Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk. Episode 41 I'm your co host, Dr. Kane. I'm Dr. Schuman, and I'm Dr. Patel, and today we're talking about the new dietary guidelines that were recently released by the US government. Speaker 1 00:42 Yeah, so keep in mind, these are more of a general guidelines. There are different dietary recommendations are published for various different disease states. As most of the listeners may know, one of the example will be like a DASH diet for hypertension. But this guideline is more of a general dietary approach for all Americans two years and older to maintain good health and prevent chronic diseases. So the emphasis here is maintain good health and prevent chronic disease, meaning, if you have a chronic condition such as diabetes or hypertension, other cardiovascular condition, you should be following guidelines that come from either American Heart Association or American Diabetes Association on top of the general guidelines. And this Dr. Sean Kane 01:24 was published by the US Department of Health and Human Services and the US Department of Agriculture. And it was actually a subcommittee, and it's called the 2015 Dietary Guidelines Advisory Committee. And this was intended to cover five years of time period. So it was published in 2015 and it's intended to live until 2020, where it will be re evaluated at that time. Speaker 2 01:43 And the one thing they did this year is there, in this five year period, there's really a focus on eating patterns, rather than solely a focus on food groups and nutrients. We always go back to things like the food pyramid and looking at those as ways to say you've got to do this and this. And there's really avoidance from that and with that, I think, and at least, in my opinion, a little bit of a subtle push away from focus on like vitamin supplements or protein bar supplement shakes, etc, really focusing on getting the nutrients from their from their food based sources. So just for that, there's a quote I pulled out of this. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less than recommended amounts. And so the punchline being, if you're you know, really, really, really, try to get these things out of of your diet and out of the food you eat. But if you can't, then perhaps it may be okay to get them from from fortification and supplements. Absolutely. Speaker 1 02:37 And one thing to also consider when looking at these guidelines, the major emphasis on is on eating pattern. So you know, in order to lose weight, it's not that you go after an Atkins diet or South Beach diet for a certain period of time, and then you revert back to your old, unhealthy eating habits. So what the advisory committee here was looking for is something that is lifelong, and that's why they call it the pattern. It should be adapted early on, and that's why there's a lot of Limelight in news and whatnot that you see that there is an increased rate of childhood obesity in America, and the focus is actually improving this dietary guidelines. So then the schools and other community providers that actually handle the food items and provisions of diet for little kids also incorporate these guidelines actually, and then decrease the rates of obesity. And this will be women into their lifestyle that they will be following throughout their life, and not just that one point every period of time. Speaker 2 03:39 Yeah, and it's you touched on it, that it's population based, and they made a point of it to to say that some of these aren't just, you know, issues for just a few people. These are actually, to the point of public health concerns. That's actually the exact, some of the wording they use to describe, you know, how under, under utilized some of these, these vitamins, are. So they talked, you know, just a couple examples before we get into the bigger picture, calcium, potassium, dietary fiber and vitamin D are under consumed chronically across all pieces of the population. So you know, it's really again, getting these dietary supplement sources, not from a supplement, not well, I'll just eat whatever I want, but take a vitamin D to supplement. But no, let's go ahead and identify sources and ways you can get these things through your foods, and do it educate across an entire lifestyle life span. Speaker 1 04:24 And that's actually a very good example you mentioned about vitamin D. So if you go on the National Osteoporosis Foundation website, you're actually able to calculate out how much vitamin D on top patient would need from what's not coming from the diet. So you can put in their dietary intake and then figure out how much they're getting out of their diet and whatever that's not getting it should be supplemented that way. So it should be a wholesome approach that you'll go after the foods first instead of using supplements. Dr. Sean Kane 04:50 So, Dr. Patel, you mentioned that the emphasis was not so much of a food pyramid and things like that we saw historically, but more on patterns of foods. What were some of the food. Patterns that we should be emphasizing for our patients. Speaker 1 05:03 So some of the patterns that they focused