Why the USDA Must Include a Low-Carb Option in the Dietary Guidelines
Our public institutions feed America. School cafeterias. Hospital trays. Nursing homes. Mental health facilities. Military bases. All follow the USDA Dietary Guidelines. If those guidelines miss the needs of people with metabolic disease, the system fails them. This is why a low-carb option in the Guidelines is not a niche request. It is a public health necessity.
When the first Guidelines came out in 1980, most Americans were metabolically healthy. Today, they are not. More than 40 percent of adults live with obesity. Roughly one in ten has diabetes, mostly type 2. A widely cited 2018 study found only 12 percent of adults metabolically healthy. Newer analyses suggest the number is closer to 7 percent. Children now face rising rates of obesity, fatty liver, and early metabolic disease. The old one-size-fits-all, high-carb pattern no longer fits the country these institutions serve.
This is not a call to force everyone into keto. The ask is simple. Add a low-carb option to the official patterns. The Guidelines already offer cultural variations. They should also reflect metabolic differences. Many Americans need lower carbohydrate intake to manage blood sugar, improve insulin resistance, reduce liver fat, and lose excess weight in a sustainable way. An official option gives patients, clinicians, and institutions a lawful, clear framework to use.
How the Guidelines shape the system
The Guidelines drive everything downstream.
• Menu standards for schools, hospitals, nursing homes, mental health facilities, and the military.
• Insurance coverage for nutrition care.
• Medical and dietetic training.
• Positions of major groups like the ADA and AHA.
Without a low-carb option, doctors risk stepping outside the accepted standard when they use low-carb therapeutically. Insurers hesitate to cover care. Institutions avoid reform. The result is a locked loop that keeps effective nutrition therapy on the sidelines.
Nina Teicholz, investigative science journalist and author of The Big Fat Surprise, has documented serious process problems around low-carb evidence in the DGA process.
Key points she discusses:
• The National Academies warning. In 2017, NASEM urged the DGA process to serve all Americans, including those with chronic disease. Without change, guidance would not apply to the majority. That is where we are.
• Mixed messages from USDA-HHS. Public statements say the Guidelines are for everyone ages two and up. Then, in stakeholder meetings, officials say they are not meant for people with chronic disease. That excludes most adults.
• Evidence buried or filtered out. In 2015, the DGAC reviewed more than 40 low-carb studies with meaningful outcomes. Internal emails, obtained by FOIA, show concern they were being buried rather than presented clearly. By 2020, new review criteria filtered out low-carb trials entirely, as if no eligible studies existed. In the current cycle, modeling replaced real-world data. Calories from carbs were removed, but not replaced with protein or fat, then the diet was labeled “deficient.” Any pattern looks deficient if half the calories vanish on paper.
• Consequence. High-quality trials and clinical programs show low-carb improves weight, A1c, triglycerides, HDL, liver fat, and markers of insulin resistance. Excluding this body of research keeps effective care out of standards used by every major institution.
Why a low-carb option fits the science
Low-carb aligns with the biology of insulin resistance. Lower carbohydrate intake reduces glucose spikes and insulin demand. Lower insulin opens the door to fat loss and improved metabolic markers. Trials and real-world clinic data show:
• Weight loss with better satiety.
• A1c reduction and fewer diabetes medications.
• Triglycerides down and HDL up.
• Liver fat down in NAFLD.
• Better glycemic control for many with PCOS.
Keto as a therapeutic version
Low-carb spans a range. Keto is the stricter end, usually 50 grams of carbs or less. It shifts the body to fat-based fuel, which supports rapid improvements in insulin resistance for many people. An evidence-based keto food pyramid centers animal protein, eggs, seafood, dairy if tolerated, and natural fats. Non-starchy vegetables and low-sugar fruits sit in the middle. Starches, grains, and sugars move to the top as occasional or avoided, depending on the goal. This structure supports nutrient density, satiety, and stable blood sugar.
What inclusion would change right away
• Schools and hospitals gain a lawful, clear pattern for lower carb menus.
• Nursing homes and mental health facilities serve metabolically safer meals to vulnerable groups.
• Military dining supports service members who need better glucose control and performance.
• Clinicians gain protection to personalize care without stepping outside standard practice.
• Insurers have grounds to cover coaching and follow-up for low-carb nutrition therapy.
• Medical and dietetic training includes low-carb as a core tool, not a fringe topic.
Answering common concerns
Protein and fat adequacy. When carbs come down, calories shift to protein and natural fats. This improves satiety and nutrient density. The diet is only “deficient” if those calories are not replaced.
Heart health. Low-carb often lowers triglycerides and raises HDL. Many see improved blood pressure and inflammatory markers alongside weight loss.
Sustainability. With proper guidance, people follow a low-carb pattern long term. Results drive adherence. Real food keeps meals simple and satisfying.
If you work in a school, hospital, care facility, or public service, you need options that match the health needs you see daily. If you are living with prediabetes, type 2 diabetes, PCOS, fatty liver, or stubborn weight gain, you deserve a pattern that supports your biology. An official low-carb option brings alignment between science, policy, and daily meals.
Women over 40 face unique metabolic shifts. Lower carb intake with adequate protein often improves energy, mood, body composition, and blood markers. An official option would reduce friction, expand access, and help families eat the way their health requires across every institution they touch, from school lunches to hospital stays.
We need USDA Dietary Guidelines that match today’s metabolic reality. Add a low-carb option. Support clinical freedom. Give schools and hospitals a path to serve metabolically safer food. Align national policy with science and with the needs of the people these institutions feed every day.
Disclaimer: The content shared here is for informational and educational purposes only and should never be taken as medical advice.
In writing this blog post, my goal is to distill research findings into a clear, approachable format that encourages critical thinking and empowers you to make informed decisions about your health.
