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Dietary Guidelines for Americans

Introduction

What should Americans eat to stay healthy?

These guidelines are designed to help answer this question. They provide advice for healthy Americans age 2 years and over about food choices that promote health and prevent disease. To meet the Dietary Guidelines for Americans, choose a diet with most of the calories from grain products, vegetables, fruits, low-fat milk products, lean meats, fish, poultry, and dry beans. Choose fewer calories from fats and sweets.

Eating is one of life's greatest pleasures

Food choices depend on history, culture, and environment, as well as on energy and nutrient needs. People also eat foods for enjoyment. Family, friends, and beliefs play a major role in the ways people select foods and plan meals. This chapter describes some of the many different and pleasurable ways to combine foods to make healthful diets.

Diet is important to health at all stages of life

Many genetic, environmental, behavioral, and cultural factors can affect health. Understanding family history of disease or risk factors _ body weight and fat distribution, blood pressure, and blood cholesterol, for example _can help people make more informed decisions about actions that can improve health prospects. Food choices are among the most pleasurable and effective of these actions.

Healthful diets help children grow, develop, and do well in school. They enable people of all ages to work productively and feel their best. Food choices also can help to reduce the risk for chronic diseases, such as heart disease, certain cancers, diabetes, stroke, and osteoporosis, that are leading causes of death and disability among Americans. Good diets can reduce major risk factors for chronic diseases factors such as obesity, high blood pressure, and high blood cholesterol.

Foods contain energy, nutrients, and other components that affect health

People require energy and certain other essential nutrients. These nutrients are essential because the body cannot make them and must obtain them from food. Essential nutrients include vitamins, minerals, certain amino acids, and certain fatty acids. Foods also contain other components such as fiber that are important for health. Although each of these food components has a specific function in the body, all of them together are required for overall health. People need calcium to build and maintain strong bones, for example, but many other nutrients also are involved.

The carbohydrates, fats, and proteins in food supply energy, which is measured in calories. Carbohydrates and proteins provide about 4 calories per gram. Fat contributes more than twice as much about 9 calories per gram. Alcohol, although not a nutrient, also supplies energy about 7 calories per gram. Foods that are high in fat are also high in calories. However, many low-fat or nonfat foods can also be high in calories.

Physical activity fosters a healthful diet

Calorie needs vary by age and level of activity. Many older adults need less food, in part due to decreased activity, relative to younger, more active individuals. People who are trying to lose weight and eating little food may need to select more nutrient-dense foods in order to meet their nutrient needs in a satisfying diet. Nearly all Americans need to be more active, because a sedentary lifestyle is unhealthful. Increasing the calories spent in daily activities helps to maintain health and allows people to eat a nutritious and enjoyable diet.

What is a healthful diet?

Healthful diets contain the amounts of essential nutrients and calories needed to prevent nutritional deficiencies and excesses. Healthful diets also provide the right balance of carbohydrate, fat, and protein to reduce risks for chronic diseases, and are a part of a full and productive lifestyle. Such diets are obtained from a variety of foods that are available, affordable, and enjoyable.

The Recommended Dietary Allowances refer to nutrients

Recommended Dietary Allowances (RDAs) represent the amounts of nutrients that are adequate to meet the needs of most healthy people. Although people with average nutrient requirements likely eat adequately at levels below the RDAs, diets that meet RDAs are almost certain to ensure intake of enough essential nutrients by most healthy people. The Dietary Guidelines describe food choices that will help you meet these recommendations. Like the RDAs, the Dietary Guidelines apply to diets consumed over several days and not to single meals or foods.

The Dietary Guidelines describe food choices that promote good health

The Dietary Guidelines are designed to help Americans choose diets that will meet nutrient requirements, promote health, support active lives, and reduce chronic disease risks. Research has shown that certain diets raise risks for chronic diseases. Such diets are high in fat, saturated fat, cholesterol, and salt and they contain more calories than the body uses. They are also low in grain products, vegetables, fruit, and fiber. This bulletin helps you choose foods, meals, and diets that can reduce chronic disease risks.

Food labels and the Food Guide Pyramid are tools to help you make food choices

The Food Guide Pyramid and the Nutrition Facts Label serve as educational tools to put the Dietary Guidelines into practice. The Pyramid translates the RDAs and the Dietary Guidelines into the kinds and amounts of food to eat each day. The Nutrition Facts Label is designed to help you select foods for a diet that will meet the Dietary Guidelines. Most processed foods now include nutrition information. However, nutrition labels are not required for foods like coffee and tea (which contain no significant amounts of nutrients), certain ready-to-eat foods like unpackaged deli and bakery items, and restaurant food. Labels are also voluntary for many raw foods your grocer may supply this information for the fish, meat, poultry, and raw fruits and vegetables that are consumed most frequently. Use the Nutrition Facts Label to choose a healthful diet.

