Why The US Dietary Guidelines Don’t Apply to 90% Of Americans And How They Can

The guidelines are supposed to be for prevention only, they're only preventing chronic disease, right? So that's only the healthy people who haven't yet contracted disease, right? So, but over time, America has, as you say, it's just become dramatically, a far greater proportion of us are unhealthy.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, that's Pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. and if you care about what food you should be eating, if you're confused about the dietary guidelines and how our government messes with our food recommendations, well, this podcast is going to be for you. It's with an incredible woman, a friend of mine, Nina Teicholz, who is a journalist. Her book, the Big Fat Surprise, was a big inspiration to me when I wrote Eat Fat Get Thin. It's beautifully written, it's incredibly researched, and it's very provocative. In fact, it was named best book of the year by the Economist, Wall Street Journal, and Mother Jones. basically upended the conventional wisdom on dietary fat, which is that fat makes us fat and fat causes heart disease, which turned out not to be so true anymore. And it's what got us into the problem that we have now. And a lot of that information was in our dietary guidelines that told us to eat eight to or six to 11 servings of bread, rice, serum pasta day and eat fat only sparingly. And as soon as we got that advice, we turned into the fattest nation on the world with over 88% of us now metabolically unhealthy and 75 percent overweight and 42 obese, which is terrifying, up from five percent in 1960 when I was born. So it's a big problem. Nina is also the founder of the Nutrition Coalition, which is a non-profit group that works to ensure government nutrition policy is transparent and is actually based on science. What a crazy idea that we should have nutrition guidelines based on science. She's been asked to testify before the USDA and the Canadian Senate. She's graduate of Stanford and Oxford, lives in New York with her husband and two sons. And welcome to the Doctor's Pharmacy, Nina.

Thank you, Mark. It's so great to talk to you and be here.

Well, you know, your work is just so important. You know, you are a rare breed, which is an investigative journalist. You don't just report on stuff that other people report on, which is most of what news is today. You actually dig into the science and look at the original data and go back to the sources and dig up what's true and not true and what we know and don't know. And so I was very inspired by your book, the Big Fat Surprise, and it led me to go on to write Eat Fat, Get Thin. And I think your work really is not just focused on educating people about nutrition science, but it's actually focused on changing the very policies that determine the food that is recommended to Americans to eat, what we call the Dietary Guidelines for Americans, which is the policies that drive nutrition recommendations throughout our government and has huge implications for every aspect of our society, including school lunches and WIC and many other food programs that are feeding literally millions and millions and millions of Americans. So why are these the most influential policies, the dietary guidelines and the most powerful lever on our food supply? And why is it so misguided?

Well, those are two separate questions, but let me take them one at a time. I mean, I think most people think they really aren't affected by the dietary guidelines. Who's even heard of them? But, you know, people know them as the food pyramid or then now we have MyPlate. But even if you don't think you're following the guidelines, they reach out and touch each and every American. So through some of those nutrition assistance programs that you mentioned, school lunches, school breakfasts, feeding programs for the elderly, women and infant children programs, you know, food that American Indian, American, sorry, food that Native Americans get, that's one in four Americans every month eating the food that's based on the guidelines. But also they are recommended by most doctors and dieticians. So if you go to a doctor, you're getting the guidelines. And in many cases, doctors are not allowed to teach anything but what the guidelines say because the guidelines are considered the gold standard. They impact the food label. You know when you turn on, you take a piece of food, sorry, you know when you go to the supermarket and you swap the, look at the back of the food package, all of that information is based on the guidelines and what they think is good food and, or, you know, what are good nutrients and bad nutrients? I mean, the nutrition facts label. Yeah, the nutrition facts label, thank you. And also, you know, the military food is based on the guidelines. I mean, every one of our government agencies is basing their food recommendations on the Dietary Guidelines. So, even though you don't go to the guidelines, the guidelines pretty much reaches each and every American. And we followed them.

I mean, we followed them, right? I mean, when the pyramid came out, we did what the government said. We eat six to 11 servings of bread, rice, or pasta, like muffins and bagels and pasta. These were health foods.

Yeah. Well, so they no longer recommend six to 11. Now it's down to six. But so, For instance, they recommend three servings of refined grains every day. You ask me what's not good guidelines about the guidelines. Three servings of refined grains every day and six servings of grains every day is a lot of carbs, right? And up to 10% of your calories can be sugar. And many people will say, well, who cares about the guidelines? They're just guidelines and you don't have to follow them. But if you look at what Americans have actually done, And there's great data on this from the government itself, the USDA. They show that since 1970, which is when we, that's when their starting point is, even though the guidelines started in 1980. But since 1970, which is about when the American Heart Association started recommending this kind of diet as well, Americans now eat 35% more vegetables, 20% more fruit, 28% less red meat, I think around 19% less saturated fats or butter. We drink 79% less whole milk than we used to. I mean, and those aren't kind of cherry-picked I'm not just giving like things that happen to work in the favor of an argument. Every single category of food that you look at, everything that we're supposed to eat more of, we eat more of, and everything we're supposed to consume less of, we consume less of. We consume 87% more vegetable oils than we did in 1970. We've also increased our carbohydrates by 30% since 1965, and we've decreased our fat by 25% as a percentage of total calories. Those are big changes.

Those are staggering changes.

