Written by: Natalie Pirolli, MS, RDN, LDN, RYT | February 14, 2024
Like most nutrition-related things, the dietary advice for heart health seems to be ever-changing and constantly contradicting itself. When the rates of cardiovascular disease (CVD) significantly increased around the 1950s, researchers started to examine what components of the diet could be to blame. By the 1960s two prominent scientists shared their conflicting reviews: John Yudkin identified sugar as the main culprit while Ancel Keys reported dietary fat (total fat, saturated fat, and dietary cholesterol) as the problem. But the sugar hypothesis didn’t seem to stick and the American Heart Association and Dietary Guidelines for Americans were pushing to reduce total fat in the diet to lower the risk for CVD.
Interestingly, years later it was discovered that the US Sugar Research Foundation paid Harvard researchers to publish falsified reports downplaying the role of sugar in CVD and highlighting fat and dietary cholesterol as the only diet components to limit to prevent disease. (This was in 1967 when researchers were not required to disclose conflicts of interest). Apparently, since the 1950s, the Sugar Research Foundation had been strategically planning for how to increase the US’s sugar intake by promoting a low-fat diet. (Low-fat versions of foods will often have added sugars to improve taste).
So which is it? Sugar or fat?
Again, like with all nutrition-related things, it is not so easy as saying "eat this, not that" and we'd benefit more from looking at our diets as a whole and focusing on what can we incorporate more of instead of just what we should eliminate. And when it comes to health we should never just be looking at our diets. We have to think about lifestyle, stress, physical activity, genetics, and how all of these factors play a role, too. This is why I always stress that nutrition advice is not one size fits all and why we can't take the advice of one headline, one research study, or one social media influencer. Research often looks at the effects of ONE isolated nutrition component, not how all aspects of our diet (and lifestyle) come together and impact our health. (Plus their message may be influenced by compensation, not science, too!)
With February being American Heart Month, I thought it would be helpful to share some insight and my top ten heart health tips. There is a good chance you, or someone you know, may have concerns about their heart health—whether it is high cholesterol, blood pressure, triglycerides, or preventative concerns. The good news is, though genetics play a role, most cases of heart disease are preventable or treatable through lifestyle habits. These tips are helpful even for those who are not worried about their hearts because they incorporate a variety of healthy nutrients that we all need and benefit from like fiber, antioxidants, omega-3s, and more.
If you thought this blog was going to be about how to protect yourself from heartbreak, I apologize. I guess my only advice there would be to know that time really does heal all and you will always learn from it. Also, don't date until you are 30. You'll just have better judgment then :)
Back to heart health! Here are my tips:
1. Focus on Fiber
Since the early 1950s, it’s been documented that dietary fiber is protective against heart disease. Soluble fiber particularly helps to lower our “bad” LDL cholesterol levels by creating a gel-like substance when digested, which picks up excess cholesterol particles in the intestines, getting rid of them on its way out (yes, as poop). This prevents any excess cholesterol from getting reabsorbed into the bloodstream. Insoluble fibers help the process by aiding bowel movements as well. You need a mix of both soluble and insoluble fiber, along with plenty of water, for regular bowel movements.
Additionally, fiber has been shown to play a role in the reduction of blood pressure and inflammation. It also positively impacts our gut microbiome, preventing dysbiosis (an imbalance of "good" vs. "bad" gut bacteria), which has been linked to several chronic diseases including heart disease.
Foods high in fiber include fruits, vegetables, whole grains (whole wheat bread, quinoa, oats, etc.), psyllium husks, beans, and seeds to name a few.
Heart tip: Here are a few fibrous additions you can try:
Add hemp hearts, ground flaxseeds or chia seeds to oats, yogurt, smoothies, salads
Add fresh/frozen berries to your yogurt and smoothies
Mix ground flaxseeds into your nut butter sandwiches or toasts
Use smashed raspberries/blueberries as the “J” to your “PB”
Stuff leafy greens like arugula into your sandwiches and wraps or as a base to your grain bowls
Add avocado to your toasts, sandwiches, and grain bowls
Add chopped broccoli or spinach to your pasta or mac and cheese
2. Know the Facts About Fats
Seeing how we've demonized the word "fat" in society it comes with little surprise there is some negativity around dietary fats. (Unless someone is keto, which we do not have time to unpack all that is unhelpful for hearts and happiness about that). The truth is we need fat in our diets. It's essential for our brains, hormone balance, mood, hair, skin, nails, and hearts among other things.