Eat a Variety of Foods

To obtain the nutrients and other substances needed for good health, vary the foods you eat

Foods contain combinations of nutrients and other healthful substances. No single food can supply all nutrients in the amounts you need. For example, oranges provide vitamin C but no vitamin B12; cheese provides vitamin B12 but no vitamin C. To make sure you get all of the nutrients and other substances needed for health, choose the recommended number of daily servings from each of the five major food groups displayed in the Food Guide Pyramid (Figure 1).

Use foods from the base of the Food Guide Pyramid as the foundation of your meals

Americans do choose a wide variety of foods. However, people often choose higher or lower amounts from some food groups than suggested in the Food Guide Pyramid. The Pyramid shows that foods from the grain products group, along with vegetables and fruits, are the basis of healthful diets. Enjoy meals that have rice, pasta, potatoes, or bread at the center of the plate, accompanied by other vegetables and fruit, and lean and low-fat foods from the other groups. Limit fats and sugars added in food preparation and at the table. Compare the recommended number of servings in Box 1 with what you usually eat.

What counts as a "serving"?

See Box 2 for suggested serving sizes in the Food Guide Pyramid food groups. Notice that some of the serving sizes are smaller than what you might usually eat. For example, many people eat a cup or more of pasta in a meal, which equals two or more servings. So, it is easy to eat the number of servings recommended.

Choose different foods within each food group

You can achieve a healthful, nutritious eating pattern with many combinations of foods from the five major food groups. Choosing a variety of foods within and across food groups improves dietary patterns because foods within the same group have different combinations of nutrients and other beneficial substances. For example, some vegetables and fruits are good sources of vitamin C or vitamin A, while others are high in folate; still others are good sources of calcium or iron. Choosing a variety of foods within each group also helps to make your meals more interesting from day to day.

What about vegetarian diets?

Some Americans eat vegetarian diets for reasons of culture, belief, or health. Most vegetarians eat milk products and eggs, and as a group, these lacto-ovo-vegetarians enjoy excellent health. Vegetarian diets are consistent with the Dietary Guidelines for Americans and can meet Recommended Dietary Allowances for nutrients. You can get enough protein from a vegetarian diet as long as the variety and amounts of foods consumed are adequate. Meat, fish, and poultry are major contributors of iron, zinc, and B vitamins in most American diets, and vegetarians should pay special attention to these nutrients.

Vegans eat only food of plant origin. Because animal products are the only food sources of vitamin B₁₂, vegans must supplement their diets with a source of this vitamin. In addition, vegan diets, particularly those of children, require care to ensure adequacy of vitamin D and calcium, which most Americans obtain from milk products.

Foods vary in their amounts of calories and nutrients

Some foods such as grain products, vegetables, and fruits have many nutrients and other healthful substances but are relatively low in calories. Fat and alcohol are high in calories. Foods high in both sugars and fat contain many calories but often are low in vitamins, minerals, or fiber.

People who do not need many calories or who must restrict their food intake need to choose nutrient-rich foods from the five major food groups with special care. They should obtain most of their calories from foods that contain a high proportion of essential nutrients and fiber.

Growing children, teenage girls, and women have higher needs for some nutrients

Many women and adolescent girls need to eat more calcium-rich foods to get the calcium needed for healthy bones throughout life. By selecting low-fat or fat-free milk products and other low-fat calcium sources, they can obtain adequate calcium and keep fat intake from being too high (Box 3). Young children, teenage girls, and women of childbearing age should also eat enough iron-rich foods, such as lean meats and whole-grain or enriched white bread, to keep the body's iron stores at adequate levels (Box 4).

Enriched and fortified foods have essential nutrients added to them

National policy requires that specified amounts of nutrients be added to enrich some foods. For example, enriched flour and bread contain added thiamin, riboflavin, niacin, and iron; skim milk, low-fat milk, and margarine are usually enriched with vitamin A; and milk is usually enriched with vitamin D. Fortified foods may have one or several nutrients added in extra amounts. The number and quantity of nutrients added vary among products. Fortified foods may be useful for meeting special dietary needs. Read the ingredient list to know which nutrients are added to foods (Figure 2). How these foods fit into your total diet will depend on the amounts you eat and the other foods you consume.

Where do vitamin, mineral, and fiber supplements fit in?

