8. What’s in a Name? Heart-Healthy Diet Plans

The 2015-2020 Dietary Guidelines for Americans holds up three U.S. Food & Drug Administration–approved models of healthy eating:

• Healthy U.S.-Style Eating Pattern
• Healthy Vegetarian Eating Pattern
• Healthy Mediterranean-Style Eating Pattern

The Healthy U.S.-Style Eating Pattern is based on foods Americans typically consume: vegetables, fruits, grains, dairy, and protein.

The Healthy Mediterranean-Style Eating Pattern is similar to the Healthy U.S.-Style pattern but contains more fruits and seafood and fewer dairy foods.

The Healthy Vegetarian Eating Pattern includes no meat or poultry, but it does contain dairy and eggs as well as plant sources of protein such as legumes and soy foods.

The key to a heart-healthy diet plan is getting enough vegetables, fruits, whole grains, low-fat dairy, and lean protein. The eating patterns above are similar in what they do not include: processed foods and food products that contain added sugar, saturated and trans fats, sodium, additives, and other ingredients that lack valuable nutrients.

For the first time, the agencies set a recommended limit on sugar intake. The new guidelines say that no more than 10 percent of your daily calories should come from sugar. It is hard to track this as a consumer because labels don’t yet differentiate between natural sugar and added sugar. The FDA is developing new labeling requirements.

Another important aspect of the new guidelines is the recommendation to reduce saturated fat intake to no more than 10 percent. And while the guidelines don’t specifically call for less red meat in your diet, you should know that red meat as well as poultry with skin and full-fat dairy products are all high in saturated fats. If you do eat red meat, choose the leanest cuts, and keep portion sizes to about 3 ounces.

As the report underscores, “healthy eating patterns are adaptable.” No one diet fits all. To work as a lifestyle, a heart-healthy diet must be flexible enough to accommodate “personal and sociocultural preferences.”

Shortcomings of the Average American Diet

The 2015-2020 Dietary Guidelines for Americans sanctioned a healthy U.S.-style diet, but more common is an unhealthy eating pattern characterized by oversized portions and too much sugar, “bad” fat, and salt. This overindulgence contributes to obesity in more than a third of the adult population; it also factors into a disease burden that ranges from high blood pressure, high cholesterol, and other risk factors for heart problems to cancer and diabetes, among other issues.

A 2014 study found that people who got 17 to 21 percent of their total calories from added sugar were nearly 40 percent more likely to die from heart disease than those who got only around 8 percent of their total calories from sugar.

Another culprit is the American weakness for fast food. Research shows that the more frequently you eat fast food:

• The more you tend to weigh
• The higher your BMI (body mass index)
• The more likely you are to be overweight or obese
• The more likely you are to develop insulin resistance (which makes you gain even more weight and increases the risk of diabetes)
• The more calories you tend to consume overall
• The more your diet tends to be full of foods that are calorie-dense (higher average calories per weight of food)
• The more total fat and saturated fat you tend to consume
• The more total carbohydrates, sugar, and sugar-sweetened beverages you tend to consume
• The more sodium you tend to consume
• The lower your diet tends to be in vitamins and mineralsthe less fiber you tend to consume
• The lower your diet tends to be in fruits and vegetables

Don’t blame just the triple-bacon cheeseburgers. Sodas draw a bead on your heart, too. Beverages sweetened with high fructose corn syrup (HFCS) increase risk factors of cardiovascular disease, according to researchers from the University of California, Davis.

In a study that divided participants into four groups consuming beverages with varying doses of HFCS, researchers found that risk factors of heart disease (blood lipoproteins, triglycerides, and uric acid) increased along with the dose of HFCS after just 15 days.

Similarly, health experts are increasingly concerned that the easy availability of highly processed foods at grocery and convenience stores is contributing to the ever-increasing rates of obesity. Researchers have defined three types of food processing:

➧  Type 1 foods are unprocessed. Example: an orange in its natural state.

➧  Type 2 foods are type 1 foods whose nutritional properties have been reduced because of processing. Examples: bread or canned vegetables as well as ingredients like fats, oils, sugars, flours, and starches.

