“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 guidelines
to improve the hearts and health of Americans of all ages and life
circumstances.
The experts who wrote the guidelines
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 guidelines 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 guidelines 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.”
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