Staggering changes. And one of the arguments that people like to make, and I think it's the prevailing wisdom in the world of public health, is this idea that Americans really don't follow the guidelines because the statistics that are released by the USDA is they say, Look, here's our target for vegetables and Americans aren't meeting it. But here's our target for fruit. Americans aren't meeting it. And that's true. But that's because when they started recommending two cups of vegetables a day, Americans weren't eating anywhere near that amount of vegetables. Americans have increased dramatically the amount of vegetables they eat. And by the way, that two cups a day went up to two and a half cups a day between 2005 and 2010. So it's like, Americans are eating in the direction of the guidelines, but we just can't get there, you know, because those were at the time pretty dramatic recommendations for an American public that really didn't eat this way.

So whether we like it or not, and whether we believe it or not, the truth is that the dietary guidelines, even though they don't seem to apply to everybody or people don't actually think they're following them, that overall as a society we have adhered to the changes that they recommend it. And that's led to some serious adverse consequences that I want to get into in a minute. But one of the things that I've learned that's so staggering to me is that the dietary guidelines really are dietary guidelines for healthy Americans, for healthy Americans. So nine out of 10 Americans are unhealthy, and those guidelines really don't apply to them. And so maybe When we look at the guidelines, we need to be thinking about what we should be recommending for a unhealthy population that's metabolically unhealthy. That means high cholesterol, high blood sugar, high blood pressure. That's 88% of Americans. So we're sick and the guidelines are for healthy people, which you may be able to tolerate more carbohydrates if you're metabolically healthy. You may be able to tolerate a wider range of foods, but when you're unhealthy, and particularly from the perspective of food is medicine, You need to be guided to eat the right things, which our policies really don't help us do.

That is one of the most astonishing things that I discovered about the guidelines when I started to dig into them. And I realized what a mismatch they are for the American population. So they are supposed to be, according to the congressional statute, they're supposed to be for the general public. Well, when they began in 1980, the general public was healthy, more or less healthy. And so the guidelines are supposed to be for prevention only. They only prevent chronic disease, right? So that's only the healthy people who haven't yet contracted disease, right? So, but over time, America has, as you say, it's just become dramatically a far greater proportion of us are unhealthy. We could go through many statistics, but, you know, more than half are pre-diabetic or have diabetes. As you said, 42% or more have obesity. And so now we have a policy that is applied to everyone, Right, and think especially about those kids, underprivileged kids receiving school breakfast or end school lunches. Their rates of obesity and diabetes and hypertension are even higher. Think about that kid who's being fed from the Women and Infant Children Program with a mother who's obese. I mean, and the guidelines, when we say that they're not for unhealthy people, what we mean is that the expert committee that prepares the science for the guidelines They do not even look at studies. They do not look at studies on how to help people lose weight, how to help somebody to reverse hypertension, how to help somebody to try to reverse diabetes. They do not look at that literature. So that's saying that they don't even consider that literature because they consider that treatment, treatment belongs to the medical practices, you know, the specialty practices of doctors. They don't want to do treatment. and all of that is totally understandable, but then the guidelines should not be applied to all Americans, which they are. You know, when you go to your doctor and you say, I'm pre-diabetic and your doctor gives you the guidelines, but they didn't look at how to reverse pre-diabetes or diabetes. So it's really this, I mean, actually our group, one of the things that we're doing at the Nutrition Coalition right now is just to say, when you come out with the guidelines, which are coming out by the end of this year, just to say, How about if we just put a warning label on them just to say, look, these are for healthy Americans only. And really, there are things that are questionable about them, even for healthy people. But please do not use this for treatment of people. You know, for the 60% of Americans who are diagnosed with a diet-related chronic disease, these guidelines don't apply to you.

That's right.

That would be a big step forward, I think.

Well, that's a big paradigm, Chef Nina, because what it would imply is that dietary interventions are actually able to be used for treatment of chronic disease, which is not the current medical paradigm. It's functional medicine, it's food is medicine, so we do.

That's correct.

But the truth is that the paradigm of do you use food to heal disease doesn't even exist in traditional circles. And what's scary is that the emerging science that really upends a lot of our old ideas that all calories are the same or that saturated fat is bad or that we should all be eating more carbohydrates. You know, these have been completely debunked by the science and yet they're still part of our guidelines.

Yeah, I think at least what you could do is to just have the guidelines not apply to so many people, right? Yeah. I mean, it's going to be a long time until we get to a paradigm where each and every medical society is using food as medicine, as you suggest. But at the moment, let's just stop giving the wrong advice to people. Somebody with diabetes telling them to eat six servings of grains a day and up to 10% of their calories as sugar is really bad advice.

Definitely bad advice. It's definitely not Dr. Hyman approved advice, for sure.

So let's just stop that. I mean, that's what I would, 'cause we're, there's really, you know, the Dietary Guidelines is a huge policy. It's supported by massively by food industries and it's very hard to change as we've discovered doing the work that, you know, I've been doing for the past couple of years, but at least have them apply to not so many people, I think would be a good solution.

Yeah, and today it drives $100 billion in funding for USDA nutrition assistance programs that are delivered to populations in need who are actually the most vulnerable and actually the most sick and actually the ones who need a healthier diet the most and to whom these guidelines apply the least.

Yeah, it's sort of a tragic mismatch really. I mean, and I've listened to, I hope nobody else has to do this, but I've listened to all the Dietary Guideline Committee meetings and listened to all our conversations. There's a lot of talk about how we need to tailor health recommendations depending.

On.

