Heart-Healthy Diets

Definition

A heart-healthy diet is an eating plan designed to keep blood cholesterol low and prevent the risk of cardiovascular diseases (heart disease and stroke) This is usually achieved by eating foods that are low in saturated fat, trans fat, dietary cholesterol, and sodium while including plenty of fruit and vegetables, whole grain foods, and some oily fish in the diet.

Healthy heart diets

NHLBI heart healthy diet guidelines

Therapeutic Lifestyle Changes (TLC) diet guidelines

American Heart Association diet and lifestyle guidelines

Saturated fat

8%-10% of the day's total calories

Less than 7% of the day's total calories

Less than 5-6% of the day's total calories

Total fat

30% or less of the day's total calories

25%-35% or less of the day's total calories

25%-35% or less of the day's total calories

Dietary cholesterol

Less than 300 milligrams a day

Less than 200 milligrams a day

Less than 300 milligrams a day

Sodium

Less than 2,300 milligrams a day

Less than 2,300 milligrams a day

Less than 2,400 milligrams a day

Calories

Enough calories to achieve or maintain a healthy weight and reduce blood cholesterol level

Enough calories to achieve or maintain a healthy weight and reduce blood cholesterol level

Number of calories based on age, gender, height, weight, and physical activity level, and whether trying to lose, gain, or maintain weight

Origins

The original healthy-heart diet arose out of ongoing nutrition research by organizations including the U.S. Department of Agriculture (USDA) and the American Heart Association (AHA). The USDA first issued dietary recommendations for Americans in an 1894 Farmer's Bulletin, according to the 1996 USDA report Dietary Recommendations and How They Have Changed Over Time. The recommendations came from W. O. Atwater, first director of the USDA's Office of Experiment Stations. He proposed a diet for American men based on protein, carbohydrates, fat, and mineral matter. In a 1902 Farmer's Bulletin, he warned about the danger of a diet consisting of too much protein or “fuel” ingredients (carbohydrates and fat). In 1941, the USDA first issued the recommended dietary allowances (RDAs). The allowances covered areas such as calorie intake and nine essential nutrients: protein, iron, calcium, vitamins A and D, thiamin, riboflavin, niacin, and ascorbic acid (Vitamin C). The USDA also released national food guides during the 1940s. The guides provided a foundation diet with recommendations for foods that contained the majority of nutrients. The guide was modified in 1956 with recommended minimum portions from food groups that the USDA called the “Big Four”: milk, meats, fruits and vegetables, and grain products.

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), is one source of information for the dietary guidelines. The institute developed both the Healthy Heart diet and the Therapeutic Lifestyle Changes diet (TLC diet), which are aimed at keeping cholesterol low and promoting overall health. The American Heart Association (AHA) is a nonprofit organization also concerned with educating the public about the relationship between diet and heart health. The organization's public education activities include issuing nutritional guidelines that are periodically revised. They reflect current scientific thinking on the importance of diet and exercise in preventing heart disease, a combination endorsed by the medical community and public health organizations.

Description

Heart-healthy diets share fundamental elements about how to prevent heart disease. The process starts with an understanding of why some foods should be avoided and others are beneficial to the heart. The first step is for individuals to be aware of the ways diet affects heart health.

An internal delivery system

The heart is a muscle, and the body's muscles require a steady supply of oxygen and nutrients. This supply is brought to the heart by blood in the coronary arteries. Heart-healthy diets are designed to keep the coronary arteries open for the delivery of oxygen and nutrients. When the arteries become narrow or clogged, the heart will not receive enough blood. This blockage causes coronary heart diseases. If the heart does not receive enough blood-containing oxygen, the person feels chest pain, known as angina. If the coronary artery is totally blocked off and no blood reaches the heart, the individual experiences a heart attack.

The narrowing or clogging of arteries is known as atherosclerosis. Blockages are caused by deposits of cholesterol and fat. Cholesterol is a soft, waxy substance that is similar to fats (lipids). Cholesterol occurs naturally and is found throughout the body in the bloodstream and cells.

Cholesterol's functions

Cholesterol is used by the body to produce vitamin D, hormones, and the bile acids that dissolve food. The body does not need much cholesterol to perform those functions, so extra cholesterol is deposited in the arteries.

