Researchers also note that possible substitutes include whole grains at one serving daily and unprocessed red meat or poultry at one serving per day.

In simple terms, the closer participants were to this ideal cadence, the higher their score was. 

The higher PURE diet score was associated with a significantly lower risk of death or CVD in regions with higher gross national incomes, confirming the importance of the diet for low-income areas. 

However, it’s equally important to advocate for access to whole and natural foods in low-income neighborhoods and those isolated from supermarkets. 

In two additional case-controlled studies, a higher diet score was also associated with lower heart attack and stroke risk. 

The study found that a 20% improvement is associated with an 8% lower risk of death and a 6% lower risk of major cardiovascular events. So, the PURE diet doesn’t have to be perfect; any improvement makes a difference.