Race, ethnicity, socioeconomic status, background, cultural needs. But one of the analyses that came out about the guidelines is that 90% of their reviews where they ended up having, these are the scientific reviews, 90% of them did not take into account race and ethnicity at all, or low socioeconomic status. And they were predominantly on white populations. In fact, when I looked at the reviews in more detail, I just couldn't get over it. It's mainly, it's often all white populations, the data that we're using. And a lot of it is like the Norwegians and the Swedes and the, all these people, they're so much healthier than we are. These populations from overseas, they sometimes they just barely include any Americans at all. And I, you know, we're, I'm not saying that there isn't some basic biology that we don't all share. We do, and we all have in common, but there are really important differences. by race and ethnicity. And so that needs to also be taken into consideration.

You've written many criticisms of the dietary guidelines and pointed out many of the flaws. And I think for most people, they don't understand how they get created. And they're created essentially by a panel of experts selected by the government who are advising the government on how they should create the dietary guidelines. The past before George W. Bush, was in office, the guidelines were based on the actual recommendations of the scientists. Now, the recommendations get put forward to a political committee who then have to determine which of those guidelines to include or not. For example, in the last Dietary Guidelines, there were some considerations about environmental impact, and those were just eliminated. Now, you can debate whether they should be in there or not, but the fact is that scientists thought it was valuable, but the government was like, no, that's too political. We're not going to do it, even if it's the right thing for human and planetary health. and what you did was to not just take the guidelines at face value, but you sort of just started to dig in and challenge some of the ideas that we haven't been challenging about why the guidelines say what they do, how they are created, and what the flaws are. And if anybody thinks that one person can make a big difference, then you should think about Nina because she basically went to Congress with the data, with the science, and lobbied as a one-person lobby group essentially. and convince Congress to appropriate a million dollars for a report by the National Academy of Sciences to look at the way in which we create the guidelines and if there's any conflicts of interest in any issues. And I'd love you to share about what was found in that report and why it was so disturbing.

Yeah, so I want to say it's super interesting what you say, this fact that it's a group of scientists who make decisions and then there's this it goes through the political, it goes through the black box of the political process and then some, you know, there's all kinds of lobbying that goes on in that process. By the way, I don't call myself a lobbyist. I think of myself as an advocate because, you know, there's, I really advocate for more rigor in and better methodology in the guidelines. But in any case, this group of scientists themselves have all kinds of questions. And so, you know, what you'd like to think is that the scientists come out with these pure, pristine recommendations. And so anything they say is golden. And we would all like to believe that and wish that were the case. But what I found in, when I looked at the last Dietary Guideline Committee is that there were a lot of conflicts of interest in terms of the members of this scientific committee getting paid by getting money from the food and pharmaceutical industries. And so what this National Academies of Medicine report did, this one that was actually the first ever peer review of the dietary guidelines that had ever happened. And one of their recommendations is you need to be transparent about the conflicts of interest among your scientists on the scientific committee because it's really important to know it's not always true. You know, scientists aren't always bought off by taking money from the food or pharmaceutical industries, but it's important to know where their biases might be, right? And to manage them. And you probably can barely find a credible medical journal now in the world today, as you must know, that doesn't require disclosure of conflicts of interest. And yet, and this is what the National Academy has said to the USDA and HHS, which run the guidelines, they said, you have to disclose the conflicts of interest on this scientific committee. And lo, they did not accept that recommendation. And so we have no disclosure about, you know, who is actually sitting on this committee. So we did some research on that, which is pretty interesting. I mean, I'm happy to share some of that with you if you'd like. I mean, these are the- what did.

You find about the people who are making our guidelines?

Included in that group is the current medical director of Nestle hit their Optifast weight loss program, which is like a formula that you take to lose weight. Well, why is that a conflict of interest? Well, if you're looking for a food-based solution for weight loss, that competes with the Optifast program, which tells you you can lose weight, better to lose weight through a formula. Also on that committee is the former executive director of Merck. which is the major huge pharmaceutical company that makes all kinds of devices and drugs for chronic disease. Again, why is that a conflict of interest? Because if you think that disease should be solved with drugs and devices, you might not be so interested in a food-based solution, right? Also was the former global director of scientific affairs and obesity for Merck, was also on the panel. There's a member of the Scientific Advisory Board of ConAgra, a huge massive food and ag company. and the former president of the Danone Institute, which is funded by the Danone yogurt company. There were also altogether five members who've been funded or consulted with Nestle. Nestle's, I think, the biggest food company in the world. Two of them had consulted for PepsiCo research and development. And then two of them are on the board of trustees of ILSI, which maybe some of your listeners know about is the International Life Sciences Institute, which is really a group that's kind of a, that was put together by the former vice president of Coca-Cola and includes members like Coca-Cola, Pepsi, Mars, Cargill, Kellogg, Hershey Company.

Yes.

I mean, they're like, their goal is to get people to eat more junk food, it seems. Yeah, I mean, and by the way.

That group is fascinating 'cause it seems like it's an independent group, International Life Sciences Institute, it sounds wonderful, but it's just a front group for the food industry. and, and they put together a scientific paper that was published in the analysis of internal medicine, essentially saying that our sugar recommendations were flawed. There was no basis in science for reducing our sugar intake and that any Association between sugar and chronic disease really was, was not valid. And when you kind of, and then you look funded by the International Life Sciences Institute, and I'm like, oh, my goodness. And, and you start to drill down on these conflicts of interest, and it's, it's no wonder why we're all confused, because we're getting information that's not filter through pure science and understanding of the data, but based on various industry interests and not public health.

