An RD Digests The New Dietary Guidelines For Americans, 2020–2025

Every bite counts when it comes to nutrition and its direct impact on our health, disease risk, and longevity. How to make every bite count is what actually matters on the daily and what The Dietary Guidelines for Americans (DGA), 2020–2025 is all about.

The new DGA made their debut a few weeks ago. Since 1980, nutrition and health experts have been nominated, vetted, and tapped to create dietary guidelines based on published scientific research. This broad nutrition road map for Americans comes out every five years—and as a public health tool, it has a pretty profound impact. While they aren't technically published for individual Americans, the latest DGA will shape the next half-decade of nutrition policies, programs, and education at the federal, state, and local levels.

Before we dive in, I want to share some important background information on how the DGA is written. To understand the process more, I interviewed several experts from the 20-member Dietary Guidelines Advisory Committee (DGAC). This group is comprised of physicians, researchers, and professors. They are medical doctors, Ph.D. scientists, dietitians, and public health professionals from all around the country.

Life-cycle nutrition is standard fare for any nutrition and dietetics university curriculum (personally, it was one of my favorite classes). Now, everybody can learn about this topic. A clear theme in the latest DGA is the "emphasis on consuming healthful dietary patterns across the life cycle," says DGAC vice-chair Ronald Kleinman, M.D., physician-in-chief at MassGeneral Hospital for Children and professor of pediatrics at Harvard Medical School.

"This is the first edition of the Dietary Guidelines to include a life stage approach," DGAC chair and professor emerita at the University of California–Davis Barbara Schneeman, Ph.D., further explains. "These guidelines illustrate that good nutrition should be integrated into all facets of health and begins at the earliest age."

I was excited to see the novel life-cycle (or life-span) focus in this year's DGA, as this approach brings attention to unique nutrition needs at key stages of life. The DGA now covers infants and toddlers; children and adolescents; adults; women who are pregnant or lactating; and older adults. 

Overarching concepts of calorie balance and nutrient density are seen for all ages. And a variety of fruits, vegetables, whole grains, dairy, protein sources, and healthy oils lay the core dietary pattern framework for all age groups (except early infancy). Then for each life stage, the DGA provides calorie levels, specific macro- or micronutrients of concern (i.e., what we need more or less of), beverage specifics, and opportunities for supplementation. Check out the guidelines' table of contents to find recommendations specific to a particular life stage.

And while nutrient needs differ by life stage, our overall dietary patterns (quantity, variety, and foods that are consumed together) are surprisingly stable throughout life. "What is striking is that after age 2, healthy dietary patterns are remarkably consistent across the life span," says DGAC member Sharon Donovan, Ph.D., R.D., professor of nutrition and director of the personalized nutrition initiative at University of Illinois, Urbana-Champaign.

This is why setting up healthful nutrition practices early on yields lifelong benefits. Because while improving nutrition at any life stage is valuable, Donovan points out that "it's easier to establish healthy dietary intakes early in life, when food preferences are being established, than it is to change dietary preferences in older children, adolescents, and adults."

In the first DGA published during a pandemic, you'd think COVID-19 would get some airtime. Unfortunately, it only got one sentence. I know most of us are ready to see coronavirus in our rearview mirrors, but it's not history (yet). 

The past 10 months have shown us scientific discoveries in real-time, linking preventable nutrition issues (e.g., vitamin D deficiency) with COVID-19. And considering immunity is a top priority, I think it's a miss that the Dietary Guidelines did not take the opportunity to inform Americans of the links between nutrition and immune function. The singular mention in the DGA explains that, "people living with diet-related chronic conditions and diseases are at an increased risk of severe illness from the novel coronavirus."

I appreciate, however, that the DGAC (remember, they wrote the 835-page scientific report to inform the much shorter DGA) adds more color to the issue, calling out two concurrent epidemics in our country: "These parallel epidemics, one noninfectious (obesity and diet-related chronic diseases) and one infectious (COVID-19), appear to be synergistic." 

