.
5 There's a few points I will
6 highlight.
7 A diet drawn from varied plant
8 sources easily satisfies protein requirements
9 without the potential for protein excess.
10 Animal proteins, being more acidic, force
11 calcium out of the body, thereby promoting
12 bone loss. Many plant sources of calcium
13 exist with absorption being high. Excellent
14 examples are dark, leafy greens like collard
15 greens and kale. Calcium from plant foods
16 would increase the intakes of boron, vitamin
17 K, and magnesium, helping reduce the risk of
18 osteoporosis.
19 Also very important in regard to
20 these basic food groups is that each serving
21 of leafy greens counts as a serving from the
22 calcium-rich foods groups and the vegetable
140
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 group, which shows the versatility of plant
2 foods.
3 Irons plentiful in beans, whole
4 grains, and fruits and flax seeds and flax
5 seed oil are good sources of omega-3s.
6 Eating patterns are changing, and
7 the diets of a great many are more plant-based
8 than a decade ago. Those moving away from
9 animal products must be supported with
10 guidance that includes alternatives to animal
11 foods and cow's milk. So we urge the Advisory
12 Committee to clearly incorporate even more
13 plant foods, specifically a well-planned, low14
fat vegan diet into the Dietary Guidelines
15 2010.
16 Thank you very much.
17 MS. HOWES: Thank you.
18 Presenter No. 40.
19 You may begin.
20 DR. KRIS-ETHERTON: Thank you for
21 the opportunity to present the views of the
22 American Heart Association.
141
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I am Penny Kris-Etherton,
2 Distinguished Professor of Nutrition at Penn
3 State, and I am a member of the American Heart
4 Association's Nutrition Committee. I also
5 served on the 2005 Dietary Guidelines Advisory
6 Committee.
7 The American Heart Association is
8 committed to promoting healthy eating plans.
9 It has long been a top priority of the
10 Association.
11 In this regard, AHA has
12 established a series of dietary, physical
13 activity, and weight control guidelines, such
14 as the Association's Diet and Lifestyle
15 Recommendations, which were most recently
16 updated in 2006. AHA firmly believes that
17 better food habits are essential to
18 cardiovascular and overall health.
19 AHA has a number of
20 recommendations we would like the Committee to
21 consider when developing its report. These
22 are described in detail in our written
142
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 comments. I would like to highlight a few of
2 them today.
3 First, the Dietary Guidelines
4 should set a limit on intake of added sugar.
5 No more than one-half of discretionary
6 calories should come from added sugars.
7 Second, the Committee should place
8 an increased emphasis on the consumption of
9 fish and describe it as an important source of
10 protein.
11 The Guidelines also should
12 emphasize plant sources of protein such as
13 legumes and beans. Other protein sources
14 should be very lean and extra lean.
15 Third, to encourage consumption of
16 healthier fats such as omega-3s, the Committee
17 should recommend consumption of 250 to 500
18 milligrams of EPA and DHA per day, which
19 equates to approximately two servings per week
20 of oily fish.
21 In addition, the Committee should
22 request that the IOM update its DRI
143
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 recommendations on essential fatty acids.
2 The Committee should tighten its
3 recommendations for saturated and trans fats.
4 Saturated fats should be less than 7 percent
5 of calories, and the trans fats recommendation
6 should be revised as low as possible, but no
7 more than 1 percent of energy.
8 Fourth, the Committee should
9 recommend a significant reduction in sodium to
10 1500 milligrams per day, the amount
11 recommended in the 2005 Guidelines for Salt-
12 Sensitive Populations. With the hypertensive
13 African-American, middle-aged, and older adult
14 populations now constituting a majority of
15 Americans, the 1500 recommendation should be
16 expanded to the entire population.
17 The Committee may want to consider
18 recommending a two-phase sodium reduction,
19 such as 1500 milligrams by 2020 with an
20 intermediate goal of 2000 by 2013.
21 MS. HOWES: Thank you very much
22 DR. KRIS-ETHERTON: Thank you for
144
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the opportunity to present AHA's comments.
2 MS. HOWES: Speaker 41, please.
3 You may begin.
4 MS. MONCRIEF: Thank you.
5 Hi, and thank you for considering
6 our recommendations for the 2010 Dietary
7 Guidelines.
8 My name is Dawn Moncrief, and I'm
9 the Director of Well-Fed World, a non-profit
10 campaign based in D.C., promoting the plant11
based solutions to improve public health and
12 increase global food security. So, obviously,
13 very well-represented here today, our views,
14 so, hopefully, it will encourage a fresh look
15 at the benefits of plant-based eating.
16 One of the things I wanted to
17 point out, as you already know, but re18
emphasize, is that heart disease, cancer,
19 stroke, and diabetes are America's top
20 killers. Diet-based solutions, such as
21 reduced meat consumption, vegetarianism, and
22 veganism, have proven to drastically reduce
145
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 these and other chronic diseases that afflict
2 millions of Americans annually.
3 As such, the benefits of plant4
based eating should be clearly delineated to
5 increase public awareness and to counter
6 public misperception.
7 Fiber- and antioxidant-rich foods,
8 particularly fresh, whole fruits and
9 vegetables, protein-rich legumes, and whole
10 grains, should be further promoted and
11 encouraged, as their positive connections with
12 health have been well-documented through
13 countless research and science-based studies.
14 The flip side is also true.
15 Research is clear about foods that show
16 detrimental effects on health. Foods that are
17 refined, processed, sugar-laden, or high in
18 saturated fats should be strongly discouraged.
19 In particular, a multitude of research shows
20 a well-established connection between foods of
21 animal origin and negative health outcomes.
22 Dietary recommendations about
146
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 animal-based products such as meat, eggs, and
2 dairy, which contain saturated fat and
3 cholesterol and are 100 percent devoid of
4 fiber, should be avoided. We should encourage
5 limiting and avoiding them altogether.
6 Recommendations should also be
7 basic enough so that people who are not food8
savvy can understand them and sophisticated
9 enough for health-conscious consumers. As
10 such, details should be provided within each
11 option in each category.
12 For example, fruits and vegetables
13 are best when they are whole, fresh, or
14 frozen, and variety is important. People
15 should eat their colors. Specify this.
16 Plant-based proteins and calciums
17 such as soy, legumes, and nuts are not only
18 adequate, but are superior in some respects,
19 in that they also provide fiber, good fats, a
20 wide variety of micronutrients and
21 antioxidants, and advantages over animal-based
22 options.
147
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 A positive step in this direction
2 would be to rename the categories. If you
3 want people to eat calcium, put calcium and
4 list dairy as one of the calcium options along
5 with the other options, such as soy and green,
6 leafy vegetables. Name the category protein
7 instead of meat, and put the other options in
8 there. That way, we are more clear for folks.
9 MS. HOWES: Thank you very much.
10 We have to move along for time.
11 MS. MONCRIEF: Okay. Thank you
12 very much, and please let science lead your
13 decisions and not the special interests.
14 Thank you.
15 MS. HOWES: Presenter No. 42,
16 please.
17 You may begin.
18 MS. SMITH: Thank you.
19 Good morning.
20 I am Ilene Smith, Senior Vice
21 President and Associate Director of the Food
22 and Nutrition Practice of Ketchum, an
148
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 integrated communications and marketing agency
2 with a history of over 40 years of helping
3 companies and commodity boards promote sound
4 nutrition messages.
5 As a registered dietitian and
6 communications professional, I work with food
7 organizations to deliver messages that help
8 consumers overcome dietary shortcomings.
9 In 2008, Ketchum commissioned a
10 global study called, Food 2020 to shed light
11 on consumers' chief food concerns today and
12 how they expect those to shift over the next
13 decade. I will focus my remarks today on what
14 we learned from the U.S. consumer. We hope
15 that this information will help guide the
16 Committee deliver recommendations in a manner
17 consistent with consumer expectations.
18 The results show that consumers
19 clearly consider health and well-being a top
20 priority with food as the gateway to wellness,
21 and painted a picture of consumers wanting
22 more -- more information, more choices, more
149
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 accountability, and more control.
2 Some key findings include:
3 Not surprising, taste, quality,
4 and price are still the top considerations in
5 choosing food. Health benefits follow these.
6 When you remove cost from the equation, taste
7 was the top barrier to healthier eating.
8 The implication here is that it
9 will be challenging to affect consumers'
10 eating habits for the better if we continue to
11 de-emphasize taste in favor of optimal
12 nutrition. We need to keep in mind that, when
13 we tell consumers to eliminate or reduce fat,
14 sugar, and salt from their foods, what they
15 hear instead is that they need to eliminate
16 taste.
17 Consumers also want to know more
18 about their food, what's in it and where it
19 comes from, and are eating with a conscious.
20 Sixty-seven percent of U.S. consumers want to
21 be able to recognize all of the ingredients on
22 a food label. Thirty-seven percent want foods
150
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 to be made with as few ingredients as
2 possible.
3 They also want more of a say in
4 how their foods are made, the amount of
5 artificial ingredients and additives used in
6 their foods, how animals used for foods are
7 treated, how land is used to make and grow
8 food, and how agricultural workers are
9 treated.
10 The implication and opportunity
11 for the Dietary Guidelines is to encourage
12 consumers to select foods based on more
13 holistic criteria than nutrients alone.
14 The research also provides some
15 indication of where the Guidelines should head
16 in 2020. When consumers were asked to project
17 what factors will become more important to
18 them in that year, nutritional value and
19 health benefits moved up the list in priority.
20 As you can see, the consumer sees
21 food in a broad scope and manner. Keeping
22 this issue in mind when deliberating nutrition
151
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 science, it is our hope that this holistic
2 view will help encourage compliance with the
3 upcoming 2010 Dietary Guidelines.
4 Thank you for this opportunity.
5 MS. HOWES: Thank you.
6 Speaker No. 43 is not present. We
7 will move along with speaker No. 44.
8 You may begin.
9 MS. HAMLIN: Chicken nuggets,
10 mozzarella sticks, pizza, cheeseburgers, and
11 hotdogs. I'm Amie Hamlin. As Director of the
12 New York Coalition for Healthy School Food, I
13 visit many cafeterias, and it is unbelievable
14 that these regular menu items are described as
15 balanced and nutritious and that they meet the
16 Dietary Guidelines for Americans.
17 Many entrees have more sodium than
18 a child should eat for the whole day. Canned
19 vegetables end up in the garbage. The
20 majority of children of color either cannot or
21 will not be able to digest the milk and may be
22 suffering in school because of it.
152
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 The majority of school meals are
2 not health-supporting. Since school meals are
3 to be consistent with the Guidelines, we
4 recommend these changes, meat and beans group,
5 change the name to the protein group, with
6 legumes and other plant proteins as the
7 primary source. Animal proteins should be
8 listed as optional or infrequent.
9 Plant proteins lower cholesterol
10 and cancer risk, and animal proteins cause
11 them to rise. There's a clear relationship
12 between animal product consumption, heart
13 disease, and cancer. With recommendations to
14 encourage more fruits, vegetables, and whole
15 grains, we need to add plant-based entrees to
16 that list.
17 Dairy group, change the name to
18 the calcium group. It is a mistake to focus
19 so much on dairy when people in the U.S.
20 cannot digest it, including the majority of
21 people of color. The possible connection of
22 dairy to prostate cancer and other health
153
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 problems means it is time to change the focus
2 away from dairy.
3 Research does not support that
4 dairy prevents osteoporosis. Osteoporosis is
5 the result of a number of lifestyle choices,
6 and reliance on dairy products is an
7 oversimplification. The Guidelines should
8 point out the other factors that contribute to
9 osteoporosis. The calcium group should
10 feature high-calcium foods and calcium11
fortified non-dairy beverages as the healthier
12 choices.
13 We must also take into account
14 that raising animals for food contributes more
15 to global warming than all transportation
16 combined, and we should not be making
17 recommendations that are unsustainable.
18 Grains group, we should not lump
19 together refined and unrefined grains. The
20 recommendation should be for most grains to be
21 whole.
22 Fruits and vegetables, let's
154
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 suggest that people dramatically increase
2 their intake of all whole fruits and
3 vegetables, especially leafy greens. Let's
4 tell people what we know.
5 As fruit and vegetable consumption
6 increases in the diet, chronic diseases and
7 premature deaths decrease, and the excess
8 consumption of animal products has been
9 repeatedly shown to be dangerous. Let's
10 actively discourage consumption of animal
11 products and processed foods.
12 The 2000 Guidelines stated that
13 most of our calories should come from plant
14 sources. This was removed for 2005. Please
15 add that statement back, emphasize it, and
16 make it very clear that the majority of heart
17 disease, type 2 diabetes, and certain cancers
18 are preventable with diet.
19 It is a free country. People can
20 choose to eat how they want, but, please,
21 let's tell them real truth, the kind that is
22 not paid for or influenced by the food
155
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 industry.
2 With our new President comes much
3 hope. On behalf of the New York Coalition for
4 Healthy School Food, it is our hope that the
5 Dietary Guidelines for Americans, which school
6 meals are based upon, can reflect dietary
7 recommendations that result in good health and
8 are expressed in a way that is easy for
9 Americans to understand.
10 The top recommendations we would
11 give are as follows, dramatically increase
12 whole unprocessed foods of plant origin,
13 especially fruits, vegetables, and legumes,
14 and plant-based entrees.
15 Dramatically reduce foods of
16 animal origin.
17 Dramatically reduce processed
18 foods.
19 Thank you.
20 MS. HOWES: Thank you.
21 Speaker 45, please.
22 MR. PHILLIPS: Good morning.
156
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. HOWES: You may begin.
2 MR. PHILLIPS: Thank you.
3 I am filling in for Dr. David Katz
4 of the Yale University Prevention Research
5 Center. My name is Chris Phillips, and I
6 represent NuVal LLC, the independent
7 nutritional scoring company formed a year ago
8 to bring to market what we truly believe could
9 become the universal standard for clear,
10 consistent, consumer-directed guidance on
11 nutrition -- one number, one decision, one
12 food at a time.
13 The full volume of information
14 that appears on the nutrition facts panel and
15 the ingredients statement is run through an
16 exhaustive algorithm developed by a dozen of
17 the nation's leading experts on nutrition,
18 computes a score 1 to 100, ultimately, for
19 every single one of the more than 50,000 food
20 and beverage products available today in the
21 average U.S. supermarket.
22 Three key points underlie my
157
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 remarks here today.
2 First, while dietary guidance
3 historically has been provided at the level of
4 the whole diet, most food choices are made not
5 with an overall plan in mind, but simply with
6 one product at a time.
7 Second, truly effective dietary
8 guidance may need to encompass both the whole
9 diet and the specific food choices that become
10 the diet.
11 And third, a flurry of systems
12 claiming to offer guidance at the level of the
13 individual food choices is currently
14 populating the marketplace, and warrants
15 scrutiny and assessment by a body of this
16 nature.
17 Consumers aren't just politely
18 asking for food guidance today. They are
19 demanding it. The proliferation of food20
scoring-assisted programs over the past year
21 in this country isn't just some, me too
22 marketing phenomenon. It is a direct and very
158
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 real response to the overwhelming consumer
2 need for nutritional clarity.
3 As I said, I am filling in today
4 for Dr. David Katz of Yale University. He is
5 the principal inventor of the algorithm called
6 the Overall Nutritional Quality Index, or
7 ONQI, which is the underpinning of the NuVal
8 system.
9 My main objective here today is
10 not really to push the NuVal system, though it
11 should come as no surprise that we believe
12 ours is singularly the best. Nothing comes
13 even close to the breadth and depth of our
14 scientific model, both in terms of the
15 nutritional variables that are measured and
16 the enormity of the food supply we are
17 scoring. It is also the only system that
18 includes in its calculation the relationship
19 between nutrients and health outcomes.
20 We see our system as a turnkey
21 solution, a universal measure that can drive
22 consumer awareness and shape their dietary
159
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 habits. But, frankly, whether it is NuVal or
2 another deserving system, all that really
3 matters in the end is that consumers are
4 finally able to rise above the clouds of
5 confusion and see, with confidence and
6 clarity, the nutritional value, or not, of the
7 food they are buying for their families.
8 I would like to encourage the
9 Dietary Guidelines Committee to look closely
10 and critically at all these systems, including
11 ours, consider how the right holistic approach
12 can actually work in tandem with the
13 Guidelines, enhance their effectiveness and
14 bring them to light.
15 By giving consumers the vital
16 information they need in plain English or
17 simple arithmetic, we finally help move the
18 needle on better nutrition. In other words,
19 consumers need something more actionable and
20 in no better place than right at the point of
21 purchase.
22 I would like to leave the
160
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Committee with a short list of questions and
2 observations.
3 Could a subgroup of the Committee
4 be assembled to look at the nutrition5
profiling systems and offer the public some
6 advice about the good ones and their value and
7 use?
8 Could the Guidelines consider
9 systems that help people make good choices
10 within food categories? The Dietary
11 Guidelines address categories of foods and
12 overall dietary pattern, but people choosing
13 bread or salad dressing cannot do so based on
14 dietary-level guidance. They need food-level
15 guidance as well.
16 And could the Committee consider
17 addressing relevant principles for food-level
18 guidance to help the public choose among the
19 proliferating systems?
20 And finally --
21 MS. HOWES: Thank you for your
22 comments.
161
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MR. PHILLIPS: Okay, thank you.
2 MS. HOWES: We need to continue
3 on.
4 MR. PHILLIPS: Thank you very
5 much.
6 MS. HOWES: Thank you. We have
7 your written statement.
8 At this time, we are delighted
9 that we will be able to go into the alternate
10 group of presenters.
11 Guideline Committee, in your books
12 they are listed as standby 1 through 13 on the
13 list. If you're following, for the public,
14 they will start with No. 46.
15 At this time, may I please have
16 Mindy Kursban to the microphone?
17 MS. KURSBAN: Good morning.
18 My name is Mindy Kursban. I'm
19 here as an individual asking to support three
20 recommendations. I would first like to share
21 my personal experience.
22 I grew up eating the standard
162
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 American diet. Fast foods several times each
2 week; Sunday mornings of eggs and bacon; every
3 lunch and dinner centered around a meat dish.
4 I was 40 pounds overweight by the
5 time I was 17 years old. At that time, I
6 began searching for information about losing
7 weight and being healthy. Today my weight is
8 where it should be, my cholesterol is 148, I
9 take no medications, I have no health issues,
10 and have been vegetarian for 17 years and
11 vegan for 11.
12 In contrast, my father, who never
13 changed his eating habits, has had two heart
14 bypass surgeries, several angioplasties, takes
15 numerous medications to control his blood
16 pressure, cholesterol, and other chronic
17 conditions, and has been diagnosed as pre18
diabetic.
19 I point this out to show that
20 choosing a healthy diet, regardless of family
21 genes, can prevent the majority of chronic
22 diseases that are now prevalent in epidemic
163
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 proportions in this country, and to serve as
2 an anecdotal example of what the scientific
3 studies we've heard about today, I'm sure you
4 all know about, support.
5 My personal involvement with the
6 World Nutrition is that I served for eight
7 years as General Counsel and Executive
8 Director of the Physicians' Committee for
9 Responsible Medicine and the Cancer Project,
10 two organizations that are spearheading
11 progressing efforts for using nutrition as a
12 tool for preventive medicine.
13 Based on this background, I
14 believe it is not only the plant foods I
15 include in my diet, but the unhealthy animal
16 products that I have excluded from my diet
17 that keeps me so healthy.
18 The three recommendations I ask
19 you to include in the 2010 Dietary Guidelines
20 are the following.
21 First, include information on the
22 benefits of following a vegan diet and
164
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 strongly recommend this eating style for
2 everyone.
3 Second, include truthful and
4 accurate information about the health risks of
5 all meats, which includes beef, pork, chicken,
6 and fish, and stop recommending their
7 consumption. They should be optional at best.
8 Third, remove the recommendations
9 that Americans consume dairy and stop allowing
10 this as a food group in the Pyramid. Dairy
11 products are healthy if you are a calf.
12 Otherwise, it is fundamentally illogical, and
13 also against an increasing amount of
14 scientific evidence being published, that
15 humans need to consume the mammary secretions
16 of another species to be healthy.
17 Thus, the four food groups should
18 be fruits, vegetables, whole grains, and
19 legumes, which not only provide adequate
20 amounts of calcium, but also many other
21 nutrients that are equally important in our
22 diet, such as vitamin A, vitamin C, vitamin E,
165
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 magnesium, potassium, fiber, and the list goes
2 on.
3 Thank you very much for the
4 opportunity to speak today.
5 MS. HOWES: Thank you.
6 Alternate No. 2, Kathleen McMahon.
7 You may begin.
8 MS. McMAHON: I am Kathy McMahon,
9 Director of Nutrition and Scientific Affairs
10 for the William Wrigley, Jr., Company, a
11 subsidiary of Mars, Incorporated, located in
12 Chicago, Illinois.
13 I am here to discuss the potential
14 role of chewing gum in the Dietary Guidelines.
15 There are two areas that we propose chewing
16 gum can be considered for inclusion in dietary
17 guidance. First, in the reduction and
18 prevention of dental caries and, second, as a
19 tool in weight management.
20 In the reduction and prevention of
21 dental caries, we request that the Committee
22 consider the addition of chew sugar-free gum
166
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 after eating when you can't brush, under
2 optimizing oral hygiene practices in the
3 carbohydrates section. The body of evidence
4 clearly shows that chewing sugar-free gum
5 provides functional oral health benefits.
6 Sugar-free chewing gum is unique because it is
7 non-cariogenic and it acts through stimulation
8 of saliva at about 10 times what is normally
9 found in the mouth.
10 Stimulated saliva leads to
11 neutralization and buffering of plaque acids,
12 oral clearance of sugars, acids, and food
13 debris from the mouth, and remineralization of
14 tooth enamel.
15 Several randomized clinical trials
16 demonstrate the benefits of chewing sugar-free
17 gum in cavity reduction. As an example, a
18 two-year randomized clinical trial was
19 conducted in Hungary with almost 550 children
20 ages 8 through 13. The treatment group chewed
21 three pieces of sugar-free gum each day for
22 two years, one piece following each meal,
167
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 while the control group chewed no gum. These
2 researchers found a close to 40 percent
3 decline in dental caries in comparison to the
4 control group.
5 In recognition of the strength of
6 the body of research evidence globally, 17
7 dental associations, including the World
8 Dental Federation, have recognized the
9 scientific evidence behind the benefit of
10 chewing sugar-free gum for oral health. The
11 American Dental Association, known for its
12 stringent policies, awarded its Seal of
13 Acceptance to sugar-free gums in 2007.
14 A second consideration, chewing
15 gum can be a strategy to help manage calorie
16 intake and weight management. Chewing gum can
17 serve as a substitute for a high-calorie snack
18 and as a small calorie savings each day that
19 can make an impact in decreasing total calorie
20 intake over time.
21 Sugar-free gum is only five
22 calories per serving and is consumed in small
168
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 amounts. The reference amount is only 3
2 grams.
3 It is found in many dietary plans,
4 and there are three studies supported by the
5 Wrigley Science Institute that demonstrate the
6 role of chewing gum in short-term hunger and
7 appetite control. Results indicate that
8 chewing gum hourly after lunch for three hours
9 helped reduce energy intake of an afternoon
10 snack. Hunger and desire to eat were
11 significantly suppressed by chewing gum.
12 In conclusion, chewing gum can
13 play a role in dental caries prevention, and
14 in weight management, because of its lower
15 calorie content, can fit well within the
16 dietary guidance and discretionary calorie
17 limits.
