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Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

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Episode 149
The Doctor's Farmacy

Why the US Dietary Guidelines Don’t Apply to 90% of Americans and How They Can

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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The dietary guidelines laid out by the government are conflicting with good health in so many ways. For one, they are recommendations that would only work for someone who is already healthy, yet close to 90% of our population in the US is metabolically unhealthy. They also don’t take ethnicity and socioeconomic status into account, among many other factors. 

This is a big issue. Clearly, we should be providing Americans with guidelines that will actually serve their health. And research shows that whether we like it or not, as a society we’ve followed the guidelines over several decades and suffered the consequences with worsening health. 

Today’s guest has been a huge inspiration to me, as she’s challenged the conventional wisdom on nutrition and continues to expose the truth behind our guidelines and the food industry. 

Nina and I dive right into the many ways in which our dietary guidelines are broken. For example, the current framework recommends 3 servings of refined grains and 6 servings of grains total, every day, and states that 10% of our calories can come from sugar. These are awful suggestions for people with type 2 diabetes and other metabolic disorders, which are rampant in the US. And since 1970, we’ve decreased fat by 25% of our total caloric intake and only gotten fatter.

So why don’t the guidelines correspond to our population’s needs? Nina tells us the disturbing truth of industry benefit over what the science says and sheds light on the conflicts of interest happening behind the scenes. She also pinpoints some of the most current research that should be governing our upcoming guidelines and how we can work towards change. 

I hope you’ll tune in to gain a better understanding of our current dietary guidelines.

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn (video / audio):

  1. How we are all affected by the U.S. dietary guidelines, even if we think we aren’t
    (3:15 / 7:06)
  2. Why the guidelines don’t apply the majority of Americans
    (8:10 / 12:01)
  3. 90% of scientific reviews that inform the U.S. dietary guidelines did not take race, ethnicity, or socioeconomic status into account
    (13:53 / 17:43)
  4. Conflicts of interest among scientists on the U.S. dietary guidelines scientific committee
    (17:31 / 21:22)
  5. How the Office of Dietary Guidelines prohibits consideration of systematic reviews
    (26:35 / 31:21)
  6. Why the U.S. Dietary Guidelines Committee chose not to consider research on weight loss and low-carbohydrate diets
    (29:46 / 34:32)
  7. The ongoing confusion about saturated fat, cholesterol, and heart disease
    (37:19 / 42:05)
  8. What can the average person do to improve the U.S. dietary guidelines?
    (48:42 / 53:28)
  9. How to design guidelines that would help fix chronic disease
    (51:38 / 56:24)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Nina Teicholz

Nina Teicholz is a science journalist and author of the New York Times bestseller, The Big Fat Surprise, which upended the conventional wisdom on dietary fat—especially saturated fat—and spurred a new conversation about whether these fats in fact cause heart disease. Named a Best Book of the Year by the Economist, Wall Street Journal, and Mother Jones, among others, it continues to be called a must-read for anyone seeking to understand the amazing story of how we came to believe fat is bad for our health—and what a better diet might look like. Nina is also the founder of the Nutrition Coalition, a non-profit working to ensure that government nutrition policy is transparent and evidence-based—work for which she’s been asked to testify before the U.S. Department of Agriculture and the Canadian Senate. 

Show Notes

  1. Learn more about The Nutrition Coalition
  2. Read, “Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review”

Transcript

Nina Teicholz:
The guidelines are supposed to be for prevention only, they’re only preventing chronic disease, right? So that’s only the healthy people who haven’t yet contracted disease, right? But over time America has, as you say, has just become dramatically… Far greater proportion of us are unhealthy.

Dr. Mark Hyman:
Welcome to the Doctor’s Farmacy, I’m Dr. Mark Hyman, that’s farmacy with an F-A-R-M-A-C-Y. A place for conversations that matter. And if you care about what food you should be eating, if you’re confused about the Dietary Guidelines and how our government messes with our food recommendations, well, this podcast is going be for you. It’s with an incredible woman, a friend of mine, Nina Teicholz, who is a journalist. Her book, The Big Fat Surprise was a big inspiration to me when I wrote Eat Fat, Get Thin. It’s beautifully written, it’s incredibly researched and it’s very provocative. In fact, it was named Best Book of the Year by the Economist, Wall Street Journal and Mother Jones. And she’s basically up ended the conventional wisdom on dietary fat, which is that that makes us fat and fat causes heart disease, which turned out not to be so true anymore.

Dr. Mark Hyman:
And it’s what got us into the problem that we have now. And a lot of that information was in our Dietary Guidelines that told us to eat eight to, or six to 11 servings of bread, rice, [cereal 00:01:21] and pasta day and eat fat only sparingly. And as soon as we got that advice, we turned into the fattest nation in the world, with over 88% of us now metabolically unhealthy and 75% overweight and 42% obese. Which is terrifying, up from 5% in 1960, when I was born. So it’s a big problem. Nina is also the founder of the Nutrition Coalition, which is a nonprofit group that works to ensure government nutrition policy is transparent and it’s actually based on science. What a crazy idea, that we should have nutrition guidelines based on science. Hmm. She’s been asked to testify before the USDA and the Canadian Senate. She’s a graduate of Stanford and Oxford. Lives in New York with her husband and two sons, and welcome to the Doctor’s Farmacy, Nina.

Nina Teicholz:
Thank you, Mark. It’s so great to talk to you and be here.

Dr. Mark Hyman:
Well, your work is just so important. You are a rare breed, which is an investigative journalist. You don’t just report on stuff that other people report on, which is most of what news is today, you actually dig into the science and look at the original data, and go back to the sources and dig up what’s true and not true and what we know and don’t know. And so, I was very inspired by your book, The Big Fat Surprise, and it led me to go on to write Eat Fat, Get Thin. And I think your work really is not just focused on educating people about nutrition science, but it’s actually focused on changing the very policies that determine the food that is recommended to Americans to eat, what we call the Dietary Guidelines for Americans. Which is the policies that drive nutrition recommendations throughout our government, and has huge implications for every aspect of our society, including, school lunches, and WIC and many other food programs that are feeding literally millions and millions and millions of Americans. So, why are these the most influential policies, the Dietary Guidelines, and the most powerful lever on our food supply? And why is it so misguided?

