There is a lot of confusion over what dietary habits contribute to heart disease and what diets are best for heart disease prevention and treatment. Is red meat good or bad? What about dietary fats and cholesterol? Fortunately or unfortunately, depending on how you look at it, there is no one-size-fits-all diet. We are all very unique when it comes to our biochemistry. Recent studies are revealing that our response to a specific type of food may be due, in part, to our genes. So, while saturated fats, red meat, grains or fava beans may not be an issue for one person, they may be for another. Rather than arguing or debating these specific issues, I’d like to point out some of the factors that are important for everyone.
The bottom line when it comes to heart disease is preventing endothelial dysfunction. Diet can address this in several ways. As mentioned in the second article of this series, a number of things can cause endothelial dysfunction including oxidized LDL, elevated LDL particle number, diabetes, certain bacteria and viruses, tobacco use, high blood pressure and age. The best way that diet can help prevent or even reverse heart disease is through improving antioxidant status, decreasing inflammation and addressing any specific risk factors that are found through laboratory testing, such as elevated apoB, low adiponectin or high homocysteine. In general, this is going to mean a diet high in fruits and vegetables and low in foods that are inflammatory to any given individual. This is also going to mean little to no processed foods or sugar, no refined grains, no fried foods and an improved omega-6 to omega-3 fatty acid ratio.
There are foods that increase inflammation in everyone and there are foods that do this more individually. Examples of foods that increase inflammation in everyone are sugar, refined grain products, fried foods and foods that are high in omega-6 fatty acids. Not only do excess omega-6 fatty acids promote more inflammation, but they also oxidize more readily than saturated fats. If you recall, oxidization is something we want to avoid. There are, however, foods that promote inflammation only in those who are genetically prone. While this could potentially be any food, there are common problem foods such as nightshades (potatoes, tomatoes, eggplant and peppers) and grains. The most common grain to be a problem is wheat, due, in part, to hybridized varieties with high gluten content combined with genetic susceptibility. Of course, this also means avoiding known allergenic foods or any foods that you may be sensitive to. Common allergenic foods include corn, soy, wheat and dairy.
As mentioned previously, it is important to focus on improving the omega-6 to omega-3 fatty acid ratio in our diet. For those of you who are new to this, omega-6’s and omega-3’s are types of polyunsaturated fats. Omega-6 fats tend to produce more inflammation than omega-3 fats, therefore omega-3 fats are generally considered anti-inflammatory, even though this isn’t exactly true. The typical Western diet tends to be loaded with omega-6’s and low in omega-3’s, due in large part to the abundant use of vegetable oils such as soy, safflower, sunflower and canola. Soy oil – commonly called vegetable oil – is probably the most common and is found in many processed and fried foods. To help balance this out, it is wise to eat less of the above vegetable oils, while consuming more foods with high omega-3 content such as fatty fish (herring, salmon, sardines, etc), walnuts, flax seed, chia seed, etc. Additionally, focusing on dairy products (if you tolerate dairy) and beef from grass fed cows (as opposed to grain fed) is going to increase the omega-3 content in those products.
There are a number of high antioxidant foods that one can focus on, but the real key is getting a sufficient quantity of a variety of vegetables with every meal. The ideal plate will be ¼ protein, ¼ starch/grain and ½ non-starchy vegetable such as kale, broccoli, cauliflower, asparagus, etc. Foods that are specifically high in antioxidants include berries, red wine, dark chocolate, espresso, green tea, walnuts (also high in omega-3’s) and pecans. Many spices, such as cloves, allspice and mint, are also very high in antioxidants. One doesn’t have to purchase special or exotic fruits to get antioxidants. There are plenty in your locally grown produce as part of a high fruit and vegetable diet.
Polyphenols are a class of compounds found in plants with a number of beneficial properties – many being both antioxidant and anti-inflammatory. Many of the previously mentioned foods contain polyphenols which are thought to exert the majority of their antioxidant action – anthocyanins in blueberries, EGCG in green tea, catechin in dark chocolate and resveratrol in red wine are a few examples. Curcumin, found in turmeric, and puerarin, found in kudzu, are two additional polyphenols that may be especially beneficial in regards to heart disease. Research has found that both curcumin and puerarin have the ability to decrease the expression of LOX-1 receptors. If you remember from my second article in this series, LOX-1 is one of the primary components involved in endothelial dysfunction. Therefore, decreasing the number of LOX-1 receptors is highly favorable in preventing or limiting the progression of heart disease.
As a general recommendation to all of my patients, I recommended eating organic as much as possible – focusing on the dirty dozen and clean fifteen if desired. I also recommend avoiding genetically modified foods simply because the full implications to our heart health and health in general are unknown at this point.
Diet in relation to heart disease is a complicated matter when you take into account genetic predisposition and biochemical individuality, but most of the above recommendations are beneficial for everyone. In addition to the things mentioned in this article, one has to consider digestive health, other illnesses, such as diabetes, environmental risk factors, stress management and physical activity. This is why I recommend a comprehensive health assessment to help individualize diet plans and treatment advice. As always, I encourage you to speak with a qualified health professional to assist in making the appropriate dietary and lifestyle changes.