Wellness Tips

How to Create A Heart Healthy Diet

Heart disease is the leading cause of death worldwide, costing approximately 18 million lives each year. A heart healthy diet will not only prevent chronic and even fatal cardio events, but will also enhance your energy, focus, sleep quality, and physical comfort. While there are numerous ways to execute a heart healthy diet, a few key nutrition principles apply across the board. Consuming the right nutrients and avoiding those that are harmful is still of utmost importance however, newer research shows that there are other crucial components such as eating patterns we must take into consideration as well. This is a lengthy post so if you don’t have a lot time, come back to it later or know that you can also read it in parts.

In this post, I summarize a few ways to help you structure a heart healthy diet. I cover the following topics:

  • Understanding which nutrients, eating patterns, foods and approaches are heart healthy
  • Comprehending appropriate portion sizes 
  • Implementing mindful eating habits
  • Promoting and maintaining a healthy gut microbiome

To begin, let’s look at specific nutrients which protect against heart disease including unsaturated fats, antioxidants, fiber, vitamins, minerals and phytochemicals. I’m going break these down so that you can learn some top food sources in which these nutrients exist and why each is uniquely important for heart health.

Top Sources of Monounsaturated fats

  • Olive oil, canola oil, peanut oil, sesame oil, and safflower oil
  • Avocados 
  • Almonds, hazelnuts, pecans
  • Olives

This type of fat is important because it:

  • Reduces LDL cholesterol
  • Raises HDL which sweeps bad cholesterol back to liver for removal
  • Lowers inflammation

Top Sources of Polyunsaturated Fats/Omega-3s:

  • Salmon, mackerel, cod fish oil, herring, sardines, halibut, oysters, anchovies, and other fish 
  • Flax seeds
  • Chia seeds
  • Walnuts 
  • Canola oil
  • Soybean oil
  • Sunflower oil

Polyunsaturated fats and omega-3s are important to preventing heart disease because they:

  • Are an integral part of cell membranes and affect function of cell receptors in membranes
  • Are a starting point for hormones that regulate blood clotting, contraction and relaxation of artery walls, and inflammation
  • Help the heartbeat steadily
  • Lower blood pressure, heart rate and triglycerides
  • Improve vessel function

Top Sources of Antioxidants:

  • Fruit
  • Vegetables
  • Dark chocolate’
  • Coffee
  • Tea
  • Red wine
  • Whole grains

Antioxidants are important to heart health because they:

  • Scavenge free radicals that can cause cell and DNA damage
  • Reduce inflammation

Top Sources of Fiber:

  • Fruit
  • Vegetables
  • Whole grains
  • Nuts
  • Seeds
  • Legumes

Fiber is important to heart health because it:

  • Lowers cholesterol
  • Lowers blood pressure
  • Fills you up
  • Helps stabilize blood sugar levels
  • Promotes healthy digestion and waste removal

Top Sources of Vitamins and Minerals

  • Almost all foods including:
  • Fruit
  • Vegetables
  • Whole grains
  • Nuts
  • Seeds
  • Legumes
  • Plant-based proteins such as tofu, tempeh, natto
  • Fish
  • Dairy
  • Eggs
  • Lean meat

Vitamins and minerals are important to heart health because:

They can reduce blood pressure, hardening of the arteries, and help your heart rhythm to stay regular.

Top Sources of Phytochemicals 

  • Fruit
  • Vegetables
  • Whole grains
  • Nuts
  • Seeds
  • Legumes
  • Coffee
  • Tea
  • Red wine
  • Dark chocolate

Phyotochemicals are important to heart health because they:

  • Help fight inflammation and block the development of new blood vessel tumor

With the above in mind, a daily meal plan that takes these nutrients into consideration could look like this:

  • A bowl of oatmeal with some walnuts and fresh berries for breakfast
  • A salad with avocado other veggies some lean protein and a dressing made with olive oil for lunch
  • A small handful of almonds for a snack and 
  • Salmon with wild rice and vegetables for dinner

