​​Ten Things to Know About the American Heart Association’s New Dietary Guidelines

The AHA’s scientific statement, “2021 Dietary Guidance to Improve Cardiovascular Health,” includes the ten recommendations listed in bold type below. For each of them, we’ve included our actionable tips and additional resources to learn more. We applaud the AHA for taking a personalized approach to cardiovascular health, which has been a core concept of the BaleDoneen Method since its inception two decades ago. To optimize your eating plan, we recommend following a diet based on your DNA, as discussed in more depth below.

1. Achieve and maintain a healthy weight. If you are overweight or obese, even small changes in your diet can dramatically improve your heart health. For example, a recent study found that people who ate 300 fewer calories a day — the equivalent of two chocolate chip cookies or a slice of pizza — not only lost an average of 16 pounds over a two-year period but also had significant improvements in their cholesterol, blood pressure, blood sugar and other markers of cardiovascular and metabolic health. Also consider intermittent fasting: Studies show that it’s one of the best anti-inflammatory diets around and can help reduce or even reverse insulin resistance, the root cause of 70 percent of heart attacks, many strokes and almost all cases of type 2 diabetes.
2. Eat a variety of fruit and vegetables. Consuming more of these nutritional powerhouses could save your life! Two Harvard studies of nearly 110,000 men and women found that people who ate eight or more servings of fruits and veggies daily were 30 percent less likely to suffer a heart attack or stroke than those who ate less than 1.5 servings. Another recent study of nearly 400,000 men and women found those whose diet was highest in fiber (found in most fruits and vegetables) had a nearly 60 percent lower risk of dying from cardiovascular disease, infectious disease, or respiratory disorders. One easy way to get a full spectrum of health benefits is to “eat the rainbow” by including a variety of colorful fruits and veggies in your daily diet. Also check out our easy recipe for building the perfect vegetable soup.
3. Choose whole grain foods. Although the AHA guidelines don’t provide much detail about which grains to choose, there is strong scientific evidence that people with certain genotypes benefit from following a gluten-free diet to protect their heart health. We use a one-time blood test to identify your haptoglobin (Hp) genotype, which offers insight into heart disease risk and which foods and supplements are beneficial for you. The Hp gene has two alleles, Hp 1 and Hp 2. Since you inherit one allele from each parent, there are three possible genotypes: Hp 1-1 (linked to low risk for heart disease), Hp 1-2 (intermediate risk) and Hp 2-2 (high risk). Recent studies suggest that people with the Hp 1-2 and Hp 2-2 genotypes benefit from a gluten-free diet as part of their heart-attack-and-stroke-prevention plan, while there’s no cardiovascular advantage for those with the Hp 1-1 genotype. Gluten-free grains include amaranth, buckwheat, oats, corn, quinoa and brown or wild rice.
4. Choose healthy proteins, mostly from plant sources. The guidelines advise using plant-based protein sources (such as beans, nuts and seeds) over processed meats. A large body of research suggests that people who eat fish several times a week — particularly oily fish, such as tuna, salmon, sardines, lake trout and herring — have a lower risk for cardiovascular disease than those who eat little or no fish. Because oily fish are a good source of heart-healthy omega-3 fatty acids, the AHA recommends having at least two servings weekly and substituting nonfat and low-fat dairy products for the full-fat versions. If you eat meat, choose small portions that are lean and unprocessed. For more ideas on heart-healthy nutrition, check out our delicious recipes.
5. Use liquid plant oils. The guidelines advise opting for plant oils, such as olive, sunflower, canola or walnut oil, instead of tropical oils (such as coconut, palm and palm kernel oil), animal fats (such as butter and lard) and partially hydrogenated fats. Unhealthy oils to avoid may be listed as “trans fats” on food labels. Our DNA-based diet uses your Apo E genotype to determine the optimum amount of fat in your diet. This test analyzes your Apolipoprotein E (Apo E) genotype, which influences both your lifetime risk for coronary heart disease (CHD) and the best diet to avoid it. The Apo E gene has three variants (E2, E3 and E4), resulting in 6 possible genotypes: Apo E 2/2, Apo E 2/3, Apo E 2/4, Apo E 3/3, Apo E 3/4 and Apo E 4/4. People with Apo E 2/2 or 2/3 genotypes have the lowest risk for CHD and do best with a diet containing 30% to 35% fat from heart-healthy sources, such as Omega-3 rich oily fish, nuts and olive oil. Those with the 3/3 or 2/4 genotypes benefit from the Mediterranean diet, which emphasizes plant-based foods, fish and moderate amounts of yogurt and cheese. This diet should have 25% to 30% fat. For people with the Apo E 3/4 or 4/4 genotypes, which are linked to the highest CHD risk, the best bet for prevention is to eat a very low-fat diet (less than 20% fat) and limit or avoid alcohol.
