解构新的食物金字塔（出色还是令人困惑）

欢迎来到《健身医生》播客，在这里我们将简化健康生活方式、运动医学和减重的复杂内容。

Welcome to the Docs Who Lift podcast where we distill and simplify the complexities of a healthy lifestyle exercise medicine and weight loss.

我们致力于为您带来一档适用于临床实践、科学建议和现实生活的真实播客。

We're to bring you a podcast that's a prescription for clinical practice, scientific recommendations, and just real life.

这是《健身医生》播客。

This is the docs who lift podcast.

嘿。

Hey.

嘿。

Hey.

欢迎回到《健身医生》播客。

Welcome back to the docs who lift podcast.

我是您的主持人，斯宾塞·阿多尔斯基医生。

I'm your host, doctor Spencer Adolsky.

我是我的联合主持人，卡尔·纳多尔斯基医生（Junior），今天我们请回了我们最爱的RDPHD，凯文·克拉特医生。

I'm my cohost, doctor Carl Nadolsky junior, and we brought back our favorite RDPHD, doctor Kevin Klatt.

我们将简要概述一下刚刚发布的最新膳食指南，这些指南引发了不小的争议。

And we're gonna be going over just a very quick brief overview of the new dietary guidelines that were just released that are causing, you know, quite a stir.

凯文医生写了一篇非常不错的Substack文章，简要介绍了其主要内容、一些矛盾之处以及整体概览。

And Kevin doctor Kevin wrote a really nice little Substack article just kinda going over, you know, the gist of it and some of the discrepancies and the overall overview.

我想了解一下，膳食指南到底是为了什么而制定的呢？

And I kind of want to get a sense of like what were what are dietary guidelines even made for you?

你在Substack文章中提到过这一点。

You alluded to it in your Substack.

我想谈谈一些人们可能根本不懂的、关于这些指南的有趣内容。

And so some of that interesting stuff that people I just don't think understand about these things.

没错。

Right.

还有关于历史和时间线的一些内容，因为我觉得这也很重要。

And a little bit of the history and the timeline because I think that matters too.

因为我觉得它们似乎有点

Because I feel like they've there there's a little

一点，

bit of,

是啊。

yeah.

我不知道。

I don't know.

它们就像是

They're they're like

随便吧。

Whatever.

你是这里的专家。

You're you're the you're the specialist here.

你来教我们吧。

You you teach us.

谢谢你们邀请我回来。

Well, thanks for having me back.

是的。

Yeah.

饮食指南。

Dietary guidelines.

我的意思是，它们最早出现在1980年。

I mean, they came about, first in the 1980.

那是美国首个官方的饮食指南。

It was the first official United States, dietary guidelines.

它们是由美国农业部和卫生与公共服务部共同制定的。

They're made by a combo effort of USDA and HHS.

你知道，它们最初只是给人们一些非常简单的建议，之后随着时间推移不断演变。

And, you know, they they started off more towards just giving people, like, really simple recommendations, and they've evolved over time.

第一个版本是一本小册子，列出了七项需要关注的重点。

So the first one was, like, a little pamphlet with, like, seven things to focus on.

语言非常模糊，比如少吃脂肪和饱和脂肪，少吃糖，多吃纤维，保持健康体重，限制饮酒，诸如此类。

Very vague language around, like, eat less fat and saturated fat, eat less sugar, eat more fiber, maintain a healthy weight, limit alcohol, that sort of thing.

合理的内容。

Reasonable stuff.

实际上没什么太大的变化。

Not much has changed incredibly.

当然，随着时间的推移，这些内容也在演变。

Obviously, like, you know, things evolved over time.

语言从过去的‘少吃’‘多吃’，逐渐转向更注重替代选择，强调饮食模式；到2005年左右，这一点变得非常明确。

The language was, less about, like, eat less, eat more, more about substitutions, more focus on dietary patterns, and things around 2005, it becomes quite clear that yeah.

我认为，当你提到1980年开始，到2005年时，情况反而变得更糟，而且没有证据表明人们在遵循膳食指南。

I think I think when you say start in 1980 and by 2005, like, things are only getting worse, and there's no evidence that people are are following the dietary guidelines.

你可以说‘多吃水果蔬菜’，但这些指导本身缺乏实质性的内容。

You can say eat fruits and vegetables all you want, but there wasn't really a lot of meat to them.

于是你开始看到变化，它们变得越来越量化，比如最终规定糖和饱和脂肪的摄入量不得超过总热量的10%。

And so you start to see changes that occur where they're getting pretty quantitative about things, where they you know, eventually, we're at the point where it's, like, less than 10% of calories from sugar and saturated fat.

随之而来的是，这些指南不再只是简单的建议，而是发展成了上百页的文件。

And then that change comes along with, like, they're not really intended to be you know, they've grown to a 100 plus page documents.

它们并不是为消费者设计的。

They're not intended to be for consumers.

它们实际上是为医疗保健专业人员和政策制定者准备的，这些人会将它们应用到各种环境中。

They're really intended to be for health care professionals and policymakers who are gonna adapt them across various settings.

比如，如果你在WIC或SNAP工作，或者在地方公共卫生部门工作，你会阅读这些指南并加以应用。

Like, if you're working in WIC or you're working in Snap or you're working in a a local public health department, you read these and you apply them.

你会了解它们的设计目的以及所有可能影响应用的背景因素，然后加以运用。

You you get all the context of what they're intended for, all the different, kind of contextual factors that might come into play and you use them.

然后，它们总是被引用在不同的政策中。

And then they're always cited in different policies.

