AHA Offers New Dietary Guidance to Improve Heart Health

The American Heart Association (AHA) recently released a new scientific statement in the journal Circulation. The 2021 Dietary Guidance to Improve Cardiovascular Health includes 10 important guiding principles to improve heart health and reduce the risk of cardiovascular disease.

Created by a panel of dietitians, nutrition researchers, and physicians, the document brings together evidence-based nutrition knowledge about heart health. Importantly, it moves away from recommending specific foods and focuses more on entire dietary patterns.

Flexibility in eating is important because no two people have the same dietary requirements. The new guidelines reflect the fact that meal planning needs to be based on the foods that people can access, afford, and enjoy based on their medical needs and preferences.

“Overall, I agree with the new guidelines for heart health,” says Vandana Sheth, RDN, CDCES, FAND, an LA-based registered dietitian nutritionist. “The focus on dietary patterns rather than specific foods allows for greater flexibility.”

Addressing Racism, Nutrition Insecurity, and More

The AHA paper also highlights structural challenges that impede adherence to heart-healthy dietary patterns, such as the abundance of marketing for unhealthy foods, nutrition insecurity, and structural racism. These tenets are often overlooked in nutrition recommendations but are impossible to ignore and are finally getting the attention they deserve.

“I am pleased the paper highlighted the challenges that impede adherence to heart-healthy dietary patterns,” says Lauren Harris-Pincus, MS, RDN, founder of NutritionStarringYOU.com and author of “The Everything Easy Pre-Diabetes Cookbook.”

Issues such as nutrition insecurity and racism create environments where unhealthy foods are the default option, making it difficult to plan a heart-healthy diet. The AHA panel acknowledges that improving diet quality and heart health across the U.S. will require addressing these systemic issues.

The AHA paper says “creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative,” and provides a list of 10 tips for heart health.

Harris-Pincus says that “lists are useless for those who don’t have access to or the finances to consistently purchase and prepare minimally processed food.”

The AHA panel also advocates for combatting nutrition misinformation, re-introducing food and nutrition education for all students, addressing structural racism and healthcare inequality. They also advise providing incentives for healthier purchases in the government-run Supplemental Nutrition Assistance Program (SNAP) program and allowing people in areas with few grocery stores to order SNAP groceries online.

10 Tips For Heart Health

The dietary guidance document is laid out with 10 tips that outline a heart-healthy eating plan. Here is some information about each tip.

Adjust Energy Intake and Expenditure

To achieve and maintain healthy body weight, adjust your energy intake and expenditure. The “calories-in, calories-out” adage made the cut, though not everyone agrees with this overly simple advice.

“It’s far too simplistic to suggest people ‘eat less and move more,’ which is generally suggested in the first guidance point,” says Harris-Pincus. “While one facet of cardiovascular disease risk is excess body fat, simply decreasing calories without attention to diet quality and lifestyle changes should not be emphasized.”

Harris-Pincus explains that continuing to focus on total energy intake and body weight only further causes more weight stigma and bias among health professionals, which impedes quality care for those who struggle with obesity.

Eat a Variety of Fruits, Vegetables, and Whole Grains

Years of clinical research show that the fiber, vitamins, minerals, and antioxidants in fruits, vegetables, and grains are protective for heart health. Of course, detractors worry about the carbs in these same foods, especially grains.

In this case, the AHA panel says that this carb-rich dietary pattern has more supportive evidence for its effectiveness when compared to a low-carb or ketogenic dietary pattern for heart health.

Choose Nutritious Sources of Protein

When selecting your protein sources include mostly plants when possible. You also should include fish regularly and choose lean cuts and unprocessed meats.

The push for more plant-based protein is popular these days, both for the health benefits (more fiber and less saturated fat than meat) and the environmental benefits.

When choosing plant protein, Sheth recommends soy, beans, and lentils, as well as nuts and seeds that have the benefit of plant-based omega 3 fats. Examples include chia seeds, flax seeds, hemp seeds, and walnuts.

Incorporate Liquid Plant Oils

According to the AHA, robust scientific evidence indicates that there are multiple cardiovascular benefits from incorporating unsaturated fats like polyunsaturated and monounsaturated fats, especially when they replace saturated and trans fats.

For this reason, they advise using liquid plant oils rather than tropical oils, animal fats, and partially hydrogenated fats. Choose olive, avocado, peanut, or another vegetable oil rather than butter, lard, margarine, shortening, coconut oil, or palm oil.

Choose Minimally-Processed Food When Possible

Choose minimally processed foods instead of ultra-processed foods. They also suggest minimizing the intake of beverages and foods with added sugars while choosing and preparing foods with little or no salt.

These three points can be grouped together because they all highlight the health detriment of eating too much ultra-processed food, which is high in sugar and sodium (plus additives and preservatives).

Studies show that about 60% of calories in the average American diet come from ultra-processed foods, which has been linked with an increased risk of developing heart disease.

Limit Alcohol Intake

If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake. The Dietary Guidelines for Americans say that if you drink, alcohol intake should be limited to one drink a day for women, or two drinks for men.

According to the AHA, the relationship between alcohol and cardiovascular disease is not only complex but appears to be impacted by the amount of alcohol a person drinks. Of course, other factors contribute to the impact including a person’s pattern of drinking, their age, and their sex.

But for some negative outcomes, there is a direct relationship between alcohol intake and the risk for stroke and atrial fibrillation. In other words, as alcohol consumption increases, so does a person’s risk.

Recognize Guidance Applies in all Scenarios

The AHA recommends adhering to this guidance regardless of where food is prepared or consumed. Whether dining out, ordering in, or cooking from scratch, the same tips listed above still apply. To protect your heart health, it is important to make decisions about what you are eating with these suggestions in mind no matter where you are or what you are doing.

Other Considerations

Although the list primarily focuses on food and nutrition, there are other elements that play a critical role in heart health, too. For instance, Harris-Pincus indicates that stress management and quality sleep are important elements for cardiovascular health since both are linked to an increased risk for heart disease.

“Meal timing is also a factor,” adds Harris-Pincus. “There is evidence that following our circadian rhythm and consuming a higher percentage of calories earlier in the day can improve risk factors for CVD such as blood lipids, glucose, insulin, and blood pressure.”