“Make America Healthy Again”. Sounds great. What does this really mean?
There’s no question that there are a lot of sick people in the United States. Obesity has definitely grown over the past few decades, as has a sedentary lifestyle. The US spends the most money on healthcare, yet has a lower life expectancy than Canada, Japan, the Netherlands, and the UK. Nonetheless, the average life expectancy was 47 in 1900. It’s 78 now.
Any dietitian will agree that eating a diet high in ultra-processed foods is not ideal. No dietitian recommends consuming sugar with abandon. Most will also advise people about how to balance their plate for macronutrients, and advise them to include foods that provide the important vitamins in minerals that they need. Why is there so much chronic disease and why are Americans developing health problems at younger ages? Why can’t we figure out a solution to providing proper health care to all Americans?
The RFK Jr’s team and I can agree that there is a chronic disease problem. That Americans are too sedentary. Perhaps even that Americans prefer processed foods and don’t value the effort required to prepare whole foods. However, we don’t agree on the root causes of this problem.
It’s not the seed oils, or the sugar, or the bowl of cereal with milk.
It’s the system, the lack of nutrition research funding, and the underutilization of allied health practitioners who actually could make a difference. Some of us have seen potential solutions come and go, but they never include provisions for a key part of the solution: Personalized medical nutrition therapy delivered by a registered dietitian.
Same As It Ever Was
We seem to have a really difficult time in this country remembering the past so that we can create a better and more progressive future. I’ve been a registered dietitian for nearly 40 years. I’ve worked in a variety of settings including over 12 years of work in clinical settings. I expected there to be much more progress in preventive health care at this point.
The MAHA movement wants you to believe that the Dietary Guidelines for Americans are to blame for chronic disease (specifically use of seed oils, processed food, intake of fruit, sugar, dairy, and wheat). For instance they use data that shows that vegetable oil use has increased since 1980, to make a case that it’s the cause of disease. That’s called an observation, and it’s not supported by science.
Turn, Turn, Turn
It is a very interesting time in history. Public mistrust in science has grown. This mistrust is fueled, not only by unqualified “influencers”, but also by people in the health care space that spread misinformation about food, nutrition and medicine.
What had been the viewpoints of one side of the aisle (protection of the environment, provision of health and nutrition safety nets) seemed to have switched camps but with a different approach (promoting electric cars, encouraging the removal of artificial dyes from food, the MAHA movement). Yet at the same time, massive budgets cuts have been occurring within the very programs that support health. It doesn’t make sense.
A Little Backstory
Early in my career, managed care companies (Health Maintenance Organizations) were the new solution to preventing disease and “fixing healthcare” (this managed care system was surprisingly championed by President Nixon). The whole concept was focused on prevention. The clinics I worked for were very effective at providing the care, but not so great at showing the benefits as income (because health insurance companies gotta make money). People did not like not being able to choose every single doctor or practitioner. In other words, having healthcare was not as important as choosing a specific doctor. Even though many clinics provided ideal health care, the HMO models went bankrupt.
Over the past 25 years, I’ve been a nutrition writer, helping people decipher nutrition misinformation so they can enjoy eating for better health. I’ve covered a lot. I’ve dug deep into topics that are both in the news and behind the scenes. Around 2005 I began digging into the question “where does our food come from”. Since, I’ve been an advocate for modern agriculture, learning that much of the claims people were concerned about, were not validated in real-life farming practices. I’ve visited dozens of farms, food companies, food processing factories, and plant-breeding facilities. I’ve spoken with biochemists and toxicologists, so I can turn complicated topics into digestible information for consumers.
Lately, I’m finding it very difficult to write about anything. Every day brings a new headline filled with either misinformation, disinformation, or unfounded claims.
Root Cause
There have been a lot of headlines and stories in the news lately about the “root cause” of chronic disease. If you were to ask ten health professionals what those causes were, you may get different, but partly correct, answers (except those involved in the current MAHA movement who believe it’s seed oils, sugar, food additives, vaccines, and fluoride).
However, the root causes of chronic disease are not a mystery (smoking, poor nutrition, physical inactivity, and excessive alcohol use). They are multi-factorial however. In many cases, chronic disease is a product of aging. While we may see more diabetes, obesity or even high blood pressure in the younger population, the burden of chronic disease falls largely to those over 80. Genetics does play a role, and I could argue that “well-managed disease” is different than “chronic disease”. In other cases, there are people at higher risk due to conditions they were born with. In addition, social determinants of health impact disease risk.
Understanding Public Health
It’s interesting that those who want the freedom to ignore science still want to benefit from everything science provides them. Public health isn’t just about you, it’s about everyone (the “public”). I worry about how the public will handle the next pandemic – and there will be one, especially if we allow our federal health systems to continue to deteriorate and lose funding and oversight.
“Public health” is different than general “wellness”. It must consider what is reasonable to maintain health for the population at large. Public health protects ALL of us from outbreaks, food borne illness, waterborne illnesses and more.
Complementary and alternative medicine began as a supplement to traditional medicine. It seems to have evolved into a war against “chemicals” in food and the environment. Many alternative medicine practitioners promote this illusion that you have control over every aspect of your health. Impossible.
I recently became aware of the Health Freedom Movement. The idea of “Health Freedom” assumes that only YOUR individual health matters, not the population at large. This thought process has deteriorated the trust in our public health system (clearly the COVID-19 pandemic weakened this trust even further. This “health freedom” viewpoint is also a barrier to the acceptance of a universal system that can provide basic health care, including preventative medicine, to all.
