December 1, 2020

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The 6 Best Diets for Heart Health

8 min read

Heart disease is the leading cause of death worldwide (1).

In addition to lifestyle factors like engaging in regular exercise and not smoking, diet is one of the best ways to protect your heart. That’s because inflammation, blood pressure, cholesterol, and other heart disease risk factors are affected by what you eat (2, 3, 4, 5, 6, 7).

In particular, diets high in fiber, healthy fats, and antioxidants have been shown to help support heart health — whereas high intakes of added sugar and processed meats are associated with an increased risk of heart disease (5, 6, 7).

While many diets claim to support heart health, it’s important to choose one that’s backed by scientific evidence and easy to maintain long term.

Here are the 6 best diets for heart health.

The Mediterranean diet is based on the traditional eating patterns of people living in Greece and Southern Italy during the 1960s (7, 8).

In general, the diet emphasizes whole, minimally processed foods, including whole grains, nuts, seeds, fruits, vegetables, legumes, fish, and extra virgin olive oil. It also includes moderate amounts of poultry, eggs, low fat dairy, and red wine (9).

Additionally, it limits or eliminates added sugars, refined carbs, highly processed snacks, and red and processed meats.

Numerous studies associate the Mediterranean diet with a reduced risk of heart disease, as well as heart disease risk factors like high cholesterol and triglyceride levels, obesity, type 2 diabetes, and high blood pressure (8, 9, 10, 11, 12, 13).

One review of 11 studies found that following a Mediterranean eating plan reduced overall risk of heart disease incidence and mortality by 40% (12).

The heart benefits of this diet are thought to be largely due to its emphasis on whole, minimally processed plant foods and healthy fats (6, 9, 14).

For example, extra virgin olive oil is rich in monounsaturated fats and compounds with potent antioxidant and anti-inflammatory properties (15, 16).

A review of 32 studies tied a higher intake of this oil — but not other monounsaturated fats — to a significantly reduced risk of all-cause mortality, heart disease, and stroke (17).

Other factors like engaging in exercise and consuming fewer added sugars may also contribute to the diet’s beneficial effects.

DASH stands for Dietary Approaches to Stop Hypertension and was designed to help prevent and treat hypertension, or high blood pressure. In turn, it reduces your risk of heart disease (18).

Like the Mediterranean diet, the DASH diet doesn’t mandate a strict food list.

Instead, it recommends specific amounts of food groups based on your calorie needs, focusing on whole grains, fruits, vegetables, low fat dairy, and lean meats while limiting red meat, refined grains, and added sugars (6, 18).

Moreover, it recommends that you limit your sodium intake to 1 teaspoon (2,300 mg) per day — and a lower salt version encourages no more than 3/4 teaspoon (1,500 mg) per day.

For individuals with high blood pressure, reducing sodium intake has been shown to significantly reduce blood pressure, especially when combined with the DASH diet (19, 20, 21, 22).

However, research suggests that this effect is less significant among people with normal blood pressure levels (19, 20, 22).

The diet’s emphasis on high fiber foods, such as whole grains and vegetables, and elimination of added sugars and saturated fats may also contribute to its heart-health effects (5, 23, 24).

Indeed, research shows that the DASH diet reduces heart disease risk factors like blood pressure, obesity, waist circumference, cholesterol levels, and insulin resistance (25, 26, 27).

An umbrella review of 7 reviews linked the DASH diet to a 20% reduced risk of heart disease, 19% reduced risk of stroke, and 18% reduced risk of type 2 diabetes (28).

Vegan and vegetarian diets are eating patterns that eliminate all meat, including poultry, red meat, and fish.

While some vegetarians include other sources of animal products, such as eggs and dairy, vegans strictly avoid all animal-derived ingredients, including dairy, eggs, bee pollen, honey, and gelatin.

Instead, these diets emphasize fruits, vegetables, beans, lentils, soy products, whole grains, nuts, seeds, and plant-based oils and fats.

This high proportion of plant foods gives vegan and vegetarian diets several health benefits. For example, these diets are often high in fiber, antioxidants, and anti-inflammatory compounds, all of which aid heart health (29, 30, 31).

Additionally, regularly consuming whole soy products like tofu is associated with heart benefits. In a review of 46 studies, soy protein intake was found to significantly reduce LDL (bad) and total cholesterol levels (32).

Furthermore, an observational study including over 200,000 people linked a regular intake of tofu and isoflavones — antioxidants in soy — to a moderately reduced risk of heart disease (33).

Several other reviews have found vegetarian and vegan diets to significantly improve heart disease risk factors, including high cholesterol and blood pressure levels, overweight and obesity, and unmanaged blood sugar levels (34, 35, 36, 37, 38).

What’s more, observational studies tie higher adherence to vegan or vegetarian diets to a reduced risk of heart disease and related mortality (39, 40, 41, 42).

Of course, diet quality remains important. Vegan or vegetarian diets that are high in added sugars, refined grains, and heavily processed foods don’t offer the same heart health benefits as those high in whole, minimally processed plant foods (43).

Created by dietitian Dawn Jackson Blatner, the Flexitarian Diet is an eating pattern that focuses on plant foods but allows moderate amounts of meat, fish, dairy, and other animal products. It encourages you to get most of your protein from plant foods.

