Watch carefully and you can see the sleight of hand built into the creation of the Dietary Guidelines for Americans (courtesy of the Harvard School of Public Health)
Oh I think we’ve followed the recommendations — low to no fat being the most onerous. Precisely that is what has made us obese and full of diabetes. They should be shut down.
The Carbohydrate-Insulin-Model (CIM), as elucidated by David Ludwig of Harvard and colleagues, explains the physiologic basis for much of this weight gain. Insulin is well known to cause weight gain, so when we stimulate insulin by eating sugar and refined grains, sure enough: we gain weight! Sugar and refined grains are provided in abundance to those on federally funded food programs, as per the DGA. Voila! Greater obesity among those using these programs.
Hi Molly, I just have to say I'm one of those colleagues with David Ludwig elucidating this model. It does explain much of the physiologic basis but it could use some more rigorous testing (much as I believe it's true).
Healthy eating ultimately needs to be about more than just biochemistry.
Ultimately it needs to be about connection: connection to ones family; connection in to one's community;connection to healthy Land.
I think there are copious examples of people eating appropriately in a vegetarian fashion and people eating appropriately in a Paleo diet fashion who are healthy. There are also copious examples of people following those dietary choices in unhealthy fashion.
Thank you, Gary. I do know that and so appreciate your work & writing over the years. I'm a semi-retired endocrinologist (still teaching medical students in Alaska) and recently gave a related community hospital Grand Rounds talk as part of my efforts on the national level around food policy.
Your conclusion statement in this paper https://pubmed.ncbi.nlm.nih.gov/35896818/ is very powerful. May I privately send you the link to my recent talk? You might be able to help with my efforts.
I pay for my own fasting insulin (FI) blood test, as it tells me more about how well I'm progressing on blood glucose. When my FI gets close to the low end of the acceptable range, all the other standard measure move into the correct ranges - the cholesterol and lipoprotein components, fasting blood glucose, and A1c. (So: I'm in non-expert agreement with the carb-insulin model.)
If you frighten people away from dietary fat, there will be a market for “fat free” foods. That food will taste like cardboard unless manufacturers add something… usually sugar.
This is a thought-provoking critique of the Dietary Guidelines for Americans (DGA) and their impact on public health. I agree with the argument that if the current guidelines continue to fail in improving health outcomes, particularly as diet-related chronic diseases continue to rise, it’s critical to reassess them rather than simply reiterate the same advice.
The point about the USDA’s methodology is especially important. The flawed approach that lumps indulgent foods like sweets and sugary beverages with meats, processed meats, and high-fat dairy creates a skewed narrative. It leads to the oversimplified and circular logic of advocating for “mostly plants,” ignoring the possibility that certain animal-based foods—when consumed responsibly—could be beneficial to health. This methodology effectively prevents any acknowledgment of the potential health benefits of balanced animal products. Instead, it sets the stage for variations of “mostly plants” or even “all plants” to dominate the conversation.
Moreover, the focus on “healthy dietary patterns” since 1980, while well-intentioned, has failed to address the underlying complexities of dietary health—namely, the individual’s biochemistry, the role of processed foods, and the varying needs based on genetic and environmental factors. As chronic disease rates continue to soar, the question becomes: Are we truly addressing the root causes, or are we merely reinforcing a flawed narrative that has not worked in the past?
This all underscores the need for intellectual humility and an openness to revisiting these guidelines, especially as it becomes clear that the current approach is not yielding the health improvements we were promised. Perhaps it’s time to explore alternatives that don’t simply push ideological diets but instead take a more holistic, evidence-based view of health.
I’m certain our genes never evolved to handle a carb rich diet. For most of us Insulin dominates our anabolic/catabolic balance and in this situation it’s impossible to burn fat. It’s such a pity we have no easy way to measure insulin (preferably at the patient level but even at the primary physician level). Equally it would help to be able to easily measure body fat directly rather than the proxy of BMI.
Ideally we want a diet that burns fat (at least 50% of the day) and carb rich diets make this impossible. I believe this is why diets like the 5/2 and intermittent fasting work largely by freeing the body from the clutches of Insulin at least for a time.
I was a primary care diabetes specialist for many years in Scotland. Patients and doctors know that Insulin lowers and controls blood sugar but they are much less aware of insulins many other affects - anabolism (including being a cofactor in cancer development, Na and water retention (raising BP), HMGCoReductase stimulation (raising cholesterol) and others. For academics who understand Reavens metabolic syndrome this shouldn’t come as a surprise.
Prevention and treatment of early T2D must focus on lowering insulin levels (low carb diet, weight loss, exercise and metformin). In the UKPDS diabetes study metformin was the only drug that lowered insulin and the only one that had positive results.
Those of us who believe in lower carb dieting need to keep beating the drum.
Thanks, Ian. Not surprisingly I agree with you about 95%. Although I'd say we need a diet that allows us to mobilize and burn fat and carb-rich diets make this difficult.
Absolutely Gary. Early T2D can be reversed to non diabetic range by very low calorie diets circa 800cals. As far as I’m aware these VLCDs don’t need to be low carb. Low calorie diets work but are hard to stick to. They are hunger associated and hard to stick to. Low carb in my eyes is better suited to most metabolisms and eating more fat and protein improves satiety and leads to less cravings for food (and carbs!). Low carbs stabilise blood sugar readings and just make so much more sense. I suspect when the low fat diets were first recommended it was easy to theorise that the fat laden arteries of vascular disease must be caused by fat? (Wrongly I believe). We can only store maybe 450gms of carb in liver and muscles and any excess is converted to saturated fat (in fat cells and arteries and in our abdomens). Eat fat to burn fat sounds perhaps paradoxical but so true.