因此，从技术上讲，联邦项目必须与膳食指南保持一致，我认为这正是它们具有影响力的地方。

So, technically, federal programs have to be aligned with what the dietary guidelines are, and that's really, I think, where they have some weight.

人们总是关注它们说了什么，以及其中的细微调整。

Everyone always focuses on what they say, and there's been tweaks and things.

比如，现在对总脂肪的关注减少了，更多地集中在减少饱和脂肪和反式脂肪上，而不是像过去那样只关注总脂肪数值。

Like, there's less of a focus on total fat, more on reducing saturate and trans fats, than than just the total fat number in the past.

但在这整个过程中，你也看到了流程的变化：过去仅仅依赖专家意见，后来进入了更多系统性综述的时代。

But across this whole time too, you've seen changes in the process to it where it used to just be expert opinion, and you moved into the era of more systematic reviews.

尽管流程发生了所有这些变化，我认为指南实际推荐的内容并没有发生太大的根本性改变。

Despite all that process change, I don't think there's been that much of a dramatic change in what the guidelines are actually recommending.

我认为人们希望这些指南能成为某种神奇的东西。

I think people want the guidelines to, you know, be this magical thing.

正如我在子部分中提到的，它们其实只是一个很小的工具。

And as I talk about a bit in the sub sack, like, they're a really small tool.

它们真正产生影响的领域仅限于学校午餐等少数方面，而在这方面确实取得了一些进展。

They really only influence things like school lunch where there's been some progress that's been made.

但你知道，它们的定位本就是一份用于支持其他政策的文件，需要州、地方和联邦政府共同运用它们，还需要有相应的立法意愿才能有所作为。

But, you know, they're intended to be a document to use to support other policies, and you need state, local, and federal government to, to be utilizing them, and and you need some, like, legislative will to do anything.

我认为，看看国会就能发现，立法意愿其实并不强，很难推动太多事情。

And I think you can look at congress and see that there's not much legislative will to do all that much.

我的意思是，正如我们在2015年看到米歇尔·奥巴马所做的那样，她当时确实努力想让营养成为奥巴马政府的中心议题。

I mean, as we saw with Michelle Obama in 2015, you know, she really tried to make nutrition the the centerpiece of or AFF before 2015.

在奥巴马时期，她试图推动，我认为最终被弱化为一场运动倡议，但她确实努力解决营养问题，却被如今那些支持MAHA的人同样贴上了‘食物警察’的标签。

During during Obama era, she tried to get the I think it got watered down to just, a movement campaign, but she really tried to tackle nutrition and just got painted as the food police by kind of the same people now who are pro MAHA.

所以，膳食指南的历史很有趣。

So it's, an interesting history of DGAs.

它们总是充满争议。

They're always controversial.

主要流程是，有一个膳食指南咨询委员会，他们会聚在一起回答一系列问题，并最终汇编成一份科学报告，然后这份报告会交给美国农业部和卫生与公共服务部，由他们正式制定膳食指南。

The the main process is that you have a dietary guidelines advisory committee that gets, together and they answer a bunch of questions and basically put together this scientific report, and then that is handed off to USDA and HHS to actually, form the DGAs.

从科学报告到实际指南之间，总会有一些改动或未被采纳的内容，我认为每年都能看到，每五年就会出现一条关于某些争议性内容的头条新闻。

And, you know, there'll be some changes or some things that aren't carried through from the the scientific report to the actual guidelines that I think every year you get to see a every five years you get, like, a headline about, like, what, you know, something controversial.

那个第一代食物金字塔是什么时候推出的？

When did that when did that first food pyramid come out?

因为每个人都聚焦于它。

Because everybody focuses on that.

因为你在子章节里提到了它。

Because you you you went in your sub sec, you talk about that.

当时，就像是

There was, like,

有那七条非常合理的内容。

a list of those seven things that are very reasonable.

是的。

Yeah.

那是1980年。

That was the 1980.

但后来那个食物金字塔是什么时候推出的？

But then you when did the actual, that food pyramid came out?

是1993年。

I was in 1993.

我当时在上三年级，或者二年级。

I was in third grade when I or second grade.

对。

Yes.

是1992年或1993年。

It was 1992 or '93.

1992年发布的。

'92 when it came out.

对。

Yeah.

好的。

Okay.

我记得我当时上三年级，记得他们第一次推出这个的时候。

So I was I was I remember I was in third grade, and I remember they first came out with it.

我当时想，天啊。

I was like, damn.

看。

Look.

看看这个。

Look at it.

我能吃掉所有这些面包。

I can eat all this bread.

这就是那种想法。

And that's kind of the thought.

就像大家都说，嗯，对。

It's like, everybody's like, yeah.

多吃点谷物。

Eat more grains.

我吃了更多意大利面，但你知道的，没什么效果。

I ate more pasta, it doesn't you know?

随便吧。

Whatever.

但后来那个出现了，然后在2011年又消失了。

But then that so that came out then, and then it went away in 2011.

嗯。

Yeah.

嗯，后来在八幡之后推出了一版更新的。

That's well, there was an updated one that came out in Soon after the Yatsu

我们自己做了个金字塔。

lift made our own, pyramid.

我们，是的。

We yeah.

我们有我们的

We had our

自己做的金字塔。

own We made a pyramid.

在2008年。

In 2008.

它实际上看起来就像，确实有点像现在的

It actually looked like the it actually kind of looked like the The current

这个金字塔。

this pyramid.

只是没有顶部饱和脂肪中的那根桩。

Just without without without the stake in the in the saturated fat at the top.

