We promised last week to dive deeper into the newly flipped and revised Food Pyramid including sharing insights. Wednesday we did it live here on Substack and over on LinkedIn. You can watch and/or listen to a recording of that here or find it where you go for your regular podcast and video content.
For some, watching or listening just isn’t a format that works, so we have put together a bit of a smorgarboard of a few highlights of the discussion, the deeper first principle design and human outcomes focused framework, as well as the detail we pulled together in advance of the session, some of which wasn’t explicitly covered.
Ellen: Friends, we had quite the conversation this week. And I came prepared—believe it or not. I even successfully streamed on two platforms simultaneously without spending an hour troubleshooting. Growth, people.
But here’s what kicked off the whole discussion, and I need you to appreciate this: The South Park episode we opened with? It’s from 2014.
Season 18. Episode called “Gluten-Free Ebola.” It shows the food pyramid getting flipped upside down, fire-hosing grain fields, removing ultra-processed snacks. There’s even an inference to removing high fructose corn syrup. These guys weren’t just making jokes—they were predicting our present reality. (You can watch it below the link is on the image)
Carter: So there’s nothing new about flipping the pyramid. It’s not that radical. It takes decades to change perspective. We had a food system that worked for us for 350,000 years. Our bodies were tuned to it. That’s System A.
Then we dove into the idea that we wanted to boost yield. We ended famine. We decided we were going to have hero healthcare to solve awful diseases and eliminate pathogens. That’s System B. It worked—for what it was designed to do.
But then we thought System B could fix food. We took the signal out of food. Getting yield up took out micronutrients and took the signals out. Signals program our bodies. Our bodies were trained for 350,000 years how to adapt to the signals they saw. We muted them. We confused our bodies.
It takes 40,000 years for us to evolve to a new system, but we tried to evolve in 70 years.
Ellen: And now we’re paying for it. But we promised everyone we’d talk about the food pyramid, so let’s get into what it actually says—because 75% of the criticism I’ve seen comes from people who didn’t read the actual guidelines.
What the New Food Pyramid Actually Says
Carter: The pyramid is sort of pointed—it’s focused on you. I’d almost like it to say “human-based outcomes” as a first principle. Human-based outcomes. You’ve got to get the food signal programming you. Your body is programmed to be healthy when it gets the right signals
Ellen: Here’s what’s getting lost in all the clip art debates. If you go to realfood.gov, you can download three PDF documents with the specifics. This is what it actually says.
The Great Divide: Who’s Cheering, Who’s Screaming
Ellen: So here’s what people are saying. I pulled together a lot on this.
Supportive voices:
* AMA president said these guidelines affirm that food is medicine
* Dr. Huberman publicly praised the pyramid on X (publicly on X, publicly on X—sorry, my brain is doing things today)
* Our friend Dr. Dariush Mozaffarian from Tufts noted that both low-fat and whole dairy are linked to lower cardiovascular disease
* National Cattlemen’s Beef Association (NCBA):
* “Pleased” with nearly doubled protein recommendations
* Kim Brackett: “Beef provides high amounts of protein plus nine other essential nutrients like iron and B vitamins”
National Pork Producers Council:
* Rob Brenneman: “America’s pork producers appreciate the 2025 Dietary Guidelines putting pork front and center on the plate”
* “Quintessentially American foods like pork chops and Easter hams can remain a staple”
* National Chicken Council:
* Ashley Peterson: “Chicken is back at the top of the new food pyramid – where it belongs”
* International Dairy Foods Association (IDFA)
* CEO Michael Dykes: “The new Dietary Guidelines send a clear and powerful message to Americans: dairy foods belong at the center of a healthy diet”
* “An important victory for consumer choice and public health”
* National Milk Producers Federation (NMPF):
