The new Dietary Guidelines for America released in late 2015-an amendment to the original guidelines that were issued 35 years ago-are not a good recipe for improving America’s dietary health. It’s true that some of the dietary recommendations would, if followed carefully by already-healthy Americans, result in some improvement to their health. But it does little to address or reverse America’s epidemic of type 2 diabetes and pre-diabetes, obesity , and downstream conditions such as Alzheimer’s and even many cancers.

You may not pay much attention to the Dietary Guidelines, but millions of kids who eat school lunches are subject to them, and its broad strokes trickle down into the public’s perception of what’s healthy.

SOME OF THE OKAY / MEDIOCRE NEWS ABOUT THE DGA

As we’ve been told before, the 2015 version of the Dietary Guidelines emphasize fruits, veggies, beans/legumes, low fat dairy, and whole grains as the foundation of a healthy diet. The new guidelines correctly recommend that we reduce our sugar intake, and admit that, for healthy adults, dietary cholesterol may not significantly elevate the blood cholesterol level or increase the risk of cardiovascular disease. And, finally, eggs and coffee are off the “black” list.

AND NOW THE BAD / NOT-SO-GOOD NEWS ABOUT THE DGA

The new Dietary Guidelines are fine and prudent for a healthy, active person, but not for those who are insulin resistant-diabetics and pre-diabetics. Fat isn’t even listed as a healthy nutrient, and the Guidelines continue to ingrain the mistaken homily that dietary fat is a cause of obesity. There is no evidence of ill effects when a variety of fats, including saturated fat, are part of a healthy diet.

The Guidelines recognize sugar as dangerous, yet diabetics are allowed 10 added teaspoons per day. Imagine allowing 10 cigarettes a day for emphysema or lung cancer patients. Indeed, it wasn’t too long ago that we didn’t make a connection between smoking and cancer or lung disease.

EXERCISE IS ONLY PARTIALLY HELPFUL

Fortunately, there are more runners now than ever before. But exercise alone is not going to fix diabetes, and for many people vigorous physical activity only minimally decreases their insulin resistance. Half of all Americans (and even more of those who enter medical clinics) are diabetetic or pre-diabetic, and I fear that this condition can be dismissed as the “new normal.” Sadly, I see too many patients with insulin resistance who progress to full blown diabetes cases before a health care provider convinces them to change course. Even when care providers do intervene, they often send patients in the wrong direction.

If we look at the predicted metabolic and lipid effects of prudently following the current DGA recommendations, we can expect to see:

an increase in TG (bad)

a decrease in HDL (bad)

an increase in small dense LDL particles (very bad)

an increase in inflammation (bad)

an increase in oxidative stress (less saturated fat = more PUFA)

an increase in obesity in most of those with insulin resistance and carbohydrate intolerance.

I am a member of the Nutrition Coalition (www.nutrition-coalition.org), a non-profit that advocates for sensible, science-based, national nutrition policy, as a means of fighting the major nutrition-related diseases of our time. We launched a petition which sparked an independent review of the Dietary Guidelines that was funded by Congress and it delayed the Guideline release. The review raised awareness and help some of the positive changes listed above but we have a long way to go.

In the last week the American Medical Association and the CDC posted a position paper on “Preventing Type 2 Diabetes”. This as well as the new Endocrine Society Guideline on “Comprehensive Type 2 Diabetes Management” still promote low fat and exercise more. What are these people who are resistant to carbohydrate to replace the fat with.carbohydrate? The ultimate goal, of course, should be to improve health, reverse disease, and lower cost-not to intensify medical management.

To reduce endogenous insulin, and insulin resistance, we need to be very specific on carb counts. For those with diabetes and pre-diabetes, more insulin means more insulin resistance, so reversing this is a function of how we tolerate carbs. Healthy fat is key to this. Fats do not raise glucose or insulin, and they satiate our hunger (which reduces unnecessary and binge eating). By contrast-and despite the conventional wisdom of the medical worldmore insulin-raising meds and more glucose control, result in more cardiovascular events and death.

Health professionals and coaches really need to work with patients. We do this in our hospital. It is fun and patients get it. Never let patients be hungry. Tell them to throw out “energy balance” and let them off the hook. It is not their fault they have Insulin Reistance leading to Diabetes.

We should also remember that genes have no effect on us unless they are expressed. Why does this matter? Eskimos and Native Americans carry genes for diabetes and pre-diabetes, but previous to modern they suffered from it. The genes were there, but were not turned on. To reverse diabetes, we need to turn on other genes.

Individuals vary, too. Most of us should be checking their post-meal glucose level (with a simple device called a glucometer, available for about $40), even if we’re not on insulin. This is a clear marker of glucose intolerance, insulin resistance, hyperinsulinemia, AGEs (Advanced Glycated Endproducts), and inflammatory pathways. Post meal sugar is so simple and telling.

I was in Connecticut to film some running exercises, and went for an hour-long, early morning run, followed by a three-egg burrito with avocado, cheese, and veggies in a whole wheat wrap. Then I did two hours of running and filming. Out of curiosity, I checked my glucose level, knowing that exercise before and after meals boosts insulin sensitivity, which is a good thing. My glucose two hours after even the fairly low carb high fat meal in a scenario where my insulin sensitivity is optimized from exercise still reflected a glucose of 125. Now just imagine if even someone like myself who is “well” did not exercise before breakfast, had three muffins, and then sat at a desk. I don’t want to do this experiment but I might just to see what the two hour post meal glucose would be. A preDM or DM person who does similar will likely be off the charts even though the sugar might reset by the next morning and a false assumption that all is well.

Thanks all for attending Low Carb Revolution #3 last week at the Clarion. You are taking charge of your health. Also tune in to “My Diet is Better Than Yours” on ABC. Guess who is winning.Abel James and low carb high fat.