National Academy of Medicine review of Dietary Guidelines is stacked with government insiders

Last year, Congress appropriated $1 million for the first-ever peer-review of the Dietary Guidelines for Americans (DGAs), by the National Academy of Medicine (NAM).  This was a huge victory…because, as you know, the DGAs have failed miserably in preventing obesity and diabetes in America. And we need change!!

Yet the NAM review is now in danger, because the proposed panel is clearly meant to uphold the status quo.
See here the NAM proposed panel and the nominators.

On August 8th, NAM announced its proposed panel. Comments are due by THIS SUNDAY, August 28th. You can comment HERE.

Here are the problems that we see:

All nominations came from government insiders. Every single panel member was nominated by a government insider, either by government employees or by people who work inside the beltway. The USDA, which produces the DGAs, itself nominated two members. NAM received plenty of nominations from outsiders (we know, because The Nutrition Coalition nominated some people ourselves and asked others to do the same), but these were all ignored. None of our nominees was even contacted by NAM for consideration. (See matrix below for nominators and nominees)

2015 DGA committee members participated in the nomination process despite instructions by Congress not to. Other nominators included two members of the 2015 DGA advisory committee, even though Congress specifically stipulated that members of that committee should recuse themselves from the process.

Nearly all proposed members are government insiders. Nearly every single panel member has a relationship to government, either as an ex-employee, a current advisor, a major USDA or NIH grant recipient, or a former member of the DGA expert committee. These people cannot be expected to be critical of the government’s nutrition policy.

The panel is not balanced:
Congress stipulated that the NAM panel should “include a balanced representation of individuals with broad experiences and viewpoints regarding nutritional and dietary information.” This point, about the importance of balance, is echoed throughout the authorizing language for the report, including this, about the overall goal of the report, “to ensure the Dietary Guidelines reflect balanced sound science;” and this, about the DGA committee, namely that it “include committee members with a range of viewpoints;” and this, about the science in the DGAs, namely: “whether scientific studies are included from scientists with a range of viewpoints.” [Italics added]

  • Yet the panel is clearly not balanced. It does not contain a single panel member representing an “alternative” viewpoint on key, contested issues, such salt, saturated fats, the evidence base for the Dietary Patterns, and the low-carbohydrate diet.

The panel lacks relevant expertise:

  •  5 of the 13 proposed members, or 38%, have no experience in nutrition or diet whatsoever:
    • One of these five has an expertise in physical exercise. This is inappropriate, given that the relevant appropriations bill stated that the DGAs should be “limited in scope to nutritional and dietary information.” Exercise may be an important part of a healthy lifestyle, but it is not the expertise requested by Congress either for this particular review or for the DGAs generally.
    • Two of these panelists have no expertise in nutrition and seem to have been selected only because they are regular appointees to NAM studies
    • Several panelists were apparently chosen for their expertise in systematic methodology. While this expertise is relevant to part of the scope of work mandated by Congress, 1-2 people would be sufficient.
      • An additional 2 proposed members, or 15%, have an expertise in some area of nutrition but not one that is relevant to the DGAs. For example, the proposed panel includes an expert on neonatal nutrition, yet the DGAs do not currently cover that age group. There is proposed member who studies how to improve dietary assessment tools, yet that subject, while important to improving the quality of observational studies, has no relevance for the DGAs.
      • An additional 3 proposed members, or 23%, have an expertise in vitamins, which is relevant, since Congress did stipulate that the NAM review should investigate how the DGAs could be made “nutritionally sufficient,” yet this was only one small part of the overall scope of the study. One person with relevant expertise would be sufficient, especially given the need for expertise in other areas.
    • Thus, after accounting for 1-2 experts in systematic methodology and another in vitamins, more than 50-60% of the panel have no background in the relevant scientific literature.

Epidemiologists are over-represented. The proposed panel includes 3 epidcmiologists, when, according to NAM’s own guidelines, the panel was only supposed to have one epidemiologist. Those of you familiar with nutrition policy know that a key problem has been an over-reliance on the weak science of epidemiology, while more rigorous clinical-trial data has been ignored. The 2015 DGA committee itself had quite a few epidemiologists, while neglecting to include members from other disciplines, such as food science.

Key areas of expertise are lacking. Congress stipulated that the first point of this study is to identify how the DGAs can “better prevent chronic disease.” The chronic diseases of concern to America are clearly obesity, diabetes, which remain runaway epidemics, and heart disease, which continues to be the country’s leading cause of death. Thus, an understanding of these health conditions and their nutritional causes are of the utmost importance. Yet the proposed committee includes virtually no expertise on these crucial issues. The proposed committee includes:

  • No expert with a background in “metabolic health,” a subject listed in the scope of work
  • No expert on diabetes
  • No expert on cardiovascular disease
  • Only one expert on obesity—with a significant conflict of interest, in that he is the medical director of a line of diet products owned by the Nestle corporation.
  • Few experts with a background in clinical nutrition–the heart of the data behind the DGAs. To be clear: this is the massive body of clinical trial data upon which the DGAs are supposed to be based. The NIH has funded billions of dollars in clinical trials on nutrition, testing whether diets low in fat and saturated fat prevent chronic disease. The panelists need to know this data, its importance, and its implications.

Given the near-complete lack of expertise on nutrition and obesity, diabetes, and heart disease, it is impossible to imagine how this panel could produce an evidence-based review that adequately addresses these topics or complies with Congressional intent.

In sum, this is a panel of scientists close to government nominated by the same beltway insiders who have been controlling nutrition policy for decades. This panel cannot be expected to be independent or objective.

As Albert Einstein said, “We cannot solve our problems with the same thinking we used when we created them” 

Moreover, this panel violates the will of Congress, which mandated that NAM, for this panel,  “include a balanced representation of individuals with broad experiences and viewpoints regarding nutritional and dietary information.” That is not the case here.

We suggest telling NAM that we, the taxpayers of this $1 MILLION effort, don’t want a report by government insiders that simply rubber stamps the government’s existing policy.

We deserve a truly independent review by a balanced and objective panel. We need this because America is fatter and sicker than ever, and we are tired of the government blaming Americans for this problem. The DGAs themselves do not reflect the best and most current science.

This is an historic opportunity to correct this failed policy. Let’s not let it go to waste.



SEND YOUR COMMENT to the National Academy of Medicine HERE:

Below is our chart on the nominators and the nominees.

See the NAM proposed panel and the nominators.

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