American Heart Association Declares This Diet the Top Heart-healthy Eating Plan

Move over, Mediterranean diet. The DASH diet is now the top heart-healthy eating plan. The plan receives a perfect score from the American Heart Association in its latest scientific assessment of heart-healthy diets.

The Mediterranean eating plan still receives good grades for fitting the association’s dietary guidelines, but it no longer is at the top of the pile.

The pescatarian and vegetarian eating patterns also fare well in the rankings, but two new fad diets—the Paleo and ketogenic diets—run counter to the association’s guidelines and so fail to rate as high on the list.

The DASH diet was first published in 1997. It has been proven in numerous studies to help those who have a history of diabetes or heart disease.

The plan is easy to follow and can work for anyone in the family, says Dr. Catherine Champagne who is a professor and registered dietitian at Pennington Biomedical Research Center, where the DASH diet was partly developed.

Aimed at Helping Confused People

The new scientific statement by the American Heart Association is aimed at helping those people, including many healthcare professionals, who might be confused by the amount of misinformation on the many popular, different dietary patterns that have mushroomed in recent years and have reached “critical levels,” says Dr. Christopher D. Gardner, who headed the writing committee that drew up the statement by the heart association.

These people might feel they do not have the training or the time to evaluate all the various diets. To help them, the heart association’s statement is meant to serve as a tool to understand which diets advance good cardiometabolic health, adds Gardner, who is Rehnborg Farquhar Professor of Medicine at Stanford University in Stanford, California.

Factors that can affect heart health are cholesterol, blood glucose, weight, and blood pressure.

The new statement is the first to analyze how closely popular diets keep to goals such as limiting the risks of heart disease as well as avoiding conditions such as obesity and Type 2 diabetes, which are a result of eating too many carbohydrates, specially processed carbohydrates, and sugar-sweetened beverages.

The Ratings

Here is how the association rates 10 categories of diets out of a total score of 100:

TIER ONE: Diets with scores higher than 85

• DASH style

This outlines an eating pattern that is similar to the Dietary Approaches to Stop Hypertension (DASH) diet. It emphasizes fruits, non-starchy vegetables, legumes, whole grains, seeds, and nuts as well as low-fat or fat-free dairy products. It also incudes poultry and lean meat, non-tropical oils, fish, and seafood.

It is low in added sugar, salt, tropical oils, alcohol, and processed foods. The protein tends mostly to be from plant sources (such as beans, legumes, or nuts).

This eating pattern is also known as the Baltic diet and the Nordic diet.

• Mediterranean style

This pattern of eating emphasizes vegetables, whole grains, fruit, seeds and nuts, fatty fish, and extra-virgin olive oil. It limits dairy products and includes moderate drinking of red wine.

Because it fails to explicitly include added salt and includes moderate consumption of alcohol (rather than limiting or avoiding alcohol) this diet receives a slightly lower score than the DASH diet.

• Vegetarian/Pescatarian style

This eating pattern is plant-based and includes fish.

Assessment

These top three dietary patterns align closely with the American Heart Association’s guidelines and may be adapted with regard to food preferences, cultural practices, and budgets to enable people always to eat this way—that is, for the long term, Gardner points out.

TIER TWO: Low-fat and vegan diets with scores from 75 to 85

• Vegetarian/Ovo/Lacto style

This plant-based eating pattern includes dairy products (lacto-vegetarian), eggs (ovo-vegetarian), or both (ovo-lacto vegetarian).

• Vegetarian/Vegan style

An eating plan that is plant-based and includes no animal products.

Assessment

These diets also emphasize eating fruits, vegetables, legumes, whole grains, and nuts. They limit alcohol as well as beverages and foods with added sugar. Restrictions in the vegan diets, however, might make it harder to follow the diets when eating out or for the long term.

Following the vegan eating pattern might increase the risk of deficiency in vitamin B-12, the association points out, which might lead to abnormalities in red blood cells, leading in turn to anemia. Clinicians therefore might recommend supplementation.

Another reason these diets score lower is that they treat all low fats equally, whereas the association’s guidelines suggest replacing saturated fats with healthier fats, such as mono- and polyunsaturated fats. Those who follow a low-fat eating pattern also might over-eat less healthy carbohydrates, such as refined grains and sugar.

TIER THREE: Very low-carb and very low-fat diets with scores from 55 to 74

• Low-fat

An eating plan that limits the intake of fat to fewer than 30% of total calories. This includes the Therapeutic Lifestyle Changes (TLC) plan and the Volumetrics eating plan.

• Very low fat

This diet limits the intake of fat to fewer than 10% of total calories. It includes the Esselstyn, Ornich, Pritikin, McDougal and Physicians Committee for Responsible Medicine (PCRM) diets. Some of these plans might also be considered vegan.

• Low-carbohydrate

This eating plan limits carbohydrates to between 30% and 40% of the total intake of calories. It includes the Zone diet, the South Beach diet, and the low-glycemic index diets.

Assessment

Some people are motivated to follow a very low-fat diet that they believe slows fatty-artery build-up.

A healthy low-carbohydrate diet has been shown to lower blood pressure, cholesterol and blood sugar as well as result in some weight loss.

These diets lost points, however, for limiting grains, legumes, and fruits (due to sugar content) in cutting down on carbohydrates. Followers of low-carb diets tend to lower their consumption of fiber while increasing that of saturated fats from meats and other animal sources, both of which go against the association’s guidelines.

The association suggests that loosening curbs on foods such as whole grains, fruits, seeds, and legumes might help people to stick to a low-carbohydrate eating plan while promoting heart health as well.

TIER FOUR: Paleolithic and very low-carb ketogenic diets with scores less than 55

• Paleolithic

Also called the Paleo diet, it excludes refined and whole grains, oils, legumes, and dairy.

• Very low carbohydrate/ketogenic

This diet limits the intake of carbohydrates to fewer than 10% of daily calories. It includes the Atkins, Well-Formulated Ketogenic, and the ketogenic diets.

Assessment

These diets, used often by people wanting to reduce weight, fail to align well with the association’s guidelines.Their strengths are that they emphasize eating fish and nuts, non-starchy vegetables, and added sugar. They also minimize drinking alcohol.

In studies up to six months long, improvements have been shown in blood sugar and body weight, but, after a year, most of those improvements were no different from those produced as a result of a less-restrictive diet, the association says.

Limits on whole grains, fruits, and legumes might result in lower intake of fiber.

These diets also are high in fat without reducing saturated fat. Low levels of fiber and high levels of fiber are both linked to the development of heart disease.

Gardner says there is no way that you can follow the Tier Four diets as they are intended and still be in line with the association’s guidelines. The diets might have short-term weight loss benefits, but they are not sustainable from a practical viewpoint, he adds.

Evaluation

Each diet was evaluated on nine of the 10 features of the American Heart Association’s heart-healthy guidelines.

The excluded tenth feature involves maintaining a healthy weight which is influenced by other factors, such as physical activity.

The scientific statement is published in the peer-reviewed journal Circulation.