Supplements of vitamins, minerals, or fiber also may help to meet special nutritional needs. However, supplements do not supply all of the nutrients and other substances present in foods that are important to health. Supplements of some nutrients taken regularly in large amounts are harmful. Daily vitamin and mineral supplements at or below the Recommended Dietary Allowances are considered safe, but are usually not needed by people who eat the variety of foods depicted in the Food Guide Pyramid.

Sometimes supplements are needed to meet specific nutrient requirements. For example, older people and others with little exposure to sunlight may need a vitamin D supplement. Women of childbearing age may reduce the risk of certain birth defects by consuming folate-rich foods or folic acid supplements. Iron supplements are recommended for pregnant women. However, because foods contain many nutrients and other substances that promote health, the use of supplements cannot substitute for proper food choices.

Advice for today

Enjoy eating a variety of foods. Get the many nutrients your body needs by choosing among the varied foods you enjoy from these groups: grain products, vegetables, fruits, milk and milk products, protein-rich plant foods (beans, nuts), and protein-rich animal foods (lean meat, poultry, fish, and eggs). Remember to choose lean and low-fat foods and beverages most often. Many foods you eat contain servings from more than one food group. For example, soups and stews may contain meat, beans, noodles, and vegetables.

Balance the Food You Eat With Physical Activity Maintain or Improve Your Weight

Many Americans gain weight in adulthood, increasing their risk for high blood pressure, heart disease, stroke, diabetes, certain types of cancer, arthritis, breathing problems, and other illness. Therefore, most adults should not gain weight. If you are overweight and have one of these problems, you should try to lose weight, or at the very least, not gain weight. If you are uncertain about your risk of developing a problem associated with overweight, you should consult a health professional.

How to maintain your weight

In order to stay at the same body weight, people must balance the amount of calories in the foods and drinks they consume with the amount of calories the body uses. Physical activity is an important way to use food energy. Most Americans spend much of their working day in activities that require little energy. In addition, many Americans of all ages now spend a lot of leisure time each day being inactive, for example, watching television or working at a computer. To burn calories, devote less time to sedentary activities like sitting. Spend more time in activities like walking to the store or around the block. Use stairs rather than elevators. Less sedentary activity and more vigorous activity may help you reduce body fat and disease risk. Try to do 30 minutes or more of moderate physical activity on most — preferably all — days of the week (Box 5).

The kinds and amounts of food people eat affect their ability to maintain weight. High-fat foods contain more calories per serving than other foods and may increase the likelihood of weight gain. However, even when people eat less high-fat food, they still can gain weight from eating too much of foods high in starch, sugars, or protein. Eat a variety of foods, emphasizing pasta, rice, bread, and other whole-grain foods as well as fruits and vegetables. These foods are filling, but lower in calories than foods rich in fats or oils.

The pattern of eating may also be important. Snacks provide a large percentage of daily calories for many Americans. Unless nutritious snacks are part of the daily meal plan, snacking may lead to weight gain. A pattern of frequent binge-eating, with or without alternating periods of food restriction, may also contribute to weight problems.

Maintaining weight is equally important for older people who begin to lose weight as they age. Some of the weight that is lost is muscle. Maintaining muscle through regular activity helps to keep older people feeling well and helps to reduce the risk of falls and fractures.

How to evaluate your body weight /H6>

Healthy weight ranges for adult men and women of all ages are shown in Figure 3. See where your weight falls on the chart for people of your height. The health risks due to excess weight appear to be the same for older as for younger adults. Weight ranges are shown in the chart because people of the same height may have equal amounts of body fat but different amounts of muscle and bone. However, the ranges do not mean that it is healthy to gain weight, even within the same weight range. The higher weights in the healthy weight range apply to people with more muscle and bone.

Weights above the healthy weight range are less healthy for most people. The further you are above the healthy weight range for your height, the higher your weight-related risk (Figure 3). Weights slightly below the range may be healthy for some people but are sometimes the result of health problems, especially when weight loss is unintentional.

Location of body fat

Research suggests that the location of body fat also is an important factor in health risks for adults. Excess fat in the abdomen (stomach area) is a greater health risk than excess fat in the hips and thighs. Extra fat in the abdomen is linked to high blood pressure, diabetes, early heart disease, and certain types of cancer. Smoking and too much alcohol increase abdominal fat and the risk for diseases related to obesity. Vigorous exercise helps to reduce abdominal fat and decrease the risk for these diseases. The easiest way to check your body fat distribution is to measure around your waistline with a tape measure and compare this with the measure around your hips or buttocks to see if your abdomen is larger. If you are in doubt, you may wish to seek advice from a health professional

Problems with excessive thinness

Being too thin can occur with anorexia nervosa, other eating disorders, or loss of appetite, and is linked to menstrual irregularity and osteoporosis in women, and greater risk of early death in both women and men. Many people — especially women — are concerned about body weight, even when their weight is normal. Excessive concern about weight may cause or lead to such unhealthy behaviors as excessive exercise, self-induced vomiting, and the abuse of laxatives or other medications. These practices may only worsen the concern about weight. If you lose weight suddenly or for unknown reasons, see a physician. Unexplained weight loss may be an early clue to a health problem.

