Dr. John Day, Cardiologist

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Top 10 Changes to New Dietary Guidelines

This past week the U.S. government released their new dietary guidelines.  These dietary guidelines are updated every 5 years and determine what the new “food pyramid/MyPlate”” looks like, what our children eat for school lunch, and how your doctor will advise you to eat.

What has changed?

After spending much of my weekend carefully dissecting this 100 plus page report, there are actually many new changes.  The biggest changes had to do with sugar, fruit and vegetables, as well as cholesterol in the diet.  Read on to see the top 10 changes to the new U.S. dietary guidelines.

Top 10 Changes to New Dietary Guidelines

1. Sugar Limits for the First Time

With Americans now getting 20% of their calories from high fructose corn syrup, something had to be done.  I applaud our government for finally setting sugar limits.

While the World Health Organization had no fear of the junk food industry in their recent recommendations to limit added sugar to just 5% of total calories, our government caved in.  To keep the sugar industry from becoming too enraged, new guidelines call for limiting added sugar to 10% of your total calories.

This is added sugar, not the natural sugar that is in fruit.  To put this in perspective, the average American eats about 2,000 calories daily.  If you limit added sugar to 10%, this means that you can have 50 grams of added sugar or 1.3 cans of sugary Coca-Cola each day and still be within the guidelines.

The problem is that sugar is not just in soda pop.  It is everywhere.  For example, yogurt and ketchup may have even more added sugar than sugary Coca-Cola.

To help my patients navigate the added sugar landmines, I advise them to read the label on everything they eat.  Track your added sugar for a day or two to see where your baseline is.  You may be surprised.  Personally, I support the Word Health Organization’s guidelines of keeping added sugar to less than 5% of your total calories.

2. Nine Servings Daily of Fruit, Vegetables, and Legumes

The new guidelines want you to eat a lot more fruit, vegetables, and legumes.  In fact, I am thrilled that they now call for 9 servings daily.  How did they define a serving?

For vegetables, a serving size is a half of a cup unless it is a salad.  For salads, a serving size is one cup.  When it comes to fruit, a serving size is a whole fruit or a half cup.

As I have been recommending 9 servings daily of fruit and vegetables to my patients for years, I am often asked how much of each you should eat?

Of the 9 servings daily, at least 5 should be vegetables.  To help guide you on vegetable selection, the report states that at least one should be green (like broccoli or kale), one should be yellow or red (like peppers or carrots), one should be a legume (like beans or lentils), and one should be a starch (like corn or green peas).  To keep things simple, make sure you are eating a rainbow of colors each day.

Surprisingly, this report counted fruit juice as a “fruit.” Fruit juice is not a health drink.  Fruit juice is not much different than added sugar.  Indeed, studies show that fruit juice causes weight gain.  My advice is to skip the fruit juice and instead focus on eating real fruit.

To get to 9 servings daily, you have to start out the day right or it is hard to catch up.  This is why I recommend that my patients include vegetables with their breakfast.  Personally, I eat a salad on most mornings as part of my breakfast.

3. No Dietary Cholesterol Limits

In a marked shift from previous guidelines, this new report has no limits on how much cholesterol you can eat.  Thus, eggs, which are loaded in cholesterol, are now in.

While it is true that for most people dietary cholesterol has little impact on blood cholesterol, there are three groups of people who seem to be very sensitive to cholesterol in the diet. For these people, dietary cholesterol can translate into plaque in the arteries of the heart and brain.  This, in turn, can lead to heart attacks, strokes, and dementia.

The three groups of people who should continue to limit dietary cholesterol are the following: those people with a family history of high cholesterol (familial hypercholesterolemia), those with a family history of Alzheimer’s Disease (ApoE4 gene), or those with diabetes.  As cholesterol is only found in meat and dairy, people with these 3 conditions should work with their physicians to minimize unnecessary dietary cholesterol.

4. No Limits on Red and Processed Meats

Not surprisingly, our government clearly caved in to the meat industry with the new guidelines.  As you might have suspected, there were no firm recommendations to limit red and processed meats.  As I discussed in blog #129, red and processed meats are now considered carcinogenic.

Interestingly, the new dietary guidelines did call out young and middle-aged men for eating too much meat and dairy in general.  Also, the document included recommendations to eat more plant-based sources of protein, like legumes and nuts, and to shift more of your meat consumption to fish low in mercury.

5. Coffee and Tea Are In

While soda pop was definitely called out in this report, coffee and tea were both encouraged based on the new science.  While some have concerns about the caffeine in these drinks, the report states that caffeine is generally recognized as safe.

When it comes to caffeine, most people are unaware that, based on your genetics, you are either a fast or slow caffeine metabolizer.  If you are a fast metabolizer, your body can tolerate large doses with minimal risk.

In contrast, if you are a slow metabolizer, like me, then caffeine lingers for a long time in your body.  For slow metabolizers, higher doses of caffeine may be dangerous to your heart.

