by Dr. John Neustadt

What you eat is one of, if not the most, important factors that determine your risk for disease. Your dietary pattern—what you eat consistently day after day throughout your lifetime—is more predictive than genetics and family history when it comes to developing chronic diseases and dying early. 

The Centers for Disease Control and Prevention (CDC) estimates that 60% of American adults have at least one chronic disease and that 40% of adults in the US are obese, a condition that costs the nation $147 billion every year.¹ In addition, being overweight or obese is associated with at least 13 types of cancer, including endometrial (uterine) cancer, breast cancer in postmenopausal women and colorectal cancer. Together, these cancers make up 40% of all cancers diagnosed in the US.² 

Diet is one of the most important risk factors for all of those diseases, and the US Department of Agriculture (USDA) sets the nutrition guidelines in this country. In addition to being the official government arbiter of what constitutes healthy eating, its guidelines have a profound impact on nutrition in the US, especially for children and those who require financial assistance when paying for groceries.³ The guidelines determine the foods that show up on lunch trays as part of the National School Lunch Program, as well as which foods are subsidized under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).^4,5

The Agency has been publishing its recommendations since 1992 when it first released the Food Guide Pyramid, also called the “Eating Right Pyramid.” Those recommendations were updated into 2005 and published as MyPyramid. My review of the updated eating guidelines was published in the journal, Integrative Medicine: A Clinician’s Journal.⁶ 

While the latest incarnation of the eating guidelines has some important improvements, yet again the USDA falls short in how its advice. If people follow the USDA recommendations, they unfortunately can still eat in a way that increases their risk for heart disease, cancers, diabetes, and other diseases. 

The USDA’s contradictory agency mandate may be the reason why it’s recommending eating patterns that unambiguously cause disease. According to the USDA website, the agency is tasked with both “helping rural America to thrive” and “to promote agriculture production that better nourishes Americans while also helping feed others throughout the world.”⁷ Their mandate is definitely not to provide the best, science-based nutrition advice. When the research is overwhelmingly clear that certain foods and dietary patterns are dangerous, what’s the Agency to do? It appears that once again economic interests won out over public health policy.

Refined or Whole Grains

In its section on grains, MyPlate recommendations advise that at least half of the grains you eat in a day (3 ounces for females and 3 to 4 ounces for men) are whole grains.⁸ That means the other half—50% of your total intake of grains—can be refined and heavily processed food that’s devoid of fiber and nutrients. 

Whole grains not only contain simple carbohydrates (eg, sugar), they also provide some protein, healthy fat, soluble and insoluble fiber, vitamins and minerals. Oats, barley and psyllium are great sources of soluble fiber and whole wheat flour and wheat bran are both great ways to get your insoluble fiber.⁹

Food processing alters food from the state it was in when it was harvested, usually to extend shelf life and removes essential nutrients.¹⁰ For example, soluble fiber can help lower blood cholesterol and blood sugar levels, while insoluble fiber aids in digestion by pushing food through your digestive system. When you eat processed grains, you lose those benefits.

Refined white flour disrupts blood sugar levels and creates insulin resistance. A 2009 study studied more than 2,000 people in India whose average refined grain intake accounted for 46% of their daily calories. Researchers found that people who ate more refined grains had an 8% larger waistline, high blood pressure and were significantly more likely than people who ate the least refined grains to be insulin-resistant and have metabolic syndrome, a set of conditions that occur together and increase your risk of heart disease, stroke, and type 2 diabetes.¹¹ 

In contrast, a prospective cohort study published in 2018 showed that women who consumed more whole grains and fewer refined grains were as much as 47% less likely to develop breast cancer.¹²  And also in 2018, the journal Metabolism published a study that looked at the impact eating whole- versus refined-grains has on insulin resistance.¹³ This study was a double-blind, randomized, controlled clinical trial, which is the gold standard in research. Participants who were in the group that consumed whole grains saw their insulin resistance improve by 18%, while those eating refined grains had a 2% increase in insulin resistance. Additionally, two hours after meals, those who ate whole grains only had an increase in insulin 14%, whereas eating refined grains increased 2-hour insulin by 39%.

The Real Dairy Science

MyPlate guidelines also recommend adults consume 2-3 cups of dairy every day. But what does the science say? 

Research shows that worldwide, 65-70% of adults are lactose intolerant.¹⁴ For these people, drinking milk or eating cheese or ice cream can cause diarrhea, post-nasal drip, excess mucous, bloating, nausea, gas, headaches and muscle, and joint pain––and that’s just the start of it.¹⁵ 

Milk is laden with an alarming number of hormones, antibiotics and viruses. Some of these hormones occur naturally, but producers also use added hormones to trick a cow’s body into producing milk nearly year-round, even while pregnant.¹⁶ Just like in humans, pregnancy floods a cow with a rush of hormones that become part of her milk. 