Nina Teicholz:
Well, those are two separate questions, but let me take them one at a time. I mean, I think most people think they really aren’t affected by the Dietary Guidelines, who’s even heard of them. But people know them as the food pyramid, or then now we have MyPlate. But even if you don’t think you’re following the guidelines, they reach out and touch kind of each and every American. So through some of those Nutrition Assistance Programs that you mentioned, school lunches, school breakfast, feeding programs for the elderly, women and infant children programs, food that American Indian, American, sorry, food that Native Americans get.

Nina Teicholz:
That’s one in four Americans every month eating the food that’s based on the guidelines, but also they’re recommended by most doctors and dieticians. So if you go to a doctor, you’re getting the guidelines. And in many cases, doctors are not allowed to teach anything but what the guidelines say because the guidelines are considered the gold standard. They impact the food label, when you turn on… You take a piece of food, sorry, when you go to the supermarket and you swap the… look at the back of the food package, all of that information is based on the guidelines and what they think is good food and or what are good nutrients and bad nutrients. I mean, I could go on.

Dr. Mark Hyman:
The nutrition facts label.

Nina Teicholz:
Yeah, the nutrition facts label, thank you. And also the military food is based on the guidelines. I mean, every one of our government agencies is basing their food recommendations on the Dietary Guidelines. So even though you don’t go to the guidelines, the guidelines pretty much reaches each and every American.

Dr. Mark Hyman:
And we’ve followed them, I mean we followed them, right? I mean when the [inaudible 00:05:07] came out, we did what the government said. We eat six to 11 servings of bread, rice cereal and pasta like muffins and bagels and pasta. These were health foods.

Nina Teicholz:
Yeah, well, so they no longer recommend six to 11. Now it’s down to six. But so for instance, they recommend three servings of refined grains every day. You asked me what’s not good guidelines about the guidelines. Three servings of refined grains every day and six servings of grains every day, there’s a lot of carbs, right? And up to 10% of your calories can be sugar. And many people will say, “Well, who cares about the guidelines, they’re just guidelines, and you don’t have to follow them.” But if you look at what Americans have actually done, and there’s great data on this from the government itself, USDA, they show that since 1970, which is when we… That’s when their starting point is, even though the guidelines started in 1980.

Nina Teicholz:
But since 1970, which is about when and the American Heart Association started recommending this kind of diet as well. Americans now eat 35% more vegetables, 20% more fruit, 28% less red meat, I think around 19% less saturated fats or better. We drink 79% less whole milk than we used to. I mean, and those aren’t kind of cherry picked, I’m not just giving things that happen to work in the favor of an argument, every single category of food that you look at it… Everything that we’re supposed to eat more of, we eat more of, and everything we’re supposed to consume less of we consume less of. We consume 87% more vegetable oils than we did in 1970. We’ve also increased our carbohydrates by 30%, since 1965, and we’ve decreased our fat by 25% as a percentage of total calories. Those are big changes.

Dr. Mark Hyman:
Those are staggering changes.

Nina Teicholz:
[inaudible 00:06:55] changes. And one of the arguments that people like to make, and I think it’s the prevailing wisdom in the world of public health is this idea that Americans really don’t follow the guidelines, because the statistics that are released by the USDA is they say, “Look, here’s our target for vegetables, and Americans aren’t meeting it.” Or “Here’s our target for fruit, Americans aren’t meeting it.” And that’s true. But that’s because when they started recommending two cups of vegetables a day, Americans weren’t eating anywhere near that amount of vegetables, Americans have increased dramatically amount of vegetables they eat and by the way, that two cups a day went up to two and a half cups a day between 2005 and 2010. So it’s like Americans are eating in the direction of the guidelines. But we just can’t get there. Because those were, at the time pretty dramatic recommendations for an American public that really didn’t eat this way.

Dr. Mark Hyman:
So whether we like it or not, and whether we believe it or not, the truth is that the Dietary Guidelines, even though they don’t seem to apply to everybody, or people don’t actually think they’re following them, that overall as a society, we have adhered to the changes that they recommended. And that’s led to some serious adverse consequences that I want to get into in a minute. But one of the things that I’ve learned that’s so staggering to me is that the Dietary Guidelines really are Dietary Guidelines for healthy Americans, for healthy Americans. So nine out of 10 Americans are unhealthy and those guidelines really don’t apply to them. And so maybe, when we look at the guidelines, we need to be thinking about what we should be recommending for a unhealthy population is metabolically unhealthy. That means high cholesterol, high blood sugar, high blood pressure, that’s 88% of Americans.

Dr. Mark Hyman:
So we’re sick. And the guidelines are for healthy People, which you may be able to tolerate more carbohydrates if you’re metabolically healthy, you may be able to tolerate a wider range of foods. But when you’re unhealthy, and particularly from the perspective of food is medicine, you need to be guided to eat the right things, which our policies really don’t help us do.

Nina Teicholz:
That is one of the most astonishing things that I discovered about the guidelines when I started to dig into them. And I realized what a mismatch they are for the American population. So they’re supposed to be, according to the congressional statute, they’re supposed to be for the general public. Well, when they began in 1980, the general public was healthy, more or less healthy. And so, the guidelines are supposed to be for prevention only, they’re only preventing chronic disease, right? So that’s only the healthy people who haven’t yet contracted disease, right? But over time America has, as you say, it’s just become dramatically… Far greater proportion of us are unhealthy. We could go through many statistics, but more than half are prediabetic or have diabetes, as you said 42% or more have obesity. And so, now we have a policy that is applied to everyone, right? And think especially about those kids, underprivileged kids receiving school breakfast and school lunches.

Nina Teicholz:
Their rates of obesity and diabetes and hypertension are even higher. Think about that kid who’s being fed from the Women and Infant Children program with a mother who’s obese. I mean, they’re… And the guidelines, when we say that they’re not for unhealthy people, what we mean is that the expert committee that prepares the science for the guidelines, they do not look at studies on how to help people lose weight, how to help somebody to reverse hypertension, how do you help somebody to try to reverse diabetes, they do not look at that literature. So that’s saying that they don’t even consider that literature. Because they consider that treatment belongs to the medical practices, the specialty practices of doctors, they don’t want to do treatment.