18 Thank you.
19 MS. HOWES: Thank you.
20 Standby No. 3, Julie Obbagy.
21 MS. OBBAGY: Hi. My name is Julie
22 Obbagy. I'm a registered dietitian as well as
169
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the Director of Scientific Affairs for the Soy
2 Foods Association of North America.
3 The Soy Foods Association of North
4 America appreciates the opportunity to comment
5 on the development of the 2010 Dietary
6 Guidelines for Americans and urges the
7 Committee to reference soy foods more
8 prominently in the final report.
9 Soy foods are a healthy choice for
10 all Americans. Soy foods contain significant
11 amounts of key nutrients that Americans are
12 advised to consume more of and are low in
13 nutrients that Americans should be consuming
14 less of.
15 For example, fortified milk, the
16 most popular soy product consumed by
17 Americans, is a high source of calcium and
18 vitamin D and a good source of vitamin A, as
19 defined by the FDA. It also provides protein,
20 iron, and potassium.
21 Whole soybeans or edamame are high
22 sources of fiber, magnesium, potassium, and
170
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 calcium.
2 In addition, soy foods are
3 cholesterol-free and low in saturated fat and
4 calories.
5 Soy foods fit into nearly every
6 category of USDA's MyPyramid, including milk,
7 vegetables, meat and beans, greens, and oils,
8 and can help Americans in meeting federal
9 dietary recommendations.
10 Soy foods contain high-quality
11 protein with all nine essential amino acids
12 and can meet the needs of children and adults
13 when consumed as the sole source of protein.
14 According to the FDA protein
15 quality determination method, soy foods are
16 the only plant-based protein equivalent to
17 eggs and milk.
18 A 2007 evidence-based review and a
19 more recent clinical study find that soy
20 protein is as good as other protein sources
21 for promoting weight loss, and that including
22 soy in the diet is a strategy for weight
171
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 management.
2 Soy foods contribute to overall
3 health for Americans throughout the life
4 cycle. In 1999, the FDA approved a health
5 claim for soy protein in coronary heart
6 disease. In 2008, four evidence-based reviews
7 confirmed that soy protein lowers total and
8 LDL cholesterol.
9 The American Institute for Cancer
10 Research's 2007 report found that a plant11
based diet which includes soy foods can help
12 reduce the risk of developing cancer.
13 More recently, clinical trials
14 exploring the role of soy in protecting
15 against breast cancer and prostate cancer have
16 shown promise.
17 The American diet continues to
18 broaden to include more culturally-diverse and
19 nutrient-rich foods. A variety of affordable
20 soy products provides choices for Americans
21 seeking more plant-based options because of
22 cultural, religious, health, or medical
172
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 reasons.
2 A recently-released National
3 Health Statistics report found nearly one in
4 200 American youths reported practicing a
5 vegetarian diet.
6 In 2008, 28 percent of Americans
7 consumed soy foods and more than a third
8 consumed soy products at least a few times a
9 week.
10 We strongly recommend that the
11 2010 Dietary Guidelines reflect the changing
12 dietary preferences and needs of the American
13 public, and urge you to feature soy foods more
14 prominently in the 2010 Dietary Guidelines for
15 Americans.
16 Thank you.
17 MS. HOWES: Thank you.
18 Standby No. 4, Eva Rand.
19 You may begin.
20 MS. RAND: My name is Eva Rand.
21 I'm a registered dietitian. I work for a team
22 of 20 primary care physicians in Bethesda,
173
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Maryland.
2 Everyone agrees the obesity
3 epidemic in our country is out of control. On
4 January 9th of this year, the National Center
5 for Health Statistics informed us that the
6 number of obese Americans now exceeds the
7 number who are merely overweight, based on
8 body mass index. That equals 34 to 33
9 percent, respectively, from data collected in
10 2005 and 2006.
11 With the rates of heart disease,
12 cancer, diabetes, and numerous other serious
13 conditions and illnesses with strong links to
14 diet, it has become apparent to me that the
15 Food Guide Pyramid is simply not a useful
16 format for helping Americans determine what
17 and how much to eat.
18 As a registered dietitian having
19 counseled thousands of patients over the
20 years, I can tell you virtually none of my
21 patients has extracted any useful information
22 from the Pyramid. Virtually none of them has
174
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 gone to mypyramid.gov to learn how to make
2 personal use of the Dietary Guidelines.
3 I believe that is because the
4 Pyramid, a triangle really, is simply a format
5 that is unappealing to people. They don't
6 know how to translate the information packed
7 into the Pyramid into something useful for
8 themselves. The one exception is the
9 inclusion of the person running up the steps
10 that was put in 2005.
11 What I propose is scrapping the
12 Pyramid altogether and replacing it with
13 something that I have found works far better.
14 Let me call it "The Food Guide Plate". This
15 is a much simpler approach that even children
16 can grasp immediately.
17 People simply want to know, what
18 should I eat? Whether it is for breakfast,
19 lunch, or dinner, they find it too confusing
20 to translate the information from the Pyramid
21 into something they can immediately use at
22 mealtime, whether at home or when eating out.
175
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 And few people have the time or interest to
2 search through the Guidelines book or website
3 to find the answers.
4 The second proposal I would like
5 to encourage is to devote more attention to
6 plant-based diets. There is ample evidence
7 that limiting or avoiding meat, poultry, fish,
8 and dairy promotes health and longevity.
9 Perhaps this diet is not for everyone, but
10 encouraging Americans to begin the process of
11 moving away from our typical meat-based fatty
12 diet toward a healthier plant-based diet just
13 makes sense.
14 The health rewards of doing so are
15 enormous, as I see every day in my practice.
16 People lose weight automatically. High blood
17 pressure drops. Blood sugar levels improve.
18 Cholesterol improves. People are able to
19 lessen or entirely get off their medications.
20 And a plant-based approach could
21 be combined by my healthy plate concept that
22 I described in the beginning of my talk.
176
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you very much.
2 MS. HOWES: Thank you very much.
3 Alternate No. 5 is not present.
4 So we will move on to Alternate No. 6, or No.
5 51, if you are following on your schedules.
6 DR. EASLEY: Good morning,
7 Committee members.
8 I am David Easley, MD, from
9 Louisville, Kentucky. I am a physician and
10 psychiatrist in private practice with the
11 Center for Cognitive Therapy.
12 Thank you for allowing me to come
13 here today and speak.
14 The Guidelines Committee, of
15 course, needs to address all components of the
16 diet, but the evidence from the Department of
17 Agriculture and its development from 1840,
18 when the nitrogen, phosphate, and potassium
19 led to abundant agriculture success and
20 Lincoln starting this Department, and then in
21 1930 food processing began, which removes
22 potassium and substitutes sodium in all
177
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 processed food.
2 The difficulty is that humans are
3 unable to remove sodium in excess of twice the
4 potassium in grams per day through the kidney.
5 The process leads to intracellar loss of
6 potassium throughout the body.
7 The cardiovascular effect is a
8 reversible effect that causes tightening of
9 muscles and causes impotency in men, and
10 failure to respond to insulin, and obesity.
11 But in the human brain, the effect of low
12 intracellular potassium is irreversible, and
13 this irreversible loss in children in mirror
14 cells causes autism, in adolescents and
15 school-aged children being fed the modern diet
16 causes attention deficit disorder and behavior
17 problems, and in the elderly, feeding them a
18 diet high in sodium, low in potassium of
19 processed food causes Alzheimer's.
20 These illnesses must be addressed
21 immediately by the Guidelines by this
22 committee.
178
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you for your attention.
2 MS. HOWES: Alternate No. 7, Kathy
3 Hoy, please.
4 You may begin.
5 MS. HOY: Good morning.
6 My name is Kathy Hoy. I'm with
7 the Produce for Better Health Foundation in
8 Wilmington, Delaware.
9 Thank you for the opportunity to
10 speak on behalf of the Produce for Better
11 Health Foundation.
12 PBH is a non-profit, consumer
13 education foundation whose purpose is to
14 motivate people to eat more fruits and
15 vegetables to improve public health.
16 Fruit and Veggies: More Matters,
17 formerly the Five-A-Day Program, is the
18 nation's largest public/private fruit and
19 vegetable nutrition education initiative, with
20 Fruit and Vegetable Nutrition Coordinators in
21 each state, territory, and the military.
22 PBH is a member and co-chair,
179
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 together with CDC, of the National Fruit and
2 Vegetable Alliance, consisting of government
3 agencies, non-profit organizations, and
4 industry, working to collaboratively and
5 synergistically achieve increased nationwide
6 access and demand for all forms of fruits and
7 vegetables for improved public health.
8 PBH commends USDA, HHS, and the
9 Dietary Guidelines Advisory Committee for
10 their important work on the development of the
11 2010 Dietary Guidelines. Overall, we believe
12 the Guidelines, as they relate to fruits and
13 vegetables, are currently solid.
14 PBH has no specific
15 recommendations for changes and strongly
16 supports continuing to base the Guidelines on
17 evidence-based science. More of our concern
18 lies in the area of properly translating and
19 communicating these core dietary messages to
20 the consumer.
21 Specifically, we have three
22 recommendations.
180
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 First, emphasize food first. PBH
2 suggests the Guidelines highlight that dietary
3 supplements cannot replace fruits, vegetables,
4 and other whole unprocessed or minimally5
processed foods.
6 Secondly, the 2005 Dietary
7 Guidelines nicely emphasized what foods should
8 be consumed more, but PBH suggests that the
9 2010 Dietary Guidelines be even more explicit
10 about what should be consumed less. It is our
11 experience that consumers are still not sure
12 what foods contain sodium, saturated fat, or
13 trans fats, and that at least several examples
14 should be explicitly identified for them.
15 Lastly, promotion. PBH encourages
16 the Dietary Guidelines Advisory Committee to
17 recognize that fruits and vegetables are
18 underconsumed by the U.S. public to a greater
19 extent than any other food group; that this
20 low consumption level impacts the variety of
21 fruits and vegetables consumed, the ability to
22 obtain both essential and protective nutrients
181
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 in adequate amounts, and the caloric density
2 of the diet.
3 We encourage maintaining
4 consistency of messaging about recommended
5 intakes to avoid consumer confusion about
6 personal requirements.
7 While underconsumption of fruits
8 and vegetables is likely the result of a
9 number of factors, fruits and vegetables are
10 clearly not promoted to the extent that other
11 food groups are. This, coupled with excessive
12 advertising of less nutritious foods, lack of
13 fruit and vegetable consumption by role
14 models, and many other factors, impacts
15 overall consumption of fruits and vegetables.
16 The aggressive promotion of fruits
17 and vegetables should be the shared
18 responsibility of federal and state agencies
19 with health and nutrition responsibilities,
20 non-profit groups such as PBH, industry
21 educators, and individuals.
22 Given limited funds, even more
182
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 coordination among all of these groups to
2 provide consistent messages to consumers is
3 important. The Committee should encourage
4 USDA and HHS to further collaborate with PBH,
5 states, educators, and the industry to promote
6 consistent fruit and vegetable messages, such
7 as, Fruits and Veggies: More Matters, that
8 are consistent with the Dietary Guidelines.
9 Thank you very much.
10 MS. HOWES: Thank you for your
11 presentation.
12 Alternate No. 8, or No. 53, if you
13 are following the list that was distributed,
14 is not here today. So we will move on to 9 or
15 54.
16 Becky?
17 Thank you.
18 DR. DOMOKOS-BAYS: Good morning.
19 I am Dr. Becky Domokos-Bays,
20 Director of Food and Nutrition Services for
21 Alexandria City Public Schools in Alexandria,
22 Virginia.
183
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I am pleased to provide comments
2 to the Committee on behalf of the School
3 Nutrition Association and its 55,000 members.
4 In 1994, the Healthy Meals for
5 Healthy Americans Act required schools
6 participating in the School Lunch or School
7 Breakfast Programs to serve meals consistent
8 with the Dietary Guidelines for Americans.
9 SNA strongly supported this provision then,
10 and we continue to strongly support the use of
11 Dietary Guidelines for Americans today.
12 Our 55,000 members at 100,000
13 schools serve 30 million students and over 36
14 million meals daily. They have the legal
15 obligation to meet these standards and are
16 committed to serving the most nutritious and
17 safe meals possible within our limited
18 reimbursement rates.
19 Since 2007, in response to
20 requests by the USDA, our members have begun
21 proactively implementing the recommendations
22 of the 2005 DGAs within the current meal
184
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 pattern requirements and nutrition standards.
2 For the last two years, most of the attraction
3 with regard to child nutrition has focused on
4 the key issue of nutrition standards.
5 School nutrition professionals
6 recognize the importance of nutrition and
7 exercise in everyday life. SNA supports
8 Dietary Guidelines that provide consistent
9 standards for schools throughout the country.
10 The Guidelines should allow for a consistent
11 and understandable meal pattern for school
12 meals which are practical and achievable and
13 be applicable to competitive foods sold
14 outside of the meal program, whether in the
15 cafeteria or down the hall in vending
16 machines.
17 SNA is deeply committed to the
18 Dietary Guidelines for Americans, and we
19 believe that they should be applied to all
20 foods and beverages sold in schools throughout
21 the school day. Foods and beverages available
22 at school can contribute to teaching children
185
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 lifelong healthy eating habits. This
2 principle will be accomplished in partnership
3 with school nutrition professionals, teachers,
4 parents, and the broader community.
5 School meals are a critical safety
6 net for children. However, they are not the
7 only source of nutrition. Meals consumed
8 outside of school hours, on weekends and
9 during academic breaks, should also meet
10 nutritional goals.
11 Current and future implementation
12 of these updated Guidelines will require a
13 collaborative effort with all stakeholders.
14 We urge the Committee to develop guidelines
15 which will better foster healthy eating habits
16 and behaviors in children both in and out of
17 the school setting.
18 The school nutrition environment,
19 including facilities, labor, and skill level
20 of employees, varies significantly across the
21 country. Regardless of professional
22 capability and available facilities, we must
186
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 provide a nutritionally-balanced school lunch
2 within the current federal reimbursement rate
3 of $2.57.
4 Within these limitations, we want
5 to work with you for the development of
6 Dietary Guidelines that are both practical and
7 achievable. Standards should be written in
8 plain language, so that people of all
9 capabilities can readily understand them.
10 As those tasked with implementing
11 the Guidelines, we must also be sure that the
12 meals we serve are attractive to our national
13 student body. The achievement of good
14 nutrition depends on consumption and
15 education, in addition to a carefully-designed
16 program.
17 SNA looks forward to working with
18 the Dietary Guidelines Advisory Committee as
19 the 2010 Dietary Guidelines for Americans are
20 developed. We will be pleased to participate
21 in any meetings or other activities that the
22 Committee holds, as may be appropriate.
187
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you very much for allowing
2 us to participate today.
3 MS. HOWES: Thank you.
4 Alternate No. 10, or No. 55 on
5 your sheet; alternate No. 11, or 56 on your
6 sheets, did not come today. So we will move
7 on with alternate No. 12, or No. 57, Maureen
8 Storey.
9 DR. STOREY: Good morning.
10 I am Maureen Storey, Senior Vice
11 President for Science Policy for the American
12 Beverage Association.
13 ABA welcomes the opportunity to
14 address Secretary Leavitt's request that the
15 panel consider one or two Dietary Guidelines
16 recommendations that would have the greatest
17 impact on consumers' health, especially
18 obesity.
19 This is a difficult task because
20 good health is not just about diet, but about
21 a lifestyle that includes other health22
promoting choices such as physical activity.
188
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Nevertheless, there are two important actions
2 that can be taken to help reverse the obesity
3 trend and to reinforce overall good health of
4 Americans. We would encourage the Committee
5 to reinforce two actions.
6 Number one, the overarching theme
7 of the 2010 Dietary Guidelines for Americans
8 should focus on the total diet, the importance
9 of physical activity, and the essential role
10 that energy balance plays in achieving and
11 maintaining a healthy weight.
12 Action two, we encourage the
13 Committee to set a dietary guideline for
14 hydration, recognizing that water is a vital
15 nutrient for sustaining life.
16 To effectively combat overweight
17 and obesity, the ABA believes that dietary
18 guidance must focus on energy balance, all
19 calories in and all calories out. To that
20 end, we must encourage consumption of
21 balanced, moderate, and varied diets that meet
22 nutritional needs while ensuring adequate
189
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 physical activity to maintain energy balance.
2 Within that context, we do not
3 believe that any one food or beverage should
4 be branded as good and another bad. This is
5 elegantly discussed by Allison and Mattes in
6 an editorial published in The Journal of the
7 American Medical Association last week. There
8 are no simple solutions to the complex issue
9 of overweight and obesity or overall good
10 health, including eliminating a single food or
11 beverage from one's diet.
12 Second, consumers must be educated
13 on the importance of hydration as part of an
14 overall healthy, active lifestyle. This is
15 important for everyday living and, in
16 particular, when there is an increase in
17 physical activity.
18 The basic science for the
19 hydration guideline was published in the 2004
20 report form the IOM on Water and Electrolytes,
21 the International Life Sciences' Monograph on
22 Hydration: Fluids for Life, and the 2007
190
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 supplement to The Journal of the American
2 College of Nutrition.
3 It is now time for the Dietary
4 Guidelines to play an important role in
5 helping to educate healthcare professionals
6 and consumers about the importance of
7 hydration.
8 In its report, the IOM panel
9 emphasized that water is the most important
10 and most essential nutrient for the body and
11 recognized that all beverages are comprised
12 primarily of water and, therefore, contribute
13 to daily hydration needs of consumers.
14 In summary, to reduce the trends
15 of overweight and obesity and to achieve
16 overall good health for all consumers, the ABA
17 proposes the following two recommendations
18 that would have the greatest impact on overall
19 health:
20 One, the overarching theme of the
21 2010 Dietary Guidelines for Americans should
22 focus on the total diet, energy balance, and
191
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the importance of physical activity in
2 achieving and maintaining a healthy weight.
3 Two, a guideline for hydration
4 should be included in the 2010 Dietary
5 Guidelines for Americans, with focus on an
6 adequate intake of total water from all
7 beverage sources and within individual energy
8 needs.
9 Thank you.
10 MS. HOWES: Alternate No. 13, or
11 speaker No. 58, is not present. So, at this
12 time, I would like to call forth our last
13 presenter, No. 32.
14 You may begin. Thank you.
15 DR. ZUCKERMAN: Yes, the good news
16 is I'm last.
17 I am Dr. Diana Zuckerman. I am
18 President of the National Research Center for
19 Women and Families. Our non-profit center is
20 dedicated to improving the health and safety
21 of adults and children by scrutinizing medical
22 and scientific research information.
192
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 In addition, I am a Fellow at the
2 University of Pennsylvania Center for
3 Bioethics.
4 There are many important issues
5 that you are going to be dealing with. I am
6 going to focus on two that we haven't heard
7 about this morning, or at least not heard much
8 about.
9 The first is methylmercury in
10 fish. In 2005, this Advisory Committee's
11 Dietary Guidelines report included information
12 about the risks of methylmercury in fish
13 consumed by pregnant and nursing women and by
14 young children. Your report was consistent
15 with a Joint Advisory by EPA and FDA that had
16 come out the year before.
17 However, recently, the FDA has
18 come out with a new draft report which has
19 been very strongly criticized by the EPA. It
20 has very major methodological flaws, one might
21 say bizarre methodological flaws. I wanted to
22 encourage you that it not influence your
193
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 thinking on this matter.
2 However, in your 2005 report, you
3 focused on fish generally, and you talked
4 about a limit of about 12 ounces of fish for
5 pregnant and nursing women and young children,
6 when, in fact, really the problem is that
7 certain fish are high in mercury and others
8 aren't. There's no reason why women should be
9 encouraged to eat less fish if the fish they
10 like are low in mercury. The problem is that
11 tuna fish is the most popular fish in America,
12 and albacore tuna is quite high in
13 methylmercury, as is most fresh tuna.
14 So I urge you, when you are
15 talking about methylmercury in fish, that you
16 distinguish between the fish that are high in
17 mercury and those that are low in mercury --
18 many are low in mercury -- and have your
19 advice be based on those different kinds of
20 fish.
21 The second issue is food
22 containers. Bisphenol A, called BPA, is an
194
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 estrogen, a chemical that is in the linings of
2 canned food and canned beverages and also in
3 the metal tops of bottled food and beverages,
4 in the lining of that metal top.
5 The National Toxicology Program of
6 NIH has stated clearly that this chemical,
7 this estrogenic chemical, gets into the food,
8 gets into the beverages, and the CDC has said,
9 yes, it gets into our bodies.
10 In a new JAMA article, they found
11 that people who had higher levels of BPA in
12 their bodies were more likely to have diabetes
13 and heart disease, even when controlling for
14 obesity. Other studies have found problems
15 with its effect on brain cognitive development
16 and also mood.
17 So I urge you to really seriously
18 look at this issue. It is an important issue
19 because of these health effects which we don't
20 fully understand yet, but, hopefully, with new
21 research coming out virtually every day, we
22 will understand it some more.
195
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 And the last thing I just want to
2 mention is a new study that came out finding
3 mercury in corn syrup. It is too new of a
4 study for me to be able to talk about it, but
5 it is, again, something that I hope you will
6 look at very seriously.
7 I would be happy to answer any
8 questions.
9 Thank you.
10 MS. HOWES: Thank you very much.
11 This concludes our presentation.
12 Would the Chair like to address
13 the group, please?
14 CHAIR VAN HORN: We would like to
15 thank everyone who took time and energy to
16 prepare remarks for today. It has been very
17 interesting to hear all of you, and we really
18 appreciate the additional input into our
19 deliberations.
20 Because you were all very
21 efficient, we were able to get through the
22 entire list, which is great.
196
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Because we have so much on our
2 agenda, we have decided to move things around
3 a little bit. For the next few minutes before
4 we break for lunch at 11:30, we would like to
5 discuss the use of the Nutrition Evidence
6 Library for the work that we are doing, and
7 have Joan Lyon, who kindly is agreeing to jump
8 in here with about 60 seconds notice, to help
9 us in describing some of the process that goes
10 into the work that we will be doing.
11 For those in the audience, this
12 Committee has been diligently at work since
13 the last time we convened publicly in
14 reviewing the evidence, and it has been with
15 great thanks to Joan and her team, and all
16 those that you see around us that have been
17 providing the additional help with the
18 evidence base.
19 So we will take just a few minutes
20 now to discuss further the process involved
21 with that.
22 Joan?
197
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. LYON: Thank you very much,
2 Linda.
3 Following this public meeting, the
4 Advisory Committee will begin using the
5 Nutrition Evidence Library online portal more
6 extensively. So at this point in time, we
7 will go through the steps in the process and
8 how the Committee will be using the Library,
9 as well as how the staff will be supporting
10 them in this process.
11 Tomorrow you will hear discussion
12 about the Committee's research question
13 development. You will see PICO charts that
14 they have developed and some that are still
15 under development or exploratory examination.
16 So, following this meeting, the
17 Committee will finalize the research questions
18 using the PICO process, reprioritize them as
19 necessary.
20 The staff will upload into the
21 Nutrition Evidence Library system the topic
22 area outline and the templated tasks that are
198
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 associated with conducting the evidence review
2 for each question.
3 The tasks include a conclusion
4 statement, an evidence summary task,
5 development of overview tables, a portfolio of
6 evidence worksheets, as well as the associated
7 literature search and sort plan results.