If you need to lose weight

You do not need to lose weight if your weight is already within the healthy range in the Figure, if you have gained less than 10 pounds since you reached your adult height, and if you are otherwise healthy. If you are overweight and have excess abdominal fat, a weight-related medical problem, or a family history of such problems, you need to lose weight. Healthy diets and exercise can help people maintain a healthy weight, and may also help them lose weight. It is important to recognize that overweight is a chronic condition which can only be controlled with long-term changes. To reduce caloric intake, eat less fat and control portion sizes (Box 6). If you are not physically active, spend less time in sedentary activities such as watching television, and be more active throughout the day. As people lose weight, the body becomes more efficient at using energy and the rate of weight loss may decrease. Increased physical activity will help you to continue losing weight and to avoid gaining it back (Box 5).

Many people are not sure how much weight they should lose. Weight loss of only 5-10 percent of body weight may improve many of the problems associated with overweight, such as high blood pressure and diabetes. Even a smaller weight loss can make a difference. If you are trying to lose weight, do so slowly and steadily. A generally safe rate is ½-1 pound a week until you reach your goal. Avoid crash weight-loss diets that severely restrict calories or the variety of foods. Extreme approaches to weight loss, such as self-induced vomiting or the use of laxatives, amphetamines, or diuretics, are not appropriate and can be dangerous to your health.

Weight regulation in children

Children need enough food for proper growth. To promote growth and development and prevent overweight, teach children to eat grain products; vegetables and fruits; low-fat milk products or other calcium-rich foods; beans, lean meat, poultry, fish or other protein-rich foods; and to participate in vigorous activity. Limiting television time and encouraging children to play actively in a safe environment are helpful steps. Although limiting fat intake may help to prevent excess weight gain in children, fat should not be restricted for children younger than 2 years of age. Helping overweight children to achieve a healthy weight along with normal growth requires more caution. Modest reductions in dietary fat, such as the use of low-fat milk rather than whole milk, are not hazardous. However, major efforts to change a child's diet should be accompanied by monitoring of growth by a health professional at regular intervals.

Advice for today

Try to maintain your body weight by balancing what you eat with physical activity. If you are sedentary, try to become more active. If you are already very active, try to continue the same level of activity as you age. More physical activity is better than less, and any is better than none. If your weight is not in the healthy range, try to reduce health risks through better eating and exercise habits. Take steps to keep your weight within the healthy range (neither too high nor too low). Have children's heights and weights checked regularly by a health professional.

Acknowledgements and Additional Information on Nutrition

Acknowledgments

The U.S. Department of Health and Human Services and the U.S. Department of Agriculture acknowledge the recommendations of the Dietary Guidelines Advisory Committee — the basis for this edition. The Committee consisted of Doris Howes Calloway, Ph.D.(chair), Richard J. Havel, M.D. (vice-chair), Dennis M. Bier, M.D., William H. Dietz, M.D., Ph.D., Cutberto Garza, M.D., Ph.D., Shiriki K. Kumanyika, Ph.D., R.D., Marion Nestle, Ph.D., M.P.H., Irwin H. Rosenberg, M.D., Sachiko T. St. Jeor, Ph.D., R.D., Barbara O. Schneeman, Ph.D., and John W. Suttie, Ph.D. The Departments also acknowledge the staff work of the executive secretaries to the committee: Karil Bialostosky, M.S., and Linda Meyers, Ph.D., from HHS; Eileen Kennedy, D.Sc., R.D., and Debra Reed, M.S., from USDA.

For additional information on nutrition:

Choose a Diet With Plenty of Grain Products, Vegetables, and Fruits

Grain products, vegetables, and fruits are key parts of a varied diet. They are emphasized in this guideline because they provide vitamins, minerals, complex carbohydrates (starch and dietary fiber), and other substances that are important for good health. They are also generally low in fat, depending on how they are prepared and what is added to them at the table. Most Americans of all ages eat fewer than the recommended number of servings of grain products, vegetables, and fruits, even though consumption of these foods is associated with a substantially lower risk for many chronic diseases, including certain types of cancer.

