By Emma Hitt Nichols, Ph.D.
More than 70 commenters delivered altogether about four hours of public comments to the Dietary Guidelines Advisory Committee (DGAC) meeting last month.
Representatives from industry, non-profit groups, supporters of plant-based foods, low carbohydrate diet advocates, and private citizens all took their turns at the microphone to express what they most wanted to see in the next Dietary Guidelines for Americans (DGA).
The July 10-11 meeting of the DGAC was the second of five meetings held as part of the process to review the science for the next set of guidelines, due out in 2020.
While all of these meetings are open to the public, this was one of only two meetings allowing public comments.
The commenters had 3 minutes each to make their statement. Viewpoints were diverse and, at times, voices became emotional. Although the police were quietly present at the event, it was encouraging that people with such strong, divergent opinions could sit calmly together in one room for several hours.
Of the commenters, about one third represented various industries, another one third or so were from non-profits (perhaps some of which are industry supported), and the remainder were private citizens, including clinicians in private practice (See Table).
Commenters to Dietary Guidelines Advisory Committee and Major Topics Covered
Nina Teicholz, Executive Director of The Nutrition Coalition, was the only person whose comment focused solely on the importance of basing the guidelines on rigorous research. One would hope this would already be the case, but as she documented, the DGA’s current scientific methodology contains serious deficits and has historically excluded a vast quantity of clinical trial research. See blog post.
Novelty of Low-Carb Commenters
While members of industry and advocates of plant-based diets have for decades dominated the food-lobbying arena in Washington, this meeting, for the first time, included a number of clinicians who implored the committee to consider their view of the marked health benefits of a low carbohydrate dietary approach, especially for the prevention of type 2 diabetes and other diet-related diseases.
Priyanka Wali, M.D., a private practitioner specializing in obesity medicine expressed her concern that the nutrition guidelines, which target healthy people, fail to address Americans diagnosed with diet-related chronic diseases who now make up most of the general public.
“If laughter [were] the best medicine, then the nutritional guidelines are ‘best practice,’ because they are a joke,” she told the stony-faced panel of committee members.
Wali pointed out that about 50% of Americans have pre-diabetes and may not even know it. “These are diseases caused by high insulin levels, which is caused by eating carbohydrates, and it doesn’t matter if it comes from whole grains, cane sugar, or 100% fruit juice.”
Sarah Hallberg, D.O., Director of the Indiana University-Arnett Health Medical Weight Loss Program and Director of the Scientific Council for the Nutrition Coalition, pointed out that the benchmark being considered by the DGAC for “low-carbohydrate” – less than 45% of daily calories – is far higher than the current standard in the scientific literature, which is lower, around 30% of calories or less. In fact, said Hallberg, optimal benefits for the prevention and reversal of type 2 diabetes are seen with carbohydrates at around 10% of daily calories.
Hallberg described the most recent findings from a large controlled clinical trial she directs evaluating a very low carbohydrate nutrition intervention in hundreds of patients with type 2 diabetes. “At one year, 60% of the 262 patients had reversed their diagnosis of type 2 diabetes. At two years, this number remained at 54%, and our patients have lost an average of 30 pounds,” she said.
She emphasized that “it is very important to review the enormous body of clinical trial evidence for a low-carbohydrate eating pattern in obesity and early metabolic disease.”
Georgia Ede, M.D., a psychiatrist, talked about the link between mental health disorders and “sluggish brain glucose processing,” which is strongly correlated with insulin resistance and a key feature of Alzheimer’s disease, now often referred to as type 3 diabetes.
“I’d love to point [my patients] proudly to our guidelines,” Ede said, “but how can I do that when our guidelines explicitly recommend refined grains and carbohydrates…which are powerful promoters of inflammation, oxidation, and insulin resistance—all root causes of brain dysfunction?”
Ede concluded by pleading to the committee that they stay “intellectually curious.”
The Case for Plant-Based
A far greater number of people turned up to advocate for vegetarian diets. These commenters represented industry groups such as the American Pulse Association, National Potato Council, Produce for Better Health Foundation, Soyfoods Association of North America, United Fresh Produce Association, and the Plant-Based Foods Association. Quite a few were also clinicians and private citizens.
Pamela Popper, Ph.D., an acolyte of vegan thought-leader Colin Campbell and director of the Wellness Forum Health, directly called out Dr. Wali’s comment from earlier in the session. “I personally take offense to anyone who would come up here and say that the dietary guidelines are a joke.”
“It’s rare to see a normal weight person in our office today,” Popper said. “Most have eaten a diet high in fat and protein—too much animal food, too much dairy, and too much processed food. Standard procedure in our office is to put these people on a low-fat, high fiber, plant-based diet, and they get better.”