It appears that we've been spending a lot of time worrying about fats when several other dietary components have been shown to have a much greater impact on our heart health. For example, trans fats and added sugars show a stronger association with CVD. Diets that are low in fat but high in carbohydrates are linked to increasing triglyceride levels—another risk factor for heart disease, while foods like fish, whole grains, fruits, and vegetables show a protective factor against CVD.
Unsaturated fats have been shown to improve cholesterol levels, decrease inflammation, and stabilize heart rhythms. These are the fats that are liquid at room temperature like olive oil, and include other food sources like fish, avocados, nuts, and seeds.
Saturated fats, which are primarily found in animal foods (meat, dairy) are actually essential too and needed for different processes like helping us absorb calcium. So they shouldn’t be completely avoided. High intake has been correlated to increasing total cholesterol (that’s a correlation, not causation), however, more recently only a weak, non-significant association between saturated fats and CVD has been shown. It's also important to consider the context: was saturated fat intake related to CVD when it was part of a balanced diet, or when was a large part of a diet that lacked fiber, omega-3s, fruits, vegetables, and other beneficial foods? Plus we need to remember the other crucial nutrients these animal foods provide: high biological value protein, iron, zinc, vitamin A, calcium, and more. To avoid these foods means we miss out on some key, easily absorbable nutrients. I recommend having a balance of both saturated and unsaturated fats in the diet.
Over the years research has not provided significant evidence to support that dietary cholesterol increases the risk for heart disease and it has also been shown to have only a very small effect on blood cholesterol levels for most people. In fact, for these reasons, the 2015-2020 Dietary Guidelines for Americans removed the recommendation to keep dietary cholesterol intake to less than 300mg/day. Shrimp and eggs are two nutrient-dense foods that are high in cholesterol, but also great sources of protein and micronutrients like selenium, iron, choline, and more. Eggs may even have a favorable effect on our HDL cholesterol levels.
Trans fats on the other hand are a fat we should be mindful of because they have been linked to not only raising LDL cholesterol levels, but also decreasing our "good" HDL cholesterol, and increasing inflammation and triglyceride levels, too. These fats are a result of heating vegetable oils in a process called hydrogenation. Common sources include frying oils used at restaurants and commercial baked goods. They are naturally present in small amounts in beef and dairy fat however, in natural form, they have not been shown to pose the same risk factors for CVD. Because the artificial or man-made form can greatly increase the risk of heart disease, the FDA has banned manufacturers from adding trans fats to processed foods as of January 2020. If you're unsure if a food you enjoy regularly has trans fats, just look for "partially hydrogenated oils" in the ingredients section of food labels. (Chances are if it is on there, it is way down on the list meaning it contains a very little amount since the FDA has gotten involved).
Heart Tip: Aim to get most of your daily/weekly fat intake from unsaturated sources, and include quality animal proteins like grass-fed beef and pasture-raised poultry and eggs which tend to have a higher nutrient content.
3. Incorporate Omega-3 Fatty Acids
Omega-3 fatty acids are a type of unsaturated fat that has been shown to reduce the risk of cardiovascular disease, heart attacks, and strokes. This is because they help to: reduce risk of blood clots and inflammation, protect artery lining by keeping it smooth and damage-free, decrease triglyceride levels, and they may also increase HDL cholesterol and lower blood pressure.
They also play an important role in brain functioning and mood, brain development in babies, skin and joint health, and may be beneficial for eczema and rheumatoid arthritis.
Sources of omega-3s include fatty fish like salmon, mackerel, sardines, anchovies, herring, and tuna. Other sources include chia seeds, ground flaxseeds, hemp seeds, walnuts, seaweed, edamame, cod liver oil, and omega-3 or fish oil supplements.
Heart Tip: incorporating hemp, chia, or ground flaxseeds into your meals will boost both omega-3s and fiber!
