What are the Dietary Guidelines for Americans?

Did you know that until 2020, we didn’t have federal dietary guidelines for pregnant and lactating women?

The Dietary Guidelines for Americans (DGA) are the federal source of evidence-based information on diet and nutrition. While most people I know aren’t waiting around for this 164-page document to drop, it’s kind of a big deal for dietitians and the food industry.

It probably impacts you more than you may realize…⠀⠀⠀⠀⠀⠀

• You remember the Food Pyramid, right? Came from the DGA. We now have MyPlate, but that’s a different topic for a different day.
• Policy – the DGA impact policies of federal programs, including what you can buy with food stamps and what school lunch should look like.
• Food Labels – the DGA set the nutrients of concern for Americans, which in turn impacts what food manufacturers list on a food label. Notice that in the past few years Vitamin C is out, and Vitamin D is in? That’s the DGA.
• Disease Prevention – the DGA outline the best evidence-based recommendations we have on preventing disease. Specifically, chronic diseases like obesity, diabetes, cardiovascular disease, and cancer.

This last point is a big one. The DGA are focused on health promotion, not disease treatment. Which means that if you are actively managing a chronic disease, it’s important to discuss things with your health care team. There are places where the Guidelines may not be right for you. 

This is especially important since 60% of American adults have at least one *diet-related* chronic disease. 

How do we define healthy?

The DGA take time to list out the core elements of a healthy diet. My favorite takeaway from this section is that ALL of the food groups are covered. When we look at the recommendations for disease prevention, there is no reason to cut out any specific type of food.

Vegetables – incl starchy, leafy greens, legumes 

Fruit – with a focus on whole vs juice 

Grains – with a focus on whole grains 

Dairy – incl lactose-free or calcium-fortified soy

Protein – meat, seafood, eggs, plant-based 

Oils – incl those found in foods like olives, nuts, salmon 

What’s new in the DGA in 2020?⠀⠀⠀⠀⠀

The DGA have been released every 5 years since 1985. But this is the first time that dietary guidelines for pregnant and lactating women, and infants have been included.

Kind of crazy isn’t it, that we are just now making recommendations and acknowledging there are unique needs during these seasons of life?

I think that one of the reasons that specific Guidelines have been lacking is that research isn’t quite as strong in these areas. There are much more significant ethical implications when doing research on pregnant women or infants. This makes evidence-based nutrition a little harder to come by.

My intent with this post is to focus on the needs of pregnant or lactating women, since that is my area of specialty. There are other interesting things to review when it comes to infants, as well as a few small changes to the general adult population. 

As I read over the guidelines, a few big picture things stood out to me. 

1. The general guidelines still apply here! The dietary guidelines for pregnant and lactating women start with the core elements to a healthy diet for all adults. The amounts might increase, and there is extra emphasis on nutrient-dense choices. But there isn’t anything radically different. 
2. There is no need to cut out food allergens. This is one of my favorite myths to bust for moms-to-be. Unless mom has her own need for restrictions, such as an allergy or intolerance, there is no need to avoid allergens during pregnancy or nursing. (In fact, eating common allergens during pregnancy and lactation may prevent food allergies. 
3. Exercise is important, but the recommendations are scarce. The DGA are very short on exercise specifics, but that’s ok because this isn’t our scope of practice. Just because the information is brief doesn’t mean the role of exercise isn’t crucial.
4. Whether you’re doing a HIIT workout or just waddling, getting an elevated heart rate for at least 150 min/week is the goal. But also – talk to a specialist here. Get personalized recommendations, especially returning to exercise postpartum! 

How well are pregnant women meeting the Guidelines?⠀⠀⠀⠀

The results are in – most pregnant and lactating women are NOT meeting the dietary guidelines. While this is not terribly surprising, since that’s true for all people, it’s still not great. Specifically, though, how do we measure up?

The Good:

Grains: In general, women are getting in enough grains. In a world that hates carbs, and would rather consider bacon healthy than a slice of whole wheat bread,, this is great news to me. 

