This article was first published in 听
鈥淢ake America healthy again鈥� sounds like a great slogan. It is loaded with nostalgia and 鈥� haziness. What is that 鈥渁gain鈥� all about? When were those halcyon days when Americans were healthier than now?
Was it in 1900, when life expectancy was around 47 and one in five children did not reach adulthood, dying regularly from tuberculosis, diphtheria, measles, scarlet fever, whooping cough and diarrheal diseases from contaminated water, milk and food? Those who survived to adulthood then died from tuberculosis, pneumonia, typhoid fever and various other infectious diseases. Polio crippled many and childbirth was often deadly. Yeah 鈥� those healthy days.
By 1950, life expectancy had climbed to 68 years thanks to water chlorination, milk pasteurization, better hygiene, antibiotic treatment of infections, vaccinations and a safer food supply thanks to preservatives and refrigeration. People were living long enough to develop heart disease due to smoking, less physical activity, unhealthy diets and undiagnosed hypertension. Today, U.S. life expectancy is around 78-79, thanks mostly to the reduction of infectious diseases that killed people early. Infections from a wound are no longer a death sentence, there is no worry about cholera being transmitted in drinking water, botulism from food is rare, toxic molds in grains can be controlled and effective medications for high blood pressure, elevated cholesterol, diabetes and some cancers are available.
Obviously, there was no era in which Americans were healthier than now, except in a romanticized imagination. Is there really a desire to return to a time when snake-oil salesmen peddled their 鈥渃ures,鈥� syphilis was treated with mercury compounds, radium was thought to be a cure for arthritis, the mentally ill were locked up in asylums, polio victims spent their lives in iron lungs and tuberculosis patients were committed to sanatoriums? Instead of looking back to a mythical 鈥渉ealthier鈥� past, we need to look to the future to try to deal with the conditions that have emerged as a result of increased longevity. These include an epidemic of obesity, a rise in Type 2 diabetes, an increase in cancers in young adults and the emergence of 鈥渕etabolic syndrome,鈥� a cluster of conditions 鈥� high blood pressure, high blood sugar, excess abdominal fat and high cholesterol 鈥� that increases the risk of heart disease, stroke and diabetes.
A more realistic slogan than MAHA would be 鈥淢ake America healthier.鈥� And there is plenty of room to do that. Among developed countries, the U.S. ranks around 30th in life expectancy (Canada鈥檚 life expectancy exceeds this by three to four years), its infant mortality rate is one of the worst among wealthy countries, and the U.S. has one of the highest rates of obesity, Type 2 diabetes and hypertension, all of which can be addressed with lifestyle modifications. On the other hand, the U.S. ranks very high in medical care. Screening for breast, prostate and colorectal cancer is effective and treatment after diagnosis is first-rate. In other words, the U.S. is very bad at preventing people from getting sick but is very good at treating them after they get sick.
Robert F. Kennedy Jr., who bizarrely occupies the position of U.S. Secretary of Health and Human Services despite having no relevant science background, seemingly wants to remedy the situation. Curiously, in pursuit of better health he has mounted a crusade against current vaccination recommendations. I say 鈥渃uriously,鈥� because vaccination has been one of the greatest scientific triumphs in history, with smallpox being totally eliminated, global cases of polio reduced by 99 per cent, and diphtheria, tetanus, rubella, whooping cough and mumps being converted into rare diseases.
, a potentially deadly disease, was on the verge of being wiped out until Andrew Wakefield published his scientifically dreadful paper linking the mumps, measles and rubella vaccine to autism. Vaccines against shingles, meningitis, pneumonia, human papilloma virus and rotavirus are also effective. According to the World Health Organization, tens of millions of deaths have been prevented by vaccines in the 20th century. Kennedy鈥檚 pseudoscientific attempts to change vaccination schedules that have been proved to prevent illness borders on the criminal. Americans will pay not only with their health but with their wallets; treatment of preventable diseases costs a fortune.
Kennedy is on somewhat firmer ground when it comes to an effort to make Americans healthier with the recently released Dietary Guidelines for Americans.
The introduction reads, 鈥淯nder President (Donald) Trump鈥檚 leadership, we are restoring scientific integrity and accountability to federal food and health policy.鈥� It should be noted that Trump drinks multiple Diet Cokes a day, disdains vegetables and dines regularly on burgers, pizza, fried chicken and well-done steak. However, let鈥檚 give credit where it is due: In line with accepted science, the guidelines do emphasize paying attention to portion size and they do steer people away from highly processed foods, something that seems to have escaped the president鈥檚 attention.
There is emphasis on avoiding added sugar and curbing refined carbohydrates. Recommendations to eat more fibre and fermented foods that support microbial diversity in the gut are evidence-based. So is advice to cut down on alcohol, although 鈥渃onsume less alcohol for better overall health鈥� is meaningless without introducing amounts.
Now for the downsides.
Mercifully, there is no recommendation to听听that Kennedy wrongly believes has nutritional benefits. The advice to increase protein intake to 1.2-16 grams per kg of body weight is not backed by evidence and neither is the need to have three servings of dairy a day. Some independent reviews have suggested that several members of the guidelines committee have ties to the beef and dairy industry. Kennedy鈥檚 misguided pledge 鈥渢o end the war on saturated fats鈥� has resulted in placing red meat and high-fat dairy at the top of the inverted pyramid published along with the guidelines, with fruit and whole grains relegated to the bottom.
The recommendation to limit calories from saturated fat to 10 per cent of total calories has been maintained, but this does not mesh with the suggestion to eat more meat and cook with beef tallow and butter. The latter is said to contain essential fatty acids, which it does not. While there is some evidence that saturated fats in dairy may not have the same impact on heart disease as saturated fats in other foods, touting meat as containing 鈥渉ealthy fats鈥� has no basis. The guidelines also fail to point out that processed meats specifically have been linked with poor health outcomes.
While the new guidelines are by not disastrous, they are not quite in step with the long-tanding recommendation to choose mono- and polyunsaturated fats over saturated fats, which basically translates to eating more plant-based foods. Still, if the advice to cut down on highly processed foods and refined carbohydrates is followed, Americans can be on the way to being healthier. As far as those supposedly healthier bygone eras, people may have been thinner, but they definitely were not healthier.
