Episode #383: Scientific Populism vs. Consensus - The 2026 Food Pyramid

25:32There's no stop signal here, overconsumption, higher calorie intake. We talked about that on the last podcast. So got to give it some credit here. They also don't condemn functionally processed foods. So things like Greek yogurt, for example, or frozen fruits or vegetables. which are technically processed, but yeah, they don't call those out, which is, which is nice. So I don't know. I view that as sort of a win. Um, as far as implementation, I have my, I have my, my skepticism there, but yeah, what do you think about, about that? Cause it's the first time I've seen that in dietary guidelines other than to say like, you know, avoid refined carbohydrates, but that's usually packed in the consensus and not like the actual document that people might read or added sugars have been, has been a well, you know, appropriately demonized thing, I think, for a fair amount of time.

26:17The problem with the processing conversation, as you've alluded to here and we've talked about before, is just one of definitions. And certainly if it's going to come to policy, because policy requires definitions. And to date remains a lack of a clear consensus definition on what is a processed or an ultra processed food that is neat and tidy and does not have some combination of both false positives and false negatives in terms of, you know, foods that we would all recognize as not being ideal for health that fail to meet certain criteria and others that clearly, as you mentioned, like Greek yogurt, for example, that are maybe technically processed in some ways that, you know, might otherwise meet certain criteria, even though it shouldn't be.

26:59So it's problematic. And I think that having clear definitions on this is going to be needed for anyone to be able to actually implement policy, especially knowing that or feeling confident that, hey, if this pisses off the wrong person. There's going to be legal challenges and then you're just in a whole mess at that point. Yeah. Yeah. I was trying to predict like what, if any sort of industry influence that this document and, and, you know, would maybe have right. Kind of, kind of similar to what happened in the nineties when the food pyramid came out and, you know, they were like, look, we gotta be low fat.

27:29Um, and the base of the pyramid is, is, is grains. And so we need to make these affordable. So, you know, some unintended consequences there. What are the unintended consequences here. Can't think of anything that comes from these, maybe the good side of the, of the guidelines. So now it's time to get into the bad. There are some things in here that have a lot of scientists and clinicians, including us deeply concerned. And so, you know, we spent the last 20 something minutes talking about, you know, how these guidelines respect the biology of the gut and the muscle. But while fixing the metabolic engine, the guidelines might have decided to ignore the plumbing.

28:06So the guidelines still recommend keeping saturated fats under 10 % of total calories. It's actually in the little pamphlet. It's also in the scientific consensus. And they acknowledge that 82 % of Americans already exceed this and that there are no biological requirements for saturated fat intake. Yet the messaging here is complicated because they're saying, oh yeah, you can use things like butter and beef tallow and eat more red meat. And to me, that is crazy. Austin, when you saw that the guidelines recommended butter and beef tallow, as well as leaning into animal-based proteins, what was your immediate reaction?

28:44Are we finally freeing the public from the failed lipid heart hypothesis, or are we watching like a populist rebellion walk us right into the cardiovascular dead end? um so i think that this is going to be an area where some people inevitably are going to just have strong opinions and disagree i just fundamentally don't think that we have been dealing with a failed hypothesis of heart disease again if you look at the actual statistics on risk of cardiovascular death it has been steadily dropping it's actually plateaued in the last few years but over the course of the last 70 years we have managed to put a huge dent into the risk of cardiovascular death through combinations of things.

29:26I will recognize combinations of less smoking, better blood pressure control, lipid lowering therapies, better treatments of acute heart attacks so they're less likely to kill people immediately and things like that. But when we survey the entire body of evidence on nutritional interventions, including highly tightly controlled metabolic ward studies and things like that, there is overall a relatively consistent directionality to it. And we have not been just like steadily marching in the opposite direction up until this point where they've like inverted things and set the course more correct.

30:02So I, you know, part of my problem with this is that it's just kind of incoherent in the sense that if you're advising people to crank up the butter and beef tallow, yet also to keep their saturated fat intake less than 10 % of calories, that's quite challenging, right? It, you know, Meeting that guideline is going to necessarily require you to opt for generally quite lean sources of protein if you're going to be relying on animal-derived sources. If you end up going with fish or other things, then that's great, and that's arguably even better in a lot of ways. But it's just if you think that guidelines drive behavior, right?

30:41And so that's one of my challenges to folks in this space is you claimed that the old guidelines caused the obesity epidemic. Now we have these new guidelines that you are a big fan of and I should expect will fix the obesity epidemic. Please set some explicit outcomes that you will be looking for. What will you be measuring? what time point do you expect this to happen by, and then we will assess at that time point. The caveat will be we need to make sure that the outcomes that we observe are not better explained by the use of GLP-1 agonists. That's been my hot take to this point, is if you think this is going to radically improve outcomes, for example, when it relates to heart disease risk, show me your predicted outcome and what you're looking for.

31:29Basically, pre-register your hypothesis. That's like a fundamentally scientific principle, right? That's how a lot of studies, when they get pre-registered, it says, here's our hypothesis, here's what we think is going to happen. And you say in advance, if this happens, our hypothesis will be supported. If this happens, well, I'll have to reject my hypothesis. The problem is that people don't operate this way. People who are fans of beef tallow are going to be fans of beef tallow no matter what happens over the long term, no matter what I say, no matter what you say. That's just the tough thing here.

