When “heart-healthy” isn’t the healthiest choice

We tend to think of heart-healthy nutrition principles as widely applicable. If prioritizing vegetables, watching salt, and limiting juice is good for us, why not for everyone?

But some heart-healthy habits can get other people into trouble. Nutrition is definitely not a one-size-fits-all field! Here are four examples.

Example 1 – Grandpa has high blood pressure, so no salt allowed

I’ve seen this in my practice, with well-intentioned family members cooking for an older relative with heart concerns, and restricting things like salt (or fat) in ways that are counterproductive.

First of all, it’s not clear that we need to restrict salt (or fat) in home cooking that much anyhow. As long as the processed, takeout, and restaurant foods are truly kept to a minimum, you can add a bit of salt to foods like home-cooked potatoes and chicken. We should be more concerned about higher-sodium processed foods like ham, ketchup, and bacon.

How much salt is reasonable? Remember that the World Health Organization suggests limiting sodium to 2000mg a day. Healthy Canada uses 2300mg. So if you’re doing about 500-600mg per meal, you’re doing great! (That’s about ¼ teaspoon of salt.)

But why not limit Grandpa’s sodium? What’s the harm? Because sometimes for older adults, the biggest nutrition concern is unintended weight (and muscle) loss, so our priority is helping them to eat enough overall. To do that, we want the food to taste good. If that means a bit more salt for Grandpa, so be it.

So ease up on the salt and other restrictions for those older relatives. 

Example 2 – Teen athletes, no sugar allowed

You’ve probably heard the rule of thumb of 6-12 teaspoons of free sugar. But that’s just an estimate, based on 5-10% of a 2000 calorie diet. Your teenage athlete might need 4000 calories a day! If so, they’d have room for 12-24 teaspoons of free sugar, or ¼ to ½ cup of sugar per day! 

So don’t panic if they enjoy what feels like more than their fair share of cookies or ice cream. They probably have more room than you do! 

Sports nutrition relies more heavily on carbohydrate than might feel healthy. But if you want your teen athletes to ease up on the sugary treats, make sure they get enough of other sources of carbohydrate for fuel, including pasta, bagels and even juice. All of those things you might be leery of if you have heart health concerns or diabetes. 

(Fun fact: You can have those things too, just in smaller portions than your young hockey player or track star.)

Example 3 – Living with an eating disorder, counting nutrients

I do like to encourage tracking nutrients like free sugar and saturated fat, for a short time, when I think it will help people learn about nutrition and feel more confident in their current eating habits. 

For example, if someone is wringing their hands about how much sugar or sodium they consume, but I can see from a food record that it isn’t that high, I might have them count those things for three days so they can relax and feel less stress about their eating.

But this habit can be triggering for people who are living with an eating disorder or even disordered eating that hasn’t been diagnosed. In my private courses and membership, we screen for this if we’re worried (using this tool, which you can use too.) 

Note that’s not a diagnostic tool, but rather a screening tool, which means it can’t give you a diagnosis. It just suggests when you might benefit from professional help. 

In the meantime, for those who might have a history of an eating disorder, or who screen positive on this tool, or even those who have a history of repeated dieting, we stay away from counting nutrients.

Example 4 – Cancer patient, loading up on veggies

This is me this year, so I’m learning a few things! 

I’ve been working with the excellent dietitian at our local cancer centre. Her advice is different in a couple of crucial ways, because with cancer, keeping weight and muscle mass ON is the name of the game:

• Eat often, even when you’re not hungry
• Prioritize animal over plant-based protein, so the fibre doesn’t fill you up. (You can’t afford it when your appetite is poor, which it certainly can be.) 
• Eat protein-rich foods first, and vegetable-rich foods like salads second.

So if you’re helping a friend or family with cancer, ask them what they need rather than assuming. That low-calorie salad may not be as useful as a chicken dish with sauce.

One Size Doesn’t Fit All

The bottom line is that heart-health nutrition principles may not be for everyone. They’re great for many with generally good health as well as those with a history of heart problems (of course) or risk factors, including diabetes, high blood pressure, and high cholesterol. 

So if you’re helping by feeding someone, ask them what they need! If it’s a close family member like the older adult in the first example, it may be appropriate to talk to their physician or dietitian. 

Or if it’s appropriate, encourage someone like a teen athlete or a person with an unusual condition (like cancer) to see a dietitian who specializes in that area.