on on inclusion of some substantial food groups and limiting certain food groups or certain items. So what they focused on is including variety of vegetables, and we will go over all these in very much detail, whole fruits. Again, emphasis is whole fruits and not fruit juices, grains, and half of these should be consumed as whole grains, fat, free or low fat, dairy and then variety of protein, again, oils, not butter. So that's another emphasis that's been put on. What are Dr. Sean Kane 05:40 some of the things that we should be avoiding then, as opposed to things that we should be emphasizing in our diet, Speaker 2 05:45 there are limitations placed on things such as saturated fat and then also our trans fats, which are ones that just to clarify a Trans fat is the kind that the body has a little bit of a more difficult time processing and breaking it down into energy so they can tend to sit around in The body and then be up taken into the cardiovascular system, where they can cause problems. And those trans fats and saturated fats really should be less than 10% of the calories per day, and specifically avoiding foods like margarine, microwave popcorn, frozen pizza, coffee creamers, things like that that are shown historically to elevate the LDL. Speaker 1 06:19 And some of the example that you just mentioned Dr. Schuman, are actually where the hidden trans fats, fats are located. And that's why the advisory committee is really watching and telling people to actually watch, read the nutrition label and weed out the trans fats, and Speaker 2 06:34 then, like in a lot of other places, you know, we're, in some cases, staying away from these hard and fast numbers. So with cholesterol, used to say a limit of 300 milligrams per day, and that was according to 2010 guidelines. We've moved away from explicitly stating, you know, Thou shalt not get above this number, but still saying, you know, you need to avoid these things. So avoid fatty meats, avoid high fat dairy products, but not giving that specific cut off anymore. Speaker 1 06:58 And I think very importantly, they emphasize to avoid the added sugar, and they're also asking, just like the trans fat, to limit this intake to about less than 10% calories per day. So putting into a perspective, if somebody is following a 2000 calorie diet, they should not be getting more than 200 calories per day that should come out of the sugars alone. Dr. Sean Kane 07:22 If you do the math on that, then 200 calories per day of added sugar. If the typical sugar molecule is about four kilo calories per gram, that means you get about 50 grams of sugar per day. That is added sugar. That's not that much if you consume, let's say, a Mountain Dew, a 20 ounce Mountain Dew, something like that. Speaker 2 07:40 And yes, and I think, and that the point is, and I think, of clarity, is that it's not saying that, you know, only 10% your calories per day are sugar. They really emphasize that if fruit, you know, the 100% fruit juices and the whole fruits are okay, again, within moderation, it's a product you can to get your calories, your sugar, calories, from those sources. And so that's, I think, something to be clear for the general population is, oh, you know, we should all just be going to a low sugar, high fat, heart protein diet. And, no, that's not what they're saying here. They're just looking at the sources of the sugar that really matters, looking at, you know, the high fructose corn syrup and avoiding those things in particular. Speaker 1 08:15 So in short, natural sugar is okay, but not the added sugars like high fructose corn syrup. Dr. Sean Kane 08:21 So did they comment on, let's say, any of the sweeteners that we see with, like a diet soda as an example? Speaker 1 08:26 Yeah, and that's a great question, because the awareness has gotten to people. And you know, whether you say awareness or the advertisement on the part of sweeteners like Equal or, you know, Truvia, or things like that, they're saying that it's okay, actually, to consume the non caloric sweetener, because they're thinking that in any given amount doesn't matter how much the consumer will consume them, the estimated intake will not reach the acceptable intake limit. So they're okay with people utilizing the non caloric sweeteners. Speaker 2 08:55 So even if you're if you are going above, it said, Well, you know, the average person says that I'm only getting, you know, two diet drinks. You say, Well, I'm getting, you know, a certain number. More than that, they found even at various extreme numbers, it's still not approaching a level which it would be concerning. Speaker 1 09:11 Yeah, and when, when I say, deemed safer. This is according to the research that is available up until now. I mean, there are tons of research that are going on in this particular subset of non caloric sweeteners. And so if we have future evidence available that will say, you know, it causes, maybe would not increase your sugar levels, or, you know, put you at high risk of diabetes, but it might do some adverse event in future. So, but for right now, with the evidence that's available, it's safer to use another limitation