New Dietary Guidelines 2025: A Functional Medicine Doctor's Analysis
The 2025–30 dietary guidelines for Americans are out! In this blog post, I will review the new guidelines, provide insight into the research that might be behind some of the changes, and summarize what these updates mean for you.
In general, the updated guidelines reflect research on Paleolithic and ketogenic diets. The biggest change is that grains no longer occupy the base of the pyramid, with metabolic health and blood sugar levels cited as part of the reason for this shift.
Food, Genetics, and The Microbiome
Gut microbes help us digest the foods we eat. Once digested, these molecules make their way into the bloodstream, where they are then transported to the liver, which filters and removes anything toxic.
The human body contains about 25,000 genes coded to make the proteins that are essential for the chemistry of life. For comparison, gut microbes contain about 5 to 9 million genes that help us complete the biochemical steps we can no longer do on our own. Optimal health requires more than just a great diet — you also need a healthy, well-balanced microbiome.
Research in the Wahls laboratory has shown something interesting: The microbes participants had at the start of our studies actually predicted whether they'd do better on the low-saturated-fat Swank diet or the modified Paleolithic Wahls diet.
Keep that in mind as you read about the new dietary guidelines. Your unique combination of genetics, microbiome health, and any existing health conditions means you might thrive on a low saturated fat diet, Mediterranean diet, Paleolithic diet, ketogenic diet, vegan diet, or even a carnivore diet. You are biochemically unique.
That said, no one does well with a lot of added sugar or white flour-based products in their diet.
The new guidelines should lead to a change in standards for school lunches, nursing homes, and registered dietitian training — but they don’t guarantee any changes in consumer behavior or industry marketing. Ultra-processed foods will still be made readily available and easier to access than fresh produce, in many cases. And the agriculture industry will still be working hard to sell products made from corn, wheat, and soybeans.
A Step-by-Step Review of The Updated 2025–2030 Dietary Guidelines
Protein
The new guidelines recommend 1.2 to 1.6 grams of protein per kilogram of ideal body weight. There’s also some discussion about the risks associated with muscle loss, and the benefit of eating protein with every meal.
Protein can come from animal sources (meat, fish, poultry, eggs, dairy) or plant sources like beans and legumes, which need to be eaten with whole grains to make a complete protein.
At 70 years old, with an ideal body weight of 64 kg (around 141 lbs.), I should be eating between 76.8 to 102 grams of protein each day.
Here's what that looks like in real food: Four ounces of meat (100 grams) contains about 30 grams of protein. To hit my protein target, I'd need about 12 ounces of meat per day, which equals roughly 400 calories (1g protein = 4 kilocalories).
For years, I've recommended at least 0.8 grams of protein per kilogram of ideal body weight for people under 60. Over age 60, protein needs increase.
With plant-based protein, the math gets trickier. Because vegetarian protein sources also contain carbohydrates, vegetarians will inevitably have a much higher carbohydrate intake than those eating animal proteins. One and a half cups of cooked beans plus ¾ cup cooked rice gives you about 30 grams of protein — but also 95 grams of carbohydrates.
It's absolutely doable for vegetarians and vegans to get enough protein, but it requires intentional planning.
Dairy
Full fat dairy without added sugar is recommended. This is an excellent source of healthy fats, vitamins, minerals, and protein.
For those without gluten or dairy sensitivity, full fat dairy can add more protein to the diet, but people with autoimmune conditions may not be able to tolerate it. Sometimes, dairy from animals other than cows (goats, sheep, etc.) may be better tolerated, as may yogurt, kefir, and certain cheeses. Fermented dairy also has the benefit of probiotic microbes.
Gut health
This is a brand-new section in the guidelines, and it's a welcome addition. The guidelines now discuss the importance of gut health as a critical part of overall health, recommending that a healthy diet should include fermented foods such as sauerkraut, kimchi, kefir, natto, and other fermented options to support a diverse microbiome.
I'm thrilled to see this. Fermented vegetables have been a traditional food across many cultures for hundreds if not thousands of years, and for good reason — they provide lactobacillus bacteria that support gut health.
If you tolerate dairy, yogurt or kefir can provide protein, healthy fats, and probiotic bacteria. Goat and sheep kefir may be easier to digest than cow's milk versions.
Start slowly with fermented foods — just a forkful at first — and gradually increase to 2 to 6 servings per day. One important caveat: If you have mast cell activation syndrome, you'll likely notice increased symptoms like rashes, headaches, or other reactions after consuming fermented foods. Pay attention to how your body responds.
Vegetables and fruit
Eat a wide variety of colorful vegetables and fruits throughout the day. Frozen, dried, fresh, or canned vegetables without added sugar can be very helpful. 100% vegetable or fruit juice should be consumed in limited portions or diluted with water. The goal is three servings of vegetables and two servings of fruit per day.
I am pleased to see that the recommendations limit fruit and vegetable juices, as their high sugar content can lead to spiking blood sugar.
In my clinical practice, I usually recommend adding green leafy vegetables to the diet, along with brightly colored vegetables, berries, and sulfur-rich vegetables like cabbage, onions, and mushrooms.
