Op-ed on the US Dietary Guidelines: the problems and how to fix them

Dear All,

First, a few housekeeping notes.

One: I’m sorry for not posting more often, but I have recently been traveling non-stop, including to a keto conference in Santiago, Chile, which was one of the best conferences I’ve ever attended in this space. If you are a Spanish speaker, I highly recommend it. ¡Vayan allí!

Second: Some of you have asked me if Gary split off from this Substack because of a falling out between us. Never! We are old (and now old) friends from the early 2000s when I started writing my book. Gary was the only person nearby with whom I could sit at lunch and talk about LDL cholesterol (Fun, right?!). There was hardly anyone in this field at the time. So, Gary has been a mentor to me—and still is. I value his work enormously—his vast knowledge of the science, his unshakable rigor, and his wry style of writing—and I encourage you all to subscribe to his new Substack column.

The other reason we had no falling out is that Gary is maybe the most deeply rational person I know, which is an excellent quality in a friend, because he responds to reasonable arguments and, remarkably, doesn’t get mad. Imagine how harmonious America would be if even a fraction of us were more like this! Cue the deep breathing and meditation for the rest of us.

We split for the reasons he wrote: the difficulty of sharing a column on this platform, in terms of finances and proportionate effort. It’s really just really hard.

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And now, to the main stage:

The following is an op-ed I wrote that came out in The Hill this week. Maybe you haven’t seen it; maybe you had trouble reading it (some folks complained about all the pop-up ads), so I am reprinting some of it here:

No matter where you stand politically, the return of Donald Trump to the White House presents a chance to reshape America’s approach to health and nutrition. His administration will have the opportunity to overhaul outdated federal dietary guidelines, which lack scientific rigor and have long contributed to our country’s chronic disease epidemic.

For 44 years, our federal government has been fattening us up like livestock — literally. Every five years since 1980, the government has published its Dietary Guidelines for Americans, advising people to get 52 percent to 56 percent of their calories from grains and other carbohydrate-rich foods, while largely avoiding the natural saturated fats found in whole milk, butter, and meat.

Grain mixed with skim milk is a well-known formula for fattening pigs — and it turns out that it fattens humans, too. In 23 states, the adult obesity rate now meets or exceeds 35 percent. Zero states had an obesity rate that high as recently as 2012.

It’s not just our collective waistlines that have expanded. Rates of nearly every chronic disease have also soared in recent decades. More than half of adults now have diabetes or prediabetes.  Up to 10 percent of kids currently suffer from non-alcoholic fatty liver disease — a condition that used to be so rare, the first pediatric case wasn’t even recorded until 1983. Just 12 percent of Americans are in “optimal” metabolic health, according to a recent University of North Carolina at Chapel Hill study.

Americans aren’t growing fatter and sicker in spite of the government’s dietary guidelines but because of them. Those guidelines shape everything from school-provided meals and SNAP benefits to the advice patients receive from doctors and nutritionists.

Now is the time to reverse this trajectory.

For more than a decade now, the most reputable scientific studies have shown that the government’s dietary advice does not prevent or reduce obesity, cancer or other diseases. People who eat diets lower in carbohydrates consistently achieve greater weight loss and have better overall heart health than people on the lower-fat diet that the government recommends.

Ultra-low-carb or “ketogenic” diets have even been shown to completely reverse type 2 diabetes without costly medications or patented meal replacement formulas. A large clinical trial found that nearly 56 percent of people with type 2 diabetes who adopted a ketogenic diet saw a reversal of the disease within 10 weeks while decreasing their medications. Compare that to the 0.5 percent to 2 percent remission rate for those on the government-recommended diet and standard care.

Despite all the evidence, the government’s dietary guidelines are stuck in 1980, having barely changed since the old “food pyramid.”

Remember that big bottom slab of the pyramid, telling us to eat a staggering six servings of grains daily, including three servings of refined grains? People took that advice to heart. Today, they’re consuming far fewer whole-fat foods and more carbohydrate-laden items like bread, cereal, and pasta than previous generations. When it comes to the fats Americans do consume, they’ve cut back on natural sources like butter and tallow while increasing their intake of highly processed seed oils by nearly 90 percent since 1970.

Their reward for following the official advice? Americans are sicker than ever. The current guidelines have likely spawned a chronic disease crisis that has caused millions of premature deaths and accounts for the vast majority of America’s $4.5 trillion annual healthcare spending.

Fortunately, merely fixing the guidelines could reverse our chronic disease epidemic, without the need for any new programs or new spending. As president, Trump should order the U.S. Department of Agriculture to fully implement recommendations made in a 2017 National Academies of Sciences report. Mandated by Congress, this report warned that the guidelines process used a methodology that “lacks rigor” and listed 11 concrete steps to increase transparency and upgrade the scientific rigor of the guidelines process.” My own 2015 investigation for the British Medical Journal showed that the guidelines are based on a “minuscule quantity of rigorous evidence.”

Every word of the guidelines should be backed by randomized, controlled clinical trial results, not mere correlations or assumptions.

For the rest, please go to The Hill (no paywall).