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American Heart Association ranks popular diets for heart health

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The American Heart Association, the leading medical organization that advocates for good heart health, has released its most recent guidelines for the best diets for your heart. I’m sure it won’t come as a surprise to most readers, but diets high in plants and low in animal fats will be the best for your heart.

The American Heart Association (AHA) used evidence-based medicine to support its rankings of diets. That is, they relied upon peer-reviewed, published science to support their rankings. You may not like the fact that keto or paleo diets are not good for your heart, but that’s what good science tells us.

I’m going to review their findings and recommendations in this article. Since it would make this article overly long and complicated, you will need to read the underlying article, described below, to find all of the science supporting their claims. It’s a lot.

flat lay photography of vegetable salad on plate
Photo by Ella Olsson on Pexels.com

AHA recommendations on diets for good heart health

In a statement published on 23 April 2023 in Circulation, scientists reviewed the scientific evidence on diets and heart health that was originally published on 7 December 2021 also in Circulation.

Here are some of their key findings and recommendations:

  1. adjust energy intake and expenditure to achieve and maintain a healthy body weight — as I have written plenty of times, weight loss and gain is a simple equation if the energy intake is less than energy expended, you will lose weight. There are no magical ways around this.
  2. eat plenty and a variety of fruits and vegetables.
  3. choose whole grain foods and products.
  4. choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms).
  5. use liquid plant oils rather than tropical oils and partially hydrogenated fats.
  6. choose minimally processed foods instead of ultra-processed foods.
  7. minimize the intake of beverages and foods with added sugars.
  8. choose and prepare foods with little or no salt.
  9. if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake.
  10. adhere to this guidance regardless of where food is prepared or consumed.

I’m sure if you spoke to your physician about a “healthy diet,” they would either list out these recommendations or give you something to read about it.

The researchers examined several popular diets and evaluated them against nine features of the American Heart Association’s guidance for a heart-healthy eating pattern.

Each diet was evaluated against 9 of the 10 features of the American Heart Association’s guidance for a heart-healthy eating pattern. Defining features of the diets were given points based on how well each feature aligned with the Association’s guidance: 1 point for fully meeting, 0.75 points for mostly meeting, and 0.5 points for partially meeting the guidance features. If an aspect of the diet did not meet the guidance at all, zero points were given for that component.

Each diet’s scores were totaled and adjusted to arrive at a rating between 0-100, with 100 indicating the closest adherence to American Heart Association’s dietary guidelines.

The diets were divided into one of four tiers, depending on their overall score. Here are some of the most popular diets divided into these four tiers.

Tier 1 — scores higher than 85 points

  • DASH-style — describes an eating pattern that’s like the Dietary Approaches to Stop Hypertension (DASH) diet, emphasizing vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat dairy and includes lean meats and poultry, fish and non-tropical oils. The Nordic and Baltic diets are other types of this eating pattern. This diet actually scored 100 out of 100.
  • Mediterranean-style — also known as the Mediterranean diet, this pattern limits dairy; emphasizes vegetables, fruit, whole grains, legumes, nuts and seeds, fatty fish, and extra virgin olive oil; and includes moderate drinking of red wine.
  • Vegetarian-style/Pescatarian — a plant-based eating pattern that includes fish.
  • Vegetarian-style (ovo-lacto) — plant-based eating patterns that include eggs (ovo-vegetarian), dairy products (lacto-vegetarian), or both (ovo-lacto vegetarian).

Tier 2 — 75 to 84 points

  • Vegetarian-style/Vegan — a plant-based eating pattern that includes no animal products. The reason that this diet did not score higher was because it lacked a lot of oils necessary for good heart health and compliance was difficult.
  • Low-fat — a diet that limits fat intake to less than 30% of total calories, including the Volumetrics eating plan and the Therapeutic Lifestyle Change (TLC) plan.
  • Very low-fat — a diet that limits fat intake to less than 10% of total calories, including Ornish, Esselstyn, Pritikin, McDougal, and Physicians Committee for Responsible Medicine (PCRM) diets. Some may also be considered vegan.

All of these diets lack the amount of “good” oils that the AHA consider important to a healthy heart.

Tier 3 — 55-74 points

  • Low-carbohydrate — a diet that limits carbohydrates to 30-40% of total calorie intake, and includes South Beach, Zone diet, and low glycemic index diets.

Tier 4 — less than 54 points

  • Paleolithic — also called the Paleo diet, it excludes whole and refined grains, legumes, oils, and dairy.
  • Very low-carbohydrate/ketogenic — limits carbohydrate intake to less than 10% of daily calories and includes Atkins, ketogenic, and the Well-Formulated Ketogenic diets.

Diets and your heart

The American Heart Association put a lot of effort into this analysis, using science to come to its recommendations. Remember that these recommendations are based on heart health as an endpoint — weight loss was not one of the endpoints, although obesity significantly increases the risk of cardiovascular disease and death.

But once again, diets high in lean meats, fish, vegetables, fruits, and nuts appear to be strongly linked to good heart health. It also provides more evidence of the value of the Mediterranean diet as one of the four best for cardiovascular health.

I know that there is a lot of noise about various diets, and some of them seem very scientific. However, as I’ve spent more time reading the science behind many of the claims, I find that there isn’t much science there — diets rarely seem to do anything for health.

However, over the past few years, more and more research has examined the value of certain diets, especially DASH and Mediterranean diets, and the science indicates that these are good for your health. And remember, no matter what a diet claims, there is a basic physiological principle for short-term weight loss — calories in must be less than calories burned. And no miracle diet is going to change that equation.

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Michael Simpson
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