they had put on along with the sugar sodium, sodium was brought in limelight as well. And before that, intake was anywhere like 3500 milligrams per day, was the recommendation. The new recommendation is less than 2300 milligrams per day. And that is coming because there are a lot of research out there that. Shows that there is moderate association between increased sodium intake and risk of cardiovascular disease. Now this association is not as strong when you look at the hypertension. We do have very strong evidence out there that the amount of sodium intake increases and the risk of hypertension also increases. So if you look at the DASH diet then or American Heart Association recommendations. They for further decrease in blood pressure. They recommend limiting the sodium intake to less than 1500 milligrams per day. Dr. Sean Kane 10:32 I can tell you to limit below 1500 milligrams is incredibly difficult, unless you're preparing 100% of your foods from fresh ingredients and things like that. To have such a strict regimen is very difficult to follow and very difficult to maintain. But certainly sodium is associated with more hypertension, so there has to be give and take there. Speaker 1 10:52 Yeah. And I see a lot of patients for diabetes and hypertension in my clinic, and sometimes when I say, you know, tell me a little bit about the salt and you're using your food, a lot of patients will come out and say, Well, I don't add salt on top of my food. And that just doesn't stop there. If you're using processed foods, if you're eating fast food, if you're using canned items, you know, cured items, they all got some sort of sodium, because, guess what? That's what's used as a preservative. Dr. Sean Kane 11:18 Then the last limitation that they offered in their recommendations regarded alcohol. So Dr. Schuman, what can you tell me about their alcohol recommendations? Speaker 2 11:27 What they they're recommending here is up to one drink per day for women and up to two drinks per day for men. And this is an important thing, just like in our clinic, when we try to be specific about talking to individuals about alcohol consumption, what do you mean by one drink? So you do have to press a little bit what they mean, you know, 12 fluid ounces of a standard beer. So something that's a higher alcohol volume generally has going to having more calories and higher alcohol. So you generally, you know, for your standard lager beer, 12 ounces, five ounces, fluid ounces of wine, or one and up to one and a half ounces of distilled spirits. That's going to be what they consider to be a drink. And the other thing they mentioned too, is that before you begin drinking, you really, it's not supposed to be something simply done for the health benefits alone. It's more if you drink, make sure to drink in moderation. But if you're, if you're a non drinker, who says, Well, you know, maybe I, if I'm, you know, if I heard about this resveratrol or heard about red wine. So let me just start, start sipping and nipping it up now. And they're saying, you know, that point, you know, it's probably not worth it. But if you are a drinker, do it smart. If you're not a drinker, doesn't necessarily mean you should begin Speaker 1 12:33 at this point. So along the lines of, you know, healthy pattern across the lifestyle, some of the other key features of these guideline recommendation include a variety of foods. So again, not just keeping it to proteins or just the carbohydrates you want to actually play with different food groups. Here, the amount of food you eat is also very important, and that kind of ties back to the ADA recommendation of portion control and plate method. And you know, use the measurements to lay out your different ingredients in the food, choosing healthier foods and beverages. So we're not just talking about choosing healthier food, but actually choosing healthier beverages. And they're also recommending to support these healthy patterns. So this is not for the consumer, but healthcare providers, academic institutions, various community programs, that provide meals to either younger kids or elderly people in the community. They should all be encouraged to use these guidelines and come up with meal plans accordingly. Speaker 2 13:34 So I guess now, just to kind of get into some of the specific food categories and what they mentioned, I believe the first one they talked about was vegetables. And so they've done here is broken them down into five subgroups based upon the nature of the vegetable as well. A lot of it too, is what's contained in nutrient wise. And so there's five groups here. They talk about your dark green vegetables, which would be your spinach, broccolis, and then we have your reds. So again, you can think of your peppers, oranges, again, similar peppers or legumes, which is going to be our generally, our beans, our starchy vegetables, and then what they call an utter other category, which we'll get to in a second. And then they refer to you, you know any, any modality is appropriate, fresh, frozen, canned, dried, cooked, or vegetable juices, with the one caveat, as mentioned before by Dr. Patel