嗯，我们确实。

Well, we yeah.

金字塔本应作为图解辅助，展示你可以轻松捕捉到的相对比例和数量，作为一种直观的视觉辅助来解释膳食指南，而这正是当前膳食指南不再做到的。

The the pyramids are supposed to act like be a pictographic accompaniment to show, like, relative proportions and amounts that you can catch, like, an easy visual to accompany and translate the tax, which is relevant for this DGA because it really doesn't do that anymore.

但直到现在，过去十五到二十年的先前指南逐渐演变为一份面向政策制定者和医疗专业人员的报告，然后这份报告被用于各种联邦项目中。

But so, like, I I think now the the up until right now, the previous guidelines for the past fifteen, twenty years had evolved to being, like, you've got this report for policymakers and health care professionals, and then you've got, that gets used in various federal programs and things.

但随后出现了像‘我的餐盘’这样的东西，还有很长一段时间一直存在的choosemyplate.gov网站，上面有大量面向消费者的材料。

But then you have things like MyPlate and a whole, like, I think it was choosemyplate.gov was the site for a long time that had, like, tons of consumer facing materials.

很明显，这些材料获得的资金可能不如应有的那么多，而且围绕‘我的餐盘’并没有形成大规模的文化变革。

It was pretty clear that wasn't getting as much funding necessarily as it maybe should have had, and there wasn't a big cultural revolution around MyPlate so much.

但确实有人努力将这份冗长的报告进行转化。

But there were efforts taken to translate that very long report.

你经常听到人们批评膳食指南过于冗长，但人们往往没意识到，这些指南本质上是面向医疗专业人员和政策制定者的报告，而另有配套材料才是专为普通消费者设计的。

Often you'll hear that dietary guidelines get critiqued for being overly long, and people don't quite get that they're more health care professional and policy report, and then that there's these accompanying materials that are intended to be the sort of consumer facing thing.

我们现在把这一切都颠倒过来了，新的膳食指南就是这样。

And we've now flipped all that on our heads with the the new DGA.

我非常喜欢MyPlate。

Well, I love the MyPlate.

所以，好吧。

So let okay.

所以大家都说，这是革命性的。

So everybody's basically saying, this is revolutionary.

让我特别烦的是，就像你说的，大家都在搞这些花里胡哨、自我吹嘘的表演，说这些有多了不起。

The the the thing that's making me so annoyed is, like, this like you say, the theatrics and the performative back self back padding that everybody's doing about these are so amazing.

这终于会改变一切，他们终于在推动真正健康的食物了。

This is gonna finally shift everything, and they're finally pushing towards real food.

但在我看来，MyPlate其实差不多，甚至只是看一眼就感觉

But the MyPlate was, you know, pretty similar as far as I can see just even just

而且它一直以来都差不多。

And it's and it's been similar forever.

我的意思是，所有的饮食指南其实变化不大，只是看起来他们似乎更倾向于推崇饱和脂肪和红肉。

I mean, all dietary guidelines, they've not a lot has changed other than it seems like they're trying to promote more of a a bias towards, say, the saturated fat and and red meat.

那些就是。

That's the the ones

科学上，让我们听听。

scientific Let's hear what

站不住脚。

unsounded.

他们到底在说什么？

What is what are they really saying?

嗯。

Yeah.

让我们听听凯文的见解。

Let's let's hear, Kevin.

我想确切地了解这些矛盾之处。

I wanna I wanna know exactly these discrepancies.

我读过你的文章，我觉得这是个好主意，但我真的很想知道，那些熟悉旧指南的人是怎么看待这些新指南的。

I I read your stuff, so I I a good idea, but I'd love to know, you know, someone who knows the previous guidelines pretty well and what these new ones say.

还有他们之前说大家一直在吃的那些假食物，现在我们终于可以吃真正的食物了。

And and the fake food that they said everyone's been eating and now we can finally eat real food.

是的。

Yeah.

是的。

Yeah.

于是他们发布了 eatrealfood.gov 网站，还发布了一份十页的膳食指南，以及一份每日份量指南，告诉人们每种食物组该吃多少。

So we got a release on like eatrealfood.gov and, so they released a 10 page dietary guideline, and then they released a daily servings guide that tells you how much of each food group to eat.

此外，还附带了一份科学评审文件，解释了他们与膳食指南咨询委员会报告（共90页）之间的某些差异，以及一个418页的附录。

And then there's a scientific review document that accompanies it that kind of explains some of the deviations that they made from the dietary guideline advisory committee report that's 90 pages, and then a 418 page appendix.

然后我们还得到了一个新的食物金字塔。

And then we also got a new food pyramid.

所以，这些东西真够让人消化的。

And so, it's it's a lot to digest.

我之前对那些只是匆匆一瞥就发表评论的人持批评态度。

I was pretty critical of people who took, like, really quick reacts.

天啊。

I'm like, gosh.

你得稍微深入了解一下。

You gotta dig into this a tiny bit.

我认为从一个非常宏观的角度来看，我称之为‘什么都没有的汉堡’，重点在‘汉堡’上——如果你真的读了那10页的报告，会发现其中很多内容和之前的指南是一样的。

I think at a super high level, yeah, I've been calling it a nothing burger with an emphasis on the burger, where it's if you if you read the actual 10 page report, like, a lot of it is the same as as previous guidelines.

如果你看看每日份量指南，很多部分也看起来非常相似。

If you look at the daily servings guide, a lot of that looks quite similar as well.

仍然是同样的蛋白质食物、乳制品、水果、蔬菜、全谷物和油脂。

It's the same protein foods, dairy, fruits, vegetables, whole grains, and then oils.

