The Dietary Guidelines 2010 Must Do No Harm Or Be Overhauled

Dr. Robert Su, author of Carbohydrates Can Kill, has written a terrific and scientifically backed article critical of the 2010 Dietary Guidelines (original article can be found here).

The report of Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, has stirred up a national controversy and is facing a wave of fierce objections from the public and many health and nutritional experts outside the US Government and the special interest groups.

The controversy is centered on the soundness of these guidelines, which are mostly a copy of the earlier guidelines since 1980, with emphasis on the more consumption of daily calories from carbohydrates and the less from fats especially the saturated fats. [1] The reliability of these guidelines are further questioned when both the statistics and the layman’s observation concur that the US population has been rapidly growing heavier to that at least six or seven out of every ten adults are either overweight or obese since 1980. [2] Worst of all, the trends in overweight and obesity has also moved into the younger population including toddlers and infants. [3, 4]

Despite that the previous Dietary Guidelines and Food Pyramids have been well publicized, reports such as this, by JD Wright, et al. “Trends in Intake of Energy and Macronutrients—United States, 1971-2000”, points out that, during the study period, the prevalence of obesity in the US increased from 14.5% to 30.9%, the average daily calorie intake increased from 2,450 kcals to 2,618 kcals for men and from 1,543 kcals to 1,877 kcals for women; the percentage of kcals from carbohydrate increased from 42.4% to 49.0% for men and from 45.4% to 52.6% for women; while the percentage of kcals from total fat “ironically decreased’ from 36.9 to 32.8% for men and from 36.1% to 32.8% for women; and the percentage of kcals from saturated fat also “notably decreased” from 13.5% to 10.9% for men and 13.0% to 11.0% for women. Only a slight decrease from protein was observed. A USDA food consumption survey for the periods between 1989 and 1991, and between 1994 and 1996, indicates the increase of daily calorie intake was caused by higher carbohydrate consumption. The NHANES data for 1971-2000 concur the USDA data, and point out that an increase of 62.4 grams in carbohydrates for women and 67.77 grams for men, while an increase of 6.5 grams in fat for women and a decrease of 5.3 grams for men. Based on these official data, excess consumption in carbohydrate, not in fat, is responsible for the uptrend in obesity for the decades since 1980. [5]

An article, by EW Gregg, et al., “Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults”, finds all risk factors except smoking and diabetes mellitus for cardiovascular disease were reduced with medications during the period between 1960 and 2000, despite the uptrends in overweight and obesity at the same time. In other words, the prevalence of diabetes mellitus has been rapidly increasing along with or exceeding the trends in overweight and obesity. [6] In the meantime, the US health care spending has continued to rise, for example, from $143 per capita in 1960 to $7,018 in 2006, or an inflation of 49.08 times. [7] Based on the “Consumer Price Index (CPI) for All Items”, the annual CPI for 1960 was 88.7 and that for 2006 was 642.658, or an inflation of only 6.81 times between 1960 and 2006. The rate of inflation for health care spending per capita was 7.21 times of that for all items during the same period! [8] The health care spending was 5.15% of the General Domestic Product in 1960 and 16% in 2006 or a total price tag at $2 trillion. In 2009, the total health care cost was $2.4 trillion. [9] These findings clearly point out the current and past dietary guidelines have failed to improve the health of Americans.

Another article for the US Department of Agriculture, by Hodan Farah Wells and Jean C. Busby, “Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005”, cites that Americans had failed to follow the dietary guidelines and food pyramids by consuming more grains especially refined grains than whole grains, too much added fats and oils, too much meat, eggs, and nuts, too much added sugars and sweeteners, too little fruits and vegetables, and too little milk and milk products. To no one’s surprise, it advises that Americans should eat more whole grains, fruits and vegetables, more low-fat milk but less cheese, more monounsaturated fats and polyunsaturated fats but less saturated fats. These recommendations are mostly the basis for the proposed Dietary Guidelines for Americans, 2010. The report recognizes the uptrends in overweight and obesity, however, its recommendations at that time were deemed to fail due to their lack of scientific and clinical evidences. [10]

Consuming more calories than the body needs for its daily activities unarguably makes it gain weight, and vice versa. The Dietary Guidelines and Food Pyramids have always emphasized food portioning for cutting the amount of calorie intake. Unfortunately, food portioning against hunger is a difficult task in the practical world. There are two types of hungers; one is physical and the other is physiological. Physical hunger as a result of an empty stomach is much easier put off for a while. However, physiological hunger as a result of hypoglycemia is a medical emergency and requires immediate feeding. Knowing how to reduce the sense of hunger or to increase satiety is critical in reducing the amount of calories, thus helps lose weight. However, the Dietary Guidelines have correctly addressed satiety, as a consequence, they have failed to help Americans control their calories consumption for weight loss. [11]

Carbohydrates other than those high in indigestible fibers are easy for digestion and absorption, and have a shorter stomach emptying time, in comparison to fats and proteins. Thus, using more fats and proteins is the best way to improve satiety that affords individuals the dietary control, helps reduce the amount of calorie intake, and facilitate weight loss. [12, 13}