I want to say there is, it was a 20-person committee and five of the members really didn't seem to have many food or pharma ties, but the other 15 did and quite a lot. And I'll just mention one other thing because people sort of, I think the general narrative that people believe is that really it's the the meat industry is the most powerful industry and they have, they're the one, the reason that we've had so many problems with our guidelines. And so there are two members of the panel with a lot of ties to the meat, dairy, eggs, you know, the kind of animal protein. But there's another two people with, with tremendous ties to the nut industry, which is like incredibly active and gives away tons of money. So, and then, and by far the majority of the people on the panel, their ties are really with the fast food, the junk food industry, the industry that, they do not want you eating real food. They don't sell real food. That's not what they sell. And so I think that one really has to, first of all, it seems sort of a no-brainer just to disclose these conflicts of interest as a matter of course. But I think it's also, you know, it shows you that the science, the scientific panel itself is, you know, is problematic in terms of their, what's going on with their interests.

Hi everyone.

Hope you're enjoying the episode. Before we continue, we have a quick message from Dr. Mark Hyman about his new company, Farmacy, and their first product, the 10-day reset.

Hey, it's Dr. Hyman. Do you have FLC? What's FLC? It's when you feel like crap. It's a problem that so many people suffer from and often have no idea that it's not normal or that you can fix it. I mean, you know the feeling. It's when you're super sluggish, your digestion's off, you can't think clearly, or you have brain fog, or you just feel run down. Can you relate? I know most people can. But the real question is, what the heck do we do about it? Well, I hate to break the news, but there's no magic bullet. FLC isn't caused by one single thing, so there's not one single solution. However, there is a systems-based approach, a way to tackle the multiple root factors that contribute to FLC, and I call that system the 10-Day Reset. The 10-Day Reset combines food, key lifestyle habits, and targeted supplements to address FLC straight on. It's a protocol that I've used with thousands of my community members to help them get their health back on track. It's not a magic bullet, it's not a quick fix, it's a system that works. If you want to learn more and get your health back on track, click on the button below or visit getpharmacy.com that's getpharmacy with an F, F-A-R-M-A-C-Y.com Now back to this week's episode. You know, and a friend of mine who's a Harvard scientist, very prominent researcher and a friend of ours essentially challenged the whole idea that we should be getting three glasses of milk a day in our recommendations. And when he spoke to someone on the Dietary Guidelines panel years ago, He said, Look, the data don't support this. Whether it works or not, there's no evidence that this is something we should be recommending. He's like, yeah, I know, but the dairy council, na, na, na, na, na. We had to support farmers. And it was really an industry-driven decision, not a science-based decision. And it's really hard to trust what's coming out of these guidelines when they're so conflicted. But what's even more disturbing to me, Nina, is the fact that and I don't understand this as a doctor scientist is how you can say we're only going to look at this evidence. We're not going to look at all the evidence. We're just going to look at evidence we want to look at. And what was really striking to me was in the last dietary guidelines under the Trump administration, there were rules on what you could look at and what you couldn't, including you couldn't look at the effective ultra processed foods or low carbohydrate diets or any things that are emerging as real yeah. Contributors to chronic disease. I mean, the, the global burden of disease study said that 11 million people die every year from eating too much Ultra processed food and not enough good foods. That should be something we look at. Right. And it was completely ignored. So can you talk about that? What, what is allowed to be even looked at and how they measure the evidence? And it had to actually be USDA research. It couldn't be independent scientific research. I mean, I just, I was so confused by. Yeah. these sort of artificial guardrails that were put up on, or blinders that were put up on the scientists says, well, yeah, this study may have shown that eating a low-carb diet is curable, can cure diabetes, but we can't look at that and we won't recommend, like how did that even happen?

You know, it is such a strange and Byzantine process and I will tell you that it's, if you take a step back from the committee, there is this this whole huge staff at the US Department of Agriculture that has been running the guidelines for some of them for decades in this group. And they're sort of the office of the guidelines and they set the rules. In fact, not only do they set the rules, but they do some of the reviews themselves. And then they sort of pretend that the committee did them. That happened with 11 of these reviews for on pregnancy and birth and and lactation. So they are the ones who set the rules as far as I can tell, although they will say that it's the committee itself that's setting the rules. But just to give you an idea of some of the craziness. Okay, so one of their rules is we're not going to look at any outside systematic reviews. Why is that? Because systematic reviews are considered kind of at the apex, if the pyramid of evidence is like this, systematic reviews, especially of clinical trials, is like right up here at the top as some of the best evidence you can get. you can get, right? You have animal model studies down here at the bottom. So they said you can't look at any outside systematic reviews. Well, in the case of saturated fats, saturated fats is a very unique story because all the really rigorous, big, large, important clinical trials were done back in the 1960s and 70s. But then they were just kind of ignored for many, many years, really.

They didn't fit the paradigm, right?

They didn't fit the paradigm.

I was like, that couldn't be true.

