There is a new list of nutritional recommendations for good cardiovascular health, released in late 2021 by the American Heart Association (AHA). The guidelines focus on dietary patterns and the balance of choices, without specifically mentioning which items would be “prohibited” or “allowed”. Altogether, ten points make up the document, all of which are evidence-based. Check the entity list:
- Adjust your calorie intake and calorie expenditure to achieve and maintain a healthy weight.
- Eat lots of fruits and vegetables of different varieties.
- Opt for whole foods or foods made with whole grains instead of refined grains.
- Choose healthy sources of protein, mainly of plant origin (legumes and nuts); regularly eat fish and shellfish; prefer low-fat and low-fat dairy products to full-fat versions; opt for lean cuts of meat over processed forms.
- Prefer liquid vegetable oils to tropical oils (coconut, palm, palm kernel) and animal fat (lard and butter), or opt for partially hydrogenated fats.
- Give preference to minimally processed foods (in natura foods) over ultra-processed ones.
- Decrease consumption of drinks and foods with added sugar.
- Choose foods with little or no salt.
- If you don’t drink alcohol, don’t start and, if you do, limit the amount.
Follow these recommendations regardless of where food is prepared or consumed. The impact of poor diet on heart health is well known. Added to a sedentary lifestyle, obesity and inadequate control of blood pressure, cholesterol, stress and diabetes, it creates the ideal terrain for the emergence of cardiovascular diseases.
According to cardiologist Francisco Maia da Silva, from Hospital Israelita Albert Einstein, also professor of cardiology at the Pontifical Catholic University of Paraná (PUCPR), head of the cardiology service at Santa Casa de Curitiba and coordinator of the Brazilian Society of Cardiology (SBC), these are the biggest cause of mortality in the world, with about 16 million cardiovascular events in 2019 alone, according to the World Health Organization (WHO).
“It is a sad reality that can be transformed with preventive attitudes, which involve reeducation measures for a healthy diet for the heart and other lifestyle changes. These are non-pharmacological measures capable of reducing the occurrence of cardiovascular events”, says the doctor. .
impact of food
Within the proposal of food reeducation and in line with the AHA guidelines, according to Maia, the general recommendation includes reducing salt, increasing the consumption of fruits and vegetables and eliminating trans fats from the diet. “These behaviors already generate a very large positive impact on heart health. People who abuse trans fats have an increase in total cholesterol and LDL (the ‘bad’) and a reduction in HDL (the ‘good’), which acts as a protection. It is present in cakes, ice cream, croissants and several other foods, having a direct impact on these levels”, highlights the specialist.
The preference, then, should always be for polyunsaturated fats, present in sources such as canola, soy, linseed, salmon and sardines, for example. Omega 3, a good fat provided by these foods, can also be purchased in capsules, as a measure to improve the patient’s lipid profile.
“All this needs to be combined with physical activity, stress control and smoking cessation. It is also very important to reduce carbohydrate intake, especially in colder cities, where consumption of this type of nutrient is usually higher. ingested, the more triglycerides increase, which are inversely related to HDL. In other words, high triglycerides mean low HDL”, explains Maia.
For those who believe that improvements take time to appear and, therefore, postpone changes in diet and lifestyle, good news: the effects are expected to be noticed in 90 days, when the patient is instructed to repeat the profile. lipid test (a simple blood test) to track rates. “Awareness to start and maintain the new habits, therefore, is fundamental. After calculating the patient’s risk in the first consultation, a goal and a plan is established for a good adherence to the new lifestyle, which also includes other professionals”, highlights the cardiologist.
Reeducation is a process
According to nutritionist Ivone Mayumi Ikeda Morimoto, professor of the Nutrition course at PUCPR, it is important to first analyze the patient’s daily diet, establishing comparisons with a healthy diet. “Having done that, the idea is that, in practice, half of the patient’s plate contains cooked or raw vegetables and that legumes such as beans are consumed daily. For breakfast, it is important to combine a dairy source with cereals such as granola and oatmeal, in addition to of a fruit. When the adjustment happens meal by meal, establishing goals in a progressive way, the advance is notable in the next consultations”, he comments.
She reminds us that individual preferences also need to be taken into account. Thus, it is possible to create a diet to the patient’s taste, always encouraging wholegrain options, legumes and vegetables. “A next step would be for the patient to analyze their previous habits, getting to know, in detail, the ultra-processed options and the various unknown substances that are part of the composition of these foods. Comparing the amount of nutrients present in these foods and in those minimally processed and in natura, the patient is educated in the process”, he explains.
Morimoto highlights that there are no bans, but sporadic releases. Sodium and sugar, for example, should be seen as the exception to the rule. “In the long term, the patient starts to understand more important concepts, such as the types of fat and their effects on the cardiovascular system. This is the true food and nutrition reeducation”, he analyzes.
diets for the heart
The largest studies on heart-specific diets are about the Mediterranean and DASH (Dietary Approaches to Stop Hypertension). In DASH, eight to 10 servings of vegetables and fruits a day are recommended, as well as the routine use of skimmed dairy foods and low fat and oilseed foods. “Analyzing the new AHA recommendations, we see that they bring a lot of DASH, but also of the Mediterranean, which suggests the consumption of fish. In Brazil, the consumption of fish is still a challenge and, even in the producing regions, it remains below the ideal among the population”, evaluates the nutritionist.
The villains of the heart
Ultra-processed foods, which contain large amounts of sodium and trans fats (hydrogenated vegetable fats), responsible for giving crunchiness, creaminess and softness to processed foods, are important villains of heart health. “There is an effort by the Brazilian government and Anvisa to ban this type of fat in the country by the year 2023. Until then, companies will have to make an extra effort to find replacements, given the future unavailability of the ingredient for manufacturing. very good news for heart health”, says Ivone.
Red meats, canned goods, sausages and preserves, which have a lot of sodium, are also included in this account. “The availability of aromatic herbs in Brazilian cuisine is immense and their use as a seasoning should be encouraged. I would say that the key to effective reeducation is to make the patient understand the concept of minimally processed, processed, ultra-processed and in natura foods, including described in the Food Guide for the Brazilian Population, also used in other parts of the world”, concludes the nutritionist.