Now that I’ve covered nutrients that promote heart health, I’m going to take a look at a few eating patterns that do the same. Studies show that the DASH and Mediterranean diets are incredibly effective ones, but I also love four other diets, which I cover in my book The Win-Win Diet and which evidence highly supports for heart health. All of these diets put fruits, vegetables, whole grains, nuts, seeds, legumes, and lean protein like fish and tofu first. They also emphasize the importance of reducing processed food. Some allow animal-product foods in moderation and others do not. The flexitarian eating pattern is one that allows for small amounts of animal-sourced foods including meat. The pescatarian pattern eliminates meat but still allows for fish, dairy and eggs. The vegetarian pattern only allows for eggs and dairy when it comes to animal-derived food and the vegan diet only allows for foods from plants. In sum, while there are others, the following eating patterns are proven to promote heart health.

Heart Healthy Eating Patterns

  • DASH Diet
  • Mediterranean Diet
  • Flexitarian: 
  • Pescatarian
  • Vegetarian 
  • Vegan

So let’s take a deeper dive into the actual foods themselves and why they are good for our heart.

Fruits and vegetables are the most important food group. They: 

  • Lower total and LDL cholesterol 
  • Reduce systemic inflammation
  • Stabilize blood sugar and maintain healthy insulin levels
  • Balance out our hunger hormones ghrelin and leptin

In considering your fruit and vegetable choices for any given day, select a:

  • Variety of color because each color has distinct antioxidants, phytochemicals, vitamins, mineral, and even fiber types.
  • Fresh whole fruits and veggies and even frozen ones with no added fat, sugar or sodium
  • If you have to buy canned or prepared foods, select those without added sodium or sugar, and which are packed in water

As far as preparation is concerned, with fruit, if you want to get fancier than eating it fresh, you can consume it in a homemade smoothie (be very careful about smoothies from stores as they are often packed with added sugar and fat) or as a stew for breakfast. You can also poach pears, apples and peaches among other fruits, and even make healthy desserts like an oat-topped fruit crumble. Small portions of dried fruit are great too (think 4-6 pieces).

My favorite easy cooking methods for vegetables are roasting them on a sheet pan with extra virgin olive oil, salt and pepper and sautéing them with simple herbs and spices and again, EVOO. Preparations to avoid are those with cream sauces, that are fried, or which are breaded.

The USDA serving sizes for the average adult are:

  • 2 cups fruit/day
  • 3 cups vegetables/day

Turning to whole grains, there’s the myth that carbs are evil, but the truth is whole grain carbs are one of the healthiest foods you can eat on the planet. The USDA recommends that we get about 3-6 servings of grains a day and that at least half of those are whole grains. 

There are so many types of whole grains from which you can choose, which to me makes eating them, an amazing culinary adventure. Common ones include: 

  • Oats
  • Barley
  • Whole wheat
  • And Brown rice
  • And then there are a host of other that are also delicious like 
  • Spelt
  • Amaranth
  • Millet 
  • Teff
  • Wild rice
  • Rye

Unique qualities of bran and fiber, which aid heart health, are they:

  • Slow the breakdown of starch into glucose maintaining steady blood sugar
  • Prevent formation of small blood clots that can trigger strokes and heart attacks
  • And lower cholesterol and move waste through digestive tract for removal. 

I experiment with and develop mouth-watering whole grain-based recipes all the time whether it’s millet with plant-based butter, cardamom and walnuts, quinoa-based vegetarian meatballs, or whole-wheat pasta. 

Next up we have protein. In general, for the lean protein group at large, you want to consume about 5 ounces per day total combining permutations or combinations of:

  • Fish (definitely try to get at least 4 ounces 2x per week as research shows that doing so enhances all aspects of health)
  • Legumes
  • Eggs
  • Soy products
  • Nuts and seeds  
  • Skinless poultry
  • Low-fat and/or vegan dairy products
  • Lean ground meats 

Dairy is a group that can either prevent or contribute to heart disease–but it is not essential. It can be good for heart health if you choose low fat or no fat products, but full fat dairy contains saturated fat, which you want to avoid eating in large quantities.

