How Food and Lifestyle affects Heart Disease

Heart disease was virtually unknown in primitive peoples who lived on simple diets of natural food but it is common in the western world. This tells us that what we eat makes a difference. This leaflet tells you which foods will help your heart and which will make it worse. We have seen many people with angina get better simply by changing their diet.

Foods That Harm

Milk

Milk is the food more strongly linked with heart disease. Seeley investigated 24 countries and found unfermented milk products had the strongest correlation with heart diseases. Grant found much the same in 32 countries. The strongest correlation with heart disease was non-fat milks in males and milk carbohydrates and sugar in females.  Note it was the carbohydrates, not the fat, in milk that linked with heart disease. In other words skimmed milk could make things worse. Some people think that it is the pasteurisation of the milk that causes the problem; so it makes sense to avoid heating milk which probably increases the danger.

Something in milk is dangerous to the heart. Studies suggest the harmful part of the milk is the protein not the fat so using skimmed milk won’t help. Some people think that it is the pasteurisation of the milk that causes the problem; so it makes sense to avoid heating milk which probably increases the danger.

A key step is to stop using milk on cereals. There are many alternatives now available. Be careful of soya milks because most contain genetically modified soya so make sure it is organic to avoid this. The risks of GM foods are unknown and it makes no sense to take a chance with your health. Consider having tea and coffee without milk.

A survey of milk consumption per head of population in the UK and rates of CHD shows these both rose in parallel in the 1960s to1970s and both decreased in parallel from the end of the 1980s and through the 1990s.

Other Foods

In a survey comparing food consumption and rates of heart disease in the 1970s the strongest correlation was with milk (o.88), then sugar (0.74) then butter (0.72). No other foods had strong correlations and the next on the list was meat (0.33). Cheese was not correlated with heart disease suggesting fermentation has a beneficial effect. (Note not all work has shown butter is harmful.)

In another study one sugary drink a day increased the risk of heart attack and stroke by 50%. Another study found each sugary drink raised the risk in women (but not men by 83%.And it’s not just sugar. Columbia University in 2012 found one Diet drink increased the risk of heart attack and stroke by 43% compared to those who didn’t take them. A 2019 study of 82,000 women over 50 years found having over 2 Diet drinks was associated with 29% more heart disease and 23% more strokes and overall mortality by 19%. Plant sterols and stanols are promoted to reduce cholesterol but they have been found to increase both cardiac and overall mortality so are best avoided.

Of those negatively correlated with heart (in other words beneficial foods), top of the list was vegetables (0.81) then wine (0.75) (again suggesting fermentation is beneficial and then olive oil (0.7). Fruit and fish had less strong negative correlations.

Meat

Wild animal meat is healthy. Meat from farm animals is not. Farm animals, particularly chickens, are bred to get as fat as they can as quick as they can and so it’s no surprise that they are bad for our health. Grass fed animals have a better combination of fats than grain fed animals (the majority).

Three studies have looked at the risk of meat in the diet. A study of 150,000 Seventh-day Adventist lasting nearly 50 years, Dr Walter Willett’ study of 100,000 people over 30 years and the EPIC (European Prospective Investigation into cancer and Nutrition) of half a million people for 12 years. The two longer studies have shown red meat increases heart risk. The first of the Seventh-day Adventists, renowned for their longevity, found three times weekly red meat doubled the risk of fatal heart disease(as compared vegetarians) and reduced life expectancy by four to five years. The second study found those who had higher red meat had increased mortality, including increased rates of cancer and heart disease. An extra portion (85g) of meat daily increased mortality by 13% and of an extra portion (35g) of processed meat (bacon, salami, sausage) increased mortality by 20%. The shorter EPIC study showed an increased risk only with processed meat.

I think the balance of evidence shows red meat has a somewhat negative effect on health and cutting down on the meat in your diet makes sense, particularly to reduce the risk of bowels cancer, but also to reduce the risk of heart disease. However meat is not a major cause.

Organic or free range products are almost certainly safer. There is however no proved link between saturated fats and heart disease and some studies suggest it may be beneficial.

