Unlocking Longevity: Your Heart is the Key - Part 2

Eating for a Healthy Heart: Navigating the World of Nutrition and Cardiovascular Disease

Welcome back! In my previous blog post Unlocking Longevity: Your Heart is the Key - Part 1, we touched upon the sobering reality that cardiovascular disease (CVD) remains a leading cause of death in the United States and worldwide. The good news is that many of the risk factors for CVD are modifiable.

Today we will talk about nutrition. Diet plays a crucial role in heart health, and making informed food choices can significantly reduce your risk. But with so much conflicting information out there, how do you know what to eat? Let’s explore what the current evidence suggests, the challenges in nutrition research, and what you can do to protect your heart.

The Challenges of Nutrition Research

Before we delve into specific foods, it’s important to understand the challenges faced by nutritional epidemiology studies. Unlike drug trials, it’s difficult to conduct randomized controlled trials (RCTs) with dietary interventions over long periods. Much of the research relies on observational studies, which can be prone to biases and confounding factors. People’s diets are complex and are influenced by many factors, so isolating the effects of single nutrients or foods is difficult.

Core Principles of a Heart-Healthy Diet

Despite these challenges, there's a strong consensus on the fundamental principles of a heart-healthy diet:

• Prioritize Plant-Based Foods: A diet rich in fruits, vegetables, whole grains (like oats, barley, brown rice, and quinoa), legumes (beans, lentils, peas, chickpeas), nuts, and seeds is consistently associated with lower CVD risk. These foods are packed with fiber, vitamins, minerals, and antioxidants that are protective against heart disease. Interestingly, taking vitamins as a supplement doesn't provide the same benefits as consuming them from whole foods. I also generally advise against green and fruit smoothies, as the blending process pulverizes fiber and releases sugars from plant cells into a liquid form that's absorbed much faster than from whole foods. This rapid sugar absorption can have negative metabolic consequences.

  
  

• Limit Processed Foods, Sugary Drinks, and Refined Grains: Processed meats (bacon, sausages/hot dogs, salami), sugar-sweetened beverages, refined grains and starches are linked to increased CVD risk.

  
  

• Choose Healthy Fats such as monounsaturated and polyunsaturated fats, found in olive, sunflower, canola oil, avocados, nuts, and fatty fish. Note that tropical oils like coconut and palm oils are high in saturated fat and may raise cholesterol in susceptible individuals.

  
  

• Reduce Sodium Intake: High sodium intake is associated with high blood pressure, which increases the risk of CVD.

  
  

Navigating Specific Foods and Nutrients

Now, let’s look at some specific foods and nutrients that often generate debate:

• Dairy: The impact of dairy on heart health is complex and controversial. Some sources suggest limiting full-fat dairy due to saturated fat content, while others argue that the type of dairy matters more. Moderate consumption of both low-fat and full-fat dairy, especially fermented products like yogurt without added sugars and cheese, may be okay, and some studies even show a protective effect for low-fat yogurt.

  
  

• Eggs: Eggs are a source of dietary cholesterol. Some studies but not all suggest that moderate egg consumption (up to one per day or two eggs up to three times a week) does not significantly increase CVD risk for most healthy individuals. People with high cholesterol may need to be more cautious.

  
  

• Meat: Processed meats, as mentioned above, should be minimized due to their link to increased CVD risk and consumed only occasionally. Unprocessed red meat has also been associated with increased risk of CVD. If you choose to eat it, it might be best to eat not more than 3-4 oz twice a week. Poultry appears to have a neutral relationship with CVD risk when consumed in moderation, up to three times a week. Many studies, however, support that replacing meat on our dinner plates with beans, lentils, peas, chickpeas, or mushrooms can be beneficial for our cardiovascular and overall health.

  
  

• Fish: Moderate fish consumption, up to twice a week, is supported by the available evidence and may reduce CVD risk. Fatty fish, in particular, are rich in beneficial omega-3 fatty acids.

  
  

• Sugar-sweetened beverages, energy drinks, and beverages with artificial sweeteners have been associated with increased CVD risk and best to be replaced with water (can be infused with natural flavors), tea, and coffee.