8 It was mentioned earlier in the
9 public comment using the steps in the
10 evidence-based review process, and the steps
11 that are being used in the Nutrition Evidence
12 Library are those common to many of the
13 organizations working in evidence-based review
14 at this point in time, including AHRQ, the
15 Agency for Healthcare Research Quality;
16 Cochrane, and others.
17 The next step in the process will
18 be to continue developing and refining the
19 literature search and sort plans for each
20 question, and the staff will assist the
21 Committee in this process.
22 Staff will upload the searches and
199
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 sort plans to the system. We have a research
2 librarian who has been conducting, and will
3 continue to conduct and document, the
4 literature searches in detail, with assistance
5 from the NEL staff.
6 The next step the Committee will
7 follow is to sort the literature search
8 results to identify the body of evidence to
9 answer each question. Staff will assist them
10 with a primary sort, which is by title. So
11 when we get the search results, we can go
12 through and eliminate many studies because the
13 title indicates it is just not relevant.
14 The second sort is by abstract.
15 The staff will use the inclusion and exclusion
16 criteria that the Committee has identified.
17 There is a generic kind of overarching set of
18 inclusion and exclusion criteria looking at
19 timeframe, study population, other criteria.
20 Then there is a question-by-question
21 development or refinement of that inclusion
22 and exclusion criteria. In particular, new
200
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 questions may have a timeline that looks back
2 further than the 2004 cutoff date for the 2005
3 Guidelines process.
4 So the staff will assist with the
5 primary and secondary sorts of the literature.
6 The subcommittee members or the person
7 designated to handle that topic or question
8 will review the work and then approve it.
9 At that point, they are approving
10 the articles that will be included for the
11 evidence-based review process. The staff will
12 then take the articles and assign them to
13 evidence abstracters who will be developing an
14 evidence worksheet on each and every study.
15 Meanwhile, the Advisory Committee
16 will be reading all of the papers. The
17 evidence worksheets are merely to assist them
18 in their deliberation and discussion, and to
19 assist us in developing the overview tables,
20 pulling data fields to support their
21 discussion.
22 So all of those products will be
201
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 input into the system, and maybe I should have
2 mentioned at the outset that we do envision
3 that this work will be accessible to key
4 stakeholders, the American public, once the
5 Committee submits its report to the
6 Secretaries.
7 Okay. So after the literature
8 search is completed and the papers are
9 identified, the work begins to review the
10 complete body of evidence. As the evidence is
11 synthesized, the Committee will develop
12 evidence summaries and a conclusion statement
13 with rationale. Along with that goes an
14 evaluation of the strength of the evidence to
15 support the conclusion.
16 Then, finally, the Advisory
17 Committee will develop its recommendation and
18 supporting rationale for the Guidelines
19 themselves, and those will be based on the
20 entire body of evidence, the conclusion
21 statements, and all of the associated
22 systematic review.
202
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 CHAIR VAN HORN: Does anyone on
2 the Committee have any questions or, as we
3 have been going through the material, starting
4 with the reading, any issues that you would
5 like to raise to Joan in terms of the evidence
6 review? No?
7 DR. NELSON: I think that I don't
8 have any real concerns, except some of the
9 questions -- I mean we are starting to get
10 into areas where it is not quite so clean, you
11 know, with behavior, the environment,
12 patterns. I mean it is just not quite as
13 direct.
14 I think the conversations that I
15 have been having with the NEL personnel and
16 Trish and others, it has actually been a good
17 conversation because we are just going to have
18 to sort of work within the system to develop
19 some of these questions further, so that we
20 can actually start looking at some of these
21 questions in a little different lens. It is
22 just going to be trickier than -- you know,
203
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the exposure is not quite as simple.
2 Necessarily, some of the outcomes may not be
3 quite as simple.
4 I just think that we are going to
5 have to be tolerant to some ambiguities, and
6 we can interpret the science once we get
7 there.
8 MS. LYON: This is definitely an
9 iterative process. We can refine the
10 questions, the literature searches and sorts,
11 and the body of evidence to support the
12 question all along the way.
13 So the key is that we document
14 that, so that it is transparent to our
15 stakeholders, policymakers, to support the
16 Guidelines.
17 CHAIR VAN HORN: Any questions?
18 Larry?
19 DR. APPEL: Yes. Two comments.
20 One, I think we have to really
21 think about this grading of the evidence and
22 its implications. If we are starting from
204
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 scratch, the issue is the grading of the
2 evidence and the quality -- the level of the
3 recommendation. In general, we have to do
4 that in -- you know, do we want to go down
5 that path?
6 But the second is, if we decide to
7 go down that path, then it has implications
8 for what was done in the past. Remember, many
9 of our questions will have been considered
10 resolved. But if we have to then go back and
11 then rate that recommendation on some scale,
12 that is an extra set of steps that I don't
13 think many of us were planning on taking.
14 Some of us have thought that some questions
15 were resolved.
16 So I think that is actually an
17 important issue to decide.
18 CHAIR VAN HORN: Yes, I think that
19 the point right now is to look at where the
20 literature was at the time that the last set
21 of Guidelines were developed and where it has
22 gone since then. I think this group has been
205
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 concentrating its attention primarily on what
2 has evolved since the last set of Guidelines
3 were developed.
4 As was pointed out, we are
5 recognizing that it is not all equal. There
6 are certain areas that have had much attention
7 and others that haven't. So trying to apply
8 similar judgment across the entire scope of
9 the Guidelines becomes a bit of a waiting
10 game, waiting from the sense of putting
11 emphasis on one thing over another, when not
12 all evidence is equal in regard to some of
13 these things. But our job is to identify that
14 as well and recognize when there are
15 limitations.
16 Tom?
17 DR. PEARSON: You may have
18 mentioned it, but several of us were on
19 several different areas, et cetera.
20 Obviously, there's a variety of stages in
21 this. Is there going to be one easily22
accessible master document to tell where we
206
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 are with each of them, or do we have to go
2 into the NEL and find that out?
3 During the question development,
4 the librarian was on and she said, oh, we've
5 already done this, et cetera. I would like
6 something kind of upfront, so that I can
7 decide which one of the places to spend my
8 time in looking at the literature.
9 MS. LYON: Well, there are several
10 facets, to answer your question.
11 First, the structure in the
12 library portal will be in an outline format,
13 and you and your subcommittee sets what you
14 want the structure to be. So you can identify
15 your key topics, and the conclusion
16 statements/questions that are associated with
17 that.
18 Your key Dietary Guidelines
19 management team staff leads for the
20 subcommittees that you are on will be working
21 closely with us, the Nutrition Evidence
22 Library staff, giving progress reports as to
207
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 how far along we are in terms of the evidence
2 worksheets to support the body of evidence
3 that you are considering.
4 So we can give you updates on
5 that. You can enter the system at any time
6 and also see that, and your staff lead can
7 pull together that information for you.
8 Meanwhile, the full text
9 electronic .pdf's of all the papers are there
10 available for you to read while we are in that
11 development process.
12 Did that completely answer your
13 question or are there others?
14 DR. PEARSON: It was kind of a
15 vague question.
16 MS. LYON: Yes.
17 (Laughter.)
18 CHAIR VAN HORN: Other comments
19 from the Committee?
20 Yes, Rafael?
21 DR. PEREZ-ESCAMILLA: In terms of
22 the issues that cut across committees and the
208
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 prevention of overlap, you know, different
2 subcommittees are looking sometimes at
3 questions that are similar, and we don't
4 necessarily participate in all the
5 subcommittee meetings all the time.
6 Is the NEL staff going to help
7 mediate, bring it to our attention when
8 overlap happens?
9 MS. LYON: Yes, definitely, and
10 that probably is one of your next discussions,
11 the cross-cutting questions.
12 We, as the staff, have been
13 collaborating to identify some of those that
14 seem to overlap for instance, macronutrient
15 distribution is a question that touches many
16 of the subcommittees. So you, as a Committee,
17 need to decide how you want to handle that.
18 Should one subcommittee have responsibility
19 for that question with various health outcomes
20 or facets dealt with within the other
21 subcommittees?
22 The information is available to
209
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 you, and we can link it within the system and
2 pull those questions into the outline for
3 various questions that are relevant. So you
4 wouldn't have to necessarily jump around from
5 question to question to find that.
6 But I think the key would be to
7 decide who on the Committee has responsibility
8 for at least developing the -- you know,
9 conducting the systematic review for that
10 piece, you know, energy balance or
11 macronutrient distribution and weight,
12 macronutrient distribution, and there's some
13 discussion with fatty acids and carbohydrates,
14 and that sort of thing individually.
15 CHAIR VAN HORN: Right. I think
16 the cross-cutting issues topic is something we
17 are going to be addressing a little bit,
18 actually, during our working lunch, which is
19 now pretty much upon us.
20 So I think, with that, we will
21 adjourn for the time being and wish everyone
22 a healthy, nutritious lunch, and return back
210
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 at 1:00 p.m.
2 Thank you.
3 DR. POST: And if I could remind
4 you, too, to wear your IDs, so that if you are
5 interested in going to the USDA healthy
6 cafeteria, you will be able to enter the
7 cafeteria wearing your ID.
8 Thanks.
9 (Whereupon, the above-entitled
10 matter went off the record at 11:18 a.m. and
11 resumed at 1:14 p.m.)
12 CHAIR VAN HORN: Good afternoon.
13 Welcome back.
14 We are ready to launch into this
15 afternoon's session.
16 We have the benefit of hearing
17 from three individuals regarding data that are
18 relevant to the work of this Committee.
19 I would like to thank those three
20 presenters in advance for the time and effort
21 that went into analyzing these data.
22 First, I would like to introduce
211
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Ms. Alanna Moshfegh. Alanna is the Research
2 Leader for the Food Surveys Research Group at
3 the Beltsville Human Nutrition Research Center
4 and with the Agricultural Research Service at
5 USDA. In that role, Alanna directs the
6 federal government's National Dietary Survey,
7 What We Eat in America, that is collected as
8 part of NHANES.
9 With that, I think we will let you
10 go. Thank you.
11 MS. MOSHFEGH: Thank you, Linda.
12 I want to thank the Committee for
13 the opportunity to share data on usual intakes
14 of Americans.
15 For my remarks this afternoon, I
16 will present summary data on usual intakes
17 analyzed from the dietary interview component
18 of NHANES. I will assess dietary intakes in
19 relation to the Dietary Reference Intakes.
20 These are reference standards for optimal
21 health published by the Food and Nutrition
22 Board at the National Academy of Sciences.
212
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 The data I will present are from
2 What We Eat in America, the name for the
3 dietary interview component of NHANES.
4 Conducting What We Eat in America has been an
5 ongoing partnership between the Department of
6 Agriculture and the Department of Health and
7 Human Services since 2002.
8 Each year, two days of dietary
9 intake data are collected on about 5,000
10 individuals of all ages. The data are
11 collected using a 24-hour dietary recall
12 methodology that was developed by USDA that we
13 call the Automated Multiple Pass Method.
14 This is a picture of the NHANES
15 mobile exam center that travels to 15
16 different sites across the U.S. each year.
17 Inside is one of the two dietary interview
18 rooms that you can see on the slide, where the
19 Day One dietary interview is conducted. The
20 second interview is conducted about three to
21 ten days later by telephone.
22 I want to spend just a few minutes
213
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of my time describing the Automated Multiple
2 Pass Method, or what we will call the AMPM.
3 It is a computer-assisted, five-step dietary
4 interview, as you can see in this slide, that
5 includes multiple passes through the 24 hours
6 of the previous day. The AMPM navigates the
7 interviewer through the recall, poses
8 standardized questions, and provides response
9 options for all the different foods and
10 beverages reported by survey respondents in
11 NHANES.
12 The AMPM has been validated using
13 a biomarker for energy expenditure. This
14 slide shows the results of the AMPM validation
15 study that was conducted at the Beltsville
16 Human Nutrition Research Center, just outside
17 of Washington, D.C.
18 We measured energy expenditure,
19 that is shown in the green bars, using a
20 double-labeled water technique on a sample of
21 just over 500 adults and compared that to
22 energy intakes that we measured with the AMPM,
214
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 that is show on the blue bars. Overall, the
2 AMPM assessed mean energy intake within 11
3 percent of energy expenditure in this large
4 and diverse sample.
5 As with other studies, we found
6 greater underreporting with higher BMI
7 classifications; but noteworthy, though, was
8 that the underreporting was less than 3
9 percent for normal weight, those being having
10 a BMI of less than 25.
11 The data I am going to be
12 presenting are primarily from a report that is
13 available on our website, and I believe the
14 Committee has received a copy in advance, and
15 we have made some copies available for you
16 here this afternoon, in case you didn't carry
17 it with you in your suitcase.
18 It assesses the adequacy of diets
19 for 24 nutrients based on the Dietary
20 Reference Intake standards appropriate for
21 assessing intakes for population groups. We
22 either use the Estimated Average Requirement
215
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 or Adequate Intake, whichever is established
2 for the particular nutrient.
3 The data are based on dietary
4 intakes from nearly 9,000 individuals one year
5 of age and older from the 2001-2002 What We
6 Eat in America, NHANES data.
7 While there have been two
8 additional dietary data releases from What We
9 Eat in America, one dataset was released for
10 2003 and 2004, another for 2005-2006, this
11 type of analysis has not yet been completed on
12 those datasets.
13 Further, I would add that we don't
14 see major dietary changes in the population
15 across the two-year periods of data release.
16 So we believe that these results are a good
17 representation of nutrient adequacy from foods
18 today.
19 For this report, usual intake
20 distributions were computed using a
21 statistical modeling method that removes the
22 within-individual variation for the age/gender
216
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 groups that we studied.
2 So why is usual intake important?
3 Dietary recommendations are intended to be met
4 over time. So it is usual intake that is
5 needed to determine where the population is
6 compared to a particular standard.
7 National dietary data are based on
8 a limited number of observations, two days for
9 the What We Eat in America data. It is seldom
10 practical to collect long-term data in these
11 national surveys because of cost and
12 respondent burden. So this statistical
13 modeling gives us a reasonable alternative in
14 order to estimate usual intakes.
15 These are the nutrients that are
16 included in the report. They are the
17 nutrients for which an EAR or an AI, Estimated
18 Average Requirement or Adequate Intake, have
19 been established and for which food
20 composition data are available.
21 In addition, in response to the
22 request from the Co-Executive Secretaries, I
217
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 will also present data for two nutrients that
2 are not in the report, for choline and
3 cholesterol.
4 Choline was not measured in 2001-
5 2002. So the data I will present there will
6 be from the 2005-2006 What We Eat in America.
7 For cholesterol, I will present estimates from
8 four years, 2003 to 2006 data.
9 Now I know you can't see the data
10 on this slide, but I want to take a minute
11 just to orient you to what is on the tables,
12 and particularly distinguish between the
13 tables for the nutrients where there is an EAR
14 versus a table for the nutrients where there
15 is an AI.
16 This table shows usual intakes for
17 iron compared to the estimated average
18 requirements for iron. The data are reported
19 by 17 age/gender groups and present mean
20 intakes and percentile distributions of usual
21 intakes of iron.
22 The estimated average requirement
218
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 value for each of the age/gender groups we
2 studied is provided, and the percent of the
3 group that has usual intakes less than the
4 EAR.
5 Now this next table is very
6 similar, but for those nutrients that have an
7 adequate intake, or an AI, in this example for
8 calcium. For those nutrients with an AI, the
9 comparison is based on the percentage that
10 have usual intakes greater than their AI.
11 Now let's get to some of the
12 selected results. This graph summarizes
13 results on an adequacy of intake for nutrients
14 having an EAR. You can see very small
15 percentages of individuals had intakes below
16 their EAR for carbohydrates, selenium, niacin,
17 and riboflavin.
18 For this next set of nutrients as
19 well, intakes for a low proportion are below
20 their EAR. Of course, it is important to
21 remember that this graph is looking at all
22 individuals, but let's look at an example
219
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 across the age/gender groups.
2 For this, let's look at
3 phosphorus. We see that close to half of
4 adolescents and teenaged females have intakes
5 that are below their EAR, even though for all
6 individuals it is only 5 percent when we look
7 across the population.
8 The nutrients of concern, when
9 compared to the EAR, are highlighted on this
10 slide in blue. Most individuals had intakes
11 that were below their EAR for vitamin E, and
12 a third to a half of the population had
13 intakes below their EAR for vitamin C and A
14 and magnesium.
15 These next slides show the
16 percentage of individuals looking across the
17 age/gender groups for those four nutrients of
18 concern.
19 The first one you can see here is
20 for vitamin E. Regardless of age, almost all
21 individuals had intakes that were below their
22 EAR.
220
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 For magnesium, the percentages of
2 individuals with intakes below their EAR were
3 greatest for teens and the elderly, and the
4 least for young children.
5 For vitamin A, the percentages
6 with intakes below their EAR were much less
7 for young children and adolescent boys
8 compared to teens and adults. The same was
9 true for vitamin C.
10 Now let's turn to selected
11 nutrients with Adequate Intakes. Adequate
12 Intakes, as defined by the DRIs are not to be
13 used to estimate the prevalence of inadequacy
14 in a population. So we evaluate these values
15 based on those with intakes at or above their
16 AI.
17 For calcium, the nutrient at the
18 top of the slide, just under a third of
19 individuals had intakes that were at or above
20 their AI. Females were even less likely than
21 males to have intakes at or above their AI.
22 For potassium and dietary fiber,
221
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 less than 5 percent of the population had
2 intakes above their AI.
3 For sodium, almost all individuals
4 had intakes at or above their AI, which, of
5 course, is not what we want to see.
6 For choline, which is based now on
7 the 2005-2006 data, about 10 percent of all
8 individuals had intakes at or above their AI.
9 As with calcium, females were even less likely
10 than males to have intakes at or above their
11 AI.
12 Now for the last data slide, which
13 is on cholesterol, the analysis is based on
14 the 2003-2006 data on nearly 18,000
15 individuals. Overall, 35 percent of
16 individuals had intakes above 300 milligrams.
17 A greater percentage of adult males than
18 females had intakes that exceeded 300
19 milligrams.
20 The data I presented can be found
21 in a report that is available on the Food
22 Surveys Research Group website. For those of
222
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 you in the audience, that is listed here in
2 this slide. The website also has numerous
3 other summarized results from What We Eat in
4 America of NHANES.
5 Thank you for your attention.
6 (Applause.)
7 CHAIR VAN HORN: Thank you,
8 Alanna.
9 Are there just a few quick
10 questions that the Committee would like to
11 raise while we have Alanna with us?
12 Yes, Tom.
13 DR. PEARSON: This is obviously an
14 ongoing survey. One of the things we are
15 going to be interested in looking at is
16 changes over time, up to the point where you
17 have the last analysis.
18 Is there a way to understand any
19 changes in the nutritional assessment
20 methodologies over this time, so we can be
21 sure there aren't any methodologic pitfalls in
22 terms of the nutritional assessments?
223
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MS. MOSHFEGH: The new method, the
2 AMPM that I spent a little time talking about,
3 was introduced and began in 2002 of NHANES.
4 We believe it is an improved method, and I
5 shared some of the results of the validation
6 study with you.
7 We see changes in the caloric
8 intake that is reported across Americans. We
9 see that that has gone up over time, but we
10 haven't, in the past recent years, done any
11 research to look at the difference that one
12 would see as you improve methodology, which we
13 always try to do. There just haven't been
14 resources for doing that. We would like to do
15 that, but we haven't had the resources to be
16 able to do it. We did do such a study a
17 number of years ago, back in, I believe it was
18 in the `80s that it was done.
19 I think the increase that we are
20 seeing in calories is probably from a number
21 of reasons. We are probably eating more food
22 than we had in the past. We also believe the
224
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 methodology is doing a better job of capturing
2 intakes.
3 So I probably didn't give you the
4 answer you wanted to necessarily hear.
5 DR. PEARSON: Well, just that if
6 we were to look at a change, we would need to
7 put over the proviso that this could have some
8 methodologic and not reality basis.
9 MS. MOSHFEGH: Yes, it could have
10 some.
11 I hope you will take comfort in
12 the results of the validation study, and that
13 we feel we have a method that is doing an
14 excellent job in terms of capturing intakes.
15 Certainly, I think anecdotally better than
16 what has been done before. So we are very
17 encouraged that we have that to be able to use
18 now for collecting recalls.
19 DR. SLAVIN: Alanna, can you talk
20 a little bit about choline? Aren't most of
21 the sources animal sources? I mean, where
22 else do you get that from? Because that
225
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 seemed to be really a problem.
2 MS. MOSHFEGH: Yes, the data was
3 surprising to me, and I haven't spent that
4 much time looking at the sources of where it
5 came from. The choline was a special run that
6 we just did comparing it to the AI, and we
7 haven't looked exactly at the dietary sources.
8 One of my staff people has looked
9 at and presented a poster on it, and we would
10 be happy to share those results with you.
11 That gives a little more information of that
12 type.
13 DR. RIMM: It probably wasn't your
14 charge today to present data on ethanol, but
15 I wanted to ask two questions. One is, if you
16 could give us a little background on ethanol
17 in 2001 and 2002?
18 The second was what you thought
19 the quality of the measure was, given your
20 validation study on other nutrients, that you
21 could speak to how well you thought your new
22 method for assessing diet did at assessing
226
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 ethanol intake.
2 MS. MOSHFEGH: Well, the
3 validation study just looked at energy. I
4 can't answer your first question. I haven't
5 really looked at that. I can go back and give
6 some summary results to you all, looking at
7 that for you.
8 DR. RIMM: So wait. You answered
9 the question that the validation study only
10 looked at energy, presumably.
11 MS. MOSHFEGH: Right.
12 DR. RIMM: But, obviously, the
13 people were self-reporting alcohol who were in
14 that study. Were there differences? You
15 stratified by BMI, but there is also the
16 potential that people who report alcohol
17 underreport, and some of the excess energy or
18 lost energy could be potential underreporting
19 of alcohol at the high end.
20 MS. MOSHFEGH: Yes. We plan to
21 look at the food intakes by the reporting
22 categories, by the underreporting categories,
227
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 and we have not yet finished that analysis.
2 DR. SLAVIN: And what was the
3 reason for not including D?
4 MS. MOSHFEGH: Vitamin D is not
5 yet in the survey nutrient database for
6 analysis. It will be in the 2007-2008 data
7 release, which is due to come out in the year
8 2010. So we are busy working on that right
9 now.
10 DR. APPEL: I wanted to follow up
11 on the validation issue. Not all nutrients
12 are measured with equal accuracy and equal
13 precision. I know more about sodium than
14 others. I know that, no matter what you say,
15 I am still concerned that it is not right.
16 Could you give us a sense of which
17 ones are the problems with accuracy? Which
18 ones are the problems with precision? Which
19 ones are the problems with both? So we can
20 put greater/lesser belief in deficiencies.
21 Because I think when you see numbers like 90
22 percent missing an EAR, you say, well, is that
228
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 a problem or is that a measurement issue?
2 MS. MOSHFEGH: I would love to
3 have the answer to that question. We haven't
4 done any further finite analysis to look at
5 that. It would start first with the foods
6 that are reported across the categories of
7 underreporting, accurate reporting,
8 overreporting. See if we see any differences
9 there. We have not done that analysis.
10 DR. APPEL: Maybe if you can't do
11 a quantitative, what is your gut sense? I
12 mean there are certain nutrients you just
13 don't believe and other ones you say, yes, we
14 got it. So if you can't do it on a
15 quantitative level, what are your instincts
16 about the ones we should trust and not trust?
