Heartfelt Eating: Best Foods for a Heart-Healthy Diet

Hypertension affects nearly half of all Americans, increasing the risk for heart disease and stroke, the leading cause of death. We can help mitigate that risk and have a healthy “change of heart” by revamping our diets.

While food fads are constantly changing, the basics of a heart-healthy diet have not, says Cheryl Strachan, a registered dietitian in Calgary, Canada, and founder of Sweet Spot Nutrition. Strachan notes the Dietary Approaches to Stop Hypertension (DASH) diet has been used to help lower blood pressure and with other heart disease risk factors since its development in the 1990s. The DASH diet is rich in fruits, vegetables, whole grains, nuts, beans and low-fat dairy foods. While it includes lean meat, fish and poultry, it limits sugary foods and fatty meats.

The Mediterranean diet, says Strachan, is another proven regimen for heart health, citing a five-year Spanish study in The New England Journal of Medicine that found the incidence of cardiovascular events was 30 percent lower among participants on this diet, supplemented with extra-virgin olive oil or nuts, compared to those assigned a reduced-fat diet.

A Mediterranean diet doesn’t necessarily mean eating dishes specific to that region. “It’s the type of foods that matters: a largely plant-based diet focused on whole grains such as the bulgur in tabouli, legumes, nuts, seeds, olive oil and some animal products like fish, poultry and dairy,” says Strachan.

Michael Greger, a Seattle physician and author of the bestseller How Not to Die, disagrees that meat-based proteins have a place in a heart-healthy diet. “Only one way of eating has ever been proven to reverse heart disease in the majority of patients: a diet centered around whole-plant foods,” says Greger, adding that the most critical risk factor is elevated LDL cholesterol. “To drastically reduce LDL cholesterol levels, we need to drastically reduce our intake of trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and playing a lesser role, dietary cholesterol, found exclusively in animal-derived foods, especially eggs.”

Michelle Routhenstein, a preventive cardiology dietitian and owner of Entirely Nourished, a nutrition counseling practice in New York City, likes to meet clients where they are rather than trying to force a drastic switch they can’t maintain. “Often, people get very broad advice, like ‘Adopt a plant-based diet,’ but when it comes to the heart, you have to find a way of eating you can commit to long term. I start by asking what foods bring them joy, as well as their food dislikes, history and culture.”

For Routhenstein, an optimal diet for the heart includes a healthy balance of good fats, lean protein and the complex carbs that are important sources of fiber. “Research has shown that every additional 10 grams of fiber per day can decrease the risk of coronary heart disease by as much as 25 percent,” by helping the body remove excess cholesterol, says the dietitian and author of The Truly Easy Heart-Healthy Cookbook: Fuss-Free, Flavorful, Low-Sodium Meals. While fatty foods are sometimes scapegoated for poor health, unsaturated fats are “really good for blood vessel health,” she adds.

Potassium is a key mineral for heart health, as it can help the body remove excess sodium, lower blood pressure and improve blood flow and blood vessel health. Yet research shows less than 2 percent of Americans get enough. Beans, sweet potatoes, lentils, beets and avocados are among many potassium-rich foods with multiple heart benefits.

There is a growing awareness of the importance of inflammation-fighting omega-3 fatty acids, particularly in fish like wild salmon, arctic char and sardines. Routhenstein also advocates omega-9 fatty acids such as in tahini and avocado. Omega-9s have been shown to help increase HDL “good” cholesterol and decrease LDL “bad” cholesterol while protecting blood vessel health.

Heart attacks often seem to occur suddenly simply because the damage happens gradually and quietly, warns Routhenstein. “Heart disease is progressive, so over time a poor lifestyle and diet can damage blood vessels and accelerate hardening of the arteries that lead to heart attacks,” she warns. “Some damage may not be entirely reversible, but it’s never too late to optimize heart functioning.”