“Let food be thy medicine,” wrote Hippocrates centuries ago. But which foods should you choose to protect the health of your heart, brain and arteries — and which ones should you avoid? In 2017, an analysis of American dietary patterns linked eating suboptimal amounts of ten foods and nutrients — too much of some and not enough of others — to nearly half of deaths from a cardiometabolic disease (CMD), such as heart disease, stroke or type 2 diabetes.

Conversely, people who ate the recommended amounts of the ten foods had the lowest risk for CMD, according to the study, which was published in Journal of the American Medical Association (JAMA). Since then, however, new studies have yielded sometimes contradictory findings about these foods, leaving Americans confused about the best and worst dietary choices. Here’s a look at the latest nutritional wisdom about these foods and how to optimize your diet for cardiometabolic wellness.

Eat More of These Five Foods

  • Nuts. People who eat nuts regularly have a lower risk for developing heart disease or experiencing cardiovascular (CV) events, such as heart attacks and strokes, compared to those who rarely or never eat nuts, according to a study of more than 210,000 men and women. Although the tasty treats are high in calories, they can also help people avoid long-term weight gain or obesity, other research shows. Moreover, eating almonds or hazelnuts may raise HDL “good” cholesterol, while pistachios help lower triglycerides. The BaleDoneen Method recommends eating a palmful of nuts daily, preferably tree nuts with skins, such as almonds, walnuts, hazelnuts and pistachios.
  • Fish. The omega-3 fatty acids in seafood have a wide range of cardiovascular benefits, including helping prevent heart disease, stroke, heart failure and sudden cardiac death; reducing triglycerides, blood pressure and chronic inflammation; and improving insulin sensitivity. The best sources of omega-3s are oily fish, such as salmon, herring, sardines, tuna and lake trout. The American Heart Association (AHA) recommends eating at least two 3½-ounce servings of non-fried fish per week.
  • Fresh vegetables. A diet high in these nutritional powerhouses could add years to your life. A new study presented at the Nutrition 2019, the annual meeting of the American Society for Nutrition, suggests that globally, low intake of vegetables is the culprit in more than 800,000 deaths from heart disease — and about 200,000 deaths from stroke — per year. The USDA advises eating two to three cups of veggies daily. Yet only one in ten adults consumes the recommended amount. An easy way to meet your goal is to fill half of your plate with vegetables and fruit. For optimal CV benefits, the BaleDoneen Method suggests “eating the rainbow” of colorful produce.
  • Fresh fruit. Do people who eat a lot of veggies, such as the Chinese, get any extra cardiometabolic benefits from eating fresh fruit? A study of more than 510,000 adults in China, where fresh fruit intake is very low, found that those who ate it daily had 36 percent lower risk for heart attack and stroke than those who ate no fresh fruit. Another recent study found that people who ate higher amounts of fresh fruit had a lower risk for diabetes. Among those who were already diabetic, the study also reported reduced rates of diabetes-related deaths and other complications in those who ate more fruit. As we recently reported, fresh fruit also lowers blood pressure and helps prevent obesity. Fruits with proven CV benefits include blueberries, apples, tomatoes and pears.
  • Whole grains/High-fiber foods. People who eat the most fiber (found in whole grains, fruit and veggies) have a 56 to 59 percent lower risk of dying from cardiovascular disease (CVD), infectious diseases or respiratory disorders, according to a study of nearly 400,000 people ages 50 and older. An even larger study found that for each extra 10 grams of fiber people ate daily, their risk for death from any cause fell by 10 percent. The USDA recommends eating 14 grams of fiber for every 1,000 calories adults consume daily (about 25 grams a day for women and 38 grams daily for men).