Another GP observation is that most doctors see insulin as a positive friendly helping agent. I believe the reverse. Our bodies do much better in a low insulin state. In T2D once you start patients on drugs that stimulate B cell insulin production or give injected insulin you might control blood sugar but the other bad effects of excess insulin offset this. As we know insulin levels in T2D are raised for 10-20 years before a patient develops T2D and continues till B cell failure unless radical steps are taken. I have postulated before that a Carb laden diet over stimulates b cell insulin production and repeated overstimulation (over years) leads to tissue tolerance to insulins effect (insulin resistance) and to T2D (an element of genetic susceptibility needed as well).
In the US sending a fasting insulin costs around $25-30. All primary doctors should draw this lab at an annual visit, in my opinion. But, then they have to know how to interpret it, and what to tell the patient. Most normal lab values for insulin go up to 28, certainly NOT a normal fasting insulin. Physicians then have to know what to tell the patient, and if the patient is already insulin resistant,’it can’t be “eat more fruits and veggies and lean protein”. Physicians learn way too little about nutrition and way too much about how to prescribe drugs.
The healthy range listed on my lab results for fasting insulin is 2 to 28 (sorry, forgot what the units are). I'm re-reading some intermittent fasting resources, and think I saw a recommended max of 10. I'm searching for the source for that number, but wish that it was not so difficult to find any discussion about a recommended range.
Fasting insulin of 28 is NOT normal! I hate the “normal” reference range. The “normal” range is established based on where 95% of people tested are going to fall. But if 93% your adult population is metabolically unwell, that makes the normal range ABNORMAL!
Have you heard of Dr. Ben Bikman? He is a professor of cell biology at BYU and studies insulin resistance, and I have heard him say fasting insulin should be 8 or less. The context matters as well. Should be low fasting insulin with normal blood sugar and normal Hemoglobin A1c. I see people with an insulin of 5.6, but then their fasting blood sugar is 105 (too high). Or they have fasting insulin of 5 but hemoglobin A1c is 5.7%, not normal.
Someone may wish to study population of India. Most of the people are vegetarian. Of those who do eat meat/fish their intake is incredibly low. Yet the diabetes rate is remarkably high.
The British researchers I mentioned in the post included those with experience working in India. In fact, as far back as 1907, when the British Medical Association hosted a conference on diabetes in the tropics, India was a major focus. Back then the wealthy westernized Indians had high rates of diabetes, not so the poor. Among several suggestions to explain it, sugar consumption was considered most likely.
Thank you, Gary. I don't disagree. I just want to make a different point. I lived and worked in India for six years before coming to the US. Cost of food relative to take home pay was very high. It has improved but still high compared to what we pay in the US (before 2020). I don't have any medical training. I visited India every few years staring in 1984 until this year, 2024. Observing people in the streets of Bombay I could see 40 percent of them looked mal nourished or I speculate lower caloric intake. Each subsequent visit fewer people in the streets looked underweight.
From my experience, we spent 70 percent of my take home pay on groceries. I had a relatively good job in that context. We could afford meat or fish maybe once in two weeks. So, people are eating mostly high carb diets because of religion, tradition and affordability.
Obesity is an endocannabinoid system problem. "Endocannabinoids and their G-protein coupled receptors (GPCR) are a current research focus in the area of obesity due to the system's role in food intake and glucose and lipid metabolism. Importantly, overweight and obese individuals often have higher circulating levels of the arachidonic acid-derived endocannabinoids anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) and an altered pattern of receptor expression. Consequently, this leads to an increase in orexigenic stimuli, changes in fatty acid synthesis, insulin sensitivity, and glucose utilisation, with preferential energy storage in adipose tissue." https://onlinelibrary.wiley.com/doi/10.1155/2013/361895
Typically, both prostanoids and endocannabinoids are over-produced when arachidonic acid intake constantly exceeds physiological requirements for an extended period of time.
One reason I tend not to comment on your posts is I think you would do yourself a favor couching your beliefs as, well, beliefs, not facts. For instance rather than "Heart disease is an inflammation problem that stems from excessive prostanoid production," you might try something like "I've come to believe that heart disease is an inflammation problem that stems from excessive prostanoid production. There's some interesting evidence supporting this possibility." Then you give the link and I'm tempted to click on it to see what the evidence is. In my experience, one sign that someone's science can't be trusted is there lack of humility when discussing their ideas. If they're not aware of the very high likelihood that they're fooling themselves, then they're almost assuredly wrong. Or at least that's belief is what got me into this business (from the very first interview I did with a "leading authority"). Just a thought for future comments...
As everyone knows, a belief is whatever a person chooses to accept as true. A fact is always true. To me it is pretty clear that inflammation stems from prostanoid overproduction. So if I say prostanoid overproduction seems to be linked to heart disease risk, will you check out these links? I found them when I Googled prostanoid overproduction heart disease.
When I wrote my first book on all this, published in 2007, several of the titles we were batting around were takes on the road to hell quote. My editor rejected them all. And, so... Good Calories, Bad Calories.
Exactly man-I. It does not matter what the topic is: mail delivery, launching rockets into space, educating children, running a railroad, or recommending what to eat, the USG will turn it into a shit-show within very few years. It is so sad to see this enacted decade after decade with no learning, no improvement, no awareness.
Bullshit. The postal service has done a good job for centuries. The problems come from the sneaking privatization of what should be a public function, necessary infrastructure for a functioning society that serves all, not just the wealthy.
Whenever you compare private with state-run services, the private ones are always superior at a lower price. That is not an accident. It's called competition which spurs innovation and cost reduction. It's just stupid to expect government provision to do as well or better without those pressures.
This is cargo-cult market fundamentalism. The Postal Service is set up to serve EVERYONE in the country, at the same price. It is a public service. Neither FedEx nor UPS will do that. Health care ought to be the same way: what we have are rapacious middlemen (like United Health Care) that are very efficient at vacuuming up income, by innovating in ways of denying care, at great cost (in money, health and lives) of the populace. It is no wonder that virtually all other advanced capitalist countries, and some not that far up the ladder, have better health outcomes for their citizenry at much lower cost. How? By constraining "the market" to ensure the needs of the citizens come before the imperatives of private profit.