17 MS. MOSHFEGH: I usually don't
18 think of it from the nutrient standpoint. I
19 think of it from the food reporting
20 standpoint, and the ability of respondents to
21 accurately report, accurately remember all the
22 foods that they consumed, and accurately
229
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 estimate the portion size.
2 For those of us that work in
3 nutrition, it is probably not quite as
4 daunting a task, but for a typical respondent
5 I think it is a very daunting task.
6 While there wasn't a lot of time
7 to talk about the unique features of the AMPM,
8 in developing it we focused very carefully to
9 where we could, if we had information about
10 foods, we wouldn't have to ask the respondent
11 to answer questions to get to that
12 description.
13 A lot of what Americans consume
14 are from fast food establishments or pre15
portioned foods. So we take a great deal of
16 time in developing our database to know what
17 those portion sizes are.
18 So if someone reported an item
19 that is pre-portioned in the marketplace, and
20 they reported it by the brand name, we
21 generally don't have to ask, well, how much
22 was it, how large was that portion? In our
230
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 database, we know that already. We just say,
2 did you eat the whole amount?
3 So in a long-about way of
4 answering it, I think we are constantly
5 striving to try to help that respondent,
6 first, remember all of their foods, and then
7 help them on the portion size estimation.
8 We use a large number of food
9 models, where the foods aren't already pre10
portioned that they have consumed, to help us
11 in that estimation, and we have done research
12 to test those models that we know they are
13 easy for people to use. We have a booklet
14 that goes home with people when we call them
15 the second day by telephone for collecting
16 that information.
17 So it is a constant struggle to be
18 sure we are always working on improving that
19 accuracy and improving helping the respondent
20 give it to us.
21 In terms of the nutrients, I would
22 add that the source of our nutrient values is
231
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 from the USDA National Nutrient Databank for
2 Standard Reference. Over the past several
3 years, there has been a monumental effort in
4 taking national samples from across the
5 country and having those foods analyzed in
6 laboratories and taking that current data and
7 incorporating it into what we affectionately
8 call SR.
9 So I am very comfortable on the
10 nutrient values that are in our database. I
11 think the job that is done there is
12 exceptional.
13 So to answer the nutrients, I
14 think what the nutrients are in the database
15 is superb. It is just what the respondent can
16 tell us in terms of remembering their foods
17 and the portion size.
18 Again, I will go back to our
19 validation study, where we were really
20 astounded with the results, particularly for
21 normal weight being within 3 percent of
22 accuracy for energy. But, of course, with
232
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 energy, the nutrients travel with those
2 calories, of course.
3 So that is my gut answer.
4 DR. NICKOLS-RICHARDSON: So,
5 related to the question of the energy itself,
6 you may have said this and I missed it, these
7 are not reported per thousand calories? So it
8 is not adjusted for energy intake?
9 So could some of this be a
10 reflection of the variability of total energy
11 intake? Is there some discrepancy in the
12 total nutrient -- and those that are meeting
13 or not meeting EAR/AI based on just sheer
14 energy of the diet?
15 Did I ask that correctly? Does it
16 make sense?
17 MS. MOSHFEGH: Yes, there could
18 be. Certainly, from the validation study, we
19 saw that underreporting was more likely for
20 overweight, and there is certainly a greater
21 proportion of the population who are
22 overweight.
233
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 So, yes, there could be
2 underreporting in terms of energy, yes. But
3 the EARs for various nutrients are based on
4 the particular nutrient, but, of course, the
5 nutrient comes with the calories with the
6 foods that get reported.
7 CHAIR VAN HORN: Thank you,
8 Alanna.
9 I think we need to move along, but
10 that was very helpful. To me, the take-home
11 message here is just the stunning number of
12 Americans who still are well below the
13 recommended intakes of calcium, potassium,
14 fiber, and choline, and the vast majority that
15 eat well beyond the recommended amounts of
16 sodium and dietary cholesterol. I mean that
17 says it very plainly right there.
18 Okay. Our next presentation is
19 Dr. Susan Krebs-Smith, the Chief of the Risk
20 Factor Monitoring and Methods Branch in the
21 Division of Cancer Control and Population
22 Sciences at the National Cancer Institute.
234
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 In that role, she oversees a
2 program of research on the surveillance of
3 risk factors related to cancer, including
4 diet, physical activity, and weight status,
5 methodologic issues to improve the assessment
6 of such factors, and issues related to
7 guidance and food policy.
8 Her valuable contributions in the
9 area of dietary assessment methodology have
10 focused on developing methods to assess
11 dietary patterns and the usual intake of
12 foods.
13 Thank you.
14 Sue?
15 DR. KREBS-SMITH: Well, thank you.
16 Good afternoon, and it is really a
17 pleasure to be speaking with you today. I am
18 quite proud to be presenting this latest, most
19 recent advance in the assessment of dietary
20 intakes on distributions of usual food intake
21 and ratios of usual energy intake.
22 Much of what I am going to be
235
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 talking about today will be in relation to the
2 recommendations that are set forth in
3 MyPyramid in the last edition of the Dietary
4 Guidelines. As the 2005 Dietary Guidelines
5 pointed out, these recommendations are very
6 similar to those in the DASH diet, and as
7 recent papers published by our office have
8 shown, they are also consistent with food
9 guides for the general public and various
10 recommendations to control obesity and
11 diabetes, heart disease and stroke,
12 hypertension, cancer, and osteoporosis.
13 MyPyramid does not provide a
14 single set of recommendations, but, rather,
15 these food group recommendations depend on the
16 appropriate level of energy, and the energy
17 levels, in turn, depend on the sex, age, and
18 activity levels of the individual.
19 You are going to be hearing more
20 about this in the next presentation from Trish
21 Britten, but I think there are a few of these
22 things about MyPyramid that need to be
236
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 understood in order to appreciate the data
2 that I will be showing you.
3 Another feature to understand is
4 what I might call the Rubik's cube nature of
5 each pattern, that the recommendations for
6 each group are all carefully calibrated to add
7 up to the respective calorie level. Within a
8 given energy level then, eating too much in
9 one area necessarily, by definition, restricts
10 intake in another area. This is an important
11 consideration. There are tradeoffs within.
12 However, fortunately, this
13 delicate balance of all these food groups
14 within a particular calorie level does not
15 need to be met every day. Rather, usual
16 intake is the key.
17 Usual intake, as Alanna had
18 mentioned, is the long-run, average daily
19 intake of a nutrient or food. Dietary
20 recommendations are generally intended to be
21 met over time. That would be something that
22 you all might want to consider, but that is
237
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the way we have always assumed it. Diet
2 hypotheses also are based on dietary intakes
3 over the long-term, chronic intake over time.
4 For that reason, it is the usual
5 intake that is of often interest to
6 policymakers when they are looking at the
7 proportion of the population at or below a
8 certain level of intake, and researchers in
9 examining the relationship between diet and
10 health.
11 Usual intake assessment based on
12 24-hour recalls has been a long-awaited
13 measure. National dietary surveys have
14 traditionally used 24-hour recalls for good
15 reason. The 24-hour recalls capture the
16 needed detail, and because they are open17
ended, they provide a cross-cultural
18 equivalency that might not be available with
19 something like a food frequency questionnaire.
20 However, individuals do not eat
21 the same thing day to day, week to week,
22 season to season. Therefore, if used as is,
238
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 unadjusted, 24-hour recalls provide only what
2 we call a snapshot in time or, in other words,
3 24-hour recalls measure dietary intake with
4 some error.
5 Now Alanna talked about one type
6 of error, under-reporting. I'm going to talk
7 about, describe this other type of error a
8 little bit now.
9 This measurement error can affect
10 the estimates of the distribution and the
11 regression analyses that would be done with
12 24-hour recall data.
13 These curves show the
14 distributions of single-day intakes, the
15 average of two-day mean intakes, and usual
16 intakes. Note that, as there are more data
17 added for each individual, the curve gets
18 taller and narrower. That is because the
19 distributions of usual intakes contain fewer
20 individuals consuming extremely small or large
21 amounts. When you only have a single day of
22 intake, you might have more people that happen
239
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 to be feasting or fasting on that day.
2 Also note that the mean for each
3 of these curves is the same. So, therefore,
4 the mean of the single 24-hour recalls could
5 be used as an estimate of the mean of usual
6 intake. But, from this, you can also see
7 that, with unadjusted 24-hour recalls, that
8 leads to an overestimation of the tail
9 probabilities or the proportion of the
10 population with very low or very high intakes.
11 So this is the problem that we were addressing
12 with our work.
13 This is also a problem in studying
14 the effect of diet on some health outcome. If
15 a single 24-hour recall left unadjusted were
16 used in a regression analyses, these analyses
17 would be biased, suggesting a flatter slope to
18 the relationship than was true, and the excess
19 variation around the fitted line would lead to
20 a loss of statistical power.
21 In 2001, after the release of the
22 2000 Dietary Guidelines, we published this
240
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 special issue of The Journal of Nutrition. It
2 came about as a result of the previous
3 committees having had relatively little
4 information at their fingertips about the
5 diets of Americans and how they related to
6 each of the Dietary Guidelines.
7 So this supplement was designed to
8 have a paper on each one of the then current
9 Guidelines, which reviewed the methods
10 available to track its progress, provided
11 benchmark data, and identified gaps and
12 limitations of the data for addressing
13 critical questions.
14 Where available, data systems at
15 the individual, community, and food supply
16 levels were considered, and there is much that
17 is still relevant about it.
18 In fact, I would mention here
19 that, in looking at the food supply data,
20 using those as one way of looking at these
21 questions, the food supply has had a
22 relatively stable methodology over time. So,
241
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 for my purposes, I like to look at the food
2 supply data to examine trends, even though I
3 feel like, when I am looking at the individual
4 survey data, I am getting more details about
5 what individuals eat. So I think we have to
6 draw on all the sources of data that we have.
7 In any case, a recurring theme
8 among the gaps and limitations of all the
9 papers in this supplement was the inability to
10 assess distributions of usual dietary intake.
11 We were limited by our then current
12 statistical methodology of examining only mean
13 intakes. So we could say something about the
14 average person, but not about the prevalence
15 of intakes above or below a recommendation.
16 But now we do have the capability
17 to predict usual dietary intake with 24-hour
18 recalls, and we can estimate usual intakes of
19 both foods and nutrients for the population
20 for the purposes of surveillance and for an
21 individual for epidemiologic research.
22 This work has been carried out by
242
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 a team of investigators, shown here, that
2 really is a transdisciplinary team across
3 numerous organizations.
4 Information related to these
5 methods are available on the website that is
6 noted here. This provides details of NCI's
7 method for estimating usual dietary intakes.
8 It provides tables of intake on foods and on
9 the intakes as ratios of energy intake. It
10 provides some SAS macros for researchers to
11 use if they want to duplicate these or do
12 other analyses, and documentation and
13 references on how these methods can be
14 employed.
15 Today I am going to be showing you
16 some data from the food intakes tables and the
17 intakes as ratios of energy intake.
18 Regarding the methods that were
19 used for these tables, we used the 2001 to
20 2004 National Health and Nutrition Examination
21 Survey, the same survey that Alanna was just
22 talking about. We had an "N" of about 18,000
243
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 people, aged one year and older. We used two
2 24-hour recalls, and we employed the MyPyramid
3 Equivalents database.
4 This database is an invaluable
5 resource, which has enhanced our capacity to
6 measure dietary intakes compared to
7 recommendations. You are going to learn a
8 little bit more, as I said, from Trish about
9 how the Pyramid works and how food groups are
10 counted, but without this database we wouldn't
11 really be able to measure food intakes
12 compared to those recommendations in the
13 Pyramid.
14 It is the end result of
15 disaggregating every food mentioned in the
16 survey, thousands of them, into their
17 component ingredients, and accounting for all
18 those ingredients within their respective food
19 groups.
20 So when we look at tomato intake,
21 yes, it includes those eaten as part of
22 ketchup as well as those eaten fresh, but the
244
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 added sugars in the ketchup are also
2 appropriately assigned to the added sugars
3 category.
4 This method that we have developed
5 at NCI was used for estimating usual dietary
6 intakes.
7 Next slide.
8 This full set of tables that is
9 shown here, we have posted to the website for
10 nearly all the food groups in the MyPyramid
11 Equivalents database, as well as other
12 combinations. This full set of tables has
13 been provided to you and is in your notebook
14 under a tab called Appendix.
15 We are going to show some examples
16 today. That is just there for your use later.
17 Today we are going to look at these tables,
18 this selected set of tables that is under a
19 tab called Food Tables. It comes right after
20 my presentation slides in your notebook. They
21 were selected to show how data could be used
22 to compare intakes to recommendations.
245
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Also on the website is this
2 complete set of tables that relates to the
3 ratio of energy or the percentage of energy
4 from all these macronutrients. This complete
5 set of tables is also in your Appendix, also
6 on the website. The public can go to look at
7 it. We have selected these two tables to talk
8 with you about today, and those are under a
9 tab called Macronutrient Tables. There is one
10 other tab, SoFAAS table, which I will talk
11 about as well in turn.
12 So just a couple more points
13 before showing you the data, just to
14 reiterate, again, MyPyramid has no single set
15 of recommendations, but, rather, food group
16 recommendations depend on the appropriate
17 level of energy, and the range of calorie
18 levels for sex/age group determines the
19 appropriate energy level along with activity
20 level.
21 The lowest level of energy
22 corresponds to the sedentary level of
246
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 activity, and the highest level of energy at
2 each sex/age group corresponds to a very
3 active lifestyle. That is an important thing
4 to keep in mind.
5 So there's not really a range for
6 each person. In fact, there is a discreet
7 amount of calories that would be appropriate
8 for each person, depending on what their sex,
9 age, and activity level is.
10 For the slides that follow, we
11 examine the distribution of intakes relative
12 to the most conservative cut point. So when
13 we are examining the possibility of
14 insufficient intakes, we used the sedentary
15 level of energy, which meant we compared
16 intakes to the minimum recommendation for the
17 sex/age group, and when examining the
18 possibility of excessive intakes, we used the
19 active level of energy, which meant we
20 compared intakes to the maximum
21 recommendation.
22 So, to orient you to the slides,
247
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 we had these sex/age groups, similar to the
2 ones Alanna had, that are used by the DRI
3 tables. The tables include means and
4 percentiles. The percentiles are what is our
5 new capability. They also include standard
6 errors of the mean. Standard errors of the
7 percentiles are not available in the slides in
8 your packet, but they are available on the
9 website, if you want to take a look.
10 In your packet, under the selected
11 tables on foods and energy sources and SoFAAS,
12 we have highlighted in red the numbers that we
13 want to draw your attention to today.
14 So, with that, we will begin to
15 start to look at those tables. I suggest, if
16 you want to look at your tab under Foods
17 Tables, you can look along while I make some
18 points about each one of the tables.
19 Total fruit is measured in terms
20 of cup equivalents per day, and the
21 recommendations range from one to two and a
22 half cups. The highlighted values in the
248
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 table that you see represent those which are
2 less than the minimum recommendation for the
3 sex/age group.
4 Among all sex/age groups intakes
5 up through the 25th percentile or below the
6 recommendations, and for most sex/age groups
7 intakes up through the 75th percentile are
8 below that level. This picture is better for
9 children because they tend to drink more juice
10 than adults do.
11 Looking at the vegetable
12 subgroups, the vegetable subgroups include
13 dark green, orange, legumes, starchy, and
14 other vegetables. They are measured in terms
15 of cup equivalents per day, and the
16 recommendations are in terms of cups per week.
17 Your packet of selected tables
18 includes a table for each one of these, except
19 starchy vegetables. But just flipping through
20 these tables, looking at the red, you can get
21 the idea that most people are below the
22 recommendation for these groups for dark green
249
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 vegetables intakes through the 95th percentile
2 or below the recommended amount among nearly
3 all sex/age groups.
4 Looking at the orange vegetables,
5 among all sex/age groups, except one- to
6 three-year-old children, intakes up through
7 the 95th percentile or below the
8 recommendations, again, the minimum
9 recommendations.
10 The picture is ever so slightly
11 better for young children because their energy
12 levels and, hence, their recommended intakes
13 of these foods is lower. Also, orange
14 vegetables like carrots and sweet potatoes are
15 often among the first vegetables introduced to
16 children.
17 Legumes and other vegetables are
18 also underconsumed by nearly everyone in all
19 sex/age groups.
20 Looking at total vegetables, these
21 also are measured in terms of cup equivalents
22 per day. The recommendations range from one
250
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 to four cups per day. Total vegetables
2 include all cooked dried beans and peas, and
3 this group also includes starchy vegetables,
4 which are dominated by potatoes. Potatoes and
5 other starchy vegetables are a great source of
6 much needed potassium, but there is no
7 shortage of intake with them.
8 For adolescents and young adults,
9 intakes through the 95th percentile fall short
10 of the minimum recommendations for total
11 vegetable intake. For 14 to 18 year olds,
12 this is true for intakes through the 95th
13 percentile. This is really interesting,
14 considering that this measure includes
15 vegetables from all sources, even those eaten
16 as French fries and potato chips.
17 Whole grains: whole grains are
18 measured in terms of ounce equivalents per
19 day. A slice of bread, a cup of ready-to-eat
20 cereal, and so on, count as an ounce
21 equivalent. Recommendations range from 1.5 to
22 five ounces per day. Among all sex/age groups
251
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 up through the 95th percentile, intakes are
2 below the minimum recommendations.
3 The next two tables relate to
4 total grains. The first one is comparing the
5 total grain intakes to the minimum
6 recommendation. The second one is comparing
7 them to the maximum recommendation, in an
8 attempt to see what intakes might be
9 excessive.
10 But for both of these tables,
11 total grains are measured in terms of ounce
12 equivalents per day. Recommendations range
13 from three to 10 ounces. While the
14 recommendation is that half of the intake be
15 whole grain, most of this intake is non-whole
16 grain.
17 Among most sex/age groups, intakes
18 are sufficient for most of the population when
19 you look at the first table for total grains.
20 But now when you move to the next table in the
21 packet, you notice the switch in the direction
22 of the highlights. The bolded values are at
252
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the other end of the distribution. This is
2 comparing those values to the maximum
3 recommendation.
4 We see that, beyond the 90th
5 percentile for all sex/age groups and beyond
6 the 75th percentile, in some cases intakes are
7 greater than the maximum recommendations.
8 These, I will remind you again, are
9 recommendations for active persons. Yet,
10 according to the 2003 to 2006 NHANES, only
11 about 3.5 percent of the population met the
12 then current Physical Activity Guidelines for
13 Activity.
14 Now there is a provision within
15 MyPyramid for additional servings of food
16 groups beyond recommendations, but these count
17 toward the discretionary calorie allowance,
18 which, as we said, is very limited.
19 Fish Guidelines. Okay, the
20 previous examples were tables with MyPyramid
21 food groups, of which the population, on
22 average, needs to either consume more or less
253
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of, but there are some foods for which there
2 is a concern about both insufficient and
3 excessive intakes, especially for vulnerable
4 groups. Fish is one such example of this for
5 women who might become pregnant, women who are
6 pregnant, nursing mothers, and young children.
7 There was a statement in the 2005
8 Dietary Guidelines Advisory Committee report
9 that the consumption of two servings, or about
10 eight ounces per week, of fish high in EPA and
11 DHA is associated with reduced risk of both
12 sudden death and CHD death in adults. In the
13 final Dietary Guidelines, this was qualified
14 to be in regard to those with a previous
15 cardiac event. But, in any case, there is
16 some standard that could be looked at with
17 eight ounces on the tables.
18 Then, from another source, FDA and
19 EPA had a report, have their advisory on their
20 website, that women and young children should
21 include fish in their diets and can safely
22 consume up to 12 ounces per week of cooked
254
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 fish, suggesting that higher intakes may have
2 some element of risk associated with them.
3 So, clearly, usual intake is the
4 measure of interest here because it is
5 cumulative exposure that they are interested
6 in.
7 When I served on a National
8 Academy of Sciences Committee on Seafood
9 Choices, we would have been very happy to have
10 had these intake data on the distributions of
11 fish that you can see in that next table in
12 your packet.
13 Total fish and other seafood are
14 measured in terms of ounce equivalents per
15 day. Eight ounces per week, just as a
16 reference point, is 1.41 ounces per day.
17 Twelve ounces per week translates to 1.71
18 ounces per day.
19 Up through the 75th percentile,
20 adult intakes are below eight ounces per week,
21 if you thought that was the standard to use.
22 But a key point to point out here, I thought
255
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 it was of interest, that none of the women or
2 young children showed intakes greater than 12
3 ounces per week at the 95th percentile. This
4 is all fish and seafood. This isn't just high
5 mercury sources. So I thought that might be
6 of interest, and it suggests that there might
7 be greater concern about whether these groups
8 are getting sufficient benefits from fish than
9 whether they are consuming too much fish.
10 There are two tables for meat and
11 meat alternates as well. They are measured in
12 terms of lean ounce equivalents per day. This
13 represents the lean portion of all meat, fish,
14 poultry, eggs, soy products, nuts, and seeds.
15 The recommendations range from two to seven
16 ounces.
17 A key point here, in looking at
18 this table, the first table, when we are
19 looking compared to minimum recommendations,
20 is that individuals may be getting more meat,
21 but not really a sufficient portion of the
22 lean. Because among all sex/age groups,
256
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 intakes up through the 25th percentile are
2 below recommendations, and this is also the
3 case for many groups up through the 50th, and
4 for adolescent girls, up through the 75th.
5 Going to the next page on total
6 meat and meat alternates, where they are
7 compared to the maximum recommendation,
8 roughly 25 percent of adult men and 10 percent
9 of adult women have intakes in excess of the
10 recommendations. Again, it is okay to have
11 more servings from each of the food groups, as
12 long as it fits within the discretionary
13 calorie allowance. Again, Trish will talk
14 with you more about this. But much of this
15 lean meat as consumed comes along with a
16 substantial amount of saturated fat.
17 Total milk, yogurt, and cheese
18 measured in terms of cup equivalents per day,
19 the recommendations ranged from two to three
20 cups, and intakes are below recommendations
21 through the 25th percentile for children, the
22 50th for adolescent males, 75th and above for
257
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 adult males, and 90th percentile for females
2 in most age categories.
3 Oils, measured in terms of
4 teaspoons per day, recommendations range from
5 three to 11 teaspoons a day. Among most
6 sex/age groups, intakes up through the 75th
7 percentile are below the recommendations.
8 In the interest of time, I am
9 going to go kind of quickly over these next
10 couple of categories, solid fats and added
11 sugars. I just want to say that the
12 highlighted values are those which appear to
13 be excessive. They are compared to what we
14 might think of as upper level standards, and
15 that much of the solid fat, from other work
16 that we have done, we know that this largely
17 comes from meats and milks and grain-based
18 desserts. Much of the added sugars comes from
19 soda, flavored drinks, and grain-based
20 desserts.
21 Let me take your attention to
22 alcoholic beverages. These are measured in
258
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 terms of drinks per day. There was a question
2 about ethanol before. We don't have ethanol
3 per se, but we have this for alcoholic
4 beverages, measured in terms of drinks.
5 Recommendations are up to one
6 drink per day for women and two drinks per day
7 for men. Unlike other components of the diet
8 for which we are more confident that intake
9 over time is what really matters, acute
10 exposure of alcohol is relevant here. One
11 drink on each of seven days is really
12 different than no drinks on six days and seven
13 drinks on one day. So appreciate we are
14 looking at usual intake, and while it meant
15 something different for the other food groups,
16 you can interpret that here.
