Why the NIH has made little progress on preventing chronic diseases

A research agenda fueled by pharma/biotech interests

Robert F. Kennedy, Jr., now the Secretary of the Department of Health and Human Services, has maintained that new research is needed to reverse chronic disease in America. That job will fall to Dr. Jay Bhattacharya, also now confirmed as the new Director of the National Institutes of Health (NIH), an agency whose mission is to “seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” In my view, Dr. Battacharya might reasonably ask why, with so many billions of dollars already spent over the course of decades, has the NIH made so little progress on establishing effective treatments for chronic disease to date.

The answer is no doubt complex, but I believe there are two principal explanations. First, the NIH has not acknowledged its own major findings on diet and health from the past 65 years of nutrition and health research and has therefore been unable to use this critical knowlede in advancing a well-informed research agenda. Secondly, the NIH has largely abandoned meaningful nutrition research on humans (i.e., we, the “living systems” the agency means to serve), pouring billions instead into solutions with commercial potential: pharmaceuticals, artificial intelligence apps, genetic solutions, nanoparticle delivery systems for drugs, and the like. Both questions are important, so I’ve divided my replies into two posts, with this Substack column addressing the second issue, with one to follow addressing the first.

The NIH grant numbers speak for themselves. I searched the NIH database, Reporter.NIH.gov, for “clinical studies” on diet. These kinds of intervention studies testing diets on humans are the only way to discover reliable information on the causal (i.e, cause-and-effect) relationships between food/diets and health outcomes—and are therefore crucial to fulfilling the hope of reversing chronic diseases in America.

Following this reasoning, I included the most prominent diets in my search terms: Mediterranean, vegan, vegetarian, low-fat, low-carbohydrate, and ketogenic. I included only those trials lasting at least four months, the minimum time required to yield results that can be extrapolated to longer term health benefits. I excluded trials on intermittent fasting [n=3]. The result was six clinical trials totalling $5,080,094 in grant awards¹

Compare this result to the funds invested in “precision nutrition,” now the focus of nearly all NIH research on nutrition, per its 2020-2030 Strategic Plan for NIH Nutrition Research. Precision nutrition, also known as “precision medicine” or “personalized dietary recommendations,” is based on the idea that people respond to diets differently, so the ideal treatment would be to devise a particular nutrition plan that will work optimally for that person’s genetics, gut microbiome, etc. As NIH Director Francis S. Collins and Gary Gibbons (whom we’ll meet shortly) wrote in the Journal of the American Medical Association soon after the NIH announced its strategic plan:

[The] field of precision nutrition aims to understand the health effects of the complex interplay among genetics, microbiome, antibiotic and probiotic use, metabolism, food environment, and physical activity, as well as economic, social, and other behavioral characteristics.

To research these topics, Gibbons and Collins discuss bioinformatics, genomics, and the power of AI models to crunch, “huge existing and forthcoming data sets toward understanding individual variation in health outcomes associated with dietary intake, dynamic eating behaviors, and innate physiological processes.”

When I searched the terms “precision health” and “nutrition,” in the NIH grants database, I found $169,000,000 in grants for 247 number of studies, about 34 times more than is spent on clinical diet trials²

A related fact is that global precision nutrition market is projected to reach $37.3 billion by 2030.

This future market will no doubt be fueled by NIH-funded precision nutrition studies on: new dietary assessment methods, novel imaging, phone apps, sensors, genomics, nutriomics (the study of how diet interacts with genes, metabolism, and health), giant new databases (see the All of Us Precision Medicine Initiative, a multi-center study currently with $18.6M in funding in this search), and AI data-driven approaches to diet responses and behavioral change. There’s also some weirder stuff in the grants database, such as laser-engraved wearable sweat sensors ($390K) and “Rosie the Chatbot: Leveraging Automated and Personalized Health Information Communication to Reduce Disparities in Maternal and Child Health” ($568K).

Color me skeptical, but when nutritionists have little consensus on a single dietary strategy to reverse obesity, diabetes, or most other chronic diseases, how will they slice and dice this zero amount of knowledge into dietary recommendations and medical treatments that can be applied to each and every American citizen? Will zero magically be multiplied by AI to be more than zero? To my mind, the premise is flawed.

The NIH nutrition taskforce

Even so, precision nutrition seems like a foreseeable outcome of the four-member NIH taskforce convened in 2016 to develop the NIH strategic plan. The taskforce members, as I found out, had virtually no expertise in studying diet and health. Instead, they had a long track record of favoring pharmaceutical or tech-based interventions to treat chronic diseases—including some startling direct investments in these pharma/tech products.