The Dietary Guidelines Experiment: Part 1
It’s difficult to believe that fifty years have passed since the first ‘consensus’ medically oriented, population-wide dietary guidelines aimed at stopping heart disease and obesity were conceived.
Particularly in light of the fact that heart disease is still the leading cause of death in developed nations and obesity has reached global epidemic proportions.
And considering that type 2 diabetes has continued its dreaded march across the globe and Western populations now have a significant and growing problem with food allergies, food intolerances, gastrointestinal diseases and autoimmunity – particularly in the younger generation. (Curiously, many people report relief from symptoms of several of these conditions by following diets which are not in line with today’s State sanctioned dietary guidelines).
While the role of sugary, refined grain and seed oil based Western food in the epidemic of chronic disease is uncontroversial and widely accepted, critics are now suggesting that there is an elephant in the room.
More to the picture.
Fifty years of dietary guidelines have simply failed to put a dent in the chronic disease mess that now affects millions upon millions of citizens.
The reasons why require a careful examination of history.
This series of articles will traverse the last fifty years of the ‘heart healthy’ population-wide dietary advice and reveal some interesting aspects of its little-known history.
The Scandinavian ‘consensus’ diet
On May 3, 1968, simultaneous press conferences were held in Oslo, Norway; Stockholm, Sweden; and Helsinki, Finland by the Medical Boards of the respective countries. The statement read “The National Board of Health and Welfare of Sweden together with the Medical Board of Finland and the Medical Board of Norway has elaborated and issued dietary recommendations for the populations of these countries…The recommendations now put forward are based on a suggestion made by the Nutritional Section of the Swedish Medical Society. For reasons of principle the Medical Board of Denmark cannot officially endorse the above recommendations but nevertheless intend to see that they will be published.”
The document itself was titled ‘Medical Views on Diet in the Scandinavian Countries’ and little did anybody know it at the time, but the ideas contained in it would have ramifications for not just unsuspecting citizens around the world, but for governments, hospitals, the military, schools, and the commodities, processed food and pharmaceutical industries.
The plan to alter national diets
The document was not just an expression of medical views regarding diet, but a call to arms about the need to deliberately alter the national diets of Scandinavian countries to prevent heart disease and obesity. “In Scandinavia, as in many other countries which are highly developed, eating habits have changed considerably during the twentieth century. The most notable change is a decrease in the total consumption of cereal products and an increase in the total consumption of fats. The consumption of sugar has also risen a great deal since the turn of the century…Nowadays people eat fewer potatoes than they did previously but on the other hand more vegetables, fruit and eggs.”
The tendency for citizens to consume too much sugar and fat was considered by the statement’s authors to be indicative of a ‘faulty diet’ which might have many adverse consequences. The authors claimed that a ‘faulty diet’ could result in too many calories which would lead to obesity. In addition, the authors cited a “close connection between the development of atherosclerotic cardiovascular diseases and the serum cholesterol level.” Moreover, “a diet rich in saturated fatty acid has an increasing effect on the serum cholesterol” while “consumption of polyunsaturated fatty acids brings about a change in the opposite direction.” The authors stated that both the quantity and type of fat in the diet in addition to other factors besides fatty foods, likely also contributed to atherosclerosis.
In an attempt to pursue a nationwide heart disease and obesity reduction programme, the national diets of the Scandinavian countries would have to change. “If we want to try and prevent the disease by means of a special diet, it should be introduced at an early stage and the change of diet should apply to the whole population.”
Experts agree to agree
The Scandinavian consensus group put forward six recommendations for dietary change, which should include 2000 calories (or less) of food per day and focus on reducing fat to between 25 percent and 35 percent of calories. The consensus document itself was not supported by much in the way of national food consumption statistics for the countries involved, solid scientific evidence supporting each of the board’s recommendations or even projected outcomes in terms of public health improvements to support the change – but who was really in a position to argue?
The recommendations put forward are as follows:
- The dietary energy supply should, in many cases be reduced to prevent overweight
- The total fat consumption, at present about 40 percent, should be decreased to between 25 and 30 percent of total calories
- The use of saturated fat should be lowered, and the consumption of polyunsaturated fat should be simultaneously increased
- The consumption of sugar and products containing sugar should be less
- The consumption of vegetables, fruits, potatoes, skimmed milk, fish, lean meat and cereal products should be increased
- From the medical and nutritional standpoint, the importance of taking regular exercise from an early age for all those who have mainly sedentary occupations should also be emphasised.
