Download Dietary Guidelines For Americans 1980 1985 1990 1995

1980
I’ll begin with an overview on dietary advice in the United States,
how it evolved and how the current Dietary Guidelines sit in the
context of many prior Guidelines.
1985
1990
1995
There have been many Dietary Guidelines. Every five years a new
committee is formed and members are asked whether there have
been any important developments since the last iteration. Not
surprisingly, every five years Committee members say, “Yes there
has been important research.”
That being said, the
recommendation that is relevant to milk has been for many years
the exact same statement. "Eat a variety of foods." If you dive into
this section of each Guideline, one of those foods is milk, and you
are supposed to drink it as part of a varied diet.
Dietary Guidelines For Americans
• Jointly developed by HHS / USDA
• Science-based advice for ages 2+
Evolution of Food Guidance at USDA
– Promote health
– Prevent chronic disease
• Federal nutrition policy / programs
Food for
Young
Children
1916
• Vehicle to speak with one voice
1940s
The Dietary Guidelines for Americans is the central document in
the United States for science-based nutrition advice for people
ages 2 and older. The Guidelines are supposed to promote health
and prevent chronic disease, but I think the most important
contribution is not the health education of individual Americans,
but rather its impact on Federal policy and programs. Every day
approximately one in five Americans consumes some food that has
been provided to him or her by the government in many different
ways. So when one changes the Dietary Guidelines, one starts to
change the food supply in the country. To me, that is the most
important aspect of this work. The Guidelines also allow all of us,
in theory, to speak with one voice, provided the recommended diet
is science-based and people can agree on the evidence and how to
interpret it.
1970s
1950s-1960s
Milk: 2 to 3
cups / day
1992
The Dietary Guidelines actually have a distant cousin and that is
the Food Pyramid, but please note that they are not the same thing.
If you go back, the first “food guidance” system started in 1916
and every few decades it has been updated. These food guidance
systems were created to teach Americans about healthy eating.
One of the important points that I learned by looking through these
old versions is that the milk recommendations were actually
significantly higher in the past. If you look, for instance, in the
1940s, children and adolescents were recommended to have three
servings a day. In the 1950s and 1960s teenagers were encouraged
to have four servings a day. And in 1992 we had the introduction
of the famous Food Pyramid, which actually recommends two to
three cups per day. Now, if you drill down and look in late
childhood and adolescence, the recommendation is three cups per
day. So it is interesting that in the age group where we have had
some concerns over the past two days of this conference, the
recommendation during 1992 to 2004 was for three servings; and
it is only in the other periods of life that two servings were
recommended.
2005 US Dietary Guidelines: Milk and Milk Products
Carlos Camargo
1
Pyramid. So, again, the Food Pyramid is a separate process from
the Guidelines themselves.
2000
Members of 2005 DGAC
Janet King, PhD, RD (Chair)
Children’s Hospital Oakland Research Institute
Oakland, CA
Lawrence J. Appel, MD, MPH
Johns Hopkins Medical Institutions
Baltimore, MD
Yvonne L. Bronner, ScD, RD, LD
Morgan State University
Baltimore, MD
Benjamin Caballero, MD, PhD
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD
Carlos A. Camargo, MD, DrPH
Harvard University
Boston, MA
Fergus M. Clydesdale, PhD,
University of Massachusetts, Amherst
Amherst, MA
In 2000 there was another iteration of the U.S. Dietary Guidelines,
and I think most people would agree that one of the unfortunate
things that happened that year was that instead of saying, “ eat a
variety of foods,” the 2000 Guidelines said “Let the Pyramid guide
your food choices.” In other words, that 1992 educational tool, the
Food Pyramid, which was created by the U.S. Department of
Agriculture for teaching Americans what to eat, became the driver
of the Dietary Guidelines instead of vice versa. In 2005 one of the
first things that we Committee members agreed upon was that the
Dietary Guidelines should drive the Food Pyramid content and not
vice versa.
