In response to increased controversy over what makes up a healthy diet, a recent JACC: Advances State-of-the-Art Review dives into the evidence both for and against several controversial foods and provides recommendations based on the available literature on cardiovascular health and outcomes.

Michael Miller, MD, FACC, et al., note that the goal of this review is "to provide evidence in support of or to refute topics that have come under scrutiny, mostly by nonscientific outlets, despite the lack of justifiable clinical data."

The review explores the current evidence surrounding beef tallow, ultraprocessed foods, full-fat dairy, seed oils, medium chain triglyceride (MCT) oils, seafood and alternative sweeteners. The authors then group these dietary components into three categories: evidence of harm, lack of evidence for harm or benefit, or evidence of benefit.

Beef tallow, ultraprocessed foods and artificial sweeteners and sugar alcohols fall under the evidence of harm category, with current guidance suggesting individuals limit or avoid consumption of these foods due to adverse cardiovascular effects. On the other hand, recommended foods include seed oils and seafood due to their association with improved cardiovascular outcomes.

The authors note similar health effects for whole fat vs. low-fat dairy, stating that "there is insufficient evidence to recommend full-fat dairy over low-fat dairy, or vice versa, as part of an overall healthy dietary pattern to minimize cardiometabolic burden and related mortality."

Additional areas of uncertainty include "health effects of MCT oils and naturally occurring sweeteners, where additional research is needed."