What is a heart-healthy diet?  Is it high protein? low fat? high carb? low carb? no carb? gluten-free?  Is it Vegetarian? Vegan? Mediterranean? Ornish? Paleo? What if you have Diabetes? What if you’re trying to lose weight?


To add to the confusion, here are a few more terms we hear all the time and see all the time at the grocery store — sugar-free,  whole grains vs enriched grains vs refined grains, good carb, bad carb, saturated fats, trans fats, good fats, bad fats. Yikes…Is your head spinning yet?!

No wonder eating healthy can seem so daunting!

I will do my best to debunk some of the myths and focus on foods that are in general healthy,  and especially heart healthy.

                   The American Heart Association recommends the following for all adults and children greater than 2 as well as for patients with known heart disease:

  • Eat 5 or more servings of fruit & vegetables every day. Dark green, deep orange or yellow fruit and vegetables are especially nutritious. Examples include spinach, carrots, peaches and berries
  • Eat 3 or more whole grain foods every day. Examples include oats, barley, brown rice, 100% whole wheat
  • Eat fish at least twice a week. Oily fish which contain Omega 3 fatty acids are most nutritious, such as salmon, mackerel, herring, trout, sardines and to a lesser extent tuna
  • Eat foods low in saturated fats, trans fat and cholesterol

Sound a little carb heavy? What if you have Diabetes or are trying to lose weight…Should you eat less carbs? First lets take a look at Carbohydrates and Grains as they are often demonized in many popular diet fads.

Let me be clear. Carbohydrates are an important part of a healthy diet!

A carbohydrate is a macronutrient, meaning they are one of the three main ways the body gets energy to support bodily functions and physical activity; the other two being proteins and fats.

The term carbohydrate refers to its chemical structure, consisting of a certain ratio of carbon, oxygen and hydrogen atoms.

Carbohydrates in food come in the form of sugars, starches and fiber.  Carbs are often classified as either simple carbs or complex carbs. A simple carb, again refers to its chemical structure, and how quickly the sugar is absorbed and digested. Simple carbs have one or two sugars and are absorbed and digested quickly. Examples are fructose found in fruit, sucrose-table sugar, and lactose – milk. Simple carbs are also in candy, soda and syrups (obviously, not good).  Complex carbs are the starches and fiber, such as whole grains, beans, peas, lentils, peanuts, potatoes, corn, parsnips.

A better distinction is between good carbs and bad carbs.

Carbs usually considered good are mostly complex carbs, such as whole grains, vegetables, beans and legumes and fruit (which are simple carbs). These are not only digested more slowly, but they also contain many other nutrients, such as vitamins and minerals. They also tend to be high in fiber. There are many studies reporting the health benefits (not just heart) of a diet rich in fiber.

Bad carbs — Think pastries, sodas, highly processed foods, white rice, white bread and other white-flour foods. Bad carbs rarely have any nutritional value. An important definition here is “refined” as in refined flour or refined sugar. While the word “refined” may bring to mind “improved, pure, elegant”, WHERE FOODS ARE CONCERNED, REFINED=BAD. REFINED=PROCESSED. All the goodness (nutrients, fiber) is stripped out of the food.

What about fat? Is there any nutritional role for fat in our diets, especially our heart-healthy diets.

Yes! Fats are ESSENTIAL! But, wait, don’t get too excited. I am not suggesting that eating a bacon cheeseburger is Essential or Healthy. As with carbs, there are good fats and bad fats.

Let’s start with the good guys — the unsaturated fats. Unsaturated fats include polyunsaturated fatty acids and monounsaturated fats. Monounsaturated fatty acids (found in olive oil, canola oil, peanut oil, nuts, and avocados) and omega-3 polyunsaturated fatty acids (found in oily fish, canola oil, flaxseed, and walnuts) should be the first choice for fats. Unsaturated fats, when eaten in moderation and used to replace saturated or trans fats, can help lower cholesterol levels and reduce your risk of heart disease.

Now on to the bad guys. There are two types of fat that should be eaten sparingly: saturated and trans fatty acids. Both can raise cholesterol levels, clog arteries, and increase the risk for heart disease.

Saturated fats are found in animal products (meat, poultry skin, high-fat dairy, and eggs) and in vegetable fats that are liquid at room temperature, such as coconut and palm oils. The 2005 Dietary Guidelines recommend limiting saturated fats to 10% or less of your total calories, while the American Heart Association recommends keeping them to just 7% of total calories.

The real BAD GUY is the artificial trans fats. They’re used extensively in frying, baked goods, cookies, icings, crackers, packaged snack foods, microwave popcorn, and some margarines. Research has shown that even small amounts of artificial trans fats can increase the risk for heart disease by increasing LDL “bad” cholesterol and decreasing HDL “good” cholesterol. Stay away from these as much as possible.

