Updated Dietary Guidelines for Americans: Is the US Diet Going Mediterranean?

Every five years, the Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) update the Dietary Guidelines for Americans. This year’s edition caused a stir, by changing their recommendations on everything from cholesterol and salt to sodas and sustainability. But these specific changes make the overall recommended pattern look a lot like the traditional Mediterranean diet.

The guidelines began in 1980 with advice to reduce fat consumption as well as cholesterol. By 1990, it included numerical targets for the amount of macromolecules you should be eating in a given day. The thought at the time was that the low-fat approach would help reduce heart disease, as the advice to micromanage macromolecules would help control calories in order to control weight. The advice appeared in our schools, official food pyramid, and in the recommendations of medical organizations.

This year’s guidelines reverse course in a number of ways that make them look far more like the Mediterranean diet than their original American approach. For example, the new guidelines encourage us to eat fat – the kind found in fish, nuts, and olive oils. We are also encouraged to eat less red meat, fewer sodas, along with more vegetables. This advice focuses more on foods than keeping up with macromolecular targets.

The US committee’s explicit pivot to a food-based approach fits in perfectly with the Mediterranean diet as well. Along these lines, they abandoned the overtired recommendation to limit cholesterol consumption (300 milligrams of cholesterol per day).

Wine too has transitioned over time from something that was not recommended by our guidelines at all – and was said to have zero nutritional value – to an acceptance that wine with the meal is not only okay, but can be heart healthy.

Does this sound familiar? The Mediterranean dietary pattern is a food based approach that leans on healthy oils from foods such as fish, olive oil, and nuts. It also contains whole grains, legumes, vegetables, along with wine at the meal. They do not count carbs, cholesterol, or calories, but just enjoy real foods in moderation.

We’re definitely moving our diet to the Mediterranean. But although the ship has sailed, we’re not all the way there yet. Before the USDA gives the Mediterranean diet a full frontal, get-in-here bear hug, they’ve got to eventually come around on saturated fat, just as they have done with wine, cholesterol, and the food-based focus.

Currently most US dietary experts applaud the advice to limit saturated fat to no more than 10 percent of daily calories, despite strong and well-designed studies showing that it is not the health liability we had assumed (much like there never was strong evidence supporting the cholesterol theory we’ve now abandoned). By contrast, the Mediterranean diet is one of the healthiest, and includes full fat, saturated fat, and dairy typically every day.

Our recommendations will one day catch up with observation. Just as the committees that set our national dietary guidelines came around on a glass of wine with the meal, pulling back on red meats, and making us count cholesterol by watching out for shrimp and eggs. It may just be a matter of time before the next cycle lets go of this old idea as well!