Heart disease is the leading killer of both 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 American Heart Association’s dietary guidelines?
In a new scientific statement, leading nutrition experts ranked 10 popular diets based on their ability to meet the AHA’s evidence-based dietary guidelines for heart health, released in 2021.
The winner? The DASH diet, which aligned 100 percent with the AHA goals for heart-healthy eating. DASH stands for Dietary Approaches to Stop Hypertension; High blood pressure is a leading cause of heart disease and stroke.
The pescatarian diet, which allows for dairy, eggs, fish and other seafood but no meat or poultry, was 92 percent in line with AHA guidelines. The lacto-ovo vegetarian diet, which allows for dairy and eggs, and variations that include one or the other, matched 86 percent.
The award-winning Mediterranean diet aligned 89 percent with AHA dietary recommendations. The Popular Diet came in third primarily because it recommends a small glass of red wine each day and doesn’t restrict salt, said lead author Christopher Gardner, a research professor of medicine at the Stanford Prevention Research Center in California. who leads its research group on nutrition studies.
“The American Heart Association says no one should drink alcohol if they haven’t started,” Gardner said. “And if they drink, do it minimally.”
Research has linked the Mediterranean diet to reduced risk of 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 that they really can be lumped together as a higher “level” of eating patterns, Gardner said.
“We were basically trying to say that a diet doesn’t have to be 100 to be good,” she said. “All top tier diets are plant based and if they are a little off basic they are not hard to correct. Paleo and keto, however, can’t really be fixed. You should overhaul them completely.
Very low-carb diets, such as Atkins, and various keto diets, such as the well-formulated ketogenic diet, or WFKD, were at the low end of heart-healthy eating patterns, due to their emphasis on red meat, whole-grain dairy products and saturated fats, as well as limited consumption of fruits and vegetables.
A vegan diet that incorporated more than 10 percent fat and low-fat diets like volumetrics were second tier: Both met 78 percent of 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 low glycemic index (64 %) were less aligned and rigged the third level of diets.
While people interested in heart health can and should use the new AHA Top 10 Diet rankings, the scientific statement was written for physicians, Gardner said. The goal is to get doctors up to speed, since nutrition isn’t often a priority in medical school.
“It’s a package insert for doctors,” Gardner said. “When they ask about diet — which I don’t think is that common — and a patient says, ‘Oh, yeah, I’m paleo. I’m vegan. Are they keto or are they DASH, ‘I don’t think they really know what that means.
This is absolutely true, said quote 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 that about 90 percent of us know next to nothing about nutrition,” said Freeman, who was not involved in developing the AHA statement.
Yet patients need their doctors to discuss nutrition with them during regular checkups, Freeman added.
“If you asked me in my heart of hearts, do I think we should have been drumming on nutrition for the past 100 years? YES. So whenever we can drum a little bit more, I’m always for it,” she said.
Now, with a color-coded chart in hand, doctors will be better informed to discuss the foods on those diets and which ones to emphasize, limit or avoid, Gardner said. Instead of talking about the benefits of specific nutrients and heart-healthy foods, the advice should focus on a general eating pattern.
“When it was a single heart-healthy nutrient, you could just inject that nutrient into the food and claim it’s healthy food, which it wasn’t,” she 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, now I’m protected.’ No, it has to be part of a general pattern of healthy eating.
At that point, Gardner pointed out that each diet in the rankings was rated as it was meant to be eaten, not as people might actually do in real life. The new statement provides insight into how doctors could advise patients who are not eating as optimally as possible, whether due to cost, lack of time or other stressors.
However, resolving these concerns may require more than individual willpower, Freeman said.
“It’s difficult to adhere to a diet in a society that allows ultra-processed comfort foods like bacon on a stick to be the norm, and asking society to change one of the major tenants of daily life is going to be very challenging,” she said. .
“But I’d also like to tell you that the plant-based food movement is the fastest growing food movement in the country,” she said. “So there is hope.”