Incorporate healthy fats
The guidelines recognize that healthy fats are plentiful in whole foods including meats, poultry, eggs, omega-3 rich seafood, nuts, seeds, full-fat dairy, olives, and avocado. When cooking, the guidelines suggest using butter or beef tallow along with olive oil.
The guidelines also recommend keeping saturated fat consumption below 10% of total calories, noting that limiting highly processed foods will help meet this goal. They acknowledge that more research is needed to determine which types of dietary fats best support long-term health.
This is where nuance comes in, though. For people with heart disease, following a very low saturated fat diet has been linked with reversal of atherosclerosis. A vegan low saturated fat diet can lead to marked reductions in cholesterol.
But very low cholesterol creates its own problems: Your body needs cholesterol to make vitamin D, sex hormones, and adrenal hormones, and too-low cholesterol can interfere with the production of those hormones.
That said, heart disease and stroke risk are more closely linked to added sugar intake and metabolic health than to fat consumption alone. As the guidelines acknowledge, more research is needed.
It is possible follow a low saturated fat approach while still eating a modified Paleolithic diet: Choose lean cuts of meat and use cooking methods like baking, broiling, or boiling rather than frying.
One more note on olive oil: I prefer that people use olive oil cold rather than for cooking. Heating olive oil above 180 degrees Fahrenheit damages hydroxytyrosol, a polyphenol thought to be a major driver of olive oil's health benefits.
Focus on whole grains
The new guidelines significantly reduce the consumption of highly processed, white flour-based carbohydrates such as white bread, ready-to-eat packaged breakfast cereals, flour tortillas, and crackers. It is recommended to consume whole grains such as rice or steel cut oats, and limit grains to two to four servings a day.
My own recommendations are less stringent here. Whole grains (quinoa, millet, teff, buckwheat, etc.) do not spike the blood sugar as much as white-flour-based products, and depending on the grain chosen, you may also be getting more fiber, which is good for your microbiome.
Limit highly processed foods added triggers and refined carbohydrates
The new guidelines encourage us to "avoid highly processed packaged, prepared, ready-to-eat, or other foods that are salty or sweet, such as chips, cookies, and candy that have added sugars and sodium (salt). Instead, prioritize nutrient-dense foods and home-prepared meals."
I would add more specific guidance to avoid artificial sweeteners and try to limit sugar to two teaspoons per day.
I am very pleased to see a specific call to reduce white flour-based and sugar added food products. I hope the administration will also ban marketing of these products to our children.
Alcohol
People who should completely avoid alcohol include pregnant women and those recovering from alcohol use disorder. For those with a family history of alcoholism, the guidelines recommend being mindful of alcohol consumption and associated addictive behaviors.
Drinking alcohol accelerates aging of the brain and increases the risk of cognitive decline.(1) It also disrupts sleep, lowering sleep quality. I recommend reducing or eliminating alcohol.
Sodium
The guidelines state that people aged 14 and over should consume less than 2,300 milligrams of sodium per day. For people who are sweating a lot because of exercise or heat exposure, higher sodium intake is needed.
Sea salt contains trace minerals and can reduce risk of mineral insufficiencies. However, sea salt does not contain iodine, which is an important mineral for the thyroid. I recommend using sea salt and suggest using seaweed as a spice a couple times a month.
Infants, toddlers, middle childhood, and adolescence
The guidelines include specific sections for each of these age groups. Key recommendations include offering new foods multiple times —infants may need to be offered a food item 8 to 10 times before they will readily eat it — modeling healthy eating behaviors, and focusing on whole, nutrient-dense foods including protein, dairy, and vegetables. No added sugars are recommended for young children.
Teaching our children to meal plan, shop, and cook from recipes using whole ingredients is an important life skill that will serve them throughout their lives.
Pregnant and lactating women
Pregnancy and lactation increase nutrient needs to support maternal health, fetal growth, and milk production. The guidelines recommend diverse nutrient-dense foods including iron-rich meats, folate-rich greens and legumes, choline-rich eggs, calcium-rich dairy, and low-mercury omega-3-rich seafood. Women should talk to their healthcare professional about prenatal vitamins during pregnancy and whether dietary supplements may be needed while breastfeeding.
It's important not to follow a low-carbohydrate or ketogenic diet while pregnant or breastfeeding.(2) The placenta will take nutrition from the mother's body to help build the developing fetus, which is why adequate nutrition is so important — both to help the baby grow and to protect the mother's health.
Poor nutrition during pregnancy or lactation can increase the risk of postpartum depression and other mental health issues. Breastfeeding takes substantial nutrition to sustain, and if a woman's diet is too low in carbohydrates, she may develop nausea, vomiting, and potentially ketoacidosis.
Older adults
The guidelines note that older adults may need fewer calories but require equal or greater amounts of key nutrients such as protein, vitamin B12, vitamin D, and calcium. To meet these needs, they should prioritize nutrient-dense foods such as dairy, meats, seafood, eggs, legumes, and whole plant foods. When dietary intake or absorption is insufficient, fortified foods or supplements may be needed under medical supervision.