I mean, they're just crazy stories. They weren't published for years. Some of them, they just weren't, they were ignored. And so they were really never reviewed by any dietary guideline committee ever. But now, due to my book and other people's work, these people have realized these trials exist. And so they've gone back and done systematic reviews of these trials. There are now almost 20 of these systematic reviews, right? But the Dietary Guideline Committee is not allowed to look at any of them. So this whole last decade of science, which has witnessed a real reconsideration of saturated fats, let's say there's still some debate, but at least there's two sides to the story now. The science is contradictory from, I think it's fair to say, but the Dietary Guideline Committee was not allowed to look at any of that past decade of research. So that's just kind of mind-boggling. Like, they're supposed to be guidelines that reflect the science that is current at the time. And now I'm literally quoting from the Congressional statute. But that is not the science that is, you know, if they can't look at the systematic reviews that kind of recapture this old science.

What's the rationale? Like, why is it off limits?

Well, they didn't give one, as what I can say, but I don't know, really. I could make an argument that some of the outside reviews are like the ones that they used in the, from the American Heart Association and American College of Cardiology previously were funded by a lot of corporate money and maybe they thought it was good to keep that out of the system. I don't, I don't know really what the reason is. And I'll tell you another amazing story, which, well, there's two more mind-boggling stories. One is that the committee decided to not to include any studies on weight loss, on obesity, even though this is like, you know, chronic disease issue number one. It's losing weight is probably the most effective way to help fight diabetes. It helps resolve almost every medical issue. Plus it helps people maintain a healthy weight. And the Dietary Guidelines have as one of their three goals helping people to reach and maintain a healthy weight. But they said we're not going to look at any studies on and who's, who's saying that?

Is it the committee? Is it the government?

The committee just said, we're not going to look at them because, because when you lose weight, that complicates other outcomes because losing weight helps so much. So they don't, they wanted to try to isolate the effects of diets without weight loss, which is, I mean, we.

Could already considering, you know, 75 of us are overweight. Or obese. That's, or obese, yeah.

So, no studies on weight loss. And then when it came to low carbohydrate diets, well, in 2000, the last time around, 2015, they did review low carb diets, but they decided not to publish it. And there was a bunch of emails about this. If anybody's interested, they can look at this Wall Street Journal article that I did where I went and got Freedom of Information Act requests on some of those emails and found that there had been quite a bit of debate over not publishing this low carbohydrate diet review. Because it's, as one person from Harvard said, this is a significant amount of research. We should not be burying it.

And what was the rationale? What were the arguments for burying it?

There was no email chain on that. At that point, it just just disappeared. So this time around they said, and this is again, this is for the 2020 guidelines that are going to be published at the end of this year. They did review low carbohydrate diets, but they couldn't find any studies except for one that had been authored by a member of the dietary guideline committee itself. So this is like, they couldn't find them. They couldn't find them. It's like, I mean, So this is so crazy because, you know, it depends on how you count them, but there's somewhere around 100 clinical trials now, at least, on low carbohydrate diets.

And- and plus many other observational trials. So there's literally hundreds of studies looking at this.

There's a massive amount of scientific literature. And remember that the Harvard committee member in 2015 was already saying this is a large amount of significant research. So, and it's a little bit like you, you know, you're trying to put together a zoo and you're looking for, you know, giraffes and you say, we only want no neck giraffes. So, you know, like you end up with no giraffes and you've got a zoo with no giraffes. Like somebody should realize there's something wrong with their selection criteria and the way that they're looking for low carb studies, right? I think I didn't explain that very well. Let me reverse that for a second. They didn't find any low carbohydrate studies because they set up their selection criteria basically to rule out finding any of the studies. I mean, their selection criteria, I mean, they set up a bunch of rules. Like, these are the trials that we want. They have to include this, they have to include that, they have to include a complete description of the diet, they have to say what percentage of fat, protein, and carbohydrate. You know, it turns out, you know, most low carb studies only include the percent of carbohydrates that are in that they are looking for. They don't include also information about the whole diet or protein and fats. So that's kind of a little bit of a overly detailed explanation, but it's like setting up a criteria that, you know, will exclude everything. And you're looking for that. That's your criteria. And you're looking at it in an all- yeah. So that's what happened. So they came up with zero studies.

So how do we deal with this? Because it's so clear, a chronic disease, most of which are driven by our diet in one way or the other. So how do we begin to kind of reconcile that? Just, it's just unconscionable to me because I can't believe all these scientists are, you know, following some pernicious agenda that makes them want to not deal with this. Is it just because the Paradigm is so strong that they haven't? kind of come up to the 21st century of science of nutrition?

I think that there are, it is hard to reckon with. Like, why do people not care more? Why did, like, why, you know, why should they not care that they omitted the entire science and low carbohydrate diets? And I think that that's because on the whole, the low carbohydrate diet is still considered sort of a taboo. And many people, mainstream scientists are really not interested in it. And so they, I think another reason is that many of these scientists are, you know, their entire careers have been devoted to promoting and believing in one kind of diet, which is the dietary guidelines, which is, you know, more fruits, vegetables, whole grains, nuts, seeds, fish, fatty fish, and, you know, less meat, less, and low fat dairy. And they believe that. and so, and many of them, as I also discovered, received many, many millions of dollars in grants from USDA and HHS, which is to say the government. So they're, they, what is their incentive to then, you know, what is their incentive to go against the government? What is their incentive to go against their entire profession, their entire field? I really think that that is, It's very hard to find somebody who will kind of spur the conventional wisdom. There's no reward for them. Like what is their actual reward to become, you become, you lose your, you potentially lose your grant, you lose the respect of your colleagues, you may no longer be invited to conferences. I mean, these are things that I documented in my book about scientists who kind of step out of line with the conventional wisdom. there are real and palpable losses to that.

