My Take on the New 2026 Dietary Guidelines and the “Inverted Food Pyramid”

By Ashlyn Smith, MMS, PA-C, DipACLM, DFAAPA, LSC

ELM Endocrinology & Lifestyle Medicine

You may have seen headlines about the new 2026 Dietary Guidelines for Americans (DGA) and the so-called “inverted food pyramid.” As a hormone, metabolic, and lifestyle medicine specialist, I’ve been asked several times for my perspective—and my answer may surprise you.

Plant-forward, whole food--just with the lifestyle medicine PA ordered!

Like most aspects of nutrition, this conversation isn’t about extremes. It’s about balance, progress over perfection, and context. Nutrition is rarely all good or all bad.

What the New Guidelines Get Right

There are several positive aspects of the updated guidance that align with what we already know from decades of nutrition and health research.

First, there is a stronger emphasis on whole foods—foods that look close to how they occur in nature. This includes fruits, vegetables, whole grains, legumes, and minimally-processed ingredients.

Second, the guidelines move further away from ultra-processed foods (UPFs) and simple sweets, including sugar-sweetened beverages (SSBs). Ultra-processed foods—such as chips, candy, fries, and many packaged snack foods—bear little resemblance to real food. While they are widely available and heavily marketed in the U.S., they are consistently linked to higher risks of metabolic disease (including type 2 diabetes and heart disease), as well as depression, cancer, and lung disease.

Finally, the continued emphasis on whole fruits, vegetables, and whole grains reflects broad agreement across medical organizations. Nutrition centered on whole foods are associated with better metabolic, cardiovascular, hormonal, and mental health outcomes for many people.

Where I Have Concerns

While there is much to support, there are also areas that deserve a closer look.

One concern is the use of the term “healthy fats” in ways that may include foods high in saturated fat, which is known to contribute to cardiovascular disease when consumed in excess. Even more concerning is any suggestion that trans fats belong in a healthy eating pattern. Trans fats have been determined by the FDA to be not safe for human consumption and were removed from U.S. food production in 2015, though trans fats do occur naturally in some animal products.

Another area that continues to generate confusion is protein.

What About Protein?

Loss of muscle—particularly in older adults, people with chronic illness, injury, or obesity with low muscle mass—is a real and important health concern. In those populations, adequate protein intake matters.

However, true protein deficiency in the general U.S. population is far less common than many people believe, based on large population studies of dietary intake. There is significant misinformation around protein needs, and culturally we often assume that more protein is always better. In reality, protein needs vary by age, health status, activity level, and overall dietary pattern.

Where Medical Organizations Agree

It’s important to note that several major medical organizations have released statements largely supporting the areas of agreement within the new dietary guidance, including:

• American Diabetes Association

• American Heart Association

• American College of Cardiology

• American College of Lifestyle Medicine

• American Society for Nutrition

  
  

While some organizations focus primarily on what they support, others have raised concerns about recommendations related to saturated fat, trans fat, and sodium intake. What’s notable is that these organizations often recommend lower intakes of saturated fat, trans fat, and salt than what is currently consumed by most Americans.

The Bottom Line

There is no single “perfect” food pyramid—and there never has been. I consider "diet" to be a four-letter word as true nutrition is not one-size-fits-all. Your hormone health, metabolic health, medical history, culture, preferences, tolerances, and lifestyle all matter.

Rather than chasing perfection or following diet trends, the most sustainable approach is one that emphasizes balance, flexibility, and individualization.

Progress matters more than perfection, and personalized nutrition will always be more effective than rigid rules.

Have more questions about personalized nutrition goals? I am here to help—let’s connect on a free consultation to discuss further!

Disclaimer:

The content on this blog is for informational purposes only and is not intended to provide medical diagnosis, treatment, or replace professional medical advice, diagnosis, or care. Always consult a qualified healthcare provider with any questions regarding a medical condition or treatment.