After decades of telling ­people to shun red meat and fear butter, the US ­government has unveiled new guidelines that turn that ­conventional nutrition advice on its head.

From this month, Americans are now being told to eat more full-fat dairy, including beef fat, and much more protein – with red meat explicitly listed as a ­recommended option.

This is a sharp break from ­official dietary advice around the world, including the UK, to limit saturated fat and lower intake of red and processed meat. Indeed, the new accompanying pyramid image places steak front and centre.

Something the reviewing experts for the new guidance concede could be ­misconstrued because a food pyramid ­visually represents the recommended ­proportions within a diet: the pointed end is for those to eat sparingly, the widest those you should eat the most of.

Meanwhile, carbs – which the previous guidance said should make up 45 to 65 per cent of daily calorie intake – are now at the bottom of the new nutrition pyramid, with Americans being told to ‘significantly reduce’ refined carbohydrates, such as white bread, packaged breakfast options, flour tortillas and crackers.

The guidance tells them to eat two to four portions of ‘fibre-rich wholegrains’ such as oats, brown rice and quinoa a day.

The new guidance’s catchline is ‘eat real food’ – and, for the first time, ‘highly ­processed foods’ are explicitly named as a category to avoid entirely. Any ‘packaged, prepared, ready-to-eat’ foods are out, it says, and ‘home-prepared meals’ should be prioritised.

US Health Secretary Robert F Kennedy Jr and Agriculture Secretary Brooke ­Rollins called it ‘the most significant reset of federal nutrition policy’ in decades.

The shift is seismic. But is it based on sound science? And will the UK now follow suit?

The backlash in the US has been fierce. The Centre for Science in the Public Interest, a public health watchdog, slammed the guidelines as ‘blatant misinformation’, warning that the advice on protein and fats is ‘confusing’ and ‘at worst, harmful’. The American Heart Association concurred, ­urging consumers to ‘limit high-fat animal products including red meat, butter, lard and tallow’.

And while meat and dairy trade bodies were quick to claim the changes as a victory (the International Dairy Foods Association, which represents US dairy processors and brands, for instance, said the new advice sent ‘a clear and powerful message to Americans: dairy foods belong at the centre of a healthy diet’), packaged-food manufacturers were far quieter (though investors reacted fast, with stocks for companies such as Kraft Heinz and General Mills ­initially down).

Part of the row is not just what the new pyramid focuses on but what it doesn’t say.

In recent years, a loud ‘anti-seed oil’ movement in the US has branded common vegetable oils such as sunflower, rapeseed and soybean as toxic ‘industrial’ fats and blamed them for obesity and heart disease.

It is a view championed by RFK Jr – whose department published the new guidance – and it has seeped into the culture war around food. But even as the new guidance gives the green light to animal fats such as butter and beef tallow (similar to dripping), only olive oil is listed as a ‘healthy’ fat.

‘There is no mention of seed oils, an anathema to RFK Jr – ­presumably because corn and soy producers explained their role in the economy,’ says Professor ­Marion Nestle, a food policy expert at New York University.

Should the rest of the world now follow in America’s steps on ­dietary thinking?

UK experts have mixed views on this. The new advice has ‘moved away from the science-­based guidelines to guidelines that are more populist and, in some cases, not supported by the science’, says Tom Sanders, a ­professor of nutrition and dietetics at King’s College London, who has pioneered research into how dietary fat affects our cholesterol and heart disease risk.

RFK Jr claims he is ‘ending the war on protein’, which baffles experts as they say Americans already eat enough.

‘There is concern about higher intakes of protein in a country that already has far more than adequate intakes of it, the implicit demonisation of vegetable seed oils and the promotion of animal fats, notably butter, lard and beef tallow,’ adds Professor Sanders.

However, he admits: ‘There is evidence to support the guidelines calling for people to base their diet on real foods, more fruit, ­vegetables and wholegrains, as well as for less added salt, sugar and alcohol.’

At the core of the new guidelines – and where the controversy lies – is a fundamentally different understanding of what drives heart disease.

For decades, the focus has been on lowering ‘bad’ LDL ­cholesterol, linked to eating more saturated fats in dairy and meat. But experts behind the US guidelines say new evidence shows high ­cholesterol is not just about the fat in your blood, but how your body responds to sugar and refined carbs.

‘The body’s ability to control blood sugar has been under-­appreciated as a driver of cardiovascular disease,’ says Benjamin Bikman, a professor of cell biology and physiology at Brigham Young University in the US, and one of the scientific review authors who advised on the new guidelines.

Professor Bikman says that ‘around 70 per cent of patients with high cholesterol still face substantial risk of heart attack or stroke’ even if on cholesterol-­lowering statins. ‘That’s a puzzle if we believe cholesterol is the whole story,’ he says.

His research, including a 2015 study published in the journal Cardiovascular Diabetology, found that markers of how well your body controls blood sugar often predicted heart attacks and strokes more strongly than ­cholesterol levels, particularly in people who are overweight.

