[00:00:00] Welcome to the Health Policy Podcast. I'm Brian Hyde. Today I'm joined by Monique Yohanan. She's the Senior Fellow for health Policy with independent Women. And, and Monique, welcome to the show. First of all, tell us just a little bit about yourself and about who you are and what you do. Brian, thank you so much for having me. I'm a physician by training. Um, I also have a Master's in public health. Uh, for about 20 years of my career I wrote evidence-based Medicine guidelines. I've also worked as a medical director for Medicaid and was a geriatrician in my clinical life and worked in AI as well. But most recently I work, as you mentioned, for as a senior fellow for health policy for independent women. Well, I understand, and I've seen the news headlines that there have been some new dietary guidelines released for America, and, and I, I haven't really taken the time to delve into it myself. So I'm hoping to pick your brain a little bit about, uh, what, uh, secretary Kennedy, uh, was, uh, was putting forth [00:01:00] in these new guidelines. Uh, can you kind of walk us through what the new guidelines are and, and what kind of a shift it represents from, from what many of us have known for, for, or at least been taught for decades. Sure. So, um, what I would say is there are lots of different ways to look at it. And so what I hope to do is walk through the basics of what the guidelines are and then give, I can provide some practical ideas about how to apply them. I'll tell you upfront, I hate memorizing lists and I like to think in terms of concepts. So, big picture, think about the old food pyramid and flip it upside down. That's the first piece. And also think about real food. So we're thinking really things that are not ultra processed by ultra processed. It means it's a Franken food that got made in a lab. It's nothing that your grandmother would recognize as food. It's nothing that is. Sealed in plastic, so we want real foods, and then there's really a change in the emphasis. So I [00:02:00] can walk through what it is and then I'm happy to go through why they came to this as well. So the what is it starts with protein as the most important piece. So try to get as much protein as you can, and it frankly doesn't matter what kind of protein. So that protein could be in the form of meat. But beans, legumes are also equally represented. So this is a diet that's fine. If you're vegan, it's fine if you're keto. The next is healthy fats, and that can take a lot of different forms. So that could be avocados, that could be olive oil. One of the bigger changes is really a focus on full fat dairy. As a way of getting those healthy fats, so cheese, but also milk products that are not skim milk or 1%, so 2% milk or whole milk as an example, milk, and those kinds of full fat dairies. Those give you a twofer because they have both protein and healthy fat. And then the third of the most important ones is fiber. And really we're thinking about [00:03:00] fiber in the forms of fruits and vegetables. So, again, I hate to memorize a list. If you can eat a piece of fruit and it still has its skin on it, that's a fruit with a lot of fiber. The fruits that you have to peel, not so much. So those, that's really the big picture of it is protein, healthy, fat, and fiber. Okay, you're talking about, this is actually making me hungry as you're talking about it. So there's gotta be something to this pyramid. You know, all I remember growing up. And for much of my adult life was basically if, if it's something that makes food taste good, I'm talking fat, saturated fat, cholesterol, that kind of thing. Um, it's not good for you and you should stay away from it. Um, this, this seems like a, a very interesting reversal and for me, a very welcome reversal. Um, what has been the reaction from, from people who, you know. Have studied food science. Are there, are there people out there who've been saying this for years and are, are finally being heard? There have been. And really when we think about this, this goes back to truly an [00:04:00] evidence-based approach. So I'm gonna go back in the way back machine. About 40 years ago at Stanford, there was a researcher who came up with this idea. Syndrome X it later became called the metabolic syndrome. So think about diabetes, high cholesterol, and that kind of excess body weight in people's middles. That was syndrome X. And the idea of it, and what researchers in 1988 noticed is if you carried a lot of body fat in your middle, that you tended to have high levels of insulin. And so they thought. Well, maybe it's this extra fat that we're carrying in our middle that's causing this extra insulin, so let's try to cut down the amount of fat we had. That's the old dietary guidelines, and that was really the basis for them, that if we cut out fat, then by nature we're gonna have carbohydrates that are low fat and then that's going to decrease the amount of insulin. That's the way things went along for about 20 years. And then about 20 years [00:05:00] ago, we started to see a a, a change in the literature. And what that literature showed is if you had an excess of foods that drove insulin secretion, then you would keep fat in your middle. So it was absolutely the opposite. And what we really learned as we studied food science, as we studied what makes people feel full, what kind of foods naturally make people want to eat fewer calories If you're on a low fat diet? That is a setup to have to white knuckle it. You are not going to feel full. And guess what happens when you don't feel full? You get a drive to eat extra calories. If you feel full, you're going to eat fewer calories. So proteins. And full