Hydrogenated Fats

These are definitely dangerous though present in smaller amounts in food. A 2% increase in hydrogenated fats was found to increase heart disease by 23% in one study and some studies have found a doubling of the rate of heart disease. Heart disease became common around the time these substances were first introduced. They are made by heating essential fats to about 500 F. Hydrogenation prolongs the shelf-life of the fats but at a great cost to our health. These synthetic fats replace the good fats in our cell causing major problems.

Whenever you see the words hydrogenated fats, trans fatty acids, vegetable fat, vegetable oil, shortenings, hydrolysed fat, hydrolysed vegetable protein on the label you are dealing with these dangerous fats. Note that these substances may also be found in foods labelled as low in saturated fat.

Remember that whenever fats are heated you produce hydrogenated fats. Major sources are margarines, supermarket oils and fried foods. However it is nearly all processed food. If food has a long shelf-life then assume it has hydrogenated fats in it. One fifth of the fat found in pizzas can be trans fats. Mayonnaise is especially high in trans fats. These fats are found in processed foods such as chips and biscuits – check the labels. Another trap is emulsifiers which typically contain monoglycerides and diglycerides which are types of trans fats without being labelled as such. If you want to use an oil for cooking then use olive oil which is more resistant to heat, as is butter. Never re-heat any oil, even olive oil.

TIP: Use butter rather than margarines. Margarine consumption was associated with more heart attacks in the massive Framingham study.

Sugar

The food with the second strongest association with heart disease is sugar. For some reason this is a bigger risk factor in females. Refined carbohydrates have a similar effect to sugar. All white flour, white bread and white rice is refined as is a lot of brown bread. Use wholemeal or whole grain wherever possible.

One or two fizzy drinks daily increased the risk of a heart attack or stroke by 50% in one study. Another study found that in women just one sugary drink daily increased the risk of stroke by 83%.

Sugar causes platelet aggregation (the blood gets thicker and stickier) and this increases the risk of heart disease. Sugar can also increase cholesterol and triglycerides within days in males and post-menopausal women. k List

Foods That Heal

Fruit and Vegetables

Many studies have confirmed that fruit and vegetables protect your heart. Perhaps the most extraordinary result of any therapy ever used in heart disease comes from Dr Dean Ornish. He did a series of trials, using state-of-the-art technology, to assess the effect of a plant-based diet of whole grains, beans, fruit and vegetables on the heart. He found people would quickly feel better, severely blocked arteries would reverse and he noted a 91% reduction in angina within a few weeks. The control group, on a standard diet, had worsening of their angina.

A Harvard study found greens have the strongest protective effect of any food and that each single daily serving of greens reduced the risk of heart attacks by 20%.

Fruit and vegetables have key nutrients such as the anti-oxidant vitamins A, C and E, flavonoids, magnesium and B vitamins which are known to help the heart. Organic vegetables contain between two to ten times the concentrations of nutrients found in non-organic vegetables,so buy these where possible. Garlic, onions and turmeric are especially beneficial. An excellent and enjoyable way of getting the benefits of fruit and vegetables is to use a juicer and make your own fruit and vegetable juice regularly. Consider using green tea which has more anti-oxidants than ordinary tea.

Essential Fats

For a healthy heart you need good fats often called essential fats. There are two essential fats: Omega 3 and Omega 6. Most people are short of the Omega 3 fats rather than Omega 6 fats. The major sources of essential fats are from oily fish, seeds and nuts.

Several studies have shown that fish protects the heart.Eat plenty of oily fish which include herring, mackerel, sardines, wild (not farmed) salmon, pilchards and anchovies. These contain the key Omega 3 fats. Avoid frying which destroys the fat. If you have heart disease then consider a fish oil (an EPA Fish oil not cod liver oil) which contains concentrated Omega 3 fats (but toxicity can be concentrated too and that the level of toxins in fish is now causing concern). Use an uncontaminated EPA fish oil.

The secret of the eskimo’s low rate of heart disease is their high fish diet.

Seeds are high in essential fats. The best seed for the heart is linseed (also called flax seed) which contains the key Omega 3 fats. It is available from all health food shops and can be added to cereals or salads. Take 1 to 2 dessert spoonfuls daily. It needs to be chewed. It is also a good idea to take in other seeds such as sunflower, safflower or pumpkin seeds. These contain more of the Omega 6 fats which are also important. If you don’t like the seeds you can use a seed oil.