31:56But my issue, again, is just the incoherence of it and the fact that I don't think that most people are going to be able to, even if they wanted to use these guidelines, design a coherent diet that leans into butter, beef tallow, and high intakes of red meat while also meeting the 10 % saturated fat guideline. One of those things is going to fail. Yeah, I agree. And it is interesting. This is like the start of the disconnect between the scientific consensus, again, this 400-page review of the current evidence to date by a panel of experts, right? Many experts and millions of dollars spent to do that.

32:32They acknowledge that, look, the primary contributors of saturated fat in the current American diet are burgers and sandwiches, desserts and sweet snacks, you know, and other mixed dishes. and they also acknowledge that reducing butter, red meat, whether it's processed or unprocessed, and replacing them with plant-based sources, that lowers cardiovascular disease risk. You should encourage beans, peas, lentils, et cetera, and monounsaturated and polyunsaturated fats. They go through all this evidence, right? So they're saying on one hand, like, we should probably reduce beef tallow, butter intake, and red meat intake, just generally speaking and shifting towards this other type of dietary pattern.

33:09The pyramid is like, nah, dog, I got this, watch. Instead of like making a case for why using beef tallow and butter would be health promoting, it seems like an add on like the rest of that whole section reads very similar to the consensus, which is like, yeah, we should probably avoid this stuff. Limit saturated fat. Choose these other options. And instead of like, no, no, no. But you can also have beef tallow and butter. It's like, to your point, incoherent. Because like, how do you how do you square that? You know? Yeah. I think that this is the result of what we'll call post-processing. After emerging from the scientific committee, the post-processing of this by the subsequent actors in this space who have certain biases and preferences and motivated reasoning, and they like beef and steak and aggression and manliness and things like that, all these kind of ideas that they want to bake into their guidelines as part of this whole kind of performative thing for spectacle.

34:02That's my perspective on it. Yeah. Yeah. Yeah, there's another interesting kind of wrinkle here. It's like this dairy hall pass. The committee found some moderate evidence that substituting red meat for dairy reduces heart disease risk. But it seemingly made its way to the new food pyramid in a very interesting way by pushing full fat dairy, specifically whole milk and cheese. I got a big concern that this may increase calorie density unnecessarily without significantly improving satiety markers. is just how full people get. Like, are people just gonna eat way more calories? And also full-fat dairy can be more rewarding than lower fat options.

34:42So we both know that the literature on full-fat dairy is pretty messy. There's just a ton of confounding variables. So like socioeconomic status, who buys low-fat or fat-free dairy, who consumes whole-fat dairy and more. Still though, when the food pyramid tells people to go full-fat for dairy, are they ignoring the fact that whole milk essentially provides a high reward, potential calorie bomb that might exacerbate the 500 calorie surplus that we're trying to fix? I think it's a maybe. It's just something that's like I'm open to seeing kind of what happens. Again, I don't think people are going to use these guidelines for their behaviors.

35:16They're going to pick what they pick regardless of what these things advise. But there may be some sort of like cultural shift. I fully recognize like when we were growing up that, you know, things were definitely leaning towards the skim milk direction more heavily. And so if there's a broader shift in the public conception, then yeah, that might impact behavior. You're right that there's going to be an energy, overall calorie impact on that. The dairy's whole topic is pretty interesting. We've talked before about how most forms of dairy, including full fat forms, with the exception of butter, don't actually tend to be especially harmful in the context of, say, blood lipids and cardiovascular disease and things like that, whereas the churning process that turns it into butter has some impact on the chemical composition, and then that has some downstream impacts that are kind of net harmful on blood lipids and cardiovascular risks.

36:02So we'll have to see what happens on that front, but I agree. There's a non-significant difference in calorie density, which seems to be a pretty major problem that we're trying to deal with. The reward aspect, yeah, I mean, no doubt that drinking a glass of whole milk is pretty thick and rich and heavy and tasty when it goes into a milkshake, much more so than skim. You also wonder to the extent that a person is sensitive to satiety signals, is there some kind of compensatory effect? We know that doesn't tend to happen with other forms of like liquid calories. Does it happen a bit more with milk?

36:35Maybe. I have less strong opinions about this in general compared with some of the other areas of the guidelines though. What do you think? Yeah, I think if they said, look, dairy's generally good. I'd be like, yeah, I agree. But the idea of pushing the full fat variety in particular is team. Yeah. I'm just like, why? Like my prediction is that you would either have a neutral effect on body weight management or a negative one, not likely a positive. That seems highly improbable to me. I think also, you know, recognizing that it's seemingly dairy sans butter seems to be pretty neutral or perhaps even beneficial on blood lipids.

37:16Yeah. I'm all for dairy. Let's do it. but I just think explicitly trying to recommend full fat versions, it just doesn't really make sense to me. I think it's almost like the pendulum swung too far the other way. It's like, look, we've been doing low fat, fat free, and a majority of the low fat, fat free products that were, you know, designed in the nineties ended up having added sugars and stuff like that. I think most people who are in this space would say, yeah, that's, that was bad. Generally not good. People overeat those things, but I don't think we have to apply that specifically to dairy.

