By Linda Carroll -
NBC News
Some of the most popular diets can help you lose weight, which can reduce your risk of heart disease.
But an eating plan that includes lots of unhealthy oils and saturated fats can also increase your risk of heart disease, even if it helps you lose weight.
For this reason, a committee of experts from the American Heart Association has developed a ranking of the 10 best diets, scoring them according to the degree of compliance with the guidelines for a healthy heart.
This is the first time the heart association has ranked the most popular diets.
The list, published this Thursday in Circulation, gave the lowest scores to the paleo and ketogenic diets (nicknamed keto), for their reliance on animal fats, such as butter and dairy, while restricting carbohydrates.
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The Mediterranean diet and Dietary Approaches to Stop Hypertension (also known as the DASH diet), which focus on whole grains, vegetables, and low-fat dairy, scored highest.
The pescatarian (eat fish but no red meat) and vegetarian diets also scored well for their heart benefits.
According to Christopher Gardner, chair of the committee and a professor of medicine at Stanford University, it's not that eating fat in general is bad for your heart.
Unsaturated fats (such as vegetable oils, from olive or sunflower, or fish, salmon, and nuts) can lower bad cholesterol levels and lower the risk of heart disease.
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Gardner and other committee members rated the diets on how well they met the American Heart Association's scientific guidelines, which are:
Eat a wide variety of vegetables and fruits.
Choose foods that contain mainly whole grains instead of refined ones.
Choose healthy sources of protein such as plants (legumes and nuts), fish and shellfish, and low-fat or skim dairy products instead of full-fat dairy products.
If meat is included, cuts should be lean and processed forms should be avoided.
Use liquid vegetable oils (olive, safflower, corn) instead of animal fats (butter and lard) and tropical oils (coconut, palm kernel).
Consume minimally processed foods instead of ultra-processed.
Limit the consumption of drinks and foods with added sugars.
Choose and prepare foods with little or no salt.
Avoid or limit alcohol consumption.
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In the new report, the committee divided the diets into four tiers, based on the score given to each guideline.
The diets with the best score were:
DASH (Dietary Approaches to Stop Hypertension), for its commitment to fish, poultry, legumes, nuts and low-fat dairy.
Mediterranean, rich in seafood, vegetables, nuts and whole grains.
Vegetarian, which includes eggs, dairy, or both.
Pescetarian, which is based on fish as the main source of protein.
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Vegan and low-fat diets came in second.
Both encourage the consumption of legumes and nuts, while limiting alcohol and foods and beverages with added sugars.
However, following a strict vegan diet could contribute to vitamin B-12 deficiency, according to cardiology experts.
Low-fat diets lost points for treating all fats equally and because people tended to substitute carbohydrates or added sugars for fat.
The third level includes diets that are very low in carbohydrates and very low in fat because they are low in fiber or because they restrict fruits, nuts and healthy fats, such as vegetable oils.
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Keto and paleo diets were also in the fourth tier, in part because of restrictions on fruits, whole grains and legumes, which can reduce fiber intake, according to Gardner.
Deepak Bhatt, director of Mount Sinai Heart and professor of cardiovascular medicine at the Icahn School of Medicine at Mount Sinai, said: "The recommendations are not only in line with the science, but probably in line with what our mothers told us growing up: eat fruits and vegetables".
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The top-rated diets also emphasize whole grains, which "not only reduce cardiovascular risk, but also the risk of cancer and other ailments, such as diabetes," said Bhatt, who was not involved in the new report.
Brooke Aggarwal, an assistant professor of medical sciences in Columbia University's division of cardiology, said the association "has done a great job of looking at popular diets and categorizing them according to how they align with their guidelines."
"Cardiovascular disease is the leading cause of death worldwide, so we should all be concerned with how to prevent it," Aggarwal said.
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For people drawn to the keto and paleo diets, eating more unsaturated fats could help.
"If you prefer red meat, then it should be lean," Aggarwal said.
The key to reducing the risk of heart disease is to increase your intake of fruits and vegetables, choose healthy sources of protein, and minimize processed foods.
"It all comes down to what a person can stick to and fit into their lifestyle," Aggarwal says.
"Controlling weight is important."
