Heart-Healthy Diets, What's the Difference?

Heart disease is the leading cause of death in the United States. Nearly 12 percent of Americans are diagnosed with heart disease and about 610,000 die from it each year. Risk factors include high blood pressure, high cholesterol, diabetes, tobacco use, physical inactivity, obesity, and an unhealthy diet. Heart disease is preventable, and even small diet and lifestyle changes can delay its progression.

What makes a diet "heart healthy?"

At the most basic level, a heart-healthy diet is one that is rich in foods that nourish the body without impairing the heart's ability to circulate blood. It is rich in fruits and vegetables, whole grains, legumes, and lean sources of protein, dairy, and heart-healthy fats. Heart-healthy diets contain limited sources of saturated fats, processed foods, added sugars, and foods with little nutrient benefit.

Several diets or eating plans are touted for their heart health benefits, and while each is unique, there are many similarities across them. Two popular eating plans have heart-healthy recommendations: Mediterranean and DASH (Dietary Approaches to Stop Hypertension). These two eating plans consistently rank as the top two diets overall and are in the top three diets for heart health, according to U.S. News ranking. A review of the Mediterranean and DASH eating plans follow, along with a comparison to the American Heart Association's diet recommendations and USDA's MyPlate.

Mediterranean Diet

The Mediterranean diet emphasizes:

• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts
• Replacing butter with healthy fats such as olive oil and canola oil
• Using herbs and spices instead of salt to flavor foods
• Choosing smaller portions of chicken or lean meat (if you eat meat)
• Eating fish at least twice a week
• Enjoying meals with family and friends
• Drinking red wine in moderation (optional)
• Getting plenty of exercise

DASH Eating Plan

The DASH eating plan provides daily and weekly nutritional goals such as:

• Eating vegetables, fruits, and whole grains
• Including fat-free or low-fat dairy products
• Choosing protein sources such as fish, skinless poultry, lean meat, beans, and nuts
• Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils; instead, choose vegetable oils
• Limiting sugar-sweetened beverages and sweets

MyPlate

MyPlate recommends healthy eating across the lifespan, which includes portion control and choosing foods rich in nutrients. MyPlate offers the following tips to help you create a healthier eating style that meets your individual needs and improves your health:

• Vegetables: eat a variety of vegetables from all five vegetable categories (dark green, red and orange, beans and peas, starchy, and other)
• Fruits: focus on whole fruits
• Dairy: choose fat-free or low-fat milk, yogurt, cheese, or milk alternatives
• Grains: make half your grains whole grains
• Protein: choose lean sources of protein and meatless protein sources
• Limit saturated fats, added sugars, and foods high in sodium

American Heart Association

The American Heart Association recommends eating an overall healthy dietary pattern that emphasizes:

• A variety of fruits and vegetables
• Whole grains
• Low-fat dairy products
• Skinless poultry and fish
• Nuts and legumes
• Nontropical vegetable oils
• Limiting saturated fat, trans fat, sodium, red meat, sweets, and sugar-sweetened beverages

The table below compares the daily or weekly recommended intake of each food group for the four eating plans described. Amounts are based on a 2,000-calorie diet.

*Legumes (beans, peas, lentils) are a subset of the vegetable group but also provide protein. Nuts and seeds are a subset of the protein food group. Cup-equivalent (cup-eq): The amount of a food that is considered equal to 1 cup from the vegetable, fruit, or dairy food groups. Ounce-equivalent (oz-eq): The amount of a food product that is considered equal to 1 ounce from the grain or protein food groups.

A healthy lifestyle is the best defense against disease. A heart-healthy eating plan is just one key part of a heart-healthy lifestyle; combining it with other lifestyle changes, such as physical activity, can help protect your heart. This lifestyle includes being physically active, maintaining a healthy weight, limiting alcohol intake, managing and coping with stress, excluding tobacco, and getting enough sleep.

Sources

• Centers for Disease Control and Prevention. "Heart Disease Risk Factors."
• National Heart, Lung, and Blood Institute. "DASH Eating Plan."
• Oldways. "Mediterranean Diet."
• U.S. Department of Health and Human Services and U.S. Department of Agriculture. "Executive Summary." In 2015–2020 Dietary Guidelines for Americans. 8th ed. December 2015.
• U.S. News and World Report. "Best Heart-Healthy Diets."