In the second month of the year, stores think about paper hearts and the medical calendar tells us that February is Heart Health Month. While we can agree that there are certain micronutrients that are good for heart health (magnesium and its best delivery system: chocolate), the medical world has not come to a clear understanding of what causes heart disease.
Revised January 26, 2015
Let's take a good look at the basics of sound nutrition for a healthy heart and cardiovascular system. The blood vessels throughout your body and the ones supplying circulation to your heart must stay clean, supple and resilient for your heart to work normally. There are certain foods you should be eating on a regular basis to keep healthy both your heart and its huge supply of blood vessels, the vascular network. Not surprisingly, there are also some foods you should be avoiding.
Looking at the physiology of a healthy heart, there are two very different structures to be nourished: the heart itself and the blood vessels surrounding the heart, the coronary arteries. The heart is a muscle and shares with other skeletal muscles of the body needs for certain nutrients to keep it strong. An amazing muscle: just for comparison, try to rhythmically contract any other muscle of your body 70 times a minute 24 hours a day and see how that feels. Just might increase your appreciation for the muscular nature of your heart. It works hard, it works constantly, and needs appropriate fuel to do its work. Muscle fibers work best without the problems caused by scar tissue, calcifications, inflammation, weakness or atrophy.
The coronary blood vessels that supply blood flow to your heart are part of the network of blood vessels that travels everywhere in your body. The three major coronary vessels divide into progressively smaller vessels, culminating in an expandable network of fine capillaries that deliver oxygen and nutrients to the hard-working muscle. (Expandable in the sense that your body is capable of creating new blood vessels when needed, up to a point.) The vessels, like the muscle, also must be strong, supple, resilient, and free of problems. The problems that can arise in blood vessels include scar tissue, calcification, atherosclerotic plaque, inflammation and weakness leading to rupture. Your doctor can take laboratory tests such as a Lipid Panel, or checking levels of Homocysteine, highly sensitive C-Reactive Protein, vitamin D, and serum glucose and insulin as indicators of the general health of your cardiovascular system.
A nutritional plan that keeps your heart healthy must provide the nutrients for needed muscular work as well as the tools for avoiding or cleaning up any problems that develop in either the muscle or the vessel walls. Most problems arise from some inflammatory stimulus. The level of inflammation in your body can rise or fall with your food choices, so making anti-inflammatory choices helps to keep your heart healthy.
- Eat a wide variety of protein from pasture-raised animals and wild fish, including eggs and organ meats on a regular basis. A handful of nuts eaten three times a week has significantly reduced cardiovascular mortality in a recent study. Make several varieties of crispy nuts. On the run, choose raw nuts and avoid roasted (usually damaged vegetable oil roasted) nuts.
- Choose organic fats, including healthy saturated fats (meat, butter, eggs), monounsaturated fats (avocado and olive oil), and gently handled polyunsaturated fats (from fish, fish oil and a small amount of flax.)
- Choose fruits and vegetables to make a “trip around the color wheel” every couple of days
- Limit sweets and either limit or eliminate grains and legumes.
- Alcohol is probably helpful, one (women) or two (men) drinks a day.
In the interests of fueling your heart as a muscle, your diet should include a regular intake of healthy protein balanced with a specific assortment of food-based nutrients.
Choose a wide variety of protein sources that are also rich in vital micronutrients such as
- the B vitamin known as folate, prevalent in liver;
- l-carnitine, found in meats, vegetables, and as a supplement or made by the body, and crucial to heart health;
- choline, found in liver, eggs, and other meats;
- coenzyme Q10, a vital element in each cell, found in meats and liver, and depleted by the drugs known as “statins”.
Previous concerns about the saturated fat in meat and eggs have not been substantiated in any reliable research. In fact, a thorough review article, which compiled data from decades of studies, showed “that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”
Ironically, it is the nature not of the saturated, but rather of the polyunsaturated fats in the meat that can determine whether they are healthy for you to a greater or lesser degree. That's right, red meat also has polyunsaturated fats, similar to chicken and fish. Meat that is fed grain, or finished with grain, has high levels of omega-6 fatty acids and should not be consumed regularly; most poultry is higher in omega-6 fatty acids. Meat that is raised and finished on grass has a higher omega-3 fatty acid content; salmon, sardines, and other “heart healthy” fish are high in omega-3 fatty acids.
