The U.S. government issues new dietary guidelines every five years that are designed to help Americans develop healthy eating habits and prevent diet-related chronic diseases. For the 2020–25 guidelines, much of the recommendations remain the same, though there are a handful of changes. The updated guidelines:
- Recognize that more than half of U.S. adults have one or more diet-related chronic disease, and emphasize that everyone, regardless of health status, can benefit from changing food and beverage choices to follow healthier diet patterns
- Stress the importance of a long-term overall healthy dietary pattern, rather than focusing on individual nutrients, foods, or food groups in isolation
- Encourage healthy diet patterns across the life span, and for the first time recommend healthy choices for infants and toddlers
“The idea is that one wants to consume foods with lots of nutritional value but with a minimum of salt, saturated fats, and sugars — particularly added sugars,” says Timothy Naimi, MD, MPH, of the University of Victoria in British Columbia, a member of the Dietary Guidelines Advisory Committee, the group of scientists that advise the U.S. government on how to write the guidelines.
“Any number of diets can satisfy these objectives,” Dr. Naimi says.
There’s broad agreement among nutritionists and scientists that a variety of healthy eating patterns can help people manage their weight and prevent diet-related diseases.
Nevertheless, some scientists say the guidelines issued in December by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) don’t go far enough on two of its measures — added sugar and alcohol — to address problems such as obesity, type 2 diabetes, heart disease, and certain cancers.
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The Controversy Around Unchanged Added Sugar and Alcohol Intake
Two of the biggest dietary causes of these chronic health problems are sugar and alcohol, and the new U.S. guidelines acknowledge this fact.
The latest dietary guidelines recommend limiting alcohol consumption to two drinks a day for men and one drink a day for women, the same advice issued previously. And the new guidelines also retain previous advice for all Americans to limit sugar intake to less than 10 percent of daily calories.
In a statement defending this decision, the USDA and HHS said there wasn’t enough evidence to “substantiate changes to the quantitative limits for either added sugars or alcohol.”
Yet some scientists still believe the government should be pushing more aggressive reductions in sugar and alcohol consumption. In July, scientists on the Dietary Guidelines Advisory Committee recommended that the government urge both men and women to limit alcohol to one drink per day and called for all Americans to consume less than 6 percent of daily calories from added sugars. These cutbacks are needed to combat obesity, type 2 diabetes, and cancer, the committee said.
“The failure of the final dietary guidelines to honor the scientific committee’s guidance to limit alcohol and sugar to safer levels is another sad example of the growing trend of politics trumping science,” says Dariush Mozaffarian, MD, DrPH, dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston.
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What Scientific Evidence Suggests About Alcohol
Several studies have linked alcohol consumption to an increased risk of premature death, heart disease, and certain cancers.
One study published in April 2018 in The Lancet, for example, found people who have just one drink a day are still more apt to die prematurely of all causes than those who drink less often. And a study published in June 2018 in the Journal of the American Heart Association linked one drink a day to an increased risk of high blood pressure in men, with rising risk for each additional daily drink; for women the risk of hypertension increased after two drinks a day.
Another previous study found alcohol responsible for up to 3.7 percent of all cancer deaths. Naimi, a member of the Dietary Guidelines Advisory Committee, was also the senior author of this study.
“For men who are drinking two drinks on most or all days compared to one drink, there is an increased risk of death from any cause,” says Naimi. “Large studies show, in fact, that the risk of death starts to increase even over one-half to one drink per day.”
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What Are the Health Risks of Eating Too Much Added Sugar?
One study published in February 2019 in the American Journal of Clinical Nutrition found that added sugars are tied to an increased risk of premature death even when limited to 7.5 to 10 percent of daily calories. Another study, published in November 2020 in the American Journal of Clinical Nutrition, found high sugar consumption was linked to a 17 percent higher risk of developing all types of cancer as well as a 51 percent higher risk of breast cancer.
Plenty of previous studies have also linked added sugars to an increased risk of obesity, which in turn is associated with a higher risk of developing chronic health problems like type 2 diabetes and heart disease, says Marion Nestle, PhD, MPH, a professor emerita of nutrition, food studies, and public heath at New York University, who served on the Dietary Guidelines Advisory Committee in 1995.
Americans get about 20 percent of their calories from sugar right now, double the target in the current guidelines, Nestle says.
“Practically everyone would be healthier eating less sugar,” she adds. “Sugar is not needed in the diet; it has calories but no other nutritional value.”
While the current dietary guidelines do stress the importance of limiting sugar and alcohol, there is plenty of evidence that the bigger cutbacks proposed by the scientific advisory committee would have even more health benefits, Nestle says.
“I can only assume that the alcohol, sugar, and soft drink industries lobbied against the greater restrictions and the industry-friendly Trump administration went along with that,” says Nestle, who is an outspoken critic of the influence of industry on food policy.
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Why the U.S. Dietary Guidelines Matter for Americans’ Health
Part of the problem with allowing people to get 10 percent of their calories from added sugar is that most foods and beverages that contain added sugar are highly processed and unhealthy, says Samantha Heller, RDN, a nutritionist at New York University Langone Medical Center in New York City. For example, drinks with lots of added sugar, like some sodas and juices, tend to be loaded with calories and light on nutrients, and foods with lots of added sugar tend to also have lots of unhealthy fats and sodium.
“It is not just the added sugar that is the problem; it is the intake of the foods that contain them … have little or no nutritional value,” Heller says. Examples of foods with added sugar are sports drinks and soda, candy, sweets, baked goods, and highly processed foods. “These kinds of unhealthy foods replace healthy, nutrient-dense foods and contribute to the risk of obesity,” she adds.
There is no one way to eat healthily, and the guidelines stop short of endorsing a specific popular diet. The guidelines do stress the importance of consuming nutrient-dense foods and beverages and paying attention to calories.
For most adults, a healthy diet should include lots of colorful vegetables and fruit; whole grains; lean protein from animal- or plant-based sources such as beans, lentils, tofu, and low-fat or nonfat dairy and dairy alternatives; and heart-healthy fats from nuts and seeds, says Vandana Sheth, RDN, owner of a private practice in Los Angeles and author of My Indian Table: Quick & Tasty Vegetarian Recipes. It should also limit added sugar, saturated fat, and sodium.
“The DASH, Mediterranean, and healthy vegetarian eating patterns can meet this guideline,” Sheth says.
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