When we ingest that milk (or milk-derived products like cheese), we’re consuming those excess hormones. Based on multiple clinical studies and years of data showing that consuming full-fat dairy cheese is associated with an increased risk for getting and dying from breast cancer, on October 3, 2019 the Physicians Committee for Responsible Medicine petitioned the US FDA to require all manufacturers of dairy cheese products to include the following warning on their labels: “Dairy cheese contains reproductive hormones that may increase breast cancer mortality risk.”¹⁷

A 2017 study funded by the National Cancer Institute concluded that “those who consumed the most American, cheddar, and cream cheese had a 53 percent increased risk for breast cancer.”¹⁸ Additionally, a 2013 study found that consuming one or more servings per day of high-fat dairy by women who had been previously diagnosed with early-stage invasive breast cancer was associated with a 49 percent increase chance of death.¹⁹ The results of this study were in keeping with the results from an earlier study.²⁰

And if men think they’re spared, they’re not. Dairy increases the risk for prostate cancer and death from prostate cancer.^21,22 A review of 23 studies concluded that dairy intake is one of the most consistent dietary predictors for prostate cancer in the published literature.²³ One of those studies evaluated data from the Physicians’ Health Study, in which diet and prostate cancer were documented in 20,885 male physicians for 11 years. Men who consumed more than 2.5 servings of dairy products per day had a 134% increased risk of getting prostate cancer compared to those who consumed half a serving per day. 

Additional studies have confirmed that consuming dairy not only may increase prostate cancer risk, but also the risk of dying from prostate cancer. Men consuming ≥3 servings/day of total dairy products had a 141% higher risk of dying from prostate cancer and a 76% chance of dying from any cause compared to men who ate less than 1 dairy product per day.²⁴ 

Your body does need the nutrients that are found in milk, yogurt, and cheese, such as calcium, phosphorus, vitamin A and vitamin D, but there are plenty of other ways to get these.²⁵ Fatty fish including salmon are high in vitamin D, calcium and phosphorous, orange whole foods including carrots, squash, cantaloupe, and mangos, as well as spinach and broccoli, are rich in vitamin A.^26,27 

Eat This Way Instead

In the 1960s, American physiologist Ancel Keys developed the Mediterranean diet, attributing the low rate of chronic disease in Mediterranean countries to the way people in the region ate. The basics of the diet are simple: it’s low in saturated fat and high in olive oil, is high in vegetables, especially leafy greens, fruit, whole grains, nuts, and beans, includes fish and poultry, dairy products and red wine in moderation, and very little red meat, eggs and sweets. 

It’s plant-based rather than meat-based and processed foods are out.²⁸ As a rule of thumb, include 7 to 10 servings of fruit and vegetables daily, and opt for whole-grain bread, farro or bulgur instead of processed or white grains. You should also aim to eat fish twice a week (avoid frying) and substitute beans, chicken or fish for red meat. You should also go heavy on the olive oil and use it in place of other oils and butter.²⁹ 

The benefits of sticking to a Mediterranean diet aren’t just inferred from noting low rates of disease in certain nations, nor is it simply another fad diet. Thousands of studies have quantified the positive impact this style of eating has on overall health.

One of the largest and most famous studies (which was originally published in 2013, then revised and published again in 2018) was a multicenter trial of observational cohort studies and a secondary prevention trial that included almost 7,500 participants, all who had a high risk of cardiovascular disease. In both renditions of the data, researchers reached the same conclusion: people who followed the Mediterranean diet were about 30% less likely to develop cardiovascular disease. People following the Mediterranean diet experienced a stroke risk reduction of 39% when compared to the control group, and the prevalence of metabolic syndrome decreased by almost 14% in people who followed the Mediterranean diet and who also ate nuts daily.³⁰ 

Other research has shown the positive effects that following a Med diet has on the liver, cancer cognitive disorders including Alzheimer’s and ADHD and digestive health. The results of a 2017 randomized, controlled clinical trial showed that just 6 months of following a Mediterranean diet reduced moderate to severe nonalcoholic fatty liver disease (NAFLD) to mild or no disease in 36% of patients.³¹ NAFLD can raise a person’s risk of developing liver cirrhosis and liver cancer and is common in obese patients and those with diabetes or metabolic syndrome. 

In a prospective cohort study published in 2019, which included more than 83,000 people aged 45 to 79 years, Swedish researchers concluded that people who closely followed a Mediterranean diet were significantly less likely to develop Crohn’s disease (CD) later in life. They found that the risk of developing late-onset CD was 12% higher among those who followed the diet poorly.³² 

As if heart, liver, bone and metabolic health wasn’t enough, a diet centered around produce, beans, nuts, whole grains and fish has also been shown to strengthen bones. In a 2017 meta-analysis, researchers found that following the Mediterranean diet increases bone mineral density and reduces the risk of osteoporotic hip fractures by as much as 21%, all while keeping milk to a minimum.³³ 

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