Nina Teicholz:
And all of that is totally understandable. But then the guidelines should not be applied to all Americans, which they are. When you go to your doctor, and you say, “I’m pre diabetic.” And your doctor gives you the guidelines, but they didn’t look at how to reverse prediabetes or diabetes. So it’s really this… I mean, actually, our group, one of the things that we’re doing at the Nutrition Coalition right now is just to say, when you come out with the guidelines, which are coming out by the end of this year, just to say, How about if we just put a warning label on them just to say, look, these are for healthy Americans only. And really, there are things that are questionable about them, even for healthy people. But please do not use this for treatment of people. For the 60% of Americans who are diagnosed with diet related chronic disease, these guidelines don’t apply to you.

Dr. Mark Hyman:
That’s right.

Nina Teicholz:
That would be a big step forward, I think. And-

Dr. Mark Hyman:
Well, that’s a big paradigm shift, Nina, because what it would imply is that dietary interventions are actually able to be used for treatment of chronic disease, which is not the current medical paradigm, right? It’s functional medicine, it’s food is medicine. It’s what we do.

Nina Teicholz:
That’s correct.

Dr. Mark Hyman:
But the truth is that the paradigm of do you use food to heal disease, doesn’t even exist in traditional circles. And what’s scary is that the emerging science that really upends a lot of our old ideas that all calories are the same, or that saturated fat is bad, or that we should all be eating more carbohydrates. These have been completely debunked by the science, and yet they’re still part of our guidance.

Nina Teicholz:
Yeah, I think at least what you could do is to just have the guidelines not apply to so many people, right? I mean, it’s going to be a long time until we get to a paradigm where each and every medical society is using food as medicine with the, as you suggest, but at the moment, let’s just stop giving the wrong advice to people. Someone with diabetes, telling them to eat six servings of grains a day and up to 10% of their calories is sugar is really bad advice.

Dr. Mark Hyman:
Definitely bad advice, it’s definitely not Dr. Hyman approved advice for sure.

Nina Teicholz:
So let’s just stop that. I mean, that’s what I… The Dietary Guidelines is a huge policy, it’s supported massively by food industries. And it’s very hard to change as we’ve discovered doing the work that I’ve been doing for the past couple of years, but at least at have them apply to not so many people, I think would be a good solution.

Dr. Mark Hyman:
Yeah, and today, it drives $100 billion in funding for USDA nutrition assistance programs that are delivered to populations in need, who are actually the most vulnerable and actually the most sick, and actually the ones who need a healthier diet than most, and to whom these guidelines apply the least.

Nina Teicholz:
Yeah, it’s sort of a tragic mismatch, really, I mean, and I’ve listened to, I hope nobody else has to do this. But I’ve listened to all the Dietary Guideline Committee meetings, listen to all their conversations, a lot of talk about how we need to tailor health recommendations depending race, ethnicity, socioeconomic status, background, cultural needs. But one of the analysis that came out about the guidelines is that 90% of their reviews where they ended up having, these are the scientific reviews, 90% of them did not take into account race and ethnicity at all, or low socioeconomic status. And they were predominantly on white populations. In fact, when I looked at the reviews in more detail, I just couldn’t get over it.

Nina Teicholz:
It’s often an all white populations, the data that we’re using. And a lot of it is like the Norwegians, the Swedes and the all these people who I think they are so much healthier than we are. These populations from overseas, sometimes they just barely include any Americans at all. And we’re… I’m not saying that there isn’t some basic biology that we don’t all share. We do and we all have in common, but there are really important differences by race and ethnicity, and so that needs to also be taken into consideration.

Dr. Mark Hyman:
You’ve written many criticisms of the Dietary Guidelines and pointed out many of the flaws. And I think for most people, they understand how they get created. And they’re created essentially by a panel of experts selected by the government who are advising the government on how they should create the Dietary Guidelines. The past before George W. Bush was in office, the guidelines were based on the actual recommendations of the scientist. Now, the recommendations get put forward to a political committee, who then have to determine which of those guidelines to include or not, for example, in the last time I checked guidelines, there were some considerations about environmental impact. And those were just eliminated.

Dr. Mark Hyman:
Now, you can debate whether they should be in there or not. But the fact is that scientists thought it was valuable, but the government was like, “No, that’s too political, we’re not going to do it, even if it’s the right thing for human and Planetary health.” And what you did was to not just take the guidelines at they’d [inaudible 00:16:02], but you sort of just started to dig in and challenge some of the ideas that we haven’t been challenging about why the guidelines say what they do, how they are created, and what the flaws are.

Dr. Mark Hyman:
And if anybody thinks that one person can’t make a big difference, then you should think about Nina because she basically went to Congress, and with the data, with the science and lobbied as a one person lobby group, essentially. And convinced Congress to appropriate a million dollars for a report by the National Academy of Sciences to look at the way in which we create the guidelines, and if there’s any conflicts of interest in any issues. And I’d love you to share about what was found in that report, and why it was so disturbing?

Nina Teicholz:
Yeah. So I want to say, it’s super interesting what you say this fact there’s a group of scientists who make decisions and then there’s this, it goes through the black box of the political process and then some… There’s all kinds of lobbying that goes on in that process. By the way, I don’t call myself a lobbyist. I think of myself as an advocate, because I really advocate for more rigor and better methodology in the guidelines. But in any case, this group of scientists, themselves have all kinds of questions.

Nina Teicholz:
And so, what you’d like to think is that the scientists come out with these pure, pristine recommendations. And so anything they say is golden. And we would all like to believe that and wish that were the case. But what I found when I looked at the last Dietary Guideline Committee was that there were a lot of conflicts of interest, in terms of the members of the Scientific Committee getting paid by getting money from the food and pharmaceutical industries. And so, what this National Academies of Medicine report did this one that was… It was actually the first ever peer review of the Dietary Guidelines that have ever happened. And one of their recommendations is, you need to be transparent about the conflicts of interest among your scientists on the Scientific Committee, because it’s really important to know… It’s not always true, scientists aren’t always bought off by taking money from the food or pharmaceutical industries, but it’s important to know where their biases might be, right? And to manage them.