canned, you do have to be aware of the amount of sodium used in there to preserve, preserve, so you want to keep that in mind. And so using low sodium selections for can would be a good idea. And then also to note that there's some overlap. And so I thought one of the things that I really liked looking at these is that they acknowledge some of the groups in which there is some overlap. So for example, all the legumes, except for green peas and green beans can also be kept, can be kind of really as a vegetable or as a protein. So if you're getting them, you can consider them in one of those two groups, and but, but with those two so green peas are considered starch, and then green beans actually get lumped in with in this other category, with onions, iceberg, lettuce, celery and. Cabbage. And then overall they're looking at is two and a half cups equivalent per 2000 calorie diet. So you can ramp that up. You know, if your diet is higher caloric intake, or if it's lower, you need to go above or below that for the general 2000 calorie diet, two and a half cups of those vegetables in one of those different kinds of ways. Speaker 1 15:19 So moving from the vegetables, let's talk about food. We mentioned Whole Foods, or 100% fruit juices that are without any added sugar. Obviously, your little kids are going to go towards that juice, you know, aspect more so than the fruit, but they're actually encouraging whole fruits, and that's because it brings that additional benefit of fiber intake as well. Again, just like the vegetables, this could be consumed in any given form, so fresh, canned, frozen, dried, we have to be sure that the canned ones, or the cup ones, they're pre made in a sugar syrup that they have, they're either without or with the lowest amount of added sugar. And then have to also consider the fact that the juices and the dry dry fruits, if they are consumed more than the recommended amount, they can actually contribute towards extra calorie intake, because there are calorie dense foods. And when you talk about looking at the amount per 2000 calorie diet, example, that would be about two cup equivalents. So if you have one cup of fruit juice that equivalents to one cup of whole fruit and should be consumed more than four to six ounce food, ounce per day if you have dried fruit. Sometimes people don't think that dried fruit is actually a fruit, but half a cup of dry fruit will equivalent to one cup of fruit. So here you're kind of seeing that pattern that it's better actually to eat whole fruit. Again, not saying that 100% food juices or dry fruits are bad, but it's more beneficial. And volume wise, it's a little bit more benefit to eat the whole fruit. Dr. Sean Kane 16:54 I think overall, it kind of makes sense that selecting something that is less processed, that has gone through less things to get it to the final product. Makes sense that you should be going more toward the less processed, more raw type option, as opposed to the very processed option, absolutely. Speaker 2 17:09 And actually that being said. Dr. Kane, that's a perfect segue into our next group, which is looking at the grains. And what they specifically mention is more of those whole grains, which again, are the generally non processed so rather than removing the the outside of the kernel, which is what we do when we make our processed white flours or more simple types of sugars and starches. So things like brown rice, quinoa and oats, where you're getting that entire bran and so they and then specifically the one, also avoiding ones with high saturated fat, added sugar or sodium. So cookies, cakes, snack foods, things like that. Not only are they processed, but then they go in there and add a whole lot of these other pieces to it. So again, looking at getting them in their simplest form, and really limiting the amount of other items you're adding into it. And they're looking at six ounce equivalents per day, and really 50% of that, or about three ounces, should come from whole grains. Speaker 1 18:02 And so actually, another recommendation, if you're focusing on whole grains, because there is this health craze, you know, the super foods and whatnot. And quinoa is supposedly the celebrity food nowadays. But if you're going, um, all your grains are coming from whole grains, they're actually recommending to include some of the folic acid fortified breakfast cereals too. This is a good way of getting additional folic acid. Again, these are fortified. So it's not like the cereal itself contains folic acid, but this is kind of looking at the neural tube defects and some of the pregnancy related complications that can come through. Speaker 2 18:36 And then just one clarification, they sometimes use words like fortified and enriched. And fortified generally refers to what you've done is you're giving back something that wasn't already there, as Dr. Patel mentioned, and then refined grains. They mentioned shooting enriched grains because, again, referring to the some of the content, the folic acid that is removed from the processing. And you're giving back what was there but taken away. And so that would the latter would