  
  

Putting it all together

Michael Pollan, author of "In Defense of Food: An Eater's Manifesto", wisely advises, "Eat food. Not too much. Mostly plants." While this is generally sound advice, two points are important to emphasize:

First, we are all different. We vary in age, sex, race, health status, culture, taste preferences, gut bacteria, and genes. One person might have protective genes and a low risk for heart disease despite eating junk food, while another might have heart problems despite a mostly vegetarian diet. One person's blood sugar might spike after eating an orange, while another's remains stable after eating cake. This highlights the need for individualized nutrition advice. Today, we have tools like scales, body composition analyzers, continuous glucose monitors, and laboratory tests to help us find the right diet or alert us to problems with the current approach to eating.

Second, it's easy to get overwhelmed by contradictory diet advice. This can lead to confusion and inaction. Remember, you don't need the perfect diet to start making positive changes. Waiting for "the perfect" anything is often an excuse for doing nothing. No matter what changes you make, they're unlikely to cause long-term harm if you pay attention to how you feel, your energy level, body weight, waist circumference, cholesterol, and blood sugar. If things aren't moving in the right direction, re-evaluate and work with your doctor to adjust your course.

When unhappy with your health, keep it simple. If you drink soda, replace it with water or tea. If you eat meat daily, try replacing it with beans or mushrooms once a week and go from there. Don't let the pursuit of perfection be the enemy of good. To improve your health, eat better today than you did yesterday. Progress happens one meal at a time.

And if your diet is already pretty good, then perhaps you'll see greater benefits by investing your effort and energy into other areas of wellness, such as physical activity, sleep, stress management, or the proper use of medications to address genetically predetermined weaknesses.

If you'd like to discuss your personal situation and receive individualized advice, schedule an appointment with the Institute for Diabetes, Endocrinology, Adiposity, and Longevity today to learn how to eat to your heart's content.

Till next time,

Dr. Koren

References:

1. Vargas G, Azarbal J, Tota-Maharaj R. A Comparative Review of Established Diets for Prevention of Cardiovascular Disease and Newer Dietary Strategies. Curr Probl Cardiol. 2021 Mar;46(3):100582. doi: 10.1016/j.cpcardiol.2020.100582.

2. Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol. 2021 Jan 23;5:100149.

3. Riccardi G, Giosuè A, Calabrese I, Vaccaro O. Dietary recommendations for prevention of atherosclerosis. Cardiovasc Res. 2022 Mar 25;118(5):1188-1204.

4. Freeman AM, Morris PB, Aspry K, Gordon NF, Barnard ND, Esselstyn CB, Ros E, Devries S, O'Keefe J, Miller M, Ornish D, Williams KA, Batts T, Ostfeld RJ, Litwin S, Aggarwal M, Werner A, Allen K, White B, Kris-Etherton P. A Clinician's Guide for Trending Cardiovascular Nutrition Controversies: Part II. J Am Coll Cardiol. 2018 Jul 31;72(5):553-568.

5. Chareonrungrueangchai K, Wongkawinwoot K, Anothaisintawee T, Reutrakul S. Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review. Nutrients. 2020 Apr 15;12(4):1088.

6. Chen W, Zhang S, Hu X, Chen F, Li D. A Review of Healthy Dietary Choices for Cardiovascular Disease: From Individual Nutrients and Foods to Dietary Patterns. Nutrients. 2023 Nov 23;15(23):4898.

7. Nestel PJ, Beilin LJ, Clifton PM, Watts GF, Mori TA. Practical Guidance for Food Consumption to Prevent Cardiovascular Disease. Heart Lung Circ. 2021 Feb;30(2):163-179.

8. Bowen KJ, Sullivan VK, Kris-Etherton PM, Petersen KS. Nutrition and Cardiovascular Disease-an Update. Curr Atheroscler Rep. 2018 Jan 30;20(2):8.

9. Diab A, Dastmalchi LN, Gulati M, Michos ED. A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now? Vasc Health Risk Manag. 2023 Apr 21;19:237-253.

Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Please consult with your healthcare provider before making any dietary changes.