4. Work on a Potassium to Sodium Ratio
We're often told to limit or avoid sodium especially if we have high blood pressure. But, you guessed it, this mineral is essential and plays many important roles in the body (hydration, stress response, getting nutrients into our cells, etc.), too. Diets high in sodium are a risk factor for high blood pressure and other cardiovascular complications, however, potassium helps to negate or counterbalance its adverse effects.
Potassium, like sodium is a mineral and electrolyte that is involved with fluid balance and nerve functioning. It also helps reduce the risk of strokes and keeps our hearts beating at the right pace. Increasing potassium intake has been shown to reduce blood pressure, especially in those with high sodium intake. When we increase potassium intake, it gets rid of excess sodium through our urine, which helps to reduce our blood pressure levels, making potassium an important nutrient for those with hypertension.
Instead of outright avoiding sodium intake, it can actually be more beneficial for our hearts (and health and well-being) if we increase potassium levels so that we get a 3:1 or 4:1 ratio of potassium to sodium in the diet, meaning we should get 3-4x more potassium than sodium.* And since most fruits and vegetables contain potassium, by boosting your intake of potassium, you're also boosting your intake of antioxidants, fiber, and a variety of vitamins and minerals.
An added bonus: potassium plays a role in blood sugar regulation as well where low levels of potassium have been linked to higher blood sugar levels. (This is helpful for tip number 6)
Some potassium-rich foods include avocados, bananas, potatoes, leafy greens (like spinach and broccoli), winter squash, dairy, salmon, and coconut water.
Heart Tip: try adding an adrenal cocktail to your day for a boost of potassium and pinch of sodium (along with vitamin C and magnesium!) 8-10oz coconut water, juice from 1/2 a lemon or lime, inch of sea salt.
*If you have been instructed to limit potassium or sodium due to kidney functioning or medications, consult with your doctor before increasing or adjust your consumption of these nutrients.
5. Eat Your Macros—yes, all 3 of them!
Contrary to the advice from many fad diets, we NEED all 3 macronutrients in our diets: carbohydrates, fats, and proteins. Simply put, all 3 break down to provide energy and necessary components (amino acids, fatty acids, glucose molecules, etc.) that our hearts and all tissues, muscles, and cells need to work efficiently.
And when we cut out a food group, we cut out all of the other helpful nutrients they supply too. For example, low or no-carb diets will lack fiber, which is likely why I’ve seen clients develop things like high cholesterol after following a keto diet for some time. They’ll also miss out on the micronutrients like beta carotene, magnesium, vitamin C, vitamin K, and B vitamins that we get from things like fruits, vegetables, and whole grains. And if we cut out fats we miss out on omega-3s, vitamin E, and other important nutrients.
Getting a balance of all 3 macronutrients in the diet helps us to receive a balance of nutrients. It also helps with the next tip.
6. Balance Blood Sugar Levels
Not only does this help us to have sustained energy levels throughout the day, but it also helps with stress management and heart health. When our blood sugar gets low (from undereating or going long hours without eating), it signals the release of epinephrine (adrenaline) and cortisol (stress hormone—more on this below). Additionally, chronically elevated blood sugar levels can harm our blood vessels and the nerves that control our hearts, increasing the risk for CVD.
Heart Tip 1: to balance blood sugar and avoid frequent highs and lows, aim to eat a balance of carbs, protein, and fat at meals and snacks. For example, instead of just a piece of toast and juice in the morning (carbs), add a couple of eggs (protein and fat) and some avocado (fat). You can even opt for whole grain bread for more fiber, which also helps with blood sugar balance.
Heart Tip 2: eat balanced meals and snacks regularly throughout the day, about every 3-5 hours to avoid long periods without eating which can lead to blood sugar lows and increase the likelihood of craving simple carbs or overeating, which can cause blood sugar spikes.
7. Diversify Your Carbs
We’re spending a lot of time on carbs because I want to make sure it’s clear I’m not promoting a low or no-carb diet! At least half of our energy intake should come from carbohydrates because it is our body’s (brain, heart—all body systems and cells) preferred fuel source.
There are two types of carbs: complex carbohydrates, which contain fiber and take longer to digest. These include fruits, vegetables, beans, lentils, and whole grains. And there are simple or refined carbohydrates that lack fiber and are quickly digested and absorbed, meaning they more quickly raise our blood sugar levels, too. These include refined grains (like white bread), sweets, and sugary drinks. Diets high in refined grains and foods with added sugars have been linked to an increased risk for CVD. Meanwhile, intake of carbs like whole grains, fruits, and vegetables shows a protective factor against CVD.
