How the US dietary guidelines continually fall short


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Once again, the advice from the expert committee informing the update of the Dietary Guidelines for Americans falls short when addressing the surge of obesity and metabolic disease in the US.

Its committee’s recommendations also fail to adequately acknowledge the variety of cultural differences that impact our food choices. We, at Diet Doctor, aim to change that.

In the US, and in the world as a whole, there seems to be a crisis happening when it comes to individuality — or a lack, thereof. It appears too many people focus on race and ethnicity in a way that hurts individuals, such as when partaking in the act of racial profiling.

Yet, we fail to recognize how identifying these differences can sometimes help. For instance, recognizing individuality can be beneficial when giving health and nutrition recommendations.

It is clear in that in preparing the ground for the 2020 update to the US Dietary Guidelines, due in December, the government is ill-prepared when it comes to providing evidence-based recommendations that will help individuals to improve their health.

As Diet Doctor’s Anne Mullens covered back in June, the advisory committee took a very narrow approach to the evidence they considered — and the end result is much of the same dogma from the previous set of guidelines.

As for any bright spots the guidelines brought about, the two major ones, as highlighted on Twitter by Nina Teicholz, is a drop in the cap on sugar (from 10% to 6%), and the fact that there was no reintroduction of caps on dietary cholesterol, despite efforts by some on the committee to do so.

The committee points out that these guidelines are meant for “healthy” Americans without chronic diseases. Depending on how we define that, it could be as little as 12% of the population.

What are the remaining 88% supposed to eat? On the one hand, this is good news. The guidelines don’t apply to them so they should be free to eat whatever they choose, right?

Unfortunately, it doesn’t work that way. As Dr. Tony Hampton pointed out in his recent op-ed for the Chicago Tribune, following these guidelines allows schools to feed our kids Cheetos and Tostitos chips and, women and infant children can get food “baskets” with Honey Kix cereal and sugary drinks from the government.

When this happens, no one screens these children, women, or infants for metabolic disease to see if they should follow the dietary guidelines. Yet, they will continually suffer from decisions made by the committee.

Dr. Hampton further points out,

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.

Groups have also expressed concern that the data underpinning the guidelines is based on predominantly white, upper-middle 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.

Unfortunately, his appeal apparently fell on deaf ears within the dietary guidelines committee. The timing was right for the committee to step forward and address the nutritional issues of race, ethnicity, and socioeconomic status head on.

Instead, they punted and continued business as usual.

How can we make progress toward helping under-represented minorities who have less access to healthy foods and higher rates of chronic disease?

It’s up to health care providers to step in. Physicians, like Dr. Hampton, who understand the specific challenges and opportunities within minority communities, can make an impact on their patients, and on the population as a whole, by making their voice heard.

It was a privilege to interview Dr. Hampton for the Diet Doctor Podcast, an episode which will be released in August. It’s also a pleasure to have him as a member of our expert review panel.

With Dr. Hampton’s help, we, at Diet Doctor, plan to start interviewing experts around the world. In doing so, we’ll be creating a series of educational content on these issues. That way, more underserved individuals can get the information they need, and more health care providers will understand how to reach these populations.

Our goal is to make low carb simple for everyone. We hope to fill the void left by the Dietary Guidelines for Americans and help individuals of different ethnicities, cultures, or socioeconomic statuses to manage their baseline health concerns.

Follow us at DietDoctor.com for more information as it becomes available.

Thanks for reading,
Bret Scher, MD FACC

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