Nina Teicholz:
You probably can barely find a credible medical journal now in the world today, as you must know, that doesn’t require disclosure of conflicts of interest. And yet, and this is what the National Academy has said to the USDA and HHS, which run the guidelines, they said, “You have to disclose the conflicts of interest on this Scientific Committee.” And lo, they did not accept that recommendation. And so we have no disclosure about who is actually sitting on this committee. So we did some research on that, which is pretty interesting. I mean, I’m happy to share some of that with you if you like, I mean, these are [crosstalk 00:19:09].

Dr. Mark Hyman:
Yeah, what did you find about the people who are making our guidelines?

Nina Teicholz:
So included in that group is the current medical director of Nestle hit their OPTIFAST weight loss program, which is like a formula that you take to lose weight. Well, why is that a conflict of interest? Well, if you’re looking for a food based solution for weight loss, if that competes with the OPTIFAST program, which tells you you can lose weight, better to lose weight through a formula. Also on that committee is the former executive director of Merck, which is the major huge pharmaceutical company that makes all kinds of devices and drugs for chronic disease. Again, why is that a conflict of interest? Because if you think that disease should be solved with drugs and devices, you might not be so interested in a food based solution, right?

Nina Teicholz:
Also was the former global director of scientific affairs and obesity for Merck was also on the panel. There’s a member of the Scientific Advisory Board of ConAgra, a huge massive Food and Ag company. And the former president of the Dannon Institute, which is funded by the Dannon yogurt company. There were also altogether five members who have been funded or consulted with Nestle. Nestle is I think, the biggest food company in the world. Two of them had consulted for Pepsi, PepsiCo research and development. And then two of them are on the board of trustees of ILSI, which maybe some of your listeners know about is the International Life Sciences Institute, which is really a group that’s kind of a… That was put together by the former vice president of Coca Cola and includes members like Coca Cola, Pepsi, [Maurice 00:20:55], Cargill, Kellogg, the Hershey’s company. I mean, their goal is to get people to eat more junk food, it seems.

Dr. Mark Hyman:
And by the way, that group is fascinating as it seems like it’s an independent group, International Life Sciences Institute. It sounds wonderful. But it’s just a front group for the food industry. And they put together a scientific paper that was published in the Annals of Internal Medicine, essentially saying that our sugar recommendations were flawed, there was no basis in science for reducing our sugar intake, and that any association between sugar and chronic disease really was not valid. And when you come out, and you look funded by the International Life Sciences Institute, and I’m like, “Oh, my goodness.” And you start to drill down on these conflicts of interest. And it’s no wonder why we’re all confused, because we’re getting information that’s not filtered through pure science and understanding of the data. But based on various industry interests, and not public health.

Nina Teicholz:
I want to say there is, it was a 20 person committee and five of the members really didn’t seem to have many food or pharma ties, but the other 15 did, and quite a lot. And I’ll just mention one other thing, because people sort of, I think the general narrative that people believe is that really, it’s the meat industry is the most powerful industry. And they’re the one, the reason that we’ve had so many problems with our guidelines. And so there are two members of the panel with a lot of ties to the meat, dairy, eggs, the kind of animal protein. But there’s another two people with tremendous ties to the nut industry, which is incredibly active and gives away tons of money. And by far the majority of the people on the panel, their ties are really with the fast food, the junk food industry. The industry that they do not want you eating real food, they don’t sell real food.

Nina Teicholz:
That’s not what they sell. And so I think that one really has to first of all, it seems sort of a no-brainer, just to disclose these conflicts of interest as a matter of course, right, that [inaudible 00:23:02]. But I think it’s also… It shows you that the scientific panel itself is problematic in terms of their, what’s going on with their interest.
Speaker 3:
Hi, everyone. hope you’re enjoying the episode. Before we continue. We have a quick message from Dr. Mark Hyman about his new company Farmacy, and their first product, the 10 Day Reset.

Dr. Mark Hyman:
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Dr. Mark Hyman:
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Speaker 3:
Now back to this week’s episode.

Dr. Mark Hyman:
… And a friend of mine, who’s a Harvard scientist, very prominent researcher, and a friend of ours, essentially challenged the whole idea that we should be getting three glasses of milk a day in our recommendations. And when he spoke to someone on the Dietary Guidelines panel years ago, he said, “Look, the data don’t support this, whether it works or not. There’s no evidence that this is something we should be recommending.” He’s like “Yeah, I know but the Dairy Council… we have to support farmers.” And it was really an industry driven decision, not a science based decision. And it’s really hard to trust what’s coming out of these guidelines when they’re so conflicted. But what’s even more disturbing to me, Nina is the fact that, and I don’t understand this as a doctor or scientist, is how you can say, “We’re only going to look at this evidence, we’re not going to look at all the evidence, we’re just going to look at the evidence we want to look at.”

Dr. Mark Hyman:
And what was really striking to me was in the last Dietary Guidelines under the Trump administration, there were rules on what you could look at and what you couldn’t, including you couldn’t look at the effect of ultra-processed foods or low-carbohydrate diets or any things that are emerging as real contributors to chronic disease. I mean, the Global Burden of Disease study said that 11 million people die every year from eating too much ultra-processed food and not enough of good foods. That should be something we look at, right? And it was completely ignored. So can you talk about that what is allowed to be even looked at and how they measured the evidence? And it had to actually be USDA research, it couldn’t be independent scientific research. I mean, I just, I was so confused by these sort of artificial guardrails or blinders that are put up on the scientists as well. Yeah, this study may have shown that eating a low-carb diet is curable, it can cure diabetes, but we can’t look at that. And we won’t recommend, how does that even happen?

Nina Teicholz:
It is such a strange and Byzantine process. And I will tell you that it’s, if you take a step back from the committee, there’s this whole huge staff at the US Department of Agriculture that has been running the guidelines for, some of them for decades in this group, and they all serve the office of the guidelines, and they set the rules. In fact, not only do they set the rules, but they do some of the reviews themselves. And then they sort of pretend that the committee did them. That happened with 11 of these reviews for on pregnancy and birth and lactation. So they are the ones who set the rules as far as I can tell. Although they will say that it’s the committee itself that’s setting the rules, but just to give you an idea of some of the craziness.

