When the FDA released its new Dietary Guidelines for Americans (DGA), 2025-2030 with an updated food pyramid in early January, a flurry of articles reported how different experts in nutrition thought the recommendations lined up with previous guidelines and with various aspects of health. But few of these looked specifically at what the new food pyramid might mean in cancer, whether in terms of how some of the changes could affect cancer risk or how they might affect the way clinicians discuss diet with their patients with cancer.

Medscape Medical News spoke with clinicians about how different aspects of the new federal food guidance might play a role in prevention and care in oncology. They included the following four individuals:

• Natalie Ledesma, MS, RDN — a senior dietician with the UCSF Helen Diller Family Comprehensive Cancer Center
• Syeda Hassan, MS, RD, CDN, and Julia Horowitz, MS, RD, CDN — registered dietitians at Montefiore Einstein Comprehensive Cancer Center in Bronx, New York
• Christopher J. Damman, MD, MA — a gastroenterologist and clinical associate professor at the University of Washington Medical Center in Seattle

Each independently shared their thoughts on the new guidance. The following roundtable transcript has been edited for length and style.

What role do the FDA’s dietary recommendations play in counseling patients about diet, and to what extent do you think they influence patients or your conversations with them about diet?

Hassan: I believe that the DGA do not play a primary role in how we advise our patients with cancer, especially those undergoing active treatment. As ambulatory oncology dietitians, we prioritize patients with high risk for cancer experiencing nutrition-related symptoms related to their malignancy and treatment, such as poor appetite, weight loss, mucositis, dysphagia, nausea, and more. For these patients, our recommendations are driven by oncology-specific, evidence-based resources, including Oncology Nutrition for Clinical Practice, ESPEN Guidelines, Americal Institute for Cancer Research, and American Society of Clinical Oncology. The focus for these patients is not population-level dietary patterns, which the DGA provides, but rather individualized counseling to help patients deal with their specific symptoms while maintaining adequate nutrition and preventing weight loss.

The DGA may be used to inform guidance for general healthy eating, which is especially useful for patients post-treatment who are transitioning to survivorship, cancer recurrence prevention, and supporting long-term health.

Broadly speaking, to what extent might any of the changes made to the new food pyramid affect cancer risk?

Horowitz: One positive change is the stronger emphasis on limiting highly processed foods and beverages that are high in added sugars, such as soda, energy drinks, chips, cookies, and candy. These foods tend to be calorie dense and nutrient poor, and regular overconsumption can contribute to overweight and obesity.

Obesity is a well-established risk factor for multiple cancers, including colorectal, postmenopausal breast, endometrial, esophageal, kidney, pancreatic, and gallbladder cancers. Diets high in ultraprocessed foods and added sugars can contribute to weight gain and metabolic dysfunction, both of which are linked to increased cancer risk. So from a cancer prevention standpoint, encouraging moderation and prioritizing whole, minimally processed foods is very much aligned with the evidence.

The updated food pyramid places greater visual emphasis on protein. For individuals actively undergoing cancer treatment, protein needs are often increased to maintain muscle mass, strength, immune function, and overall nutritional status. In that context, emphasizing adequate protein intake is appropriate.

From a cancer prevention perspective, however, the type of protein matters. There is strong evidence that limiting red and especially processed meats is associated with lower risk for colorectal cancer. While the new guidelines do not set strict limits on red meat, they do recommend consuming a variety of protein sources, including plant-based options such as beans, lentils, soy, nuts, and seeds, which support a more plant-forward approach.

The guidelines also encourage healthier cooking methods, such as baking, roasting, or grilling, instead of deep frying, which can help reduce excess calories and certain harmful compounds formed during high-temperature cooking.

Damman: Processed meat is a class 1 carcinogen, and red meat is just below class 1 in terms of the evidence associated with colorectal cancer. I don’t think most people appreciate just how strong that evidence is for processed meats. The way the new dietary guidance appears to de-emphasize concerns about saturated fats [by not recommending that people limit their intake of saturated fats] will likely lead to people eating even more red meats and processed meats, relatively speaking, and that may contribute to the rising risk for colorectal cancer that we’re seeing.

In terms of what it is about the processed and red meats [that increases risk], we don’t know for certain, but it’s more likely, in the processed meats, the nitrosamines that are added to preserve the meat.

Ledesma: Another area that can play a role is the more lenient recommendation toward alcohol consumption. We know that alcohol is associated with different digestive-related cancers from the head and neck — esophageal and gastric — all the way down to colon and rectal cancer, as well as postmenopausal breast cancer and liver cancer. So there are pros and cons and some conflicting messaging across the board.

Will the new changes to the food pyramid make it easier or harder to advise patients on diet when it comes to thinking about reducing cancer risk in those without cancer and advising patients who currently have cancer?

