New Dietary Guidance to Improve Cardiovascular Health

My holiday wish list includes a magic wand to make those extra eggnog-and-fruitcake-pounds melt off my body as quickly as a snowman in a heat wave turns into a puddle of water. And once the holidays are over, I will head to the supermarket with good intentions, hoping my New Year's resolutions to eat well and exercise will help me to become a little less hefty!

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The good news is there is new information about how I can go about this and still enjoy the things I love.

On November 2, 2021, The American Heart Association issued a scientific statement, "2021 Dietary Guidance to Improve Cardiovascular Health" which supersedes its 2006 one on diet and lifestyle recommendations. 

The new statement focuses on numerous factors, including: 

• The importance of overall dietary patterns rather than endorsement or prohibition of individual foods or nutrients
• The necessity of starting wholesome habits at a young age
• Common features of nutritious eating patterns that promote cardiovascular health
• Benefits of heart-healthy choices (including nutrient dense foods, fish or poultry, low fat dairy, healthy fats,) that affect not only cardiovascular health but reduce the risk of other chronic conditions such as Type 2 diabetes, while also promoting kidney function, fostering cognitive abilities, lowering cognitive decline in later years and decreasing all-cause mortality
• Structural and societal challenges that interfere with the ability of individuals and communities to adopt healthful dietary patterns, including food and nutrition insecurity, socioeconomic factors, structural racism and neighborhood segregation and targeted marketing of unhealthy foods and beverages to certain populations
• The recognition that food choices are reflective of personal preferences, ethnic and religious practices and life stages

"We have good data that shows that when you modify unhealthy dietary patterns, we see improvements in cardiovascular disease factors which are also beneficial to overall health," says Dr. Alice Lichtenstein, director and senior scientist of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, and chair of the writing committee of the 2021 Scientific Statement.  

"One objective in releasing these guidelines is to encourage the adoption of healthier eating patterns which still allows some intake of foods that people find pleasurable. Eating is meant to be enjoyable," Lichtenstein adds.

Eating healthfully is also good for the environment. Dietary patterns that favor animal-based food production and consumption contribute to greenhouse gas emissions, while primarily plant-based diets result in increased sustainability and decreased carbon footprint.

The dietary guidelines, which focus primarily on prevention rather than treatment of disease, include 10 features which recommend that individuals:

• Balance calorie intake with those expended through exercise to achieve a healthy body weight. Engage in at least 150 minutes of moderate physical activity per week. 
• Choose a wide variety of fruits and vegetables to ensure adequate essential nutrients and phytochemicals. Deeply colored fruits and vegetables (leafy greens, apples) are more nutrient-dense than lighter colored ones. Whole fruits and vegetables provide more dietary fiber and satiety than juices.
• Select foods made mostly with high-fiber whole grains rather than refined grains. These also have beneficial effects on gut microbiota.
• Choose healthy sources of protein, such as fish and seafood (wild-caught fish is especially beneficial because of omega-3 fatty acid content) for at least two meals per week, legumes and nuts, low-fat/fat-free dairy, poultry and, if desired, lean meat. 
• Use polyunsaturated oils such as soybean, corn and sunflower oils or monounsaturated fat sources such as canola and olive oils rather than saturated or transfats such as palm oil or coconut oil.

• Choose minimally processed foods instead of ultra-processed ones. Consumption of ultra-processed foods has been associated with adverse health outcomes including overweight and obesity, type 2 diabetes, cardiovascular disease, cancer and all-cause mortality.
• Minimize intake of drinks and foods with added sugars. 
• Select and prepare food with little or no salt. In the U.S., the greatest sources of dietary sodium chloride are processed and packaged foods, food prepared outside the home and restaurant foods. 
• If you don't drink alcohol, don't start. If you choose to drink alcohol, limit your intake. The 2020 to 2025 Dietary Guidelines for Americans recommends no more than one drink per day for women and two drinks per day for men.
• These guidelines should be followed whether food and beverages are eaten or prepared within the home or in any other setting, a nod to the fact that Americans (at least pre-COVID-19) eat out on a regular basis, use meal prep delivery services or order food in, rather than cooking. A report in Science Daily concluded that meals prepared away from home tend to be higher in energy density, fat and sodium, but lower in fruit, vegetables, whole grains and protective nutrients such as dietary fiber and antioxidants. 

The current scientific statement emphasizes the importance of addressing systemic challenges and ends by pointing out that "creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative."

For example, a provision of incentives for healthier purchases such as fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) would be helpful.

"While we can make recommendations, it is up to our policy makers to address these concepts so inequities can be minimized," says Lichtenstein.

"It is important for us to look at what drives people to make decisions that are clearly not in their best interests, and to encourage them to make small changes in the right direction," says Lichtenstein, adding, "You are never too old to make shifts and improve your diet."

Often, our dietary patterns are based on habitual behaviors, such as when we go to the supermarket and mindlessly select the same foods we have always chosen. One reason that people, particularly older adults who live alone, don't always eat adequate amounts of fresh fruits or vegetables is because they tend to go bad if not eaten relatively quickly.

Buying whole fruits rather than pre-cut fruit salad helps to preserve freshness. And, when necessary, frozen vegetables or fruit can be substituted for fresh. Prewashed, bagged salad greens, pre-cut butternut squash and peeled carrots make it easy to prepare a salad for one. Preparing a healthy recipe that will provide several servings and freezing them in individual portions also works well for one-person or small households.

Lichtenstein emphasizes: "Striving for healthier dietary patterns is an ongoing process. You can eat food that you enjoy while still following current guidelines to improve cardiovascular and overall health." That, to me, sounds like a recipe for health AND happiness!

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications. Read More