Chapters Transcript Video New Dietary Guidelines: Changes, Research, Clinical Applications for Cardiovascular Health Back to Symposium Click Here to View Presentation Deck Who has heard news, uh, surrounding the new dietary guidelines that were released earlier this year? We saw some They were in the headlines quite a bit there at the beginning of the year. So we, what we're going to talk today about is being able to identify changes between the 2020 guidelines and the 2025 guidelines. We'll talk about some of the scientific evidence behind them, review current trends that are going around on social media, and then talk about key recommendations we can actually use for our patients. I don't have any disclosures. Let's do a quick history lesson. Um, in 1980, the first dietary guidelines were released. I always like showing this because you can see that first graphic there, the 1234567, those were the original 1980 dietary guidelines. Uh, in 1992, we got the food pyramid and everybody remembers the food pyramid. That seems to be what our patients remember the most. They remember that food pyramid. 2011, we got the MyPlate graphic, which is there on the bottom of your screen. And then in 2026, the beginning of this year, we got this inverted food pyramid. So, we have to talk about the changes and the similarities here, um, and there's, there's kind of a, a gap in the actual content of the guidelines versus the messaging and the marketing of the guidelines that really we need to differentiate. So let's talk about what stayed the same first. We need to get adequate fruits and vegetables, emphasis on fiber-rich whole grains, eat a variety of protein sources from plants or animals. The saturated fat recommendations stayed the same and the sodium recommendation stayed the same. What changed? So there is some real food is kind of the terminology they're using for the messaging here. They mentioned highly processed foods for the first time. I'm going to go over that in a little bit. The protein recommendations changed. There is some different messaging around dietary fats. There's a decrease in the added sugar recommendation, and then alcohol limits were removed. So I'm going to start off with what stayed the same. And it's actually, it's physically impossible for me to go 24 hours without telling somebody to eat more fruits and vegetables. So we have to start there. And, uh, the fact of the matter is, is that 10% of Americans get their recommendation of vegetables and 12% get their recommendation. Of fruit. You can see this is a really great graphic that, um, is from the 2020 guidelines. On the far left, we have total vegetables on the very far left, uh, bar there. You can see that purple at the top is the number of people getting enough of that thing, and the bottom are people that are not getting adequate vegetables. So that stayed the same. We want 3 cups of vegetables, 2 cups of fruit. I find that that is a pretty good way to explain it to patients. Um, that's something that they can actually use. It does not have to be three different cups of vegetables. So for my folks who, They're like, I only like green beans. I'm like, cool. Can we start by eating more of those and then we can worry about other vegetables. Um, Perfection here muddies the waters. They want, uh, patients think that they need to be eating all organic, all fresh, that they cooked homemade, um, but really frozen and no salt added canned options are just as nutritious. They're a great option. They last longer. Um, and then the organic versus conventional can really muddy the waters there. Um, I don't have time to do all of the things, so we're going to be fast. Um, rinsing your produce does a lot of the work there. Um, and so it's not something that I feel that most patients need to spend the extra money on. OK, moving on to whole grains. This is a zoom in of that last graphic I showed you, and you can see 98% of Americans do not get their recommendation of whole grains. Um, the recommendation from 2020 was 50% of your grains should be whole grains. The new recommendation says as much, as many whole grains as possible is the, the, Uh, language they're using here, but you can see refined grains are really high on there, whole grains are really low. When we're talking to patients about this, encouraging, choosing the whole grains whenever possible, they're looking for whole wheat bread, whole grain bread, brown rice, quinoa, um, those ones at the bottom can sometimes be a little out there. So it really is going Be your clinical judgment. If you say quinoa, you might lose somebody. So whole grain bread is a great option there. Um, this stamp here is from the Whole Grain Council. It is on a lot of our packaged whole grain foods. It's a great option for your patients to look for without feeling overwhelmed by looking at the ingredient list or the other parts of the label. Protein. So the protein guideline did change slightly. In 2020, it was 0.8 g per kilogram of body weight. I did the math for you there. For a 200 pound person, that's about 73 g per day. The 2025 guidelines updated to 1.2 to 1.6 g per kilogram for a 200 pound person, that's 109 to 145 g per day. On average, though, Americans are consuming about 1 g per kilogram