“Americans Can’t Afford to Wait Any Longer.  It’s Time to Overhaul the U.S. Dietary Guidelines.”  Atkins Nutritionals, Inc. spearheaded an open letter to the USDA this morning in the New York Times and the Washington Post. Over fifty healthcare professionals co-signed it, including our own Christopher M Palmer, MD. 

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.”  

But whose facts should we believe?  After reviewing their sources below I decided that I believe these doctors are making a reasonable request.  I’m sharing what I found below in case it saves someone else some time. 

Nurse Christie and I are volunteers with no financial relationship with Atkins, Chris Palmer MD, or anyone else involved.  I’m an economist by training and lover of relevant data by profession. 

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

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 (Centers for Disease Control and Prevention in Atlanta, GA) approved the protocol for this study concerning metabolically healthy Americans. The article was published electronically in November of 2018 and in print February of 2019 

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. 

Personally, I find it shocking that 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 

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.

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.

I found this to be high enough that the US Dietary Guidelines should still be overhauled.  As a result I did not dig into why the CDC and Menke prediabetes methodologies result in different numbers. 

  1. National Diabetes Statistics Report. Centers for Disease Control & Prevention. Retrieved July 6, 2019.
  2. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control & Prevention. Retrieved July 6, 2019.   [This report gives great detail.]

    “An estimated 30.3 million people of all ages—or 9.4% of the U.S. population—had diabetes in 2015…

    “An estimated 33.9% of U.S. adults aged 18 years or older (84.1 million people) had prediabetes in 2015… Nearly half (48.3%) of adults aged 65 years or older had prediabetes”

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.”

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

American Diabetes Association. Standards of Medical Care in Diabetes – 2019. Diabetes Care. Jan 2019; 42 (suppl 1), S50-S51 

This source also checks out.   The American Diabetes Association also released a version abridged for Primary Care Professionals. Since this is more concise, so I’ve excerpted the relevant sections below:

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  

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) [ Bold added by author for emphasis.]

Fact checks out.

The American Diabetes Association has moved their position to embrace current, relevant science.  

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

So what can we do to help?

You can leave a public comment for the 2020 Dietary Guidelines Advisory Committee.  

For example,

Dear Secretary Sonny Perdue,

I strongly urge the committee, the USDA, and HHS, to draft and publish Dietary Guidelines that are consistent with current science and prioritize our most vulnerable populations. Neither these evidence-based recommendations, nor the processes that produce them, should be compromised by industry interests or external political pressures.

Sincerely, 

My name

My town, State, zip code

 

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