Nina Teicholz:
Okay, so one of their rules is we’re not going to look at any outside systematic reviews. Why is that? Because systematic reviews are considered kind of at the apex, if the pyramid of evidence is like this, systematic reviews, especially if clinical trials is like right up here at the top is some of the best evidence you can get, right? You have animal model studies down here at the bottom. So, they said, you can look at any outside systematic reviews. Well, in the case of saturated fats, okay, saturated fats is a very unique story, because all the really rigorous big, large, important clinical trials were done back in the 1960s and ’70s. But then they were just kind of ignored for many, many years really.

Dr. Mark Hyman:
They didn’t fit the paradigm, right?

Nina Teicholz:
They didn’t fit the paradigm.

Dr. Mark Hyman:
That couldn’t be true, so it just-

Nina Teicholz:
Right. I mean, they’re just crazy statutories. They weren’t published for years, some of them, they just weren’t… they were ignored. And so they were really never reviewed by any Dietary Guideline Committee ever. But now, due to my book and other people’s work, people have realized these trials exist. And so they’ve gone back and done systematic reviews of these trials, they’re now almost 20 of the systematic reviews, right? But the Dietary Guideline Committee, not allowed to look at any of them. So this whole last decade of science, which has witnessed a real reconsideration of saturated fats, let’s say there’s still some debate, but at least there’s two sides to the story now. The science is contradictory from I think it’s fair to say, but the Dietary Guideline Committee was not allowed to look at any of that past decade of research. So that’s just kind of mind boggling. They’re supposed to be guidelines that reflect the science that is current at the time. And now, I’m literally quoting from the congressional statute, but that is not the science that is… If they can’t look at the systematic reviews that kind of recapture this old signage-

Dr. Mark Hyman:
… What was the rationale? Why is it off limits?

Nina Teicholz:
… Well, they didn’t give one, as what all I can say. But I don’t know, really. I could make an argument that some of the outside reviews are like the ones that they used in the, from the American Heart Association and American College of Cardiology, previously, were funded by a lot of corporate money, and maybe they thought it was good to keep that out of the system. I don’t know really what the reason is. And I’ll tell you another amazing story, which, well, there’s two more mind boggling stories. One is that the committee decided not to include any studies on weight loss, on obesity. Even though this is like chronic disease issue number one. Losing weight is probably the most effective way to help fight diabetes, it helps resolve almost every medical issue. Plus, it helps people maintain a healthy weight. And the Dietary Guidelines have as one of their three goals helping people to reach and maintain a healthy weight. But they said we’re not going to look at any studies on obesity.

Dr. Mark Hyman:
Who’s saying that, is it the committee, is it the government-

Nina Teicholz:
It’s the committee. The committee just said we’re not going to look at them, because when you lose weight that complicates other outcomes, because losing weight helps so much. So they wanted to try to isolate the effects of diets without weight loss, which is, I mean, we could already [crosstalk 00:30:44].

Dr. Mark Hyman:
… Considering 75% of us are overweight or obese. Yeah.

Nina Teicholz:
So no studies on weight loss. And then when it came to low-carbohydrate diets, the last time around 2015, they did review low-carb diets, but they decided not to publish it. And there was a bunch of emails about this, if anybody’s interested, they can look at this Wall Street Journal article that I did, where I went and got Freedom of Information Act requests on some of those emails, and found that there had been quite a bit of debate over not publishing this low-carbohydrate diet review. Because it’s, as one person from Harvard said, “This is a significant amount of research. We should not be burying it.”

Dr. Mark Hyman:
What was the rationale? What were the arguments for burying it? You found-

Nina Teicholz:
There was no email chain on that. At that point, it just disappeared. So this time around, they said, and this is, again, this is for the 2020 guidelines that are going to be published at the end of this year. They did review low carbohydrate diets, but they couldn’t find any studies, except for one that had been authored by a member of the Dietary Guideline Committee itself. So this is like-

Dr. Mark Hyman:
… They couldn’t find them?

Nina Teicholz:
… They couldn’t find them. I mean, so this is so crazy, because it depends on how you count them. But there’s somewhere around 100 clinical trials now at least on low-carbohydrate diets.

Dr. Mark Hyman:
And plus many other observational trials. So there’s literally hundreds of studies. Looking at-

Nina Teicholz:
There’s a massive amount of scientific literature, and remember that the Harvard committee member in 2015, was already saying this is a large amount of significant research. And it’s a little bit like, you’re trying to put together a zoo, and you’re looking for giraffes, and you say we only want no neck giraffes. So you end up with no giraffes, and you’ve got a zoo with no giraffes. Somebody should realize there’s something wrong with their selection criteria and the way that they’re looking for low-carb studies, right? I think I didn’t explain that very well, let me reverse that for a second. They didn’t find any low-carbohydrate studies, because they set up their selection criteria basically to rule out finding any of the studies. What I mean by selection criteria, I mean, they set up a bunch of rules, like these are the trials that we want. They have to include this, they have to include that, they have to include a complete description of the diet, they have to say what percentage of fat, protein and carbohydrate.

Nina Teicholz:
Well it turns out most low-carb studies only include the percent of carbohydrates that they are looking for. They don’t include also information about the whole diet or protein and fats. So that’s kind of a little bit of a overly detailed explanation, but just like setting up a criteria that you know will exclude everything that you’re looking for.

Dr. Mark Hyman:
… Like, I only want Americans from this one town, who are five foot seven and a half with green eyes, blonde hair, have never eaten a strawberry, and go to sleep on Sundays at three o’clock in the afternoon, every week. And essentially, good luck finding that person, right?

Nina Teicholz:
And you’re looking for that. That’s your criteria, and you’re looking at an all African American neighborhood. So you know you’re going to find [inaudible 00:34:12]. So that’s what happened. So they came up with zero studies.

Dr. Mark Hyman:
So how do we deal with this, because it’s so clear from the literature that the amount of refined carbohydrates and starches and sugars in our diet, which is about 60% of our calories, is really driving this chronic disease pandemic, which is making us susceptible to the COVID pandemic and which is driving our health care costs, and creating so much suffering where six out of 10 Americans have a chronic disease, most of which are driven by our diet in one way or the other. So how do we begin to kind of reconcile that there’s no conversation about this and that the government is ignoring this. I mean, it’s just unconscionable to me, because I can’t believe all these scientists are following some pernicious agenda that makes them want to not deal with this. Is it just because the paradigm is so strong that they haven’t kind of come up to the 21st century of science of nutrition?