Protein: Total protein needs are being met on average by pregnant and lactating women. We can probably dive into timing to fine-tune things, but again, let’s call it a win!

The Bad:

Veggies: As in, we’re not getting enough. The areas that are weakest include red veggies (e.g., tomato, bell pepper), starchy veggies (e.g., potatoes, squash, corn), and beans/peas/lentils. 

Seafood: Again, we’re woefully shy of the recommendations. This is not a surprise to me at all, since we’ve scared too many women into avoiding seafood while pregnant. Plus, if you’ve got food aversions, seafood might be at the top of that list.

The Ugly:

Sugar and salt. As in, we’re eating it all. Helloooooo pregnancy cravings and all the “eff it” mentality. We gotta enjoy our food, but we also need to focus on the nutrient-dense options.

Saturated fat: Getting too much, but I’d like to get more granular information on this one before making a strong judgment call. Here’s a bit of a spicy take: many sources of saturated fat are great sources of other key nutrients (think: stewed meats, dark meat poultry, full-fat dairy, etc). But if you’re getting all your saturated fat from baked goods or French fries…

Important nutrients during pregnancy and lactation

As we continue to drill down, let’s look at the key nutrients included in the dietary guidelines for pregnant and lactating women.

Folate

This is the one everyone has heard of. But did you know that the most important time to get the nutrient is BEFORE you get pregnant? So don’t wait until you pee on a stick for this one. The Guidelines say to supplement a month before getting pregnant, but how many of us know when that will be?!

A better recommendations is for all women capable of getting pregnant to supplement, either individually or as part of a prenatal vitamin. You want to look for 600-800 mcg of methylated folic acid.

Iron

Your needs increase during pregnancy and a little during lactation. However, if you haven’t gotten your cycle back yet postpartum, you could be OVER-supplementing if you keep taking your prenatal. It’s super important to discuss your situation with your healthcare team to keep your levels appropriate.

Choline

Most women are not meeting their daily choline needs AND most prenatal vitamins don’t have enough (if any) choline. Double whammy. So unless you’re eating 2-3 eggs each day, you probably need a supplement.

Iodine 

It may be considered one of those “lesser known” nutrients, but I’m thrilled to see the DGA acknowledge iodine. I’m hopeful it will put more pressure on creating high-quality supplements, since iodine is not often included in prenatal vitamins.

When you use salt in cooking or at the table,  be sure to make it iodized salt. Your fancy salts are pretty, but don’t have the levels of iodine that you need.

Rather get it through other foods? Try seaweed. As a crunchy snack, on top of popcorn or eggs, or even in sushi.

Omega-3, specifically DHA

You may have heard about the importance of omega-3s, and one kind of omega-3 that is important to brain development is DHA. The best way to meet recommendations is to choose 8-12 oz of a variety of seafood each week, with an emphasis on cold water fatty fish (salmon, tuna, sardines, herring). Not gonna happen? Look for a supplement that contains AT LEAST 300 mg DHA.

Mercury

Mercury is the only thing on this list that you should actually avoid. This is where the “fish concern” during pregnancy comes in. Yes, mercury poisoning can be a very significant issue – if it happens.

But, seafood is also rich in another mineral, selenium. Selenium and mercury compete for absorption in the body, which means that you will absorb way less mercury from fish than you think.

That said, there are 3 big ones to avoid during pregnancy due to the extreme levels of mercury: shark, swordfish, and king mackerel.

Canned tuna can be a concern, especially since it is the cheapest and most convenient fish for Americans. In general, 6 oz per week of chunk light tuna is fine. But there are two brands that sell low-mercury tuna – Safe Catch and Wild Planet. 

Whew, that’s a lot. Where do I go from here? Make sure you check out my Ultimate Guide to Prenatal Vitamins! It will walk you through the process of choosing a prenatal vitamin, what other potential supplements you may need (spoiler: all prenatals are missing something), as well as my favorite brands.