The Dietary Approaches to Stop Hypertension (DASH) diet prioritizes abundant consumption of fruits, vegetables, whole grains, lean proteins, and healthy fats. According to experts, opting for healthy eating habits that offer a variety of choices is far more beneficial than following overly restrictive fad diets.
To assess the diets’ alignment with heart health guidelines, the American Heart Association (AHA) evaluated ten popular eating patterns. The results, published in the AHA’s journal, Circulation, disprove the myths surrounding restrictive fad diets, which ranked poorly in terms of heart health.
In recent years, diets like keto and paleo have gained immense popularity, but they may restrict carbohydrate intake and emphasize protein without adequately considering saturated fat. The proliferation of these diets and the dissemination of misinformation about their health benefits have been amplified by social media, as highlighted by the authors of the AHA statement.
“The public — and even many healthcare 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 Christopher Gardner, PhD. He is the Rehnborg Farquhar Professor of Medicine at Stanford University in California, and one of the experts who is behind the draft of recommendations. He recently spoke to AHA in a press release.
About Cardiometabolic Health and Its Importance
Cardiometabolic health encompasses the interplay of various elements influencing metabolism, encompassing the body’s processing and utilization of nutrients from food. It significantly correlates with cardiovascular disease, a leading cause of mortality in the United States. Key factors contributing to cardiometabolic health include blood glucose levels, cholesterol and other lipids, blood pressure, and body weight.
Experts advise that the most effective approach to preserving cardiometabolic health is through the adoption of sustainable lifestyle and dietary habits. By committing to these practices over the long term, individuals can promote their overall well-being and reduce the risk of cardiovascular issues.
“Some diet plans are hard to maintain long term. It’s better to pick a diet that becomes part of your overall healthy lifestyle, something you can maintain throughout your life, rather than jump from fad diet to fad diet,” Nicholas Ruthmann, MD, MPH, said. He is a staff cardiologist at Cleveland Clinic and was not involved in the formulation of the new guidance.
How the AHA Scored the Diets for Heart Health
The 10 diets were evaluated by the researchers based on how closely they adhered to the AHA’s heart-healthy eating pattern. The key features of this pattern include:
· Prioritizing healthy protein sources such as plant-based options, fish, low-fat dairy products, and lean meats.
· Preferring liquid plant oils like olive or avocado over tropical oils (e.g., coconut or palm), animal fats, or partially hydrogenated fats.
· Opting for unprocessed whole foods rather than ultra-processed foods.
· Emphasizing a diverse selection of vegetables and consuming them abundantly.
· Choosing whole grains instead of refined ones.
· Minimizing the intake of drinks with added sugars.
· Avoiding the consumption of alcohol.
AHA-Ranked Best and Worst Diets for Heart Health
Revised Tiers based on Dietary Recommendations:
Tier 1 (Highly Recommended):
– DASH-style eating pattern
– Mediterranean-style diet
– Pescatarian diet
– Vegetarian diet
Tier 2 (Recommended):
– Vegan diet
– Low-fat diet
Tier 3 (Moderately Recommended):
– Very low-fat diet
– Low-carb diet
Tier 4 (Not Highly Recommended):
– Paleo diet
– Keto diet
Keto and Paleo Lowest
Despite encouraging the consumption of non-starchy vegetables, nuts, and fish while minimizing alcohol and added sugar intake, ultra-low-carb diets remain high in fat, particularly saturated fat, and lack sufficient fiber.
The authors of the study observed that individuals adhering to keto and paleo diets typically experience weight loss during the initial six months of adopting the diet. However, after one year, this weight loss advantage is comparable to that of individuals following less restrictive diets that are more sustainable in the long term.
“For many of my patients, I’ve found that keto and paleo-based diets are often not sustainable,” said Dr. Ruthmann. She also said that if you’re already at higher risk for heart disease, these diets can elevate it more and the risk factors for heart disease aside from poor diet are being overweight or obese, smoking, physical inactivity, and suffering from diabetes.
Ruthmann emphasized the significance of including healthy fats, such as mono- and polyunsaturated fats found in avocados, in our diets. However, he also pointed out that certain eating plans advocate consuming excessive amounts of saturated fats and animal protein, which may contribute to the accumulation of plaque in the arteries.
The Mediterranean Style Diet Ranked Among the Best, But Came with a Caveat
The AHA has long praised the Mediterranean way of eating for its focus on whole grains, lean meats, and abundant vegetables, considering it as one of the top dietary choices to promote heart health. However, in the recent guidelines update, the authors mentioned that the diet received a deduction in points due to its suggestion of moderate alcohol consumption, particularly red wine. This recommendation contradicts the AHA’s advice, which advises limiting or completely avoiding alcohol intake for optimal heart health.
“I never recommend drinking wine to actively protect against having a heart attack or stroke,” Ruthmann said. “This said, you really have to look at the total picture. If you’re eating a healthy diet, exercising, and your blood pressure and blood sugar are under control, I think a glass of red wine a couple times a week is probably fine. Everything in moderation, of course.”
He advises against alcohol consumption for individuals at higher risk of heart disease or those who have experienced a cardiac event, such as a heart attack or stroke. Moreover, regularly indulging in alcohol could hinder one’s efforts to lose weight.
“If you’re focused on a diet with hopes for weight loss, wine and most alcohol contain more sugar than you may realize and are full of empty calories, neither of which will help lose and keep that weight off over time,” Ruthmann added.
The DASH Diet’s Perfect Score
The DASH-style eating pattern adheres fully to the American Heart Association’s guidelines for promoting heart-healthy eating. This diet emphasizes the consumption of foods low in salt, added sugar, alcohol, tropical oils, and processed ingredients, while emphasizing the intake of non-starchy vegetables, fruits, whole grains, and legumes. Protein sources predominantly consist of plant-based options like beans, nuts, and legumes, as well as fish, seafood, lean meats, and low-fat or fat-free dairy products.
In essence, this eating pattern closely resembles the Mediterranean diet’s approach to food, with the sole distinction of not including moderate alcohol consumption.
AHA Stresses the Need for Variety for Long-Term Success and Heart Health
The top-tier eating patterns that received the highest scores are the DASH diet, Mediterranean diet, pescatarian diet (which includes fish but no other meat), and vegetarian diets that incorporate eggs. These diets offer a wide variety of foods, which is crucial for their health benefits.
In the second tier, vegan and low-fat diets were placed. These diets may lack diversity, making them challenging to adhere to and potentially leading to nutrient deficiencies. The third tier includes very low-fat and very low-carb diets, falling just before the keto and paleo diets. Both very low-fat and very low-carb diets restrict important foods recommended by the AHA guidelines.
Low-carb diets advise people to avoid fruits, whole grains, and legumes, inadvertently leading to low fiber intake and potential nutrient deficiencies. On the other hand, low-fat diets avoid saturated animal fats that are harmful to heart health, but they may result in deficiencies in vitamin B-12, essential fatty acids, and protein, leading to anemia and muscle weakness, as mentioned in the evaluation.
“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,” Ruthmann said. “Literally, just a few months of fad dieting could lead to lifelong detrimental consequences for your heart.”
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