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Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Susan Weiner, MS, to discuss the recently released US Dietary Guidelines.
Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!
In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Susan Weiner, MS, a nationally recognized dietitian and diabetes care and education specialist, for an in-depth discussion of the newly released US Dietary Guidelines and the inverted food pyramid. The conversation is framed for clinicians navigating nutrition counseling in diabetes and cardiometabolic care, with a focus on how these recommendations translate - or fail to translate - into real-world practice.
00:00:01 Intro
00:01:00 The new food pyramid and a history of diet guidelines
00:03:36 Shortcomings of the new guidelines
00:09:33 The headache of food labeling
00:11:11 New alcohol guidelines
00:13:26 How the guidelines form policy
00:14:55 How professional organizations deal with the guidelines
00:17:38 Linoleic acid in processed foods
00:25:15 Too much protein?
00:30:32 Translating the guidelines for patients
00:37:11 Outro
Weiner begins by providing critical historical context, noting that the traditional food pyramid has not been used since 2011 and that the current changes effectively replace the MyPlate model rather than revising the pyramid. She explains that the Dietary Guidelines are updated every five years and are informed by an extensive scientific advisory report exceeding 400 pages, while the public-facing guidance consists of a condensed narrative and visual summary. A central theme of the discussion is the disconnect between these two documents, with Weiner highlighting that several evidence-based findings did not clearly carry through to the final recommendations.
The panel examines major shifts in emphasis, including an increase in recommended protein intake and greater prominence of animal-based foods and full-fat dairy. Weiner raises concerns about internal inconsistencies, particularly the continued recommendation to limit saturated fat to less than 10% of total calories while simultaneously promoting food patterns that could easily exceed that threshold. The group discusses how these recommendations may unintentionally displace fiber-rich foods such as fruits, vegetables, legumes, and whole grains—an issue of particular relevance for people with diabetes, cardiovascular disease, kidney disease, and those treated with GLP-1 receptor agonists.
Additional areas of ambiguity are explored, including the lack of explicit guidance on processed meats, minimal discussion of fiber targets despite references to gut health and fermented foods, and confusing messaging around sodium use. The episode also highlights the removal of specific quantitative alcohol limits, replaced by the vague directive to “drink less,” which Weiner argues weakens clinical counseling and may have downstream implications for public health messaging and policy.
The discussion broadens to consider equity, affordability, environmental impact, and feasibility, questioning how these guidelines will affect federal nutrition programs, school meals, and food access in resource-limited communities. The episode concludes with a call for clinicians to rely on individualized medical nutrition therapy and professional judgment, while anticipating that organizations such as the American Diabetes Association and American Heart Association may issue more targeted guidance in response to these controversial updates.
