Racial Bias in the US Dietary Guidelines

The US Dietary Guidelines are released every five years by the United States Department of Agriculture (USDA). The new 2020 – 2025 US Dietary Guidelines were released 12/29/2020.

According to the Executive Summary, “The aim of the Dietary Guidelines is to promote health and prevent disease.” The US Dietary Guidelines are recommendations for what Americans should eat, are the policy upon which USDA feeding programs and nutrition education in schools and other institutions are based, and are also the basis for nutrition education materials for use in schools and other institutions.

The USDA feeding programs include the school meal programs, among many others. The school meal programs include school breakfasts, lunches, after school snacks, and more.

Beginning more than 15 years ago, the Coalition for Healthy School Food has provided in-person oral testimony, in Washington, for the guidelines for 2010, 2015, and 2020. Each of those years, we’ve seen significant testimony before the Dietary Guidelines Committee about the disproportionate impact of the standard American diet on people of color, as well as the power of a plant-based diet to prevent and reverse chronic diet-related diseases. As a result, the US Dietary Guidelines Committee, which writes the proposed guidelines, is fully aware of this information provided by the many organizations and health professionals which focus on healthy plant-based nutrition. They provide a report with recommended guidelines, but in what is a highly political process, they don’t have the final say. The final say is highly influenced by the food industry and politics. 

One of the USDA’s missions is to promote American agricultural products, including meat, dairy, and eggs – foods that are strongly associated with diet-related diseases and which also crowd out the healthier whole plant foods. And, as noted before, another mission of the USDA is to develop and promote the US Dietary Guidelines for the purpose of helping Americans achieve good health and avoid chronic diet-related diseases. These are two conflicting missions. 

We are not the first organization to recommend that the US Dietary Guidelines efforts be moved to a different national agency, for example, the Department of Health and Human Services, or even a new agency, so that they are not dealing with a conflict of interest. Our federal government needs to prioritize evidence-based research over promoting unhealthy American agricultural products. The USDA should also be helping farmers who produce food that is not healthy transition to growing healthy plant food crops. But moving agencies alone will not be enough to change how Americans are advised to eat until “big food” stops calling the shots.

Key Takeaways from the 2020 – 2025 US Dietary Guidelines:

In the Guidelines, food recommendations are still influenced by the food industry, and the strongest evidence-based science for reversing heart disease and type 2 diabetes, and preventing other diseases, is still not mentioned.

Three main points that the new guidelines are emphasizing are the following:

1. Chronic diet-related diseases are prevalent, including heart disease, type 2 diabetes, obesity, and some types of cancer, and 50% of American adults have at least one of these. Their premise here is that everyone can benefit by shifting to healthier eating patterns.
2. The second has to do with dietary patterns, that nutrients and foods are not consumed in isolation.
3. The third is the different needs of individuals at different stages of life.

Let’s unpack each of these a little bit more.

1. Given the prevalence of diet-related diseases, in more than 50% of the adult population, why don’t the guidelines cite the diets that research has shown time and again to reverse heart disease, the biggest killer of Americans, and type 2 diabetes, another disease taking a huge toll on Americans? Furthermore, these diseases disproportionately impact persons of color, yet there is no mention of that.
2. An aspect they get right: “Researchers and public health experts, including registered dietitians, understand that nutrients and foods are not consumed in isolation. Rather, people consume them in various combinations over time—a dietary pattern—and these foods and beverages act synergistically to affect health. The Dietary Guidelines for Americans, 2015-2020 puts this understanding into action by focusing its recommendations on consuming a healthy dietary pattern. The 2020-2025 Dietary Guidelines carries forward this emphasis on the importance of a healthy dietary pattern as a whole— rather than on individual nutrients, foods, or food groups in isolation.”  This is important and something that has been at the forefront of the messaging by T. Colin Campbell, PhD. We are proud to have Dr. Campbell on our advisory board. However, the Guidelines then fail to mention the healthy dietary pattern, a whole food plant-based diet, which has been proven to reverse heart disease and type 2 diabetes and results in lower rates of the diet-related diseases, including heart disease, type 2 diabetes, certain cancers, and some autoimmune illnesses among those who follow such an eating pattern. People who follow a whole-food, low-fat, plant-based diet are the only dietary pattern as a group where people on average are not overweight. People who follow this diet rarely have high cholesterol or high blood pressure. Normally after switching to such an eating pattern, these high numbers: weight, blood pressure, and cholesterol plummet to a healthy level.

There are different dietary needs at different stages of life, and yet the overall messaging of healthy eating is much more the same than different for the various phases of life. By focusing so much on the different stages of life, they are missing the bigger picture of the benefits of a whole food plant-based diet for all. Instead of creating a framework for different life stages, they could have easily incorporated the different needs when discussing each food group.

