Heart-Healthy Diet

Frightening news: The American Heart Association recently released a report stating that by 2050, at least six out of 10 Americans will have some type of cardiovascular disease. That includes coronary heart disease, heart attack, stroke, heart failure, heart arrhythmias and vascular disease.

But there is encouraging news—80% to 90% of heart disease is preventable through science-based lifestyle changes…and getting the right nutrition tops the list, says preventive cardiology nutritionist Michelle Routhenstein, MS, RD, CDE, CDN.

A heart-healthy diet keeps your heart beating effectively and efficiently. Eating the right foods even can help if you’ve already been diagnosed with cardiovascular disease.

What a heart-healthy diet does: Prevents plaque accumulation in the arteries (reducing risk for atherosclerosis, a thickening or hardening of the arteries) and even prevents plaque formation and progression, shrinking and stabilizing soft plaque…improves blood flow and reduces blood pressure…minimizes inflammation…and prevents excess strain on the heart muscle.

What Is a Heart-Healthy Diet?

A heart-healthy diet plan promotes healthy weight maintenance, provides fuel for regular workouts and helps prevent insulin resistance, which occurs when the cells in a person’s muscles, fat and liver don’t respond well to the blood-sugar regulating hormone insulin. Chronically elevated blood sugar levels caused by insulin resistance can lead to compromised blood vessel health…increased plaque accumulation…elevated blood pressure…inflammation that increases risk of blood clotting…and more.

These consequences make it harder for the heart to do its job. That can lead to, among other things, heart failure, when the heart cannot sufficiently pump blood throughout the body. Bottom line: Insulin resistance and heart disease go hand in hand—people who have had a heart attack often are insulin-resistant.

Some of the most significant drivers of insulin resistance include…

• Poor nutrition. Regular consumption of simple carbohydrates such as white bread and other refined grains, candy and soda causes blood sugar swings that trigger insulin surges. Over time, this cycle creates insulin resistance.
• Excess body fat. Carrying excess weight around the abdomen, called central obesity, is particularly concerning. This fat releases chemical messengers that contribute to insulin resistance.
• Low levels of physical activity, which is important for overall and heart health.

What’s in a Heart-Healthy Diet?

A heart-healthy diet consists of the right balance of complex carbohydrates, lean proteins and healthy fats to combat insulin resistance and keep weight in check. These macronutrients are necessary for cardiac optimization.

Complex carbohydrates. Whole grains (brown rice, whole grain pasta, quinoa, barley, oats, whole-wheat bread), beans and legumes, vegetables and fruits are your body’s preferred energy sources. Fiber-rich complex carbs such as these help slow the digestion of these foods, allowing your body to metabolize the carbohydrate more effectively. Besides keeping blood sugar levels stable and making it easier to maintain or achieve a healthy weight, complex carbs help keep energy levels high, giving you the oomph you need to exercise.

The bulk of complex carbs in a heart-healthy diet should come from non-starchy vegetables such as asparagus, cabbage, celery, cucumber, eggplant, mushrooms, peppers, radishes, lettuce, tomatoes…cruciferous veggies, such as broccoli, cauliflower and Brussels sprouts…and leafy greens, including kale, spinach and collards.

Healthy fats. When crafting a heart-healthy diet plan, don’t neglect good-for-you fats like the ones found in avocados, nuts, seeds, olives and olive oil, and fatty fish. Many heart-healthy fats, like those found in salmon, sardines, walnuts, flaxseeds and chia seeds, increase the body’s levels of omega-3 fatty acids, which reduce heart disease risk by calming inflammation. Your body also needs healthy fats to absorb fat-soluble vitamins (A, D, E, and K) and antioxidants like carotenoids, all of which promote cardiac health.

Lean proteins. Fish, white meat poultry, legumes, nuts, soy, and low-fat and fat-free dairy help preserve muscle mass and keep you feeling full. Think of these as side dishes to complement the complex carbs and healthy fats above.