fat, dairy, full fat, whole healthy fats in general are going to make you feel more full. So the focus of this is, let's stop blaming people. The reality is the old dietary recommendations were a setup for people to eat more calories and to gain weight. This is a [00:06:00] way of eating that is naturally gonna make you feel more full. I'm looking at an article or an opinion piece that you wrote for real clear health.com, and one of the things you point out here is that there is no one perfect diet. Can I get you to expand a little bit on that and tell me why? Why can't we approach this as one size fits all? It can't be because. Here's the reality. We are all very different and the exact form of this, which is why I don't think it's a good idea to focus on number of servings or anything. You are gonna try things out that are gonna work for you. For some people, the best diet, based on their metabolism is to be keto, to eat lots of protein and fat in that way. For other people, it's gonna be vegan. For other people, it's gonna be some sort of hybrid Mediterranean. So the focus is. Eat real foods, focus on protein, focus on healthy fats, and focus on fiber and you're gonna be fine. And really it fits into pretty much any kind of [00:07:00] diet. But I, and by diet, I mean not the thing that you do to lose weight by diet, I mean, the thing that you do that is the way you are going to eat. That's gonna be a way of eating that you can stick with. So it's really, what do you like to eat? Because if I give you a diet that says, um, you know, you have to eat fruit, uh, a hundred percent fruit and, and you hate fruit, that is a bad diet for you, even if it works for me. So it really is. Think of those categories and if I were gonna say, you know, rule of thumb, think about that. Protein, fat, and fiber, a great meal has all three. A good meal has two of the three and Okay. Has one of the three I, I think if you don't have at least one of those, try to stay away from them. But really it's just trying to fit those categories. Not any specific type of diet, not any specific counting. And I hate to ask this because it seems like so many areas of our lives are just [00:08:00] politicized, you know, to, to the point of saturation. But, um. Did politics play a little bit of a role or a big role in, in the food pyramid that we knew up until just, uh, just a few days ago? And, and for that matter, are there people claiming that, oh, this is just a political move on the part of Secretary Kennedy? I. Well, I wish that in some ways that this were not such a political thing, but, uh, to your point, politics do end up playing an important role in our lives. I think the reality is we've had solid science on this for 20 years, but part of it, I'm gonna blame my own profession. So doctors really, I'm not gonna put any financial impact on it. I'm sure there are doctors who had no financial interests, who fell into the idea of. The old hypothesis that you have to avoid fat, and the best way to avoid fat is to eat less fat. So once people get an idea in their minds, doctors just hate saying they're wrong. So I think that I'm gonna [00:09:00] blame my own profession, most of all. I do think very unfortunately, um. It happened during President Obama's administration. I don't know to what extent he was directly involved, but taking whole milk, taking 2% milk out of public schools, I think was a huge mistake. And let me be clear on this. I have a nephew who has type one diabetes. If I had to pick a drink for him and my choices were a full sugar. Soda or a glass of skim milk. I pick the soda every day of the week because the problem with skim milk, the problem with that kind of extra low fat dairy is it doesn't just have sugar, but it kicks up your insulin response and it kicks it up double the amount that a regular soda would be. And the thing is, we had this evidence and we had this science, but I think a lot of people were just. Hey, they had staked their professional careers on it. I think now we really, this is a very science-based approach, and so I'm very grateful for it. [00:10:00] I'm curious as, as you look around, uh, and as, as you see, you know, the trends in, in other countries, I'm, I'm thinking specifically Europe. Um, I have some family that lives there and it seems like the, the struggle with, uh, with obesity. Does not appear to be as severe there as it is, um, in the us. And you know, this is just a casual observation, but it seems like we struggle with our weight a lot more. Does that have a lot to do with, with the, the kinds of food that, that we're eating or what's allowed within, uh, within our food systems? I think we eat snacking wi wise a lot more than our friends in Europe do. Um, we tend to not sit down and have a meal with people. And I would say, you know, there is a way that we eat that. The way that having meals as a celebration, having meals as a way of coming together and being part of community that I wish we had more of that in the United States. So it isn't just what we eat, but it is how we eat. The eating on the go while you're walking. That's not something you [00:11:00] see so much except for American tourists who are in Europe. Um, but I would say this, there are a lot of chemicals and a lot of preservatives that aren't allowed in Europe. Um, and so. To the extent that we can avoid ultra processed foods, that we can avoid extra preservatives. I mean, the rule of thumb is if your grandmother wouldn't recognize it, probably not a great idea to eat it. Well, that's true. And, and again, this is not about food restrictions. So if you're going to eat things that I would say are on the junky side, make them yourselves. And so I