EBM Tools for Practice: Heart-Healthy Dietary Patterns Can Be Budget-Friendly

Introduction
It is common to hear the saying “it is expensive to eat healthy”, but does it have to be? When it comes to healthy eating, it isn’t only the cost that can be unsettling, but the massive amount of conflicting nutrition information available to interpret. The anxiety surrounding “What should I be eating?” and “How will it affect my budget?” increases further when you add a condition such as hyperlipidemia and the recommendation of following a heart-healthy diet to the equation.
Essentially, a heart-healthy, budget-friendly diet can be characterized by 3 categories:

  1. Following a healthy dietary pattern
  2. Focus on key dietary elements
  3. Cost-effective grocery shopping

Following a Healthy Dietary Pattern
When it comes to dietary recommendations for those needing a heart-healthy diet, try to keep the recommendations simple to understand and to adhere. Focusing on a healthy dietary pattern is a great way to provide generalized guidance while allowing the individual to personalize the recommendations to their preferences, lifestyle, and budget. A healthy dietary pattern also helps shift the focus more onto what the individual should be eating rather than what they shouldn’t be eating, which allows for a more positive and sustained approach.1

Healthy dietary patterns such as Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Vegetarian, and Healthy U.S.-Style dietary patterns beneficially impact ASCVD risk factors such as hyperlipidemia.2 These dietary patterns share commonalities2 of:

  1. Focusing on plant foods and lean protein sources (fish, seafood, plant-based protein from nuts, seeds, legumes)
  2. Limiting saturated and trans-fat intake
  3. Emphasis on whole, unprocessed/minimally processed food
  4. High intake of fiber-rich food (fruits, vegetables, whole grains, nuts, seeds)
  5. Limiting sugars, refined starches, as well as sugar-sweetened beverages

Focus on Key Dietary Elements

  1. Eliminate intake of all sugar-sweetened beverages2-5; Sugar-sweetened beverages can lead to excess calorie intake while adding no nutritional value. As a general guideline, this includes any drink that has more than 5 calories per serving (with the exception of skim/low-fat white milk) such as juices, regular soda, lemonades, chocolate milk, etc. Drinking water as the primary beverage is the best option. Coffee and tea without sugar are acceptable, as are calorie-free water flavor additives or diet soda occasionally. Milk should be skim or low-fat and limited to no more than 2 cups daily.
  2. Increase soluble fiber intake2-4,6; Soluble fiber binds to cholesterol in the gut and helps facilitate “excretion over absorption” of dietary sources of cholesterol. Fruits, vegetables, beans/legumes, whole grains, flax seeds are a good source of soluble fiber.
  3. Focus on healthy fats rather than unhealthy fats2-4,7; Limit red meat, butter, cheese, whole-fat dairy such as whole milk and whole-fat yogurt. Choose skinless chicken, fish, tuna, and turkey. Substitute ground turkey instead of ground beef. Use low-fat cheese and low-fat yogurt (preferably Greek yogurt for more protein). Focus on healthy fats from plants like avocados, nuts, seeds.
  4. Eat most meals at home versus out; Eating out is difficult to do without consuming significant amounts of saturated fats, refined carbohydrates, and calories. It is best, (and often cheaper) to eat at home as much as possible.


Cost-Effective Grocery Shopping
Fruits/vegetables:

  • Canned or frozen fruits and vegetables are cost-effective and still have fiber!
  • Look for low- or no-added salt/sugar when buying canned items.

Protein:

  • Buy lean meats and fish in bulk and freeze what you cannot use immediately.
  • Canned fish is high in healthy fats and is reasonably priced.
  • Ground turkey is a similar price to ground beef and lower in saturated fats.
  • Egg beaters are cholesterol-free and cost-effective.
  • Low-fat, Greek-style yogurt particularly when bought in tubs is cheaper than buying individual cups of yogurt.

Staples:

  • Brown rice, beans (black beans, pinto beans, kidney beans, (not baked beans, as they have sugar added)), oatmeal, and nut butters are shelf stable and can be purchased in bulk for a cheaper unit price. They can also be found in low-cost stores like DollarTree.

Drinks:

  • Water is the healthiest, most cost-effective option!
  • Zero-calorie drink alternatives such as diet teas, diet sodas, water flavor additives such as “Crystal Light” should be avoided, as they can contribute significantly to one's grocery bill.

Quick Meals:

  • Meal replacements such as “Lean Cuisine” are an acceptable option to keep available to prevent eating out as frequently and will often be cheaper. These meal replacements are often highly processed and high in sodium so should not be a frequent addition to a heart-healthy diet but instead used as a substitute for eating out which is also high in saturated fat, calories and sodium.

Snack Options:

  • Popcorn kernels to pop your own popcorn - high in fiber, low in calories. Pop with olive oil instead of butter for healthier fats.
  • Buying snack foods in bulk such as dried fruits is cheaper than buying individual packages at convenience stores.
  • Individual bags of “Pirates Booty”, “Veggie Straws”, “Rice Cakes”, protein bars will help with cost-effective shopping and portion control.

Meal Planning and Other Tips8:

  • Plan meals around weekly sales.
  • Buy generic or store brands when able.
  • Eat prior to shopping to avoid impulse buying of unnecessary items.

Conclusion
A heart-healthy diet is the foundation for the prevention and treatment of cardiovascular disease, and it doesn’t have to strain your food budget. To summarize:

  • Focus on a healthy dietary pattern that is provider/dietician approved and works for the patient. Some options include Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Vegetarian, and Healthy U.S.-Style. Patients may gravitate towards foods and styles most closely connected to their culture.
  • Focus on the principles of eliminating sugar-sweetened beverage intake, increasing fiber intake, focusing on healthy fats rather than unhealthy fats, and eating most meals at home.
  • When grocery shopping, plan your meals around weekly sales, buy store brands when able, cut out processed foods, and focus spending your grocery money on whole foods that will leave you feeling satisfied and energized.

Ms. Murdy has no financial relationships to disclose.


References

  1. USDA. DGA. Dietary Guidelines for Americans 2020-2025. DietaryGuidelines.gov.
  2. Nutrition Interventions for Adults with Dyslipidemia: A Clinical Perspective from the National Lipid Association. Kirkpatrick CF, Sikand G, Petersen KS, Anderson CAM, Aspry KE, Bolick JP, Kris-Etherton PM, Maki KC. Journal of Clinical Lipidology. (2023) 17, 428-451. DOI: https://doi.org/10.1016/j.jacl.2023.05.099
  3. Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV, Underberg JA and Panel NLAE. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol. 2015;9:S1-122 e1,
  4. Larson-Nath, C. (2023). ASPEN Pediatric and Neonatal Nutrition Support Handbook. Chapter 16 on Dyslipidemia. American Society for Parenteral and Enteral Nutrition.
  5. National Lipid Association – Achieving A Healthy Weight. Clinician’s Lifestyle Modification Toolbox. 2022.
  6. National Lipid Association - Adding Soluble Fiber to Lower Your Cholesterol. Clinician’s Lifestyle Modification Toolbox. 2024.
  7. National Lipid Association - Dietary Fats and Your Heart - Choosing Wisely. Clinician’s Lifestyle Modification Toolbox.
  8. National Lipid Association – Heart-Healthy Eating on a Budget. Clinician’s Lifestyle Modification Toolbox.

Article By:

Kari Murdy, RD, LD

University of Minnesota Masonic Children’s Hospital

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