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♪ ♪ KATKO: Welcome, America, to "Balancing Act," the show that aims to tame the political circus of two-party politics.

I'm John Katko.

This week: The USDA Food Guides, past and present.

Are they effective?

We'll ask Dr.

Brett Scher from the Coalition for Metabolic Health in his Center Ring, then registered dietitian Jane Burrell, and Dr.

Robert Kiltz will take to the trapeze to weigh in on the benefits and drawbacks of the new food pyramid.

But first, let's walk the tightrope.

♪ ♪ Since the 1940s, Americans have been fed a steady diet of nutrition advice from the federal government.

That advice came through a series of food guides.

And believe it or not, when these guides were first created, they weren't warning us about overeating, but rather not eating enough.

In 1943, during World War II, the government introduced the Basic Seven to promote staying nourished during food shortages and rationing.

The idea was simple: eat something from each group every day.

It was an early attempt to cover the whole diet in seven broad food categories, though it did not call out sweets or added sugars the way later guides would.

By 1956, they slimmed down the guide to the Basic Four: milk, meat, fruits and vegetables, breads, and cereals.

This period still focused on getting enough nutrients but didn't yet come with clear limits on fats, sugars, or total calories.

Then came the recommendation many Americans remember most: the 1992 Food Guide Pyramid.

Carbs were now the main course, with 6 to 11 recommended servings of grain products a day, including several from whole grains.

Fats and sweets were pushed to the top as more of a garnish, to be used sparingly.

The middle layers emphasized fruits and vegetables and protein foods.

In 2005, the pyramid became MyPyramid, more personalized, and it baked physical activity into the icon.

Then in 2011, the pyramid was eliminated for MyPlate, a quick, practical reminder for real meals.

The recipe for success: a simple visual cue was created.

Build a balanced meal, and make half the plate fruits and vegetables.

The USDA put it this way: reaching a healthier weight is a balancing act.

The secret is learning how to balance your energy in and balance your energy out.

We may also want to balance the information we're taking in, which brings us to today's special: the new pyramid that turns the old pyramid on its head, literally.

Carbs are still at the bottom of the now inverted pyramid, meaning eat fewer.

Meat and dairy take the top spot, meaning eat more, along with fruits and vegetables.

The theme is to return to the basics: more whole foods, less ultra-processed food, and a sharper warning label on added sugars and refined starches.

Notably, this messaging puts more emphasis on protein, which some people applaud, and others find not as palatable.

It should also be noted that many have criticized various food guides as not having been shaped by science alone.

Over the years, journalists and public health researchers have documented how major food and agriculture industries have pushed back when federal advice might hurt sales.

In 1991, for example, the USDA delayed and effectively pulled back its planned release of the Eating Right Pyramid after objections from the meat and dairy industries.

In fact, the American Society for Nutrition has called for stronger transparency in conflict-of-interest safeguards in the dietary guidelines process.

Now, all of this is a lot to digest.

So, let's process it with our expert in the center ring.

♪ ♪ Joining me now is Dr.

Brett Scher, director of the Coalition for Metabolic Health.

Doc, let's get right into it.

What does the coalition do?

What's your goal?

DR.

SCHER: Thanks, John.

Yes, I'm the medical director of the Coalition for Metabolic Health, and we're a collection-we're a group of clinicians and scientists and nonprofits and business leaders-really dedicated towards making metabolic health more of a focus within our medical community.

I mean, there's no secret that the metabolic health of this country has really been going in the wrong direction for decades, as we see the rise of obesity and diabetes and all the complications from metabolic dysfunction.

So, we are a collection of experts really geared towards education and policy reform to try and help reverse that trend.

KATKO: So, Doc, what do you do with respect to the food pyramid and its different iterations?

DR.

SCHER: Yeah, I mean, when you look at the core of what is causing metabolic dysfunction, food is one of the most critical aspects.

And when you look at what sets the policy of how food is promoted and how food is discussed and what we eat in schools and in the military and in, you know, retirement homes and so forth, that comes, unfortunately, from the dietary guidelines.