Cholesterol and fats do not dissolve in the bloodstream and are moved through the body by lipoproteins. These consist of a lipid (fat) surrounded by a protein. Total cholesterol consists of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL).

VLDL carries triglycerides, a form of blood fat that could affect the heart. LDL is known as “bad” cholesterol, and HDL is known as “good” cholesterol. HDL may help the body by clearing fat from the blood and removing extra cholesterol, according to the AHA. LDL is made in the body by the liver and from foods, particularly those rich in saturated fat or trans fats.

Fat facts

Food contains three types of fats that should be monitored in a heart-healthy diet:

Saturated and trans fats contribute to high LDL cholesterol and an increased risk of heart disease. Unsaturated fats, on the other hand, promote higher levels of HDL cholesterol and help keep overall cholesterol in check. They can be used to replace saturated fat or refined carbohydrates in foods, which will also promote lower LDL levels. The AHA recommends limiting total fat intake to 25%–35% of daily calorie intake, with no more than 7% coming from saturated fats and less than 1% from trans fats. The majority of fats should come from poly- and monounsaturated sources.

Sodium

Sodium and salt (sodium chloride) are often mentioned in information about heart-healthy diets. The AHA recommends that people consume less than 2,300 milligrams (mg) of salt per day. This amounts to about 1 teaspoon of salt. Some organizations recommend a slightly higher maximum amount of 2,400 mg. This recommended intake is for healthy people and may be lower for people with certain health conditions.

The diets of most Americans contain too much salt, and processed foods are generally the source of this sodium. A diet high in salt tends to raise blood pressure, and this could lead to heart disease, stroke, and kidney damage.

Reducing the amount of sodium in a diet lowers blood pressure. In addition, foods high in potassium such as bananas, dates, dried apricots, prunes, raisins, and avocados can counteract some of the effect of sodium on blood pressure, according to the USDA guidelines.

Creating a heart-healthy diet

The U.S. federal government and the AHA are among the organizations that provide recommendations for a healthy lifestyle. The recommendations frequently parallel those of the NHLBI's Healthy Heart diet, a plan that emphasizes the consumption of less fat, less cholesterol, and less sodium. These guidelines also agree that diets should include fiber-rich foods such as fruits, vegetables, and whole grain products as well as oily fish such as salmon or mackerel. This diet mirrors the Mediterranean diet, which has been associated with improved heart health profiles. Studies have also shown that following a healthy vegetarian or plant-based diet is associated with reduced risk of heart disease.

Guidelines also focus on the importance of regular physical activity to prevent or lower the risk of heart disease. Conversely, inactivity or sedentary behavior is associated with increased risk of poor cardiovascular health. Regular physical activity can reduce this risk while also providing the benefits of avoiding excess body weight and improving cardiovascular fitness. The U.S. Department of Health and Human Services (DHHS) Physical Activity Guidelines for Americans recommend that healthy adults complete at least 150 minutes of moderate intensity physical activity per week, including muscle strengthening exercises on two or more days each week. Although these recommendations are designed for healthy people, the guidelines also apply to a heart-healthy diet. More specific instructions can be found in plans to lower cholesterol levels.

DIETARY GUIDELINES FOR AMERICANS 2015–2020. The Dietary Guidelines define a healthy eating plan as one that:

The 2015 Dietary Guidelines for Americans was the eight edition of the dietary guidelines. These guidelines were developed to provide guidance on how healthy eating patterns and regular physical activity can help people achieve and maintain good health and reduce risk of chronic disease throughout the lifespan. The guidelines provided examples of a number of healthy eating patterns, recognizing that people eat combinations of foods at meals rather than single foods in isolation.

Some specific guidelines included:

More specific guidelines and examples of healthy eating patterns can be found at https://health.gov/dietaryguidelines/2015 .

People can create a diet following these guidelines by using online tools such as the USDA's ChooseMyPlate (formerly MyPyramid) plan and calculators on the NHLBI pages for the Heart Healthy and TLC diets. Some internet sites produce an individualized plan with specific calorie amounts, recommended foods, serving portions, and a system to track physical activity.

