General Medical

Eating for Heart Health

Editors’ Note: We live in a world where we are concerned about what we eat, where it comes from, how it is produced, what its carbon footprint is, whether it comes from genetically modified foods, and the impact of water use in a world of increasing climate change. All of this affects not only our food choices but the moral decision made by many people about whether or not to eat meat, poultry, fish, eggs, or any dairy products. This is the first post by Stephanie Middleberg, a registered dietitian who has agreed to discuss the changing guidelines in food recommendations for the prevention of heart disease (this is American Heart Month). We are not making recommendations about what anyone should eat from a moral or ethical vantage point.  We leave those decisions up to each of you. —Ed.

6877886245_3a0e1f2a15_zImage from Flickr via (Creative Commons License)

Heart-health nutrition guidelines have changed recently.  The scientific advisory panel for the Dietary Guidelines for Americans—a joint project of the Departments of Agriculture and Health and Human Services—has recommended that limitations on dietary cholesterol be removed from the upcoming 2015 Dietary Guidelines, which will be released in its final version in the fall of 2015.  This edition, as recently noted by The Washington Post, will mark perhaps the biggest change since the original 1977 advice by dropping the warning about cholesterol consumption. 

 People who wanted to lower their cholesterol and triglycerides in the late 20th century to decrease their risk of heart disease had quite different grocery shopping lists than those that nutritionists recommend now.  Just think about those choices:  skim milk, cartons of pre-sorted egg whites or Eggbeaters, margarine or a tub of I Can’t Believe It’s Not Butter.  At the checkout counter these choices seemed both sensible and an interpretation of what doctors meant with their instructions to eat a heart-healthy diet.

Fast forward to 2015, where on the Today show there was a demonstration of  people drinking coffee with a stick of  grass-fed butter in it! People are drinking full-fat milk, eating numerous eggs with the yolks, and sales of beef and pork are through the roof!  Are these really the new recommendations? Why did the recommendations change? What should your 21st-century menu planning and grocery lists look like?

There is a major shift occurring, not only in our tastes but in dietary recommendations based on science.  As a nutritionist, I cannot be more supportive of this direction.  Meat and poultry are an integral part of the American diet, and the Dietary Guidelines Advisory Committee’s failure to recognize the role of lean meat as a component of the American diet has been a source of disagreement between the agribusiness industry and the government and health organizations that work with nutrition and medical scientists, including the members of the American Heart Association.  The new guidelines are likely to support eggs, shellfish, and liver as part of a heart-healthy diet.  The addition of lean meat and poultry is still not fully on the table, but as a nutritionist I believe that these nutrition-dense foods, in small amounts, can be an important part of a balanced diet.

Twentieth-century guidelines were based on the concept that heart disease was the result of a diet high in fat and cholesterol, resulting in low-fat dietary guidelines that were first published in 1977.  These guidelines influenced every major health organization, whether governmental or health association, and they were treated as the truth.  Want to prevent heart disease? Cut out the butter, fat, eggs, and red meat and replace these with “low fat” industrially produced food like products that were filled with the wonders of modern science: artificial flavorings, chemical additives, etc. There was no debating it; even science was claiming the same thing.  Yet as low fat became the norm (and the recommended foods were filled with high fructose corn syrup, trans-fat, salt. and refined carbs), all the things it was meant to eliminate—obesity, diabetes, and, yes, even heart disease—became more and more prevalent.

The arguments over the dangers of saturated fats will continue in spite of the evidence that dietary sources of cholesterol do not always increase the cholesterol in the blood stream.  Each person has a genetic makeup that affects how the dietary cholesterol will be managed in that person’s body.  There is an ongoing discussion about the relationship of total cholesterol (as well as the many sub-types of cholesterol) to the risk of developing heart disease. 

We have not yet done a complete 180.  While we now know that many of these fats are actually good for us, no one is saying you should go out and eat a dozen eggs for breakfast and follow up with a cheeseburger for lunch.  However, you can include high-quality fats, organic eggs, wild fish, and omega 3s, as well as plant-based fats (nuts, seeds, avocados, for example) in your diet along with small amount of grass-fed meat and pasture-raised chickens.  Be mindful of portion size (keep to two eggs max at any one serving; limit meat portions to 4 ounces; keep butter in cooking to one to two tablespoons).  There IS such a thing as TOO MUCH of a good thing.  However, modifying your intake of fats is not the only important part of the equation. There are many other pillars to nutritional health, such as the quality of the food you’re eating, quantity, and timing.  A diet that is primarily focused on whole plant-based foods, with the inclusion of healthy fats (see the list below), high-quality proteins, and complex carbs makes sense and yields long-term health and weight benefits.

And that leads us to the next point: What is too much of a good thing as it relates to your physical body?  We still use the once-ubiquitous BMI (body mass index), but we no longer consider it to be the holy grail of determining the risk level for a host of ailments, including heart disease.  A focus on the BMI used to be one of the hottest trends in nutritional and bariatric medicine (a weight-loss medical subspeciality).  Companies, mostly out of business now, offered at-home BMI measuring devices as they rushed in to get part of the new, lucrative weight-loss market. Where are all those devices today? In the garbage. Why? Well, BMI does not provide the total story. Professional athletes, in great physical shape, might have BMI numbers that would put them in the obese category. Then there are many people with a low BMI who appear slim but are in terrible physical health. The question to ask is, what are other indicators of physical health in relationship to weight and body mass? The most important indicator is fat distribution, such as waist-to-hip ratio. Those with a lot of belly fat are at far greater risk for heart issues. We are also learning that the type of cholesterol is a more important indicator of heart disease risk than total cholesterol. Science is taking us in new nutritional directions.  


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  • Kevin March 5, 2015 at 5:49 am

    eating healthy and regular exercise will all contribute to keeping your heart healthy.

  • Roz Warren February 20, 2015 at 8:19 am

    I’ve been avoiding low fat salad dressing for years. Thanks for backing me up.

  • ellen sue spicer-jacobson February 16, 2015 at 3:06 pm

    Excellent article! I just posted the link on my website and encourage readers to read the article. The list at the end needs to posted in many places!

  • Abigail congdon February 16, 2015 at 8:04 am

    This is thought provoking and seems sensible but, truly, full fat dairy? Is this really so? What a turn around.. I look forward to hearing more. Thanks AC