Macronutrients. Micronutrients. Plant foods. Animal foods. What matters most is that you understand how to use them to lay the groundwork for healthy eating. In that respect, think of them as bricks in the road leading you to a potentially life-changing destination: a heart-healthy dietary pattern.
Focus more on your overall eating pattern than individual foods. A number of dietary patterns are well supported by research as being beneficial for your cardiovascular health, while, for others, the evidence is lacking or suggests potential shortfalls. No single dietary pattern is perfect for everyone, but the dietary patterns outlined in the following pages provide you with plenty of options to help you customize an eating plan for your individual needs and preferences. Remember, your eating plan is not a short-term quick fix; you are going to be in this for the long haul.
You’ll notice a common theme among the healthy eating patterns: They are higher in vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes, and nuts, moderate in alcohol (among adults), lower in red and processed meats, and low in sugar-sweetened foods and drinks and refined grains.
It’s never too late to change the way you eat to benefit your heart health. If need be, take small steps and build your heart-healthy eating pattern incrementally. Use the information in this chapter as a blueprint to guide you in this process. As you modify your diet, do it in a way that includes types of foods you enjoy and want to share with other people.
The Tufts MyPlate for Older Adults
In your younger years, you probably didn’t think much about how many meals you ate or how much food you consumed to satisfy your appetite. Now that you’re older, you might be surprised that you shouldn’t be eating like you once did. The needs of your body change with age, and your dietary pattern should be adjusted to meet those needs. If you’re like many people, your calorie requirements decline with aging, due to changes in your metabolism and physical activity level, but you still need the right nutrients to fuel your body’s engine (see “Nutrients of Concern Among Older Adults”).
So, experts at the Tufts Human Nutrition Research Center on Aging developed MyPlate for Older Adults, geared toward the dietary issues relevant to older adults. The MyPlate for Older Adults is a visual guide that offers examples of foods that can help you shift your diet to a healthier eating pattern that you can sustain, and it corresponds with the DGA (see “MyPlate for Older Adults”). For more information, visit https://hnrca.tufts.edu/myplate.
A Healthy Way to Eat in the U.S.A.
You don’t have to eat foods that are unfamiliar to you (or most Americans) to follow a heart-healthy eating pattern. In fact, the DGA’s “Healthy U.S.-Style” eating pattern is derived from foods that Americans typically consume.
The key elements of the Healthy U.S.-Style dietary pattern include:
- 5 cups per day of vegetables (including dark-green, red, orange, and starchy vegetables and legumes) and fruit
- 6 daily servings of grains, of which at least half are whole grains
- 3 daily servings of dairy
- 5.5 ounces of protein each day, including seafood, lean meats and poultry, and eggs, as well as nuts, seeds, and soy products
- About 5 teaspoons of unsaturated vegetable oils each day
For examples of serving sizes of fruits, vegetables, grains, and proteins, see Chapter 3. Visit the DGA website to learn about food recommendations for other daily calorie totals and get more details: https://health.gov/dietaryguidelines/2015/guidelines/appendix-3.
A Mediterranean-Style Diet
There’s a reason why many medical experts recommend that you “eat like a Greek.” In general, the incidence of heart disease has been lower in Greece, Italy, Israel, and other countries bordering the Mediterranean Sea, due, in part, to how they eat (although other factors, such as physical activity, probably play a role, too). That doesn’t mean you can load up on pizza, spaghetti and meatballs, and “Americanized” versions of Mediterranean foods that contain more meat, sugar, and calories, though. Instead, follow the traditional eating patterns enjoyed in countries around the Mediterranean decades ago, when rates of chronic diseases there were among the lowest worldwide.
There’s no single Mediterranean diet because the foods consumed across the region are as diverse as the cultures residing there. However, their dietary patterns do share a number of common traits (such as a higher intake of unsaturated fats than a typical Western eating pattern). According to the American Heart Association (AHA), these are characteristics common to a Mediterranean dietary pattern:
- High consumption of fruit, vegetables, nuts, and seeds
- A high intake of beans and potatoes, as well as bread and other cereals
- Consumption of unsaturated fats; more than half the fat calories come from monounsaturated fats, especially from olive oil
- Low to moderate intake of fish, poultry, and dairy products
- Little red meat consumption
- Low intake of eggs (zero to four times a week)
- Low to moderate consumption of wine.
