For more than 40 years, the food pyramid has been the “holy book” of healthy eating across the Western world, placing carbohydrates and grains at the foundation of our daily diet. During the same period, however, the global community has experienced an unprecedented increase in obesity, type 2 diabetes, and metabolic diseases — a phenomenon that is now recognized as one of the greatest public health challenges worldwide, and particularly in the United States.
What went wrong? Were the official dietary guidelines scientifically outdated, misinterpreted, or simply unsuitable for the modern, sedentary lifestyle? In the interview that follows, the Pathologist specializing in Diabetes Mellitus, Evangelos Fousteris, speaks with scientific clarity and clinical experience about the great shift in nutritional thinking: The role of carbohydrates, the restoration of protein and fat, the concept of insulin resistance, and why today doctors talk about "real food" and not just calories.
For decades, the food pyramid placed grains and carbohydrates at its base, recommending up to 11 servings per day. With today's approach to metabolism, obesity, and diabetes, how detrimental has this guideline ultimately proven to be to the explosion of obesity and Type 2 Diabetes worldwide?
“I wouldn’t exactly use the term ‘harmful’. Dietary recommendations are influenced by and adapted to the lifestyle of the time. Imagine, for example, what recommendations we would have had during the “Great Famine” in 1315 AD in Europe, where over 7 million people died of starvation. If one looks at this history evolutionary, where the average person cultivated the land and lived in an environment where they expended many calories per day, then these portions of carbohydrates were indeed needed to stay alive.
As we moved towards automation (industrial revolution), sedentary work and significantly increased the hours we spend in front of screens (for work or entertainment), this brought about a dramatic change in energy expenditure and the subsequent insulin resistance. Especially since 1990, when these lifestyle changes are most pronounced, as well as the parallel increase in consumption of ultra-processed foods, we have been led to an explosion in obesity rates across the planet, naturally dragging along the rates of type 2 diabetes.
With this in mind, I imagine you understand why, under the current sociocultural conditions, a dramatic reduction in carbohydrates and an increase in protein and vegetable consumption have been proposed. Under today's conditions, 11 servings of carbohydrates is like adding fuel to the metabolic fire. For an organism that is already metabolically burdened, this amount of carbohydrates translates into a constant oversupply of glucose in the blood."
In the new approach, protein takes on a central role. Why is adequate protein consumption so critical for metabolism and glucose control, and why have we demonized or downplayed it in the past?
"Protein consumption is crucial for our metabolism. Protein has been unfairly demonized, largely due to fears about the saturated fat that often accompanies it. However, protein is the most filling macronutrient and has a high "thermic effect" - the body expends energy simply to digest it, so the final calories it yields are fewer than the equivalent amount of carbohydrate.
For a person with obesity and/or diabetes, protein is a "shield" as it slows down the absorption of glucose from meals and protects muscle mass, which is the main glucose-burning "factory" in our body.
"Perhaps, of course, the intake of 1.8 g. protein per kilogram of body weight per day (suggested by recent guidelines) is not so scientifically documented, but we will see in the future with new studies what effect such a diet will have, e.g. on blood lipids or kidney function."
How dangerous were the previous recommendations for specific groups, such as people with prediabetes or metabolic syndrome? Is it possible that the “official” diet itself was worsening their health condition instead of improving it?
"I don't think that was the spirit of the previous guidelines. The carbohydrates that were recommended and are now recommended are mainly from fruits, vegetables and legumes. We recommend that all foods be as close to their primary form as possible, that is, not heavily processed. And before, but more emphatically now in the new guidelines, it is recommended to avoid overly processed foods, whether protein (e.g. cold cuts) or carbohydrates (e.g. breakfast cereals, white bread, brioche, croissants, etc.). Let's not forget, also, that many studies have shown the metabolic benefits of the Mediterranean Diet in people with metabolic syndrome - a pre-diabetic condition. This diet is based on minimally processed carbohydrates and good fats (olive oil)."
As a clinician, were you and your informed colleagues (Diabetologists, Nutritionists), actually following the old pyramid model in recent years, or had its lack of validity already been established through scientific studies or in clinical practice, long before the official revision?
"You are right, we have been adapting our instructions for at least 10 years, personalizing each time to the person we are dealing with. Moreover, a multitude of studies have come to revise our traditional nutritional advice: Strong data on the metabolic benefits of ketogenic diets (very low carbohydrate intake) or intermittent fasting (eating for a limited period of time within 24 hours). And why is that? Because the environment has changed, we have created the so-called "obesogenic" environment, so "classical" nutritional approaches no longer benefit us. You know, not all calories are the same: Our body is not a simple wood-burning boiler, but a complex chemical factory. The data shows an undeniable correlation between ultra-processed foods and the risk of obesity, diabetes, and cancer."
