More than a decade and a half ago, the U.S. Department of Agriculture (USDA) created a powerful and enduring icon: the Food Guide Pyramid. This simple illustration conveyed in a flash what the USDA said were the elements of a healthy diet. The Pyramid was taught in schools, appeared in countless media articles and brochures, and was plastered on cereal boxes and food labels.
Out with the Pyramid, In with the Plate
The Dietary Guidelines for Americans 2010: Progress, Not Perfection
The Long Road to the 2010 Dietary Guidelines for Americans
Commentary from Dr. Walter Willett and Colleagues on the Dietary Guidelines Advisory Committee Report
Carbohydrates: Good Carbs Guide the Way
Protein: Moving Closer to Center Stage
Fats and Cholesterol: Out with the Bad, In with the Good
Vegetables and Fruits: Get Plenty Every Day
Calcium and Milk: What's Best for Your Bones and Health?
Lower Salt & Sodium, A Key to Good Health
Tragically, the information embodied in this pyramid didn't point the way to healthy eating. Why not? Its blueprint was based on shaky scientific evidence, and it barely changed over the years to reflect major advances in our understanding of the connection between diet and health.
With much fanfare, in 2005, the USDA retired the old Food Guide Pyramid and replaced it with MyPyramid, a new symbol and "interactive food guidance system." The new symbol, basically the old Pyramid turned on its side, has been criticized ever since its debut for being vague and confusing. In 2011, the USDA replaced this much-maligned symbol with a new food icon, MyPlate.
The good news is that these changes dismantle and bury the original, flawed Pyramid. The bad news is that the new icon, while an improvement over MyPyramid, still falls short on giving people the nutrition advice they need to choose the healthiest diets.
As an alternative to the USDA's offering, faculty members at the Harvard School of Public Health built the Healthy Eating Pyramid. It resembles the USDA's pyramid in shape only. The Healthy Eating Pyramid takes into consideration, and puts into perspective, the wealth of research conducted during the last 15 years that has reshaped the definition of healthy eating.
In the children's book Who Built the Pyramid?, (1) different people take credit for building the once-grand pyramid of Senwosret. King Senwosret, of course, claims the honor. But so does his architect, the quarry master, the stonecutters, slaves, and the boys who carried water to the workers.
The USDA's MyPyramid also had many builders. Some are obvious—USDA scientists, nutrition experts, staff members, and consultants. Others aren't. Intense lobbying efforts from a variety of food industries also helped shape the pyramid.
In theory, the USDA pyramid should reflect the nutrition advice assembled in the Dietary Guidelines for Americans. According to the USDA, the guidelines "provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases."
This document, which by law must be revised every five years, aims to offer sound nutrition advice that corresponds to the latest scientific research. The panel assembled to create the guidelines usually generates 100 or so pages of dense nutrition-speak. This document is translated into a reader friendly brochure aimed at helping the average person choose a balanced and healthy diet. Of far greater importance, the Dietary Guidelines for Americans set the standards for all federal nutrition programs, including the school lunch program, and helps determine what food products Americans buy. In other words, the guidelines influence how billions of dollars are spent each year. So even minor changes can hurt or help a food industry.
According to federal regulations, the panel that writes the dietary guidelines must include nutrition experts who are leaders in pediatrics, obesity, cardiovascular disease, and public health. Selecting the panelists is no easy task, and is subject to intense lobbying from organizations such as the National Dairy Council, United Fresh Fruit and Vegetable Association, Soft Drink Association, American Meat Institute, National Cattlemen's Beef Association, and Wheat Foods Council. ()
Dietary Guidelines 2005: Two Steps Forward, One Step Back
Released in early January 2005, the Dietary Guidelines for Americans 2005 continues to reflect the tense interplay of science and the powerful food industry. Several of the recommendations in the current version represent important steps in the right direction:
Dietary Guidelines 2010: Progress, Not Perfection
The long-awaited new U.S. dietary guidelines, released on January 31, 2011, are a step in the right direction, but they don’t go quite far enough to spell out what Americans need to do to stay healthy—not a surprise, given the strong influence of the food industry on U.S. food policy.
Read more about the new Dietary Guidelines for Americans 2010.
The USDA Pyramid, Brick by Brick, and MyPlate
Distilling nutrition advice into a pyramid was a stroke of genius. The shape immediately suggests that some foods are good and should be eaten often, and that others aren't so good and should be eaten only occasionally. The layers represent major food groups that contribute to the total diet. MyPyramid tried to do this in an abstract way, and failed.