Yeah. And by the way, people who really understand this whole saturated fat issue, which we're going to talk about in a minute, you know, can, can listen to an earlier podcast. Nina was my second guest ever on the doctor's Pharmacy, so that was really awesome. I mean, we did go into it, but I, I want to come back to, you know, we talked about the low carbohydrate issue, but it's also sort of connected to the fat issue because as you decrease carbohydrates, you have to increase something else in your diet, which should be fat and of course a little bit of protein. But the, the guidelines essentially still say we should be eating less than 10 of our calories as fat and that even.

I don't say that. No, the guidelines, the guidelines now advise between 31 and 33%.

No, I mean a saturated fat. Sorry, saturated fat. That's in 10 of our diet is saturated fat. I misspoke and yeah, about, you know, they've actually removed the restriction on total fat, although they did it in a sort of side note and they didn't announce it. And it was sort of an embarrassed acknowledgement that, oh boy, we don't have to worry about total fat in the diet, because it's not related to weight gain or to heart disease, which was a big shift in the 2015 dietary guidelines. But they still recommended that we eat less than 10% of our calories as saturated fat to reduce heart disease. Now, and if you have heart disease already, it should be less than 5% saturated fat. which kind of is interesting because when you look at the literature, it doesn't quite all add up. And even, you know, just the joke I always make is that, you know, breast milk is 25% saturated fat, so we should be restricting breast milk to babies because it's literally got five times the amount of saturated fat that we recommend in our dietary guidelines for people who have heart disease. But what we know now is quite different about saturated fat. And there was an incredible review paper that was published in the Journal of the American College of Cardiology in June of 2020. titled Saturated Fats and Health: the Reassessment and Proposal for Food-Based Recommendations and with a state-of-the-art review by the Journal of the American College of Cardiology. And it essentially said a number of really interesting things I'd like to go into, but sort of question the orthodoxy that all saturated fat is bad and it's bad for everybody. So I'd love you to sort of talk about the impact of this paper, how you think it might influence the dietary guidelines in 2020 or at all, and what we should really be thinking about it, the take homes around saturated fat in our diet, because people are still confused about it.

There's a lot of confusing messages about it, so I think people are right to be confused. That paper said many things. I want to say one of the most important things about that paper was its authors. Its authors included three former members of previous Dietary Guideline Committees, including the chair of the committee in 2005. So these are basically that expert committee that makes the guidelines saying, you know, we got it wrong on saturated fats, which is an extraordinary thing. And the paper basically argued a number of things, which I think I should share just a few of them, but one of them was that this fear of saturated fat and the argument that is still held out against it is that it tends to raise your LDL cholesterol, which is known as your bad cholesterol. It can be a transient rise, it can be a permanent rise. But what this paper points out is that the rise in lowering your LDL cholesterol through diet, in diet studies, has never been shown to lead to any impact on heart disease. It may happen that it works with drugs. You know, when you take statins, that's what statins are designed to do in part. But it really has never been shown to be reliably true. if you do that through diet. So, and saturated fat raises a kind of LDL cholesterol that is called your large and void. There are different kinds of LDL cholesterol. It becomes a complicated story, but it doesn't raise the type of LDL cholesterol or LDL particles that are considered the worst for heart disease. Those are small, dense ones. Saturated fat tends to raise the large, buoyant ones. So that was a bit, one important point of the paper. I think Two other important points is that this paper reviewed those clinical trials like everybody else did and said no effect on cardiovascular mortality and no effect on total mortality. That was the result of those paper, those clinical trials. And this paper said, I think really importantly, we have to be careful of restricting saturated fats because of the foods in which we find them. And you do potential harm if you restrict if you restrict these foods like, you know, all kinds of meat and full fat dairy and cheese and, you know, coconut oil or coconut butter or dark chocolate is another example, you are missing out on the nutrients needed nutrients in those foods. And in fact, one of the things that's disturbing about the dietary guidelines is that they do not they don't meet all our nutrient needs. if you follow them perfectly, you will still come up short on a few important nutrients, including vitamin D, which we now know is really important for fighting COVID, and choline, and I think it's potassium, and maybe iron. I don't know this off the top of my head, but I think that, so it's very important not to restrict those foods, which is what saturated, the limits on saturated fats do. And so their argument in this paper was we need a food-based guideline. we should not be focusing on this micronutrient, this of saturated fat.

Well, this goes back to the whole idea of nutritionism, which is the reductionist approach to the individual nutrients in food as a way of helping food companies to modulate those nutrients and still provide crappy food. So, if you reduce saturated fat, you reduce salt, reduce sugar, these are things that food companies can manipulate in their formulations. But if you say eat whole foods, what are they going to do? Right?

So the limits on saturated fats are a way to kind of keep down or to limit consumption of these whole natural foods which provide nutrients. And it's really important that we get nutrients because eating nutrients in foods is, you know this, but I mean it's far more what we call bioavailable, which means that your body is able to digest and absorb them, right? We say you can get your iron from fortified Kellogg's Crispies or whatever, because they fortify those grains with iron, but you will absorb it much better if you get that iron from, say, meat. And that's true of all nutrients. It's better to absorb them and eat them in the natural form in which they're found. And that was the argument of this paper. So what was the argument?

