When it comes to preventing cardiovascular disease, some experts feel the recommendations may not go far enough.
Every five years, the U.S. government issues a new edition of the Dietary Guidelines for Americans, a report that “helps Americans make healthy choices for themselves and their families.” But if you’re concerned about having a heart attack or stroke, the advice in the latest update doesn’t entirely agree with what many nutrition experts—as well as the American Heart Association—recommend.
We asked Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, to share his thoughts about where the new guidelines may not be aggressive enough for people at risk for heart disease. Here’s his advice on five dietary components of note.
The guidelines say: A healthy eating pattern includes variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.
Grouping lean meat with other types of protein is just plain wrong because the health implications from these foods are very different. Many people assume it’s the saturated fat in beef, lamb, and pork that’s the main problem. But while saturated fat certainly isn’t as healthy as liquid vegetable oils, it has the same relation to heart disease as most carbohydrates. However, lean red meat also contains cholesterol, heme iron, and other components that likely contribute to the risk of heart disease, Dr. Willett says. “If you like red meat, think of it like lobster, and enjoy your favorite cut occasionally as a special treat,” he says.
The guidelines say: Consume less than 10% of calories per day from added sugars.
The new guidelines are the first ever to include a limit on added sugars, which is based on research showing that people who eat less sugar tend to have lower rates of cardiovascular disease. But Dr. Willett says the limit suggested by the American Heart Association (AHA)—about 5% of calories—is better. That translates to about 6 teaspoons of sugar a day for women and 9 teaspoons per day for men. “In practical terms, this means avoiding sugar-sweetened beverages, sweet snacks and desserts, and other highly sweetened foods, like many yogurts and some soy milk. Adding a teaspoon of sugar to coffee, tea, or cereal a few times a day is not a problem.” The FDA will probably add a line to the Nutrition Facts label for added sugar, which will make tracking your added sugar much easier, he adds.
The guidelines say: Consume less than 2,300 milligrams (mg) per day of sodium.
Because excess sodium is closely tied to high blood pressure—a major risk factor for heart disease—you’re better off aiming for the 1,500 mg of sodium per day recommended by the AHA. “There aren’t many studies looking at this level in relation to heart disease risk, but we do know it will lower blood pressure. And more than 90% of Americans will develop high blood pressure at some point in their lives,” says Dr. Willett. Eating less salt is easier than you might think. Fresh, natural food is low in sodium. Also, don’t add salt during cooking, especially to things like rice, pasta, and oatmeal. The School of Public Health’s Nutrition Source website has more tips on cutting salt at health.harvard.edu/eatlesssalt.
Cholesterol (and eggs)
The guidelines say: No specific limit on cholesterol (earlier guidelines recommended a limit of 300 mg per day).
Some of the media coverage on this change failed to point out that the guidelines still recommend that people limit the amount of cholesterol and saturated fat they eat. But it’s best to think of this in terms of food, says Dr. Willett. It turns out that eggs—the main source of dietary cholesterol—don’t seem to raise heart disease risk any more than other foods in a typical American breakfast. But that doesn’t mean eggs are an ideal choice, says Dr. Willett. “Think of your breakfast choices as a spectrum, from a bowl of oatmeal with nuts and fruit on one end to donuts and pancakes with butter at the other end. Eggs are in the middle.”
For your heart’s sake, it’s better to stick to the oatmeal end of the spectrum, limiting eggs to just two a week, especially if you have diabetes. Studies show an increased risk of heart disease among people with diabetes who eat more than three egg yolks a week.
The guidelines say: A healthy eating pattern can include three to five 8-ounce cups of coffee a day.
Not only does drinking coffee seem to be safe, some evidence suggests that it might reduce the risk of diabetes and possibly heart disease, though not all studies would support this. So this first-ever inclusion highlighting coffee in the guidelines is one that Dr. Willett supports, with some significant caveats. First, the caffeine in coffee can cause insomnia, which many people don’t link to their java habit. Over time, a lack of sleep may be hard on your heart. And in some people, caffeine may aggravate palpitations and other heart rhythm problems (see page 8). Follow your doctor’s advice about coffee if you already have a serious heart rhythm disturbance.