Vivian Kominos, MD, started cooking at the tender age of 2, standing on a step stool at her grandmother’s side.
Kominos’s father was a chef, and food was a big deal in their Greek household. An integrative cardiologist, Kominos grew up on the Mediterranean diet, eating beans and fish, olive oil and lots of vegetables. It’s the kind of balanced nutrition she teaches as an assistant professor of medicine at the University of Arizona College of Medicine – Tucson’s Andrew Weil Center for Integrative Medicine.
When she first saw the federal government’s new food pyramid graphic, which was released in January with updated Dietary Guidelines for Americans, she was stunned.
“The inverted pyramid is pretty confusing,” she said. “These guidelines are so important, and we have to understand them and be able to explain them.”
Kominos, along with other health care professionals and nutrition experts, has been fielding questions from the public, medical residents and even fellow physicians who are confused by the updated icon, which features an upside-down pyramid with animal-based proteins prominently pictured along with full-fat dairy products, like whole milk and butter. It’s a departure from previous guidelines that emphasized low-fat foods and plant proteins.
“We have good evidence that plant-forward diets are better for cardiovascular disease, cancer, diabetes and inflammation, and plant-based proteins are not highlighted on the graphic,” said Mari Ricker, MD, director of the Integrative Medicine in Residency program at the Weil Center and a professor of Family and Community Medicine.
Courtesy of the U.S. Department of Health and Human Services and U. S. Department of Agriculture
An updated guide
The U.S. Department of Agriculture and U.S. Department of Health and Human Services publish the Dietary Guidelines for Americans every five years. The document offers advice on what to eat and drink to maintain health and prevent diet-related diseases. It guides nutrition policy for federally funded programs like the National School Lunch Program.
The blueprint through 2030 advocates eating real food over processed products. That’s advice U of A health and wellness experts applaud.
“If you can eat food in its original form and mostly plants, you can’t go wrong,” Kominos said.
Other suggestions – like boosting animal protein and including fats like butter and beef tallow – are harder to get behind.
“It is concerning that some of the new recommendations have not been shown to prevent or delay chronic disease,” said Vanessa da Silva, PhD, RDN, director of the U of A Cooperative Extension’s Diabetes Prevention Program. “And sadly, most American adults already have at least one chronic condition, so the guidelines might not apply to many of the people struggling to make sense of them.”
Not necessarily for every body
Experts doubt many Americans will read the detailed 10-page document that goes along with the flipped food pyramid, which doesn’t spell out how much to eat of recommended foods, unlike the MyPlate icon that was used from 2011 until last year.
“Nutrition is often confusing to people because messaging about what, when and how much to eat comes from many different places and spaces, not all of them reputable,” said Melanie Hingle, PhD, MPH, RDN, a professor and associate director for the School of Nutritional Sciences and Wellness at the U of A College of Agriculture, Life and Environmental Sciences.
For example, “influencer experts” on social media hype protein consumption — which the guidelines bumped up to 1.2 grams to 1.6 grams per kilogram of body weight from 0.8 grams per kilogram — but people have differing needs based on physical activity, age and body size, she said.
At the same time, Americans don’t consume enough fiber.
“It’s in foods like vegetables and fruits and whole grains and legumes,” Hingle said. “The more fiber you eat has been directly linked to lowering your risk of chronic disease; so, overemphasizing protein and not addressing fiber at all is a missed opportunity.”
It’s important to take into account that people have specific dietary needs, Kominos said.
“We have to individualize our nutritional therapies,” she said.
Mari Ricker, MD, always tells students to eat a rainbow of fruits and veggies, advice that adults should follow, too.
Photo by Noelle Haro-Gomez, U of A Health Sciences Office of Communications
Ricker said more people are on GLP-1s, medications used to treat Type 2 diabetes and for weight management, which means they’re eating less. So, it’s even more important that they eat varied, nutrient-rich food.
The simple nutrition advice she shares when she talks to kids works for grown-up Americans, too: “Eat the rainbow. Eat as many different fruit and vegetable colors as you can.”
Just one part of a whole
If you’re confused by the new recommendations, Ricker suggests consulting respected sources that rely on evidence-based research. The Weil Center has an extensive patient education library that covers a variety of nutrition topics, and, of course, you can always consult with your health professional, Ricker said.
“A conversation with your physician or nutrition expert is really important,” she said.
It’s also vital to remember that diet is just one part of the bigger picture when it comes to health. You need to consider not only what you eat, but also physical activity, immunizations, stress management and sleep, said da Silva.
“Eating healthy is just one aspect of overall health,” she said. “You can’t forget that.”