Six swaths of color sweep from the apex of MyPyramid to the base: orange for grains, green for vegetables, red for fruits, a teeny band of yellow for oils, blue for milk, and purple for meat and beans. Each stripe starts out as the same size, but they don't end that way at the base. The widths suggest how much food a person should choose from each group. A band of stairs running up the side of the Pyramid, with a little stick figure chugging up it, serves as a reminder of the importance of physical activity.
MyPyramid contains no text. According to the USDA, it was "designed to be simple," offering more details at the USDA's MyPyramid website. Unless you took the time to become familiar with MyPyramid, though, you would have no idea what it means. Relying on the Web site to provide key information—like what the color stripes stand for and what the best choices are in each food group—guarantees that the millions of Americans without access to a computer or the Internet will have trouble getting these essential facts.
The USDA also chose not to put recommended numbers of servings on the MyPyramid because these differ from individual to individual according to weight, gender, activity level and age. Instead, it offered personalized Pyramids on its website.
In 2011, after much criticism, the US government scrapped the MyPyramid icon and replaced it with the fruit- and vegetable-rich MyPlate icon, seeking an even simpler way to show Americans how to eat right. While it's a major improvement, the MyPlate icon still falls short on giving people the nutrition advice they need to choose the healthiest diets. Read more about the shortcomings of MyPlate.
Building a Better Pyramid
If the only goal of the USDA's food icons is to give us the best possible advice for healthy eating, then they should be grounded in the evidence and be independent of business.
Instead of waiting for this to happen, nutrition experts from the Harvard School of Public Health created the Healthy Eating Pyramid, and updated it in 2008. The Healthy Eating Pyramid is based on the best available scientific evidence about the links between diet and health. This new pyramid fixes fundamental flaws in the USDA pyramid and offers sound information to help people make better choices about what to eat. (View a larger PDF image of the new pyramid, in a separate window.)
The Healthy Eating Pyramid sits on a foundation of daily exercise and weight control. Why? These two related elements strongly influence your chances of staying healthy. They also affect what you eat and how your food affects you.
Getting to Your Healthy Weight: Science based advice on weight control
5 Quick Tips for Getting More Physical Activity: How to fit exercise into your life
Exercise and weight control are also linked through the simple rule of energy balance: Weight change = calories in – calories out. If you burn as many calories as you take in each day, there's nothing left over for storage in fat cells, and weight remains the same. Eat more than you burn, though, and you end up adding fat and pounds. Regular exercise can help you control your weight, and it is key part of any weight-loss effort.
The other bricks of the Healthy Eating Pyramid include the following:
The body needs carbohydrates mainly for energy. The best sources of carbohydrates are whole grains such as oatmeal, whole wheat bread, and brown rice. They deliver the outer (bran) and inner (germ) layers along with energy-rich starch. The body can't digest whole grains as quickly as it can highly processed carbohydrates such as white flour. This keeps blood sugar and insulin levels from rising, then falling, too quickly. Better control of blood sugar and insulin can keep hunger at bay and may prevent the development of type 2 diabetes. Plus, a growing body of research suggests that eating a diet rich in whole grains may also protect against heart disease.
Healthy Fats and Oils
Surprised that the Healthy Eating Pyramid puts some fats near the base, indicating they are okay to eat? Although this recommendation seems to go against conventional wisdom, it's exactly in line with the evidence and with common eating habits. The average American gets one-third or more of his or her daily calories from fats, so placing them near the foundation of the pyramid makes sense. Note, though, that it specifically mentions healthy fats and oils, not all types of fat. Good sources of healthy unsaturated fats include olive, canola, soy, corn, sunflower, peanut, and other vegetable oils, trans fat-free margarines, nuts, seeds, avocados, and fatty fish such as salmon. These healthy fats not only improve cholesterol levels (when eaten in place of highly processed carbohydrates) but can also protect the heart from sudden and potentially deadly rhythm problems.
Vegetables and Fruits
A diet rich in vegetables and fruits has bountiful benefits. Among them: It can decrease the chances of having a heart attack or stroke; possibly protect against some types of cancers; lower blood pressure; help you avoid the painful intestinal ailment called diverticulitis; guard against cataract and macular degeneration, the major causes of vision loss among people over age 65; and add variety to your diet and wake up your palate.
Nuts, Seeds, Beans, and Tofu
These plant foods are excellent sources of protein, fiber, vitamins, and minerals. Beans include black beans, navy beans, garbanzos, lentils, and other beans that are usually sold dried. Many kinds of nuts contain healthy fats, and packages of some varieties (almonds, walnuts, pecans, peanuts, hazelnuts, and pistachios) can now even carry a label saying they're good for your heart.
