Whilst cardiovascular disease (CVD) is the leading cause of death globally, the good news is that the risk of it can be hugely reduced by simple changes to our diet and lifestyle.
These are called ‘modifiable factors’ ie. things we do can do which have a positive impact on our health. Following a few simple actions can reduce the reliance on medications or operations and increase our ability to live life as well as we'd like.
The INTERHEART study, published in the Lancet in 2004, followed 30,000 people in 52 countries. Researchers found that lifestyle changes could prevent at least 90 percent of all heart disease.
The 2009 EPIC study considered 23,000 people who adhered to 4 simple behaviours: not smoking, exercising 3.5 hours a week, eating a healthy diet, and maintaining a healthy weight. Sticking to these four behaviours alone seemed to prevent 81% of cases of heart attacks and 50% of cases of strokes (as well as 93% of cases of type 2 diabetes (T2D) and 36% of cases of all cancers).
Looking at exercise, a recent study concluded that a combination of endurance and strength training improved the risk profile of CVD in overweight adults.
Being overweight and/or a smoker increases your risk of heart attack or stroke, as does having T2D and high cholesterol. And even if you’re not in any of these categories, the impact of stress can also be a significant contributing factor to heart issues. Regular exercise helps reduce the effects of stress, contributes to weight loss and maintains muscle strength and tone – and remember that the heart is a muscular organ right in the centre of your blood circulation system.
Which brings me onto blood pressure, a fundamental indicator of your CV health. As most of you know, a blood pressure reading is made up of two figures: the pressure on your arteries when your heart contracts (the first figure, called systolic) and when it’s relaxed (the second figure, diastolic). In most people, systolic blood pressure can rise steadily with age due to the increasing stiffness of large arteries, long-term build-up of plaque due to inappropriate cholesterol levels and chronic stress.
In addition to the physiological effects of stress causing ill-health, we can often use poor coping strategies to manage life-load, resorting to ‘quick reward’ foods such as chocolate, biscuits, cake, crisps and takeaways, as well as increased alcohol or caffeine intake. Often our exercise levels decrease, we don’t sleep as well and we put on weight. This scenario can lead to hypertension - a significant risk factor for heart attack or stroke.
So, what constitutes ‘a healthy diet’? There is no single diet that suits everyone, because as individuals, we all differ slightly in our health needs. But there are guidelines which if we follow, can give us the foundation of good health and significantly reduce the risk of CVD. Let me clarify two areas first:
1. Dietary fat: you may have been told to cut fat from your diet if you are overweight, have ‘high’ cholesterol or already have a diagnosis of hypertension or CVD. But not all fat is bad for your health; in fact, we have a fundamental need for ‘essential fatty acids’ without which our body cannot function. 60% of our brain is made from fat, fat is vital to the functioning of our nerves, cholesterol is the basis of our steroid hormones (including oestrogen, testosterone and cortisol) and we need fat to absorb fat-soluble vitamins. Fat keeps us warm, protects our organs and provides an energy source.
However, too much fat is inflammatory. Systemic inflammation is the cause of most of our modern diseases (and if you don’t know about this, you should watch my short, free video 'What does Health Really Mean?'). Carrying excess fat is not only bad for your joints but it produces inflammatory chemicals which disrupt the normal function of your body, including your cardio-vascular system.
And not all dietary fats are equal. It is the TRANS-FATS in ultra-processed foods which cause the main breakdown in our body systems. Trans-fats are a kind of Frankenstein fat added to food to improve shelf life and mouthfeel of products. Trans-fats are high in omega-6, a type of fat which is highly inflammatory if eaten in excess, and stiffens our blood vessels. One study found that the risk of heart disease doubled with each 2 percent increase in calories from trans fats (Iqbal, 2014). Another researcher concluded: “On a per-calorie basis, trans fats appear to increase the risk of CHD (coronary heart disease) more than any other micronutrient.” (Mozaffarian et al., 2006).
Traditional advice has been that dietary fat is the cause of high cholesterol and CVD. However, it’s now increasingly accepted that it’s the combination of fat (especially trans-fats) with highly processed carbohydrates which causes ill-health.
2. Carbohydrates: like fats, not all carbohydrates are equal in terms of their nutrient value or calories. Both broccoli and croissants are carbohydrates: the first is packed full of health-supporting nutrients including fibre, anti-oxidants, vitamins and minerals. It’s pretty much in its natural state. The second is highly-processed: low in fibre, packed full of trans-fats, refined grains (which strips out all nutrient value), sugar and empty calories.