The heart-healthy foods probably sound familiar—that’s because they are staples in the Mediterranean diet. Mediterranean-style eating is indeed linked with heart health. The diet’s emphasis is nutrient-dense, plant-forward and anti-inflammatory foods. Problem: Many people misinterpret the Mediterranean diet because of things they’ve heard through the grapevine or read in headlines. Example: Some cardiac clients started consuming multiple cups of olive oil a day, thinking it was good for their heart. But that much olive oil could cause weight gain and may make you feel so full that other critical heart-healthy foods are crowded out.

The number of servings and portion sizes for carbs, proteins and fats depend on individualized factors such as your current cardiovascular health, weight, age, gender, exercise levels, kidney functioning and more. Best: Consult a cardiovascular nutritionist, dietitian or other health professional with heart health expertise. To find one near you, go to EatRight.org (click on “Find a Nutrition Expert”).

What About Foods to Avoid?

Newly diagnosed heart patients often receive a list of all the foods to avoid—salt, carbs, red meat, fat, oils and fruit. But this kind of advice tends to foster overly restrictive “heart-healthy diets,” resulting in nutrient deficiencies that overstress the cardiovascular system.

Consider the “no salt” advice. Most cardiac patients are advised to reduce their sodium intake because high amounts of sodium can increase blood pressure and damage blood vessels, raising the risk for heart attack, stroke and heart failure. While that is true, your sodium-to-potassium ratio may matter more than the amount of sodium you consume. Reason: Sodium and potassium work together to regulate blood pressure. They function best when in a 1:3 or 1:2 ratio, meaning when an individual consumes two to three times more potassium than sodium. (Potassium also stabilizes the heart’s electrical impulses, ensuring a steady heartbeat and preventing arrhythmias.) If you slash your sodium intake significantly but don’t take steps to obtain sufficient potassium—either via potassium-rich foods (bananas, oranges, avocados, spinach, beans and lentils, potatoes)—you’re not doing your heart the favor you think you are.

Other deficiencies that can result from avoidance-based nutrition plans…

• Magnesium. A 2018 Journal of the American Heart Association study by University of Michigan researchers found that more than 20% of people with heart failure are magnesium-deficient. Magnesium, found in whole grains, nuts, black beans and dairy, is a key player in the regulation of blood sugar and blood pressure, and it is considered especially important for heart attack patients, especially those who take diuretics. If a person drastically reduces or eliminates carbs, as many heart patients do, he/she can become magnesium-deficient. Compounding the problem—cutting carbs means increasing fats and protein. Very high-fat, low-carb plans such as the Keto diet can increase inflammation and bad (LDL) cholesterol levels, elevating risk for atherosclerosis and heart disease.
• Calcium. That same study also found that more than 20% of heart failure patients are calcium-deficient. Calcium has a hand in heartbeat regulation, blood clotting and skeletal health. That last one is important because failing to consume enough calcium-rich foods and beverages signals bones to release calcium in an attempt to regulate levels. Besides weakening bones themselves, that calcium enters your heart’s two main coronary arteries and settles there in a phenomenon called arterial calcification, increasing atherosclerosis risk.
• Vitamins A, D and K-2…selenium…folate…and iodine. Deficiencies of these can result from avoiding nutrient-dense foods, ironically increasing risk for the very cardiovascular problems patients are trying to avoid.

Rather than viewing heart health through a lens of exclusion, focus on what heart-healthy foods you can add to your diet. Top picks: Berries, fatty fish, nuts, seeds, leafy greens and cruciferous vegetables, whole grains, extra-virgin olive oil, low-fat or fat-free dairy, avocados. A heart-healthy diet plan built on these foods in the right quantities and pairings delivers the macro- and micronutrients your heart needs. Also: Don’t forget a little dark chocolate (80% or more) for cardioprotective antioxidants—about one to two ounces two to three times a week.