For example, slow metabolizers have up to a 64% increased risk of a heart attack depending on their caffeine dose.  Fortunately, consuming up to 100 mg of caffeine daily seems to be safe even for slow caffeine metabolizers.

In addition, recent scientific reports have shown that coffee may increase the risk of heart attacks in younger patients with high blood pressure.  To find out if you are a fast or slow caffeine metabolizer, you can take a simple home saliva test from 23andMe.

6. Half of Your Grains Can Be Processed

At one time our government’s dietary guidelines recommended up to 11 servings of grains each day.  Fortunately, the new guidelines no longer recommend a specific number of grains daily.

Interestingly, the report does state that Americans now seem to be eating the “right amount” of grains.  Even more surprising was that the new dietary guidelines say that up to half of your grains can be fully processed and refined.

This was a huge mistake.  If you follow these new grain guidelines, then odds are that you will suffer from weight gain and possibly even diabetes.

When it comes to grains, you need to follow the science.  Processed and refined grains are clearly associated with obesity and diabetes.  In contrast, real whole grains have been linked to less cardiovascular disease without weight gain issues.

7. Keep Restricting Salt

While the latest U.S. dietary guidelines have slightly loosened salt recommendations, they still call for restricting salt to less than 2,300 mg of sodium daily.  To put this in perspective, one teaspoon of salt has 2,300 mg of sodium.

As 80% of the salt the typical American gets is from processed and fast foods, the real answer is to limit processed and fast foods.  In my opinion, as long as processed and fast foods are rarely eaten, then flavoring your real food with some salt is probably fine unless your doctor tells you otherwise.

Indeed, as I discussed in blog #138, recent scientific studies show that salt restriction may be dangerous for the heart.  Of course, people suffering from high blood pressure, and other heart conditions, should not increase their salt intake unless your doctor says it is OK.

8. Keep Limiting Saturated Fats to 10% of Your Calories

While cholesterol limits were dropped, the Atkins Diet and Paleo Community were angered to see ongoing saturated fat limits.  What does the science say?

As I covered in blog #118, saturated fat seems to be neutral when it comes to the risk of cardiovascular disease. The key is that if you limit saturated fat, what are you eating instead?

For example, if you replace saturated fats with refined carbohydrates, like we did in the 1980s and 1990s, heart disease and premature death risks go up.  On the other hand, if you replace saturated fat with omega 3 fats or complex carbohydrates (fruits, vegetables, and legumes), cardiovascular disease and premature death risks go down.

Saturated fats are complicated.  It goes without saying that most physicians agree that the saturated fat in a hamburger or hot dog probably is not good for you.  Where it gets complicated is when it comes to nuts.  Nuts clearly prevent heart disease and increase longevity, yet they are also high in saturated fat.  Should the saturated fat in nuts count toward your daily limit of saturated fat?

My feeling is that if you are eating a mostly plant-based diet, then you don’t need to worry about limiting saturated fat unless your doctor tells you otherwise.

9. Eat More Fat Free and Low Fat Dairy

As with previous guidelines, the U.S. dairy industry exerted their influence on this document as well.  Indeed, according to our government, you are not eating enough non-fat or low-fat dairy.

Why non-fat or low fat dairy?  This is because full fat diary was felt to have too many calories and too much saturated fat.

As I discussed in blog #38 and blog #85, dairy is very controversial.  For example, people living in Japan, Singapore, or Hong Kong, rarely consume dairy but yet have some of the lowest rates of heart disease and bone fractures in the world.  If dairy is so critical to human health, why do these people live so much longer than we do?

10. Eat More Polyunsaturated and Monounsaturated Fats

Coming in at number 10, our government says you need to eat more polyunsaturated and monounsaturated fat.  What exactly does this mean?

The problem is that this guideline was not well defined.  Nor did they distinguish between the omega 3 and the omega 6 polyunsaturated fats.

Here is what the new dietary guidelines should have said:

1. Eat nuts and seeds daily to get monounsaturated fats.

2. Eat something high in the omega 3’s, like salmon, walnuts, or chia seeds, each day.

3. Avoid processed and fast foods which are high in the disease causing fats.

Take Home Message

While our government’s dietary guidelines have improved from previous years, the guidelines are still very much controlled by the sugar, meat, and dairy industry.

Still confused on what you should be eating?

Instead of a 100 page report telling you what you should eat, I can summarize 99% of what you need to know about eating healthy in just one simple sentence.  This sentence was adapted from Michael Pollan’s book, In Defense of Food.

Eat real food, not too much, mostly plants.  

In other words, eat real food not processed or fast foods.  Eat healthy portions and focus on a mostly plant-based diet.

What is your view of these new dietary guidelines?  I look forward to reading your comments below.  Also, please leave your questions and I will do my best to answer every one.

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