Heart disease is the leading cause of death in the United States. According to the American Heart Association, about 1.5 million Americans will suffer heart attacks this year. However, statistics do not equal fate. Many proactive steps are available to help reduce the risk, from the foods we eat (and avoid), to the herbs and supplements we take and the lifestyle changes we incorporate.
Health practitioners have known for some time that for good heart health, we need to avoid saturated fats and watch our cholesterol levels — and many studies continue to confirm this. Lowering our cholesterol concentrations can result in a 25 percent decrease in death from heart disease, according to research published in the British Medical Journal.
People tend to be much more aware of their blood lipid profiles today than they were even a few years ago. A lipid profile is a blood test that measures levels for total cholesterol, high-density lipoprotein (HDL, also known as “good” cholesterol), low-density lipoprotein (LDL, also known as “bad” cholesterol) and triglycerides.
The goal is not to achieve as low a cholesterol level as possible but to achieve a healthy cholesterol ratio. This ratio refers to the amount of total cholesterol to HDL cholesterol and should be at least 3.5:1 — higher numbers are associated with a lower risk of heart disease. (To find this ratio, divide your total cholesterol by your HDL level.) Because this ratio increases with higher HDL levels, increasing HDL is important for a healthy heart. The best way to increase HDL is to exercise. Decades ago, heart patients were told to rest, but now we know that 20 to 30 minutes of aerobic exercise three to five times a week can prevent the development of heart disease (and reduce symptoms in those who already have heart disease).
Besides cutting down on foods that are high in saturated fat, such as red meat, eating more plant sterols can help reduce cholesterol levels. Sterols are lipid-soluble compounds that include beta-sitosterol, stigmasterol and campesterol. Good sources of plant sterols include peanuts, seeds, whole grains, nuts and legumes, such as soybeans. Plant sterols decrease cholesterol by reducing the amount of cholesterol absorbed by the gastrointestinal tract.
In fact, according to research published in the Journal of the American Medical Association (JAMA), a diet that included 2 grams a day of sterols, 42 grams a day of soy protein and 19 grams a day of viscous fiber, such as oats, decreased cholesterol as effectively as statin drugs did.
If you need more motivation to reduce red meat in your diet — or eliminate it altogether — consider this: Red meat is not only high in saturated fats but also high in methionine. This essential amino acid is converted to homocysteine by the body. Homocysteine has been identified as another risk factor for heart disease. Homocysteine can be lowered by taking vitamin B6, folic acid and vitamin B12.
Lowering cholesterol is not the only factor involved in reducing the risk of heart disease. Besides high cholesterol, the most important risk factors for cardiovascular disease are smoking and high blood pressure. In fact, smoking could be the most detrimental of these risk factors. One review of the medical literature, published in JAMA in 2003, found that for patients with heart disease, the risk of death was decreased by 36 percent if the patients quit smoking. The next important risk factor is high blood pressure. Many people have high blood pressure without knowing it, so it’s important to have your blood pressure checked periodically.
An estimated 10 percent to 50 percent of people who develop heart disease do not have high cholesterol or high blood pressure, nor do they smoke, according to another 2003 JAMA article. This means many people can be unaware that they were at risk for heart disease until it is too late. Consider some of the following additional means to keep your heart healthy, whether you have known risk factors or not.
The main form of heart disease involves atherosclerosis of the coronary arteries. This means the blood vessels that bring essential nutrients and oxygen to the heart muscle have become too narrow to perform their function, so the heart muscle starves. The earliest step in this process is thought to be damage to the inner walls of the blood vessels. After the vessel is damaged, narrowing can occur by the buildup of plaque. Once this happens, the body responds by creating inflammation and blood clotting, processes that can block blood flow through the vessels.
Controlling inflammation and excess blood clotting are important factors in decreasing the risk of heart disease. Eating plants that contain flavonoids (see “Fabulous Flavonoids” for examples) as well as dietary fiber, vitamins and minerals, ranks with getting enough exercise, reducing cholesterol and controlling blood pressure as a key component in preventing heart disease.
Whether you have heart disease or want to make sure you never do, the following tips and information can help keep your heart healthy and happy.
Rather than reducing your intake of saturated fat by substituting carbohydrates, it might be more beneficial to substitute unsaturated fats — those that are liquid at room temperature. Unsaturated fatty acids include monounsaturated and polyunsaturated fats. Monounsaturated fats reduce blood cholesterol and triglyceride levels, and decrease proteins associated with blood clotting, which decreases the risk of heart disease. Sources of monounsaturated fats include olive oil, canola oil, peanut oil and avocados.
