Heart Healthy Eating: what you need to know

Twenty years ago, doctors advised patients to use margarine, eat pasta and avoid chocolate; now, we know margarine can kill you faster than butter, pasta increases the risk of heart disease and chocolate is really good for you. So what’s the truth about heart healthy eating?

The biggest news: fat intake isn’t the biggest issue. “Total dietary fat isn’t a concern any more, and saturated fat isn’t even in the top five things to avoid,” says Dariush Mozaffarian, M.D., Dr.PH., a cardiologist at Harvard Medical School in Boston. It’s more important to avoid transfats, found in margarine and other hydrogenated oils, and to emphasize healthy fats, Mozaffarian says.

Meanwhile, it’s time to toss the pasta and pastries for good. “One of the most important new findings is that a high intake of refined starches and sugars substantially increases the risk of heart disease,” says Walter Willett, M.D., Dr.PH., chairman of the department of nutrition at the Harvard School of Public Health. “These foods depress beneficial HDL cholesterol and raise triglyceride levels and inflammatory factors.” New studies have found that inflammation plays a crucial role in all stages of atherosclerosis and in the development of heart disease.

As for specific foods, the latest research shows that emphasizing fish, fruits, vegetables, olive oil and nuts, and washing them down with green tea, may be the best approach. And the best news: more studies are finding that a little dark chocolate can be a heart-healthy dessert. Following, the latest research on heart healthy eating—and two great recipes to get you started.

Fish. Good news for fish lovers: it’s still a catch, in terms of heart health. Several studies and reviews this year have confirmed once again that omega-3 fatty acids, the healthy fats in fish, decrease the risk of all types of cardiovascular disease (CVD), including heart attack and stroke, and can reduce the risk of death from coronary artery disease by as much as 50 percent. And if you’re not wild about fish, here’s some interesting news: walnuts are rich in alpha linolenic acid (ALA), a type of omega-3 fatty acid, as are snails and frogs (just so you know); those sources of ALA appear to be efficiently absorbed and transformed to eicosapentaenoic acid (EPA), the type of omega-3 found in fish. Eating fatty fish at least twice a week seems to have the greatest effect. How to eat more: Top salads with grilled or poached salmon; serve sardines the traditional way, broiled with lemon juice, garlic and parsley; make a heart-healthy tuna salad with olive oil, diced apples, minced onions and fresh basil.

Fruits and vegetables. As if you needed another reason to eat your fruits and veggies: a produce-rich diet helps prevent heart disease.  One new study suggests that if fruit and vegetable intakes were increased to 600 grams (about five servings) per day, it could reduce the incidence of heart disease and stroke by as much as 24 percent. Antioxidants, especially vitamin C, carotenoids and flavonoids, prevent the oxidation of cholesterol in arteries, and vitamin C prevents inflammation, strongly associated with heart disease. Fiber from fruits and vegetables also figures prominently in reducing heart disease risk. And other new research suggests that the beneficial effects of fruits and veggies are a result of their high content of nitrate, which is converted into compounds that help protect the heart. How to eat more: Make stir-fries with a rainbow-colored assortment of veggies; use deep, leafy greens like spinach and kale for salads; munch on berries for snacks and dessert.

Nuts. Remember when—not so long ago—we thought nuts were forbidden food? Now we know they’re great for our hearts. Nuts have been shown to reduce inflammation, and people who eat nuts five or more times a week have a lower risk of heart disease. Their cardioprotective effect seems to be due mainly to their high content of omega-3 fatty acids. Best nut choices include walnuts, almonds, pecans, pistachios and macadamia nuts, which have been shown to decrease total and LDL cholesterol. How to eat more: Sprinkle a couple of tablespoons of almonds on salads; stir crushed walnuts and raisins into plain yogurt; add pecans to stir-fry vegetable dishes.

Olive oil. Move over, butter; it just keeps getting better for olive oil. In new research, people who followed a Mediterranean diet rich in olive oil showed a significant reduction in blood glucose levels, blood pressure and cholesterol, compared with people who followed a low-fat diet. Olive oil has long been known to increase HDL cholesterol levels and lower LDL cholesterol, and it now appears to reduce C-reactive protein levels, a marker of inflammation. Some new research also suggests that the beneficial effects of olive oil are related not only to its high content of oleic acid, which can help prevent LDL oxidation,  but also to its wealth of antioxidant polyphenols (18). How to eat more: Substitute olive oil for other oils in cooking; whisk with lemon juice and fresh herbs for a simple salad dressing; serve in a small dish, sprinkled with coarsely ground black pepper and rosemary, as a dip for bread.

Green tea. Coffee drinkers, it’s seriously time to rethink your favorite brew; the heart healthy benefits of green tea keep pouring in. Consumption of both green and black tea have been linked with decreased risk of heart disease, in part because of their high content of antioxidant flavonoids.  Now, new research suggests that green tea also works by inhibiting the body’s synthesis of cholesterol. In addition to its cholesterol-lowering effects, green tea has also been shown to inhibit the development of atherosclerosiss.  How to eat more: Drink green tea chai, with a little milk and honey, as a morning beverage; toss two tea bags into a pot of boiling water for cooking rice; make a strong brew and use as a cooking liquid for poached salmon.

Chocolate. We’ve saved the best for last: chocolate does, indeed, appear to have potent cardioprotective effects, and eating chocolate on a regular basis may help lower blood pressure and reduce the risk of heart disease (23). Cocoa and chocolate contain fairly high amounts of antioxidant flavonoids, especially catechin and epicatechin (24). New reviews suggest that cocoa and chocolate lower blood pressure, reduce inflammation, increase HDL and decrease LDL oxidation (25). In one study, cocoa also appeared to repair aging blood vessels and improve their function (26). Choose extra-dark chocolate for the highest antioxidant content, and eat it moderately—about an ounce a day is plenty. How to eat more: Grate a couple of teaspoons of dark chocolate on top of fruit salad; top chicken breasts with a dark-chocolate mole sauce; dip ripe strawberries in melted dark chocolate.

SIDEBAR
Starting Early: Heart Health For Kids

Not so long ago, the biggest health worries in the preschool crowd were bumps, bruises and the occasional bout of strep throat. Now, with the growing epidemic of obesity among U.S.kids, heart disease is rapidly becoming an issue.

“Kids today are smoking younger, exercising less, and eating more salt and saturated fats than ever before–unhealthy habits that can increase the risk of heart disease,” says Philip R. Nader, M.D., professor of pediatrics at University of California, San Diego. “Thirty to 60 percent of children in the United States exhibit at least one risk factor for cardiovascular disease by the age of twelve. We can no longer wait until mid-life to worry about the damaging effects of an unhealthy lifestyle.”

According to the U.S. Department of Health and Human services, risk factors for heart disease, such as high cholesterol and high blood pressure, are much more common in overweight children and adolescents compared to those with a healthy weight. Meanwhile, the prevalence of overweight adolescents has nearly tripled in the last 20 years.
What’s the best approach? In addition to encouraging kids to exercise and teaching them about the hazards of smoking, dietary changes can have a tremendous impact on the future cardiovascular health of your kids.

“Generally speaking, a healthy diet with relatively low fat is recommended,” Nader says, “and the ‘five-a-day’ or more (servings of fruits and vegetables) mantra is good for kids.”