Happy Valentine’s Day from the American Heart Association
[11 minute read]
When deciding on a blog topic for Quick Bites, I try to choose a topic that is both timely/relevant AND exciting to me. So this month, we are talking about heart health; specifically the recently released and updated American Heart Association’s guidelines. This topic is timely because a) the guidelines were released in November of 2021, and b) it’s almost Valentine’s Day; a holiday I unabashedly love!
While every topic I write about for Quick Bites satisfies the “it’s exciting to me” requirement, this one is especially important as the maternal side of my family has known heart-issues. It seems we come from a genetically cholesterol-heavy family, so I need to be hyper aware of my heart health. If you have a family history of cardiovascular disease, or know someone who does, then this post is for you!
On 02 November 2021, the American Heart Association published a scientific statement titled “2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement from the American Heart Association.” This statement supersedes their last update from 2006.*
Though the new guidance is only 16 pages in length, it’s a dense 16 pages ( think of a bowl of chewy, nutritious wild rice), so I’m providing you a summarized version of the guidance. But if you’d like to delve into the original topic yourself, it’s a great read and useful resource.
The purpose of the AHA’s scientific statement was to:
Emphasize the importance of dietary patterns beyond just individual nutrients. Basically this means that one diet or approach, does not fit all. My favorite quote from this section was this doozy:
"There is insufficient evidence to support any existing popular or fad diets such as the ketogenic diet and intermittent fasting to promote heart health."
2. Underscore the critical role of starting healthy patterns EARLY in life. There is well-documented evidence that the prevention of pediatric obesity is key to preserving and prolonging ideal cardiovascular health. The issue here tho is that the responsibility of these healthy eating patterns falls to parents, schools, caregivers, etc, not the children themselves. So if you’re a parent, please take this seriously.
3. Promote common features of dietary patterns that promote CV health
This section provides the bulk of the document, i.e. the meat or bean of the burger. The figure below visually summarizes the common features of a dietary pattern that promotes CV Health:
One: Adjust Energy Intake & Expenditure to Maintain a Healthy Body Weight:
Aim for at least 150 minutes of moderate physical activity per week
Remember that energy needs vary widely from person to person - basically energy needs can be anywhere from 1,200 to 2,500 calories depending on the person and their lifestyle.
Watch your portion sizes - overeating HEALTHY FOODS can lead to weight gain
Longterm adherence to any dietary pattern is more important than any short term gains, so choose a method of eating that you can stick with on the daily
Two: Eat Plenty of Fruits and Veggies & Choose a Wide Variety
Evidence from observational and intervention studies show fruits and veggies - but not white potatoes - are associated with a reduced risk for CVD (cardiovascular disease)
You’ll get more fiber and feel fuller if you choose whole fruits and vegetables over juices
Fresh, frozen, canned, and dried fruits and vegetables are a great addition to a diet, especially for those of us who are strapped for time. Just make sure to check the label and choose varieties without any added salt or sugar.
If you want to know exactly what 5 servings of fruits/veggies per day is, read my last post!
Three: Choose Mainly Whole Grain Foods Over Refined Grains
Whole grains are a rich source of fiber. Fiber is a powerhouse and can reduce cholesterol from your bloodstream.
"Products made with at least 51% whole grains are typically classified as whole grain.” This was a good reminder to really investigate labels because if a product claims to be “whole grain,” it may be more accurate if the label claimed this instead: “about half our product is whole grain!”
For my diet specifically, I get whole grains from my whole grain bread (with no added sugar), old fashioned oats, 100% whole wheat pasta, popcorn (this doesn’t include popcorn with lots of oils or butter), quinoa, whole grain cornmeal, wild rice, spelt flour, and whole wheat tortillas.
Observational studies and RCTs (randomized controlled trials) have shown that choosing whole over refined grains is associated with a lower risk of CHD (coronary heart disease) and a reduced risk of CVD.
Four: Choose Healthy Sources of Protein;
mostly from plants like legumes and nuts. Substituting animal sources of protein with plant sources not only protects your health but also reduces your carbon footprint to protect planetary health as well.
Many plant-based meat alternatives are highly processed with added salt and sugars, saturated fat, stabilizers, and preservative, so it is ideal to just go with beans, not an ultra processed bean patty or meat alternative. At present there is limited research on the short- and long-term effect of these processed plant-based meat alternatives
also from fish and seafood - higher intakes of fish and seafood are consistently shown to reduce CVD issues, with an especially ideal frequency being 2 to 3 servings of fish per week. The best outcome occurs when 2 servings of fish (baked or grilled, not battered or fried) replace foods rich in saturated fat .
