Current clinical recommendations support the use of the DASH and Mediterranean diets for the treatment of Cardiovascular Disease (CVD). The Planetary Health Diet promotes a very similar eating pattern to these diets. By consuming a dietary pattern high in fruits and vegetables there will be a natural increase in potassium while decreasing sodium. Most of the sodium in the standard American diet comes from ultra-processed foods which are very limited in these diets.

The diet recommendations for cardiovascular disease support a Planetary Health Diet by supporting the transition to decreasing saturated fats and increasing unsaturated fats while remaining at an adequate protein level. Consuming moderate to limited amounts of lean proteins will reduce saturated fat intake. In addition, these dietary patterns promote an increase in legumes, nuts, and seeds which provide protein, fiber, and unsaturated fats and contribute to a resilient food system with positive climate impacts.

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Clinical Recommendations for the management of Cardiovascular Disease:

1. Limit Trans Fats
2. Limit saturated fat to less than 6% of calories
3. Increase Omega 3 intake
4. Increase fiber intake

Reduce Trans Fat:

• Artificial trans fats have proven to be detrimental to cardiovascular health as they lower HDL, and raise LDL and CRP (1,2).
• The industrial use of trans fats has been banned or restricted in 40 countries including the USA, Canada, and the European Union.
• Animal proteins contain naturally occurring trans fat (3). Trans fats are primarily found in ultra-processed foods such as crackers, cookies, and chips.

Planetary Health Diet Considerations:

The planetary health diet promotes plant-based foods and limits consumption of ultra-processed foods and does not contain a significant amount of trans fats. Ultra-processed and packaged foods have a significant impact on the environment (5). However, it is a privilege to access whole foods and the accessibility of food will vary based on socioeconomic status, location, and systemic barriers such as food apartheid. All factors should be assessed to determine if a food will contribute to a just, equitable, and resilient climate future. Additionally, participating in advocacy to reduce barriers to whole food should be prioritized.

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Reduce Saturated Fat:

• Saturated Fats can increase LDL which leads to plaque build-up and increases the risk of cardiovascular disease.
• The general recommendation for Americans is to limit saturated fats to less than 10% of calories (4).
• The American heart association recommends less than 6% of calories from saturated fats when CVD is present (6).
• The primary sources of saturated fats come from animal sources as well as tropical oils.
• The diet should consist of 20-30% of calories from unsaturated fat sources including fatty fish, plant oils, nuts, seeds, avocados, and olives.

Foods High in Saturated Fats:

• Whole fat dairy
• Fatty meats
• Coconut oil, palm oil
• Deep fried foods
• Shortening
• Non-dairy creamers

Foods Low in Saturated Fats:

• Vegetables
• Fruit
• Beans and lentils
• Grains
• Avocado and olive oils
• Nuts and seeds

Foods high in unsaturated fats:

• Olive and avocado oil
• Avocados
• Nuts and seeds
• Olives
• Fatty fish

Notes: As saturated fat consumption decreases, unsaturated fat should increase. Low-fat diets are not effective at reducing the risk of cardiovascular disease (7).

Planetary Health Diet Considerations:

The planetary health diet promotes unsaturated fats from nuts and seeds and plant oils while having moderate dairy and limited animal proteins reducing saturated fat intake.

Foods that are naturally higher in saturated fats typically have an increased environmental impact. Animal proteins require increased resource use, like water and land, for production. Palm and Coconut oils are often produced in unsustainable ways that contribute to deforestation, monocropping, and utilize large amounts of land. Additionally, the production of palm oil may rely on the exploitation of laborers.

As with all foods, the sustainable production of food is nuanced and personal ethics should be considered as well as advocating for a more just and equitable food system.

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Increase Omega 3s:

• Omega 3s are a type of unsaturated fat that has anti-inflammatory properties. They are beneficial in reducing total triglycerides, a risk factor for CVD.
• Omega 3s are most effective when in an optimum balance with Omega 6’s, a 1:4 ratio.
• Omega 6s should be reduced to optimize omega-3 benefits (8).