He says refined carbohydrates and highly processed foods spike blood sugar and force the body to produce excessive insulin. The more insulin your body produces, the less your cells respond to it –and over time, these high insulin levels damage blood vessels, ­promote inflammation and cause fat to accumulate around the heart and in the arteries.

Research in the journal PLoS One in 2014 also found that blood levels of saturated fat are not ­simply a reflection of how much butter or cheese you eat: when people were put on diets high in carbs – mainly starchy and sugary foods – their blood markers of ­saturated fat rose.

‘By calling for reductions in refined carbohydrates and highly processed foods, the guidelines target the primary dietary ­drivers,’ says Professor Bikman.

Naveed Sattar, a professor of cardiometabolic medicine at the University of Glasgow, says it’s ‘good to see’ the advice to cut refined carbs and highly ­processed foods – but while this will help people lose weight, improve blood pressure and reduce fat in organs such as the liver, when it comes to lowering cholesterol ‘the biggest impacts came from cutting trans fat in foods and then ­saturated fats’.

And Mike Lean, a professor of human nutrition at Glasgow ­University, who pioneered the use of low-calorie diets to put type 2 diabetes into remission, concurs, saying the new guidelines risk missing the obvious: that excess weight is at the root of disease, not insulin spikes (caused by carbs and sugar).

‘The guidelines have been influenced by confusing recent publications about insulin spikes which are not the underlying cause of health problems,’ says Professor Lean – the main driver of poor health is excess body weight and long-term calorie overload.

He adds: ‘Higher levels of insulin are mostly to do with people being overweight – many massively so in the US. They are not addressing the elephant in the room.’

That elephant is size: more than 70 per cent of US adults are overweight or obese (the UK is not far off that, at around 64 per cent).But perhaps the most eye-­catching feature of the new guidelines is that they ­encourage full-fat dairy – reversing the previous US advice to go for low-fat or fat-free dairy.

The NHS Eatwell Guide says: ‘Go for lower-fat and lower-sugar products where possible, such as semi-skimmed, skimmed or 1 per cent fat milk, reduced-fat cheese or plain low-fat yoghurt.’

But experts who wrote the ­scientific evidence report that underpins the new US guidance argue that saturated fat does not act the same way in every diet.

Eat it alongside sugar, white bread and ultra-processed foods, and it does harm, they claim. Eat it as part of a diet based on meat, fish, eggs, veg, wholegrains and legumes, and the risk disappears.

The recommendation is based on several large studies, including the Prospective Urban Rural ­Epidemiology study, led by ­Cambridge University and ­published in The Lancet in 2018, which tracked more than 136,000 people in 21 countries.

It found that higher dairy intake – more than two servings per day – was associated with a 16 per cent lower risk of cardiovascular death and a 22 per cent lower risk of major cardiovascular disease.

Crucially, the study found ­similar results even when the researchers looked at people eating whole-fat dairy, not just low-fat. (The liver makes saturated fat when we eat lots of sugar and refined starch, which may explain why saturated fat looks more harmful in high-carb, processed diets than in diets built around whole foods.)

‘There is a widespread misconception that eating dairy products is harmful for cardiovascular health, and this study lays that to rest,’ the researchers said.

Then, in 2020, a major review in the Journal of the American College of Cardiology found that ­saturated fat alone does not determine a food’s health effects.

Full-fat cheese and yoghurt, for instance, also contain protein, calcium, magnesium and vitamin K (unlike butter, ghee and beef tallow, which are basically ­concentrated fat).

The research suggests the ­nutrients in a food work together to influence how your body ­processes the fat – for instance, calcium can bind to fatty acids in the gut, reducing the amount absorbed into the bloodstream, while the protein slows digestion, preventing blood sugar spikes.

But the new guidelines add ­confusion by recommending keeping saturated fat below 10 per cent of daily calories – the same limit as before.

‘It will be almost impossible to meet the recommendation of below 10 per cent if Americans replace vegetable oils with animal fats and eat more red meat,’ says Professor Sanders.

Professor Lean adds: ‘And ­advising people to use beef tallow for cooking is bonkers and flies in the face of all evidence.

‘Beef tallow is a highly calorific food and packed with long-chain saturated fats [one of the key building blocks of artery plaques over time] that raise the risk of heart disease and diabetes.’

Professor Sanders agrees that dairy fat is different from beef fat because it contains about 20 per cent medium-chain and short-chain saturated fatty acids that do not raise blood cholesterol levels.

‘However, butter and meat ­consumption raises blood ­cholesterol levels more than cheese and milk – and is also associated with an increased risk of heart disease,’ he says. ‘High intakes of red meat are also associated with increased risk of cancers of the colon, breast and prostate.’

He also points out that cardiovascular deaths have fallen five-fold since the 1980s, a period when fat intake dropped from 42 per cent of calories to 35 per cent.

‘Some of this reduction can be attributed to lower fat intake,’ says Professor Sanders.

It’s not only the new US rules on fat that are controversial.

