Our hearts are small, but full of devotion - the adult heart beats 100,000 times each day, nonstop. Blood flows through thousands of miles of tiny vessels, and the way must be kept clear. If the path is blocked, we may pay the sudden and often deadly price of a heart attack. The most frequent cause of heart attacks is atherosclerosis, or "hardening of the arteries." The arteries are damaged by small deposits of plaque that build up over time.
These deposits are formed by cholesterol, which finds its way into the artery walls, in an effort to heal the artery wall, and the immune cells that try to remove it. When pieces of plaque break off, clots form, getting in the path of the blood as it travels through the blood vessels that supply the heart. Atherosclerosis is just one form of heart disease or cardiovascular disease (CVD), a term that includes all diseases of the heart and blood vessels.
While supplements and medications are often prescribed by physicians, it's possible to influence cholesterol levels, body mass index and blood pressure by altering your lifestyle, including your diet. Whether or not you're experiencing heart issues now, it's a good idea to look at your diet and the way you eat to keep your heart healthy.
What's for breakfast? And, uh, lunch?
Avoiding extremes of caffeine, sugar and unhealthy fats is worthwhile, but leaves many of us wondering, "What's left for breakfast?" Most of us understand what we need to cut out, but just what can we serve up that will protect the heart?
As a start, it's back to the basics for all of us - kids included.
The connection of diet and lifestyle to heart disease is well documented, says Melody Cole, registered dietician and certified diabetes educator for UW Health. "Today's kids have a shorter life expectancy than their parents, which is mostly attributed to unhealthy lifestyle behaviors - poor eating habits and lack of activity." About 17% of U.S. children are considered overweight, putting them at greater risk for chronic illness such as heart disease and diabetes, Cole adds.
Many of the building blocks of nutrition - vitamins and minerals - found in whole foods, grains, legumes, fruits and vegetables and low-fat proteins and dairy products, offer protection for the heart.
Cole suggests starting the day with a nutritious boost from a bowl of steel-cut oats, blueberries, ground flax seed and low-fat yogurt. Begin to switch out refined morning carbs with whole-grain cereals or waffles and fresh fruit. And why not a leftover stir-fry or some eggs and vegetables? And to carry you through the day:
- It's trendy to go green, and in the world of vegetables, broccoli, and all of the leafy greens, like kale, collards, spinach and mustard greens, are great, providing plenty of vitamins and minerals, including calcium and magnesium. Both of these key minerals help promote normal blood pressure and a steady heartbeat.
- Our need for calcium is high, so many foods, like juices and grains, are fortified. Other good sources of calcium are dairy products, salmon, sardines, tofu and eggs.
- You'll also find magnesium in legumes, nuts (almonds, peanuts and cashews), whole grains and, guess what, chocolate. Good to know this treat has value, but if you're craving more chocolate than you'd like to admit, you might just be craving minerals. Consider other good sources of magnesium, because while high-quality chocolate has some nutritional value, it is also high in saturated fats, caffeine, sugar and calories.
- Don't forget about the deep oranges, yellows and reds of other fruits and vegetables. When you see these colors, you can count on carotenoids - one category of the do-good antioxidants (which protect our cells from damage and are linked to a reduced risk of cardiovascular disease).
- Wild blueberries claim the highest levels of antioxidants, but also include squash, carrots, sweet potatoes and pumpkin for their beta-carotene, and strawberries, watermelon, cherries, cranberries, cantaloupe, green and red peppers and all of the citrus fruits for their vitamin C. Tomatoes provide lycopine (better absorbed from tomato paste or sauce than fresh tomatoes).
- Seafood, seeds, garlic and mushrooms are good sources of the antioxidant selenium, along with vegetables from the Cruciferae, or cabbage, family. Broccoli is a member of this big family, which also includes kale, collards, cabbage, Brussels sprouts, cauliflower, bok choy, mizuna, rutabaga and mustard greens. If you have been diagnosed with hypothyroid disease (not uncommon for women in midlife), avoid raw vegetables in this family because they have thyroid-inhibiting components. Fortunately, these chemicals are destroyed after being cooked, so lightly cooked broccoli and the other veggies are just fine.
- A few popular beverages, like hot cocoa, red wine, grape juice and green tea, are also good for their antioxidant properties, and recently the benefits of antioxidants were discovered in legumes - especially black, red and kidney beans, which are full of fiber, too.
- Legumes are also valuable as a source of folic acid, also called folate. Folic acid is one of the B vitamins, along with B6 and B12, that offer special protection to the heart because they help to break down homocysteine, an amino acid that may promote atherosclerosis. Clinical research in the 1990s suggested that high homocysteine levels ranked up there with high cholesterol as a predictor for atherosclerosis. Optimal levels of nutrients are always controversial, but these studies prompted the government to fortify our cereals and some grains, like wheat flour, with folic acid since 1998.
- Black-eyed peas may be the legume heartiest in folic acid, but black, pinto, kidney and lima beans, as well as peanuts, are good too. The green leafy vegetables show up again, and asparagus and okra rank way up there, but Brussels sprouts and broccoli, citrus fruits, strawberries, cantaloupe, grapes and eggs are worthy sources too.
Not all salt is created equal
If you have high blood pressure, limiting salt intake is traditionally recommended for heart health, because salt can increase the fluid in the blood vessels and make the heart pump harder. But, there are more pieces to the salt-intake puzzle.
The bigger picture is that sodium is essential, so we need it in our daily diet, but potassium and sodium need to be in balance - about 5:1 potassium to sodium. If we stick to whole foods, high sodium intake is less of an issue than if our diets are filled with processed foods, which are very high in sodium. Have you read a processed food label lately?