如果你看看文本内容，里面很多都是很合理的东西。

If you look at, like, what the text says, it's a lot of reasonable stuff.

多吃水果和蔬菜，减少添加糖的摄入。

Eat fruits and vegetables, keep added sugars low.

他们实际上提出了非常激进的建议，比如10岁以下的孩子不应该摄入任何添加糖。

They actually have really aggressive, like, no kids under 10 should be eating any added sugars.

所以，你可以说这是个理想化的目标。

So, you could argue that's aspirational.

你也可以认为这完全不现实、不可行，但他们确实明确提出了这一点，比如他们提到要吃乳制品和肉类，当然，还谈到了一些关于婴儿喂养的基本建议。

You could argue it is, like, completely, unlikely to happen and not feasible, but, they really put it out there, like, that that was quite strong where you know, then they said eat, like, dairy and meats, of course, and they talk about the basic things you would expect around, like, tailoring for infancy.

很明显，他们请了一些儿科医生来撰写这份报告。

It's clear they had some pediatricians write it.

这是我在子栈中想指出的一点。

That was one thing I'd point out in the sub stack.

很明显，这些不同报告中有很多作者，声音也多种多样。

It's quite obvious there's like many authors and many voices throughout all these different reports that they made.

即使在饮食指南这10页内容内部，也能清楚看出有些部分是某人写的，另一些部分则是其他人写的。

Even within the dietary, the 10 pages themselves, it's it's clear some people wrote some section and then some others wrote another section.

所以它并不是

So it's not

他们是一致的。

They're cohesive.

不，这显然不是由营养师或受过食品训练的人撰写的，因为我的子部分中有一个叫‘FLUBS’的板块，里面充斥着关于食物成分或标签的明显错误。

No, it's very clearly not written by like a dietitian or somebody who has training in food because there's just I have a little section of my subsect called FLUBS, but just like blatantly wrong things about food composition or labels that they have that are incorrect.

所以，是的，我不想过多纠结于这些琐碎的事情。

So, yeah, it's I don't wanna get too much into that petty stuff.

但总的来说，他们所讲的很多内容

But at a high level, a lot of, like, what they

说

say

看起来都一样。

looks the same.

但我觉得，当涉及到健康脂肪和乳制品部分时，情况就开始发生变化并出现矛盾了，他们在科学综述文件中进一步解释说，健康脂肪就是天然食物中含有的脂肪。

But I think, you know, where where things start to change and get a bit contradictory is in, like, the healthy fats and dairy section they emphasize, and more in the scientific, review document they explained, that healthy fats are just natural like, foods found in or fats found in natural foods.

所以，肉类、乳制品、鸡蛋、三文鱼、坚果和种子、橄榄和牛油果，基本上就是他们的清单。

So meat, dairy, eggs, salmon, nuts and seeds, olives, and avocado basically are their list.

所以这些都属于健康脂肪。

So those are all healthy fats.

因此，这与过去的做法有相当大的差异，过去他们明确提到要包括全脂乳制品并推荐全脂乳制品。

So that is a pretty substantial deviation from the past where they they call out, like, including full fat dairy and recommend full fat dairy.

肉类，我认为他们默认指的是脂肪含量较高的部位，但这一点有点含糊其辞。

Meats, it's I think it's assumed that they would be fattier cuts, but it's a little bit skirts that a little bit more.

但这可是个重大变化。

But that's quite a deal.

你知道吗，那个列表中的一些内容，在过去的指南中我们曾称之为健康脂肪。

You know, some of the some of the things in that list, we would have called healthy fats in past guidelines.

比如三文鱼、坚果和种子，坚果和种子。

So salmon, nuts and seeds Nuts and seeds.

种子油。

Seed oils.

嗯，种子油并没有被列入，而这

Well, so seed oils don't make it into s, and that's

但种子确实含有，而且这些

a Except that the seeds do, and those

它们里面含有油脂。

are those are those have the oils in them.

对。

Right.

但任何菜籽油、大豆油、红花油这些都完全缺失了。

But so but any, canola, soybean oil, that that is safflower oils, those are all missing.

他们明确指出，只能用黄油、橄榄油和牛油来烹饪。

They actually explicitly say to only cook in butter and olive oil and beef tallow.

哇。

Wow.

而且他们还专门做了一项科学综述，讨论使用种子油烹饪食物的担忧。

So and and they have a whole thing on a scientific review about concerns from, cooking foods within seed oils.

我觉得我们可能需要一个长达两小时的播客才能彻底讲清楚这些。

And I think we probably would need, like, a two hour long podcast to really go and all that.

但接着他们又令人困惑地保留了饱和脂肪占热量10%的上限。

But but then they kind of confusingly keep the 10% of calories cap on saturated fats.

我本来想问

I was gonna ask

你澄清一下，因为我注意到了这一点。

you to clarify that because I saw that.

人人都说，哦，他们建议多吃饱和脂肪。

Everyone says, oh, they're saying to eat more saturated fat.

它在金字塔图里。

It's in the pyramid.

但在实际文本中，对于饱和脂肪的建议仍然完全一样，如果我没记错的话。

But then in the actual text, it still says the same exact thing for saturated fat, if I'm not mistaken.