And as someone who worked at Boeing for 35 years, I can tell you that private corporations are no guarantee of intelligence, efficiency, or cost reduction.
'...nutrition researchers had an obligation to make their best guess about the diet-disease relationship. Then the public could decide whether to take it or not..."I want you to tell me what your best sense of the data is right now.”'
I know the gold standard is supposed to be RCTs. Anybody who reads at all about nutrition knows that it's very difficult to do because dietary effects tend to be long-term, useful long-term RCTs would be impractical and prohibitively expensive, and short-term studies using surrogate endpoints can be misleading because of assumptions made about endpoint choices.
That doesn't mean that the epidemiological studies we're left with are of any use whatsoever. As Gary points out many assumptions have to be made in study design, and some of those can be deliberately misleading. Food frequency questionnaires are notoriously, if not wildly, inaccurate. Additionally, in the following statistical analysis, even more assumptions and misleading choices can be made; corrections for assumed confounders pile error on error. It's not just Garbage In Garbage Out, it's Garbage In + Manipulated Garbage = Even Worse Garbage Out.
All of this to try to determine how to feed our Paleolithic metabolisms in the 21st century without making ourselves sick.
If only the nutrition-research industry could put more emphasis on evolutionarily-appropriate dietary habits, or at least as close as we can get to such in the modern world. After all, that's what we were designed to eat.
Unfortunately, entrenched dogma, careerism, and powerful industrial influences make this difficult.
Another good point. The nutritional epidemiologists say it's too expensive and difficult to do the RCTs, which is true, so we should believe the associations from the epidemiological studies are causal instead. Kind of like saying, yes, science is hypothesis and test, but if you can't afford the tests or they're too hard, you're allowed to embrace the hypothesis.
I wrote about this problem in just this context for Nina's Unsettled Science earlier this year.
That was part 1 and I have a part 2 that needs to be edited and I'll post it on this site. Regrettably, it's another one of my failures to keep these posts short.
The Dietary Guidelines problem is agnotological. USDA and Health and Human Services bureaucrats control all aspects of the updating process. They choose the library of evidence. They choose the people who evaluate the evidence. Then they write the Guidelines according to what they believe to be true. https://www.drjaywortman.com/blog/wordpress/2012/06/
Unfortunately, critics like Gary limit the scope of what they regard as acceptable evidence to randomized controlled trials. At this juncture there is enough experimental biochemistry to link excessive linoleic acid to the inflammatory diseases and excessive arachidonic acid intake to the global obesity/diabetes epidemic. https://pubmed.ncbi.nlm.nih.gov/37630747/
Norwegian animal science researchers have a much better grasp of the particulars than human nutrition science researchers. In 2011 they commented, "Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available." https://pmc.ncbi.nlm.nih.gov/articles/PMC3031257/
In 2016 South African and German veterinary science researchers included these comments in a research paper comparing health outcomes for captive and free range cheetahs. "The increased proportional intake of dietary fat, decrease in feeding frequency and increased physical activity in free-ranging compared to captive cheetahs are all predicted to result in enhanced mitochondrial FA oxidation through the lowering of circulating glucose concentrations and insulin:glucagon ratios. During fasting/refeeding cycles and increased levels of exercise, tissue PUFA concentrations have been shown to deplete rapidly in both humans and rats. These studies show that most PUFAs, including α-linolenic acid (ALA) and linoleic acid (LA), are preferentially oxidized in periods of exercise or fasting. During refeeding, SFAs and monounsaturated fatty acids (MUFAs), such as palmitic acid and oleic acid, are also more rapidly replaced than any of the PUFAs. Similarly, the concentrations of most plasma PUFAs and MUFAs have been shown to be significantly lower in rats fed a high fat ketogenic diet than in controls. The predicted increase in FA oxidation in free-ranging cheetahs is therefore likely to also skew their serum FA profiles toward lower proportional serum concentrations of PUFAs and MUFAs relative to SFA." https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167608
It wouldn't be reasonable to expect consumers to be aware of this sort of commentary. Unfortunately, those who shape dietary advice for consumers are not aware of this information either. It's agnotology in action. https://www.apa.org/news/press/releases/2023/10/why-we-choose-ignorance
As I said, "critics like Gary" like to be more certain that we're right before we start telling a nation to change how they eat. That's different from giving individual advice.
Your response does not address my concern. I fail to see how randomized controlled trials can dispel uncertainty. It takes experimental biochemistry to resolve a controversy of this sort. "Is a particular dietary recommendation harming people in the U.S.? For almost 20 years, scientists have been arguing over whether Americans and others on a typical Western diet are eating too much of omega-6s, a class of essential fatty acids. Some experts, notably ones affiliated with the American Heart Association, credit our current intake of omega-6s with lowering the incidence of cardiovascular disease. Others, which include biochemists, say the relatively high intake of omega-6 is a reason for a slew of chronic illnesses in the Western world, including asthma, various cancers, neurological disorders and cardiovascular disease itself." https://www.asbmb.org/asbmb-today/science/110212/an-essential-debate
The overzealous scientists who established American Heart Association dogma back in the 50s made two mistakes regarding fat intake and heart disease. They jumped to a conclusion. Almost immediately, they jumped to a solution. Since then, their successors have doggedly tried to prove the correctness of their original assumption. Here is their latest attempt to justify the original conclusion.
Linoleic acid (LA), as a part of the wider debate about saturated, omega-6 and omega-3 fatty acids (FAs) and health, continues to be at the center of controversy in the world of fatty acid research. A robust evidence base, however, demonstrates that higher intakes and blood levels of LA are associated with improved cardiometabolic health outcomes... across the range of typical dietary intakes, higher LA is beneficial. Recent trials of LA-rich oils report favorable outcomes in people with common lipid disorders." https://pmc.ncbi.nlm.nih.gov/articles/PMC11391774/
Here is the key to understanding why higher intakes of linoleic acid appear to be beneficial. "...across the range of typical dietary intakes, higher LA is beneficial."
