Can Diet Support Heart Health or Even Reverse Heart Disease?

Imagine the hope that comes with hearing that heart disease might not only be slowed or improved to some extent but possibly ‘reversed’ through diet. As a nutritionist grounded in evidence-based practice, I understand why this idea captures people’s attention.

This idea becomes even more desirable when you look at the facts, such as that about 1 in 20 adults aged 20 and older have coronary artery disease (CAD) or that in the United States, someone has a heart attack every 40 seconds.

However, the term ‘reversal’ is often used too inconsiderately, creating unrealistic expectations for people who already suffer from heart disease. In a real-world setting, while completely reversing heart disease may not be an option, the goal is to reduce heart disease risk or slow the disease progression.

In this article, I will examine the diets most associated with the positive impact on heart health support and how these approaches can realistically fit into long-term management.

What is heart disease?

Cardiovascular disease is a broad term that refers to quite a few heart conditions, with the most common being coronary artery disease (CAD) and cerebrovascular disease (CVD).

Coronary artery disease (CAD), also known as coronary heart disease (CHD), occurs when there is reduced blood flow to the heart muscle, which can lead to a heart attack or even heart failure.

Cerebrovascular disease (CVD), on the other hand, is a condition that usually leads to stroke or transient ischemic attack (TIA, mini-stroke), which is caused by blocked or reduced blood flow to the brain.

There are some factors known to increase the risk of heart disease. One of the major risk factors is high blood pressure for many heart-related conditions. Other factors, such as elevated or ‘unhealthy’ cholesterol levels, diabetes, and obesity, may contribute to cardiovascular disease progression.

Certain behaviors and lifestyle factors may also impact the progression and increase the risk of cardiovascular disease. Drinking alcohol excessively, not being physically active, and smoking can all contribute to high blood pressure and cardiac health issues over time.

Apart from these lifestyle factors, dietary patterns that are high in saturated fats, trans fats, and sodium long term are associated with an increased risk of heart disease.

How can dietary changes positively impact heart health?

My profession and experiences in my close surroundings made me realize that balanced and healthy eating habits from an early age up to late life stages are essential for supporting heart health. At this point, it would be difficult to even count the number of instances where simple heart-healthy dietary adjustments made a meaningful impact on the overall well-being of my family, friends, and clients.

These lived experiences align with a growing body of scientific literature exploring how dietary patterns may influence heart health across the lifespan. According to the American Heart Association (AHA), a primarily plant-based diet that is calorically adequate for the individual case, rich in fiber, and a variety of essential micronutrients is necessary for blood pressure management and heart health support.

A balanced, heart-healthy diet that emphasizes whole foods, replaces saturated fats with unsaturated fats, and limits sodium, trans fats, and added sugar intake may help lower low-density lipoprotein (LDL) cholesterol levels and contribute to proper vascular function.

These dietary principles may also help address risk factors associated with heart disease, such as blood sugar imbalances and excessive body weight.

Key dietary approaches for heart health management and risk reduction

Some scientific articles suggest that certain dietary patterns, such as Mediterranean, plant-based, and DASH diets, align well with the AHA recommendations for supporting cardiac health.

While it’s unlikely that these dietary patterns can ‘reverse’ heart disease, they may help lower blood pressure and blood lipid levels and positively impact other health-related parameters.

The Mediterranean diet

The Mediterranean diet encourages a higher daily intake of fruits and vegetables, whole grains, nuts, and seeds. At the same time, this diet recommends limiting or avoiding highly processed foods and red meat.

One meta-analysis included 11 observational studies to see whether the Mediterranean diet could help lower the risk of cardiovascular diseases, including coronary heart disease. The authors noted that people who followed this dietary pattern the closest had about a 24% lower risk of developing heart issues than those who followed these dietary principles the least.

Another meta-analysis involving 35 randomized controlled trials assessed whether the Mediterranean diet impacts blood pressure. The authors noted that these dietary principles may make small but meaningful changes in blood pressure levels over time.

Key recommendations and practical tips

If you are planning to implement some dietary practices of the Mediterranean diet:

• Choose minimally processed foods. Limiting processed foods like those from refined grains will help minimize added sugar, sodium, and saturated fat intake while adding more fruits and vegetables, whole grains, and legumes will provide essential micronutrients to support heart health.
• Limit processed meat. Minimizing hot dogs, deli meats, and bacon in your daily diet, which tend to have higher saturated fat and sodium content, may help you follow the general dietary recommendations to support a healthy heart.
• Use extra virgin olive oil. Olive oil is rich in unsaturated fats, which may contribute to high-density lipoprotein (HDL) cholesterol maintenance in the blood.
• Focus on protein from fish and seafood. Fatty fish provides polyunsaturated fats, especially omega-3 fatty acids.
• Minimize red meat consumption. Red meat in the Mediterranean diet can occasionally be substituted by a moderate intake of lean meats such as chicken or turkey.

To make the Mediterranean diet easier to implement in your everyday life, I recommend swapping white bread for whole wheat bread, eating fatty fish at least two to three times a week, and eating at least half a cup of vegetables with each meal as much as possible.

Whole-food, plant-based diets

A whole-food, plant-based diet includes a higher intake of whole grains and vegetables. It focuses on plant protein sources while avoiding animal-based foods. The most common plant-based dietary patterns include vegetarian and vegan diets.