37:47And, you know, we have hopefully functioning synapses and can like discern between two different cases. And you would have hoped for better considering how many people are, you know, taking in this information. But I think nothing surprises me anymore. This podcast is brought to you by Biggs. At Barbell Medicine, we spend a lot of time talking about what it takes to build a body that can handle high level performance. But the recovery and health side is just as critical. Over the last six years, an incredible team of healthcare professionals did something that most people thought was impossible.

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40:08When people say the standard American diet, they're not referring to guidelines type dietary patterns. It's just what people normally eat. Well, that P to S ratio is really low, mainly because we consume a lot of saturated fat relative to polyunsaturated fat. The current ratio is about 0.5 and we're really aiming for one or even two. But when that ratio is low, dietary cholesterol can increase blood lipids quite a bit. And now with the recommendation that beef tallow and butter are fine, this could be an even bigger problem without any comment on dietary cholesterol. Austin, what do you think?

40:40Is the, you know, no mentioning of dietary cholesterol a big issue or are you just like, well, look, no one reads the guidelines anyway and no one would care, so it's fine. I do feel like I keep coming back to saying nobody's been reading these or acting upon them and I do continue to stand by that. My issue with, you know, the idea that maybe we should have mentioned something like that is, Also, a broader concern about how guidelines should be communicated to the public. Should it be, on one hand, in terms of foods, or should it, on the other hand, be in terms of nutrients? So when you tell a person or the general population who you should assume are not highly educated in this space that you should consume less saturated fat, that is completely meaningless to people out there, right?

41:25So that is a nutrient-based dietary recommendation that nerds, bodybuilding bros, scientists, we understand, but the general population does not operate on a kind of nutrient-based model of diet, of nutrition. That is not where their understanding comes from. And so I don't think that public health dietary guidelines should be rooted in nutrient-based communication to say things like sodium or saturated fat or cholesterol or p to s ratios or things like that but rather it should be fundamentally i think food-based so eat more of these foods eat less of these foods ideally eliminate these foods part of the problem though is even if the scientific committee were to establish statements like that in their you know statement to say that these foods should be prioritized these should be reduced these should be eliminated, there's still, again, that subsequent layer of filtering that these go through before they're communicated to the public where various actors and industry influence and USDA and things like that have an opportunity to either soften some of that language or shift it actually to some of this nutrient-based labeling or kind of recommendations that kind of give them more space to operate here.

42:46So it makes it so that, for example, food industry might then be able to reformulate their food product to meet something that is more nutrient-based while still being a food that probably shouldn't be eating, right? Or they might give them kind of a little bit longer leash to operate in that space compared with if it was just like, hey, probably shouldn't eat this food. Yeah, that might have a more dramatic impact on their bottom line. Yeah. Yeah. I think if I had to buy my druthers, the phrase that you love that I say, you know, there are like various pages in this food pyramid. And, you know, it'll start out with like energy, and then it goes to protein and then it goes to fruits and vegetables.

43:21And so to your point, I agree. The majority of what's on that page should be eat this, eat more of this, eat less of that. And then it should ideally be accessible for most people, whether high income, low income, and everything in between. I would prefer that at the top of that page or the very first bullet point to have some sort of like maybe, it's not science sounding, but like just discrete statement. So for example, in the fat section, we should limit saturated fatty acid intake. Like eat more of these foods, eat less of these foods, and here are some like fringe cases. Mainly to like make it clear and ultimately you're trying to increase the skill set of the people who are consuming this information of navigating a label in our current environment.

44:03Or at least just having some fund of knowledge stuff so where they could like assess something that's not immediately clear to them. Like, well, this has a high amount of saturated fat. The food guidelines didn't say anything about saturated fat, so I'm kind of like up a creek. I mean, obviously, that's a relatively rare case. The person read the food pyramid and the guideline, and then they're ultimately, you know, making this, having this question. Yeah, that's just, in my perfect world, that's how it would look like. Yeah, I think that's a reasonable take. The art of public health communication is complex, and there's a lot of those implicit decisions that need to be made.

44:35And it can be challenging if you don't have active knowledge or expertise in this space, because you might be like, well, I understand this stuff really well, and here's how I I'd communicate it. And that might not land at all with the, you know, the person in front of you or with the broader public. Yeah. I'd be very curious to know how this was like workshopped. Like they had a focus group after focus group after focus group. And at the end, the focus group is like, we get it. Beef tallow. I'm taking a bath. All right. So we've talked about the good, we've talked about the bad, and now we've got to talk about the ugly.

45:04We went into the weeds of lipidology, talking about all sorts of stuff related to P to S ratio, saturated fat, et cetera. But maybe there's a hidden cost to this saturated fat endorsement that goes beyond the cholesterol panel. When the cultural narrative shifts so aggressively towards red meat and animal fats, it could create a retreat from plant-based foods. Now, we know that meat has exactly zero grams of dietary fiber. We also know that only 6 % of Americans currently meet the recommended intake for dietary fiber. By prioritizing meat for protein, the guidelines could be contributing to a massive fiber intake delta.

45:40And this may be like a sort of substitution trap. In 1992, the original food pyramid, we substituted fat for refined grains. In the new guidelines, we seem to be encouraging people to ignore great sources of fiber that were prominent in the previous guidelines, like beans, peas, lentils, et cetera, and instead choose more calorie-dense, zero-fiber animal proteins. Austin, are we watching the government repeat the exact same mistake of 1992, where they focused so hard on one variable, protein, that they inadvertently create a whole new public health crisis in the form of a 25 gram per day fiber gap?