6. Choose minimally processed foods. Make fresh foods and those with minimal processing (such as raw, unsalted nuts) the mainstays of your diet and avoid packaged foods that contain preservatives, artificial colors or flavors and chemicals you can’t pronounce. Common examples of processed foods include breakfast cereals, meat products (such as bacon, salami, sausages and deli meats), microwave or frozen meals, packaged snacks (such as potato chips and taco chips) and store-bought baked goods.
7. Minimize or avoid foods and beverages with added sugar. As we recently reported, sugar is actually worse for your heart than saturated fat. In fact, a recent study found that a diet high in sugar triples risk for fatal cardiovascular disease, and other research shows that excessive sugar intake raises risk for cancer, diabetes, obesity and many other chronic or life-threatening diseases. About 75 percent of packaged foods contain added sugar, including many that you don’t think of as sweet, such as tomato sauce, salad dressing and many sauces and condiments. Watch out for sugar’s various aliases on food labels, such as sucrose (table sugar), corn syrup, molasses, honey, fructose and almost any other ingredient that ends with “ose.” A good rule is to avoid any food that lists sugar in any of its guises among the first 3 ingredients. Also ditch sweet drinks: Consuming just one or two sugar-sweetened beverages daily – such as energy drinks, fruit drinks, soda or coffee drinks – raises risk for a heart attack or dying from CVD by 35 percent, diabetes risk by 26 percent, and stroke risk by 16 percent, according to a 2015 Harvard study. Instead, quench your thirst with our refreshing fruit and herb-infused water recipes.
8. Limit alcohol consumption. Over the years, many prospective studies have reported an association between moderate drinking (one drink daily for women and two for men) and a 25-40 percent reduction in risk for CHD. Some researchers also reported decreased risk for heart attack, stroke, type 2 diabetes and high blood pressure in moderate drinkers. However, alcohol consumption also has a wide range of short- and long-term perils, including increased risk for atrial fibrillation (a dangerous type of irregular heart rhythm that is a major risk factor for stroke) and some forms of cancer. A study of nearly 600,000 people across 19 countries reported that having ten or more drinks a week shortened life expectancy. The AHA and BaleDoneen takeaway: If you don’t currently drink alcohol, don’t start. As we recently reported, following an optimal lifestyle can reduce your heart attack and stroke risk by up to 90 percent, even if it doesn’t include alcohol. If you imbibe moderately, discuss the risks and benefits with your provider.
9. Select and prepare foods with little or no salt. Cut back on the “Salty Six:” bread and rolls, pizza, sandwiches, cold cuts and cured meats, soup and burritos and tacos, all of which typically contain high levels of sodium. Limiting or avoiding packaged, processed foods, which are typically high in salt, may lower your blood pressure or help you avoid hypertension in the first place, the AHA reports. It’s also important to be aware that blood pressure guidelines have recently changed. Nearly half of U.S. adults — many of whom are undiagnosed and unaware of their peril — have high blood pressure, a condition that is often called “a silent killer” because it gives few clues to its presence as it wrecks hidden mayhem on the blood vessels and vital organs, including the heart and brain.
10. Make heart-healthy choices wherever you eat. Recent studies show that people who dine out frequently consume nearly 500 more calories daily than those who mostly eat at home. Not only were people who often ate at restaurants at increased risk for obesity, but in one large study, this group was also 31 percent more likely to have a dangerous buildup of arterial plaque, boosting their risk for heart attacks and strokes — and were also at increased risk for diabetes and high blood pressure. To counteract these threats, the AHA recommends that people follow its heart-healthy dietary guidelines no matter where they eat. For example, people can choose salad over French fries when they’re eating out, and have fresh fruit instead of chocolate cake for dessert. Another option is to pack healthy meals to enjoy when you’re away from home, such as our zesty Thai carrot and cucumber noodle salad in a Mason jar or our Must-Have Kale Salad to Go. For more heart-healthy recipes, click here.