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The 10 best diets for heart health – ranked
From vegan to low-carb, Mediterranean to palaeolithic, here are the leading ways to eat your heart healthy
In the confusing world of diet advice, how refreshing would it be if there were a study to end all studies? One that delivers the final word on what’s actually good for us. Well, in the name of clarity, the American Heart Association (AHA) has published a fool-proof assessment of the 10 most popular diet plans. In the first study of its kind, diets are ranked by how well they improve heart health.
“People are rightly confused about what and how to eat,” says nutritionist TC Callis, author of The Building Blocks of Life: A Nutrition Foundation for Healthcare Professionals (CRC Press), who used to work for the UK government in food regulation.
“The NHS EatWell guidelines in the UK don’t make a great deal of sense and are very poorly communicated. In the absence of trustworthy advice, people turn to social-media influencers who sell them the idea that you can live healthily by following fad diets, for example raw food. It’s deeply concerning and can be massively harmful.”
The AHA guidelines chime with those from British Heart Foundation (BHF) and include the core principles of a heart-healthy diet: plenty of fruit and vegetables, wholegrain wherever possible, some meat, fish, eggs and plant-based protein and to limit sugar, salt and alcohol intake.
Rating the diets on a scale of one to 100, the AHA’s leader board looks like this: The Dash (Dietary Approaches to Stop Hypertension) eating plan (100); pescatarian diet (92); Mediterranean diet (89); vegetarian diet (86); vegan diet (78); low-fat diet (78); very low-fat diet (72); low-carbohydrate diet (64); palaeolithic (53) and very low-carbohydrate or ketogenic diet (31).
“What we eat affects a number of the different risk factors for heart and circulatory disease, including blood pressure, cholesterol and weight,” says Victoria Taylor, BHF’s senior dietitian who says her recommendations align with the AHA’s top 10 diets for heart health below.
If more of us are inclined to follow the diets at the top of the AHA’s list, it can only be a good thing, says TC Callis. “As a trusted voice in this space, the AHA has highlighted the good basic guidelines to eat by that reoccur in each of its top-ranking diets. Fill your plate with plants, but not exclusively. Stay away from anything ultra-processed and eat real food, which involves peeling, chopping, cooking and chewing.”
Even healthcare professionals are starting to see the importance of a food-first approach. Dr Syed Ahsan is a consultant cardiologist and heart rhythm specialist at London Heart Clinic. “I think the AHA’s guide is also a useful tool for healthcare professionals like me who are beginning to look at health more holistically.
“In the past we have been guilty of being a bit insular in how we approach treatments – perhaps prescribing medication for high cholesterol rather than looking into the lifestyle factors contributing to it,” says Dr Syed. “Now, I work with dietitians to look at a patient’s lifestyle and diet – the Dash diet emphasises the advice I would give patients.”
Here, in descending order, are the heart experts’ top 10 tips for cardiac health.
1. The Dash (Dietary Approaches to Stop Hypertension) Eating Plan
Ticking all the boxes, the Dash diet – which was purposely designed to reduce blood pressure by US researchers at the National Heart, Lung, and Blood Institute (NHLBI) – limits salt, sugar, alcohol and processed foods and promotes eating lots of plant-based proteins including legumes, beans, nuts with the occasional addition of seafood and meat.
A diet rich in fibre, calcium and wholegrains – all of which help reduce cholesterol and our risk of heart disease – gets a thumbs up from nutritionist Dr Somi Igbene. “Eating less salt is going to reduce your risk of high blood pressure and eating some fish is going to boost your intake of omega-3 fat, which gives you more of the ‘good cholesterol’,” she says. All the food groups are in there, so it’s therefore sustainable and adaptable for different cultures.
2. Pescatarian diet
Thanks to the high vegetable count and the addition of fish, this is a high-fibre diet that’s rich in heart-healthy omega-3 fatty acids. Dr Somi says: “Oily fish are full of these fats, which research shows play an important part in keeping your heart and cholesterol levels healthy.”
You might be missing out on iron and B12 though, as well as other nutrients which red meat and poultry contain, so you may need to look at supplements if you’re sticking to this one. “There are a lot of vitamins and minerals in meat that benefit your health,” says Dr Somi.
3. Mediterranean diet
The style of eating followed by those living in sunnier climes is a long-standing favourite among health experts, with research linking it to a reduced risk of heart disease, dementia and Type 2 diabetes. According to a study published in the BMJ earlier this year, sticking closely to a Mediterranean diet may cut a woman’s risks of cardiovascular disease and death by nearly 25 per cent.
Celebrating fresh produce, it’s a diet rich in fruit, vegetables, wholegrains and cereals, and includes some fish, meat and dairy produce. Olive oil, a source of unsaturated fat, replaces saturated fats, such as butter or lard, as a cooking staple.
Unlike the Dash diet, whose guidelines were developed based on scientific research, the Mediterranean diet has evolved without strict guidelines – people simply started following it because they noticed those eating it were healthier. Although it lost points for not having strict guidelines on salt intake, it’s a way of eating that promotes cooking from scratch.
