Milk Serves Americans Well, Lipps Says

The federal government is seeking comments related to the next iteration of the Dietary Guidelines for Americans as it reviews the science behind healthy eating, with a plan expected next year. Dairy has always had a central role in proper nutrition, and newer science reinforces that. That doesn’t mean the process is easy, two experts said in a Dairy Defined podcast released today. 

“One of the biggest distinguishing factors in this year's advisory committee is a focus on using a health equity lens to ensure that the committee considers factors such as socioeconomic position, food security, race, and, or ethnicity and culture,” said Brandon Lipps, who during his time as  USDA deputy undersecretary for Food, Nutrition and Consumer Services, oversaw the writing of the 2020 Dietary Guidelines in partnership with the Department of Health and Human Services. “With products like milk that have so many available nutrients, we can serve Americans so well. And we need to make sure that the committee thinks about the basics when they're talking about that.”

Lipps, co-founder of Caprock Strategies, was joined by NMPF Director of Regulatory Affairs Miquela Hanselman in the podcast. 

Transcript

Alan Bjerga: Hello and welcome to the Dairy Defined Podcast. Action on the dietary guidelines for Americans is picking up. Dairy has always had a central role in proper nutrition and newer science reinforces that. That doesn't make the process easy. Joining us is someone who knows a lot about how the guidelines get put together. Brandon Lipps during his time as USDA Deputy Undersecretary for Food, Nutrition and Consumer Services oversaw the writing of the 2020 Dietary Guidelines in partnership with the Department of Health and Human Services. The West Texas native has also worked in both university and policy settings. And is tapping into all of that as the co-founder of Caprock Strategies, which build strategies for lasting change so regular people can thrive.

We also are speaking with someone who is currently in the trenches of the dietary guidelines debate, NMPF's Miquela Hanselman, our Director of Regulatory Affairs. Thank you for joining us.

Brandon Lipps: Thanks Alan. It's great to be here.

Miquela Hanselman: Yeah, thanks for having me, Alan.

Alan Bjerga: Let's start with you, Brandon. Give us, from your experience, the textbook report on how the dietary guidelines are supposed to be drafted. Then tell us what really happens.

Brandon Lipps: Thanks for that, Alan. First, I want to say Americans often forget that ensuring proper nutrition in this country begins at the farm, not with the dietary guidelines. And I'm always excited to have the opportunity to work with organizations like the National Milk Producers Federation that represent farmers here in the Beltway on important issues from farm to nutrition, for sure.

I'm going to start with your question from a slightly different angle. Make sure our audience understands, what are the dietary guidelines supposed to do. They're designed to improve the health of Americans through better nutrition. We have a test for that here in the Beltway called the Healthy Eating Index. And you might be surprised to know that the average American scores a 58 out of 100 on that test. I wouldn't be happy if my children brought that home on one of their exams and certainly folks wouldn't be happy if they made that on their own exam. So the question is, how did we get here? And to talk about that, I'll head back to your question and start with a scientific foundation for the guidelines.

Congress requires the guidelines be, and I quote from statute, "based on the preponderance of scientific and medical knowledge, which is current at the time the report is prepared." Now, while this seems like a basic task, it really is quite complicated, as you noted in the intro. If you ask the average American what it means in practice, they're likely to tell you that a group of scientists come together, break clinical trials on the best combination of foods for Americans, study those results, and then make recommendations for the general public. In fact, that would be a wonderful opportunity to study the true effects of dietary consumption. But the problem is that such studies are basically impossible without confining a large population of individuals over a number of decades to control both what they consume and for all other intervening factors.

Most of us agree that this is not an option in modern society. The problem with defining the proper science begins at this point. Should the guidelines consider only randomized clinical controls? Should they also consider epidemiological studies? And if the studies can't consider the entire diet at one time and over time, then how should we combine that evidence to make those recommendations?

So, here's what happens at the agencies. Every five years at the direction of Congress, the secretaries of the U.S. Department of Agriculture and the Health and Human Services appoint a committee of scientists who I will acknowledge that just like may come with their own bias to this work. Those scientists are supposed to use three approaches to review the available nutrition data. At the risk of being a little too nerdy, I'm going to cover those three approaches quickly, just to give us some background.

Alan Bjerga: Nerds are a big part of our listenership. You keep going.

Brandon Lipps: That's good to hear, Alan, I feel like I fit in. One is systematic reviews. It's basically a summary of scientific studies. Two is what they call food pattern modeling, and there's a lot of chatter about that this year. And you can probably guess it's computer modeling that results in what foods provide what nutrient combinations. And then the third is data analysis, which is simply statistical analysis of some very large data sets, mostly that the government controls. And they use those three to make the dietary recommendations to the secretaries. As you might imagine, the transparency, which really, Alan, we have to define as the ability for Americans to understand what is happening in this process, varies on each of those three methodologies, and on the three as a whole. As does the agreement from stakeholders on what best represents the science out of each of those methodologies, and what should the secretaries rely on.