already. So protein deficiency is not a super common problem. Um, it is, it does depend on different populations. So looking here, elderly patients, GLP-1 users, and kidney disease all have different, might have different protein needs. Elderly patients are more likely to be deficient in protein. They have higher rates of food insecurity and their appetites change. So they tend to eat more carb-rich, um, easy to make meals, especially if they're living on their own. GLP-1 users, this is a big one. So protein needs are likely higher for GLP one users, but research is still going on here. The ranges for recommendations are 1.2 g per kilogram to 2 g per kilogram for GLP-1 users. Really, what we're seeing is they are, their lack of appetite is decreasing their overall protein intake. Um, so that is something to be considerate of with your patients. And then lastly, kidney disease patients may need lower protein. Um, so that 0.8 g per kilogram might be a much more appropriate option for them. As you can see, protein is king right now. Everything is advertised as protein. We've got protein Pop-Tarts, protein Doritos. These are the kinds of things your patients are seeing and going, Oh, it's protein and I'm supposed to have more protein, so I'm going to have these protein Pop-Tarts. Uh, one protein Pop-Tart has 2.5 g of protein. And I think 3 or 4 teaspoons of 3 or 4 packs of sugar added to it. Um, so we really need to emphasize lean proteins, and it's just not a situation that I run into very often where I'm having to talk so much about protein. It's just everywhere right now. Um, this is a great segue here though, because you can see here we have a lot of ultra-processed food options. And that brings us into highly processed food. I'm checking my time here. So, in the 2020 guidelines, they never used the terminology processed, highly processed, ultra-processed. They did use limit foods with added sugars, added sodium, added saturated fats. The new guidelines did use that terminology. You can see here on the right, avoid highly processed, packaged, prepared, ready to eat, or other foods that are salty or sweet, such as chips, cookies, and candy. So, they're very similar, but this is the first time that the guidelines have explicitly said highly processed. The trick here from a perspective of the industry is that there's no easy definition of highly processed or ultra-processed, um. We have the Nova classification, which I'm going to go over in just a quick second, but 55% of Americans, or sorry, 55% of the average calories consumed by Americans are from ultra-processed foods. So these are convenient. They tend to be cheaper. In some cases, they are more shelf stable, so they just are something that people are reaching for more often. Which brings us to the Nova classification. This is out of Brazil, and it is, if you see a headline or a study that says ultra-processed food, they are using this Nova classification. Most of the research coming out about ultra-processed foods are from this classification. So you can see here, group one. Is unprocessed or minimally processed foods. Think, um, apples, broccoli here. Group 2 is actually ingredient foods. So these would be like oil, butter, sugar. Technically, these are group two because they are not often eaten on their own. They're often eaten with other things. Group 3 is processed. So a great example of this that I use at work a lot is a bag of frozen broccoli is technically processed, right? But I would never tell you not to eat frozen broccoli. Group 4 is ultra-processed. This means that there is something that happened in the processing that you cannot do at home. That's what that means here. This is the best we have right now, but it's not perfect. There are certain things that are ultra-processed that I am happy for people to eat. Low-fat Greek yogurt is a good example. Certain whole grain breads are a good example of class 4 for this ultra-processed category. The reason this matters so much is we kind of had an idea that processed foods were problematic. In 2019, there was this excellent study published, and it was a metabolic ward study. If you, uh, have looked at nutrition research, you can see that it's really complex. It's difficult to Study because there's so many confounding variables for all of us. So they actually put people in a metabolic ward where they measured their every output, they measured every movement, they measured the food after they ate it. Um, it was perfectly tailored. And so study participants were randomized. They were either given whole foods or they were given processed foods. And they were given each meal was the same calories. It was matched for protein, it was matched for fat. Then they lived like that for 2 weeks, and at the end of the 2 weeks, they switched places. So the regular group went to the ultra-processed group. Participants on the ultra-processed diet ate an average of 500 more calories per day than the folks in the regular group. And this is important because this was true whether they started off at the ultra-processed diet or if they ended with the ultra-processed diet. They were instructed to eat as much as they wanted. And then they asked, hey, how satisfied were you? How, like, did you enjoy the