At this point you might be wondering how dairy contributes to hearth health and the answer is that some studies show that consumption of dairy has an inverse relationship with weight gain. Then there are fermented dairy products that contain probiotics, which are live good bacteria and yeast that naturally live in your body and fend off the bad bacteria, keeping the gut microbiome in balance. I’ll get to the importance of that shortly. 

When talking about dairy these days, the question about plant-based milk alternatives always comes up. Plant-based milk beverages, cheeses and other products are great substitutes, but choose those without added sugar and carrageenans and know that they are not necessarily nutritionally good replacements for regular dairy. They might be missing key nutrients like calcium, protein, and vitamin D. 

As far as alcohol is concerned, the overall heart healthy message according to the USDA and the majority of other reputable sources is, the less alcohol you drink, the better. That said recommendations suggest at most:

  • < 2 servings of alcohol per day for men
  • <1 serving of alcohol a day for women

1-drink equivalents are:

  • 12 ounces of beer (150 kcal)
  • 5 ounces of wine (120 kcal)
  • 1.5 ounce of 80 proof distilled spirits (100kacal)
  • 7 ounces run and cola (9 ounces)

As mentioned, there are more ways to heart healthy eating than nutrients, eating patterns and foods. There are also approaches to how we eat or habits that can significantly impact heart health. 

Portion size is one of them. Avoidance of overeating helps prevent weight gain and chronic metabolic diseases such as obesity, diabetes, hypertension and all the others we’ve covered.  I’ve listed some easy tips that can help you keep your portions under control. You can use:

  • Small plates & bowls: using a small plate makes you feel like you’ve eaten more than if you’d had the exact same portion on a larger
  • Avoid seconds and thirds 
  • Eat larger portions of nutrient-rich 
  • Foods and smaller portions of nutrient-poor foods
  • Get to know USDA serving sizes, which are noted above and which you can easily Google by searching the 2020-2025 guidelines.

Another approach is mindful eating. You want to make:

  • Eating a sensory experience
  • Take the time to look at and smell your food before diving into it. Taste it and savor the flavor, texture and even sound of it. You might think food is only fuel but if you make it a sensory experience, it’s healthier way to eat and will move you towards achieving your heart healthy diet goals.
  • Slow chew your food 
  • Socialize while eating
  • Set up a calming environment with candles, flowers, relaxing music, or anything else conducive to making for a pleasant experience
  • Eat until you’re full noting that
  • Your brain and your stomach register “full” differently with your brain 20 minutes behind

The last approach I’m going to cover in this post is the gut microbiome, which affects all organs and systems, including the heart.

Dysbiosis is a term for an altered gut microbiome when the good and bad bacteria that live in our intestines are out of balance. It occurs most commonly in: adults with a poor diet, some babies, and the elderly. Dysbiosis can lead to atherosclerosis, hypertension, and heart failure.

Therefore, knowing foods that are gut harming is key to a heart healthy diet and they include:

  • Too much red meat
  • Fried foods
  • Food with antibiotics
  • Alcohol

On the other hand, many foods enhance the gut microbiome and reverse damage to it, while at the same time, they boost our immune response. 

Gut healthy foods include:

  • Prebiotics which feed the good bacteria in the colon, fiber-rich food like those that contain the fermentable fiber inulin, and those that have oligosaccharides
    • Vegetables, fruits, whole grains, legumes, Chicory root, dandelion greens, asparagus, Jerusalem artichokes, garlic, onions, leeks, bananas, and whole grains are specific examples of these
  • As mentioned, probiotics is another category of gut healthy food. They occur in fermented products like
    • Yogurt, kefir, kimchi, and Sauerkraut

Now, I’m going to switch to the nutrients that drive heart disease. They are saturated fat, trans fat, sodium and sugar. I will go into detail about each of these in a moment but first, below are the dietary guidelines of how little of these drivers we should be eating. 

