In my time as a heart surgeon I have seen that the most common cause of heart disease in my patients is diet.
And it troubles me to think that I was almost in the same situation. Despite following the official guidelines for a ‘healthy balanced diet,’ my weight was increasing and my health deteriorating, and I’m not the only victim of the misguided food pyramid – 88% of people are metabolically unhealthy.
Despite these long-established guidelines for how to eat a heart healthy diet, the CDC still reports that heart disease is the leading cause of death in the US.
It is clear that the way we are eating is not as healthy as we have been led to believe.
The AHA’s guidelines for 2021
The American Heart Association has recently released its updated dietary guidelines for 2021, and, given the failures of previous dietary advice, I was keen to see if the updates are a step in the right direction to a healthier America and help you make sense of what’s optimal for fueling your body.
Let’s take a look at the AHA guidelines for 2021 together:
1. ‘Adjust energy intake and expenditure to achieve and maintain a healthy body weight’
Maintaining a healthy weight is important for heart disease prevention. But there is a big difference between being healthy and being thin and it is outdated advice like this that causes many of the misconceptions around weight. I expect we all know someone who is so desperate to reach ‘a healthy weight’ that they begin to starve themselves, follow a ‘detox’ or other fad diet.
A healthy diet is not just about calories in = calories out.
Let’s say someone only eats a few slices of pizza a day and burns the calories off at the gym. Even if they lose weight, it doesn’t change the fact that they are only eating pizza! This is not a heart healthy diet, nor are they getting adequate nutrition.
So while I do agree with the need to maintain a healthy body weight, this guideline fosters the misconception that weight itself is the end goal. Considering we know it’s possible for people to eat junk food but remain slim, the message needs to be clearer that what’s important is maintaining a healthy weight as a result of correct food choices. Reaching a healthy weight is a byproduct of making the correct choices regarding food and lifestyle.
2. ‘Eat plenty of fruit and vegetables, choose a wide variety’
This one was a predictable inclusion in the guidelines, and it’s not a bad recommendation. However, the issue with this guideline is that eating fruits and vegetables is not a magic fix that will make you healthier if other choices are unhealthy.
What I mean is, eating vegetables won’t outweigh everything else you eat. Eating a bag of Doritos and an apple is no healthier than just eating a bag of Doritos, because the chips are full of bad fats and chemicals and the apple won’t undo that. Likewise, the person in the previous section who only ate pizza would gain some nutritional benefit from adding broccoli to their plate, but it wouldn’t be sufficient. They’d still be consuming harmful foods and be lacking adequate protein.
So the only merit of fruits and vegetables as a dietary strategy is what they’re replacing in your diet. If, for example, you ate the apple instead of the Doritos then that’s a healthy decision with genuine benefits.
It’s also important to keep fruit and vegetables in the proper context. They can be included as part of a heart healthy diet, but as the only macronutrient they can contain is fibrous carbohydrates, they should not form the foundation.
3. ‘Choose food made mostly with whole grains rather than refined grains’
This advice seems to be serving the interests of no one but the food industry.
The one good aspect of this advice is that the less refined the grain, the healthier it is. So if you’re eliminating refined grains and replacing them with unrefined grains, that’s a positive step.
But the failing food pyramid has long recommended a diet built around whole grain products, and all you have to do to see the results of this advice is look around at the ever-rising figures of chronic illnesses.
Eating whole grains and unprocessed carbohydrates can be part of a heart healthy diet, but I still would not recommend them as a major part of a diet, particularly for people who are not metabolically healthy. In other words, eat them in moderation as part of an overall healthy diet, rather than expecting the grains to be the healthy aspect.
4. ‘Choose healthy sources of protein’
The American Heart Association recommends four sources of protein, which are:
- Mostly from plants, legumes and nuts: As humans, it is incredibly difficult for us to get adequate amounts of protein from only eating plants, as the human body finds it more difficult to extract protein from plants than it does meat. There are also a number of essential amino acids that are difficult to obtain from plants (amino acids are essential as they form the foundation of the cells in your body). One recent study, from November 2021, found that animal protein correlated with reduced mortality in older adults, whereas plant-based protein did not.