If you’re vegan, this may be when you start asking “Uh, what about me?!” Well, the only mention of “vegan” in the AHA document was this sentence: “However, individual nutrient supplements may be needed in cases of nutrient inadequacy or for those eating restricted diets (eg, vegans, certain groups of older adults).” Estimates on U.S. citizens adhering to a vegan diet are all over the place, from 9 million people to 6% of the population, but either way there is definitely a growing population of vegans out there so it would have been helpful if the AHA”s scientific statement had addressed them more equally.
low fat or fat-free dairy products instead of full fat are associated with a lower risk of all-cause mortality, CVD, overweight, and obesity.
-Replacing saturated dairy fat with vegetable or polyunsaturated fat is associated with lower risk of CVD and stroke, however this replacement is STILL being debated as there may be some benefits to fuller fat yogurt, etc. Making an overall shift to unsaturated fat from saturated fat does show beneficial findings tho.
If you do choose meat, choose lean cuts that are UNprocessed - there is a direct association between high red meat intake and CVD risk, and even more so with processed meat which is also associated with higher mortality. The term “processed meats” includes meat, poultry, or seafood products preserved by smoking, curing, or salting or the addition of chemical preservatives . Processed meats (such as bacon, salami, sausages, hot dogs, deli meat (eg turkey, ham) and pepperoni) are high in saturated fat, cholesterol, salt, and nitrites. Replacement of red and processed meat with alternative foods such as unprocessed poultry, fish, nuts, and legumes was associated with a lower risk of total and CVD mortality.
These processed meats are ubiquitous and really tough to give up. My partner loves snacking on salami or prosciutto and a slice of pepper-jack cheese. And let’s face it, nuts and beans aren’t going to be a worthy substitute for him, so sometimes it’s about reducing rather than replacing.
Five: Use Liquid Plant Oils Rather Than Tropical Oils (coconut, palm, and palm kernel) or partially hydrogenated
Cardiovascular benefits are best reaped when you replace saturated and trans fats (animal and dairy fats and partially hydrogenated fat) with unsaturated, nontropical liquid plant oils
Association with good health is stronger with polyunsaturated fats (soybean, corn, safflower** and sunflower oil, walnuts, and flax seeds) than monounsaturated fats (canola and olive oils, and nuts; high oleic acid safflower and sunflower oils; and peanuts and most tree nuts and their butters.) Monounsaturated fats are always better than saturated fats or trans fats.
Six: Choose Minimally Processed Foods over Ultra-processed Foods
See my post “What’s the Skinny, or Rather the Fat, on Ultra-processed Foods?” for a discussion on the issues with UPF’s from definition to health.
Consumption of ultra-processed foods is associated with overweight, obesity, and metabolic syndrome (metabolic syndrome is a cluster of conditions that happen together increasing the risk for heart disease, stroke, and type 2 diabetes.)
Intake of UPFs is associated with greater energy intake, type 2 diabetes, and all cause mortality.
While it can be a time-consuming task, when it comes to your heart-health it’s best to emphasize as many un- or minimally-processed foods over ultra-processed foods as possible.
Seven: Minimize Intake of Beverages and Foods with Added Salt and Sugar
Consumption of added sugar and added salt is consistently associated with risk of type 2 diabetes, CHD, and excess body weight
What about diet-soda? Due to mixed findings reported for low-energy sweeteners on body weight and metabolism, there is still debate on the benefits of sugar substitutes, so I suggest you try and sub out one or two sugar-sweetened drinks a day with a cup of black coffee, hot tea, iced-tea, water, sparkling water, infused water, kombucha or freshly squeezed and lightly sweetened lemonade, instead of heading straight for the diet-soda.
Eight: Choose and Prepare Foods with Little or No Salt
A direct relationship exists between salt and high blood pressure
This relationship is especially distinct in Black individuals, middle-aged and older-aged people, and individuals with hypertension.
“In the United States, the leading sources of dietary sodium are processed foods, foods prepared outside the home, packaged foods, and restaurant foods, together accounting for almost three-quarters of total dietary sodium.”
Of note, even foods labeled 100% whole wheat or organic can be high in sodium. So always remember to check your labels!
Nine: If You Do Not Drink Alcohol, Do Not Start; If You Choose to Drink Alcohol, Limit Intake
The association between alcohol and cardiovascular issues and stroke caught me by surprise: 'The highest risk is with NO intake AND high intake, and the lowest risk is with 1 to 2 drinks per day” As someone who gave up alcohol over 20 years ago, I was a little bummed to be in the “highest risk” category ha!
All based on observational studies, so they cannot show actual cause and effect
The AHA does not encourage non-drinkers or former drinkers to start downing a couple drinks a day just for CV health: ". . . especially in light of the deleterious effects of alcohol on numerous other outcomes (injuries, violence, digestive diseases, infectious diseases, pregnancy outcomes, and cancer).
Ten: Adhere to Guidance Wherever Food is Prepared
Food is prepared and eaten everywhere, not just in the home, which limits the amount of control we have over our food. Additionally, much of the food we make at home is prepared with packaged or processed ingredients. Here's where public health comes into play: "Policies should be enacted that encourage healthier default options such as making whole grain rather than refined grain products available and minimizing the sodium and sugar content in products."