Refined or ultra-processed carbohydrates are found in a wide variety of foods: white bread, pasta, muffins, cakes, cookies, crackers, bagels, take-aways and ready-meals. Unfortunately, these foods make up a pretty good chunk of the modern Western diet. One study from China found that a higher carbohydrate intake, mainly from refined grains, was associated with an increased risk of coronary heart disease among 117,366 adults (Yu et al., 2013).
If you’re eating plenty of plant-based carbohydrate foods, your fibre intake will naturally increase. The opposite is the case if you eat an ultra-processed diet where the refined foods are stripped of their fibre. Fibre is essential for healthy gut and bowel function, keeps up fuller for longer and helps stabilise our blood sugar.
Sugar, a form of carbohydrate, is one of the main culprits of heart disease; it’s the most inflammatory substance you can put into your body. Added sugars from foods like sweets, desserts, juice and soft drinks can spike blood sugar levels and damage the blood vessels, increasing the risk of T2D and heart disease. A study from Harvard School of Public Health found that participants who drank the highest levels of sugar-sweetened beverages had a 20% higher relative risk of developing coronary heart disease than those who drank the lowest amount (de Koning et al., 2012).
And you’ll find added sugars in most highly processed foods, even savoury ones: sugar is a preservative, increasing the shelf life of products, and because most processed foods are full of chemicals and additives, adding sugar compensates for the loss of flavour as a result (especially in ‘low-fat’ varieties).
WHAT THIS MEANS IS …
1. Eat healthy fats such as avocado, oily fish, seaweeds, full fat natural, live yogurt and kefir, nuts and seeds. These help to keep us fuller for longer and stabilise blood sugar. They are high in omega3 fatty acids which keep structures pliable, allowing easy passage of nutrients into cells, keep our blood vessels flexible and our nervous system (brain and nerves) working optimally. They are also hugely anti-inflammatory. Trans-fats and an excess of omega6 fatty acids can lead to hardening of blood vessels, increasing the risk of hypertension.
2. Consume plenty of vegetables and fruits: focus specifically on eating veggies which grow above the ground and fruit that can be grown in this country. These foods naturally contain either less natural sugar or lower amounts of carbohydrate. At each meal, have this cover at least half of your plate. Over the course of a week, aim to eat all different colours - span the rainbow to enjoy a diverse intake of nutrients.
3. Eat a source of protein at every meal and snack; again, protein helps satiation and and blood glucose regulation. This can be any fish/seafood, poultry, meat, nuts, seeds, tofu, eggs. Try to eat more oily fish and/or more vegetable sources of protein over the week. Ideally, eat two to three vegetable-based protein meals weekly.
There have been numerous studies connecting processed meats, like hot dogs, salami, bacon, sausages and tinned meat to a range of adverse effects on health. Not surprisingly, processed meats can also negatively affect heart health, so best to limit them. Sourcing organic, grass-fed rather than grain-fed red and white meats will provide better quality nutrients.
4. Think carefully about the quality (what kind) and the quantity (how much) of starchy carbs like bread, pasta, cereals, potato, rice. Focus on wholemeal over white bread (brown sourdough is even better), sweet potato over regular white potato, basmati or brown rice over long grain. You can also swap them for cauliflower rice or courgetti.
5. Vegetable oils can be very damaging for heart health. Oils such as rapeseed and sunflower seed are inflammatory (even though the supermarkets are brimming with these options) due to their high levels of pro-inflammatory omega-6. Swap these for olive, avocado and coconut oils.
6. Remove as much sugar as you can from your diet as this is the real villain. This means saving sugary treats for special occasions and, most of the time, ditching breakfast cereals, cakes, cookies, pastries, and so on, and checking the label of jarred sauces and carton soups, where sugar often lurks.
7. Avoid fizzy soft drinks. Eliminating soft drinks is one of the best things that everyone can do for their heart. Besides being laden with controversial chemicals, colourants and other unhealthy ingredients, soft drinks are also brimming with added sugars.
So, give your heart some love by not smoking, eating real foods and moving regularly – your weight will stabilise or decrease, and you’ll feel better for it overall.
Have a happy Valentine’s Day xx