- Regular intake of fish and seafood: This is a valid inclusion. Fish and seafood are a valuable part of any heart healthy dietary strategy.
- Low-fat or fat-free dairy products instead of full fat dairy products: Dairy is naturally high in fat, so this recommendation is advising you to eat processed food. Not only that, but when making low-fat dairy products, additives like sugar are invariably added to improve the taste, so these foods contribute to people eating more sugar than they were aware of.
- If meat or poultry are desired, choose lean cuts and avoid processed forms: This guideline, more than any of the others, shows the misguided idea that this list is based on: that all fat is unhealthy. The natural fats present in meat and dairy are important aspects of a heart healthy diet, and what really needs to be avoided are the artificial trans-fats – unfortunately, they are present in most food products! Fat is an essential macronutrient that is vital for proper hormone regulation. Plus, animal products, including meat, continue to be the best sources of protein for humans. Protein is also very satiating, meaning when we eat it we feel full for longer – and this helps us to avoid reaching for snacks and sweets.
5. ‘Use liquid plant oils rather than tropical oils (coconut, palm and palm kernel), animal fats (butter and lard), and partially hydrogenated fats’
This is perhaps the worst recommendation on this list. ‘Vegetable oils’ are an artificial, processed oil that bear no relation to the vegetables they’re made from. Their name is little more than a marketing technique. In fact, the unsaturated fats in vegetable oils oxidize when heated, and this can cause inflammation in the body – a significant risk factor for heart attacks.
Vegetable oils contain large amounts of omega 6 fatty acids. Along with omega 3, these are essential oils that our body cannot produce by itself, so it’s important that we eat them. However, we have to eat them in the right ratio, of less than 1:4 (Omega 3:6) – but as omega 6 is present in almost all of our packaged foods and we’re largely deficient in omega 3, that ratio has been measured at 1:16! The result is we’re already consuming more omega 6 than we should be, and as it can cause inflammation (which is an important function in a healthy body) an excess of omega 6 has been linked to a large range of health conditions;.
- Chronic heart disease
- Diabetes
- A number of forms of cancer
My advice is ditch the vegetable oils as quickly as possible, and stick to olive oil, coconut oil, butter, lard or tallow.
6. ‘Choose minimally processed foods instead of ultra-processed foods’
A small amount of credit is due here, it is definitely better to eat slightly less unhealthy food than super unhealthy food.
But the truth is that as humans, all we should eat are things that grow in the ground or things that eat what grows in the ground. This means boxes of cereal, potato chips and cookies should not be in your kitchen.
7. ‘Minimize intake of beverages and foods with added sugar’
Again, this advice has some merit, but I would always say to avoid these wherever possible. Enjoy them on occasion if you want to, but they shouldn’t be consumed daily. The same should go for artificially sweetened beverages as there is no benefit to these other than that they are not sugar.
8. ‘Choose and prepare foods with little or no salt’
Salt is a necessary element of a heart healthy diet, as sodium is an electrolyte that is essential for the function of our cardiovascular system.
The concern around salt comes from the abundance of it in our processed foods, but it’s the vehicle that salt comes in – i.e. foods like chips and fries – that is unhealthy, not the salt itself. And, of course, because it’s present in so many common foods, many people are consuming more salt than they should. Once you eliminate processed foods from your diet, you may need to actually supplement your salt intake. Therefore, this AHA guideline is accurate for people who consume a lot of salty and processed foods, but inaccurate for people eating unprocessed and whole foods.
Finding your heart healthy diet
Overall, the advice given here is a continuation of the misguided advice we have been given for decades. If you’re looking to improve heart health then the focus should be on eating real whole foods and avoiding the lab-created concoctions so prevalent in the Western diet.
That doesn’t mean being too restrictive. You can enjoy a heart healthy diet whether you have carbs in your diet, follow a keto plan, or are vegan.
If you’re ready to take control of your diet to become healthier than ever before, I invite you to read my new book, which explains how to eat metabolically healthy on a range of diets.