Current Dietary Guidelines

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A number of national or professional health organizations have recommended guidelines for healthy diets, either for general health or focused on specific aims such as controlling obesity or diabetes, or preventing heart disease. Most current guidelines emphasize limitation of caloric consumption from fats. For example, the Chinese Ministry of Health guidelines for prevention and control of overweight and obesity in adults included moderate caloric restriction plus physical activity with an emphasis on diets with low fat content, complex carbohydrates (including cereals), and fresh fruits and vegetables [2]. In the setting of dyslipidemia, they also recommend limitation of saturated fat and cholesterol.

The American Diabetes Association published a technical review of dietary guidelines for people with or at high risk of developing diabetes [3]. Recommendations for people with either type-1 or type-2 diabetes were to include carbohydrates from whole grains, fruit, vegetables, and low-fat milk. Less than 10% of calories should be derived from saturated fat, and about 10% should come from polyunsaturated fat. In the typical American diet that contains more than the recommended amount of saturated fat, the calories from saturated fat should be replaced by calories from carbohydrate and monoun-saturated fat, with the combination of the two making up 60-70% of dietary intake. Interestingly, there was insufficient evidence to recommend how much of this combination should be carbohydrate and monounsaturated fat. Another controversial point for which they found insufficient evidence was the glycemic index of foods. Thus, they made no recommendation regarding choosing foods based on the glycemic index. This technical review also contained recommendations concerning energy balance and obesity [3]. The reviewers concluded that prescription of weight-loss diets alone was unlikely to produce sustained weight loss, but structured programs including exercise and behavioral modification could produce sustained weight loss of 5-7%. The effectiveness of this type of program was, in fact, shown in the Diabetes Prevention Program clinical trial [4].

Similar, though not identical, dietary recommendations were made by the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes [5] and the American Heart Association [6]. Notably, none of these guidelines from professional health organizations recommended high-fat low-carbohydrate diets, or extremely low-fat diets (<10% of calories), despite the recent interest in such diets (see below).

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Dieting Dilemma and Skinny Solutions

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