Observation and experiment support that conclusion. However, the conclusion is based on an incomplete data set. Typical intakes of linoleic acid are excessive in people with obesity. "Fatty acid composition in the Western diet has shifted from saturated to polyunsaturated fatty acids (PUFAs), and specifically to linoleic acid (LA, 18:2), which has gradually increased in the diet over the past 50 y to become the most abundant dietary fatty acid in human adipose tissue. https://pmc.ncbi.nlm.nih.gov/articles/PMC9060469/
Insulin sensitivity is controlled by the endocannabinoid system. "In obese states, endocannabinoid levels are increased and might exert unfavorable effects on insulin-sensitive tissues." https://pubmed.ncbi.nlm.nih.gov/19559361/
What causes an increase in endocannabinoid levels? "Endocannabinoids and their G-protein coupled receptors (GPCR) are a current research focus in the area of obesity due to the system's role in food intake and glucose and lipid metabolism. Importantly, overweight and obese individuals often have higher circulating levels of the arachidonic acid-derived endocannabinoids anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) and an altered pattern of receptor expression." https://pubmed.ncbi.nlm.nih.gov/23762050/
Endocannabinoid and prostaglandin overproduction are regulated according to cell membrane arachidonic acid concentrations. "Because arachidonic acid (AA) competes with EPA and DHA as well as with LA, ALA and oleic acid for incorporation in membrane lipids at the same positions, all these fatty acids are important for controlling the AA concentration in membrane lipids, which in turn determines how much AA can be liberated and become available for prostaglandin biosynthesis following phospholipase activation." https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/
Notice that saturated fats cannot compete with arachidonic acid for positions in cell membranes. So, swapping linoleic acid-rich seed oils for saturated fat will attenuate AEA and 2-AG production which improve insulin sensitivity which allows people to lose weight without experiencing discomfort. The newly-minted GLP-1 receptor agonists alter cell signaling." Biomedical obesity research is all about treatment with molecules that alter cell signaling. Reducing arachidonic acid intake can get the job done without added expense or side effects. "Chicken meat with reduced concentration of arachidonic acid (AA) and reduced ratio between omega-6 and omega-3 fatty acids has potential health benefits because a reduction in AA intake dampens prostanoid signaling, and the proportion between omega-6 and omega-3 fatty acids is too high in our diet." https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/
"As Americans have become ever less healthy, the DGA advice has become only and ever more of the same".
Although I have no medical or scientific expertise, experience, or qualifications, I suspect that this is not a scientific or medical issue but a psychological one. Mainly mass psychology.
People - not excluding the cleverest, highest-achieving, and highest-paid experts - like to be popular, and agreeing with others is more likely to make one popular than disagreeing. And the more people agree with an official party line, the greater the pressure becomes on any remaining holdouts to conform.
As a result, the DGA authors seem to have decided that "when you're in a hole, you should keep on digging".
All the confusion and confounding, on top of the vested interests, desire to get and maintain reputation, and strong dislike of ever admitting to having been wrong about even the slightest little thing, could perhaps be sidestepped if we simply take the trends in US public health, described by Mr Taubes at the start of his article, as a non-rigorous but suggestive mass trial of the DGA.
May I strongly recommend Chapter 2, "The Most Intolerant Wins: The Dominance of the Stubborn Minority" in Nassim Nicholas Taleb's book "Skin In The Game"? Taleb writes that "It suffices for an intransigent minority - a certain type of intransigent minority - with significant skin in the game (or, better, soul in the game) to reach a minutely small level, say 3 or 4 percent of the total population, for the entire population to have to submit to their preferences".
That holds good when the "population" is a board, a committee, or a research team. Or even a tightly-knit, determined, somewhat fanatical group of, say, vegans.
I agree in that certainly mass psychology and group think comes into it. And, yes, anything by Taleb is worth reading. Although in this case, it's a stubborn majority, which raises a whole host of other issues (and so a whole host of subjects to discuss on this Substack).
Your mention of group think brought to mind a calendar Despair Inc sells captioned, "Peer Review: A rigorous process through which often dubious ideas gain broad scientific consensus before becoming unquestionable dogma." https://despair.com/products/peer-review?
Then there's an article entitled 'Consensus Science and the Peer Review' which says, "It is our responsibility as scientists, physicians, reviewers, and/or editors to be alert and always remember that '...consensus is invoked only in situations where the science is not solid enough.'" https://pmc.ncbi.nlm.nih.gov/articles/PMC2719747/
Science is all about explaining how the real World works. Myth is all about jumping to conclusions based on observation and limited understanding. As JFK remarked in his June 11, 1962 Commencement Address at Yale University, “The great enemy of truth is very often not the lie--deliberate, contrived and dishonest--but the myth--persistent, persuasive and unrealistic. Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought."
Oh I think we’ve followed the recommendations — low to no fat being the most onerous. Precisely that is what has made us obese and full of diabetes. They should be shut down.
Thank you, Gary!
The Carbohydrate-Insulin-Model (CIM), as elucidated by David Ludwig of Harvard and colleagues, explains the physiologic basis for much of this weight gain. Insulin is well known to cause weight gain, so when we stimulate insulin by eating sugar and refined grains, sure enough: we gain weight! Sugar and refined grains are provided in abundance to those on federally funded food programs, as per the DGA. Voila! Greater obesity among those using these programs.
Hi Molly, I just have to say I'm one of those colleagues with David Ludwig elucidating this model. It does explain much of the physiologic basis but it could use some more rigorous testing (much as I believe it's true).
Healthy eating ultimately needs to be about more than just biochemistry.
Ultimately it needs to be about connection: connection to ones family; connection in to one's community;connection to healthy Land.
I think there are copious examples of people eating appropriately in a vegetarian fashion and people eating appropriately in a Paleo diet fashion who are healthy. There are also copious examples of people following those dietary choices in unhealthy fashion.