Once the committee makes those recommendations, historically, the secretary have taken the scientific committee recommendations, they put them out for comment. NMPF can comment, I can comment, all of your listeners can comment. The secretary should review those comments and then they write the dietary guidelines. So sorry, a bit of a long answer, but a good background on the complicated science involved in producing the dietary guidelines.

Alan Bjerga: And given your involvement in 2020, what are you seeing from the process of creating the guidelines this year? Are there any trends that make this year different from what you've seen in the past?

Brandon Lipps: Certainly, Alan. I'd say that every committee is a unique committee. They come in with their own biases. Most of them do their best to try to set those aside, but they certainly have backgrounds that influence where they're headed. They have personal beliefs that influence what they want to look at. We can't take those out. We need to acknowledge that they exist and be aware of them as we move forward.

But one of the biggest distinguishing factors in this year's advisory committee is a focus on using a health equity lens to ensure that the committee considers factors such as socioeconomic position, food security, race, and, or ethnicity and culture. Those are the factors stated on the website. And while I think we all agree that health equity is extremely important in a country as diverse as ours, the process of writing the guidelines is significantly affected when any new factor is added to this already complicated process.

I think the focus on health equity has actually helped many stakeholders recognize the true complexity in providing dietary guidelines for what Congress said should be the general public. On a related note, there's renewed focus in the nutrition community on something called precision or individualized nutrition. You can get somebody much smarter than I to tell you about that. But it may be a better way to answer some of these unique questions. It's a science for the future though and not for today.

In the meantime, I wonder if maybe we need to go back to the basics when issuing guidelines. After all, all Americans aren't consuming three servings of dairy a day, they aren't making half their plate fruits and vegetables, and they're clearly failing at the healthy eating index. The more complicated that we make dietary guidelines and the less even if just perceived, transparent the process, the lower we're going to see those healthy eating index scores go. We have to make an effort to meet Americans where they are if we truly want to improve the health of Americans.

Alan Bjerga: And thank you for providing that context, Brandon, and bringing it back to the healthy eating index. I think that really helps focus this down. Miquela, if we could talk for a moment about dairy. What are the most important things the dietary guidelines panel needs to do to ensure that dairy keeps playing its necessary role in nutrition?

Miquela Hanselman: I would say first off, they should keep recommending three servings of dairy for older children and adults. And maintaining dairy is a distinct food group. I think that really emphasizes the important role that dairy has in the diet. Additionally, we've called for the committee this time to include the newer science on full fat dairy and the health benefits that are associated with those products. And then lastly, not substituting in any plant-based alternatives that aren't nutritionally equivalent to dairy products as a more equitable option, when there are lactose free and low lactose dairy options for those that do have lactose intolerance.

Alan Bjerga: Brandon was talking about that social equity lens. Looking at that emphasis on meeting people where they are, as Brandon was saying, where can dairy fit within that?

Miquela Hanselman: Dairy has lots of great options and I want to give kudos to the dairy companies. They've developed a lot of lactose-free dairy products and also some dairy products are naturally low in lactose. And so, this has made dairy more available to everyone. Because we know that lactose intolerance is an issue, and so now there's products that those people consume without having to deal with the side effects of not being able to digest lactose.

Additionally, if you look at school milk, that's a great example of another way. Companies have reduced the added sugars to make flavored milk a healthier product overall for children. And it still has those 13 essential nutrients that white milk has. I would say there's lots of great products in the dairy case now and lots of options for everyone.

Alan Bjerga: From where you're sitting in the process, do you have any concerns about how things are playing out thus far?

Miquela Hanselman: I keep going back to that substituting in plant-based products for dairy. We know that a lot of these plant-based alternatives, I would say all of them aren't nutritionally equivalent to dairy. The only one that is recognized in the dairy group as an alternative right now is fortified soy. And even fortified soy doesn't meet the 13 essential nutrients of a glass of milk.

If the committee was to recommend plant-based alternatives in place of dairy products for those that are lactose intolerant or just don't want to consume dairy, there can be some real consequences with that. We've seen cases of where parents have fed children these plant-based products and they now have kwashiorkor or different nutrition-related diseases that we haven't seen in the United States in a good bit of time. Watching that very closely and trying to continue to emphasize to the committee in our comments and any conversations with USDA and HHS that there is a real risk of substituting plant-based products and for dairy because they aren't nutritionally equivalent. And recommending that would be honestly, a disservice to Americans.

Alan Bjerga: Brandon, let's talk a little bit more about what you meant when you were talking about dietary guidelines getting back to basics.

Brandon Lipps: I think that's related to what Miquela just said. Americans are always in search of dietary guidance that will make them healthier. As a general population, we all want to live healthier, we want to eat better, we want to exercise better. Some of us do a better job of making those choices than others. But the reality is when the advice we're given is so complicated that we don't know which direction to go, we tend to give up. It happens regularly, not just in nutrition recommendations, but in many things.