PROTEINS. I probably don’t have to convince the average reader to eat protein. And yes, it is also an important Macronutrient. What I’d like you to think about, however, is the type of protein you consume. Protein is found in animal-based products (meat, poultry, fish, and dairy) as well as vegetable sources such as beans, soy, nuts, whole grains and to a lesser extent green vegetables. Animal protein, unfortunately, also comes with significant saturated fats. The best choices of protein are fish, legumes (beans), nuts and if you must have meat, lean poultry.

Here are a few examples of “Diet Plans” that I would consider Heart Healthy

Mediterranean Diet

The Mediterranean diet is rich in heart-healthy fiber and nutrients, including omega-3 fatty acids and antioxidants. The diet consists of fruits, vegetables, and unsaturated “good” fats, particularly virgin olive oil. Olive oil has been associated with lower blood pressure, a lower risk for heart disease, and possible benefits for people with type 2 diabetes. There are several variations to the Mediterranean diet, but general recommendations include:

  • Limit red meats.
  • Drink one or two glasses of wine each day if alcohol is enjoyable and there are no reasons to restrict its use.
  • Limit whole fat dairy products.
  • Eat moderate amounts of fish and poultry. Fish is the diet’s main protein source.
  • Eat plenty of fresh fruits and vegetables, nuts, legumes, beans, and whole grains.


The salt-restrictive DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure, and may have additional benefits for preventing heart disease, stroke, and heart failure. Effects on blood pressure are sometimes seen within a few weeks. This diet is rich in important nutrients and fiber. It also provides far more potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day) — but much less sodium — than the average American diet.

DASH diet recommendations:

  • Limit sodium (salt) intake to no more than 2,300 mg a day (a maximum intake of 1,500 mg a day is a much better goal and is now endorsed by the American Heart Association).
  • When choosing fats, select monounsaturated oils, such as olive or canola oils.
  • Choose whole grains over white flour or pasta products.
  • Choose fresh fruits and vegetables every day. Many of these foods are rich in potassium, fiber, or both, which may help lower blood pressure.
  • Include nuts, seeds, or legumes (dried beans or peas) daily.
  • Choose modest amounts of protein (no more than 18% of total daily calories). Fish, skinless poultry, and soy products are the best protein sources.
  • Other daily nutrient goals in the DASH diet include limiting carbohydrates to 55% of daily calories and dietary cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

Low-Fat Diets

Dietary guidelines recommend keeping total fat intake to 20 – 30% of total daily calories, with saturated fat less than 10% of calories. Very low-fat diets generally restrict fat intake to 20% or less of total daily calories. The Ornish program, recommended for some heart disease patients, limits fats even more drastically. It aims to reduce saturated fats as much as possible, restricting total fat to 10%, and increasing carbohydrates to 75% of calories. While this program has been scientifically shown to result in  Regression of heart disease, it is a very demanding regimen that is difficult to maintain.

  • It excludes all oils and animal products except nonfat yogurt, nonfat milk, and egg whites.
  • It emphasizes whole grains, legumes, and fresh fruits and vegetables.
  • People in the program exercise for 90 minutes at least three times a week.
  • Stress reduction techniques are used.
  • People do not smoke or drink more than two ounces of alcohol per day.


Not so Heart Healthy

Low Carbohydrate Diets

Low carbohydrate diets generally restrict the amount of carbohydrates but do not restrict protein sources, which for many, results in greater meat and saturated fat consumption.

The Atkins diet restricts complex carbohydrates in vegetables and, particularly, fruits that are known to protect against heart disease. The Atkins diet also can cause excessive calcium excretion in urine, which increases the risk for kidney stones and osteoporosis.

The jury is still out on other low-carb diets, such as South Beach, The Zone, and Sugar Busters, and the Paleo diet. Low-carbohydrate diets help with weight loss in the short term, possibly better than diets that allow normal amounts of carbohydrates and restrict fats. However, overall, there is not good evidence showing long-term efficacy for these diets. Likewise, long-term safety and other possible health effects are still a concern, especially since these diets restrict healthy foods such as fruit, vegetables, and grains while not restricting saturated fats.

Take home message . The heart healthiest foods are:

  • Fruit and Vegetables (all of them),
  • “whole” grains such as oats, barley, quinoa, brown rice. If it’s white, don’t eat it!
  • Fish
  • Legumes (beans, peas) and nuts
  • Foods rich in fiber
  • Good fats, such as olive oil and avocado
  • Eat the other stuff sparingly


And remember, what we eat is 50% of our health; the other 50% is physical activity.

By Dr Millie Lee