Unarguably, based on biochemistry, a majority of blood glucose, in particular during the postprandial period, is from dietary carbohydrates. The elevation of postprandial blood glucose is positively linked to the total of the ingested carbohydrates or glycemic load. The slope of rising postprandial blood glucose level is closely tied to the purity of the ingested carbohydrates or glycemic index, regardless of the types of carbohydrates depending on their chemical structures. Complex carbohydrates (polysaccarides) such as starchy foods only take a longer period before they are broken into monosaccarides for absorption. Complex carbohydrates, nevertheless, still affect the postprandial blood glucose level based on their glycemic loads and glycemic indices. Thus, the higher the glycemic load and glycemic index of foods are ingested, the greater of the excursion, in both the height (elevation) and the width (duration), of the postprandial blood glucose level will be.

In response to the increase of postprandial blood glucose level, the pancreas produces and releases insulin for facilitating the cells to take up glucose for producing energy, storing the excess glucose by converting it into glycogen and fat. When an individual consumes more carbohydrates, his pancreas responses with more insulin production and release that may result in hypoglycemia before mealtime. Consequently, he requires more feedings, especially with more carbohydrate, which followed by hyperglycemia during the postprandial period; more insulin produced and released; and hypoglycemia before mealtime. Such a vicious cycle helps individuals consume more foods especially high in carbohydrate and more calories; thus gain weight. To reverse this vicious cycle with carbohydrate-restricted, fat-rich diets helps individuals maintain a stable, normal blood glucose level, increase satiety, and lose weight. [14]

The grave but often ignored impacts of a rising postprandial blood glucose level on the health include (1) inflammation and pro-inflammation; (2) arteriosclerosis and atherosclerosis; (3) vasoconstriction or hypertension; (4) pro-thrombosis; and (5) glycation and pro-glycation. Having understood these impacts, consuming excessive carbohydrate at 45-65% of total calories as recommended in the proposed Dietary Guidelines for Americans 2010 is extremely dangerous to the health of Americans. [15] While the Guidelines urge Americans to reduce the amount of added sugar, they fail to address the serious consequence of consuming High Fructose Corn Syrup (HFCS) including overweight/obesity, hypertriglyceridemia and high in VLDLs, that have caused cardiovascular diseases, non-alcoholic fatty liver disease, and others. [16, 17, 18, 19, 20]

Because of the unpleasant appearance of fat and the unwarranted but repeated public warnings, more people have become lipophobic, thanks to the success in publicizing the current and previous Dietary Guidelines and Food Pyramids for the past three decades. As aforementioned, fats and proteins provide satiety, in addition to the supply of essential fatty acids and amino acids. Until the recent years, many study results mistakenly condemned fats, especially the saturated fats, for diseases in the presence of abundant carbohydrates especially those that high in glycemic indices and glycemic loads. [21] Recent studies have shown the protective roles of fats in the situations of restricting carbohydrates. [22] The fear of short supply of the blood glucose with carbohydrate restrictions is simply baseless. Through gluconeogenesis from both fats and proteins, a stable blood glucose level within the normal range is achieved without the risk of either hyperglycemia or hypoglycemia. Thus, increasing the consumption of fats and proteins in place of restricting carbohydrates helps stabilize the blood glucose level, maintain a low level of inflammation, which reduces the risks of developing diseases including diabetes mellitus, coronary heart disease, cancers, and just to name a few. [23]

In summary, the proposed Dietary Guidelines for Americans, 2010, should recommend only a total 125-175 grams of daily carbohydrate consumption or under 20% of the total daily calorie intake, preferably with those that low in glycemic indices and glycemic loads. To replace carbohydrates, the Dietary Guidelines should recommend 50% of the total daily calories from fats, at least evenly from both unsaturated and saturated fats, with emphasis on essential fatty acids. Consequently, the Dietary Guidelines should recommend 30% of the total daily calories from proteins with emphasis on essential amino acids.

Understandably, the USDA, through its policies, must continue to help the agriculture industry make profits by promoting grains, vegetables, fruits, livestock, and et cetera to consumers. However, it should not be concerned about the impacts of changing dietary guidelines on the industry. Rather, it should encourage the industry to continue producing grains, and other carbohydrate foods for (1) feeding the lovestock, (2) manufacturing foods with low carbohydrate content, and (3) converting the grains and other carbohydrate foods for alternative fuel.