And if you look historically at nutrition headlines, certainly I get that consumers get what you call whiplash nutrition advice. At one time, we're not supposed to be eating fat anymore, and so the marketplace made a type of fat that turned out to be really bad for us. And so, they jerked that off the market and everybody decided that they were going to focus on sodium. And we flipped back and forth on sodium. And then we've moved on to sugar.

The problem is not any one nutrient, it's to make sure that we get the balanced nutrients that we need across our dietary patterns over a week, over a month, certainly over our lifetime. And as Miquela talked about with products like milk that have so many available nutrients, we can serve Americans so well. And we need to make sure that the committee thinks about the basics when they're talking about that.

I do believe that that's their good intent on the focus on health equity, is that they're trying to consider the needs of different populations, different cultures. But we have to be careful that we're not confusing consumers as we move forward. One thing I want to point out in line with that, I think the Harvard Nutrition source talks about the availability of calcium in spinach, not just what's reported as there, but the availability in it. I believe you would have to eat seven cups of cooked spinach to get the same calcium that would be available in a cup of milk.

So while we might model a recommendation that says, "If you want to get your calcium, you can eat seven cups of spinach.", everybody knows that no American's going to eat seven cups of spinach at every meal, even if at one meal. So, obviously that recommendation's outside of something that the committee would make. But it is an example of the complication and changing recommendations when you talk about moving recommendations from three cups of dairy today to some substitute that's not providing those nutrients that Americans have been used to consuming in those products.

So I just caution the committee to be careful, if they consider that. I know we have some great folks watching that, but at the end of the day, we have to produce guidelines that have a proper scientific basis. And if that doesn't exist, we can't stretch it to make a recommendation. If it doesn't exist, we need to wait five more years. And we have to make sure that whatever that result is instills confidence in Americans or we've failed the process before we even start.

Alan Bjerga: And along with that consistency, that also implies a certain deliberate approach in terms of considering the science, following the process. You hear lots of things around Washington. And I know one thing that I've heard is a thought that perhaps you might have a dietary guidelines that could be moved up. This is an election year, and what would be some of the challenges inherent toward what would seem to be a rushed approach?

Brandon Lipps: I think the primary challenge inherent in that, Alan, is really the loss in confidence of the stakeholders in this process and the American public. The committee can move at the speed that they want to move. They have a dedicated career staff who will provide them the data they need on the timeline they need. They can move very quickly, they can go on the usual timeline. I hear a lot of question concern there about whether the secretaries are going to put the committee's report out for public comment before they translate that to the dietary guidelines. I expect that they will, but affirmation of that I think, would be helpful for everyone. And at the end of the day, all stakeholders are not going to agree. But certainly making sure that there's opportunity in the process for that comment to happen is extremely important to ensuring that the American public can have faith in what comes out.

Miquela Hanselman: Just so listeners know, kind of the way the timeline runs is that the committee is currently reviewing the science. They’re supposed to release the report by the end of October. Once that report comes out, there’ll be an opportunity for the public to submit comments on that report. And then USDA and HHS will take those comments into consideration and the recommendations from the committee to write the final policy document, which is the Dietary Guidelines for Americans. And that’s expected to be out by the end of 2025.

Alan Bjerga: Brandon, Miquela, anything we've missed?

Brandon Lipps: Alan, there is one important note that I want to point out, certainly as we look to the future. The current dietary guideline statute was written decades ago, and I think what we all know was a different era. Science has changed, scientific methods have changed, and with all this new science and methodology, the transparency which is expected to be the norm, has become, I think, even more complicated. I do think that the committees and the dedicated staff at USDA do their best to be transparent about the process, but it's complicated. We have to make sure that stakeholders and Americans can understand the process, as I've said before.

There is a proposal in the recent Farm Bill passed out of the House Agriculture Committee that provides a great starting point about ensuring that we're all on the same page about what the science should be, what that should look like, and how transparency should work in that process. Stakeholders should come together and work with Congress to decide how we can restore confidence in the dietary guidelines process today and moving forward. And I might say that it's probably time to make sure that our Senate friends take the same consideration on their farm bill that our friends in the House did.

Alan Bjerga: We've been speaking with Brandon Lipps, co-founder of Caprock Strategies and a former Deputy Undersecretary for food, Nutrition, and Consumer services. He's joined by NMPF Regulatory Affairs Director, Miquela Hanselman. NMPF's been all over the guidelines. For more on our work, just go to our website, nmpf.org and select Nutrition under our Key Issues section.

To hear more of these podcasts, all you have to do is go to our website or go to Apple Podcasts, Spotify, Google Podcasts, and Amazon Music and search under the podcast name Dairy Defined. Thank you for joining us.