Special Report: Dietary Guidelines miss key nutrition issues

In episode 4 of this Special Report, Colleen Sloan, PA-C, RDN, joined Catherine McManus, PhD, RDN, LD, and Viet Le, DMSc, MPAS, PA-C, FACC, to examine areas where the 2025–2030 US Dietary Guidelines may fall short, including fiber intake, whole grains, plant-based milk alternatives, and alcohol guidance.

The panel agreed that dietary fiber—despite its well-established benefits for cardiovascular health, glycemic control, weight management, and gut health—received less direct emphasis than in prior guidelines. Le noted that fiber remains one of the most effective and accessible dietary tools for improving cardiometabolic health, while McManus emphasized that Americans across the lifespan continue to fall far below recommended intake levels.

McManus also raised concern that the guidelines’ increased emphasis on animal-based protein sources could unintentionally deprioritize plant-based proteins, many of which are key sources of dietary fiber. Sloan highlighted a disconnect between the text-based recommendations—which encourage multiple servings of fruits, vegetables, and whole grains—and the visual food guide, where whole grains appear minimized. The panel agreed that this misalignment may confuse patients and requires clinician clarification.

The discussion also addressed populations with higher carbohydrate and fiber needs, including children, adolescents, pregnant individuals, and those who are lactating. McManus emphasized that carbohydrates—particularly from whole grains—are a preferred energy source during periods of growth and development, making visual underrepresentation especially problematic in pediatric care.

The experts also noted the absence of guidance on plant-based milk alternatives, despite their growing use among individuals who are lactose intolerant or avoid dairy for cultural or personal reasons. McManus pointed out that prior guidelines offered clearer direction on choosing fortified, low–added sugar alternatives—guidance that could have been retained.

Finally, the panel discussed updated alcohol language in the guidelines, which now advises individuals to “limit” intake without specifying numeric thresholds. Le suggested the change was intended to simplify public messaging, similar to broader physical activity guidance, though the group acknowledged that reduced specificity may create uncertainty for patients.

Overall, the panel emphasized that while the Dietary Guidelines provide a population-level framework, clinicians play a critical role in personalizing recommendations—especially in areas where guidance is vague, incomplete, or visually misleading.

Our Experts:
Colleen Sloan, PA-C, RDN, pediatric physician assistant and registered dietitian; host of The Exam Room Nutrition Podcast.
Catherine McManus, PhD, RDN, LD, assistant professor of nutrition, Case Western Reserve University; Cleveland Clinic Foundation.
Viet Le, DMSc, MPAS, PA-C, FACC, preventive cardiology physician assistant and associate professor of research, Intermountain Health.