For most of the population, moderate amounts of salt are a good source of sodium, but not all salt is equal. A quick read of the famous blue label of a common refined iodized sea salt shows: salt, calcium silicate (anticaking agent), dextrose, potassium iodide and sodium bicarbonate. We might wonder what sugar is doing in our salt. Nonetheless, the ingredients of a container of more whole, natural sea salt reads quite differently: chloride, sodium, magnesium, sulfur, potassium, calcium, silicon and iron. Magnesium and potassium are valued for balanced blood pressure.
Eliminate refined table salt and substitute pure mineral-rich sea salt or herbal and seaweed shakes, like those that include kelp. Have you tried gomasio, a.k.a. sesame salt? It's a blend of sesame seeds and sea salt, available at many grocery stores and natural food stores.
Zalta Herb Infused Sea Salts, locally produced by Renaissance Farm, are high quality, blending Italian sea salt with fresh herbs such as thyme, rosemary or basil for flavor. (These are available at the Dane County Farmers' Market and some local grocery stores.)
To balance sodium, grab bananas for potassium, but also eat potassium-rich papaya, apricots, apples, dates and raisins, celery, broccoli, artichokes, asparagus, tomato and potatoes; beef and salmon are good sources too. Variety is a plus - eat some of this and some of that to make sure you get some of everything.
A more recent addition to the heart-healthy list are the essential fatty acids (EFAs). EFAs aid in the production of prostaglandins, which regulate body functions such as heart rate and blood pressure.
EFAs are composed of two families of essential fats: omega-3 and omega-6; neither is created in the body on its own, so they must be supplied through the diet - that's why they're called essential. We get plenty of the omega-6 oils, but lack in the omega-3 oils, and this shortfall can enhance the possibility for inflammation. Food sources of omega-3 include flax seeds, walnuts, salmon, sea vegetables and green leafy vegetables.
The American Heart Association has a conservative position about supplements, believing it's best to get all nutrients from food, but it does make an exception for omega-3 fatty acid supplements, recommending them in its 2007 "Guidelines for Preventing Cardiovascular Disease in Women." Dietician Cole recommends eating oily fish like salmon, trout and sardines twice a week to increase omega-3 fats, cutting saturated fat to less than 7% of calories, and eliminating trans fat. Another hint: "Add one-fourth cup walnuts or almonds to your daily diet to reduce your LDL cholesterol and help prevent diabetes," Cole says. Furthermore, women with heart disease should consider a daily supplement of 850 to 1,000 mg of EPA and DHA; 2 to 4 grams for women with high triglycerides, says Cole.
Vitamin C is also essential and must come from our diets because, unlike most other mammals, we do not have the ability to make it ourselves. Vitamin C promotes the healthy growth of collagen, which research suggests strengthens the walls of arteries, including those of the heart. While more research needs to be done on the cardioprotective value of vitamin C, the recommended daily allowance (RDA) is minimal and may not account for our current needs for vitamin C, especially since it is easily depleted by smoking and stress. Eat vitamin C-rich foods every day.
It's best to prepare fruit and vegetables just before eating to maintain their nutritional vibrancy. Vitamins are somewhat fragile. Water-soluble and heat-sensitive vitamins, like vitamin C and the B vitamins, can be lost during cooking. Light stir-frying is a good method; if you use a microwave, studies have shown that using the least amount of water possible will protect some of the vitamins. Vitamins can also be destroyed by air (A, E and C vitamins) and light (C and B vitamins), so drink your juice right after you pour it. Cover fruits and vegetables, like the other half of that grapefruit or cantaloupe, before storing in the refrigerator. Salad bars are a good choice, but remember that the longer the food has been sitting, the fewer vitamins remain. To avoid fat rancidity, be sure walnuts or other nuts are fresh if you're buying in bulk (you can usually smell rancid fat), and keep nuts and seeds refrigerated until use.
Finally, for the best nutrition possible, buy fresh and local. Enjoy the pleasure of visiting one of the many the local farmers' markets and broaden your mealtime horizons by cooking at home.
Know your healthy heart numbers
Heart disease is well known as a leading cause of death for men, but only recently has it been reported as the number-one cause of death for American women, killing 500,000 each year. Fewer than 100 years ago, Dr. James Herrick suggested that heart attacks were linked to blood clots in the coronary artery, and the last century has seen considerable exploration and education about heart health.
A series of inexpensive tests can now provide insight into individual heart health. Locally, the Wisconsin Heart and Vascular Institute offers "Know Your Numbers" and other individualized screenings that identify risk for heart and vascular disease.
"We want to eliminate the commonly held idea that heart disease is simply a byproduct of getting older," says institute cardiologist Dr. John Moses. "We want to empower individuals with key numbers that will impact their choices about their health." The organization also has a Wellness Institute that supports heart education. See wiheart.cardiologydomain.com.
The American Heart Association suggests these numbers for both men and women:
- Total cholesterol: less than 200 mg/dl
- LDL ("bad") cholesterol: less than 100 mg/dl is optimal
- HDL ("good") cholesterol: 50 mg/dl or higher
- Blood pressure: less than 120/80 mmHg
- Fasting glucose: less than 100 mg/dl
- Body mass index (BMI): less than 25 Kg/m2 (Normal range is 18.5-24.9; overweight range, 25-29.9; obese range, 30 and over)
To calculate your BMI, use the online calculator program from the National Heart, Lung and Blood Institute: www.nhlbisupport.com/bmi/bmicalc.htm
Where to get more information
See additional heart-healthy ideas with this story on TheDailyPage.com
American Heart Association
National Heart Lung and Blood Institute
Get more fruits and veggies into your daily diet
Zalta Herb Infused Salts