The Bigger Picture: Mortality in Infectious Disease and Chronic Disease
Let’s take a step back and look at public health from a prevention standpoint. As I recently heard – “preventing heart disease doesn’t matter if you die young from measles or small pox”. A big part of a good public health system is preventing the spread of infectious disease (viruses, bacteria, pathogens). Preventing diseases that are easily spread to anyone, of any age, is much easier in theory, than preventing the types of chronic disease that take years to develop and are the leading causes of death (keep reading).
If you look at chronic and infectious disease from 1980 to 2014, you’ll observe a few things. First of all, the population has grown since 1980, and diagnostics have evolved. Both of these facts change the data collected – more people, more diagnoses. Infectious disease mortality decreased from 1900 through 1950 (except for the 1918 pandemic spike). This was largely due to vaccines (small pox, diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella hepatitis B, hepatitis A, varicella, and Streptococcus pneumoniae). From 1980 through 2014, infectious diseases composed 5.4% of all deaths. Most infectious disease deaths from 1980 through 2014 were due to influenza or pneumonia. There were also major changes in mortality from West Nile virus, and C difficile over this period.
However in the 1980s, there was the AIDS crisis. When I got out of college, they were treating a regular rotation of patients with HIV/AIDS at the hospital (I evaluated these patients’ nutrition status and needs every week when I began practicing clinical nutrition and dietetics in the mid to late 1980s). This is something you rarely see now at in-patient settings, thanks to infectious disease research and treatment. However due to the HIV/AIDS epidemic, deaths from infectious disease increased from 42.0 per 100,000 people in 1980, to 63.5 per 100,000 people in 1995. A decline in HIV/AIDS mortality in 1995 was associated with the introduction of antiretroviral therapy.
Leading Causes of Death in 2022
Flash forward to 2022, and we see a different picture when it comes to causes of death.
- Heart disease: 702,880
- Cancer: 608,371
- Accidents (unintentional injuries): 227,039
- COVID-19: 186,552
- Stroke (cerebrovascular diseases): 165,393
- Chronic lower respiratory diseases: 147,382
- Alzheimer’s disease: 120,122
- Diabetes: 101,209
- Nephritis, nephrotic syndrome, and nephrosis: 57,937
- Chronic liver disease and cirrhosis: 54,803
Heart disease is now the leading cause of death and vaccine-preventable disease death rates have decreased significantly since 1980. Yet today, many people are skeptical about vaccines, and some are working to undermine the well-oiled machine that was the public health system.
We came a long way in preventing death from infectious disease in the 20th century. It would seem that now it’s time to tackle reducing the mortality from chronic diseases.
While we do have some good research serving as the foundation for diet in both health (prevention) and disease, nutrition is a fairly young science, and has never been well-funded. You would think that supporting more funding towards nutrition research would be a great idea leading to the discovery of more proven connections between diet and health.
Instead, it seems the MAHA movement wants to police the food supply before there’s any evidence to support their guesses. Enter – the wellness industry.
The Wellness Industry
I’ve watched the wellness industry grow over the past 20 years. It’s been fueled by food activists, functional and alternative medicine doctors, chiropractors, and “holistic healers”, who slowly molded public perception of food, nutrition, and medicine.
It’s important to understand that the Make America Healthy Again movement was originally a PAC (political action campaign) founded by Robert Kennedy Jr. Those involved since the beginning in the MAHA movement include other activists – Vani Hari, Moms Across America, Del Bigtree, and Calley Means. The MAHA movement is built on the idea that food and chemicals in the environment are causing chronic disease. Unlike in science, where there’s a hypothesis first, the MAHA brigade is starting with the conclusions. The movement makes bold statements like “Poor diet is a leading cause of mortality in the U.S., contributing to over 500,000 deaths per year.”
Poor diet can absolutely be related to risk of disease, but it’s a stretch to say diet alone causes deaths.
The wellness industry started small, with fear-mongering food messages (“high fructose corn syrup causes obesity!”), then focused on messages against GMOs (which really was about the herbicide glyphosate), and now has a stranglehold in the nutrition space. It has created all sorts of myths based on a fear of chemicals (choosing “clean ingredients” – whether household cleaners or food). It promotes the avoidance of seed oils, sugar, dairy, and wheat, claiming toxicity or inflammatory side effects. Somehow this food fear led people to fear proven childhood vaccines (resulting in the current measles outbreak and the avoidance of getting vaccinated to prevent highly infectious diseases). We are now witnessing the unraveling of our public health system.
Science is Not the Enemy
I absolutely agree that simple things like getting outside, moving our bodies more, getting good sleep, managing stress, and eating well, all work together to support good health. That’s why I chose my profession. However it is painful to watch all of this “contrarian medicine” unfold.
In an ideal world, we don’t need these grifters to prevent more chronic disease. We need a more cohesive health care team with more health education. We need to utilize more registered dietitians (who believe me, with an average salary of $60k a year, aren’t in it for the money) and other allied health professionals (such as physical therapists and certified nurse practitioners) as part of a bigger health education system.
Prevention: The Wheel has Already Been Invented
Preventative medicine helps tackle issues before they become chronic (and sometimes, even medications do help prevent chronic disease). Imagine if every doctor and pediatrician office added dietitians and health educators to their staff? They need a federal incentive to do it, and I guarantee they would get results (and people would still be able to eat a sandwich or enjoy a bowl of cereal)!
Having an annual check-up with your doctor is also part of preventative medicine. Preventative medicine involves getting annual bloodwork, having access to health education and nutrition counseling to help you make the modifications needed to lower blood pressure, lose weight, or improve lipid panels. Preventing chronic disease also means having access to smoking cessation, stress management sessions, and other health education.
No, doctors do not need to learn more about nutrition in medical school. They need to learn better diagnostics, how to do a physical exam, and how to responsibly prescribe medicine.
The wheel has already been invented – registered dietitians are trained in nutrition and diet therapy. Utilize them.
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