17 But that being said, the intakes
18 seemed to be exceeding the recommendations at
19 the high-end tail of the distribution for
20 adults.
21 Again, to somebody's question
22 about ethanol and whether or not that was
259
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 being captured or underreported, I was
2 actually pleasantly surprised to see that
3 there were reports at all, that excessive
4 intakes even showed up on the distribution.
5 I thought they looked anyway reasonable, but
6 we don't have anything to compare it to in
7 terms of validation.
8 This next slide shows energy from
9 solid fats, alcohol, and added sugars. It is
10 in a category of its own. In the development
11 of the Healthy Eating Index, a colleague,
12 Patricia Guenther, came up with this nice
13 acronym, SoFAAS, to represent the energy from
14 solid fats, alcohol, and added sugars.
15 It is measured in terms of
16 calories. It represents a large portion of
17 the discretionary calories, but not those
18 discretionary calories that come from extra
19 servings of the food groups. So, in other
20 words, this isn't all the discretionary
21 calories, but it is most of it.
22 Recommendations for discretionary
260
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 calories range from 171 to 512 calories per
2 day. Now look at the calorie levels on those
3 tables, and it is really impressive. I think
4 you see that this is where a lot of the excess
5 calories are coming from.
6 Among all sex/age groups, 75
7 percent or more of the population had intakes
8 of these SoFAAS which exceeded the maximum
9 recommendation for discretionary calories, and
10 it didn't count the extra servings from
11 various food groups.
12 Total fat, going to the next
13 section of the notebook, total fat is measured
14 in terms of percentage of calories. The
15 recommendation is between 20 and 35 percent of
16 calories. At the fifth percentile, none of
17 the sex/age groups had intakes below 20
18 percent of calories from total fat, but at the
19 75th percentile and above, all sex/age groups
20 had intakes above 35 percent of calories from
21 total fat.
22 Saturated fatty acids are measured
261
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 in terms of percentage of calories also.
2 Their recommendation is less than 10 percent
3 of calories. The current recommendation is
4 less than 10 percent of calories.
5 Among all sex/age groups, intakes
6 at the 50th percentile and beyond were above
7 the recommendation, and for some groups,
8 values as low as the 25th percentile were also
9 above the recommendation.
10 So, to summarize, these data
11 really kind of reinforce the same impression
12 that we had with earlier data when we were
13 able to only look at means and previous
14 examinations of the food supply. But now we
15 have the ability to examine the proportion of
16 the population with various levels of intake
17 to document the extent of what might be
18 dietary problems.
19 I hope that these and other tables
20 that are on the web will be of use to you in
21 your deliberations. We can say, just to sort
22 of summarize across what we have seen
262
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 today, that really a large swath of Americans
2 have low intakes of fruit; vegetables,
3 especially non-starchy; whole grains; milk,
4 yogurt, and cheese; and oils. They have
5 modest intakes of fish. They have sufficient,
6 and in some cases excessive, intakes of total
7 grains, meats and meat alternates. They tend
8 to have excessive intakes of calories from
9 these SoFAAS and from saturated fat.
10 What none of these tables showed,
11 but what could be examined, are the
12 percentages above or below particular cutoffs.
13 So if there are particular cutoffs that you
14 are interested in, it may be possible for us
15 to prepare and provide that information on the
16 web in time for your consideration. So please
17 let us know.
18 And that's it.
19 (Applause.)
20 CHAIR VAN HORN: Questions for
21 Sue?
22 DR. PEREZ-ESCAMILLA: I have a
263
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 question here.
2 Thank you for a wonderful
3 presentation. I think this is one of the most
4 useful ways I have seen the dietary intakes of
5 Americans being presented.
6 DR. KREBS-SMITH: Oh, thank you.
7 DR. PEREZ-ESCAMILLA: I think it
8 is very clear that people under-report their
9 energy intakes as a function of their body
10 mass index category. But with regard to the
11 macronutrient composition in terms of percent
12 of the calories from fat, from carbs, and so
13 on, do we have the same problem or are those
14 data more reliable across BMI categories?
15 DR. KREBS-SMITH: We have very
16 little information about nutrients other than
17 energy. Protein has been looked at as well,
18 and there seems to be less underreporting with
19 that. But whether there's differential
20 underreporting by nutrients or food groups,
21 and then according to BMI groups, that is
22 harder to say.
264
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Is that the question?
2 DR. PEREZ-ESCAMILLA: That was
3 just percent of calories from fat, percent of
4 calories from carbs.
5 DR. KREBS-SMITH: Right.
6 DR. PEREZ-ESCAMILLA: Even if the
7 absolute reporting is not accurate, you can
8 still have the composition of the diet being
9 reported accurately.
10 DR. KREBS-SMITH: Right.
11 DR. PEREZ-ESCAMILLA: That is what
12 the question is.
13 DR. KREBS-SMITH: Well, that gets
14 to the question of whether there's
15 differential under-reporting. So if there is
16 under-reporting of energy in general, but if
17 under-reporting was the same across the board,
18 then there wouldn't be any difference. But we
19 suspect that there may be differential under20
reporting, and we don't have a way to confirm
21 that. Kind of along the lines with what
22 Alanna was saying, we just have very scant
265
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 evidence about this.
2 We have conducted some studies
3 where we identified low-energy reporters and
4 what we called non-low energy reporters based
5 on what we thought a person's calorie intake
6 should be compared to what their body mass
7 index was. Then we just compared reports to
8 see whether the low energy reporters versus
9 the others reported more often certain foods,
10 whether they reported them with greater --
11 whether they were more or less likely to
12 report them at all, whether they reported them
13 more frequently, whether they reported them
14 with different portion sizes, and so on.
15 We saw that the low energy
16 reporters had each one of those kinds of
17 things. They tended to report foods less
18 often or not report them at all, and with
19 smaller portion sizes. It seemed to be across
20 a wide range of foods.
21 One thing, also, that you might
22 want to keep in mind is whether or not these
266
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 people who are being asked to report their
2 intake, if they are overweight, they could
3 truly be dieting at that time. Actually,
4 people who are overweight are more likely to
5 be dieting on any one day, cutting back on
6 their calories. Then they might just be doing
7 it just because suddenly you have brought
8 attention to asking about their intakes, so
9 then they might be under-eating on that day
10 according to their usual. And finally, they
11 might be just underreporting because of this
12 social desirability thing.
13 One thing that I thought was of
14 interest with the data that I was presenting
15 was the general population is below intakes on
16 all, what we consider, Nutrient-bearing
17 groups, fruits, vegetables, whole grains, you
18 know, even milks and meats to some extent, the
19 lean portion of the meat and the skim milk.
20 They tend to be overconsuming on the solid
21 fats and the added sugars, and this in spite
22 of underreporting.
267
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 So if they are under-reporting and
2 we are seeing this, and if social desirability
3 is playing into this at all, then the
4 situation is even a little worse than I showed
5 you. So at least I think we could say that.
6 DR. FUKAGAWA: That was very
7 interesting and alarming at the same time.
8 (Laughter.)
9 But are you able to do subgroup
10 analyses to look at regional differences or
11 differences in ethnic groups in terms of
12 intake, lifestyle choices, vegans versus
13 omnivores, or socioeconomic class, was the
14 other one?
15 DR. KREBS-SMITH: Those are great
16 questions and all things that we would like to
17 get into. This statistical methodology is
18 very new and very complicated. I didn't want
19 to take time to go into that today, and you
20 didn't need to understand it.
21 But it takes an incredible amount
22 of computer time to take two 24-hour recalls
268
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 on each person and examine the inter2
individual variability, and then look at that
3 amongst sets of two in the whole population
4 and try to draw information from that, and
5 model what we expect to be usual dietary
6 intake. So it takes a long time to run. So
7 that is just my reason for why we haven't done
8 it yet.
9 And I think it takes a substantial
10 sample size. So we might be limited in some
11 of the groups that we could look at. I
12 imagine we could do black, white, maybe
13 Mexican-Americans. I don't know that the cell
14 sizes would be great enough in NHANES in a
15 couple of years, but possibly in four years to
16 do some other subgroups of ethnic groups.
17 Certainly, we have been able to do it by age.
18 What was your other --
19 DR. FUKAGAWA: Regional.
20 DR. KREBS-SMITH: Regional. I
21 don't know -- well, I just don't know about
22 regional differences. No, I didn't think with
269
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 NHANES you could look at the regional
2 differences. These are national-level
3 estimates.
4 DR. FUKAGAWA: Right, right.
5 DR. KREBS-SMITH: So, yes.
6 DR. FUKAGAWA: But I just thought
7 if you --
8 DR. KREBS-SMITH: Right, right,
9 but I think that, because of the way the
10 sample is done, I am not sure that you can
11 look at it by regional differences.
12 DR. RIMM: Susan, I agree with
13 Rafael, that was really a spectacular
14 presentation, very helpful.
15 DR. KREBS-SMITH: Thanks.
16 DR. RIMM: So thank you.
17 It strikes me that one of the main
18 things that we are struggling with is obesity
19 in this country. Then you presented the data
20 on SoFAAS, that 100 percent of adult males and
21 females under 50 are eating in excess of
22 discretionary calories, which is quite
270
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 impressive.
2 So the question would be, have you
3 looked at this, to give us some guidance on --
4 is a lot of that coming from added sugars,
5 from alcoholic beverages, or from solid fats?
6 Is there an equal distribution or should we be
7 focusing more of our efforts on one of those
8 three as an area where there is an excess of
9 discretionary calories?
10 DR. KREBS-SMITH: Oh, okay. Well,
11 the two slides I went quickly over were solid
12 fats and added sugar.
13 DR. RIMM: Then I missed that.
14 DR. KREBS-SMITH: So you can take
15 a look at those --
16 DR. RIMM: Can you pull that? Can
17 you pull discretionary? I guess so. You can
18 pull discretionary calories from that?
19 DR. KREBS-SMITH: The way I tried
20 to look at those separately was to look at, I
21 think it is grams of solid fat and the
22 teaspoons of added sugars.
271
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 There is no particular
2 recommendation for the grams of solid fat and
3 the teaspoons of added sugars, but in the last
4 edition of the Dietary Guidelines, in the back
5 of that there were some examples of how the
6 discretionary calorie allowance might be
7 distributed. It was distributed between those
8 two. Alcohol was just --
9 DR. RIMM: Very small --
10 DR. KREBS-SMITH: -- avoided.
11 So with those examples, which one
12 could chose to have it all from discretionary
13 -- from solid fat or could choose to have it
14 all from added sugar, but, really, that is
15 probably pretty unrealistic because in almost
16 any way you would be eating in America, you
17 need a little bit of the solid fat, so you
18 could occasionally have something other than
19 skim milk as a milk choice, and so on.
20 So it pretty much split them. I
21 am not sure if it split them evenly in terms
22 of the calories, but we used those examples.
272
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 So if you look at the table under
2 the foods section, there is a table on solid
3 fat and a table on added sugars. The red
4 highlights there are the values that are above
5 the examples in the back of the most recent
6 edition of the Dietary Guidelines, if that is
7 not too complicated.
8 DR. RIMM: Okay. All right. I
9 will have to think through that.
10 DR. KREBS-SMITH: But that might
11 be some -- yes. But, without a set
12 recommendation, I just used those as examples.
13 DR. NELSON: I have a quick
14 question.
15 DR. KREBS-SMITH: Yes?
16 DR. NELSON: Thinking about the
17 SoFAAS, which are quite profound, this table
18 is pretty profound, and I do also have to say
19 that this is very helpful.
20 DR. KREBS-SMITH: Thank you.
21 DR. NELSON: Thinking about the
22 types of foods, is there any sort of digging
273
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 deeper into the pattern of eating like snacks
2 or on-the-move or anything? Because I think
3 that there is some evidence that this snacking
4 sort of phenomena of Americans, which is so
5 different than it used to be in the type of --
6 you know, there's just so many types of snacks
7 that are out there.
8 I wonder if there is any sense of
9 whether it is meals, desserts, snacks, or
10 foods eaten away from home, or is there any
11 kind of qualitative or, well, quantitative --
12 because you have it from the actual way that
13 the data is gathered.
14 DR. KREBS-SMITH: Right. I am not
15 aware of any analyses, though. There may be,
16 but I don't know any to point you to, on where
17 those SoFAAS are coming from in terms of
18 distribution throughout the day.
19 DR. NELSON: Yes.
20 DR. KREBS-SMITH: However, we did
21 do an analysis where we looked at foods as --
22 there are different ways that you can group
274
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 foods. You can group foods this way, where
2 all the foods that are reported in the survey
3 are disaggregated to their MyPyramid
4 categories --
5 DR. NELSON: Right.
6 DR. KREBS-SMITH: -- and report
7 them that way. You can also look at them the
8 way that they are foods as eaten, we say. The
9 old-fashioned food groups: meat mixtures or
10 breakfasts, and things like that.
11 DR. NELSON: Right.
12 DR. KREBS-SMITH: Think about the
13 way that the foods are presented at mealtime
14 or as snack kind of items.
15 So we did an analysis where we
16 grouped the foods both ways, and we tried to
17 see which of those foods as eaten were the
18 major contributors to these MyPyramid19
equivalent food groups.
20 That was where I sort of slipped
21 in there that a lot of the solid fat was
22 coming from servings of the milk group other
275
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 than skim milk, from meats that are fattier
2 meats, but, also, a big portion of grain-based
3 desserts, for example.
4 So those extra servings of grains
5 that are non-whole grain are also --
6 DR. NELSON: Cakes or cookies?
7 DR. KREBS-SMITH: Yes, the cakes,
8 cookies, and so on. I mean there is some
9 grain in there, but it is also supplying a lot
10 of solid fat in that and sugar.
11 We can supply you with that
12 article, if you are interested.
13 DR. APPEL: That was great.
14 Just some questions about missing
15 nutrients. I didn't see trans. I didn't see
16 mono, omega-3, omega-6. I know that we don't
17 have recommendations, but even if just for
18 trans where they are trying to keep it as low
19 as possible, has that been either --
20 DR. KREBS-SMITH: I think those
21 are all limitations of the database.
22 Alanna, can you address that?
276
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I mean trans, we don't have a
2 database that has it -- but omega-3 and
3 omega-6 we have? Okay, individual fatty
4 acids, we could look at that.
5 DR. APPEL: And can you do that
6 for trans? I know it has been a problem, or
7 is that the one --
8 DR. KREBS-SMITH: Well, I think
9 with the trans, there isn't a complete
10 database of the amount of trans-fatty acids in
11 these foods.
12 Yes, it takes a lot of resources
13 to complete those databases. We understand
14 that a new thing -- trans, even though we have
15 been aware of it for a while, takes a long
16 time to have the additional resources to fill
17 in those holes in the databases.
18 DR. NICHOLS-RICHARDSON: So when
19 you take the food group information and link
20 it together with the nutrient information,
21 what is your sense of what these two pieces
22 are telling you overall? So, for example, are
277
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 there certain age groups or certain genders,
2 or combinations of that, that we need to be
3 concerned about in particular? So when you
4 look at these pieces collectively, what is
5 your sense of, what is it telling us?
6 DR. KREBS-SMITH: Well, I was
7 focusing mainly on the food intakes and
8 somewhat on the macronutrients.
9 Linda mentioned that I was
10 involved in some food guidance earlier in my
11 career. So that is the way I am often
12 thinking about it.
13 But I think of foods as those
14 carriers of nutrients. So I think that, if we
15 can get people eating the right foods, then
16 the nutrients will come along with that.
17 But things are out of balance.
18 What seems to be out of balance is that we are
19 getting far too many of our calories from
20 these sources of solid fat and added sugar
21 primarily; alcohol is in with that as well.
22 But I think the bulk of the calories are
278
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 coming from solid fats and added sugars.
2 Too few of our calories are from
3 fruits and vegetables and whole grains, and
4 from lean meats and their alternates, and skim
5 sources of the milk group.
6 DR. NICHOLS-RICHARDSON: And from
7 this, your sense of these pieces, again, do
8 you get the sense that, within given calorie
9 guidelines, energy guidelines, that
10 micronutrient needs can be met?
11 DR. KREBS-SMITH: Yes. I think
12 that they can. Well, Trish will address that
13 later.
14 With the development of MyPyramid,
15 I think that they have demonstrated how that
16 can be met with appropriate choices. But I
17 think that the public doesn't quite get this
18 -- I'm not sure if Rubik's cube was the best
19 analogy, but I said that earlier. In my mind,
20 it all has to lock into place.
21 We have to realize the
22 implications of a choice. You can have a
279
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 choice of full-fat cheese for your first
2 serving of milk in the day, but once you have
3 done that, you have just used up a fair amount
4 of your discretionary allowance now. You are
5 not going to have any other serving, anything
6 extra for any other food group or any sugar in
7 your coffee.
8 That allowance is so small -- I
9 think it definitely can be done, but I think
10 that people need to appreciate how small that
11 allowance is. I don't think people get that.
12 They are certainly not eating that way.
13 Okay, yes, Larry?
14 DR. APPEL: Yes, one more
15 question. I am trying to figure out what you
16 have and don't have.
17 So you gave us an idea of the
18 SoFAAS calories, but are there tables, or ones
19 that are in preparation, of total calories and
20 calories from vegetables, calories from fruit?
21 You have shown us where the worst is, but the
22 distribution of the other food groups? I mean
280
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 to look at the whole picture here.
2 DR. KREBS-SMITH: Right. We
3 haven't done that. It was easy to do with the
4 SoFAAS calories because we could take solid
5 fat and multiply it times nine and the alcohol
6 times seven, and the sugars. There was a
7 constant factor.
8 So for fruits, if we had the total
9 cup equivalents of fruits, there isn't a
10 constant amount for the calories of that.
11 So I am not sure how
12 straightforward that would be to do.
13 DR. APPEL: Yes, I guess the
14 reason I bring that up, in part because the
15 scientist in me says, well, we're distressed;
16 this looks like a bad number. But I would
17 like to see the whole thing add up, to make
18 sure that the calculations are right and that
19 we know that we have a bigger problem than
20 probably any of us thought.
21 DR. KREBS-SMITH: Yes. Well, what
22 I have done is, back when we first had the
281
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 MyPyramid Equivalents database, and we were
2 only looking at the mean intakes, and I looked
3 at what the mean total calorie intake reported
4 in the survey was, and I had the mean number
5 of servings from each one of the MyPyramid
6 equivalents groups, I multiplied it times --
7 dug into Trish's background information on an
8 average serving from each one of the groups
9 and how many calories comes with an average
10 serving of that, multiplied that out. It
11 pretty much came up to the average calorie
12 intake in the U.S. population, then around
13 2,000 or 2100 calories. You could see what
14 the average amount was from SoFAAS and that
15 that it all fit.
16 You could see that this large
17 amount of SoFAAS taken out of the total
18 calorie allowance was keeping them from
19 getting sufficient amounts of fruits,
20 vegetables, grains, and other things; that it
21 does all add up.
22 So there's a little back-of-the282
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 envelope calculation.
2 CHAIR VAN HORN: I want to jump in
3 on that one, only because I had the same
4 question, kind of the flip side of what Shelly
5 was saying.
6 You know, it is one thing to think
7 about, can we meet nutrient needs? It is
8 another thing to actually use real data and be
9 able to demonstrate to people that, by
10 avoiding certain foods, you don't meet
11 nutrient needs, and, indeed, linking what we
12 all know is true, that you can be overweight
13 and undernourished. To be able to actually
14 use our own data to document that, I think
15 could be very compelling because I don't think
16 people quite understand that concept.
17 It struck me, as you were speaking
18 about it, and also the prior comments about
19 the overweight being likely to under-report,
20 what we do have, then, is in the normal weight
21 or ideal weight -- I know we have a few out
22 there -- those data should be fairly true.
283
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I mean, to be able to look at who
2 are the winners, what are they eating, and how
3 do they stay that way?
4 DR. KREBS-SMITH: Right.
5 CHAIR VAN HORN: To, again, just
6 be able to use our own data to come up with
7 the kinds of comparisons that would allow
8 people to say, wow, you know, if I just ate
9 more fruits and vegetables, I wouldn't have to
10 worry about inadequate potassium --
11 DR. KREBS-SMITH: Yes.
12 CHAIR VAN HORN: -- or the things
13 that were so vividly pointed out by Alanna.
14 You know, to really use the real
15 data to use as a teaching tool.
16 DR. KREBS-SMITH: Yes. Well, I
17 commend you all for your interest in these
18 data because, as I said, it hasn't always been
19 something that the Committees have looked at.
20 We have been trying, of course, to improve our
21 methods and have more data to provide all
22 along.
284
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 But it always seemed to us that it
2 was an important part, an important
3 consideration, how is the population eating,
4 before knowing how it is that you guide them
5 to modify that.
6 So thank you for your interest in
7 that.
8 DR. PEARSON: Table 28 obviously
9 uses part of the Pyramid having to do with
10 protein, et cetera. But is there any way that
11 that can be broken out? Obviously, of the
12 quite variable different constituents of that,
13 there is a lot of different things that are of
14 interest for which there are specific --
15 DR. KREBS-SMITH: Yes.
16 DR. PEARSON: -- research data,
17 benefit and harm, and et cetera, et cetera.
18 Can that be broken out so you can
19 look at almost like the quality of that part
20 of the Pyramid from group to group?
21 DR. KREBS-SMITH: Right. So that
22 is the total meat, poultry, fish? Yes.
285
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 DR. PEARSON: Yes.
2 DR. KREBS-SMITH: In your packet,
3 under the Appendix, you will see the full set
4 of tables, and they are on the web, for others
5 who want to look at it as well.
6 But I think we have other
7 subgroups --
8 DR. PEARSON: So that is where it
9 is?
10 DR. KREBS-SMITH: Yes, so 18
11 through 28.
12 DR. PEARSON: So those would add
13 up to form this?
14 DR. KREBS-SMITH: Yes. Yes.
15 DR. PEARSON: Okay. Thank you.
16 DR. ACHTERBERG: Well, again, good
17 data, Sue, and it is going to take some time
18 for us to integrate and synthesize --
19 DR. KREBS-SMITH: Oh, I'm sure.
20 DR. ACHTERBERG: -- all of this.
21 But, as I am glancing through, one
22 of the findings that surprised me from the
286
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 previous presentation is what the phosphorus
2 levels were for young girls. I had a hard
3 time understanding that based on my
4 understanding of what these girls typically
5 eat.
6 So I am wondering, besides looking
7 at it from overweight or underweight in terms
8 of overreporting or underreporting, are there
9 other groups that may have larger errors in
10 their reporting that we need to consider as we
11 interpret these data?
12 DR. KREBS-SMITH: Wondering
13 whether underreporting varies by different
14 sex/age groups?
15 DR. ACHTERBERG: Yes.
16 DR. KREBS-SMITH: I am unaware of
17 any information on that.
18 Alanna, do you know anything about
19 underreporting by sex/age group?
20 I am going to turn it over to her.
21 MS. MOSHFEGH: When you look at
22 the phosphorus data for girls, their EAR is
287
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 about twice that of adults for teenaged girls
2 and teenaged boys. So that is one thing that
3 is driving the high percentage that have
4 intakes that fall below their EAR.
5 DR. ACHTERBERG: Even though
6 they're guzzling soda? I am trying to put
7 this together.