Thank you, Gary. I do know that and so appreciate your work & writing over the years. I'm a semi-retired endocrinologist (still teaching medical students in Alaska) and recently gave a related community hospital Grand Rounds talk as part of my efforts on the national level around food policy.
Your conclusion statement in this paper https://pubmed.ncbi.nlm.nih.gov/35896818/ is very powerful. May I privately send you the link to my recent talk? You might be able to help with my efforts.
I pay for my own fasting insulin (FI) blood test, as it tells me more about how well I'm progressing on blood glucose. When my FI gets close to the low end of the acceptable range, all the other standard measure move into the correct ranges - the cholesterol and lipoprotein components, fasting blood glucose, and A1c. (So: I'm in non-expert agreement with the carb-insulin model.)
If you frighten people away from dietary fat, there will be a market for “fat free” foods. That food will taste like cardboard unless manufacturers add something… usually sugar.
This is a thought-provoking critique of the Dietary Guidelines for Americans (DGA) and their impact on public health. I agree with the argument that if the current guidelines continue to fail in improving health outcomes, particularly as diet-related chronic diseases continue to rise, it’s critical to reassess them rather than simply reiterate the same advice.
The point about the USDA’s methodology is especially important. The flawed approach that lumps indulgent foods like sweets and sugary beverages with meats, processed meats, and high-fat dairy creates a skewed narrative. It leads to the oversimplified and circular logic of advocating for “mostly plants,” ignoring the possibility that certain animal-based foods—when consumed responsibly—could be beneficial to health. This methodology effectively prevents any acknowledgment of the potential health benefits of balanced animal products. Instead, it sets the stage for variations of “mostly plants” or even “all plants” to dominate the conversation.
Moreover, the focus on “healthy dietary patterns” since 1980, while well-intentioned, has failed to address the underlying complexities of dietary health—namely, the individual’s biochemistry, the role of processed foods, and the varying needs based on genetic and environmental factors. As chronic disease rates continue to soar, the question becomes: Are we truly addressing the root causes, or are we merely reinforcing a flawed narrative that has not worked in the past?
This all underscores the need for intellectual humility and an openness to revisiting these guidelines, especially as it becomes clear that the current approach is not yielding the health improvements we were promised. Perhaps it’s time to explore alternatives that don’t simply push ideological diets but instead take a more holistic, evidence-based view of health.
Sorry to drag in politics, but this is one of RFK's goals. The amount of regulatory capture over the decades has entrenched the current methodology.
Oh, you don’t offend me bringing up RFK and his goals! Let’s hope he can make some serious positive changes! 🤞🏼
Abolish the DGAs and the whole HHS infrastructure concerned with diet. And we will all get healthier
I’m certain our genes never evolved to handle a carb rich diet. For most of us Insulin dominates our anabolic/catabolic balance and in this situation it’s impossible to burn fat. It’s such a pity we have no easy way to measure insulin (preferably at the patient level but even at the primary physician level). Equally it would help to be able to easily measure body fat directly rather than the proxy of BMI.
Ideally we want a diet that burns fat (at least 50% of the day) and carb rich diets make this impossible. I believe this is why diets like the 5/2 and intermittent fasting work largely by freeing the body from the clutches of Insulin at least for a time.
I was a primary care diabetes specialist for many years in Scotland. Patients and doctors know that Insulin lowers and controls blood sugar but they are much less aware of insulins many other affects - anabolism (including being a cofactor in cancer development, Na and water retention (raising BP), HMGCoReductase stimulation (raising cholesterol) and others. For academics who understand Reavens metabolic syndrome this shouldn’t come as a surprise.
Prevention and treatment of early T2D must focus on lowering insulin levels (low carb diet, weight loss, exercise and metformin). In the UKPDS diabetes study metformin was the only drug that lowered insulin and the only one that had positive results.
Those of us who believe in lower carb dieting need to keep beating the drum.
Thanks, Ian. Not surprisingly I agree with you about 95%. Although I'd say we need a diet that allows us to mobilize and burn fat and carb-rich diets make this difficult.
Absolutely Gary. Early T2D can be reversed to non diabetic range by very low calorie diets circa 800cals. As far as I’m aware these VLCDs don’t need to be low carb. Low calorie diets work but are hard to stick to. They are hunger associated and hard to stick to. Low carb in my eyes is better suited to most metabolisms and eating more fat and protein improves satiety and leads to less cravings for food (and carbs!). Low carbs stabilise blood sugar readings and just make so much more sense. I suspect when the low fat diets were first recommended it was easy to theorise that the fat laden arteries of vascular disease must be caused by fat? (Wrongly I believe). We can only store maybe 450gms of carb in liver and muscles and any excess is converted to saturated fat (in fat cells and arteries and in our abdomens). Eat fat to burn fat sounds perhaps paradoxical but so true.
Another GP observation is that most doctors see insulin as a positive friendly helping agent. I believe the reverse. Our bodies do much better in a low insulin state. In T2D once you start patients on drugs that stimulate B cell insulin production or give injected insulin you might control blood sugar but the other bad effects of excess insulin offset this. As we know insulin levels in T2D are raised for 10-20 years before a patient develops T2D and continues till B cell failure unless radical steps are taken. I have postulated before that a Carb laden diet over stimulates b cell insulin production and repeated overstimulation (over years) leads to tissue tolerance to insulins effect (insulin resistance) and to T2D (an element of genetic susceptibility needed as well).
In the US sending a fasting insulin costs around $25-30. All primary doctors should draw this lab at an annual visit, in my opinion. But, then they have to know how to interpret it, and what to tell the patient. Most normal lab values for insulin go up to 28, certainly NOT a normal fasting insulin. Physicians then have to know what to tell the patient, and if the patient is already insulin resistant,’it can’t be “eat more fruits and veggies and lean protein”. Physicians learn way too little about nutrition and way too much about how to prescribe drugs.