4. Discuss the benefits of a good diet beyond just CV -
The AHA devotes an entire section of their scientific statement to showing how the dietary pattern they are promoting is not just good for heart health but good for your overall health.
5. Highlight structural challenges that impede adoption of good practices
While I’m ever interested in nutrition, this fifth section was the most interesting because it dug into the complexities of food choice. The AHA clarifies how our food choices are not necessarily our own but that of our food environment; a food environment that is also influenced by systemic government policies at all levels that impede adoption of healthy practices from structural racism to the placement of foods in the grocery store aisles. These “upstream systemic problems” need to be addressed, in particular among people who are underrepresented because of their race or ethnicity. Additionally, the AHA says that nutrition misinformation among the public and health care professionals must be combatted.
Socioeconomic factors and food & nutrition insecurity - "Federal food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), provide supplemental assistance for food purchases, but these programs only support a fraction of the monthly household food supply." This was an “oh shit” moment for me because many of the people who are in need of this (malnourished) assistance, may also be undocumented so aren’t even eligible for these programs in the first place (non-citizens with a specific immigration status are eligible). While WIC was updated in 2009 to promote healthier foods, corresponding SNAP initiatives have not been implemented
Structural racism and neighborhood segregation - including inequitable institutions like schools, workplaces, prisons, and health care. "Many communities with a high proportion of people from underrepresented races and ethnicities have few supermarkets but many fast food, convenience, and dollar stores. Lack of access to adequate transportation adds to the difficulty in purveying healthy foods in these communities."
Targeted marketing of unhealthy foods and beverages - "Black and Hispanic children are more likely to be exposed to advertising for processed food and beverages through outdoor, television, digital, and print advertising than non-Hispanic White children." The AHA mentions how online shopping was considered a possibly equitable tool by the government, specifically with a USDA-sponsored pilot program that allowed SNAP users to access online grocery shopping. However, “Online shopping, initially thought to be an opportunity for reducing disparities in food purchases, actually might have the opposite effect by using artificial intelligence to promote unhealthy foods and beverages. These practices are likely to have a disproportionate and deleterious effect on shoppers who may come from low-income, under-resourced, and underrepresented groups."
(Lastly) Looking to the Future - Precision Nutrition - “The National Institutes of Health 2020 to 2030 Strategic Plan for National Institutes of Health Nutrition Research focuses on precision nutrition to determine the impact on health of not only what individuals eat, but also of why, when, and how they eat throughout the life course.” These precision nutrition programs are still being researched and developed, thus the AHA recommends: “. . . the current focus on public health nutrition strategies to improve the food environment is warranted.”
The AHA scientific statement is important because it lays out clear guidance that is based on solid research and scientific evidence. However, the guidance doesn’t necessarily tell you HOW to implement this healthy dietary pattern. So their statement is more about the WHY you should eat in accordance with heart health and less about the HOW.
A few guidelines from 2006 that you will not see in the updated guidance are “aim for a healthy body weight,” “aim for a desirable lipid profile,” “aim for a normal blood pressure,” and “aim for a normal blood glucose.” The new guidance is more about lifestyle and patterns and less about specific metrics like weight and lipid profiles. You also won’t see “avoid use and exposure to tobacco products.” I can only hope this means that Americans continue to quit smoking as my partner did 2-1/2 years ago!
Guidance that continues to this day are the good ol’ mainstays: eat your fruits and veggies, choose whole-grain and high-fiber foods, consume fish at least twice a week, minimize intake of beverages with added sugar, prepare and choose foods with little or no salt, and consume alcohol in moderation. A new addition to the guidelines is specific to processed foods, which says a lot about our current eating habits.
** For safflower and sunflower oils that are high in polyunsaturated fats, choose “high-linoleic safflower oil” over “high-oleic safflower oil” which contains more monounsaturated fats. While the AHA document did call out “high oleic” safflower and sunflower oils as significant sources of monounsaturated fats, they didn’t specify “high-linoleic” safflower and sunflower oils in the list of polyunsaturated oils, they just said “safflower and sunflower oils.” When I first purchased safflower oil, I realized I had purchased the high-oleic type only because of the claim on the front about all the monounsaturated fats! Since the high-oleic oils (heavy with monounsaturated fats) are best for high heat cooking, they are easier to find than the oils that are significant sources of polyunsaturated fats. So be aware when choosing your safflower and sunflower oils! I wish this would have been explained in the AHA document, and will be emailing the lead contributors to tell them about my own personal experience.
Look forward to future posts where I tackle some of the 10 features above and give you practical tips to implement them in your own life!
Thanks for reading!
~ Trilety Wade
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Header Photo Credit: Natliya Vaitkevich