Pros and Cons of the New US Dietary Guidelines - Medscape

The updated US Department of Agriculture’s Dietary Guidelines for Americans for 2025-2030 are presented in an upside-down pyramid. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr, has made no secret of his disdain for the long-abandoned food guide pyramid, which was replaced in 2011 by MyPlate. So, I wasn’t surprised to see the legacy pyramid turned on its head in the new guidelines.

The new guidelines aim to encourage protein, fruit, vegetable, and probiotic intake, while discouraging refined carbohydrate and alcohol intake among Americans to prevent chronic disease and promote wellness. As a renal dietitian who sees patients with (often preventable) chronic diseases every day, I have strong feelings about these new guidelines.

Too Much Protein

The new guidelines increase the recommended protein intake for a healthy adult from 0.8-1 gram of protein per kilogram of body weight a day to 1.2-1.6 grams. No other reputable organization, such as the American Heart Association, recommends that much daily protein for a healthy adult to meet their needs. That amount of daily protein isn’t necessary unless the individual is trying to lose weight or build muscle, and may be optimal for many people with catabolic illness or metabolic dysfunction.

Whether the average American is consuming too much protein has been a popular conversation topic in the nutrition world for many years now. I don’t take issue with the general public surpassing the previous recommendations on protein intake, as long as their fluid intake is appropriate to facilitate removal of waste products of protein from the blood and their kidney function remains optimal.

The new recommendations also promote animal protein. Although recent research suggests that older adults may benefit from increased intake of animal protein, increasing intake of plant-based protein has been shown to benefit the general population and facilitate the prevention of chronic diseases such as diabetes, cardiovascular disease, chronic kidney disease, and some cancers.

Thin Advice on Refined Carbohydrates and Alcohol

Like its predecessor, the new guidelines recommend limiting intake of highly processed foods, refined carbohydrates, and alcohol. I think we all agree on the need to limit these as able. Afterall, a diet high in ultraprocessed foods has been shown to promote poor cardiometabolic health and to increase incidence of overweight/obesity and cardiovascular disease.

My concern is not with the advice but with the lack of context in the new guidelines. I think it’s prudent to address intake of refined carbohydrates and alcohol in light of their negative impact on insulin resistance.

Another concern is that the recommendations to limit alcohol and refined carbohydrates are so vague as to be ineffective. What constitutes too much alcohol in a day? One drink? Seven drinks? How does the public know whether they are eating too many refined carbohydrates if they aren’t given a baseline to compare their own intake to? I wish these recommendations had been better presented as solid guidelines.

Kudos on Fruits and Veggies

The new guidelines place fruits and veggies at the top of the pyramid and recommend not only fresh produce but also canned and frozen options. This is my favorite of the updated guidelines. The average American gets about half of the fiber recommended. This is one of our biggest nutritional weaknesses as a nation, given the positive impact that a diet high in fruits and vegetables has been shown to have just on chronic disease prevention. Increasing intake of fiber and polyphenol-rich fruits and vegetables can only serve to reduce rates of metabolic dysfunction and cancer, especially in young adults.

However, I wish the new guidelines elevated plant-based proteins as much as fruits and vegetables. Legumes like beans, peas, nuts, and seeds can be an affordable option to increase intake of protein, fiber, and antioxidants. I would argue that the soluble fiber content of most beans and peas is even more important because the new guidelines list beef tallow and butter, which have been shown to increase cholesterol, as healthy fats. A diet high in soluble fiber can help to manage elevated low-density lipoprotein levels that result from animal fat consumption.

Probiotics: Where’s the Yogurt?

The link between the gut microbiome and metabolic health is clear at this point, although more research is required to fully explain the connection. I appreciate the new guideline’s emphasis on the need to incorporate fermented foods into the diet for gut health. However, the examples listed — sauerkraut, kimchi, kefir, and miso — while delicious, are not common foods in the average American diet, nor are they readily available or affordable.

That’s why I cannot fathom why yogurt, which is widely available, affordable, and commonly eaten, is not listed as a probiotic option, especially as it is a good source of protein — one of the HHS secretary’s other priorities.

Probiotic-rich foods have been found to support kidney function by reducing systemic inflammation. However, I would strongly encourage my renal patients to limit high-sodium probiotic-rich foods in favor of yogurt, kefir, kombucha, or low-sodium cottage cheese with live and active cultures to avoid increasing blood pressure and promoting further kidney damage.

A Word on Saturated Fat

While recent research suggests that we may have unfairly demonized saturated fat, I hesitate to take that as proof that we need to increase saturated fat intake in the American diet. We know that diets high in plant-based proteins with limited animal-based proteins provide significant benefit to the general population regarding disease prevention.

I will continue to encourage patients to be judicious with animal-based fat intake by considering their preferences, the dish being prepared, and the purpose of the fat. Even I prefer to eat eggs cooked in butter.

Just Too Vague

My primary concern is that these guidelines are too vague for actual implementation. There are no solid recommendations except for protein intake. We know that patient goals should be measurable, and the vague recommendations in the new guidelines make it impossible to determine who is meeting them and who isn’t.

Luckily, the recommendations reiterate dietary principles that healthcare providers have practiced for years. Institutions that are required to follow the guidelines, which are the foundation for all federal food assistance programs, may struggle to implement changes without solid, measurable recommendations. On the other hand, lack of guidance, as well as financial cost, may save the people they serve from a diet of meat and butter.