And I say "unfortunately" because of the trend that we've seen for the past couple of decades.

So, with this latest iteration of the dietary guidelines, we're very hopeful that that's something that can address sort of the misconceptions and the failings of prior versions to help reverse this worsening of metabolic health that we see and actually start promoting metabolic health in sort of a whole foods, real foods approach that can really feed metabolic health.

KATKO: So, Doc, these food guides, first of all, in the past and present, have they been effective, number one?

And even if they are, do Americans actually follow them?

DR.

SCHER: Yes, it's a great question.

Are they effective, and do Americans follow them?

So, on an individual basis most people probably don't follow them.

But it's important about how these guidelines shape policy.

Where do subsidies go, for what kinds of food?

They shape what's allowed in schools, for school meals, in school lunches.

I've got kids who are in public schools, and they hate their food.

You know, they know what healthy food is, and they don't like what they're getting at school, but it fits the dietary guidelines.

And like I mentioned before, the military, any federal program has to adhere to the dietary guidelines.

So even though you as an individual don't have to adhere to the dietary guidelines, the message still influences what you see, what you see at the grocery store, how much things cost, and what's being provided at federal programs.

So they're still very influential.

And your first question was, are they effective?

I mean, all you have to do is see the rise in obesity, type 2 diabetes, metabolic dysfunction, fatty liver disease.

It's gone nowhere but up.

So based on that, no, they're not effective.

You can't say that they caused that epidemic, but they certainly were part of the environment that allowed this epidemic to happen.

And so we really do need to do something drastic and something different to try and stem it.

And that's why I think it's good that the pyramid is now flipped on its head and the dietary guidelines have been really revised.

KATKO: So imagine that the past guidelines have been off-kilter.

You're hopeful for this moment.

Let me ask a fundamental question.

Should the government be in the business of providing dietary advice at all?

And if not, where should we look for guidance?

DR.

SCHER: Yeah, that's a great question.

You know, there are some people who say the only guidance should be "eat like your great grandparents ate," right?

Like, that should be the dietary guidelines.

But we have to recognize we're in a world where the government has been providing dietary guidelines, and the laws are set up the way they are and reflected in the dietary guidelines.

So we have to work with the environment that we're in and make sure that those guidelines are as evidence-based and as practical and as clinically useful as they can be to really help improve metabolic health.

And like I said, the way it's been going clearly shows it hasn't been.

So it's definitely time for a change.

KATKO: So what about the influence of special interest groups?

That is, special interest food groups, special interest agricultural groups, and other such groups.

DR.

SCHER: Yeah, special interests are definitely a concern, and that's one thing at the Coalition for Metabolic Health.

We really try to be a group of experts without those outside influences and without the industry influences so that we can provide really objective information and guidance to help people improve their metabolic health without that influence.

Now, if you look at the prior guidelines and the people on the committees, you know, there were tons of conflicts of interest from pharmaceutical companies and from processed food companies.

And then with the newer guidelines, of course, there are still conflicts of interest.

It's not devoid of conflicts of interest.

There are fewer and more along the lines of agriculture.

So I guess you could say it's a step in the right direction, although in a perfect world, we wouldn't have those outside influences.

And like I said, at the Coalition for Metabolic Health, that's something we really try to influence-to be objective, to represent the science, to represent the clinical experience, and not have those outside influences.

KATKO: So you're somewhat hopeful about the new food pyramid.

Let's talk a little bit more about it.

Tell me, what is your overall assessment of that new food pyramid?

DR.

SCHER: Well, I think it's certainly a step in the right direction.

I really like just the whole concept of "eat whole foods, real foods."

I mean, such a simple statement, but so important.

I really appreciate the explicit reduction in refined grains and sugars.

I mean, the fact that prior guidelines didn't come right out and say, "We need to limit refined grains and sugars," but allowed them rather in the dietary guidelines, it seems like a real misstep.

So I'm really encouraged that that is now explicit in the guidelines.

And the increase in protein-I mean, protein is such an important macronutrient for feeling full and eating less and for improving metabolic health and improving strength and avoiding frailty.

