Fact check – Americans Can’t Afford to Wait Any Longer. It’s Time to Overhaul the U.S. Dietary Guidelines

“Americans Can’t Afford to Wait Any Longer.  It’s Time to Overhaul the U.S. Dietary Guidelines.”  More than 50 doctors, researchers, and clinicians signed an open letter that was published in the New York Times and the Washington Post on July 9, 2019. Why?

The message is powerful. “Base the 2020 Dietary Guidelines on current, relevant science which supports a controlled carbohydrate eating approach as a viable option for Americans.”

In light of the current epidemics of diabetes and obesity in our country, this issue is central to our health as a nation. The Centers for Disease Control and Prevention in Atlanta, GA (CDC) stated in their 2020 National Diabetes Statistics Report that 34.5% of adult Americans have pre-diabetes, and 13% have diabetes. Add to that other measures of metabolic health, like blood pressure, obesity, blood lipids, and waist circumference and the picture of poor metabolic health in this country becomes grimmer. That leaves only an estimated 12% of the population meeting the criteria of being metabolically healthy.

Are these facts real? Should we believe them? After reviewing the doctors’ sources, I decided they are making a reasonable request of the USDA based on the evidence.  I’m sharing what I found to save you some time. I did the research for you! Sources are included to make fact checking easier.

As the movie Fat Fiction pointed out, the frightening co-morbidities in our current pandemic highlights the urgency.

Nurse Christie and I are volunteers with no financial relationship with Atkins, PBS, Fat Fiction, or any of the signatories involved.

In late 2018, the ADA recommended lowering carbohydrate intake to prevent or even reverse diabetes in addition to other eating approaches.

The ADA added a low carbohydrate option for treating diabetes.((American Diabetes Association. Standards of Medical Care in Diabetes — 2019. Diabetes Care. Jan 2019; 42 (suppl 1), S50-S51.))(1)

A low-carb diet has proven to be an effective and sustainable way of lowering insulin resistance and even reversing type 2 diabetes.((Hallberg, S. J., Gershuni, V. M., Hazbun, T. L., & Athinarayanan, S. J. (2019). Reversing type 2 diabetes: A narrative review of the evidence. Nutrients, 11(4), 766. https://doi.org/10.3390/nu11040766))(2) The American Diabetes Association also released a version abridged for Primary Care Professionals. This is more concise, so here’s excerpts:¹(3)

Section 3. PREVENTION OR DELAY OF TYPE 2 DIABETES, Nutrition

Additional research is needed regarding whether a low-carbohydrate eating plan is beneficial for persons with prediabetes…

1. PREVENTION OR DELAY OF TYPE 2 DIABETES

Eating Patterns, Macronutrient Distribution, and Meal Planning …Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes…  In addition, research indicates that low-carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes. There is inadequate research in type 1 diabetes to support one eating plan over another at this time…

1. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES

Diet, Physical Activity, and Behavioral Therapy – Recommendations

…Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss…” (6.1) [emphasis added.]

Fact checks out.

The American Diabetes Association has moved their position to embrace current, relevant science and included a low-carbohydrate approach for diabetics.

Only 12% of the U.S. population is metabolically healthy

This is alarming. Let’s look at the study. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey. 2009-2016. Metabolic Syndrome and Related Disorders. 2018.

The study – large sample, representative, and recent.

The authors looked at data from 2009 – 2016 from the National Health and Nutrition Examination Survey (NHANES). “NHANES is a nationally representative survey of the U.S…, selected by a complex … sampling design.”  The sample size was large, with 8,721 participants completing the survey. A review board at the CDC approved the protocol for this study concerning metabolically healthy Americans.

The scientists concluded that

“Changing … guidelines to more recent cut points decreased the proportion of metabolically healthy Americans from 19.9% …. to 12.2%.

“Between 1988-1994 and 2011-2012, the prevalence of diabetes increased in the overall population and in all subgroups evaluated.

“The prevalence of metabolic health in American adults is very low, even in normal weight individuals…. Most disturbing was the absence of optimal metabolic health in adults who had obesity, less than a high school education, were not physically active, and were current smokers.”

Fact checks out.

If only 12% of Americans are considered metabolically healthy,  what could be the cause?

72% of Americans are either overweight or obese

National Center for Health Statistics: Obesity and Overweight Adults. Centers for Disease Control & Prevention. Retrieved July 6, 2019.