be considered enriching. Dr. Sean Kane 19:01 So you're saying fortified means that they add something that wasn't there. Enriching means that they took it out and then they put it back, correct, got it so in terms of the recommendations for dairy, they recommend fat free or low fat dairy. So low fat would be like 1% or less. Some dairy options could include yogurt cheese, soy beverages that are fortified. This would not include almond rice, coconut or hemp milk. You can get these for your calcium intake, but they don't really count towards your dairy spectrum. The recommendations are two cups per day for children that are two to three years old, two and a half cups if you're four to eight years old, or if you're nine to 18 or up. So adults, three cups per day of dairy would kind of qualify you for that. Speaker 1 19:42 Yeah, and a lot of the time when I talk about what, tell me about your dairy intake. Oh, I don't really drink milk. But then there could be a lot of hidden sources of cheese and forms of pizza, you know, adding cheese on their salad, adding piece of cheese on their sandwiches, and stuff like that, too. So. Always good to ask further questions, to assess the intake. Speaker 2 20:03 I think another next category they talk about is protein and so again, that I know in this big one, we think of protein bars, protein shakes, protein supplements, but really what they focused on is breaking them down into different kinds of categories that there are protein sources for everyone, whether you're a vegetarian, whether you're a vegan, whether you eat anything put in front of you. So in animal sources you're looking you've got your lean meats and your poultry and your eggs. And then what's interesting, they're really focused on seafood. One of the things I noticed in here is talking about, specifically, eight ounce equivalent of seafood per week per 2000 calorie diet. So again, if your calorie intake is more or less than that, then you can ramp that up. But that the main thing for this because of the polyunsaturated fatty acids, the EPA and the DHA that are within those fishes, they really strongly recommend getting that eight ounce serving at least one per week. Speaker 1 20:53 And very importantly, I'm glad you mentioned that seafood was actually given a little bit more attention in the guideline. I don't want consumer to think that shellfish is one of the recommendation behind the seafood recommendation, it's actually healthy fish like salmon, halibut, tuna, files and things like that. Again, when it comes to tuna consumption, it's not one of those tuna salads that are fortified with mayonnaise. They should be just plain old without added fat, type of seafood items. The other Speaker 2 21:23 interesting thing is, with the exception of eggs, each of the above, so the lean meat, poultry, fish, they're sources of heme iron. And there's some evidence that I had come across in the past, and I was glad to see that they brought it up too, that heme iron may be better absorbed or more bioavailable in the body compared to non heme iron and so that doesn't mean that plant derived sources aren't you know, you're going to be anemic, but it just means you may need to get more or work to make sure that they're being absorbed appropriately. So the vegetable sources, unsalted nuts and seeds, legumes, soy, 5.5 ounce equivalents per day, per 2000 calorie diet. Again, those you can get your iron, but you just may want to be aware that the absorption may be a little more decreased, yeah. Speaker 1 22:02 And I think the important word over there is unsalted, because, again, we want to limit the source of sodium as much as possible. So the one last thing that's left that the guideline calls for attention is oils. Again, it's not like you're sitting and drinking a cup of oil, but we use the oils to cook our foods with and so what they're saying is, you know, you want to use fats in form of oil. So oil is liquid at room temperature, because there are high percentages of Mono Unsaturated and polyunsaturated fatty acids in there. The way I tell my patients in the clinic is whatever that is liquid at room temperature, it's going to be liquid in your blood vessels, and whatever, it's solid at room temperature, it's going to be solid in your blood vessels. So they kind of get the picture. Is what I'm talking about when I mentioned oils. And when you look at the scientific trials and studies and stuff, they have found that there is more evidence exist for cardiovascular benefit out of PUFA, or PUFA, we call it polyunsaturated fatty acids versus the monounsaturated fatty acids. But both of these can be beneficial. So like I mentioned earlier, consuming seafood, one of the rationale is because higher level of PUFA. So some of the healthier oil example I would give to my patient is canola oil, corn oil, olive peanut, sunflower, safflower, soybean oil. Actually, they also have identified certain food items, not like beans that you extract the oil out of, but things like nuts, seeds, again, seafood, olives and avocado are really good source of healthy oils too. A lot of craze you might have noticed in the news lately