OP/ED
Heart disease is the leading cause of death in the United States.
As a practicing cardiologist for more than 20 years, I’ve watched patients do everything “by the book.” They eat according to the Dietary Guidelines for Americans and still see their weight climb, blood pressure rise and heart health deteriorate.
The problem isn’t their effort. It’s the guidance, which promotes highcarb, low-fat diets that can actually worsen heart disease. Many assume that by following the government’s recommendations they can improve their health. Too often, the opposite is true.
With the next edition of the Dietary Guidelines scheduled for release in early 2026, we have a critical opportunity to align federal nutrition policy with modern science. Done right, this update can save lives.
Since 1980, the Departments of Agriculture and Health and Human Services have issued the Dietary Guidelines. These recommendations shape the food in school cafeterias, military mess halls, hospitals, and nursing homes. They inform SNAP and WIC benefits, nutrition education, and the labels on grocery store shelves.
From the start, the guidelines steered Americans wrong. Saturated fat — and cholesterol by extension — were stigmatized, while bread, pasta, and cereal became staples of the American diet.
Four decades later, the guidelines remain out of step with the health needs of the majority of Americans. They impose arbitrary caps on saturated fat, despite no consistent link to higher rates of heart disease or mortality. And they direct Americans to get 4565% of their calories from carbs — sidelining low-carb options proven to support weight loss, stabilize blood sugar, and reduce the risk factors that drive heart disease.
Today, 93% of Americans live with metabolic dysfunction. More than 75% of Americans are overweight or obese. Heart disease mortality rates have increased even as cholesterol levels have steadily fallen.
Like most physicians, I was trained to be wary of fat and to consider carbs the foundation of a healthy diet. I dismissed suggestions that a lowcarb or keto diet could improve cardiovascular outcomes.
But when I cautiously introduced the approach to my patients, I saw transformations I couldn’t ignore: their insulin sensitivity, blood sugar levels, and blood pressure began to improve.
Their experiences mirrored what the science was showing: the lowfat, high-starch model had it backwards.
A review of randomized trials found that low-carb diets significantly improved weight, blood sugar, and blood pressure — the risk factors that drive heart disease. In patients with type 2 diabetes, keto approaches dramatically lowered blood sugar while delivering substantial weight loss.
The upcoming Dietary Guidelines offer a chance to finally get it right. That means prioritizing whole foods, removing limits on saturated fats, and including low-carb options.
The nation’s leading killer isn’t inevitable. If the Dietary Guidelines are updated to reflect modern science, millions of Americans could soon be on the path to reclaiming their heart health.
Bret Scher, MD, is a board-certified cardiologist and lipidologist, and medical director of the Coalition for Metabolic Health. This piece originally ran in the Times of San Diego.
