What is a Heart Healthy lifestyle? Part 2
In Part 1, we investigated the conventional approach to cardiovascular disease and why scientific evidence does not necessarily support a low saturated fat, vegetable oil-, grain-rich diet.
What About Physical Activity?
Regular exercise is vital for longevity. Some research suggests physical activity may even “outperform traditional risk factors including smoking, total cholesterol, gender, cancer, stroke, diabetes, and coronary heart disease.”
We may view exercise in a negative light, imagining a crowded gym, painfully sore muscles, and gasping for breath. The reality is that our cardiovascular system functions best when we move frequently throughout the day, and this movement can look different from person to person. Focusing on movements that you enjoy is usually the key to sustainability.
Physical activity could look like walking your dog, dancing, swimming, performing chair squats, yoga, following along with an at home workout video, etc.
A general goal is to shoot for at least 150 minutes of exercise, including a minimum of 60 minutes of strength/weight/resistance training.
What About Stress?
Stress can take years off your life; certain types of stress may be worse than others and certain people may tolerate stress differently. For instance, social isolation is as good of a predictor of mortality or better than many standard factors, including high cholesterol. There is also evidence that someone who has had six or more adverse childhood experiences (violence, abuse, neglect, etc.) has a lifespan that is 20 years shorter than someone who had no adverse childhood experiences.
Stress management does not always mean “avoiding stress” but rather learning how to cope with stress. Often chronic health symptoms surface when stress load exceeds our stress tolerance. Stress is thought to play a large role in triggering an autoimmune disease, for instance.
One can decrease their “stress load” by practicing regular meditation, setting good boundaries, and staying organized. One can also increase their “stress tolerance” by introducing a small “stress” and training their body and nervous system how to handle it. Examples include exercise, taking a cold shower and breathing deeply, yoga, and working with a mental health therapist.
What About Sleep?
Lack of sleep is a major stress to our bodies. Adults thrive off 8-10 hours of restful sleep a night, but Americans usually get less than 7 hours. Sleep deprivation has tremendous consequences for our heart health. For instance, sleep apnea increases the risk of heart failure by 140%.
Poor sleep also decreases metabolism and increases hunger cravings, contributing to excess body fat.
Getting out in sunlight (especially in the morning), going to bed on time, turning off screens, setting a bedtime routine, and not eating food or drinking alcohol within 2 hours of bedtime are good habits to try for a good night’s sleep.
What About Body Weight?
Maintaining a body mass index (BMI) in the “normal” range is one of the most common recommendations from medical professionals. While there is plenty of evidence that too little or too much weight can affect heart health, the BMI is likely not the best way to determine ideal weight. For instance, a review considering 97 studies and 2.88 million individuals, showed that the “overweight” BMI was associated with significantly lower all-cause mortality.
There are many issues with the BMI, namely that it does not consider body fat versus muscle mass, nutrient intake, exercise, stress, sleep, or any of the other factors mentioned in this blog series.
Rather than fixating on a certain weight goal, (which can contribute to disordered eating) focus on healthy behaviors that can lead to a weight that is healthy for you.
What About Salt and High Blood Pressure?
High blood pressure is a significant contributor to cardiovascular disease. Conventional guidelines say to limit salt. The American Heart Association somehow expects American to limit sodium to as low as 1,000-1,500 mg for optimal health. However, low sodium recommendations are actually quite controversial. One scientific review suggests that “there is no scientific basis for a public health recommendation to alter sodium intake,” since 90% of the worlds’ population currently consumes a sodium intake that is not associated with increased mortality.
Somehow potassium has not gotten much media attention even though this mineral is just as important for blood pressure regulation as salt. Potassium rich sources include vegetables and fruits, especially bananas, spinach, sweet potatoes, and melons.
While sodium may need to be limited to less than 2,300 mg a day for adults with hypertension, it is unlikely that adults with normal blood pressure, who eat plenty of potassium (at least 4,700 mg/day), and are active, also need to limit salt.
Salt and potassium are not the only contributing factors to high blood pressure. Other considerations include body fat percentage, physical activity, stress, sleep, and hydration.
It is hard to overestimate the importance of proper hydration for cardiovascular health. Proper water intake regulates blood pressure, reduces inflammation, and reduces risk of developing heart failure.
One of the best ways to measure proper hydration is if urine color is clear to slightly yellow rather than dark yellow. Most adults need at least 9 cups of water a day or 72 ounces.
What’s a “Heart Healthy Lifestyle” Then?
In conclusion, a heart healthy lifestyle varies based on the individual. That is why working with healthcare professionals and investigating the scientific literature is so important. For proper nutrition advice, consider working with a registered dietitian; they are the healthcare practitioners who undergo the most extensive training in nutrition science and nutrition counseling.
Maintain a healthy weight, not by focusing on the BMI, but by engaging in healthy behaviors such as regular exercise, stress management, and getting enough sleep. Also, consume plenty of nutrient-dense, low processed foods like vegetables, fruit, proteins (fish, Greek yogurt, chicken, legumes, etc.), and fats (avocados, nuts, seeds, dark chocolate, etc.). Limit refined carbohydrates, drink plenty of water, and get as much dietary variety as possible.
The low fat, low salt guidelines have long been challenged and even conventional guidelines have started to change based on high-quality research.
References
Ekaterina Smirnova, PhD, Andrew Leroux, ScM, Quy Cao, MS, Lucia Tabacu, PhD, Vadim Zipunnikov, PhD, Ciprian Crainiceanu, PhD, Jacek K Urbanek, PhD, The Predictive Performance of Objective Measures of Physical Activity Derived From Accelerometry Data for 5-Year All-Cause Mortality in Older Adults: National Health and Nutritional Examination Survey 2003–2006, The Journals of Gerontology: Series A, Volume 75, Issue 9, September 2020, Pages 1779–1785, https://doi.org/10.1093/gerona/glz193
Brown DW, Anda RF, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2009 Nov;37(5):389-96. doi: 10.1016/j.amepre.2009.06.021. PMID: 19840693.
Pantell M, Rehkopf D, Jutte D, Syme SL, Balmes J, Adler N. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health. 2013 Nov;103(11):2056-62. doi: 10.2105/AJPH.2013.301261. Epub 2013 Sep 12. PMID: 24028260; PMCID: PMC3871270.
Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med. 2008 Jun 15;4(3):261-72. PMID: 18595441; PMCID: PMC2546461.
Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013 Jan 2;309(1):71-82. doi: 10.1001/jama.2012.113905. PMID: 23280227; PMCID: PMC4855514.
Graudal N. A Radical Sodium Reduction Policy is not Supported by Randomized Controlled Trials or Observational Studies: Grading the Evidence. Am J Hypertens. 2016 May;29(5):543-8. doi: 10.1093/ajh/hpw006. Epub 2016 Jan 27. PMID: 26817656.
