Transcript: 

Shireen Abdullah (0:00)

Podcasting from Dallas, Texas, I am Shireen, and this is the Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah (0:32)

Dr. Heather Eicher Miller is a professor in the Department of Nutrition Science at Purdue University. She’s a nutrition epidemiologist who researches dietary intake and dietary quality in the US population with a focus on low-resource populations. Welcome, Dr. Eichermiller.

Heather Eicher-Miller (0:49) 

Thank you so much! It’s great to be here.

Shireen Abdullah (0:51)

Well, I’ll say welcome back because we’ve had you. It’s been a couple years since we had you on our podcast, but extremely exciting to have you on. We definitely have something new and exciting to talk about here on the podcast. But before we dive in, Dr. Eicher Miller, as a refresher, can you tell our audience a little bit about what led you to focus your career and your research on diet quality and food security? What led you to it?

Heather Eicher-Miller (1:16)

Sure, yeah. So I think a lot of my experiences before going to graduate school really kind of influenced that focus. And so, for example, I grew up in a small rural area in Indiana that was really focused on agriculture and food production And then after finishing college, I moved to Philadelphia, and I worked as a social worker, which was really a totally different environment for me.

Heather Eicher-Miller (1:44)

And there were different physical and social, you know, constraints for people that I noticed in having enough food for the families that I served. And after this, then my husband and I moved and worked in the Philippines for about two years or so. And this was again another kind of agricultural context similar to where I grew up. But it was really different in the sense of all of the different global, you know, market, market kind of stuff going on that really left a lot of people in food-insecure situations.

Heather Eicher-Miller (2:22)

And so after kind of seeing all those things, I, I became pretty interested in food insecurity. And when I returned to the United States, I tried to pursue graduate school with a focus on food security. And I’ve kind of stayed in that area ever since. But probably, you know, we kind of shift throughout our careers. But I, I’m really interested still in that and also more deeply in dietary patterns. But, yeah, that’s my journey.

Shireen Abdullah (2:56)

Thank you for sharing that. And you know, when we talk about dietary patterns and diet quality, especially in the US, we hear a lot about ultra-processed foods and less nutrient-dense foods as well. So your work really looks at sort of this large-scale dietary patterns across populations. And now, if we were to zoom in into the US from a big picture, excuse me, perspective, how would you describe that diet quality in the US Today? Are we headed in a positive direction, I guess? Can you help us understand that?

Heather Eicher-Miller (3:30)

Well, I’ll just say we have a lot of opportunity for improvement.

Shireen Abdullah (3:37)

I love the way that you put that. Very optimistic. Please keep going.

Heather Eicher-Miller (3:41)

So right now, currently in the United States, as a population, our diet quality is pretty poor. And we can evaluate that by thinking about the dietary guidelines for Americans’ patterns as they are made for us there. Like, patterns mean, like having, you know, five servings of fruits and vegetables a day, getting enough of the recommended amount of dairy, like all the things we need to do to try to do every day.

Heather Eicher-Miller (4:18)

So if we use that pattern as our, like, A+, and then we quantify what dietary intake in the US looks like, we can see that for all Americans two and older, we get a score of 56 on a scale that would go to 100. So our score is about an F+. And there is some variation, you know, in this scoring. If we look across different factors like age, sex, race, ethnicity, income, and other things.

Heather Eicher-Miller (4:53)

And one of the biggest differences is by age because we really do have different, you know, behaviors throughout the lifespan. So think about feeding an infant compared to how an adolescent eats compared to older Americans. And there is about a 15-point difference in the scores based on age. So we have better scores in diet quality for very young children and older adults.

Heather Eicher-Miller (5:24)

And then we kind of get to a low point in our diet quality when we’re adolescent or young adult ages. So, yeah, this, that’s, I think that’s a really important consideration. When we think about how to improve diet, then in the long term, we really need to consider a lot of these different factors that can make diets different.

Shireen Abdullah (5:51)

If we were to double-click into it a little bit. Dr. Eichenmiller, can you tell us a little bit more about what are some of the common nutritional gaps you see across different populations? So, yeah, there are definitely some commonalities, and then we also have some differences. So, for example, some of the commonalities are kind of things we’re probably aware of, like across all age groups, across, you know, sexes, race, ethnicity, income.

Heather Eicher-Miller (6:21)

We’re all pretty much not getting enough vegetables and fruits in our diet, and also not enough whole grains. And then we’re kind of overdoing it on the saturated fats and added sugars, and sodium. So as far as, like, differences among age groups, you know, we also have that, like I mentioned, how age can make a big difference. So when we think about that with regard to dietary patterns, we see that like, for example, young kids are generally meeting a lot of the dairy recommendations. But then, as we get into adolescence and older ages, we don’t meet those as well.