➧  Type 3 foods are “ultra-processed” foods made by combining types 1 and 2. Examples include fast foods (think cheeseburger, fries, and orange soda).

Often, Type 2 and Type 3 foods lack nutritional value. Many experts believe the greater the consumption of Type 2 and 3 foods, the greater the risk for obesity and chronic diseases. Type 3 (ultra-processed) foods are usually more palatable because of added ingredients, like sugar, fat, and salt. Diets made up of types 1 and 2 foods are far superior nutritionally to diets made up of types 2 and 3.

Writing in the July 2016 issue of Journal of the American College of Nutrition, researchers also concluded that most important risk factors for developing Alzheimer’s disease (AD) are connected to diet.

Eating a Western diet characterized by the consumption of three of the most important dietary risk factors for AD—meat, sweets, and high-fat dairy products—may increase the risk of this most common type of dementia, which affects 42 million people globally. People living in the U.S. have about a 4 percent risk of developing AD. Reducing meat consumption could significantly reduce risk of the disease.

Food choices wreak havoc on the brain in other ways and can lead to a vicious cycle of anxiety, angst, mood swings, brain fog, and other depression symptoms. Two reasons:

Carbohydrates and sugars. Eating foods high in sugar and carbohydrates such as doughnuts, cereal, candy, hot dogs and sodas cause a temporary increase in serotonin, the feel-good brain chemical that eases your tension, calms your mood, and makes you happier. Since eating these foods has an anti-anxiety effect (albeit a short-lasting one), they often become “comfort foods.” Think about it: When you’re feeling depressed or stressed out, do you often crave breads or a chocolate fix to help you feel better? While these foods indeed provide a temporary euphoric feeling, on the flip side, sweets and carbs also induce a quick and shocking crash; that is, soon after serotonin is temporarily increased, it suddenly drops. This dramatic lowering of serotonin leads to feelings of sleepiness, hostility, anxiety, and depression.

Vegetable oils. You may remember the old anti-narcotics commercials—in the days before marijuana was legalized in a number of states—that showed eggs frying in a pan along with the stark voice-over warning, “This is your brain on drugs.” Most people would never consider that eating French fries or onion rings would produce some of the same effects as smoking marijuana. But according to new research, the concept isn’t so far-fetched. A study conducted by the National Institutes of Health revealed that the human body uses a vegetable oil ingredient to produce endocannabinoids, natural compounds similar to the psychoactive components of pot. These endocannabinoids stimulate appetite, akin to the infamous marijuana “munchies.” Ingesting large amounts of soy, corn, and other polyunsaturated fry oils may leave you feeling foggy-brained, distracted, and tired—and craving more doughnuts and fries.

Healthy U.S.-Style Eating Pattern

If you’re in relatively good health but have been told to eat better for an improved cardiovascular system, you may wonder just what a good cardiac diet entails. Fortunately, an eating plan that promotes good heart health can be simple and include plenty of foods you enjoy. The key is often minimizing or eliminating the parts of your diet that can worsen the health of your heart and blood vessels.

A heart patient diet may be more stringent, with tighter recommendations on sodium intake and weight loss, for example. But in general, what’s right for someone with a heart condition is going to be appropriate for someone trying to avoid becoming a heart patient.

Eat a variety of foods: To make sure your cardiac diet provides the nutrients your body needs, make sure it includes a wide range of healthy foods. One way to think about it is in terms of colors. Eat a rainbow of fruits and vegetables: red peppers, leafy greens, oranges, and orange sweet potatoes, for example. Different-colored fruits and veggies provide assorted antioxidants, the substances that fight off disease-causing free radicals. Along with a variety of fruits and vegetables (try to eat four to five servings of each daily), a well-rounded cardiac diet includes whole grains, lean proteins (fish, poultry, low-fat or non-fat dairy products, or vegetarian sources such as beans, nuts, quinoa, soy milk).

