Diet and Heart Health: American Heart Association’s Dietary Guidelines Go Plant-Based

The American Heart Association has always promoted healthy eating to prevent cardiovascular disease. However, their 2021 dietary guidelines may surprise you.

Image courtesy of AHA publication (Lichtenstein et al., 2021)

Heart disease is the number one cause of death in the US, and has been since at least 1950. That’s over 70 years.

It’s also the top cause of death globally. However, for a few countries, other causes of death have beat out heart disease, such as Japan, South Korea (but not North Korea), Israel, and France (where heart disease is lower than cancer rates) and sub-Saharan African nations such as Zambia, Kenya, and South Africa (where HIV/AIDS beat heart disease).

But even in those “exception” countries, heart disease ranked second.

Many factors contribute to heart disease. But one indisputable predictor of a healthy heart is diet. What you eat matters for your health, and your cardiovascular health is no exception.

What Does a “Healthy Diet” Mean in Terms of Heart Health?

In an era where we often hear about plant-based, paleo, keto, and Mediterranean diets, what constitutes a heart-healthy diet? The American Heart Association (AHA) offers an updated answer for 2021.

The AHA released a document entitled: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association (Lichtenstein et al., 2021).

In this document, they outline their recommendations for promoting cardiovascular health, and include many scientific citations to back their claims.

The AHA recommendations shift over the years as more empirical evidence rolls in. And 2021’s list includes some interesting recommendations that might surprise you.

The American Heart Association’s Dietary Guidelines for Cardiovascular Health

Here is the list of recommendations for 2021:

  1. Adjust energy intake and expenditure to achieve and maintain a healthy body weight
  2. Eat plenty of fruits and vegetables, choose a wide variety
  3. Choose foods made mostly with whole grains rather than refined grains
  4. Choose healthy sources of protein:
    1. Mostly protein from plants (legumes and nuts)
    1. Fish and seafood
    1. Low-fat or fat-free dairy products instead of full-fat dairy products
    1. If meat or poultry are desired, choose lean cuts and avoid processed forms
  5. Use liquid plant oils rather than tropical oils (coconut, palm, and palm kernel), animal fats (eg, butter and lard), and partially hydrogenated fats
  6. Choose minimally processed foods instead of ultra-processed foods*
  7. Minimize intake of beverages and foods with added sugars
  8. Choose and prepare foods with little or no salt
  9. If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
  10. Adhere to this guidance regardless of where food is prepared or consumed

Let’s compare this list to the AHA’s recommendations from 2006:

  1. Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
  2. Consume a diet rich in vegetables and fruits.
  3. Choose whole-grain, high-fiber foods.
  4. Consume fish, especially oily fish, at least twice a week.
  5. Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by:
    1. choosing lean meats and vegetable alternatives
    1. selecting fat-free (skim), 1%-fat, and low-fat dairy products
    1. minimizing intake of partially hydrogenated fats
  6. Minimize your intake of beverages and foods with added sugars.
  7. Choose and prepare foods with little or no salt.
  8. If you consume alcohol, do so in moderation.
  9. When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations.

When you compare the two lists, many recommendations stayed the same in this 15-year period: maintain healthy weight, eat a variety of fruits and veggies, eat whole grains as much as possible, minimize added sugars, use little to no salt.

However, I found the items that changed pretty interesting.

Meat and Protein

In 2006, the AHA promoted fish twice a week and lean (low-fat) meats and dairy. Back then, they recognized the importance of the omega-3 fats in fish, and the emphasis on low-fat animal products aims to reduce saturated fat intake, which is linked to heart disease risk.

The list for 2021 looks similar in its recommendation of fish, seafood, and low-fat meats and dairy. But it added two items:

  • Avoiding processed meats (bacon, sausage, deli meats, etc.)
  • And, most notably, choosing sources of protein “mostly from plants (legumes and nuts)”

Yes, you read that right. The American Heart Association recommends what is essentially a heavily plant-based diet.

Anyone else hear the paleo, keto, and carnivore diet folks flipping out?


Another interesting addition to the 2021 list of recommendations? This:

Use liquid plant oils rather than tropical oils (coconut, palm, and palm kernel), animal fats (eg, butter and lard), and partially hydrogenated fats.

In 2006, the AHA offered specific percentages for saturated fats, partially hydrogenated fats, and cholesterol, with the goal of keeping those percentages small. But now, the AHA has veered away from percentages and made a strong claim that we should choose vegetable oils over all other fats.

This is a big stance to take, especially when certain groups claim that vegetable oils are the spawn of Satan. I looked into this question and couldn’t find any compelling evidence for that claim, which you can read about here.  

Why this strong stance? More empirical evidence has surfaced showing that saturated fats (found in animal fat and tropical oils) increase risk for cardiovascular disease. This same reasoning explains the new emphasis on plant-based protein sources.


In 2006, the AHA recommended alcohol in moderation, something many of us grew up hearing. Now, they tell you to essentially avoid alcohol or, if you choose to drink, to limit intake.

The health value of alcohol goes back and forth. Why this stricter recommendation? Maybe because alcohol has its drawbacks health-wise, whereas NOT drinking poses no risks to your cardiovascular health.

So… there you go. The AHA has spoken.

I look forward to seeing the next 15 years bring.

What do you think about the new recommendations?

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The Rogue Scientist

Christie Hartman is a writer and scientist specializing in science-based health. A biology major as an undergrad, she completed her PhD in behavioral genetics at the University of Colorado Boulder. Before starting her writing career, she worked as a scientist and professor at CU’s School of Medicine, where she studied the genetic contributions to substance abuse and antisocial behavior.

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