Table 53. Selected health conditions and risk factors, by age: United States, selected years 1988–1994 through 2015–2016. Centers for Disease Control & Prevention. Retrieved July 6, 2019.

The CDC’s National Center for Health Statistics puts 71.6% of American adults as overweight and obese from 2015-2016.  They also utilize the NHANES data set.

Fact checks out .

With 72% of Americans overweight, could our diet be part of the problem?

52% are either diabetic or prediabetic – Dietary guidelines?

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi:10.1001/jama.2015.10029 [PubMed]

The study by Menke et al. also examined data from the large, representative NHANES source but they broke it up differently.

The abstract’s Results & Conclusions section states:

“Between 1988-1994 and 2011-2012, the prevalence of diabetes increased in the overall population and in all subgroups evaluated.”

In the study’s Discussion section:

“We found the prevalence of prediabetes was 37% to 38% in the overall population, and consequently 49% to 52% of the population was estimated to have either diabetes or prediabetes. The prevalence of prediabetes was greater than 30% in all sex and racial/ethnic categories, and generally highest among non-Hispanic white individuals and non-Hispanic black individuals.”

Their sample sizes were large.  From 1999 to 2012 they grouped 17,937 cases in two year increments. The number of cases ranged from 2005-2006, n = 2,191 (the low) to 2009-2010, n = 3118  (the high). With this much data they were able to analyze many sub-groups.

Fact checks out. Dietary Guidelines?

The authors found diabetes increasing no matter how they grouped the data. For me, this underscores the need for a wide reaching solution, such as modifying dietary guidelines.

The CDC uses a competing but still compelling statistic – 43.3% prediabetic or diabetic.

The CDC uses a competing but still compelling statistic – 43.3% prediabetic or diabetic. Update! The current CDC National Diabetes Statistic of 2020 report concurs with the estimate of approximately 50% prevalence of pre-diabetes or diabetes in US adults. This current report documents the upward trend.

I found this to be more than high enough to warrant an overhaul of US Dietary Guidelines.

1. National Diabetes Statistics Report. Centers for Disease Control & Prevention. Retrieved July 6, 2019.
2. National Diabetes Statistics Report, 2020: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control & Prevention. Retrieved February 25, 2020.   [This report gives great detail.]

Among the US population overall, crude estimates for 2018 were:

• 34.2 million people of all ages—or 10.5% of the US population—had diabetes.

• 34.1 million adults aged 18 years or older—or 13.0% of all US adults—had diabetes (Table 1a; Table 1b).

• 7.3 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes, Table 1b). This number represents 2.8% of all US adults (Table 1a) and 21.4% of all US adults with diabetes.

• The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older.

Center for Disease Control

Fact checks out.

Even the more conservative statistic embraced by the CDC and ADA finds that 2 out of every 5 Americans is prediabetic or diabetic.

More than 20% of all healthcare spending in the U.S. is on obesity-related illness.

The study that is probably the source is behind a paywall, and their abstract did not state this statistic.

Cawley J, Meyerhoefer, C.  The medical care costs of obesity: An instrumental variables approach. Journal of Health Economics. Volume 31, Issue 1.  January 2012, Pages 219-230. https://doi.org/10.1016/j.jhealeco.2011.10.003

However, the 20% statistic from this study is referenced by The Atlantic and two Cornell University affiliated sources, which was enough to convince me.

Grandoni, D. 20.6% of U.S. Health Care Costs Are Caused by Obesity. The Atlantic. The Wire. APR 13, 2012.

Kelley, S. Obesity accounts for 21 percent of U.S. health care costs. Cornell Chronicle. April 12, 2012.

Cornell University. (2012, April 9). Obesity accounts for 21 percent of U.S. health care costs, study finds. ScienceDaily. Retrieved June 29, 2019 from www.sciencedaily.com/releases/2012/04/120409103247.htm

Fact checks out.

I believe this fact is also confirmed my external sources.

We are not alone in this view about overhaul of US Dietary Guidelines

Redesigning the Process for Establishing the Dietary Guidelines for Americans. National Academies of Sciences, Engineering, and Medicine. September 14, 2017. Retrieved July 1, 2019.

