US dietary guidelines have made us ill — let's change them already
'We have let the industry tell us as a government what's healthy and what's not healthy,' Dr. Makary warned in a recent interview, calling for an overhaul of the pyramid.
They're right to be concerned. Rates of diet-related diseases — including obesity, diabetes, osteoporosis, and iron-deficiency anemia — continue to rise. Anemia alone affects 10 million Americans, causing symptoms like chest pain, headaches, and fatigue. Left untreated, it can lead to serious heart problems, premature births, and stunted growth in infants and children.
Given the stakes, adequate nutrition should become the new cornerstone of national dietary policy. MyPlate, the visual representation of the official Dietary Guidelines for Americans, shapes everything from school lunch programs and hospital meals to broader federal health initiatives.
Yet the government's recommended dietary patterns continue to fall short. According to the 2025 guidelines' own expert report, a person following these recommendations to the letter will still not meet adequacy goals for iron, vitamin D, choline, and folate — nutrients crucial for brain development, bone health, and the prevention of birth defects, among other vital functions.
The responsibility now lies with the Departments of Agriculture and Health and Human Services to make a final decision on the expert report's findings and develop the official 2025-2030 Dietary Guidelines, which are due out this year. With widespread nutrient inadequacies affecting population health, it is crucial that the new guidelines effectively address nutritional needs.
The nutritional status of adolescent girls illustrates these concerns. Nearly 40 percent of females between the ages of 12 and 21 years are iron deficient. More than 6 percent are so low in iron that they develop anemia — meaning they don't have enough healthy red blood cells to carry oxygen around their bodies. This represents a significant public health challenge during a critical period of growth and development.
The nutritional challenges extend to bone health. By the expert report's measure, among girls aged 14 to 18 years: 68 percent fall below adequacy for calcium, 89 percent for magnesium, more than 97 percent for vitamin D, and 23 percent for protein. These deficits during adolescence — a critical period for bone development — help explain why approximately half of women aged 50 or older will experience a broken bone resulting from osteoporosis.
Pregnancy and lactation amplify these challenges. Nutritional deficiencies during pregnancy can jeopardize the health of mother and baby, in extreme cases leading to complications such as developmental delays and neurological damage. Iron remains a public health concern for pregnant women, critical for oxygen transport and fetal brain development. Similarly, iodine, vital for producing maternal and fetal thyroid hormones, is often overlooked in dietary recommendations.
The expert committees behind the guidelines' scientific reports have previously acknowledged these nutrient gaps and their public health significance. But little action has been taken. The current report continues to reflect similar nutrient gaps in its recommendations.
For instance, the committee recommends that Americans consume three servings of refined grains per day — not because they're healthy, but because they're enriched with added nutrients. Without these enriched foods, the recommended diet would be even less adequate in essential nutrients.
Enriched grains were a reasonable priority when introduced in the 1940s. In the previous three decades, nutrition scientists had successfully identified the vitamins and minerals needed to sustain human growth and good health. Although these experts identified milk, eggs, butter, organ meats, and green leafy vegetables as nutrient-dense 'protective' foods, the government opted instead to deliver vitamins and minerals to people by adding nutrients to refined grains. After all, wartime rationing was in effect, and after the war grains were still cheaper.
This policy got a boost in the mid-20th century when nutritionists started focusing on the threats of heart disease and cancer, and determined that the consumption of animal foods, laden with saturated fat and cholesterol, should be reduced. Meat, poultry, and eggs — some of the more nutrient-rich fare available — were villainized.
The fallout from stigmatizing nourishing foods is that basic nutrition has been imperiled. For example, it takes more than 4,000 calories of unenriched refined grains to get the same amount of essential nutrients that can be obtained by eating less than 300 calories of beef or eggs. You would have to eat twice as many calories of even quinoa as of beef or eggs to provide comparable micronutrient value.
Many nutrients from animal foods are more easily absorbed than those in plants or enriched refined grains. Additionally, grains, legumes, nuts, and seeds can contain high levels of a compound called phytate, which hinders the body's absorption of iron, zinc, and calcium. Yet the guidelines' scientific report stresses the health benefits of beans, peas, and lentils over animal products and overlooks issues of nutrient absorption and adequacy.
Remarkably, the current report moved its own goalposts in a way that downplays current nutrient inadequacies. Before this year, it used a benchmark called the 'Recommended Dietary Allowance,' which represents the daily intake required to meet the nutritional needs of about 98 percent of all healthy individuals. The new report instead adopted the Estimated Average Requirement, a benchmark representing the needs of just half of healthy individuals. In other words, if everyone met the new benchmark, half the population would still face vitamin and mineral inadequacies. This problematic shift in assessment criteria is not explained in the report.
These methodological decisions raise important questions. What is the rationale for changing from the Recommended Dietary Allowance to a lower-nutrient standard? How does the continued emphasis on refined grains align with goals for optimal nutrition?
Moving forward, we need to put nutrition back into our nutrition policy. The upcoming guidelines should prioritize nutrient sufficiency to support pregnant women, growing children, and optimal health for all.
Nina Teicholz, Ph.D., is a science journalist and author. Ty Beal, Ph.D., is head of food systems data and analytics at the Global Alliance for Improved Nutrition.
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