We're going to put the link to this paper in the show notes because it's very important. what really struck me from looking at the paper was, you know, there was kind of a bunch of points that were really important. First, you sort of highlighted that, that despite the current recommendation around saturated fat, there was mounting evidence that basically didn't show that saturated fats or reducing cause heart disease or reducing saturated fats lowered the risk of heart disease. And this is from a review of all the data and actually increasing saturated fats may protect against stroke.

Right, I forgot to mention that.

The second thing that was really interesting was you mentioned this thing about the particle size and that matters because if you're creating the small dense particles, which by the way comes from eating carbohydrates and sugar and starch, not fat, you're actually more likely to get heart attacks than eating saturated fat, which is creating these large buoyant cholesterol particles for most people. I think there's some genetic variations. But they're also said that it matters what you eat them with. And in my book, Effect, then I made a huge point of this, that if you eat saturated fat, the context of a low starch and sugar diet, it's okay. But if you start sick in the saturated fat in carbohydrate rich diets, that creates a problem because then you get the double effect of insulin inflammation and the saturated fats, and then it can become a problem. So I would warn people to say that, you know, you don't get to eat cookies and ice cream and cake, which have saturated fat and carbohydrates. You should be eating, you know, butter on your broccoli, not on your bread. and that actually makes a huge difference. The other thing they said, which is really interesting to me, is that they have to look at the actual data on these whole foods and whole fat dairy, unprocessed meat, dark chocolate, all saturated fats, but they're in this complex, rich, nutrient-dense food, and none of them were associated with heart disease. In fact, it may be the opposite, and there was no data to really suggest that we should limit these foods, which is pretty amazing and that they recommend that we eliminate all these population wide upper limits on saturated fat in the United States because it won't reduce the risk of heart attack or death. That's pretty dramatic statement and to be published in the Journal of the American College of Cardiology, right? It is. That's like a, this is not some left wing radical journal that wants to upend the orthodoxy. This is, this is the journal of the American Heart Association.

And cardiologists are considered some of the most conservative groups on saturated fats. So I think it was really significant. I mean, these authors literally concluded the caps on saturated fats are no longer warranted. They're no longer needed. And it was such an incredibly prestigious group of people who really were knowledgeable about the field. And again, had themselves passed nationwide population-wide limits on saturated fat, but we're saying we were wrong to do that. So it's an extraordinary paper. It's extraordinary that it got published in that journal. But I have to say, I'm disappointed by the results. I mean, I don't think that one newspaper covered it, or I have seen almost no no news coverage of it at all. And, you know, I think just recently the BMJ did a news piece on this group of scientists and this paper. And in fact, this group of scientists went beyond the paper. They actually wrote a letter to the secretaries of USDA and HHS saying it is urgent for you to really rethink these guidelines. and they also wrote a letter to Congress. And throughout the process, they submitted numerous public, you know, you can submit public comments to USDA during the process, and they submitted all this literature, this scientific literature to the Dietary Guideline Committee, and all of that's just been ignored. So it's, it's really, it's an extraordinary story. I mean, the ability to, like, just not see anything, but what you, you want to see is as I think, or the vested interests that are involved here are too powerful to overcome.

So let me ask you this, you've been working on this for a long time to try to update and improve and make the dietary guidelines more evidence-based and there's a lot of challenges to that. But it seems that a Congressional Oversight Committee gave a million dollars to the National Academy of Sciences created a very independent objective report, which made a series of recommendations, all of which were pretty much ignored. And the question is, in the context of the average person, what we can do, how does this process change? Do we need to call our congressmen? Do we need to create a massive movement to have a different secretary of agriculture? I mean, who are the people that are going make these determinations? Is it the Secretary of Agriculture? Is it the head of HHS who's working with the Health and Human Services Department, working with the Dietary Guidelines Committee as well? I mean, who's in charge that's causing these roadblocks to actually implementing an evidence-based approach to a dietary guidelines?

Well, that is a magical question. I'm sorry.

Because there's somebody who's picking the people on the committee, right?

There's somebody who's doing that. Yeah, well, that's, it is the question. I think that, I think that one would have more luck with Congress than with USDA and HHS because those agencies, now who knows what will happen with the Biden administration, but I think those agencies are deeply invested in this policy and it would be very difficult for them to dramatically, drastically change course. Remember, There's an office at USDA where these people have been working on these guidelines for decades. And one of them stood up at the beginning of this whole other process and said, if everybody just followed our guidelines, you would all be healthy. I mean, these are their baby, and I think it's very hard to believe it. I've sort of come to the conclusion that it probably takes members of Congress kind of a congressional oversight. I mean, it's offensive that they spent a million dollars on this report by the National Academy of Sciences and then it was just ignored. It sits on a shelf getting dusty and the agencies, the governmental agencies that were supposed to implement it just didn't. And so, I mean, we, our group urges people that you can go to the nutritioncoalition.us, which is our website, and there's a Take Action budget where you can go and contact your member of Congress. And we, at this point, we are just simply asking for what we talked about at the beginning of the podcast, which we're just simply asking for the dietary guidelines to be limited to the people that it actually addresses. Just be limited to healthy people, not.

To over 12% to 12% of Americans. The 12% not to, not to 12% of Americans. The rest of you just ignore this because it's going to make make you sick and fat.

Well, something like that. I mean, if you aren't reviewing the science on people with these disease states, then please do not try, do not try to pretend that you're for all Americans because you're not. That's, I think, the very best that anybody could hope for, which is to have a policy that doesn't overreach.