Fish, Poultry, and Eggs
These foods are also important sources of protein. A wealth of research suggests that eating fish can reduce the risk of heart disease, since fish is rich in heart-healthy omega-3 fats. Chicken and turkey are also good sources of protein and can be low in saturated fat. Eggs, which have long been demonized because they contain fairly high levels of cholesterol, aren't as bad as they've been cracked up to be. In fact, an egg is a much better breakfast than a doughnut cooked in an oil rich in trans fats or a bagel made from refined flour. People with diabetes or heart disease, however, should limit their egg yolk consumption to no more than 3 a week. But egg whites are very high in protein and are a fine substitute for whole eggs in omelets and baking.
Dairy (1 to 2 Servings Per Day) or Vitamin D/Calcium Supplements
Building bone and keeping it strong takes calcium, vitamin D, exercise, and a whole lot more. Dairy products have traditionally been Americans' main source of calcium and, through fortification, vitamin D. But most people need at least 1,000 IU of vitamin D per day, far more than the 100 IU supplied by a glass of fortified milk. (See the multivitamins section, below, for more information on vitamin D needs.) And there are other healthier ways to get calcium than from milk and cheese, which can contain a lot of saturated fat. Three glasses of whole milk, for example, contains as much saturated fat as 13 strips of cooked bacon. If you enjoy dairy foods, try to stick mainly with no-fat or low-fat products. If you don't like dairy products, taking a vitamin D and calcium supplement offers an easy and inexpensive way to meet your daily vitamin D and calcium needs.
Use Sparingly: Red Meat, Processed Meat, and Butter
These sit at the top of the Healthy Eating Pyramid because they contain lots of saturated fat. Processed meats, such as bacon, hot dogs, and deli meats are also very high in added sodium. Eating a lot of red meat and processed meat has been linked to increased risk of heart disease, diabetes, and colon cancer. If you eat red meat every day, switching to fish, chicken, or beans several times a week can improve cholesterol levels. So can switching from butter to olive oil. And eating fish has other benefits for the heart.
Use Sparingly: Refined Grains—White Bread, Rice, and Pasta; Potatoes; Sugary Drinks and Sweets; Salt
Why are these all-American staples at the top, rather than the bottom, of the Healthy Eating Pyramid? White bread, white rice, white pasta, other refined grains, potatoes, sugary drinks, and sweets can cause fast and furious increases in blood sugar that can lead to weight gain, diabetes, heart disease, and other chronic disorders. Whole grain carbohydrates cause slower, steadier increases in blood sugar that don't overwhelm the body's ability to handle carbohydrate. The salt shaker is a new addition to the "Use Sparingly" tip of the Healthy Eating Pyramid, one that's based on extensive research linking high-sodium diets to increased risk of heart attack and stroke. (Read more about why cutting back on salt is good for your health, and try these delicious recipes from The Culinary Institute of America that spare the salt.)
Multivitamin with Extra Vitamin D (For Most People)
A daily multivitamin, multimineral supplement offers a kind of nutritional backup, especially when it includes some extra vitamin D. While a multivitamin can't in any way replace healthy eating, or make up for unhealthy eating, it can fill in the nutrient holes that may sometimes affect even the most careful eaters. You don't need an expensive name-brand or designer vitamin. A standard, store-brand, RDA-level one is fine for most nutrients—except vitamin D. In addition to its bone-health benefits, there's growing evidence that getting some extra vitamin D can help lower the risk of colon and breast cancer. Aim for getting at least 1,000 IU of vitamin D per day; multiple vitamins are now available with this amount. (Many people, especially those who spend the winter in the northern U.S. or have darker skin, will need extra vitamin D, often a total of 3,000 to 4,000 IU per day, to bring their blood levels up to an adequate range. If you are unsure, ask your physician to check your blood level.) Look for a multivitamin that meets the requirements of the USP (U.S. Pharmacopeia), an organization that sets standards for drugs and supplements.
Optional: Alcohol in Moderation (Not for Everyone)
Scores of studies suggest that having an alcoholic drink a day lowers the risk of heart disease. Moderation is clearly important, since alcohol has risks as well as benefits. For men, a good balance point is one to two drinks a day; in general, however, the risks of drinking, even in moderation, exceed benefits until middle age. For women, it's at most one drink a day; women should avoid alcohol during pregnancy.
