It's clear to me that there is a great deal of nutritional advice grounded in weak or worthless evidence. A few reasons that the evidence is weak: Long-durations RCTs are very hard to run (they would ideally run for decades, it's generally hard to blind people to what they are eating, it's hard to make people stick for long periods to diets they haven't chosen themselves). Observational studies are badly confounded and you can't control perfectly for all confounders. The usual "Why Most Published Research Findings Are False" problems are exacerbated by the existence of food producers with big budgets and huge incentives to influence the findings.
Is there any trustworthy guide to well-grounded nutritional science that leads to actionable advice? (beyond, don't eat things that are poisonous, try to avoid deficiencies in a range of vitamins and minerals that are frankly difficult to avoid getting enough of if you live in a rich country and eat a vaguely normal diet) Or do I have to sift through it by myself? I've found it hard to find any trustworthy consensus on questions as basic as, is there any health consequence to eating lots of saturated fat, or, does drinking a modest amount of alcohol provide strong health benefits compared to not drinking alcohol?
I thought this piece made a good argument about nutritional pseudoscience: https://metarationality.com/nutrition.
This is one of those cases where satisficing not optimizing is a rational approach. Eat a variety of not overly processed foods, consume in moderation, avoid overindulging regularly in eating and drinking, pay attention to your personal allergies and sensitivities. There is no good evidence-based nutritional advice beyond this for a good reason: once you satisfice, any extra tinkering is swamped by the noise of factors unrelated to nutrition. Of course, there are always outliers, and if you find or suspect yourself to be one of the rare ones for whom the basics don't cut it, you indeed have to tinker. But in this case asking for general "rationalist guides" on nutrition will not get you what you want.
Definitely worth fixing nutritional deficiencies! The Pareto principle applies: most people will get no nutritional deficiencies by satisficing, not optimizing. As I said, "if you find or suspect yourself to be one of the rare ones for whom the basics don't cut it, you indeed have to tinker".