Will the Real Food Pyramid Please Stand Up?

The USDA's Food Guide Pyramid is on the defensive these days. Critics claim it does little to protect against chronic diseases like heart disease, stroke, type 2 diabetes and cancer.

That's also the verdict of a recent series of Harvard University studies tracking 100,000 men and women during 15 years. Those whose diets ranked in the top 20 percent of the USDA's Healthy Eating Index (a gauge of Pyramid compliance) lowered their overall risk of heart disease and stroke by a modest 28 percent (men) and 14 percent (women,) compared to people scoring in the bottom 20 percent. Those in the top 20 percent of Harvard's more demanding Alternate Healthy Eating Index, however, cut their risk by a more impressive 39 percent (men) and 28 percent (women).

Hold on, though, the real Food Pyramid diet is getting a bum rap, and here's why. What most of us know about the Pyramid comes largely from its familiar image on food packages. It hasn't changed since its 1992 release to promote the third edition of the Dietary Guidelines for Americans (1990). Indeed, it's easy to confuse the Pyramid graphic (and the limited information that it conveys) with the actual Pyramid way of healthy eating. There's a big difference.

In fact, the Pyramid image is only the tip of a largely unseen "iceberg" of dietary advice that has improved a lot over the years. By law, the Dietary Guidelines are revised at least every five years, and the fifth edition came out in 2000.

Just last year, the government's Institute of Medicine increased daily fiber goals and widened the recommended range for carbohydrate intake to a more flexible 45 percent to 65 percent of total calories. It also approved a broader range for fat intake (20-35 percent) but with added emphasis on fat quality.

The Pyramid image, itself, is now finally under review, and an updated version is due out in 2004. Until then, here's how to get the most out of the current Pyramid by applying the major dietary updates of the past 11 years. These improvements come close to meeting Harvard's tougher standards.

Quality counts: The 1992 Pyramid image doesn't reveal the fact that each of the 5 Food Groups contains foods ranging in nutritional quality from "thumbs-up" (high) to "halfway thumbs-up" (fair). If you eat mainly the less nutritious foods within each Food Group, you'll end up with a C grade diet. If you also overdo the "go easy" foods in the Pyramid's Tip (soda, high-fat meats, french fries, etc.), you'll slip to a D grade or worse.

It takes an A or B grade to aid weight control and provide optimal protection against chronic diseases. You don't have to eat only thumbs-up foods, but most Americans consume too few. That's a key reason why the typical American diet rates only a D+ on the USDA's Healthy Eating Index. By the way, this index dates back to 1994 and has become too lax a gauge of true Pyramid compliance, another reason the Pyramid appeared less impressive in the Harvard studies.

Grain Group tips: Eat fewer refined, processed grains and more whole-wheat bread, brown rice, popcorn (air popped or very low fat), and breakfast cereals with at least three grams of fiber per 100 calories. Convincing research shows eating at least 3 whole-grain servings a day can notably reduce your risk of chronic diseases, and the extra fiber content aids weight control. Just one in 15 Americans now meets this goal.

Vegetable & Fruit Groups: Aim for 5 to 9 total servings a day for better weight control and lower chronic disease risk. Go for variety, and include more colorful produce such as broccoli, spinach, carrots, tomatoes, winter squash, sweet potato, cantaloupe, pink grapefruit, plums, prunes, berries and cantaloupe. They're generally richer in nutrients, especially beneficial antioxidants which help slow the aging process and fight disease. Consume more whole fruits than juice, but go easy on canned fruits in sugar-laden heavy syrup.

Milk Group: Low-fat dairy foods such as skim milk, one percent milk, and low-fat or fat-free yogurt and cheese are the wisest choices for most adults and children over age two. Compared to full-fat versions, they save you 65-100 calories a serving and reduce your intake of heart-risky saturated fat. Aim for three low-fat dairy servings daily.

Protein Group (meat, fish, beans, nuts, eggs): Most Americans could benefit from more emphasis on fish, skinless poultry, beans, and nuts. Fatty fish such as salmon, herring, mackerel, sardines, bluefish, whiting, and halibut are especially high in heart-healthy omega-3 fat, proven to markedly reduce the risk of fatal heart disease, stroke, and sudden cardiac death. The American Heart Association recommends eating two weekly servings of broiled or baked fish.

The Pyramid Tip: The "eat sparingly" tip foods are generally calorie rich, low in healthy nutrients, and high in added sugars or in "go easy" nutrients like sodium, saturated fat, or partially hydrogenated fat (vegetable shortening). But liquid (non-hydrogenated) canola, olive, and soybean oils, as well as salad dressings containing them, are healthy exceptions. Even modest amounts provide effective levels of beneficial types of fat.

What about the Pyramid and weight gain? A recent Tufts University study tracking 459 men and women over several years found those with a "meat and potatoes" eating pattern gained about 1.8 pounds a year, while those with a true Pyramid diet gained just 0.3 pounds. So why any weight gain at all? Like most Americans, this group was relatively sedentary, which shows that exercise is also essential for weight control.

David Leonard Educational Program Coordinator, Food and Nutrition