AMERICAN HEART ASSOCIATION DIET AND LIFESTYLE RECOMMENDATIONS. The AHA's plan starts with an individual determining how many calories are needed to maintain a healthy weight. People are advised not to eat more calories than they burn through activity. They should create a meal plan that includes:

The association advises the public to cut back on:

The association certifies grocery products that meet the organization's standards. Certification on packaging is indicated by a red heart with a white check mark. All products with that symbol meet association criteria per serving (or amount customarily consumed) for a number of nutrients, such as total fat, saturated fat, sodium, and cholesterol, with additional recommendations not limited to subcategories such as whole grain foods, grain-based snacks, smoothies, and lean meats and seafood.

THE NHLBI HEART HEALTHY DIET. The NHLBI recommends that meal planning for the Healthy Heart diet be based on these guidelines:

THE TLC DIET. The Therapeutic Lifestyles Changes (TLC) diet helps to lower the cholesterol of people who have a heart disease or are at risk of developing one. The TLC section of the NHLBI contains online tools similar to those for the Healthy Heart diet. The guidelines for the low-saturated fat, low-cholesterol TLC diet are:

Function

Heart-healthy diets help reduce the risk of cardiac disease by including foods that keep total cholesterol and LDL cholesterol at healthy levels. A heart-healthy diet may involve lowering cholesterol levels by reducing the amount of foods high in fat and sodium. At the same time, individuals should work to increase HDL levels through diet and exercise.

A heart-healthy diet is a lifelong process that starts with education about the effects of food on the heart. People on this diet learn to make wise food choices, relying on information that includes the nutritional labels on processed food. The labels provide information about the calories, fats, sodium, and sugar in a single serving of the product.

Benefits

Heart-healthy diets are intended to help people lower their cholesterol levels and reduce their risks of cardiovascular disease. Heart-healthy diets can be preventive and, because they employ basic principles of healthy eating, are considered safe for people ages two and older to follow. Parents who place their children on heart-healthy diets not only help them with physical health but also give their children the basic tools for a lifetime of healthy habits.

The NHLBI Healthy Heart diet and other formal diets can also be used as weight loss plans to help obese and overweight people shed excess pounds. Obesity is a risk factor for heart disease, as are diabetes and high blood pressure. People diagnosed with these conditions will benefit from a following a heart-healthy diet in addition to the treatments recommended by their doctors.

Because heredity is a risk factor for heart disease and high cholesterol, people with a family history of either condition may wish to follow a heart-healthy diet. The NHLBI defines a person at higher risk of developing heart disease as someone with a father or brother diagnosed with this condition before the age of 55 or someone with a mother or sister with this condition diagnosed before the age of 65.

Furthermore, cholesterol levels rise as a person ages. The level rises in men at age 45 and older. For women, the increase is generally seen at age 55 and older, according to NHLBI.

Precautions

Heart-healthy diets are safe for people ages two and older. Some individuals may need to consult their doctors before eating some foods, such as fish. In 2004, the U.S. Food and Drug Administration and the Environmental Protection Agency warned pregnant women and nursing mothers to limit their consumption of fish and shellfish to 12 ounces (340.2 gm) per week. The warning was issued because of the risk that toxins in seafood might cause developmental problems in babies and children. Furthermore, women who are pregnant or nursing should not eat shark, marlin, and swordfish because of the high mercury content in these fish.

Risks

When following a heart-healthy diet, people need to be aware of the nutritional content of the foods they consume. They need to evaluate that information and make wise food choices. For example, the AHA points out that nuts and seeds are cholesterol-free sources of protein and a source of unsaturated fat, but nuts and seeds are high in calories. Furthermore, frozen meals that are low in calories and fat should be examined for their sodium content.

KEY TERMS
Angina—
A medical condition that occurs when insufficient blood flows into the heart, which causes chest pains.
Atherosclerosis—
A type of arterial disease that increases the chance for cholesterol depositing as plaque on the inner surface of the arteries, which can reduce blood flow.
Cardiovascular—
Related to the heart and blood vessels.
Cholesterol—
A waxy substance made by the liver and also acquired through diet. High levels in the blood may increase the risk of cardiovascular disease.
Diabetes—
A condition in which the body either does not make or cannot respond to the hormone insulin. As a result, the body cannot use glucose (sugar).
Hypertension—
High blood pressure.
Triglyceride—
A natural fat found in tissue; it is formed from one molecule of glycerol and three molecules of fatty acids.