Nina Teicholz:
I think that there are… It is hard to reckon with. Why do people not care more? Why should they not care that they omitted the entire science and low-carbohydrate diets, and I think that that’s because on the whole, the low-carbohydrate diet is still considered sort of a taboo and many people, on mainstream scientists are really not interested in it. And so they… I think another reason is that many of these scientists their entire careers have been devoted to promoting and believing in one kind of diet, which is the Dietary Guidelines, which is more fruits, vegetables, whole grains, nuts, seeds, fish, fatty fish, and less meat and low fat dairy, and they believe that.

Nina Teicholz:
And many of them, as I also discovered, received many, many millions of dollars in grants from USDA and HHS, which is to say the government. What is their incentive to go against the government? What is their incentive to go against their entire profession, their entire field? I really think that that is… It’s very hard to find somebody who will kind of spur the conventional wisdom. There’s no reward for them, what is their actual reward to become… You potentially lose your grant, you lose the respect of your colleagues, you may no longer be invited to conferences. I mean, these are things that I’ve documented in my book about scientists who kind of step out of line with the conventional wisdom, there are real and palpable losses to that.

Dr. Mark Hyman:
Yeah. And by the way, people who really initiated this whole saturated fat issue, which we’re going to talk about a minute, can listen to an earlier podcast. Nina was my second guest ever on the Doctors Farmacy. So that was really awesome. I mean, we did go into it. But I want to come back to, we talked about the low carbohydrate issue, but it’s also sort of connected to the fat issue, because as you decrease carbohydrates, you have to increase something else in your diet, which should be fat. And of course, a little bit of protein. But the guidelines essentially still say we should be eating less than 10% of our calories as fat. And that even-

Nina Teicholz:
No, they don’t say that. The guidelines now advise between 31% and 33% of [crosstalk 00:37:48].

Dr. Mark Hyman:
… I mean, saturated fat, sorry, saturated fat, less than 10% of our diet is saturated fat I misspoke. And yeah, about… They’ve actually removed the restriction on total fat, although they did it in a sort of side note, and they didn’t announce it. And it was sort of an embarrassed acknowledgement that, “Oh, boy, we don’t have to worry about total fat in the diet, because it’s not related to weight gain, or to heart disease.” Which was a big shift in the 2015 Dietary Guidelines. But they still recommended that we eat less than 10% of our calories as saturated fat to reduce heart disease. Now, and if you have heart disease already, it should be less than 5% of saturated fat. Which kind of is interesting, because when you look at the literature doesn’t quite all add up. And even, just the joke I always make is that, breast milk is 25% saturated fat. So we should be restricting breast milk to babies, because it’s literally got five times the amount of saturated fat that we recommend in our dietary guidelines for people who have heart disease.

Dr. Mark Hyman:
But what we know now is quite different about saturated fat. And there was an incredible review paper that was published in the Journal of the American College of Cardiology in June of 2020, entitled Saturated Fats and Health, the reassessment and proposal for food based recommendations, and with a state of the art review by the Journal of the American College of Cardiology. And it essentially said a number of really interesting things I’d like to go into but sort of question the orthodoxy that all saturated fat is bad, that it’s bad for everybody. So I’d love you to sort of talk about the impact of this paper, how you think it might influence the Dietary Guidelines in 2020, or at all? And what we should really be thinking about is to take homes around saturated fat in our diet, because people are still confused about it.

Nina Teicholz:
There’s a lot of confusing messages about it. So I think people are right to be confused. That paper said many things, I want to say one of the most important things about that paper was its authors. Its authors included three former members of previous Dietary Guideline Committees, including the chair of the committee in 2005. So these are basically that expert committee that makes the guideline saying, “We got it wrong on saturated fat.” Which is an extraordinary thing.

Nina Teicholz:
And the paper basically argued a number of things, which I think I should share just a few of them. But one of them was that this fear of saturated fat and the argument that is still held out against it is that it tends to raise your LDL cholesterol, which is known as your bad cholesterol. It can be a transient rise, it can be permanent rise. But what this paper points out is that the rise in lowering your LDL cholesterol through diet, in diet studies, has never been shown to lead to any impact on heart disease. It may happen that it works with drugs, when you take statins, that’s what statins are designed to do, in part. But it really has never been shown to be reliably true if you do that through diet, and saturated fat raises a kind of LDL cholesterol that is called your large and [inaudible 00:40:54] they’re different kinds of LDL cholesterol becomes a complicated story. But it doesn’t raise the type of LDL cholesterol, or LDL particles that are considered the worst for heart disease. Those are the small dense ones, saturated fat tends to raise the large voyant ones.

Nina Teicholz:
So that was one important point of the paper. I think two other important points is that this paper reviewed those clinical trials like everybody else did and said, no effect on cardiovascular mortality and no effect on total mortality that was the result of those paper, those clinical trials. And this paper said, I think really importantly, we have to be careful of restricting saturated fats because of the foods in which we find them. And you [inaudible 00:41:37] potential harm if you restrict these foods, like all kinds of meat and full-fat dairy and cheese and coconut oil or coconut butter, or dark chocolate is another example, you are missing out on the nutrients, needed nutrients in those foods.

Nina Teicholz:
And in fact, one of the things that’s disturbing about the Dietary Guidelines is that they don’t meet all our nutrient needs. If you follow them perfectly, you’ll come up short on a few important nutrients, including vitamin D, which we now know is really important for fighting COVID, and [Coleen 00:42:19], and I think it’s potassium and maybe iron. I don’t know this on top of my head. But I think that, so it’s very important not to restrict those foods, which is what the limits on saturated fats do. And so, their argument in this paper was we need a food based guidelines, we should not be focusing on this micronutrient of saturated fats.

Dr. Mark Hyman:
Well this goes back to the whole idea of nutritionism, which is the reductionist approach to the individual nutrients and food as a way of helping food companies to modulate those nutrients and still provide crappy food. So if you reduce saturated fat, you reduce salt, reduce sugar, these are things that food companies can manipulate in their formulations. But if you say eat whole foods, what are they going to do, right?