* CEO Gregg Doud: “NMPF thanks HHS and USDA for recognizing dairy’s critical role”
* “Recognition of dairy’s benefits at all fat levels”
* American Heart Association (AHA):
* “Commends” emphasis on fruits, vegetables, whole grains, cutting added sugars and processed foods
* BUT:“Concerned that recommendations regarding salt seasoning and red meat consumption could inadvertently lead consumers to exceed recommended limits for sodium and saturated fats”
Critical voices:
* Academy of Nutrition and Dietetics:
* President Deanne Brandstetter: “Some of the recommendations in the DGAs are not aligned with the current body of evidence and will create challenges for implementation”
* Specific Concerns:
* Saturated Fat emphasis inconsistent with 10% limit
* Doesn’t consider those who can’t/won’t consume dairy
* Low-calorie sweeteners: guidelines emphasize moderation despite evidence they’re “generally considered safe”
* Dr. Christopher Gardner from Stanford: “I’m very disappointed in the new pyramid that features red meat and saturated fat sources at the very top, as if that’s something to prioritize. It does go against decades and decades of evidence and research”, criticized bypassing of standard scientific review process
* Dr. Marion Nestle (we have signed books from her now btw) wrote up her early take here: “Muddled, contradictory, ideological, and retro…A mixed bag. These guidelines are big wins for the meat, dairy, and alcohol industries (alas). The loser: ultra-processed foods (yes!). The recommendation to reduce highly processed foods (a euphemism for ultra-processed) is the one great strength of these recommendations. Following that advice might help Make America Healthy Again. But the rest must be viewed more as ideology than science, and also must be interpreted in the light of this administration’s destruction of what was once a reasonably effective public health service (CDC, FDA, NIH) and system. Eating more meat and fat is unlikely to help people resist measles and other illnesses preventable by vaccination.”
* Dr. Eric Topol posted “a summary of data supporting more meat” with a blank box—okay, it’s funny
* Dr. Neal Barnard (Physicians Committee for Responsible Medicine) - “The guidelines have unjustly condemned highly processed foods and exonerated meat and dairy products. They should have done the reverse.” Filing petition to recall guidelines due to conflicts of interest.
From LinkedIn Comments:
* “No fiber mention? Hello, skyrocketing cancer”
* Was the new food pyramid created by people at USDA and HHS who stole the idea from South Park? LOL! (spoiler alert - the episode is from 2014!!! The link below is active to take you to the clip from episode it’s classic)
* Is the new Food Pyramid really that controversial? (Not a political post.) OK, so it’s not really a pyramid. That’s the most controversial part of it. But America has been trending in this direction. Yes, it may be a case of the haves and have nots. Yes, there is a portion of America going the wrong way. But consider: 1. U.S. egg consumption is up, from 250 eggs/person in 2010 to 288 eggs/person in 2022. 2. U.S. beef consumption is up, from 55.4 lbs/person in 2015 to 59.1 lbs/person in 2021. 3. Full-fat yogurt share is up, from 49% of U.S. yogurt sales in 2013 to 70% in 2022. 4. Ultra-processed food intake among U.S. adults is down, from 55.8% of calories in 2013–2014 to 53.0% in 2021–2023. 5. Ultra-processed food intake among U.S. youth is down, from 65.6% of calories in 2017–2018 to 61.9% in 2021–2023. 6. Soft drink availability is down, from 45.5 gallons/person in 2000 to 36.1 gallons/person in 2021. 7. Added sugar availability is down, from 111 lbs/person in 1999 to 94 lbs/person in 2021.
* The only news I see with this new food pyramid? We’re 30 years late teaching kids they need to eat real food.
* This isnt radical. This is a well overdue course correction. Because the old food pyramid didn’t make us healthier. It made us sicker, heavier, and metabolically broken. Real food was never the problem. Ignoring human biology was.
* Have they acknowledged the load of pesticides we’re ingesting, and recommend clean organic?
* The question is: how much lobbying influenced the new guidelines?
* Where do the peptides sit in the new pyramid?
