A Healthy Heart Diet:
Addressing More Than Abnormal Cholesterol

A healthy heart diet needs to address the many underlying factors that can contribute to cardiovascular disease risk.  This includes abnormal cholesterol, but also other important factors such as, inflammation, oxidative stress, micronutrient status, metabolic syndrome, insulin resistance and blood sugar imbalances.  Optimizing your diet and nutritional status to address these imbalances is a key component for both prevention and management of cardiovascular disease. 


Healthy Heart Diet:
Key Diet Related Factors that Contribute to Cardiovascular Disease

1. Abnormal Cholesterol:

One of the biggest myths about diet and cardiovascular health has to do with the impact of dietary fat and cholesterol.   For most people, dietary cholesterol intake doesn’t impact blood cholesterol levels  and a low fat diet doesn’t necessarily correlate with improvements in blood cholesterol or cardiovascular health.   In fact, a diet high in refined sugars and high-glycemic carbohydrates appears to have a greater negative impact on blood cholesterol and other markers of cardiovascular health than dietary fat.

A healthy cholesterol diet includes a balance of healthy fats, low-glycemic carbohydrates, high fiber, whole traditional soy foods, antioxidant and other micronutrients.

2. Inflammation:

 Chronic, low-grade inflammation has been linked with many negative health associations and chronic diseases, including cardiovascular disease.  High levels of C-Reactive Protein (CRP), a marker of inflammation, have been linked with cardiovascular disease risk.

It is important to address any causes of chronic inflammation for both prevention and management of cardiovascular disease.   Inflammation can arise due to a number of factors including poor diet, poor gut health, hyperinsulinemia, food sensitivities, environmental toxicants (chronic mercury ingestion may be a risk factor for cardiovascular disease), chronic infections such as gum disease (periodontal disease has been linked with heart disease) and chronic stress.   

A healthy heart diet = anti inflammation diet

An anti inflammation diet includes: an organic, whole foods diet approach that is abundant in non-starchy vegetables and a balanced ratio of healthy fats such as: extra virgin olive oil, avocado, nuts/seeds, organic, unrefined & expeller pressed grapeseed and canola oils, evening primrose oil/GLA, wild salmon/fish oil, sardines, fresh ground flaxseed, virgin coconut oil, coconut milk and modest amounts of organically raised, grass fed and finished, lean animal foods (limited red meat).  Include some whole intact grains, whole fruits and legumes.   Anti-inflammatory spices include: turmeric, ginger, chili pepper, black pepper, paprika, cinnamon and clove.  You should avoid refined sugars, flours and other high-glycemic carbohydrates, refined/industrial vegetable oils, fried foods and all types of hydrogenated oils and fats. 

3. Oxidative Stress:

Since the body works as a whole system, most underlying causes of disease are interconnected.  Inflammation and oxidative stress work in a vicious cycle – one influences the other and vice versa - and you really can’t talk about one without the other.

High oxidative stress can be caused from both internal and external factors. In general, it occurs when increased concentrations of free radicals are not properly counterbalanced by antioxidant and other nutrients (ie. vitamins E and C, carotenoids, selenium, glutathione, lipoic acid, coenzyme Q10) resulting in damage to body cells.  

Lipid peroxide is a term that describes fats that have been damaged by free radicals and elevated blood lipid peroxides have been linked to many cardiovascular conditions.  Oxidized LDL cholesterol (from free radical damage) has emerged as a significant risk factor for cardiovascular disease.  Polyunsaturated fats (PUFA) are highly susceptible to damage under conditions of oxidative stress and the component of LDL that is most likely to become oxidized is the PUFA.  Excess iron (from diet and/or supplementation) is associated with increased production of free radicals and linked with increased risk of chronic disease including heart disease.

WHAT DIETARY MEASURES CAN YOU TAKE TO KEEP OXIDATIVE STRESS IN CHECK? A healthy heart diet to reduce oxidative stress:

Avoid excess caloric intake

Eat an antioxidant rich diet:  Eat a rainbow of vegetables and fruits every day (8-10 servings of vegetables and fruits per day), brazil nuts, herring and wheat germ are rich sources of selenium, nuts/seeds and their oils are good sources of vitamin E.

Eat a balance of healthy fats, anti inflammation diet: Emphasize monounsaturated fats (almonds, avocado), some quality, unrefined omega–6 fats (nuts/seeds, grapeseed oil), quality omega-3 fats (wild salmon, walnuts, flax), and modest amounts of quality saturated fats (virgin coconut oil, organic, grass fed and finished, free-range lean meats).   

