The Best and Worst Diets for Heart Health
Heart healthy diets
There are some diet choices, like consuming too much processed meat and soda, that can put your heart at risk. But what you do eat is just as, if not more, important as what you don’t eat.
That’s why following a heart healthy diet is important. Read on to find out more about the best heart healthy diets that could help you lose weight (if that’s your goal), lower your risk of heart disease, and keep your ticker strong.
Best: The DASH Diet
The acronym stands for Dietary Approaches to Stop Hypertension, and the plan was designed by the National Heart, Lung, and Blood Institute specifically to lower blood pressure and prevent hypertension. DASH emphasizes foods high in fiber, vitamins, and minerals, and low in saturated fat, salt, and sugar, and the concept has withstood scientific scrutiny for 20 years: It’s effective for lowering blood pressure and cholesterol.
On this heart healthy diet, you’ll be eating plenty of fruits and vegetables, whole grains, beans, nuts, fish, poultry, and low-fat dairy, while taking it easy on fatty meats, sweets, and high-sodium processed foods (which are some of the worst foods for your heart) .
A typical day on the DASH Diet: Breakfast: Yogurt with fruit and nuts. Lunch: Turkey and roasted vegetable sandwich on whole-wheat bread. Snack: Vegetables with hummus or guacamole for a snack. Dinner: Fish with vegetables and brown rice.
Bottom line: The emphasis on eating whole foods without cutting out entire food groups makes the DASH Diet easier to stick to in the long run, and its proven effectiveness makes it a great heart-healthy plan. (Learn more about the best foods for lowering blood pressure.)
Best: The Mediterranean Diet
Perhaps the most popular and sensible approach around, the plan follows the eating patterns of people from the Mediterranean region, where the prevalence of cardiovascular disease is much lower than most other parts of the world. The diet features fruit, vegetables, whole grains, beans, nuts, olive oil, and fish, and allows poultry, eggs, and dairy in moderation. Sweets and red meat are an occasional treat. Following this diet has been proven time and time again to be beneficial for lowering the risk of cardiovascular disease thanks to the inflammation-reducing benefits of fruits, vegetables, and unsaturated fats (like olive oil).
A typical day on the Mediterranean Diet: Breakfast: A vegetable omelet. Lunch: Farro salad with chickpeas, vegetables, and vinaigrette. Snack: Fruit with a handful of nuts. Dinner: Whole-grain pasta with seafood, vegetables and olive oil and a glass of red wine.
Best: Vegan Diet
Ready to eliminate all animal products including meat, fish, poultry, eggs, and dairy? While many people follow a vegan diet to protect the planet or for animal rights, it’s also a great heart healthy diet. Inflammation plays a key role in the development and progression of heart disease, and a healthy vegan diet includes many anti-inflammatory foods: polyphenol-rich fruits and vegetables, unsaturated fats from nuts and seeds, and fiber-rich whole grains. Research in Contemporary Clinical Trials Communications found that following a vegan diet can dramatically reduce inflammation. Plus, a review in the American Journal of Clinical Nutrition found that going vegan can also lower your cholesterol and help you shed pounds—and that’s great for your heart.
A typical day on a vegan diet: Breakfast: Avocado toast with scrambled tofu and an almond milk berry smoothie. Lunch: Quinoa lentil salad with tahini dressing. Snack: Trail mix. Dinner: Black bean walnut burgers on a whole-grain bun with a green salad.
Bottom line: If you can commit to this plan, your heart will thank you. Just make sure you are getting enough of certain nutrients, particularly vitamin B12. This vitamin is typically found only in animal-derived foods, but many products (like cereal and dairy-substitutes) are fortified with it. Nutritional yeast can also be a good source of vitamin B12. (Follow these tips to have a heart-healthy day.)
Best: Flexitarian Diet
The term “flexitarian” combines flexible and vegetarian. A flexitarian diet is mostly vegetarian, with meat included as something to enjoy once in a while. The premise of flexitarianism is that you can get the health benefits of a meat-free diet by eating vegetarian most of the time, while still allowing yourself a burger from time to time so you can avoid feeling deprived.
