Hesitantly, slowly and--to some top nutritionists--altogether a bit tardily, the American Heart Assn. has cautiously revised its dietary guidelines, arguing that while Americans have made progress toward eating habit reform, a great deal more remains to be accomplished.
The new guidelines recommend far less salt, less overall fat consumption and greater attention to moderation in alcohol use. But if the issuance of the new dietary advice in Washington last week may have seemed a bit like something happening in natural slow motion, government and private sector physicians say they believe the United States may be ripe for a national campaign to rouse awareness of overconsumption of fatty foods.
High blood fat leads to formation of plaque deposits in the coronary arteries--a condition called atherosclerosis.
It can eventually lead to heart failure, heart attacks or other catastrophic events. While there is evidence that some susceptibility to atherosclerosis is inherited, the vast majority of the disease occurs because of poor nutritional habits.
For now, said Dr. John LaRosa, the American Heart Assn.--which has been criticized in the past for moving too slowly and too cautiously to urge Americans to take specific steps to modify their diets--believes that a renewed dietary modification program is the best way to begin a process of nutritional reform. LaRosa is acting dean and professor of medicine at the George Washington University School of Medicine and chairman of the heart association’s nutrition committee.
LaRosa was one of several physicians who presided at a Washington press conference last week at which the new heart association dietary guidelines were announced. The new version of the guidelines represents just the latest revision of the standards that were first developed 25 years ago to try to help people decide what--and how much--to eat.
Still a Long Way to Go
Though the new heart association program noted that Americans have already greatly modified their eating habits--selecting more fish and poultry and less red meat, less whole milk and high-fat dairy products and moderating their consumption of salt and alcohol--the association said far more progress remains to be made.
Key elements of the new plan are these:
- For the first time, the heart association--which has previously urged moderation in salt intake but without a specific consumption goal--urges Americans to restrict their sodium intake to one gram--about a level teaspoon--for each 1,000 calories they consume every day. No one should consume more than three grams of sodium, the heart association said.
However, in a telephone interview, LaRosa conceded it may be difficult for many consumers to know exactly how much sodium they are eating because many processed foods--including some frozen vegetables--contain large concentrations of sodium. Heart association nutritionists say every American should stop adding any salt to food--and that more healthful herbs and spices can often turn out to be more interesting flavors than salt, anyway.
The association urged government and industry organizations to step up efforts to provide more accurate and comprehensive labeling for all food products so consumers can know far more than they do now about sodium, cholesterol and total fat in the foods they eat.
- Cholesterol intake should not exceed 100 milligrams for every 1,000 calories eaten every day. The recommendation marks the first time the association has formally taken note of the large differences in body size and food consumption among people. The new standard takes into account the varying food intake needs of people as diverse as large men who eat a great deal and small women who eat comparatively little.
- Saturated fat (the type contained in animal products and some other foods) should be restricted to less than 10% of all calories eaten and the total of all fats, including saturated and unsaturated types--should be not more than 30% of all calories. This standard represents a reduction from the 35% that was deemed permissible when the most recent set of heart association guidelines was published in 1978.
- Protein should constitute 15% of all calories and carbohydrates should account for 50% to 55% or more.
- Alcohol consumption should be further reduced to a goal of not more than 50cc of alcohol per day--the rough equivalent of two distilled liquor drinks, two glasses of wine or two beers. In terms of danger to the heart, a drink is a drink, the association said, and it doesn’t matter if it is hard liquor or something less intoxicating.
Aware of Criticism
LaRosa said the heart association is aware it has been criticized in the past for not moving more aggressively to urge specific limits on salt and alcohol. He said, however, that the group has only recently been satisfied that evidence for such specific advice on quantities of the two substances is incontrovertible.
“It’s becoming pretty clear that excess alcohol consumption--over two drinks a day, and it doesn’t matter (of) what--is very strongly associated with high blood pressure levels.
“We’ve probably had an intuitive sense of that for a long time. You think of the beefy man with a red face slugging down three or four drinks a day and you just knew his blood pressure was high. But going from that kind of clinical observation to being something you could say cuts across a large population was not easy. We felt it was time.
“The heart association is considerably more assertive than some other large agencies or associations but is still fairly conservative. Things like this really do affect the public and the industries that supply the public.
“My own feeling is that we have a lot of work to do to make (all of) these dietary recommendations understandable to the public. We have a good scientific and medical base, but now we have the job to get that knowledge into the public awareness.”
Dr. Basil Rifkind, head of the federal government’s National Heart, Lung and Blood Institute’s cholesterol monitoring program, said that while the heart attack death rate has dropped in the United States by as much as 40% in the last 20 years, far more remains to be done in terms of reform of public attitudes about how much and what to eat.
What Consumers Can Do
He suggested a variety of steps consumers can take:
- If you eat red meat, try to eat smaller portions of it than you do now and stick to the leanest cuts--those with the smallest amount of fat marbling. Chicken and other poultry products can be substituted as can fish of all types--a food that can be consumed essentially without limitation in a healthy diet. Poultry should be stripped of its skin before it is cooked because the skin contains most of the harmful fat in fowl.
- All dishes should utilize far less deep frying and depend more on sauteing, broiling or roasting.
- Always substitute margarine for butter. Just as important, however, always use soft margarine--the kind sold in tub containers--because the variety sold in sticks contains possibly hazardous chemicals used to make it stay firm.
- Cut down on cheese intake and take advantage of the growing variety of cheese made with low-fat milk.
- Do not eat more than two or three eggs a week total, including those eaten fresh and in foods--such as commercial baked products--that contain eggs.
- Instead of ice cream as a dessert treat, try sherbet or water ices. Avoid whole milk, and drink skim milk if you can tolerate the taste or low-fat milk if you can’t.
“We’re talking about putting ice cream back into its old ceremonial function rather than a staple of the diet,” said Barbara Dennis, a government nutritionist who works with Rifkind. “I don’t think these are things everyone can change to tomorrow, but you’d be surprised at the change that can take place gradually,” said Rifkind. “The first level of change (in a program like this) is for most people probably the easiest,” said Dennis. “Go from a higher-fat food item to a similar one that is lower in fat. Go from regular hamburger to very lean ground beef, for instance.
“Then get in the habit of not adding fat (including butter or margarine) to vegetables.
“The next level and what might be more difficult for some people--depending on how tied they are to traditional Anglo-Saxon meal patterns--is to decrease the amounts of total fat, switching from a six-ounce portion of meat to three or two ounces.
“A way to do that is have the meat combined with vegetables--just as you see it in Italian or Oriental cuisine. You mix the ingredients together, serving the dish with something like rice or spaghetti.
Elements of Drama
“You end up with spaghetti and meat sauce, for instance, but a dish where you have less meat than you would if you had just a piece of meat on your plate.”
If none of this seems as exciting as the promise, say, of a diet in which you eat pineapple seven days in a row and are rewarded with an allegedly guaranteed weight loss, Dr. William Castelli of the Framingham (Mass.) Heart Study sees it quite differently.
“I think there is drama in this,” he said. “The drama is the fact that this process of atherosclerosis, heart attack and stroke and all of their manifestations is killing half the men and women who die in the U.S.”