所以我认为，这些内容在表面上并不一致，真的很难理解。另一个与此相关的重大变化是，他们基本鼓励增加蛋白质摄入量，建议达到每公斤体重1.2至1.6克，而目前的摄入量大约在每公斤体重1到1.2克之间，不同生命阶段和体重会有些许差异。

So I don't think, these things don't align on the surface, and it's it's very hard to so so the other major change that dovetails with this is they basically encouraged, increasing protein intake, so to between 1.2 to 1.6 grams per kilogram body weight, the current, you know, current intakes are between one and one point two kilograms with some variation across, like, life stages and things there, and weight body weights.

但总体而言，我们的摄入量已经超过了目前推荐的每日摄入量（RDA）了。

But in general, we eat more than what is the current RDA of of Mhmm.

每公斤0.8克，但还没达到1.2到1.6的范围。

Point eight grams per kilo, but not quite 1.2 to 1.6 range.

这比我们目前的摄入量会有所增加。

So that would be a bit of a boost from what we're currently eating.

对于普通成年人，他们大致提出一个阈值，大约在80到100克之间。

And for, like, an average adult, they kinda put forth a threshold of something more like 80 to a 100 grams.

我认为这份综述中的实际数字是100克。

I think a 100 grams is the actual number in the review.

这意味着额外摄入相当多的蛋白质。

So that would be, you know, quite a quite a bit extra protein.

对于你们这些健身爱好者来说，这可能听起来微不足道。

Know, for you guys lifting audience and things, like, that probably sounds like nothing.

但如果你真的去规划一种饮食，既要让饱和脂肪低于总热量的10%，又要强调动物性高蛋白食物，同时还包含更多脂肪丰富的动物产品，这其实非常困难。

But it's really hard if you sit there and try and plan a diet that is less than 10% of calories from saturated fat, but emphasizes high protein foods like animal foods, and then is also including more fatty animal products.

所以我们应该顺其自然。

So it's We should we should just down the line.

我们应该让这个播客由劳拉的牛肉赞助。

We should get this podcast sponsored by Laura's Beef.

就是那种你经常看到的、93%到96%瘦肉的瘦牛肉。

It's the, you know, the one, the lean beef that you see that's always in the, you know, the 93 to 96% lean.

哦，牛肉来了。

Oh, there's the beef.

因为，没错。

Because, like yeah.

因为有个在Instagram上的人，很多人在讨论这些指南，他展示了这种饮食的实际样子。

So because this there's a guy on, on Instagram, there are people going off about the guidelines and he showed what the diet looked like.

它是0%的希腊酸奶。

It was 0% Greek yogurt.

它是上等里脊肉。

It was top sirloin.

是非常瘦的肉块。

It was very lean cuts of meat.

对。

Right.

脂肪丰富的乳制品和肉类。

Was fatty dairy and meat.

非常类似于我们现在的饮食方式。

Very similar to kind of how how we eat.

虽然我现在喜欢一些更肥的肉，因为味道真的很好。

Although I I like some fattier meats now just because it it just tastes so good.

但那到底想要什么？

But what what the what does it want?

之前的指南从未说过绝对不能吃脂肪丰富的肉类和全脂乳制品。

The past guideline never said, like, don't ever eat fatty meats and whole fat dairy.

它只是说，嗯。

It just yeah.

它只是强调要尽量减少摄入。

It it was emphasizing minimize that.

乳制品和其他食物，但重点在于，当你向公众传达信息时，他们不会去计算饱和脂肪占总热量的百分比。

Dairy and things, but it was more about, like, when you're when you're communicating to the public, they're not gonna calculate, like, their percentage of calories per saturated fat.

因此，你应该强调那些饱和脂肪含量较低的脂肪来源，弱化或建议限制饱和脂肪含量较高的脂肪来源。

So you emphasize the fat sources that are lower in them and deemphasize or recommend restricting the fat sources that are higher in them.

但从来不是说完全不能用黄油烹饪。

But it was never, like, never cooking butter.

只是说，黄油应该少量使用，而你大部分的烹饪应该使用这些不饱和油脂的混合物。

It was just like that should be sparing compared to the predominant you know, most of your cooking should be in a mix of these more unsaturated oils.

所以这些是很大的差异，而这也正是指南之间缺乏一致性的原因。

So that's a those are big deviations and and kind of this is where the guidelines don't really align with one another.

很明显，整个科学评审和附录的全部内容都是为了取消通常建议用多不饱和脂肪替代饱和脂肪的做法。

Like, it's quite clear the entire scientific review was and the larger appendix was all gearing up for taking away the the typical recommendation to replace saturated fats with PUFAs.

但随后他们又奇怪地保留了饱和脂肪10%的上限，而这个10%的数字一直以来都源自食物模式建模。

But then they kind of, like, weirdly still retain the 10% cap on saturated fat, which was always that 10% number always came from, food pattern modeling that is done.

因此，基于美国典型食物及其营养成分，他们列出了推荐的完整膳食计划，包括各食物类别的不同份量，并说明：在这样的饮食结构下，你有多大可能满足我们所提出的营养需求，比如膳食纤维、蛋白质等？

So, the foods and their nutrient composition of typical American foods are you know, they lay out the whole meal plan that is recommended with the different serving sizes of the different food groups and say, what's the likelihood that you meet the estimated nutrient requirements, fiber, protein, etcetera, that we're saying you know, that we say are the nutrient requirements?

按照我们推荐的饮食模式，你有多大可能达到这些营养目标？

What's the likelihood you meet them with the food pattern that we're recommending?

因此，要让饮食中超过10%的热量来自脂肪，同时又满足纤维、叶酸等营养素的需求，真的非常困难。

And so it's it's really hard to have a diet more than 10% of calories and hit fiber, hit folate, etcetera, etcetera.