Forget about Numbers and Focus on Quality
You'll notice that the Healthy Eating Pyramid does not give specific advice about the numbers of cups or ounces to have each day of specific foods. That's because it's not meant to be a rigid road map, and the amounts can vary depending on your body size and physical activity. It's a simple, general, flexible guide to how you should eat when you eat.
There's just one basic guideline to remember: A healthy diet includes more foods from the base of the pyramid than from the higher levels of the pyramid. Within this guideline, however, there's plenty of flexibility for different styles of eating and different food choices. A vegetarian can follow the Healthy Eating Pyramid by emphasizing nuts, beans, and other plant sources of protein, and choosing non-dairy sources of calcium and vitamin D; someone who eats animal products can choose fish or chicken for protein, with occasional red meat.
Choosing a variety of fresh, whole foods from all the food groups below the "Use Sparingly" category in the Healthy Eating Pyramid will ensure that you get the nutrients you need. It will also dramatically lower your salt intake, since most of the salt in the U.S. diet lurks in processed food—canned soups, frozen dinners, deli meats, snack chips, and the like.
Perhaps the only foods that are truly off-limits are foods that contain trans fat from partially hydrogenated oils. Luckily, in the U.S. and Canada, trans fats must be listed on nutrition labels. More and more food manufacturers, restaurants, and even entire communities are going trans fat-free, making it easier to avoid this health-damaging type of fat.
The Healthy Eating Pyramid summarizes the best dietary information available today. It isn't set in stone, though, because nutrition researchers will undoubtedly turn up new information in the years ahead. The Healthy Eating Pyramid will change to reflect important new evidence.
This isn't the only alternative to the USDA's MyPyramid. The Asian, Latin, Mediterranean, and vegetarian pyramids promoted by Oldways Preservation and Exchange Trust are also good, evidence-based guides for healthy eating. The Healthy Eating Pyramid takes advantage of even more extensive research and offers a broader guide that is not based on a specific culture. The original Healthy Eating Pyramid is described in greater detail in Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, by Walter C. Willett, M.D. (the Fredrick John Stare Professor of Epidemiology and Nutrition in the Departments of Nutrition and Epidemiology at Harvard School of Public Health) with Patrick J. Skerrett (published by Free Press, 2005).
Failing the Test
Back in the 1990s, the USDA's Center for Nutrition Policy and Promotion created the Healthy Eating Index "to measure how well American diets conform to recommended healthy eating patterns." () In its original form, this score sheet used five elements from the longstanding USDA Food Guide Pyramid (number of daily servings of grains, vegetables, fruits, meat, and dairy products) and five from the 1995 Dietary Guidelines for Americans (total fat in the diet, percentage of calories from saturated fat, cholesterol intake, sodium intake, and variety of the diet). A score of 100 meant following the federal recommendations to the letter while a score of 0 meant totally ignoring them. (The USDA has since updated the score sheet to reflect the Dietary Guidelines for Americans 2005.)
To see how well the principles embodied in the Healthy Eating Pyramid stacked up against the government's advice, Harvard School of Public Health researchers created an Alternate Healthy Eating Index with a scoring system similar to the USDA's index. They then compared the two indexes, using information about daily diets collected from more than 100,000 female nurses and male health professionals taking part in two long-term studies.
Men who scored highest on the USDA's original Healthy Eating Index (meaning their diets most closely followed federal recommendations) reduced their overall risk of developing heart disease, cancer, or other chronic disease by 11 percent over 8 to 12 years of follow-up compared to those who scored lowest. Women who most closely followed the government's recommendations were only 3 percent less likely to have developed a chronic disease. () In comparison, scores on the Alternate Healthy Eating Index did appear to correlate more closely with disease in both sexes. Men with high scores (those whose diets most closely followed the Healthy Eating Pyramid guidelines) were 20 percent less likely to have developed a major chronic disease than those with low scores. Women with high scores lowered their overall risk by 11 percent. Men whose diets most closely followed the Healthy Eating Pyramid lowered their risk of cardiovascular disease by almost 40 percent; women with high scores lowered their risk by almost 30 percent.
1. Hooper M, Heighway-Bury R. Who Built the Pyramid? Cambridge, Mass.: Candlewick Press, 2001.
2. Abboud L. Expect a food fight as U.S. sets to revise diet guidelines. Wall Street Journal: August 8, 2003, B1
3. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. The Healthy Eating Index (PDF). 1995. Accessed on December 15, 2010.
4. McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002; 76:1261-71.
The aim of the Harvard School of Public Health Nutrition Source is to provide timely information on diet and nutrition for clinicians, allied health professionals, and the public. The contents of this Web site are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site. The information does not mention brand names, nor does it endorse any particular products.
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