Breaking Down the New Dietary Guidelines 2025–2030: Evidence, Gaps, and Real-World Practice - Episode 6
Navigating Added Sugar Recommendations Across Different Age Groups and Clinical Contexts
Part 6 of the discussion takes a closer look at added sugar recommendations from the guidelines and scenarios where individualization may be needed.
In part 6 of the discussion, the conversation turned to one of the more contentious areas of the updated dietary guidelines: added sugars. Colleen Sloan noted that while recommendations to limit added sugars are not new, the most recent guidelines take a more restrictive stance, prompting debate about how realistic and applicable these recommendations are, particularly across different age groups and clinical contexts.
Catherine McManus began by outlining how the guidelines address added sugars in pediatrics. For early childhood, the recommendation is to avoid added sugars altogether, a position she fully supports given the well-established associations between added sugar intake and adverse health outcomes. However, in middle childhood, defined in the guidelines as ages 5 to 10, the recommendation goes further, stating that no amount of added sugar is recommended.
While McManus agreed with this principle in theory, she raised concerns about its practicality. Drawing on both research and clinical experience, she noted that overly restrictive guidance can backfire, turning certain foods into “forbidden” items that children may later overconsume when given the opportunity. Given that humans are physiologically wired to prefer sweet, salty, and high-fat foods, she suggested that framing the guidance around limiting or avoiding added sugars, rather than stating that no amount is recommended, may better support realistic, sustainable dietary behaviors.
Slaon echoed the need for nuance, particularly when working with adolescent athletes. She explained that for this population, foods containing added sugars can serve as effective, quick sources of energy before intense physical activity or long competitions. This, she emphasized, reinforces the idea that clinicians must interpret population-level guidelines through the lens of the individual patient. A recommendation that may be appropriate for an older adult with metabolic syndrome, for example, may not apply in the same way to an active teenager who metabolizes glucose very differently.
From the adult and cardiology perspective, Viet Le emphasized that the dietary guidelines are designed as broad, population-level guardrails rather than prescriptive rules for every individual. He stressed that the role of the clinician is to contextualize these recommendations based on each patient’s circumstances, resources, and goals. In practice, this means acknowledging real-world constraints such as work schedules, access to food, and socioeconomic factors, and helping patients make better or more optimal choices within those limitations. Le described this as a “good, better, best” framework, rather than an all-or-nothing approach.
He further noted that even within cardiology, patient needs vary widely, from individuals with limited access to fresh foods to athletes with established coronary disease who still aim to train and compete. For his patients, the added sugar guidance provides a reference point, but counseling often centers on overall dietary patterns, such as Mediterranean or DASH-style eating, with an emphasis on plant-forward choices and incremental swaps rather than drastic restriction.
Ultimately, he cautioned that overly rigid recommendations can lead to frustration and disengagement, whereas flexible, personalized guidance is more likely to support long-term adherence and meaningful health improvements.
Our Experts:
Colleen Sloan, PA-C, RDN, pediatric physician assistant and registered dietitian.
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.