The healthy range listed on my lab results for fasting insulin is 2 to 28 (sorry, forgot what the units are). I'm re-reading some intermittent fasting resources, and think I saw a recommended max of 10. I'm searching for the source for that number, but wish that it was not so difficult to find any discussion about a recommended range.
Fasting insulin of 28 is NOT normal! I hate the “normal” reference range. The “normal” range is established based on where 95% of people tested are going to fall. But if 93% your adult population is metabolically unwell, that makes the normal range ABNORMAL!
Have you heard of Dr. Ben Bikman? He is a professor of cell biology at BYU and studies insulin resistance, and I have heard him say fasting insulin should be 8 or less. The context matters as well. Should be low fasting insulin with normal blood sugar and normal Hemoglobin A1c. I see people with an insulin of 5.6, but then their fasting blood sugar is 105 (too high). Or they have fasting insulin of 5 but hemoglobin A1c is 5.7%, not normal.
Someone may wish to study population of India. Most of the people are vegetarian. Of those who do eat meat/fish their intake is incredibly low. Yet the diabetes rate is remarkably high.
The British researchers I mentioned in the post included those with experience working in India. In fact, as far back as 1907, when the British Medical Association hosted a conference on diabetes in the tropics, India was a major focus. Back then the wealthy westernized Indians had high rates of diabetes, not so the poor. Among several suggestions to explain it, sugar consumption was considered most likely.
Thank you, Gary. I don't disagree. I just want to make a different point. I lived and worked in India for six years before coming to the US. Cost of food relative to take home pay was very high. It has improved but still high compared to what we pay in the US (before 2020). I don't have any medical training. I visited India every few years staring in 1984 until this year, 2024. Observing people in the streets of Bombay I could see 40 percent of them looked mal nourished or I speculate lower caloric intake. Each subsequent visit fewer people in the streets looked underweight.
From my experience, we spent 70 percent of my take home pay on groceries. I had a relatively good job in that context. We could afford meat or fish maybe once in two weeks. So, people are eating mostly high carb diets because of religion, tradition and affordability.
So is the vegetable oil consumption very high.
Regarding vegetable oil consumption, read page 902 of this paper to get a feel for heart disease in India prior to the onset of the obesity epidemic. https://pmc.ncbi.nlm.nih.gov/articles/PMC487855/?page=8
Heart disease is an inflammation problem that stems from excessive prostanoid production. https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/
Obesity is an endocannabinoid system problem. "Endocannabinoids and their G-protein coupled receptors (GPCR) are a current research focus in the area of obesity due to the system's role in food intake and glucose and lipid metabolism. Importantly, overweight and obese individuals often have higher circulating levels of the arachidonic acid-derived endocannabinoids anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) and an altered pattern of receptor expression. Consequently, this leads to an increase in orexigenic stimuli, changes in fatty acid synthesis, insulin sensitivity, and glucose utilisation, with preferential energy storage in adipose tissue." https://onlinelibrary.wiley.com/doi/10.1155/2013/361895
Typically, both prostanoids and endocannabinoids are over-produced when arachidonic acid intake constantly exceeds physiological requirements for an extended period of time.
Hi David,
One reason I tend not to comment on your posts is I think you would do yourself a favor couching your beliefs as, well, beliefs, not facts. For instance rather than "Heart disease is an inflammation problem that stems from excessive prostanoid production," you might try something like "I've come to believe that heart disease is an inflammation problem that stems from excessive prostanoid production. There's some interesting evidence supporting this possibility." Then you give the link and I'm tempted to click on it to see what the evidence is. In my experience, one sign that someone's science can't be trusted is there lack of humility when discussing their ideas. If they're not aware of the very high likelihood that they're fooling themselves, then they're almost assuredly wrong. Or at least that's belief is what got me into this business (from the very first interview I did with a "leading authority"). Just a thought for future comments...
Best,
gt
Thanks for the advice. I love criticism.
As everyone knows, a belief is whatever a person chooses to accept as true. A fact is always true. To me it is pretty clear that inflammation stems from prostanoid overproduction. So if I say prostanoid overproduction seems to be linked to heart disease risk, will you check out these links? I found them when I Googled prostanoid overproduction heart disease.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9962914/
https://www.ahajournals.org/doi/10.1161/atvbaha.123.320045
Meat intake in India may not be as low as you imagine. https://www.statista.com/statistics/826711/india-poultry-meat-consumption/
https://theprint.in/india/what-the-cluck-punjabis-arent-butter-chicken-fiends-their-meat-consumption-is-among-indias-lowest/2227277/
The tired cliche applies: the road to hell is paved with good intentions
There were probably some idealistic alruistic people involved BUT when government gets involved it is inevitably gets corrupted and politicized.
You CANNOT use a coercive monopolistic political bureaucracy to solve complex human problems. Try and the problems will ALWAYS get worse
Government can only protect freedom and rights.
Given liberty humans then have the best chance of finding peace health and happiness
When I wrote my first book on all this, published in 2007, several of the titles we were batting around were takes on the road to hell quote. My editor rejected them all. And, so... Good Calories, Bad Calories.
Exactly man-I. It does not matter what the topic is: mail delivery, launching rockets into space, educating children, running a railroad, or recommending what to eat, the USG will turn it into a shit-show within very few years. It is so sad to see this enacted decade after decade with no learning, no improvement, no awareness.
Bullshit. The postal service has done a good job for centuries. The problems come from the sneaking privatization of what should be a public function, necessary infrastructure for a functioning society that serves all, not just the wealthy.
Whenever you compare private with state-run services, the private ones are always superior at a lower price. That is not an accident. It's called competition which spurs innovation and cost reduction. It's just stupid to expect government provision to do as well or better without those pressures.
This is cargo-cult market fundamentalism. The Postal Service is set up to serve EVERYONE in the country, at the same price. It is a public service. Neither FedEx nor UPS will do that. Health care ought to be the same way: what we have are rapacious middlemen (like United Health Care) that are very efficient at vacuuming up income, by innovating in ways of denying care, at great cost (in money, health and lives) of the populace. It is no wonder that virtually all other advanced capitalist countries, and some not that far up the ladder, have better health outcomes for their citizenry at much lower cost. How? By constraining "the market" to ensure the needs of the citizens come before the imperatives of private profit.
