Dietary Guidelines to Treat and Prevent Atherosclerosis

The Physicians Committee

Dietary Guidelines to Treat and Prevent Atherosclerosis

Atherosclerosis, clinically defined as hardening of the arteries, is an early form of heart disease in which plaque builds up inside the arteries and limits blood flow to major organs, including the heart, brain, and kidneys, and to the pelvis, spine, arms, legs, fingers, and toes. This can cause heart failure, stroke and aneurisms, chronic kidney disease, back pain, erectile dysfunction, and peripheral artery disease.


Plaque Formation and Symptoms

The prefix “athero” originates from Latin roots to signify soft gruel-like deposit.1 Arterial plaque consists of cholesterol, fat deposits, calcium, and excess fluid, which can block off an artery or decrease the rate of blood flow throughout the entire body.  When blood flow is restricted, two things happen: A blood clot forms—further narrowing the arteries—or a heart attack occurs. In the United States, a heart attack takes place every 43 seconds, attributing to 1.5 million heart attacks each year—about half of which result in death.2  

Chest pain, shortness of breath, dizziness, fatigue, or a tingling sensation in the hands, feet, and toes, are all symptoms of reduced blood flow throughout the body, which can be diagnosed through a series of tests, including an electrocardiogram (EKG), stress test, ankle-brachial index test (ABI), blood tests, X-rays, echocardiography, angiography, computed tomography scans, magnetic resonance imaging (MRI), and positron emission tomography (PET).



Pathology and Dietary Risk Factors

Atherosclerosis often starts in childhood, 20 years before a formal diagnosis.3 Vascular physiologist Michael Skilton, Ph.D., with the University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, suspects it starts in utero, based on the effect parents’ dietary choices have on the development of endothelial function, or development of cells that line the arteries.4

Click to enlarge. Photo Credit: Pepine, Am J Cardiol 1998

According to the American Society of Nutrition, 97 percent of adults fall short on recommended dietary fiber intake, a nutrient only found in plants, with adults and teens consuming roughly half of the government’s recommended five servings of fruits and vegetables each day.5-6 Only 13 percent of adults consume 1.5 to 2 cups of fruit, and just 9 percent eat 2 to 3 cups of vegetables each day.7 Our nation’s dietary patterns help illustrate why one-third of adults have elevated cholesterol and high blood pressure,8-9 and why two-thirds struggle with excess weight,10 three leading risk factors for cardiovascular disease.


The good news is that a plant-based dietary intervention is even more effective than today’s leading medications to treat and prevent heart disease, thanks to a high intake of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals and a reduced intake of saturated fats and cholesterol.11-12 About half of Americans, even those who maintain a healthful weight, still have at least one modifiable risk factor, such as high blood pressure or elevated cholesterol, for chronic disease.13 Integrating diet and other lifestyle changes—exercise, maintaining a healthful weight, avoiding tobacco, and limiting alcohol consumption—leaves consumers with only desirable side effects and can prevent around 80 percent of all premature heart disease cases.14

It’s never too late to start: Studies show heart-attack survivors who adopt a high-fiber diet reduce the risk of a recurrence by about 40 percent, compared to survivors who make no dietary changes.15

To fast track your diet for optimal heart health, here are five guidelines to follow:

Dietary Guidelines for Atherosclerosis Prevention

The Dietary Guidelines for Atherosclerosis Prevention will be released at the International Conference on Nutrition and Medicine (ICNM) for Cardiovascular Disease at 2 p.m. EST on Saturday, Aug. 1, 2015.

The dietary guidelines are as follows:

1.    Choose plant-based foods: vegetables, beans, whole grains, and fruit.
2.    Minimize refined grains, added salt, and sweeteners.
3.    Include some nuts and seeds; avoid oils.
4.    Avoid foods containing saturated and trans fats.5.    Have a reliable source of vitamin B12.



1.    Choose plant-based foods: vegetables, beans, whole grains, and fruit.

The average adult at risk for cardiovascular disease who adopts plant-based diet, coupled with weekly nutrition education classes, can expect to lose 10 pounds,16 reduce blood pressure by 7/5 mm Hg,17 lower LDL cholesterol levels by 13 mg/dL,18 improve blood sugar, or A1c, by 1.2 percentage points, and even see gains in productivity, in just five months.19-20 Children who struggle with obesity and follow a plant-based diet show similar results—while also improving insulin resistance, high-sensitivity C-reactive protein, and myeloperoxidase, emerging risk factors for inflammation and heart disease.21

Plant-based vegan diets also provide participants of all ages with the largest net weight loss, an advantage for those—75 percent of men, 67 percent of women, and 31 percent of children—struggling with excess body weight.22-24

By centering meals around vegetables, fruits, whole grains, and legumes, individuals can expect to see a high return on their health investment, as studies show this approach reduces the risk of an early death, certain forms of cancer, and dementia.25-27

2.    Minimize refined grains, added salt, and sweeteners.

In addition to increasing consumption of plant-based foods, which helps boost intake of vitamin A, vitamin D, vitamin E, folate, vitamin C, calcium, magnesium, potassium, and fiber—nutrients under-consumed in the American diet—it’s best to limit or avoid refined grains, added salt, and sweeteners.13    

Refined Grains

Refined grains are starches that have been stripped of nutrients by food processing techniques and include white rice, white flour, and products made from other starches. You’ll find refined grains lurking in the cereal aisle and snack food section at your local grocery store. Opt instead for intact whole grains, which include wheat berries, brown rice, barley, oats, and quinoa, which provide insoluble fiber that helps remove excess cholesterol from your body.


