New Dietary Guidelines May Cause Confusion

A new set of dietary guidelines to promote healthy eating has many physicians wondering how well their patients will practice what is preached.

The guidelines, released Wednesday by a panel of experts at the National Academies' Institute of Medicine in Washington, D.C., expand the recommended daily intake ranges of carbohydrates and fat, but leave the previous protein intake unchanged. (See table below)

The guidelines also double the amount of exercise recommended daily to maintain a healthy weight from 30 minutes to one hour.

The aim is to help refocus dietary concerns on different priorities, explains panel member Dr. Benjamin Caballero, director of the Center for Human Nutrition at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore.

But if the new numbers read like Greek to you, you are probably not alone.

"People in my community are confused about what they hear in the news about nutrition recommendations and many lack understanding of the scientific method for evaluating the evidence presented," says Dr. Janice Gable, a physician in rural Konnarock, Va.

These confusing new percentages are impractical and may make a bad situation even worse, say some, as the battle between low-fat and low-carb diet gurus wages on and the American waistline continues to expand.

"The 'Diet of the Day' barrage our patients receive creates a lot of confusion. The rampant publication of dietary anecdotes, coupled with the huge industry of those making money from the dietary and exercise business, creates even more confusion ... These new guides will do nothing to help," says Dr. David M. West, program director of St. Mary's Family Practice Residency in Grand Junction, Colo.

"For years I have instructed my patients to eat a variety of foods, have small amounts of fats from animals, and exercise every day," he says. "Nothing I have ever read is better advice than this."

Individualized Nutrition

Not everyone was so critical of the new guidelines. Nutritionists are applauding the latest changes, which reflect a wider range of options from which healthful diets can be constructed.

"The range allows development of eating plans that meet an individual's needs, rather than a 'one size fits all,'" says Connie Diekman, director of University Nutrition at Washington University in St. Louis.

"As a dietitian, I have always used the numbers as points of reference and then I develop eating plans from there," she says. "This seems to make healthy eating much more enjoyable and easier."

Yet some worry that without help like Diekman's, many people will fall short of their healthy eating goals.

"By increasing the amount of carbohydrate to 65 percent and the fat to 35 percent, all we are doing is 'biggie'-sizing our French fries," says Dr. Tim Tobolic, a family physician from Byron Center, Mich.

"My patients, unless they have spent considerable time with a dietitian or significant self-study, don't pay attention to grams, weight or portion sizes, let alone percentages," he says. "I'm not saying they shouldn't, but they don't."

Caballero acknowledges that interpreting these numbers may be daunting for the average American, but says that the panel's recommendations are meant to be interpreted for the public by other sources.

"Now a number of agencies and other committees will have to translate this into educational programs, guidelines, food labeling and many other activities and so the impact of our report is rather indirect," he explains.

Active Weight Loss

In addition to creating a wider range of nutrient intakes, the new guidelines place considerable emphasis on physical activity. New daily caloric recommendations vary based on activity level, and the panel also recommends a total of one hour of moderate exercise daily.

For many who have trouble meeting the surgeon general's current recommendation of 30 minutes a day, an hour of exercise may seem impossibly unattainable, and some physicians are wary of this possible interpretation.

"I fear that an hour a day for most people will be so far from the current activity levels, that it will seem overwhelming and thus fail as a recommendation," says Dr. Philip Ades, a cardiologist from the University of Vermont in Burlington. "Why put out a recommendation that is highly unattainable?"

Panel experts suggest this goal may not be out of reach, saying that it is a total of all daily activity that counts, not just the solid sweat-in-the-gym exercises.

"Vacuuming, unloading the car — everything counts," says Caballero. "Of course, small activities count for less, but you can change your lifestyle from the time you get up until the time you go to bed and really increase the calories you burn."

With a little interpretive help by health-care experts about how best to merge activity and healthy eating, some hope the new guidelines will be able to accomplish their goal of improved public health and curbing the American epidemic of obesity.

"Providing this information to the public will hopefully allow people to realize that healthy eating isn't about perfect, it's about finding the right balance with the foods you like," says Diekman.