8 MS. MOSHFEGH: Right. Yes. I
9 mean, so that is one reason why. Also,
10 teenaged girls, their calories are less,
11 obviously, than teenaged boys.
12 DR. ACHTERBERG: Thank you very
13 much.
14 DR. KREBS-SMITH: Thank you.
15 CHAIR VAN HORN: Our third speaker
16 is Dr. Trish Britten, who is a nutritionist
17 and project leader with the Center for
18 Nutrition Policy and Promotion of USDA.
19 Dr. Britten has been with USDA for
20 nine years. Her major contributions have
21 included leading the development of the
22 MyPyramid food guideline system and conducting
288
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the food modeling analyses used in the
2 development of the 2005 Dietary Guidelines.
3 Trish?
4 DR. BRITTEN: Thank you.
5 I know we are a little pressed for
6 time. So I am going to try to go quickly, but
7 I hope not too quickly. So that we can cover
8 it.
9 But I am giving a little bit of a
10 different kind of presentation than just data.
11 I am going to give you some background on how
12 the Pyramid and how the original Pyramid and
13 MyPyramid were constructed, and then some of
14 the current research we are doing, the process
15 we are in right now, where we don't have final
16 results, but to let you know what will be
17 coming this spring to you.
18 Everyone is aware that USDA has a
19 long history of food guidance. For most of
20 its history, this focused on a base diet that
21 would give you the nutrients you needed with
22 no concern for overconsumption.
289
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 However, the Pyramid in 1992 was
2 unique in that it focused on a total diet, not
3 just getting adequate nutrients. Of course,
4 we have built MyPyramid on that model.
5 The original Pyramid set guiding
6 principles for development, and these are
7 unchanged until today. We still use these.
8 The first three are, it is based
9 on fostering overall health, not one specific
10 disease or lack thereof. It is based, to the
11 extent that we have it, on up-to-date
12 research, so as up-to-date as we can get. And
13 again, it is based on the total diet.
14 There were principles to make it
15 useful, flexible, practical, realistic. These
16 principles dictate that we use common foods,
17 not a food that might be very unusual, but
18 high in a particular nutrient, that we are
19 flexible in providing all consumers with
20 choices within food groups, not trying to
21 specify food groups so finely that only one
22 food would fit. So we don't have an oyster
290
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 group, you know, or something like that. And
2 to make it practical for the whole family,
3 assuming that families eat together. So we
4 would not have different food groups for
5 different ages, that we would have different
6 amounts for the same food groups, so that it
7 would go across.
8 And the final principle is that it
9 be evolutionary. So that it could be changed
10 with time and it can be updated. That is what
11 we did between the original Pyramid and
12 MyPyramid, and that is what we are doing again
13 now.
14 The food intake patterns are what
15 I am talking about today. Obviously,
16 MyPyramid has a lot of consumer materials.
17 There is lots of pages of text and guidance,
18 but today I am talking about the underlying
19 what and how much to eat that drive all of
20 that, all of that advice.
21 These food intake patterns are
22 designed to meet the DRI and the DGA
291
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 recommendations, and they are based on 12
2 different patterns. We have 12 patterns that
3 differ by energy level, and they are designed
4 for varying population groups and different
5 energy needs.
6 As everyone has mentioned, intakes
7 are to be met over time. So we don't assume
8 that a person needs to eat everything on a
9 daily basis to that exact amount.
10 The first thing in developing the
11 food intake patterns was to determine nutrient
12 goals and calorie needs. The nutrient goals
13 were the easiest part of the whole thing, is
14 there a DRI? Is there a Dietary Guidelines
15 recommendation?
16 The calorie needs, we had to ask,
17 what are the calorie needs of various groups
18 in the population? Actually, the DRI also
19 helped us there because they have estimated
20 energy requirements, and we used those
21 equations to determine -- and I am just
22 showing you the men, but we did the same thing
292
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 for women here. We said, at each age, what
2 would the EER, the Estimated Energy
3 Requirement, be for a reference size? In
4 other words, a healthy weight, average height
5 person of this sex at different energy levels.
6 From this, we got this whole
7 range. We did it every year up to age 18 and
8 then every five years from 19 through 80.
9 But, as you can see, it is not a
10 point, it is a bar. So we go from sedentary
11 to active, and we can see the range of energy
12 needs for a reference size individual.
13 When we looked at both men and
14 women -- and I only show three-year-olds here,
15 there's also two-year-olds -- all of the
16 energy needs were between 1,000 and 3,200
17 calories. You have very tall people. You
18 have people that are more than a healthy
19 weight. Their needs would not be maintained
20 on this, but we had to choose some reference
21 sizes.
22 If you look at a single energy
293
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 level -- and I have put a band of 100
2 calories, around 2,200 in this example -- you
3 can see that it crosses over various segments
4 of the population. This is how we determined
5 whose needs should be met, whose nutrient
6 needs should be met at that energy level.
7 So here we have fairly active
8 young adolescent males and sedentary to
9 moderately-active older men at 2,200 calories.
10 Some women will also fall under this category.
11 If you go up to 2,800 calories,
12 then you see that the 2,800-calorie pattern
13 should meet the needs of moderately-active
14 older teenaged boys and younger men.
15 So this is what we did at each one
16 of the 12 calorie patterns. We determined who
17 fits it, who has the highest nutrient need of
18 all those groups that would fit that pattern.
19 Then we would set that pattern to meet their
20 needs.
21 In doing MyPyramid, we stuck
22 fairly close to the food groups in the
294
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 original Pyramid. We did this because we were
2 being evolutionary. We did do some tweaking,
3 and tweaking is always possible, but we did
4 not spend a lot of time reevaluating and re5
assessing food groups.
6 We then calculated nutrient
7 profiles for each food group. That is where
8 I am going to spend a little time. What is a
9 nutrient profile?
10 A nutrient profile answers the
11 question, what nutrients would you expect
12 from consuming a given amount, on average, of
13 a food from this group? Because everyone is
14 going to make a different choice in terms of
15 the fruit or the specific vegetable they eat.
16 So how do we calculate that?
17 If you look just at dark green
18 vegetables and just vitamin A, the vitamin A
19 value differs greatly between half a cup of
20 cooked spinach and half a cup of cooked
21 broccoli.
22 So then we look at the consumption
295
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 of each one of these items. We see that --
2 and here I summarized all the others, that I
3 just showed you the consumption of the cooked
4 spinach is 15 percent of all dark green
5 vegetables, cooked broccoli is 36 percent.
6 So then we do a weighted average
7 for each nutrient, where the nutrient profile
8 is the sum of the nutrient contribution of
9 each food -- and this is specific to a
10 nutrient -- times its likelihood of being
11 eaten or the percent of total.
12 So, for each food, for each
13 nutrient, and each food group or subgroup, we
14 calculate these profiles. This is what we use
15 to build the basis for the food patterns.
16 It is very important to remember
17 that, as Sue was talking about, when we do
18 these calculations, we have disaggregated
19 these foods. So they are based on nutrient20
dense forms of the foods.
21 If you were looking at foods in
22 the vegetable group, any fat or oil that was
296
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 used to fry a vegetable would have been pulled
2 out and assigned to the solid fat or the oil
3 category, and you would just have the basic
4 vegetable. So they are the best-case scenario
5 for the foods in that group.
6 Then we determined the recommended
7 amounts for each food group. How we construct
8 this is an iterative process. We establish an
9 initial amount. For MyPyramid, the initial
10 amounts were the amounts in the original
11 Pyramid. Then we compare the resulting
12 nutrient content to the goals for that group,
13 which, remember, is the highest nutrient
14 standard for any age group that would need
15 that many calories.
16 Then if we don't have enough, then
17 we start iteratively changing the amounts that
18 we would recommend. Again, it is that Rubik's
19 cube or that jigsaw puzzle where everything
20 has to fit together. If you increase the
21 amount from one group, you are going to have
22 to decrease somewhere else or, in the end, you
297
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 decrease discretionary calories, which is why
2 they are so low.
3 In selecting groups to increase,
4 we look at a couple of things. One is, where
5 are the nutrients that we are missing? Where
6 is the potassium? Where is the vitamin A?
7 Then we also look at typical
8 consumption because we do not want to be
9 recommending amounts that are so outrageous
10 that we could not support them at all. We
11 might with some subgroups. We go to two,
12 three, four times typical consumption. We
13 don't want to go to 20, 30, 40 times typical
14 consumption. So that is kind of our limits.
15 It is qualitative determination.
16 We don't have any standard, we say we will not
17 go above, you know, X times.
18 Then, as Sue pointed out, the
19 remaining calories, after the nutrient needs
20 are met from each food group, are defined as
21 discretionary calories that can be used in any
22 way the person desires, assuming they have
298
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 eaten everything in the leanest, low-fat form.
2 And you saw the patterns. This is
3 just a sample pattern. One thing I wanted to
4 point out here is that these patterns include
5 amounts from each food group and in some cases
6 from subgroups.
7 In the grains group, it is
8 recommended that at least half -- so for 6-
9 ounce equivalents, three or more of the ounce
10 equivalents would be whole grains.
11 In the vegetable group, the
12 vegetable group is a very broad category of
13 foods. To get the nutrients, there are
14 subgroups, and these recommendations are
15 weekly. Asking a person to eat five different
16 types of vegetables every day in small amounts
17 would be pretty impossible. So we make weekly
18 recommendations there, hoping that they will
19 be able to rotate vegetables through the week.
20 I have some comments about the
21 vegetable groups, too, that we might not get
22 today, but we would like to do some things
299
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 with the vegetable group because we have this
2 other category that is pretty much a lot of
3 vegetables in there.
4 We have an oils allowance. We
5 don't consider oils a food group, but we do
6 have essential fatty acids, that about half of
7 the essential fatty acids come from these
8 oils. So we need to include them. They
9 aren't discretionary. Then we have an
10 allowance for 267 calories for discretionary
11 calories.
12 What I am going to talk about now
13 is the things that we are doing right now.
14 There's four things we are doing right now.
15 I don't have results for you, a couple of very
16 preliminary results, but I will have the
17 results of this later this spring for your
18 use. These new patterns with updated nutrient
19 profiles will be available for modeling work
20 later on in your process.
21 Okay, here's the four things, and
22 I am just going into them and talking about
300
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 each one.
2 We never had a nutrient profile
3 for the milk group. We didn't have it because
4 it was felt that skim milk was the best
5 representation for the milk group.
6 But when we looked at current
7 consumption, we really needed to have a
8 nutrient profile because there's a lot of
9 foods that differ greatly from skim milk that
10 people are eating now.
11 So we had to identify item
12 clusters. This is where I am going to stop
13 and take a step back and say, what's an item
14 cluster? This is the first place I came upon
15 it.
16 What is an item cluster? You
17 heard Sue describe how we disaggregate foods.
18 This is how you take a mixed dish, beef stew,
19 which would be a meat mixture or something in
20 foods-as-eaten grouping, and we break it down
21 into its components. It has some meat, some
22 orange vegetable, other vegetables, starchy
301
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 vegetable, and refined grains.
2 You heard about the Pyramid
3 Equivalents database. That breaks it down
4 into the groups. What we do at CNPP is we
5 take that and we pick out the actual
6 ingredient that is in it.
7 So, for each food, we look at that
8 orange vegetable that is in the beef stew and
9 we say, what is it? In this case, it's
10 carrots.
11 We look at the other vegetable,
12 quote, other vegetable, that is in the beef
13 stew, and we look at it and we say, what is
14 it? And it is onions in this case.
15 So we go through each food and
16 identify the specific ingredients. Then we
17 can take all of those specific ingredients and
18 aggregate them into an item cluster.
19 So we take the cooked carrots from
20 the beef stew, from the vegetable soup, from
21 the carrot cake, from the vegetable lasagna,
22 and plain, old cooked carrots, and hundreds of
302
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 other foods literally, probably thousands of
2 other foods, and put them into a cooked carrot
3 item cluster.
4 Then we assign plain cooked
5 carrots to represent all the cooked carrots
6 that are eaten wherever and however.
7 Obviously, the other ingredients
8 in all these foods would all go into various
9 different item clusters.
10 The reason that we needed item
11 clusters and a nutrient profile in the milk
12 group is that, when we looked at consumption
13 of different types of milk -- and this is just
14 the females, but the males are very similar --
15 if you look at all the bars from the bottom up
16 to the red bar there, that is all the plain
17 milk, fluid milk that is consumed. Then when
18 you look above it, this is cheese, other milk
19 products, yogurt products, things that are
20 consumed that may differ from just the fluid
21 milk.
22 So, especially when you see that
303
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 over 60 percent for young and middle-aged
2 women of all their milk consumption comes from
3 these other foods, we didn't feel that
4 capturing the nutrients in skim milk was
5 sufficient.
6 So we have developed 65 item
7 clusters, and there is a whole range of
8 things, all different kinds of cheeses and
9 milk and sauces, and ice creams, and things
10 like that.
11 Then we calculated the consumption
12 of each one of these item clusters, choose a
13 representative food for each one, and
14 calculate the nutrient profile.
15 Just for your information, this is
16 just the types of milk into various item
17 clusters that are above 1 percent of total
18 consumption. But the one that I find most
19 interesting is this is all the cheeses that
20 are above 1 percent of consumption. Look at
21 the impact of pizza. It is over 10 percent of
22 total milk group consumption, just the cheese
304
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 on pizza.
2 Notice that the top one there is
3 reduced-fat cheese because that is part-skim
4 mozzarella. The other is the Parmesan that is
5 on the pizza.
6 But you get a huge impact. Then
7 when you start looking at this and breaking it
8 down by item cluster, you begin to see where
9 the cheese is being eaten.
10 So, right now, what we are doing
11 is we have this consumption work. We are in
12 the process of identifying the best possible
13 representative food that is a low-fat, no14
added-sugars form of the food to represent
15 each item cluster. Then we will have our
16 consumption-weighted nutrient profile. We are
17 very close to having that.
18 The vegetable group, we did
19 essentially the same thing, but we felt the
20 need to expand our item clusters. We had some
21 limitations before in our item clusters. So
22 we are going through the same process.
305
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 For example, original item
2 clusters included all green and red peppers
3 together. We know there's some real nutrient
4 differences between them, and red pepper
5 consumption has really increased. So we have
6 separated. Now we have four pepper clusters.
7 Foods like green beans often
8 included foods eaten in smaller amounts. So
9 we had snow peas, asparagus, okra, and
10 artichokes all part of the green bean cluster.
11 If you had asked me, before we did this, how
12 much asparagus are people eating, I couldn't
13 have told you because it was all clumped with
14 green beans. So we have gone through that and
15 identified it.
16 We also couldn't have told you
17 exactly how many French fries or potato chips
18 people were eating because it was all grouped
19 with boiled potatoes, which was the low-fat
20 version of a French fry, right? Cooked in
21 water instead of fat.
22 But now what we have is we have a
306
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 separate -- we can show you exactly how many
2 French fries, how many potato chips, et
3 cetera, are eaten. Then we can represent with
4 a low-fat version of a French fry, potato
5 chip.
6 So what we are doing right now is
7 we are doing that calculation of a
8 consumption-weighted nutrient profile. I
9 don't have it yet because our programmer had
10 her baby six weeks prematurely. So she is on
11 maternity leave. She is coming back in
12 February, folks.
13 Then we will be able to look a
14 little more closely at the vegetable groups,
15 some things that I would like to talk with
16 more of the Committee about as we go through
17 the spring, which is looking at potential
18 changes in some of the subgroups that might
19 facilitate meeting certain nutrient needs.
20 Let me just give you one example to know what
21 I am talking about.
22 We have an orange vegetable
307
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 subgroup. Consumption is very small, and the
2 vast majority of it is carrots. So we are
3 getting very close to recommending carrots to
4 all Americans, whereas there are other choices
5 that could meet the needs.
6 We also have this very large,
7 diverse group of foods called other vegetables
8 that includes tomatoes, all tomato products in
9 there. Tomatoes have a nutrient profile that
10 we think is similar enough to orange
11 vegetable, and we are going to look at this
12 closely, that we might be able to make a red13
orange group, which would be understandable to
14 consumers and give them a lot more choices,
15 and be able to boost the consumption of those,
16 and get the tomatoes out of that other
17 vegetable group, which people don't
18 understand. So those are the kinds of things
19 we are looking at.
20 This is the most exciting one.
21 Okay, so everybody who was asleep out there,
22 wake up.
308
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 (Laughter.)
2 We are developing a systematic
3 approach to assigning foods to a specific area
4 within each MyPyramid group. Everybody knows
5 this. Okay?
6 But what we have said is that the
7 base is wider than the tip because the base
8 represents nutrient-dense forms of foods, and
9 the tip represents those that have more SoFAAS
10 in them. But we have never really told people
11 where foods go and identified them.
12 What we are doing now is we are
13 doing tiers. We are developing tiers within
14 each of the food groups, so that, when we
15 finish this, we can be able to say, for
16 example, fat-free milk is in tier one. Two
17 percent milk is in tier two. Two percent
18 chocolate milk is in tier three because it has
19 some fat and it also has quite a bit of sugar
20 in it.
21 Okay, in the grain group, we could
22 say bread is in tier one, pancakes are in tier
309
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 two, and sweet rolls are in tier three.
2 When we do this, we will be able
3 then to identify amounts, proportions, that
4 should be consumed from each of these.
5 It operationalizes this concept of
6 discretionary calories that is very hard for
7 people to understand and get a hold of when
8 you are talking about actual foods. It will
9 identify those foods that have high
10 consumption and that are high in SoFAAS and
11 provide guidance for within-food-group choices
12 that is very specific.
13 It is not new to us. This is an
14 NHLBI project that did GO SLOW WHOA Foods.
15 This is a Washington State University project
16 that said build on a healthy base and
17 separated them out.
18 What is unique about ours is that
19 we are doing it in a very objective way by
20 amount of SoFAAS in each food. We are not
21 looking at a food and saying, I think that
22 goes in the top or I think that goes in the
310
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 middle.
2 We are doing it on single-group
3 foods to start with. We are not trying to
4 tackle at this point in time foods that are
5 such a mix of so many food groups that you
6 couldn't figure out whether the SoFAAS went to
7 the meat in the beef stew or they went to the
8 vegetable or they went to the wherever.
9 So we are starting with this, and
10 we are starting with food group foods. So we
11 are not dealing with soda yet because we know
12 soda is all SoFAAS.
13 We are calculating the calories
14 from SoFAAS, and we are identifying test
15 cutoffs, potential cutoffs. Then after we
16 identify these and look at what it is, we will
17 be able to select final cutoffs, and then what
18 would the recommended consumption levels be
19 for each tier.
20 Now this is all based on
21 preliminary work. Remember, we don't have
22 final, updated nutrient profiles yet. So take
311
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 these numbers with a grain of salt because
2 they will probably shift a little bit.
3 But I think the big message is not
4 going to change. That is that, if you look
5 group by group -- remember, tier one is very
6 low in SoFAAS. Milk, very little consumption
7 from tier one, very high consumption from tier
8 two, and very high consumption from tier
9 three. Most cheese fits into tier three.
10 Fruit, if people are eating fruit,
11 they are eating it without SoFAAS, very little
12 consumption outside of tier one.
13 Vegetables, the majority of
14 consumption is in tier one, but we have some
15 substantial in tier two and three.
16 Meat and beans, tier two is
17 predominant. So there is room for improvement
18 there.
19 Grains, also, whole grains are
20 more likely to fit into tier two than are
21 refined grains. This is an artifact of the
22 fact that there is so much plain white bread
312
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 eaten, which fits into tier one, whereas, tier
2 two, the whole grains are much more likely to
3 be eaten as breakfast cereals, which are
4 likely to have sugar added. So that is why
5 you see that.
6 If you were to assume that, from
7 education, we would increase whole grain bread
8 consumption, then you would see those numbers
9 shift. Hopefully, over time we will see those
10 numbers shift because that is what we want to
11 do.
12 But this gives us specific targets
13 for where we want to work and where we want to
14 focus. That is what we are trying -- that is
15 where we are going.
16 As I said, specific messages,
17 providing feedback to consumers, and then we
18 can, then, look at food choices by tier and
19 determine how it influences overall diet
20 quality. So we could look at HEI scores for
21 people whose food choices were in various
22 tiers, and we can monitor changes over time.
313
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 We can see how we are doing.
2 So these are the four things that
3 we are doing. The one I didn't talk about was
4 just updating the nutrient profiles for all
5 the groups.
6 That, in a nutshell, is it.
7 Any questions?
8 (Applause.)
9 DR. PEREZ-ESCAMILLA: In terms of
10 the feedback to consumers, do you have some
11 specific ideas as to how the tier information
12 could be --
13 DR. BRITTEN: How we would
14 feedback information to consumers?
15 DR. PEREZ-ESCAMILLA: Right, in
16 terms of the tiers. I mean, what are you
17 thinking about?
18 DR. BRITTEN: Well, there's two
19 ways to think about feedback from consumers.
20 One is, as we are developing the materials to
21 teach these principles or to communicate these
22 principles, that we would get feedback, that
314
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 we would do focus group testing, and we would
2 get feedback from consumers to help us make
3 sure our messages were correct.
4 But then we would look at specific
5 messages that we could give that would help a
6 person understand your choice is toward the
7 top of the Pyramid or too many of your choices
8 in this food group are toward the top of the
9 Pyramid. If you selected these other foods
10 instead, it would drop you. So you could give
11 people advice based on, if they are eating
12 something that would be in tier three, you
13 could suggest getting them down to tier two.
14 We have interactive tools. What
15 we would like to do is eventually, to build
16 into the interactive tools, we can tell
17 people, here are the choices that you made
18 that are in tier two or tier three, and here's
19 a specific list of foods that you could choose
20 instead that would be in a lower tier.
21 DR. PEREZ-ESCAMILLA: And do you
22 think it would have any application for food
315
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 labels, for actually putting a symbol related
2 to the tier on the food products that people
3 are buying -- eventually? I don't know.
4 DR. BRITTEN: It could. It could.
5 One of the things I want to say is
6 this is right now for, remember, foods that
7 fall into a single food group. We have got to
8 look at how we can expand this. This is going
9 to take a lot of synthesis of ideas to see how
10 we can do this for mixed dishes, and a lot of
11 the packaged products have more than one food
12 group. So if you took a packaged dinner, for
13 example, we couldn't do that.
14 DR. ACHTERBERG: Just
15 commendations for this work. We have needed
16 this for a long time.
17 I hope that, as these datasets are
18 built, that we can fold them back and
19 integrate them into our other datasets to
20 understand who is eating which from which tier
21 and relate it to the nutrients, and so forth.
22 So I hope, as it is being designed, it is
316
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 being designed so we can integrate datasets.
2 DR. BRITTEN: Yes, yes. Each food
3 that we have is assigned, actually, by its
4 NHANES survey code. So all of those survey
5 codes would have a specific tier assigned to
6 them. So you could analyze that data based on
7 that.
8 DR. APPEL: Thanks a lot.
9 At the end of 2005, I barely
10 thought I understood what you were doing. I'm
11 glad you had a presentation today.
12 So a few questions: one is -- it
13 is a very proximal question -- is that you
14 have food groups, and it is a little bit
15 peculiar. Nuts is a vegetable, nuts is meats
16 and beans.
17 DR. BRITTEN: It is the beans that
18 fall into two.
19 DR. APPEL: Yes, but the question
20 I have -- and this is consistent, I think,
21 with some of the comments we heard earlier --
22 what is the feasibility and implications if we
317
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 were to say there should be a category called
2 nuts, seeds, and legumes, you know, at a
3 theoretical level and a practical level?
