By The Nutrition Coalition
USDA-HHS finally announced the members of the advisory committee for the 2020 Dietary Guidelines, a powerful group of experts who will determine what constitutes a healthy diet. Their work has implications not only for nutrition and health in the United States but is likely to influence food policy globally.
In its educational efforts, The Nutrition Coalition (TNC) emphasized the need for the committee to include top experts in “evidence-based” medicine. These are scientists who know how to properly prioritize scientific evidence and could help bring a much-needed scientific foundation to the Dietary Guidelines. (A “lack of scientific rigor” in the Guidelines was noted by the National Academies of Sciences, Engineering, and Medicine, or NASEM, in a 2017 Congressionally mandated report to review the guidelines process). Such experts could also create some distance between the committee and the established interests who inevitably shape the Guidelines—from Big Food and Big Pharma, to scientists entangled in various conflicts of interest.
Towards this end, TNC especially promoted the candidacy of Stanford professor John Ioannidis, arguably the world’s top expert in evidence-based policy, who was nominated by the entire editorial board of the prestigious American Journal of Clinical Nutrition. Should anyone doubt his qualifications, take a moment to download the 200+ page “short version” of his CV and note that, among his hundreds of publications and awards, he has virtually no conflicts of interest.
Rather than Ioannidis or another, similar top expert who was nominated, however, USDA-HHS named a committee member who represents the very opposite of evidence-based medicine: a religiously-motivated researcher following a belief system that the vegetarian diet is part of God’s divine will. Indeed, while dismissing the application of Ioannidis, one of the most respected, highly awarded, and highly cited scientists in the world, USDA-HHS instead chose a promoter of the doctrine of the Seventh Day Adventist Church.
Joan Sabaté is Chair of the Nutrition Department at the Seventh Day Adventist institution, Loma Linda University. He teaches the vegetarian doctrine as part of the church’s “Health Ministry” offerings, and has written a long paper about the various “successes” of the church in spreading its dietary beliefs worldwide. In both his research, outreach, and educational activities—including serving as chairperson of the International Congress on Vegetarian Nutrition, hosted every 5 years by Loma Linda University—Sabaté has devoted his career to the promotion of the vegetarian diet.
What is religion doing in the Guidelines? Conflicts of interest come in many forms—financial, non-financial, professional, etc.—but a religious conflict of interest, because it is among the most deeply held of beliefs, may be the strongest. There can be no argument that this kind of ideology should not be informing population-wide public policy.
Major Conflicts of Interest with Big Food and Big Pharma
In addition to his religious beliefs, Sabaté has numerous financial conflicts of interest, having accepted funding from the Almond Board of California, the National Pecan Shellers Association, the International Tree Nut Council Nutrition Research and Education Foundation, and the “nut, soya, and avocado growers” generally, in addition to multiple grants from both the National Peanut Board, and the California Walnut Commission.
It would be unfair to single out Sabaté for financial conflicts of interest, however.
Jamy Ard, for example, of Wake Forest University, has long been extremely close to the food giant Nestlé. Since 2009, he has served as the Medical Director for Nestlé’s Optifast, a food-replacement supplement, and he is pictured virtually as a company employee on the company’s website. Ard also serves on Nestlé’s advisory board and has received $431,883 from Nestlé to study Optifast. Indeed, Ard has served on the advisory boards of several pharmaceutical companies, all of which make drugs targeted at nutrition-related diseases. These include Arena Pharmaceuticals, Novo Nordisk, Japanese global giant Eisai, and Vivus, which makes the weight-loss drug Qsymia.
Steve Heymsfield of the Pennington Biomedical Research Center, meanwhile, was for years the Global Director of Scientific Affairs and Obesity at Merck and has also served on advisory boards for other pharmaceutical companies, including the Tanita corporation, which sells devices to measure obesity, and Medifast, a competitor to Optifast, the maker of meal-replacement shakes.
Barbara Schneeman of U.C. Davis served as president of the Dannon Institute, founded by the eponymous yogurt-maker, and has also been funded by the potato industry. She has served as a trustee and was funded by the International Life Sciences Institute (ILSI), a group supported entirely by giant food and chemical companies such as Coca-Cola and Monsanto. Other committee members funded by or consulting to ILSI include Teresa Davis, Jamy Ard, Regan Baily, Ronald Kleinman, and Elizabeth Mayer-Davis.
