Heart disease is the leading killer of men and women worldwide, according to the World Health Organization, but there are ways to significantly reduce your risk.
Along with regular exercise and not smoking, a healthy diet is a key way to keep heart disease at bay. But which diet best meets the dietary guidelines of the American Heart Association?
In a new scientific statement, leading experts in nutrition ranked 10 popular diets on their ability to meet the AHA’s evidence-based dietary guidance for heart health, published in 2021.
The winner? The DASH diet, which was 100% aligned with AHA goals for heart-healthy eating. DASH stands for Dietary Approaches to Stop Hypertension; high blood pressure is a major contributor to heart disease and stroke.
The pescatarian diet, which allows dairy, eggs, fish and other seafood but no meat or poultry, was 92% aligned with the AHA guidelines. The lacto-ovo-vegetarian diet, which allows dairy and eggs, and variations that include one or the other, were 86% aligned.
The award-winning Mediterranean diet was 89% aligned with the AHA dietary recommendations. The popular diet came in third mostly because it recommends a small glass of red wine each day and doesn’t limit salt, said lead author Christopher Gardner, a research professor of medicine at the Stanford Prevention Research Center in California who directs its Nutrition Studies Research Group.
“The American Heart Association says no one should drink alcohol if they haven’t started,” Gardner said. “And if they do drink, to do so minimally.”
Research has linked the Mediterranean diet to reduced risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer as well as weight loss, stronger bones, a healthier heart and longer life.
But all of these diets share so much in common they can really be grouped together as a top “tier” of eating patterns, Gardner said.
“We basically were trying to say a diet doesn’t have to be 100 to be good,” he said. “All of the diets in the top tier are plant-based, and if they are off base a bit aren’t hard to fix. Paleo and keto, however, really can’t be fixed. You’d have to completely overhaul them.”
Very low-carb diets, such as Atkins, and various keto diets, such as the well-formulated ketogenic diet, or WFKD, were in the bottom tier of heart-healthy eating patterns, due to their emphasis on red meat, whole dairy and saturated fats, as well as limited fruit and vegetable intake.
A vegan diet that incorporated more than 10% fat and low-fat diets such as volumetrics were in the second tier — both met 78% of the AHA dietary guidelines, according to the statement.
Very low-fat diets with less than 10% fat, which applies to some vegan lifestyles (72%), and low-carb diets such as South Beach, Zone and the low-glycemic index (64%) were less aligned and made up the third tier of diets.
While people concerned with heart health can and should use the new AHA ranking of the 10 diets, the scientific statement was written for physicians, Gardner said. The goal is to get doctors up to speed, since nutrition is not often prioritized in medical school.
“It’s a cheat sheet for doctors,” Gardner said. “When they do ask about diet — which I don’t think is all that often — and a patient says, ‘Oh, yeah, I’m paleo. I’m vegan. I’m keto or I’m DASH,’ I don’t think they really know what that means.”
That’s absolutely true, said preventive cardiologist Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver.
“We surveyed 1,000 cardiologists five or six years ago, and it turns out about 90% of us know almost nothing about nutrition,” said Freeman, who was not involved with developing the AHA statement.
Yet patients need their doctors to be discussing nutrition with them during regular checkups, Freeman added.
“If you asked me in my heart of hearts do I think we should have been banging the drum about nutrition for the last 100 years? Yes. So every time we can bang the drum a little more, I’m always in favor,” he said.
Now, with a color-coded chart in hand, doctors will be better informed to discuss the foods on those diets and which to emphasize, limit or avoid, Gardner said. Instead of talking about the benefits of specific heart-healthy nutrients and foods, advice should focus on a overall pattern of eating.
“When it was a single heart-healthy nutrient, you could just inject that nutrient into food and claim it’s healthy food, which it wasn’t,” he said. “Or if there’s a superfood like chia seeds, you could take a really unhealthy food and sprinkle chia seeds on it and say, ‘Ah, I’m now protected.’ No, it needs to be part of an overall healthy pattern of foods.”
To that point, Gardner stressed that each diet in the rankings was evaluated as it was intended to be eaten, not as people might actually do in real life. The new statement provides information on how doctors might counsel patients who are not eating as optimally as possible, either due to cost, lack of time or other stresses.
However, fixing those concerns may take more than individual willpower, Freeman said.
“It’s hard to adhere to a diet in a society which allows ultraprocessed comfort foods like bacon-on-a-stick to be the norm, and asking society to change a major tenant of everyday living is going to be very challenging,” he said.
“But I would also tell you the plant-based food movement is the fastest-growing food movement in the country,” he said. “So there’s hope.”