Choose the right fats: Healthy fats such as the unsaturated fats found in olive oil, fish, nuts, seeds, and avocados are good for the heart. A heart patient diet should definitely include these items because they can help lower your LDL (“bad”) cholesterol. Just be careful if you’re counting calories, as these foods can bump up your calorie intake in a hurry: As they say, “Everything in moderation.” A good cardiac diet shouldn’t include much saturated fat, such as that found in red meat or in processed foods.

Some research suggests that the amount of saturated fat in the diet may not be a significant predictor of heart disease. But this unhealthy fat is still a source of dietary cholesterol, and it should be consumed in moderation, if at all. Foods high in saturated fat also tend to be high in calories, so there are two reasons to keep them to a minimum in your diet.

The issue of dietary cholesterol has actually been debated significantly in recent years. Most of the cholesterol in your body is manufactured by the liver, but some cholesterol comes from what you eat.

For a long time, foods high in cholesterol—eggs, for example—were viewed as bad for the heart. (It should be noted, however, that almost all the cholesterol in an egg is in the yolk, so egg whites are basically cholesterol-free.) Recent research, however, has underscored the degree to which your genetics play a role in your cholesterol profile. If your parents had high LDL levels, chances are you will too, regardless of how healthy you eat.

That shouldn’t be viewed as a green light to eat as much high-cholesterol food as you want. Dietary cholesterol can still play a small part in your LDL levels, so why give your LDL count any help?

Even worse than saturated fats are trans fats. They’ve been shown to raise LDL and lower HDL (“good”) cholesterol levels. Trans fats are being phased out of many foods and restaurants, as governments seek to improve public health by banning them or otherwise discouraging their use.

Trans fats, often labeled as “partially hydrogenated oil,” help preserve the shelf life of baked goods and other products. But they have no nutritional benefits while posing obvious health risks.

Portion control: Many people looking for a good cardiac diet also need to lose weight. And one of the staples of weight control is portion control. Smaller servings reduce your caloric intake, but they do so without you having to make major changes in the specific foods you eat.

You can practice portion control by simply splitting meals with your spouse or partner. Instead of having a whole sandwich, have half. Skip desserts during the week. Drink a glass or two of water before you eat a meal, so you’ll be less hungry and will eat less food. These simple ideas can help you cut down on the amount of food you consume.

Get some nutrition counseling: If you’ve gone through cardiac rehabilitation, you’ve probably learned a few things about what makes a good heart patient diet. Part of cardiac rehab is learning what you should eat, how to exercise safely and how to make other heart-healthy lifestyle decisions.

If you aren’t a heart patient, you can still benefit from the advice of a dietitian familiar with a healthy cardiac diet. Your doctor can prescribe the services of a dietitian to help you plan meals and learn what foods to avoid and what to include in a diet that’s good for your heart and your overall health.

Healthy Vegetarian Eating Pattern

The government-sanctioned “healthy vegetarian eating pattern” includes no meat or poultry, but it does contain dairy and eggs as well as plant sources of protein such as legumes and soy foods. Plant-based diets take many forms.

While vegetarian dietary patterns are defined by avoidance of certain foods of animal origin, beneficial results may not always be attributed to reduced consumption of animal products, but more from an increase in nutritional components related to plant foods, such as increased fiber intake. Significant differences in body mass index (BMI) levels, ranging from 24.1 for vegans to 28.3 for non-vegetarians in one large study, may result from differences in energy absorption and use.

Another factor is the difference in intake of specific nutrients, such as potassium, which is considered an important micronutrient in prevention of hypertension, and increased soy consumption, which has been found to reduce risk of female-specific cancers among vegans.

