We’ve long been advised to minimize fat and cholesterol for heart health. But research shows that the relationship between diet and cardiovascular health is more complex. While trans fats are demonstrably harmful, several large-scale studies have challenged low-fat orthodoxy.
Omega-3 fatty acids from fatty fish, flaxseeds, walnuts, and other sources have been consistently linked to reduced inflammation and better heart health. A landmark 2013 study published in The New England Journal of Medicine found that participants who followed a Mediterranean diet, which features plenty of extra-virgin olive oil and nuts, had fewer cardiovascular events compared with those on a low-fat diet.
Similarly, a seven-year randomized controlled trial published in The Lancet in 2022 followed 1,002 patients with established coronary heart disease. Participants ate either a Mediterranean diet rich in monounsaturated fats or a low-fat diet higher in carbohydrates. The group on the Mediterranean diet experienced a 26 percent lower risk of heart attack and stroke compared with those on the low-fat protocol.
Multiple meta-analyses, too, have shown that total saturated-fat consumption is not reliably associated with heart disease risk. What’s more, replacing fats with refined carbohydrates may increase that risk because low-fat, high-carb diets tend to elevate blood-sugar levels.
“There is some research that suggests that saturated fat can raise your LDL cholesterol, but that data shows that it’s probably more of an increase in those big, less-toxic LDL than the more dangerous smaller ones,” says Bhojraj. (For more on LDL, see “Understanding LDL Cholesterol.”)
What Your Heart Needs
Heart disease remains the leading cause of death in the United States. Some practitioners are now adopting an integrative cardiometabolic approach that involves new dietary and lifestyle measures to boost heart health. For more, see “8 Ways to Support Heart Health,” from which this article was excerpted.
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