* Why are whole grains at the bottom? Why aren’t beans/lentils higher up? I think I see a tiny clip art that might be a bean. Why are red meat/saturated fats, at the top? This is terrible. Very confusing and expensive
* Feels like the 90s are back, and not in a good way. Did they just decide to ignore the existence of MyPlate? To me, that framing was more easily understood and much more digestible (pun intended) for the average person.
* I’ll leave it the experts in nutrition science to comment on the make-up of the new Dietary Guidelines for Americans, but a friendly reminder that the DGA isn’t worth much if we don’t increase supports like SNAP, boost funding for child nutrition programs, raise wages, and bring down prices. The well off always have access to whole foods and dietary advice is they want it. The poor do not.
* I don’t think I’ve ever met an adult who plans their diet based on gov’t nutritional guidelines. It seems like something you spend a lot of time learning in grades 4-6 and then forget about.
* Interesting that there’s no mention at all of sweets or pasta etc. Or even serving size. It doesn’t seem very realistic, but rather all or nothing.
* It matters more what is fed in the school choice programs. This is where habits are formed. Nutritious food requires zero plastic packaging, more plant based foods for better lifelong habits (lower meat and diary percentages in keeping with its detrimental effects on health - individual and planetary). We are otherwise teaching bad behaviors, tastes and habits.
* Some day perhaps we can all go back to common sense and just eat all things in moderation and most things sourced locally and from farms rather than factories (or better yet your backyard garden!). There’s no magic solution out there with slick and sexy graphics or lousy clip art.
* Given how they flipped the triangle, I think this can now be accurately called “The pizza slice diagram” given how prominently saturated fats are featured within this. Seems fitting. An absolute joke of an update
The Uncomfortable Truth About Scale and Affordability
Ellen: Two things hit me immediately after reading through the pyramid last week.
First: We aren’t ready to deliver this food pyramid at scale—not in a way that isn’t going to just make people sick. It’s like healthcare trying to scale up a broken thing.
Second: Who can afford this? When you read the actual dietary guidelines, you start to see you could eat along the food pyramid with SNAP. But it feels disingenuous to recommend something we haven’t made affordable or scalable yet.
Carter: Well, it’s a big system. You’ve got to start somewhere.
The practical question is: where does this data get used? The food pyramid informs school lunch. It informs SNAP. It informs FDA policy. There are downstream triggering events—labeling standards, marketing claims. Cheerios can get a marking that says “heart healthy” but grass-fed beef can’t. Those kinds of things can change now.
But nobody in the real world looks to the FDA to be the leading voice on things. That’s not a criticism. The purpose of government is to take decisions that have been made in the market and stabilize them. Like when the railroads were all different gauges, and finally someone said this is what the gauge will be. That’s government’s job.
Ellen: So this is validation for the early adopters. They were right.
Carter: Yes. And the question is how do we build on it. Musk developed his spacecraft by saying: if I can make a rocket reusable, I can cut the cost of launch to orbit by a factor of a thousand. He started from first principles instead of saying “that’s too hard.”
Human-based outcome. Getting the right food to have the right signals in your body. That’s the first principle. 2026 is the year to lane-change from working within the existing system to saying: humans want to be healthier, that’s the market, lean in and figure out how to do it.
The Nursing Home Opportunity
Ellen: Mike Canji (FareRx) made a great point in the chat: the food pyramid touches nursing homes. If they accept Medicare and Medicaid, they need to adhere to the new guidelines. And who owns those contracts? Aramark, Sodexo. Push for change upstream.
Carter: Let me walk through this because I think it’s interesting from a first-principle standpoint.
What are you trying to do with a nursing home? You’re trying to persuade people that mom and dad are better off at this nursing home rather than another one because you feed them the right stuff. That’s a marketing message.
If they’re making $50,000-60,000 a year off mom and dad, and there’s an incremental 20% cost on food to reduce customer acquisition costs—that’s interesting math.