Heather Eicher-Miller (7:03)

Another thing is protein foods. We see protein a lot these days, you know, out in the social landscape and marketing, and actually most that’s area where most Americans are doing quite well. We’re already pretty much eating the amount of protein foods we need. With the exception of adolescent girls. They’re the one group that doesn’t do very well at meeting those protein food recommendations.

Heather Eicher-Miller (7:34)

And adolescents as a whole is a group where there’s a lot of dietary gaps. And then, you know, thinking about these main food groups that we all have gaps in, as I mentioned, fruits and vegetables and whole grains, those are then kind of the source of a lot of these nutrients that we’re also not getting enough of as a population, like fiber, vitamin D, calcium and potassium. And the vitamin D and calcium would come more from dairy that a lot of us are also not doing well at. So, you know, these are kind of some of the areas that we could really target.

Shireen Abdullah (8:19)

It took me a second to come off mute there. That’s helpful context.

Shireen Abdullah (8:23)

Dr. Eicher-Miller, when you look at overall diet quality in the variations across different populations, like you were talking about how differences in diet quality translate into long-term risk for chronic conditions like diabetes. Of course, we do a lot of work in that space. So always curious to understand that intersection. And what does that tell us about where prevention efforts should be focused today?

Heather Eicher-Miller (8:48)

Yeah, this is a great question and one that we really try to focus on in the work that we do. And we know that a lot of these gaps in diet quality that I mentioned leave us with gaps in certain nutrients. And they also oversupply us with things that are not helping us, like, for example, added sugars; they’re giving us extra calories, but not, you know, much micronutrients with that. So. And then we also know that there are some major killers and causes of chronic disease in our country.

Heather Eicher-Miller (9:27)

And some of those major killers are like cardiovascular disease and all those related diseases. Also, as you mentioned, diabetes, a lot of different types of cancers. Osteoporosis is a big concern for older Americans. It’s related to these dietary factors. And then we also have obesity as an underlying issue that can increase risk for a lot of these outcomes, as well.

Heather Eicher-Miller (9:56)

So we need to eat a diet that can support all the nutrients we need to prevent those diseases and not give us too many calories that are not nutrient-dense. So the issue then, as you brought up, is that we really need to focus on the importance of diet, making sure people have the nutrition education that they need to equip them to eat a healthful diet at young ages and support in doing that throughout the lifespan.

Heather Eicher-Miller (10:31)

So we need to work, I feel like we need to work more on prevention and also implementation of the Dietary Guidelines and thinking about how we can change behaviors to prevent those things and to help us keep all Americans healthy.

Shireen Abdullah (10:52)

I do want to. You mentioned the Dietary Guidelines. I do want to talk about your contribution there in just a second. Before we do, though, you know, you studied how food security status influences what people actually eat, what they’re able to access. There’s often this assumption that having enough food means people are meeting their nutritional needs because there’s this excess food available.

Shireen Abdullah (11:19)

Based on your work, though, how does food security shape nutrient intake and overall diet quality? And what, where do we see some of the biggest disconnect, perhaps between the quantity of food and the quality of its nutritional value?

Heather Eicher-Miller (11:34)

Yeah, I’m really glad that you asked about this. So here, I think it’s important to remember the poor diet that all of us have. We already have diets as a population that are in an F+. And we all have these dietary gaps and shortfalls in eating certain kinds of foods. I mentioned vegetables, fruits, whole grains, and then things we overconsume like saturated fats, added sugar, and sodium.

Heather Eicher-Miller (12:05)

So in food-insecure situations, what often happens is that these dietary gaps can widen. So it tends to be that a lot of food-insecure situations are, you know, they have the same overall context that everyone has, but it’s just less resources to try to obtain the food that they need. And so we’re going to see these gaps widen. We’re going to see diet quality sink even lower to give us a score of like, instead of an F+, an F. And so I think, you know, those are some of the, some of the differences there are, but honestly, the differences are not that wide compared with everyone.

Heather Eicher-Miller (12:57)

And I think sometimes that’s a little overhyped. But we certainly do need to focus on closing those gaps. And you know, we have about 15% of all American households that are in situations of food insecurity. About 5% of those households actually don’t have enough food to eat. So that’s an even more dire situation, but for the 10%, then, that do that, they’re getting enough food; they just have less resources to really put towards thinking about the kinds of food. It’s like when you’re in a situation like that, I think you just are really trying to make sure everyone has enough.

