By Emma Hitt Nichols, PhD

The Nutrition Coalition again stood out as the only group to comment exclusively on the need for more rigorous science in the Dietary Guidelines for Americans (DGA), during the most recent meeting of the advisory committee, on January 23-24, in Houston, Texas. Some sixty other oral commenters represented mainly various industry groups, associations, and non-profits as well as a number of individuals and doctors speaking on their own behalf.

This was the fourth of five committee meetings and the last one to allow oral comments. The committee is appointed to review the science for the next iteration of the DGA, due out at the end of this year. The last meeting will be held on March 12-13, at the D.C. headquarters of the U.S. Department of Agriculture, which together with Health and Human Services (USDA-HHS), oversee the guidelines.

The Nutrition Coalition Speaks Out for Strong Science

Representing The Nutrition Coalition (TNC), Associate Director Ted Eytan, MD, a Washington D.C.-based family medicine specialist without any ties to industry, spoke about the need to base government nutrition policy on rigorous scientific evidence.

“We care that the recommendations that go out to all Americans are trustworthy, reliable, and up-to-date,” said Eytan.

Nina Teicholz, TNC’s Executive Director, has written about the need for the Guidelines to use an accepted, state-of-the art methodology (like GRADE or Cochrane), as recommended by the National Academies of Sciences, Engineering, and Medicine. The USDA has thus far rejected this recommendation and instead insisted on using its own, unverified methods.

Says Teicholz, “Without reliable science, it would be preferable to not issue a recommendation or issue a weak recommendation, which would allow the public to make its own, educated choices.” She added, “Let’s not forget that key dietary recommendations have had to be reversed in the past, such as the caps on dietary cholesterol and the low-fat diet. It’s better to be cautious than to overstep what the science can reliably tell us.”

Another issue raised by Eytan at the meeting was the lack of evidence to support the existing 10% cap on saturated fats, which have been tested in rigorous clinical trials including tens of thousands of people and funded by governments around the world—yet have never been directly reviewed by any DGA advisory committee.

Low-Carb vs. Vegan

Several groups and individuals, many of them healthcare professionals, advocated for specific dietary approaches. Whether low-carb, plant-based or anti-dairy, sentiments ran high. Commenters spoke about dramatic personal health benefits they had experienced personally or as practitioners treating their patients.

Brooke Goldner, MD, a psychiatrist in Spring, Texas, spoke about how following a strict plant-based eating approach had helped her overcome the autoimmune disease lupus. “As a doctor who is desperately trying to save lives—and as a former patient who has almost died many times because I didn’t have this information—I beseech you to take this seriously,” she told the Committee.

Likewise, Linda Carney, MD, a physician practicing lifestyle medicine in Austin, Texas, said she sees dramatic benefits when her patients completely stop eating animal products, including meat dairy and seafood. According to Carney “an oil-free, plant-based, low-fat diet of whole, unprocessed foods powerfully reverses disease.” She claimed she has seen reversal of multiple sclerosis, diabetes, high blood pressure, heart disease, and asthma using a plant-based approach.

In favor of a low-carb, ketogenic approach, Tony Martinez, an attorney based in New York and a candidate for the New York State Senate, spoke about being a patient in remission from heart disease and type 2 diabetes by following a ketogenic diet for the last several years. “I understand people here have very strong opinions about what we should be eating…but we have to have options, including a low-carb option, and this needs to be recognized,” he said.

Nadir Ali, MD, an interventional cardiologist at HCA Houston Healthcare Clear Lake in Webster, Texas, stated that he has been in practice for 30 years and that for the first 24 years, he advised his patients to eat a diet recommended by the guidelines. “My patients did not improve on this diet despite being disciplined and following my recommendations,” he said. “Instead they became increasingly pre-diabetic or diabetic and developed overt heart disease—It was a dreadful experience to go to my office.”

About 6 years ago, said Ali, he began a low-carb diet and lost 30 lbs. With a low-carb diet and intermittent fasting, “I see my patients losing weight, improving their blood pressure, blood sugar, and cholesterol quality,” and they have been able to stop taking medications. He also urged that the guidelines include a low-carb recommendation as an option, which he defined as being less than 20% of calories from carbohydrates. “There are plenty of robust clinical trials,” to support this, he stated.

Doug Reynolds from Low Carb USA pointed out that there is a “growing mountain” of clinical trial evidence to support a low-carb approach. He added that although he commends the committee for considering a low-carb dietary pattern, he has “grave concerns” that the threshold of 45% from carbs that is currently being used by the USDA committee “doesn’t even come close” to being able to achieve the goals of a low-carb approach. Reynolds echoed Ali’s point about the need to define the diet correctly and also suggested adding a ketogenic subcategory, of 10% of energy as carbs or less.

Despite the diverging opinions, perhaps one indisputable fact is that the general U.S. population is not metabolically healthy. Over 70% of American adults are overweight or obese and more than half have pre-diabetes or diabetes. The DGA is intended for the “general public,” according to its Congressional mandate, yet in practice, USDA-HHS continue to focus exclusively on “healthy Americans” and are excluding studies on the treatment of diseases such as type 2 diabetes. This means that the Guidelines will omit the very science needed to address the crises of diet-related diseases in our country.

Industry Commenters

At least 20 of the 50 commenters represented industry groups seeking to bring attention to their products. Groups included the Beer Institute, the American Beverage Association, the National Potato Council, the National Pork Board, the National Confectioners Association, and the International Bottled Water Association. Also present were the representatives from the American Heart Association, Institute of Food Technologists, Physicians Committee for Responsible Medicine, and the Academy of Nutrition and Dietetics.

A complete list of commenters is available here.