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Healthy Diet Guidance

Thank you for engaging me in assessing your overall cardiovascular status, including dietary issues. Maintaining a healthy diet is key to cardiovascular health. There is a confusing range of available diets which may have purposes or primary goals that are not always focused on cardiovascular health over the long term (e.g. rapid weight loss diets). A convenient summary of many of them, their pros and cons, and written for non-professionals is available at https://health.usnews.com/best-diet/best-diets-overall. (1) Diets that promote cardiovascular health have many components that are similar. These have been summarized by professionals in several key publications (2-12) and the basic themes are described below. The main goal is to adapt these elements in a fashion that fits within your sociocultural environment and that is sustainable over the long-term. This will ensure that the quality of your diet is excellent. The quantity that is appropriate will be determined largely by your overall level of activity and will be reflected by your weight, waist circumference and body mass index which should be discussed with your health care provider and monitored, among other factors, so that a comprehensive approach to healthy eating and healthy living can be achieved.

Keys for a healthy diet:

  • Eat 5 or more servings of fruits and vegetables daily. Choose a variety of colours and types of fruits and vegetables.
  • Eat 3 or more servings of legumes (dried beans, peas and lentils) each week.
  • Eat more whole grain products and high fibre starches when selecting carbohydrates.
  • Eat 2 servings of low fat milk, milk products and alternatives daily. Choose skim, 1%, 2% milk, lower fat cheese (20% milk fat or less) and low fat fermented dairy foods such as kefir and yogurt (0%, 1%, 2%).
  • Eat 3 or more servings of fish or seafood each week (i.e. almost every other day).
  • Choose lean proteins such as eggs, skinless chicken or skinless turkey over red meat and processed meat. Aim for no more than 2 servings of red meat and no more than 1 serving of processed meat each week.
  • Use olive oil as your main source of fat to cook and add flavor to food.
  • Replace snacks such as chips and crackers with unsalted nuts and seeds. Aim for 3 or more servings of nuts per week.
  • For those who use alcohol, drink wine in moderation, about one glass per day for women and two glasses per day for men. It is not recommended to add alcohol to the diet of those who do not normally use alcohol in the first place.
  • Don’t skip breakfast.
  • Choose home-cooked meals rather than restaurant (sit-down, fast food, take-out) meals.
  • Limit the use of butter and margarine. Choose plant-based alternatives instead.
  • Limit the intake of sugary drinks such as sodas and juices/punch and other sweetened beverages.
  • Limit the intake of sugary snacks such as cookies, dessert, pastries, and candies.
  • Limit the intake of fried foods.


  1. U.S. News. Best Diets Overall. https://health.usnews.com/best-diet/best-diets-overall U.S. News, 2020.
  2. Health Canada. https://food-guide.canada.ca/static/assets/pdf/CDG-EN-2018.pdf. Health Canada, 2019.
  3. Wharton S, Lau DCW, Vallis M et al. Obesity in adults: a clinical practice guideline. CMAJ 2020;192:E875-E891.
  4. Vadiveloo M, Lichtenstein AH, Anderson C et al. Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2020;13:e000094.
  5. Powell HS, Greenberg DL. Screening for unhealthy diet and exercise habits: The electronic health record and a healthier population. Preventive medicine reports 2019;14:100816.
  6. Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med 2011;40:67-71.
  7. Kahan S, Manson JE. Nutrition Counseling in Clinical Practice: How Clinicians Can Do Better. JAMA 2017;318:1101-1102.
  8. Johnston CS, Bliss C, Knurick JR, Scholtz C. Rapid Eating Assessment for Participants [shortened version] scores are associated with Healthy Eating Index-2010 scores and other indices of diet quality in healthy adult omnivores and vegetarians. Nutr J 2018;17:89.
  9. Segal-Isaacson CJ, Wylie-Rosett J, Gans KM. Validation of a short dietary assessment questionnaire: the Rapid Eating and Activity Assessment for Participants short version (REAP-S). Diabetes Educ 2004;30:774, 776, 778 passim.
  10. Rasmussen E, Fosnacht Morgan AM, Munson R et al. Use of an Electronic Medical Record to Track Adherence to the Mediterranean Diet in a US Neurology Clinical Practice. Mayo Clinic proceedings Innovations, quality & outcomes 2018;2:49-59.
  11. Schröder H, Fitó M, Estruch R et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 2011;141:1140-5.
  12. Estruch R, Ros E, Salas-Salvado J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med 2018;378:e34.