Government dietary guidelines, unintended consequences and pub...(also noting that an increasing prevalenc...),Health

Dr. Marantz and colleagues present data that support these trends; however, they are careful to note that this temporal association does not prove causation. Instead, says Dr. Marantz, it raises the possibility of a net harmful effect of seemingly innocuous dietary advice. These dietary recommendations did not necessarily cause harm, but there is a realistic possibility that they may have.

In a commentary published in the same issue of the American Journal of Preventive Medicine, Steven H. Woolf, MD, MPH, from Virginia Commonwealth University and Marion Nestle, PhD, MPH, of New York University, maintain that the guidelines are supported by decades of research. While they agree with Dr. Marantz that people often compensate for low-fat intake by consuming more calories, they disagree that the guidelines were wrong to encourage low-fat diets. The guidelines were not the culprit, said Dr. Woolf, who believes that the government was right to share what was known about the dietary causes of disease.

Woolf and Nestle do not dispute that guidelines can have unintended consequences. However, they write, When the prevailing message fails to achieve its intended aims or achieves the wrong ends, the solution is not to abandon the enterprise but to reshape the message to achieve desired outcomes.

Continuing the dialog, Marantz, Bird and Alderman respond in a further commentary, When trying to mitigate potential harm from past guidelines based on inadequate science, issuing reshaped guidelines with similarly inadequate science merely perpetuates past mistakes. It might sometimes be best to avoid translating flaccid arguments into rigid guidelines. Ultimately, this boils down to a difference in world view, much like the distinction between clinicians guided by the therapeutic imperative and
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