Surprise! The Mediterranean diet falls in the third slot. Learn about the top two diets, plus the other fads that don’t quite make the grade.
Reviewed by Dietitian Jessica Ball, M.S., RD
The Mediterranean diet is often applauded as one of the best diets for overall health. It is rich in fruits, vegetables, whole grains, fish and seafood and legumes and light on dairy and meat (and, as a result, low in saturated fat, too, which is a topic still up for debate in the heart-health world). It’s a heart-smart way to eat, and can be beneficial in many other areas of health as well. Mediterranean dieters also tend to have lower risk for certain cancers, cognitive decline, type 2 diabetes and more.
Circling back to heart disease risk, the Mediterranean diet tied for first in the U.S. News and World Report‘s 2022 rankings for the best diets for heart health, but a surprising new victor came out on top in 2023. That 2023 best diet for heart health also earned a gold medal in a new scientific statement from the American Heart Association, published April 27, 2023, in its journal Circulation. The U.S. News and World Report health panel and AHA cardiologists now agree that the DASH diet (which is short for Dietary Approaches to Stop Hypertension) appears to be the best diet for heart health.
Read on to learn more about what makes DASH such a heart-smart eating style, then study up on how nine other popular diets ranked in the evidence-based analysis by AHA professionals.
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What This Heart Health Study Found
If you’ve scrolled through TikTok lately, chances are high that you’ve been served some, shall we say “questionable” nutrition and diet advice. Remember the canola oil scandal circa summer 2022?
To help set the record straight, the AHA decided to pull together a committee of professors and doctors to analyze research related to 10 common diet plans to help sort out fact from fiction.
“The number of different, popular dietary patterns has proliferated in recent years, and the amount of misinformation about them on social media has reached critical levels,” statement writing committee chair and Stanford University professor of medicine Christopher D. Gardner tells American Heart Association News. “The public—and even many health care professionals—may rightfully be confused about heart-healthy eating, and they may feel that they don’t have the time or the training to evaluate the different diets. We hope this statement serves as a tool for clinicians and the public to understand which diets promote good cardiometabolic health.”
The committee evaluated how 10 popular diets aligned with the AHA’s dietary advice for a heart-healthy eating pattern:
Consuming a wide variety of fruits and vegetables
Choosing mostly whole grains instead of refined grains
Using liquid plant oils rather than tropical oils
Eating healthy sources of protein, focusing on those from plants, seafood or lean meats
Minimizing added sugars and salt
They excluded commercial diet programs, such as Weight Watchers and Noom, as well as any short-term fad diets that are typically followed for fewer than 12 weeks and for non-heart health reasons, such as intermittent fasting or Whole30. The cardiologists then rated each of the 10 selected diets on a scale of 1 to 100 for how well they fit these heart-smart goals.
Related:5 Surprising Heart-Healthy Foods You Should Be Eating
According to this AHA panel, these diets are ranked from most to least heart-healthy.
Very low-fat: 72
Very low-carb/keto: 31
Only one—the DASH diet—scored a perfect 100, since it’s low in salt, added sugars, tropical oils (which can contain saturated fat), alcohol and highly processed foods. The DASH diet also promotes the consumption of fruits, whole grains and vegetables, and the main sources of protein are lean options like fish, seafood, beans, legumes and low-fat dairy.
The Mediterranean diet came in at a strong third place, but was docked since it allowed for moderate alcohol consumption (which is another research area that’s still up in the air about its benefits and drawbacks). The Mediterranean diet also doesn’t focus as much on limiting sodium intake. The primarily plant-based pescatarian diet, which allows for fish and seafood, and the vegetarian diet also rated well.
“If implemented as intended, [these four] dietary patterns align best with the American Heart Association’s guidance and may be adapted to respect cultural practices, food preferences and budgets to enable people to always eat this way for the long term,” Gardner says in the press release.
Animal-product-free vegan and low-fat diets (typically with a cap of 30% or fewer calories from fat) tied right in the middle. They earn points for their emphasis on fruits, veggies, whole grains, beans, legumes and nuts all while limiting added sugar and alcohol, but eating a vegan or very low-fat diet is not easy for most Americans. Both of these diets may be too restrictive to stick with for the long haul, the AHA committee confirms. Beyond that, certain deficiencies may occur while on a vegan diet (such as with vitamin B12, omega-3s, iron and zinc), and low-fat diets might lead diners to lean into less-healthy carbs, including added sugars and refined grains, to fill in the gaps.
Very low-fat and low-carb diets fall into the seventh and eighth positions since they usually recommend restricting foods that are actually heart-healthy choices. It’s tough to consume nuts and healthy plant oils as part of a very low-fat diet, which often includes less than 15% of calories from fat, for example. And on a low-carb diet, fruits, grains, beans and legumes are often in short supply, which means that fiber often is as well.
Closing out the line-up, paleo and very low-carb/keto diets fall in ninth and tenth place.
“While there will likely be short-term benefits and substantial weight loss, it isn’t sustainable. A diet that’s effective at helping an individual maintain weight-loss goals, from a practical perspective, needs to be sustainable,” Gardner confirms.
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The Bottom Line
According to a new scientific report by a committee of professors and cardiologists who analyzed the current body of scientific evidence, the DASH, pescatarian and Mediterranean diets are among the best diets for heart health. More research and education is required to inform Americans about how to follow each of these eating patterns in culturally relevant, accessible and affordable ways, the authors admit.
But for now, you can take heart in knowing that choosing any of the above is a boon for your cardiovascular health, especially if you’re currently more familiar with the standard American diet or are a keto or paleo devotee.
Try these nutritious diets out by adding some of these tasty DASH diet recipes to your menu this week, or kick things off with this 7-day DASH diet meal plan. If the DASH diet isn’t your jam, try these nutritious and delicious pescatarian and Mediterranean dinner ideas.
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