Keto, Paleo Diets Rank Low for Heart Health, Report Says

April 28, 2023 – The paleo and keto diets have a lot of followers but aren’t necessarily good for heart health, the American Heart Association said in a ranking of popular diets.

The top-10 listing was released Thursday in the journal Circulationand is the first time the association has ranked popular diets. In a news release, it said it hoped the list would help the public and medical professionals wade through misinformation about dieting that has surged on social media.

The keto and paleo diets may help people lose weight in the short term, but both “are high in fat without limiting saturated fat. Consuming high levels of saturated fat and low levels of fiber are both linked to the development of cardiovascular disease,” the Heart Association said.

“They are highly restrictive and difficult for most people to stick with long term,” said Christopher D. Gardner, PhD, chair of the writing committee for the report and a professor of medicine at Stanford University. “While there will likely be short-term benefits and substantial weight loss, it isn’t sustainable. A diet that’s effective at helping an individual maintain weight loss goals, from a practical perspective, needs to be sustainable.”

The list was based on how closely the diets line up to the Heart Association's guidelines for heart-healthy eating.

The DASH (Dietary Approaches to Stop Hypertension) racked up 100 points and was ranked the best diet for heart health, based on those guidelines. Also ranking in the association's top tier were the pescatarian diet (92 points), the Mediterranean diet (89 points), and the vegetarian diet (86 points). The news release noted that the Mediterranean diet lost a few points because it doesn’t address added salt and allows moderate alcohol consumption.

Vegan and low-fat diets were placed in the Heart Association's second tier, with very low-fat and low-carb diets in the third tier. In the fourth and bottom tier were the paleo and keto/very low-carb diets, including the Atkins diet.

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