Schneeman explains the committee faced a logistical, timing challenge: "The COVID-19 pandemic emerged as the committee moved into its final phases of work." She went on to say that, "As a committee, we were struck with the vulnerability of those with diet-related chronic diseases (e.g., obesity, type 2 diabetes, and cardiovascular disease) to the most serious outcomes from infection with the virus. In addition, the disruptions due to the pandemic have resulted in food insecurity and hunger, increasing the challenges to make healthful dietary choices." 

DGAC member Regan Bailey, Ph.D., MPH, R.D., echoes this paradox, sharing that while "nutrition is critical to the immune defense and resistance to pathogens, both undernutrition and overnutrition can impair immune function." (Bailey is a professor in the Department of Nutrition Science at Purdue University, as well as director of the Purdue Diet Assessment Center.)

At mindbodygreen, we recently explored undernutrition in the complex problem of food insecurity, as well as overnutrition (and unhealthy nutrition patterns) in the synergy between metabolic health and immunity. 

Based on these insights, I believe embracing healthful nutrition patterns, supporting food security initiatives, addressing nutrient gaps, and maximizing other lifestyle factors (e.g., physical activity, sleep, etc.) are powerful levers we can choose to pull to improve metabolic health and thus our immune system. 

Indeed, DGAC member Linda Van Horn, Ph.D., RDN, L.D., professor of preventive medicine at Northwestern University and chief of the Nutrition Division at Feinberg School of Medicine, underscores the fact that, "now more than ever, the importance of healthy eating, weight control, and prevention of both cardiometabolic and infectious diseases is a recognized goal, worldwide."

Ultimately, diving deeper into the nutrition/immune system relationship in the Dietary Guidelines was passed onto the next iteration (2025–2030). In the meantime, Donovan shares these actionable insights: "a healthy immune system depends upon an adequate intake of many nutrients, protein, long-chain polyunsaturated fatty acids (especially omega-3s), vitamins (e.g., vitamin C and the fat-soluble vitamins A, D, and E), and minerals (e.g., iron and zinc)." 

Having not been included since the 1985 Dietary Guidelines, baby nutrition experienced a DGA revival this year. Since nutritional needs commence immediately after birth, it was about time to bust the myth that "food before one is just for fun." By including nutrition recommendations for infants from birth to 24 months, this DGA "thus, at last, creates guidelines for the entire life cycle and population," says Kleinman.

Whenever feasible, exclusive breastfeeding is strongly recommended for the first six months of an infant's life. The benefits of human milk can continue through or after the first year, too. When breastfeeding is not an option, iron-fortified infant formula is recommended. 

Donovan, an expert in maternal-child nutrition, explains, "If you are a parent, the best time to set your child on a healthy trajectory is early in life. Breastfeeding is the best start, as much and for as long as it works for the mother and infant."

Vitamin D supplementation (liquid dropper format) for infants can start after birth. Interestingly, if the breastfeeding mom is vitamin D replete (possible with sufficient, daily supplementation), the baby will be, too. But most Americans, moms included, are not getting adequate vitamin D.

Starting at around 6 months of age, babies need to be given a variety of nutrient-dense, complementary foods from all food groups. Exposure to potentially allergenic foods is important, too. Donovan recommends that, "when you introduce new foods, present a variety of tastes and textures and model healthy nutrition behaviors by eating these foods as a family."  

When you make every bite count in a nutrient-dense fashion, there's not room for too much more. For example, it's prudent to have a conservative daily nutrition "budget" for added sugars and alcohol.

To that end, I was excited about the DGAC's recommendations in their 2020 scientific report to reduce added sugar and alcohol intake. Specifically, they recommended decreasing the daily limit of added sugars from 10% to 6% of calories and reducing the daily limit of alcohol consumption for men from two drinks to one drink per day. 

The final DGA chose not to adopt those reductions and instead carried forward the limits for added sugars and alcohol from the last DGA (2015–2020)—i.e., 10% of calories from added sugars, with a two-drink daily limit for men and one-drink limit for women. But in a bold, if not binary, move, the DGA recommended that children 2 years and younger avoid all added sugars from foods and beverages.

