The Dietary Guidelines for Americans have been updated to include, for the first time, recommendations across the lifespan. 

Dr. Donald Hensrud, director of the Mayo Clinic Healthy Living Program, says the dietary guidelines, which are updated every five years, are designed to give the best recommendations on what to eat and drink to promote health and prevent disease.

One of the changes for this edition of the guidelines is focused on a lifespan approach from infancy to older adulthood. "We've known for quite some time that for the first six months of an infant's life, they should be fed exclusively human breast milk," says Dr. Hensrud.

"Another addition that people may not be aware of is that when foods are introduced to an infant around the age of 4 to 6 months, peanut-containing foods can be added to the diet after checking with the infant’s health care provider. The evidence shows that by adding peanuts early in the diet, it may prevent allergies later on. Also, under the age of 2 years, no added sugars should be included in the diet of children. Added sugars do not provide any health benefit

Watch: Dr. Donald Hensrud discusses 2021 Dietary Guidelines for Americans.

Journalists: Broadcast-quality sound bites with Dr. Hensrud are available in the downloads at the bottom of the post. Please "Courtesy: Donald Hensrud, M.D./Healthy Living Program/Mayo Clinic."

Key recommendations from the guidelines include:

• For about the first 6 months of life, exclusively feed infants human milk. 
• At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially allergenic foods along with other complementary foods. 
• From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight and reduce the risk of chronic disease.
• Limit foods and beverages higher in added sugars, saturated fat and sodium, and limit alcoholic beverages.

Dr. Hensrud says that before the guidelines are released, a scientific report on dietary guidelines is published. The dietary guidelines are then derived from this scientific report.

"What many people who work in nutrition would have liked to have seen is a lower limit for added sugars and alcohol. This was included in the scientific report, but did not end up in the Dietary Guidelines," says Dr. Hensrud.

"For example, the dietary guidelines recommend no more than 10% of calories as added sugars. But the scientific report recommended no more than 6%," he says. "Similarly, previous guidelines recommended up to no more than an average of two drinks per day for men. The scientific report recommended lowering this to one drink a day on average for both men and women. The Dietary Guidelines still recommend up to two drinks a day for men."

Dr. Hensrud says the less added sugars in your diet, the better it will be. "We know that there is very little health benefit and many health risks from including too much added sugars in the diet. Sugars that are naturally present, such as in fruit, are fine to have in the diet."

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"The real sugar we should worry about is added sugars," says Dr. Donald Hensrud, who heads up the Mayo Clinic Healthy Living Program and is the author of The Mayo Clinic Diet.

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Dr. Hensrud says added sugars account for a big portion of calories in most people's diets and are one of the main causes of weight gain.

But there are sweet treats that don't have any added sugars: fruit.

"It gets a reputation of being high in sugar, but a small piece of fruit is only about 60 calories," he says. "There's a lot of water. There's other nutrients. There's fiber. So there [are] many other beneficial things in fruit."

Not only will sugar from fruit not cause you to gain weight, it likely does the opposite.

"Studies have shown when people increase their fruit and vegetable intake, their overall risk of gaining weight decreases because they're not eating something else that's higher in calories," Dr. Hensrud says.

So having a sweet tooth doesn't have to be a bad thing. Just make sure you're picking the right sweets with the right kind of sugars.

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DEAR MAYO CLINIC: Are artificial sweeteners bad for your health? I want to cut down on sugar in my diet. I’ve found many products that are sugar-free, but they’re sweetened with things like Splenda, stevia and NutraSweet. Are these reasonable alternatives to sugar, or should they be avoided?

ANSWER: Artificial sweeteners available in the U.S. are regulated by the Food and Drug Administration (FDA). Extensive research on the safety of artificial sweeteners has found that using them in moderation doesn’t pose health concerns.

Artificial sweeteners are synthetic or highly refined sugar substitutes. They’re sometimes called “intense sweeteners” because they are significantly sweeter than sugar. You’ll find artificial sweeteners in many processed foods, including soft drinks, powdered drink mixes, candy, jams, jellies, dairy products and baked goods.

One of the highly touted benefits of artificial sweeteners is that they have virtually no calories. In contrast, one teaspoon of sugar has about 16 calories. That means a can of sweetened cola with 10 teaspoons of added sugar has about 160 calories. The same amount of cola sweetened with the artificial sweetener aspartame has none.

If you’re trying to lose weight or prevent weight gain, products with artificial sweeteners may be an attractive option. It’s important to note, however, that their effectiveness for long-term weight loss isn’t clear.

Another benefit is that artificial sweeteners aren’t carbohydrates. So, unlike sugar, artificial sweeteners generally do not raise blood sugar levels. If you have diabetes, talk to your primary health care provider or a dietitian before you use products with artificial sweeteners.

Over the years, there has been concern that artificial sweeteners may cause health problems, including cancer. That’s largely because of studies dating to the 1970s that linked the artificial sweetener saccharin to bladder cancer in laboratory rats. Because of that, saccharin once carried a label warning that it may be hazardous to your health. There’s no sound scientific evidence that any artificial sweeteners approved for use in the U.S. cause cancer in humans, according to the National Cancer Institute and other health agencies. Given this, the warning label for saccharin was dropped.

