The Heart of the Matter

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February is National Heart Health Month, which often means our screens are filled with public service announcements and ads from the American Heart Association and related organizations that highlight supposedly “heart healthy” interventions. Are all the drugs and lifestyle choices that are promoted really the best options available for prevention and treatment of heart disease, though?

Maybe not always, or not for everyone.

American society tends toward a one-size-fits-all approach to targeting widespread issues like cardiovascular disease, which affects an estimated 18.2 million adults and costs upwards of200 billion dollars a year to manage. While it's easy to see why health experts and advisory agencies want to attack such a widespread problem aggressively, sometimes an aggressive attack misses the mark on a lot of the subtle, more diverse contributing factors that cause the disease to affect so many people in the first place. There also may not be a lot of room for flexibility in treating each person according to what’s best for him or her as an individual. Genetic factors, lifestyle choices, diet, and even medications can swing each person's risk factors and responses to treatment in very different directions.

For instance, here are some recent findings that may contradict some of the common medical advice related to prevention and treatment of cardiovascular disease:  

1.      All saturated fats are the same, and they're all bad for you. The question of whether saturated fat is universally harmful or all saturated fats are equally “bad” is one that seems to call for further research, especially when you consider the fact that for years the American Heart Association (AHA) promoted margarine laden with trans fats as a healthier alternative to butter. We know now that trans fats are so unhealthy that the FDA has finally implemented a ban on partially hydrogenated oils (which are high in trans fats), and that most margarine manufacturers have made efforts to limit the trans fat content of their products--but the fact remains that the AHA didn’t recognize the distinction until far too late and has never acknowledged what effect their recommendation to replace butter with margarine might have had on public health. Considering that the CDC estimates that consumption of trans fats causes upwards of 20,000 heart attacks per year, the consequences of this oversight were almost certainly severe.      

2.      Sugar is a sweet substitute for fat. The American Heart Association has known the role of sugar in promoting and worsening heart disease for decades. Yet when the AHA began its campaign to encourage low-fat diets for prevention and treatment of cardiovascular disease, they appeared to ignore or gloss over the food industry’s strategy of compensating for the loss of flavor in reduced-fat or fat-free versions of various foods loading those foods with sugar. As a result, rates of obesity skyrocketed—and since obesity is a risk factor for CVD, rates of cardiovascular disease rose just as dramatically. The American Heart Association to this day has never addressed the massive harm likely suffered by the general public as a result of its failure to address this issue. In fact, the AHA still allows products with up to 2+ teaspoons of sugar per serving (or 5 teaspoons for yogurt!) to receive its official “Heart Check” label that supposedly certifies a food as heart-healthy—for a fee, of course. Could this refusal to take action to counter the negative effects of sugar have anything to do with pressure from corporate sponsors? At the very least, it raises some uncomfortable questions about whose best interests are served by .

3.       Science never collides with marketing. The AHA’s “Heart Check” certification program is what some would refer to as a “pay for play” enterprise. Not all foods that meet the criteria for inclusion in the Heart Check program are automatically given the label; rather companies who wish to feature the label on their packaging must pay a registration fee plus annual maintenance fees for each product that receives the label. While the actual amounts haven’t been publicized in several years, the last time that figures could be obtained, registration fees were in the neighborhood of $7500per company and annual administrative fees for each product were around $2500.Even at a conservative estimate of two new registrations and 200 products being recertified each year, this represents a half-million dollar influx of cash for the American Heart Association. It would seem that it’s not in their best interests to be too restrictive about the number of processed foods in particular that could receive Heart Check approval.

4.       Product labels tell the whole truth. The primary evidence that the AHA presents to validate the benefits of their Heart Check label to cardiovascular health is, on closer inspection, not an endorsement of the AHA’s heart check criteria at all. The survey, found here, merely compares the cardiovascular health of 11,000 Americans who reported eating more Heart Check-eligible foods in a 24-hour period. There are multiple issues with this survey. First, self-report is one of the least accurate ways of gathering data from individuals. The survey period of 24 hours is also extremely short and not necessarily reflective of each individual’s regular eating habits, since many of us have days where we eat much better than others. But perhaps the most important criticism is that they survey did not differentiate between foods that have actually obtained the Heart Check certification and those that simply qualify for it. For instance, a daily meal of diet soda, high-sugar yogurt, and a sandwich made with processed deli meats and low-fat mayonnaise would be considered equally “heart healthy” as a daily consisting of whole, organic vegetables and natural, high-quality protein sources. That does not, however, serve as proof that the two meals are actually equivalent.

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What's the moral of the story?

The lesson in all of these issues is not that you can't trust anything from the American Heart Association, ever. What this should serve as is a reminder that you must always, always be an informed consumer. This reminder is not only pertinent to the American Heart Association, in fact. Anytime there is corporate influence, potential conflicts of interest, more questions than answers, or a lack of hard evidence, it’s important to consider where the information you’re receiving originates, who stands to benefit from leaving out criticism, and how the funding is obtained.

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