Recommendations for Heart Health

In June 2006 the American Heart Association (AHA) released their latest Diet and Lifestyle Recommendations for healthy Americans. These guidelines are an update to their 2000 dietary recommendations.1The new recommendations focus on long-term changes in diet and other lifestyle factors associated with cardiovascular disease.

• While the AHA new guidelines continue to recommend a modest reduction in total dietary fat to less than 30% of energy, the emphasis remains on cutting the LDL-cholesterol raising saturated and trans fatty acids.• In 2000, the AHA recommended all Americans cut their intake of saturated plus trans fat to no more than 10% of total calories and limit cholesterol to no more than 300mg per day. The new guidelines go even further reducing saturated fat and trans fat intake to no more than 8% of total calories. The average American diet contains about 17% of calories from these two cholesterol-raising fats. The new guidelines recommend saturated fat intake be reduced to no more than 7% of calories and cuts trans fats to no more than 1% of calories.• Unfortunately, while the new statement continues to recognize the impact of dietary cholesterol in raising LDL and promoting cardiovascular disease, the AHA continues to say up to 300mg of dietary cholesterol a day is acceptable. Adult men currently consume about 341mg and adult women about 242mg of cholesterol a day so the AHA guideline for cholesterol intake would have little or no impact on LDL levels even if all American adults adopted this guideline.• The AHA for the first time discourages the consumption of refined sugar and particularly in soft drinks because of growing evidence it promotes weight gain and adds “empty calories” to the diet.• The new statement discontinues their earlier recommendation to increase soy protein to lower LDL levels.• Despite the Institute of Medicine’s statement indicating even healthy young Americans should ideally consume no more than 1,500mg sodium per day, the AHA continues to recommend sodium be limited to less than 2,300mg per day even though they agree with the Institute of Medicine’s report that blood pressure rises with sodium intakes above 1,500mg/day. Why? They believe the scientifically more appropriate goal “…is not easily achievable at present.”No one can argue with the AHA’s current recommendation to attain and maintain a healthy body weight and be more physically active. However, the AHA continues to recommend calorie counting for weight control even though there is little reason to believe it is effective in the long run by itself. A far better approach would be to recommend even greater amounts of whole fruits, vegetables, beans and whole grains. Indeed, the evidence is fairly good that reducing dietary fat aids weight loss largely because it reduces calorie density and increases satiety per calorie.

Bottom Line:Clearly the AHA continues to move in the right direction. The less saturated fat and trans fat the better. However, given the growing evidence of the adverse effects of trans and saturated fats on human health they should have recommended limiting trans fat as much as possible and saturated fat to less than 4% of energy. The AHA’s failure to take more aggressive stands on salt/sodium and cholesterol despite recognizing that greater reductions are certainly safe and more effective for reducing heart disease risk factors makes it clear that the AHA is still far from recommending an optimal diet for reducing cardiovascular disease.By James J. Kenney, PhD, RD, FACN.1. Circulation 2006;114:1-15