that has been after the coconut oil. We certainly do not know the pure health benefit that comes out of it, yet. It's more of a celebrity driven type of advertisement. But do know that oil, such as coconut oil, palm oil, or palm kernel oils, are high in saturated fat, and the way you can tell is that if these oils are left at room temperature, they're going to turn solid, unless that room temperature is little bit on the warmer side, you have to heat them up to become liquid. So again, that happens because there are more saturated fatty acids in them. Dr. Sean Kane 24:14 So Dr. Patel, you're saying that you would not recommend this more of a fat coconut oil versus, let's say, an olive oil or canola oil or something like that. Speaker 1 24:23 Yeah, just purely based on the composition of the coconut oil, palm oil and palm kernel, because they got more saturated fats. And the guidelines calls for actually limiting the amount of saturated fat to less than 10% in their regular calorie diet. That's why I would recommend against it and use more of the healthier oil, such as canola, corn, olives, peanuts, etc. Dr. Sean Kane 24:46 So in thinking about, you know, where do these recommendations come from? Generally speaking, when we think about dietary clinical trials, these are actually incredibly difficult to run, and have a lot of issues with internal validity, because oftentimes. Terms of the way that they assess whether coconut oil is a good oil or a bad oil, is by having a patient keep a diary. And oftentimes the diaries aren't as accurate as they could be. And on top of that, because these aren't randomized trials, they actually are finding associations versus causations, meaning that maybe people who tend to eat canola oil, are also more often smokers or something like that, so we have a lot of confounders that can kind of hinder some of our evaluations. With that said, we do have some good evidence about, as an example, Mediterranean diet with cardiovascular disease outcomes, that would be definitely the exception to the rule. But when taken as a whole, we do see trends in the data, and that's where some of these recommendations come from. So in terms of thinking about the recommendations from the guidelines, what can we say about the clinical effects that we would anticipate if a patient were to follow some of these recommendations? Speaker 2 25:53 It's a good question. Dr. Kane, so again, as you mentioned, there are some strong evidence for some of these and a little bit less or so for others. So for a strong evidence, right off the bat, reduced risk of cardiovascular disease that's been seen. So that's that's gonna be the one we're mostly hanging our hats on, that was emphasized throughout the document. And then there's some moderate evidence for reduced risk of type two diabetes, certain types of cancers, and then also the likelihood of being overweight or obese. Speaker 1 26:21 And, you know, besides putting out the strength of the evidence, they're talking about the consistency of the evidence too between these food groups. So what they found that, you know, when they looked at all the studies and trials and you know, retrospective data that was there, they found that high intake of vegetables and fruits yield the very consistent outcomes. Then recommendation was slightly less consistent in terms of consuming whole grains, and it was very less consistent when it comes to fat free intake of the dairy or low fat dairy intake, seafood, legumes and nuts. So we know for sure that, you know when they say that you need to eat green leafy vegetables, you know, healthy vegetables, and variety of source of fruits and stuff, it's it's really high consistency, and they're basing it off of various different trials that are saying the same thing. Dr. Sean Kane 27:17 So one thing that always comes to mind when we think about what recommendations are we providing to patients is that sometimes patients have specific dietary requirements that are either voluntary or involuntary that they need to follow. So as an example, eating meat or not know certain things that they can or can't have in a diet because of allergies. So what things do the guidelines do to address some of these more special cases that you know, our special dietary circumstances for patients, Speaker 1 27:44 good question. And I think you know they're really, really focusing, like we discussed earlier, on the pattern of diet. So keeping the cultural and personal preferences in mind, they've actually put out three different appendices. So one is for the US, style, eating pattern. So if you're you know, more accustomed to meat, potato, vegetable type of diet. Then there have recommendation or appendices for Mediterranean style eating diet. So this is more vegetable, whole grains that's healthy, seafood and fruits and vegetables type of diet. And then there is also an appendices for vegetarian eating pattern. And if you open up this appendices, what it does there are done tons and tons of tables out there for somebody who's on an 800 calorie diet a day, or 10, I don't know, 1000 calorie diet a day, up until 2500 2600 calorie diet per day. So