The Food Pyramid: Does It Miss the Point?

There’s a food fight afoot over the last thing you’d imagine could inflame peoples’ passions: a dull-as-dishwater government chart.

It’s a graphic that most of us know well: the food guide pyramid, that worthy, eat-right teaching tool from the U.S Department of Agriculture.

Four levels. Five food groups. With--let’s hear it, class--grains at the base. Fruits and vegetables one tier up. Next, the protein group, with dairy right next door. Then finally--at the sinful peak--those added sugars and oils.

Some nutrition experts say the pyramid does a fine job at thumbnail-sketching how we should eat. If only we ate that way, so many of us would be healthier.

But some think the government is leading people astray. It’s high time, they say, that the pyramid had its slabs rearranged to better reflect current thinking on diet and disease.

After all, the pyramid--released in 1992 and modified only slightly in 1996--is nearly a decade old. A lot of research has come down since then.

More to the point, say critics, the graphic is studded with mixed signals from top to bottom.

“Good” poly- and mono-unsaturated oils are lumped together with “bad” saturated fats; proteins from fish and beans appear no different than those from red meat.

And in an effort to get us to cut down on fat, it’s been guiding us to go hog wild on refined carbohydrates.

“It’s like a recipe for obesity,” says UCLA’s Dr. Ian Yip, associate chief of the UCLA Center for Human Nutrition.

“A visitor from outer space, coming in and looking at it, would think that the major dietary problem in the U.S. is carbohydrate deficiency,” says Dr. Meir Stampfer, chair of epidemiology at the Harvard School of Public Health. “That is not our problem.”

The pyramid is important because it is one of the few guides to healthy eating that is well enough known to partially counter the billions of dollars spent annually by industry promoting junk food.

Nevertheless, it has never really been determined whether people who eat according to the pyramid’s strictures end up healthier than those who don’t. That is ironic, say critics, since researchers have done exhaustive polling to find out how many Americans are aware of the pyramid and follow its dictums. They have even compared the effectiveness of a wheel, a bowl or a shopping cart shape to that of a pyramid.

In fact, a preliminary study reported at scientific meetings last year suggests that a pyramid diet has little or no effect on health.

This isn’t to deny the strong link between good diet and good health, says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health and senior author of the study. It’s just that the pyramid doesn’t reflect that link.

Take, he says, the placement of the potato, which has inspired serious discussion in scholarly journals. There the spud sits, as if butter wouldn’t melt on its flesh, in the big, virtuous “vegetable” section--which we’re guided to sample three to five times daily for good health.

That’s the last place it should be, says Willett. He thinks the spud should be shoved upstairs to the pyramid’s pointy peak--the part we’re supposed to sample with great restraint.

Granted, he says, potatoes will get you by in a famine. Granted, eating one or two won’t cause civilizations to crumble. But there’s nothing restrained about Americans’ annual tater tally.

And that, Willett holds, is contributing to the ever-widening girth of American waists and an epidemic of chronic ailments such as heart disease and diabetes.

He has problems with practically every tier of the pyramid, from its wide base to its tip.

“It’s confusing,” agrees Lawrence Kushi, professor of nutrition and epidemiology at Columbia University in New York. “There are some things in our diet we really should be minimizing and others we should be increasing: The pyramid makes no distinction between the two.”

Others don’t think the pyramid deserves such a drubbing.

“Could it use a little tweaking? Yeah, sure--but I haven’t seen another tool that’s better,” says Alice Lichtenstein, professor of nutrition at Tufts University.

“It’s under constant criticism that ranges from the sublime to the ridiculous,” says Marion Nestle, professor and chairwoman of the department of nutrition and food studies at New York University, who studies the politics of government nutrition policies.

Nestle is not denying its faults. But those who diss the pyramid, she says, should bear in mind what it replaced, and what it took--politically--to get the graphic to Americans in the first place.

Health Concerns Changed Over Years

In the beginning, there was no pyramid. Just food groups--their numbers waxing and waning like the moon in successive government brochures. Five groups in 1917. Twelve in 1933. Eight in 1942; seven and 11 (simultaneously, in different USDA pamphlets) in 1943; four in 1946; back to five in 1979.

