Mediterranean, vegetarian or vegan, DASH, "paleo", low fat and more: the offer of diets or eating patterns is wide, adapting to the tastes and objectives of each person. If that goal is to take care of cardiovascular health, it does not give all the same, according to a recent scientific statement from the American Heart Society (AHA).
The AHA (American Heart Association) evaluated 10 popular diets and rated them according to the degree of adherence to the dietary guidelines developed and promoted by the medical association for their proven benefits for the heart.
The results, which were published in a paper in the journal Circulation, showed that some were more aligned and others less aligned with the AHA guidelines.
"The number of different and popular dietary patterns has proliferated in recent years, and the amount of misinformation about them on social media has reached critical levels," said Christopher Gardner, chairman of the drafting committee for the new scientific statement.
"The public, and even many health professionals, may rightly be confused about heart-healthy eating, and may feel they don't have the time or training to evaluate different diets," said Rehnborg Farquhar, who is also the Rehnborg Farquhar Professor of Medicine at Stanford University in California.
Gardner said he hopes this new statement will serve as a "tool for everyone to understand which diets promote good cardiometabolic health."
AHA Dietary Guide to the Heart
The American Heart Association's Dietary Guidelines (updated in November 2021) brings together key features that a diet should include to support cardiometabolic health.
According to the AHA, a dietary pattern that promotes heart health includes:
. balancing food intake and calories with physical activity in order to maintain a healthy weight,
. the choice of a wide variety of fruits and vegetables,
. whole grains,
. healthy proteins, such as fish or shellfish
. low-fat or fat-free dairy products,
. lean meat cuts,
. non-tropical vegetable oils,
. and limiting consumption of red and processed meats, salt, alcohol and processed foods with added sugars.
Adhering to these guidelines helps optimize overall metabolic and cardiovascular health and reduces the risk of obesity, high blood pressure, type 2 diabetes, and hypercholesterolemia (high cholesterol), which threaten heart and overall health.
10 popular diets under the magnifying glass
The new scientific statement is the first to look at the extent to which 10 popular dietary patterns adhere to those characteristics:
DASH: Describes an eating pattern similar to the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat dairy products, and includes lean meats and poultry, fish, and not tropical oils. The Nordic and Baltic diets are included within this dietary pattern.
Mediterranean: Also known as the Mediterranean diet, this pattern limits dairy products; highlights vegetables, fruits, whole grains, legumes, nuts and seeds, fatty fish and extra virgin olive oil; and includes moderate consumption of red wine.
Vegetarian/pescetarian: A plant-based eating pattern that includes fish.
Vegetarian/Ovo/Lacto: Plant-based eating patterns that include eggs (ovo-vegetarian), dairy products (lacto-vegetarian), or both (ovo-lacto-vegetarian).
Vegan: A plant-based eating pattern that does not include animal products.
Low-fat diets are diets that limit fat intake to less than 30% of total calories, including the TLC diet, designed to control cholesterol.
Very low-fat diets: limit fat intake to less than 10% of total calories. Many are vegan.
Low-carb diets: limit carbohydrates to 30-40% of total caloric intake. Includes those with a low glycemic index.
Paleolithic diet: Also called the "paleo diet," it excludes whole and refined grains, legumes, oils, and dairy products.
Ketogenic diets or keto diets: also called limits carbohydrate intake to less than 10% of daily calories.
Each diet was evaluated against the characteristics of the AHA guideline for a heart-healthy eating pattern.
The only element that was not used in the score was "eating to achieve an adequate energy balance to maintain a healthy weight", since at this point other factors such as the level of physical activity influence, clarified the members of the drafting committee.
Diet characteristics were awarded points based on how well their characteristics aligned with AHA guidelines. The final score they could get ranged from 0 to 100. According to these results, four levels of recommendation were defined.
The authors of the scientific statement noted that the only element of the guideline that was part of all dietary patterns was to "minimize intake of foods and beverages with added sugars."
Balanced and sustainable diets in the long term, in the lead. Photo Shutterstock.
DASH, Mediterranean, pescetarian and lacto-ovo vegetarian: the 4 best diets for the heart
Level 1: score above 85
The four highest rated patterns are flexible and provide a wide range of healthy foods to choose from.
The DASH diet received a perfect score, as it meets all AHA guidelines.
The Mediterranean diet was also among the top-rated. Since it doesn't explicitly address added salt and includes moderate alcohol consumption (rather than avoiding or limiting alcohol), it scored slightly lower than the DASH diet.
The authors also noted that most of the characteristics of a vegetarian eating pattern align with the AHA dietary guideline.
Pescetarian and vegetarian eating plans that include eggs, dairy, or both also ranked at the highest level of recommendation.
"If implemented as intended, these dietary patterns best align with American Heart Association guidance and can be adapted to respect cultural practices, food preferences and budgets to allow people to always eat this way, over the long term," Gardner said.
Vegan and low-fat diets
Level 2: scores 75-85
Vegan and low-fat diets also emphasize the consumption of vegetables, fruits, whole grains, legumes and nuts, while limiting alcohol and foods and beverages with added sugar.
"However, restrictions on vegan eating pattern may make it more difficult to stick to it long-term or when eating out," the statement said.
And it adds that following a vegan eating pattern can increase the risk of vitamin B-12 deficiency, which can cause abnormalities in red blood cells that lead to anemia; Therefore, doctors may recommend supplementation.
Low-fat diets often treat all fats equally, while the AHA guidance suggests replacing saturated fats with healthier fats, such as monounsaturated and polyunsaturated fats.
In turn, he warns that people who follow low-fat diets may end up overconsuming less healthy carbohydrate sources, such as added sugars and refined grains.
Low-carbohydrate diets can promote fiber deficiency. Photo Shutterstock.
Very low-fat, low-carb diets
Level 3: scores 55-74
These dietary patterns have a low to moderate alignment with the guidance of the American association.
The authors note that a healthy low-carb eating pattern has been shown to affect weight loss, blood pressure, blood sugar, and cholesterol equally compared to a healthy low-fat diet. However, both patterns restrict the food groups prioritized in the Association's guidance.
Very low-fat diets (usually vegan) lost points for limiting the consumption of nuts and healthy vegetable oils (not tropical). This eating pattern can also lead to deficiencies of vitamin B-12, essential fatty acids and protein, which promotes anemia and muscle weakness, they said.
Meanwhile, low-carb diets restrict fruits (due to sugar content), cereals and legumes.
"By restricting carbohydrates, its adherents tend to decrease fiber intake while increasing saturated fat consumption (from meats and animal foods), both of which contradict the Association's guidance."
The statement suggests that "loosening" restrictions on food groups such as fruits, whole grains, legumes and seeds can help people maintain a lower-carb eating pattern, which contributes to long-term heart health.
Diets rich in processed meats, saturated fats and sodium, enemies of the heart. Photo Shutterstock.
The Worst Diets for the Heart: Paleo and Ketogenic
Level 4: scores below 55
These two eating patterns, which are frequently used for weight loss, align poorly with the AHA's dietary guidelines, the statement warns.
They are diets that promote the consumption of high levels of saturated fats and low levels of fiber (by restricting the intake of fruits and whole grains), guidelines that are related to the development of cardiovascular diseases.
In studies lasting up to 6 months, improvements in body weight and blood sugar have been shown with these diets. However, after one year, most of the improvements were no different from the results of a less restrictive diet.
"These are very restrictive patterns and difficult for most people to follow in the long term. While there are likely to be short-term benefits and substantial weight loss, they are not sustainable. A diet that is effective in helping a person maintain weight loss goals, from a practical perspective, must be sustainable," Gardner said.
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