I consider my Pan-Asian Modified Mediterranean (PAMM) diet to be the best heart healthy diet. It’s a combination of the heart healthy diet eaten by the people on the Greek island of Crete (also known as the Mediterranean diet) and a diet common among people living on the Asian side of the Pacific Rim. I’ve been recommending the PAMM diet since the mid-1990s when the results of the Lyon Heart Diet Study were published.
In the Lyon trial, 605 heart attack survivors were assigned to eat either a Mediterranean-style diet or a diet recommended by the American Heart Association (AHA). Four years later, participants following the Mediterranean-style heart healthy diet plan were 50 to 70 percent less likely to have had repeat heart attacks. Best of all, there had been no sudden deaths in this group.
Even more promising, a separate analysis of the study found that deaths from all causes were also significantly lower among those following the Mediterranean diet. When researchers looked at cancer development in the third and fourth years of the study, they found similar advantages to the Mediterranean-style heart healthy diet plan.
So, what was it about the Mediterranean diet that made it so superior for heart health? The key appears to be essential fatty acids (EFAs).
The Best Diet for Heart Health Includes Essential Fatty Acids
EFAs are critical for heart health, and a study of EFAs published in 1995 supports this assumption. People who ate one meal of fatty fish per week—such as salmon, anchovy, and mackerel—experienced a 50 percent reduction in sudden cardiac death!
In this context, the advantage of the Mediterranean heart healthy diet plan is clear. It, along with the diet favored along the Pacific Rim, are both rich in omega-3 fatty acids. Even more important, both diets include two particularly beneficial EFAs, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The typical Western diet, by contrast, is rife with refined carbohydrates and animal proteins and includes few, if any, inflammation-reducing omega-3s. But essential fatty acids are just the “tip of the iceberg” when it comes to the heart health benefits of the PAMM diet.
What Should You Eat on the Pan-Asian Modified Mediterranean Diet?
When eating for heart health, you want to avoid foods that contain sugar, refined white flour, partially hydrogenated oils, processed fruit juices, and omega-6 oils such as corn, safflower, soy, and canola. Plus, you want to limit starchy vegetables such as corn, peas, and carrots.
Overall, you want to eat 40 to 45 percent slow-burning, low-glycemic index carbohydrates; 30 to 35 percent healthy fats; and 20 to 25 percent protein. I also urge you to eat organic as much as possible. Here are my guidelines for following the PAMM diet.
Vegetables in a Heart Healthy Diet Plan
Vegetables make it easy to prepare nutritious, delicious, and inexpensive meals that promote optimal heart health—which is why they are of utmost importance to my PAMM plan. There are many vegetables out there to choose from, and they are all packed full of nutrients and fiber to help you cut your risk factors for heart disease. I suggest you use vegetables liberally to make great snacks, sandwiches, and sides.
How much should you eat? For a heart healthy diet plan, aim for two to three servings of vegetables daily. One serving of organic vegetables is equal to:
- ½ cup chopped, nonleafy vegetables (raw or cooked), such as cauliflower, Brussels sprouts, broccoli, or cucumber
- ¾ cup fresh vegetable juice
- 1 cup leafy greens (raw), such as spinach, kale, or Swiss chard
Fill Up on Fruit as Part of a Heart Healthy Diet
Mediterranean and Pan Asian peoples integrate fresh fruit into their heart healthy diet plan with great results—and I believe anyone seeking optimum heart health should do the same. Specifically, fruits contain lots of water and fiber to fill you up on relatively few calories. Fruits also contain antioxidants, vitamins, and minerals (not to mention flavor) that promote a healthy heart and a healthy body. So, fill up the fruit bowl!
How much should you eat? I recommend that you aim for one to two servings of fruit daily, choosing organic as often as possible. One serving of fruit is equal to:
- ¼ melon
- ½ cup berries or chopped, fresh fruit
- ½ avocado
- 1 medium piece, such as a peach or an apple
- 2 chopped figs
Healthy Fats for a Healthy Heart
For optimal heart health, my PAMM diet emphasizes a generous quantity of high-quality fats—as much as 35 percent of your daily calories—which can help slash your risk of developing heart disease. One of my favorite sources of heart healthy fat is olive oil, which I often call the “secret sauce” of the Mediterranean diet. That’s because olive oil contains a powerful combination of healthy monounsaturated fats and special antioxidants known as polyphenols, both of which help block the oxidation of LDL cholesterol. Olive oil also appears to help reduce inflammation, which is the real culprit behind heart disease.
In addition to olive oil, wholesome fats you should eat in a heart healthy diet include fatty fish, nuts and nut butters, flaxseed, soy, and avocados.