Seed oils are an even more concentrated source of essential fat but take care for there are hazards for the unwary. They must be cold or cool-pressed, which in effect means buying from a health food store. Do notheat these.

The Seed Oil Paradox

Cold-pressed sunflower oil is great for your health giving you essential fats (omega 6 in this case) whereas sunflower oil from a supermarket is a major health hazard. The reason is that the essential fats have become hydrogenated on heating and processing. They will both be labelled as high in polyunsaturates but they have very different effects on your body. Linseed oil is very beneficial for the heart but is harder to find and more expensive

Another excellent source of essential fats is nuts. Several studies have shown that nuts protect your heart. The best are almonds and walnuts (not roasted nuts). There is also a little essential fat in vegetables.

Supplements

In a study of 443 menaged between 70 and 85 years over 5 years done by the Karolinski Institute giving 200mg Co-enzyme Q10 and 200iu selenium reduced heart disease by 53%.

In a study of 10,000 men done by the University of Copenhagen monitored over 29 years those with low Vitamin D levels as opposed to optimal levels had a 64% increased risk of myocardial infarct and an 81% increased risk of dying from heart disease. Vitamin D comes mainly from sunshine.

The Mediterranean Diet

The Mediterranean diet is known to be associated with a low rate of heart disease and a low rate of cancer. It is almost identical to the diet recommended above in that it is high in fresh fruit and vegetables, grains and olive oil and low in meat and dairy products. A study in 2000 compared the effect of eating the Mediterranean diet compared to standard dietary advice in patients with heart attacks. After 4 years those on the Mediterranean diet had a 70% reduction in heart disease compared with those given standard advice and this diet gave three times the reduction of risk given by cholesterol drugs. Of some interest is that this was achieved without any change in cholesterol.

Seventh-day Adventists

          This group of people have been studied in great detail partly because of their reputation for longevity. They typically outlive all other groups living a western lifestyle. Three useful facts have emerged from these studies.

  1. As mentioned before, those who are vegetarians outlive and have less heart disease than those who eat meat. Vegetarians had half the rate of fatal heart disease.
  2. Those who ate nuts five times a week also had half the risk of heart disease whether vegetarian or not.
  3. Men who drank 5 or 6 glasses of water daily reduced their risk of a heart attack by 60-70% compared with those who drink considerably less.

Lifestyle and Heart Disease

     What can help heart disease and how does it compare with taking heart drugs?

Keep in mind the best ever trial of statins showed a reduction of risk of heart disease of 40% in men who already had heart disease.  However since the regulations on drug trials were tightened up in 2005 trials of statins have failed to show any consistent benefit on mortality.

It is interesting to compare the benefit of statins with various nutrients. Nuts reduced the risk of heart disease by 50%, water (5 to 6 glasses daily) reduced the risk by 70% (in males) in the above study and in another study of 20,000 people (this time in both men and women followed for 6 year) drinking 5 or more glasses had half the rate of fatal coronary event compared with those drinking 2 glasses or less.  A Chinese study found that eating 100 grams of fruit daily (equivalent to half an apple) reduced the risk of a heart attack by 60%. Another found each 25 grams of fruit eaten daily reduced the risk by 9%. Other research has shown drinking tea (without milk) three times a day reduces the risk of heart disease by 30%, having oily fish three times a week reduces the risk by 30%. Doubling exposure to sunlight reduces the risk by 50%. In other words numerous studies show that healthy foods protect to a greater level than the best drugs available and more surprisingly just drinking more water outperforms all drugs.

Nitric Oxide (NO)

Nitric oxide (NO) may be the single most important substance for heart health. It is produced by our arteries, causing relaxation of the arterial walls (hence opening up arteries). This simple molecule also stimulates new blood vessel growth and has an anticoagulant effect. Anything which increases NO levels is extremely good news for coronary heart disease. The most well-known drug to increase nitric oxide is sidenafil (Viagra) but statins (which also have heart negative effects such as reducing Co-enzyme 10) and ACE inhibitors also increase nitric oxide. The supplement pycnogenol (pine bark) increases NO.

 Anything that reduces NO is bad news for the heart and blood vessels. The best known drug to do this is thalidomide which cuts off the blood supply from developing limbs. However acid-blocking drugs called PPIs (such as omeprazole and lansoprazole) also block NO. As you would expect they are bad for the heart. They are associated with a 16-21% increase in heart attacks and a 25% increase in all-cause mortality. But worse still, for anyone who should develop a heart attack whilst on these drugs, the risk of death is doubled.  This illustrates the critical importance of NO.

