We live in a weirdly politicized and polarized time, and little better illustrates this than some of the critiques we see against the “MAHA” movement (since when did removing artificial additives from the food supply become a “conservative” issue?)
But before I get into that, I want to stress that this blog – like the practice of medicine itself – is not political. On a personal level, my politics are fairly moderate, and I have at different times in my life found myself agreeing with and voting for candidates from both major parties (and, more often, being highly critical of both parties), and I certainly have a LOT of concerns with the current administration. On a professional level, my only allegiance is to good science and good medical care. In the exam room, I am neither a Democrat nor a Republican, a liberal nor a conservative, and I’ve had wonderful relationships with patients of every political stripe over the years.
I state all of this because I don’t want what I’m about to write to be interpreted as an endorsement of any particular politician or political party. Rather, I want to highlight how reasonable scientific discussion can get dismissed as partisanship when it is offered by a politician, and to once again demonstrate just how poorly our national media does of keeping the public informed about issues of science and health.
Now onto specifics: there have been a lot of headlines the past few weeks about how Secretary of Health and Human Services Robert F. Kennedy Jr is planning to update national nutritional guidelines to “recommend the consumption of more saturated fat”. The Wall Street Journal, for example, covered the story with the following headline:
(The article then leads off with a discussion about the coming fight over how much ice cream, cookies, and pizza Americans will be told to eat).
But this is an absurd misrepresentation. Whatever you think of RFK Jr, he’s certainly NOT recommending people eat more ice cream, cookies, or pizza. Nor is he in fact suggesting that people go out of their way to eat more steak and butter per se. Rather, he is proposing to create guidelines that advise Americans to focus on eating real, unprocessed, fresh foods, with a focus on good quality meat and vegetables. And, if a side effect of that is that people eat more saturated fat, then he doesn’t object.
There is a lot that can be said about the above dietary advice, but I would note a few things:
The science of whether or not saturated fat is bad for you is too complicated to cover in this blog post. But it’s worth acknowledging that this is a controversial topic with many scientists credibly proposing over the past 10 years or so that – at the very least – saturated fat is not as harmful as previously thought. And even if saturated fat is not good for human health, in the real world nutrition always involves tradeoffs. If you replace your saturated fat with an avocado or good quality olive oil, that probably is a win. If you replace it with the highly processed and sugary “low fat” products that populate our current supermarkets, you’ve probably done more harm than good. Accordingly, there needs to be some nuance around the discussion of whether saturated fat is “good” or “bad.”
While it’s probably true that the current nutritional guidelines – which encourage limiting saturated fats as well as sugars and processed carbs – are healthier for many people than what RFK is proposing, less than 10% of Americans actually follow the current guidelines. So yes, in a hypothetical world in which most Americans were following current guidelines and eating a diet of mostly unprocessed fruits, vegetables, legumes, and whole grains, it’s possible that RFKs advice would worsen the health of the nation. But we don’t live in that world. Almost no credible scientist would argue that RFKs proposed diet is worse than what Americans are currently ACTUALLY eating. If – and I grant it’s an if – some Americans change from a diet of junk food to the one RFK is suggesting, it almost certainly will improve the health of the nation.
About those current guidelines: they themselves are the product of a political process that favored some lines of research while downplaying others. The history of this is a lengthy topic in its own right and I won’t get into it here. But it’s worth noting that things like the famous “food pyramid” were not drawn up because every scientist was in unanimous agreement, based on well done rigorous studies, about what the perfect diet is. Rather it was created by a consensus committee of selected nutritionists, with abundant input from the big food companies. Does that automatically mean that the prior guidelines were all wrong and the proposed new ones are right? No. But if we are going to be skeptical of what RFK is proposing simply because he has a political agenda (and we should be!), we ought to apply the same skepticism to prior guidelines as well which, under the influence of money from big companies and the guidance of a particular cohort of scientists who had their own biases, favored some lines of research while ignoring others.
Finally, the central piece of RFK’s proposal – to focus on eating specific foods rather than individual nutrients (e.g. “eat meat and vegetables,” not “eat less saturated fat and more fiber”) is actually EXACTLY what many scientists in the world of nutrition have been saying for years. Humans eat foods, not nutrients, and people are more likely to comply with advice that caters to that fact. Moreover, foods in nature exist in complex matrices that affect our health in ways beyond the sum of any particular nutrients. A piece of broccoli is not just fiber and vitamins; it’s a complex “package” of thousands of different nutrients that combine to create positive effects on our health. Saturated fat seems to be bad for health in certain circumstances, but accumulating evidence suggests that full-fat dairy – milk, cheese, yogurt, etc – is quite healthy for humans, despite being high in saturated fat. Ergo, it’s too simplistic to just state that saturated fat is “good” or “bad” for you. The source of the fat and the context of the overall dietary pattern are more important.
My point here is not to defend saturated fat per se, nor to specifically endorse the guidelines that RFK Jr. will be putting forward. But I do think there are some good ideas contained in what he is proposing, even while I acknowledge many well-founded critiques.
Simply stating “I voted for Trump, so I like what RFK is proposing,” or “I am a Democrat, so I oppose RFKs new guidelines” is not helpful. There is a lot of nuance and complexity to medical science, as well as much that we still don’t fully understand. Making sound decisions in the face of all of this requires a willingness to listen, to debate in good faith, and to be open to the idea that sometimes people you disagree with might have something valid to add to the conversation.