Research suggests that following a Mediterranean-style eating pattern is associated with a lower risk of heart attack, stroke, and death from cardiovascular events, as well as lower LDL cholesterol levels and potential benefits for brain health.
How to ‘Go Greek’
You don’t have to eat exotic, hard-to-find foods when following a Mediterranean-style diet, but the majority of your foods will be whole, minimally processed items, rather than prepared foods that come in boxes, bags, or cans or from fast-food joints. The DGA provides an example of this dietary approach on their website at https://health.gov/dietaryguidelines/2015/guidelines/appendix-4/. For further guidance, visit the website for Oldways, a nonprofit organization in partnership with the World Health Organization and Harvard School of Public Health: oldwayspt.org/traditional-diets/mediterranean-diet.
DASH to a Healthier Diet
The National Institutes of Health sponsored the Dietary Approaches to Stop Hypertension (DASH) trials to help determine the best dietary pattern for cardiovascular health and, more specifically, lowering blood pressure and preventing hypertension. The initial DASH study found that, compared with a control diet resembling a typical Western eating pattern, a diet rich in fruits and vegetables, as well as a combination diet high in fruits, vegetables, and low-fat dairy products and low in saturated and total fat, were associated with significant reductions in systolic and diastolic blood pressure. The second trial, the DASH-Sodium study, found that reducing sodium consumption from about 3,300 milligrams (mg) a day to about 2,300 mg a day was associated with blood pressure reductions among the participants who followed the combination diet high in fruits, vegetables, and low-fat dairy products, as well as those who ate the original DASH study control diet. Reducing sodium even more, from 2,300 mg to 1,500 mg a day, resulted in further blood pressure reductions and was particularly beneficial for people who already had high blood pressure. In the studies, the DASH diet also was associated with reductions in LDL cholesterol. Other research supports the overall cardiovascular benefits of the DASH eating plan.
The DASH dietary pattern is low in sodium and saturated fat, while being rich in unsaturated fat, potassium, calcium, magnesium, fiber, and protein. A major advantage of the DASH approach to eating is that it doesn’t require special foods or complicated menus. Instead, the DASH plan spells out the kinds of foods to eat and how much you should consume each day based on different calorie requirements (see “Delve Deeper into the DASH Diet”).
The DASH studies included people with hypertension or at increased risk for it, but you don’t have to have high blood pressure to benefit from the DASH way of eating. Because the diet and other heart-healthy eating plans share many basic tenets—namely, increased consumption of fruits, vegetables, whole grains, and low-fat and nonfat dairy products, along with fewer foods high in saturated fat, sodium, and added sugars—the DASH diet is also in line with dietary recommendations to improve other aspects of heart health and reduce key cardiovascular risk factors besides blood pressure, such as hyperlipidemia, type 2 diabetes, and obesity. Simply put, the DASH dietary pattern “exemplifies healthy eating,” as the DGA notes.
The MIND Diet for Your Brain and Heart
The DASH and Mediterranean diets have been well studied for their beneficial effects on the heart and blood vessels. Some research suggests that these diets also may benefit your brain. These findings prompted researchers to develop the appropriately named Mediterranean-Dash Intervention for Neurocognitive Delay (MIND) eating pattern as a dietary strategy against Alzheimer’s disease (AD). MIND is a hybrid diet that takes elements from the DASH and Mediterranean eating patterns and emphasizes consumption of foods linked to better brain health while limiting or avoiding those that are bad for your brain. The MIND diet recommends consuming green leafy vegetables, berries, nuts, beans, whole grains, fish, poultry, and olive oil, and limiting red meat, cheese, butter, pastries and sweets, and fried or fast foods.
