New analysis suggests whole diet approach to lower cardiovascular risk has more evidence than low-fat diets

A study published in The American Journal of Medicine reveals that a whole diet approach, which focuses on increased intake of fruits, vegetables, nuts, and fish, has more evidence for reducing cardiovascular risk than strategies that focus exclusively on reduced dietary fat. This new study explains that while strictly low-fat diets have the ability to lower cholesterol, they are not as conclusive in reducing cardiac deaths. By analyzing major diet and heart disease studies conducted over the last several decades, investigators found that participants directed to adopt a whole diet approach instead of limiting fat intake had a greater reduction in cardiovascular death and non-fatal myocardial infarction.

Early investigations of the relationship between food and heart disease linked high levels of serum cholesterol to increased intake of saturated fat, and subsequently, an increased rate of coronary heart disease. This led to the American Heart Association's recommendation to limit fat intake to less than 30% of daily calories, saturated fat to 10%, and cholesterol to less than 300 mg per day.

"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," says study co-author James E. Dalen, MD, MPH, Weil Foundation, and University of Arizona College of Medicine. "These diets did reduce cholesterol levels. However they did not reduce the incidence of myocardial infarction or deaths."

Carefully analyzing studies and trials from 1957 to the present, investigators found that the whole diet approach, and specifically Mediterranean-style diets, are effective in preventing heart disease, even though they may not lower total serum or LDL cholesterol. The Mediterranean-style diet is low in animal products and saturated fat, and encourages intake of monounsaturated fats found in nuts and olive oil. In particular, the diet emphasizes consumption of vegetables, fruit, legumes, whole grains, and fish.

"The potency of combining individual cardioprotective foods is substantial – and perhaps even stronger than many of the medications and procedures that have been the focus of modern cardiology," explains co-author Stephen Devries, MD, FACC, Gaples Institute for Integrative Cardiology (Deerfield, IL) and Division of Cardiology, Northwestern University (Chicago, IL). "Results from trials emphasizing dietary fat reduction were a disappointment, prompting subsequent studies incorporating a whole diet approach with a more nuanced recommendation for ."

Based on the data from several influential studies, which are reviewed in the article, Dalen and Devries concluded that emphasizing certain food groups, while encouraging people to decrease others, is more cardioprotective and overall better at preventing than a blanket low-fat diet. Encouraging the consumption of olive oil over butter and cream, while increasing the amount of vegetables, fruits, whole grains, nuts, and fish promises to be more effective.

"The last fifty years of epidemiology and clinical trials have established a clear link between diet, atherosclerosis, and cardiovascular events," concludes Dr. Dalen. "Nutritional interventions have proven that a 'whole diet' approach with equal attention to what is consumed as well as what is excluded is more effective in preventing cardiovascular disease than low fat, low cholesterol diets."

More information: "Diets to Prevent Coronary Heart Disease 1957 – 2013: What Have We Learned?" by James E. Dalen, MD, MPH; Stephen Devries, MD, FACC (DOI: 10.1016/j.amjmed.2013.12.014), appears in The American Journal of Medicine.

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