Researchers have compared the eating habits of omnivores vs. herbivores of various stripes. Some findings:

• Vegetarians consumed less meat, eggs, and dairy products compared with non-vegetarians.
• Vegans (who abstain from all animal products) and lacto-ovo-vegetarians (dairy and egg eaters) consumed negligible amounts of meat.
• Pesco-vegetarians (fish eaters) and semi-vegetarians consumed much less meat compared to non-vegetarians.
• Vegans consumed the lowest amount of eggs and dairy products, and non-vegetarians consumed the highest amount; other vegetarian groups consumed intermediate amounts.
• Vegetarians consumed lower amounts of added fats, sweets, snack foods, and non-water beverages, with vegans consuming the lowest amounts and non-vegetarians the highest amounts.
• Vegetarians consumed higher amounts of most of the other major food groups of plant origin compared to non-vegetarians, including legumes, soy foods and meat analogues, nuts, seeds, grains, potatoes, avocados, fruits, and vegetables.
• Vegans consumed the highest amounts of daily energy from these plant food groups, and non-vegetarians the lowest amounts; the other vegetarian groups consumed intermediate amounts.

Food consumption patterns among vegetarians go well beyond mere avoidance of meats or other animal foods. Notable across the spectrum was the moderate-to-large increase in consumption of a broad variety of plant foods, including legumes, soy foods and meat analogues, nuts, seeds, grains, potatoes, avocados, and fruits, rather than concentrated increases in only a few food groups.

This increased consumption would be expected to result in higher intakes of a variety of phytochemicals, many of which are thought to confer health benefits. Nut consumption, for example, is linked to reduced cardiovascular disease risk and increased longevity, while increased consumption of fruits and vegetables may be linked to a lower risk of certain cancers.

The Pescetarian Plan

Pescetarians avoid red meat and poultry yet eat all manner of seafood, including fish, shrimp, and clams, along with dairy, eggs, and an abundance of plant foods. A 2007 article in the American Heart Association journal reported that eating fish just once or twice a week was associated with a 42 to 50 percent reduction in the risk of sudden cardiac death in healthy adults. Whether it’s the lack of saturated fat-laden red meat, high intake of fruits and vegetables, heart-healthy omega-3 fatty acids in fish, or abundance of minerals in shellfish, a pescetarian diet is a great way to keep your body healthy.

Here’s how to eat the pescetarian way:

• Make at least 50 percent of your meal vegetables (or 50 percent fruit at breakfast.)
• Add a little healthy fat, such as olive oil, nuts, or avocados, when sautéing vegetables or dressing salads.
• Fill one-fourth of your plate with high-quality protein. While most experts recommend seafood two to three times per week, this plan suggests eating seafood once a day, along with other vegetarian choices, such as tofu, edamame, yogurt, cheese, and eggs at other meals. Legumes, such as beans and lentils, also are good protein sources.
• Enjoy one-half cup of whole grains and/or other starchy foods (like sweet or white potatoes) four or five times a day.

Environmental contaminants like polychlorinated biphenyls (PCBs) and mercury that wash into waterways can sometimes build up in fish. To limit exposure, aim for small and medium-sized fish such as sardines, smelt, trout, and flounder. Shellfish, octopus, and squid also tend to be low in mercury. Since chemicals can concentrate in fat, remove that before cooking.

Vegan Pros and Cons

A recent study of people who ranged from vegan to vegetarian to all-out meat-eaters found that vegans had a lower intake of cholesterol, total fat, saturated fat, and sodium, and higher intake of dietary fiber and polyunsaturated fat compared to those on an omnivorous diet. Some of these differences were particularly striking; for example, sodium intake in vegans was less than half of that for people who were eating meat. The vegan diet received the highest scores on two scoring scales that predict positive health outcomes. Other studies on vegan diets have found similar results.

As vegans tend towards healthier consumption of many nutrients, such as lower cholesterol and higher fiber intake, it is not surprising that these trends often translate into improved health. People following a vegan, plant-based diet tend to show greater weight loss and better BMIs than those eating meat, and they can be at a reduced risk for high blood pressure, type 2 diabetes, and mortality from cardiovascular disease.

A 2015 study involving obese children showed that the benefits can begin early. After four weeks on a vegan, low-fat diet, kids showed significantly reduced BMI, systolic blood pressure, weight, total cholesterol, LDL cholesterol, insulin levels, markers of heart disease like high sensitivity C reactive protein, and more. These changes are all related to a reduced risk of cardiovascular disease.