Now, who owns nursing homes? BlackRock owns something like 400,000 lives in various nursing homes. BlackRock would also have an interest in underwriting the supply chain infrastructure.
So now you can start saying: here’s a system serving a distinct group of customers with a distinct interest. We’re going to build out infrastructure to allow farmers to franchise themselves and deliver into this system. There’ll be some price premium, and we can operate in a different supply chain—like Fairlife—that’s protected from being destroyed by commodity crops.
Ellen: I want to add—it’s not just nursing homes. It’s hospitals too. I have a friend whose mother-in-law is in the hospital right now. She needs to heal. She’s not getting fed food that will heal her quickly. That’s a design flaw. We’re not feeding people to heal them for acute incidents.
Carter: I agree. It’s an important point. But we don’t have a supply chain that meets the new pyramid. If everybody tomorrow started eating real food, we would stock out immediately.
The Economics: Food + Healthcare = Constant
Ellen: Let me back up to something we talk about all the time. There was a graph in a New York Times article last summer showing that over 100 years, consumers have consistently spent about 24-27% of their income on food and healthcare combined.
In the early 20th century, 90%+ of that bucket went to food, with the rest on healthcare. Now it’s completely flipped—most goes to healthcare.
Carter: So the externalities are centered on the person making the decision, which is helpful. And there’s a time component—you make bad decisions in your 30s that affect you in your 60s.
But here’s the thing: you see your parents and grandparents deteriorate. That’s a time machine built into families. We process that 20 times a day, often privately.
Ellen: My mom is the perfect example. She has late stage dementia. She’s only 78, I’m only 53. She’s got 25 years on me, and I’m watching this thinking: I do not want that to happen to me. How do I stop it?
Carter: There’s a time machine on those externalities that influences behavior. Doctors say patients don’t care enough about themselves—I don’t think that’s true.
When my mother was dying, the last thing she said to us was: “I shouldn’t have smoked.”
We’d been saying that for 50 years. But she knew.
The HSA/FSA Question
Ellen: Kendall Callahan Kendall Callahan (I think I tagged the proper one - if not, please let me know!) raised an important point: What about FSA/HSA dollars for whole ancestral foods? It would immediately lower prices 20%+ by removing the tax.
And Laurie Kortowich PLANTSTRONG pointed out the current requirements. For foods to be covered by HSA, they must:
* Not satisfy normal nutritional needs
* Treat or manage a specific illness
* Have use substantiated by a licensed medical provider
Carter: That’s the same structure as a drug.
Ellen: Exactly. And Richard Chamberlain (please message me your handle so I can tag you!) expanded on this beautifully in the comments: Imagine a regenerative beef product with soil nutrient profile, amino acid density, omega-3 ratio, inflammatory markers, heavy metal absence, verified metabolic impact. Pair that with a CGM showing reduced glucose spikes, HRV improvement, inflammation reduction. Then a doctor writes: “This food is prescribed for insulin resistance, metabolic syndrome, and inflammation.”
That’s food as medicine with real infrastructure.
Carter: Look, from a policy standpoint, I’ve had direct conversations with senators working on this. Their general attitude is: let’s give a carrot to the corporates to lean in this direction.
The challenge is legislators don’t want to pay for food. They’re afraid lobbyists and rent-seekers will show up and it’ll become a new problem. The right won’t support funding food directly. The left may demand it. It’s complicated.
But here’s what’s different right now: lobbyists are getting nowhere in DC. That’s a huge shift nobody’s reporting.
The System C Grocery Store
Laurie Kortowich was on fire and described something that stopped us both: A new type of grocery store where all traditional slotting and digital marketing fees are not in play. Where all products are 100% focused on promoting health. Where food is prescribed, tastings are provided, cooking is demonstrated, and people leave with meals that feed their family in line with their health goals.
Carter: That’s the System C grocery store. Let’s define it.
Here’s the thing about grocery economics. The first order of profit comes from slotting fees—they charge CPGs to put products on shelves. The second is digital advertising. The third is you actually buying food.
