Worku Abebe
Figure 1 The Food Guide Pyramid - 002468Late last month, the Dietary Guidelines Advisory Committee for the US Department of Health and Human Services and the US Department of Agriculture announced its recommendations for the 2105 Dietary Guidelines for Americans.  This is a panel of nationally recognized nutrition and medical experts which convenes every five years for scientific updates and recommendations based on the latest available knowledge.  The first edition of Dietary Guidelines for Americans was announced sometime in 1980. The proposed recommendations are particularly important as they become the guiding principle for developing nutrition policy, nutrition education, and programs such as the Supplemental Nutrition Assistance Program, the WIC Program and School Lunch Program.  The guidelines are intended to provide advice for Americans aged 2 and above, including those at increased risk of chronic diseases.  As such, they encourage individuals in this age group to focus on eating healthy diet that can help achieve and maintain a healthy weight, promote health and prevent diseases.  Although the guideless are based on the dietary habits of most Americans and thus intended to serve Americans, they can also be of value to people with different cultural and dietary backgrounds, including Ethiopians.
In their review of the scientific literature, the experts in the Advisory Committee looked for associations between diets and major disease, such as diabetes, cancer and heart conditions.  Accordingly, they categorized different dietary items as beneficial or harmful to health.  Their review turned up consistent evidence for the health benefits of fruits and vegetables.  Other identified items with less consistent health benefits include whole grains, legumes/beans, seeds, nuts and seafood/fish.  Further, besides diet-related observations, the moderate consumption of coffee and alcohol/wine has been found to possess beneficial health effects.  With regard to harmful items, the Advisory Committee found convincing evidence that high consumption of red and processed meat, refined/proceeded grains and other foods, and sugar-sweetened foods and beverages (in the form of added sugar) are detrimental.  Additionally, high intake of items like salt (sodium), saturated/hydrogenated/solid fats, (eg., butter, meat fat, margarine), and partially hydrogenated oils/ trans fats/shortenings (eg., oils used for frying chips, for making cookies, and in pizza tops) are identified as having adverse health consequences in many people.  One may ask: What is the scientific evidence behind these observations?  Do they have any relevancy to the dietary habits of the average Ethiopian?
Fruits and vegetables are major contributors of a number of nutrients that are under consumed and these include various vitamins, such as vitamins A, C and K, potassium, magnesium and fiber, and various polyphenols with antioxidant and medicinal properties. Consequently, fruits and vegetables are associated with reduced risk of many chronic diseases, including hypertension, and diabetes.  They are relatively low in calories which can replace high calorie foods that cause weight gain and are linked to different health problems. Since most Ethiopians do not seem to eat sufficient fruits and vegetable for optimum heath, it is imperative that they change their dietary habits and begin consuming more of these classes of food items.
The other plant-based foods mentioned- that is, whole grains, legumes/beans, nuts and seeds- are also health-promoting by providing such important nutrients as carbohydrates, proteins, vitamins, minerals, “good” fats and fiber.  Other plant-based substances include components with antioxidant and medicinal properties.  The presence of fibers in plant food items gives the benefit of regulating blood levels of glucose in the body, among other beneficial effects.  Seafood, primarily fish, is believed to be a good source of proteins and healthy oil/fat.  The oil/fat from fish is well known for its anti-inflammatory properties and for maintenance of healthy heart and circulation, and in brain development.  While the regular consumption of some of the above food items by most Ethiopians is a likely possibility, it is also likely that some of the items mentioned are missing from their diets.  For optimum health, it is thus important that Ethiopians should include in their diets as much food varieties as possible.
It is almost in the tradition of most Ethiopians to drink several cups of coffee each day.  This is not surprising as Ethiopia is the origin of coffee, after all.  Fortunately, there is good news in the proposed Dietary Guidelines concerning the consumption of coffee.  Based on the latest research, the Advisory Committee concluded that moderate consumption of coffee, that is, 3 to 5 cups per day, is beneficial for health.  This level of coffee intake is associated with a reduced risk for type 2 diabetes, cardiovascular disease, and even Parkinson’s disease and liver cancer.  However, caution should be exercised against adding excess sugar or high-fat dairy or dairy substitutes.  In addition, high levels of caffeine, as found in energy drinks or caffeinated beverages, are harmful, particularly to kids and pregnant women.
