Overall heart-healthy diet is more important than occasional indulgences

The fourth in a five-part series of articles that explain the new heart disease and stroke prevention guidelines.

Don’t sweat satisfying a sweet tooth every now and then.

New cardiovascular prevention guidelines from the American Heart Association and American College of Cardiology reveal that sticking to an overall heart-healthy diet is more important than avoiding – or agonizing over – the occasional indulgence.

“Cake and ice cream at a birthday party don’t need to be confessed,” said Robert Eckel, M.D., professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora. Unless, of course, there’s a birthday party every day, and cake and ice cream become diet staples.

Eckel co-chaired an expert committee that plunged into the latest scientific research and reported on what are now considered the best dietary and exercise patterns to lower blood pressure and cholesterol.

The biggest takeaway: So long as Americans make healthy decisions the great majority of the time and stay mindful of the big picture, they can build cardiovascular health that’s muscular enough to handle the rest.

Nearly two-thirds of U.S. adults have high or elevated blood pressure. Another one-third of adults have elevated levels of bad (LDL) cholesterol. Reducing those ranks and preventing heart disease and stroke is the purpose of the new recommendations, some of which replace previous best practices from the American Heart Association.

A separate guideline offers recommendations on diet and physical activity for weight loss.

“This is where heart health starts,” Eckel said. “Lifestyle is the beginning of everything we do to prevent heart disease and stroke.” The recommended dietary pattern emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. It also calls for limits on red meat and sugary foods and beverages. Many diets fit that pattern, including the Mediterranean diet, the DASH – short for Dietary Approaches to Stop Hypertension – eating plan promoted by the National Heart, Lung, and Blood Institute and diets suggested by the U.S. Department of Agriculture and the American Heart Association.

The pattern can be easily adapted based on a person’s cultural and food preferences. The guidelines also place specific limits on a trio of unhealthy nutrients: sodium, saturated fat and trans fat.

Currently, the average American adult consumes about 3,600 milligrams of sodium a day. For people who need to lower their blood pressure, the new guidelines recommend a step-down approach that caps daily sodium intake at no more than 2,400 mg. Getting daily sodium consumption down to 1,500 mg is desirable because it can lower blood pressure even further.

“Nearly all of us are consuming too much sodium, and regardless of what the target is, getting sodium intake as low as possible should be the overall goal,” said Gordon Tomaselli, M.D., co-chair of the subcommittee that guided the completion of the guidelines and chief of cardiology at Johns Hopkins University School of Medicine in Baltimore.

Cutting out processed foods high in sodium and cooking at home more often is a good start, Tomaselli said. That’s because up to 75 percent of the sodium in the average American’s diet comes from processed or restaurant foods.

“People may not even know they’re eating it,” said Tomaselli, a past American Heart Association president.

To lower cholesterol, the new guidelines recommend reducing saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day – the average of what an adult eats each day – that’s about 13 grams of saturated fat.

The majority of saturated fat comes from meats such as fatty beef, lamb, pork and poultry with skin. Full-fat dairy products, such as butter, cream, cheese and products made from whole or 2 percent milk, are also high in saturated fat.

The new guidelines also call for people to avoid trans fats – which shouldn’t be as hard after the Food and Drug Administration announced in November that it intends to ban trans fats in processed foods. Trans fats are currently found in many fried foods and baked goods such as pastries, pizza dough, pie crust, cookies and crackers.

By following the recommended dietary pattern, Americans don’t necessarily need to worry about constantly keeping track of how much sodium, saturated fat and trans fat they’re eating, Eckel said.

“They’re already staying within the recommended levels because they’re eating a heart-healthy diet,” he said.

Being physically active is also important to prevent heart disease and stroke. Just 40 minutes of aerobic exercise of moderate to vigorous intensity done three to four times a week is enough to stay healthy. Brisk walking, swimming, bicycling or a dance class are excellent choices.

“What the guideline emphasizes is that any exercise is good for you,” Tomaselli said. “Many people don’t exercise at all, so exercising a bit more today than you did yesterday is a good way to train to the recommended time.”

While some patients will need medications to manage blood pressure and cholesterol, Eckel said doctors should simultaneously prescribe the diet and exercise strategies laid out in the new guidelines. “Lifestyle modification should be incorporated throughout the therapeutic window,” Eckel said.

“These recommendations should be a part of the practice of every physician who is concerned with prevention.”