Most of the calories in your diet should come from grain products, vegetables, and fruits

These include grain products high in complex carbohydrates breads, cereals, pasta, rice found at the base of the Food Guide Pyramid, as well as vegetables such as potatoes and corn. Dry beans (like pinto, navy, kidney, and black beans) are included in the meat and beans group of the Pyramid, but they can count as servings of vegetables instead of meat alternatives.

Plant foods provide fiber

Fiber is found only in plant foods like whole-grain breads and cereals, beans and peas, and other vegetables and fruits. Because there are different types of fiber in foods, choose a variety of foods daily. Eating a variety of fiber-containing plant foods is important for proper bowel function, can reduce symptoms of chronic constipation, diverticular disease, and hemorrhoids, and may lower the risk for heart disease and some cancers. However, some of the health benefits associated with a high-fiber diet may come from other components present in these foods, not just from fiber itself. For this reason, fiber is best obtained from foods rather than supplements.

Plant foods provide a variety of vitamins and minerals essential for health

Most fruits and vegetables are naturally low in fat and provide many essential nutrients and other food components important for health. These foods are excellent sources of vitamin C, vitamin B6, carotenoids, including those which form vitamin A (Box 7), and folate (Box 8).

The antioxidant nutrients found in plant foods (e.g., vitamin C, carotenoids, vitamin E, and certain minerals) are presently of great interest to scientists and the public because of their potentially beneficial role in reducing the risk for cancer and certain other chronic diseases. Scientists are also trying to determine if other substances in plant foods protect against cancer. fruits such as carrots, corn, peas, pears, and berries (Box 9).

Folate, also called folic acid, is a B vitamin that, among its many functions, reduces the risk of a serious type of birth defect (Box 8). Minerals such as potassium, found in a wide variety of vegetables and fruits, and calcium, found in certain vegetables, may help reduce the risk for high blood pressure (See Boxes 3 and 14).

The availability of fresh fruits and vegetables varies by season and region of the country, but frozen and canned fruits and vegetables ensure a plentiful supply of these healthful foods throughout the year. Read the Nutrition Facts Label to help choose foods that are rich in carbohydrates, fiber, and nutrients, and low in fat and sodium.

Advice for today

Eat more grain products (breads, cereals, pasta, and rice), vegetables, and fruits. Eat dry beans, lentils, and peas more often. Increase your fiber intake by eating more of a variety of whole grains, whole-grain products, dry beans, fiber-rich vegetables and fruits such as carrots, corn, peas, pears, and berries (Box 9).

Choose a Diet Low in Fat, Saturated Fat, and Cholesterol

Some dietary fat is needed for good health. Fats supply energy and essential fatty acids and promote absorption of the fat-soluble vitamins A, D, E, and K. Most people are aware that high levels of saturated fat and cholesterol in the diet are linked to increased blood cholesterol levels and a greater risk for heart disease. More Americans are now eating less fat, saturated fat, and cholesterol-rich foods than in the recent past, and fewer people are dying from the most common form of heart disease. Still, many people continue to eat high-fat diets, the number of overweight people has increased, and the risk of heart disease and certain cancers (also linked to fat intake) remains high. This guideline emphasizes the continued importance of choosing a diet with less total fat, saturated fat, and cholesterol.

Foods high in fat should be used sparingly

Some foods and food groups in the Food Guide Pyramid are higher in fat than others. Fats and oils, and some types of desserts and snack foods that contain fat provide calories but few nutrients. Many foods in the milk group and in the meat and beans group (which includes eggs and nuts, as well as meat, poultry, and fish) are also high in fat, as are some processed foods in the grain group. Choosing lower fat options among these foods allows you to eat the recommended servings from these groups and increase the amount and variety of grain products, fruits, and vegetables in your diet without going over your calorie needs.

Choose a diet low in fat

Fat, whether from plant or animal sources, contains more than twice the number of calories of an equal amount of carbohydrate or protein. Choose a diet that provides no more than 30 percent of total calories from fat. The upper limit on the grams of fat in your diet will depend on the calories you need (Box 10). Cutting back on fat can help you consume fewer calories. For example, at 2,000 calories per day, the suggested upper limit of calories from fat is about 600 calories. Sixty-five grams of fat contribute about 600 calories (65 grams of fat x 9 calories per gram = about 600 calories). On the Nutrition Facts Label, 65 grams of fat is the Daily Value for a 2,000-calorie intake (Figure 4).

