Our Dietary Guidelines must address chronic health issues
Many people don’t realize that Cheetos and Tostitos are part of the National School Lunch Program for kids in public schools and that Honey Kix cereal, along with sugary drinks, are part of the “basket” of foods the government provides women and infant children.
I can tell you, as a primary care doctor, that these foods are not appropriate for people struggling with obesity, diabetes and other diet-related conditions. Sugars and starches will only worsen their conditions. These foods are even more perilous for my minority patients who suffer from higher rates of these diseases yet often have little choice but to rely on government food. We need choices. It’s time for the government to move away from its one-size-fits-all model and instead offer a true range of dietary options for our diverse nation, 60% of whom are now afflicted with a chronic disease.
Fortunately, now is a moment to have an impact on the Dietary Guidelines for Americans — our nation’s national nutrition policy — which is being updated. The expert report is due out in a matter of weeks, and this will inform the guidelines, jointly issued by the departments of Agriculture and Health and Human Services, by the end of the year. These 2020-2025 guidelines will guide food choices for the next five years.
As rates of obesity, diabetes, fatty liver disease and Alzheimer’s all continue their relentless rise, altogether causing 1.8 million deaths per year, one has to wonder why we are not more alarmed by this “slow” pandemic that has been steadily gaining on America since 1980. During this time, the guidelines haven’t worked.
In my clinic, I believe I can see the reason. People at risk for obesity and other related diet-diseases who follow the guidelines — a high-grain diet with 10% of calories as sugar — reliably get worse, not better.
If there is one thing I know as a doctor, it’s that people with Type 2 diabetes and other chronic diseases cannot eat the same quantities of grains and sugars that healthy people can. People with these illnesses have, in effect, an intolerance for carbohydrates.
By ignoring the U.S. dietary guidelines and reducing the carbohydrate load in my patients’ diets, I’ve been able to help them regain their health.
One patient with Type 2 diabetes visited me after tragically losing her mother to diabetes. At that time, her average blood sugar had reached 11.2, almost double the threshold for a diabetes diagnosis, but she was determined to make a change. By eating a low-sugar, low-carbohydrate diet, this patient successfully brought her blood sugar under control, lost 100 pounds and reduced her blood sugar to 4.8. I was able to take her off insulin — essentially reversing her diagnosis of diabetes.
Dozens of rigorous clinical trials support this anecdote. Low-carb diets have been shown not only to reverse diabetes diagnoses but also to reduce blood pressure and improve the vast majority of heart disease risk factors. In a controlled trial of 262 adults with Type 2 diabetes, 56% reversed their diagnosis with a lowcarbohydrate diet, sustaining these results for two years. In fact, since 2018, the American Diabetes Association has considered a low-carb diet as a standard of care for the disease.
The startling reality is that the dietary guidelines don’t even address people with disease. The USDA has stated that the guidelines are only for “healthy” Americans.
Thus, the scientific reviews soon to be published in the expert report have ignored all the clinical trials on weight loss and virtually all clinical trials on lowcarbohydrate diets. It’s hard to understand how the guidelines could possibly aim to help America if it is ignoring our obesity problem.
Groups have also expressed concern that the data underpinning the guidelines is based on predominantly white, uppermiddle class individuals, and that many studies were not adjusted for important “potential confounders such as race/ ethnicity (and) socioeconomic status.”
The guidelines, as we know, make no accommodations for people of different races, ethnic and cultural backgrounds.
My patients with means have options to buy fresh foods, while my patients from disadvantaged backgrounds live in food deserts without choice, often further disadvantaged by lack of access to health care and environmental factors.
These are significant obstacles, yet good nutrition is one of the most — if not
crucial factors for good health. As one of only 3,000 board-certified obesity medicine specialists in the U.S., I’ve come to learn this after years of study.
According to the World Health Organization, “health is not merely the absence of disease or infirmity, it is a state of complete physical, mental and social wellbeing.” We need a fundamental paradigm shift in health care to focus not just on treating chronic disease but also to understand its root cause — poor nutrition — to provide a clearer path to better health.
With the next iteration of the guidelines due out this year, we have the opportunity to make meaningful reform that could save lives. The federal agencies overseeing this policy should slow down the process to provide time to examine the science in order to ensure trustworthy, evidencebased guidelines — for Americans.