A smart selection of heart healthy proteins include the variety of nutrients available from:
- Meat and eggs from pasture-raised animals, including poultry and 4-legged animals such as beef, lamb, and pork, at least two servings daily. Although people think of chicken as somehow “lighter” and better for your health than beef, it is the 4-legged grass eaters such as cattle and lamb (and wild game) that are higher in omega-3 fatty acids, important for all aspects of health, particularly to reduce levels of inflammation. Eat 4-legged meats 4-5 days a week, save poultry for just one day a week.
- Wild-caught cold water fish provide valuable omega-3 fatty acids and excellent proteins. Choose from salmon, halibut, mackerel, sardines, and include them in your meal plan two times a week.
- Organ meat from pasture-raised animals, beef, lamb or chicken, once or twice a week. Although chicken meat is high in not-so-needed omega-6 fatty acids, the chicken livers are higher in omega-3 fatty acids. If you have never tried chicken liver pate, sample one of the recipes found on my website and tell me if you like it! Eat liver once a week, or supplement with Dr. Ron's Organ Delight.
- Vegetarian sources of protein can include eggs, raw milk, and cultured milk products, but supplementation with Dr. Ron's Organ Delight would provide a greater range of vital micronutrients. Dairy follows the same guidelines as in other pages on this site: raw is best. If you can't buy raw milk, look for full fat and un-homogenized dairy from cows raised on pasture.
- Vegan strategies for obtaining adequate protein fall short of the necessary protein and micronutrients requirements, necessitating supplementation of vitamins B12, K2 and Zinc, at a minimum. Ideally, adding fish oil and Organ Delight would provide a better balance, but may be unacceptable to most vegans. In that case, the best supplement would be Flax Seed Oil, not recommended in general because of the difficult process of transforming it into the essential oils we need. Denise Minger has a great discussion on supplementation recommended for those choosing to eat a vegan diet. Additionally, vegan sources of protein require careful preparation (long soaking and slow cooking) to minimize the toxins and anti-nutrients that are present on the outside of the beans as nature's way of getting beans through our digestive systems and into the ground before they sprout. Good for the beans, hard on our guts!
A healthy cardiovascular system and a healthy human body require a diversity of fat sources in the diet and the avoidance or minimizing of unhealthy fat sources, which can lead to a chemical process called “oxidation”, which causes inflammation in a multitude of ways.
- Saturated fats in the diet are not associated with an increased risk of heart disease, a now well-documented reversal of decades of prior theories. Saturated fats (coconut oil, butter, cheese) raise both “good” and “bad” cholesterol, terms which are misnomers but which I'll address elsewhere, and promote the production of Type A LDL particles (large, buoyant and safe) over Type B (small, hazardous) LDL particles. Saturated fats are relatively stable when heated.
- Monounsaturated fats (olive oil, avocado oil, macadamia nuts and oil) are also relatively stable when heated. As a component of either the Mediterranean Diet or other healthy, balanced diets, olive oil consumption appears to reduce the risk of cardiovascular disease.
- Polyunsaturated fatty acids (PUFA) are highly unstable to cooking and, although we need both of the essential fatty acids (omega-3 and omega-6), our current diet emphasizes the omega-6's to a fault. You can probably stop eating them right now, hold off for some time, and still have some in reserve! Nuts are a good source of PUFA's, and nuts must be prepared as carefully as grains and beans to be kind to your gut! Avoid commercial roasted nuts, as roasting is usually done with vegetable oils.
- Bad: Trans fatty acids. Naturally occurring trans fats (in butter) are helpful and definitely not the problem that artificial trans fats have been. Remember Crisco? It seemed so convenient, but then, oh darn, we found that it does terrible things to not only our blood lipids but to our actual blood, blood vessels, and general levels of inflammation. It is thanks to the pioneering work of Mary Enig from the Weston Price Foundation that trans fats are labeled in food, but bear in mind that any processed food can contain trans fats, but they can be labeled as “zero” if they are below a threshold amount. Better not to eat boxed and packaged foods.