Vay Liang W. Go, MD
University of California at Los Angeles
Los Angeles, CA
Penny M. Kris-Etherton, PhD, RD
Penn State University
University Park, PA
Joanne R. Lupton, PhD
Texas A&M University
College Station, TX
Theresa A. Nicklas, DrPH, MPH, LN
Baylor College of Medicine
Houston, TX
Russell R. Pate, PhD
University of South Carolina
Columbia, SC
F. Xavier Pi-Sunyer, MD, MPH
Columbia University
New York, NY
Connie M. Weaver, PhD
Purdue University,
West Lafayette, IN
The members of the 2005 Committee are listed here. The person
who I think played the strongest role in terms of milk
recommendations was Connie Weaver, who is a popular speaker
and prolific writer who focuses on osteoporosis and how milk
relates to peak bone mass. And I have to comment, having
listened to all the presentations here; this may be one of the first
conferences on milk that has had no presentations on bones and
bone health. I think that is what makes this conference so
extraordinary, our focus here on all the other potential effects of
milk. However if you lived in a world of bone health and
osteoporosis and fractures, you'd have a very different view of the
value of milk and milk products, as Connie does.
Process for 2005 Guidelines
May 2003
Aug 2003
Dietary Guidelines
Advisory Committee
Major Topics
1. Aiming to meet nutrient intake recommendations
Aug 2004
Jan 2005
Dietary Guidelines
for Americans
Apr 2005
USDA Food Pyramid
2. Energy
Federal
Food
Policy
3. Discretionary calories
4. Fats
5. Carbohydrates
6. Selected food groups (e.g., fruits & vegetables)
7. Fluid and electrolytes
The process involved three phases. The first was formation of the
Advisory Committee, which is supposed to review the science.
Next came the writing of the actual Dietary Guidelines, which are
a summation of that science written by the staff at the Departments
of Agriculture (USDA) and Health and Human Services (HHS).
At the risk of offending someone, I can tell you as a participant
who survived this process that it was wonderful to have Health and
Human Services there because the conflicts are quite real and at
times quite distressing. In fairness to the USDA, they are in a very
awkward spot where they are trying to promote agriculture (which
now means the food and beverage industries) at the same time as
they are trying to create healthy diet recommendations. We heard
repeatedly that, “all foods are part of a good diet” and that, “there
are no bad foods” and so forth. So it was helpful to have people
from HHS there to remind us of the purpose of the entire project –
to develop science based advice to promote health and prevent
chronic disease. Finally, from the official Dietary Guidelines, the
USDA then had a second chance to come up with their own spin
on the data in creating their instructional tool, the new Food
8. Ethanol
9. Food safety
In any case, the whole spectrum of diet was reduced to these nine
neat categories or chapters. It’s important to recognize that one of
these categories, # 6, was what we might call a “potpourri” chapter
for things one can't quite put under protein or under fat, things that
don't quite fit anywhere else. This chapter housed fruits and
vegetables, whole grains, and milk.
Milk, Hormones & Human Health
October, 2006
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more fruits and vegetables. There was nothing controversial about
recommending more whole grain. So, really, the controversy for
item #6 was about milk. And as I have told Walt (Willett) and
others, I was focusing my time primarily on trans fats, sugarsweetened beverages, alcohol and food safety. So this milk
recommendation was a less important concern.
9 Key Messages
1.
Consume a variety of foods within and among the basic food groups
while staying within energy needs
2.
Control calorie intake to manage body weight
3.
Be physically active every day
4.
Choose fats wisely for good health
5.
Choose carbohydrates wisely for good health
6.
Increase daily intake of fruits and vegetables, whole grains, and
reduced-fat milk and milk products
7.
Choose and prepare foods with little salt
8.
If you drink alcoholic beverages, do so in moderation
9.
Keep food safe to eat
1. Nutrient Adequacy
Recommendation:
Consume a variety of foods within and among the
basic food groups, while staying within energy needs.
Basic food groups are:
– Fruits
– Vegetables
– Grains
– Milk, yogurt and cheese
– Meat, poultry, fish, dry beans, eggs, and nuts
Here are the 9 Key Messages that emerged from each chapter. As
we reviewed the evidence behind each of these different areas, the
areas of major controversy were without question, fats,
carbohydrates and then this potpourri chapter for selected food
groups.