These numerous plant-based diet benefits for your health might inspire you to try a vegan diet for you and your family. But this kind of diet is not easy, and oftentimes people who remove animal products from their diet have a hard time meeting the recommended values of many nutrients. While vegans may have healthier intakes of things like cholesterol and fiber, studies show they often have the lowest calcium and protein intake compared to other diets; these levels can drop below the national dietary recommendations. Make sure to get plenty of calcium, protein, and vitamin B12, which are some of the nutrients that many vegans and vegetarians often lack.

Look for calcium-rich greens like Swiss chard, spinach, and collard greens or B12-fortified foods like almond milk or rice milk to fill these gaps. Supplementation, if necessary, can help to reduce the risk of becoming deficient in vital nutrients.

And remember, you don’t necessarily have to go vegan or vegetarian to be healthy, or to lose weight. This is simply one strategy, and it may not be right for you. Animal products, including meat, can certainly be included as part of healthy diet.

The Healthy Mediterranean-Style Eating Pattern

Study after study suggests that the Mediterranean diet may offer major benefits. Consuming a Mediterranean diet rich in whole grains, fruits, and vegetables, moderate in olive oil, fish, and alcohol, and modest in sweets was linked to longer lifespan.

Researchers evaluated data from 4,676 women in the Nurses’ Health Study, for example, and found that those who consumed a Mediterranean-style diet had longer telomeres, which indicates protection against aging and risk of cancer, heart disease, and other chronic diseases. (Telomeres are structures at the end of chromosomes within DNA; shorter telomeres are linked with signs of aging.)

The Mediterranean diet focuses on a small group of staple foods:

• Vegetables
• Fruits
• Healthy fats (especially olive oil)
• Nuts and seeds
• Legumes
• Unrefined whole grains
• Fish

People who eat a Mediterranean diet tend to experience significant health benefits, ranging from reduced blood sugar to better memory. Here are seven of the top health advantages of the Mediterranean diet:

1. Preserves memory and prevents cognitive decline. Full of healthy fats for the brain, the Mediterranean diet can be good for boosting brain power and preventing dementia and cognitive decline. In one study, researchers found that high adherence to a Mediterranean diet was associated with a 40 percent reduced risk for cognitive impairment. In another study published in Neurology in 2015, close adherence to a Mediterranean-style diet was associated with less brain atrophy, with an effect similar to five less years of aging. Researchers evaluated the eating habit surveys and MRI (magnetic resonance imaging) brain scans of 674 elderly individuals with an average age of 80 years. Those who reported eating habits that resembled a Mediterranean style diet had a larger total brain volume and more grey and white matter than people who didn’t regularly follow many aspects of the Mediterranean diet. Higher fish intake and eating less meat also were associated with larger total brain volume.



2. Reduces your risk for heart disease. Studies show that following a Mediterranean diet can greatly reduce your risk for cardiovascular disease, including coronary heart disease, myocardial infarction (heart attack), and stroke. This is likely due to the Mediterranean diet’s positive effects on cardiovascular risk factors, including high blood pressure, triglycerides, and cholesterol.
3. Strengthens bones. One study suggests that certain compounds in olive oil may help preserve bone density by increasing the proliferation and maturation of bone cells. Another study found that dietary patterns associated with the Mediterranean diet may help to prevent osteoporosis.
4. Manages diabetes and controls blood sugar. The Mediterranean diet has proven to have beneficial effects for diabetes. It might be able to prevent type 2 diabetes and can help improve blood sugar control and cardiovascular risk in those who already have it. When the Mediterranean diet was compared to a low-fat diet, people with type 2 diabetes who followed the Mediterranean diet fared much better; fewer people needed treatment, and they experienced greater weight loss and better blood sugar control.
5. Fights depression and averts dementia. People who follow the Mediterranean diet may be protected against depression, too. A 2013 study found that people who followed a Mediterranean diet most closely had a 98.6 percent lower risk of developing depression than people who followed it the least closely. The Mediterranean diet appears to promote brain health overall. One study showed that people who were moderately diligent in following the Mediterranean diet slashed their risk of Alzheimer’s nearly in half.
6. Protects against cancer. Higher adherence to a Mediterranean diet may help fight off cancer. A systematic review of studies found that overall, people who adhere to the diet the most have a 13 percent lower rate of cancer mortality compared to those who adhere the least. Specific cancers protected against include breast cancer, colorectal cancer, gastric cancer, prostate cancer, liver cancer, and head and neck cancer.
7. May lengthen life. Successful agers are much more common in cultures that do not consume the Western diet. There is growing interest in investigating how diet influences telomeres—the nucleotide sequences at the end of chromosomes. Scientists think that shorter telomeres are a sign of shorter lifespan.