The key to the flexitarian diet is to focus on plant-based proteins like beans, legumes, nuts, and seeds, rather than animal proteins, while also incorporating whole grains, fruits, vegetables, and dairy. There’s no rule saying how often to eat meat while on the flexitarian diet. But research in JAMA Internal Medicine supports the idea of replacing even a little of the meat in your diet with plant-based proteins to benefit your heart while lowering your risk of death from other diseases like cancer.
A typical day on the flexitarian diet: Breakfast: Oatmeal with fruit and nuts. Lunch: A whole-grain wrap filled with vegetables and chickpeas for lunch. Snack: Yogurt with berries and granola. Dinner: Vegetable-noodle soup with either white beans or chicken.
Bottom line: This is a good heart healthy diet plan for people who like the idea of vegetarianism but can’t completely quit meat.
Best: Nordic Diet
The Nordic Diet was created by a group of chefs, doctors, scientists, and nutritionists in order to address increasing obesity rates in Nordic countries. It’s based on three main guidelines: Try to eat more plants and less meat, more foods from the sea, and eat more foods from the wild countryside—especially berries.
Studies on the Nordic Diet in the Journal of Internal Medicine found that it helps reduce total and LDL cholesterol levels, while also aiding in weight loss. The Nordic Diet is based on nutritious foods that are common in Nordic countries, so you’ll see recommendations for lots of root vegetables, cabbages, fish like mackerel and trout, grains like oats and barley, and wild mushrooms and berries.
A typical day on the Nordic diet: Breakfast: Oatmeal with wild berries and nuts. Lunch: Barley salad with beans, cabbage and vinaigrette. Snack: A pear with walnuts. Dinner: Salmon with mushrooms and roasted root vegetables.
Bottom line: This is basically the Mediterranean diet except you replace olive oil with rapeseed (canola). You can’t go wrong. (These are the 50 best foods for your heart.)
Worst: Keto Diet
Researchers have yet to thoroughly test this popular plan. On the ketogenic diet, more than 70 percent of your calories come from fat, with only 5 percent of calories coming from carbohydrates. The remaining 25 percent of calories are protein. That’s a far cry from the trusted and established Institute of Medicine’s recommendation that you aim for 45-65 percent carbs, 20-35 percent protein, and 10-35 percent fat.
Research in the European Journal of Clinical Nutrition suggests that the ketogenic diet can help improve levels of blood fats like triglycerides and cholesterol—but those results may be short-lived according to research in the British Journal of Nutrition, because the diet is so hard to stick to.
A typical day on the keto diet: Breakfast: Eggs cooked in butter with bacon and avocado. Lunch: Caesar salad with meat or fish, cheese, and plenty of oily dressing. Snack: Meat and cheese slices. Dinner: Beef curry with coconut milk, non-starchy vegetables and cauliflower “rice”.
Bottom line: Although the jury is still out, it might be best to steer clear of keto because it’s difficult to stick with long-term and there are plenty of other easier diets with decades of research behind them.
Worst: Paleo Diet
This diet is based on what some people believe our Paleolithic ancestors ate. It consists solely of foods available to a hunter-gatherer society: grass-fed meat, fish, eggs, nuts, seeds, vegetables, and fruit. The plan eliminates all grains, beans, dairy, processed foods, and refined sugar.
Paleo supporters claim that it lowers the risk of chronic diseases like heart disease and cancer, but there’s limited research to back up such claims. One small study in the European Journal of Clinical Nutrition of nine people found that a paleo approach helped improve blood pressure and cholesterol levels, but these improvements were in comparison to participants’ usual—less-than-healthy—diets, so there’s no comparison between paleo and a proven heart healthy diet.
A typical day on the paleo diet: Breakfast: Free range eggs cooked in coconut oil with natural bacon and sautéed vegetables. Lunch: Organic chicken thighs with a baked sweet potato and vegetables. Snack: Nuts and seeds with dried coconut. Dinner: Grass-fed steak with squash and greens.
Bottom line: Eliminating processed foods and refined sugar? Great. Dumping all grains and legumes? Not so great—these fiber-rich foods can do wonders for your heart health.
Worst: Low-Fat, High-Carb Diet
In the 1980’s and 90’s, nutritionists and health experts believed that eating fat and cholesterol leads to weight gain and higher cholesterol levels in the blood. According to a meta analysis in the American Journal of Medicine, this turned out to be flat wrong. But no one figured it out until the entire United States (and much of the world) had overloaded on refined carbohydrates and sugar, dramatically driving up the rates of obesity and heart disease.