“The chances are you’ll be eating less salt by avoiding hidden salt in processed foods,” says BHF’s dietitian Victoria Taylor. Points were also lost for moderate alcohol consumption, which Victoria explains is an optional extra that doesn’t come recommended by the BHF. “The less you drink the better,” she adds.
4. Vegetarian diet
Ranked lower by the AHA for posing a health risk, nutritionist TC Callis explains that those eating a vegetarian diet may face vitamin deficiencies: “There’s a whole list of nutrients that vegetarians – and vegans – frequently fall short of,” she says. “That includes B12, B2, niacin, iodine, iron and zinc. They tend to have lower bone density as a result and are more likely to suffer from osteoporosis and bone fractures.” Taking supplements can help, but only if your body is able to absorb them, which is dependent on your individual physiology.
5. Vegan diet
Without any animal products (unlike vegetarians who sometimes eat dairy), a vegan diet is a wholly plant-based diet. Honey, for instance, isn’t considered suitable for vegans because it is an animal product. Despite there being a wealth of advice on what vegans need to supplement, Dr Somi points out it isn’t a cure-all solution. “Not everyone can get the nutrients they need from a vegan diet simply because their bodies can’t absorb the vitamins and minerals as well as they would from eating an animal-based protein,” she explains.
If you don’t want to eat animal products, supplementation is the only option. Intravenous vitamin infusions are becoming increasingly popular among vegans who have issues absorbing supplements orally, but it’s wise to talk to your GP first to check you have a legitimate deficiency first because excessive levels of vitamins aren’t good for you.
6. Low-fat diet
Swapping saturated fat found in meat and dairy for low-fat alternative dairy products and unsaturated fats found in vegetables, nuts and seeds – the low-fat diet is a hotly debated topic.
“I remain unconvinced about the low-fat mythology,” says TC Callis. “Fat is not the enemy and that ideology is based on deeply flawed science. There is increasing evidence that saturated fat isn’t that bad for you and in fact, we need it. In particular, substances in dairy fat are hugely beneficial. Low-fat dairy options have so many fillers and additives.”
In recent years, research coming from both University of Bergen in Norway and the University of Limerick in Ireland, has called to question advice that was accepted for decades: that a low-fat diet is the key to a healthier heart. While researchers in Limerick concluded that dairy products have a positive effect on human cardiovascular health, those conducting a small study in Bergen concluded that high-quality saturated fat does not raise the “bad” cholesterol in the blood.
Now, experts want us to understand that some fat from whole, unprocessed foods is essential in maintaining our health because it helps our bodies absorb fat-soluble vitamins A, D, E and K and is a source of omega-3 fatty acids.
7. Very low-fat diet
Restricting fat in all its forms – saturated or unsaturated – following a very low-fat diet means that nuts, seeds, avocado and plant oils as well as meat and dairy are out. By cutting a considerable amount of fat out of your diet, you’re removing fats that help you absorb essential vitamins, as well as important omega-3 fatty acids. You’re also more likely to turn to processed carbohydrates to feel satisfied and these are known to play a role in high cholesterol, a risk factor for heart disease.
8. Low-carb diet
Not to be confused with a very low-carb diet (below) this version involves cutting out refined carbohydrates found in pasta and bread and starchy vegetables like potatoes. Unlike a very low carb diet, which is high in fat, this version takes a more balanced approach and includes moderate protein and fat intake. Lean animal proteins served with non-starchy vegetables form most of your meals.
With points deducted for being restrictive and difficult to maintain, a low carbohydrate diet could mean you’re eating more animal products and therefore an unhealthy amount of saturated fat, which can lead to high cholesterol and an increased risk of heart disease.
9. Palaeolithic diet
Known as the caveman diet, the paleo diet is an eating plan based on what humans may have eaten in the palaeolithic era: raw vegetables, fruits, nuts, seeds and lean grass-fed meat. Anything processed, such as dairy, refined sugar or cereal, is off the menu.
BHF’s dietitian Victoria Taylor points out that its emphasis on red meat is at odds with research-based advice to eat it occasionally. “If you’re cutting out carbohydrates that contain vital nutrients like wholegrains, beans, pulses, even some fruits and vegetables, it means losing key sources of fibre, calcium and energy,” says Victoria. “That could affect your health in the long term.”
10. Very low-carb or ketogenic diet
With some of the best-known cult diet plans falling into this category (such as Atkins and Dukan), the AHA has penalised this pattern of eating because of how restrictive it is. The emphasis is on fatty meats, fish, nuts and dairy, while carbohydrates are limited to low-carb vegetables such as leafy greens. Root vegetables and fruit are out.
The keto diet specifically is based on the theory that by eating this way (low carb, high fat) you can send your body into a state of “ketosis” where your body starts to burn fat instead of carbohydrates. While most do lose weight at first – giving rise to its popularity as a fad diet – it’s hard to follow over a long period of time and promotes eating more red meat than the heart-healthy guidelines suggest.