And government advice reflected the times. In the early 20th century, malnutrition--not obesity--was the main health concern, and people were more apt to die of infectious diseases such as influenza and typhoid than diet-influenced maladies like heart disease.

Thus the USDA’s efforts were aimed at coaxing people to eat a wide variety of foods so they wouldn’t be malnourished. This dovetailed happily with its other job: to promote U.S. agriculture in all its various forms.

Even when the winds began to change and data started accruing on the influence of saturated fat, cholesterol, salt and sugar on human health, government advice remained bland, says Nestle.

Take, for example, 1979’s “Hassle-Free Guide to a Better Diet.” It stated that although many scientists believed poor diet contributes to chronic conditions such as heart disease, some felt that there wasn’t sufficient evidence yet--”so the choice,” said the pamphlet, “is yours.”

But that wasn’t bland enough for the meat, egg and dairy industries, which, among other things, took umbrage at the fact that the artwork displayed grains, fruits and vegetables higher in the list than eggs and meat. Vigorous protest ensued. A follow-up brochure planned by the USDA was scrapped.

More fur flew over the 1980 publication of the government’s first dietary guidelines, which are the basis for government nutrition and education programs today. The same thing happens every five years when those guidelines are revamped by the USDA and Department of Health and Human Services.

“Every word of these things is picked over and fought over,” Nestle says.

Thus it’s par for the course that the Sugar Assn. argued vigorously this year against use of the word “limit” to guide our sugar intake in the most recent guidelines, preferring the more generous-sounding word “moderate.” (The association won.)

And that the Produce for Better Health Foundation (funded by fruit and vegetable growers) insisted that the word “choose” was “not motivational enough” when applied to fruits and vegetables; that “enjoy” was a better word. (The foundation lost.)

But such quibbling is small potatoes compared to the fuss that ensued when the food pyramid--after a decade of labor--blipped onto the radar screen of the meat and milk industry in 1991. And no wonder, because the pyramid, which was designed to convey the dietary guidelines in an easily understood way, did something radical.

Unlike a “food wheel” graphic rolling around previously, there was a pointed message in the graphic’s pointy shape: one of proportionality.

“It makes it very clear that some foods are better to eat than others,” Nestle says.

Industry protests contributed a one-year delay to the public release of the pyramid. But today, the graphic is all over the place. On cereal boxes and posters. In textbooks and nutrition education materials.

And the pyramid has a slew of relatives. There are ones tailored for kids and seniors. There’s a soul food pyramid, with collard greens in the veggies and chitterlings in the peak. There’s a food pagoda, and even a vegan food trapezoid, with the “animal food” part of the pyramid lopped right off.

Some of these pyramids are simply slapped together. Some are the fruits of much scientific labor. But none have been as rigorously number-crunched as the USDA’s original.

“People think we pulled the pyramid out of the air--that we woke up in the morning and said ‘Aha!’ ” says Eileen Kennedy, deputy undersecretary for research, education and economics at the USDA. “But a lot of really, really tedious analytical work went into building the pyramid.”

The critics also have been doing a lot of research, and they don’t like the way the pyramid often groups “good” with “bad,” clouding a healthy message.

Take oils. Many studies have linked eating large amounts of saturated fats (found in meat, dairy and eggs) and trans fats (made from the industrial hardening of vegetable oils) to such ailments as heart disease. Other fats--polyunsaturated and mono-unsaturated vegetable oils and certain fish oils--don’t seem to have those harmful effects, and some seem, in fact, to be protective.

“People should be eating reasonable amounts of these [good oils],” says Harvard’s Stampfer.

Yet by lumping all oils together at its peak, the pyramid makes no such distinction. It suggests limiting all of them--and that kind of advice does much harm, Stampfer says.

Or take the protein class (which we’re told to sample two to three times daily), made up of a collection of very different foods: red meat, poultry, fish, dry beans, eggs and nuts.

“It’s really a hodgepodge, and I think it really needs to be pulled apart,” says Kushi. “There are some things in that group you really shouldn’t be eating two to three times a day, and there are others--like nuts and beans--you should be eating on a regular basis.”

And then there’s that grain group--six to 11 servings daily--sitting at the base. The pyramid encourages us to eat truckloads of carbohydrates, making no distinction between a whole grain roll and a slab of white bread--but it should, insists Willett.