And as someone who worked at Boeing for 35 years, I can tell you that private corporations are no guarantee of intelligence, efficiency, or cost reduction.
Interesting back and forth. Thanks all. My not-well-enough-informed bias is with Jim. It could go either way. Depends on the situation.
Soon all the explanation when I publish on Amazon on January 1, 2025 my book,
The Anti-Wellness Diet ( Why Trump Won).
This is a brilliantly written article. I will it share on X.
'...nutrition researchers had an obligation to make their best guess about the diet-disease relationship. Then the public could decide whether to take it or not..."I want you to tell me what your best sense of the data is right now.”'
Talk about mission creep.
Nicely done, Gary!
I know the gold standard is supposed to be RCTs. Anybody who reads at all about nutrition knows that it's very difficult to do because dietary effects tend to be long-term, useful long-term RCTs would be impractical and prohibitively expensive, and short-term studies using surrogate endpoints can be misleading because of assumptions made about endpoint choices.
That doesn't mean that the epidemiological studies we're left with are of any use whatsoever. As Gary points out many assumptions have to be made in study design, and some of those can be deliberately misleading. Food frequency questionnaires are notoriously, if not wildly, inaccurate. Additionally, in the following statistical analysis, even more assumptions and misleading choices can be made; corrections for assumed confounders pile error on error. It's not just Garbage In Garbage Out, it's Garbage In + Manipulated Garbage = Even Worse Garbage Out.
All of this to try to determine how to feed our Paleolithic metabolisms in the 21st century without making ourselves sick.
If only the nutrition-research industry could put more emphasis on evolutionarily-appropriate dietary habits, or at least as close as we can get to such in the modern world. After all, that's what we were designed to eat.
Unfortunately, entrenched dogma, careerism, and powerful industrial influences make this difficult.
There needs to be a massive paradigm upheaval.
Another good point. The nutritional epidemiologists say it's too expensive and difficult to do the RCTs, which is true, so we should believe the associations from the epidemiological studies are causal instead. Kind of like saying, yes, science is hypothesis and test, but if you can't afford the tests or they're too hard, you're allowed to embrace the hypothesis.
I wrote about this problem in just this context for Nina's Unsettled Science earlier this year.
https://unsettledscience.substack.com/p/less-meat-more-plants-a-rules-of
That was part 1 and I have a part 2 that needs to be edited and I'll post it on this site. Regrettably, it's another one of my failures to keep these posts short.
The Dietary Guidelines problem is agnotological. USDA and Health and Human Services bureaucrats control all aspects of the updating process. They choose the library of evidence. They choose the people who evaluate the evidence. Then they write the Guidelines according to what they believe to be true. https://www.drjaywortman.com/blog/wordpress/2012/06/
Unfortunately, critics like Gary limit the scope of what they regard as acceptable evidence to randomized controlled trials. At this juncture there is enough experimental biochemistry to link excessive linoleic acid to the inflammatory diseases and excessive arachidonic acid intake to the global obesity/diabetes epidemic. https://pubmed.ncbi.nlm.nih.gov/37630747/
Norwegian animal science researchers have a much better grasp of the particulars than human nutrition science researchers. In 2011 they commented, "Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available." https://pmc.ncbi.nlm.nih.gov/articles/PMC3031257/
In 2016 South African and German veterinary science researchers included these comments in a research paper comparing health outcomes for captive and free range cheetahs. "The increased proportional intake of dietary fat, decrease in feeding frequency and increased physical activity in free-ranging compared to captive cheetahs are all predicted to result in enhanced mitochondrial FA oxidation through the lowering of circulating glucose concentrations and insulin:glucagon ratios. During fasting/refeeding cycles and increased levels of exercise, tissue PUFA concentrations have been shown to deplete rapidly in both humans and rats. These studies show that most PUFAs, including α-linolenic acid (ALA) and linoleic acid (LA), are preferentially oxidized in periods of exercise or fasting. During refeeding, SFAs and monounsaturated fatty acids (MUFAs), such as palmitic acid and oleic acid, are also more rapidly replaced than any of the PUFAs. Similarly, the concentrations of most plasma PUFAs and MUFAs have been shown to be significantly lower in rats fed a high fat ketogenic diet than in controls. The predicted increase in FA oxidation in free-ranging cheetahs is therefore likely to also skew their serum FA profiles toward lower proportional serum concentrations of PUFAs and MUFAs relative to SFA." https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167608
It wouldn't be reasonable to expect consumers to be aware of this sort of commentary. Unfortunately, those who shape dietary advice for consumers are not aware of this information either. It's agnotology in action. https://www.apa.org/news/press/releases/2023/10/why-we-choose-ignorance
As I said, "critics like Gary" like to be more certain that we're right before we start telling a nation to change how they eat. That's different from giving individual advice.
Your response does not address my concern. I fail to see how randomized controlled trials can dispel uncertainty. It takes experimental biochemistry to resolve a controversy of this sort. "Is a particular dietary recommendation harming people in the U.S.? For almost 20 years, scientists have been arguing over whether Americans and others on a typical Western diet are eating too much of omega-6s, a class of essential fatty acids. Some experts, notably ones affiliated with the American Heart Association, credit our current intake of omega-6s with lowering the incidence of cardiovascular disease. Others, which include biochemists, say the relatively high intake of omega-6 is a reason for a slew of chronic illnesses in the Western world, including asthma, various cancers, neurological disorders and cardiovascular disease itself." https://www.asbmb.org/asbmb-today/science/110212/an-essential-debate
The overzealous scientists who established American Heart Association dogma back in the 50s made two mistakes regarding fat intake and heart disease. They jumped to a conclusion. Almost immediately, they jumped to a solution. Since then, their successors have doggedly tried to prove the correctness of their original assumption. Here is their latest attempt to justify the original conclusion.