Saturated Fat

  • <10% of total calories per day (USDA)
  • 5-6% of total calories per day (AHA)

Trans Fat

  • <1% of energy (AHA)

Cholesterol

  • <300mg/day (AHA)

Sodium

  • <2300mg for healthy individuals (USDA)
  • <1500mg for individuals at risk for CVD (AHA)*

Sugar

  • < 10% of calories per day 

You’ll notice it says less than 2300mg of sodium, and just to give you an idea of what this is, it is the equivalent of about 1 teaspoon of salt. For sugar <10% of added sugar calories amounts to approx. 9 tsp. for men and 6 for most women and children.

Now let’s take a look at each driver, beginning with saturated fat. Saturated fat increases LDL cholesterol, reduces HDL, can cause systemic inflammation, and can raise triglycerides, all of which increase our risk factors for cardiovascular disease.

Below I’ve listed fats and oils most appropriate to include in your diet and those that are best to avoid. 

Choose:

  • Olive oil
  • Canola oil
  • Vegetable and nut oils
  • Trans-fat free margarine

Avoid:

  • Butter
  • Palm and coconut oils
  • Meat
  • Dairy
  • Gravy
  • Cream sauce
  • Non-dairy creamers
  • Condiments (i.e. mayonnaise)

Note: according to the USDA, the top sources of saturated fat in the U.S. are:

  • Sandwiches (29%)
  • Desserts and Sweet Snacks (11%)
  • Rice, pasta, other grains and mixed dishes (7%)
  • Dairy (5%)

Trans fat is another detriment to heart health. These fats are partially hydrogenated oils made by heating liquid vegetable oil in the presence of hydrogen gas and a catalyst. Much like saturated fat, they:

  • Raise LDL 
  • Lower HDL
  • Create inflammation 
  • Contribute to insulin resistance

The best thing you can do for your heart vis-a-vis trans-fat is to eliminate it from your diet as much as is possible and you can do so by avoiding processed and restaurant foods that are fried (think chips, onion rings and French Fries) or baked (doughnuts, and packaged cookies) or that contain margarine.

An interesting factoid about trans-fat is that it can have a harmful effect on our hearts, even in very small amounts, because for each additional 2 percent of calories from trans-fat we consume daily, the risk of coronary heart disease increases by 23%. The good news is that the U.S. has almost entirely eliminated trans-fat from the food industry since 2018, but be aware of the fact that this is not the case in many other countries.

Regarding sodium, use herbs and spices, salt-free seasoning blends and other flavoring alternatives to table salt as much as possible. Whether it’s my tofu and broccoli curry recipe, vegetarian soups, or cumin and turmeric tahini dressing, I’ve really learned to curb my use of salt in favor of herbs and spices. Baking fish with just a pinch of salt and pepper, EVOO, and then garnishing it with parsley and lemon slices is another quick and healthy low sodium dish I love to make. Homemade foods are for sure the most reliable however, if you eat packaged, frozen, canned or prepared foods, read the labels carefully and select those that are marked low-sodium,” “reduced sodium,” or “no salt added”.

Finally, turning to sugar, the greatest sources are:

  • Sugar sweetened beverages/soda, fruit juice, energy/sports drinks
  • Desserts and sweet snacks
  • Candy & Sugars
  • Breakfast bars
  • Sweetened coffees, teas
  • Sandwiches
  • Ice cream/frozen yogurt
  • Candy, cookies, pastries, pies
  • Ready-to-eat cereals
  • Pudding 
  • Added sugar
  • Artificial sweeteners

This doesn’t mean you can never enjoy these foods, but that it’s best to eat them occasionally. It’s also best if you can make them at home with healthier natural ingredients. Try making soda yourself with soda water and a splash of fresh juice, your baked goods with organic maple syrup, and as with sodium, even herbs and spices. Bananas and other fresh fruits are also great natural sweeteners for frozen desserts as well as baked goods.

In sum, while a heart healthy diet has evolved and does indeed comes down to healthy and unhealthy nutrients, recent studies show that it’s equally important to understand these nutrients in the context of the foods we eat, eating patterns, and approaches that promote heart health.

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