Compared to whole grains, refined starches like white bread and pasta (as well as a nice big baker spud) cause large spikes of sugar to enter our blood. That, in turn, causes spikes of the hormone insulin, which removes sugar from our blood and alters the metabolism of fats. Some studies suggest that we get hungry again faster after we eat such foods; and some researchers think these foods over-tax our insulin system, raising our risk for adult-onset diabetes and heart disease.

“There is a notable absence of studies showing the benefits of high consumption of potatoes and bread,” Willett comments.

As for dairy foods: At the least, critics say, the pyramid should distinguish between high- and low-fat milk. But, in fact, data on whether drinking milk in adulthood wards off osteoporosis “are extremely mixed, and not very convincing at all,” Kushi says.

Given all these purported flaws, pyramid critics aren’t surprised by results from a study conducted by Marji McCollough of the Harvard group. It examined the diet of thousands of male health professionals and female nurses over many years and showed that those who ate most like the pyramid dictates didn’t improve their health much.

Men only moderately reduced their heart disease risk; women, even less so. Neither group decreased its cancer risk.

But there’s a potential problem, say Nestle and Kennedy. Since it’s not feasible to control thousands of peoples’ diets for decades, epidemiologists must ask people what they eat and hope they get accurate reports. There are different ways to collect such data, and some researchers fault the method used by the Harvard group. Maybe the people in the study weren’t eating according to the pyramid anyway, critics say.

There’s a problem, too, with concluding that eating potatoes and refined starches causes big spikes in blood sugar, even if they do under laboratory conditions.

“You very rarely eat a potato in isolation,” says Kennedy. Things change a lot, she says, when you’re loading up your belly with a big mix of foods.

Many Suggestions for Alteration

The pyramid is likely to be modified in the next few years, says Kennedy. Whether those changes will satisfy its critics is another matter.

Some think the USDA--because its mission is also to promote U.S. agriculture--is the wrong government body to be implementing dispassionate nutrition advice.

Some want to add features to the pyramid: stairs up its side, plus a little person climbing them, to underscore the importance of exercise; a reminder to drink plenty of fluids; a reminder that everyone’s nutritional issues are different, depending on genes.

The Center for Science in the Public Interest, a consumer group, has devised a 3-D pyramid--with separate faces for the good, the so-so and the ugly for each class of food.

And some want a major overhaul. For instance, a “California Cuisine” pyramid developed at UCLA pushes carbohydrates up a floor and puts fruits and vegetables at the base instead. A “Mediterranean diet pyramid” emphasizes a diet rich in whole grains, plant foods, olive oil, and wine in moderation.

Others feel the move should be away from the rococo and more toward the minimalist. Forget about anything as complicated as a pyramid. How about concentrating on a few simple suggestions?

“If we encouraged people to eat more fruits and vegetables and to eat less junk food, a lot of the battle might be won,” says Kelly Brownell, director of the Yale Center for Eating and Weight Disorders at Yale University.

But the biggest problem with the government’s nutritional education message may have less to do with its precise form and more with what it takes to pound that message home: money.

“Even if we had a perfectly up-to-date, unarguable tool in the pyramid--if it were perfected to that degree--it would still require considerable commitment on behalf of the government,” says Dr. Ronald Krauss, head of the division of nuclear and molecular medicine at the Lawrence Berkeley National Laboratory in Berkeley.

Such commitment doesn’t yet exist, Nestle says. The annual advertising and promotion budget of a big-time candy bar is around $50 million, she says. Ad money in the U.S. alone for McDonald’s was more than $600 million in 1999--and even more when you factor in promotional items such as giveaway toys, she says.

In contrast, the government’s highest-profile nutrition education effort--the five-a-day fruits and vegetables campaign--gets a million from the government and another million from industry each year.

“I’d like to see a major national campaign with some real money behind it--to see if we can do some education,” says Nestle. “Nobody’s ever tried.”

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Competing Pyramids

Some nutrition researchers fault the U.S. Department of Agriculture’s food guide pyramid for failing to give the best advice that nutrition science can offer. They have designed alternative pyramids that they feel do a better job.