A review published in the August 2016 issue of the European Journal of Clinical Nutrition found that specific foods—including processed meats, cereals, and sugar-sweetened beverages—were associated with shorter telomere length, while traditional Mediterranean dietary patterns were linked with longer telomere length. It seems increasingly clear that emphasizing this healthful and delicious eating style is the way to go if you want to live a long, vibrant life.

Simple Rules for the Mediterranean Diet

Following the Mediterranean diet can be best tackled by dividing foods into five categories recommended for daily, weekly, monthly, or rare consumption (see chart):

➧  Daily (eat multiple times per day)

• Fruits
• Vegetables (excluding starchy corn and potatoes)
• Healthy fats (olive oil)

➧  Daily (eat at least once per day)

• Legumes (beans, peas, etc.)
• Unrefined whole grains
  (brown rice, steel cut oats, etc.)

➧  Weekly (eat multiple times per week)

• Fish (wild)
• Nuts and seeds (almonds, walnuts, sunflower seeds, pumpkin seeds, etc.)

➧  Monthly (eat 3 to 4 times per month or less)

• Poultry
• Eggs
• Organic cheese and yogurt

➧  Rarely (eat only on occasion)

• Saturated fats from red meat and dairy products (besides organic cheese and yogurt)
• Refined sugars and sweets
• Luncheon/deli meats

The DASH Diet

Dietary Approaches to Stop Hypertension—known commonly by its acronym, DASH—was developed through research sponsored by the National Institutes of Health. The goal was to identify foods good for the heart and the entire cardiovascular system, but with the specific goal of preventing high blood pressure. According to the U.S. News & World Report’s 2016 Best Diets ranking, a panel of health experts has named the DASH diet the best overall eating plan, edging out the Mediterranean diet.

The DASH diet has already been proven to reduce high blood pressure. In one study, people who followed the diet for three weeks saw a drop in blood pressure similar to that achieved by taking blood pressure medications. Because the DASH diet lowers blood pressure, it reduces the risk for heart disease and stroke. It may also may be effective for preventing kidney stones.

One of the most appealing aspects of the DASH eating strategy is that it doesn’t require special foods or complicated menus. Instead, there are guidelines that spell out what kinds of foods should be consumed and how much should be eaten per day. For example, for a 2,000-calorie-per-day diet, the DASH eating plan suggests a daily intake of:

➧  6 to 8 servings of grains. Serving-size examples: 1 slice bread; 1 cup ready-to-eat-cereal, with serving sizes between 1/2 cup and 11/4 cup; 1/2 cup cooked rice, pasta, or cereal.

➧  6 or fewer servings of meat, fish, or poultry. Serving-size examples: 3 ounces cooked lean mean, skinless poultry, or fish.

➧  4 to 5 servings of vegetables. Serving-size examples: 1 cup raw leafy vegetable; 1/2 cup cooked vegetable; 6 ounces vegetable juice.

➧  4 to 5 servings of fruit. Serving-size examples: 1 medium fruit; 1/4 cup dried fruit; 1/2 cup fresh, frozen, or canned fruit; 6 ounces vegetable juice.

➧  2 to 3 servings of low-fat or fat-free dairy products. Serving-size examples: 8 ounces milk; 1 cup yogurt; 11/2 ounces cheese.

➧  2 to 3 servings of fats and oils (preferably healthy options, such as olive oil). Serving-size examples: 1 teaspoon soft margarine; 1 tablespoon low-fat mayonnaise; 2 tablespoons light salad dressing; 1 teaspoon vegetable oil.

