Aim for an overall healthful dietary pattern, the American Heart Association advises, rather than focusing on “good” or “bad” foods.
Published Nov. 29, 2021 Updated Nov. 30, 2021
There are no “good” foods and “bad” foods. Rather, it’s your overall dietary pattern that matters most when it comes to healthful eating.
That’s the main message from the American Heart Association in its latest nutrition guidance to improve the hearts and health of Americans of all ages and life circumstances.
The experts who wrote the recommendations recognize that people don’t eat nutrients or individual ingredients. They eat foods, and most people want to enjoy the foods they eat while staying within their budgets and, the association hopes, without injuring their bodies.
This doesn’t mean you need to totally avoid Big Macs, Cokes and French fries, but it does mean you should not regularly indulge in such fare if you want to stay healthy.
Dr. Robert H. Eckel, a former president of the American Heart Association, and an endocrinologist and lipid specialist at the University of Colorado Denver, told me he “occasionally” indulges in foods outside a wholesome dietary pattern. The operative word here, though, is “occasionally.”
Dr. Neil J. Stone, a preventive cardiologist at the Feinberg School of Medicine at Northwestern University, who praised the thoughtfulness and expertise of the guidance committee, said in an interview, “There’s no such thing as one diet that fits all, but there are principles to form the basis of diets that fit everyone.”
He added: “The goal is to make good nutrition possible for all. The healthier we can keep everybody in this country, the lower our health costs will be.”
In the 15 years since the heart association last issued dietary guidelines to reduce the risk of cardiovascular disease, almost nothing has changed for the better. The typical American diet has remained highly processed. Americans consume too much added sugars, artery-clogging fats, refined starches, red meat and salt and don’t eat enough nutrient-rich vegetables, fruits, nuts, beans and whole grains that can help prevent heart disease, diabetes and cancer.
But rather than become discouraged, the association decided to try a different approach. For too long, nutrition advice has been overly focused on individual nutrients and ingredients, Alice H. Lichtenstein, the guidelines’ chief author, told me, and it hasn’t been focused enough on overall dietary patterns that can best fit people’s lives and budgets.
So instead of a laundry list of “thou shalt not eats,” Dr. Lichtenstein said, the association’s committee on nutrition and cardiovascular disease chose to promote heart-healthy dietary patterns that could suit a wide range of tastes and eating habits. In avoiding “no noes” and dietary revolutions, the new guidance can foster gradual evolutionary changes meant to last a lifetime.
The committee recognized that for people to adopt and stick to a wholesome dietary pattern, it should accommodate personal likes and dislikes, ethnic and cultural practices and life circumstances, and it should consider whether most meals are consumed at home or on the go.
For example, rather than urging people to skip pasta because it’s a refined carbohydrate, a more effective message might be to tell people to eat it the traditional Italian way, as a small first-course portion. Or, if pasta is your main course, choose a product made from an unrefined carbohydrate like whole wheat, brown rice or lentils.
“We’re talking about lifelong changes that incorporate personal preferences, culinary traditions and what’s available where people shop and eat,” said Dr. Lichtenstein, a professor of nutrition science and policy at the Friedman School at Tufts University. “The advice is evidence-based and applies to everything people eat regardless of where the food is procured, prepared and consumed.”
The guidelines’ first principle is to adjust one’s “energy intake and expenditure” to “achieve and maintain a healthy body weight,” a recommendation that may be easier to follow with the next two principles: Eat plenty of fruits and vegetables, and choose foods made mostly with whole grains rather than refined grains. If cost or availability is an issue, as is the case in many of the country’s food deserts where fresh produce is scarce, Dr. Lichtenstein suggested keeping bags of frozen fruits and vegetables on hand to reduce waste, add convenience and save money.
Some wholesome protein choices that the committee recommended included fish and seafood (although not breaded and fried), legumes and nuts, and low-fat or fat-free dairy products. If meat is desired, choose lean cuts and refrain from processed meats like sausages, hot dogs and deli meats that are high in salt and saturated fat.
The committee’s advice on protein foods, published during the climate talks in Glasgow, was well-timed. Choosing plant-based proteins over animal sources of protein not only has health value for consumers but can help to foster a healthier planet.
Experts have long known that animal products like beef, lamb, pork and veal have a disproportionately negative impact on the environment. Raising animals requires more water and land and generates more greenhouse gases than growing protein-rich plants does.
“This is a win-win for individuals and our environment,” Dr. Lichtenstein said. However, she cautioned, if a plant-based diet is overloaded with refined carbohydrates and sugars, it will raise the risk of Type 2 diabetes and heart disease. And she discouraged relying on popular plant-based meat alternatives that are ultra-processed and often high in sodium, unhealthy fats and calories, and that “may not be ecologically sound to produce.”
To protect both the environment and human health, the committee advised shifting one’s diet away from tropical oils — coconut, palm and palm kernel — as well as animal fats (butter and lard) and partially hydrogenated fats (read the nutrition label). Instead, use liquid plant oils like corn, soybean, safflower, sunflower, canola, nut and olive. They have been shown to lower the risk of cardiovascular disease by about 30 percent, an effect comparable to taking a statin drug.
As for beverages, the committee endorsed the current national dietary guideline to avoid drinks with added sugars (including honey and concentrated fruit juice). If you don’t currently drink alcohol, the committee advised against starting; for those who do drink, limit consumption to one to two drinks a day.
All told, the dietary patterns that the committee outlined can go far beyond reducing the risk of cardiovascular diseases like heart attacks and strokes. They can also protect against Type 2 diabetes and a decline of kidney function, and perhaps even help foster better cognitive abilities and a slower rate of age-related cognitive decline.
The earlier in life a wholesome dietary pattern begins, the better, Dr. Lichtenstein said. “It should start preconception, not after someone has a heart attack, and reinforced through nutrition education in school, K through 12.”
And during annual checkups, Dr. Eckel said, primary care doctors should devote three to five minutes of the visit to a lifestyle interview, asking patients how many servings of fruits, vegetables and whole grains they consume and whether they read nutrition labels.