What is a heart healthy lifestyle? Part 1
Defining “Heart Healthy”
Did you know that 1 in 3 Americans die from cardiovascular disease? This includes a range of conditions that affect the heart and vascular system such as coronary artery disease, stroke, and heart failure.
For decades, health organizations, food companies, and medical practitioners recommended a narrow range of nutrition advice for heart health such as to limit total fat and saturated fat, limit dietary cholesterol, limit salt, eat plenty of grains, cook with Canola oil, perform aerobic exercise regularly, and keep your BMI in the “normal” category.
If you've noticed, there are a lot of other voices in healthcare and the media that recommend very different advice, sometimes the opposite! So, who should you trust? What is heart healthy? Is it vegan, Mediterranean, keto, flexitarian, carnivore, intermittent fasting, or something else?
What About Saturated Fat and Dietary Cholesterol?
When analyzing nutrition research, it doesn’t take long for your head to swim with all of the controversies. It’s also easy to see that the conventional medical approach for cardiovascular disease is often supported by poor evidence or no evidence at all!
Take this hypothesis that is widely supported by conventional American healthcare: saturated fat and dietary cholesterol must be limited and contributes to heart attacks and strokes. The idea is this: too much saturated fat and dietary cholesterol —> high LDL-cholesterol —> cardiovascular disease.
The problem with this hypothesis is that it has been disproven many times. Not only does saturated fat and dietary cholesterol not increase the risk of early death but not all LDL cholesterol may be so bad after all. The idea that dietary cholesterol must be limited is particularly preposterous. Very little dietary cholesterol is absorbed and our liver just makes a little less to compensate.
Going a little deeper into the pathophysiology, there are two types of LDL molecules: large, buoyant, fluffy LDL and small, dense LDL. Small LDL is much more likely to oxidize and stick to artery walls than large LDL molecules. Saturated fat has not been shown to increase the small, harmful, easily oxidized LDL and may even decrease it.
What About Other Fats?
Research does seem to suggest that a heart healthy diet is one that is diverse, meaning you eat a wide variety of whole, less processed, nutrient-dense foods. Why does processing foods often make them less “heart healthy?”
Take cooking oils, for instance. Less processed fats like extra virgin olive oil and avocado oil are richer in micronutrients and withstand heat better than highly processed fats like Canola oil and soybean oil. I’m not talking about smoke point here, I’m pointing out the oxidative stability. So, even if Canola oil does not reach a certain smoke point, it produces more carcinogenic and inflammatory compounds than olive and avocado oil.
Omega 3-rich foods and monounsaturated fats are consistently documented to improve cardiovascular markers and outcomes. Foods rich in some these fats include fish (especially salmon and sardines for omega 3’s), avocados, olives, nuts, and seeds.
Added trans fats are significantly harmful to heart health. Thankfully, they have mostly been eradicated from the food supply when the FDA declared added trans fats are no longer Generally Recognized as Safe in 2018. Small amounts of added trans fats (< 0.5 gram/serving) may still be in highly processed foods like pie crusts, donuts, or French fries. Watch out for the term “partially hydrogenated oil.”
What About Carbohydrates?
When carbohydrates are refined, they are depleted of fiber as well as vitamins and minerals. This has a negative impact on our heart health, as these carbohydrates do not provide us the level of micronutrients we need, and the “simple carbs” are converted to blood sugar much quicker. This gives our body, hormones, and mood a roller coaster ride instead of the smooth, little boost of energy it desires. Refined carbohydrates, including sugar, are found in soda, candy, white bread, white rice, pasta, and fruit juice and in many packaged foods.
Besides its blood sugar controlling effects, dietary fiber (from unprocessed carbohydrate-rich foods) helps balance our serum (blood) cholesterol by helping to dispose of the excess (we excrete it in stool).
Uncontrolled high blood sugar in diabetes stiffens arteries and damages the interior walls, making them more prone to cholesterol accumulating on them (atherosclerosis).
What About Antioxidants?
Antioxidants are the phytochemicals in plant foods like fruits and vegetables that help blunt the harmful effects of oxidative stress and inflammation. Oxidation and inflammation are natural and necessary processes that keep us alive. However, left unchecked, oxidative stress and chronic inflammation are the root cause of most cardiovascular diseases. Antioxidants improve insulin sensitivity and protect cells from free radicals, which are unstable molecules that cause damage in the body.
The best way to ensure you are getting enough antioxidants is to eat all the colors of fruits and vegetables.
This concludes part 1 of “What is a Heart Healthy Lifestyle?” In part 2, we’ll discover how other nutritional factors like salt play a role as well as stress, sleep, and exercise!
References
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Alzaa, D. F. (2018). Evaluation of Chemical and Physical Changes in Different Commercial Oils during Heating.
Kozakova M, Palombo C. Diabetes Mellitus, Arterial Wall, and Cardiovascular Risk Assessment. Int J Environ Res Public Health. 2016 Feb 6;13(2):201. doi: 10.3390/ijerph13020201. PMID: 26861377; PMCID: PMC4772221.
