Heart-healthy eating: what to eat, what to limit and the DASH plan

What you eat is something you can change every day. This article explains what heart-healthy eating looks like, using advice from the US National Heart, Lung, and Blood Institute (NHLBI), the US CDC and the World Health Organization (WHO).

1. Introduction

The CDC explains that heart disease can be prevented through daily habits, including a diet with plenty of fresh produce and fewer processed foods, and by managing conditions such as high cholesterol, high blood pressure and diabetes ^[2]. The WHO says healthy diets rest on four principles: adequacy, balance, moderation and diversity ^[3].

2. The DASH eating plan

DASH stands for Dietary Approaches to Stop Hypertension. NHLBI describes it as a flexible, balanced eating plan for the long term. It needs no special foods and instead sets daily and weekly goals ^[1]. It emphasises ^[1]:

• Vegetables, fruits and whole grains
• Fat-free or low-fat dairy products
• Fish, poultry, beans, nuts and vegetable oils

It limits foods high in saturated fat, such as fatty meats, full-fat dairy and tropical oils like coconut, palm kernel and palm oil, along with sugar-sweetened drinks and sweets ^[1]. NHLBI suggests choosing foods rich in potassium, calcium, magnesium, fibre and protein, and lower in sodium. Servings are adjusted to your daily calorie needs ^[1]. On a 2,000-calorie diet, NHLBI suggests each day 6 to 8 servings of grains, 4 to 5 of vegetables, 4 to 5 of fruit, 2 to 3 of low-fat or fat-free dairy and no more than 6 of meat, poultry and fish. Each week it suggests 4 to 5 servings of nuts, seeds, dry beans and peas, and 5 or fewer of sweets ^[1].

3. Fruit, vegetables and fibre

The WHO advises adults to eat at least 400 g of fruit and vegetables a day. It recommends getting most carbohydrates from whole grains, vegetables, fruit and pulses, which are beans, peas and lentils ^[3]. The CDC adds that foods high in fibre and low in saturated fat, trans fat and cholesterol can help prevent high cholesterol, and suggests more fresh produce and fewer processed foods ^[2].

4. Fats

The WHO says total fat should be 30 percent of daily energy or less. Saturated fat should be no more than 10 percent and trans fat no more than 1 percent. Unsaturated fats from fish, nuts, avocado and plant oils are preferred, and industrially produced trans fats should be avoided ^[3]. The CDC advises limiting saturated fat, trans fat, sodium, added sugar and alcohol ^[2].

5. Salt, sodium and potassium

Sodium is one part of salt: 5 g of salt contains about 2 g of sodium. The WHO advises adults to limit salt to under 5 g a day. Most salt comes from processed foods, so choosing lower-sodium products helps ^{[1, 3]}. The WHO also advises at least 3,510 mg of potassium a day, which can be raised by eating fresh fruit and vegetables ^[3]. NHLBI says the DASH plan sets a daily sodium limit of 2,300 mg or less, and that 1,500 mg a day lowers blood pressure even further ^[1].

6. Sugar and alcohol

The WHO says free sugars, which include sugars added to food and drinks, should be under 10 percent of daily energy (about 50 g on a 2,000-calorie diet), and staying at 5 percent or less may bring further benefits. Non-sugar sweeteners are not recommended as a way to cut sugar ^[3]. The CDC advises limiting added sugar and alcohol ^[2].

7. Other habits that work with diet

The CDC links healthy eating with other habits ^[2]:

• Keeping a healthy weight, since extra weight strains the heart and blood vessels
• Being physically active, such as 2.5 hours of moderate activity each week for adults
• Not smoking, and quitting if you do
• Getting cholesterol and blood pressure checked regularly
• Taking prescribed medicines exactly as directed

8. Special groups

People with diabetes should monitor blood sugar closely and follow their care team's treatment and lifestyle recommendations ^[2]. Ask your doctor or a registered dietitian before making big changes, and do not stop any medicine because you changed your diet.

Changing the way you eat is easier in small steps. The CDC suggests eating more fresh produce and fewer processed foods ^[2]. The WHO notes that most salt comes from processed foods ^[3]. NHLBI says to adjust the number of servings to your daily calorie needs ^[1]. Aim for steady habits you can keep for years rather than a strict short-term diet, and ask your doctor or a registered dietitian to help you plan meals that fit your culture, budget and health conditions.

9. When to see a doctor

Talk to a doctor before changing your diet if you have high blood pressure, high cholesterol or diabetes, or are unsure what diet suits you. The CDC says people with high blood pressure need more frequent checks, cholesterol should be tested at least every 4 to 6 years (more often with a diagnosis or family history), and your treatment plan should be reviewed regularly with your care team ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

10. Conclusion

A heart-healthy diet is built on vegetables, fruit, whole grains, fish, poultry, beans, nuts and unsaturated fats, with less salt, sugar and saturated fat. Combined with activity, a healthy weight and no smoking, it helps protect the heart. Your doctor can help you plan changes that suit your health.