Choose a diet low in saturated fat

Fats contain both saturated and unsaturated (monounsaturated and polyunsaturated) fatty acids. Saturated fat raises blood cholesterol more than other forms of fat. Reducing saturated fat to less than 10 percent of calories will help you lower your blood cholesterol level. The fats from meat, milk, and milk products are the main sources of saturated fats in most diets. Many bakery products are also sources of saturated fats. Vegetable oils supply smaller amounts of saturated fat. On the Nutrition Facts Label, 20 grams of saturated fat (9 percent of caloric intake) is the Daily Value for a 2,000-calorie diet (Figure 4).

Monounsaturated and polyunsaturated fat. Olive and canola oils are particularly high in monounsaturated fats; most other vegetable oils, nuts, and high-fat fish are good sources of polyunsaturated fats. Both kinds of unsaturated fats reduce blood cholesterol when they replace saturated fats in the diet. The fats in most fish are low in saturated fatty acids and contain a certain type of polyunsaturated fatty acid (omega-3) that is under study because of a possible association with a decreased risk for heart disease in certain people. Remember that the total fat in the diet should be consumed at a moderate level — that is, no more than 30 percent of calories. Mono- and polyunsaturated fat sources should replace saturated fats within this limit.

Partially hydrogenated vegetable oils, such as those used in many margarines and shortenings, contain a particular form of unsaturated fat known as trans-fatty acids that may raise blood cholesterol levels, although not as much as saturated fat.

Choose a diet low in cholesterol

The body makes the cholesterol it requires. In addition, cholesterol is obtained from food. Dietary cholesterol comes from animal sources such as egg yolks, meat (especially organ meats such as liver), poultry, fish, and higher fat milk products. Many of these foods are also high in saturated fats. Choosing foods with less cholesterol and saturated fat will help lower your blood cholesterol levels (Box 11). The Nutrition Facts Label lists the Daily Value for cholesterol as 300 mg. You can keep your cholesterol intake at this level or lower by eating more grain products, vegetables and fruits, and by limiting intake of high cholesterol foods.

Advice for children

Advice in the previous sections does not apply to infants and toddlers below the age of 2 years. After that age, children should gradually adopt a diet that, by about 5 years of age, contains no more than 30 percent of calories from fat. As they begin to consume fewer calories from fat, children should replace these calories by eating more grain products, fruits, vegetables, and low-fat milk products or other calcium-rich foods, and beans, lean meat, poultry, fish, or other protein-rich foods.

Advice for today

Sugars come in many forms

Sugars are carbohydrates. Dietary carbohydrates also include the complex carbohydrates starch and fiber. During digestion all carbohydrates except fiber break down into sugars. Sugars and starches occur naturally in many foods that also supply other nutrients. Examples of these foods include milk, fruits, some vegetables, breads, cereals, and grains. Americans eat sugars in many forms, and most people like their taste. Some sugars are used as natural preservatives, thickeners, and baking aids in foods; they are often added to foods during processing and preparation or when they are eaten. The body cannot tell the difference between naturally occurring and added sugars because they are identical chemically.

Sugars, health, and weight maintenance

Scientific evidence indicates that diets high in sugars do not cause hyperactivity or diabetes. The most common type of diabetes occurs in overweight adults. Avoiding sugars alone will not correct overweight. To lose weight reduce the total amount of calories from the food you eat and increase your level of physical activity.

If you wish to maintain your weight when you eat less fat, replace the lost calories from fat with equal calories from fruits, vegetables, and grain products, found in the lower half of the Food Guide Pyramid. Some foods that contain a lot of sugars supply calories but few or no nutrients (Box 12). These foods are located at the top of the Pyramid. For very active people with high calorie needs, sugars can be an additional source of energy. However, because maintaining a nutritious diet and a healthy weight is very important, sugars should be used in moderation by most healthy people and sparingly by people with low calorie needs. This guideline cautions about eating sugars in large amounts and about frequent snacks of foods and beverages containing sugars that supply unnecessary calories and few nutrients.

Sugar substitutes

Sugar substitutes such as sorbitol, saccharin, and aspartame are ingredients in many foods. Most sugar substitutes do not provide significant calories and therefore may be useful in the diets of people concerned about calorie intake. Foods containing sugar substitutes, however, may not always be lower in calories than similar products that contain sugars. Unless you reduce the total calories you eat, the use of sugar substitutes will not cause you to lose weight.

Sugars and dental caries

Both sugars and starches can promote tooth decay. The more often you eat foods that contain sugars and starches, and the longer these foods are in your mouth before you brush your teeth, the greater the risk for tooth decay. Thus, frequent eating of foods high in sugars and starches as between-meal snacks may be more harmful to your teeth than eating them at meals and then brushing. Regular daily dental hygiene, including brushing with a fluoride toothpaste and flossing, and an adequate intake of fluoride, preferably from fluoridated water, will help you prevent tooth decay (Box 13).