Avoid rancid, oxidized fats and oils: 

a. Avoid damaged fats such as, hydrogenated or partially hydrogenated fats and oils, industrial vegetable oils, roasted nuts and fried foods. 

b. Essential fatty acids are very unstable and can easily become oxidized.    If you are taking supplemental fish oil make sure it is a quality professional line brand and the total EPA/DHA is not  >40% of the total grams of fish oil.  Flax oil needs to be refrigerated and kept in a light protective, opaque container.  Avoid flax meal and grind whole flaxseed prior to using.

c. To minimize oxidation when cooking or baking with make sure you are using oils that can withstand heat (ie. use coconut oil or organic butter for baking, use grapeseed or avocado oil for high temperature cooking and do not cook with heat sensitive hemp, toasted sesame, flax or olive oil). 

d. Choose quality olive oil in dark glass or tin containers.

Choose a high quality, professional line multivitamin with chelated minerals.  Do not take excess quantities of only 1 or 2 antioxidants or other nutrients.   Get your iron status checked (CBC, ferritin, total iron, TIBC, transferrin saturation %) and do not supplement with iron unless necessary.

4. Micronutrient status:

 An inadequate nutrient intake has been associated with many chronic diseases, including heart disease.  Sub-optimal levels of B vitamins such as folate and B12 as well as magnesium have been linked with cardiovascular disease risk.  For example, elevated homocysteine levels, a risk factor for cardiovascular disease, is attenuated by supplemental folate and other B vitamins. 

WHAT TO DO? A healthy heart diet to address micronutrient insufficiencies:

Get your homocysteine levels checked.  Consider getting your magnesium levels checked (red blood cell (RBC) magnesium is the best measure). Make sure your daily multivitamin with minerals contains sufficient amounts of a chelated form (ie. glycinate, citrate) of magnesium and methylated forms of folate and vitamin B12. Wheat bran, wheat germ, almonds and cashews are good sources of magnesium.  Green leafy plants, legumes and brewer’s yeast are rich sources of folate.  Vitamin B12 is only found in animal foods. Vitamin B6 is found in brewer’s yeast, sunflower seeds and wheat germ.

 5. Cardio-metabolic health:

Metabolic syndrome and unhealthy body composition (increased fat-to-muscle mass) are risk factors for cardiovascular disease as well as other conditions like type 2 diabetes.   Metabolic syndrome is characterized by having at least 3 of the following markers: elevated waist circumference, elevated triglycerides, low HDL cholesterol, hypertension (diet to lower blood pressure) and elevated fasting glucose (an indicator of insulin resistance).   

Central obesity, blood sugar and insulin imbalances, high blood pressure and abnormal blood cholesterol levels influence each other (as well as other systems) and your risk of disease.   Anything driving chronic inflammation contributes to insulin resistance (and vice versa).  Are you starting to get the idea that underlying factors of disease are interconnected? Even if you only have 1 marker of metabolic syndrome it’s worth correcting.

WHAT TO DO? A healthy heart diet to address cardio-metabolic health:

Unhealthy body composition can be due to a number of factors like overeating (high fat, high sugar), lack of physical activity as well as other factors (certain medications, hormone imbalances).   A low-glycemic impact diet plan (40% or lower of total calories from carbohydrate with avoidance of refined sugars, flours, low-glycemic carbohydrates; balanced healthy fats; adequate, quality protein) along with an exercise program that emphasizes resistance and interval training is a good starting point to address metabolic syndrome and unhealthy body composition.  

Eat a variety of foods rich in potassium (sunflower seeds, wheat germ, almonds, brazil nuts), calcium (leafy greens, sardines, canned with bones, almonds, tofu, natural hard cheeses) and magnesium (wheat bran, wheat germ, almonds, cashews). 

Choose a high quality, professional line daily multivitamin with chelated minerals as part of your healthy heart diet.   Try glucomannan (konjac root, sometimes called a “super fiber”) powder or capsules pre-meal as it has been shown to improve metabolic syndrome.

Consider additional testing: In general, low vitamin D levels are associated with chronic disease risk and this includes metabolic syndrome and cardiovascular disease.   Check your vitamin D levels and supplement with vitamin D3 based on your blood levels (aim for 50-80 ng/dL).   You may also consider glucose insulin tolerance, hemoglobin A1C and RBC magnesium tests.

Heart healthy diet plans should consider all of these factors and create food plans that help to manage the many root causes and imbalances that can contribute to cardiovascular disease. 

This is general guide to a healthy heart diet and will need to be personalized based on your health condition.  Other factors such as stress management, adequate sleep and exercise are important for prevention and management of cardio-metabolic conditions.  I hope this page gives you some new ideas on how to modify your diet to help manage and support your health.  

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Some references: Clinical Nutrition: A Functional Approach, 2nd Ed., 2004; IFM Functional Nutrition course, 2012; Hu and Willett. Optimal diets for prevention of CHD. JAMA. 2002;288(20):2569-2578.; Astrup et al. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr 2011;93:684–8.; Siri-Tarino et al. Saturated fat, carbohydrate and cardiovascular disease Am J Clin Nutr 2010;91:502–9; Aggarwal, B. Healing Spices: How to use 50 everyday and exotic spices to boost health and beat disease.  Sterling Publishing Co., Inc.  2011. Natural Medicine Comprehensive Database

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