food? And the satisfaction scores for ultra-processed and Whole Foods were equally high. So despite the fact that the Whole Food group was eating less calories by a lot, 500 calories per day. They were still saying that they were just as satisfied as when the ultra-processed food group was saying that. So this was the first randomized control trial we had that really showed that ultra-processed food made us eat more of it. Now, it didn't tell us why and that research is still ongoing. Um, satiety is a big question here. The volume of the food is a question, right? How much water is packed in. I can eat, you know, a Twinkie or a giant salad. That's kind of a big question mark with the volume of food. So that research is still being done, but what we know. Is what we kind of already knew is that ultra-processed foods make us want to eat way more of them. So the implications for your patients and talking to them about it gets a little bit tricky, right? Because we don't have a great definition. Um, I don't, unless I have somebody who's really interested and wants to hear, I don't usually bring up the Nova classification. The language that I use is actually very similar to what is in these dietary guidelines. Avoid highly processed, packaged, prepared, ready to eat foods. An example I often give is you have corn that is on the cob, just picked, that is a whole food. You have canned, no salt added corn, that is a processed food. And then you have Doritos, which are made out of corn. And that would be an ultra-processed food. That's the, the example I give all the time because it really helps for people to, to bring that home. All right. Next we have fats. So this is where the messaging and the content is really important to look at. On, uh, the screen there, I have the screenshot from the guidelines. It says that healthy fats are healthy fats are plentiful in many foods such as meats, poultry, eggs, omega-three rich seafood. Nuts, seeds, full-fat dairy, um, olives and avocados. OK. Next we have, when cooking with or adding fats to meals, prioritize oils with essential fatty acids such as olive oil. Other options can include butter or beef tallow. This is where we, the messaging does not match the, the science here. Essential fatty acids are omega 3 and omega 6 fatty acids. Beef tallow, butter, and olive oil, actually, are not good sources of essential fatty acids. So this is incorrect. Essential fatty acids come from polyunsaturated fatty acids, which I'm going to bring up in just a moment. The reason this matters is because the saturated fat guideline did not change. The guideline up until 2025 was less than 10% of total calories should be coming from saturated fat. That's in line with the American Heart Association, the World Health Organization. That's still there. In general, saturated fat consumption should not exceed 10% of total calories. So despite the fact that if you look at this picture here, you see steak, and you see butter and you see cheese, and they say, butter or beef tallow, all of those are very high in saturated fat, and they are going to bring you above that 10% recommendation. These are fat compositions of common cooking oils here. You can see that coconut oil, butter, and beef tallow are all quite high in saturated fat. This is a percentage breakdown versus our olive oil, or avocado oil, our canola oil are all much, much lower there. So now we have to talk about seed oils for just a second, and I, this is hard because we could talk about this for like, you know, hours and people seem to be doing that online. Who's heard the term seed oils? Yes. um, seed oils are oils extracted from seeds, and they are the hot thing right now for people to be talking about. They are often high in polyunsaturated fatty acids. The trend here is that they cause inflammation and that they increase your risk for heart disease. The randomized control trials we have, the meta-analysis we have do not show that for polyunsaturated fatty acids. Most of the, most of the time when the influencers are talking about these things and their inflammatory properties, they're talking about mechanisms when we actually Zoom out to the person and the randomized control trials we have on humans, that does not appear in the research. So the truth of the matter for inflammation, intake of polyunsaturated fatty acids is associated with lower inflammatory markers or neutral inflammatory markers when we look at randomized control trials. They are not causing more inflammation than a saturated fat would be. Increased risk of heart disease. The truth is, is that randomized control trials, when you replace saturated fat with polyunsaturated fats in the diet, there is a reduction in the risk of heart attack and death from heart-related events. You can see here, this, uh, graphic is taken from a meta-analysis, and all of those studies, with the exception of one, showed a decrease in the risk of heart attack and cardiovascular death. Here's the truth of it, is that vegetable oils are commonly used in ultra-processed foods. They're flavor neutral, they're heat resistant, they're, they're resistant to, to changes in flavor over time. And so they're perfect for Doritos. I guess I have Doritos on the brain. We're just going to