Advice for today

Use sugars in moderation sparingly if your calorie needs are low. Avoid excessive snacking, brush with a fluoride toothpaste, and floss your teeth regularly. Read the Nutrition Facts Label on foods you buy. The food label lists the content of total carbohydrate and sugars, as well as calories.

Choose a Diet Moderate in Salt and Sodium

Sodium and salt are found mainly in processed and prepared foods

Sodium and sodium chloride — known commonly as salt — occur naturally in foods, usually in small amounts. Salt and other sodium-containing ingredients are often used in food processing. Some people add salt and salty sauces, such as soy sauce, to their food at the table, but most dietary sodium or salt comes from foods to which salt has already been added during processing or preparation. Although many people add salt to enhance the taste of foods, their preference may weaken with eating less salt.

Sodium is associated with high blood pressure

In the body, sodium plays an essential role in regulation of fluids and blood pressure. Many studies in diverse populations have shown that a high sodium intake is associated with higher blood pressure. Most evidence suggests that many people at risk for high blood pressure reduce their chances of developing this condition by consuming less salt or sodium. Some questions remain, partly because other factors may interact with sodium to affect blood pressure.

Other factors affect blood pressure

Following other guidelines in the Dietary Guidelines for Americans may also help prevent high blood pressure. An important example is the guideline on weight and physical activity. The role of body weight in blood pressure control is well documented. Blood pressure increases with weight and decreases when weight is reduced. The guideline to consume a diet with plenty of fruits and vegetables is relevant because fruits and vegetables are naturally lower in sodium and fat and may help with weight reduction and control. Consuming more fruits and vegetables also increases potassium intakes which may help to reduce blood pressure (Box 14). Increased physical activity helps lower blood pressure and control weight. Alcohol consumption has also been associated with high blood pressure. Another reason to reduce salt intake is the fact that high salt intakes may increase the amount of calcium excreted in the urine and, therefore, increase the body's need for calcium.

Most Americans consume more salt than is needed

Sodium has an important role in the body. However, most Americans consume more sodium than is needed. The Nutrition Facts Label lists a Daily Value of 2,400 mg per day for sodium [2,400 mg sodium per day is contained in 6 grams of sodium chloride (salt)]. In household measures, one level teaspoon of salt provides about 2,300 milligrams of sodium.

Most people consume more than this amount

There is no way at present to tell who might develop high blood pressure from eating too much sodium. However, consuming less salt or sodium is not harmful and can be recommended for the healthy normal adult (Box 15).

Advice for today

Fresh fruits and vegetables have very little sodium. The food groups in the Food Guide Pyramid include some foods that are high in sodium and other foods that have very little sodium, or can be prepared in ways that add flavor without adding salt. Read the Nutrition Facts Label to compare and help identify foods lower in sodium within each group. Use herbs and spices to flavor food. Try to choose forms of foods that you frequently consume that are lower in sodium and salt.

If You Drink Alcoholic Beverages, Do So in Moderation

Alcoholic beverages supply calories but few or no nutrients. The alcohol in these beverages has effects that are harmful when consumed in excess. These effects of alcohol may alter judgment and can lead to dependency and a great many other serious health problems. Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history. If adults choose to drink alcoholic beverages, they should consume them only in moderation (Box 16).

Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals. However, higher levels of alcohol intake raise the risk for high blood pressure, stroke, heart disease, certain cancers, accidents, violence, suicides, birth defects, and overall mortality (deaths). Too much alcohol may cause cirrhosis of the liver, inflammation of the pancreas, and damage to the brain and heart. Heavy drinkers also are at risk of malnutrition because alcohol contains calories that may substitute for those in more nutritious foods.

Who should not drink?

If you drink alcoholic beverages, do so in moderation, with meals, and when consumption does not put you or others at risk.

Food Exchange List

A calorie is a calorie is a calorie whether it comes from fat or carbohydrate. Anything eaten in excess can lead to weight gain. You can lose weight by eating less calories and by increasing your physical activity. Reducing the amount of fat and saturated fat that you eat is one easy way to limit your overall calorie intake. However, eating fat-free or reduced-fat foods isn't always the answer to weight loss. This is especially true when you eat more of the reduced fat food than you would of the regular item. For example, if you eat twice as many fat-free cookies you have actually increased your overall calorie intake. The following list of foods and their reduced fat varieties will show you that just because a product is fat-free, it doesn't mean that it is "calorie-free." And, calories do count!

