The California Cuisine Pyramid
David Heber, MD ,Ph.D

Dr. David Heber is Professor of Medicine and Public Health and Director of the UCLA Center for Human Nutrition which includes one of only two National Cancer Institute-funded Clinical Nutrition Research Units dedicated to the study of nutrition and cancer prevention.

Development of the California Cuisine Pyramid

The USDA Food Guide Pyramid has proven to be a widely recognized and useful tool for educating the public on dietary guidelines for a healthy diet (1). In addition to the USDA Pyramid, several other pyramids including a vegetarian pyramid, an Asian Pyramid, a Soul Food Pyramid, and a Mediterranean Diet Pyramid have been developed. All of these pyramids have in common a standard serving size and the recommendations that the diet be based in succeeding order from bottom to top on different identified food groupings. The UCL A Center for Human Nutrition as part of a 1997 scientific conference developed a new California Cuisine Pyramid based on a consideration of recent data on the increasing incidence of obesity, the special role of fruits, vegetables, cereals, grains and dietary fiber and the pre-eminent influence of taste on food choices.

The particular emphasis of this new pyramid is the prevention of cancer and other chronic diseases associated with obesity and aging. The reasons that this pyramid evolved in California relates to the unique environment and food availability in California as well as its people. California has clearly influenced lifestyle and dietary habits in the nation through its influence on entertainment and media. California also originated the national "5-A-Day for Better Health" public education program with the support of the National Cancer Institute (2). This point of sale education program in produce sections of markets attempts to increase the intake of fruits and vegetables based on the epidemiologic data related to the preventive effects of these foods. Increased fruit and vegetable intake provides increased intake of phytochemicals, fiber and other micronutrients while also displacing other high calorie and high fat foods.

Why a California Pyramid ?

The State of California, with its population of nearly 32 million residents, is the most populous and ethnically diverse state in the nation. It also leads the nation in the production of more than 75 crop and livestock commodities including dairy products. In fact, California is the leading agricultural state in the nation with significant production of over 250 agricultural commodities. More than half of all the nation’s vegetables, fruits, and nuts are produced in the state. California is the sole (>95%) domestic source for almonds, artichokes, avocados, dates, figs, kiwi fruit, lima beans, olives, persimmons, pistachios, pomegranates, prunes, raisins, and walnuts(3). California also enjoys a favorable climate permitting year-round physical activity, and there is some evidence that California residents are more active than residents of most of the rest of the country (4).

National food consumption surveys do not allow comparisons on a state by state basis, but comparisons can be made between the West region and other regions of the country. Residents of the West region eat significantly more fruits and less total meat, poultry and fish, less sausages and frankfurters, and fewer dark green leafy vegetables than the rest of the country. Total vegetable consumption is not different among regions, but this data is influenced by the most common vegetable in the US which is potatoes as french fries. Fewer residents in the West reported no fruit consumption, and a greater number reported zero consumption of sausages and frankfurters. In fact, market surveys demonstrate that 26 percent of melons, 24 percent of fresh vegetables, and 14 percent of fruits including citrus are consumed by Californians (see table 1).

The rates of smoking are significantly lower in response to a widely publicized government campaign against smoking, and the age-adjusted death rate from cancer is considerably lower among Californians than in the rest of the nation. In fact, cancer death rates have been below the national target rate for the year 2000 since 1987, and have been steadily declining since 1990.

Fruits and Vegetables at the Base

The "5 a Day – for Better Health" campaign originated in California with support from the National Cancer Institute and has since been adopted as a national campaign. The concept is based on a simple, achievable message for diet improvement based on the minimum fruit and vegetable consumption consistent with a cancer preventive effect in the epidemiologic literature. A significant body of international epidemiologic data now indicates that intake of 400 to 600 grams of fruits and vegetables is protective for several common forms of cancer.

The "5 a Day – for Better Health" campaign and the California lifestyle have resulted in some remarkable levels of awareness. The 1995 California Dietary Practices Survey, a telephone based survey of over 1000 adults representative of the state’s population indicated that 80 percent of adults agreed that "what a person eats or drinks affects their chances of getting cancer" up from 30 percent when this variable was first measured in 1989. Nearly half were able to name without assistance fruits and vegetables that reduce cancer risk, up from 24 percent in 1989. The most common motivations for eating fruits and vegetables were staying healthy, reducing disease risk, doing the right thing, and losing or controlling weight. The most common reported barrier to eating more fruits and vegetables was perceived lack of availability of these items in restaurants and at work.

Since individual foods have multiple effects based on their contents of fiber, micronutrients, and phytochemicals, a pyramid based on fruits and vegetables while also encouraging high fiber cereals and grains was developed. This differed from the USDA Food Guide Pyramid in having fruits and vegetables at the base rather than cereals, grains and breads and emphasizing high fiber cereals and grain products as well as starchy vegetables on the second tier.