One meta-analysis with 13 prospective cohort studies aimed to assess how following a plant-based diet is linked to the development of heart-related conditions and the mortality rates from cardiovascular diseases. The researchers discovered that a greater adherence to an overall plant-based diet reduced the risk of cardiovascular mortality and heart disease development by 8–10%.

However, it is important to keep in mind that not all plant-based diets may be equally beneficial. Some vegan or vegetarian patterns may have more refined grains, added sugars, and processed plant-based foods, which may not offer the same potential heart health benefits as those rich in minimally processed plant foods.

Key recommendations and practical tips

Adopting a well-planned plant-based diet requires some preparation. Here are a few recommendations and tips:

• Choose foods naturally low in saturated fats and rich in unsaturated fats, such as those containing liquid plant oils like olive oil, flaxseed oil, or canola oil. These may help support ‘healthy’ blood lipid (fat) levels when used in place of saturated fats from animal sources.
• Eating foods high in plant protein, such as legumes, tofu, lentils, and tempeh, can be an alternative to most animal products and help reduce saturated fat intake.
• Focus on a variety of fruits and vegetables, including frozen vegetables, for convenience, which provide fiber, potassium, and other nutrients to help support blood pressure regulation.
• Aim for low-fat options and make sure to check food labels, as some vegan products may still contain higher levels of saturated fats, sodium, and added sugars.

When adjusting to a plant-based diet, I would recommend including at least one cup of cooked legumes and one to two cups of a variety of vegetables per day as your base. This may help support the intake of adequate plant protein, fiber, and key micronutrients.

The DASH (Dietary Approaches to Stop Hypertension) diet

The DASH diet was first introduced by the National Heart, Lung, and Blood Institute (NHLBI) for potentially helping to reduce blood pressure levels. While this diet does not require any special foods, it provides daily and weekly nutritional goals.

The DASH diet emphasizes vegetables, fruits, whole grains, low-fat and fat-free dairy products, lean meat, nuts, and vegetable oils.

One meta-analysis examined 30 clinical trials to determine whether the DASH diet could help lower blood pressure in all participants, those with and without high blood pressure. The authors discovered that the DASH diet may help lower both systolic and diastolic blood pressure, especially in those with an overall higher daily sodium intake.

Key recommendations and practical tips

• Use sources of unsaturated fats, such as olive oil or other liquid plant oils, instead of tropical oils like coconut or palm oil, which tend to be higher in saturated fats.
• Limit sodium intake from foods by choosing lean protein like poultry instead of highly processed meat products. This diet recommends limiting sodium intake to no more than 1,500–2,300 mg per day.
• Minimize added sugars from sweetened beverages and desserts while including more whole-grain bread, fruits, and vegetables in daily meals.
• Opt for low-fat dairy products instead of full-fat or plant-based dairy alternatives.

From personal practice, lowering sodium intake may be challenging at first, but try choosing ‘no salt added’ or ‘low sodium’ products and seasoning meals with herbs and spices without additional salt. This, alongside choosing whole foods, may help you fit within the daily sodium limits.

General heart-healthy eating guidelines

A closer look at some of these dietary patterns offers valuable insight into what constitutes a general heart-healthy diet. While these diets may differ in a cultural context or specific food choices, they consistently emphasize prioritizing a plant-based diet and eating minimally processed foods.

A common trend across these patterns is reducing processed foods, particularly those high in saturated fat, trans fat, sodium, and added sugars. The heart-healthy diet also focuses on limiting full-fat dairy products, refined carbohydrates, fried foods, tropical oils, and partially hydrogenated fats, often found in packaged snacks or baked goods.

Something to have in mind when planning your daily meals is that, according to AHA dietary guidelines, total fat intake should make up no more than 25–35% of your daily calories, with saturated fat limited to no more than 7% of total energy intake. Additionally, dietary cholesterol should be kept under 300 mg per day. In a 2,000 kcal diet, this would equate to around 56–78 g of total fat and 16 h of saturated fat per day.

The importance of a holistic approach to heart health

Following a nutritious diet plays one of the central roles in supporting a healthy heart and potentially reducing heart disease risk, but it’s only one piece of the puzzle in a much larger picture.

A holistic approach to heart health requires more than following certain dietary practices. It involves:

• Maintaining a healthy body weight by including regular physical activity, which could be anything from walking to exercising in the gym. AHA recommends accumulating around 30 minutes of physical activity on most days of the week.
• Managing stress levels by getting adequate, good-quality sleep and practicing mindfulness techniques.
• Minimizing harmful habits by reducing excessive alcohol intake and avoiding smoking.

While lifestyle and dietary habits form the foundation of heart health, they may not be enough in some cases, especially for people already facing heart issues.

In these cases, professional medical help and doctor-prescribed medications become essential tools in managing heart conditions. Routine check-ups, bloodwork, and medications that help control critical risk factors such as high blood pressure or cholesterol levels, alongside lifestyle interventions, form an integrative approach that offers the strongest support for long-term cardiovascular well-being.

Final thoughts

While the idea of being able to ‘reverse’ heart disease is compelling, it's important to approach this concept with realistic expectations. Diet alone is unlikely to fully ‘reverse’ heart health challenges, but adopting healthy eating patterns can still play a role in supporting a healthy heart. When combined with a holistic approach and medical care, these habits may offer a sustainable way to work towards a healthy heart at any stage of life.