Cardiovascular disease (CVD) is an illness of epic proportions. It is the number one killer of both males and females throughout the world (although cancer is catching up). CVD is actually an umbrella term for a range of conditions including coronary artery disease, heart attack, cardiac arrest, congestive heart failure, and congenital heart disease – however coronary artery disease is still the leading cause of death within the CVD grouping. The good news is that almost all of the risk factors for CVD are modifiable by dietary and lifestyle interventions, which I will be covering here.
Dietary risk factors for CVD – not what you may assume
Most assumptions regarding the dietary risk factors for CVD have until recently been fairly wide of the mark. Saturated fat and cholesterol have been targeted as the main culprits in the dietary causation of CVD, however most of the scientific literature simply does not bear this out (for more detail on this topic see my post The Cholesterol Myth). Rather, it is a diet high in refined carbohydrates, processed industrial seed oils, and chemical additives that seem to be the biggest causative dietary factors. Diets that are low in carbohydrates and high in healthy fats (more on these later) actually lower CVD risk by modifying several factors that play a role in its development. These include lowering serum triglycerides, fasting glucose, blood pressure, body mass index, plasma insulin and c-reactive protein.
A heart healthy diet – start with cutting the refined carbs
The number one dietary step for CVD prevention is definitely reducing the intake of refined carbohydrates. Cutting out the addition of white sugar to your morning cup of tea or coffee is the most obvious and transparent example of this, however the number of foods and beverages that contain an unhealthy level of these triglyceride and insulin raising agents is staggering. Most packaged and processed food will contain at least some added sugar (as well as the other two CVD culprits – industrial seed oil and chemical additives) so it pays to examine every ingredient panel before adding them to the grocery cart. Unfortunately many manufacturers will attempt to sidestep the listing of ‘sugar’ on their ingredient list by using an alternative such as fruit juice concentrate, evaporated cane juice, malt syrup, glucose, fructose, dextrose, corn syrup, caramel etc. Even more deceptively, the ingredient list may have a number of these sugars scattered throughout so that the sugar content seems lower than it actually is (the ingredients are always listed in descending order from the largest to smallest input). Luckily in Australia the government standards require food manufacturers to list some nutrients, including carbohydrates, in a nutrition panel with the quantity per serve plus the quantity per 100g. The carbohydrate content has a sub section stated as sugar which tells you the true volume of sugar, as some carbohydrates may be fibre (which is actually an important consideration for CVD prevention – see below). My advice is to look at the sugar content per 100g, as this basically gives you the percentage of sugar contained in the product.
Here is a nutrition panel in which the total carbohydrate content is the same as the total sugar content. This means that there is no fibre contained within the product. Also note that the % of total sugar is 12.4% (12.4g per 100g)
Here is a nutrition panel in which the total carbohydrate content is 89.4g per 100g, but only 25.1g are listed as sugars. This is still a product that contains a whopping 25.1% sugar though so is far from healthy
My advice is to avoid anything that has more than 5% sugar listed in the panel (or 5g per 100g). Look out for foods that may be considered healthy such as yoghurt and muesli – more often than not these contain considerably high levels of sugar. Of course sugar laden soft drinks, cordials, and fruit juices are absolutely to be avoided.
Reduce your intake of industrial seed oils
These are another major causative factor for CVD (and another example of completely misguided public health policy). As I outline in step one of my email series Five Steps To A Healthier Life, industrial seed oils such as sunflower, safflower, corn, soybean, cottonseed and canola are all highly harmful. When used in processed foods, these oils are readily oxidised, in turn causing systemic inflammation in the body and especially in the cardiovascular system. This inflammation sets the scene for the formation of occluding plaques in the arteries and blood vessels, the main driver of CVD. Unfortunately the predominant (and incorrect) medical opinion that saturated fat from animal products is a major causative factor for CVD has meant that the public health focus (and in turn that of food manufacturers) has been to decrease the consumption of animal fats such as butter and tallow as well as full fat dairy products, and to increase the consumption of the plant based industrial seed oils mentioned above. A perfect recipe for increasing rates of CVD.