High Fiber Cererals and Grains and Starchy Vegetables

The base of the Food Guide Pyramid does not specify the fiber content of the foods recommended. It is now clear that low fiber pastas and breads can lead to weight gain. Recent epidemiologic data has underscored the important role of dietary fiber from cereals in ensuring that consumers reach the National Cancer Institute goal of 25 to 35 grams of dietary fiber per day. This level can be reached with a lesser number of servings when these are concentrated on high fiber choices. Starchy vegetables were included on the second tier rather than at the base so that consumers would not make their 5 to 11 servings based on a predominance of potatoes and corn. Already, it is clear that the most commonly eaten vegetable in the U.S. is the potato as french fries. The lack of diversity in fruit and vegetable intake among Americans is problematic if they are to achieve cancer-preventive effects by eating phytochemicals found in a variety of fruits and vegetables as well as cereals and grains.

Protein from Plant and Animal Sources

A modified plant-based diet in which protein is derived both from plant and animal sources is recommended. While there are over 150,000 edible plant species on earth, only about 1500 are being eaten and protein sources in the U.S. from plants are drawn from a very limited number of plant species. Soy beans in particular provide a nutritionally complete protein eaten to a very limited extent in this country but eaten regularly by over 2/3 of the world’s population. Recently, soy protein isolate was given approval by the FDA for a cholesterol-lowering food claim. There is also emerging evidence on the effects of soy protein as an antioxidant and tumor growth inhibitor in the laboratory. Combining beans or other legumes with rice or corn can also increase the protein quality of either food leading to a high quality protein. However, these proteins remain below soy protein in quality. Therefore, increased use of soy protein in recipes can introduce isoflavones and high quality protein into the diet balancing the meat-derived protein which dominates the American plate today contributing a significant portion of total and saturated fat in the diet. Grain-fed beef, veal, pork and lamb have excess fat by comparison to grass-fed animals and are clearly higher in fat content than white meat of chicken, white turkey, many varieties of ocean-caught fish and shellfish.

Taste Enhancers Rather than Fats, Sweets and Oils

Taste is a major determinant of food choices. Both fat and sweets are taste enhancers. The free market in foods has demonstrated that higher fat, higher sweet foods are among the fast selling food categories including soft drinks and snack chips. Food producers have been using commercial vegetable oils rich in linoleic acid and poor in antioxidants in order to enrich the taste and fat content of processed foods. Since the 1980’s there has been a heightened awareness of the relationship between dietary fat intake and a number of chronic diseases. In response to this, over 1000 so-called fat-free foods were developed in the last decade. The concept of quality of fat intake in terms of fatty acid composition as well as fat grams is a difficult concept to convey to consumers.

The American Heart Association has recommended balancing 30 percent fat as one-third each of monounsaturated, saturated, and polyunsaturated fats. However, this is practically impossible for consumers eating processed foods to accomplish. Furthermore, enriching the diet with fish oils and linolenic acid to take advantage of the benefits of increased omega-3 fatty acids has been difficult without dietary supplementation with pills or oils.

The Surgeon General and a number of government and private health advisory groups in the late 1980’s recommended decreasing total fat, both saturated and unsaturated to 30 percent or less of total calories. This recommendation has been misinterpreted as a target fat intake of 30 percent. In fact, recommending 20 percent fat intake, as in the California Cuisine Pyramid, falls well within the USDA Pyramid Food Guide. In our view, 20% fat is more than enough to achieve taste quality without promoting obesity with extra hidden fats. Furthermore, there are no recommended spices on the USDA Pyramid, which recommends using fats, sweets and oils "sparingly". The California Pyramid recommends using spices such as chiles, garlic, peppers and cilantro among others. It also recommends using olives, avocados, and other sources of monounsaturated and omega-3 rich fats for enhancing taste as needed.

Conclusion

The California Pyramid in the setting of the 1999 White House Conference on Nutrition, Health and Longevity. The need for statewide acceptance in California. The role of dairy products and meat in the pyramid. Why this is not a disruption but an enhancement of the agricultural industry in America. The promise of biodiversity, responsible farming and the integration of silicon valley and the Central Valley.

This is not a threat to the USDA pyramid but a natural evolution based on the background of the USDA pyramid. It is not a food only pyramid but also is a basis to include physical activity, water, and dietary supplement advice. Until the food supply truly provides all the necessary vitamins and minerals for every American we need to insist that safe levels of dietary supplementation and food fortification are legitimate means to enhance nutritional health.

References

1.US Department of Agriculture. The food guide pyramid. Hyattsville Maryland. Human Nutrition Information Service, 1992 (Publication HG252).

2. Foerster SB, Kizer KW, DiSogra LK, Bal DG, Krieg BF, and Bunch KL. California’s "5 a Day – for Better Health!" Campaign: An innovative population-based effort to effect large-scale dietary change. Am J Preventive Medicine 1995;11:124-131

3. Buckley ET. Analyses of data sources provided by the US Dept of Agriculture, National Agriculture Statistics Service, Economic Research Service, and Agricultural Marketing Service. Chicago: Associated Marketing, 1997.

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