a lot of examples are given as to how much and what amount of what certain food groups that person should be consuming to meet the calorie requirement. Dr. Sean Kane 28:47 So in looking at the guidelines, they actually have a very nice website, but going through the website and the guidelines, I was thinking to myself, you know, if I was just a normal consumer, this would be a lot of information. There's no way that I would really kind of consume this data, if you will, on my own as a normal consumer, and they're actually very clear that these guidelines are not for consumers. This is for healthcare providers and policymakers to say. You know, this is what the US government recommends. So therefore our school lunches will look like X, Y and Z, or this is what I will be recommending to my patients, or maybe the ADA, when they come up with their guidelines, will take a look at these guidelines and say, how should we influence our recommendations based on what we're seeing? Speaker 1 29:29 And that's absolutely correct, even though the guideline document looks very neat and nicely organized, and there are some tools that you can play around with to see how you can substitute from less healthy items to healthier items, including beverages, snacks, desserts, etc, etc. But I definitely agree that this tool is more going to be serving for healthcare professionals to educate their patient and nutrition educators as well as the institutions that are responsible for. Of meal development for elderly and younger consumers. Dr. Sean Kane 30:04 To summarize, I think the way to kind of wrap things up is to focus on the five things that the guidelines emphasized above all else. And they had a list of five things that are very accessible within the guidelines. The first thing that we've talked about a lot is to follow a healthy eating pattern across your lifespan. So not just eating tuna all day, but making sure that you have a good variety of proteins, good variety of vegetables and fruits, and that it's not just something that you do when you turn 50, that it's something that you encourage children to be doing all the way through adulthood. Speaker 1 30:36 Second emphasis is on variety of food. Like I said, not just tuna all day, looking at the density of the nutrient as well. So something that will give you 200 calorie, what might look like a tablespoon full versus, you know, a cup full of a healthier item could be just as much of calorie, but it's gonna make you fuller, and it's gonna satisfy your hunger. Well, you're not going to consume a whole lot of calories out of that and the amount of food too. So portion control plate method, you know, actually sizing out your portions of various different items on your plate, too. Speaker 2 31:13 And then the third one was to limit calories from additives such as sugars and saturated fats. Again, now that you should have, you know, completely avoid sugars, but make to get them from pure plant derived sources, rather than from additives. And the same thing with avoiding saturated fats, moving more towards those polyunsaturated fats, and then reducing sodium intake, which, again, both this and those sugars. It can also be done by by looking at, you know, the sources you get. So if you are choosing things like canned fruits and canned vegetables, you're looking for those with lower sugar added and lower sodium respectively. But then overall reduced sodium intake is important. Dr. Sean Kane 31:47 The fourth guideline from the guidelines was to shift to healthier foods and beverage choices. So there's two things there. One, beverages matter, then two, to think about. How can you transition from a pasta plate that is very high in calories, to a similar pasta plate that doesn't have as many calories but is just as tasty. So that shift from less healthy to more healthy is something that they encourage as well. Speaker 1 32:12 And the last point they encourage is to support these healthy patterns of eating. And that starts from, you know, you being a parent to a toddler, you know, starting healthy at home, schools providing healthier lunches and having certain health patterns. Or, you know, cafeteria food at work as well. So all the different institutions and families should be considering this healthier lifestyle. Now. Does that mean that, you know, in future, all of our vending machines will be equipped with carrot chips, and you know, you go to a movie theater, they're gonna serve, I don't know, hummus, and you know vegetables instead of hot dog. We don't know that yet, but definitely, looking at the obesity epidemic and increase chronic conditions and United States all together, something to consider that we should be all following the new dietary guidelines. Dr. Sean Kane 33:08 So with that, I think that kind of wraps up the 2015, dietary guidelines. I'm Dr. Kane, Unknown Speaker 33:13 I'm Dr. Schuman, and Unknown Speaker 33:14 I'm Dr. Patel, and eat smart. Narrator - Dr. Abel 33:18 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store, search for HelixTalk and place your review there Narrator - ? 33:29 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.