- Bad: Most vegetable oils, including celebrated canola oil. They are far too rich in omega-6 fatty acids, which diminish the amount of effective omega-3's and they are particularly dangerous if used for cooking. Sadly, most restaurants do rely on vegetable oils for cooking. You might be surprised, ask your waiter to ask the chef.
Heart-specific micronutrients will be found most plentifully in the organ meat, mentioned above, and complemented well with sources from other foods.
- Quercetin should be included on a daily basis, whether from citrus fruits (lemon on the salmon!), onions, red wine, or dark berries. A recent study showed that berries can reduce the rate of heart disease in women and at the very least, they will still offer beneficial quercetin to men.
- Folate from liver (weekly) or from leafy greens (daily). A good rule of thumb is that for one or two meals a day, leafy greens (eaten raw as salad, or cooked, or even fermented into sauerkraut) take up most of the real estate on your plate - about 2/3 the size of a standard dinner plate. Cooked down, the spinach pile will shrink, but cooked carefully, without excessive heat or exposure to unstable vegetable oils, the nutrients will still be there.
- Monounsaturated fats from avocado, olive oil, lard from free-range pigs and butter from pasture raised cows, as well as certain nuts. Although walnuts are deemed “heart-healthy”, they are rich in polyunsaturated fatty acids with a predominance of omega-6 fatty acids: macadamia nuts, cashews, filberts, and almonds might be a better choice because a larger proportion of their fats are monounsaturated fats.
- Anti-oxidants and polyphenols in fresh or frozen berries, half a cup a day, is best, or any fruit (up to 3 pieces a day) that is colored throughout the fruit, such as melons, plums, apricots. Although a vitamin C pill theoretically provides anti-oxidant benefits, there is no doubt that foods containing vitamin C and other anti-oxidants provide more effective anti-oxidant protection.
- Dark chocolate, one ounce daily of 85% cacao or greater, provides beneficial magnesium as well as resveratrol.
- Garlic seems to contain something that has wonderful effects on lipid levels, blood consistency, and more. Not a micro-nutrient but more of a supplement, the likely active component allicin, makes a savory addition to your regular meal planning and helps your heart at the same time.
As probiotics are emerging as key components of a healthy immune system - one function of which is to regulate the proper balance of allowing yet limiting inflammation - probiotics are a valuable part of a heart healthy diet. A part of the discussion can be found here. Probiotics can be incorporated in a variety of ways:
- Lacto-fermented vegetables, such as kim chee or sauerkraut, easily homemade by this recipe, deliver generous quantities of lactobacillus, one of the most numerous species of flora in a healthy intestinal system.
- Fermented dairy, either yogurt, kefir, or cheese provide smaller amounts of lactobacillus and other milk-friendly bacteria.
- For those who tolerate some grains, and within reasonable amounts, beer can be a refreshing serving of probiotics.
- If none of the fermented foods appeal to you, choose a probiotic supplement as described below.
Cook proteins gently.There is an appeal to a seared piece of meat, but not to your arteries. Both the meat and the oil (hopefully organic lard, butter, ghee, or olive oil) suffer from exposure, however brief, to high temperatures. You can get a bit of brownness with gentle heats, and never be tempted to cook with (or eat!) highly unstable vegetable oils or canola oil. Alternatively, find recipes that poach or stew rather than frying or broiling. A gentle roasting might be somewhere in the middle.
And eggs! When you're cooking eggs, the delicate cholesterol (easily oxidized) is well protected if you don't break the yolk during cooking. Egg yolks from healthy chickens may be eaten raw, but always cook the egg whites before eating.
Grains and beans. While the conventional wisdom is to consume a diet rich in whole grains and high fiber beans, they are not necessarily safe to eat. Folks with existing health problems, particularly problems with a component of increased inflammation, might do well to eliminate them completely for a month to see if the grains and beans are adding to your problem. They are not an essential part of your diet, so if you do better without them, that's fine.