Linoleic acid (LA), as a part of the wider debate about saturated, omega-6 and omega-3 fatty acids (FAs) and health, continues to be at the center of controversy in the world of fatty acid research. A robust evidence base, however, demonstrates that higher intakes and blood levels of LA are associated with improved cardiometabolic health outcomes... across the range of typical dietary intakes, higher LA is beneficial. Recent trials of LA-rich oils report favorable outcomes in people with common lipid disorders." https://pmc.ncbi.nlm.nih.gov/articles/PMC11391774/
Here is the key to understanding why higher intakes of linoleic acid appear to be beneficial. "...across the range of typical dietary intakes, higher LA is beneficial."
Observation and experiment support that conclusion. However, the conclusion is based on an incomplete data set. Typical intakes of linoleic acid are excessive in people with obesity. "Fatty acid composition in the Western diet has shifted from saturated to polyunsaturated fatty acids (PUFAs), and specifically to linoleic acid (LA, 18:2), which has gradually increased in the diet over the past 50 y to become the most abundant dietary fatty acid in human adipose tissue. https://pmc.ncbi.nlm.nih.gov/articles/PMC9060469/
Insulin sensitivity is controlled by the endocannabinoid system. "In obese states, endocannabinoid levels are increased and might exert unfavorable effects on insulin-sensitive tissues." https://pubmed.ncbi.nlm.nih.gov/19559361/
What causes an increase in endocannabinoid levels? "Endocannabinoids and their G-protein coupled receptors (GPCR) are a current research focus in the area of obesity due to the system's role in food intake and glucose and lipid metabolism. Importantly, overweight and obese individuals often have higher circulating levels of the arachidonic acid-derived endocannabinoids anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) and an altered pattern of receptor expression." https://pubmed.ncbi.nlm.nih.gov/23762050/
Endocannabinoid and prostaglandin overproduction are regulated according to cell membrane arachidonic acid concentrations. "Because arachidonic acid (AA) competes with EPA and DHA as well as with LA, ALA and oleic acid for incorporation in membrane lipids at the same positions, all these fatty acids are important for controlling the AA concentration in membrane lipids, which in turn determines how much AA can be liberated and become available for prostaglandin biosynthesis following phospholipase activation." https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/
Notice that saturated fats cannot compete with arachidonic acid for positions in cell membranes. So, swapping linoleic acid-rich seed oils for saturated fat will attenuate AEA and 2-AG production which improve insulin sensitivity which allows people to lose weight without experiencing discomfort. The newly-minted GLP-1 receptor agonists alter cell signaling." Biomedical obesity research is all about treatment with molecules that alter cell signaling. Reducing arachidonic acid intake can get the job done without added expense or side effects. "Chicken meat with reduced concentration of arachidonic acid (AA) and reduced ratio between omega-6 and omega-3 fatty acids has potential health benefits because a reduction in AA intake dampens prostanoid signaling, and the proportion between omega-6 and omega-3 fatty acids is too high in our diet." https://pmc.ncbi.nlm.nih.gov/articles/PMC2875212/
Thank you Gary. You are an American treasure.
Thanks. I'm not quite sure I'd go that far, but I appreciate the thought.
"As Americans have become ever less healthy, the DGA advice has become only and ever more of the same".
Although I have no medical or scientific expertise, experience, or qualifications, I suspect that this is not a scientific or medical issue but a psychological one. Mainly mass psychology.
People - not excluding the cleverest, highest-achieving, and highest-paid experts - like to be popular, and agreeing with others is more likely to make one popular than disagreeing. And the more people agree with an official party line, the greater the pressure becomes on any remaining holdouts to conform.
As a result, the DGA authors seem to have decided that "when you're in a hole, you should keep on digging".
All the confusion and confounding, on top of the vested interests, desire to get and maintain reputation, and strong dislike of ever admitting to having been wrong about even the slightest little thing, could perhaps be sidestepped if we simply take the trends in US public health, described by Mr Taubes at the start of his article, as a non-rigorous but suggestive mass trial of the DGA.
May I strongly recommend Chapter 2, "The Most Intolerant Wins: The Dominance of the Stubborn Minority" in Nassim Nicholas Taleb's book "Skin In The Game"? Taleb writes that "It suffices for an intransigent minority - a certain type of intransigent minority - with significant skin in the game (or, better, soul in the game) to reach a minutely small level, say 3 or 4 percent of the total population, for the entire population to have to submit to their preferences".
That holds good when the "population" is a board, a committee, or a research team. Or even a tightly-knit, determined, somewhat fanatical group of, say, vegans.
I agree in that certainly mass psychology and group think comes into it. And, yes, anything by Taleb is worth reading. Although in this case, it's a stubborn majority, which raises a whole host of other issues (and so a whole host of subjects to discuss on this Substack).
Your mention of group think brought to mind a calendar Despair Inc sells captioned, "Peer Review: A rigorous process through which often dubious ideas gain broad scientific consensus before becoming unquestionable dogma." https://despair.com/products/peer-review?
Then there's an article entitled 'Consensus Science and the Peer Review' which says, "It is our responsibility as scientists, physicians, reviewers, and/or editors to be alert and always remember that '...consensus is invoked only in situations where the science is not solid enough.'" https://pmc.ncbi.nlm.nih.gov/articles/PMC2719747/
Science is all about explaining how the real World works. Myth is all about jumping to conclusions based on observation and limited understanding. As JFK remarked in his June 11, 1962 Commencement Address at Yale University, “The great enemy of truth is very often not the lie--deliberate, contrived and dishonest--but the myth--persistent, persuasive and unrealistic. Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought."
Peer review = dogma enforcement. Malcolm Kendrick has written a lot about this.
7th Day Adventism
'on top of the vested interests'
Everything you say sounds true, and I think it is, but I also think you're underselling the regulatory capture angle.
Fair enough. To avoid writing an essay of my own, I did focus on one specific thought.