Low-Calorie, Lower-Fat Alternatives

These low-calorie alternatives provide new ideas for old favorites. When making a food choice, remember to consider vitamins and minerals. Some foods provide most of their calories from sugar and fat but give you few if any vitamins and minerals.

This guide is not meant to be an exhaustive list. We stress reading labels to find out just how many calories are in the specific products you decide to buy.

How Much Are You Eating?

How much do you eat?

Suppose you had dinner at an Italian restaurant last night. You ordered spaghetti with meatballs. While you were waiting for your order, you ate 2 slices of garlic bread. How can you tell if this dinner is too much food for you? You need to estimate how much you ate, and then compare that to Food Guide Pyramid recommendations.

Think about your plateful of spaghetti and meatballs. Estimate the amounts of spaghetti, sauce, and meat. You may decide, for example, that the spaghetti portion was about 2 cups, the tomato sauce looked like about 1 cup, and the meatballs were about 6 oz. With the 2 slices of garlic bread, you now have an idea about how much you ate for dinner. But how do your portions translate into standard servings? Chart 1 [page 3] lists the serving sizes for each Food Guide Pyramid food group. According to the Pyramid, your portions equal the following number of servings:

Spaghetti Dinner:

Pyramid Recommendations

To figure out if your spaghetti dinner was the right amount of food for you, use the Pyramid. Chart 1 also lists the number of servings recommended for each Pyramid food group, based on your calorie needs. Over a day, you should plan on eating the number of servings recommended from each group.

For example, if you need about 1,600 calories a day, the Pyramid recommends 6 daily servings from the Grains (Bread, Cereal, Rice& Pasta) group. How does this compare to your spaghetti dinner? Your dinner had 6 servings the total daily recommendation for someone with your calorie needs. If you had counted your portions of spaghetti and bread as only 1 serving each, you might think you had only eaten 2 servings from the Grains group .But, you actually ate 6! By comparing the portion you ate with a standard Pyramid serving, you can judge whether your daily intake is right for you.

Pyramid serving sizes and the recommended number of servings from each group are guides to help determine your daily intake. Your portions do not have to match the standard serving size they can be larger or smaller. But, the amount you eat over the day should match the total amount of a food that is recommended. Often, the food portions of grains and meats that people choose are larger than the Pyramid serving size. Be especially careful when counting servings from these groups to figure out how many Pyramid Servings are in your portions.

How can you follow pyramid recommendations?

Let's go back to the spaghetti dinner. In this example, you know that you should have 6 daily servings from the Grains group. Before dinner, you estimate that you have already had 3 Grains group servings. So, only 3 more servings would meet your recommended intake. To keep to 3 servings, you eat only one slice of garlic bread. When you see the large plate of spaghetti, you set aside half on your plate and ask for a "doggie bag" to take it home. Then, the following would have been your choices from the Grains group over the day:

In 4 sensible portions, you have consumed your recommended 6 servings of grains. Note that an active man may need about 2,800 calories each day. Checking chart 1, this man's Grains group recommendation would be 11 servings per day. The full spaghetti dinner might fit easily within his recommended food choices for the day.

One key to making wise food choices is knowing how much you are eating, as well as how much you should eat. This is especially important if you are trying to lose weight or manage your weight.

Tips to Help You Choose Sensible Portions

Many items sold as single portions actually provide 2 or more Pyramid servings. For example, a large bagel may actually be equal to 3 or 4 servings from the Grains group. A restaurant portion of steak may be more than the recommended amount for the whole day. Chart 2 lists other common examples of foods that are often sold or prepared in portions larger than 1 Pyramid serving.

Nutrition facts label serving sizes

The serving sizes listed on the Nutrition Facts label may be different from Food Guide Pyramid serving sizes. Many Pyramid serving sizes are smaller than those on the Nutrition Facts label. For example, 1 serving of cooked cereal, rice, or pasta is 1 cup for the label but only ½ cup for the Pyramid.

Use the Nutrition Facts label to make nutritional comparisons of similar products. The label serving size is not meant to tell you how much to eat, but to help identify nutrients in a food and to make product comparisons easier. To compare the calories and nutrients in two foods, first check the serving size and the number of servings in the package. Serving sizes are provided in familiar units, such as cups or pieces.

The bottom line

The Dietary Guidelines offer sound advice that will help to promote your health and reduce your risk for chronic diseases such as heart disease, certain cancers, diabetes, stroke, and osteoporosis. The 10 Guidelines are grouped into the ABC's of nutrition: