ACC review: Plant-based diet with little or no animal products is best

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NutritionResearchers from the American College of Cardiology’s Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council have released their second review of nutritional “hypes” and controversies around dairy products, added sugar, legumes, coffee and tea, alcohol, energy drinks, mushrooms, fermented foods, Omega-3s and vitamin B12.

Most of the evidence continues to reinforce that a predominantly plant-based diet lower in fat, added sugars, added salt, processed foods, and with limited if any animal products.

“The current nutritional recommendations show a heart-healthy diet is high in fruits, vegetables, whole grains and nuts in moderation,” said Dr Andrew Freeman, FACC, director of cardiovascular prevention and wellness at National Jewish Health and the review’s lead author. “However, there are many food groups which can result in confusion for patients, including dairy, added sugar, coffee and alcohol.”

While low-fat dairy can significantly lower blood pressure, several studies have shown a link between dairy intake and increased LDL cholesterol, fractures and all-cause mortality. There is no clear consensus on dairy intake among experts, but after a review of multiple meta-analyses, the researchers determined that dairy should be consumed with caution, as it is unclear if there is benefit or harm, and, as it serves as a big source of saturated fat and salt in the US, should be limited if consumed at all.

Consumption of added sugars (table sugar and high fructose corn syrup) has been linked to increased risk for coronary heart disease, stroke and worsened atherosclerotic cardiovascular disease. The researchers strongly recommend that individuals eliminate added sugars from their diet as much as possible, including processed foods and sugar-sweetened beverages such as regular soda, fruit drinks and sports drinks.

Legumes, which encompasses beans, chickpeas, lentils, peas and soybeans have been shown to successfully reduce coronary heart disease and improve blood glucose, LDL-C, systolic blood pressure and weight. “Legumes are affordable and a rich source of protein,” Freeman said. “We should be incorporating more beans and bean-dishes like hummus into our diets to promote heart health.”

The review also covered the following nutritional topics: coffee – overall the habitual consumption of coffee is associated with lower risks of all-cause and cardiovascular mortality, and there is no association between coffee and hypertension development; tea – both black and green tea consumption without added sugars, sweeteners, or milks and creams appear to be safe and even associated with improved cardiovascular health and blood lipids; and alcohol – while the relationship between alcohol consumption and cardiovascular disease is complicated, low-to-moderate intake is associated with reduced risk of total cardiovascular disease. However, due to risks of falls, certain cancers and liver disease, the researchers don’t recommend that individuals consume alcohol for cardiovascular benefit.

Additionally, the following topics were reviewed: energy drinks; mushrooms; fermented foods; omega-3 fatty acids; and vitamin B12.

Current evidence supports consumption of plant-based proteins, legumes, OM3s, mushrooms, coffee and tea without added sugars, low-to-moderate amounts of alcohol and fermented foods. The verdict on dairy as part of a heart-healthy diet is still out, and if consumed, full-fat dairy should be avoided.

“There is no perfect, one size fits all dietary pattern for preventing heart disease,” Freeman said. “But, most of the evidence continues to reinforce that a predominantly plant-based diet lower in fat, added sugars, added salt, processed foods, and with limited if any animal products seem to be where the data is pointing us. It is important for clinicians to stay on top of rising food trends and current scientific evidence to provide meaningful and accurate nutritional advice for patients.”

Abstract
The potential cardiovascular (CV) benefits of many trending foods and dietary patterns are still incompletely understood, and scientific inquiry continues to evolve. In the meantime, however, a number of controversial dietary patterns, foods, and nutrients have received significant media attention and are mired by “hype.” This second review addresses some of the more recent popular foods and dietary patterns that are recommended for CV health to provide clinicians with current information for patient discussions in the clinical setting. Specifically, this paper delves into dairy products, added sugars, legumes, coffee, tea, alcoholic beverages, energy drinks, mushrooms, fermented foods, seaweed, plant and marine-derived omega-3-fatty acids, and vitamin B12.

Authors
Andrew M Freeman, Pamela B Morris, Karen Aspry, Neil F Gordon, Neal D Barnard, Caldwell B Esselstyn, Emilio Ros, Stephen Devries, James O’Keefe, Michael Miller, Dean Ornish, Kim A Williams, Travis Batts, Robert J Ostfeld, Sheldon Litwin, Monica Aggarwal, Andrea Werner, Kathleen Allen, Beth White, Penny Kris-Etherton

American College of Cardiology material
Journal of the American College of Cardiology abstract
Journal of the American College of Cardiology 2017 review abstract


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