Problems with the new Guidelines:

• The Vegetarian Dietary pattern, listed in the appendix, does not mention a fully plant-based (vegan) diet – the dietary pattern most associated with an ideal weight and lower rates of chronic diseases. Yet the fully plant-based diet has been mentioned in previous guidelines.
• The Guidelines incorporate fortified soy milk into the dairy category, but specifically eliminates other non-dairy milks from the dairy category: “Other products sold as “milks” but made from plants (e.g., almond, rice, coconut, oat, and hemp “milks”) may contain calcium and be consumed as a source of calcium, but they are not included as part of the dairy group because their overall nutritional content is not similar to dairy milk and fortified soy beverages. Therefore, consuming these beverages does not contribute to meeting the dairy group recommendation.”

• Why is their nutrient composition different? Because many of them don’t contain as much protein. Yet, despite all the protein hype in this country, protein is not considered a “nutrient of concern” and most people get too much. Too much animal protein has many negative health consequences.

• The failure to address the impact of dairy on persons of color is a huge omission, and to continue promoting dairy as a major part of the diet when it makes a huge percentage our population sick is unconscionable.

• We see this racial bias on a regular basis because the US Dietary Guidelines are taught in school as the MyPlate Guide. This is the pictorial representation of the US Dietary Guidelines. Children who are experiencing tummy aches, constipation, and diarrhea daily are not learning that the cause could be dairy, which they are encouraged to have 3 – 4 times a day. Forty to fifty-three percent of African American and Latinx Americans will get type 2 diabetes at some point in their lives, compared to 33% of the population overall. Teens that have type 2 diabetes already are not learning that it could be reversed with a low-fat, whole food plant-based diet. We can not have equity until healthy foods, and evidence-based nutrition education is available to all.

• Under “Protein Foods” meat, poultry, eggs, and seafood are listed before nuts/seeds/soy products. In the Executive Summary, beans, peas, and lentils are left completely out of the protein group even though where they are listed under vegetables it mentions that they can count as a vegetable or a protein. This is a huge omission, especially since the image of that category seems to include a bean. Beans, peas, and lentils should be the first grouping of food listed under “protein foods” never mind that they were directly omitted from this category. In the narrative that discusses protein, it does make reference to beans, peas and lentils, but most people don’t read the details, they look at the summaries and the images that illustrate those summaries.

• Here again, the failure to address the impact of meat, dairy, and eggs on persons of color is a huge omission. While foods and beverages that come from animals are problematic for all people, they are far more so for people of color.

• Aside from directly excluding beans, peas, and lentils from the protein group, the guidelines note that “Protein also is found in some foods from other food groups, such as dairy.” Actually, protein is found in all whole foods, including all whole plant foods. Fruit is really the only category where the amount of protein is on the lower end. As a percentage of calories, vegetables and grains, and to a lesser extent, fruits, are also sources of protein in the diet.

• Five years ago, the Dietary Guidelines Committee, to their credit, tried to get environmental considerations mentioned as part of the US Dietary Guidelines. That’s because the single biggest thing any individual can do to work to reverse climate change is to eliminate or at least reduce the animal products in their diet. Politics prevailed and this recommendation was discarded and not included in the final 2015 Guidelines, with the reasoning that the Dietary Guidelines are about nutrition only and don’t take into consideration other factors. Really? They have, for a long time now, included exercise, and they still do. They also include cost of food. The problem is that climate change creates huge climate events that harm and kill people, and the warming environment brings diseases from warmer climates to places they were never before seen. In addition, the warming climate and climate events have a huge and negative impact on food crops. The continued omission of the impact of diet on the environment is a real shame.

• Clicking over the MyPlate page, I took a quiz. For each group it asked me how often I ate foods from each of the categories. It also asked if I was vegetarian (vegan was not an option). Even though I clicked yes for vegetarian, and even though I said I ate foods from the plant-based proteins, and fortified soy milk more than 6 times a week each (the highest number of servings you could choose in each category), the results were that I needed help in the protein and dairy category, and it sent me to a list of recipe’s that could help: most of which contain chicken, none of which were vegetarian (never mind vegan) but also angel food cake (5 grams of protein per slice)… It’s obviously a major problem to tell vegetarians (or vegans) to each chicken, and why would they be recommending angel food cake???

There is a lot more to unpack about why these guidelines are unlikely to help anyone get healthier, including lack of direct messaging about the benefits of a plant-based diet. It is our hope that the new incoming administration will prioritize the health of people over the profits of “big food” and make the US Dietary Guidelines truly fulfill the stated purpose… to promote health and prevent disease.