Nearly all the committee members have a long list of conflicts of interest with food, pharmaceutical, or supplement companies. The NASEM, in its review of the Guidelines’ process, had recommended disclosing and managing these conflicts of interest, yet USDA-HHS rejected these recommendations.
The Nutrition Coalition will be working on filling this gap by cataloguing the conflicts of committee members and will be reaching out to them for their help in ensuring full disclosure of any potential conflict of interest that might influence the development of the Guidelines. It is our hope that knowing such conflicts will help, as NASEM intended, the committee to better manage them.
Another Strike Against Evidence-Based Policy
The Nutrition Coalition supported Ioannidis’s candidacy principally because he has written and spoken extensively about the need to reduce our reliance on biased science in the creation of nutrition policy. He has particularly emphasized that epidemiology is an especially weak type of science which therefore invites bias in its interpretation. Among other things, epidemiology cannot, in the vast majority of cases, establish cause and effect. Unfortunately, this very same epidemiology has long been used as the foundation for much of our Dietary Guidelines—leading to serious reversals in recommendations, such as the 2015 elimination of caps on cholesterol and the end of the formal “low-fat” diet recommendation. These two longstanding pieces of dietary advice were founded upon an excessive trust in epidemiological findings and were only reversed when the science supporting them could not be confirmed by more rigorous clinical trials.
It is therefore problematic that 11 out of 20 of committee members either work or have been trained in the field of epidemiology. TNC hopes that they will understand the limitations of this data and the value in giving primacy to the more rigorous data from clinical trials on humans, especially when that data contradicts the epidemiological/observational findings.
Some Promising New Viewpoints on the Committee
To USDA’s credit, the agency fulfilled a pledge it made last fall to encourage “fresh points of view” on the committee, by “including members with varying points of view on the topics and questions to be examined.”
For example, appointee Lydia Bazzano of Tulane University is the first-ever committee member with at least some research background that includes low-carbohydrate diets, a new topic on a list of subjects to be addressed for this iteration of the Guidelines. Also, Heather Leidy, a protein specialist from Purdue University, is likely the first committee member to bring the perspective that increased protein consumption might be an effective strategy for fighting obesity.
These new viewpoints are likely to face a challenge from an old guard who have served on the Guidelines’ committees before and could therefore be expected to have an instinct to defend the status quo. This includes Dr. Schneeman, two times a member of the Guidelines committee, in 1990 and 1995, and Northwestern Medical’s Linda Van Horn, who served as chair of the 2010 Dietary Guidelines committee. At the time, she told the Washington Post,
Since those 2010 Guidelines that Van Horn oversaw, rates of diabetes and obesity have in fact continued their relentless climb upwards. We hope this gives pause to all members of the 2020 committee. This new committee has an opportunity to embrace new ideas that might have a chance at reversing these diseases. We sincerely hope they seize this challenge, learn from past mistakes, and with an open mind, embrace new ideas for the future.
Tucker D. Goodrich contributed extensive research for this article.
Jamy Ard: Professor, Epidemiology and Prevention, Wake Forest University
Regan Bailey: M.P.H, Public Health and Epidemiology, Johns Hopkins University
Lydia Bazzano: PhD, Epidemiology, Tulane University
Carol Boushey: PhD; Nutritional Sciences and Epidemiology, University of Washington
Elizabeth Mayer-Davis: PhD, Epidemiology, University of California, Berkeley
Timothy Naimi: physician and alcohol epidemiologist at Boston Medical Center
Rachel Novotny: “Research Interests: Nutritional epidemiology,” University of Hawaii at Mānoa
Joan Sabaté: Professor of Nutrition and Epidemiology, Loma Linda University School of Public Health
Linda Snetselaar: Department: Epidemiology, University of Iowa
Jamie Stang: Associate Professor, Division of Epidemiology and Community Health, University of Minnesota
Linda Van Horn: “focus of work...cardiovascular epidemiology” Northwestern Medical https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=13194