- The American Heart Association (AHA) analyzed the most popular diets out there for heart healthy properties.
- The DASH and Mediterranean diets were some of the healthiest.
- The AHA recommends against the keto and Paleo diets for heart health.
Heart disease is the No.1 cause of death in the U.S. and, with that, many people want to do what they can to boost their heart health. Now, the American Heart Association is breaking down the most heart-healthy diets out there—and the organization also called out a few popular diets they say aren’t doing your heart any favors.
The scientific statement, which was published in the AHA’s journal Circulation, says there is a “proliferation of nutrition misinformation and misplaced emphasis” with several popular eating plans right now. The point of the statement, the AHA says, is to “assess alignment of commonly practiced U.S. dietary patterns with the recently published American Heart Association criteria, to determine clinical and cultural factors that affect long-term adherence, and to propose approaches for adoption of healthy dietary patterns.” Basically, the organization wants to make it easier for people to choose heart healthy diets from the most popular options out there.
The AHA then ranked popular diets, designating the DASH (Dietary Approaches to Stop Hypertension) diet the winner. This diet is 100% aligned with the AHA’s goals for healthy eating, the organization notes. Also in the mix: The highly popular Mediterranean diet, along with vegan and low-fat diets.
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“Epidemiological research on the DASH and Mediterranean diets are what informed the AHA’s guidance in the first place, so it stands to reason those would score the highest,” says Scott Keatley, R.D., co-owner of Keatley Medical Nutrition Therapy.
But the AHA made a point to say that two diets—keto and Paleo—“align poorly” with the organization’s dietary guidance for a heart healthy diet. “Restrictions on fruits, whole grains, and legumes may result in reduced fiber intake,” the AHA explained in a press release. “Additionally, these diets are high in fat without limiting saturated fat. Consuming high levels of saturated fat and low levels of fiber are both linked to the development of cardiovascular disease.”
Here’s what you need to know about the top diets for heart health, plus how experts recommend you choose the right fit for you.
First, what are the features of a heart-healthy diet?
The AHA released a statement in 2021 that broke down the key features they say make for a heart healthy diet. Those recommend looking for an an eating plan that does the following:
- Balances food and calorie intake with physical activity to maintain a healthy weight
- Includes a wide variety of fruits and vegetables to get a full range of nutrients from food (instead of supplements)
- Chooses whole grains and other foods made up mostly of whole grains
- Includes healthy sources of lean and/or high-fiber protein like nuts and legumes, fish or seafood, low fat or non-fat dairy, and lean cuts of meat while limiting red and processed meats
- Uses liquid non-tropical plant oils like olive or sunflower oils
- Chooses minimally processed foods over ultra-processed foods as much as possible
- Minimizes intake of drinks and foods with added sugar
- Chooses or prepare foods with little or no salt
- Limits alcohol consumption
- Uses this guidance, no matter where food is prepared or eaten
What are the top diets for heart health?
The AHA divided the most popular diets out there into “tiers,” with Tier One being the highest and Tier Four (keto and Paleo) as the lowest. The massively popular Mediterranean diet didn’t come out on top, but it was close. These are the top diets, ranked from highest to lowest, according to the AHA.
The Dietary Approaches to Stop Hypertension (DASH) diet was originally designed to help lower blood pressure. It provides daily and weekly nutritional goals, and encourages people to focus on the following foods, according to the National Institutes of Health (NIH):
- Vegetables, fruits, and whole grains
- Fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
- Limiting foods that are high in saturated fat, like fatty meats, full-fat dairy products, and tropical oils like coconut, palm kernel, and palm oils
- Limiting sugar-sweetened beverages and sweets
DASH got a perfect score from the AHA for meeting all of the organization’s guidance.
A Mediterranean diet is based on people who live in the Mediterranean region. It focuses on plant-based foods and whole grains, along with healthy fats, according to the Cleveland Clinic. But the Mediterranean diet allows for a glass of wine a day and doesn’t address salt consumption, which is why the AHA says it was ranked lower than the DASH diet.
“The Mediterranean style of eating is my go-to for everyone I see, and then we personalize as needed,” says Kate Cohen, an R.D. at the Ellison Clinic at Providence Saint John’s Health Center in Santa Monica, Calif. “The Mediterranean diet is the most evidence-based plan out there—it’s heart-healthy and sustainable because it’s not about eliminating food groups or deprivation. It’s built on a foundation of whole, unprocessed, anti-inflammatory plant foods and healthy fats, including vegetables, fruits, legumes, nuts, seeds and of course, cold-pressed extra virgin olive oil. It leans into cold-water fish, but it’s not a requirement if seafood is not your jam, plus it includes smaller amounts of meats, eggs, cheese and yogurt.”