4 DR. BRITTEN: At a theoretical
5 level, we have subdivided other groups, and
6 there's no reason we could not do subgroups
7 with specific recommendations, as we have done
8 for whole grains or as we have done for
9 vegetables.
10 I would caution that we look at it
11 very carefully, how we do it, so that we
12 don't, by implication, suggest that specific
13 percentages come from something like red meat,
14 even though we know we would like to push them
15 away from that.
16 So we might want to look at a
17 model like whole grains, where we talk about
18 at least such-and-such should come from
19 another. But it is very, very easy to do
20 because it is set up that way already.
21 However, we have this issue with
22 legumes, that our recommendations for legumes
318
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 fall under the vegetable group, even though
2 they can be counted as meat by vegetarians.
3 We keep them in the meat group very
4 specifically to allow them to count as a plant
5 source in that group.
6 But, for most people, the vast
7 majority of their legume consumption should
8 come as a vegetable. The nutrients are
9 similar. They are a plant food. People see
10 them as a vegetable.
11 So it has always been an issue.
12 Legumes are a cross-over product. We look at
13 it very carefully, how we make that message.
14 But, to date, it has been more
15 useful for us to identify them as a vegetable
16 subgroup because we can recommend more.
17 DR. APPEL: I think this would
18 follow up on something Joanne said at the last
19 meeting. What if the organizing principle
20 became the source of protein, though, you
21 know, meat versus vegetable protein? And also
22 consistent, I think, with what Linda has been
319
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 thinking about in terms of health benefits of
2 the vegetable protein. Is that an organizing
3 principle?
4 You know, you have food groups,
5 you put them together because they are
6 similar. You know, they grow in the ground or
7 you pick them off trees.
8 This one is organizing principles
9 based on health, which is you have to have so
10 much protein to live, and you have a choice.
11 It is either meat or vegetables or some
12 distribution in between.
13 DR. BRITTEN: So you are
14 suggesting that it go back to a nutrient
15 system?
16 DR. APPEL: It might be for just
17 this one -- you know, nothing is ever perfect
18 or absolutely 100 percent standardized, but
19 that seems to be -- there are a few RDs on
20 this, but I remember this very explicitly,
21 that Joanne mentioned this, you know, in how
22 she starts her sources of foods with, where's
320
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the protein coming from?
2 DR. BRITTEN: Well, all things can
3 be looked at. All things can be looked at.
4 What we have found is we try to do
5 this as food-based guidance rather than
6 nutrient-based guidance because that becomes
7 a slope of, what other nutrients do you
8 specify to their own food group?
9 CHAIR VAN HORN: I think, just
10 following up on that a little bit, is of all
11 the things that are confusing to the public,
12 and yet what is very clear in the literature,
13 is that diets that are higher in plant-based
14 protein, vegetable proteins, are associated
15 with lower BMI, lower lipids, lower blood
16 pressure, et cetera. Yet, if you ask the
17 average person, what's a plant-based protein,
18 I'm sure they wouldn't be able to tell you.
19 So the point is, even I think as
20 Larry points out, even seeing beans next to
21 meats is confusing for a lot of people because
22 they don't know how to make that connection.
321
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I think our goal is to try, using our
2 evidence-based research model here, to
3 simplify for the consumer how to make the
4 choice and apply that knowledge when they
5 actually pick up a food and say, oh, these
6 nuts actually are giving me protein or these
7 beans are giving me protein. So, instead of
8 meat, I should be eating this for lunch.
9 I think what has come across very
10 clearly -- you see this very clearly with kids
11 -- they understand that cheese is a source of
12 protein. They get that. So they can easily
13 become a vegetarian by putting cheese on their
14 pizza.
15 But they don't understand the rest
16 of the nutrient adequacy issues that we would
17 want to convey to them. In fact, that leads
18 me to the second point I was going to make,
19 and our group here has heard me say this
20 before.
21 But in a study we did in
22 adolescents, it became very mind-blowing to us
322
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 when we realized that a third of calories came
2 from snacks, desserts, and pizza. To us, what
3 that represents is no longer is the idea of a
4 meal even coming across. So that people don't
5 know you are supposed to have a vegetable and
6 a fruit and a grain, and all of that. It is
7 a food court mentality out there.
8 So I think what is getting lost,
9 especially in our younger people, is what you
10 need to put into a meal in order to achieve
11 the nutrient adequacy.
12 So I think, while we are looking
13 at these tiers, if there is some way to help
14 understand that, if you eat from tier one, you
15 know, you can eat the foods you want to enjoy,
16 but there's lower-fat versions or lower-sodium
17 versions, or whatever --
18 DR. BRITTEN: Yes.
19 CHAIR VAN HORN: -- you know, to
20 still meet those needs.
21 DR. BRITTEN: That is a really
22 good point.
323
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 I do want to point out that the
2 issue of the meat, the title of the food group
3 is meat and beans group. That was actually
4 done by the 2000 Dietary Guidelines Committee
5 because they wanted to emphasize that beans
6 could fall in, they could be served as a plant
7 protein source. We have kept that name for
8 the group. So we always talk about the meat
9 and beans group.
10 People do get very confused about
11 it. If somebody has an answer to simplifying
12 it, you know, putting it into one group or the
13 other -- we want people to eat beans even if
14 they eat sufficient other protein sources. We
15 want them to eat the beans for all the other
16 nutrients in them. So it's an issue.
17 DR. NELSON: Well, a couple of
18 comments.
19 One quick fix might be having it
20 be the beans, seeds, and meat group. I mean
21 switching the name, so that the emphasis is
22 different, that is one thing.
324
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 But I think this is fascinating.
2 I get concerned from the consumer perspective
3 because they already are so confused by what
4 the Pyramid says, that you start adding tiers.
5 That is just a comment.
6 But one question is, is there any
7 evidence that the Pyramid at all evokes any
8 understanding around calories? To me, the way
9 it is set up is very much more around nutrient
10 adequacy. Thinking about the work that we are
11 doing, and needing to focus much more on
12 caloric intake, I get concerned. I would love
13 to think that there is another way to evoke an
14 understanding around -- and I know we have the
15 runner going up the stairs, but I think it is
16 really around caloric intake, some kind of an
17 icon, some kind of an image.
18 I am concerned just from the
19 Pyramid -- I think it has done a good job with
20 nutrient intake. I am not sure around just
21 energy.
22 DR. BRITTEN: Well, the tiers
325
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 project is one way we were trying to attack
2 that, is to let people know that there are
3 choices they can make that would be lower in
4 energy from SoFAAS in each group.
5 And when you saw the data that Sue
6 presented, the SoFAAS is really the elephant
7 in the room when you are talking about excess
8 caloric intake. We are not too worried about
9 people consuming too much from a specific food
10 group. We are concerned about the excess fat
11 and sugar that they are consuming.
12 That is so huge.
13 So trying to set up the tiers to
14 make better choices and use that concept, and
15 we have, in all our interactive tools, we have
16 calories, we count calories --
17 DR. NELSON: Yes.
18 DR. BRITTEN: -- as well as the
19 groups. We also count calories from extras,
20 which are the SoFAAS, to help them see that.
21 DR. NELSON: Just one follow-up
22 question about, to that end, this health
326
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 communications piece about the research on the
2 influence of the Pyramid on actual food
3 choices. Has anybody really, really tested
4 that in a way, like in the general public with
5 a general sort of reading level?
6 DR. BRITTEN: We do not have a
7 good, well-designed intervention study that
8 tests across the general public. We have a
9 lot of anecdotal evidence, and we have it
10 incredibly widely used as a part of nutrition
11 education programs that are not just the
12 Pyramid, but they are traditional nutrition
13 education programs where it would be difficult
14 to tease out what the educator is talking
15 about as opposed to just the Pyramid.
16 So it is something I wish we had
17 an answer to and we don't.
18 DR. NELSON: And potatoes, at some
19 point we've got to move potatoes out of
20 vegetables or do something with potatoes.
21 DR. BRITTEN: Potatoes are a
22 nutrient-rich vegetable.
327
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 DR. NELSON: I know, but the way
2 that most Americans eat them is not so
3 nutrient-rich is the issue.
4 DR. BRITTEN: Well, I will give
5 you all the data that we have on our item
6 clusters.
7 DR. NELSON: Okay. Yes.
8 DR. BRITTEN: Now that we have
9 separated all those out, I will show it all to
10 you, yes.
11 CHAIR VAN HORN: Well, I want to
12 thank you, all three of our speakers really,
13 for an incredibly rich afternoon. I think
14 they deserve another round of applause.
15 (Applause.)
16 We will now be taking a 15-minute
17 break. When we come back, we will be hearing
18 from our Fluid and Electrolytes Committee on
19 their progress.
20 Thank you.
21 (Whereupon, the above-entitled
22 matter went off the record at 3:09 p.m., and
328
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 resumed at 3:24 p.m.)
2 CHAIR VAN HORN: Okay, we need to
3 get started.
4 So I would like to introduce Larry
5 Appel, who is going to talk about the work
6 that they are doing in the Fluid and
7 Electrolytes subcommittee.
8 Larry, I will let you go from
9 here.
10 DR. APPEL: Okay, great. Let's go
11 ahead and start.
12 I made an error on the first
13 slide. And you always should acknowledge key
14 staff. So Holly McPeak was our senior staff
15 person that's keeping our group together, and
16 besides myself, Tom Pearson and Christine
17 Williams are members of this subcommittee.
18 So I'm going to divide this -- I
19 mean this is actually a little bit redundant
20 from what I did at the last meeting. So I'll
21 go through the three questions that are in now
22 the sodium, potassium, and water section.
329
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 So the first one, the question
2 was, what amount of fluid is recommended for
3 health? And these are the three conclusions.
4 One, the combination of thirst and
5 usual drinking behavior -- it's hard to hear.
6 There's a lot of noise.
7 CHAIR VAN HORN: Excuse me. Could
8 we shut the doors in the back? We're having
9 a little trouble hearing up here. Thank you.
10 DR. APPEL: It's a bit of a
11 distraction.
12 So anyway, the first conclusion
13 was the combination of thirst and usual
14 drinking behavior, especially the consumption
15 of fluids with meals, is sufficient to
16 maintain normal hydration.
17 I will just make a comment that,
18 in the IOM Committee on Fluid and
19 Electrolytes, there is uniform agreement that
20 there is no problem that people have alluded
21 to, like chronic dehydration. That's just not
22 a clinical problem with otherwise healthy
330
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 people.
2 The second one is that healthy
3 individuals who have routine access to fluids
4 and who are not exposed to heat stress consume
5 adequate water to meet their needs.
6 And third is that purposeful
7 drinking is warranted for people who are
8 exposed to heat, stress, or who perform
9 sustained, vigorous activity.
10 So these are the deliberations
11 that we had on water. We did an initial
12 literature search. And then we had a
13 conference call with Dr. Mike Sawka, who
14 participated in the Institute of Medicine DRI
15 report, and who is a world expert on
16 hydration.
17 And he agreed with the conclusion
18 that we reached, didn't even recommend
19 tweaking it. So the consensus was that we are
20 on track.
21 Now there are some additional
22 plans that I think we need to do just to make
331
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 sure. So I think we should do, if there is
2 one area where there might be new literature,
3 where there was some data -- it's not
4 particularly great, but it's on kidney stones.
5 Does increased fluid intake prevent kidney
6 stones? So I think we could do a search on
7 that. Nobody was aware of any ground-breaking
8 study that might change.
9 And then we are thinking of
10 enhancing the text on a few issues. One is
11 water in the elderly, which came up in at
12 least one public comment, water with meals,
13 the vitamin/mineral content of fortified
14 water, since some are now being promoted as
15 sources of nutrients. And then the
16 recommendation for non-caloric fluid sources,
17 given the other issues of concern.
18 So I guess what I would do would
19 be to stop there and take questions, and then
20 I'll do potassium, and then I'll do sodium.
21 DR. SLAVIN: I just wanted to
22 point out that the Carbohydrate Protein Group
332
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 is looking at artificial sweeteners, when we
2 would overlap with you probably on that last
3 non-caloric fluids sources. There might be
4 some cross-Committee sharing we could do on
5 that.
6 DR. APPEL: Yes, it's probably
7 more of -- I'm not sure we're going to be
8 doing a literature search per se, but it's
9 sort of in the context of other chapters of
10 liquid versus solid, as well as total caloric
11 intake. I don't think we mention anything
12 about calories in the chapter.
13 DR. RIMM: Larry, two things come
14 to mind. One is, I don't know, maybe since I
15 recently read papers on water and bladder
16 cancer, is that -- I don't know -- something
17 else that has been searched or worth pursuing?
18 DR. APPEL: Yes, I think actually
19 from your shop there might have been --
20 DR. RIMM: Well, that was one from
21 a while ago, but I know I have seen several
22 others since, or maybe I just have reviewed
333
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 them or something. But I don't know if, while
2 you are studying kidney stones, you can add it
3 to the list potentially.
4 And the second thing was related
5 to a lot of what we talked about today, is
6 just the behavioral aspects of the diet for
7 people who drink more water. Does it replace
8 other things? Does it impact on how you eat
9 or what you eat or satiety? I don't know. Is
10 there enough literature on that?
11 DR. APPEL: Well, yes, I mean I
12 think there's some --
13 DR. RIMM: Maybe that's not here.
14 DR. APPEL: -- acute feeding
15 studies. You know, if you pre-load with
16 water, what is the impact on subsequent
17 caloric consumption? I don't think we've -- I
18 mean we could -- a lot of things are related
19 to energy balance, and not everything should
20 flow towards -- But I mean I think we could do
21 a literature search on these.
22 These are sort of like
334
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 subquestions within the primary question, but
2 I think that'd be reasonable.
3 Okay, so that's water.
4 So potassium. So the research
5 question, what are the health effects of
6 potassium intake on health?
7 And the three conclusions were,
8 first, diets rich in potassium can lower blood
9 pressure and lessen the adverse effects of
10 salt on blood pressure. They reduce the risk
11 of developing kidney stones and possibly
12 decrease bone loss.
13 You can already see, by the way,
14 that there is, embedded in our recommendations
15 are some tentative words, because the evidence
16 we didn't feel was so strong that you could be
17 definitive on these. And so, when you think
18 about grading of evidence, I mean, sometimes
19 you can do it just by A, B, C, which I
20 actually think would be problematic, or you
21 can use words that I think might be better,
22 because some people might dismiss a B or C
335
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 recommendation.
2 Anyway, so the second conclusion
3 was: in view of the health benefits of
4 potassium and its relatively low intake, at
5 least 4,700 milligrams is recommended. That
6 is the adequate intake level for potassium.
7 And three, blacks are especially
8 likely to benefit from an increased intake of
9 potassium.
10 So in terms of our deliberations
11 on potassium, we did an initial literature
12 search, and didn't really find literature that
13 would either enhance or conflict.
14 You know, the DRI Committee felt
15 that we should be doing trials of increased
16 potassium intake, increased fruit and
17 vegetable intake, as a means to actually
18 prevent osteoporosis or prevent kidney stones,
19 but none of those trials have been done.
20 We did have a conference call from
21 one of the world's experts in this area, Dr.
22 Curtis Morris, from UCSF, and he felt that the
336
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 conclusion was accurate as written.
2 So our consensus was that, again,
3 similar to water, we'll just add key points to
4 the text.
5 So our plans are to do a PICO
6 search focusing on blood pressure as an
7 outcome and cardiovascular disease as an
8 outcome, just to make sure we're not missing
9 anything.
10 And then we are going to, either
11 here or in the sodium chapter, deal with
12 interactions of sodium/potassium as well as
13 the sodium/potassium ratio.
14 And I think also something that
15 should be done, and whether it's done as part
16 of the Dietary Guidelines or whether it should
17 be done as -- there's also an IOM panel going
18 on concurrently dealing with strategies to
19 reduce sodium.
20 It's like, if you're going to use
21 salts that replace, that are used as a
22 substitute for sodium, what is their mineral
337
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 content? There are a lot of sea salts, kosher
2 salts, other things that have been
3 recommended. And so what is the mineral
4 content?
5 And I attempted to do that myself
6 over the past few days, and it's very hard to
7 find that data, and I think it would be
8 useful, either in this report and/or the IOM
9 report.
10 So then I'll open it up for
11 questions on potassium.
12 CHAIR VAN HORN: I would actually
13 like to jump right in there, since I was on
14 that phone call when we discussed that.
15 And it's now to me, and I'm sure
16 to the rest of you, after Alanna's
17 presentation -- she showed the percentages of
18 Americans with usual intakes at or above their
19 adequate intakes. And there, right there, is
20 so clearly described, you know, the extremely
21 high intake of sodium and the inadequate
22 intake of potassium that Americans currently
338
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 have.
2 And as you get into this ratio of
3 sodium and potassium, you know, the DRIs are
4 what they are, but they're not necessarily
5 taking into consideration the fact, do we need
6 a compensatory increased intake of potassium
7 because we need to accommodate our extremely
8 high intake of sodium?
9 And you know, I mean we all would,
10 I'm sure, recommend that people cut down on
11 their sodium, but in the absence of that, the
12 fact that we're also undereating potassium,
13 and obviously it's the fruit/vegetable
14 problem, that is what would help, but right
15 there you see it very clearly demonstrated,
16 that it's a problem of both sides being
17 extreme.
18 DR. APPEL: Yes. I mean all the
19 evidence points that the two work together,
20 and they basically have sort of like opposite
21 effects 90 percent of the time.
22 The problem that I think we have
339
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 is, you know, if we want to have -- it's hard
2 dealing with interactions in the context of
3 policy recommendations. You know, if your
4 sodium intake is low, then your potassium
5 intake can be low. We can say that, but in
6 terms of like reaching the final conclusion,
7 I think we did a pretty good job.
8 Let me just go back. When we say
9 that diets rich in potassium mitigate the
10 adverse effects of salt on blood pressure,
11 that gets at the interaction question. But I
12 think we can put some more text in.
13 CHAIR VAN HORN: You know, to
14 build on the data that we now have in front of
15 us showing just how disparate we are in terms
16 of what we are currently eating versus what we
17 would need to eat in order to really do
18 justice to that statement is really
19 astronomical, I mean as far as actually making
20 that work in the real dietary situation. We
21 are so far away from that.
22 So you could use real data on a
340
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 real diet to document and demonstrate just how
2 far apart those two things are.
3 DR. APPEL: Okay.
4 CHAIR VAN HORN: I think that's
5 the point, if I'm not mistaken, that the
6 presentations that we had today, which were
7 all just incredibly valuable, are real-time
8 examples of why the science that we're
9 documenting needs to be very targeted, because
10 the diet that we're eating is totally opposite
11 of what we're discovering. And we've got the
12 real data now to illustrate that.
13 That's all. That's my suggestion.
14 Others? Do other people have
15 thoughts?
16 DR. SLAVIN: I just wonder, like
17 maybe Alanna probably already has this data,
18 where our sodium would come from in the last
19 NHANES, because probably a lot of it came from
20 dairy, didn't it? I mean I don't know.
21 Because we always say fruits and vegetables,
22 but if you look at usual intakes that people
341
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 are already consuming, where is it coming
2 from?
3 DR. APPEL: It comes from a lot of
4 food groups, but actually, the biggest one, or
5 one of the biggest, is sort of this grain and
6 baked good group, because it's used to bake
7 bread. You know, salt is put in as well as
8 sodium bicarbonate.
9 I think dairy, the GMA, or Grocery
10 Manufacturers' Association, did their own
11 analysis. It hasn't been published. I think
12 I showed a slide last time. In my
13 recollection, it's a little bit over 10
14 percent.
15 There's one figure that gets cited
16 all the time, but it just puts processed food
17 together, you know, like 70 percent. It
18 doesn't split it out much more than into the
19 groups that I think we're interested in.
20 Part of the problem is that there
21 have not been updates on sources of sodium,
22 and not just sort of like food group sources,
342
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 but where you're getting it, like at home, and
2 then outside of the home.
3 And a lot of people, you know,
4 people always say, you know, I go out to eat
5 and I get a huge bowl of sodium, but I don't
6 think there's any documentation out there,
7 even though I think most people believe that
8 is true.
9 DR. SLAVIN: But it seems like
10 there's been a move in the industry to move
11 away from sodium and towards potassium, and
12 that wouldn't be captured until later, outside
13 of any database.
14 So as the foods that are available
15 change, you're not going to get that for a
16 while.
17 CHAIR VAN HORN: I mean, I think
18 the nutrient database clearly can only keep up
19 with the food supply so quickly.
20 But to answer your question, when
21 you look at the 2005 Guidelines, in Figure 4,
22 they show in a pie chart fashion -- I'm sure
343
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 you remember it -- the segments of sodium
2 contributions, and 77 percent come from
3 processed foods.
4 DR. APPEL: Yes. Well I think
5 that's from the Mattes data, that small study.
6 I don't know. Is that the very
7 simplistic pie chart with like four or five B-
8 ? You know, that is basically old data from
9 about 60 people, and it's very tricky to
10 measure it.
11 CHAIR VAN HORN: Right.
12 DR. APPEL: And actually, it's a
13 critical research need. Where is the sodium
14 coming from now --
15 CHAIR VAN HORN: Exactly.
16 DR. APPEL: -- given the
17 changes --
18 CHAIR VAN HORN: Right.
19 DR. APPEL: -- in food consumption
20 patterns?
21 CHAIR VAN HORN: Well I would
22 hope, following up on that, that, again,
344
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 looking at the 2005 Guidelines and the data
2 and the illustrations that were provided, we
3 should be able to update every single one of
4 those on the basis of what was just shown us
5 today. I mean, that's just beautiful data,
6 and it's much more current. And it can really
7 help to drive home --
8 DR. APPEL: Yes.
9 CHAIR VAN HORN: -- the disparate
10 nature of what we're recommending versus what
11 we're eating.
12 DR. APPEL: What's happening, yes.
13 DR. RIMM: That was still 2001 to
14 2004, though.
15 CHAIR VAN HORN: Yes.
16 DR. RIMM: I assume that's where
17 the food composition databases are from. I
18 mean I think that's part of the problem is you
19 have to update the food composition
20 databases --
21 CHAIR VAN HORN: Exactly.
22 DR. RIMM: -- as well as where the
345
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 data are coming from.
2 CHAIR VAN HORN: Right. That is a
3 problem.
4 I would hope that, as we are more
5 electronic, you know, it will be possible to
6 upload the new nutrient data more quickly than
7 what was done in the past, but that's a whole
8 other topic.
9 Anyone else? Comments?
10 (No response.)
11 Great.
12 Okay, Larry?
13 DR. APPEL: All right. Okay. And
14 here's the third research question. What are
15 the effects of salt, sodium chloride intake on
16 health? And we reached two major conclusions.
17 First, the relationship between
18 salt, sodium chloride intake and blood
19 pressure is direct and progressive without an
20 apparent threshold. Hence, individuals should
21 reduce their salt intake as much as possible.
22 And the third is, in view of the
346
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 currently high levels of salt intake, daily
2 sodium intake of less than 2,300 milligrams is
3 recommended.
4 And then two more conclusions:
5 many people will benefit from further
6 reductions in salt intake, including
7 hypertensive individuals, blacks, and middle8
aged and older adults.
9 And I'll just have an aside here
10 that the CDC estimated that this actually is
11 about 68 percent of adults. So we have a
12 recommendation that the 2,300 applies to
13 around 32 percent, and a lower level, 1,500,
14 applies to this group.
