Best Diet For Heart Disease Prevention - Health Tips From The Professor

Are The American Heart Association’s Recommendations Correct?

Author: Dr. Stephen Chaney

What is the best diet for heart disease prevention?

Heart disease is a killer. It continues to be the leading cause of death – both worldwide and in industrialized countries like the United States and the European Union. When we look at heart disease trends, it is a good news – bad news situation.

The good news is that heart disease deaths are continuing to decline in adults over 70.
The decline among senior citizens is attributed to improved treatment of heart disease and more seniors following heart-healthy diets.
The bad news is that heart disease deaths are starting to increase in younger adults, something I reported in an earlier issue, Heart Attacks Increasing in Young Women of “Health Tips From the Professor.”
The reason for the rise in heart disease deaths in young people is less clear. However, the obesity epidemic, junk and convenience foods, and the popularity of fad diets all likely play a role.

Everyone has a magic diet for reducing heart disease risk. The American Heart Association tells us to avoid fats, especially saturated fats. Vegans tell us to avoid animal protein. Paleo and keto enthusiasts tell us carbs are the problem. Who is correct?

Of course, we don’t eat fats, carbohydrates, or proteins. We eat foods. That is why a recent study (T Meier et al, European Journal of Epidemiology, 34: 37-45, 2019) is so important. It reported which foods increase and which decrease the risk of premature heart disease deaths.

How Was The Study Done?

The authors of the current study analyzed data from the “Global Burden of Diseases (GBD) Study”, a major world-wide effort designed to estimate the portions of deaths caused by various risk factors.

The current study focused on the impact of 12 dietary risk factors on heart disease deaths between 1990 and 2016 for 51 countries in four regions (Western Europe, Central Europe, Eastern Europe, and Central Asia).

The dietary risk factors were:

Diets low in fiber, fruits, vegetables, legumes, nuts and seeds, polyunsaturated fatty acids, omega-3 fatty acids, and whole grains.
Diets high in sodium, processed meats, sugar-sweetened beverages, and trans fatty acids.

Saturated fat and meat were not explicitly included in the GBS Study data. However, diets low in polyunsaturated fats and omega-3 fats are likely high in saturated fats. Similarly, diets low in fruits, vegetables, whole grains, and legumes are likely higher in meats. The study also did not include dairy, and some recent studies suggest that some dairy foods may decrease heart disease risk.

For simplicity I will only consider the findings from Western Europe because their diet and heart disease death trends are similar to those in the United States.

Best Diet for Heart Disease Prevention?

The study found that in 2016 (the last year for which data were available):

Dietary risk factors were responsible for 49.2% of heart disease deaths.
6% of all diet-related heart disease deaths occurred in adults younger than 70, and that percentage has been increasing in recent years.

When they looked at the contribution of individual foods to diet related heart disease deaths, the percentages were:

Diets low in whole grains = 20.4%
Diets low in nuts and seeds = 16.2%
Diets low in fruits = 12.5%
Diets high in sodium = 12.0%
Diets low in omega-3s = 10.8%
Diets low in vegetables = 9.0%
Diets low in legumes = 7.0%
Diets low in fiber = 5.7%
Diets low in polyunsaturated fats = 3.7%
Diets high in processed meats = 1.6%
Diets high in trans fatty acids = 0.8%
Diets high in sugar-sweetened beverages = 0.1%

So, what is the best diet for heart disease prevention?

In short, this study concluded:

A primarily plant-based diet is the best protection against premature death due to heart disease.
All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
Meat was not included in the analysis, but it is likely that most people’s diets in this region of the world contained some meat. The most likely take-away is that meat does not affect heart disease risk in the context of a primarily plant-based diet.
Dairy was not included in the analysis either, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease in Western Europe.”

While every study has its weaknesses, this study is consistent with multiple previous studies showing that primarily plant-based diets are best for reducing heart disease risk. You will find a more complete discussion of these studies in my book “Slaying The Food Myths.”

Are the American Heart Association’s Recommendations Correct?

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
This study also supports the heart-health benefits of the Mediterranean and DASH diets.
Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

The Bottom Line

A recent study provides some important clues. It looked at dietary patterns associated with reduced risk of premature death from heart disease in Western Europe. The study concluded:

A primarily plant-based diet is the best protection against premature death due to heart disease.
All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
Meat did not appear to affect heart disease risk in the context of a primarily plant-based diet.
Dairy was not included in the analysis, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease.”

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
This study also supports the heart-health benefits of the Mediterranean and DASH diets.
Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.