A whole diet approach to lower heart risk has more evidence than low-fat diets

Harold Mandel's picture
A heart healthy salad

Heart disease is a killer and poor dietary habits have been associated with heart disease. Eating high cholesterol, high fat and sugary food has been associated with increased risk for heart disease. Recent research shows there is more evidence for the benefits of a whole diet approach than for a low fat diet approach to lower cardiovascular risk.

An understanding of the potential cardioprotective properties of nutrition has been relatively recent with most of the relevant studies completed in the last several decades, reported The American Journal of Medicine. Over the course of that time there has been a focus on nutritional intervention for heart disease. There was an emphasis on lowering dietary fat with the goal of preventing heart disease by reducing serum cholesterol, in early trials.

The results which were obtained from trials which focused exclusively on lowering dietary fat were disappointing. This lead to subsequent studies which incorporated a whole diet approach along with a recommendation dealing with fat intake. The Mediterranean-style diet has proven to reduce cardiovascular events to a degree which is greater than low fat diets, and equal to or greater than the benefit which is observed in statin trials. The Mediterranean-style diet focuses on:

1: Vegetables

2: Fruit

3: Fish

4: Whole grains

5: Olive oil


This new study has shown that a whole diet approach, which focuses on increased intake of fruits, nuts, vegetables, and fish, has more evidence for lowering cardiovascular risk than strategies which focus exclusively on reduced dietary fat, reports Elsevier. Mediterranean-style diets were found to be the most successful.

It has been explained by this study that while strictly low-fat diets have the ability to decrease cholesterol, they are not as conclusive in lowering cardiac deaths. An analysis of major diet and heart disease studies which were conducted over the past several decades, showed that participants who were directed to adopt a whole diet approach instead of limiting fat intake had a greater reduction in cardiovascular death and non-fatal myocardial infarction.

In early investigations of the relationship between food and heart disease there was an association found between high levels of serum cholesterol and increased intake of saturated fat, and subsequently, an increased rate of coronary heart disease was observed. This lead to the following recommendations by the American Heart Association:

1: Limit fat intake to less than 30% of daily calories

2: Limit saturated fat to 10% of daily calories

3: Limit cholesterol to less than 300 mg per day

Study co-author James E. Dalen, MD, MPH, has said, "Nearly all clinical trials in the 1960s, 70s and 80s compared usual diets to those characterized by low total fat, low saturated fat, low dietary cholesterol, and increased polyunsaturated fats." Dalen went on to say that although these diets lowered cholesterol levels, they did not reduce the incidence of myocardial infarction or deaths from coronary heart disease.

The researchers found that the whole diet approach, and specifically that of Mediterranean-style diets, are effective in preventing heart disease, even though they may not decrease total serum or LDL cholesterol. There is low consumption of animal products and and saturated fat with the Mediterranean-style diet. This diet also encourages consumption of monounsaturated fats which are found in nuts and olive oil.

There has been a clear association established between diet, atherosclerosis, and cardiovascular events. This research shows that it's not enough to just avoid certain foods that can harm your cardiovascular status. It's also important to include certain heart healthy foods in your diet. I therefore support the position that a whole diet approach should be encouraged for patients in order to help lower cardiovascular risk. The Mediterranean-style diet in particular seems to be best and tastes delicious.