This narrow focus clearly came as a surprise to some members of the 20-person appointed expert committee tasked with overseeing the science of the 2020 guidelines. They’d been gathered in Washington by the Departments of Agriculture and Health and Human Services, which jointly oversee the policy. One committee member asked, for instance, whether a study on obese people that looks primarily at weight loss would be included. The answers, from USDA staffers, came back repeatedly: That study would likely be excluded; that most included studies are only of populations that are healthy or at risk for obesity; and the guidelines are for “prevention” only.
Why is this “prevention” diet not appropriate for sick people? Recent science indicates that many people with nutrition-related diseases typically have a “broken” metabolism that makes them far less able to process starches and sugars. While some people can reverse obesity and diabetes with calorie restriction, others find more success reducing carbohydrates alone — for example, eating fewer grains and/or sugary foods. For these people, USDA and HHS should offer a nutritional option that is lower in carbohydrates than the existing guideline options, which all stipulate eating 50 to 55 percent of daily calories as carbohydrates.
A lower-carbohydrate approach could be a windfall for many. It has been demonstrated to work whether one is merely overweight or formally “obese,” prediabetic or “diabetic.” As a patient slides from the “pre” state of disease into its full-blown horror, a diagnosis is essentially just a name-change. One’s metabolic health has been steadily declining all along, and the solution for reversal, independent of one’s position along that downward slope, is the same. This means USDA and HHS’s hard-line distinction between “prevention” and “treatment” of chronic diseases is often meaningless.
That the guidelines are not for all Americans has been known for some time. It was one of the reasons that in 2015, during the last review of the guidelines, the House Agriculture Committee summoned the heads of both the USDA and HHS to the Hill for a lengthy hearing. Both Democrats and Republicans heavily criticized the current approach, no doubt responding to the law that states that the guidelines should be for a “general public.” Shortly after this hearing, Congress appropriated $1 million for the first-ever outside peer review of the guidelines’ process, by the National Academies of Sciences, Engineering, and Medicine. Regarding the policy’s scope, the report stated, “Given the range in health status and the prevalence of chronic diseases in the population . . . it is essential that future DGA be developed for all Americans whose health could benefit by improving diet.”
The USDA gives a nod to the “general public” requirement in its 2020 charter for the guidelines. However, in practice, the agency is clearly designing a program for healthy people only.
Nutrition-related diseases kill about 4,300 people daily, according to the Centers for Disease Control and Prevention — the equivalent of nearly 11 jumbo jets crashing and killing every person on board, every day. Where are the emergency expert panels, the headlines, the congressional outrage devoted to this massive, unparalleled public health crisis? The guidelines, whether through design or implementation, are clearly a failed policy. It’s time to ground the planes and acknowledge this disaster. Independent experts with no vested interest in the status quo are urgently needed to rethink the problem.
The USDA has already resisted reforms to improve the guidelines development process by avoiding conflicts of interest on the current advisory committee. (One member, for example, is the medical director on a meal replacement program owned by Nestle, one of the world’s largest food companies.) So the committee is unfortunately unlikely to undertake this much-needed radical overhaul. Nor do the odds seem high that the USDA office in charge of this policy for decades will turn a critical spotlight in on itself. But something has to change. The government is spending $12 million on guidelines for 40 percent of us, at most. It’s time we get away from a one-size-fits-all diet and instead have a range of options that could together be a Dietary Guidelines for All Americans.