Which Diets Are Favored by Cardiologists?

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Having served as a member of the American Heart Association (AHA) Council on Lifestyle and Metabolic Health and the American College of Cardiology Nutrition & Lifestyle Workgroup, our team has recently examined the scientific evidence for dietary nutrients in promoting and/or worsening cardiovascular health.   Admittedly, the dietary portfolio of well conducted, large, randomized and long-term (3-5+ years) diet trials is scant when compared to drug studies. As a result, dietary evidence is often derived from smaller-scaled randomized studies performed over a shorter timeframe and from observational studies.  Nevertheless, there is sufficient information available for health professionals to make a determination as to which diets might be the most favorable for overall heart health.

With this in mind, we were commissioned by AHA several years ago to write a Presidential Advisory on Dietary Fats and Cardiovascular Disease.  Led by my colleague, Dr. Frank Sacks, we showed that the replacement of animal-derived saturated fat (such as beef and processed meats) with plant-derived unsaturated fats (such as nuts, seeds, avocado) or whole grains (such as barley, buckwheat, quinoa) was associated with a reduced risk of heart disease.  However, replacing saturated fat with simple carbs (such as added sugars) had no effect and substitution with trans-fats raised the risk of heart disease.  In other words, the bottom line is that plant-based fats (as above plus oils such as canola, safflower and olive) are heart-healthier when compared to animal-based saturated fats.

Not to be outdone by the AHA, the ACC also commissioned our Nutrition Workgroup to assemble a document entitled “Trending Cardiovascular Nutrition Controversies”.  Led by colleagues, Dr. Andrew Freeman and Penny Kris-Etherton, we summarized the heart-healthy and heart-harmful foods/diets based on the best available evidence. Complementing the AHA Presidential Advisory’s focus on fats, this document found plant-based proteins to be significantly more heart healthy than animal-based proteins.  We also added green leafy vegetables, nuts, berries and extra virgin olive oil to round out the most impactful, heart healthy foods. In contrast, we recommended against diets enriched in fried foods, processed meats and sugar-sweetened drinks.  Our follow-up paper, “A Clinician’s Guide for Trending Cardiovascular Nutrition Controversies: Part II” added foods enriched in omega-3 fatty acids (such as marine-derived fish), legumes, mushroom and selected beverages (tea, coffee and alcohol, in moderation).

When summing up these documents, the dietary picture is consistent with that consumed in the Mediterranean region.  In fact, many cardiologists, including yours truly, also favor fish as the primary source of animal fat.  This was highlighted in recent papers by my colleagues and members of our workgroup, Drs. Emilio Ros and James O’Keefe.  This in no way discredits other heart-healthy diets, including Dean Ornish’s lacto-ovo-vegetarian diet (click here for our recent paper that showed favorable effects of the atherogenic gut byproduct, TMAO with this diet compared to a high saturated fat diet).  In fact, some of my cardiology colleagues favor such low fat diets and other vegetarian or vegan diets.  At this time, however, there is a larger body of evidence supporting the Pesco-Mediterranean Dietary approach.

So when you’re ready, grab some berries, a handful of nuts, a fishing rod and your favorite vino…for our heart’s sake, let’s drink to that!

Michael Miller, MD, FAHA, FACC is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore.  Check out his HeartHealth Tip of the Day on Twitter @mmillermd1

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