And when we look at the old RDA, the recommended daily allowance of protein at this 0.8 grams per kilogram of ideal body weight-it sounds complicated, but really it was like 50 to 60 grams of protein a day for most people, which is insufficient to really promote optimal metabolic health and satiety.

So the increase in protein, I think, is a fantastic emphasis.

And in broadening the scope of sources of protein-there was such a plant-heavy focus before, but now recognizing the importance of animal-based foods for very bioavailable protein with fewer calories and fewer carbohydrates and how that can impact metabolic health-I think is also a really important recognition.

KATKO: So you're telling me that a good strip steak is okay once in a while?

DR.

SCHER: Oh, 100%, 100%.

But the key is, it's not adding, you know, more animal protein to a high refined grain, high sugar, high-calorie diet.

And that's where I think there's the guidelines, and then there's the implementation and the messaging, right?

It's not eating the standard American diet and just increasing more protein.

It's reducing the refined grains and sugars and then increasing animal protein to fill that spot within the context of a whole foods diet.

That is the key.

And unfortunately, people might pick and choose the parts they like and ignore the others, but it really is the whole overarching aspect of what is a healthy diet.

Whole foods, reduced refined grains and sugars and refined carbs, and increased protein, including the animal sources of protein-all of that together.

KATKO: So let's talk about the latest gigantic trend in this country.

I think we all have seen it with our friends or ourselves, and that is the GLP-1 injections that are causing dramatic weight losses in people.

Are they a good idea overall?

And should this be part of the whole mix of the nutrition?

DR.

SCHER: Yeah, you know, GLP-1s have obviously taken the medical world by storm and have had some of the best effects we've seen for weight loss.

But as with a lot of things in medicine, I think they're being overused and they're being promoted as the easy solution, but they don't reverse the cause of what led to the weight gain and the metabolic dysfunction in the first place.

And it is truly just trying to put a Band-Aid on it.

And as we've seen, people don't stay on these drugs for very long.

The majority of the people don't make it a year.

So what have you done for those individuals?

If you gave them a drug without the lifestyle coaching, without the beneficial lifestyle interventions, but you gave them a drug that they're not going to stay on, so they lose the weight and then the evidence shows they gain it right back.

So for that individual, we've done them a disservice by just giving them the medication.

So the medication absolutely has a role.

And at the Coalition for Metabolic Health, we came up with a task force to make a statement about GLP-1s and about responsible stewardship and use of these medications where they absolutely can be beneficial but have to be used in conjunction with effective lifestyle interventions.

And, you know, ketogenic and low-carb diets are certainly one of those-not the only one-but certainly one that has been proven to be effective.

And only by using those in conjunction with each other are we really impacting the future health of the patient.

Because committing someone to a lifelong dependency on a medication is not doing them many favors, but really teaching them how to keep their weight off, how to maintain their metabolic health, and using the GLP-1s as a tool to help them achieve that with other strategies for the long term is really the proper way to use these medications.

KATKO: Yeah, it sounds like everything in moderation, including moderation at times, I guess.

Dr.

Brett Scher, director of the Coalition for Metabolic Health, thank you so much for some terrific information.

Now for discussions of the new food pyramid, let's take to the trapeze.

Joining me now is Dr.

Robert Dr.

Rober Kiltz, founder/CEO of CNY Fertility with offices over the country, and Jane Burrell, registered dietitian at Syracuse University.

I want to welcome you both to the show, and Jane, let's start right with you.

Are you a fan of the new food pyramid?

What's hot and what's not?

BURRELL: So I would say, in in general, I'm not a fan of the pyramid.

There are some things that I do like about it-the emphasis on eating whole foods, lots of fruits and vegetables.

That's all been there.

Some of the obvious things that I do not appreciate are at the top of the pyramid, you know, beef and butter and eggs have center stage.

Although those can be part of a healthy diet, I think it's kind of misleading to see them so prominently at the top.

KATKO: So, Doc, you're part of the carnivore movement in this country, so I take it you have a little bit of a different take.