Research and general acceptance

More than a century ago, W. O. Atwater of the USDA cautioned about the dangers of overeating. His warning proved accurate. Cardiovascular disease has been the leading cause of death in the United States in each year since 1900, with the exception of 1918, according to the American Heart Association's Heart Disease and Stroke Statistics—2012 Update. The AHA compiles the statistical report annually in conjunction with government agencies.

According to the 2018 report, CVD was reported as the underlying cause of nearly 836,546 deaths, or about 1 of every 3 deaths in the United States. About 2,000 Americans die of CVD each day, which is an average of one death every 38 seconds, and 92.1 million U.S. adults are living with some form of CVD or aftereffects of a stroke. In 2013, cardiovascular disease was responsible for 31% of all deaths globally.

QUESTIONS TO ASK YOUR DOCTOR

Since the 1970s, research has shown the link between chronic diseases, such as heart disease and stroke, and risk factors, such as carrying excess body weight, smoking, physical inactivity, and poor nutrition. To help communicate simple messages, the American Heart Association gauges the cardiovascular health of the nation by tracking seven key health factors and behaviors that increase risk of cardiovascular disease, Life's simple 7.These include not smoking, being physically active, having a healthy diet, maintaining a healthy body weight, and controlling blood cholesterol, blood pressure and blood sugar levels. Federal agencies and organizations have responded with a range of programs to promote the benefits of heart-healthy diets.

See also American Heart Association No-Fad Diet ; Coronary heart disease ; DASH diet ; Healthy People 2020 ; Low-cholesterol diet ; Low-fat diet ; Low-sodium diet ; TLC diet ; Trans fats .

Resources

BOOKS

American Heart Association. American Heart Association No-Fad Diet: A Personal Plan for Healthy Weight Loss. 2nd ed. New York: Clarkson Potter, 2011.

Pinnock, Dale. Eat Your Way to a Healthy Heart. London: Quadrille, 2018.

WEBSITES

American Heart Association. “Diet and Lifestyle Recommendations.” Heart.org . http://www.heart.org/HEARTORG/HealthyLiving/Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WtxD0C7wapp (accessed May 24, 2018).

American Heart Assocation. “Healthy Eating.” Heart.org . (accessed May 24, 2018).

American Heart Association. “Heart and Stroke Statistics (2018).” Heart.org . (accessed May 24, 2018).

American Heart Association. “Lifestyle Changes for Heart Attack Prevention.” Heart.org . http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Lifestyle-Changes_UCM_303934_Article.jsp (accessed May 24, 2018).

Mayo Clinic. “Menus for Heart-Healthy Eating: Cut the Fat and Salt.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/hearthealthy-diet/art-20046702 (accessed May 24, 2018).

MedlinePlus. “Diets.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/diets.html (accessed May 24, 2018).

National Heart, Lung, and Blood Institute. “Healthy Weight Tools.” National Institutes of Health. http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/tools.htm (accessed May 24, 2018).

Office of Disease Prevention and Health Promotion. Dietary Guidelines for Americans, 2015–2020. U.S. Department of Agriculture, U.S. Department of Health and Human Services. https://health.gov/dietaryguidelines/2015 (accessed May 24, 2018).

U.S. Department of Agriculture. “ChooseMyPlate.” ChooseMyPlate.gov . http://www.choosemyplate.gov (accessed May 24, 2018).

U.S. Department of Agriculture. “Food and Nutrition.” U.S. Department of Health and Human Services. https://www.usda.gov/topics/food-and-nutrition (accessed May 24, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Ste. 2190, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www . eatright.org .

American Heart Association, 7272 Greenville Ave., Dallas, TX, 75231, (888) 242-8883, help@onlineaha.org, https://www.onlineaha.org .

British Heart Foundation, Greater London House, 180 Hampstead Rd., London, United Kingdom, NW1 7AW, +44 20 (0300) 330 3322, http://www.bhf.org.uk .

National Heart, Lung, and Blood Institute, Bldg. 31, 31 Center Dr., Bethesda, MD, 20892, (301) 592-8573, nhlbiinfo@nhlbi.nih.gov, http://www.nhlbi.nih.gov .

Liz Swain
Revised by Anne P. Nugent, PhD RNutr

  This information is not a tool for self-diagnosis or a substitute for professional care.