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

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next edition of the Dietary Guidelines scheduled for release this month, we have a critical opportunity to move beyond outdated orthodoxy and align federal nutrition policy with modern science and clinical experience.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.

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. 

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. 

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.

Right now, there’s not age limit for how old someone has to be to ride an e-bike, but Tuesday Carlsbad City leaders will meet here at the City Council Chambers to discuss the possibility to change that age limit to 12-years-old.

“These kids that are riding on the streets they’re taking up traffic, they should be subject to traffic laws,” Rastagar said.

Salomon owns an e-bike and rides his bike to work.

He said he often sees kids on e-bikes riding unsafely.

“When they change lanes, for example going from a bike lane, which is on the right side turning left, they usually swerve across two, three lanes of traffic without looking, for example, that says the judgement isn’t there,” Rastagar said.

Earlier this year AB2234 passed, allowing cities in unincorporated areas in San Diego County to establish a minimum age for riding e-bikes.

The new law applies to only the class of e-bikes that go 20 miles per hour.

As a result, Tuesday, the Carlsbad City Council will consider approving their traffic and safety mobility commission’s recommendation, that kids 12 and younger…not be allowed to ride e-bikes.

A move that gives residents like Thurza Heim some peace of mind.

“I understand why they love the e-bikes but they are often riding them without helmets, breaking traffic laws, a lot of them are so young they don’t understand the traffic laws,” Thurza Heim said.

Rastagar wishes the minimum age for riding e-bikes would be 16-years-old and teens were required a license before getting behind the handlebars.

He understands the dangers young kids and teens are exposed to on e-bikes because he’s treated patients who have been seriously injured by them.

“I do recall not too long ago a 16-year-old patient who I saw with the aftermath of a skull fracture, crashed on his e-bike,” Rastagar said. “Look at my helmet it’s a regular bike helmet, this thing will work in a 10, 15 mile per hour crash, sometimes these bikes, particularly these e-motorcycles, they’ll hit 30-40 miles an hour.”

Regina doesn’t allow her eleven-year-old daughter to ride an e-bike because she’s seen the dangers firsthand.

“I think it was two years ago, when a car hit a mom with a baby, maybe it was about 2-3 years ago. Unfortunately, mom passed away,” Kagramanyan said.

NBC 7 reached out to the City of Carlsbad for comment and is awaiting a response.

According to Carlsbad police, in the last three years, they’ve issued more than 180 e-bike citations and 230 warnings for violations that include running red lights, failing to stop signs, riding on sidewalks, and engaging in dangerous riding behaviors.

November was a busy month for new business arrivals in La Jolla, with a couple of long-anticipated restaurants opening along with other establishments. Here’s a look.

Vispring

This new luxury mattress showroom is at 7464 Girard Ave., replacing Faded Awning, which opened in 2010 and closed in January this year.

Vispring officially ushered in the new business with a grand opening Nov. 4.

The location marks “a strategic expansion into one of Southern California’s most affluent markets,” according to the business’s website. It’s one of its many expansions this year, starting with Orange County in January and New York City and Dallas in June. Additional locations are set to open soon in Washington, D.C.

The company, which sells handmade European mattresses, is celebrating its 125th anniversary. To commemorate the La Jolla opening, Vispring is offering a free Heaven mattress topper with the purchase of a mattress until Thursday, Jan. 1.

Vispring is open from 10 a.m. to 6 p.m. Mondays through Saturdays. Learn more at vispring.com.

Hummingbird Fine Jewelry & Piercing

After a year of planning and building, La Plaza La Jolla’s newest addition is here.

Hummingbird Fine Jewelry & Piercing, a sister location to Enigma Professional Piercing Studios, offers gold and implant-grade titanium jewelry for ear and body piercings. Its focus, co-owner Evan Spencer told the La Jolla Light, is offering “a safe, comfortable and high-end experience” with high-quality jewelry and aseptic technique.

Spencer is the lead piercer and store director, joined by co-owner Didier Suarez and piercer Jenna Bee.

Hummingbird opened Nov. 14 at 7863 Girard Ave. and is slated to host a grand-opening celebration from 3 to 7 p.m. Saturday, Dec. 6.

“We are extremely enthusiastic about the quality of our products, the level of our service and experience and the safety and care that goes into every service we offer,” Spencer said.

Hummingbird is open from 11 a.m. to 6 p.m. every day but Wednesdays. Find out more at hummingbirdpiercing.com.

PopUp Bagels

Breakfast is back at 637 Pearl St., with New York chain PopUp Bagels making its local debut Nov. 21.

PopUp Bagels offers fresh-baked bagels and a rotating lineup of schmears ranging from plain cream cheese to spicy buffalo butter. Rather than offering traditional bagels cut in half with cream cheese in the middle, PopUp encourages customers to grip the bagel, rip off a piece and dip it in a cup of schmear.

PopUp Bagels replaces Breakfast Republic, which left the Pearl Street address in March as part of what a representative called a lease buyout from the property owner.

This is PopUp’s first brick-and-mortar location on the West Coast. Its expansion to San Diego was facilitated by San Diego State University graduates Griffin Thall and Paul Goodman, who secured a franchise deal with the corporate team in New York and are now planning 10 PopUp Bagels locations in San Diego County over the next five years.

PopUp Bagels is open from 7 a.m. to 4 p.m. daily. Find out more at popupbagels.com.

Dora Ristorante

This new southern Italian coastal cuisine restaurant opened Nov. 20 at 9165 S. Scholars Drive in the Theatre District Living and Learning Neighborhood at the southwest corner of UC San Diego’s campus, across the street from La Jolla Playhouse.

Dora Ristorante comes from chef Accursio Lota and his wife, Corinne Goria, of La Jolla, the owners of North Park’s popular Cori Trattoria Pastificio.

As part of the couple’s partnership with La Jolla Playhouse, the Dora team will design prix-fixe menus and cocktails themed to each playhouse production.

Hours are 4-9 p.m. Tuesdays through Thursdays and 11:30 a.m. to 3 p.m. and 5-9 p.m. Fridays through Sundays. Reservations are available at doralajolla.com.

— San Diego Union-Tribune staff writer Pam Kragen contributed to this report.

La Jolla Business Roundup is published monthly by the La Jolla Light. Send your business news to staff writer Noah Lyons at noah.lyons@lajollalight.com. ♦