Ranking of 10 Popular Diets by Cardiologists for Maintaining Heart Health

A recent study published in the scientific journal Circulation analyzed 10 of the most popular diets for their heart health benefits. The diets were ranked based on their alignment with the 2021 AHA Dietary Guidance for promoting cardiometabolic health. The study found that the diets could be grouped into four tiers with the highest-scoring diets being those that promoted a diet rich in fruits, vegetables, whole grains, and plant protein sources.

The highest-scoring diets include DASH, Mediterranean, pescatarian, and ovo/lacto-vegetarian diets. The DASH diet received a perfect score for its focus on low salt, added sugar, tropical oils, and processed foods, and promotes high, non-starchy vegetable intake, fruits, whole grains, and legumes. Proteins included in the DASH diet are primarily plant-based, fish, and lean meats. The Mediterranean diet includes limited alcohol intake and the pescatarian and ovo-lacto-vegetarian diets vary in how much animal protein they allow, while still promoting heart-healthy fats and high intakes of fruits and vegetables.

The lowest-scoring diets are restrictive in nature and exclude multiple food groups, including the Paleo diet and very low carbohydrate/ketogenic diets. These diets also encourage excess consumption of food groups to limit which can raise LDL cholesterol levels due to high animal protein and saturated fat content. According to Dr. Maya Vadiveloo, Associate Professor in Nutrition at the University of Rhode Island and co-author of the study, exclusion of important heart-healthy nutrients, including fruits, vegetables, and whole grains, may lead to nutritional deficiencies.

Dr. Gregory Katz, a cardiologist at NYU Langone in New York City, emphasizes the importance of diet sustainability and adherence. Any highly restrictive diet pattern can be difficult for long-term adherence, and dietary patterns should be adapted to cultural practices, food preferences, and budget constraints for long-term success.

Overall, the study aims to provide consumers and healthcare providers with a better understanding of how dietary patterns align with healthy dietary guidance for heart health. As consumers navigate the abundance of dietary information available on the internet and social media, the study serves as a resource for informed decision-making.

The diets in this study were evaluated under the assumption they were followed as intended. Of course, it is rare that an individual follows a diet perfectly in the long term and the rate of adherence decreases as the rules become more restrictive.

According to Dr. Vadiveloo, “It is critical to consider whether consuming a pattern is realistic using a Social Determinants of Health lens.”

There are several factors that go into our food choices and the food environment exerts a major impact.

'The environment dictates your behaviors, not the other way around,' Dr. Katz concluded. 'If you create an environment where the default option is healthy, you’ll often be healthy.”