现在你必须摄入更多的蛋白质，而这又是他们每日份量指南中的另一个问题——他们对不同食物的蛋白质当量设定根本说不通。

So now that you have to get way more protein, which, this is another area in their daily servings guide, their food their their protein equivalencies for different serving sizes of food don't really make any sense.

一个鸡蛋被等同于三盎司的肉类，或者说是家禽类。

You have, one egg is the same as three or, like, three ounces of meat and so like a poultry.

所以，他们把大约20克的蛋白质等同于六克。

And so you've got, like, 20 something grams being equivocated to six grams.

坚果和种子的情况也是如此。

It's the same for, like, nuts and seeds.

他们给出的实际蛋白质食物份量从六克到二十六克不等，完全混乱。

The actual like protein food serving sizes they give are all over the place from like six to 26 grams.

然后他们还建议每天食用三到四份这样的份量。

And then they recommend three to four of those.

如果你摄入的蛋白质食物包括坚果和种子，那只有六克。

Well, if you're including any protein foods that are like nuts and seeds, that's only six grams.

所以你的其中一份餐食，如果没有考虑窗口期，基本上要

So one of your servings without the window, basically have

吃

to

吃希腊酸奶，这个饮食计划中有很多希腊酸奶。

eat or Greek yogurt, a lot of Greek yogurt in, this meal plan.

健美运动员，他们就是你

A bodybuilder, they which is, you

知道，我们吃这些。

know, we we eat those.

不过。

Though.

甚至不是因为健美运动员的饮食实际上会含有更多碳水化合物和低脂蛋白质，而不是高脂蛋白质。

Not not not even because a bodybuilder diet would actually be probably higher in carb and low fat proteins, not high fat proteins.

是的。

Yeah.

我的意思是，你的希腊酸奶，如果有的话，必须是0%脂肪的。

Well, I'm saying, like, your Greek yogurt, if it has it's gonna have to be 0%.

它必须是

It's gonna have to be

他们想要全脂乳制品在

They they want full fat dairy in

图片里，但不在

the picture, but not in

文字里。

the text.

他们说要包含全脂乳制品。

They say include full fat dairy.

于是Instagram上的人就说：不。

And so then the the people on Instagram are like, no.

就用0%的吧，但上面没说可能包含一些这种东西。

Just use 0%, but it says it doesn't say may include some of this.

它说的是要包含。

It says include it.

然后他们给出的所有例子都是0%的希腊酸奶，无脂希腊酸奶。

And then and the examples they're all putting out are 0% Greek fat free Greek yogurt.

对。

Yeah.

而且也不清楚，嗯。

And it's not clear, like Yeah.

当他们说每天三份乳制品并包含全脂时，意思是这三份都必须是全脂的吗？

Are they saying have like, when they say three servings of dairy and include full fat, do they mean all three servings should be full?

很多事情都不太明确，你可以说他们允许一定程度的灵活性，但要规划出符合他们所有目标的饮食仍然非常困难。

Not not too much is clear, which you could argue they're allowing for, like, some level of flexibility, but it's still pretty hard to plan a diet that meets all the targets that they're saying.

然后，显然，他们推出的金字塔图看起来像一个低碳水化合物饮食金字塔。

And then, obviously, you come to the issue that the pyramid then that they produce is like looks like a low carb diet pyramid.

你知道，他们把金字塔倒过来了，而金字塔本来应该是表示底部是应该重点强调的食物，其数量和比例相对于文本中的建议。

You know, they've kind of inverted the pyramid and they've got you know, a pyramid is supposed to convey the you know, at the bottom, the things you should emphasize with with amounts and proportions relative to what the text would have said.

随着你向上移动，金字塔的每一层是你应该减少分量的食物，而最顶端则是你应该尽量避免的食物。

And then as you go up the pyramid is the things you should have smaller portion sizes of and at the top, the things you should minimize.

但他们把金字塔倒过来了，上面全是大块牛排、整只火鸡，嗯。

Well, they flipped the pyramid upside down and it is like massive cuts of steak, an entire turkey Mhmm.

整只火鸡。

An entire turkey.

八片奶酪、一整盒全脂牛奶，还有鸡蛋、三文鱼、酸奶，然后你只得到每种坚果各一个，比如一颗杏仁。

Eight wedges of cheese, a whole thing of whole milk, and like eggs, salmon, yogurt, and then you get like one of each nut, it's like a single almond.

当你靠近金字塔的尖端时，另一侧底部是些非淀粉类蔬菜，再往上是些水果，而最顶端却是全谷物——以前金字塔的顶端通常是应该尽量避免的食物，但文本并没有建议减少全谷物，反而强调了它。

As you get closer to the point of the pyramid, you have some non starchy vegetables at the other side of the base, and then some fruits, and then at the top you have whole grains, which typically the top of the pyramid before was things you've minimized, but the text doesn't recommend minimizing whole grains, they kind of emphasize it.

所以，这些份量以及它们在金字塔中的位置，并没有真实反映文本所推荐的相对比例，这非常令人困惑，但我想大多数人，你知道的，我们讨论的并不是1990年膳食指南的文本内容。

So we this is like a the portions the, like, the portion sizes and where they land on the pyramid don't actually convey any information about what the like, the relative amounts the text recommends, so it's quite confusing, but most people I think, you know, we're not talking about the text of the 1990 dietary guidelines.

我们讨论的是1992年的金字塔，因为那是人们记得的东西。

We're talking about the 1992 pyramid because that's what people remember.

