As the old adage goes, ‘We are what we eat’ – what we put into our body directly influences our health. More importantly, besides commonly known risk factors for cardiovascular disease such as high blood pressure and high blood cholesterol, diet is another major risk factor closely linked to diabetes and obesity which further increases one’s risk of getting heart diseases.

A Heart Healthy Diet

Dr Huang Zijuan, Consultant from the Department of Cardiology advises individuals with risk of heart disease to switch to a heart healthy diet and make deliberate changes to lower or control their cholesterol. She explains more below.

Q: What foods increase risk of heart disease?

Foods that were found to be linked with worse outcomes for your heart would be red meat, processed meat, animal oils like butter, foods with high glycaemic index and refined starchy foods. Even though white meat like chicken is better than red meat, it is still advisable to consume in moderation. A meta-analysis based on available evidence suggested that we could take up to three servings of white meat a week. It did not find an association with increased cardiovascular disease with such moderate amounts of intake of white meat. Fish on the other hand, was found to have beneficial effects for heart health1.

Q: If I’m at risk of heart disease, what dietary changes should I take note of?

A heart healthy diet is one that is more plant-based, meaning it contains more plant-derived foods2. A plant-based diet emphasises more peas, legumes, nuts, grains, fruits and vegetables3. It refers to a wide range of diets, from those including a small amount of animal products like meat and dairy (lower in amount than in the standard western diet) to the other end of the spectrum where the diet solely contains plant products. A popular example is the Mediterranean diet.

It has been found that the greater the amount of healthy plant-derived foods such as whole grains, fresh fruits, green vegetables, legumes, peas and root vegetables, the greater the associated benefit on cardiovascular health. On the other hand, less healthy plant-derived foods such as fries (made with potatoes), cakes (made primarily with flour which comes typically from wheat grains) as well as cookies, doughnuts and soft drinks4, do not have the same beneficial effects. Hence we should try to consume a whole food plant-based diet and not just plant-based foods.

Q: What is a whole food plant-based diet and how does it affect my heart?

Whole food plant-based diets emphasise the use of fresh fruits, vegetables, seeds, nuts, roots, legumes and wholegrains, rather than refined, processed foods like white rice, added oil, added sugar and foods made with white flour. A whole food plant-based diet is rich in fibre, anti-oxidants, plant protein, phytochemicals, vitamins and minerals. When such nutrients are taken in their natural state in a plant-focused diet, rather than from supplements, they have been shown to be associated with a decrease in the incidence of diabetes, obesity, high bad cholesterol levels, hypertension, heart disease, stroke and cancer2, 5. Randomised controlled trials have also shown a decrease in blood lipids (bad cholesterol-LDL and fats-TG), Hba1c (a long-term measure of blood sugar), BMI (body mass index), waist circumference and blood pressure, with whole food plant-based diets5.

Studies have reported reversal of coronary artery blockages using whole food plant-based diets with vegan6 and intensive low fat vegetarian7 approaches. Such full plant-based diets aimed at reversal of coronary artery disease, would need to be done with adequate knowledge and guidance on supplementation from health professionals (like dietitians)8.

Q: What is the best way to reduce the amount of cholesterol in a diet?

A common assumption is that cholesterol intake causes higher blood levels of cholesterol. However, it is actually the saturated fat consumed that causes more effects. Saturated fat consumption increases the amount of bad cholesterol we produce and release into our bloodstream. Saturated fat is more commonly found in animal fats, red meat, egg yolks, butter, cream, and also in certain plant oils like coconut milk/oil and palm oil.

Often times, we do not realise how much saturated fat we are taking at each meal. Cardiac guidelines recommend 10% or less of our energy intake to be made up of saturated fat3 to lower the chances of developing cardiovascular disease. To achieve this, we can follow some basic principles – to eat more foods like whole grains, fresh fruit, vegetables, legumes, peas, tofu, tempeh and root vegetables, and avoid excessive oil or cream in our food. Even healthier oils like olive oil contain saturated fat, so it is good to be careful about added oil in our diet, especially if you already have heart disease. The exception to oils is where it comes to fish, especially oily fish such as salmon, which is beneficial for heart health. Fish or seafood can be taken twice a week for cardiovascular benefits.

The individual’s genetic makeup is one other important factor affecting the amount of cholesterol you produce, and this may result in high bad cholesterol levels in your blood even if you are already controlling the amount of saturated fat in your diet. High levels of bad cholesterol that are undiagnosed and untreated, may lead to cardiovascular events like strokes and heart attacks.

1 Riccardi G, Giosuè A, Calabrese I, Vaccaro O. Dietary recommendations for prevention of atherosclerosis. Cardiovasc Res. Published online July 6, 2021. doi:10.1093/CVR/CVAB173

2 Patel H, Chandra S, Alexander S, Soble J, Williams KA. Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management. Curr Cardiol Rep. 2017;19(10). doi:10.1007/s11886-017-0909-z

3 Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. Published online September 24, 2021. doi:10.1093/EURJPC/ZWAB154

4 Satija A, Bhupathiraju SN, Spiegelman D, et al. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017;70(4):411-422. doi:10.1016/J.JACC.2017.05.047

5 Craig WJ, Mangels AR, Fresán U, et al. The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients. 2021;13(11). doi:10.3390/NU13114144

6 Esselstyn CB, Ellis SG, Medendorp S V., Crowe TD. A strategy to arrest and reverse coronary artery disease: A 5-year longitudinal study of a single physician’s practice. J Fam Pract. 1995;41(6):560-568.

7 Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-2007. doi:10.1001/JAMA.280.23.2001

8 Mariotti F, Gardner CD. Dietary Protein and Amino Acids in Vegetarian Diets-A Review. Nutrients. 2019;11(11). doi:10.3390/NU11112661

This article is from Murmurs Issue 41 (September – December 2021). Click here to read other articles or issues.