Rethinking the plate

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MARY REICHARD, HOST: Up next: what to eat.

For decades, the federal government told Americans to avoid eating fat, load up on grains, and trust the experts.

Meanwhile, rates of obesity and chronic disease soared. Type 2 diabetes spiraled up. High blood pressure, fatty liver…illnesses linked to what’s known as "metabolic syndrome" became commonplace.

MYRNA BROWN, HOST: Last week, the federal government released the new 2025-2030 U.S. Dietary Guidelines, put out by two agencies: the Department of Health and Human Services and the Department of Agriculture.

REICHARD: Depending upon who you ask, it’s either overdue progress or the same old, same old with some new mistakes thrown in. And it’s important to remember that this is a policy document, not a scientific paper.

I spoke to three experts who approach nutrition from different angles. Two think the new guidelines are a real improvement. One sees little meaningful change.

Dr. Bret Scher is a cardiologist and medical director for the Coalition for Metabolic Health. He was not involved with creating these guidelines, but says the guidelines do move in a better direction.

SCHER: I think the overarching, main message is focus on real food and whole foods, which shouldn't be all that revolutionary, but kind of is in the guidelines…

The guidelines say to eat fewer refined grains, less added sugar, and most critically, more protein. Past guidelines recommended 0.8 grams of protein per kilogram of body weight. Now a kilogram is roughly two pounds, so, for a 150 pound person, that’s 55 grams of protein a day. Roughly a large chicken breast or a big can of tuna.

Scher calls that the very minimum just to prevent deficiency.

And that resonates with PhD nutritionist and researcher Nina Teicholz.

TEICHOLZ: There is quite a lot to celebrate in these guidelines. There has long been a move in the scientific community arguing that for optimal health, much more protein is needed.

Dr. Scher says a bigger shift is the acknowledgment that one-size-fit-all diets just don’t work. This is the first time the guidelines explicitly recognize metabolic dysfunction; things like insulin resistance, type 2 diabetes, and obesity…and state that low-carbohydrate diets work for people with those conditions.

Older guidelines were for “healthy” Americans. And there are fewer of those these days:

SCHER: You know, there are studies showing that 93% of Americans have sub optimal metabolic health. So if you're only making a guideline for that 7% of people, that part really never made a whole lot of sense to me.

Teicholz says past guidelines relied on weak evidence. But this time, she says, something unusual happened:

TEICHOLZ: Never before has the agency completely rejected the scientific report put together by the official Dietary Guideline Advisory Committee. That's the expert group that is appointed every five years to review the science and make recommendations. The recommendations from that report were wholesale rejected by HHS. That is unprecedented.

Instead, HHS put together a separate group of scientists who conducted fresh systematic reviews. Those reviews helped form the final changes.

TEICHOLZ: …so these were not just picked out of thin air. I mean, they were supported by rigorous evidence.

She also says transparency around conflicts of interest improved this go round. Several members of the panel receive money from beef, dairy and other food industry groups. That invites scrutiny, particularly from proponents of plant-based nutrition.

Dr. Joel Kahn is one of those–he’s a preventive cardiologist who sees the guidelines differently. He agrees that Americans eat too much ultra-processed food. But he doesn’t think the guidelines represent a great breakthrough. He says everybody agrees on the acronym spelled c-r-a-p:

KAHN: ….stands for calorie rich and processed C, R, A, P ….not at all new is to cut back added sugar….Stop eating so much garbage food, start cooking real food at home. There's nothing really new about it.

He would like to see more of a focus on plant-based proteins. Things like beans, lentils, legumes, whole grains that are associated with lower rates of heart disease, cancer, and kidney disease.

KAHN: I've never in my life, as a very nutrition- educated cardiologist, measured exactly how many grams per day of protein. I know I'm not protein deficient. I can lift weights, I can exercise, and my lab values are exceptionally good, but I do it by beans and peas and lentils and leafy greens and whole grains.

Red meat and saturated fat sharply divide nutrition experts, as do the benefits of animal versus plant proteins.

But those debates aside, Scher, Teicholz, and Kahn say prior guidelines failed Americans and are at least partially to blame for increased obesity and chronic disease. 

So why trust the guidelines now?

SCHER: I think maybe one of the reasons you can trust it, is because we sort of saw what happened with the old guideline….And so even if it didn't directly cause it, it certainly led to the environment that contributed to it. And so how do you fix that? Well, you reverse it, you undo it. And that's what these new guidelines are doing.

So, where does this leave the average American? All three experts agree we eat way too much ultra-processed food; we should reduce added sugar; and cook real food at home more often.

And in a country where metabolic disease is the norm, maybe it’s a good thing the debate is out in the open.

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