That said, can we never have sweets or sugary drinks? No. (I'm literally sipping a sweet chai latte while typing this). It comes back to looking at our diet as a whole—it is likely not going to impact our heart health if we enjoy some refined carbs and sweets as part of a diet that also provides adequate protein, fat, complex carbs, fiber, and micronutrients. It is when simple carbs make up a large part of our diet and displace the intake of whole grains, fruits, vegetables, and legumes that we can have issues.
Heart Tip: enjoy sweets after balanced meals/snacks or with protein to help stabilize blood sugar levels. Example: instead of just a piece of banana bread for a snack, add nut butter (protein/fat) and a cup of milk/soy milk (protein). Enjoy your sweetened chai latte after a protein-rich breakfast (as I am doing now!).
8. Incorporate Phytonutrients
Phytonutrients are natural chemicals that give plants their color. They are associated with a slew of benefits, namely acting as antioxidants and having anti-inflammatory effects—two things that help to reduce the risk of CVD. For example, reducing inflammation and oxidative stress, particularly in our arteries helps to prevent plaque buildup and atherosclerosis.
Heart Tip: eat the rainbow! Eating a variety of fruits and vegetables means we’re getting a variety of phytonutrients (and other nutrients). Try to incorporate different colors in your salad like leafy greens, red tomatoes, yellow peppers, orange carrots, etc., and switch up your veggie side at dinner to a different color each week (ex. broccoli/asparagus, sweet potatoes/butternut squash, beets, etc.).
9. Move More Mindfully
Moderate physical activity is beneficial for not only increasing HDL cholesterol but also lowering blood pressure, triglycerides, and LDL cholesterol. Aerobic exercise in particular can improve circulation and be heart-strengthening (must be why they call it cardio!). Choose forms of movement you enjoy to reap their benefits and increase the likelihood you’ll continue them regularly. Remember this is not limited to going to the gym—exercise includes walking, cleaning your home, gardening/yard work, and more forms of movement.
Exercise is also a form of stress relief and can improve our stress response. Forms of exercise like yoga or tai chi that focus on breathing and the mind-body connection can be a form of meditation, which also reduces stress. That brings us to my last tip…
10. Manage Stress
During times of stress, cortisol constricts our blood vessels to increase blood pressure and the delivery of oxygenated blood throughout our body. It does this in an attempt to help us in fight-or-flight situations. However, chronic stress can damage blood vessels with this arterial constriction which can lead to plaque buildup—two factors that increase the risk of heart attack. Chronic stress is also linked to increased inflammation, along with poor sleep, cigarette use, and excessive drinking—lifestyle factors known to increase our risk for CVD.
Managing stress is easier said than done. Start with stressors that are in your control, like avoiding blood sugar lows/long periods of time without eating and reducing time spent on social media, and incorporate some stress-reducing activities you enjoy (walks, time with friends, journaling, etc.).
Key Takeaways
We should focus more on what our diet looks like as a whole as it's not one single food or food group that contributes to or protects us from heart disease, but our eating patterns and lifestyle habits.
Aim to increase heart-healthy nutrients like fiber, omega-3 fatty acids, whole grains, potassium-rich foods, and colorful fruits, and vegetables. These foods can help to displace or provide a healthy balance with the ones that may be contributing to our heart concerns like those foods high in added sugars, sodium, trans fats, etc.
Incorporate a balance of all 3 macronutrients to meet nutrition requirements and help balance blood sugar levels.
By incorporating some of these diet and lifestyle habits, along with reducing some others (like smoking cigarettes and excessive drinking), we can enhance our health and protect our hearts.
Keep in mind that even small changes make an impact. Taking a quick walk on your lunch break, adding chia seeds to your cereal for extra fiber and omega-3s, and adding a vegetable side at dinner are all steps towards a healthier heart!
Interested in learning more about how you can improve your health and well-being through nutrition? Schedule a free 15 minute consultation call to learn more about working together, subscribe to my monthly newsletter, or reach out with any questions!
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