46:15I don't know that they're going to be creating a new public health crisis as a result of a fiber, you know, insufficient fiber intake, because most people are already consuming insufficient amounts of this fiber in their diet. There would be, you know, certainly a strong case to be made for potential health benefits by significantly increasing that intake from a variety of plant-based food sources. And I would say that that reflects probably the most substantial change in like my own habitual dietary pattern in recent years, yours as well to some extent, you know, more strongly leaning into a lot more plant-based sources of all sorts of, you know, nutrients, including protein and fiber and things like that, just based on our understanding of the evidence and kind of where it's been.

46:57And these are not actually based on new findings either, but just kind of becoming more familiar with this whole body of evidence. So I don't know that these guidelines represent a clear shift away from high fiber foods, more so like insufficient prioritization of those that would represent good sources of dietary fiber, because they're not recommending against the consumption, for example, of legumes or lentils. But if you look, it's like it might be implied that they're not, you know, placed as high on the, you know, this inverted pyramid now, with the base being at the top, oddly. And so this is in the face of pretty abundant available evidence that we have in terms of food substitutions that substituting super fatty cuts of meat for some of these plant-derived food sources has a host of health benefits on people.

47:48And they, in fact, do not become acutely protein deficient or chronically protein deficient by making such a substitution. A lot of things tend to improve. So again, fundamentally, people aren't reading or listening or paying attention to the guidelines to make their decisions. If they were, I still don't know that this is going to be like, you know, open up this new health crisis as a result of poor fiber intake because most people aren't consuming enough anyway. would I prefer and I think you would as well that uh the shift and the nudge and the encouragement have gone in the other direction of you know more people would stand to benefit from the inclusion of these foods on a regular basis in their diets recognizing that like legumes are honestly you know super culturally prominent in some parts of the world and not terribly so in the U.S.

48:30and we would actually stand to benefit by you know increasing their prevalence in our habitual diets for for a lot of reasons yeah I think we would both prefer that for a lot of potential health benefits. That's not the way that they went. I, again, my pre-registered hypothesis here is that that choice is unlikely to, you know, make a hugely deleterious impact, just as I would predict that if they had emphasized it more, I'm still not sure it would have had a hugely beneficial impact either. Yeah. You imagine though, so they bumped the protein intake up, right? And let's say they made this pyramid and where that steak and that cheese nugget in the chicken it's just a big bean instead like look we want you to eat more protein primarily by increasing your legume intake like eat more edamame yeah they you know we're you're taking um a subgroup of vegetables and you're combining to a subgroup for protein foods and like ultimately the increase in fiber would be generally good uh did you ever watch the netflix series travelers the travelers all right so you know i don't no spoilers here on the barbell medicine podcast we don't do any spoiling uh but basically these people from the future come back and they try to prevent the end of the world right and they're like yeah standard story and something i would definitely watch you would you would like this series interestingly they're all vegans in the future and they come back and the idea they look around there's one scene they're looking around everyone's eating meat and they're like this is barbarians yeah but i think that kind of that kind of like touches on just most people who go down this you know health fitness wellness this sort of rabbit hole, particularly with formal education and, you know, review of the evidence, you tend to shift towards having more plant-based food in your diet.

50:16It doesn't mean you necessarily switch to a vegetarian or vegan, but you include more because you just, it's overwhelming. You just can't ignore it. Like even with the most, I'm good at rationalizing. I am excellent at it, but I cannot rationalize away all of that evidence. And so, yeah, that would have been interesting if the food pyramid it's like yeah we flipped it upside down now it looks like a piece of pizza but the top corner this is huge bean it's like yeah that would have been interesting so also this ignores anything about like planetary health uh which we are not experts in but like to the extent that this changes that at all some concerns some concerns there all right so we're we're still in the ugly section here there's some non-nutritive sweetener hate here which why like it i think you There are issues with the evidence on non-nutritive sweeteners, mainly because when you look at it, by and large, they do not discriminate between where those non-nutritive sweeteners are coming from.

51:15Meaning like there are many ultra-processed foods that, again, low, not very filling, high in calories, contain a bunch of stuff that you probably don't want. You go, oh yeah, by the way, you're going to eat too much of it, that have non-nutritive sweeteners. And they're artificial sweeteners or naturally occurring sweeteners that still don't have any calories. And so if you compare somebody who's eating a lot of those to somebody who's eating none of those, you're like, see, non-nutritive sweeteners, terrible for you. Instead, if you just restrict your analysis to people that are eating foods with added sugars or consuming drinks, sugar-sweetened beverages being the most prominent, they're replacing those with non-nutritive sweetened beverages, there's an improvement.

51:54And so it just seemed weird. Like, again, this is a pretty short document. why even waste the you know the text on this there's so many other things like it just seemed like a weird kind of line in the sand to draw and like not accurate also yeah i think you know anybody who's taking an honest look at the overall body of evidence and uh about these in particular but also about like the state of public health in general is going to have a hard time making a case that the use of non-nutritive sweeteners in general or any one of them in particular is like contributing to a large fraction of like public morbidity or premature mortality or something like that so i agree i wouldn't waste my time worrying about these yeah in fact i would have done the opposite more diet cokes sure yeah let's do it uh then this other weird thing that falls definitively in the ugly sort of category there's this retreat on alcohol it went from two drinks for men one drink for women um which admittedly is not great because like what is a drink there was no like this is a standard drink, but whatever guidelines.

