The 2026 Dietary Guidelines and What They Mean for People with CKD

You may have heard the recent news about the updated US Dietary Guidelines — and how they differ significantly in certain ways from the prior guidelines.

There are a few key areas where the guidelines were updated. Let’s look at what changes and how these changes might apply to you if you have kidney disease.

More straightforward calls to limit highly processed foods

The new guidelines state, “Avoid highly processed packaged, prepared, ready-to-eat, or other foods that are salty or sweet, such as chips, cookies, and candy that have added sugars and sodium.”

It’s true that highly processed foods can be rich in ingredients like sugar and sodium – as well as added potassium and phosphorus, which you might be avoiding if you have kidney disease.

But, I worry that this message gets distilled down to “avoid anything processed that comes in a package, bag, box, or can.”

Just because a food item is “processed” or comes in a box, doesn’t automatically mean it’s “bad”. For example, many patients use convenient food or drinks like nutrition bars or shakes to help meet their daily nutritional needs.

Foods that are processed can be convenient, rich in beneficial nutrients, and affordable. There are many reasons why we might select them. In my opinion as a dietitian, there is room to include various types of processed foods in a balanced diet that also emphasizes fresh, whole foods as much as possible.

Increase in daily protein recommendations

The new guidelines suggest 1.2-1.6 grams of protein per kilogram of body weight, a drastic increase from the previously recommended 0.8 g/kg body weight.

This may be confusing for patients with CKD who are often advised to limit protein. Keep in mind that these guidelines are for the GENERAL population and do not apply to people with CKD.

Continue to defer to your doctor and dietitian regarding the right amount of protein for you. As a dietitian, I use kidney-specific nutrition guidelines and an individual assessment of each patient to determine my recommendations for protein intake, rather than the US Dietary Guidelines.

Stricter limit on added sugars

The previous guidelines advised keeping added sugars to <10% of daily calories. The guidelines state, “While no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet, one meal should contain no more than 10 grams of added sugars.”

The advice to limit non-nutritive, artificial sweeteners may be confusing to people who use these as an alternative to regular sugar. As a dietitian, I’m not sure there’s adequate evidence to support this guidance.

Sugar alternatives can be safely used in small amounts, including among patients with CKD, but in larger or more frequent doses, they could alter your gut microbiome.

For example, if you drink diet soda all day long as your primary source of hydration, this would likely provide excessive amounts of artificial sweetener. But if you enjoy baking now and then and sub half your white sugar for Splenda, or use a little artificial sweetener in your morning coffee, that’s likely not an issue.

No specific limit on alcoholic beverages

While the prior guidelines suggested no more than two drinks per day for men and one drink per day for women, the new guidelines simply state to “consume less alcohol for better overall health.” This updated guideline is very vague and has drawn criticism from groups like US Alcohol Policy Alliance.

While the current kidney nutrition guidelines do not specifically address alcohol, an article on the National Kidney Foundation website suggests to limit alcohol intake and consult with your doctor about how much, if any, alcohol is appropriate for you. While most of us think of the liver as the primary organ harmed by alcohol consumption, it also negatively impacts kidney function and can cause increased blood pressure.

Contradictory messages about saturated fat

The dietary guidelines say “when consuming dairy, include full-fat dairy”, a departure from prior guidance to choose low-fat or fat free dairy. The White House has posted on social media stating “whole milk is back.”

The new guidelines also suggest using fats like butter of beef tallow, in addition to other fat sources like olive oil.

Altogether, the new guidelines and the new “inverted food pyramid” emphasize whole milk, red meat, and other foods rich in saturated fats.

If you look at the inverted pyramid graphic, you will notice that these fatty foods – meat, cheese, whole milk, eggs, butter, etc – take up nearly 1/3 of the pyramid!

I find this food pyramid graphic to be quite misleading, because despite these higher fat foods being recommended throughout the guidelines, and heavily emphasized in this graphic, the actual guidelines maintain the prior recommendation to keep saturated fats to less than 10% of daily calories. This graphic is in conflict with what the guidelines say.

The most recent kidney nutrition guidelines (2020 KDOQI Guidelines and 2024 KDIGO Guidelines) recommend to limit saturated fats, and opt for unsaturated fats instead. The American Heart Association recommends a strict limit of <6% of daily calories from saturated fat.

These disease-specific guidelines are more appropriate for patients with kidney disease and/or heart disease, and they are what I tend to refer to when offering nutrition guidance to my patients.

The New Pyramid versus MyPlate

The previous visual tool we used was called MyPlate which breaks up food groups into portions of the plate, offering guidance on suggested portions. A similar tool I like to use to help explain healthy eating is the Harvard Healthy Eating Plate.

Prior to MyPlate, from 2005-2011, we had a tool called MyPyramid. The “old” Food Guide Pyramid was used between 1992-2005.

If you look at MyPlate and the most recent set of guidelines, you’ll notice they are similar to the new guidelines in some key ways:

• Emphasis on whole fruit and a variety of vegetables
• Encourage whole grains
• Choose various types of protein foods
• Opt for healthy fats

You can still find the old MyPlate website here.

The new guidelines are being painted as an “overhaul” of the prior guidelines which had “Fruit Loops at the top of the pyramid”, according to the Secretary of Health & Human Services Robert F. Kennedy Jr, but if you reference the prior guidelines, you will see that we’ve had an emphasis on whole, less processed foods for quite a while now.

Final Thoughts

While the new guidelines differ in some key ways, at the core, there remains an emphasize on fruits, vegetables, whole grains, and varied protein sources – key principles of a healthy, balanced diet.

But certain aspects of the new guidelines – in particular, the emphasis on higher protein intake and foods rich in saturated fat – would not be appropriate for patients with kidney disease.

Overall, the most important thing to keep in mind is that no matter what the guidelines say, you need to determine what’s best for YOU personally. Working with a renal dietitian like me is the best way to figure out what’s right for you and your body’s needs.