What is your take?

DR.

KILTZ: Well, I think that this new food pyramid or triangle, whatever you want to call it, is a step forward, which I think is important.

I am meat-centric, fatty meat-centric, and I think fruits and vegetables in lower amounts is what I generally support.

I think it's great that removing the processed foods and focusing on real food is a plus.

KATKO: So, Doc, the obesity problem in the United States, it's been around, seems like forever.

Every time I go overseas, I look into the populations in general.

It just seems like Americans are heavier, more out of shape.

What do you think is the real cause of that?

DR.

KILTZ: Well, I think the problem is we've been recommended to eat primarily a plant and processed food diet and low fat, which ultimately is getting us fat, but it's also getting us sick.

and low fat, which ultimately is getting us fat, but it's also getting us sick.

The cost of healthcare is rising.

More and more people are infertile and sick, and the problem, I think, is three to six meals a day.

They don't add fasting, and I think they're not adding the fat.

That's where Atkins, Paleo, and carnivore diets focus on fat, eating less frequently.

I think that reduces inflammation and helps us be healthier.

KATKO: So, Jane, tell us about the blue zones.

You know what blue zones are?

BURRELL: Of course.

The blue zones are areas of the world where there's a greater proportion of the population that makes it to age 100.

So there has been a lot of investigation of the blue zones in terms of what is their lifestyle, their characteristics of, you know, things like exercise, what they eat, their social engagement.

And one thing that is very, very prominent and rings through very frequently is those that live the longest tend to eat more of a plant-based diet.

They do-they might have a little bit of animal proteins.

They don't necessarily have a low-fat diet, but they have a healthy fat diet, which means more of the unsaturated fats.

And they also-they're more active than we are, you know, the general population.

So I think that it goes beyond diet, food choices.

They do have fresh whole foods, but it's more than simply, "Are you eating plants or animals?"

It's more complex.

KATKO: Doc, your response?

DR.

KILTZ: Well, I agree with Jane that a community and culture and lifestyle are critical.

My grandmother lived to 104 on an Italian Mediterranean diet, and I'm not telling people you need to eat only meat.

I think a culture-rich environment is critical-community - and I think it's important to have something valuable to do.

And for me, it's work and art and connections.

And that's where I think we all come together.

And in general, I think animal products, meat, and fat are part of those diets in the blue zones.

KATKO: So, Doc, let's switch gears for a bit.

GLP-1s are the injections to reduce weight.

They seem to be all the rage these days.

What are your thoughts on those, and what do you think of the use of those long-term?

DR.

KILTZ: Well, I think if we could find a more natural way of living through a diet that's more natural, which is whole foods, eat less frequently, add more fatty meat, I think many people, through keto and even Atkins, they lost a lot of weight.

I think they could be used in the short term, but I think it's a fix that is not right.

We want to get back to whole foods, natural community involvement, and reducing inflammation.

And I think if you do that, you'll reduce a significant amount of obesity.

And with that, many of the diseases will help be reduced or go away.

KATKO: So, Jane, what's your thought?

BURRELL: I agree.

I think that they are a necessary tool based on where we are right now.

There's obviously ways to modify the diet and avoid their use, but I will say, for some, they are necessary given our food environment.

And I think that's really the most important thing to look at is the food environment.

What food is available to people?

What is affordable?

Do they have access to it?

That has a bigger impact on what they eat than any government agency telling them what to eat.

KATKO: So, Jane, do you think long-term, all the effects can be just as bad for some of these injections?

I mean, I know a lot of people who have taken these injections, and I've noticed that not only do they lose weight, but they also lose muscle mass, and that can't be a good thing.

BURRELL: Of course, that's a concern, that loss of muscle mass.

That changes quality of life and increases, you know, risk of falls and injuries.

You know, it's related to immune function.

Sure, there are ways to work around that, right?

We can have resistance training.

The way that I approach any of this is from an individual perspective, right?

We can't make a blanket statement and say, "This is good for everyone.

This is bad for everyone."

We need to look individually and look at where the biggest impact is for a person in their whole situation, right?

There's everything about their lifestyle.

KATKO: Right.

So, Doc, I want to take a step back for a second here.

We've kind of peered around the edges of this, but it seems like over the decades, with the various iterations of the food pyramid and the food guides, that two things have kind of infected it.

One is politics, and the other one seems to be special interests - the dairy industry, processed food industry, whatever -having undue influence on it.

How do you fix that if that is indeed the case?

DR.

KILTZ: Well, I think no matter what you do between industry and politics, you'll never separate them.

They're part of our lives.

I think one of the important things is, like we're doing today, sharing stories.

And I always say the stories are more powerful than the science.

And the more we can share the stories about how lifestyle, dietary changes, whole foods, and nutrition are really going to be a key.

We're working with industries that are part of all of our lives, so we're not separating these things.

I think we work together on this, sit down together, and help give people choices in this.

That's the thing that I've found the most important.

I think social media, programs like you're doing, and as Jane Burrell is doing, we're out there trying to help people individually and in communities to heal with lifestyle and dietary changes and not drugs.

And certainly, we just need to all work together.

That's, I think, the most important part of this.

BURRELL: Yeah, I absolutely agree with that.

I think we have to look at it from a systems approach, right?

We have to make the food that is nourishing more affordable, and that means that maybe we need to hold some accountability of industry who is, you know, making these foods so palatable and so easy to overconsume and available everywhere.

If we could change that environment - that's policy at its best, right?

This should not be about, you know, who is making the most money.

But we know the reality of that, right?

The more product sells, the more that their profits go up, and that is going to just keep the narrative and the push.

So let's change the marketing of these foods based on the new dietary guidelines.

I'm starting to see some change already.

KATKO: Jane, let's give you about 30 seconds left for each of you.

So your 30 seconds-wave a wand.

What would you tell someone is the most important thing if they want to get themselves in shape or get themselves healthier, nutrition-wise?

BURRELL: My recommendation to everyone is eat more plants, more fruits, more vegetables.

They're going to reduce inflammation, they're going to make you feel better, make you full, meet your nutrient needs, and keep your calories in check.

And then, you know, get the other whole foods.

I'm a big advocate of those whole foods.

KATKO: I agree.

Dr.

Kiltz, you have the final word.

DR.

KILTZ: Faith and positivity to be shared with our brothers and sisters around the globe, number one.

I personally believe that fatty meat, some plants, eat less frequently, fasting is critical, and the flow of life-let's all get together and work together in a positive way so that we can help you and everyone else find the thing that feels right for them.

And if you're sick, that's where I think meat, carnivore, and fasting come in.

But always, faith and positivity is something.

KATKO: So, Dr.

Kiltz and Jane Burrell, I want to thank you both.

You've inspired me to go home and have a steak with asparagus tonight.

Thank you so much.

And we appreciate your time, and we hope for a healthier America.

Now it's time for My Take.

Government food guides were born Government food guides were born in a moment of real food insecurity.

During World War II, shortages and rationing made nutrition a very serious concern for millions of Americans.

Sadly, those concerns have remained consistent for many in our country.

What remains inconsistent, however, is the guidance itself-the pyramid, the plate, the messaging.

It keeps getting tweaked, and to many Americans, it can feel like even nutrition advice isn't immune from the push or pull of politics and special interests.

Is nothing sacred?

So here's an idea: Why not create a permanent, nonpartisan nutrition committee structured to be insulated from political swings and industry pressure?

Give it one job and one job only: Do what's best for America's nutritional priorities.

Grounded in scientific evidence, communicated clearly, and realistic enough for families to actually follow them.

Because we owe it to the public to separate nutritional health from an unhealthy environment of Washington, D.C.

And that's my take.

That's all for this week, folks.

To send in your comments for the show or to see "Balancing Act" extras and exclusives, follow us on social media or go to BalancingActWithJohnKatko.com.

Thank you for joining us, and remember, in the circus that is politics, there's always a balancing act.

I'm John Katko.

We'll see you next week, America.

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