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Opinion: As a cardiologist, I know the dietary guidelines are failing our hearts

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Opinion: As a cardiologist, I know the dietary guidelines are failing our hearts


Meals at a restaurant on the UC San Diego campus. (File photo by Chris Stone/Times of San Diego)

Heart disease — affecting almost half of American adults — is the leading cause of death in the United States, claiming 700,000 lives each year. 

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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 — the federal government’s blueprint for nutrition policy — and still see their weight climb, blood pressure rise, and heart health deteriorate. 

The problem isn’t their effort. It’s the guidance itself, which promotes high-carbohydrate, low-fat diets that can actually worsen metabolic health, which can in turn worsen heart disease. Many assume that by following the government’s recommendations they can improve their health — but, too often, the opposite is true.

With the next edition of the Dietary Guidelines scheduled for release this month, we have a critical opportunity to move beyond outdated orthodoxy and align federal nutrition policy with modern science and clinical experience. Done right, this update can turn back the tide of chronic illness and save lives.

Since 1980, the Departments of Agriculture and Health and Human Services have issued the Dietary Guidelines every five years. These recommendations shape not only personal choices but also the food in school cafeterias, military mess halls, hospitals and nursing homes. They inform SNAP and WIC benefits, nutrition education, and even the labels on grocery store shelves.

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From the start, however, the guidelines steered Americans in the wrong direction. They marked a sharp departure from prior eating patterns by encouraging Americans to cut back on natural dietary fats and rely more heavily on refined high-carbohydrate foods. Saturated fat — and cholesterol by extension — were unjustly stigmatized, while bread, pasta and cereal became staples of the American diet.

The recommendations were not made with a metabolically vulnerable population in mind. For people already struggling with insulin resistance, obesity or diabetes, a high-carbohydrate diet frequently only compounds the problem by driving up insulin, promoting visceral fat storage around vital organs, and fueling a cycle of weight gain and chronic disease.

Four decades later, the guidelines remain out of step with science and with the health needs of the majority of Americans. They impose arbitrary caps on saturated fat, despite evidence showing no consistent link to higher rates of heart disease or mortality. They recommend dietary protein well below optimal levels for most populations. And they direct Americans to get 45-65% of their calories from carbohydrates — sidelining low-carb or ketogenic diet options proven to support weight loss, stabilize blood sugar, and reduce the risk factors that drive heart disease. 

Americans are being pushed toward metabolically damaging eating patterns. 

Today, 93% of Americans live with metabolic dysfunction — meaning their bodies struggle to convert food into energy efficiently. This breakdown in basic metabolic processes fuels the country’s epidemic of chronic disease. More than 75% of Americans are now overweight or obese. Heart disease mortality rates have increased from the 2010s to the 2020s, even as cholesterol levels have steadily fallen. 

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Put plainly: Federal nutrition policy has fallen far short of making Americans healthier. I know this to be true not only from statistics but from my own patients’ journeys. Many of them ate exactly as federal guidance prescribed and still found themselves gaining weight and developing hypertension, diabetes and heart disease. For years, I resisted the idea that fault could lie with the guidelines. 

Like most physicians, I was trained to be wary of fat and to consider carbohydrates as the foundation of a healthy diet. I dismissed suggestions that a low-carb or ketogenic diet could improve cardiovascular outcomes.

But then I tried it myself — and my own weight, cardiovascular markers, and energy improved. 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. These changes struck at the true drivers of coronary heart disease — metabolic dysfunction, obesity and type 2 diabetes — all stronger predictors than cholesterol levels. 

Their lives changed without a scalpel or a prescription. And their experiences mirrored what the science was increasingly showing: that the old low-fat, high-starch model had it backwards. 

A review of randomized trials found that low-carbohydrate diets significantly improved weight, blood sugar and blood pressure — the very risk factors that drive heart disease. 

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Another analysis comparing different levels of carbohydrate restriction showed consistent benefits across degrees of reduction. And, in patients with type 2 diabetes, ketogenic approaches have dramatically lowered average blood sugar as measured by HbA1c — a long-term measure of glucose control — while delivering substantial weight loss, all changes known to reduce cardiovascular complications. 

Yet our national guidelines remain stuck in an outdated paradigm. 

The upcoming 2025-2030 Dietary Guidelines offers a chance to finally get it right — to align federal recommendations with the latest, most rigorous evidence. That means prioritizing whole foods, removing limits on saturated fats, optimizing protein intake, and including low-carbohydrate and ketogenic options for the metabolically vulnerable. 

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 the founding medical director of the Coalition for Metabolic Health.

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Top-ranked Jannik Sinner beats Alexander Zverev to win Wimbledon again

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Top-ranked Jannik Sinner beats Alexander Zverev to win Wimbledon again


Jannik Sinner is starting to make a habit of responding to adversity in Paris with Wimbledon titles.