15 And that individuals should
16 concurrently increase their consumption of
17 potassium because a diet rich in potassium
18 blunts the effects of salt on blood pressure.
19 And so that's the flip side, or I
20 mean both pieces of the interaction.
21 Okay, so deliberations on sodium.
22 We've had discussions on two conference calls.
347
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 There is an IOM study on strategies to reduce
2 sodium intake. I serve on that panel.
3 And as I mentioned, the 1,500
4 milligrams applies to -- actually, the number
5 is 68.
6 Christine has done an initial
7 literature search on salt in children, and
8 she's going to go through that.
9 So there is, based on the initial
10 two calls, there is potential for the
11 conclusion to change.
12 First, CVD is not mentioned as an
13 outcome in the conclusion, and I think it
14 should. We'll have to craft that.
15 Second, the upper limit applies to
16 most adults, based on the 68 percent figure,
17 and there's no statement about children.
18 So I'll also continue with this,
19 and then take questions.
20 So rather than having what I call
21 new questions, these are sort of subquestions
22 that probably would be within the same
348
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 chapter:
2 What are the health effects of
3 sodium intake on blood pressure in children?
4 And secondly, what are the effects
5 of sodium on, not just blood pressure, but
6 cardiovascular disease, stroke, coronary heart
7 disease, left ventricular mass, heart failure,
8 kidney disease, end-stage renal disease,
9 proteinuria, bone mineral density,
10 osteoporosis, gastric cancer, esophageal
11 cancer, and stomach cancer? That is trying to
12 get all your MeSH terms correct and display
13 them here.
14 And then the last is, what are the
15 health effects of sodium/potassium ratio?
16 There's been some publications on that,
17 including one from our group last week.
18 So I guess we could discuss
19 everything but that first question about
20 sodium intake in children. Christine's going
21 to present some preliminary findings on that.
22 So I'll open it up to questions.
349
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 DR. PEARSON: Larry, I wonder if
2 that IOM study of strategies to reduce sodium
3 might -- obviously, the timing is going to be
4 later, but --
5 DR. APPEL: It's concurrent.
6 DR. PEARSON: It's very
7 concurrent, but I mean the question is, could
8 that serve as essentially an implementation
9 partner with this in terms of the Guidelines
10 here then being passed on to there?
11 DR. APPEL: Yes, I think that is
12 focusing on implementation, and maybe that's
13 a lesson for us as we think about some of the
14 discussion this morning and internal
15 discussions on how to enhance dissemination.
16 Obviously, this is a single
17 nutrient. It's a bit unusual as a single
18 nutrient, and given sort of the sources of
19 sodium basically in the food supply added by
20 others, not really selected by us. So it
21 makes it a very unusual kind of nutrient where
22 you might take that approach, but I think it's
350
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 a lesson that we might want to use.
2 DR. PI-SUNYER: Larry, let me ask
3 you about question No. 2. It seems to me that
4 it's not clear whether you're talking about,
5 what are the effects of sodium on development
6 of all these conditions, or are you talking
7 about, what are the effects of sodium in the
8 treatment of these conditions? I think the
9 two are quite different, and if you get into
10 treatment, I think you are going to go on
11 forever.
12 DR. APPEL: I wasn't planning on
13 treatment. I think I'm aware of at least sort
14 of three trials in which cardiovascular
15 disease was the outcome, so taking people who
16 got some type of intervention that involved
17 reduced sodium. I think I presented last
18 time, and two of the interventions were
19 reduced sodium behavior interventions. One of
20 them was a reduced sodium/increased potassium
21 salt, and then they followed people long-term,
22 and they had differences in clinical outcomes.
351
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Those are three trials I'm aware of. And I
2 think we just need to do a search.
3 They came up, actually, earlier in
4 the comments today, the treatment issue, you
5 know, like use of sodium in people with heart
6 failure. And there was a trial that was
7 published on that topic. I don't think we
8 want to get into clinical populations like
9 heart failure patients, type I diabetics,
10 stuff like that.
11 I mean, we're not going to have a
12 clinical trial with gastric cancer and
13 esophageal cancer, but I think there have been
14 some reports. It was a diet and cancer report
15 that was completed that listed sodium as a
16 high probability risk factor for gastric
17 cancer, and I think that deserves a look at.
18 You know, none of the
19 recommendations are based on cancer
20 prevention, but on the other hand, maybe we
21 would flip into that as a recommendation,
22 depending on any new evidence.
352
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 They've done all the work, and so
2 we can just copy without plagiarizing.
3 CHAIR VAN HORN: Are you referring
4 to the AICR report? Is that the one you
5 are --
6 DR. APPEL: NCRF, right?
7 CHAIR VAN HORN: Right. Exactly.
8 Because I would agree with you that we should
9 take advantage of that full report, because my
10 recollection of it is that the single most
11 important thing is what we've been talking
12 about all day, which is reduce obesity and
13 reduce weight as being the single most
14 important thing you can do to lower your risk
15 for cancer.
16 DR. APPEL: Yes.
17 CHAIR VAN HORN: So as we engage
18 in our discussions here regarding the same
19 kinds of issues, that would appear to be a
20 useful piece of information to include.
21 DR. APPEL: And as an aside, and
22 it might be relevant to other subcommittees,
353
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 is that one, in the last 2005 Committee
2 report, two things happened.
3 One, if there was what appears to
4 be a strong, evidence-based document that is
5 completed, we used that heavily. We used that
6 for like the fruits and vegetables and cancer
7 recommendations last time.
8 And the second thing we did was
9 to, in several of the chapters -- I know this
10 was actually a lot in the lipids -- was to
11 just comment on the other recommendations, so
12 that the world realizes that we are not out of
13 the blue on any of these recommendations, not
14 that we're going to reach the same conclusion,
15 but we're often within the same sort of window
16 of either a level or general recommendation.
17 So that kind of report I think
18 would be useful and probably should get --
19 actually, I think we got copies of that from
20 after the last one.
21 CHAIR VAN HORN: If there aren't
22 other comments on that, maybe we can go to
354
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Christine to talk about children.
2 DR. WILLIAMS: Thank you.
3 Larry asked me to briefly cover
4 the topic of sodium and blood pressure in
5 children.
6 And for background, the 2005 DG
7 research questions included the question,
8 what are the health effects of sodium? But
9 the emphasis was on adults.
10 In the 2010 process, the same
11 research question will address the general
12 population, both adults and children.
13 And the rationale for addressing
14 the health effects of sodium during childhood
15 and adolescence include an expanding body of
16 scientific literature linking sodium intake
17 with blood pressure in youths.
18 This will be a subquestion: what
19 are the health effects of sodium intake on
20 blood pressure in children? And in PICO
21 format, it will cover children and adolescents
22 two to 19, looking at dietary sodium,
355
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 comparing higher and lower levels of sodium
2 intake, and the outcome blood pressure.
3 In the United States and other
4 industrialized countries, blood pressure
5 gradually increases through childhood and
6 adolescence, and the rise is about 1.9
7 millimeters of mercury per year for boys, and
8 1.5 millimeters of mercury for girls, which is
9 a rather steep increase. In adults, it's only
10 about 0.6 millimeters of mercury. So it's a
11 steep rise in childhood.
12 This is in contrast to Yanomami
13 Indians in South America, where they don't use
14 salt, and the blood pressure does not increase
15 throughout life. In fact, it remains at
16 levels that are similar to 7- and 11-year-old
17 children in the United States.
18 So the key thing is, how can we
19 decrease this rise in blood pressure in
20 children over their childhood and adolescence?
21 Some disturbing information from
22 the literature shows that comparing data from
356
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 NHANES III, 1988 to 1994, with NHANES 1999 to
2 2000, we have seen an increase in mean
3 systolic and diastolic blood pressure in both
4 boys and girls. The mean systolic blood
5 pressure has increased by 1.4 millimeters of
6 mercury, and diastolic by 3.3 millimeters of
7 mercury. And the increases have been higher
8 among minority youth.
9 Another study has shown that the
10 proportion of children and adolescents who
11 have pre-hypertension or hypertension has
12 increased in children also between 1988 and
13 1999. And there's an ethnic and gender gap
14 that also appeared for pre-hypertension in >88
15 and for hypertension in >99.
16 And this increase in obesity among
17 youth is partially explained by the rise in --
18 the increase in obesity partially explains the
19 rise in high blood pressure and pre-high blood
20 pressure during this time period.
21 This is data from the Bogalusa
22 heart study. And you can see, for the dark
357
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 green bar, children whose BMI percentile is
2 above the 97th percentile clearly have a much
3 higher risk of high blood pressure, both
4 systolic and diastolic.
5 We studied more than a thousand
6 pre-school children and found the same
7 relationship, a two to three-and-a-half
8 percent increase in likelihood of high blood
9 pressure, both systolic, diastolic, or both,
10 among children who are obese versus normal
11 weight.
12 So sodium and blood pressure in
13 childhood, besides obesity, there's evidence
14 that dietary factors, especially a high intake
15 of sodium, affects blood pressure levels in
16 children and adolescents.
17 And He and MacGregor published a
18 meta-analysis of 10 clinical trials among
19 children and three among infants looking at
20 the effects of sodium reduction in children in
21 2006. And there are many other observational
22 studies that have studied the link between
358
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 sodium and blood pressure in youth, as well.
2 This is a summary chart of the
3 meta-analysis. And for systolic blood
4 pressure for these 10 trials, which involved
5 about a 42 percent reduction in sodium intake,
6 the reduction was about 1.17 millimeter of
7 mercury for systolic, and 1.29 for diastolic.
8 Some people would say that this is
9 a relatively small decrease, but if you saw
10 this in a population approach across the whole
11 population, and if it was sustained over time,
12 it could have a significant decrease in
13 overall hypertension among adults and in
14 cardiovascular disease.
15 Sodium intake among U.S. children
16 is very high. On the left side, you can see
17 the adequate intake levels for sodium for
18 children, between 1,000 milligrams per day and
19 1,500, and the upper level, 1,500 to 2,300.
20 And in contrast, the actual sodium intake in
21 children today, you can see for the blue ones,
22 which are 2005 to 2006, the values are very
359
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 high. And in fact, about 95 percent of 5- to
2 8-year-olds and more than 90 percent of older
3 children exceed the upper level for sodium
4 intake.
5 For potassium intake in children,
6 it's very low, similar to adults. Potassium
7 intake, adequate intake for potassium is
8 between 3,000 and 4,700. There's no UL for
9 potassium.
10 And you can see that the actual
11 intake for children is about 2,000 for young
12 children, 2,300 for younger children. So in
13 fact, less than three percent of children four
14 to 18 met the AI for potassium, and that was
15 for NHANES 2001 to 2002.
16 So in conclusion, there's a trend
17 toward higher blood pressure levels among U.S.
18 children and adolescents. This was observed
19 for the decade between >89 and >99 to 2000.
20 And this trend, the increase in child and
21 adolescent obesity, explains some, but not all
22 of the trend toward higher blood pressure,
360
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 increased prevalence of high blood pressure in
2 youth. And efforts to prevent obesity in
3 childhood will be important in reversing these
4 trends.
5 But dietary intake, especially of
6 sodium and potassium, has also been shown to
7 have a significant influence on blood pressure
8 in childhood. The dietary intake of sodium in
9 U.S. youth is very high, with the majority
10 exceeding the upper limit, and there is
11 evidence that reducing dietary sodium reduces
12 blood pressure in youth.
13 Thus, Dietary Guidelines
14 emphasizing reduced sodium intake in children
15 and adolescents could prove to be an important
16 component of public health strategies to
17 reduce hypertension and related cardiovascular
18 disease.
19 Dietary intake of potassium in
20 U.S. youth is very low, with the majority not
21 meeting the AI. And since diets rich in
22 potassium can lower blood pressure and lessen
361
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 the adverse effects of salt on blood pressure,
2 Dietary Guidelines should emphasize increasing
3 potassium intake in children and adolescents
4 through increased consumption of fruits,
5 vegetables, and whole grains.
6 So the next step will be to
7 conduct a formal literature search on the
8 question, what are the health effects of
9 sodium on blood pressure in children, which,
10 again, is a new subquestion under the main
11 question, what are the effects of salt,
12 sodium intake on health?
13 The timeframe will probably go
14 back to the 1980s, since there is a lot of
15 important research to be covered, and this is
16 a new question. And again, we'll cover
17 children between birth and 19, even though the
18 Guidelines only refer to children two to 19,
19 and studies in the English language.
20 Last slide. Thank you.
21 CHAIR VAN HORN: Comments?
22 DR. NELSON: I have a question
362
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 about going back to 1980. And it's just sort
2 of the food supply was very different, obesity
3 rates were really different. I mean, children
4 were different in 1980 than they -- I just,
5 I wonder about some of the findings in 1980
6 may be not as relevant as findings in the >90s
7 and the 2000s.
8 DR. WILLIAMS: Well, I think some
9 of the important studies in the 1980s were
10 actually intervention trials where the data
11 would still be pertinent.
12 DR. NELSON: Okay.
13 DR. WILLIAMS: Some of the
14 observational studies, of course, might be
15 different when the intake is different.
16 DR. NELSON: Okay.
17 CHAIR VAN HORN: Other comments
18 from the group?
19 (No response.)
20 CHAIR VAN HORN: Larry, do you
21 want to incorporate anything from the
22 children's --
363
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 DR. APPEL: No, I think we have a
2 few things here. I don't think we have as
3 much as some of the other committees.
4 And we'd like to -- I think we're
5 in a position, at least with water and
6 potassium, to actually make -- it could be
7 prototypes, if we get those right, and then
8 review those with the whole group. You know,
9 because I think the sense is that those, and
10 particularly those chapters, you know, need
11 some, maybe some updates, and we might want to
12 repackage things a bit differently, and if we
13 agree, then at the next meeting we might say,
14 yes, this is the stamp or the general
15 approach. Others might have those examples,
16 as well.
17 Sodium is going to take more work
18 because we have literature searches on this
19 topic, on a variety of topics.
20 DR. PEARSON: Christine, I just
21 was wondering, the whole idea of the effects
22 of salt on health in children, obviously,
364
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 children tend to be healthy. But there had
2 been a number of worrisome studies looking at
3 left ventricular mass and aortic stiffness, et
4 cetera, into the adolescent years.
5 Are you going to include those in
6 terms of -- because these aren't symptomatic
7 issues, but they certainly portend pediatric
8 routes for vascular disease with blood
9 pressure and --
10 DR. WILLIAMS: There have been a
11 lot of studies looking at cardiovascular risk
12 factors and early precursors of heart disease.
13 I'm not aware of any of those studies that
14 have linked sodium in particular. It's a
15 further step away, but certainly there are
16 related to high blood pressure.
17 DR. PEARSON: I guess my point is
18 I think we should look at those, because I
19 think those would be probably the more
20 sensitive markers of this thing than maybe
21 even blood pressure. Some of those looked
22 like they were preceding the blood pressure in
365
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 some studies, it seemed.
2 DR. WILLIAMS: We could do that.
3 DR. PI-SUNYER: Christine, are you
4 thinking of looking at the interaction between
5 weight gain and sodium intake? In other
6 words, we have a lot fatter kids now than we
7 used to. And so --
8 DR. WILLIAMS: I think a lot of
9 the observational --
10 DR. PI-SUNYER: In response to
11 what Mim was saying, would there be a
12 different interaction between the taking of
13 sodium according to what your weight is?
14 DR. WILLIAMS: There have been
15 more recent studies looking at that
16 interaction, and some that deal with
17 overweight teenagers, and changes in sodium
18 sensitivity with dieting. So we will be
19 looking at that.
20 CHAIR VAN HORN: The dietary
21 intervention study in children, while it was
22 emphasizing lipids and lowering saturated fat
366
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 and dietary cholesterol in children, there was
2 one paper that related to the reduced sodium
3 intake of that population and lower blood
4 pressures that accompanied it. It was modest.
5 It wasn't a significant reduction, and that
6 wasn't the target for that study, but it at
7 least illustrated that it can be done.
8 DR. WILLIAMS: That's true.
9 CHAIR VAN HORN: Other comments
10 from the Committee?
11 Xav?
12 DR. PI-SUNYER: Larry, the other
13 question I wanted to ask you is, what about
14 the elderly as a subgroup? I mean, these are
15 people who have a huge amount of hypertension,
16 a very high prevalence. Their taste buds have
17 dropped off.
18 Is there special recommendations
19 or anything that should be done on people
20 above a certain age?
21 DR. APPEL: Well, a few pieces in
22 the puzzle. One, because they are
367
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 hypertension, their blood pressure levels are
2 high, and they're at cardiovascular disease.
3 At least if you do the modeling, these are the
4 group that really benefits immediately.
5 And in all of the analyses that
6 have been done, sodium reduction in the
7 elderly, you get more bang for your buck, and
8 it's immediate. And that's also, obviously,
9 again, the group that has high CVD. I mean
10 you get, you know, this is where you're going
11 to get a lot of benefit immediately.
12 In terms of the taste issue, I
13 think the plan is to embellish the section
14 that we have on taste. And this might
15 actually be one of those things that bridges
16 the other group at the IOM, because there's an
17 expert, Gary Beauchamp, on this.
18 But I think we dealt, to some
19 extent, with it in the previous report, but
20 not focusing on the elderly. I mean the
21 general, and it's been a while since I
22 reviewed the literature, but the general
368
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 impression is that, within five, six weeks,
2 people get acclimated. But acute reductions
3 in sodium, you know, people don't like it.
4 But gradual reductions over time, plus the
5 acclimation process.
6 Now is it different in the elderly
7 versus non-elderly? That's, I think, what
8 you're getting at. And we could check that.
9 I don't know the answer to that.
10 CHAIR VAN HORN: I'm sorry, Naomi?
11 DR. FUKAGAWA: No, that's okay.
12 Go ahead.
13 DR. PEARSON: Is the IOM study
14 looking at strategies to reduce sodium in
15 children? Do you know if they're including
16 that? The IOM study on strategies?
17 DR. APPEL: Yes, the IOM Committee
18 is interested in all stages, and children,
19 yes, you know, that's going to be part of it.
20 DR. FUKAGAWA: So my comment was
21 just, as I recall, there's a recent study out
22 about sodium intake in congestive heart
369
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 failure.
2 DR. APPEL: Yes. There are
3 actually two recent studies out that I could
4 comment on, one dealing with the heart
5 failure, and the other one dealing with the
6 sodium/potassium ratio. And I can comment on
7 both.
8 DR. FUKAGAWA: Okay.
9 DR. APPEL: So there actually has
10 been a clinical trial in the setting of heart
11 failure. It wasn't done in the United States.
12 It was done in, I think it was in Italy. It
13 was a European country.
14 A very interesting study. They
15 took people with really bad heart failure. I
16 mean, for people who are clinically-oriented,
17 these are people who are taking 500 milligrams
18 of Lasix a day, and they're on a
19 Spironolactone, and they're on an ACE
20 inhibitor. They randomized people to then
21 normal sodium versus low sodium.
22 So lo and behold, the people that
370
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 got the reduced sodium, they did worse. Now
2 why would you say that? Because they are so
3 heavily medicated beyond even what people in
4 the United States are doing. It was an
5 unusual population. It would be like adding
6 triple diuretic therapy, you know.
7 So I'm getting more familiar with
8 the heart failure literature, and I can tell
9 you there is no other trial out there. So
10 that's the last one standing, but it's in a
11 population and in a management strategy that
12 is very different from what goes on in the
13 United States. So that's the heart failure
14 study.
15 If you want a copy, I can even
16 provide it to you.
17 Then last week we published a
18 study from the trials of hypertension
19 prevention, a long-term follow-up study. It
20 was a sodium/potassium ratio.
21 And as the sodium/potassium ratio
22 increased, so did the risk of heart disease.
371
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 But when you looked at sodium/potassium
2 individually, it didn't predict.
3 But this was in the control group
4 in the TOHP study. So you have to take a step
5 back.
6 About two years ago, there was a
7 paper in BMJ that followed people who had been
8 assigned to the control group or the reduced
9 sodium intervention, and followed them up to
10 13 years. And they found a reduced risk of
11 cardiovascular disease by roughly 30, 40
12 percent. So that's an active intervention
13 versus control, and this paper dealing with
14 the sodium/potassium ratio was just looking at
15 those in the control group.
16 So if you actually put the two
17 pieces of the puzzle together, sodium
18 reduction reduced cardiovascular disease, and
19 on the basis of the most recent study, you'll
20 get more bang for your buck if you
21 concurrently increase your potassium intake.
22 And I think that's the story
372
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 within that cluster of two studies.
2 CHAIR VAN HORN: I guess that
3 would have implications, also, again, going
4 back to the data we were just discussing in
5 terms of the inadequate potassium intake that
6 we all have, including children. You know,
7 that the emphasis especially in children and
8 the School Lunch Program, et cetera --
9 DR. APPEL: Yes.
10 CHAIR VAN HORN: -- you know, in
11 driving up the dietary sources of potassium.
12 It would seem like a wise move.
13 PARTICIPANT: I think it's
14 difficult, though, because looking at a lot of
15 the foods, it was commented that most foods
16 only provide about 10 percent of the potassium
17 you need, like even a banana. So it's a
18 difficult task to get potassium up to the AI.
19 So I think we really need a lot of effort on
20 decreasing sodium as well as increasing
21 potassium.
22 PARTICIPANT: Can I just ask about
373
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 active, you know, like adolescents that are
2 very active? And I guess there is some point
3 in your discussion already that there are
4 extreme situations for electrolytes that
5 aren't reflected here.
6 DR. APPEL: It sometimes comes up,
7 you know that, well, what about people who are
8 really physically active, and they sweat off
9 a storm of sodium? You know, a lot of the
10 populations that are in these extremely low11
salt environments, you know, less than 10
12 millimoles, like the Yanomami Indians, they
13 are very physically active. What it is is
14 that, when they sweat, they sweat water, as
15 opposed to like a saline solution.
16 And there actually is even a study
17 that varied sodium intake in the setting of a
18 -- and this wasn't physical activity, it was
19 a thermal effect -- kept people in a room that
20 was like 100 degrees, and they fed them
21 different levels of sodium. And then they
22 tested their urine and their sweat and their
374
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 feces for the amount of sodium.
2 And they all ratcheted down on a
3 lower sodium intake. So basically, you have
4 compensatory mechanisms that prevent you from
5 losing sodium.
6 So getting back to your original
7 point, if people are physically active, and
8 they are routinely physically active on a low9
sodium diet, they'll do fine because they will
10 have acclimated.
11 And we mentioned this in the IOM
12 report. If you have, though, a sudden severe
13 heat stress, and you're not acclimated to
14 that, well, you're going to have problems.
15 But that's sort of an unusual bird anyways,
16 and I don't think we make recommendations for
17 sudden peculiar settings.
18 CHAIR VAN HORN: Exactly.
19 All right. Well, everyone has
20 been incredibly attentive, and the information
21 has been rich. And we've really enjoyed
22 hearing from everyone today.
375
NEAL R. GROSS
COURT REPORTERS AND TRANSCRIBERS
1323 RHODE ISLAND AVE., N.W.
(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com
1 Thank you so much.
2 We are going to adjourn now, and
3 we'll reconvene in the morning at 8:00 with a
4 discussion on nutrient adequacy.
5 Thank you.
6 (Whereupon, the Committee was
7 adjourned for the day at 4:10 p.m. to
8 reconvene the following day, Friday, January
9 30, 2009, at 8:00 a.m.)