How much should you eat? I recommend you aim for three to five servings of healthy fats and oils daily, emphasizing omega-3 oils and minimizing omega-6 oils (such as corn, safflower, canola, and vegetable oils) as much as possible. One serving of fat or oil is equal to:
- 1 tablespoon extra-virgin olive oil
- 1 tablespoon ground flaxseeds or chia seeds
- 1 ½ tablespoons almond (no sugar added), tahini, or other nut butter
- 2 ounces walnuts, almonds, or macadamia nuts
- 2 ½ ounces avocado
Whole Grains and Heart Health
Whole grains, legumes, nuts, soy, and seeds are also an important part of the PAMM diet, providing complex carbohydrates, fiber, protein, vitamins, and minerals. Complex carbohydrates are “slow burners”—meaning they convert to glucose slowly, support stable blood sugar levels, and aren’t converted to fat as easily as refined carbohydrates. And seeds, nuts, and beans contain important nutrients called phytosterols, which can help decrease your risk of heart disease.
How much should you eat? I recommend that you aim for one to two servings of whole grains three to four times a week. One serving is equal to:
- ¼ to ½ cup steel cut oatmeal
- ¼ to ½ cup short grain brown rice
- ½ cup cold whole-grain cereal like amaranth, quinoa, and barley
- 1 slice multi-grain bread such as Ezekiel
Also, aim for one to two servings of legumes daily. One serving is equal to:
- ½ cup cooked beans, chickpeas, or lentils
In terms of soy, aim for two servings of soy weekly in a heart healthy diet plan. One serving is equal to:
- ½ cup tofu or tempeh
- 1 cup soy milk
Finally, try for two to three servings of nuts and seeds daily. One serving is equal to:
- 8 walnut halves or 12 almonds
- 1 tablespoon ground flaxseeds
- 2 teaspoons tahini (sesame paste), peanut butter, or other nut butter (choose varieties made from 100 percent nuts or seeds with no added oils or sugars)
The Heart Health Benefits of Fish & Eggs
Fish and eggs are important foods for heart health. Both are rich in protein and EFAs, which are key to decreasing your risk of heart disease.
When opting for fish, it’s important to note that large predatory fish contain some of the highest amounts of mercury, so I’m cautious about swordfish and tuna. I also recommend avoiding farm-raised and freshwater fish because they are subject to pesticide and insecticide runoff. Ultimately, wild-caught, migratory, cold-water fatty fish, such as salmon, scrod, cod, and Atlantic halibut are your safest bets. The right kind of fish have wonderful heart health-boosting benefits, which is why I recommend choosing fish over meat and poultry as often as possible in a heart healthy diet plan.
Eggs are also a good source of protein and supply essential nutrients such as magnesium and sulfur, plus omega-3 essential fatty acids—again key for a healthy heart. Look for organic eggs with animal welfare labels indicating cage-free, pasture-raised, or the like.
How much should you eat? I recommend eating two or three servings of wild (not farm-raised) fish per week, keeping in mind that one serving of fish or seafood is equal to four ounces of fish, and up to six eggs per week.
Heart Healthy Meats and Poultry
Pan Asian and Mediterranean people are not vegetarians, yet they don’t overindulge in red meat or poultry in a heart healthy diet plan—and that helps lower their risk of heart disease. Red meat, in particular, is high in environmental toxins, which is linked to inflammation in the arteries—a key factor in heart disease. Consumption of large amounts of meat is also associated with a blood factor called homocysteine. Homocysteine is a byproduct of protein breakdown and is also associated with arterial inflammation and, consequently, heart disease.
That said, it’s easy to see how cutting down on the amount of meat you eat, as well as changing the type of meat you eat, can have a significant impact on your cardiovascular system.
How much should you eat? I recommend that you aim for two to three servings per week of free-range poultry and one to two servings per week of free-range beef, lamb, or buffalo for a heart healthy diet plan. Keep in mind that one serving of poultry or meat is equal to 4 ounces of skinless chicken, lamb, or extra-lean meat (about the size of a deck of cards).
Is Milk Good for the Heart?
It can be, with caveats. Dairy products can be confusing when you’re eating for heart health. On one hand, nonorganic dairy foods appear to be detrimental to a heart healthy diet plan because of their high levels of hormones. But on the other hand, they contain health-promoting calcium, protein, and vitamins B12, K2, and D, which all support a healthy heart.
The people of the Mediterranean have not cut dairy out of their lives and still achieve optimum heart health. With that in mind, dairy foods do have a place in the PAMM diet that I recommend for a healthy heart.
How much should you eat? I recommend that you aim for up to two servings of dairy daily and only organic products in a heart healthy diet plan. One serving of dairy is equal to:
- 1 ounce feta or mozzarella cheese
- 1½ ounces hard cheese (a good source of vitamin K2)
- Up to 2 to 3 ounces milk or half and half for coffee or tea
- 1 tablespoon grated Parmesan, Romano, or Pecorino cheese
- ½ cup yogurt or cottage cheese
- ½ cup ricotta cheese
NOTE: All of the serving guidelines above are based on a 1,800 to 2,000 calories-per-day eating plan. If your goal is weight reduction, consume smaller portions to lower your caloric intake.