The Open Letter states:

“The National Academies of Sciences, Engineering, and Medicine (NASEM) released a consensus study report in 2017 that recommended the Guidelines address the needs of all Americans and cautioned against a one-size fits all approach. “

“The Dietary Guidelines for Americans (DGA) provides nutritional and dietary information with the intention of promoting health and preventing chronic disease, and serves as the basis for all federal nutrition policies and nutrition assistance programs, as well as nutrition education programs. This guidance is updated and released every 5 years by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS). The process of updating the DGA is informed by an assessment of relevant scientific data by a federal advisory committee of nationally recognized experts, called the Dietary Guidelines Advisory Committee (DGAC). Congress mandated that the National Academies of Sciences, Engineering, and Medicine (the National Academies) evaluate the process used to update the DGA. This mandate resulted in two reports. The first report, Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process, highlighted opportunities to improve the DGAC selection process. This second report, Redesigning the Process for Establishing the Dietary Guidelines for Americans, offers a comprehensive review and recommendations for improving the rest of the process to update the DGA.” [Bold shows author’s emphasis.]

Fact checks out.

If you prefer video format or are still doubting, I found NASEM’s webinar informative and persuasive.

NASEM Health and Medicine Division. Redesigning the Process for Establishing the Dietary Guidelines for Americans. YouTube Channel. Published Dec 13, 2017.

This includes a link to NASEM’s hour long webinar “Redesigning the Process for Establishing the Dietary Guidelines for Americans.”

I found these studies compelling and agree that current, relevant science should be included in the 2020 Dietary Guidelines.  What did you think?

The Low-Carb Action Network shows us how to change dietary guidelines

Low-Carb Action Network (L-CAN)’s well written website will educate you on the issues.

• Take Action by contacting your representatives 
• Become a member of the Low-Carb Action Network

Fact checked by Christie Barnett, APN and Captain Captain Mani Malagon.

Other resource guides & toolkits you might value

Curious about improving metabolic health with lifestyle?

• Lifestyle Medicine, the key to metabolic healing
• What is metabolic health? A layperson’s definition and a biochemist’s perspective

Where do I start improving my metabolic health?

• Your patient toolkit for prediabetes & type 2 diabetes
• What to eat? Get clever! Clinicians’ flexible approach to tailoring carb reduction to you.
• Want more detail on carbohydrate reduction? A round-up of quality, what-to-eat guides from around the web
• Best resources for an overview of keto – Metabolic Multiplier’s round up of the best resources we’ve found by evidence-based organizations & clinicians. For patients, families & caregivers.
• Keto doctors near me – over 20 directories of low-carb professionals

For clinicians using therapeutic carbohydrate reduction (TCR), ketogenic diet therapies (KDT)

• Best Keto resources for clinicians & other practitioners
• How to build my ketogenic therapy treatment team – Support for the more complex cases.
• Why write medical case reports about unique cases? – Our round up can save you time.

For colleagues interested in amplifying metabolic health

• Overview schematics help us think about metabolic health – Understand our Organizing Research team‘s thinking behind these 3 metabolic health research portals
• Communication guide to unite advocacy for metabolic health – Suggested language  metabolic health advocacy. Principles. Language to use or avoid. Food & lifestyle first.
• Style Guide to unite advocacy for metabolic health – Welcome new team members! Many of you encourage using one voice for metabolic health. Below are suggestions from your fellow clinicians, scientists and professionals. See our Communication Guide as well. We’d love to hear…
• What Foundations support Metabolic Health? Charities, advocacy & grassroots groups using metabolic interventions & health to treat metabolic conditions.

Success stories from the our team

• Metabolic Multipliers
  • Is love a conversation that heals? Doctor Vyvyane Loh
  • Nick Norwitz: an athletic diet?
  • Mani’s “keto boot camp” by Cassey Hauser
• Captain Malagon
  • Food from my local farm regenerates soil and bodies
  • Pain started my ketogenic journey (Part 1)
  • Coronavirus quarantine – how a lifetime in submarines eases my use of isolation for self-improvement
• Cecile’s
  • Her husband’s story – Raj’s journey from obese and diabetic to healthy
  • How the heck did we get a Harvard Business School MBA to work with us for free?
• Nurse Christie – My mother’s suffering spurred me to find keto

1. American Diabetes Association. Standards of Medical care in Diabetes – 2019: Abridged for Primary Care Providers. Clinical Diabetes. 2019 Jan; 37(1): 11-34. https://doi.org/10.2337/cd18-0105 [↩]