The top-ranked Sinner beat Alexander Zverev 6-7 (7), 7-6 (2), 6-3, 6-4 Sunday for his second consecutive title at the All England Club after his German opponent appeared bothered by a knee issue following a slip to the grass on a key point in the third set.

Sinner’s fifth Grand Slam title came in his first tournament since a second-round meltdown at the French Open, when he wilted in a Paris heat wave.

A year ago, Sinner beat Carlos Alcaraz in the final at the All England Club after wasting three match points against his rival in the Roland Garros final.

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It was Sinner’s 10th straight victory over Zverev, who was coming off his first Grand Slam title at the French Open.

Linda Noskova beat Karolina Muchova in an all-Czech women’s final on Saturday for her first Grand Slam title.

Prince William joined his wife Kate and two of their children for the final in a star-studded Royal Box that also included actors Dustin Hoffman, Nicole Kidman and Ben Stiller.

Zverev slips

The top two seeds appeared perfectly matched until Zverev earned his first break point of the match at 3-3 in the third set — 2 hours and 42 minutes in. Sinner produced a drop shot and Zverev slipped and appeared to hyper-extend his right knee as he attempted to change directions behind the baseline.

Zverev grasped his knee in apparent discomfort and Sinner went around the net and helped his opponent up off the grass. Zverev quickly resumed playing but he appeared slightly hampered and slung his racket across the baseline in frustration when he missed a forehand and handed Sinner the first break of the match and a 5-3 lead in the third. Sinner then served it out.

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Zverev had also lost 14 straight sets to Sinner and when he claimed the opening set of the final with a forehand winner up the line to conclude a tight tiebreaker, he let out a loud roar toward his box as he bent over in celebration.

Zverev continually cranked out serves at up to 139 mph (224 kph), while Sinner produced a series of well-placed aces at a slightly lower speed.

But Sinner began to read Zverev’s serve better in the second-set tiebreaker and Zverev started to miss forehands.

Paris meltdown

Amid stifling heat and humidity in Paris in late May, Sinner had his 30-match winning streak ended after coming within one game of a straight-set victory over Juan Manuel Cerundolo, who was ranked No. 56.

Conditions were cooler in southwest London for the final, with clear skies and a temperature of 82 degrees Fahrenheit (28 Celsius) but it was also breezy — which led to a series of shanked shots from both players.

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Sinner went in for medical exams in Milan after the Paris defeat and didn’t play an official match again until he arrived at Wimbledon, where he twice had to come back from a set down in a five-set marathon against Miomir Kecmanovic in the first round.

Sinner then didn’t drop a set the rest of the way until the final, having dominated against Novak Djokovic in the semifinals.

Despite the defeat in the final, Zverev will leapfrog Alcaraz into the No. 2 spot in the rankings on Monday.

Alcaraz missed both the French Open and Wimbledon this year due to a right wrist injury.

Associated Press writer Mattias Karén contributed.

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Wimbledon is keeping the World Cup off its official screens, even in the players’ lounge. Fans and players can still watch on their phones, but tournament TVs will stay focused on tennis.



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Record campaign cash was spent in San Diego’s City Council primaries. Did it pay off?

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Record campaign cash was spent in San Diego’s City Council primaries. Did it pay off?


Races for San Diego City Council attracted an unprecedented amount of cash this year from groups funded by labor unions, business interests and statewide organizations — but the results were decidedly mixed.

A committee supporting Josh Coyne in District 2 spent $300,000, but Coyne didn’t come close to making the November runoff. Rafael Perez finished last in the District 8 race despite $150,000 in committee support.

But Gerardo Ramirez made the District 8 runoff after benefiting from more than $200,000 in committee support, and Richard Bailey finished first in District 2 thanks partly to more than $200,000 in committee support.

Those sums are dramatically higher than typical San Diego council race contributions from independent committees, which allow supporters to exceed the $800 maximum an individual can contribute directly to a campaign.

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Such committees, which are required to raise and spend money independently from the candidate they support, also make it possible for corporations, labor unions and merchant groups to participate at all.

City campaign rules bar those types of organizations from contributing directly to candidates, but they can contribute to committees that either support or oppose individual candidates.

There’s no obvious reason why so much more was contributed this year to these committees, but Perez said one likely factor is that two council seats — Districts 2 and 8 — are open seats with termed-out incumbents.

“Open seats attract a lot of attention,” he said.

The last two council elections in 2022 and 2024 each had only one open seat — District 6 in 2022 and District 4 in 2024 — and almost no committee spending.

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Still, San Diego council races are generally low-profile contests with relatively little at stake — especially in a primary.

For example, this year’s District 8 race, while hotly contested, featured four Democrats with similar views on most issues and no clear impact on the city’s toughest challenges — housing, homelessness and the budget crisis.

