Suggested Citation: Garko, M.G. (2013, April). Coronary heart disease – Part V: Diet and nutrition as part of a personal prevention program to combat coronary heart disease. Health and Wellness Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.
Coronary Heart Disease – PART VI: Diet and Nutrition As Part Of A Personal Prevention Program To Combat Coronary Heart Disease
Michael Garko, Ph.D.
Host of Let’s Talk Nutrition
In 400 B.C., Hippocrates, the father of modern medicine, proposed, “Let food be your medicine and medicine your food.” From before and since the time of Hippocrates, an overwhelming amount of anecdotal, cross-cultural evidence and decades worth of scientific evidence has emerged to support the food as medicine paradigm. Therefore, when it comes to preventing, delaying and treating coronary heart disease (CHD) and other forms of cardiovascular disease (CVD), it makes eminently good dietary and nutritional sense to adopt Hippocrates’ food as medicine approach to maintaining health.
However, diet and nutrition are treated too frequently as if they were just therapeutic alternatives for pharmaceuticals and medical procedures.[i] Diet and nutrition are not alternative therapies. Rather, diet and nutrition are intrinsic to the way health is heightened and disease is disarmed. At the same time, diet and nutrition possesses the potential to trigger chronic disease processes. Hence, diet and nutrition can be either medicinal or detrimental, making them elemental in creating either health or disease.
It is not being claimed that diet and nutrition are responsible solely for creating health or disease or that the theory and practice of diet and nutrition should not or cannot be integrated with traditional (i.e., allopathic) or nontraditional (i.e., complementary) therapies to prevent and cure chronic diseases, generally, and CHD, specifically. Instead, the view espoused here is that diet and nutrition play an inextricable role in either preventing or promoting chronic diseases (e.g., CHD), depending on the dietary patterns (e.g., what is eaten, why it is eaten, when it is eaten, how often it is eaten, etc.) and nutritional quotient of the food constituting the day-to-day nutritional world of people.
With this perspective in mind, the purpose of the April, 2013, issue of Health and Wellness Monthly is to focus on diet and nutrition as fundamental to a Personal Prevention Program to maintain cardiovascular health and minimize the odds of developing and dying from CHD. The Diet and Lifestyle Recommendations Revision of the American Heart Association (AHA) will be featured because it recognizes the importance of diet and nutrition and other lifestyle factors in the prevention and treatment of CVD and does not consider them as just alternatives to prescription drugs and procedures.
Specific focus will be given to the unique features of AHA’s Diet and Lifestyle Recommendations Revision, its goals and recommendations for cardiovascular risk reduction, tips to implement the recommendations and two examples of daily dietary patterns based on 2000 calories compatible with AHA’s recommended dietary goals.
In order to gain a full understanding of all its facets, the reader is encouraged to examine AHA’s entire scientific statement on diet and lifestyle in the prevention and treatment of CVD. A copy of the statement can be retrieved at www.americanheart.com.
Unique Features of AHA’s Diet & Lifestyle Recommendations Revision
The literature is replete with all sorts of dietary protocols and programs to promote cardiovascular health. Notwithstanding the chorus of voices calling for people to reform their nutritional lives with particular dietary and other lifestyle practices so as to prevent diseases of the heart and blood vessels, the AHA’s Diet and Lifestyle Recommendations Revision merits special consideration because of its unique features distinguishing it from previous AHA reports and policy statements on the connection between diet and CHD and numerous other approaches that tend to be recycled versions of the AHA’s dietary guidelines and recommendations (see Lichtenstein, et al., 2006).
There are ten features of the Diet and Lifestyle Recommendations Revision that make it effective in tackling the daunting task of preventing and treating CHD. First, the recommendations are designed with both the general public (including adults and children over two years of age) and clinicians in mind. This is reflected in the AHA’s contention that “maintaining a healthy diet and lifestyle offers the greatest potential of all known approaches for reducing the risk for CVD in the general public” and that its Diet and Lifestyle Recommendations Revision “can be applied by healthcare practitioners to the clinical management of patients with or at risk for CVD” (Lichtenstein, et al., 2006, p. 83).
Second, the guidelines were derived from decades of scientific research, including the most recent scientific evidence related to cardiovascular health since AHA’s last set of guidelines published in 2000. According to the AHA, a panel of nutrition and heart disease experts reviewed more than 90 scientific studies from different journals in the medical literature to come up with the revised and updated recommendations (see American Heart Association, 2006).
Third, the Diet and Lifestyle Recommendations Revision recognizes that “diet is part of an overall healthy lifestyle” (Lichtenstein, et al., 2006, p. 82) and not something that is separated from other aspects of persons’ day-to-day lives.