52:54And now it's to a vague consume less because apparently it's a social lubricant. While the less is better, that's certainly true. This shift towards vagueness is like a classic policy pivot. It's lip service that avoids holding the industry accountable while leaving the consumer without a concrete target, just less. Again, I would prefer it say like, generally speaking, alcohol is not health promoting as little as possible. Like that'd be fine. It'd probably, you know, anger some people that probably contribute to the development of these guidelines, but it would also have the benefit of being accurate.

53:27Yeah. And also Dr. Oz wouldn't be like a meme right now. So bizarre. Yeah. It's honestly, it's like, what is your job? What are you being asked to do? What are you charged with? You are not here to be the secretary of social lubrication. I'll say that, right? If you were, then that would be your primary charge of finding all the things that confer that supposed benefit almost independent of their potential risks. And then you can state your case and you can be part of a committee. And you're like, well, I'm here from the standpoint of social lubrication and here's a beneficial thing. And then you can debate with people from the other side who are just like, nah.

54:08But it also leads to increased risk of all sorts of downstream health consequences and problems. And then you can hash it out and see which has the greater net benefit or net harm, which I think is not a controversial thing for anybody taking an honest look at these. So this is just an example of that kind of going from the scientific committee level to the post-processing, the filtering, how language can get weakened and massaged a little bit based on the stakeholders and who's involved in that decision-making to make these guidelines ultimately a bit impotent by the end, just to, you know, less.

54:41It's like, yeah, a lot of people get told that they should probably drink less. This is often not news to them in many of these situations. But that's not the purpose of these guidelines, and nor are the guidelines intended to help socialize the population. Yeah. Yeah. Look, if there's a department for social lubrication, I'm signing up. You're here for it? Well, I'm here for that and Space Force. I'm signing up for both. All right. So the other ugly part, and perhaps the most interesting to you, Dr. Baraki, is the uptake and the potential for that. So first off, what do these guidelines actually do?

55:16Most people think these guidelines are just a pamphlet for doctor's offices or something to post up in the school cafeteria. But in reality, they are the budgeting blueprint for billions of dollars in annual federal spending. So we've got the National School Lunch Program, 30 million children, feeds every day. You got the WIC program. You've got SNAP, Supplemental Nutrition Assistance Program, military rations and VA hospitals. This could theoretically affect a lot of actual meals going in actual bodies every day. To the extent this changes, so now like all of the French fries served in the school cafeteria are there, you know, from tallow.

55:56Like what? or like you can't get diet soda anymore because non-nutritive sweeteners generally bad like again what like some of this is hyperbole but it's like the same amount of hyperbole from the other side of the coin i shudder to think what these changes would actually have on the national school lunch program because if the current budget is x right you get this amount of money and now we're protein's got to go up specifically from animal sources, which are generally more expensive. Oh, by the way, no non-nutritive sweeteners. You can't use, can't use any of those. Um, and we're going to cook in beef tallow and butter.

56:33And it's like, so it's gotten way more expensive and like less health promoting. Doesn't seem like a win to me. I'm going to come back to my hot take from earlier. Tell me what outcome you're hoping to impact by making this change, right? Here's the outcome that I'm looking for. Here's what I expect is going to happen. Here's how long I expect it's going to take for this to manifest wholesale, right? I expect to see children's health improve in this way. I want to see children's blood pressure come down, their BMIs or their growth charts that they'll fall back onto a healthy part of the growth chart, childhood obesity will go down.

57:09These are all the things that I'm expecting will happen as a result of me switching to cooking fries and beef tallow and these other sorts of things in schools. If that happens by this date, that will reinforce my hypothesis. I'll pat myself on the back and we'll carry on. Okay. If it does not happen, I will be forced to reject my hypothesis and we will alter the plan, go in a different direction, test an alternative hypothesis or revert back to what we were doing before. They won't do that. People will not pre-register their hypothesis like this, but that would be how I would charge them with these kinds of things.

57:40If they are put into positions of power with the ability to impact these policies, then that's what I'm looking for. That's what I want to hear. Yeah, and that's just like federally subsidized uptake. What about the actual uptake in the public? To me, this also raises just the price point of eating a guidelines type diet. You know, they talk about protein floor and moving away from shelf stable refined grains. They're making a massive assumption that the American consumer can't afford to participate. If you've got time to prep, quote, real food and a budget for 1.2 grams of protein per kilogram body weight per day of high-quality animal protein, look, you're in.

58:19You're in the club. Whereas most vulnerable populations are in low socioeconomic status brackets, these guidelines don't look like a map at all. They look like a wall. Now, the previous MyPlate guidelines, it was estimated that this would cost about$1 ,200 a month for a family of four. That's the previous guidelines, right? would definitively be cheaper than these current guideline-recommended foodstuffs. The food budget, on the other hand, for the average middle-income family in America is$518 a month. For low-income, it's$322 a month. This is a budgetary crisis. Protein, animal sources in particular, the prices are forecasted to rise.