Target sodium levels vary based on age, co-existing health conditions, ethnicity, and gender. Consult with a health care provider to find an ideal target, which may range from 1,500 to 2,300 milligrams each day.28 Ninety percent of the population overconsumes sodium, with an average intake of 3,592 milligrams each day.29 For individuals struggling with hypertension, high amounts of sodium contribute to excess fluid in the body and makes it harder for the heart to maintain optimal blood flow—increasing the risk for cardiovascular problems.

Added Sweeteners

Added sweeteners are added to foods as they are processed and include sugar-sweetened beverages, sodas, candy, grain- and dairy-based desserts, sugary breakfast cereals, and yogurt. A diet rich in these additives increases the risk for cardiovascular disease by 38 to 50 percent, based on daily consumption patterns.30

Swapping added sugars for fruit that’s packed with vitamin C into one’s diet offers protective benefits, reducing the risk of cardiovascular disease by 15 percent and the risk of an early death by 20 percent.31 Try a cup of oranges, strawberries, red pepper sticks, pineapple, cooked broccoli or Brussels sprouts, which provides close to 100 percent of the daily value of vitamin C for men, women, and children.32

3.    Include some nuts and seeds; avoid oils.

Nuts and seeds—particularly almonds, walnuts, pine nuts, Brazil nuts, and flaxseeds—offer heart-healthful benefits, thanks to their nutrient density: They provide fiber, vitamin E, plant sterols, L-arginine, polyunsaturated and monounsaturated fats, and omega-3-fatty acids. These vitamins, nutrients, and minerals team up to lower LDL cholesterol levels, attack plaque formation, and provide flexible support for the arterial walls, reducing the likelihood of blood clots.33-35

Use just a small amount a few times each week since nuts are a high-calorie food. One to 1.5 ounces, the size of your palm, provides roughly 250 calories and is all you’ll need to reap the heart-healthful benefits.36-37 Try crushing a handful of nuts or seeds in your palm and use to top salads, soups, breakfast bowls, or to add to sauces or stews.

With nuts and seeds it’s best to go straight to the source and skip oils, their processed counterparts. When oil is extracted from its original source—sunflower seeds, olives, walnuts, etc.—the fiber is removed and calories start to add up fast, nullifying the health and weight-loss benefits a plant-based diet has to offer.38

4.    Avoid foods containing trans and saturated fats.  

Trans Fats

The Food and Drug Administration is phasing out trans fatty acids, fats that remain solid at room temperature, which you’ll find in margarine, coffee creamers, chicken wings, pastries, crackers, chips, and most packaged and prepared food items. Trans fats manipulate cholesterol, increasing the bad, LDL levels, while decreasing the good, HDL levels. In addition to altering cholesterol ratios, trans fats cause damage to cells that line arterial walls and increase inflammation, a precursor for obesity, heart disease, cancer, and stroke.39

The Nurse’s Health Study, a Harvard review of 166 women who developed coronary artery disease, finds study participants who consumed the most trans fats, an average of 3.6 grams per day (the equivalent of a double quarter-pounder with cheese with a small vanilla milkshake) tripled their risk for an immediate heart attack.40-41 The Harvard School of Public Health estimates we can prevent a quarter of a million heart attacks each year simply by eliminating trans fats from our diets.42

Saturated Fats

Saturated fats, which you’ll find in animal products and oils, pose significant heart-health risks, too: For every 1 percent increase in energy from saturated fat intake, LDL cholesterol concentration increases by about 2 percentage points.43 Similar patterns emerge with dietary cholesterol; for every 100 milligrams consumed, the equivalent of half an egg, total cholesterol increases by about two to 10 points.44 The leading sources of saturated fat in the American diet, which often come prepackaged with dietary cholesterol, are cheese, pizza, dairy- and grain-based desserts, and chicken, followed by processed meats, including sausage, franks, bacon, ribs, burgers, and Mexican mixed dishes.45 Recent statistics show more than 70 percent of children and teens and more than 50 percent of U.S. adults exceed saturated fat recommendations.13 Diets rich in saturated and trans fats cost consumers years from their life, compared to counterparts who opt for healthful plant-based fare.46

5.    Supplement with vitamin B12.

Adults and children over the age of 14 should consume 2.4 mcg of vitamin B12 each day, through supplements or multivitamins without added aluminum, copper, or iron. Women who are pregnant or breastfeeding should consume 2.6 and 2.8 mcg, respectively.47

Resources for Cardiovascular Health

Download heart-healthful educational tools, pasted below, at

Metabolic Risk Factors

In addition to knowing what foods to favor, it’s good to know which metabolic risk factors to assess for optimal cardiovascular health: body mass index, waist circumference, glycemic control, blood pressure, and cholesterol.48-54

Heart-Healthful Biometric Targets

BMI (kg/m2) Waist Circumference (inches) Glycemic Control Blood Pressure (mmHg) Cholesterol (mg/dL)
< 25
≤ 23 for Asian Americans   
Men ≤ 40
Women ≤ 35
A1c <  5.7 %
*Pre-diabetes starts at 5.7%
*Diabetes starts at 6.5%
Fasting blood glucose <  100 mg/dL
< 120/80 mmHg Total Cholesterol <180 to 200  
HDL > 40 (Strive for >60)
Triglycerides <150
Total cholesterol = HDL + LDL + .20 (Triglyceride Level)

 *Target ranges for glycemic control, blood pressure, and cholesterol will vary based on pre-existing health conditions and comorbidities, particularly for diabetes, hypertension, and heart disease. If you are a patient, consult with your health care provider to learn about your target range. Check in with your health care provider every four to six weeks to assess results.




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