American Heart Association Releases the First Updated Dietary Guidelines in 15 Years

New statement emphasizes sustainability, education, and finding a healthy-eating pattern in a sea of processed foods.

By Becky UphamReviewed: November 5, 2021FacebookTwitterPinterestCopy LinkFact-Checked

Adopting a heart-healthy diet isn’t about drastically changing your diet or restricting yourself to “good” foods that you don’t especially like, according to the American Heart Association’s new dietary recommendations.

“We recommend that you find a dietary pattern that’s consistent with what you enjoy but is still heart-healthy,” says Alice H. Lichtenstein, DSc, chair of the writing group for the AHA statement and senior scientist and director of cardiovascular nutrition team at the USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

“What we’ve learned is that when people try to make drastic changes in their diet because they suddenly decide they want to get healthier, they frequently don’t stick with those changes for a long period of time,” she says. If you make changes within your current dietary pattern that consider factors such as affordability, availability, convenience, and what you like to eat, it’s more likely to become more of a way of life, Dr. Lichtenstein.

2 out of 3 Heart Disease–Related Deaths May Be Prevented by a Better Diet

“People do look to the American Heart Association for dietary guidance, and the last statement issued was 15 years ago; it was time to update it,” says Lichtenstein. The new guidance was published on November 2, 2021, in the AHA’s flagship journal, Circulation.https://08c7da0d93b1111a2b35e184a03ac61b.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

Much of the advice — including eating a diet rich in fruits, vegetables, whole grains, and lean proteins — hasn’t really changed, she says. “But we know the messages have not necessarily been resonating as much as we would like them to,” she acknowledges.

Heart disease is the leading cause of death in both men and women in the United States, causing an estimated 659,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

More than two-thirds of heart disease-related deaths worldwide can be linked to food choices, according to a study published in October 2020 in the European Heart Journal Quality Care Clinical Outcomes. Study authors estimated that six million deaths could have been avoided through better diets.

To Eat a Heart-Healthy Diet, Focus on Eating Patterns

The new guidelines emphasize dietary patterns as opposed to individual foods or nutrients, says Lichtenstein. “Healthy eating is not only about what you eat, but also about what you don’t eat. If you’re eating more fruits, vegetables, and whole grains, you’re probably eating less of other foods that aren’t as heart-healthy,” she says.Top ArticlesREAD MOREDemonizing certain foods or food groups isn’t helpful, says Lichtenstein. “Stop thinking of foods in terms of good or bad. If you love a food, it’s okay to enjoy it — just don’t eat it frequently or in large portions,” she says.Takeout, Meal Kits, and Pre-Prepared Meals: How We Eat Today

There have been societal changes, including changes in the way we eat, that were important for the new guidelines to address, says Lichtenstein. “We get our food differently — part of that was accelerated by the pandemic, but people are getting prepared foods from restaurants and grocery stores or using meal kits more,” she says.

That needs to be considered and factored into a person’s whole dietary pattern, she says. “All the food and beverages and food you consume affect your health, regardless of whether they are prepared or eaten in your home or outside of it.”

Include More Sustainable Healthy Sources of Protein From Plants and Seafood

There is more of an understanding and concern about sustainability and carbon footprint than there was 15 years ago, and the new guidelines reflect that, says Lichtenstein.

“Carbon footprint” is the total greenhouse gas emissions caused directly or indirectly by a person, organization, event, or product, according to the Center for Sustainable Systems at the University of Michigan in Ann Arbor. Food accounts for about 10 to 30 percent of a household’s carbon footprint, and meat products have a larger carbon footprint per calorie than grain or vegetable products.

The basic principles of a heart-healthy diet — focusing on eating fruits, vegetables, and plant-based sources of protein — are consistent with a sustainable and environmentally responsible way of eating, says Lichtenstein.

Plant-based sources of protein can include foods like beans, lentils, peas, nuts, tofu, and seeds, according to the U.S. Food and Drug Administration (FDA).

Whatever Your Dietary Pattern, Consume Less Processed Food

Many popular diets emphasize consuming a lot protein and limiting carbs, but people should be wary if those diets involve a lot of highly processed foods, including items like high protein drinks or protein bars, says Lichtenstein. “And keep in mind there are healthy sources of carbohydrates, which would include things like whole grains and beans. Avoiding the less healthy sources of carbs is a good practice, as those tend to be highly refined and also have a fair amount of sugar and salt added,” she says.

The last several years has brought a growing recognition that healthy fats are good, she says. “At one point, there was sort of a phobia against fat of any type, but there are healthy sources of fat and less healthy sources of fat. In our statement, we make it clear that we are not recommending a low-fat diet, but rather that people get most of their fat from plant-based sources or seafood rather than animal-based fats,” says Lichtenstein.

Nutrition Inequities Reinforced by Food Insecurity, Limited Access to Healthy Foods and Targeted Marketing

There are societal challenges that make it harder for some individuals to consume a heart-healthy diet, and many of those issues disproportionally impact people from diverse race or ethnic backgrounds, according to the AHA statement.

Some of those factors include the following:

• Food and nutrition insecurity, as an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020
• Many communities with a higher proportion of racial and ethnic diversity having few grocery stores but many fast-food restaurants
• Targeted marketing of unhealthy foods and drinks to people from diverse racial and ethnic backgrounds, by way of ad campaigns and sponsorship of community events

Education on Nutrition and Healthy Eating Patterns Should Begin in Kindergarten

Food and nutrition education should begin in kindergarten and continue until graduation, says Lichtenstein. “Many kids may not be familiar with many foods or where they come from. They may not have people in their lives that are teaching them about what healthy foods are available or how to prepare them — everyone doesn’t have those opportunities,” she says.

Basic facts about nutrition and the shelf life and affordability of different foods should be taught at an early age, and then these concepts could be incorporated into real world scenarios as children get older, says Lichtenstein. “By having a framework with which to evaluate all the information that’s out there, they will be able to make better choices as adults,” she adds.

The committee also recommended that medical school provide more nutrition education to future health providers.

Expert Tips on Developing a Healthy Eating Pattern That You Actually Like

Educating yourself about the nutritional content of different foods is a good idea, but beware of misinformation on the internet, says Lichtenstein. “Getting information from reputable sources like government websites — the FDA or the National Institute of Health (NIH) — is a safe bet,” she says. Advocacy organizations such as the AHA or the American Diabetes Association will have sound dietary advice as well, she says.

If you read something about a certain food or diet that seems “too good to be true” it probably is, she says. When in doubt about embarking on a type of diet, talk to your healthcare provider.

Developing an eating pattern that’s going to work for you may take a little more work in the beginning, but once you figure it out it can easily become second nature, says Lichtenstein.

Shop around. Find out what different foods are available in your neighborhood at a price point that you’re willing to pay.

Find the healthiest options of the foods you eat regularly. Take time to compare different foods that you enjoy. “For example, if you like to eat soup or crackers, look at labels to find choices that are lower in sodium, added sugars or unhealthy fats.”

Check the internet for nutritional information on takeout or prepared meals. Many places have nutritional information for different items. As a general rule — even for prepared foods or takeout foods — the less processed the better.

When faced with options, keep heart-healthy guidelines in mind. If you’re faced with choices about bread or rice, choose whole grains when possible. When putting together a salad, focus on more vegetables and fewer items like bacon bits or heavy dressings.

Enjoy your food. Frequently people think that if a food is healthy, it’s not good, says Lichtenstein. “Not true. There’s so much of a range and flexibility in healthy choices — you should be able to find one that you enjoy.”