Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 1 of 17
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`Corey Page (Cal. Bar No. 218789)
`cpage@evansandpage.com
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`Geneva Page (Cal. Bar No. 235633)
`gpage@evansandpage.com
`EVANS & PAGE
`2912 Diamond Street #346
`San Francisco CA 94131
`Ph: (415) 896-5072
`Fax: (415) 358-5855
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`UNITED STATES DISTRICT COURT
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`NORTHERN DISTRICT OF CALIFORNIA
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`PHYSICIANS COMMITTEE FOR
`RESPONSIBLE MEDICINE,
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`a nonprofit membership organization,
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`and
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`SETH AMMERMAN, MD,
`an individual,
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`DONALD FORRESTER, MD,
`an individual,
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`HEATHER SHENKMAN, MD,
`an individual,
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`Plaintiffs
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`v.
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`TOM VILSACK, Secretary,
`United States Department of Agriculture
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`and
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`XAVIER BECERRA, Secretary,
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`Department of Health and Human Services,
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`Defendants.
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`Case No. 3:21-cv-03088
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`COMPLAINT FOR DECLARATORY
`AND INJUNCTIVE RELIEF
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`PAGE 1
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 2 of 17
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`INTRODUCTION
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`This is an action under the Administrative Procedure Act, 5 U.S.C. § 706, against the
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`A.
`1.
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`Secretary of the United States Department of Agriculture (“USDA”) and the Secretary of the
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`Department of Health and Human Services (“HHS”). Defendants have jointly published new
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`Dietary Guidelines for Americans every five years since 1980. Pursuant to the National Nutrition
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`Monitoring and Related Research Act, this document must include “nutritional and dietary
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`information and guidelines for the general public” based on “the preponderance of the scientific and
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`medical knowledge which is current at the time the report is prepared.” 7 U.S.C. § 5341(a).
`2.
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`In December 2020, Defendants jointly issued the newest edition of the Dietary Guidelines
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`for Americans. USDA & HHS, DIETARY GUIDELINES FOR AMERICANS, 2020-2025 (2020)
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`(hereinafter Dietary Guidelines), https://www.dietaryguidelines.gov/sites/default/files/2020-12/
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`Dietary_Guidelines_for_Americans_2020-2025.pdf. According to the report, “diet-related chronic
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`diseases, such as cardiovascular disease, type 2 diabetes, obesity, and some types of cancer, are
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`very prevalent among Americans and pose a major public health problem. Today, more than half
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`of adults have one or more diet-related chronic diseases.” Id. at p. viii. Yet due to their conflicts of
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`interest, Defendants intentionally use inconsistent, misleading language and biochemical
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`terminology to frustrate the purpose of the report and to avoid providing sound and accessible
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`dietary information and guidance on how to overcome and reverse these chronic diseases. As a
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`result, the Dietary Guidelines fail to reflect current “scientific and medical knowledge.”
`Defendants’ failure to comply with statutory mandates is arbitrary and capricious, inter alia, in
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`violation of the Administrative Procedure Act, 5 U.S.C. § 706(2).
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`B.
`3.
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`JURISDICTION AND VENUE
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`Pursuant to the Administrative Procedure Act, 5 U.S.C. § 706, Plaintiffs have exhausted all
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`administrative remedies and now seek judicial review. This Court has both subject matter
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`jurisdiction over this action and personal jurisdiction over the parties pursuant to 5 U.S.C. § 706.
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`This court also has jurisdiction over this action pursuant to 28 U.S.C. §§ 1331, 1361. Venue lies in
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`this district under 5 U.S.C. § 703.
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 3 of 17
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`PARTIES
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`Plaintiff Physicians Committee for Responsible Medicine (“Physicians Committee”) is a
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`C.
`4.
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`nonprofit public health organization that advocates for preventive medicine through proper
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`nutrition, encourages higher standards for ethics and effectiveness in medical research, and
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`conducts clinical research on the relationships between food and disease. Established in 1985, the
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`Physicians Committee is a national organization representing more than 175,000 members,
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`including 17,000 physicians, as well as other medical professionals, scientists, and lay persons.
