What is the cardiac diet?

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The cardiac diet aims to reduce the risk of cardiovascular disease by encouraging people to eat heart-healthy, anti-inflammatory foods.

According to the American Heart Association (AHA), these are the basic principles of the cardiac diet:

• include a wide variety of vegetables and fruits
• limit sugar and salt
• choose whole grains instead of highly refined or white grains
• get protein from plant sources such as legumes, nuts, and seeds, whenever possible
• if including animal products in the diet, try to choose:
  • fish and seafood
  • lean meats
  • low fat or fat-free dairy
• cook with liquid non-tropical plant oils, such as olive oil
• limit highly processed foods
• if including alcohol in the diet, try to do so in moderation

A person may also wish to consider removing alcohol from their diet.

The cardiac diet also involves adjusting calorie intake and exercise levels to reach or maintain a moderate weight. This can have numerous health benefits, including reducing the risk of developing heart disease and diabetes.

Several diets follow the general pattern for heart-healthy eating listed above. These diets include:

• Mediterranean diet: This diet focuses on fruits and vegetables, whole grains, legumes, and olive oil.
• Dietary approaches to stop hypertension (DASH): The DASH diet is intended to help lower blood pressure. It promotes eating plant-based whole foods while avoiding salt, sugar, and most fats.
• Healthy U.S.-style diet: This diet is very similar to the DASH diet. It recommends choosing nutrient-dense foods across food groups, and limits salt, sugar, and saturated and trans fats.
• Vegetarian whole-food diets: Replacing animal proteins with plant-based sources such as legumes and nuts can benefit heart health.

One 2019 review suggests that the DASH diet, the Mediterranean diet, and vegetarian diets have the most evidence for cardiovascular disease prevention.

The AHA says that the following foods are beneficial for heart health:

Fruits and vegetables

The phrase “eat the rainbow” is a useful way to remember to consume a variety of different colored fruits and vegetables each day. The different types of antioxidants that plant foods contain can help protect the heart.

Fruits and vegetables are also good sources of fiber, which is essential for heart health.

Experts suggest eating 4–5 servings (2.5 cups) of vegetables per day.

People should try to focus on eating non-starchy vegetables and limiting portion sizes of starchy vegetables, such as potatoes and squash.

Consider colorful fruits and vegetables such as:

• apples
• blueberries
• broccoli
• oranges
• peppers
• spinach and other leafy green vegetables
• tomatoes

Oily fish

Oily fish contains omega-3 fatty acids, which have anti-inflammatory properties and are good for the heart.

The AHA suggests eating 2 servings of fish per week. Oily fish, also known as fatty fish, is the most beneficial. A serving is 3 ounces of cooked fish, which is equal to three-quarters of a cup of flaked fish.

Fish that are high in omega-3 fatty acids include:

• salmon
• black cod
• mackerel
• herring
• sardines
• bluefin tuna

Some people should use extra caution about what types of fish to eat. This includes:

• children
• people who are trying to become pregnant
• pregnant people
• people who are breastfeeding or chestfeeding

The Food and Drug Administration (FDA) advises that these groups should avoid larger fish such as shark, swordfish, and marlin. This is due to higher mercury levels in some types of fish.

Whole grains

Limiting refined grains and instead choosing whole grains helps lower a person’s risk of cardiovascular disease.

Whole grains contain more beneficial fiber than refined grains. Examples include:

• whole grain bread
• whole grain pasta
• oats
• brown rice

Nuts, seeds, and legumes

The best diets for cardiovascular health include 2–3 cups of nuts, seeds, and legumes daily.

Legumes such as beans, tofu, and chickpeas are generally lower in calories than nuts and seeds. Nuts and seeds are very energy-dense, and some are expensive. Depending on a person’s budget and desired calorie intake, they may choose to eat larger volumes of legumes and smaller servings of nuts and seeds.

A person may wish to try adding the following to their diet:

• Nuts: These include peanuts, walnuts, almonds, Brazil nuts, hazelnuts, pecans, and cashews.
• Seeds: These include sunflower seeds, pumpkin seeds, flaxseeds, hemp seeds, and chia seeds.
• Legumes: These include soybeans and soy products such as tofu and tempeh, chickpeas, lentils, black beans, kidney beans, adzuki beans, and fava beans.

Low fat dairy foods

The AHA acknowledges that there is mixed evidence surrounding saturated fats found in full-fat dairy and the risk of heart disease.

However, it says that most of the evidence suggests that people should consume less saturated fat in their diet. A person can consume less saturated fat by choosing nonfat and low fat dairy products, such as:

• skim or 1% milk
• nonfat or low fat yogurt
• low fat or reduced-fat cheeses

Lean meats

People who choose to include meat in a cardiac diet are encouraged to select lean cuts of meat that are unprocessed. Saturated fats and other substances found in red and processed meats may harm heart health.

