With the July publication of the Scientific Report of the 2020 Dietary Guidelines Advisory Committee, it has become obvious that when it comes to describing what constitutes a healthy diet, the grain-based foods industry and the nutrition science community speak completely different languages. Because of how flour based-foods are characterized in the report the milling and baking industries have good cause to be pessimistic about how wheat-based foods will be portrayed in the Dietary Guidelines for Americans.
For decades, the milling and baking industries have promoted enriched grains as foundational to public health, and for a long time the authors of the Dietary Guidelines agreed. The enrichment of wheat flour and rice with B vitamins and iron helped propel grains into the coveted base position of the Food Guide Pyramid when it was introduced by the US Department of Agriculture. The stature of complex carbohydrates appeared to be bolstered in 1998 when fortification was mandated for enriched grains with another B vitamin — folic acid.
Fast forward to 2020, and in the 835-page scientific report of the DGAC, the role enriched grains have played in good health has been expunged. In the body of the report, the term “enriched grains” appears once. By contrast, the pejorative and vague expression “refined grains” appears 50 times, consistently as something to avoid. Overlooking the demonstrated benefits of folic acid fortification, the report urges women of child-bearing age to reduce intake of refined grains for “optimal pregnancy outcomes.” Whole grains, by contrast, are adulated throughout the report, even as the committee acknowledges 98% of Americans fail to consume recommended levels.
At the heart of the widening communications gap are the growing numbers of Americans who are not making healthy eating choices, as measured by record rates of obesity, type 2 diabetes and other chronic diseases, and the research the DGAC uses to understand and address what’s often characterized as a worsening health crisis.
Central to the DGAC analysis is an increased focus on dietary patterns. The concept, introduced in the Guidelines in 2010, is predicated on the sound idea that people don’t eat individual foods (grains, dairy, added sugars …) in isolation but various recurring combinations. The committee’s reliance on dietary patterns also is premised on the theory that components in dietary patterns have “interactive, synergistic, and potentially cumulative relationships that can predict overall health status and disease risk more fully than can individual foods or nutrients.” Dietary patterns are a centerpiece of the report.
What’s lost in translation is how the committee makes recommendations about individual foods based on dietary patterns. The committee found that food components to limit, such as added sugars, solid fats and sodium, often are consumed in products containing grains, such as desserts, breakfast cereals, burgers, sandwiches and mixed dishes such as pizza. The committee then recommends consuming fewer refined grains.
The fallacy of this approach is evident in a review of how Americans ate in the 20th century. Per capita flour consumption was higher than current levels in 63 years during the 1900s, yet obesity rates were far lower as was the incidence of type 2 diabetes. There is no shortage of evidence Americans can consume flour-based foods at current or higher levels without becoming obese. By contrast, per capita intake of added sugars was below current levels in 15 years of the 1900s; for added fats and oils, per capita intake was below current levels in zero years during the 20th century. In other words, grains aren’t the problem.
Together with the growing popularity of diets that encourage the avoidance of grains, the advice to reduce intake of refined grains has taken a toll. The DGAC estimates that 50% of Americans currently consume total grains at levels below recommendations. Without concerted efforts by grain-based foods, the consumption deficit is likely to grow in coming years with harmful consequences for the health of the American public and of the industry.