In addition, a DASH eating plan also suggests eating 4 to 5 servings of nuts, seeds, dry beans, and peas each week, but no more than 5 servings of sweets.

Other foods that lower blood pressure may include those rich in omega-3 fatty acids. Several studies have found that diets high in omega-3 fatty acids may help reduce blood pressure and lower the risk of heart disease. These foods include salmon, tuna, and other fatty, cold-water fish.

In addition to fatty fish, such choices as blueberries, oatmeal and other high-fiber cereals, potatoes (which are high in magnesium and potassium), dark chocolate, and beet juice are also associated with lower blood pressure.

Does DASH Lower  “Bad” Cholesterol?

Along with including foods that lower blood pressure, the DASH diet may also be effective at lowering your LDL (“bad”) cholesterol and helping you lose weight if you’re overweight or obese. Research shows that losing just 10 or 15 pounds can lead to a noticeable reduction in your blood pressure.

The guidelines also list the types of foods that should be avoided. These include foods high in saturated fats—red meat, whole milk and other full-fat dairy, and tropical oils such as coconut and palm kernel oils, for example. Go easy on the whole milk and cheese if you want to help lower your blood pressure.

The DASH diet also emphasizes a reduction in sodium (salt). The original eating plan recommends consuming no more than 2,300 milligrams (mg) per day. Even greater benefits may be achieved by lowering your daily intake to no more than 1,500 mg.

Sodium increases blood pressure by causing the body to hold onto more fluid. When fluid levels build up in the body, the result is a greater volume of blood. Blood pressure is simply the force of blood flow against the interior walls of the arteries. More blood volume means greater force and higher blood pressure.

If you cut down on your sodium intake, eat smaller portions, and make fruits and vegetables the main staples of your diet, you’ll be off to a good start in eating right for your heart and your blood pressure.

DASH Weight-Loss Tips

While the DASH eating plan isn’t designed to promote weight loss, it is rich in low-calorie foods. The National Institutes of Health advises, “You can make it lower in calories by replacing high-calorie foods with more fruits and vegetables—and that also will make it easier for you to reach your DASH eating plan goals.” Here, the NIH offers examples.

➧  To increase fruits:

• Eat a medium apple instead of four shortbread cookies. You’ll save 80 calories.
• Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds. You’ll save 230 calories.

➧  To increase vegetables:

• Have a hamburger that’s 3 ounces instead of 6 ounces. Add a 1/2-cup serving of carrots and a 1/2-cup serving of spinach. You’ll save more than 200 calories.
• Instead of 5 ounces of chicken, have a stir fry with 2 ounces of chicken and 11/2 cups of raw vegetables. Use a small amount of vegetable oil. You’ll save 50 calories.

➧  To increase low-fat or fat-free dairy products:

• Have a 1/2 cup serving of low fat frozen yogurt instead of a 11/2-ounce milk chocolate bar. You’ll save about 110 calories.

Other Good Diets: Just Follow the Healthy Eaters

As you can see from the similarities among the three eating patterns recommended by the U.S. government, the key to a healthy diet plan is getting enough vegetables, fruits, whole grains, low-fat dairy, and lean protein. These eating patterns also are similar in what they do not include: processed foods and food products that contain added sugar, saturated and trans fats, sodium, additives, and other ingredients that lack valuable nutrients. Other heart-friendly plans replicate these basics and highlight certain foods.

The Portfolio Diet

Developed by researchers at the University of Toronto, the Portfolio diet is low in saturated fat and cholesterol, similar to other plans, but higher in viscous fiber, soy protein, plant sterols (compounds found in plant foods), and nuts. In addition, the diet is rich in fruits, vegetables, whole grains, and plant proteins, emphasizing the idea that no single food can make a significant difference, but taken together—a portfolio of foods—they can improve cholesterol levels, reduce inflammation, possibly lower blood pressure, and ultimately improve heart health.