58:58Plant product prices have been relatively stable price-wise. Also, ironically, legumes are incredibly cheap. Yeah, 100%. Yeah, there's a lot of specialized niche or unique scenarios that are not addressed here. They're just like fundamentally excluded or not recognized. And that's honestly where skilled dieticians are so valuable is by recognizing and having solutions and ways to improve the nutrition and health of these selected situations that people have. Maybe socioeconomic in nature, maybe medical in nature. And you're right that many of them are just not at all addressed by the guidelines.

59:39You're just kind of like out of the club, unfortunately. Sorry. Yeah. Yeah. Thanks for playing. And then finally, again, probably your favorite part of this entire podcast. No one follows the guidelines. Researchers often use this metric called the healthy eating index to measure adherence to dietary guidelines on a scale from zero to 100. The average American score has hovered around 56 to 58 for decades. Interestingly, since about 1999, these healthy eating index scores have actually improved slightly, reading slightly more whole fruit and fewer empty calories, just a little bit. Yet obesity and metabolic disease have increased significantly since that time frame.

1:00:20Data shows on average only about 10 % of the population follows the guidelines with any consistency. Now, this is based on like surveillance data from questionnaires. They're not like following people around and like, oh, you ate that. So this is self-reported, by the way. It's probably like the physical activity guidelines. It's probably half that, if that. So maybe 5 % charitably. For the other 90 % or 95%, the guidelines are just background noise in a food environment that's screaming at them to eat more and eat stuff that's not on the food pyramid anyway. So, like, I don't know how many millions of dollars were spent to formulate this thing.

1:00:54But like the two potentially good things compared to the bad and the ugly, I'm like, it feels like that money could have been better allocated. You know, like an exercise promotion one. If RFK Jr. and the Maha movement was like, we got to exercise and we're going to take all this money and do this. We might not agree with the implementation, but we'd find a lot less to be like, look, and you did this wrong too, I think. Yeah. Yeah, I have little else to add at this point beyond, you know, pay attention to the trends, the trajectories, the outcomes, adjust for the impact of, you know, biomedical innovation, science, GLP-1 agonist, things like that.

1:01:36And then be prepared to change your opinion if things do not go in the direction that you expect in the coming years to decades. That's a long enough time horizon that, you know, by the time it becomes abundantly clear whether this is working or not, people will have forgotten this saga anyway. Um, so I, I continue to lack a great deal of optimism on that front either, but I, I wish that there was more kind of intellectual honesty, logical consistency. Um, you know, there's other areas of this, of these guidelines that for example, criticize the use of absurd observational data in one realm while heavily leaning into observational data in another realm.

1:02:12Um, and so just the, the logical incoherence and inconsistency of it, I think is what is probably most frustrating because I know it's not going to get better. Yeah. Yeah, I think there's some argument here that these guidelines are kind of a form of policy lip service. By providing this like what to eat framework, the government places the entire burden of health on individual choice. If you get sick, the government can say, well, we told you to eat all the protein and avoid the ultra processed foods. It's not our fault. Your fault. This, of course, ignores the upstream policies that dictate what food is available.

1:02:44And the new food pyramid doesn't fix the farm bill. It just changes the educational advice. Educational, doing a lot of heavy lifting in that phrasing. So Austin, we're looking at a nearly$100 billion policy shift here. But when we look at the HEI scores, we see that the average American is basically failing a nutrition test every single day. Is the new food pyramid actually designed to change the American diet? Or is it just a political rebrand that allows the government to look busy while the underlying food environment, the subsidies and the ultra-processed food availability, remain completely untouched?

1:03:17I don't actually know that the underlying food environment is going to be completely untouched. It may be the case that some incentives change, realign. There might be some food reformulation. I hope not, but maybe even to more align with some of this stuff of like, you know, there's some of these restaurants. Like you look at, I think it was Shake Shack or something that said like now 100 % beef tallow, steak and fries and stuff like that or steak and shake. Sorry. Don't don't sue us. Whoever I, whoever I said. I'll cut that out. And so there's, you know, there's, there's some impact on things.

1:03:45Um, I, it's just hard to predict what the impact is going to be when historical uptake of these guidelines has been relatively poor. You're right that, you know, as we've talked about on our last podcast as well, the availability of calories and the way that those calories are packaged and delivered our surrounding food environment dictates way more of our routine, habitual, uh, food related behaviors and our eating behaviors much, much, much more than any graphic, any guideline, any label that slapped onto the side of a cereal box or milk carton, as we learned when we were kids, too. And so this is ultimately a bit of a shrug for me.

1:04:25I think that there's just a lot of moving parts here between guidelines, how that impacts policy, the biomedical space, and our best attempts to fight back against these things. We're trying to hold back the doors with our meager tools like trisepatide and things like that. So ultimately, where it all shakes out is going to obviously remain to be seen. And then, you know, in another five years, uh, who knows who's going to be in power, writing these guidelines, designing these guidelines, and we might be, I don't know, back to square one again. Yeah. I'll be curious if there's any impact on these new guidelines, the new food pyramid on that, you know, big food, uh, trial that we talked about in the last podcast is like, do they enter this as evidence?

1:05:05Like, look, even the government admits this is problematic. Uh, that would be interesting. And the subsequent downstream effects from that, or even upstream, like as far as policies related to subsidized crops and such, but then there's more complicated food insecurity, so on and so forth. To me, I don't know, this is maybe a little more hokey, so you can roll your eyes if you like, or maybe you agree. I think if you put the American public in a room, you somehow got them all in a room and you said, look, what do we agree on with respect to nutrition? Everyone would agree, look, if you live here, you should have the opportunity to eat a health promoting dietary pattern.