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`More than 25,000 of these members reside in California. The organization brings this action on
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`behalf of its members and on behalf of itself.
`5.
`the unlawfully developed Dietary Guidelines because these members are misled as to the harmful
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`Physicians Committee members who are laypersons are harmed by Defendants’ adoption of
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`effects of consuming meat and dairy, which in turn has a direct negative bearing on their health and
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`their families’ health.
`6.
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`Physicians Committee members who are physicians are harmed by Defendants’ adoption of
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`the unlawfully developed Dietary Guidelines because the Dietary Guidelines interfere with patient
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`education and undermine patient care. This is particularly true for Physicians Committee member
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`physicians who work in facilities, such as hospitals, that are required to serve meals that are based
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`on the Dietary Guidelines. California Code of Regulations (“C.C.R.”) tit. 15, § 1241. Such
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`member physicians are constrained by the Dietary Guidelines when they prescribe meal plans for,
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`and provide nutrition advice to, their patients. In these ways, the Dietary Guidelines impair the
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`physicians’ relationships with their patients, making it more difficult for the physicians to
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`accomplish their professional objectives of keeping their patients healthy.
`7.
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`The Dietary Guidelines also harm the Physicians Committee by compelling the organization
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`to expend scarce resources to accomplish Defendants’ statutorily mandated duty to inform
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`Americans of dietary steps to protect their health. By neglecting their duty, Defendants have
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`compelled the Physicians Committee to expend resources to counter misinformation regarding
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`healthy diets. One of the Physicians Committee’s principal organizational objectives, to which it
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`has devoted extensive time and resources, is to publicize to its members and the public the health
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 4 of 17
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`benefits of consuming plant-based foods and avoiding meat and dairy products. The Dietary
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`Guidelines seriously impair the work of the Physicians Committee and render it necessary for the
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`Physicians Committee to expend substantial time and resources that normally would be devoted to
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`other organizational initiatives to inform the public that the Dietary Guidelines reflect the economic
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`interests of the meat and dairy industries rather than sound public health advice.
`8.
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`Plaintiff Seth Ammerman, MD, has been a citizen and resident of San Francisco County,
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`California, since 1985. Dr. Ammerman is a member of the Physicians Committee and is board-
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`certified in pediatrics and adolescent medicine. Dr. Ammerman has more than 35 years of clinical
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`experience. Dr. Ammerman’s pediatric and adolescent medicine practices focus on prevention and
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`early intervention through the promotion of healthy lifestyle behaviors. His patients are adolescents
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`making lifelong decisions about their health practices and underserved populations with higher
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`rates of obesity and related chronic health issues; these patients need straightforward
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`recommendations based on the best evidence. As a physician, Dr. Ammerman is harmed by the
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`Dietary Guidelines because the Dietary Guidelines impair the health of these patients, thereby
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`making it more difficult for Dr. Ammerman to accomplish his professional objectives of keeping
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`his patients healthy. Dr. Ammerman also faces the dilemma of having to make medical
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`recommendations that are contrary to the Dietary Guidelines, as well as exposure to liability based
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`on any alleged “reasonableness” standard derived from the Dietary Guidelines.
`9.
`California, since 1975. Dr. Forrester is a member of Physicians Committee and was board-certified
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`Plaintiff Donald Forrester, MD, has been a citizen and resident of Sacramento County,
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`in family medicine from 1978 to 2018. Dr. Forrester has 40 years of clinical experience and
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`teaches and presents on the prevention and reversal of chronic conditions. In these roles, Dr.
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`Forrester understands that more than 70 percent of the nation’s medical costs are due to chronic
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`conditions that result from poor food choices. Dr. Forrester is harmed by the Dietary Guidelines
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`because Defendants’ failure to provide guidelines “based on the preponderance of the scientific and
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`medical knowledge” contributes to chronic conditions that could have been prevented, resulting in
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`avoidable suffering for his patients. Dr. Forrester provides lectures and interviews on health and
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 5 of 17
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`nutrition, and this work is made more difficult when the Dietary Guidelines contradict sound
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`scientific information and are contrary to his science-based nutrition teachings.