The latest guidelines also set a protein target of 1.2g to 1.6g per kilogram of body weight per day – substantially higher than the previous 0.8g per kilogram.

For an 80kg man, 0.8g per kilogram is about 64g of protein a day – around two chicken breasts. The new target is almost double that: 96g to 128g. (The UK target is about 0.75g of protein per kilogram body weight for adults; roughly 55g a day for men.)

Professor Stuart Phillips, an expert in dietary protein and muscle health at McMaster University in Canada, says there’s good evidence that higher protein intakes benefit older adults (60 and over), people trying to lose weight and those who exercise regularly. But for the general population, ‘the evidence for clear additional ­benefit is much weaker’.

Professor Sanders concurs, ­saying: ‘There is little evidence to ­support the higher protein recommendation.’

Even the experts who advised on the new guidelines are concerned that the focus on protein might encourage people to eat more meat at the expense of other foods, including fibre-rich wholegrains, vegetables, and beans – especially as the pyramid visual places red meat at the top. While the written guidance still pushes alternative protein sources, including eggs and ­lentils, Professor Bikman is ­concerned that ‘the imagery of the inverted food pyramid ­featuring steak and butter will confuse people. There’s a risk that the message “eat more protein” could become a licence for excess in some minds.’

Dr Ty Beal, a senior scientist at the Global Alliance for Improved Nutrition (an international non-profit foundation) and also involved in advising on the new US guidelines, says the push for more protein makes sense – but only if it’s from the right foods.

‘Protein is the most satiating macronutrient,’ he says.

‘As long as protein comes from whole foods, it could help curb excess calorie intake and reduce chronic disease.’ But he, too, fears that some people will take ‘eat more protein’ to mean ‘eat more meat’ – and little else.

Dr Beal’s other fear is ‘the food industry developing and marketing highly-processed high-protein foods’. ‘The guidelines clearly state that protein should come from whole foods, but industry can be very clever,’ he says.

This is where all the experts ­generally align: the urgent need to avoid ultra-processed foods, as expressly spelt out for the first time in the new US guidelines.

Around 70 per cent of the ­average American diet is now ultra-processed – foods made from industrial ingredients, bulked out with additives and engineered to be over-eaten (that figure in the UK is around 57 per cent).

And large national diet studies consistently show that the more ultra-processed food people eat, the lower the overall nutrient density of their diet tends to be, because ultra-processed calories displace fruit, veg, legumes and wholegrains, which provide key vitamins and minerals.

But good intentions alone aren’t enough, warns Professor Lean. ‘Dietary guidelines are no use without matched policies for food production and supply,’ he says. In other words, if whole foods are expensive and fast food is ­everywhere, people can’t follow the advice.

Will these new guidelines have any impact in the UK?

A spokesperson for the Department of Health and Social Care said there are no plans to update guidance on saturated fats or protein, adding: ‘We are also ­taking decisive action to tackle the obesity crisis, including ­banning the sale of energy drinks for under-16s, cracking down on junk food advertising, extending the soft drinks industry levy to sugary milk-based drinks and making it mandatory for shops to meet targets and report on the sale of healthy foods.’

Dr David Unwin, GP specialising in weight loss, says... 

Controversial, but it's transformed our patients' lives

Something huge has happened in the US that has thrown the science and practice of nutrition into chaos. And I welcome it.

The origins were not auspicious. This dietary revolution has come via the Secretary of the US Department of Health, Robert F Kennedy Jr, who has also questioned the scientific consensus that vaccines do not cause autism. So it was with some scepticism I heard of his goal to Make America Healthy Again.

There’s no doubt this is urgently needed: more than 70 per cent of adults in the US are overweight or obese and rates of type 2 diabetes and some cancers are rising. (The picture is similarly grim in the UK.)

The US publishes new dietary guidelines every five years, but I wasn’t anticipating the latest would change this situation, as it would require changing what we eat, especially sugar and refined, starchy carbs.

Yet the old dietary pyramid has now been turned on its head. Previously US guidelines (like the UK’s) advised filling up on starchy staples such as potato, rice, bread and cereal, but now grains and bread are at the bottom.

The new guidelines also state: ‘No amount of added sugars or non-nutritive sweeteners is ... considered part of a healthy or nutritious diet’. Wow!

And when announcing all this, RFK Jr said: ‘For decades, federal incentives have promoted low-quality, highly processed foods and pharmaceutical intervention instead of prevention. This changes today.’

I never thought I would live to see the day when the US government seemed to be waging war against its own ultra-processed food industry. But that’s how serious things have become.

These new guidelines align with what we’ve been doing in my practice for type 2 diabetes – advising a low-carb approach (avoiding foods that raise blood sugar levels while prioritising protein and green veg; i.e. whole foods over highly processed). So far 155 of our patients have used this diet to put their type 2 into remission.

It’s an approach yet to be embraced in the UK guidelines on diabetes or by many healthcare professionals. My hope is that this now finally changes.