1:05:40We want our food supply to generally be healthy. We don't want too many restrictions because this is the land of liberty, so we want to be in charge. But we also want our basic food supply and water supply and everything else to be healthy, especially for children and vulnerable populations. I think everybody would be on board for that. There might be one straggler who's like, nah, make it unhealthy. It's like South Park riders, for example. I think you're less likely to have people who say, no, make it unhealthy, but more so people who are like, no, I'm not willing to pay for it to be healthy.

1:06:07Yeah, yeah, yeah. way more common. You achieve that, and that's where people would start to disagree. But if this food pyramid came out and was like, look, we want everybody to have the opportunity to eat a health-promoting dietary pattern. Here's how we think that should be laid out, and here's how we're going to do about it. Yeah, people would disagree, perhaps, on the implementation, but there's this opportunity for cohesion and unification. Like, look, we're all in this together. Let's work together. But instead, they chose violence. They're like, nah, we're going to lean into this heavily meat-focused thing.

1:06:33We're going to make some strange choices about saturated fat intake and ignore, you know, mountains of research on, on fiber and, and, and legumes and such like that just seems like missed opportunity. And also like one mention about exercise. I don't know. It just could have done better. That to me is we could have done. Well, I mean, always could do better. These things are going to continue to evolve with time. I think, you know, whether this ends up being a more consistent trend or whether this ends up being a blip kind of depends on, uh, you know, how we vote in a couple of years. So TBD.

1:07:03TBD. All right. So what I did, we've talked about the new food pyramid and old food pyramids and everything else. I thought, well, what if we were tasked with coming up with our own version of a dietary guideline? Like, no, we don't have a multimillion-dollar budget to recruit the best interdisciplinary team available to help us out. Then again, the new food pyramid seemed to ignore most of their experts anyway, so we could just be in the clear. Instead, yeah, we've taken the latest evidence surrounding dietary practices and boiled it down to the barbell medicine dietary guidelines for Americans, particularly adults.

1:07:37Our philosophy is pretty simple. Dietary behavior isn't a matter of willpower. It's an emergent process. It happens when your genetics and your subconscious appetite regulation collides with the food environment that's been engineered to be frictionless. So a few points here. First off, we're starting with energy and the environment. This needs to be a reality check. Again, this is an emergent process, like how much food we eat. And so we need to, to the extent it's possible, to modify our microenvironments, what happens at home, what happens at the office, so on and so forth. We would like to make those foods rich in either minimally processed foods or processed foods that don't have added sugar in them or are hyperpalatable, very tasty, and have a lot of calories.

1:08:18To the extent we can do that, that would be awesome. We would also want to make sure that folks are eating in a way that's not distracted. So no screens at the table and oh yeah, by the way, ideally eat at a table if you can. We think that should result in a better amount of energy intake or calorie intake by default, meaning that you don't have to weigh and measure every single thing, log everything into an app. But if you wanted a calorie target, there are opportunities and resources for that. We have our own calorie calculator you could use if you want. For protein, 1.2 grams of protein per kilogram of total body weight per day is fine.

1:08:50that can go up to 1.6 grams per kilogram body weight. That's fine for most. It could be higher if you train hard or if you prefer a higher protein intake. Nothing really bad is gonna happen. It's just gonna cost more money. And further, where we deviate from the new food pyramid is that the source doesn't really matter as much as the total number. We do agree you should prioritize lean protein, particularly unprocessed sources, so chicken breast, fish, legumes, Greek yogurt, tofu, et cetera. And yeah, we would lean heavily into more plant-based proteins, particularly because the fiber intake also relatively cheap comparatively.

1:09:26Next, moving on to fruit and vegetable. The current guidelines say, look, get at least three servings of vegetables and two servings of fruit per day. We wouldn't disagree with that. We would just say, try to have more if you can. And it doesn't matter if it's frozen or fresh, just have more and vary them as much as possible. We want folks to target at least 30 to 40 grams of fiber per day, which I think is another thing missing from the current guidelines. Just put it out there. It's a number, but some people would be interested in seeing that. Other thing to include here is that whole fruit is better than fruit juice.

1:09:58You could blend it if you want to because that preserves the fiber, but juicing removes the pulp. It can be frozen fruit as well if you want to do this. For carbohydrates, two rules of thumb that Austin talked about in a recent fiber - The biology of both comparing the grams of carbohydrates to the grams of fiber, and those two ratios are 5 to 1 and 10 to 1. If a food has a ratio of 5 to 1 grams of carbohydrates to grams of fiber, that makes it an elite choice. We're talking about things like lentils, raspberries, non-starchy vegetables. If a carbohydrate source has 10 grams of carbohydrates to at least 1 gram of fiber, that is acceptable.

1:10:36Likely a processed food or a starchy carbohydrate, both of those can help you meet your health goals. For fat intake, we would recommend to reduce the fat intake from red meat and also butter, also beef tallow, if we're being explicit here. If someone is looking for a numerical target, it would be less than 10 % of total calories from saturated fat. You don't need to micromanage and specifically count milk or yogurt if you don't want to. In fact, I think most people shouldn't be micromanaging their saturated fat intake. We would also advise to limit dietary cholesterol if you're at high risk for heart disease and focus on increasing the intake of polyunsaturated and monounsaturated fats from like olive oil, fish, nuts, etc.