Eat Less of These Five Foods

  • Salt. The AHA recommends a limit of no more than 2,300 mg. per day of sodium and ideal limit of no more than 1,500 mg. for most adults. Cut back on the “Salty Six:” bread and rolls, pizza, sandwiches, cold cuts and cured meats, soup and burritos and tacos, all of which typically contain high levels of sodium. Limiting or avoiding packaged, processed foods, which are typically high in salt, may lower your blood pressure or help you avoid hypertension in the first place, the AHA reports.
  • Processed meats. People who eat the most processed meat — such as bacon, beef jerky, salami and other deli meats — have a higher risk for CVD. A study published in JAMA linked processed meat consumption to 57,766 deaths from CMD in 2012. What’s more, eating as little as one hot dog or a few strips of bacon daily raises colon cancer risk by 20 percent, according to a new study published in International Journal of Epidemiology (IJE). Processed meat has also been tied to increased risk for cancers of the breast, pancreas and prostate.
  • Sugar-sweetened beverages. Consuming just one or two sugar-sweetened beverages daily – such as energy drinks, fruit drinks, soda or coffee drinks – raises risk for a heart attack or dying from CVD by 35 percent, diabetes risk by 26 percent and stroke risk by 16 percent, according to a recent Harvard study. Sweet drinks have been called “liquid candy” and rank as the top source of added sugar in the U.S. diet. Quench your thirst with plain or sparkling water flavored with a spritz of lemon or lime or try our refreshing fruit and herb infused water recipes.
  • Red meat. Recently, conflicting studies have stirred debate about the effects of red meat. In the IJE study discussed above, eating 2½ ounces or more of red meat per day raised colon cancer risk by 20 percent. However, controversial new “guidelines” published in Annals of Internal Medicine in November contend there is not enough scientific proof of harm to tell people to cut back on red meat. This paper by a panel of nutritionists contradicts the federal government’s Dietary Guidelines for Americans, recommendations from the World Health Organization and other medical groups, and numerous studies pointing to the health benefits of eating less meat and more plant foods. The BaleDoneen Method joins these authorities in continuing to advise patients to limit red meat. Healthy sources of protein include seafood, legumes (beans and peas), nuts, oats and low-fat dairy products, while leafy, green vegetables are an excellent source of iron.
  • Saturated fat. For 50 years, saturated fats were demonized as the No. 1 dietary culprit for arterial disease. Two major studies report that the effect of cutting down on saturated fats depends on how you replace them. Swapping them with healthy fats (such as those found in oily fish, olive oil, most nuts and avocados) or high-fiber carbs (such as whole grains) may benefit heart health, while replacing saturated fat with refined carbs (such as baked goods or sweets) is likely to do the opposite. In fact, as we recently reported, sugar is actually worse for heart health than saturated fats.

What’s the Best Diet to Protect Cardiometabolic Health?

Rather than advise a one-size-fits-all diet based on the average results from large studies, the BaleDoneen Method recommends a diet based on your DNA. We use genetic tests to identify the optimal eating plan for each patient. Ask your healthcare provider for more info on the two genetic tests discussed below. Using them to guide your dietary choices can help you lower your risk for heart attacks, strokes and diabetes:

  • Apo E genotype. This test analyzes your Apolipoprotein E (Apo E) genotype, which influences both your lifetime risk for heart disease and the best diet to avoid it. The results can be used to determine the optimal amount of fat in your diet and whether you should limit or avoid alcohol. A diet based on your Apo E genotype fights the leading risk for heart attack and a major risk for stroke: abnormal lipid levels. Studies show that eating the right foods for your Apo E genotype raises levels of HDL (good) cholesterol and lower levels of LDL (bad) cholesterol and triglycerides.

Haptoglobin genotype. If you have type 2 diabetes, this test can reveal if you have a genotype that quintuples risk for heart disease — and guide precision-medicine treatments to almost eliminate this risk, a peer-reviewed recent BaleDoneen study reported. If you are not diabetic, you can learn if you have a genotype linked to increased risk for intestinal, autoimmune and inflammatory disorders and if you’d benefit from a gluten-free diet and probiotics.