Dietary Guidelines for Americans 2020 released

The 9th edition of the Dietary Guidelines for Americans 2020-2025 is out, with the tagline to Make Every Bite Count. Intended for policy makers, healthcare providers, nutrition educators, and Federal nutrition program operators, the new edition has expanded to almost 150 pages, providing nutrition guidelines for even more age groups throughout the life cycle. As in the previous edition, the Dietary Guidelines emphasize dietary patterns rather than promoting specific nutrients or foods. This allows for greater flexibility in food choices, as health benefits are achieved by consuming a wide variety of nutrient-dense foods across different food categories, rather than a few “superfoods.” In addition, the Dietary Guidelines again emphasize how nutrition educators need to be aware that food choices are strongly impacted by age, race, cultural traditions, environment, food access, budget, and personal beliefs and preferences. [1]

Highlights from the Guidelines

What’s new:
  • Recommended dietary patterns for infants and toddlers (birth to 23 months).
  • Food allergy prevention in infants; for example, the guidelines recommend introducing peanut-containing foods as early as 4-6 months in infants at high risk for peanut allergy, to lower the risk of developing a peanut allergy.
  • An expanded comprehensive section on healthy dietary patterns and food safety during pregnancy and lactation, and recommendations for breast feeding.
  • New sections on overweight and obesity in children and pregnant women.
  • Addressing health problems stemming from obesity-related stigma and discrimination.
  • More user-friendly graphics, such as how to modify meals to be higher in nutrients while controlling calories, sugar, and sodium; sample menus; and interpreting the Nutrition Facts label.

The key players in the “Healthy U.S.-Style Dietary Pattern” remain unchanged from the previous edition of the Guidelines:

  • Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables
  • Fruits, especially whole fruit
  • Grains, at least half of which are whole grain
  • Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives
  • Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products
  • Oils, including vegetable oils and oils in food, such as seafood and nuts

Dietary components to limit:

The guidelines carry over the same limits for saturated fat, added sugars, and sodium, but this time include a specific age range:

  • For added sugars, the limit is 10% or less of total calories starting at age 2. For context, drinking even one 20-ounce bottle of soda would exceed this recommended 10% limit. A new advisory suggests that infants and toddlers younger than 2 years avoid all foods and beverages containing added sugars.
  • For saturated fat, the limit is less than 10% of total calories starting at age 2.
  • For sodium, the limit is less than 2,300 milligrams daily for older teenagers and adults, and less for children younger than age 14 (1,200 mg/day for ages 1-3; 1,500 mg/day for ages 4-8; and 1,800 mg/day for ages 9-13).
  • Although the recommended amounts for alcohol have not changed, the messaging is subtly different, placing an emphasis on limiting drinks rather than drinking in moderation. The prior edition suggested up to two drinks daily for men and one drink for women. The new guidelines emphasize a limit of two drinks or less for men and 1 drink or less for women, followed by a statement that drinking less is better for health than drinking more.

Where the Guidelines fall short

While the Guidelines include dietary patterns that remain examples of healthy diets (“Healthy Mediterranean-Style Pattern,” and “Healthy Vegetarian Pattern”), the dietary targets for the “Healthy U.S.-Style Pattern” emphasize a diet relatively high in meat, eggs, and dairy foods. Dr. Walter Willett, Professor of Epidemiology and Nutrition in the Department of Nutrition at Harvard T.H. Chan School of Public Health said this about the new Guidelines:

In general, there was minimal change from the last edition of the Guidelines, which did include many positive suggestions. However, guidance that considers scientific evidence on specific protein sources and health, and also the environmental consequences of dietary patterns, is needed to provide Americans with advice and policies for healthy and sustainable diets. The current Dietary Guidelines fail to do this.

Like the previous edition, the Guidelines are silent on the environmental impacts of their dietary targets, which other analyses show would have serious impacts on climate change and other environmental footprints because of the relatively large amounts of meat and dairy foods recommended. [2] Along with varying impacts on human health, different foods also have differing impacts on the environment. The production of animal-based foods tends to have higher greenhouse gas emissions than plant-based foods—and red meat (especially beef) and dairy stand out for their disproportionate impact.

Willett points out that the Guidelines’ continued dairy recommendation of 3 servings per day has never been justified by evidence for health outcomes, and the guidance for low-fat and fat-free dairy products doesn’t detail a plan for disposal of the fat naturally present in milk:

Because the disposal of dairy fat would be hugely wasteful, it would almost certainly remain in the food supply, which makes this recommendation somewhat of a fantasy. The report does appropriately mention that soy milk is an alternative to cow milk, but to avoid the large greenhouse gas emissions associated with dairy food consumption at three servings per day, the majority of milk and dairy foods would need to be plant-based.

Similarly, the Guidelines also recommend lean meats, but don’t discuss the fate of cuts of meat that are not lean. Willett says that realistically, they would almost certainly be consumed, “probably as cheap cuts and processed meats, especially by low-income groups who already experience excess rates of obesity and diabetes.”

It’s notable that the overall protein recommendation leads with “lean meats,” which could be interpreted by consumers as including “lean” or “low-fat” cuts of bacon or other processed meats. Although further guidance clarifies that “most intake of meats and poultry should be from fresh, frozen, or canned, and in lean forms (e.g., chicken breast or ground turkey) versus processed meats (e.g., hot dogs, sausages, ham, luncheon meats),” [1] this statement is buried within the chapters of the guidelines, rather than emphasized within the summarized protein recommendation. This is a particularly important distinction, since consuming healthy protein sources like beans, nuts, fish, or poultry in place of red meat and processed meat can lower the risk of several diseases and premature death.