A Pescatarian diet is a plant-based eating pattern that includes fish. It allows followers to eat dairy, eggs and seafood, but no meat or poultry.
This form of vegetarianism allows for dairy and eggs. The AHA says that ovo-vegetarian diets (which allow for eggs), lacto-vegetarian diets (which include dairy products), and ovo-lacto vegetarian diets are all included in this group.
Vegan diets focus on eating plant-based foods and avoiding animal products.
“I do see vegetarian and vegan diets gaining popularity,” says Molly Rapozo, R.D.N., senior nutrition and health educator at Pacific Neuroscience Institute in Santa Monica, Calif. “When focused on whole foods and plant proteins, these diets are an excellent source of nutrient-dense foods that are easier on the environment.”
The AHA notes that vegan diets were ranked lower because restrictions on the diet can make it hard to follow long-term or when eating out. “Following a vegan eating pattern may increase the risk of vitamin B-12 deficiency, which may cause red blood cell abnormalities leading to anemia; therefore, supplementation may be recommended by clinicians,” the AHA says.
Low-fat diets limit fat intake to less than 30% of your total calories, and include the Volumetrics diet and the Therapeutic Lifestyle Change (TLC) plan.
The AHA says these diets were ranked in tier two because they treat all fats equally, while the AHA recommends replacing saturated fat with healthier fats like mono- and polyunsaturated fats. The AHA also has concerns that people who follow low-fat diets may have too many carbs, like added sugars and refined grains.
Very low-fat diet
A very low-fat diet is one that limits fat intake to less than 10% of total calories. This includes diets like the Ornish, Esselstyn, Pritikin, McDougal, Physicians Committee for Responsible Medicine (PCRM) diets. These tend to be vegan diets, the AHA says, noting that some studies have shown their potential to slow progression of fatty artery build-up. It’s in Tier Three, though, because it restricts some food groups that the AHA recommends.
This includes diets that limits carbohydrates to 30 to 40% of total calorie intake. The South Beach, Zone diet, and low glycemic index diets are included. The AHA says that these diets are in Tier Three because they restrict fruits, grains, and legumes.
“Low carb diets are generally low in fruit, vegetables, and whole grains because these foods contain carbohydrates,” says Deborah Cohen, R.D.N., an associate professor in the department of clinical and preventive nutrition sciences at Rutgers University School of Health Professions. “They also restrict the intake of nuts and seeds, both of which are good sources of monounsaturated fatty acids.”
People also tend to have less fiber while eating more saturated fats on these diets, which contradicts the AHA’s guidance.
Keto and Paleo diets
These diets were given low marks by the AHA for shunning food groups the organization recommends and promoting foods that the AHA discourages people from eating in high amounts. “Keto and Paleo both encourage consumption of red meat and other high fat foods,” Deborah Cohen says. “Red meat in excess can contribute to the development of cardiovascular disease because of its high saturated fat content.”
Both diets limit fruits and vegetables and “thus are lower in fiber and phytochemicals,” she says. “In addition, long term compliance on a Keto has been shown to be very difficult and when the goal is to prevent cardiovascular disease, which is a chronic disease, an eating style needs to be adhered to for a long long time,” she adds.
How to choose the right diet for you
It can be overwhelming to choose an eating plan, but experts say it’s important to select one you know you’ll be able to stick with. “Pick a diet that is manageable for the long-term, that provides you a baseline of all the foods that will keep your body healthy and yourself happy,” Keatley says.
Rapozo also recommends thinking about the foods you’re currently eating and enjoy and trying to eat healthier from there.
Kate Cohen says it’s important to think about why you want to change your eating plan, too. “You need to know your ‘why’ to stick with changes over the long haul,” she says. “It’s not always going to be easy, so you need to know what this is all about for you. Are you trying to lose weight to lower cholesterol and reduce the risk of cardiovascular disease? Do you want to feel better, have more energy, and look better in clothes? You’re much more likely to be successful if you have clear goals and understand what is motivating you.”
If you’re still unsure, Deborah Cohen suggests consulting a dietitian, if possible. They can “obtain a comprehensive nutrition and diet assessment and make individualized recommendations based on an individual’s current and past health, family history, current eating habits, physical activity, allergies and intolerances, food preparation capabilities, weight history, and financial considerations,” she says.
Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more. She has a master’s degree from American University, lives by the beach, and hopes to own a teacup pig and taco truck one day.