Fourth, AHA’s recommendations are in harmony with the earlier stated perspective recognizing diet and nutrition as being foundational to cardiovascular health and not alternatives to pharmaceuticals and medical procedures. The authors of the Diet and Lifestyle Recommendations Revision acknowledge that although significant advances have been made in the prevention and treatment of CVD using drug therapies and procedures, diet and nutrition and other lifestyle therapies are the foundation of clinical intervention for prevention (see Lichtenstein, et al., 2006).
Fifth, compared to earlier versions of its dietary recommendations to prevent and treat CVD, the AHA’s most recent scientific statement is reformatted and organized to make it easier to understand and follow. Among the elements contained in the Diet and Lifestyle Recommendations Revision that make it more accessible and meaningful to readers are (1) goals to reduce CVD risk, (2) clearly stated diet and lifestyle recommendations, (3) practical tips to implement the diet and lifestyle recommendations and (4) even two examples of daily dietary patterns to accomplish the dietary goals with a meal plan at 2000 calories.
Sixth, the Diet and Lifestyle Recommendations Revision was designed with the intention of making it flexible in the sense of meeting the unique needs for growth, development, and aging. In fact, the AHA has published a separate set of guidelines focusing specifically on the special health and dietary needs of growing children (see Gidding et al., 2005).
Seventh, AHA’s recommendations takes into consideration that adults and children more and more are developing the dietary pattern of eating food prepared outside of the home (e.g., restaurants, grocery stores, schools, day care centers, etc.). Hence, the Diet and Lifestyle Recommendations Revision emphasizes the importance of following healthy eating patterns at home and away from home.
Eighth, in order to facilitate adoption of AHA’s diet and lifestyle recommendations, the Diet and Lifestyle Recommendations Revision contains high-priority recommendations specified for healthcare professionals, restaurants, the food industry, schools, and local policies.
Ninth, while the Diet and Lifestyle Recommendations Revision acknowledges that people must take personal responsibility for their well-being by exercising healthy diet and lifestyle choices, it also recognizes the influence of environmental factors (i.e., the constellation of cultural, societal and commercial forces) on human behavior and whether people consume excess calories, follow a healthy diet and engage in regular physical activity.
Tenth, finally and perhaps most important of all, AHA’s Diet and Lifestyle Recommendations Revision is based upon the lifestyle practices and nutritional principles of balance, variety and moderation, which together help prevent the development or recurrenceof heart and blood vessel diseases and promote overall health.
Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction
AHA’s recommended diet and lifestyle goals to reduce the risk of CVD are as follows:
- Consume an overall healthy diet.
- Aim for a healthy body weight.
- Aim for recommended levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.
- Aim for a normal blood pressure.
- Aim for a normal blood glucose level.
- Be physically active.
- Avoid use of and exposure to tobacco products (Lichtenstein, et al., 2006, p. 83).
Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction
AHA’s recommended diet and lifestyle recommendations to reduce the risk of CVD are as follows:
- Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
- Consume a diet rich in vegetables and fruits.
- Choose whole-grain, high-fiber foods.
- Consume fish, especially oily fish, at least twice a week.
- Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by choosing lean meats and vegetable alternatives; selecting fat-free (skim), 1%-fat, and low-fat dairy products; and minimizing intake of partially hydrogenated fats.
- Minimize your intake of beverages and foods with added sugars.
- Choose and prepare foods with little or no salt.
- If you consume alcohol, do so in moderation.
- When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations (Lichtenstein, et al., 2006, p. 83).
Practical Tips To Implement Diet and Lifestyle Recommendations
AHA’s recommended tips to implement its diet and lifestyle recommendations to reduce the risk of CVD are as follows:
- Know your caloric needs to achieve and maintain a healthy weight.
- Know the calorie content of the foods and beverages you consume.
- Track your weight, physical activity, and calorie intake.
- Prepare and eat smaller portions.
- Track and, when possible, decrease screen time (e.g., watching television, surfing the Web, playing computer games).
- Incorporate physical movement into habitual activities.
- Do not smoke or use tobacco products.
- If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day) (Lichtenstein, et al., 2006, p. 86).
Food Choices and Preparation
- Use the nutrition facts panel and ingredients list when choosing foods to buy.
- Eat fresh, frozen, and canned vegetables and fruits without high-calorie sauces and added salt and sugars.
- Replace high-calorie foods with fruits and vegetables.
- Increase fiber intake by eating beans (legumes), whole-grain products, fruits, and vegetables.
- Use liquid vegetable oils in place of solid fats.
- Limit beverages and foods high in added sugars. Common forms of added sugars are sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey.
- Choose foods made with whole grains. Common forms of whole grains are whole wheat, oats/oatmeal, rye, barley, corn, popcorn, brown rice, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum.
