- The American Heart Association has rated 10 popular diets according to how well they adhere to their heart-health guidance.
- They have categorized these diets into four tiers, with Mediterranean, pescatarian, and vegetarian diets achieving the highest scores.
- Paleo and keto diets scored lowest in the American Heart Association’s rankings.
- Experts say you can reduce your risk of heart disease by eating more fruit, veggies, and whole grains while limiting your intake of saturated and trans fats.
When it comes to eating well, there’s a lot of conflicting information out there. Knowing what foods to eat for improved overall health can sometimes feel unclear or confusing.
Cutting through some of the noise, new research from the American Heart Association (AHA) has rated 10 popular diets and offered rankings on how well they adhere to heart-healthy living.
The researchers categorized the diets into four tiers, with tier 1 achieving the highest heart-healthy scores, and tier 4 achieving the lowest.
Perhaps unsurprisingly, the Mediterranean diet – an eating pattern often recommended by experts – was ranked tier 1 for heart health, alongside pescatarian and vegetarian eating patterns. These diets achieved heart health scores of 85 and above.
Popular diets like paleolithic and very low-carb/Keto eating styles, however, didn’t fare so well. They were placed in tier 4 and were awarded scores of less than 55.
To categorize each diet, the research team rated how well popular dietary patterns align with the
Each diet was measured against 9 out of 10 of the key features listed in the guidance, including how well they limit unhealthy fats and excess consumption of carbohydrates.
Here’s how 10 of the most popular diets today stack up.
“It’s hard to argue with the healthfulness of each of these diets and their reflected high scores. These diets are promoting a wide range of nutrients that focus on protein, healthy fats, whole grains (fiber), fruits, and vegetables, which are the building blocks for all healthy lifestyles,” says Bari Stricoff, a registered dietitian for WellEasy.
The diets in tier 1 all provide adequate amounts of fiber, which Stricoff says is essential for heart health for several reasons. “Fiber plays an important role in lowering cholesterol levels, maintaining a healthy weight, and managing blood sugar,” she explains.
As for the Mediterranean diet, Stricoff notes rich foods that are great for your heart include:
“These foods are great sources of unsaturated fatty acids. Monounsaturated and polyunsaturated fats, specifically, have been shown to increase HDL cholesterol,” she explains.
“That’s good news for your heart health because more favorable ratios of LDL to HDL cholesterol have been shown to be protective against cardiovascular disease,” Stricoff says.
However, both involve eating plenty of fruits, veggies, nuts, and whole grains and are linked with a reduced risk of heart disease, which may explain why they’ve been grouped together.
“However, without appropriate supplementation, the vegan diet can lack essential nutrients, like long-chain omega-3 fatty acids which reduce inflammation, reduce triglyceride levels, and increase HDL or ‘good’ cholesterol levels,” she explains.
The researchers also note that vegan diets carry an increased risk of Vitamin B12 deficiency. “Vitamin B12 deficiency can have negative implications on heart health which may explain its lower ranking,” says Huntriss.
As for low-fat diets, Huntriss believes they have achieved tier 2 status as they are low in saturated and trans fats, both of which are fats associated with an increased risk of heart disease and higher cholesterol levels.
However, just as low-fat diets reduce less-healthy fats, they also reduce the intake of healthy fats which can be protective of heart health. “This may explain the low-fat diet’s slightly lower ranking,” Huntriss explains.
Though very low-fat and low-carb diets are popular weight loss tools, the American Heart Association describes them as having “low to moderate alignment” with their heart-healthy guidance.
“Very low-fat diets have been linked to weight loss, improved blood sugar control, and reduced risk of heart disease, however, they typically eliminate a lot of healthy fats and tend to be higher in carbohydrate and protein sources,” says Huntriss.
Similarly, Stricoff points out that to make up for the removal of fat, many food companies add sugars and sweeteners to enhance flavor. “Consumption of these highly processed low-fat products is often worse for heart health,” she explains.
Why might low-carb diets have achieved tier 3 status? “Low carb diets can be low in fiber which supports healthy cholesterol levels, and often they are high in saturated fat,” says Huntriss.
Stricoff believes low-carb diets have achieved this ranking based on the assumption that you will increase your fat intake and lower your consumption of fiber. However, she notes that the relationship between low-carb diets and heart health is complex.
“Some studies suggest that a low-carb diet may have beneficial effects on heart health, while others argue that it may have negative consequences,” she says.
Out of all 10 diets, paleo and keto-style diets achieved the lowest ranking.
“In regards to the very low-carb diet and ketogenic approach, it’s likely that individuals will not consume their recommended amount of fruits, vegetables, whole grains, and fiber, which may have an adverse impact on heart health,” says Stricoff. “While there is one argument that ketones can produce the same short chain fatty acids in the gut, the diversity of your gut microbiome will be negatively impacted.”
Huntriss adds that while keto may lead to rapid weight loss and improved blood sugar control in the short term, it could increase cholesterol levels and the risk of heart disease in the long term, as a limit on saturated fat is not often advised.
As for paleo – an eating style that emphasizes lean protein sources, fruits, vegetables, nuts, and seeds while eliminating dairy, grains, legumes, and processed foods – Huntriss says it can be high in saturated fat due to its promotion of animal products and foods such as coconut oil.
“These foods can raise cholesterol levels so it is therefore seen as offering an increased risk for heart disease. At the same time, legumes and whole grains, which are supportive of heart health, are not allowed on the diet,” she explains.
If you want to improve the heart healthfulness of your diet, what can you do?
Huntriss says increasing your fruit and vegetable intake is an important first step. They’re packed with fiber and antioxidants but importantly, potassium which can help to lower blood pressure, a big risk factor for heart disease,” she explains.
You can also choose whole grains rather than refined grains. “Try to include whole-grain bread, pasta, and cereal in your diet over refined versions,” Huntriss advises. “Whole grains are not only rich in antioxidants but also rich in fiber, which can help lower cholesterol levels and reduce the risk of heart disease.”
Next, aim to include healthy fats (found in nuts, seeds, and olive oil) and reduce your consumption of trans and saturated fats. To do this, Huntriss says to choose lean proteins, such as chicken and fish, and limit red meat and high-fat dairy products. Be wary of margarines, cakes, biscuits, and fried foods, too.
By making these small changes and being mindful of the American Heart Association’s rankings, Huntriss says you can not only reduce your risk of heart disease but improve your overall health as well.