Costco figured this out. You pay your membership fee, that covers the slotting fee issue. So Costco has 6,000 SKUs compared to Walmart’s 60,000. They’re not dependent on CPGs paying for shelf space.
When people move to a digital platform without slotting fees, the whole “I’m walking down the aisle, I see this, I buy those potato chips” thing goes away. That’s a marketing technique. CPGs spend $15 billion a year marketing to you. Whole Foods spends $400 million. There’s a reason one is easier than the other.
Ellen: H-E-B (Stacy Bates) is probably closest to delivering this right now. Hy-Vee has dietitians on staff dedicated to food as medicine. And Andy Beckman from Garmin told us Albertson’s offers discounts on healthy food products based on activity through their Sincerely Health app.
Carter: Why don’t we do this: define the System C grocery store as a reference architecture. Put it out there. Go through all the grocery stores and score them. Put it on GitHub so everybody can download it.
Laurie poinetd out that Whole Foods has ingredient standards. We need a store with health standards.
Ellen: We need a new food pyramid image that points down to health outcomes. That’s the new grocery store.
Carter: We can have it pushing its way down like a wedge.
The Capital Markets Problem
Carter: This goes back to capital allocation. We know there are CPGs very focused on human-based outcomes. They’ve been investing for two or three years. They’ve persuaded their boards. They’re looking more like pharma companies—building differentiated products with moats around them.
The reason protection matters is investors say: you have a protected interest, you can enter this market and deal with the three-to-five-year timeline because someone won’t just steal it from you.
We still have a capital markets problem. Capital markets understand how to do pharma. They have zero idea how to do food.
JPM Healthcare Conference is this week. Quick history: it was originally the Hambrecht & Quist Conference. In the 90s, H&Q was the only investment bank that could articulate what the internet meant. Nobody knew what Netscape or Amazon was in 1995. H&Q hired journalists as analysts to tell the story and explain to people what was going on.
Every single deal from ‘94 through the early 2000s had Hambrecht & Quist on the book because they were the ones who understood. JPM bought them, and the healthcare conference is the byproduct.
The point is: capital markets don’t understand this yet. We have to re-educate them.
Ellen: And part of assembling capital is showing this can be orchestrated. All the parts are in place. The problem is they’re cross-sector and cross-industry. People aren’t aware of what’s going on or how things could be realigned with existing assets.
That’s on us. This tribe of folks that’s growing.
2026: The Tipping Point Year
Carter: I’ve been saying there would be a tipping point. I thought it would be later, but it’s earlier—because of AI, because of Claude Code, because everything is accelerating.
I was at Farm Con last week—1,300 farmers. When I asked how many are using Claude Code, 30 hands went up. These farmers spent Christmas coding to do better agronomy and integrate all their reports to improve nutrient density.
This is happening.
There’s a large group—20 million, 30 million, 40 million people in the US—who get Function Health as a Christmas present and check their blood levels. Who load their medical data into ChatGPT. They’re early adopters trying to figure this out.
Ellen: And don’t get me started on the AI side. We’re allowing consumers to create their own healthcare, disintermediate healthcare the way we know it. At the same time, we’re pricing them out of healthcare. The first place people go is the grocery store, their pantry.
They can’t just go to the pharmacist and get six prescriptions. They’re looking for solutions they can do on their own. Now is the time for food to step up and take share from healthcare.
The Big Picture: Why System C Changes Everything
For those newer to our work, here’s the framework we keep coming back to—and why we think 2026 is the year it all shifts.
System A: The Original Design (350,000 years)
For most of human history, food and health were the same thing. Our bodies evolved to read signals from what we ate—micronutrients, compounds, the whole symphony of information in real food. Those signals programmed our metabolism, our immune systems, our ability to heal. Food was the operating system. There was no separate “healthcare” because the food was the care.