Maybe we just changed the title, Dietary Guidelines for Healthy Americans.

That would work.

But that speaks to the next issue, which is how do we design guidelines for an unhealthy America to fix chronic disease? Because that's really the main question.

Yeah, I mean, I think that you and I would agree on a lot of the things that, I mean, I think that the very first thing you should do is to stop giving people the wrong advice, right? So that would be wonderful to just level the playing field so that there is no longer, you're no longer giving unhealthy people the wrong advice. You're no longer telling the person with diabetes to have six servings of grains a day. And then after that, I think there's, you know, there's, there's a whole literature on low carbohydrate diets that show them to be effective, I think probably most convincingly for the reversal of a type 2 diabetes diagnosis, for reversing that process. And that's why the American Diabetes Association has now in their guidelines is mentions not only of low-carb but of the keto diet as good viable options and the best diet for glycemic control, which means controlling your blood sugar, which is the most important thing you can possibly do in diabetes. And also, by the way, and this is an important kind of ancillary to what we're talking about, which is in the literature on how to avoid the worst outcomes for the coronavirus. One of the, what they, a study recently found that what most tightly associates with, what is most associated with poor outcomes was high blood sugars upon admission to the hospital.

Yeah, yes.

So keeping your glycemic control in control is super important.

It's so important, yeah.

So, I mean, I think that literature, you know, as a start, reversing diabetes in America, which drives the majority of healthcare costs. I think we have less clear literature that it clearly does a very good job for weight loss, but I think we still need more literature on that. But it's clearly viable and safe, and there's long-term enough data. I mean, I'm talking multiple, nine trials that are at least two years, which is considered long enough to see any negative side effects. And one trial that's gone now five years, Okay, so that's not what we would, a real long-term trial would last 10 years long enough to hang around and get data on mortality.

Outcomes.

Yeah, right? But we know that it's safe. So, you know, and it improves the vast majority of inflammatory factors and cardiovascular risk factors. So, like, that's a good place to start. Much research needs to be done, but that research can't happen while everybody's convinced that there's just one size fits all diet for everyone. Like it has to loosen up a bit so there is an allowance of a conversation that at least starts saying, look, we need to have a diversity of options for people in different states of metabolic health. We can't assume that everybody is going to respond to this one size fits all dietary guideline diet.

Yeah, that's so important. And I think hopefully with a new administration, although I'm pretty cynical, things might open up. I think there's, in fact, Shelly Pingree was being recommended as one of the potential candidates for the USDA Secretary of Agriculture, who's an organic farm regenerative farmer from Maine, who's a congresswoman who understands these issues. So there may be some light at the end of the tunnel. I think eventually we'll get there, but we really have a moment where, honestly, we could be addressing this pandemic of COVID differently by not having a mask mandate, but having a let's get healthy America mandate to become pandemic resistant through improving our diet. And like you said, if the number one risk factor for getting really sick and dying is high blood sugar, which affects 88% of Americans at some level or another, right? Not necessarily diabetes, but at some level, and one in two have pre-diabetes or type two diabetes. I mean, it's half of Americans. You think this would be a massive public health message. But nobody's talking about it. I mean, I am, but nobody's talking about it. So I think we have a lot of work to do.

Yeah, I mean, I wrote an op-ed in the Wall Street Journal about exactly that. I said, you know, it's not about the masks we put over our mouth, but the food that goes in them.

Yeah, yes.

And why don't we make ourselves more resistant to the virus so that we have better outcomes? And why do we think that some countries have done so well and we've done so poorly? poorly, part of the reason surely must be that we have such high rates of obesity and diabetes and hypertension, all those things which correlate very highly with higher rates of hospitalization and death from the.

I mean, think of, I mean, where, yeah, where China, you know, was the epicenter of coronavirus. Now it's very little, but they also, you know, have three million. Well, they do have some, but it's not as much. It's more and more, but, but it's more. more, but they have so many people, but there, there's three deaths for every million population. Here we have 500 deaths for every million population in China, the obesity rate's 2.6%. Here it's 42%. Just saying it might be related.

Yeah.

So anyway, Nina, thank you for amazing work that you're doing with the Nutrition Coalition to raise awareness about dietary guidelines. It's not a sexy job, but it needs to be done. And it's important that you are looking at the science because so few are. And I think that I'm really impressed with the fact that you've been able to highlight some of these issues, to raise awareness, to drive public support. And I think people listening can start to pay attention and look at the Nutrition Coalition's educational information on the dietary guidelines, learn about them, learn why they're important, and learn why it's important for you to be active in having a voice about this. Because your congressman and senators listen. I mean, if 10,000 people wrote or emailed or called to their senators or congressmen, they pay attention. And I think we hopefully will be able to have a voice for this in the future as we begin to really face down the real crisis that we're facing around food and health and chronic disease and COVID and how it's all connected. So thank you for your work, Nina. Thank you for being on the Doctor's Pharmacy podcast. Been great to have you.

Thank you very much.

People can check out her book, the Big Fat Surprise. Check out the Nutrition Coalition website, which is nutritioncoalition.us. And you can also, if you want to get active, you can go to nutritioncoalition.us/take-action, which I encourage you to do because we all need to be active in making a difference because we can. And if you love this podcast, please share it with your friends and family on social media, leave a comment, we'd love to hear from you and we'll subscribe wherever you get your podcast and we'll see you next time on the Doctor's Pharmacy.