In a study involving 923 men and women, ages 58 to 98, followed an average of 4½ years, researchers assigned scores based on how well the participants adhered to the MIND diet, a DASH diet, or Mediterranean-style eating pattern. Those with the highest MIND diet scores (reflecting the closest adherence to the diet) were 53 percent less likely to develop Alzheimer’s disease than the participants with the lowest scores. Even moderate adherence to the MIND diet (the second-highest third of MIND scores) was associated with a 35 percent lower AD risk, whereas only the top third of DASH or Mediterranean diet scores were associated with lower AD risk.
A Look at Plant-Based Diets
As the findings from the DASH study and many other investigations suggest, following a dietary pattern that is based primarily on plant foods and contains fewer animal-sourced foods is associated with a lower risk of cardiovascular disease, obesity, hypertension, type 2 diabetes, and other conditions. In general, vegetarian and vegan diets are lower in saturated fat and sodium and higher in unsaturated fat and beneficial fiber than the typical “Western” style of eating. The DGA outlines a vegetarian diet that includes dairy foods and eggs as an example of a healthy dietary pattern https://health.gov/dietaryguidelines/2015/guidelines/appendix-5/.
If you follow a vegetarian style of eating, eat a bounty of whole fruits, vegetables, whole grains, and legumes, while limiting processed foods high in added sugars, saturated fat, sodium, and refined grains. Include plenty of plant protein sources in your diet, such as legumes, nuts, seeds, quinoa, and soy products. If you’re a lacto-ovo-vegetarian, meaning that you consume milk, milk products, and eggs along with plant foods, you also can get protein from these sources.
Animal foods also are the main dietary providers of vitamins B12 and D, calcium, iron, zinc, and omega-3 fatty acids, so be sure you’re getting enough of these essential nutrients from other sources (see “Sources of Key Nutrients for Vegans”). Instead of abandoning animal products altogether, you might try following a pescatarian diet, which includes fish in addition to plant foods. Fish can provide you with protein, vitamins B12, and D, some calcium, and (especially cold-water, fatty fish) omega-3 fatty acids. Another option is a lacto-ovo-vegetarian eating plan, which includes milk, eggs, and milk products and can provide you with calcium, vitamin D (in fortified products), and protein without any consumption of animal flesh. Some evidence suggests that eating a lacto-ovo-vegetarian diet is associated with a reduction in heart disease and stroke risk factors (see “Vegetarian, Mediterranean Diets May Improve Cardiovascular Risk Factors”).
Choose the Right Foods
Just because you cut out or limit animal-sourced foods from your diet doesn’t guarantee you’ll be eating healthfully. You still need to be smart with your food selections. Technically speaking, French fries, potato chips, and doughnuts are vegan, but they’re hardly heart-healthy food choices.
So, if you follow a plant-based dietary pattern, make sure you do more than refrain from eating meat. Fill your vegetarian plate with good choices that will benefit, not detract from, your heart health.
Diets in Question
The healthful dietary plans endorsed by the DGA and most other health experts are supported by a significant body of scientific research. The recommendations take into account, among other things, data on what most Americans are eating, the relationships that different foods have with good health, and how these foods fit into a pattern that maximizes optimal health outcomes.
Finding a dietary pattern that’s best for you can be difficult, especially when you’re faced with a barrage of marketing campaigns promoting diets that promise everything from rapid weight loss to better memory. Oftentimes, these eating plans require you to limit or cut out certain beneficial foods that normally are part of a well-balanced diet. And, questions remain about what their full impact is on your heart and other aspects of your health over the long term, as well as whether people can stick with them in the long run.
Low-Fat Eating
Low-fat diets were once considered the norm for heart-healthy eating. After all, it would be expected that trimming fat from your diet would help you cut calories and manage your weight. With nine calories per gram, fats are more energy dense than protein and carbohydrates, which contain four calories per gram.