我认为人们会记住这个金字塔，它几乎直接扇你一巴掌，告诉你多吃全脂动物产品，少量蔬菜水果，然后尽量少吃谷物。

I think people will remember this pyramid, who basically just kind of slaps you in the face and says eat a ton of the full fat animal products and some vegetables and fruits and then minimize grains.

我觉得你一眨眼就会错过扁豆。

I think you can blink and miss lentil.

你看，这里面根本没有扁豆、鹰嘴豆或大豆。

Like, there's there's no lentils or chickpeas or soybeans on this.

对吧？

Right?

只有豆类和冷冻豌豆。

It's just bean beans, and frozen peas.

因此，你很容易错过很多健康的植物性食物来源。

And so you get you can you can miss a lot of the, kinda healthy plant food sources.

当时人们担心，他们会全面转向动物蛋白。

This was an area that was people, I think, were worried, that they were gonna go all out on animal protein.

不过文本中确实提到，要均衡摄入健康的植物性和动物性蛋白。

And they do mention in the text, like, a mix of healthy plant and animal protein.

但正如我们之前讨论过的，他们给出的份量和份数意味着你实际上必须有75%

But as we were talking about with the serving sizes that they give and the number of servings, you basically have to have 75%

是的。

Yeah.

动物蛋白。

Animal protein.

这

Which

所以，你知道，我非常怀疑，人们根本不会遵循这些指南。

So, you know, I'm super cynical, and people don't follow the guidelines anyway.

人们说，但如果这改变了学校午餐怎么办？

How people are saying, but what if this gets school lunches changed?

你之前提到过，他们甚至没有真正定义食物的加工方式，至少在Nova以及这些不同的加工分类方式上没有。

Is you mentioned before that they don't even they don't even really define the processing of the food, at least with the the Nova and all these different ways of categorizing process.

他们

They

根本就不是说让他们去吃加工食品。

don't even guidelines, do it's not like they were saying go eat processed food.

这简直让我抓狂。

That's what drives me insane.

每个人都说，天哪。

Everyone's like, oh my god.

我们终于在讨论要吃足够的食物了。

We're finally talking about eating enough food.

这其实是一回事。

It's like, it's the same thing.

我们仍然在吃更多的蔬菜、水果和豆类。

We're still eating more vegetables, fruits, beans.

不管怎样都要去做。

Do it anyway.

嗯，是的。

Well Yeah.

因此，这份指南中的另一大重点是，它对加工食品用了大量相关表述。

So that's the other big thing in this guideline is they they have a lot of language around processed foods.

他们曾呼吁对超加工食品进行定义，但至今尚未达成最终定义。

They've had a call out for defining ultra processed foods, and a definition hasn't been finalized yet.

关于这些事情，大家始终无法达成一致。

Nobody can agree on these things.

你知道，当人们想到加工食品时，都会说，我经常开玩笑说这就像色情内容。

You know, everybody, when they think processed food, they're all like you know, I always joke it's like porn.

你一看就知道是什么，但没人能给出一个明确的定义。

You know it when you see it, but nobody can come up with a definition for it.

加工食品的情况也正是如此。

And that's kinda how processed food is.

人们长期以来一直试图为垃圾食品建立一个科学术语，但并未真正成功。

People have been trying to make a scientific term for junk food for quite a long time and haven't really succeeded.

因此，他们最终选择不使用‘超加工’这个术语，尽管大量引用了相关文献。

So they settle on not using ultra processed even though they cite a lot of that literature.

他们只是使用'高度加工'这个词，并抛出一些模糊的定义，而人们对此表示支持。

They just use the word highly processed and kind of throw some vague definitions out there, which people are cheering on.

这就像，如果你属于美食运动圈，或者类似这样的群体，我不知道。

And it's like it's I I guess if you're kind of, like, in the foodie movement or or kind of, like, I don't know.

我曾在各个经济阶层中从事过大量的临床营养学工作，如果我在每个层级询问什么是加工食品，你会得到无数种不同的答案。

I've done a lot of clinical dietetics all across the economic spectrum, and if I asked what a processed food was at every tier, you would get so many different answers.

一旦你告诉人们他们的蛋白粉是加工食品，他们的燕麦奶拿铁也是加工食品，他们会非常生气，从而不再关注加工食品的管控。

And the moment you tell people that their protein powder is processed and their oat milk latte is processed, they get really pissed off and don't regulate processed foods anymore.

但人们一直在支持这种说法，却没有给出一个可监管的明确定义。

But, people have been cheering it on, but not having a definition for it that's, like, regulatable.

就我所看到的他们所写的内容而言，这实际上不太可能转化为任何有意义的联邦法规。

Like, I don't know from what they've written that it'll actually carry over into any meaningful federal regulation.

因为要制定法规，你必须能够明确界定某种东西，并且能够执行它。

Because that regulation, you need to be able to find something and you need be able to enforce it.

所以，如果你无法定义或执行某件事，就很难对其进行监管。

And so if you can't define or enforce something, it's really hard to regulate around it.

所以还不清楚这一点是否会纳入学校午餐。

So not clear whether that will make it into school lunch.

我猜测学校午餐现在只会提供全脂牛奶作为选项。

I suspect school lunch will just have whole milk as an option now.

之前已经提供过2%的牛奶作为选项了。

There was already 2% as an option.

所以，我觉得这样也还行吧。

So like, that's okay, I guess.

指南中忽略的一个重要问题是，它们过于偏向肉类和乳制品，明显支持肉类和乳制品。

One of the things that guidelines really miss out on is they're so meat and dairy, like pro meat and dairy.

