Dietary Recommendations for Disease Prevention

Adherence to the Dietary Guidelines for Americans, developed by the U.S. Department of Agriculture (USDA), produces only a small reduction in the risk of suffering major chronic diseases. However, following a modified version of the USDA diet, one that incorporates findings from newer research, can reduce disease risk to a greater extent, according to a study in the American Journal of Clinical Nutrition(2002;76:1261–71).

The USDA Dietary Guidelines for Americans include the following recommendations: (1) eat a variety of foods; (2) balance food intake with physical activity, in order to maintain an appropriate body weight; (3) consume plenty of grains (especially whole grains), vegetables, and fruits; (4) choose a diet low in total fat, saturated fat, and cholesterol; (5) consume sugars in moderation; (6) use salt in moderation; and (7) limit alcohol intake to moderate amounts. Although the development of these guidelines was based on a great deal of research, the amount of benefit one can obtain from following them has been found to be surprisingly small: only an 11% reduction in chronic-disease risk for men and a 3% reduction for women.

A growing body of research indicates that certain dietary factors not addressed in the USDA guidelines may be important for disease prevention. Specifically, there is evidence that heart disease risk can be reduced by consuming nuts and soy protein and by replacing red meat with poultry and fish. Avoiding trans fatty acids (found in margarine and partially hydrogenated vegetable oils) may also help prevent heart disease. In addition, research suggests that taking a multivitamin can reduce the risk of heart disease (presumably by lowering homocysteine levels) and possibly cancer.

Researchers developed a new index of diet quality, the Alternate Healthy Eating Index (AHEI), which included not only the USDA recommendations, but the additional factors not considered in the USDA guidelines as well. The dietary habits of 38,615 men and 67,271 women were evaluated, and each person's diet was given an AHEI index score. During a follow-up period of 8 to 12 years, participants with high AHEI scores (indicating close adherence to the recommendations) had a lower incidence of major chronic disease (heart disease, cancer, or death not due to trauma) than did people with low scores. Men with the highest scores had a 20% lower risk of chronic disease than did men with the lowest scores. For women, the corresponding risk reduction was 11%. The improved outcome in both men and women was due mainly to a reduction in the risk of heart disease.

The results of this study suggest that the USDA Dietary Guidelines for Americans could be improved upon by adding some new recommendations: consume nuts and soy protein, emphasize poultry and fish over red meat, avoid foods that contain trans fatty acids, and take a multivitamin.

Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.

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