If you don't have elevated levels of inflammation and you like grains and beans, you could develop inflammation from these foods unless you prepare them carefully. Grains and beans are naturally packaged to irritate the digestive tracts of foraging animals, so that the grains can safely sprout after they exit the body with a nice batch of fertilizer. They exert the same irritating effect in our intestines, unless we soak them an appropriate amount of time before preparing or consuming. See the clear guidelines in Nourishing Traditions (by Sallon Fallon and Mary Enig) about preparing grains and beans to minimize irritation.
Sugar! Sugar has the same bad reputation in the coronary neighborhood as elsewhere in the body. Table sugar and fructose both have adverse effects on your lipid levels as well as your blood sugar and blood insulin, with some reason to believe that fructose is even more harmful than regular sucrose, or table sugar. Eat the sugars that appear naturally in foods, and reserve added sugar for occasional (few times a month?) treats.
Alcohol. Although it's not clear why, it seems that those who have one or two drinks a day have less cardiovascular disease than those who abstain. If you don't already drink, that's fine. If you do - a drink (women) or up to two (men) a day seems to decrease the risk of cardiovascular disease without increasing the risk of any other diseases.
Salt. Sigh, salt… Almost as hated and feared as saturated fat, our most time-tested seasoning is also a necessary micronutrient, and our bodies generally are wise in determining the amount we need by taste. Conventional cardiology will tell you that salt is to be avoided, but science writing award winner Gary Taubes will say, and I quote, “Salt, We Misjudged You."
The issue with salt is that it's easy to over-consume salt in processed and packaged foods, along with sugar and beverages to balance the salty taste. Excess salt is a known and intentional appetite driving food additive. The bottom line is not to avoid salt, but rather to avoid processed foods. At your own stove and table: salt to taste.
Folks with known congestive heart failure are the exception: you need to follow doctor-prescribed guidelines, which often still obey the same rule: no processed foods, no restaurant food (or “Hold the salt in cooking please”), and you can still salt your own food to taste.
Pritikin and Ornish
Some science has tentatively supported, and Medicare has wholeheartedly funded, interventions suggested by nutritionist Pritikin and Dr. Dean Ornish that reduce dietary protein quite low (15-20% of calories), fat even further (10%) and fill out the carbohydrate calories with complex carbs: beans, grains, veggies, and fruit. Egg whites and nonfat milk. Such dietary strategies are espoused in Colin Campbell's book The China Study, although not in the China Study itself, and in the documentary, “Forks Over Knives.” Despite claimed success, the ultra-low fat strategy has not fared well in recent studies compared to the Mediterranean Diet and the Paleo Diet, both of which - and I don't mean this trivially - are far more tasty and likely far more sustainable.
What Campbell, Esselsteyn, and Ornish all get RIGHT is that a diet composed of real, whole foods is undeniably better for every part of your body than a processed, packaged, and sweetened plate of the standard American diet (SAD). And if plant-based, low fat was the only alternative to the SAD, it would be a great choice. But of course you can eat the dietary program described above, find lots of research to substantiate your choice, and enjoy a steak with your big plate of salad. The best critique of "Going Vegan Is THE Way to Save Your Heart" is offered by Denise Minger here, in her smart and funny blog article. She teases apart the documentary, and with it, all the claims to vegan superiority.
If you're following the above dietary guidelines, and your lab tests (see below) stay within the normal range, your supplements can be limited to the basics. Fish Oil taken in the range of 1000-1500 mg daily. If you eat cold water fish twice a week, this may be unnecessary: a blood test for omega 3's is helpful, but not always available.
Vitamin D3, in sufficient doses to keep your blood levels normal, or approximately 40-65 ng/mL.
Dr. Ron's Organ Delight is important for folks who don't eat liver and obtain the vital nutrients through their food. Take 1-3 capsules daily.
