Can the Paleo Diet Help Prevent Heart Disease?

When you think of ways to fight heart disease, adopting the so-called caveman diet might not immediately jump to mind as a tried-and-true option. But given that heart disease is the No. 1 killer in the United States — almost 700,000 Americans die from it every year — the search for solutions to improve heart health and prevent future heart events is understandably a concern for many. (1)

Over the past decade, researchers have explored whether the paleo diet — a restrictive approach based on the eating habits of our hunter-gatherer ancestors — can benefit people’s heart health. So far, it’s a mixed bag: Some findings are encouraging, while some members of the medical community remain skeptical about this diet plan.

“Overall, the effect of the paleo diet on heart disease risk really depends on how you choose to follow it,” says Kelly Kennedy, RD, a nutritionist for Everyday Health. Unlike other plans, the paleo diet doesn’t recommend portion sizes by food group, nor does it incorporate exercise — which is known to be good for overall health and preventing heart disease. (3)

But following a paleo diet food list does require a focus on certain foods and the elimination of others. For instance, on the paleo diet, you’re encouraged to eat lots of fruits, veggies, fats, and proteins, while processed foods like chips, cookies and candy, as well as legumes (beans), most dairy, and grains are off-limits.

This approach has pros and cons, Kennedy says. “My main concern overall would be the fact that major sources of fiber, vitamins, and minerals are being eliminated by not including whole grains, soy, and dairy,” Kennedy explains. “However, if someone compensates and follows the paleo diet by having lots of fruits, vegetables, and lean protein sources such as skinless poultry and fish, they should be able to mostly compensate for these losses.”

There certainly has been a disconnect between some paleo enthusiasts and the medical community. For instance, while paleo recommends the elimination of whole grains, the American Heart Association states that whole grains can actually lower cholesterol and the risk of stroke, type 2 diabetes, and obesity. (4)

That being said, there are some encouraging signs out there. While some people may try the diet because they want to lose weight, when followed correctly, some studies suggest it could benefit your ticker.

In fact, a systematic review from 2019 that looked at a wide range of relevant studies cited a number of potential heart health benefits, which were linked to the diet’s cardio-friendly effects on areas like weight loss, body fat, and blood pressure. But the study noted that more research was needed to definitively establish a paleo-cardio connection. (5)

One major risk factor for heart disease is type 2 diabetes. People who have type 2 diabetes can often develop hypertension, high cholesterol, and obesity — all major contributors to heart disease. (6)

Some research points to the potential of the paleo diet to help people with type 2 diabetes, but the overall body of evidence is mixed. A meta-analysis from 2020 of relevant research concluded that the paleo diet did not significantly affect diabetes or metabolic system any more than other diets perceived as “healthy.” The researchers suggested that more studies with long-term follow-ups were needed to establish the true impact of the paleo diet on diabetes. (7)

Kennedy urges people who are considering adopting paleo to realize that this diet allows for some foods that many experts do not consider heart healthy. She says that red meat and some of the saturated-fat-laden foods — such as ghee, coconut oil, and butter — may pose heart-health risks. “If someone eats those foods on a regular basis, their heart health will certainly suffer,” she warns.

Red meat is one of the elements of paleo that causes experts, including Kennedy, to question whether it’s good for heart health. Indeed, there’s a growing body of literature that suggests eating too much red meat can harm the organ. (8) That doesn’t mean you can’t eat any red meat — just enjoy it in moderation. The American Heart Association (AHA) recommends choosing lean cuts when possible and opting for poultry and fish without skin — and prepared without saturated and trans fats — to protect your heart. If you need to lower your cholesterol, aim to reduce your saturated fat intake to a max of 5 to 6 percent of your total calories, or 13 g if you’re consuming 2,000 calories per day. (9)

Kennedy also says it’s important to remember that a heart-healthy diet is one that is low in sodium, and that while paleo may be naturally lower in sodium with the elimination of processed foods, paleo diets rarely come with “any recommended sodium restrictions.” The most recent U.S. Department of Agriculture’s Dietary Guidelines for Americans recommend that you consume no more than 2,300 milligrams (mg) of sodium per day. (10)

“In addition, when cutting out foods, such as legumes and whole grains, which are rich sources of fiber and some of the best cholesterol-lowering foods, it’s not a good combination,” she adds. Not only can removing whole food groups lead to nutrient deficiencies down the line, but if you’re managing a condition such as type 2 diabetes — which can be better controlled with fiber — or have another underlying health issue, the paleo diet may have more cons than pros.

Be sure to talk to your doctor before trying the paleo diet, especially if you have an underlying health condition.

Kennedy says that, as with any diet, paleo comes with both negatives and positives for heart health. It’s not a fail-proof, fully scientifically vetted cure-all, but it does have potential for yielding some heart-healthy results.

She adds that removing packaged and processed foods, refined grains, added sugar and artificial sweeteners, limiting alcohol, and including whole foods — especially fruits and veggies — are all major positives.

On the negative side, she says eliminating whole grains, dairy, legumes including peanuts and soy, and allowing red meat (like bacon), butter, ghee, and coconut oil as “healthy fats” could eventually lead to heart health problems.

As always, if you are looking to improve your heart health, whether through exercise or dietary changes, it’s crucial to ask the advice of your doctor and find out what works best for you.