Carrying out the programme
Changing a nation’s diet is no easy task and the authors of the consensus document knew they would need help – particularly from academics, nutritionists, those who cater to schools, military, hospitals and other institutions and eating places. The food industry also needed to be involved – by choosing suitable commodity materials and specifying the contents of packaged foods. Caterers should calculate the nutritional value of foods in line with the new requirements and the media should also be involved, promoting consumer information to support the new nutritional recommendations.
Sweden’s national experiment
In 1969, the Swedish National Board of Health and Welfare took many of the recommendations put forward by the medical consensus group on board and pushed for a 10-year campaign aimed at changing the national diet. It was a curious move, given that heart disease in Sweden was not considered to be a major problem and nowhere near the levels observed in the United States. The leading causes of death for both men and women was suicide followed by car accident. Ischemic heart disease killed four times as many men than women and was more common in northern Sweden, than the south – indicating other factors at play.
Obesity statistics do not seem to exist for Sweden’s population in 1968-69 however military conscription records indicate that obesity was rare among young men at the time. In addition, Sweden’s annual per capita consumption statistics reveal that sugar, fat and oil consumption had been in decline since 1960 while vegetable and fruit consumption was slightly up.
In spite of this, the public health experts pressed ahead. The recommended dietary changes (based upon average food consumption data from 1960) were as follows:
- Green vegetables, dried peas and beans (+100%).
- Fruit (+50%).
- (a) Potatoes (+25%); (b) Other root vegetables (+100%).
- Standard milk (+25%).
- Meat, fish and eggs (±0).
- (a) Flour, meal macaroni for direct consumption (+25%); (b) Crispbread and soft bread (+25%).
- Fats and oils (-25%).
- Other products: sugar, syrup, sweets etc (-25%).
Swede’s take heed
In 1974, Sweden measured the impact of a portion of the new recommendations.
- Sugar consumption declined from 27.89kg to 21.68kg.
- Fresh vegetable consumption increased from 14.5kg to 20.3kg.
- Poultry consumption increased from 1.49kg to 3.99kg.
- Potato consumption declined from 86.81kg to 65.72kg.
- Consumption of certain fruits declined although the overall pattern remained stable.
- Fat consumption declined from 41 percent of energy in 1965 to 38 percent of energy in 1974.
Statistics also show that:
- Starch consumption (pasta, noodles and flour), which had been in decline, started to increase.
- Milk consumption, which had been in decline, started to increase.
Clearly, the Swedish people, for the most part, started to change their diet. Sugar and fat consumption continued to decline and fresh vegetable, milk and starch consumption increased.
The giant consensus-based, population-wide experiment was starting to work.
The experts had successfully disrupted the diet of around eight million citizens.
One of the architects of the scheme was Professor Arvid Wretlind, then Professor and Head of the Department of Nutrition and Food Hygiene at the Swedish National Insitute of Health and Scientific Advisor to the Swedish National Board of Health and Welfare. Wretlind passed away in 2002, however, historians have noted “During that time (1962-1970), his main activities were to try to improve the food habits of the Swedish population. He was gratified that they were successful in introducing a diet containing less fat and more unsaturated than saturated fats. He was also responsible at that time for achieving a lower sugar intake and a higher fiber intake in the diet.”
The Scandinavian diet project and subsequent evidence of public compliance likely influenced the minds of diet experts from around the world. The idea of imposing universal dietary instructions – or as the Swede’s might say ‘changing the national diet‘ – however ill-conceived, under-researched or well-intentioned, started to spread.
Sources: (1.) Keys, A., ‘Official Collective Recommendation on Diet in the Scandinavian Countries‘ Nutrition Reviews, Sept. 1968, Vol. 26, No.9, pg. 259-263 (2.) ‘Dietary Goals for the United States’, Second Edition, Washington, 1977 (3.) ‘Juul, F., Hemmingsson, E., ‘Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010‘, Public Health Nutrition: 18(17), 3096-3107 doi:10.1017/S1368980015000506 (4.) Wall, S., Rosen, M., Nystrom, L., ‘The Swedish Mortality Pattern: A Basis for Health Planning?’; International Journal of Epidemiology (1985), Vol. 14, No.2, pg. 285-292 (5) Shenkin, A., ‘Obituary, Professor Arvid Wretlind‘, Nutrition, February 2003, volume 19, Issue 2, pg. 203
Part 2 coming soon…