Vitamin D. If sun exposure is not giving you adequate vitamin D3 levels (40-65 ng/mL), take Pure Encapsulations Vitamin D3. Take as needed to normalize blood levels.
Magnesium. Thorne Research Magnesium Citramate: Take 150-600 mg daily according to bowel tolerance of this or other healthy magnesium supplement.
Lipid Profile. Years ago, your doctor ordered a single test for total cholesterol, and based a health program based on that single number. Now we know that a detailed lipid panel includes values for sub-fractions of the various kinds of lipids found on a routine panel. For instance “LDL”, termed the “bad cholesterol”, is actually made up of good LDL (large, buoyant, type A LDL) and bad LDL (small, beady, inflammatory type B LDL), so the total amount is meaningless without knowing how the sub-fractions are partitioned.
Simple interpretation of the Lipid Profile that is almost always borne out by more detailed testing is that your value of triglycerides should be 100 or less and your HDL should be 50 or more, the ratio between them (TG/HDL) always < 2.0. If it's not, you can correct it by eating less carbohydrates. Simple. If your numbers are way off, you will probably have to eliminate grains, legumes, sweets and overly sweet vegetables, and include more healthy proteins and fats. A little exercise, a little red wine, and all should be good, for most people. Stubborn problems require professional consultation.
Homocysteine. Homocysteine is a protein that a healthy body recycles into methionine and cysteine by attaching a methyl (-CH3, remember chemistry?) group donated from B vitamins, particularly vitamin B12, B6 and folate. If your dietary intake or physiological absorption of those vitamins is limited, or if you have a genetic predisposition, your homocysteine levels can be higher than optimal and indicate an increased risk for cardiovascular disease and others. If your vitamin levels are adequate, but your homocysteine levels high (9 mcmol/L or higher), you might want to have the genetic testing done. If you have the full genetic abnormality in the MTHFR gene, you can benefit from taking pre-methylated (CH3 already attached!) versions of the pertinent B vitamins.
Iron. It has been proposed that pre-menopausal women are relatively immune from heart disease because of their monthly menstrual cycle. Although there is a risk of anemia, it is rare that a woman has too much iron when she is still cycling. Iron is an oxidizer, consuming valuable anti-oxidants, and where there is clearly excessive iron, cardiovascular disease is increased. For men and for women no longer cycling, a reasonable approach to iron is to consume it regularly in the iron-containing foods that have so many other benefits to the heart, linked with regular (3-4 times a year) blood donation to decrease high levels of iron. (A Ferritin level of 30-40 is great, under 100 is fine. Over that, maybe some Red Cross visits would be good.)
hs-CRP. The C-reactive protein test, the highly sensitive version, measures the subtle levels of inflammation that raise your risk of cardiovascular disease, and can arise from various seemingly minor inflammatory processes in the body. The ideal value is less than 1.0 mg/L, and although average is 1.0-3.0 mg/L I'm not sure that's a good idea considering the average level of health being tested, so think < 1.0 as your goal. Levels higher than that indicate the need to look for a source of inflammation: allergies, infections, or food sensitivities. The first step I'd recommend would be to eliminate gluten, legumes, and dairy for a month and re-test. Normalization points to one of those as the culprit; failure to normalize indicates the need for further testing.
The well known lifestyle choices are still true: keep a healthy weight, refrain from smoking (first or second hand) and chewing tobacco, and monitor your blood pressure so you can seek attention if it goes above ideal, which is less than 120/80. What hasn't received proper attention is the importance of balancing your nervous system.
Exercise has long been described as key to a healthy heart, but the definition of what that means has been widely debated. The topic deserves a full-length article of its own, but let me make two observations based on recent positions within the fitness and medical communities.
