Featured article in the Summer 2016 Issue of Nutrition Close-Up
Guiding Stars, North America’s leading private nutrition guidance program, recently announced that the organization has updated its approach to factoring dietary cholesterol into its ratings system. The move came in response to evolving scientific evidence and changes reflected in the 2015 Dietary Guidelines for Americans.
Dr. Mitch Kanter, Executive Director of the Egg Nutrition Center (ENC) spoke with Dr. Leslie Fischer, a scientific advisor to the Guiding Stars program and one of the rating system’s chief developers, about the Guiding Stars system and the rationale behind the changes in its cholesterol rating. Here’s what Dr. Fischer had to say in response to ENC’s questions:
ENC: Can you describe the Guiding Stars program for our readers? What’s it all about?
Dr. Fischer: Guiding Stars is now celebrating its 10th anniversary. We’re the world’s first store-wide, point-of-purchase nutrition guidance program. Shoppers can follow the stars to make more nutritious purchasing choices using a simple, easy to understand one, two, or three-star system. The program is based on a patented, evidence-based, transparent algorithm that objectively evaluates the nutritional quality of foods, weighing nutrients to encourage such as vitamins, minerals, and fiber against nutrients to limit such as sodium, added sugars, and saturated fat. We maintain an extensive database of over 100,000 foods that is audited and updated on a regular basis.
ENC: What’s the story behind the algorithm?
Dr. Fischer: It’s actually quite interesting. The algorithm was created by a scientific advisory panel that includes experts in nutrition, biochemistry, and public health. They meet regularly and continue to review the latest nutrition science. Whenever national or international nutrition policy such as the Dietary Guidelines for Americans (DGA) are revised, the Guiding Stars scientific advisory panel carefully reviews those recommendations and the most current consensus scientific evidence to determine whether any revisions should be made to the algorithm. This procedure was followed when the 2015 DGA were released in early 2016.
ENC: How does the Guiding Stars program help shoppers make healthier purchasing decisions?
Dr. Fischer: Guiding Stars is a simple, at-a-glance tool that allows shoppers to quickly identify and choose foods that offer the most nutrition for the calories. It essentially takes the guesswork out of nutritious shopping by eliminating the need to compare every item in the store. That saves shoppers time. Instead of having to study food labels, shoppers can quickly glance at shelf tags within each section of a store and pick out the items earning stars. The purpose of Guiding Stars is not to tell shoppers what to buy, but to help them make more nutritious choices for themselves and their families.
ENC: What surprised you most about the changes in the federal government’s 2015 Dietary Guidelines?
Dr. Fischer: One thing that surprised me most was the shift away from isolated nutrients and the emphasis on different overall eating patterns that encompass multiple lifestyles and can be tailored to individual preferences. The recommended quantitative limit on added sugars was also an unexpected change.
In terms of cholesterol, while elevated blood cholesterol is a known risk factor for cardiovascular disease, the most current scientific evidence does not support a direct link between dietary and blood cholesterol. For example, a very recent study conducted in Finland found that regular egg consumption over a 20-year follow-up period did not increase the risk of coronary heart disease.
ENC: What research can you point to that may have prompted changes in the dietary cholesterol guidelines?
Dr. Fischer: The Dietary Guideline’s revised position on dietary cholesterol is in contrast to its recommendations for saturated fats (which call for a quantitative limit of less than 10% of total calories per day) and trans fats (consumption should be as low as possible), which are more definitively linked to increased blood cholesterol levels. The switch in emphasis away from dietary cholesterol and onto saturated fats and trans fats is not unique to the DGA. In 2013, the American Heart Association and the American College of Cardiology released new guidelines about diet and other lifestyle changes for the management of cardiovascular disease risk factors in adults. Their recommendations also did not call for a specific limit on dietary cholesterol, and instead emphasized restricting saturated fat and trans fats intake.
It is important to note that the removal of a quantitative limit on dietary cholesterol in either the DGA or the Guiding Stars algorithm does not mean that dietary cholesterol intake is no longer important, especially among at-risk populations such as individuals with type II diabetes. This is largely because most foods that are high in cholesterol also tend to be high in saturated fat. However, cholesterol-containing foods such as eggs and shellfish which are lower in saturated fat need not be limited in the same way, and can be enjoyed as part of an overall eating pattern that supports cardiovascular health.
ENC: For years Americans were told to limit their fat intake, and to make carbohydrates the main staple of their diets. Our understanding of these issues seems to be evolving. What are your thoughts on this issue?
Dr. Fischer: It now seems very clear that fat is an essential component of a healthy diet and it is fat quality rather than fat quantity that truly matters. Many fats such as omega-3 fatty acids found in fish, eggs, and nuts, and monounsaturated fatty acids found in olive oil are heart healthy and have anti-inflammatory properties. Such healthy fats and oils should be included as part of a healthy eating plan. In most cases, adhering to a low fat diet can result in overconsumption of added sugars and refined carbohydrates. This dietary pattern has been linked to elevated insulin levels, weight gain, and related chronic diseases such as type 2 diabetes.
ENC: What are your personal thoughts on eggs? Does your family consume eggs regularly?
My family and I definitely enjoy eggs on a regular basis. My husband is from Turkey and I have always marveled at the eggs there. They are purchased so fresh that they are not even refrigerated in the grocery store but rather laid out on large layered crates or flats. The yolks have a deep golden, almost orange hue to them and they taste absolutely delicious. Currently several of our neighbors raise chickens, and my two kids (who are now teenagers) have always enjoyed collecting eggs in a rainbow of colors. We love to go to the farmer’s market, buy some local cheese and whatever vegetables are in season, and then come home and make a beautiful frittata with those fresh eggs. That is one of the many ways that we enjoy eggs.
ENC: Any new changes you see coming along over the next few years regarding diet and health? Any nutrients we should watch out for?
Dr. Fischer: A growing body of evidence has been linking artificial colors to inattentiveness and hyperactivity in sensitive children. In response to this Guiding Stars will soon be studying the issue to consider possibly debiting foods containing artificial colors. One outcome might be that any foods containing artificial colors will get fewer stars or no stars at all. We are starting to see more food manufacturers replace artificial colors with naturally sourced color additives such as beetroot juice (as is widely being done in Europe).
Also given the new changes announced by the FDA to the Nutrition Facts Label, the exact amount of added sugars will soon be specified on all foods carrying a food label. As this information has previously not been available, the Guiding Stars algorithm has had to rely on a proxy estimate of added sugars. Once this information is available, the algorithm will be revised in order to evaluate and debit added sugars more accurately.
Dr. Leslie Fischer is a member of the scientific advisory panel for the Guiding Stars point-of-purchase nutrition guidance system and was one of the chief developers of the evidence and policy-based algorithm that underlies this patented program. She previously was a faculty member in the Nutrition Department at the University of North Carolina for over 16 years where she worked on nutrition-based clinical research trials, including a study on whether maternal intake of eggs or supplemental choline during pregnancy can enhance fetal brain development. Dr. Fischer is a co-founder of Nutrigenetics Specialists, a private dietetics practice specializing in genetics-based nutrition counseling. She received her PhD in Molecular and Developmental Biology from Columbia University and obtained her MPH in Nutrition from the University of North Carolina at Chapel Hill. Prior to moving to North Carolina, Leslie lived in Istanbul, Turkey for two years where she worked as a faculty member in the Biology Department at Bosphorus University. She is passionate about cooking and the Mediterranean diet.