A study published earlier this year found that women who consistently drank two or more artificially sweetened beverages a day had a higher risk for stroke than women who drank those beverages less frequently or not at all. Although more research is needed, these findings point to the value of consuming artificially sweetened beverages in moderation.

The FDA regulates artificial sweeteners as food additives, and they must be reviewed and approved by the FDA before being made available for sale. The FDA has established an acceptable daily intake for each artificial sweetener. The acceptable daily intake is set at conservative levels. That means those amounts are likely to be higher than most people would typically consume.

Be aware, though, that it can be hard to pinpoint the exact amount of artificial sweeteners in your diet. Most companies do not share the quantities of artificial sweeteners in products because that information is considered to be part of the companies’ proprietary recipes. In addition, artificial sweeteners are in products you might not expect, such as bran cereal, so you may be consuming more artificial sweeteners daily than you realize.

If your goal is a healthier diet, instead of eating processed foods with artificial sweeteners, choose whole foods, such as fruits and vegetables. Many are naturally sweet, and they also have the benefit of containing healthy nutrients. This is in contrast to artificial sweeteners, which have no nutritional value.

If you regularly drink artificially sweetened beverages as a replacement for sweetened drinks, use that as a stepping stone to drinking more plain water. Your body needs the water, and there’s no question that it’s good for you. — Katherine Zeratsky, R.D.N., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Artificial sweetener debate continues: Mayo Clinic Radio Health Minute published 3/4/19
• Added sugars: Don’t get sabotaged by sweeteners published 2/12/19
• Mayo Clinic Minute: Why drinking diet soda isn’t the best way to manage weight published 6/5/18
• Housecall: Can you handle the sugar challenge? published 4/2/18

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Watch: How to break up with sugar.

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Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

It's not just a sweet tooth. Your body needs sugar.

"Our body does need sugar in the form of those complex carbohydrates, so, like, your grains, your fruits and vegetables, and milk, just for energy," says Bonsall.

But Bonsall says that doesn't mean your body needs added sugars.

"They are sugars that are added to the product and not naturally found in that item," she says.

Bonsall says a good example is orange juice, which can consist of just the natural sugars found in oranges. But some juices add extra sugar that your body doesn't need. And consider this before adding sugar to your food or drink.

"Like your table sugar, not found in whole grains or fruits and vegetables, those types of things should be limited to less than 10 percent of your calories per day," she says.

So think twice before picking up those cookies, candies and sweets. And consider the amount of added sugar in your diet.

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Watch: The Mayo Clinic Minute 

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If your goal is healthier living in this school year, here’s some good news:

“So, minimal kinds of changes can make a big difference,” says Dr. Bhide.

The first assignment: Simply subtract sugar from your student’s diet. Focus on sugary soda drinks and other highly concentrated sweet treats.

“We know that reducing sugar will certainly decrease your risk of diabetes,” adds Dr. Bhide.

It will also reduce your child’s risk of obesity and other chronic medical conditions.

“If it was a small amount, we could utilize it," explains Dr. Bhide. "But, when you have high amounts of sugar – especially fructose – that is converted to fat. So it is, I think, more important to monitor your sugar and try to prevent eating a lot of sweets.”

Dr. Bhide says to look for ways to reduce sodium, too. Add more fruits and vegetables to meals and snacks. Make sure your student is getting a good night’s sleep. And remember:

“Just making that small intervention can make a big difference.” says Dr. Bhide.

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In this Mayo Clinic Minute, dietitian Kate Zeratsky explains how, when used correctly, honey and other natural sweeteners can help your health. Jeff Olsen reports.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

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Take the sugar challenge

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Mayo Clinic nutrition expert and editor of the The Mayo Clinic Diet Dr. Donald Hensrud says the updated guidelines are useful, especially in regards to recommendations such as reducing sugar intake, but they are not perfect, as some important information is missing. "Although the guidelines are required and purported to be 'based on the preponderance of current scientific and medical knowledge,' they did not include some of the recommendations of the Scientific Advisory Committee and therefore do not describe an optimal dietary pattern.  For example, the World Health Organization recently classified processed meat as a carcinogen and red meat as a probable carcinogen, based on evidence that has been in existence for some time. Yet, the Dietary Guidelines make no mention of this and state that processed meat can be accommodated in a diet if the diet is within limits for other nutrients."

Dr. Hensrud says, "Despite some of these shortcomings, it is important to recognize that for most people, following the Dietary Guidelines will improve their nutritional status and health."

The 2015-2020 Dietary Guidelines list the following five main points:

• follow a healthy eating pattern across the lifespan
• focus on variety, nutrient density and amount
• limit calories from added sugars and saturated fats, and reduce sodium intake
• shift to healthier food and beverage choices
• support healthy eating patterns for all

What does a healthy eating pattern include?

• a variety of fruits and vegetables
• whole grains
• fat-free or low-fat dairy
• oils
• limiting saturated fats and trans fats, added sugars (less than 10 percent of calories per day), and sodium (less than 2,300 mg per day)
• alcohol in moderation: up to one drink per day for women and two for men
• be physically active

Authors of the guidelines suggest people work healthful eating patterns into their daily routines by making small changes over time. And they say their recommendations are not rigid, but can fit into any personal or cultural preferences and fit into any budget.

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