            However if we want our arteries to work well, we need a better understanding of how nitric oxide works. How do we keep or levels of NO optimum? The first point is nitric oxide is rapidly destroyed by free radicals which then cause arteries to stiffen. These free radicals, in turn, are destroyed by anti-oxidants. Free radicals have multiple sources (smoking, junk food, pollution, stress).

So if we want good levels of NO, the key is to reduce our exposure to free radicals and increase our levels of anti-oxidants.  A third strategy is to have the building blocks for NO readily available.

Putting people on an anti-oxidant rich diet has been shown to improve arterial dilation within two weeks. Anti-oxidant rich foods are basically fruit, vegetables, herbs and spices and the richer the colour and the more variety of colours the better. NO is produced from nitrates in food. Having more of these will also increase NO. Rich sources of nitrates are leafy green vegetables, beetroot, rhubarb, basil and coriander.

I think dealing with these factors is central to improving heart health and it is likely to be more effective than simply using a drug.

Physical Fitness

A study published in 1999 that followed 25,000 executives for 10 years found that low fitness accounted for three times as many deaths as caused by elevated cholesterol in those who had a normal weight (though less for the obese). The interesting fact was that those who were least fit but became fitter, the risk of dying was reduced by half. A study of women also found those who were least fit were far more likely to die of heart disease and had twice the risk of dying from any cause over the next 20 years.

When it comes to stroke the situation is even more marked: a sedentary lifestyle increases the risk eight-fold, smoking increases it six-fold, raised blood pressure increases it two to fourfold and diabetes increases it twofold. A raised cholesterol had little effect on risk.

I think this is worth emphasising this as people often worry unduly about having raised cholesterol but worry less about lack of activity which is far more dangerous.

Electromagnetic Fields

We know these affect heart rhythm and function. These come from wifi, DECT phones, smart meters and mobile phones and masts. Because of this anyone with a heart problem needs to keep their exposure low and, in particular, avoid carrying mobile phones anywhere near their heart, such as an inside pocket.

Why is Heart Disease Decreasing?

Most chronic diseases (cancer, diabetes, neurological and auto-immune diseases) have been rising dramatically in recent decades. But not so with heart disease which has been in steady decline since its peak in the 1950s and 1960s (with a 43% drop in the USA between 1988-94 and 1999 – 2004). What is happening? No one knows for sure but a clue comes from a recent major review in the BMJ (2018:362:k3310). This article found heart disease increases and decreases with our exposure to heavy metals. They discovered that a decline in exposure to just two heavy metals (lead and cadmium) was responsible for a 32% of the drop in cardiovascular disease during this time period. Lead had a similar effect on increasing the risk of stroke and cadmium had an even greater effect on increasing the risk of stroke (compared to cardiovascular disease).

How do we explain this? Firstly unleaded petrol became available in the UK in mid 1980s and all petrol became unleaded by 1996. Secondly smoking has been decreasing steadily since the mid-1950s. Cigarettes are a major source of cadmium and contain many other toxins besides. I suspect a further reason is that hydrogenated fats have also been decreasing in the food supply. Although this is good news, some problems remain. It is well established that higher levels of particulates (mainly from vehicle exhausts) increase the risk of heart attacks and this is an increasing problem in urban areas.

And Finally

Although not related to food it is worth knowing that there is a strategy that can reduce risk of heart attacks by 88% (in men). This study of 2,800 males over 9 years found that those who donated blood had a 0.7% risk of future heart attacks as against 12.5% in those who didn’t (88% reduction in risk).  Blood donors have also found to have half the rate of cancers. Admittedly this was a small study but it showed a huge difference and a highly significant reduction in heart attacks. The likely explanation of this is that donating blood reduces viscosity (makes blood less sticky) which is known to reduce risk of heart attacks. (This may also explain why drinking more water helps so much). Women rarely develop heart disease before the menopause but after this their risk starts to approach that of men. It is likely that until the menopause periods protect women in the same way by making blood less sticky. Blood donations have also been found to reduce gastro-intestinal cancers by 50%.