Studies have shown the Portfolio eating plan to be almost as effective as some statins for lowering cholesterol. Flexibility is an advantage of the diet, providing opportunities to make as many substitutions for the foods you currently eat as you are comfortable with.

The effectiveness of the Portfolio eating plan was first tested in 2002 among 46 healthy adults with high cholesterol levels, and it was found to have significant cholesterol-lowering powers (28.6 percent decrease in “bad” LDL cholesterol), similar to that of the commonly prescribed cholesterol-lowering drug, Lovastatin (30.9 percent decrease). It also lowers blood pressure, a major risk factor for cardiovascular disease.

One study involving people with elevated cholesterol compared the effectiveness of the Portfolio with DASH. While the DASH diet was easier for people to stick with over six months, the Portfolio diet was more effective at lowering blood pressure. Some studies also have found that following the Portfolio plan can raise blood levels of “good” HDL cholesterol, which has been linked to a decrease in cardiovascular disease.

The New Nordic Diet

This dietary pattern is based on the traditional, regional foods—fish, game, berries, whole grains, and root vegetables—of Scandinavian countries, which include Finland, Norway, Denmark, Iceland, and Sweden. This eating style has gained momentum because nutrition researchers and chefs from this region have come together to discuss the increasing rates of obesity and chronic illnesses in their countries, which are linked to changing eating patterns.

While once Scandinavian diets were based on wholesome, minimally processed, regional foods such as fish, rye, and beets, today’s diets include more meat, highly processed foods (i.e., pizza, hot dogs, and chips), and refined grains.

Research reveals benefits for following the New Nordic Diet, which also can help shine a light on healthy eating practices in your own diet at home.

Swedish study participants who consumed seasonal, local foods, such as herring, canola oil, whole grains, berries, unsalted nuts and seeds, and root vegetables, and who avoided processed meat, sugar and refined grains had improved blood cholesterol and blood pressure levels compared to those who ate more refined grains, added sugars, and butter, and less fruits and vegetables.

Eating like a Scandinavian

These are the hallmarks of the New Nordic diet:

➧  Protein: Enjoy more fish and less red meat. The New Nordic diet emphasizes two fish, two vegetarian (for example, bean and pea dishes), and three lean animal protein (such as poultry) meals per week.

➧  Whole grains: Incorporate more whole grains into your meal plan, such as oats, rye, and barley, while decreasing refined flour, pasta and rice. Rye bread or barley-based side dishes or salads are delicious.

➧  Fruits and vegetables: Choose local and sustainable produce, such as fresh herbs, berries, and root vegetables, including potatoes or turnips. If possible, shop your farmers market choosing fruits and vegetables that are in season in your region.

➧  Fats: Canola (polyunsaturated and rich in omega 3s) is the oil of choice in the New Nordic Diet, with a decreased use of butter; olive oil (monounsaturated) may be incorporated as an alternative.

➧  Dairy products: Low-fat milk, yogurt (no added sugar), and cheese may be consumed in moderate amounts (2 servings per day).

➧  Beverages: Decrease consumption of sugar‑sweetened beverages, including 100 percent juice (eat whole fruits instead). Coffee, tea, and moderate alcohol consumption may be enjoyed as part of this eating pattern.

New Nordic Diet Weight Benefits

Danish subjects who consumed foods found in the New Nordic Diet lost weight—approximately 10 pounds in six months—without counting calories. In another study of Danish subjects, published in the European Journal of Nutrition, researchers found that participants who ate foods, such as berries, cabbage, potatoes, whole grains, and fish with fresh herbs, along with daily exercise, had a lower incidence of weight regain after initial weight loss.

Research even shows that the New Nordic Diet is more environmentally sustainable, with a 35 percent reduction in meat consumption than the typical Danish diet, along with increased intake of local produce and whole grains.

You can translate the New Nordic Diet to your own backyard by focusing on eating more locally produced fruits, vegetables, fish, and whole grains instead of highly processed foods such as processed meats (i.e., ham, sausage), refined grains (i.e., white bread and snack chips), and sugary foods and beverages. As a bonus, choosing local, regional foods can help you lower your carbon footprint.

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