Heather Eicher-Miller (13:47)

They’re not, that they’re not hungry. So those are, you know, some of the really, really difficult things that households with food insecurity have to consider.

Shireen Abdullah (13:58)

You know, I’ll ask another question on this train, which is like, based on, again on your research: where do you see some of the biggest mismatch, perhaps, between the dietary guidance and what it recommends and what people facing food insecurity can realistically even do?

Heather Eicher-Miller (14:18)

Yeah, so I mean first I, I do just want to kind of highlight that I think there is this misconception that between the population, diet quality and low-income diet quality is quite wide. But this, it’s like we’re all eating so poorly that that gap to food-insecure households’ diet quality is actually not that wide. And so we really need to do more to raise all ships, I think.

Heather Eicher-Miller (14:49)

But then also considering all of the different factors that when we choose food, it’s such a complicated decision. We have to weigh, you know, how much it costs, what, where we can get it, how much time it takes to prepare it, whether people in our household will eat it or not, and health considerations, allergies, there’s so many different things and these are even made worse when you don’t have money to kind of throw towards that problem or make things easier.

Heather Eicher-Miller (15:24)

So I think that people, you know, I, I really wish that people wouldn’t think that somehow low-income folks are making these less healthful choices because they don’t, you know, they don’t care or they don’t. Oftentimes, people understand a more healthful diet. They just don’t feel that they can access it, or they don’t feel like it’s attainable for them. And I think some of the messaging we have going on around food promotion of certain types of foods that are being portrayed as more healthful are also not very helpful. 

Shireen Abdullah (16:09)

Dr. Eicher Miller, for many individuals and families, food choices are really shaped by constraints like cost, time, availability. We just talked about that. How do these real-world factors show up in the data that you study, and how should they change the way we approach nutrition recommendations or even interventions?

Heather Eicher-Miller (16:31)

Sure! Yeah, I agree. I think there are so many factors that families are trying to optimize or put together every time that they go shopping, every time that they’re selecting food for their families. And as you mentioned, these can be considerations of cost, where they have to go to get food, health preferences.

Heather Eicher-Miller (17:00)

We have food preparation gaps, gaps in, you know, if whether people have all of the equipment they need to cook the food or store the food. And even, you know, I think sometimes thinking about what to make that decision can also be really difficult call, like planning.

Heather Eicher-Miller (17:20)

And I also feel that a lot of these decisions, they can kind of have a, bring a lot of negative feelings because of the expectations that are often put on us through social marketing and media, and feeling like we have to kind of do it all and like, make beautiful from-scratch meals for every meal.

Heather Eicher-Miller (17:44)

And I think that can feel really unrealistic and unattainable for a lot of people out there. So one of the things that I think could help with this is trying to kind of cut through that and do a better job of meeting people where they are, their real-life situation. Like, maybe they really only have 10 minutes to put a meal together. So how can we support people making maybe some small shifts or choosing a different product that is a similar price or cheaper and empowering them with education to make those choices rather than kind of suggesting these unrealistic changes?

Heather Eicher-Miller (18:34)

I really think that traditional nutrition education to help people know, understand how to read labels, for example, and think about what nutrients are in that food and comparing prices, that can all be very concrete and helpful. And so keeping the focus on nutrition and having that be rooted in people’s real life is a way that we could help with that.

Shireen Abdullah (19:01)

So for our audience here, another fun fact about the work that you do, Dr. Eicher-Miller, is that you. You actually—recently, very recently—served on the 2025 Dietary Guidelines Advisory Committee. And I’m just out of curiosity, I’d love to understand that process and how, you know, the. The guidelines sort of turn into the actual, you know, guidelines that are issued.

Shireen Abdullah (19:31)

But what did this experience on being on. About being on the committee? Like, what did this experience really show you about the gap between the science on diet quality and food security and the way sort of federal nutrition guidance ultimately shape? Because the way I understand it, you make these recommendations and then, sort of it’s on the, you know, it’s on the individual groups to then decide where it goes from there.

Heather Eicher-Miller (19:56)

Yeah. So one of the things I learned and we could better, you know, we could understand more fully is how the. The dietary guidelines, although, you know, they are kind of made, generally, for professionals and put out as a grounder in, like, what dietary patterns should look like to prevent chronic disease.

Heather Eicher-Miller (20:20)

We know that a lot of most people don’t actually follow them very well, but the biggest impact they do have is towards these federal programs. So, for example, one of the most massive impacts is through the school lunch and breakfast programs, which impact, you know, almost a big majority of the kids throughout the United States.