Foods High In Omega-3s:

• Mackerel
• Salmon
• Anchovies
• Flax Seeds
• Chia seeds
• Algae

Foods High in ALA:

• Chia seeds
• Flax seeds
• Walnuts

Foods High In Omega-6s:

• Corn Oil
• Soybean Oil

Notes:

• Corn and soybean oil are very common in the food system, they make the base of many packaged salad dressings, sauces, non-dairy creamers, and are often the oils used to fry foods.
• ALA is the source of omega 3’s found in plants and has a very low conversion rate.
• Vegan sources of DHA and EPA can be found in algae supplements (9).

Planetary Health Diet Considerations:

The planetary health diet contains a moderate amount of animal protein sources which would allow for an intake of fatty fish consistent with the recommendations for omega 3s. In addition, the planetary health diet promotes nuts and seeds which provide ALA sources of omega 3’s.

Fishing can have negative environmental impacts from ocean pollution to overfishing and negatively impacting the biodiversity of sea life. It is important to be aware of the nuance surrounding fishing and the types of fishing that contribute to a more just and equitable food system. Despite the fishing industry has a considerable environmental impact, fish and seafood are important to many cultural cuisines and accessible seafood like packaged tuna can be a quality protein and omega-3 source for those on a limited budget.

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Increase Fiber:

• Fiber is found in complex carbohydrate sources such as fruits, vegetables, and whole grains.
• Fiber helps slow digestion and binds to excess cholesterol preventing it from being reabsorbed.
• Fiber supplements have been shown to reduce cholesterol levels but whole food sources should be promoted as they have more to offer including potassium, photochemical, and antioxidants (10).

Insoluble Fiber: supports digestive regularity

Soluble Fiber: shown to lower blood cholesterol, blood sugar regulation

Fiber recommendations:

• RDA: 38 g/day for men, 25 g/day for women

High Fiber Foods:

• Whole grains
• Beans and lentils
• Apples
• Berries
• Leafy greens

Notes: Consider gradually increasing to avoid negative GI effects.

Planetary Health Diet Considerations:

Increased consumption of high-fiber foods promotes climate resistance by supporting biodiversity, polycropping, and the production of foods that provide nitrogen to the soil, such as beans. Additionally, the prioritization of high-fiber foods increases the percentage of total energy consumption of whole foods that are derived from plants and reduces the percentage of total energy consumption from animal products that typically have an increased environmental impact (3).  

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References:

1. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/trans-fat
2. Esther Lopez-Garcia, Matthias B. Schulze, James B. Meigs, JoAnn E. Manson, Nader Rifai, Meir J. Stampfer, Walter C. Willett, Frank B. Hu, Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction, The Journal of Nutrition, Volume 135, Issue 3, March 2005, Pages 562–566, https://doi.org/10.1093/jn/135.3.562
3. https://www.who.int/news/item/07-12-2021-countries-with-regulations-protecting-people-from-industrially-produced-trans-fat-tripled-over-the-past-year
4. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
5. Clark M, Springmann M, Rayner M, Scarborough P, Hill J, Tilman D, Macdiarmid JI, Fanzo J, Bandy L, Harrington RA. Estimating the environmental impacts of 57,000 food products. Proc Natl Acad Sci U S A. 2022 Aug 16;119(33):e2120584119. doi: 10.1073/pnas.2120584119. Epub 2022 Aug 8. PMID: 35939701; PMCID: PMC9388151.
6. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats#:~:text=The%20American%20Heart%20Association%20recommends,of%20saturated%20fat%20per%20day.
7. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV; American Heart Association. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2017 Jul 18;136(3):e1-e23. doi: 10.1161/CIR.0000000000000510. Epub 2017 Jun 15. Erratum in: Circulation. 2017 Sep 5;136(10 ):e195. PMID: 28620111.
8. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
9. https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids#:~:text=Studies%20of%20ALA%20metabolism%20in,converted%20to%20DHA%20(7).
10. Reynolds, A.N., Akerman, A., Kumar, S. et al. Dietary fibre in hypertension and cardiovascular disease management: systematic review and meta-analyses. BMC Med 20, 139 (2022). https://doi.org/10.1186/s12916-022-02328-x

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