Ted Barnett, M.D., with the Rochester Lifestyle Medicine Institute stated that “the next dietary guidelines should acknowledge that most of the suffering associated with our current epidemic of chronic disease could be alleviated if we all adopted a whole-foods plant based diet.”
According to Barnett, who cited several anecdotes of health improvements in his patients, including one case of diabetes reversal, “a whole food, plant-based eating pattern should be considered the default diet by the DGA.”
Perhaps the only common ground between the dueling low-carb and plant-based diet advocates was that they would likely agree that whole foods are superior to processed ones. No one stood up to defend packaged, sugary foods, although a representative from Wrigley’s did make a comment encouraging people to chew more gum.
Representatives from both the National Dairy Council and the National Milk Producers Federation commented in support of dairy, but overall, there appeared to be a strong, perhaps coordinated, anti-dairy sentiment from quite a few of the speakers.
Dotsie Bausch, former Olympic athlete and now Executive Director of the newly launched Switch4Good, an-anti dairy organization, expressed concern that the guidelines recommend the consumption of dairy foods. Bausch cited the fact that 65% of the population is lactose intolerant.[8, 9]
In a similar vein, Milton Mills, M.D., with the Gilead Medical Group (no relationship to the pharmaceutical company) suggested that the DGA are “racist” because they recommend dairy.
“The vast majority of people of color are intolerant of the lactose that is in milk,” he said. He added that “we have no more reason to suck on the teat of a cow than we have to suck on a breast of a post-partum weasel.”
Follow the Money
Whether some of the private citizens speaking were funded by industry is unclear given that financial disclosures were not provided. This left the casual observer wondering.
For instance, the Good Food Institute, a non-profit based in Washington, DC, turns out to have plant-based food companies among its major supporters. The same can be said of the True Health Initiative, which also advocates in the interests of its plant-based corporate supporters, and Nutritionfacts.org, a group supported by a combination of corporate interests and individuals. Meanwhile, the neutral-sounding Council for Responsible Nutrition turns out to be a group representing pharmaceutical and supplement companies.
By contrast, the anti-dairy Switch4Good group, which appears to have recently been founded with a very sophisticated website, does not state the source of its funding. Nor does Grain Chain, or another new group, Balanced.
One can only hope that the Committee members will use their collective expertise and experience to make sense of what they heard during the meeting and to separate out accurate science from corporate agendas.
The Nutrition Coalition’s Teicholz said that while the guidelines’ experts encourage incorporating the tastes and preferences of the public, the job of the Guidelines Committee is, most importantly, to be guided by the best and most rigorous scientific evidence.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Nina Teicholz Commenter 28. https://bit.ly/30ua0Fn [1:25:21 to 1:28:28]. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Priyanka Wali, M.D. Commenter 13. https://bit.ly/30ua0Fn [42:13 to 45:13]. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Sarah Hallberg, DO. Commenter 64. https://bit.ly/30ua0Fn [3:16:50 to 3:19:40]. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Georgia Ede, M.D. Commenter 54. https://bit.ly/30ua0Fn [2:53:20 to 2:56:20]. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Pamela Popper, N.D., Ph.D. Commenter 49. https://bit.ly/30ua0Fn. [2:38:44- to 2:41:44]. Accessed August 7, 2019. 2020 Dietary Guidelines Advisory Committee Second Meeting. Ted Barnett, M.D. Commenter 67. https://bit.ly/30ua0Fn. [3:25:45 - to 3:28:30]. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Michael Dodds, Mars Wrigley. Commenter 76. https://bit.ly/30ua0Fn. [3:53:37- to 3:56:30]. Accessed August 8, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Dotsie Bausch. Commenter 66. https://bit.ly/30ua0Fn. [3:22:39- to 3:25:39]. Accessed August 7, 2019.
 National Institutes of Health. Lactose Intolerance Frequency. https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics. Accessed August 7, 2019.
 2020 Dietary Guidelines Advisory Committee Second Meeting. Milton Mills, M.D.. Commenter 69. https://bit.ly/30ua0Fn. [3:31:45- to 3:34:45]. Accessed August 7, 2019.
 The Good Food Institute. https://www.gfi.org/. Accessed August 8, 2019.
 True Health Initiative. https://www.truehealthinitiative.org/. Accessed August 8, 2019.
 NutritionFacts.org. https://nutritionfacts.org/supporters/. Accessed August 8, 2019.
 Council for Responsible Nutrition. https://www.crnusa.org/membership-member-center/member-companies. Accessed August 8, 2019.
 Switch4Good. https://switch4good.org/. Accessed August 8, 2019.
 GrainChain.com https://www.grainchain.com/. Accessed August 8, 2019.
 Balanced.org https://www.balanced.org/. Accessed August 8, 2019.