For the past 45 years (since 1980), the federal government has published the Dietary Guidelines for Americans —the principal policy guiding diet in the United States—with three goals: to (1) promote good health, (2) help Americans reach a healthy weight, and (3) prevent chronic disease. However, by any measure, the guidelines have failed to achieve these goals.
U.S. obesity rates turned sharply upwards in the same year that the Dietary Guidelines were launched. Other chronic diseases such as diabetes soon followed.
What is wrong with the guidelines?
For all Americans age 2 and older, they recommend:
- 5 1/2 teaspooons of seed oil daily (to replace whole, natural saturated fats)
- 6 servings of grains daily, including 3 servings of refined grains
- Up to 10% of calories as sugar
In all, the guidelines advise more than 50% of calories as carbohydrates.
By contrast, Americans in 1965 ate 39% of calories as carbohydrates. Obesity rates then were under 15% for adults (As of 2016, the obesity rate was nearly 43%–the most recent CDC number available).
Thus, the Dietary Guidelines, by telling us to eat so many grains and sugars, have very likely increased the risk of chronic disease or possibly even caused the chronic disease epidemics. This possibility is supported by the fact that a very large body of rigorous science (i.e., randomized, controlled clinical trials) demonstrates that type 2 diabetes and obesity, among other diseases, can be reversed (or put into remission) by eating a diet low in carbohydrates. [1]
The case for type 2 diabetes is especially strong. No other whole-foods approach has the science (i.e., clinical trials) to show that it can reverse this disease—not low-calorie, low-fat, vegan/vegetarian, Mediterranean, DASH, or any other diet. Only a very low-carbohydrate diet is backed by a high level of scientific evidence.
A further problem is that the Dietary Guidelines do not supply all the essential vitamins and minerals needed for life, even if you follow this policy perfectly. “Nutrients that do not meet Recommended Dietary Allowance or Adequate Intake goals include the following: Iron, Vitamin D, Vitamin E, Choline, and Folate," according to the USDA 2020 expert report.
The guidelines are the single most powerful policy affecting what Americans eat. They are taught in schools (K-12) and are considered the “gold standard” by doctors, nutritionists, dieticians and other health professionals.
By law, the guidelines are also required to be followed by all federal nutrition programs, such as school lunches, SNAP (Supplemental Nutrition Assistance Program), food for women, infants, and children (WIC), and programs for the elderly. Also, nutrition programs for the military.
At a time when 93% of Americans adults are metabolically unhealthy, the Dietary Guidelines exclude advice for people with obesity, diabetes, heart disease, cancer, or any other chronic disease.
At least 60% of American adults had one or more chronic diseases in 2016. The number today is no doubt far higher. However, the Dietary Guidelines do not provide treatment advice for sick people. The policy is designed for prevention only.
What does this mean? In plain terms, the process of creating the Guidelines does not include a review of the scientific literature on how to reverse obesity, type 2 diabetes, or any other chronic disease. For instance, the 2020 Guidelines process explicitly excluded the entire scientific literature on weight loss.
People contend that the problem is not the Guidelines because Americans don’t follow them. However, the best available evidence does not support this idea See charts here: Americans Have Followed the Guidelines — The Nutrition Coalition
Why do the guidelines give ineffective/wrong advice?
- The Guidelines are based on weak science.
- “[T]he recommended diets are supported by a minuscule quantity of rigorous evidence that only marginally supports claims that these diets can promote better health than alternatives.” –BMJ cover story, 2015
- “Dietary recommendations were introduced for 220 million US…in the absence of supporting evidence from RCTs [randomized, controlled clinical trials]” and there’s still no RCT evidence to support the advice on saturated fat and total fat. according to at least two dozen systematic reviews of the evidence.
- The USDA is actively suppressing the science. See, for example: USDA Ignoring the Science on Low-Carb Diets
Two 2017 reports by the National Academies of Sciences, Engineering, and Medicine (NASEM), mandated by Congress with a $1 million allocation, concluded that:
- The current guidelines’ process for reviewing the science falls short of meeting the “best practices for conducting systematic reviews,” and that “methodological approaches and scientific rigor for evaluating the scientific evidence” needs to “be strengthened.”
- "The methodological approaches to evaluating the scientific evidence require increased rigor to better meet current standards of practice.”
- “To develop a trustworthy DGA [dietary guidelines], the process needs to be redesigned.”
NASEM made 11 recommendations to USDA, to improve the rigor and transparency of the guidelines process. Congress then allocated another $1 million for NASEM to monitor the USDA’s progress. An analysis of these follow-up reports concluded that the USDA has not fully implemented even one of the NASEM recommendations [2]
Still, although the USDA has largely ignored the NASEM recommendations, these reports are the solid foundation needed for future change.
- The Dietary Guidelines process has been captured’ by industry
- 95% of the expert committee** responsible for the science in our current guidelines had at least one tie with a food or pharmaceutical company.
- A total of more than 700 conflicts of interest were found on the committee
- The corporations with the most frequent and durable connections to the committee were Kellogg, Abbott, Kraft, Mead Johnson, General Mills, and Dannon.
Also, the USDA office that runs the Dietary Guidelines has formal partnerships with more than 100 food companies, as the Nutrition Coalition discovered. Food industry influence at USDA — The Nutrition Coalition
What are the policy solutions?
Given that the guidelines were established by a 1993 act of Congress, they may not be easy to repeal. That 1993 law calls for all federal programs to follow the guidelines (schools, etc), so unless the law changes, it’s not possible to do an end-run around this policy.
- One solution is to require an additional “dietary pattern” in the guidelines for people with diet-related chronic diseases, such as obesity and diabetes. This pattern is likely to be one low in carbohydrates
- Require that conflicts of interest are balanced and managed and that the entire process of committee selection and COIs be made transparent. It’s not realistic to require that a committee have no conflicts of interest. Every nutriton scientist has at least some. But these conflicts should be transparently reported, and they could be managed. This was a recommendation by the NASEM.
- Require that the USDA office that oversees the guidelines use outside systematic reviews. This is a technical point, but it would mean getting away from the highly flawed reviews of the science that are currently used as a basis for our guidlines recommendations.
- Appoint someone to lead the guidelines that has an understanding of the most recent and most rigorous science as well as the guidelines process. Re-upping the status quo with more mainstream nutrition experts won’t work.
The changes in the Guidelines that will need to be made to ensure that they can start to restore health to Americans as well as protect our children against future disease, the guidelines must:
- Remove the cap on saturated fat
- Stop recommending seed oils
- Stop recommending that “lower is better” for sodium.
- Stop recommending 6 servings of grains per day.
- For people with metabolic conditions, offer a very low-carbohydrate diet
These changes are the only evidence-based way to start reversing diet-related chronic diseases in America.
[1] Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets
[2] (USDA Fails to Fully Implement National Academies’ Advice for Bringing “Transparency,” “Rigor” to the Dietary Guidelines — The Nutrition Coalition