While researchers are still trying to figure out whether—or how much—saturated fats (the kind in meat and dairy) harm your heart, we do know this: Eating a very low-fat diet is very unsatisfying. In research, the low-fat approach doesn’t improve cardiovascular risk when compared to diets high in unsaturated fats, according to research in the American Journal of Epidemiology and Diabetes Care.
A low-fat, high-carb diet could look like: Breakfast: Cereal with non-fat milk and a banana. Lunch: A chicken breast on a roll with low fat mayo and lettuce. Snack: Pretzels or popcorn and an apple. Dinner: Pasta with tomato sauce and extra lean ground turkey.
Bottom line: Some fats are good, so plan to get moderate amounts of unsaturated fats (like anti-inflammatory omega-3s) in your heart healthy diet.
Worst: The Whole 30 Diet
Short-term commitments to an extreme diet just don’t work—people tend to fall back into bad habits. And that’s the problem with the Whole 30 Diet: For 30 days, you commit to the rules including eating exclusively whole foods like vegetables, meat, eggs, fish, some fruit, and some fats from sources like avocado, nuts, and seeds. Anything “processed” including grains, dairy products, legumes (like beans and peanuts), sugar, and alcohol is off-limits.
After 30 days, you can slowly re-introduce foods to see which ones actually cause issues for you. However, I’ve worked with many clients who turn to the Whole 30 as a permanent diet, hoping to make it their heart healthy diet. The issue is that there is no independent research on the Whole 30 diet as a temporary or permanent diet. Its restrictive guidelines cut out many heart-healthy foods, like kefir, yogurt (whose probiotics have been associated with heart health), whole grains, and legumes.
A typical day on the Whole 30 Diet: Breakfast: Eggs and vegetables cooked in coconut oil. Lunch: Salad with chicken and avocado. Dinner: Steak with a sweet potato and vegetables cooked in coconut oil.
Bottom line: As with paleo, eliminating entire food groups isn’t wise and could harm your heart.
Worst: The Alkaline Diet
The concept is that lowering the acidity of your body makes you healthier and less prone to illnesses like heart disease. Proponents of the Alkaline diet claim that eating mostly alkaline foods (such as vegetables, beans and legumes, some fruit, almonds, chia seeds, and buckwheat) and limiting acidic foods (such as meat, poultry, fish, eggs, dairy, grains, most nuts and seeds, berries, alcohol, sugar, and caffeine) can balance out the acidity in your body and returns your body to a healthy pH.
A typical day on the alkaline diet: Breakfast: Chia seed pudding made with almond milk. Lunch: Vegetable and bean salad. Snack: Apple with almond butter. Dinner: Salad with tofu and avocado.
Bottom line: While the emphasis on vegetables and plant-based proteins is good for a heart healthy diet, there’s absolutely no research backing up the claim that the diet’s alkalinity is beneficial, and the concept doesn’t really hold up to scientific scrutiny. Next, read up on these things cardiologists do to protect their own hearts.
- National Heart, Lung, and Blood Institute: " DASH Eating Plan "
- Nutrition, Metabolism and Cardiovascular Diseases: "Mediterranean diet and the incidence of cardiovascular disease: A Spanish cohort"
- American Journal of Clinical Nutrition: "Health effects of vegan diets"
- European Journal of Clinical Nutrition: "Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet"
- JAMA Internal Medicine: "Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality"
- Journal of Internal Medicine: "Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET)"
- Journal of Internal Medicine: "Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome – a randomized study (SYSDIET)"
- The National Academies of Sciences Engineering Medicine: "Summary Report of the Dietary Reference Intakes"
- European Journal of Clinical Nutrition: "Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets"
- British Journal of Nutrition: "Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials"
- The Journal of Nutrition: "Greater Whole-Grain Intake Is Associated withLower Risk of Type 2 Diabetes, Cardiovascular Disease, and Weight Gain"
- American Journal of Medicine: "Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors"
- American Journal of Epidemiology: " Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials "
- Diabetes Care: "One-Year Comparison of a High–Monounsaturated Fat Diet With a High-Carbohydrate Diet in Type 2 Diabetes"
- Nutrients: "Probiotics and Prebiotics: Present Status and Future Perspectives on Metabolic Disorders"