Ledesma: For me as an individual practitioner, it will have no impact. I’m going to use evidence-based medicine. I’m going to encourage those whole, unprocessed foods. I’m going to really aim for patients to get in 10 types of vegetables, fruits, herbs, and spices daily. I want them to make sure they’re getting enough protein, not just animal protein but also incorporating some plant proteins and absolutely making sure they’re getting a good amount of dietary fiber. I’m thinking of the gut microbiome and gut health and how that plays a significant role for immune function. We’re seeing how the gut essentially affects every aspect of our health.

Hassan: In some ways, the new changes to the food pyramid will make it easier to advise patients with cancer on diet — particularly patients in remission or survivorship, where the focus shifts more toward long-term health, reducing risk for recurrence, and managing other comorbidities, such as cardiovascular disease or diabetes. For example, the emphasis on consuming whole, nutrient-dense foods — such as whole fruits, vegetables, protein, and healthy fats — aligns with what oncology registered dietitians counsel about foods to support immune function, gut health, and overall healthy diet, which are essential for long-term health.

In other ways, the updated pyramid may make nutrition counseling more challenging. One concern is the placement of whole grains at the bottom of the pyramid. In oncology nutrition, we emphasize intake of complex carbohydrates because these fiber-rich foods help regulate blood sugars, support the gut microbiome, and are associated with reduced risk for/recurrence of certain cancers, such as colorectal cancer. Placing whole grains at the bottom could unintentionally send the message that intake of these foods should be minimized, which does not reflect evidence-based oncology nutrition recommendations.

Another challenge is the inconsistency in the guidelines regarding saturated fat. While the new dietary guidelines state that saturated fat should be limited to no more than 10% of total calories, foods that are high in saturated fat — such as full-fat dairy, red meat, and butter — are toward the top of the pyramid. This can be confusing for patients, especially when it is often advised to adopt dietary patterns that support cardiometabolic health alongside cancer/cancer recurrence prevention. In oncology nutrition guidelines, we commonly recommend limiting red meat intake to two to three palm-sized servings per day as higher consumption of red meat has been associated with increased risk for colorectal and other cancers. The pyramid’s strong emphasis on animal-based proteins may make counseling patients on benefits of plant-based protein and lean protein sources a bit challenging.

Overall, given the new changes to the pyramid, oncology dietitians may need to spend more time correcting misconceptions to help patients understand how to apply these recommendations safely and appropriately within the context of their cancer care.

Given the strong evidence base supporting an association between heavily plant-based diets and a lower risk for various cancers, how might any of the new recommendations related to meat or dairy consumption potentially interact with cancer risk?

Damman: If we’re looking at things purely from a colon cancer standpoint, there’s some really interesting research recently published on dairy and colorectal cancer, and it shows it may be protective. There’s a few different considerations regarding whether somebody consumes full-fat or low-fat dairy. One is if you’re looking to generally consume fewer calories and manage your weight, then having lower-fat dairy can be helpful.

Ledesma: There’s also the thought of red meat, as well as other foods, increasing a component called insulin-like growth factor-1 (IGF-1) [which plays a role in the development and promotion of many cancers]. It’s a hormone produced primarily by the liver in response to growth hormone, and anything with hormones is about balance. IGF-1 is not a bad thing, but if we get too much, it can be a risk factor.

Horowitz: It’s important to remember that protein intake is especially critical for patients undergoing cancer treatment. Adequate protein helps maintain muscle mass, support immune function, and preserve strength during intensive therapies. Animal protein and dairy can fit into a balanced, overall healthy dietary pattern. From a cancer prevention standpoint, the key considerations are moderation, particularly limiting processed meats and emphasizing plant-forward choices while maintaining nutritional adequacy.

Could following any of the new recommendations influence microbiome in a way that’s relevant to cancer?

Ledesma: We know that highly processed foods disrupt the delicate balance of our gut bacteria. So the focus of these new dietary guidelines to really limit or eliminate the processed foods is certainly one win for the gut microbiome. The other component is really recommending fermented foods — things such as sauerkraut, kimchi, kefir, miso, and kombucha — to really support a diverse microbial ecosystem. Fermented foods can be a probiotic to help facilitate proper digestion and absorption of nutrients, so that’s a great addition to the guidelines. [Fermented foods are linked to a reduced risk for cancer.]

The recommendation in the guidelines also support intake of prebiotics, probiotics [which have been shown to play a role in response to immunotherapy], and polyphenols [which have been shown to have anticancer properties]. Plant foods — berries and pomegranates and even olives and capers or even a cup of coffee — are going to provide polyphenols.

Horowitz and Hassan reported having no disclosures. Damman reported consulting for Oobli, Supergut, and BCD Bioscience. Ledesma reported being on the speakers bureau for Lilly Oncology; Kate Farms; and Digestive Care, Inc.

Tara Haelle is a science/health journalist based in Dallas.