System B: The Great Decoupling (1950s–present)
We made a trade. To end famine and feed billions, we optimized for yield. It worked—we ended mass starvation in much of the world. We also built hero healthcare to eliminate pathogens and solve acute diseases. Life expectancy jumped.
But then we made a mistake: we thought System B could fix food too.
We stripped the signals out. Industrial agriculture muted the micronutrients. Ultra-processing removed the information our bodies were trained to read. We confused our metabolic systems—asking them to adapt in 70 years to changes that would normally take 40,000 years of evolution.
The result? Chronic disease exploded. Healthcare costs consumed an ever-larger share of household budgets. We now spend roughly the same percentage of income on food + healthcare as we did 100 years ago (~25%), but the ratio completely flipped: what used to be 90% food / 10% healthcare is now the reverse.
System B gave us cheap calories and expensive disease.
System C: The Reintegration (emerging now)
System C isn’t about going backward. We keep the wins from System B—hero healthcare for acute problems, the ability to feed billions. But we redirect the chronic disease burden back to where it belongs: food.
The first principle is simple: human-based outcomes.
Not yield optimization. Not shareholder returns. Not regulatory compliance as an afterthought. Human-based outcomes as the starting point for every decision in the food system.
What does System C look like in practice?
* Food with signals intact. Nutrient density measured, verified, and valued. Regenerative practices that restore the micronutrient profile our bodies expect.
* Grocery stores built around health outcomes. No slotting fees distorting what gets shelf space. Dietitians on staff. Food prescribed based on your metabolic data. You walk out with meals aligned to your health goals.
* Economic realignment. The 25% of income we spend on food + healthcare doesn’t change - but it shifts back toward food. You pay a premium for real food; you save multiples on healthcare you no longer need.
* Capital markets that understand the thesis. Investors backing food companies the way they back pharma - with outcome data, protected differentiation, and long time horizons.
* Supply chains redesigned for humans, not commodities. Farmers verticalized into nutrient-dense production. Local infrastructure reducing waste and preserving quality. Parallel systems that don’t get destroyed by commodity pricing.
The food pyramid pointing down to health outcomes isn’t just a cute visual - it’s the whole philosophy. Start with the human. Work backward to the food. Let everything else reorganize around that.
Why 2026?
Three things are converging:
* Validation from above. The new dietary guidelines - whatever their flaws - put “real food” in the government’s vocabulary. That’s regulatory cover for everyone ready to move.
* Tools from the side. AI is letting consumers take control of their own health data. Farmers are coding their own agronomy systems. The infrastructure for personalized nutrition is being built in garages and on kitchen tables.
* Pressure from below. People are watching their parents deteriorate. They’re getting CGM data and Function Health panels as Christmas gifts. They’re doing the math on what chronic disease will cost them. The demand is there - visceral, personal, and growing.
System B took 70 years to build. System C won’t take that long. The question is whether we build it intentionally—or let it emerge chaotically while the wrong players capture the upside.
That’s why we’re here. That’s what Food is Health is about.
The Bottom Line
Ellen: We have two choices with this food pyramid. We can pick it apart and dismiss it like we’ve done before. Or we can recognize that 75% of what sits in grocery stores is ultra-processed cheap calories—and we now have a food pyramid that sends you to a website called realfood.gov.
Carter: This is validation for all the early adopters. They were right.
Ellen: Private industry can take this and run with it. Turn it into affordable nutrition, nutrient density, a complete redesign. We don’t have to wait. We can be the ones to take the good parts and build.
Carter: Or someone else takes the bad parts and builds with those instead.
Ellen: Exactly. So—what do you think? Are you ready to help define the System C grocery store?
Carter: Let’s do it. Here’s the architecture. Different grocery stores can say they’re moving in this direction. We define it, evolve it, put it out there.
Ellen: Tell your friends. If you came today and you learned something, tell them to subscribe. We’re going to do some cool stuff this year.
Carter: 2026. This is the year.