Unprocessed lean meats include:

• skinless poultry
• 90% or 95% lean ground chicken or turkey
• wild game

People who choose to eat red meat as part of a cardiac diet may benefit from choosing the leanest cuts available. For ground beef, look for 95% extra lean on the label.

There are several foods a person should try to limit when following the cardiac diet. These include:

Red and processed meats

Red meat is a source of saturated fat. According to several studies, replacing red or processed meat with plant protein may lower the risk of heart disease.

Plant proteins include nuts, legumes, whole grains, and soy products.

Sugar-sweetened foods and beverages

Many processed foods and beverages contain added sugars, especially sodas and energy drinks.

The Dietary Guidelines for Americans recommend limiting calories from added sugars to no more than 10% each day. If following a 2,000-calorie diet, this equates to 200 calories, or 12 teaspoons of sugar, per day.

Avoiding excess sugar may help a person reach or maintain a moderate weight and prevent heart disease.

Processed foods

Processed foods often contain long lists of ingredients, many of which are not beneficial for a healthy heart. For example, many processed foods contain:

• high sugar
• high salt
• trans fats
• saturated fat
• additives and food colorings

When possible, try to cook meals from scratch using whole foods, and choose whole food snacks.

Refined carbohydrates

Refined carbohydrates lack fiber and can cause a person to feel hungry again quickly. Replacing refined carbohydrates with nutrient-dense whole grains lowers the risk of many conditions, including stroke and metabolic syndrome.

Some refined carbs to limit include:

• white bread, pasta, and rice
• cakes, cookies, and pastries
• many breakfast cereals
• pizza dough
• white flour

Learn about heart-healthy dessert options here.

Alcohol

The cardiac diet plan suggests consuming little or no alcohol. People who consume alcohol may wish to consider doing so in moderation. This means consuming no more than one drink per day for females and no more than two drinks per day for males.

Some people believe that a moderate intake of red wine can help protect the heart because it contains antioxidants. However, the evidence for this is weak, according to the AHA.

Salt

Research suggests a link between salt consumption and high blood pressure. Limiting salt intake can lower blood pressure and may also reduce cardiovascular health risks.

Many processed foods contain added salt, so a person can monitor their intake by reading the labels and instead choosing whole foods, when possible. Eating foods cooked at home with limited or no salt, rather than restaurant foods or takeout, can also help lower salt intake.

People can make a start with the cardiac diet using the following meal plan:

• Breakfast: Try overnight oats topped with flaked almonds and blueberries. Serve with low fat yogurt.
• Lunch: Try a salmon and avocado salad, including green leaves, peppers, red onion, tomatoes, cucumber, and a squeeze of lemon.
• Dinner: Prepare a vegetarian bean chili. Serve with brown rice and a green salad.
• Snack options: Opt for hummus and carrot sticks, apple slices and a spoonful of nut butter, or a boiled egg with a spoonful of guacamole.

Some people may find that altering their eating habits is challenging at first.

A person may wish to try making gradual changes, maybe two each week. This is preferable to making many changes all at once and then giving up quickly.

Another tip is to add herbs and spices to meals to boost their flavor, instead of salt or heavy sauces. Keeping a food journal or having a diet buddy can also help people with motivation.

It is important to recognize that not everyone has the same access to health-promoting foods. Factors such as income level and neighborhood amenities affect whether a person can easily purchase items such as fresh fruits and vegetables. These factors are also influenced by structural racism in the U.S., as the AHA notes in its diet guidelines.

These are real and complex challenges. Changing them may involve actions such as policy changes and food access projects.

On an individual level, making a cost-effective meal plan that meets a person’s specific needs is one way to help make a cardiac diet more accessible. Consider planning meals for the week, and prioritizing ingredients that are frozen or can be stored safely for longer periods of time.

When eating restaurant meals or takeout, a person can aim for dietary choices that follow the cardiac diet. Some restaurants label menu items as low calorie, low sodium, “healthy,” or “light” choices.

Some options that a person may choose to eat at restaurants include:

• skinless poultry
• fish or seafood
• legumes such as black beans, lentils, or tofu
• sides of cooked vegetables or salad
• whole grains, such as whole grain bread or brown rice
• vegetable-based flavorings such as pico de gallo, guacamole, herbs, or spices

People may wish to avoid fried foods and sauces and dressings high in sugar, salt, and fat. They may also aim to limit their alcohol intake when dining out.

Some other tips for a healthy heart include:

• exercising regularly
• avoiding long periods of sitting
• quitting smoking
• relieving stress through activities such as mindfulness or yoga

Starting and sticking to the cardiac diet is a process. If a person is used to eating refined carbs and processed foods frequently, they may find it difficult to make larger dietary changes. Trying the tips above may help.

Whole grains, vegetables, legumes, and oily fish are nutritious staple foods to include in the cardiac diet. People may wish to limit processed foods, sugar, salt, and saturated fats.

It can be helpful for people to plan their diet and be mindful of their choices when dining out. Getting daily exercise and managing stress are also beneficial for heart health.

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