When you look at the actual recommendations and how they relate
to milk, one of the issues related to nutrient intake and the other to
the presence of milk in the “selected foods” group. Finally, I
recall some discussion about fluids and electrolytes, and
specifically potassium intake – something that I know Walter
wants to return to shortly. So this was the basic structure of our
work. And then the Committee, broken into subcommittees,
reviewed the scientific literature in a systematic way. This aspect
of the Committee work was very well done. And here are the
recommendations that we gave to the Secretaries of USDA and
HHS. For nutrient adequacy, it was the old, “eat a variety of
foods,” and one of those food groups was, of course, milk.
Areas of Consensus (6)
1. Consume a variety of foods within and among the
basic food groups while staying within energy needs
2. Control calorie intake to manage body weight
3. Be physically active every day
----------

7. Choose and prepare foods with little salt
8. If you drink alcoholic beverages, do so in moderation
9. Keep food safe to eat
1. Nutrient Adequacy
The conclusions for other areas were pretty straightforward – even
if it did take a lot of discussion to actually recommend that people
should exercise more to keep off weight, and that people should
choose and prepare foods with little salt.
(continued)
Nutrient Intake
• Adults do not consume enough vitamins A, C, and E;
calcium; magnesium; potassium; and fiber.
• Children do not consume enough vitamin E, calcium,
magnesium, potassium, and fiber.
Areas of Controversy
• At the same time, in general, Americans consume too
many calories and too much saturated and trans fat,
cholesterol, added sugars, and salt.
4. Choose fats wisely for good health
5. Choose carbohydrates wisely for good health
6. Increase daily intake of fruits and vegetables,
whole grains, and reduced-fat milk and milk products
And if you look a little more into the nutrient adequacy, the focus
was, of course, the low calcium intake of Americans.
Approximately 70 percent of the calcium intake for Americans
comes from milk and, like it or not, if you look at the calcium
intake of adolescents, it is abysmal; it is very low. For example, 70
percent of 9 to 18-year-old boys have less than adequate intake.
92 percent of 9 to 18-year-old girls have less than adequate intake.
So in a world where you are trying to increase calcium intake and
simultaneously increase potassium and, perhaps Vitamin D; milk
looks quite attractive.
4. Choose fats wisely for good health – avoid solid fats
5. Eat more whole grains and less added sugars
6. Increase daily intake of fruits and vegetables
But what about those areas of controversy? Here are the actual
recommendations and below what I would have preferred, perhaps
in 2010. There was nothing controversial about recommending
2005 US Dietary Guidelines: Milk and Milk Products
Carlos Camargo
3
1. Nutrient Adequacy
A brief word on potassium, our recommendation was to increase
consumption of foods with potassium, which I think is sound.
However, I remember repeated references, which I found
somewhat surprising, that milk was a great source of potassium.
Again, Walt will comment on that shortly.
(continued)
Special Groups
Iron:
For adolescent females and women of
childbearing age
Folic Acid:
pregnant
pregnancy
For women capable of becoming
and in the first trimester of
Vitamin B12:
For those over age 50
2005 Dietary Guidelines
(Jan 2005)
• Overall message
– Eat fewer calories
– Be much more active
– Make wiser food choices
Vitamin D:
For the elderly, persons with dark skin,
and persons exposed to insufficient
UVB radiation
• ↑ consumption
– Fruits & vegetables
– Whole grains
– Non-fat or low-fat milk
And Vitamin D was a focus of discussion. Unfortunately, that
conversation got cut short because we had to rely on the Institute
of Medicine’s (IOM) Daily Recommended Intake (DRI)
documents, and the Vitamin D report is almost a decade old and
probably out-of-date. Accordingly, our hands were tied.