对于替代品将何去何从，目前并不明确；它们反对加工食品，而这实际上也会反对肉类替代品。

There's really not clear what's gonna happen with alternatives, so they're against processed foods, which, would be against, you know, meat alternatives.

这也会反对市场上大多数大豆奶，而它们本是优质的乳制品替代品。

It would be against most soy milks on the market, which would be a solid dairy alternative.

因此，人们已经表达担忧：如果你有乳糖不耐受，或者根本不吃乳制品和肉类，这些指南几乎完全忽视了你。

So people have expressed concern already that, like, you know, this if you're not if you have lactose intolerance or if you just don't eat dairy, don't eat meat, this guideline doesn't barely considers you.

尽管他们专门有一节讲素食者和纯素食者，但这种说法并不合理。我不知道他们是误解了膳食指南咨询委员会的分析，还是故意曲解了，但他们基本上让人觉得，如果你选择纯素食或素食，就会缺乏各种营养素。

Even though they have a whole section on vegans and vegetarians, it doesn't make a ton of sense and it it, they they I don't know if they misinterpreted or intentionally misutilized some analysis the dietary guidelines advisory committee did, but they basically make it sound like if you're gonna go vegan or vegetarian, you're gonna be, like, deficient in all these nutrients.

这其实并不准确，比如维生素A这类营养素，你不太可能缺乏。

That is not really the case, like, including, like, vitamin a and things that you're not gonna be likely deficient in.

所以，他们采用了美国农业部典型健康饮食模式的食物模型。

So what they did was they took the food pattern modeling from the typical USDA healthy style.

他们估算出，如果遵循这种饮食模式，你会摄入哪些营养素。

So, they estimate the nutrient, the nutrients you'd get if you ate that dietary pattern.

而膳食指南咨询委员会只是做了一项分析，移除了鸡蛋和乳制品，然后指出如果去掉这些，你会缺乏哪些营养素。

And the DGAC just did an analysis where they removed the eggs and the dairy and then said like what nutrients you'd be a shortfall if you take those out.

但他们并没有用其他食物来替代。

And then they didn't substitute it with anything.

没有任何植物性替代品。

So no plant based alternative.

他们只是直接去掉了这些热量。

They just took all those calories out.

而这些新的膳食指南却利用这项分析，声称素食者会缺乏大量营养素，但这项分析基于一个极低热量的饮食模型，而这个模型从未被膳食指南咨询委员会打算实际使用。

And the, this, new dietary guidelines use that analysis to say that there's this, like, huge long list of nutrients you'd be deficient in if you're a vegan, but it was from, like, an extremely low calorie meal plan, from some modeling exercises that was never intended to be consumed by, the DGAC.

所以这里面有很多非常奇怪的地方。

So it was quite a lot of, like, bizarre things.

我在子栏目中还详细列举了更多不一致之处。

I I detail even more in the the sub stack of just a lot of inconsistencies.

比如，如果你认为人们应该多吃水果、蔬菜、谷物和乳制品，看到这张图觉得合理，那也没问题。

Like, you know, if you're somebody who's like, yeah, people should eat fruits and vegetables and and grains and dairy and you look at that image and think it seems reasonable, it's fine.

我不是来告诉你你错了，但这些图像确实存在明显的份量失真。

Like, not here to tell you you're wrong, but, it's pretty portion distortion on the the imagery.

文本内部存在自相矛盾的地方。

The text has contradicting things within it.

文本内容明显与金字塔图示所展示的内容相矛盾。

The text pretty clearly contradicts with what the pictograph, in the pyramid, like, shows.

那么，所有这些内容最终将如何转化为政策呢？我认为，美国农业部部长已经表示他们会这么做，但目前联邦法规中已经明确列出了学校午餐标准，具体规定了每周必须摄入的水果、蔬菜、全谷物和蛋白质食物的份量，并对添加糖、饱和脂肪和钠设定了上限。

And so and then how all this is actually gonna get translated in any policy, I think, you know, the USDA secretary has said that they're gonna do that, but it's really clear what will hold weight and what will you know, right now on the code of federal regulations, there's, like, school lunch standards that are there that very explicitly lay out, like, different amount different serving amounts per week that need to be consumed from fruits and vegetables and whole grains and protein foods, and then, you know, caps on added sugar, saturated fat and sodium.

不清楚这些规定中哪些会保留，哪些会被取消。

It's not clear which of those are gonna stay or go.

你知道，他们在这里对添加糖有非常严格的规定，但这是按每餐和每次零食分类的，而不是像总体不超过10%热量那样。

You know, they have very strict added sugar guidelines here, but it's given as a per meal and per snack category rather than like an overall less than 10% of calories.

所以不确定他们是否会以这种方式更新《联邦法规汇编》。

So not sure if they're gonna update CFR in that way.

所以我们还有很多事情要等待。

So we have a lot to to wait on.

我始终向人们强调的是，四十年来我们一直说要低糖、高纤维、多吃水果和蔬菜，但根本没什么效果。

What I always emphasize for people at the end of the day is that we've been saying eat low sugar, eat high fiber, eat fruits and vegetables for forty years and it's done nothing.

所以单这一点就足以说明膳食指南的影响力有多么微弱。

So that that should tell you alone how much the the the power of the dietary guidelines is quite minimal.

它们本身只是一个起点，政策制定者需要以此为依据来推动相关政策。

They themselves are a starting point that then policymakers would need to go and use them to justify policies.

实际上，人们过于关注指南说了什么，却很少关注我们究竟如何利用这些指南来真正落实它们？

And and and really, there's so much focus on, like, what the guidelines say and not like, well, what are we doing with the guidelines to actually implement them?