Proposing an important public policy such as the Dietary Guidelines for Americans 2010 must first “Do No Harm” to all Americans. With the due respect for its vast knowledge in diet and health to the group of experts and specialists in diet and health, consisted of both the members of the Dietary Guidelines Advisory Committee and the staff members of both the USDA and HHS who are involved in research for and preparing this important public policy, questions must ultimately be raised as to (1) the health and fitness of these experts and specialists, and (2) the experience of these experts and specialists in adhering to the current and previous Dietary Guidelines and Food Pyramid. If any of them suffers from overweight or obesity, diabetes mellitus, coronary heart disease, cancers, and other diseases despite that they have practiced the Dietary Guidelines as they have wanted other Americans to follow, they should first question the soundness of these guidelines for failing to protect themselves from gaining weight and falling to disease(s.) If any of them has the difficulty in practicing these guidelines, they should realize why many Americans have failed to follow these guidelines. The most important proposals for this group of experts and specialists are that each of them conducts self-experiments in finding how their serial of blood glucose levels [24, 25] behave during the period of two hours after consuming different carbohydrates including whole grains and fruits, which they strongly recommend in the Dietary Guidelines to Americans; and that they try restricting carbohydrates for a period of one week with series of postprandial blood tests before a meal and after eating the meal continued for two hours at every 15 minutes between tests. They should share their experience and outcomes with the public. The first-hand experience from each individual of this group of experts and specialists will help them sensibly overhaul these Dietary Guidelines 2010 for restoring and maintaining the health of Americans, and, at the same time, for reducing the health care cost.

Robert Su, Pharm.B., M.D.


1. United States Department of Agriculture Center for Nutrition Policy and Promotion. “Dietary Guidelines for Americans.” DietaryGuidelines.Gov.

2. Centers For Disease Control And Prevention. “Prevalence of overweight, obesity and extreme obesity among adults: United States, trends 1960-62 through 2005-2006.” NCHS Health E-Stat.

3. Centers For Disease Control And Prevention. “Obesity Prevalence Among Low-Income, Preschool-Aged Children — United States, 1998—2008.” Morbidity and Mortality Weekly Report. July 24, 2009 / Vol. 58 / No. 28

4. Ogden CL, et al. “Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008.” Journal of American Medical Association. 2010;303(3):242-249

5. JD Wright, MPH, J Kennedy- Stephenson, MS, CY Wang, PhD, MA McDowell, MPH, CL Johnson, MSPH, National Center for Health Statistics, CDC. “Trends in Intake of Energy and Macronutrients—United States, 1971-2000.” Journal of American Medical Association. 2004;291(10):1193-1194.

6. Edward W. Gregg; Yiling J. Cheng; Betsy L. Cadwell; et al “Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults.” Journal of American Medical Association. 2005;293(15):1868-1874

7. Samuel L. Baker . “U.S. National Health Spending, 2006.” Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina.

8. United States Department of Labor. “Consumer Price Index – All Urban Consumers.” Databases, Tables & Calculators by Subject.

9. The Henry J. Kaiser Family Foundation. “Trends in Health Care Costs and Spending.”

10. Hodan Farah Wells and Jean C. Busby. “Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005.” US Department of Agriculture

11. Ball SD, et al. “Prolongation of Satiety After Low Versus Moderately High Glycemic Index Meals In Obese Adolescents.” Journal of Pediatrics, Volume III, Number 3, Pages 488-494, in March 2003.

12. McMillan-Price J, et al. “Comparison of 4 Diets of Varying Glycemic Load on Weight Loss and Cardiovascular Risk Reduction in Overweight and Obese Young Adults. A Randomized Controlled Trial.” Archives of Internal Medicine. Volume 166, Number 14, Pages 1466-1475. July 24, 2006.

13. Abdul-Rahman M, et al. “A High-Fat Diet in Obese Patients Induces Weight Loss, Leads to Improved Insulin Resistance, and Lowers Systolic Blood Pressure Despite Marked Increase in Dietary Sodium Intake.” Endocrine Practice. Abstract-Obesity #201. Volume12, Supplement 2, Page 50. April 2006.

14. Boden G, et al. “Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.” Annals of Internal Medicine, Volume 142, Number 6, Pages 403-11. March 15, 2005.

15. Su RK. “Role of Hyperglycemia.” Carbohydrates Can Kill. Pages 347-354.

16. Marriott BP, et al. “National Estimate of Dietary Fructose Intake Increased From 1997 To 2004 In the United States.” The Journal of Nutrition. 139: 1228S–1235S, 2009.

17. US Department of Veterans Affairs. “Fatty Liver Disease: A New Epidemic?”

18. Dunn W, Schwimmer JB. “The obesity epidemic and nonalcoholic fatty liver disease in children.” Current Gastroenterology Reports. 2008 Feb;10(1):67-72.

19. Hudgins LC, et al. “Human Fatty Acid Is Stimulated by a Eucaloric Low Fat, High Carbohydrate Diet.” Journal of Clinical Investigations, Volume 97, Number 9, Pages 2081–2091. May 1996.

20. Basciano H, Federico L, and Adeli K. “Fructose, insulin resistance, and metabolic dyslipidemia.” Nutrition & Metabolism, (Lond). 2005; Volume 2, Number 5, and online February 21. 2005.

21. Jakobsen MU, et al. “Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index.” American Journal Of Clinical Nutrition. April 10, 2010. 2010;91:1764–8

22. He K, et al. “Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study.” British Medical Journal. Volume 327, Number 7418, Pages 777-82. October 4, 2003.

23. Su RK. “Reading List.” Carbohydrates Can Kill. Online.

24. Su R. “A Series of Blood Glucose Tests.” My Blog. August 27, 2009.

25. Su R. “Why Does Everyone Need Annual Series Of Blood Glucose Tests?” My Blog. October 7, 2009.

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