Dr. Perlmutter’s Views on the 2025–2030 Dietary Guidelines for Americans

For decades, federal dietary guidance has struggled to keep pace with what clinicians and researchers have observed on the front lines of chronic disease. The newly released Dietary Guidelines for Americans, 2025–2030 represent a meaningful and, frankly, refreshing shift in the right direction. Their central message, “eat real food” is not revolutionary, but it is profoundly important given the metabolic and neurological crisis we now face as a nation.

At the heart of these guidelines is a clear acknowledgment that highly processed foods and refined carbohydrates are major drivers of poor health outcomes. This is not subtle. The document repeatedly calls for a dramatic reduction in ultra-processed foods laden with added sugars, refined starches, unhealthy fats, excess sodium, and chemical additives. That clarity matters. Nearly 90% of U.S. healthcare spending now goes toward managing chronic disease, much of which is diet-driven. These guidelines finally begin to address the root cause rather than merely the downstream consequences.

Protein Returns to Center Stage

One of the most notable changes is the reimagined, upside-down food pyramid that places protein at the top. The guidelines recommend prioritizing high-quality, nutrient-dense protein at every meal, with intake targets of roughly 1.2–1.6 grams per kilogram of body weight per day. This aligns well with emerging data on protein’s role in metabolic health, muscle preservation, immune resilience, and healthy aging.

Importantly, the guidance does not vilify animal-based proteins. Eggs, poultry, seafood, red meat, and full-fat dairy are all explicitly included, alongside plant-based options such as legumes, nuts, seeds, and soy. What deserves even greater emphasis, however, is quality. Not all protein is created equal. My consistent recommendation is to choose meats that are grass-fed or pasture-raised whenever possible. These choices deliver superior fatty-acid profiles, fewer environmental contaminants, and better micronutrient density, factors that matter profoundly for brain and metabolic health.

Dairy, Fat, and the End of Fat Phobia

The guidelines’ endorsement of full-fat dairy without added sugars represents another important departure from outdated dogma. Full-fat dairy provides fat-soluble vitamins, high-quality protein, and bioactive lipids that support satiety, glycemic control, and brain health. Combined with the broader inclusion of healthy fats, olive oil, avocados, nuts, seeds, eggs, omega-3-rich seafood, this guidance reflects a growing recognition that fat itself is not the enemy. The real problem has been industrially processed foods masquerading as “low-fat” or “heart-healthy.”

While the document maintains a general recommendation that saturated fat remain below 10% of total calories, it appropriately notes that significantly limiting ultra-processed foods will naturally help achieve this goal. That nuance is critical. It shifts the focus from macronutrient blame to food quality and dietary context.

Fruits, Vegetables, and the Microbiome Connection

The recommendation to consume a wide variety of colorful vegetables and fruits, three servings of vegetables and two of fruit daily, will surprise no one. What is encouraging is the explicit link made between whole foods, fiber, fermented foods, and gut microbiome health. The guidelines acknowledge that highly processed foods disrupt microbial balance, while vegetables, fruits, and fermented foods like kefir, kimchi, and sauerkraut support microbial diversity as I described in Brain Maker.

This matters deeply for brain health. The gut–brain axis is no longer theoretical, and dietary patterns that nurture microbial diversity are increasingly associated with reduced inflammation and improved cognitive resilience.

Whole Grains, Refined Carbohydrates, and Metabolic Reality

The guidance on whole grains is appropriately restrained. While fiber-rich whole grains are included, there is a strong and repeated recommendation to significantly reduce refined carbohydrates such as white bread, packaged breakfast foods, crackers, and flour tortillas. For individuals with insulin resistance, prediabetes, or other chronic conditions, the guidelines even acknowledge that lower-carbohydrate approaches may be beneficial under medical supervision. This level of flexibility is long overdue.

A Pragmatic View of Supplements

Finally, the document takes a realistic stance on dietary supplements. Rather than dismissing them outright, supplements are recognized as appropriate tools for specific populations, infants requiring vitamin D, adolescents with limited access to nutrient-dense foods, older adults with impaired absorption, and individuals following vegetarian or vegan diets. This is sensible, evidence-based guidance that respects biological variability rather than forcing a one-size-fits-all approach. My view is that appropriate personalized lab testing can go a long way towards defining the supplement needs of any individual.

The Bottom Line

These guidelines are not perfect, but they represent a substantial improvement over prior iterations. By prioritizing real food, emphasizing protein and fat quality, and directly calling out ultra-processed foods as a central problem, they align far more closely with what we know about metabolic and brain health today. If widely adopted, and properly implemented, they will meaningfully shift the health trajectory of millions of Americans.

Quality matters. How food is grown, raised, and prepared matters. And reducing ultra-processed foods is not a fringe idea, it is foundational. On that point, these guidelines get it right.