While the DGA didn't adopt the DGAC's tighter added sugar and alcohol limits, Schneeman adds that the guidelines do "indicate that for most Americans there is little room in the diet for added sugars and that individuals should not drink alcohol for any health reason, and for those who do choose to drink, drinking less is better for health."

Richard Mattes, Ph.D., MPH, R.D., distinguished professor of nutrition science and head of the Department of Public Health at Purdue University, adds that because "there is very limited discretionary energy in the diet, nutrient-dense foods should be emphasized."

When it comes to de-emphasizing added sugars and alcohol, we don't have to wait five years for the next DGA edition to limit intake of these empty calorie sources (and probable toxins when consumed liberally).

There are health benefits of limiting alcohol intake. Kleinman explains, "More alcohol intake doesn't translate to better health." And the science indicates that alcohol consumption (even within the DGA limits) may increase the risk of death from certain cancers or cardiovascular disease.

When it comes to added sugars, 63% of Americans surpass the current, liberal cutoff (10% of calories). Foods and beverages that deliver added sugars (think processed foods, sweetened beverages, sweets, etc.) lack nutrient density while being packed with calories. The regular consumption of added sugars contributes to nutrient gaps, energy excess, obesity, inflammatory processes, and an increased risk for chronic diseases.

I've seen the DGA criticized by some in the media as only being for healthy people, thus limiting its relevance to all Americans. That's a misconception.

Busting this myth, Bailey says, "The Dietary Guidelines are developed to help all Americans and are based on rigorous evaluation of the scientific literature, including [for] those living with chronic diseases."

The reason it's important to include people (via data, research) who are healthy and not healthy in the DGA is because the majority of Americans are, sadly, unhealthy.

Almost 75% of adults and 40% of children and teens are overweight or obese. Sixty percent of adults have 1 or more chronic diseases related to diet. I'm especially talking about obesity, type 2 diabetes, cardiovascular disease, and certain types of cancer.

In the Dietary Guidelines, you will find broadly applicable, science-backed, and sustainable dietary patterns. The DGA refer to these as healthy U.S., healthy Mediterranean, and healthy vegetarian styles.

Schneeman explains why: "These patterns are associated with nutrient adequacy and reduced risk of diet-related chronic diseases; the core elements of these recommended patterns can be adapted to fit various personal and cultural preferences and household budgets."

And while there's no single best dietary approach for all, "nutrient-dense foods should be emphasized," says Mattes. "Balance, moderation, and variety are still the most important characteristics of a healthful diet."

In addition to nutrient density, variety, and attention to portion size, whole foods and more plant intake are also evident themes in the DGA. Whether vegetarian or not, all Americans would benefit from being more plant-centric in our dietary approach. As Van Horn explains, "Currently dietary intake among the US population falls far short of the recommendations, especially in regard to intakes of fruits/vegetables/whole grains/nuts/legumes and plant-based protein/fiber and oils."

Medical nutrition therapy approaches for specific groups of people with acute or chronic health conditions (e.g., a low-FODMAP diet for those with irritable bowel syndrome or a gluten-free approach for celiac disease and gluten-intolerant individuals) will not find their way into the DGA. That's because these dietary approaches are not researched or designed for the broader, general U.S. population. 

The same goes for the ketogenic diet. This high-fat, low-carb, moderate-protein dietary pattern was originally used 100 years ago to treat pediatric epilepsy. Keto has gained broad appeal in recent years, and while there is a growing amount of research on the keto diet in adults (e.g., for weight loss and improving cardiometabolic disease), its long-term sustainability is questionable. More importantly, a larger body of evidence1 would be needed before it's rolled out as national public health guidance.

Just like most nutrition and lifestyle recommendations, the Dietary Guidelines' guidance for healthy eating can and should be personalized to your age, health status, genetic makeup, personal and cultural preferences, and economic considerations. 

This concept of dietary customization was espoused by the new DGA. It's also been echoed by The Academy of Nutrition and Dietetics, who chose "Personalize Your Plate" as this year's National Nutrition Month banner and education focus.