The Best and Worst Diets for Heart Health

Ten popular diets were evaluated by the American Heart Association (AHA) for how well they follow AHA's recommendations for heart-healthy eating.

The guidelines, which were released this past Thursday in the AHA's journal Circulation, corrected widespread falsehoods regarding the least heart-healthy fad diets.

The popularity of restrictive diet regimens like the ketogenic and paleo approaches has skyrocketed in recent years. The authors of the AHA statement acknowledged that social media has increased both the diets and the misconceptions about the health benefits of these diets.

"The general population, and perhaps even many healthcare experts, may be understandably puzzled about heart-healthy eating, and they may believe they lack the time or expertise to evaluate the many diet plans. Christopher Gardner, PhD, the Rehnborg Farquhar Professor of Medicine at Stanford University in California and one of the experts who drafted the recommendations, said in an AHA press release that he hoped the statement would help clinicians and the public understand which diets promote good cardiometabolic health. 

What Is Cardiometabolic Health, and Why Is It Important?

Health in the areas of metabolism, or how the body processes and utilises the nutrients in food, and cardiovascular disease, one of the top causes of death in the United States, is known as cardiometabolic health. Blood sugar, cholesterol, other lipids, blood pressure, and weight are all examples.

Experts agree that the key to lifelong cardiometabolic health is establishing a set of consistent behavioural and dietary patterns.

It can be challenging to stick to a certain food plan indefinitely. Rather than bouncing around from fad diet to fad diet, adds Nicholas Ruthmann, MD, MPH, a staff cardiologist at Cleveland Clinic who was not involved in the new recommendations, it is better to choose a diet that becomes part of your overall healthy lifestyle, something you can keep throughout your life. 

How the AHA Scored the Diets for Heart Health

Each of the 10 diets was given a score based on how well its suggested eating pattern matched the AHA's heart-healthy eating pattern. Among these are: 

Protein can be obtained from a variety of healthful foods, such as plants, seafood, low-fat dairy products, and lean meats.

substitutes for tropical oils (like coconut or palm), animal fats, or partially hydrogenated fats with liquid plant oils (like olive or avocado).

choosing full, unrefined foods over highly refined options.

Getting in a wide range and quantity of vegetables in one's diet

Consuming more whole grains and less processed grains

Limiting intake of sugar-sweetened beverages and eliminating alcohol

Keto and Paleo Ranked Lowest for Heart Health

Although adherents of ultra low-carb diets are encouraged to include foods like nonstarchy vegetables, nuts, and fish and to limit their intake of alcohol and added sugar, these diets are nevertheless heavy in fat (especially saturated fat) and low in fibre.

In addition, the authors pointed out that studies have shown that the weight loss benefits of the ketogenic and paleo diets are similar to those of less restrictive diets that are easier to adopt for life, but only for the first year.

According to Dr. Ruthmann, "for many of my patients, I've found that keto and paleo-based diets are often not sustainable," and they can increase the risk of heart disease if you're already at a greater risk. In addition to a poor diet, variables such as obesity, smoking, inactivity, and diabetes increase the likelihood of developing cardiovascular disease.

While some fat consumption is necessary, and these diets do include healthy fats like those found in avocados, they also encourage consuming large quantities of saturated fats and animal protein, which can cause plaque accumulation in the arteries, as noted by Ruthmann. 

The Mediterranean Style Diet Still Ranked Among the Best, But With a Caveat 

The AHA has long touted the Mediterranean diet as one of the greatest ways to eat to support heart health due to its focus on whole grains, lean meats, and plenty of veggies. The authors of the revised guidelines highlighted that the diet lost some points because it encouraged moderate alcohol intake (particularly red wine), which is counter to the advice given by the American Heart Association (AHA).

To prevent a heart attack or stroke, Ruthmann does not advocate drinking wine. However, the big picture is what you should focus on. A glass of red wine a few times a week seems harmless if you're otherwise healthy and active with normal blood pressure and blood sugar levels. Of course, moderation is key to everything.

People who are at a higher risk for developing heart disease or who have previously experienced a cardiac event, like a heart attack or stroke, are not encouraged to drink alcohol. Consuming alcohol on a regular basis may also impede weight loss.

"If you're on a diet with the intention of losing weight, wine and most alcohol contain more sugar than you may realise and are full of empty calories," explains Ruthmann.

The DASH Diet Received a Perfect Score

All of the American Heart Association's recommendations for heart-healthy diet could be found in the DASH eating plan. Nonstarchy vegetables, fruits, whole grains, and legumes are emphasised in this diet whereas refined grains, oils from tropical plants, and processed foods are limited. Beans, nuts, and legumes are examples of plant-based sources of protein. Fish, shellfish, lean meat, and fat-free or low-fat dairy products are some good animal-based options.

The eating plan is similar to the Mediterranean diet, except that moderate alcohol consumption is avoided.

AHA Emphasizes Variety for Long-Term Success and Heart Health 

The key to the success of the DASH diet, the Mediterranean diet, the pescatarian (who eats fish but no other meat) diet, and the vegetarian diet that includes eggs is that they all encourage people to eat a wide range of foods.

Diets that are vegan or low in fat tend to lack variety, which can make them difficult to follow and may lead to nutrient shortages, hence they scored worse. Due to their similarity in limiting vital nutrients recommended by the AHA, very low-fat and very low-carb diets share a third-place finish with ketogenic and paleo eating plans

In order to lose weight on a low-carb diet, many people skip high-fiber foods like fruits, whole grains, and legumes. This, in turn, can lead to vitamin deficiencies. Although low-fat diets are better for heart health since they cut out unhealthy saturated animal fats, the evaluation found that they can cause deficiencies in vitamin B-12, important fatty acids, and protein, leading to anaemia and muscle weakness.

"A more holistic, plant-based, fish-forward diet that is part of a larger heart-healthy lifestyle is going to be better for your heart long term and, actually, much easier to stick with for life," adds Ruthmann. Literally, only a few months on a fad diet can have long-term negative effects on your cardiovascular system.