I agree with this — older adults do often need greater support to get sufficient protein, vitamins, and minerals. Supplements may be helpful, but should always be taken under medical supervision.
Individuals with chronic disease
The guidelines state that following these dietary recommendations can help prevent the onset (or slow the progression of) chronic disease, especially cardiovascular disease, obesity, and type 2 diabetes. Individuals with certain chronic diseases may experience improved health outcomes when following a lower-carbohydrate diet. The guidelines recommend working with a healthcare professional to identify and adopt a diet that is appropriate for your specific health condition.
This is the crux of the work I’ve been doing in my clinics for decades. Research has shown that people who have obesity, metabolic syndrome, prediabetes, or diabetes will likely respond well to a low-carbohydrate diet. A Paleolithic diet with 80 grams of carbohydrates may be beneficial. A ketogenic diet with 20 to 50 grams of carbohydrate may be even more beneficial.
Numerous meta-analyses of Paleolithic diet studies have demonstrated that a Paleolithic diet improved insulin sensitivity, blood sugar control, and cardiometabolic risk factors.(3-6) Additionally, several meta-analyses of ketogenic diet studies have demonstrated that a ketogenic diet improves insulin sensitivity, blood sugar control, and weight loss,(7-9) and ketogenic diets have been used as an adjunct in cancer treatment.(10) Do not follow a ketogenic diet while breastfeeding.(2)
Vegetarian and vegans
The guidelines recommend that vegetarians and vegans consume a variety of whole foods, especially protein-rich foods such as dairy, eggs, beans, peas, lentils, legumes, nuts, seeds, tofu, or tempeh, while limiting highly processed vegan or vegetarian foods that can include added fats, sugars, and salt..
The guidelines note that vegetarian diets often fall short in vitamins D and E, choline, and iron, whereas vegan diets show broader shortfalls in vitamins A, D, E, B6, and B12; riboflavin; niacin; choline; calcium; iron; magnesium; phosphorus; potassium; zinc; and protein. To avoid nutrient gaps, the guidelines recommend prioritizing targeted supplementation, diversifying plant protein sources, and monitoring nutrient status periodically.
It's absolutely possible for those who are committed to being vegetarian or vegan because of spiritual or cultural beliefs to maintain their health. I'm glad to see guidance to help identify which nutritional supplements can support vegetarians and vegans. Unfortunately, some individuals adopt vegetarian and vegan diets without knowing how to ensure they have complete protein and a well-balanced diet.
The bottom line
These changes to the dietary guidelines are an improvement, but changing behavior around food is not easy for anyone. In addition, we live inside a food system that prioritizes maximizing profit without consideration of the health consequences.
Ideally, our government would also work to improve the quality of our food supply, the accessibility of nutrient rich whole foods, and limit the marketing of high-sugar, ultra-processed, white flour-based products to our children. However, that's unlikely to happen. We need to do what we can for ourselves and our families.
The bottom line: Eat sufficient protein — whether from animal or plant sources. Eat more vegetables. Model healthy eating for your children. Have your children help with meal preparation and cleanup. And begin, step by step, to steadily improve your diet.
We can do this.
Citations
- Zhang R, Li B, Miao Y. Alcohol consumption and risk of dementia: a systematic review and meta-analysis. Intern Med J. 2025.
- Osborne KC, Oliver JJ. Lactation ketoacidosis induced by breastfeeding while on a ketogenic diet. Am J Emerg Med. 2022;56:392 e5- e6.
- Bahrami M, Bakhshimoghaddam F, Ahangarpour A, Jafarirad S. The Paleolithic diet and chronic disease risk: a GRADE-assessed systematic review and dose-response meta-analysis of prospective cohort studies and randomized controlled trials. Crit Rev Food Sci Nutr. 2025:1-16.
- Ghaedi E, Mohammadi M, Mohammadi H, Ramezani-Jolfaie N, Malekzadeh J, Hosseinzadeh M, et al. Effects of a Paleolithic Diet on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2019;10(4):634-46.
- Jamka M, Kulczynski B, Juruc A, Gramza-Michalowska A, Stokes CS, Walkowiak J. The Effect of the Paleolithic Diet vs. Healthy Diets on Glucose and Insulin Homeostasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2020;9(2).
- Sohouli MH, Fatahi S, Lari A, Lotfi M, Seifishahpar M, Gaman MA, et al. The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2022;62(17):4551-62.
- Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110(7):1178-87.
- Wang Z, Chen T, Wu S, Dong X, Zhang M, Ma G. Impact of the ketogenic diet as a dietary approach on cardiovascular disease risk factors: a meta-analysis of randomized clinical trials. Am J Clin Nutr. 2024;120(2):294-309.
- Yuan X, Wang J, Yang S, Gao M, Cao L, Li X, et al. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutr Diabetes. 2020;10(1):38.
- Zhang M, Zhang Q, Huang S, Lu Y, Peng M. Impact of ketogenic diets on cancer patient outcomes: a systematic review and meta-analysis. Front Nutr. 2025;12:1535921.
