When you consider that 80{1988d9d489508ec78ab74a3fa170fc3a0f353566b665413f00453621c0c8b81d} of heart disease can be prevented by healthy lifestyle habits, it makes sense to prioritize the one habit you can’t live without: eating. But many people — including doctors — aren’t sure which diets are best for keeping your heart healthy.
This problem was the inspiration behind a recent scientific statement from the American Heart Association (AHA), published earlier this year in Circulation, says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health.
“People hear about all sorts of popular diets in the news and on social media. But they don’t have a good sense about which ones actually have scientific evidence behind them,” Hu says.
Neither do most doctors, as they receive very little nutrition training as part of their education. (Note that although the word “diet” is often associated with weight loss, it more generally refers to the kinds of foods people typically eat.)
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The statement ranks 11 popular diets based on how well they align with the AHA’s dietary guidelines, which recommend limiting saturated fat and excess carbohydrates, especially highly processed carbs and sugary drinks. The evidence comes from decades of randomized trials, population-based studies and other research, says Hu, who served as a reviewer for the scientific statement.
“It’s no surprise that all of the top-tier diets are mostly plant-based,” says Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital.
Vegetables, fruits, whole grains, beans, and nuts are all naturally low in saturated fat. They’re also good sources of fiber and contain a variety of antioxidants.
“What I like about the DASH and Mediterranean diets is that they include fish, which is a good source of both healthy fats and protein,” McManus says.
But these two diets (along with various iterations of vegetarian-style eating patterns) can also include a range of other healthy proteins, such as beans, nuts, poultry, dairy products and eggs.
Another reason the top two diets get high marks is that they encourage people to limit refined grains and added sugars.
“A healthy dietary pattern should focus on whole, real foods and limit processed foods, which tend to add extra salt, sugar and fat into your diet,” McManus says.
Don’t feel you have to abandon familiar foods that you grew up eating. “Following cultural traditions and preferences is important for helping people stay with a diet over the long term,” Hu says.
McManus agrees. “You might need to make some adjustments to how your traditional favorite foods are prepared,” she says, like swapping in a healthier fat.
You’ll be more likely to stick with healthy, lasting changes if you make small, gradual changes that are flexible, family-friendly and realistic, she adds.
This table ranks popular diets in tiers based on how closely they align with heart-healthy guidelines.
Diets in tier 1 (green) adhere most closely with heart-healthy guidelines.
DASH Mediterranean Pescatarian Ovo-lactovegetarian Lactovegetarian
These diets (light green) align well with heart-healthy guidelines but may be harder to follow.
Diets in tier 3 (yellow) align somewhat with heart healthy guidelines but may restrict healthy foods such as nuts and plant oils.
Tier 4 diets (orange) align poorly with heart healthy guidelines, as they include too many animal sourced foods high in unhealthy fats and restrict healthful plant-based foods.
Adapted from American Heart Association Scientific Statement.
