SARAH MCCAMMON, HOST:
This week, the Trump administration announced sweeping changes to dietary guidelines for Americans. Health Secretary Robert F. Kennedy Jr. called it the most significant reset in federal nutrition policy in history. He urged Americans to prioritize protein and cut back on added sugars and processed foods. For more, Marty Makary, the commissioner of the Food and Drug Administration, joined us in the studio. Welcome.
MARTY MAKARY: Great to be with you, Sarah.
MCCAMMON: So let's start with this new food pyramid. We all grew up looking at this. The new one, of course, illustrates new dietary guidelines, and I think those changes have been confusing for some people. You know, we now see a visual that prioritizes more meat and cheese, whereas the small end of the pyramid seems to indicate that you should eat fewer whole grains. This is what people see. This is what kids will learn in the classroom. Is that what you intend?
MAKARY: Well, the old food pyramid was really corrupted. The field of nutrition science has been one of the most corrupted by industry sciences in all of medicine. We want protein guidelines that allow people to thrive. We want to call out ultra-processed foods, talk about sugar in a meaningful way for the first time, and actually saying there is no threshold for appropriate amounts of sugar in children. They don't need added sugar.
So we are taking a bold position. We are flipping it upside down, and as - you're right, we are ending sort of a war on fat by talking about the entire spectrum of food that people should have, including the types of grains. A calorie is not a calorie. And you want grains that are not stripped of fiber and chopped up and function like sugar. That's part of the ultra processing.
MCCAMMON: No sugar for kids - you might be making some enemies here, at least in the toddler set. But you talked about I think what you described as sort of corruption of nutrition science. I mean, who do you blame for that?
MAKARY: Well, there was medical dogma that took on a life of its own. And for 50 years, the medical field has made this mistake of demonizing healthy, saturated fats. And as you remember, when we were growing up, they would encourage you to drink low-fat milk, even if it was chocolate milk. So ironically, they took out the healthy, saturated fat and added sugar, and that was supposed to be healthier.
We now have a chronic disease epidemic. The focus on fat has paralleled and ushered in an entire generation of kids with high insulin - what we call insulin resistance - high levels of inflammation and chronic diseases never seen before at this rate in the human race. And it is not a coincidence.
MCCAMMON: Do you see this as, you know, a misunderstanding of the data, or do you believe decisions were made in bad faith intentionally?
MAKARY: It's just sort of going along with the bandwagon thinking at the time. And that, in fact, was the story of the food pyramid, this dogma that you should have breads and cereals and pastas as the dominant part of a diet, carbohydrates that were really refined carbohydrates, that functioned like sugar in many cases, but no one talked about it.
MCCAMMON: On the subject of ultra-processed and processed foods, you do recommend cutting back on those, but they make up a huge percentage of the foods that Americans eat, especially people who live in food deserts and places where there's limited access to fresh food. What will the administration do to make nonprocessed, healthier foods more affordable and accessible to more Americans?
MAKARY: Well, our charge is to provide guidance that is medically sound. Now, there's a tremendous effort right now to increase affordability in the Trump administration, and our role at the FDA is to make sure that people have good guidance. Now, it turns out, a lot of times, healthier food can be lower cost because it's local, it's not chemicalized. If you look at some of the ultra-processed food, and you turn the package around, you might see 30 different ingredients. That's a warning. That tells you that this is not the sort of food that your body thrives off of.
MCCAMMON: There's been a big focus in the administration on improving public health, of course, through a better diet and also through less reliance on drugs. And yet, we're seeing a boom in GLP-1 drugs, weight loss drugs like Ozempic. There's now a new pill version of Wegovy, which the FDA just approved recently. Are these policies at odds?
MAKARY: Well, we don't want people to start with a GLP-1 drug. We want people to have good information about eating healthy. We were literally, as a medical field and government, giving people the wrong information about what is healthy food. And so we're setting the record straight, and at the same time, we need to make sure that the GLP-1 medications - which, by the way, mimic a hormone that normally works in the body - that that's available as a second- or third-line treatment.
MCCAMMON: I also want to ask you about some of the criticism the administration has faced regarding recent changes to the childhood immunization schedule. There have been accusations that the administration is circumventing the long-standing public process for making these kinds of changes and ignoring the well-established science. How do you respond?
MAKARY: We want to see greater uptake of the childhood vaccines, and the way that we need to do that is to meet people where they're at. So we have presented now a hierarchy of vaccines, where we've identified a list of core essential vaccines. Overall, it results in about 38 doses in one's childhood as opposed to 72. And the idea is that 38 is better than zero.
MCCAMMON: You're almost saying you don't want the perfect to be the enemy of the good.
MAKARY: That's true because we are seeing vaccination uptake rates go down with childhood vaccines. That's been going on for the four years of COVID because I think people have had tremendous distrust of public health. We are trying to win back public health trust, and we're trying to see more kids get essential core vaccines.
MCCAMMON: I think a lot of people would say that Health Secretary Kennedy is partly to blame for that distrust in the public health system and specifically in vaccines, given some of the positions he's advocated, including spreading debunked ideas about a connection between vaccines and autism. Isn't he partly responsible for that?
MAKARY: I don't think vaccines cause autism, but the reality is vaccine uptake rates have gone down in the Biden administration during the COVID years. And the outbreaks that we're seeing - for example, with measles - started before Secretary Kennedy came to office. In fact, they are global, that is, international outbreaks that are going on around the world. And we want to see people get the measles shot. Secretary Kennedy has promised, if you want a vaccine, you can get the vaccine. All vaccines are recommended and covered, but we are putting out a hierarchy of core, essential vaccines that we really want kids to get if they are low-risk, that is, healthy.
MCCAMMON: But, I mean, he suggested that measles vaccines cause unnecessary deaths. Does that help the effort to, as you say, increase the uptake of necessary vaccines among children?
MAKARY: Look, I can only speak for myself, but I have heard Secretary Kennedy articulate very clearly and publicly that the best way to prevent measles is through vaccination.
MCCAMMON: I've been talking with Dr. Marty Makary, commissioner of the Food and Drug Administration. Dr. Makary, thank you for your time.
MAKARY: Great to be with you, Sarah. Thank you. Transcript provided by NPR, Copyright NPR.
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