There’s no set rule on how much or how often you should eat animal products, so it depends on your preferences.

You’re encouraged to eat mostly whole, minimally processed foods and limit or avoid added sugars, refined grains, processed meats, and other highly processed foods.

While the variation allowed on this diet makes it hard to study, observational studies link a higher adherence to plant-based diets to a lower risk of heart disease (40, 41, 42).

Plus, fruits, vegetables, whole grains, and legumes — which the diet encourages — have been tied to improvements in heart disease risk factors (23, 43, 44, 45, 46).

Compared with a strict vegan or vegetarian diet, the Flexitarian Diet may be a more realistic option for those who want the heart benefits of a plant-based diet without having to give up meat and other animal products.

The Therapeutic Lifestyle Changes (TLC) diet was developed by the National Institutes of Health (NIH) to help reduce the risk of heart disease and stroke.

It includes dietary and lifestyle recommendations to promote optimal cholesterol levels and a healthy weight, such as (47):

  • getting at least 30 minutes of moderate intensity exercise per day
  • aiming to get 25–35% of your daily calories from fat
  • limiting saturated fat to no more than 7% of your daily calories
  • limiting dietary cholesterol to no more than 200 mg per day
  • eating 10–25 grams of soluble fiber per day
  • eating at least 2 grams of plant sterols or stanols per day
  • eating only enough calories per day to support a healthy weight

While research is limited, several studies reveal that the diet lowers LDL (bad) cholesterol levels. In particular, an older, 32-day study in 36 adults found that the TLC diet reduced this marker by 11% (48, 49, 50).

The diet is thought to work by upping your intake of soluble fiber, which is found in foods like oat bran, nuts, seeds, beans, lentils, and several fruits and vegetables.

High overall fiber intake is associated with a reduced risk of heart disease, and soluble fiber in particular has been shown to reduce total and LDL (bad) cholesterol levels (30, 51, 52, 53).

The TLC diet also recommends a daily intake of plant stanols or sterols, which are naturally occurring compounds in foods like fruits, vegetables, whole grains, legumes, nuts, and seeds.

Research suggests that eating 2 grams of plant sterols or stanols per day, as the diet recommends, may help reduce LDL (bad) cholesterol levels by 8–10% (54).

A final strength of the TLC diet is its recommendation to get at least 30 minutes of moderate exercise per day.

Studies show that regular exercise is important to maintain heart health and protect against disease. In fact, one review estimates that physical inactivity may account for up to 6% of heart disease cases worldwide (55, 56).

Low carb diets not only restrict your carb intake but are also typically higher in protein and/or fat than the typical Western diet. They tend to limit foods like breads, grains, pasta, potatoes, and sugary snacks and beverages.

Depending on the specific diet, carbs may be restricted to 10–40% of calories per day (57, 58).

Research suggests that low carb diets may boost heart health by reducing certain heart disease risk factors, including overweight, obesity, and high triglyceride and blood pressure levels, while increasing HDL (good) cholesterol (57, 59, 60, 61).

While one review found an increase in LDL (bad) cholesterol, it also showed a greater increase in HDL (good) cholesterol, suggesting that low carb diets may help maintain a favorable LDL to HDL ratio (60).

Although these results are promising, more long-term research is needed.

Additionally, not all low carb diets are inherently heart healthy. Some observational studies note an increased risk of heart disease and related death in people following these diets (62, 63).

Yet, a study that considered diet quality associated low carb diets rich in plant protein and fat with a reduced risk of death from heart disease and all causes — whereas those high in animal protein and fat were linked to an increased risk (63).

As such, diet quality is key. In particular, low carb diets should contain adequate amounts of fiber from plant foods like vegetables and emphasize healthy fats, such as avocados, nuts, seeds, minimally processed plant oils, and fish rich in omega-3s.

When choosing a heart-healthy diet, consider factors like nutrition quality, scientific evidence, how easy it is to follow, and whether you can sustain it long term.

While more studies are needed on the role of individual nutrients, research indicates that diets rich in whole foods, especially plant-based ones, benefit heart health (5, 6, 7).

Therefore, healthy diets allow a variety of whole foods and are low in added sugars and processed fats. Current research suggests that it’s the type of fat — rather than the amount — that’s most important when it comes to heart health (64, 65, 66).

For example, mono- and polyunsaturated fats may aid heart health, whereas trans fats have been shown to increase LDL (bad) cholesterol, decrease HDL (good) cholesterol, and worsen inflammation (64).

Research on saturated fats is inconclusive, but the U.S. Department of Agriculture (USDA) recommends limiting your intake to no more than 10% of your daily calories (64, 67, 68).

As heart disease prevention involves several lifestyle factors, it can be helpful to choose a plan that promotes a healthy weight and regular physical activity.

Finally, before starting on any diet, consult your healthcare provider to make sure that it’s the right option for your needs.

Several diets have been shown to boost heart health.

Despite their differences, these eating patterns all emphasize whole, minimally processed foods and restrict processed ones, especially those high in added sugar and saturated fat.

Of course, diet is just one piece of the equation.

To support your heart health, it’s also important to exercise regularly, refrain from smoking, and find ways to reduce your stress levels (69).

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