Every five years, two federal agencies – the Departments of Agriculture (USDA) and Health and Human Services (HHS) – release the Dietary Guidelines for Americans, which are nutrition recommendations “to promote health and help prevent chronic disease.” These Guidelines influence food policies, such as school lunches and food stamps, and set nutrition standards for health professionals and food manufacturers. The 2020-2025 Guidelines, published in December 2020 with the theme of making “every bite count,” recommended the following:

• Follow a healthy dietary pattern at every life stage.
• Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
• Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits.
• Limit food and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

These recommendations are based on a scientific review from the 2020 Guidelines Advisory Committee, whose members are scientists. However, the 2020-2025 Dietary Guidelines excluded the advisory committee’s recommendation for lower added sugars and alcohol consumption targets.

What are the added sugars and alcohol nutrition guidelines?

According to the FDA, in contrast to the naturally occurring sugars found in most fruits, added sugars are added during the processing of foods or by hand. Sugar-sweetened beverages, desserts, sweet snacks, and candy are the main sources of added sugars in the American diet.

In its scientific review, the 2020 Guidelines Advisory Committee recommended that added sugars should make up less than 6 percent of daily calories. However, this recommendation for a lower target was not included in the 2020 Guidelines. Unchanged from 2015, the 2020 recommendations state that “A healthy dietary pattern limits added sugars to less than 10 percent of calories per day.” This translates to about 45 grams of carbs from sugar per day for a 1800 calorie daily diet.

The Advisory Committee also recommended limiting daily alcohol consumption to one drink a day for both men and women. Despite this recommendation, the 2020 Guidelines remains unchanged from 2015 and advises one drink per day for women and two for men. However, the new Guidelines state that “even drinking within the recommended limits may increase the overall risk of death,” which aligns with the findings of the Advisory Committee.

What do the experts have to say about the 2020 Dietary Guidelines?

It is unclear why the USDA and HHS chose not to include the Advisory Committee’s recommendations around added sugars and alcohol consumption. Dr. Dariush Mozaffarian, Dean of the Tufts University Friedman School of Nutrition Science and Policy, stated that the failure of the 2020 Dietary Guidelines to include the more stringent added sugars and alcohol recommendations “is another sad example of the growing trend of politics trumping science.” According to the New York Times, the USDA and HHS supports limiting added sugars and alcohol intake but federal agencies believe “the evidence reviewed since the 2015-2020 edition does not substantiate quantitative changes at this time.”

The choice to not lower added sugars and alcohol recommendations is surprising to experts, in part because the guidelines are focused on disease prevention. As stated in the guidelines, diet-related chronic conditions such as prediabetes, diabetes, obesity, and cardiovascular disease “are very prevalent among Americans and pose a major public health problem.” Over 10.5 percent of the US population has diabetes, and 36.5 percent of US adults have obesity.

Limiting added sugars and alcohol consumption can help prevent type 2 diabetes and other chronic conditions. Sugar consumption is directly associated with type 2 diabetes. Drinking one sugar-sweetened beverage per day can increase your risk for type 2 diabetes by 13 percent. Alcoholic drinks that contain high amounts of sugar and alcohol have been proven to affect blood sugar and glycemic control. Dr. Charlie Alexander, an endocrinologist formerly at Merck, said, “We are clearly not making enough progress in the fight against obesity and type 2 diabetes,” and he is disappointed that the 2020 Guidelines did not reflect the strict added sugars and alcohol recommendations of the Advisory Committee. Similarly, Dr. Francine Kaufman,  Chief Medical Officer of Senseonics, said that “a more bold stance might have had a greater effect on the diabetes and obesity epidemics.”

Are these nutrition guidelines meant for people with diabetes?

The 2020 Dietary Guidelines are for all Americans and were not written specifically for people with diabetes and other chronic conditions. However, with 60% of US adults living with a chronic disease, the 2020 Dietary Guidelines acknowledge that nutrition recommendations should focus on people living with, or at risk for, diet-related chronic conditions. Dr. Kelly Brownell, Director of the World Food Policy Center, believes that moving forward, there should be more disease-specific nutrition recommendations for people with diet-related diseases.

Though the Guidelines are helpful nutrition recommendations for everyone, people with diabetes should consult their healthcare providers and diabetes-specific resources for nutrition recommendations. Dr. Brownell recommends that people reduce their added sugars consumption “to as low as you find tolerable,” and if you drink alcohol, “do so in moderation.” According to Hope Warshaw, MMSc, RD, CDCES and author of Diabetes Meal Planning Made Easyand Eat Out, Eat Well, people can help reduce their added sugars intake by using low and no calorie sweeteners. Read more about reducing added sugars intake here.

Though experts are disappointed that the 2020 Dietary Guidelines for Americans failed to incorporate the recommended lower targets for added sugars and alcohol consumption, the 2020 Dietary Guidelines are a comprehensive and impactful collection of nutrition guidelines. With this year’s focus on people with chronic conditions, we are advocating for the 2025-2020 US Dietary Guidelines to incorporate the nutrition needs of people with diabetes and prediabetes.