`10.
`Angeles County, California, since 2007. Dr. Shenkman is a member of the Physicians Committee
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`Plaintiff Heather Shenkman, MD, has been a citizen and resident of Los Angeles in Los
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`and board-certified in general and interventional cardiology with more than 13 years of clinical
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`experience. Dr. Shenkman’s practice focuses on the prevention and improvement of heart disease
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`with a focus on lifestyle interventions. As a physician, Dr. Shenkman is harmed by the Dietary
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`Guidelines because the Dietary Guidelines impair the health of Dr. Shenkman’s patients, thereby
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`making it more difficult for Dr. Shenkman to accomplish her professional objectives of keeping her
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`patients healthy. Dr. Shenkman also faces the dilemma of having to make medical
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`recommendations that are contrary to the Dietary Guidelines, as well as exposure to liability based
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`on any alleged “reasonableness” standard derived from the Dietary Guidelines.
`11.
`USDA and HHS are United States agencies within the meaning of 5 U.S.C. § 552(f)(1). USDA
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`Defendants are Secretary Tom Vilsack of USDA and Secretary Xavier Becerra of HHS.
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`regulates matters concerning agriculture, and HHS regulates matters regarding human health in the
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`United States.
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`D.
`12.
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`LEGAL FRAMEWORK
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`At least once every five years, Defendants “shall publish a report entitled Dietary
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`Guidelines for Americans.” 7 U.S.C. § 5341(a)(1) (internal quotations removed).
`13.
`general public” that are “based on the preponderance of the scientific and medical knowledge
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`“Each such report shall contain nutritional and dietary information and guidelines for the
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`By statute, the Dietary Guidelines “shall be promoted by each Federal agency in carrying
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`which is current at the time the report is prepared.” Id. § 5341(a)(1)–(2).
`14.
`out any Federal food, nutrition, or health program.” Id. § 5341(a)(1).
`15.
`or identified population subgroups shall submit the text of such guidance” to Defendants, who then
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`“Any Federal agency that proposes to issue any dietary guidance for the general population
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`“shall review and approve or disapprove such guidance to assure that the guidance either is
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 6 of 17
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`consistent with the ‘Dietary Guidelines for Americans’ or that the guidance is based on medical or
`new scientific knowledge which is determined to be valid by the Secretaries.” Id. § 5341(b)(1)–(2).
`16.
`food assistance meal programs, nutrition education efforts, and decisions about national health
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`Under this framework, the “U.S. Government uses the Dietary Guidelines as the basis of its
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`objectives.” Dietary Guidelines at p. 12. Defendants also may block other agencies from issuing
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`dietary guidance that Defendants view as inconsistent with the Dietary Guidelines.
`17.
`programs must “reflect the most recent,” and be “consistent with the goals of the most recent,”
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`For example, food served in schools and child care facilities under USDA’s child nutrition
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`Dietary Guidelines. 42 U.S.C. §§ 1758(a)(4)(C)(i), (f)(1)(A), 1766(g)(2)(B)(i)(I), (u)(3)(C)(iv)(I),
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`1779(b)(1)(C)(i).
`18. Similarly, “the Older Americans Act Nutrition Program incorporate[s] the Dietary
`Guidelines in menu planning; the Special Supplemental Nutrition Program for Women, Infants, and
`Children applies the Dietary Guidelines in its program and educational materials; and the Healthy
`People objectives for the Nation include objectives based on the Dietary Guidelines.” Dietary
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`Guidelines at p. 12.
`19.
`receiving grant funds. E.g., 7 U.S.C. § 2036a(b); 42 U.S.C. § 3030g-21(2)(A)(i) (mandating that
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`Federal nutrition programs require adherence to the Dietary Guidelines as a condition of
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`State nutrition programs for older Americans “shall . . . comply with the most recent Dietary
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`Guidelines for Americans”).
`20.
`“The Dietary Guidelines also provides a critical structure for State and local public health
`promotion and disease prevention initiatives.” Id.; e.g., CAL. EDUC. CODE § 51210.4(c); CAL.
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`HEALTH & SAFETY CODE § 1596.808(d), 1596.8661(c).
`21.
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`The Dietary Guidelines have been incorporated into regulations in the vast majority of
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`states, forming the basis of the mandatory minimum nutritional requirements for assisted living
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`facilities, children’s residential facilities, hospitals, and recreational camps throughout the country.
`E.g., C.C.R. tit. 15, §§ 1241, 1461; C.C.R. tit. 22, § 7638.5(a)(2).
`22.
`use by individuals and those who serve them in public and private settings, including health
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`The Dietary Guidelines also provide “foundational, evidence-based nutrition guidance for
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 7 of 17
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`professionals, public health and social service agencies, health care and educational institutions,
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`researchers, agricultural producers, food and beverage manufacturers, and more.” Dietary
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`Guidelines at p. 12.
`E.
`STATEMENT OF FACTS
`23.
`the report by “add[ing] a new step of identifying topics and scientific questions to begin the process
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`In developing the current Dietary Guidelines, Defendants restricted the usual broad scope of
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`of developing the next Dietary Guidelines.” Id. at p. 8. Defendants “identified potential topics and
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`supporting scientific questions that were of greatest importance and relevance to Federal nutrition
`programs, policies, and consumer education priorities.” Id.
`24.
`After receiving and reviewing public comments, Defendants “posted the final topics and
`questions, . . . defining which areas of nutrition expertise were needed on the Committee.” Id.
`25.
`Defendants then appointed a federal advisory committee “with the single, time-limited task
`of reviewing the 2015-2020 Dietary Guidelines, examining the evidence on the selected nutrition
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`and public health topics and scientific questions, and providing independent, science-based advice
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`and recommendations to USDA and HHS. The 20 nationally recognized scientific experts
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`appointed to the Committee represented a mix of practitioners, epidemiologists, scientists, clinical
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`trialists, and others from every region of the United States.” Id.
`26.
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`The “Committee worked collaboratively for 16 months and deliberated on the scientific
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`reviews in six meetings, all of which were open to the public. Two of the six meetings included an
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`opportunity for the public to provide oral comments to the Committee. An ongoing period for
`written public comments to the Committee spanned 15 months of its work.” Id. at p. 11.
`27.
`of nutrition science and provided advice to the Departments for . . . development of this 9th edition
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`“The Committee’s work culminated in a comprehensive scientific report on the current state
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`of the Dietary Guidelines.” Id. at p. v. “This report was not a draft of the Dietary Guidelines; it
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`was a scientific document that detailed the Committee’s evidence review and provided advice to
`USDA and HHS.” Id. at p. 8 (footnote omitted).
`28.
`positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or
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`The Committee found that “[c]ommon characteristics of dietary patterns associated with
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 8 of 17
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`nonfat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils and low
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`consumption of red and processed meats, sugar-sweetened foods and drinks, and refined grains. In
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`addition, the Committee found that negative (detrimental) health outcomes were associated with
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`dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods
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`and beverages, and refined grains.” Dietary Guidelines Advisory Committee, Scientific Report of
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`the 2020 Dietary Guidelines Advisory Committee pt. A, at pp. 8–9 (2020) (hereinafter “DGAC
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`Report”), https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_
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`2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.
`29.
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`“The Committee’s review found that reducing saturated fat intake by replacing it with
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`unsaturated fats, particularly polyunsaturated fat, lowers the incidence of CVD [cardiovascular
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`disease] in adults. . . . The recommended shift from saturated to unsaturated fats occurs best within
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`the context of a healthy dietary pattern consisting of higher intakes of vegetables, fruits, legumes,
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`whole grains, nuts and seeds, with some vegetable oils, low-fat dairy, lean meat and poultry, and
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`fatty fish and lower intakes of red and processed meats, sugar-sweetened foods and drinks, and
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`refined grains.” Id. at pt. A, at p. 9.
`30.
