Don’t get started on alcohol if you haven’t. It’s poison for your heart and weakens its muscles from the very first sip. Start diet changes early, match exercise with your diet portion to maintain ideal body weight and give up saturated fats entirely. These are guidelines for a heart-friendly diet issued by the American Heart Association, which have been published in the journal ‘Circulation.’
The new guidelines supersede those of 2021 and bring about a more sustainable kind of diet that agrees with all parameters of heart health, namely cholesterol, blood sugar, hypertension and obesity. “The most significant change from the earlier guidelines is focussing on early diet change. Though the AHA doesn’t mention how early, probably factoring in those on poor, energy-deficient diets, it can be assumed that healthy diet discipline is crucial for foundational years. This is clear from its crackdown on high salt, high sugar foods. It takes a bold stance against alcohol consumption, calling for immediate limits by drinkers, and links a good diet with exercise and weight, calling for a holistic approach to preventive heart health,” says Dr Ranjan Shetty, lead cardiologist and medical director at Sparsh Hospital, Bengaluru. So, what’s the nine-step approach?
Continue heart-healthy dietary patterns across one’s lifetime
The AHA guidelines do not focus on ingredients alone but prioritise a dietary approach to heart care that almost becomes your daily food habit. They elaborate that the impact of diet quality on cardiovascular health starts as early as the prenatal period. Therefore, it calls for changes in diet and lifestyle behaviour among pregnant women. “In India, most women tend to develop gestational diabetes and hypertensive disorders. Since dietary patterns and habits shape the child’s foundational health and food environment in growth years, the AHA has taken a very pragmatic approach,” says Dr Shetty. The guidelines even recommend a heart-healthy dietary pattern for children starting at one year of age. The guidelines say, “Role modelling heart-healthy dietary patterns at every life stage can help sustain cardiovascular health across the life course and encourage favourable intergenerational transmission of positive lifestyle behaviours.”
Choose the same heart-friendly diet regardless of where it is consumed
One of the strongest dietary guidance norms talks about making conscious and consistent food choices, be they at homes, commercial establishments, institutions (schools, workplaces, hospitals), and recreational venues. “This emphasis on the sameness of a heart-healthy diet — characterized by high fibre, fruits, vegetables, healthy fats and low sodium/sugar — is universally beneficial because it addresses the foundational causes of cardiovascular disease, such as high blood pressure, inflammation and plaque buildup, rather than just treating symptoms. Such diets, like the Mediterranean or DASH plans, improve cardiovascular health in nearly everyone by reducing bad (low density lipoprotein or LDL) cholesterol and improving blood vessel function,” says Dr Shetty.
What foods have been recommended?
The AHA has re-emphasised eating plenty of vegetables and fruits, whole grains, choosing healthy sources of protein like plant proteins, unsaturated fats (like those derived from nuts) in place of saturated fat, choosing minimally processed foods instead of ultra-processed foods, minimising intake of added sugars in beverages and foods, reducing salt intake and staying away from alcohol if not already a drinker.
The guidelines advocate an all-nutrient approach to foods. “Legumes (beans, peas, and lentils) and nuts are good sources of protein and are rich in unsaturated fat and fibre. Dietary patterns higher in legumes and lower in red and processed meat have been associated with lower coronary heart disease risk,” they say. “While advocating a low carb diet, the guidelines make room for smart use of protein foods that also contain complex carbohydrates. These do not break down easily and delay sugar release in the bloodstream. A single cup of cooked lentils provides approximately 36–40g of carbohydrates, though their high fibre content (14–16 g) results in about 20–24g of net carbs, making them a nutritious, high-fibre, plant-based food,” says Dr Shetty.
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The guidelines recommend fish and seafood because of their omega-3 fatty acid content compared to other forms of animal protein. To help those who are still on red meat transition gradually, the guidelines advise lean cuts, avoiding processed forms and limiting portion size. “What I like is the way the association points out to the hidden dangers of processed meat, which contain extra salt, nitrates, flavour enhancers, binders and fillers and smoke flavour. The framers quote substitution analyses indicating that the replacement of processed meats with other protein sources is associated with lower mortality rates,” says Dr Shetty.
The AHA also breaks down what makes for added sugar. “These include brown sugar, cane sugar, confectioner’s sugar, coconut sugar, invert sugar, raw sugar, white granulated sugar, corn syrup, high-fructose corn syrup, rice syrup, malt syrup, maple syrup, pancake syrup, fruit juice concentrates, nectar, concentrated vegetable juices, honey, molasses, dextrose, fructose, glucose, maltose, lactose, and agave nectar. There is strong evidence to support recommendations to minimize added sugar intake across the life course,” say the guidelines.
Added sugar is proven to raise the risk of obesity, Type 2 diabetes, coronary heart disease and cardiovascular mortality. “It has been estimated that adults consuming above 25% of energy from added sugars have a nearly three-fold higher risk of CVD mortality compared with those consuming less than 10% of energy from added sugars,” explain the guidelines.
Adjust energy intake and expenditure
Experts have stressed on preserving a healthy body weight across the life course to optimise cardiovascular health. “Basically, what they are saying is that make sure that the number of calories that goes in should be expended and not pile up unspent. Interestingly, the guidelines recommend that everybody should be encouraged to participate in muscle-strengthening activities throughout the life course,” says Dr Shetty.
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Adherence to the nine-step approach is the easiest way to ensure prevention against all lifestyle-induced diseases.
