The “Southern Diet” May Raise Risk Of Sudden Cardiac Death

Regularly eating a Southern-style diet full of added fats, fried foods, processed meats, eggs, organ meats, and sugar-sweetened beverages may lead to a higher risk of sudden cardiac death, while staying closer to a Mediterranean diet that prioritizes whole foods, whole grains, legumes, fruits, and vegetables, however, can reduce the risk of sudden cardiac death.

“While this study was observational in nature, the results suggest that diet may be a modifiable risk factor for sudden cardiac death, and, therefore, diet is a risk factor that we have some control over,” said lead author James M. Shikany, DrPH, a professor of medicine at the University of Alabama at Birmingham.

“Improving one’s diet – by eating a diet abundant in fruits, vegetables, whole grains and fish such as the Mediterranean diet and low in fried foods, organ meats and processed meats, characteristics of the Southern-style dietary pattern, may decrease one’s risk for sudden cardiac death,” said Shikany.

For this study data from more than 21,000 adults aged 45 or older who participated in the REGARDS national research projects was examined. Participants were enrolled from 2003 to 2007 and asked to complete an in-depth questionnaire focused on their eating habits. They were each contacted every six months to follow up on their diet and cardiovascular health.

All participants were placed into one of five groups based on their eating patterns:

• Those who followed a Southern-style diet.
• Those who followed a “convenience” diet heavy on easy-to-make foods such as pasta and pizza.
• Those who followed a plant/fish-based diet high in fruits and vegetables.
• Those who followed a “sweets” diet heavy on added sugars, chocolate, and sugar-sweetened breakfast foods.
• Those who followed an “alcohol and salad” diet that was heavy on beer, wine, liquor, green leafy vegetables, and other salad toppings.

It was noted that these patterns are not mutually exclusive. “All participants had some level of adherence to each pattern, but usually adhered more to some patterns and less to others,” Shikany explained. “For example, it would not be unusual for an individual who adheres highly to the Southern pattern to also adhere to the plant-based pattern, but to a much lower degree.”

Findings showed that after an average of nearly 10 years of follow-up every 6 months more than 400 sudden cardiac deaths had occurred. Overall participants who primarily followed a Southern-style diet had a 46% higher risk of sudden cardiac death than participants who avoided this diet the most. Also, participants who closely followed a traditional Mediterranean diet had a 26% lower risk of sudden cardiac death than those who followed it the least.

“These findings support the notion that a healthier diet would prevent fatal cardiovascular disease and should encourage all of us to adopt a healthier diet as part of our lifestyles,” added Stephen Juraschek, MD, Ph.D., a member of the American Heart Association’s Nutrition Committee of the Lifestyle and Cardiometabolic Health Council. “To the extent that they can, people should evaluate the number of servings of fruit and vegetables they consume each day and try to increase the number to at least 5-6 servings per day, as recommended by the American Heart Association. Optimal would be 8-9 servings per day.”

“This study also raises important points about health equity, food security, and social determinants of health,” he continued. “The authors describe the “Southern Diet” based on the U.S. geography associated with this dietary pattern, yet it would be a mistake for us to assume that this is a diet of choice. I think American society needs to look more broadly at why this type of diet is more common in the South and clusters among some racial, ethnic or socioeconomic groups to devise interventions that can improve diet quality. The gap in healthy eating between people with means and those without continues to grow in the U.S., and there is an incredible need to understand the complex societal factors that have led and continue to perpetuate these disparities.”

This study further expanded in earlier research on participants from the same nation stroke project, REGARDS, conducted in a 2018 analysis and a 2015 study investigating following a southern-style diet, interventions, heart disease, and risk of death. 

The American Heart Association’s Diet and Lifestyle recommendations emphasize eating vegetables, fruits, whole grains, lean protein, fish, beans, legumes, nuts, and non-tropical vegetable cooking oils such as olive and canola oil. Limiting saturated fats, sodium, added sugar, and processed meat are also recommended. Sugary drinks are the number one source of added sugar in the U.S. diet, according to the Centers for Disease Control and Prevention, and the American Heart Association supports sugary drink taxes to drive down consumption of these products.