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Scientists break down the best heart-healthy diets

Amidst the chaos of ever-changing diet trends, determining which ones genuinely promote heart health can be a daunting task. But now, a recent scientific statement published in the American Heart Association journal Circulation, offers valuable insight and guidance.

The researchers evaluated the heart-healthy elements of ten popular diets, revealing that while many align closely with the American Heart Association‘s dietary guidance, some fall short.

Dr. Christopher D. Gardner is the chair of the writing committee for the new scientific statement and a professor of Medicine at Stanford University. He noted that the multitude of diets and the misinformation surrounding them have reached unprecedented levels.

“The public – and even many health care professionals – may rightfully be confused about heart-healthy eating, and they may feel that they don’t have the time or the training to evaluate the different diets. We hope this statement serves as a tool for clinicians and the public to understand which diets promote good cardiometabolic health,” said Dr. Gardner.

The term “cardiometabolic health” refers to a group of factors that affect metabolism – the body’s processes for breaking down nutrients in food and building and repairing tissues to maintain normal function – and the risk of heart and vascular disease. These factors encompass blood glucose, cholesterol and other lipids, blood pressure, and body weight. Abnormal levels of one factor can increase the risk for heart disease, but when multiple factors are abnormal, the risk of heart disease is compounded, often leading to more severe disease.

The statement evaluates the alignment of popular dietary patterns with the American Heart Association’s Dietary Guidance. This guidance includes ten key features of a dietary pattern designed to improve cardiometabolic health, with a focus on limiting unhealthy fats and reducing the intake of excess carbohydrates. 

The study is the first of its kind to analyze how closely popular dietary patterns conform to these features. Importantly, the guidance is designed to be adaptable to individual budgets, personal tastes, and cultural preferences.

How the research was conducted 

The experts reviewed the defining characteristics of several long-term dietary patterns, which were grouped by similarity into ten categories: 

  1. DASH-style
  2. Mediterranean-style
  3. Vegetarian-style/Pescatarian
  4. Vegetarian-style/Ovo/Lacto
  5. Vegetarian-style/Vegan 
  6. Low-fat 
  7. Very low-fat 
  8. Low-carbohydrate
  9. Paleolithic
  10. Very low-carbohydrate/ketogenic diets

Each diet was assessed against nine of the ten features of the American Heart Association’s guidance for a heart-healthy eating pattern. The defining features of the diets were assigned points based on their alignment with the Association’s guidance.

Results of the analysis 

Tier 1 comprised the highest-rated eating plans with scores surpassing 85

Among the top performers were the DASH-style eating pattern, which earned a perfect score by meeting all the AHA’s guidance. These top-tier diets are flexible, offering a broad array of healthy foods, low in salt, added sugar, alcohol, tropical oils, and processed foods. They’re rich in non-starchy vegetables, fruits, whole grains, and legumes. Protein sources in these patterns tend to be mostly plant-based, supplemented with fish, seafood, lean poultry and meats, and low-fat or fat-free dairy products.

The Mediterranean-style diet also received high marks, though it fell slightly short of the DASH pattern as it doesn’t explicitly address added salt and includes moderate alcohol consumption. Vegetarian-style diets, including Pescatarian and those that incorporate eggs and dairy, also ranked highly. 

“If implemented as intended, the top-tier dietary patterns align best with the American Heart Association’s guidance and may be adapted to respect cultural practices, food preferences and budgets to enable people to always eat this way, for the long term,” said Dr. Gardner.

Tier 2, with scores between 75 and 85, included Vegan and low-fat diets

These diets also emphasize consumption of vegetables, fruits, whole grains, legumes, and nuts while limiting alcohol and added sugars. However, the restrictions in the vegan eating pattern may make it challenging to follow long-term, potentially increasing the risk of vitamin B-12 deficiency, leading to anemia. 

Low-fat diets often treat all fats equally, whereas the AHA guidance recommends replacing saturated fat with healthier fats. Those following a low-fat diet may risk overconsuming less healthy carbohydrates, but these factors can be mitigated with proper counseling and education.

Tier 3, with scores between 55 and 74, included very low-fat and low-carb diets

Although some people may be drawn to very low-fat diets due to their potential to slow the progression of fatty artery buildup, and while healthy low-carb diets have been shown to affect weight loss, blood pressure, blood sugar, and cholesterol similarly to healthy low-fat diets, these patterns do restrict food groups emphasized in the AHA’s guidance. 

Very low-fat diets may lead to deficiencies of vitamin B-12, essential fatty acids, and protein, while low-carb diets often result in decreased fiber intake and increased saturated fat consumption. The statement suggests that loosening restrictions on certain food groups may promote long-term adherence and heart health.

Tier 4, with scores less than 55, included Paleolithic and very low-carb/Ketogenic diets

These diets, often followed for weight loss, align poorly with the AHA’s guidance. Despite their emphasis on consuming non-starchy vegetables, nuts, and fish, and minimizing alcohol and added sugar, these diets restrict fruits, whole grains, and legumes, leading to reduced fiber intake. Additionally, they are high in fat without limiting saturated fat, which is linked to the development of cardiovascular disease.

“There really isn’t any way to follow the Tier 4 diets as intended and still be aligned with the American Heart Association’s Dietary Guidance,” said Dr. Gardner. “They are highly restrictive and difficult for most people to stick with long term. While there will likely be short-term benefits and substantial weight loss, it isn’t sustainable. A diet that’s effective at helping an individual maintain weight loss goals, from a practical perspective, needs to be sustainable.”

More tips for healthy eating

Maintaining a balanced diet is essential for promoting good health and well-being. Here are some additional tips for healthy eating:

Eat a Variety of Foods

No single food contains all the essential nutrients needed by the body. Therefore, consuming a wide range of different foods including fruits, vegetables, lean proteins, whole grains, and dairy (or dairy alternatives) is key to maintaining good health.

Stay Hydrated

Water plays a vital role in nearly every bodily function. Aim to drink at least 8 glasses of water a day. However, needs can vary based on activity level, age, and climate.

Control Portion Sizes

Pay attention to portion sizes to avoid overeating. Even healthy foods can lead to weight gain when consumed in excessive amounts.

Limit Added Sugars

Foods and drinks with added sugars can contribute to weight gain and tooth decay. Try to limit consumption of these products and opt for natural sugars found in fruits and vegetables instead.

Eat Regular Meals

Skipping meals, especially breakfast, can lead to out-of-control hunger, often resulting in helpless overeating. Regular meals help maintain energy levels and control appetite.

Consume Healthy Fats

Not all fats are bad. Unsaturated fats, like those found in avocados, nuts, seeds, and fish, are beneficial for heart health.

Limit Salt Intake

High sodium intake can lead to high blood pressure, which increases the risk of heart disease and stroke. Aim to consume no more than 2,300 mg of sodium per day, which is about one teaspoon of salt.

Plan Your Meals 

Planning meals ahead of time can help ensure a balanced diet and avoid last-minute unhealthy food choices.

Include Fiber in Your Diet

Dietary fiber can help maintain a healthy weight and lower the risk of diabetes, heart disease, and some types of cancer. Good sources include fruits, vegetables, whole grains, and legumes.

Read Food Labels 

Understanding food labels can help you make healthier choices. Check for ingredients, serving sizes, and nutrient information.

Remember, a healthy diet is most effective when combined with regular physical activity. Always consult with a healthcare professional or dietitian if you need specific dietary advice or have any health concerns.


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