The key to a healthy heart is lifestyle, not a strict diet, according to new guidelines from the American Heart Association.
About every five years the AHA updates its diet advice. This year, for the first time, the guidelines stress lifestyle as much as diet.
Tufts University researcher Alice Lichtenstein, DSc, chairs the AHA nutrition committee that wrote the new recommendations.
"We wanted to present recommendations that would be easily adopted by the general public," Lichtenstein tells WebMD. "There is a de-emphasis on numbers, and more on answering basic questions: What can I do? How do I do it? How do I make changes right now?"
The new guidelines don't lay down the law about how much to eat, what to eat, and when to eat. They instead focus on healthy diet and lifestyle patterns. And they offer practical ways for real people to make lifesaving changes, says WebMD's director of nutrition, Kathleen M. Zelman, MPH, RD.
"Eighty percent of heart disease is preventable with healthy lifestyle: good food, fitness, and normal weight," Zelman says. "Dietary patterns are what it's all about. The AHA says, 'This is the gold standard.' But you don't have to get there overnight. It is not about perfection -- it is about making progress toward the healthier lifestyle. And the payoff is huge."
The guidelines appear in the July 4 issue of the AHA journal Circulation.
In Balance: Food and Activity
Lichtenstein says it's all about balancing the food one takes in with the energy one puts out.
"If you have the best diet, but get no physical activity or if you smoke, it is going to impact your heart health," she says. "When one makes decisions about food choices and activity patterns, it is important to make sure they are balanced."
In a nutshell, the AHA says you can avoid heart disease if you:
--Eat a healthy overall diet.
--Balance calories consumed with calories burned.
--Get at least 30 minutes of physical activity each day.
--Eat lots of fruits and vegetables.
--Choose whole-grain, high-fiber foods.
--Eat fish -- especially oily fish such as salmon -- at least twice a week.
--As much as you can, avoid saturated fats and trans fats.
--Cut back on cholesterol by choosing lean meats and fat-free or low-fat dairy foods.
--Cut back on beverages and foods with added sugars.
--Cut back on salt added to food -- especially if you're middle aged or older, African-American, or have high blood pressure.
--If you drink alcohol, drink in moderation.
--Make healthy choices when dining in restaurants.
Don't let this list overwhelm you, Lichtenstein and Zelman say. The idea isn't to burn out after two weeks of strenuous effort, but to gradually adopt healthy habits for the rest of your life.
"We're talking about making small, incremental, permanent changes in your habits," Lichtenstein says. "This is the only way to make enough of a change, for a long enough time, to accrue benefits."
Advice for the 'Average' Person
How do we average, heavier-than-we-should be, underactive Americans do this?
"What a person has to do first is think in an honest way: What am I eating? Then look at the guidelines," Lichtenstein say. "Hmm, I am still using full-fat dairy foods. That is a change I can make. I am not eating enough fruit and vegetables. How can I increase this? Should I make sure there's more fruit around the house to snack on? Should I stock up with more frozen vegetables so they are on hand when I make dinner? Should I learn to make fresh vegetables?"
Rather than look at each item with despair, Lichtenstein and Zelman advise us to go down the list and think, truthfully, about what we can do.
"You want to make small changes and make progress by baby steps," Zelman says. "You don't have to be perfect. If your diet is on the less-healthy end of the spectrum, start by choosing better meat, see if you can get salmon every week. Buy brown bread instead of white. Get half whole-wheat pasta."
The same thing goes for exercise.
"Nobody says you have to get all your exercise at once; you can do it a little at a time," Lichtenstein says. "If you work in a building with stairs, go out of your way to use the stairs. If you don't have stairs, think about how to do more walking when doing errands, like parking further away from the store. Or maybe you can find a neighbor or family member you can take walks with. There is no one easy answer for everybody. But you are never too old or too out of shape to be active. It is a matter of incorporating exercise into daily life, so it really will be your permanent, default mechanism."
Practical Tips for a Healthy Heart
The AHA guidelines offer some very practical advice:
--Learn how many calories you need a day -- and know the calorie counts for the foods you eat.
--Track your weight and physical activity.
--Prepare and eat smaller portions.
--Track your screen time -- and try to cut back on time spent in front of the TV and computer, and playing video games.
--Add physical movement to your daily activities.
--If you drink, no more than one drink a day for women and two for men. A drink is one 12-ounce beer, one 4-ounce glass of wine, or a 1.5-ounce shot of 80-proof spirits. All contain ½ ounce of alcohol.
--Read the nutrition information on the foods you buy.
--Don't add high-calorie sauces, salt, or sugar to your vegetables.
--Replace high-calorie foods with fruits and vegetables.
--Increase fiber intake by eating more beans, whole-grain foods, fruits, and vegetables.
--Stop using solid shortenings; use liquid vegetable oils instead.
--Cut down on sugared beverages.
--Choose fat-free or low-fat dairy foods.
--Cut back on pastries and sweet baked goods.
--Reduce salt intake by comparing the salt content of different brands, choosing lower-salt versions of processed foods, and using fewer salty condiments, such as ketchup.
--Choose lean cuts of meat. Remove skin from poultry.
--Instead of frying or sauteing meats and fish, try grilling, baking, or broiling them.
--Instead of fruit juices, eat whole fruits.
--Try using meat substitutes in your favorite recipes.
“It is the whole-package approach that really is necessary. Don't think about diet without thinking about physical activity," Lichtenstein says. "Don't fall into the trap of just focusing on one food. We're always hearing about the benefits of this or that specific food, but when we talk about diet and lifestyle, we really have to talk about the whole package. You cannot sprinkle wheat germ on a hot fudge sundae and get good results."
By Daniel J. DeNoon, reviewed by Louise Chang, MD
SOURCES: Lichtenstein, A.H. Circulation, July 4, 2006; vol: 114. News release, American Heart Association. Alice H. Lichtenstein, DSc, professor of nutrition science and policy, Tufts University; and chair, American Heart Association Nutrition Committee. Kathleen M. Zelman, MPH, RD, director of nutrition, WebMD.