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`“To reduce saturated fat intake, the dietary pattern should replace sources of saturated fat
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`with sources of polyunsaturated fats by substituting certain animal-source foods, especially
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`processed meats and certain high-fat dairy products, with sources of polyunsaturated fats, such as
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`seafood, seeds, nuts, legumes, and appropriate vegetable oils.” Id. at pt. B, ch. 2, at p. 9.
`31.
`Departments received written comments on the report over a 30-day period and also held an online
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`Defendants “posted the scientific report and asked the public for comments. The
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`meeting to hear oral comments.” Dietary Guidelines at p. 11.
`32.
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`Following the public comment period, Defendants’ “development of the 2020-2025 Dietary
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`Guidelines involved a step-by-step process of writing, review, and revision conducted by a writing
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`team of Federal staff from USDA and HHS. The writing team included Federal nutrition scientists
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`with expertise in the Dietary Guidelines and related research and programs as well as specialists
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`with expertise in communicating nutrition information.” Id. at pp. 11–12.
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 9 of 17
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`On December 29, 2020, Defendants jointly issued the most recent edition of the Dietary
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`33.
`Guidelines.
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`The Dietary Guidelines Fail to Include
`“Nutritional and Dietary Information and Guidelines for the General Public”
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`Despite the statutory mandate to provide “nutritional and dietary information and guidelines
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`34.
`for the general public,” 7 U.S.C. § 5341(a)(1), the new edition states, “The Dietary Guidelines for
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`Americans is developed and written for a professional audience.” Dietary Guidelines at p. 13.
`35.
`Of the 149 pages of substantive content, the Dietary Guidelines devote only one to
`“actionable consumer messages and resources” for “individuals, families, and communities.” See
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`id.
`36. When describing foods to avoid for optimal health, the Dietary Guidelines use technical
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`terms instead of commonplace terms for the foods themselves. The Dietary Guidelines use the term
`“saturated fat” 158 times, including on the “actionable consumer messages and resources” page, see
`id., without clearly explaining how to identify its sources.
`37.
`products and meat and go so far as to suggest that grains are somehow major sources of saturated
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`The Dietary Guidelines hide the fact that the leading sources of saturated fat are dairy
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`fat: “The top sources of saturated fat for adults are sandwiches (e.g., deli sandwiches, burgers,
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`tacos, burritos, grilled cheese, hot dogs) and other grain-based mixed dishes (e.g. spaghetti and
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`meatballs, casseroles, quesadillas) that typically contain ingredients from several food groups that
`are not in nutrient-dense forms, including grains, protein foods, and dairy.” Id. at p. 102; see id. at
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`p. 45 fig.1-11.
`38.
`(“Grain-based foods in nutrient-dense forms limit the additions of added sugars, saturated fat, and
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`Such text is misleading because grains have virtually no saturated fat. See, e.g., id. at p. 45
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`sodium.”). Rather, dairy, meat, poultry, and eggs are high in saturated fat whether they are
`included in sandwiches or eaten on their own. See id. at pp. 44, 45 fig.1-11; DGAC Report pt. D,
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`Equally misleading is the image that takes up nearly half of the page that starts the
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`ch.9, at p. 2.
`39.
`“Saturated Fat” subsection. The image primarily features avocados, nuts, and seeds, even though
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`not one of these foods is a top source of saturated fat, as demonstrated in the figure on the very next
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`page. Dietary Guidelines at pp. 44, 45 fig.1-11. In an accurate image, dairy and meat would
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`instead be featured, consistent with the statement that “[s]aturated fat is commonly found in higher
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`amounts in high-fat meat, full-fat dairy products (e.g., whole milk, ice cream, cheese), butter,” and
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`oils. Id. at p. 44. Although the Guidelines correctly note that saturated fat poses health risks, these
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`choices of wording and images deliberately hide its major sources from the public.
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`The Dietary Guidelines Do Not Reflect the
`“Preponderance of the Scientific and Medical Knowledge Which is Current”
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`40.
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`The Dietary Guidelines provide a particularly harmful definition of “nutrient dense”:
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`“Vegetables, fruits, whole grains, seafood, eggs, beans, peas, and lentils, unsalted nuts and seeds,
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`fat-free and low-fat dairy products, and lean meats and poultry—when prepared with no or little
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`added sugars, saturated fat, and sodium—are nutrient-dense foods.” Id. at pp. x, 73, 95, 110, 123.