However, a low-fat diet is not among the healthy dietary patterns included in the DGA. Similarly, the AHA notes that fats are an important part of a heart-healthy diet. You just have to choose your fats carefully (see Chapter 2 for more about healthful and unhealthful fats). By following a dietary pattern emphasizing fruits, vegetables, and whole grains, as well as low-fat/fat-free dairy products, legumes, fish, skinless poultry, and liquid vegetable oils for food preparation and salad dressing, your overall diet naturally will be rich in beneficial unsaturated fats and lower in saturated fat.
Low-Carb Diets
The general idea behind a low-carb diet is that when you eat very little carbohydrate, you force your body to use its fat stores as a source of energy instead of the glucose that’s produced following carbohydrate consumption.
Diets low in carbs and higher in protein may provide some weight-loss benefits in the short term. And, evidence suggests that eating plenty of foods high in refined carbs, such as white bread, white rice, white pasta, and products containing added sugars, can contribute to weight gain and increase the risk of type 2 diabetes. The downside of a low-carb diet is that you have to restrict beneficial carb-containing foods, such as whole grains, fruits, and vegetables, that are key elements of well-established heart-healthy dietary patterns. And, for the majority of individuals, it is hard to stick with a low-carb diet in the long term; although low-carb diets often produce short-term weight loss, the success rate in keeping the weight off is poor. The bottom line is that it’s more important to focus on the quality of your carbohydrate sources than to drastically cut your carb intake. If you want to cut back on carbs, start by limiting or avoiding refined carbohydrates.
The Keto Diet
The keto (ketogenic) diet severely restricts carbohydrates and forces your body to use fat instead of blood glucose as its main source of energy. Your body converts fat into fatty acids and ketone bodies, which serve as fuel in the absence of glucose.
Like other low-carb eating patterns, a ketogenic diet necessitates cutting out healthful foods rich in complex carbs (for example, many fruits, whole grains, and beans) along with poor carb choices, like refined grains. Typically, vitamin supplements are recommended to make up for nutrients that are not derived from food when these carb sources are eliminated from the diet. Furthermore, some versions of the keto diet encourage foods high in saturated fat, including fatty cuts of meat and processed meats.
Some studies suggest that a keto diet can provide some benefits in terms of weight loss and diabetes management. However, questions remain about how long people can maintain a ketogenic diet and whether its benefits are sustainable. And, for the most part, health experts agree that there is no evidence for the long-term benefits and safety of a ketogenic eating pattern. Note that women who want to become or are pregnant should avoid a ketogenic diet.
The Paleo Diet
This dietary pattern is intended to mimic the eating habits of humans living in the Paleolithic period, better known as the Stone Age. The notion behind the Paleo diet is that, since modern ways of eating (like diets rich in saturated fat, refined carbohydrates, and added salt and sugar) can contribute to chronic medical conditions, eating like our early ancestors did may help us avoid some of these problems. Fact is, research has shown that humans in the Paleo period rarely lived beyond their 30s, so they probably died of an infectious disease or accident before they could develop heart disease, cancer, and other chronic diseases. Plus, several of the foods recommended by followers of today’s Paleo diet weren’t available to our Stone Age ancestors.
The Paleo diet does have its upsides. It recommends consuming beneficial foods like fresh fruits and vegetables, nuts and seeds, fish, and other seafood, while avoiding refined grains, added sugar, and salt. Some research suggests that following a Paleo diet may help with short-term weight loss and blood glucose control, but long-term data are lacking.
However, some aspects of the Paleo eating pattern are concerning. For one, the diet calls for eliminating several foods recommended by nutrition experts, such as legumes, whole grains, and dairy products. Also, followers of the Paleo eating pattern are advised to choose grass-fed meats, which are purported to be healthier than other types of meat (whether this is the case remains under debate). As a result, you might think grass-fed beef is better for you than it really is, so you might run the risk of consuming too much of it, resulting in a high intake of saturated fat.
Overall, the Paleo diet has not been researched as intensively as other common dietary patterns, and its long-term effects aren’t known. And, the DGA and large, reputable health organizations, including the American Heart Association and American Diabetes Association, have not endorsed the Paleo diet.
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