The New Dietary Guidelines for Americans, Part II: What the Guidelines Got Wrong

What the Guidelines Got Wrong

In my last post, we looked at all the positive changes that are in the new Dietary Guidelines for Americans – and there are quite a few of them.  Of course, the new guidelines are not perfect.  If I were writing them, there are certainly things I would word differently.

While grains have been dethroned from their spot at the base of the pyramid, which is a huge win, I still think that they are given more prominence than they should be.  The recommendation is two to four servings of grains a day – which may be an acceptable level of carbohydrate for very metabolically healthy individuals, but I strongly suspect that many people, even those who are not yet significantly overweight or noticeably diseased, are already insulin-resistant enough that they should be having no grains at all or only a very little bit. 

The guidelines don’t say that grains are necessary, but I would go farther and say that they are completely unnecessary – while some people may be able to get away with them, I don’t think that anybody really stands to benefit in any way from including them.  If you are very active and want more carbs, starchy vegetables and tubers or fruit provide the same benefits and tend to be less inflammatory.

The new guidelines still retain the advice to limit sodium to 2,300 mg a day or less.  For most people, I think this advice is unnecessary, and that attempts at limiting sodium can actually be detrimental for health and just make food a lot less appetizing and enjoyable.  The guidelines do correctly point out that eliminating processed food will already significantly reduce the sodium content of your diet.  For most people, once you’ve eliminated processed foods, I would advise that you salt your food to taste and don’t worry about your sodium intake unless you have a specific reason to believe that you are consuming either too much or too little.  

I would have more explicitly called out seed oils.  Having said that, I do think the shift towards healthy fats and the removal of the glowing endorsement of seed oils is a huge step in the right direction.  

My Biggest Complaint – The Saturated Fat Cap

Finally, my biggest complaint: despite the removal of almost all fat-phobic language, the new guidelines still recommend capping saturated fat intake at 10% of total calories.

There are two problems with this advice.  The first is that it is almost impossible to follow while also following the other advice contained in the guidelines.  The second is that there is no good evidence that it will lead to any health benefit.  

Let’s look at the first problem.  The guidelines recommend eating whole-foods rich in healthy fats, including eggs, meat, nuts, and full-fat dairy.  A large percentage of the “healthy” fats from those sources is saturated, including about 40% of the fat in red meat, 30% of the fat in eggs, and more than half of the fat in dairy and coconut products.  These are healthy foods the guidelines are telling us to eat liberally.    Yet, they go on to say, “In general, saturated fat consumption should not exceed 10% of total daily calories”.  The guidelines point out that avoiding processed foods will help to reduce saturated fat content, which is true, but once you actually try to crunch some numbers, you see that it is very easy to far exceed these guidelines while only eating real whole foods.

Let’s say that you are eating 2,000 calories a day.  That means that no more than 200 of those calories should come from saturated fat, which is about 22 grams.  Let’s say you have one tablespoon of butter throughout the day (which, throughout the course of a whole day, is not that much).  That’s seven grams.   Then you have one cup of whole milk (the guidelines recommend three servings of full-fat dairy a day).  That’s another five grams.  You have three eggs for breakfast – that’s another 4.5 grams.  If you have one hamburger patty, containing between five to nine grams of saturated fat, your daily total is somewhere between 21.5 grams and 25.5 grams.  One cup of milk, three eggs, one hamburger, and one tablespoon of butter are enough to put you over the 10% saturated fat cap for the day.  As you can see, this is not a realistic goal if you are eating full-fat dairy, meat, or eggs in any appreciable amount.  

The guidelines acknowledge that we really don’t have research establishing that a particular ratio of different kinds of fat in the diet is optimal for health: “More high-quality research is needed to determine which types of dietary fats best support long-term health.”

If you read the appendix explaining the science behind the nutritional guidelines, most of the section devoted to saturated fat is spent meticulously sorting through all the science ostensibly showing that saturated fat is bad for you and explaining why this research is garbage.  Indeed, it may have actually increased negative health outcomes at a population level by encouraging people to replace natural nutrient-dense foods containing saturated fat, such as dairy and meat, with more processed and higher-carb alternatives: 

“Although well-intentioned, these nutrient-specific targets encouraged food reformulation strategies that replaced natural fats first with PHVOs then later with refined oils, starches, sugars, and chemical additives. The result was a generation of “Cholesterol Free,” “‘Low-Fat,” and “‘HeartHealthy” foods that met labeling criteria but did not necessarily improve diet quality or population health.”

They even explicitly single out the 10% cap on saturated fat as an example of a restriction lacking any scientific basis:  “A half century of research has not confirmed that lowering saturated fat below 10% of energy—or substituting it with linoleic acid–rich oils—reduces coronary heart disease or mortality risk. Overall, causal evidence does not demonstrate cardiovascular or mortality benefit from lowering saturated fat below current population averages.”  Yet, without any explanation, the current guidelines retain this arbitrary 10% cap on saturated fat. 

Maybe this is a political compromise, but it still creates a great deal of tension and confusion in what is otherwise a scientifically rigorous document.  How will this practically play out, as schools and hospitals try to honor the gist of the guidelines (eat real whole foods, including meat, eggs, and dairy, liberally) while also following the letter (don’t let saturated fat exceed 10% of total calories)?  I don’t know.  If you are not in a school or hospital and are making your own food decisions, though, it’s your decision whether to follow the spirit of the guidelines and eat as much meat, eggs, dairy, and coconut as you want, or to follow the strict cap on saturated fat, even as the writers of the guidelines themselves admit that there is no good evidence for this recommendation. 

What Do the New Guidelines Mean for You?  

If you rely on school lunches or hospital food services for a significant portion of your diet, your life just got a lot easier.  Still educate yourself and choose wisely, but people eating from publicly-funded food programs should at least have an easier time getting healthy food now.

Overall, the new guidelines are cause to celebrate.  No, they’re not perfect, and the saturated fat cap in particular certainly looks more like a political compromise than like an evidence-based recommendation.  Still, the momentum is moving in the right direction: processed foods, especially processed carbs and sugar, are finally being called out for the villains that they really are, and whole nutrient-dense foods are being emphasized more than ever before.  The war on animal foods and the myopic cholesterol-centric view of health are not present at all in these guidelines.  

Of course, you don’t need to wait for the public health guidelines to be perfect before you start improving your health.  As always, your health is in your hands; it’s ultimately you, not your doctor and not the government, who is in charge of your health.  Still, it’s encouraging to see guidelines which might help budge public opinion in a better direction.

What do you all think of the new Dietary Guidelines for Americans?  Let me know in the comments!