Four diets clinically proven to help the heart

We hear a lot about different diets from the media. The information is often contradictory and confusing. What really works? Let’s go back to the basics. Eating more fruits, vegetables, good fats, whole grains, and healthful protein packages, and less of the not-so-good stuff works for the heart. A host of studies has shown that each of these elements, by itself, can lower cholesterol, blood pressure, and blood sugar; improve the flexibility of arteries; or protect against heart attack, stroke, and other forms of cardiovascular disease. Put various pieces together and the protective effect is even more powerful.

If you are a do-it-yourselfer, don’t hesitate to wade right in and fiddle with your diet. After all, this isn’t rocket science, and only you know what foods you like, which ones you can’t stomach, and what kinds of dietary changes you can realistically make.

But what if you’d rather have someone else cook up a diet to help you counter or prevent heart disease? There are scores of “healthy heart” diet books in the marketplace. Very few of those diets, though, have been tested to see how well — or even if — they work. Four diets forged in rigorous clinical trials are the real McCoy. These are the DASH diet, a higher-protein diet, the cholesterol-lowering portfolio diet, and a Mediterranean-type diet.

These four are much better for the heart than the average American diet. Yet each has its own subtle effects that, in some cases, could detract from the benefits, and none except the Mediterranean-type diet has been studied long enough to know exactly how it affects heart disease or survival. You can assume that the improvements that all four yield in cholesterol levels and blood pressure will translate into protection against heart attack or stroke. But when it comes to nutrition, making assumptions can be tricky.

Diet details Here’s how four rigorously tested diets stack up in composition and in how they affect six key aspects of cardiac risk. DASH: Seven to nine servings a day of fruits and vegetables; two to three servings of low-fat dairy products; emphasis on whole grains, nuts, poultry, and fish; minimal saturated fat, red meat, and sweets (55% of calories from carbohydrates, 18% from protein, and 27% from fats). OmniHeart higher protein: Six servings a day of fish, poultry, red meat, and eggs; three servings of beans, nuts, seeds, or soy; plenty of fruits and vegetables; and some low-fat dairy products (48% of calories from carbohydrates, 25% from protein, and 27% from fats). Portfolio diet: Five to 10 servings of fruits and vegetables; whole grains instead of highly refined ones; mostly plant protein; soy foods instead of meat, soy milk instead of dairy; plenty of soluble fiber from oats, barley, eggplant, okra, and natural psyllium supplements; margarine enriched with plant stanols or sterols, such as Benecol or Take Control; nuts, preferably almonds, every day (48% of calories from carbohydrates, 21% from protein, and 31% from fats). Mediterranean-type diet: There is no such thing as the Mediterranean diet. In general, a Mediterranean-type diet is low in saturated fat and high in fiber; fruits, vegetables, grains, beans, nuts, and seeds are eaten daily and make up about half of the diet; fat, much of it from olive oil, may account for up to 40% of daily calories; cheese or yogurt usually eaten each day, along with a serving of fish, poultry, or eggs; red meat on occasion; small amounts of red wine typically taken with meals; regular physical activity is a part of daily life.
Diet	Total cholesterol	LDL	HDL	Triglycerides	Blood pressure	Blood sugar
Average American diet	increase	increase	decrease	increase	increase	increase
DASH diet	decrease	decrease	decrease	same	decrease	?
OmniHeart higher protein	decrease	decrease	decrease	decrease	decrease	?
Portfolio diet	decrease	decrease	Same	decrease	decrease	?
Mediterranean-type diet	decrease	decrease	increase	decrease	decrease	decrease

Bringing it home

These four diets are alike in many ways. They are heavy on food from plants (fruits, vegetables, beans, nuts, and seeds) and light on saturated fat, sodium, and sweets. They aren’t vegetarian, although the portfolio diet comes pretty close. Instead, they are “flexitarian” — they emphasize healthy plant foods, but also include poultry, seafood, dairy foods, and sometimes even steak.

The most encouraging finding from trials comparing weight-loss diets is that long-term weight loss can be accomplished a variety of ways — there’s no one-size-fits-all strategy. The same will probably hold true for heart healthy diets. What’s important is to find a plan you can stick with for a long lifetime. Remember that there are a lot of ways to achieve a healthy diet and still eat what you love!

What kind of diet do you follow? Is it working to keep your blood pressure low and to keep your heart healthy in general?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Healthy Eating for a Healthy Heart
Research shows that more than 80% of heart disease can be prevented by certain lifestyle choices, including eating a healthy diet. From Harvard Medical School, Healthy Eating for a Healthy Heart lays out practical eating guidelines based on the best science available. This special report will help you understand basics of a healthful (and tasty) diet, and also contains 40 heart-healthy, original recipes to help put you on the road to better eating.