Where does heart health stand with the new Dietary Guidelines?

It’s Heart Month and conversations continue around the new Dietary Guidelines for Americans (DGA). Heart disease is the leading cause of death in the U.S. – so how do we reconcile the new DGA with a heart-healthy eating pattern?

Unfortunately, the face of the new DGA is the new inverted food pyramid, which prominently displays foods not normally associated with heart health – a thick marbled steak, a container of ground beef (which could be lean!), a carton of whole milk, and a stick of butter.

But the pyramid doesn’t tell the whole story. For that, you have to delve into the text of the DGA.

Let’s look at some of the recommendations and how they align with heart health:

Eat real food: While there’s no perfect definition of real food (this poster helps), eating more whole foods, like vegetables, fruits, beans, nuts, seeds, whole grains, and fish is the basis for the Mediterranean-style eating pattern that many experts recommend for heart health. 

Prioritize protein foods at every meal: Protein helps you feel full, which may help you eat less overall. The new DGA say to “consume a variety of protein foods,” but a heart-healthy eating pattern prioritizes plant-based protein sources. They list animal protein sources first, including red meat, which increases the risk of heart disease. While heart-healthy cooking methods are promoted, I was surprised to see “flavor with salt.” Spices and herbs are also listed in the suggestion, but the salt goes against heart health.

Consume dairy: Dairy is a good source of calcium, which may help lower blood pressure. But the new DGA recommends full-fat dairy, which goes against the American Heart Association (AHA) and other guidelines. However, there’s limited evidence that saturated fat in dairy may not be as detrimental to heart health compared to fat from meat (J Acad Nutr Diet. 2023;123(12):1808-1830). Regardless, the extra calories in whole milk and yogurt may be an issue for some people. The suggestion to skip the added sugar in dairy products is a plus.

Eat vegetables and fruits throughout the day: Yes! Pile on the veggies and fruits, but a big NO to “flavor with salt.”

Incorporate healthy fats: This depends on your definition of healthy fats and that’s the controversy most people are talking about. The new DGA appear to put saturated fat in meat on the same heart-healthy pedestal as the fat in “omega-3-rich seafood, nuts, seeds, … olives, and avocados.” And they mention cooking with butter or beef tallow (not heart-healthy) in the same context as olive oil (heart-healthy). And there’s also the recommendation to limit saturated fat to no more than 10% of calories – a nod to heart health, but so conflicting and confusing for consumers!

Focus on whole grains: Fiber from whole grains helps with satiety and can help lower cholesterol. We’re told to “[s]ignificantly reduce the consumption of highly processed, refined carbohydrates,” which have no place in a heart-healthy eating pattern. But what about ready-to-eat cereals, some of which are a good source of fiber (possibly some people’s only source?)?

Limit highly processed foods, added sugars, and refined carbohydrates: Yes! Eating less of these foods makes it much easier to follow a health-healthy eating pattern and can help prevent diabetes and obesity, which are risk factors for heart disease.

Limit alcoholic beverages: More controversy here due to the removal of alcohol drink limits (one a day for women, two a day for men) that appear in the previous DGA. Many experts now call for cutting out alcohol completely. AHA warns of the danger for people with high blood pressure and diabetes, as well as the added calories that can be an issue.

Other recommendations: Consuming less than 2300mg of sodium/day, avoiding added sugars, and a nod to gut health – all heart-friendly concepts!

A heart-healthy eating pattern is important, but don’t forget the other components of a heart-healthy lifestyle, including moving every day, getting enough quality sleep, managing stress, and not smoking.

Some of your clients, patients, and audiences may benefit from completing the AHA's My Life Check®. This online tool is a way to assess your heart health and better understand your risk for heart disease.

Hollis Bass, MEd, RD, LD