Heather Eicher-Miller (20:47)

So that’s really important in supporting their healthful dietary patterns throughout their lifespan. And we also, you know, in this country, try to keep the cost of that program pretty low with really a minimal amount of money that’s spent on each of those meals. But, you know, I think, too, if we could shift priorities a bit towards thinking about the growth, development of our pediatric population in this country and, you know, shift resources towards supporting the better nutrition through these programs, we could really make a huge impact in the health of all Americans.

Heather Eicher-Miller (21:32)

So that’s, you know, I think that’s a major impact of the dietary guidelines. And also, that’s another program that really impacts across strata. You know, it’s across income levels, and it’s across all different other kinds of factors. So that’s one thing I would say that’s helpful.

Shireen Abdullah (21:56)

And just so we understand, as part of the advisory committee, you sort of do the appropriate research, you provide your recommendations, and then from there, it’s USDA, other groups that kind of make the ultimate decision, correct?

Heather Eicher-Miller (22:11)

That’s right, yeah. So we do not implement. We obviously don’t have a role in implementation or changing any of those programs.

Shireen Abdullah (22:20)

Okay.

Heather Eicher-Miller (22:21)

We do as a kind of outside group of nutrition experts, we review all of the science on certain questions that are set out for us. And we also help to prioritize some of those questions that we will address. And we review the evidence in three ways. We do scientific literature reviews that are very systematically done and rigorous to look at the relationship between diet and health.

Heather Eicher-Miller (22:55)

Then we also do data analysis where we look at what, you know, like I was sharing those dietary quality estimates, we look at dietary quality in the whole population and then also split by different factors. We look at nutrient intake, we look at the rates of chronic disease. And then the third method is through food pattern modeling. And that’s really important to actually operationalize the dietary pattern that we are recommending.

Heather Eicher-Miller (23:28)

So, you know, that recommendation of eating five a day, five fruits and vegetables, we can actually. And all the amounts from the other food groups, we can test that with food pattern modeling to see if eating that way really does help us meet all the recommendations for the different nutrients and keep our saturated fat, added sugar, and sodium below the levels that they need to be.

Heather Eicher-Miller (23:57)

So it’s all three together. You know, make it a really rigorous evaluation. Once we get our results, we write them up in a report and submit those to the government. And then the one that will actually make the policy.

Shireen Abdullah (24:16)

That’s interesting. And to everyone interested, the dietary guidelines, the 2025 dietary guidelines that Dr. Eicher-Miller was advisory committee member for, they are open and available. So it is available online. You can Google and find it and you can see what the, what the recommendations were.

Shireen Abdullah (24:36)

But as we wrap up, we’re toward the end of this episode here today. Dr. Eichier-Miller, where do you see the biggest opportunities for improving diet quality and nutrition security in the coming years? What does it look like? So, like I said, I think we really need to work a lot on implementing the guidelines on helping people change their behaviors and on those things that influence all of us as a society, all those different environmental factors, the food landscape that’s out there.

Heather Eicher-Miller (25:13)

And I think in order to do that, we really need a lot of cooperation between government, food industry, and agriculture. Everyone is part of this, and we all need to work together. And I think through more dialogue, especially on some of these dietary gaps and confusing messaging, that we could cut through and help people really change their behaviors, eat healthfully, and also, you know, be part of the food supply.

Heather Eicher-Miller (25:51)

Like we need our industry partners to be part of this, and they have to make money on the foods they make, but we can work together on making those foods more helpful. And yeah, and also too, just focusing more on prevention and those messages and supporting prevention, better diets, more physical activity throughout the lifespan.

Shireen Abdullah (26:15)

Very helpful. Thank you, Dr. Eicher-Miller, for your perspective and for joining us on the podcast and your time here today with us. To our listeners, thank you for tuning in to another episode of the Amlos podcast.

Shireen Abdullah (26:27)

You know what time it is. Head over to your social media and answer this good question, which is when you think about your daily meals, where do you notice the biggest gaps in nutrition? Again, we repeat the question: Head over to Yumlish on Facebook or on Instagram, find this podcast post, and then comment below to tell us when you think about your daily meals, where do you notice the biggest gaps in nutrition?

Shireen Abdullah (26:51)

So we’ll continue the conversation over there. Dr. Eicher-Miller, thank you so much for your time. Such a pleasure having you on for the second time. Thank you.

Heather Eicher-Miller (26:59)

Thank you. It’s great to be part of it.

Shireen Abdullah (27:03)

Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective. 

Shireen Abdullah: (27:23)

You can also visit our website, yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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Connect with Heather Eicher-Miller!
Website URL: https://hhs.purdue.edu/directory/heather-eicher-miller/

LinkedIn URL: www.linkedin.com/in/heather-eicher-miller