- Cut back on pastries and high-calorie bakery products (e.g., muffins, doughnuts).
- Select milk and dairy products that are either fat free or low fat.
- Reduce salt intake by comparing the sodium content of similar products (e.g., different brands of tomato sauce) and choosing products with less salt; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt; and limiting condiments (e.g., soy sauce, ketchup).
- Use lean cuts of meat and remove skin from poultry before eating.
- Limit processed meats that are high in saturated fat and sodium.
- Grill, bake, or broil fish, meat, and poultry.
- Incorporate vegetable-based meat substitutes into favorite recipes.
- Encourage the consumption of whole vegetables and fruits in place of juices (Lichtenstein, et al., 2006, p. 86).
Two Examples of Daily Dietary Patterns
AHA’s examples of daily dietary patterns consistent with its recommended dietary goals at 2000 calories are as follows:
6 to 8 servings per day
7 servingsper day
|1 slice bread; 1 oz dry cereal¶; cup cooked rice, pasta, or cereal|
4 to 5 servings per day
5 servingsper day
1 cup raw leafy vegetable, cup cut-up raw or cooked vegetable, cup vegetable juice
4 to 5 servings per day
4 servingsper day
|1 medium fruit; cup dried fruit; cup fresh, frozen, or canned fruit; cup fruit juice|
|Fat-free or low-fat milk and milk products||
2 to 3 servings per day
2 to 3 servings per day
|1 cup milk, 1 cup yogurt, 1 oz cheese|
|Lean|| meats, poultry, and fish||
<6 oz per day
5 oz per day
|Nuts, seeds, and legumes||
4 to 5 servings per week
Counted in vegetable servings.
cup (1 oz), 2 Tbsp peanut butter, 2 Tbsp or oz seeds, cup dry beans or peas
|Fats and oils||
2 to 3 servings# per day
Amount depends on daily calorie level
|1 tsp soft margarine, 1 Tbsp mayonnaise, 2 Tbsp salad dressing, 1 tsp vegetable oil|
|Sweets and added sugars||
5 or fewer servings per week
|1 Tbsp sugar, 1 Tbsp jelly or jam, cup sorbet and ices, 1 cup lemonade|
|*Dietary Approaches to Stop Hypertension. For more information, please visit http://www.nhlbi.nih.gov/health/public/heart/hbp/dash.|
|Therapeutic Lifestyle Changes. For more information, please visit http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi. TLC includes 2 therapeutic diet options: Plant stanol/sterol (add 2 g per day) and soluble fiber (add 5 to 10 g per day).|
|Whole-grain foods are recommended for most grain servings to meet fiber recommendations.|
|This number can be less or more depending on other food choices to meet 2000 calories.|
|¶Equals to 1 cups, depending on cereal type. Check the product’s Nutrition Facts Label.|
|||Lean cuts include sirloin tip, round steak, and rump roast; extra lean hamburger; and cold cuts made with lean meat or soy protein. Lean cuts of pork are center-cut ham, loin chops, and pork tenderloin.|
|#Fat content changes serving counts for fats and oils: For example, 1 Tbsp of regular salad dressing equals 1 serving; 1 Tbsp of low-fat dressing equals serving; 1 Tbsp of fat-free dressing equals 0 servings (Lichtenstein, et al., 2006, p. 87).|
The Diet and Lifestyle Recommendations Revision represents the AHA’s most recent scientific statement on diet and lifestyle in the prevention and treatment of CVD. It is a comprehensive, easily understood and thoughtfully crafted approach to cardiovascular risk reduction which can be applied flexibly by the general public and clinicians alike. It is grounded in decades of scientific research on the role of diet and nutrition to help promote overall well-being and health and prevent the development or recurrenceof heart and blood vessel diseases and. It follows sound dietary and nutritional principles and practices which can be applied throughout the life cycle, from childhood to adulthood. Perhaps, most importantly, the Diet and Lifestyle Recommendations Revision captures the spirit and meaning of Hippocrates’ axiom, “Let food be your medicine and medicine your food” in that it recognizes how diet and nutrition are intrinsic to preventing and treating CVD and not simply alternative therapies to improving the cardiovascular health status of people.
American Heart Association (n.d.). Diet and lifestyle recommendations revision 2006. Retrieved November 15, 2006, from
[i] While related, the concepts of nutrition and diet are not synonymous. Generally speaking, nutrition is the process of nourishing or being nourished by food. Specifically, nutrition is the process by which humans and other living organisms assimilate and metabolize food to produce energy, while creating, sustaining and repairing cells, tissues and organs. The concept of diet is used in this article to mean the food and liquid consumed typically each day on a regular basis.