Nina Teicholz:
Yeah, so the limits on saturated fats are a way to kind of keep down or to limit consumption of these whole natural foods, which provide nutrients. And it’s really important that we get nutrients in that, because eating nutrients in foods is… You know this, but I mean, it’s far more what we call bioavailable, which means your body is able to digest and absorb them, right? So we say, you can get your iron from fortified Kellogg’s Krispies or whatever. And because they fortify those grains with iron, but you will absorb it much better if you get that iron from say, meat. And that’s true of all nutrients, it’s better to absorb them and eat them in the natural form in which they’re found. And that was the argument of this paper. So what was the effect-

Dr. Mark Hyman:
We’re going to put the link to this paper in the show notes because it’s very important. And I think what really struck me from looking at the paper was, there was kind of a bunch of points that were really important. First, you sort of highlighted that despite the current recommendation around saturated fat, there was mounting evidence that basically didn’t show that saturated fats, or reducing caused heart disease or reducing saturated fats lowered the risk of heart disease. And this is from a review of all the data. And actually increasing saturated fats may protect against stroke.

Nina Teicholz:
… Right, I forgot to mention that.

Dr. Mark Hyman:
The second thing that was really interesting was you mentioned this thing about the particle size and that matters, because if you’re creating the small dense particles, which by the way comes from eating carbohydrates and sugar and starch, not fat, you’re actually more likely to get heart attacks and eating saturated fat which is creating these large point cholesterol particles. For most people, I think there’s some genetic variations. But they’re also said that it matters what you eat them with. And in my book Eat Fat, I think I made a huge point of this, that if you eat saturated fat in the context of a low starch and sugar diet, it’s okay. But if you start [sticking 00:45:00] in the saturated fat in carbohydrate rich diets, that creates a problem. Because then you get the double effect of insulin inflammation and the saturated fats, and then it can become a problem.

Dr. Mark Hyman:
So I would warn people to say that you don’t get to eat cookies and ice cream and cake, which has saturated fat and carbohydrates, you should be eating butter on your broccoli, not on your bread. And that actually makes a huge difference. The other thing they said, which is really interesting to me is that they have to look at the actual data on these whole foods. And whole fat dairy, unprocessed meat, dark chocolate, all of those saturated fats. But they’re in this complex, rich, nutrient dense food and none of them were associated with heart disease. In fact, it may be the opposite. And there was no data to really suggest that we should limit these foods, which is pretty amazing. And that they recommend that we eliminate all these population wide upper limits on saturated fat in the United States, because it won’t reduce the risk of heart attack or death. That’s a pretty dramatic statement and to be published in the Journal of the American College of Cardiology, right? This is not a some left wing radical journal that wants to upend the orthodoxy. This is the Journal of the American Heart Association.

Nina Teicholz:
And cardiologists are considered some of the most conservative groups on unsaturated fat. So I think it was really significant. I mean, these authors literally concluded the caps on saturated fats are no longer warranted. They’re no longer needed. And it was such an incredibly prestigious group of people who really were knowledgeable about the field and again, had themselves passed nationwide, population wide limits on saturated fat, but we’re saying we were wrong to do that. So it’s an extraordinary paper. It’s extraordinary that I got published in that journal. But I have to say, I’m disappointed by the results. I mean, I don’t think that one newspaper covered it, or I have seen almost no news coverage of it at all.

Nina Teicholz:
And I think just recently the BMJ cut did a news piece on this group of scientists and this paper and in fact, this group of scientists went beyond the paper, they actually wrote a letter to the secretaries of USDA and HHS saying, it is urgent for you to really rethink these guidelines. And they also wrote a letter to Congress, and throughout the process they submitted numerous public, you could submit public comments to USDA during the process. And they submitted all this literature, this scientific literature to the Dietary Guideline Committee, and all of that’s just been ignored. So it’s an extraordinary story, I mean, the ability to just not see anything but what you want to see is I think… or the vested interests that are involved here are too powerful to overcome.

Dr. Mark Hyman:
So let me ask you this, Nina, you’ve been working on this for a long time to try to update and prove and make the Dietary Guidelines more evidence based. And there’s a lot of challenges to that. But it seems that a congressional oversight committee gave a million dollars to the National Academy of Sciences, created a very independent objective report, which made a series of recommendations, all of which were pretty much ignored. And the question is, in the context of the average person, what we can do, how does this process change? Do we need to call our congressmen? Do we need to create a massive movement to have a different Secretary of Agriculture? I mean who are the people that are going to make these determinations? Is it the Secretary of Agriculture? Is it the head of HHS who started working with the Dietary Guidelines committee as well? I mean, who’s in charge that’s causing these roadblocks to actually implementing an evidence based approach to our Dietary Guidelines?

Nina Teicholz:
Well, that is a magical question. I’m sorry.

Dr. Mark Hyman:
Because there’s somebody who’s picking the people on the committee, right? There’s somebody who’s doing that?

Nina Teicholz:
Yeah. Well, it is the question. I think that one would have more luck with Congress than with USDA and HHS, because those agencies… Now who knows what will happen with the Biden administration, but I think those agencies are deeply invested in this policy, and it would be very difficult for them to dramatically drastically change coure. Remember, there’s an office at USDA where these people have been working on these guidelines for decades. And one of them stood up at the beginning of this whole [inaudible 00:49:57] process and said, “If everybody just followed our guidelines, you would all be healthy.” I mean, these are their baby and I think it’s very hard to go up against that.

Dr. Mark Hyman:
Believe it.

Nina Teicholz:
Yeah. So I’ve sort of come to the conclusion that it probably takes members of Congress kind of a congressional oversight. I mean, it’s offensive that they spent a million dollars on this report for the National Academy of Sciences and then it was just ignored, it’s on a shelf getting dusty. And the governmental agencies that were supposed to implement it just didn’t. And so, I mean, our group urges people that you can go to the nutritioncoalition.us, which is our website, and there’s a take action budget where you can go and contact your member of Congress. And at this point we’re just simply asking for what we talked about at the beginning of the podcast, so we’re just simply asking for the Dietary Guidelines to be limited to the people that it actually addresses, just be limited to healthy people not to overeach-

Dr. Mark Hyman:
To 12% of Americans.