Drinking a limited amount of alcohol, especially in the form of wine, is considered beneficial, particularly for cardiovascular health.  However, it is not recommended that anyone begins drinking alcohol due to its potential unintended problems.  From the relatively excessive amounts of alcoholic drinks consumed by most Ethiopians, it is clear that the harmful effects outweigh the potential benefits. Thus, if there is a need for consumption of alcoholic drinks, some adjustment (reduction) of the quantities consumed is necessary to get the anticipated benefits.  For those who do not drink alcohol for any reason, purple or red grape juice has health benefits too.
Frequent intake of red meat, processed or unproceeded, is considered unhealthy not only from the point of view of health but also from its negative environmental impacts.  Healthwise, high meat consumption is tied with increased risk of colon cancer and type 2 diabetes, and when this is coupled to the processing of meat, with likely associated with additional harmful chemicals, the outcome is expected to be even worse.  Concerning the environment, it has been shown that meat eaters contribute more to global warming that do fish eaters, vegetarians and vegans.  Based on these observations, red meat is considered to be comparatively an inefficient source of calories and protein, suggesting that meat consumers should look for better sources of these two nutrients, such as poultry, pork, shrimp, fish and eggs, which require relatively less amount of feed and land to produce them.  It is well known that many Ethiopians love to eat meat in different forms, including kurrt, keteffo and tibes.  From the information stated in the new Dietary Guidelines, it is important to keep in mind the adverse health and environmental effects associated with the consumption of high amount of meat.
Refined grains, processed foods, and sugar-sweetened foods and beverages are considered harmful in a number of aspects, and when taken in excess, they are proven to contribute to at least to obesity, type 2 diabetes, tooth cavities, cardiovascular disease, including high blood pressure and arthrosclerosis. This is due to their ability to cause relatively a rapid increase in blood glucose, without providing any other nutrient with significant health benefits. In other words, they are sources of empty calories which can cause multiple adverse consequences with excess amount consumption.  The removal of beneficial nutrients by processing the original natural substances and the addition of extra sugar make these food items particularly detrimental.  It is worrisome that recently the use of such food ingredients by Ethiopians especially in urban communities is getting greater popularity.  For instance, in most of these communities nowadays it is rare to find enjera made from pure teff, but mostly mixed with plenty of processed wheat and/or corn flours. This is a harmful trend that needs to be halted.                          
The recommendation for limiting the intake of common salt (sodium) is linked to its untoward effects on the cardiovascular system.  Excess consumption of salt has been shown to lead to hypertension and kidney problems, especially in the elderly and blacks at any age.  Because of the connection of diabetes to these disease conditions, diabetic patients are commonly advised to limit their intake of salt.  It appears that most Ethiopians are not aware of these effects of common salt since they are usually observed to use it with their foods and the coffee they consume without any restrictions.  Educating the community about the effects of salt should be an important consideration by concerned professionals.
Saturated/hydrogenated fats are solid/semi-solid substances which include such food items as butter (“qebbie”), margarine and the “fat stuff” in meat.  On the hand, partially hydrogenated/trans fats or shortenings are “thick” oily liquids mostly used to fry food substances such as potato chips.  Both classes of fats are used by the body to make cholesterol, the main substance that causes of atherosclerosis and the associated cardiovascular problems.  In addition to boosting the levels of LDL (bad cholesterol), some of these fat substances can also decrease the good cholesterol, HDL, making the problem even worse.  Most Ethiopians love to add plenty of qebbie in their food and also eat relatively excess amount of meat that contains unhealthy fat.  The information in the new US Dietary Guidelines provides evidence justifying the consumption of less of these food items in order to lead a healthier lifestyle.
In brief, the Advisory Committee for the new Dietary Guidelines for Americans found that a diet higher in plant-based foods and lower in calories and animal-based foods is more health promoting and is associated with less environmental impacts compared to most other diets in use.  The evidence suggests that at least part of the information complied is highly relevant to the dietary habits of other communities with different cultural backgrounds, including Ethiopians

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