• Eat less
– Salt (less than 2300 mg)
– Solid fats, including trans fats (as low as possible)
– Added sugars, especially sugar-sweetened beverages
Well, in the end, here is a summary of the 2005 U.S. Dietary
Guidelines in one slide. The messages are very common sense,
and, of course as this audience knows, there was a
recommendation to increase consumption of -- remember those
foods to encourage? – milk. Yes, to my later dismay, I realized
that milk had become a fruit and vegetable, which I think is
somewhat unfortunate.
But please don’t misconstrue this
criticism. There were a lot of good things in those 2005
Guidelines, for instance, specific instruction about eating less salt,
specific advice about cutting trans fats, a specific focus on sugarsweetened beverages in relation to obesity, and more. The linkage
of sugar-sweetened beverages to obesity was something that had
not been done before by a U.S. government agency.
6. Selected Food Groups
Recommendation:
Increase daily intakes of fruits and vegetables, whole
grains, and reduced-fat milk and milk products.
Fruits and Vegetables:
At 2000 kcal/d, 9 servings (4-_ cups)
Whole Grains:
At least 3 servings (3 ounces) per day
 Milk:At 1600 kcal/day or more, 3 cups of non-fat or low-fat
milk (or the equivalent)
The specific recommendation for milk is shown here: at 1600
kcal/day or more, 3 cups of non-fat or low-fat milk (or the
equivalent). It later occurred to me that this simple
recommendation had magically elevated milk to the level of fruits
and vegetables and whole grains, but that’s another story.
7. Sodium and Potassium
Recommendation:
Choose and prepare foods with little salt.
•
•
•
•
•
Nearly all Americans consume substantially more salt than
they need.
The general goal for adults is to consume less than 2,300 mg
of sodium per day.
Many persons will benefit from reducing salt intake even more.
At this point, in early 2005, the USDA got their chance to review
and revise these messages as they prepared the materials for
educating the public, the new Food Pyramid. And I am not sure
how happy the average USDA person was, but I do know that a lot
of other people in the food and beverage industries were very
unhappy. And so when the new Pyramid emerged about four
months later, I must tell you, it was a profound disappointment. I
think all of you would agree that this graphic, with a little skinny
person climbing stairs next to a rainbow, well, it conveys very
little information. And this was the result of more than $2 million
of research. What a disappointment. Nevertheless, the actual
At the same time, individuals are encouraged to
increase their consumption of foods rich in
potassium. Potassium lowers blood pressure and
blunts the effects of salt on blood pressure.
Increase potassium to at least 4,700 mg daily.
Milk, Hormones & Human Health
October, 2006
4
Dietary Guidelines persist and I’m pleased to report that they are
changing the American food supply in many ways, for instance,
the school lunch program. Today there will be almost 30 million
kids having a federally funded school lunch and their diet is
changing for the better as a result of the recommendations by our
group.
If you go to the My Pyramid website, which has been provided by
the USDA, there is a little more information about actual food
products. I am not sure what you are supposed to learn quickly
from this site; but here it is, milk, with the recommendation of
three cups.
Summary
To surprise of many, the 2005 Dietary Guidelines
adopted most of the DGAC advice
• Focus on CALORIES
• More “realistic” times for PHYSICAL ACTIVITY
• MORE fruits & vegetables, whole grains
• LESS solid fats, sugar-sweetened beverages
In summary, and to the surprise of many, the 2005 Dietary
Guidelines adopted most of the Advisory Committee’s advice.
Many of the recommendations were significant improvements
from the 2000 Guidelines. With regard to milk, and looking at the
transition from the 2000 to the 2005 Guidelines, for the adolescent
group that is of perhaps greatest concern, there actually was no
change; both Guidelines recommended three cups. For the rest, in
other words, the younger and the older groups, the milk
recommendation went from two to three servings. My take on it,
at the time, was that there were other battles to fight, and so this 1cup increase went through without much concern on my part. As
you’ve seen from the data presented over the past days, it's not
exactly clear, at least in my mind, that there is a major health
hazard. We need continued research on the effects of milk on
health to resolve lingering doubts.
2005 US Dietary Guidelines: Milk and Milk Products
Carlos Camargo
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