use that as my example for the day. They're perfect for Doritos. Well, they also are very calorically dense. And so they add a lot of calories to our ultra-processed foods. And then I just said a few minutes ago that ultra-processed foods make us want to eat more of them. And so it is true that we are eating more seed oil. Oils than ever before, partially because of the ultra-processed foods. It does not appear, based on the research we have, that the seed oils are the problem. It appears that the excess calories and the excess sugars, carbohydrates, in general, are part of the problem. So practical implications. How are we working with patients on this? I recommend less than 10% of total calories from saturated fat for actual numbers there, 2000 calories a day would be about 21 to 22 g of saturated fat. The biggest sources in the American diet. Number one is cheese. That's, I'm just as sad as you are about that. Number 2, we've got butter beef tallow lard for cooking. This is in vogue. One of the problems I'm seeing is people are switching from canola oil to butter and beef tallow. So they're increasing their saturated fat consumption, processed meats and ultra-processed foods. So when I'm talking to patients, I'm saying, hey, check that label, look at that saturated fat content, compare labels to each other, um, cook with your oils that are liquid at room temperature is a good way to put that for people to understand. Um, and then when I have patients who feel very strongly about seed oils, and I have them a lot, I don't push back too diff too hard sometimes because I want to make sure that we're still getting to a productive place. And so instead of shutting them down completely, Um, I will often say, OK, I totally get that you're uncomfortable with seed oils. I need you to do avocado or olive oil as an, as an option as opposed to butter and beef tallow. So that problem that I mentioned before, that's switching out the canola oil for the butter, I don't want to see that. So if we can, if you don't want to do canola oil, that's fine. I'm not going to argue. I really need you to do the olive oil or the avocado. And I have, most of my patients are pretty amenable to that. All right, added sugars. Um, there was a slight change here. The 2020 guidelines said 10% of total calories, that's about 50 g. The new guidelines say the goal is zero, but limit to 10 g per meal and 5 g per snack, comes out to about 40 g if you're eating three meals and two snacks a day. So they're not completely different from each other. However, the average American gets about 68 g of sugar, added sugar per day. Um, our biggest concern here is that sugar is replacing calories that we could be getting vitamins and minerals and nutrients from. Um, so there is some room for small tiny amounts of added sugars here and there, but it's limited. So when we're talking to patients about this, they're often added for taste and texture. So for example, if, uh, I have a patient who needs a granola bar, and that granola bar has whole grains and it has fiber and it has some protein in it, and it has a few grams of added sugar. I'm usually not too upset about that. But if it has a lot of added sugar and it's missing that fiber, it's missing those whole grains, that's a big red flag for us. So we talk a lot about labels in my classes. You can see added sugar is on the label. A nice trick that I tell people is one pack of sugar that you would add to your coffee is 4 g. And so that's a quick math equation. This, uh, example right here has 2.5 packs of sugar in it. That gives us actually like something tangible that we can use when we're making decisions. All right, I am right on time. Alcohol, it changed slightly. The 2025 guidelines say consume less alcohol for better overall health. The 2020 guidelines said no more than two drinks, two drinks per day for men, one drink per day for women. I don't know why we took that out. I think that tangible things are almost always better. I wanted to make note of that. And then sodium, 2300 mg a day for the general population, stayed the same. But this is a cardiac conference, so I had to fit it in here. Individuals with hypertension or prehypertension should aim for 1500 mg per day, and the average American is getting 3500 mg of sodium per day. The main culprit, ultra-processed foods and restaurant foods. So, in conclusion, the nutrition science has evolved, but the core principles have stayed remarkably similar. You can see here, eat a variety of foods, maintain ideal weight, avoid too much fat, saturated fat, eat foods with adequate starch and fiber, avoid too much sugar, avoid too much sodium. That's from 1980. Um, they're getting, patients are getting a lot of messaging. They're getting marketing on protein, seed oils, and ultra-processed foods. Now is really one of the most important times that we have to really be championing evidence-based nutrition and the actual science behind it. Um, and lastly, we don't need to be perfect with our diet. Um, meaningful changes that are small over time make a huge difference and perfection is almost always the enemy of progress, especially when we're talking about nutrition. Thank you. Published Created by Related Presenters Blake Avery, MD
BROADCASTMED