haven't talked about grains. I would say to the extent that you're gonna have grains in your diet, think about how you can make them. So if you're going to eat bread, it's a lot better for you if you make it. If you're going to eat pasta, make the pasta, but that means it's gonna be a lot harder. There'll probably be a lot less of it in your diet. So this isn't about taking anything away, but anything that's really gonna be super difficult to make, you have to [00:12:00] ask yourself, is that really something that I wanna be part of my routine? I do think that in Europe there is a way of approaching food that is important. We have a lot to learn from that. Okay. That's one of the things, I'm glad you mentioned grains, just because, um, I, I know of people who have, um, intolerance for, for gluten for instance, you know, here in the States. But for, for some reason, you know, in European countries they can eat to flour products with no problem whatsoever. That's right. And I do think, um, it probably is a combination of the preservatives that are in those grains and just the way that we are growing our foods and some of the chemicals and things that are part of the way food is produced here. So I do think, again, um, there's no particular diet that I would say that this new way of approaching food, um, really precludes. I would say it's uncommon that people can keep a healthy insulin level, a [00:13:00] healthy hormone response to their foods if they have a diet that's very rich in grains. So to the extent that the food that we have available in the United States, I would say the grains that we have here, probably to the extent that they can be limited, is probably for the better. So, uh, as far as, uh, people's ability to, to access good food under the new guidelines, uh, I'm curious, do does this affect, uh, yeah. FDA or, you know, uh, USDA guidelines in terms of, um, you know, inspection and making sure that, that the food supply is safe. And I'm, I'm specifically thinking as it pertains to, uh, things that are produced like within one's community, farmer's markets and things like that. Um. Does, does the new food guidelines, do they, do they steer people toward choices that that can better be accommodated, you know, closer to home? Yeah, I, and I do think that, that's a good point that, you know, we think about oils and things like that in terms of the food we eat, but the further away. The foods that you have is from you in many [00:14:00] ways. You have to ask yourself how healthy is that? And it sort of becomes a proxy for it that, you know, to the extent that you can eat seasonally. That's great. I will say this though, I grew up, um, quite poor. Um, my family, we were on food stamps and what I will say is it's more difficult, but, you know, I grew up eating a lot of bean soups. Um, there are ways that you can have a food diet that fits in with a pyramid that aren't necessarily about spending a fortune. So if you have the ability to shop locally, to shop in season, to buy fresh foods available, if that's part of your food budget, I think that's great. And if it doesn't, I think there's still a great deal of nutrition in Whole Foods. That are dried and even many canned foods as well. But you really wanna look again, how can you minimize the processing of foods? And so it does take a bit more time, but it doesn't necessarily have to be a lot more expensive. One final question for you, and that is with these new f [00:15:00] food guidelines, and my understanding is these are, uh, supposed to be for, for the next five years roughly. Yes, that's correct. Is is, is this something that's likely to change? Are we gonna see a snap back in the other direction? You know, depending on political leadership Yes. Is is, is it the kind of thing that, that would be prone to, to that sort of manipulation? You know, I hope not. Um, we did just have a new act where, um, we have reintroduced whole milk and 2% milk into public schools. I think that that's a great start. I do think that, um. I, I worry that this might lead to some backlash, that it could be political, but I, I wanna be really clear, and in the piece that you mentioned that I had in real clear health, there are studies that are there, there is published literature on this that goes back a couple of decades. When you look at the evidence, the evidence for eating high protein foods and full fat dairy is that you get full faster for high protein. [00:16:00] Your body actually will start to produce a chemical that's very much like its own GLP one. So eating a high protein diet. Some people are lucky. They are born with a lot of extra GLP one on board. I am not one of them, but I will tell you if you have that natural tendency, good for you. If you don't. Eating this kind of food, eating high protein is going to enhance your body's own ability to make GLP ones, and we know that you'll eat about 500 calories less a day without trying. If you eat full fat dairy instead of whole fat dairy, you are going to be fuller. You will eat about 500 calories a day. Without trying, and if you eat fiber in the form of fruits and vegetables that you can bite into, that kind of fiber in your diet is going to help your body be able to manage the glucose that you eat. You're going to just have better digestion. Just in general, you're gonna be healthier. So I hope [00:17:00] it doesn't flip back and become political in that way because I do think the evidence really is supportive. Again, we are talking with Monique Yona Yohanan. She is a physician as well as a senior fellow for health policy at Independent Women. Thank you so much for joining us on the Health Policy Podcast. Thank you so much, Brian.