Again when buying processed and packaged foods pay close attention to the ingredient listing (unfortunately the nutrient panel does not list ‘fat from industrial seed oil’ but rather only differentiates the saturated fat proportion of total fat content). Obviously you want to look out for the seed oils listed above, but also be on the lookout for anything listed as ‘hydrogenated’ or ‘partially hydrogenated’. Avoid using any of these oils in your cooking (heat is a strong driver of oxidation), but also avoid their use generally as even exposure to air can cause most of these oils to go rancid in a short period of time. Margarine is a definite no-no as it is a perfect storm of hydrogenated industrial seed oils – choose butter instead as a healthy option. When cooking use stable fats such as butter, tallow or lard, or coconut oil as a plant based alternative. Olive oil is really your healthiest choice when it comes to heat free application such as salad dressings, but look out for extra virgin varieties as they have the highest antioxidant content and are therefore the most stable.
Increase your intake of fibre
Dietary fibre, particularly soluble fibre, has the ability to bind to and lower cholesterol in the digestive tract. This can be beneficial in those with hypercholesterolaemia as it will reduce to formation of serum lipoprotein carriers (particularly LDL and VLDL). However as noted in my post The Cholesterol Myth this may have little benefit if the advice above is not followed due to the fact that serum triglycerides are far more likely to cause an increase in LDL and VLDL, and these are raised predominately by a high sugar diet. Psyllium husk, oatmeal and barley are all excellent sources of soluble fibre. Fruit such as pears, apples, and berries are all great sources of soluble fibre (but it’s best to limit fruit consumption to a couple of serves a day to reduce sugar load). Legumes such as lentils, split peas, and black beans are also powerhouses of soluble fibre.
Supplemental nutrients
Niacin (vitamin B3) has been shown to improve a number of CVD parameters including decreasing fibrinogen levels (a blood clotting agent), reducing LDL and VLDL as well as raising HDL, increasing LDL particle size, and reducing serum triglycerides. B vitamins are usually found in combination in nature so I always suggest taking a B complex in conjunction with a stand alone Niacin supplement.
Vitamin C is the body’s main water-soluble antioxidant and thus helps protect the arteries and blood vessels from free radical damage and subsequent plaque formation.
Essential fatty acids such as EPA and DHA from fish can be helpful in lowering serum triglycerides. Be mindful of flaxseed oil touted as an excellent source of these EFAs – they only exist in a precursor form that are difficult for your body to convert to the active EPA/DHA forms. Additionally flaxseed oil can be readily oxidised when exposed to heat, light and oxygen and so storage is paramount. When oxidised, these oils can be just as damaging as their industrial seed counterparts mentioned above.
Magnesium is a crucial cardiac nutrient, however unfortunately the majority of the population are deficient due to soil depletion and the over consumption of processed foods. Magnesium is best taken in the orotate, citrate and bisglycinate forms for cardiovascular health.
Coenzyme Q10 is a powerful antioxidant that can prevent the oxidation of VLDL and LDL particles in the bloodstream. It is also a crucial component of the energy cycle in cardiac cells.
Herbal medicine
Garlic is an excellent herb for the prevention of CVD as it works on a number of levels: it can reduce total blood cholesterol, act as a serum antioxidant, and inhibit platelet aggregation and clot formation. To boost its effectiveness garlic should be consumed fresh, and be chopped or crushed and then put aside for ten minutes before swallowing to activate its health providing constituents.
Green tea can significantly reduce cholesterol and serum triglycerides, and raise HDL.
Globe artichoke has excellent blood lipid lowering effects through its ability to stimulate bile production.
Olive leaf is a powerful cardiovascular antioxidant, and can also reduce platelet aggregation.
Ginkgo is also an excellent cardiovascular antioxidant, as well as a promoter of peripheral blood flow.
Curcumin from Turmeric can significantly lower serum triglycerides, as well as act as an effective anti-inflammatory agent.
Berberine from various herbs such as Phellodendron, Barberry and Golden Seal can significantly lower serum triglycerides and LDL.
The importance of working with a practitioner
As always the advice given here is only a guide post in finding your way to a healthier life. I recommend working with a practitioner if you feel you are at risk for the development of CVD, and especially before undertaking any of the complimentary medicines mentioned due to their potential interactions with other medications. I encourage you to take charge of your own health and always take heed of the wise words of Benjamin Franklin: “An ounce of prevention is worth a pound of cure.”
In wellness,
James