But District 2 features a Republican-turned-independent in Bailey who could, if elected, break up the all-Democratic City Council for the first time since Republican Chris Cate was termed out in 2022.

Coyne said he thinks the $800 contribution limit has prompted an evolution in how city campaigns get funded, with many larger interests focusing more on independent committees than contributing directly to candidates.

“The $800 cap seems like a small amount to some people,” Coyne said.

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It’s also not totally clear why the big spending had such patchy results in the June primary.

Political consultants often say that money is important in political races but that it typically only works for candidates who also have a compelling message, a natural appeal to voters or both.

Strong support from a political party can also help a candidate overcome big opposition spending by an independent committee, Coyne and Perez said in interviews last week.

Nicole Crosby didn’t get nearly the kind of committee support Coyne and Bailey got in District 2 — but she was endorsed by the county Democratic Party in a heavily Democratic district and easily advanced to the runoff.

Perez noted that the party endorsement also comes with money and volunteers to canvas neighborhoods and provide other campaign help.

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In the District 8 race, the party declined to make an endorsement and rated all four candidates as qualified.

Another possible reason Crosby easily beat Coyne for the runoff’s second slot opposing Bailey — despite Coyne’s $300,000 in committee money — is her compelling pitch as a candidate.

She’s a city prosecutor who served on the Clairemont Town Council and a school parent-teacher association. Coyne works for a downtown merchants group and didn’t boast such a breadth of community involvement.

The bulk of Coyne’s independent support came from a local construction union, Local 89 of the Laborers International Union. That union has discussed possibly pursuing a 2028 ballot measure aiming to raise the city’s sales tax.

In contrast to Coyne, committee money appears to have been a key factor in helping Gerardo Ramirez secure the second slot in the District 8 runoff to face first-place finisher Antonio Martinez in November.

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Ramirez got more than $200,000 from a statewide committee focused on electing Latino candidates that is strongly influenced by Assemblymember David Alvarez.

A win in November by Ramirez would continue the legacy of Alvarez in District 8, who represented the district from 2010 to 2018 before being succeeded by his aide Vivian Moreno.

Ramirez now serves as chief of staff for Moreno, who can’t run for re-election this year because of term limits.

Ramirez narrowly edged Venus Molina by 302 votes for second place, possibly because he received significantly more committee financial support than the roughly $50,000 Molina had.

But Perez, who got $75,000 each from the American Federation of Teachers and the National Association of Realtors, finished a relatively distant fourth.

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Bailey appears to have benefited from his committee support, most of which came from business interests, because he finished first. But he only led Crosby by 475 votes and got under 35% of the votes cast.

In November, he will need to win a majority of voters in a district where registered Democrats outnumber registered Republicans two to one.

It’s likely Bailey’s narrow first-place margin is partly because of an independent committee opposing Bailey that got more than $150,000 from local labor unions and the county Democratic Party.

The consultant who helped lead that committee, Dan Rottenstreich, said last week that the goal was not defeating Bailey in the primary but limiting how many Democrats might support him.

The committee sought to expose what Rottenstreich characterized as Bailey’s extremism in mailers and digital ads to persuade moderate Democrats not to support him.

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“We did important work,” said Rottenstreich, suggesting that Democrats willing to vote for Bailey in June would be more likely to vote for him again in November.

“He can’t win without support from Democrats, so we wanted to limit that support,” Rottenstreich said.

Some suggest campaign money matters less these days because voters have gotten sick of their mailboxes being flooded with fliers — but Rottenstreich said candidates still need to promote themselves.

In the June 2 primary, many candidates opted for a blend of mailers and digital advertising on Facebook and other social media platforms.

Rottenstreich said today’s more dispersed media landscape forces candidates to promote themselves in multiple ways.

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Exact contributions by campaign committees won’t be known until final disclosures for the June primary get submitted at the end of this month. The figures used are based on the latest reports, which cover contributions and spending through May 29.



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Endo injury overshadows 2-0 Angel City victory over San Diego – Equalizer Soccer

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Endo injury overshadows 2-0 Angel City victory over San Diego – Equalizer Soccer





Credit: Maria Lysaker-Imagn Images

Angel City FC’s 2-0 win over the San Diego Wave on Saturday should have been a cause for celebration. Instead, it was marred by injury. 

It didn’t take long for ninth-place Angel City to take down the NWSL table leaders in San Diego. Maiara Niehues scored in the 17th minute, marking four straight games with a goal for the Brazilian international. Ary Borges finished the job with a goal less than 10 minutes later. 

But heartbreak ensued just before the halftime whistle when Jun Endo went down with what appeared to be a non-contact injury. The Japanese midfielder grabbed her knee and could be heard sobbing before she walked off the pitch. 

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Endo tore her ACL in 2024 and went through a recovery process that lasted more than a year. She returned to the pitch in June 2025 and completed her first full 90 minutes in Angel City’s win over the Orlando Pride on July 3. 






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