`41.
`but regular canned black beans, which contain added salt, not. Dietary Guidelines at p. 22 fig.1-2.
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`Based on this definition, the Dietary Guidelines deem vegetable oil a nutrient-dense food
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`This is not supported by science. Moreover, as noted above, dairy, meat, poultry (including so-
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`called “lean” varieties), and eggs are high in saturated fat, which the Dietary Guidelines warn
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`against.
`42.
`much saturated fat and sodium. Id. at pp. 77 fig.3-2, 79 fig.3-4, 82 fig.3-6, 85 fig.3-8. Yet the
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`The figures in the Dietary Guidelines repeatedly demonstrate that children consume too
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`Dietary Guidelines continue to promote meat and dairy, foods that contain them in large amounts.
`43. For example, the “Avoid Foods Higher in Sodium” section for toddlers states, “In addition
`to keeping sodium intake within limits for toddlers (see Appendix 1), another reason to avoid high-
`sodium foods is that taste preferences for salty food may be established early in life.” Id. at p. 61
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`(emphasis in original). Yet the recommendations for toddlers contravene this advice, stating, “For
`dairy, families can introduce yogurt and cheese . . . before 12 months” (id. at p. 60), even though
`dairy products are a top source of sodium in the diet. See, e.g., DGAC Report pt. D, ch. 14, at p.
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`25.
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`The Dietary Guidelines include “dairy (including milk, yogurt, and cheese)” in the healthy
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`44.
`meal pattern for toddlers, even though toddlers already consume more dairy than recommended.
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`Dietary Guidelines at pp. 63, 65 fig.2-2.
`45.
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`The section on beverages reiterates the push to consume milk but lacks any scientific
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`support for this recommendation: “Beverages that are calorie-free—especially water—or that
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`contribute beneficial nutrients, such as fat-free and low-fat milk and 100% juice, should be the
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`primary beverages consumed.” Id. at p. 35.
`46.
`The Dietary Guidelines also incorrectly state that “[m]ost individuals would benefit by
`increasing intake of dairy” (id. at p. 33), even though there is no convincing evidence that this is
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`true. Moreover, the section does not mention the well-accepted scientific evidence showing the
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`association between dairy intake and prostate cancer, a leading cause of cancer death. World
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`Cancer Research Fund & American Institute for Cancer Research, Continuous Update Project, Diet,
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`Nutrition, Physical Activity and the Prevention of Cancer, Summary of Evidence (2018), https://
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`www.wcrf.org/sites/default/files/Matrix-for-all-cancers-A3.pdf.
`47.
`Similarly, the Dietary Guidelines are unclear as to whether soy milk meets its dairy
`recommendation or may be offered only as an alternative for individuals who are lactose intolerant.
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`See Dietary Guidelines at p. 33.
`48.
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`In the Dietary Guidelines’ calorie level for adults table, the number of recommended
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`servings of nearly every food group rises as the number of daily calories consumed rises. Dietary
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`Guidelines at pp. 96 tbl.4-1, 125 tbl.6-1. The dairy group is the sole exception, however; the table
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`recommends the same number of dairy servings regardless how low an adult’s calorie intake drops.
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`Id. This defies logic and suggests that the Dietary Guidelines’ dairy recommendation are based on
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`something other than “scientific and medical knowledge”—namely the economic interests
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`described below.
`49.
`component agency. Through NIH, Defendant Becerra issues publications regarding lactose
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`Defendant Becerra oversees HHS, of which the National Institutes of Health (“NIH”) is a
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`intolerance, which is the inability to digest lactose, the primary carbohydrate in dairy.
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 12 of 17
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`Once regarded as a disease, lactose intolerance is now recognized as the biological norm
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`50.
`after infancy for all mammals, including humans. NIH, NIH Consensus Development Conference:
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`Lactose Intolerance and Health 30 (2010) (hereinafter “NIH Consensus Report”), https://consensus.