Nina Teicholz:
… The 12%, not to overreach-

Dr. Mark Hyman:
This is good for 12% of Americans, the rest of you just ignore this because it’s going to make you sick and fat, something like that.

Nina Teicholz:
… Something like that. I mean, if you weren’t reviewing the science on people with these disease states, then please do not try to pretend that you’re for all Americans, because you’re not. That’s, I think, the very best that anybody could hope for, which is to have a policy that is that doesn’t overreach.

Dr. Mark Hyman:
Maybe we just changed the title, Dietary Guidelines for Healthy Americans.

Nina Teicholz:
That would work. And then [crosstalk 00:51:37] think of that.

Dr. Mark Hyman:
But then that speaks to the next issue, which is, how do we design guidelines for an unhealthy America to fix chronic disease? Because that’s really the main question.

Nina Teicholz:
Yeah, I mean, I think that you and I would agree in a lot of the things that… I mean, I think that the very first thing you should do is to stop giving people the wrong advice, right? So that would be wonderful to just level the playing field so that you’re no longer giving unhealthy people the wrong advice, you’re no longer telling the person with diabetes to have six servings of grains a day. And then after that, I think there’s a whole literature on low-carbohydrate diets that show them to be effective, I think, probably most convincingly for the reversal of a type two diabetes diagnosis for reversing that process. And that’s why the American Diabetes Association has now in their guidelines is mentions not only of low-carb, but of the keto diet as good viable options and the best diet for glycemic control, which means controlling your blood sugar, which is the most important thing you can possibly do in diabetes.

Nina Teicholz:
And also, by the way, and this is an important kind of ancillary to what we’re talking about, which is in the literature on how to avoid the worst outcomes for the coronavirus. The study recently found that what most tightly associates with and what is most associated with poor outcomes was high blood sugars upon admission to the hospital. So keeping your glycemic control in control is super important.

Dr. Mark Hyman:
It’s so important. Yeah.

Nina Teicholz:
So I mean, I think that literature, as a start reversing diabetes in America, which is, drives the majority of health care costs. I think we have less clear literature that it clearly does a very good job for weight loss. But I think, we still need more literature on that, but it’s clearly viable and safe. And there’s long term enough data. I mean, I’m talking multiple nine trials that are at least two years, which is considered long enough to see any negative side effects. And one trial that’s gone now five years. Okay, so that’s not what we… A real long term trial would last 10 years, long enough to hang around and get data on mortality.

Dr. Mark Hyman:
Outcomes.

Nina Teicholz:
Yeah, right. But we know that it’s safe. And it improves the vast majority of inflammatory factors and cardiovascular risk factor. So that’s a good place to start, much research needs to be done. But that research can’t happen while everybody is convinced that there’s just one size fits all diet for everyone. It has to loosen up a bit to so there is an allowance of a conversation that at least start saying, “Look, we need to have a diversity of options for people in different states of metabolic health. We can’t assume that everybody is going to respond to this one size fits all Dietary Guideline diet.”

Dr. Mark Hyman:
Yeah, I know it’s so important. And I think hopefully, with a new administration, although I’m pretty cynical things might open up. I think there’s, in fact Chellie Pingree was being recommended as one of the potential candidates for the USDA Secretary of Agriculture, who’s a organic [agenda 00:54:54] farmer from Maine who’s a Congresswoman who understands these issues, so that there may be some light at the end of the tunnel, I think eventually we’ll get there. But we really have a moment where, honestly, we could be addressing this pandemic of COVID differently by not having a mass mandate, but having a let’s get healthy America mandate to become pandemic resistant through improving our diet. And like you said, if the number one risk factor for getting really sick and dying is high blood sugar, which affects 88% of Americans at some level or another, right, not necessarily diabetes, but at some level [inaudible 00:55:29]. And one and two have prediabetes or type two diabetes [others 00:55:32] half of Americans. You think this would be a massive public health message, but nobody’s talking about it. I mean I am, but no one’s talking about it. So I think we have a lot of work to do.

Nina Teicholz:
Yeah, I mean, I wrote an [update 00:55:44] in the Wall Street Journal about exactly that. I said, it’s not about the mask we put over our mouth, but the food that goes in them. And why don’t we make ourselves more resistant to the virus so that we have better outcomes? And why do we think that some countries have done so well, and we’ve done so poorly, part of the reason surely must be that we have such high rates of obesity and diabetes and hypertension, all those things which correlate very highly with higher rates of hospitalization and death from the coronavirus.

Dr. Mark Hyman:
I mean, where China was the epicenter of coronavirus, now it’s very little, but they also have three million-

Nina Teicholz:
They don’t have any fat people.

Dr. Mark Hyman:
… Well, they do have some, but it’s not as much, but it’s more and more but they have so many people. There there’s three deaths for every million population. Here we have 500 deaths for every million population. In China, their obesity rates 2.6%, here it’s 42%. Just saying, it might be related. So anyway, Nina, thank you for amazing work that you’re doing with the Nutrition Coalition to raise awareness about Dietary Guidelines. It’s not a sexy job, but it needs to be done. And it’s important that you are looking at the science because so if you are, and I think that I’m really impressed with the fact that you’ve been able to highlight some of these issues, to raise awareness, to drive public support.

Dr. Mark Hyman:
And I think people listening can start to pay attention and look at the Nutrition Coalition’s educational information on the Dietary Guidelines, learn about them, learn why they’re important and learn why it’s important for you to be active in having a voice about this because your congressmen and senators, listen, I mean, if 10,000 people wrote or emailed or called to their senators or congressmen they would pay attention. And I think we hopefully will be able to have a voice for this in the future as we begin to really face down the real crisis that we’re facing around food and health and chronic disease and COVID and how it’s all connected. So thank you for your work Nina, thank you for being on the Doctors Farmacy podcasts, been great to have you.

Nina Teicholz:
Thank you very much for having me.

Dr. Mark Hyman:
Check out her book The Big Fat Surprise, check out the nutrition coalition website which is nutritioncoalition.us. And you can also if you want to get active, you can go to nutritioncoalition.us/take action, which I encourage you to do because we all need to be active in making a difference because we can. And if you loved this podcast, please share it with your friends and family. On social media leave a comment we’d love to hear from you and well subscribe wherever you hear your podcasts and we’ll see you next time on the Doctor’s Farmacy.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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