1:11:17Ultimately, to reduce the risk of heart disease. With respect to ultra processed foods, we would agree with the current guidelines to limit them, particularly foods with added sugar. So you can look on the label for syrups, things that end in OSE and so on, particularly liquid foods that have added sugar like sodas, for example. So soft drinks, also sweetened cereals, instant soups, frozen pizzas. Check out the label. On the other hand, we disagree that people should inherently limit non-nutritive sweeteners, especially when we're talking about liquid foods. So replacing sugar-sweetened beverages like sodas with the diet versions can be useful, but ultimately, if we're going to keep coming back to the same thing, your diet probably shouldn't be that sweet overall.

1:11:56Moving on to alcohol and sodium, I think the recommendation of limiting alcohol intake to one to two standard drinks per day or abstain is fine. It increases the reward value of food, provides non-filling or non-satiating liquid calories. So you'd want to balance that against any perceived benefits. But ultimately, if somebody's not drinking already, I don't think that there's a health benefit to starting drinking. And generally speaking, less alcohol is better. For sodium intake, we would recommend to attack this by reducing intake of ultra-processed foods, especially those that have a lot of sodium in them.

1:12:31That's the primary source of excess sodium in the diet as well as an increased calorie intake. So you come at it from both of those ends, eating less calories overall based on a better dietary pattern that defaults to a more correct energy intake and also reduction in ultra-processed food intake, reduces sodium intake. That doesn't apply to athletes. Their sodium needs are highly variable, and that's outside of what would be the dietary guidelines for Americans. There'd be dietary guidelines for athletes, for example. We have a hydration podcast we can refer you to on that. And finally, for supplements.

1:13:03Now, look, you're like, look, these are dietary guidelines for Americans. Why the heck are you talking about supplements? Come on, man. Well, look, 75 % of Americans take dietary supplements every year. It's a$35 billion a year market. We want to make sure that people are doing so responsibly. So a few things. One, you'd want to make sure that your supplement that you're taking is third-party tested. The biggest sort of players in the space are NSF, Informed for Sport. That's who we use. USP. This is going to be on the label somewhere. If it's not on the label and you still have questions, you can search these databases to make sure that they are third-party tested.

1:13:36You'd also want to make sure that your supplement is certified for current good manufacturing processes should also be on the label. It appears as a CGMP sort of shield type thing most of the time. And then after meeting those two criteria, there should be good evidence for not only safety, but as well as efficacy. Does it do the thing that you're taking it for? If a supplement meets all of those, we're probably in favor of you doing so if you want to spend the money. Fortunately or unfortunately, depending on what your perspective is here, not a lot of supplements fit all those. So your supplement bill would be maybe less than you think.

1:14:13But on the other hand, if you own a supplement company, you probably didn't like that section. Yeah, I think that's fair. That's my similar take on the approach to supplements is like there should be a concrete benefit that I'm looking for that for some reason is applicable to me. And I want to feel confident that it is going to deliver that to me and that it is going to be safe in doing so. And I don't know, there are very, very few supplements that meet those criteria. I even kind of shrug at taking creatine myself, not much more beyond that. Your brain health. Yeah, sure. Your brain, come on.

1:14:47How are you so smart without creatine? There are certainly some supplements that have maybe some more benefit for unique scenarios that don't necessarily apply to me that, you know, I'd be open to discussing with somebody on a case by case basis. But, you know, overall, these guidelines are reasonable. I think that they reflect a lot of how you and I both tend to eat. I would say, you know, more plants, more training, less sugar, less alcohol might be an even simpler way to distill things down for a lot of people that would have like a net benefit on population health. I would feel more confident that if I said like those four things that there'd be a bigger shift in population health if they were to uptake it than by leaning harder into beef tallow.

1:15:25But that's my hot take for this one. Big bean energy. Yeah. All right. Well, as we wrap this up, I'm struck by a sense of deja vu. In the 90s, we were given a map that ignored the biological reality of refined grains because it was more convenient for the economy. Now we're being given a new map that corrects the protein error but seems to ignore the reality of lipidology, fiber, and food practices of the American public in general, all while creating division in the public. The reality is that the new food pyramid is mostly the same. It's mostly fine, and it likely won't change how people eat in America.

1:16:01Now, at Barbell Medicine, our guidelines are born from the existing evidence base and our experience in the field. We focus on things that actually move the needle if people were to do them. So things like environmental mastery, a protein recommendation that supports muscle and training, a fiber-to-carb ratio that protects the gut, and a P-to-S ratio that guards the heart. Now, if you want to take a deeper look at the Barbell Medicine Dietary Guidelines, we've put together a comprehensive resource on our website that will be available soon. It'll be in the show notes as soon as it's ready. If you found this episode helpful, please share it with a friend or a family member.

1:16:33The best way to combat a rigged food environment is through community and shared evidence. While you're there, leave us a five-star rating and a review. It really helps drive traffic to our podcast so we can keep bringing you all the latest nuance in health and fitness. Special shout out to Dr. Austin Baraki for joining us. I'm Dr. Jordan Feigenbaum. We'll catch you next week and every week right here on the Barbell Medicine Podcast.