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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Healthy Heart Healthy Heart

The Perfect Diet (Really!)

July 09, 2013

By Thomas H. Lee M.D.

Harvard Medical School

Many people feel overwhelmed by information on diets, and just want to know what to do. After all, there are so many diets out there right now, most doctors are every bit as confused as their patients. For many years, the American Heart Association has been recommending a low-fat diet with less than 300 milligrams of cholesterol per day, and 30% of calories from fat. But while they pursued this heart-healthy diet, Americans got fatter and fatter. About a decade ago, nutrition experts began to wonder whether we were doing something drastically wrong.

When low-carbohydrate diets like the Atkins Diet came along, cardiologists recoiled at the notion of so much fat. The Atkins Diet actually has 68% of total calories from fat, which in the past would have been considered a sure road to a heart attack. What these cardiologists didn't take into account was that these low-carbohydrate diets actually led to overall decreases in caloric intake. With the resulting weight loss, cardiac risk factors often improve.

The problem with low-carbohydrate diets is that most people cannot sustain them, and they regain the weight they lost. In addition, experts continue to be nervous about the long-term effects of such a high-fat diet on overall health.

So dozens of other diets compete for Americans' attention — most without evidence to prove they help people live longer, healthier lives: Glycemic index diets (like the South Beach Diet) that allow carbohydrate consumption as long as they do not make blood glucose shoot up too high. Very-low-fat diets that allow less than 15% of total calories from fat.The Mediterranean Diet, which includes large amounts of plant foods, fish and poultry in moderate amounts, rare use of red meats, and wine in low to moderate amounts with meals.

My own favorite diet is the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension, which is unusual among diets in that it has actually been evaluated in a research study, and shown to offer real health benefits. It is similar to a Mediterranean-type diet, in that it includes high amounts of fruits, vegetables, low-fat dairy products, whole grains, nuts, fish, and poultry. DASH diets have low amounts of total and saturated fats, red meats, sweets, and sugar-containing beverages.

The DASH diet can lower blood pressure, particularly if you also reduce the amount of salt in your diet. It is similar in some important ways to the complex pyramid approach recently recommended by the U.S. Department of Agriculture (USDA) Neither approach is really a weight-loss diet, but an approach to eating that provides guidance on the relative proportion of foods for someone eating a "normal" amount of calories (about 2,000 per day).

As good as some of these diets are, and delectable as some of their recipes might be, most people just don't like following a diet. A few principles of how to eat just might be enough for you to improve your health, and maybe lose some weight along the way.

Here's the bottom line — four relatively simple recommendations:

  1. Decrease your carbohydrate intake, especially of refined and high glycemic-index carbohydrates.
  2. Increase your consumption of fruits, vegetables, and whole grains.
  3. Increase your intake of polyunsaturated fats by increasing the amount of plant oils and fish in your diet.
  4. Limit yourself to moderate amounts of low-fat dairy products and nuts.

The authors of this review concluded by reminding readers that "food is fuel, and people will lose weight if they burn more calories than they consume." Portion size and total calorie intake is more important than the mixture of foods you eat. With these common-sense dietary strategies and an active life style, you can lose weight and reduce your risk of heart disease.

Thomas H. Lee, M.D. is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.

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