Many analysts argue that the old pyramid was shaped more by the interests of the US food and grain industry than by biology. Do you think this fact justifies today's public skepticism and distrust of official government health guidelines?
"I don't know and I don't think so. But I think the new proposed food pyramid is a courageous adaptation (adaptation) in the modern way of life, and of course it concerns the USA more, where they were issued. The legislative framework in the USA regarding food (labels, ingredients, genetically modified organisms, etc.) is very different from Europe. The same industrial food has a different composition in Europe and another in the USA. That is why the new guidelines emphasize: Eat real food. We need to return to “real food”: If a product has words in the list of ingredients that you cannot pronounce or that are not found in your grandmother’s kitchen, then your body probably does not know how to handle it. I think it is a first and strong blow to the food industry, which must adapt to the needs of modern man.”
The old pyramid focused obsessively on avoiding fats, leading the industry to replace them with sugar and refined carbohydrates. What was the “price” of this obsession for the cardiovascular health of the population?
"The demonization of fat, which began with studies in the 70s, led to a tragic substitution: we removed the fat and added sugar, fructose, and starch to make the food taste good. The price was an increase in obesity, insulin resistance, diabetes, resulting in chronic systemic inflammation, and an increase in cardiovascular disease and death. Today we know that sugar and refined carbohydrates "hurt" the blood vessels much more than natural fats."
It would be useful to refer to insulin resistance, which is the connecting link between the old diet and modern diseases.
"Insulin resistance is, if one thinks about it, a "normal" or to put it more accurately, a pathophysiological response of our body to the oversupply of energy through carbohydrates. The modern environment, therefore, with the abundance of processed and ultra-processed carbohydrates (tasty, addictive, cheap and ubiquitous foods) leads us to increased consumption, which leads to constant spikes of glucose in the blood, a permanent postprandial hyperglycemia that leads to hyperinsulinemia. A consequence of this is insulin resistance, as the cells of our body no longer want this oversupply of glucose, hence metabolic dysregulation, obesity and diabetes. And the previous instructions, however, did not say eat processed industrial carbohydrates. What was implemented was a deliberate distortion of the instructions by the industry and a solution of necessity by modern households, for economic reasons and lack of time for cooking.
With the implementation of the new guidelines that limit carbohydrates and emphasize good fats and proteins, how long can we expect to see a measurable improvement in general health indicators and a reduction in chronic diseases?
"The amazing thing about metabolism is its plasticity. By limiting refined carbohydrates and emphasizing 'real foods,' we see improvements in insulin and triglyceride levels in just a few weeks. If we limit our daily calorie intake, weight loss is a natural consequence as the body regains access to its fat stores."
How difficult is it to "re-educate" the general population and for doctors to revise in practice 'dogmas' that have been taught as doctrines for 40 years? What is the first step a citizen should take today to "reverse" the pyramid on their plate?
“Retraining is difficult because behaviors are deeply ingrained and constantly reinforced by the media and advertising. But the first step is simple: Fill your plate with vegetables and protein, not starch, not ultra-processed foods. Replace bread or rice with double the serving of green vegetables and add good quality protein (fish, eggs, meat) and olive oil. This simple move inverts the pyramid in practice and signals the metabolism to start healing.”
"In conclusion, we would say that the problem of obesity has reached pandemic proportions and is the trigger for many non-communicable diseases:
- Mechanical: Osteoarthritis, gastroesophageal reflux, sleep apnea syndrome, chronic low back pain, cholelithiasis, etc.
- Metabolic: Prediabetes, diabetes, hypertension, hyperlipidemia, hyperuricemia, metabolic liver steatosis, chronic kidney disease, infertility, etc.
- Others: Depression, anxiety disorders, stigma, cancer, etc.
It is clear that we all need to act now:
- IThe scientific community with revised guidelines, education of health professionals and the public, implementation of personalized programs for the prevention and control of metabolic diseases
- II. Society with information actions, especially for sensitive population groups (e.g. children and adolescents, economically vulnerable groups) as well as with struggles for equal access to health structures and improvement of the environment
III. the state with legislative interventions, such as restrictions on food industries, correct food labels, taxation of ultra-processed foods, reimbursement of obesity drugs, subsidizing exercise programs, etc.
The battle has begun. But we are still only at the beginning of taming the metabolic tsunami of obesity!
photo bs65me – https://pixabay.com