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`nih.gov/2010/images/lactose/lactose_abstracts.pdf. For lactose intolerant individuals, consuming
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`dairy causes diarrhea, pain, and other, sometimes serious, digestive symptoms. Id. at pp. 35–36.
`51.
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`Lactose intolerance is prevalent among people of color. According to Defendant Becerra,
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`“specific populations show high levels of intolerance, including approximately: 95 percent of
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`Asians, 60 percent to 80 percent of African Americans and Ashkenazi Jews, 80 percent to 100
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`percent of American Indians, and 50 percent to 80 percent of Hispanics.” NIH, Lactose
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`Intolerance: Information for Health Care Providers 2 (2006) (hereinafter “NIH Fact Sheet”), https:
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`//www.nichd.nih.gov/sites/default/files/publications/pubs/documents/NICHD_MM_Lactose_FS_
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`rev.pdf.
`52.
`digestion of lactose. NIH Consensus Report at 30. “Lactose intolerance is least common among
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`In contrast, most people of northern European descent carry a genetic mutation enabling the
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`people of northern European origin, who have a lactose intolerance prevalence of only about 2
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`percent.” NIH Fact Sheet at 2.
`53.
`About 24 percent of Americans belong to populations that are frequently or predominantly
`lactose intolerant. See U.S. Census Bureau, QuickFacts: United States (2019), https://www.census.
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`gov/quickfacts/fact/table/US/PST045219.
`54.
`disproportionately and/or historically been affected by diet-related disparities” and to have
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`The Dietary Guidelines purport to have considered “ethnic populations who have
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`prioritized “scientific studies that examine the relationship between diet and health across all life
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`stages, in men, women, and children from diverse racial and ethnic backgrounds.” Dietary
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`Guidelines at p. 4.
`55.
`once, stating “Individuals who are lactose intolerant can choose low-lactose and lactose-free dairy
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`Yet Defendants address this common and normal condition in the Dietary Guidance only
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`products.” Dietary Guidelines at p. 33.
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`Case 3:21-cv-03088-LB Document 1 Filed 04/28/21 Page 13 of 17
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`Instead, and despite high saturated fat and the prostate cancer concern noted above,
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`56.
`Defendants repeatedly recommend dairy—referencing it more than one hundred times in the
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`Dietary Guidelines—even though they know that nearly a quarter of American adults cannot
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`consume it.
`57.
`consumption of red and processed meats” and that detrimental health outcomes are associated with
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`The Dietary Guidelines recognize that healthful dietary patterns feature “relatively lower
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`“higher intake of red and processed meats.” Id. at p. 23. “Replacing processed or high-fat meats
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`with beans, peas, and lentils would have similar benefits, as well as increasing dietary fiber, a
`dietary component of public health concern.” Id. at p. 34.
`58.
`World Health Organization due to its association with “cancers of the colorectum, pancreas, and
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`Indeed, red meat, regardless of fat content, is a Group 2A carcinogen according to the
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`prostate.” International Agency for Research on Cancer, Working Group on the Evaluation of
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`Carcinogenic Risks to Humans Volume 114, Red Meat and Processed Meat 497 (2018), https://
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`Red meat consumption is associated with an increased risk of overweight, obesity, and type
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`monographs.iarc.who.int/wp-content/uploads/2018/06/mono114.pdf.
`59.
`2 diabetes. DGAC Report pt. D, ch. 8, at p. 39 tbl.D8.1.
`60.
`Plant protein sources are linked to lower all-cause or cardiovascular-specific mortality, and
`animal protein sources are linked to increased cardiovascular mortality. Id.
`61.
`As such one might expect the Dietary Guidelines to list meat last as a “protein food” choice.
`Instead, the Dietary Guidelines repeatedly list meat as the first recommended protein source. E.g.,
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`Dietary Guidelines at pp. 20 tbl.1-1, 29, 100 fig.4-4. Plant foods rich in protein are listed last and in
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`the smallest quantity (“Nuts, Seeds, Soy Products”) or not at all (“Beans, Peas, Lentils”), see id.,
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`even though the Di