- “Aerobic” exercise is overrated. There are many benefits to a pleasant walk in the park: companionship, flexibility, range of motion, improved sleep and perhaps some vitamin D exposure. Take that exercise one step up, to gentle running or jogging (running at a pace either allowing for conversation) and the controversy heats up. Although moderate sustained exercise is loosely referred to as “cardio”, it is not so clear that it benefits either cardiovascular health, or other indicators of general health such as weight, insulin resistance, or general fitness. Dr. Kurt Harris wrote two excellent pieces here and hereon the oxymoron of “cardio” exercise, detailing the increased evidence of cardiac damage in marathon runners, chalking up 35 miles weekly in their training. Many of the marathon runners “looked” a lot healthier than their sedentary counterparts (lean, better lab values), but, uh oh, had more calcified plaque in their coronary arteries. Not good. Particularly bad if you are a carb-loading “cardio” athlete: more inflammation. Maybe a lot of “cardio” exercise is in fact stressful and not beneficial for keeping your heart and coronary blood vessels healthy.
- Exercise that doesn't come naturally to non-athletes may bring you the greatest benefit for cardiovascular health. If you don't see yourself as athletic, I'd like to encourage you to try something new - alternating sprints and rests in a way that incorporates weight lifting and interval exercise, yet with no special equipment required. It will be challenging but rewarding!
What you'll need is comfortable clothing, with a cushioned (a towel? thick carpeting?) floor space, a counter or table that stands somewhere between waist and hip height and a clock with an easily visible second hand.
- Spend 5 minutes walking around, stepping as high as you safely can and swinging your arms. Face and place your hands on the counter standing 2-3 feet away; keeping your back straight, gently lower your chest toward the counter and push yourself away again, a “countertop push-up”. Find the right distance for your feet so you can do this comfortably. Twist gently from side to side. Get down on the floor, pull your knees one at a time to your chest, and get back up again a couple of times. Now for the challenge:
- Note the clock and Sprint Push-ups! for 20 seconds. Position yourself “your distance” from the counter and do as many of the counter-top pushups as you can do in 20 seconds. Rest for 10-50 seconds until you are ready to…
- Sprint again! Repeat the 20 seconds of pushups! Repeat the rest
- Lower yourself to the floor. Lie on your back with your knees bent, feet flat on the floor. Hands behind your neck and Sprint Sit-ups! Lift up head, neck, hands and upper chest, keeping your mid and low back on the floor. Repeat as many times as you can in 20 seconds. Rest for 10-50 seconds until you are ready to…
- Repeat the 20 seconds of Sprint Sit-ups!
- Congratulations! At this point you can call it a day, and just let yourself cool down with a walk around the room. But when this routine seems a little easier to you, repeat the Sprint sections you like until you have done a total of eight sprints. That's one full set and great exercise.
- Work yourself up to doing one or two sprint sessions, two or three days a week.
- Alternate Sprint Squat. Proper positioning is very important to squat safely. Position yourself in front of a low chair, sideways to a mirror. Stand tall with your hands at your side. Before you begin to lower yourself to the chair, push your own butt out and back and aim for the chair, lifting your arms in front of you as you sit on to the chair. Before you start back up, push your butt back and up and follow with straightening of your legs and relaxing of your arms. Repeat several times with the chair, noticing the lead of your butt and lower back, before you try it without the chair, lowering yourself just as far as is comfortable.
Nervous system balance usually means that your over-active sympathetic (fight or flight) nervous system is crowding out the effectiveness of and time spent with dominance of your parasympathetic nervous system. Take a little time to exercise your parasympathetic (rest and digest) nervous system, by:
- Meditation. Meditation may be challenging, because no one does it perfectly! But it's also comforting because just doing it gives you the benefit, whether or not you do it "well." See these simple instructions for guidelines about meditating on your own at home. Alternatively, find a group that meditates together, or seek out a teacher.
- Breathing exercises. I've learned this from a few teachers, and it is great at helping me relax to return to sleep if I wake too early. Position the tip of your tongue on the roof of your mouth, right behind your upper front teeth. Open your mouth and make a "whooshing" kind of exhale. Inhale to the count of 4, mouth open or closed. Hold your breath for the count of 7. Make another whooshing exhale, for the count of 8. Repeat four times. You can go through the whole series twice a day for maximum benefit, so it will be maximally relaxing when you repeat it in the night, or before you go into the dentist's office!
And now that you've read this long article… stand up, walk outside and get some sunlight!