The most important fatty acids are the omega-3s (components of polyunsaturated fatty acids), because they can decrease triglyceride levels and LDL without decreasing HDL. They also decrease inflammation, inhibit platelet stickiness and lower blood pressure, according to research published in the American Journal of Clinical Nutrition in 2000. Omega-3 fatty acids are found in fatty fish such as halibut, mackerel, herring and salmon. Vegetable oils high in omega-3 fatty acids include canola oil, flaxseed oil, walnut oil and soy oil. Flaxseeds are a particularly rich source and are easy to add to your diet — just grind the seeds and sprinkle them on top of cereal or yogurt. Additional foods containing omega-3 fatty acids are pinto beans, walnuts, pumpkin seeds, purslane, spinach and leeks.
Trans fatty acids are unsaturated fats that have been processed by hydrogenation to make them solid. The best-known trans fat is margarine. Although margarine was once touted as a beneficial alternative to butter — which is high in saturated fat — we now know trans fats can raise LDL, lower HDL and raise triglyceride levels, according to research from countless sources, including the New England Journal of Medicine. These fats should be avoided — not always an easy task because they are ubiquitous in processed foods, such as crackers, cookies, packaged baked goods and microwave popcorn. You can identify trans fats by looking for the phrase “partially hydrogenated vegetable oil” on product labels.
Flavonoids (also known as polyphenols) are products of plant metabolism that have strong antioxidant properties in the body. Literally thousands of flavonoids have been identified, too many to possibly name them all here. But this large family of plant chemicals includes lignins (found in nuts and whole grains); proanthocyanins (in grapes and pine bark); anthocyanins (found in grapes, red wine, berries and purple-colored fruits and vegetables); isoflavones (found in soybeans); catechins (found in tea, grapes, cocoa and wine); tannins (in tea and nuts); and quercetin (in grapes, wine and onions).
Several studies, including one published in 2002 in the American Journal of Clinical Nutrition, have found that increasing consumption of flavonoids decreases the risk of coronary heart disease. Flavonoids act as antioxidants to prevent the oxidation of LDL, a process thought to be the first step in plaque formation. Flavonoids also can inhibit platelet activity, which decreases abnormal clotting. Heart patients are often advised to take an aspirin daily to achieve the same anti-clotting effect.
To increase your consumption of flavonoids, eat onions and soy, or drink tea and wine, or just increase your consumption of fruits and vegetables in general. One long-term study, published in the American Journal of Clinical Nutrition in 2002, found that people who ate more than three daily servings of fruits and vegetables had a 27 percent lower risk of dying from heart disease over the 19-year period of the study. And the benefits didn’t extend to just heart disease — those who ate more fruits and vegetables had a 15 percent lower chance of dying from any cause than people who ate less than one serving a day.
The Allium family, which includes garlic (Allium sativum), onions (A. cepa) and leeks (A. ampeloprasum), is the primary contributor of plant organosulfur compounds. In many clinical trials, garlic has been found to reduce total blood cholesterol levels, LDL levels and triglyceride levels, according to a research review published in 2002 in the Nutrition Journal. Raw garlic seems to have the most beneficial effect. Powdered garlic, which is low in allicin, the compound responsible for garlic’s greatest health benefits, has the lowest effect.
Garlic extracts inhibit platelets, as well as several other factors involved in blood clotting. Garlic also helps lower blood pressure. Many preparations of garlic are available, not all of which have been studied, but one fresh garlic clove per day is sufficient to reduce cholesterol and reduce platelet function. Side effects of garlic can include gastrointestinal discomfort and nausea. As with any herb or drug that affects blood clotting, you should let your physician know prior to having surgery if you’re taking garlic.
Fiber refers to plant carbohydrates that our digestive system cannot digest. They pass through the gastrointestinal tract without being absorbed, carrying cholesterol with them. Fiber is found mainly in whole grains, such as whole-wheat bread, oatmeal and brown rice. Besides containing fiber, these grains are high in magnesium, selenium, phytosterols and other plant chemicals. Whole grains can improve lipid profiles, decrease blood pressure and improve blood glucose levels. In the United States, wheat often is supplemented with folic acid, which decreases the risk of heart disease.
Magnesium deficiency is associated with an increased risk of heart disease. Studies, including one published in 2003 in the American Journal of Cardiology, have found that people who eat foods rich in magnesium have a lower risk of heart disease. Good magnesium sources include whole grains, peanuts, beans, seeds and leafy green vegetables. If you live in an area with hard water, your drinking water already contains plenty of magnesium.
Folic acid, vitamin B6 and vitamin B12 all help prevent heart disease by decreasing levels of homocysteine, according to a 1997 article published in Cardiology. Enriched grain products in the United States are fortified with at least 140 grams of folic acid per 100 grams of grain. Other good sources of folic acid include dark, leafy green vegetables, lentils and chickpeas. Because vitamin B12 is found mainly in meat, vegetarians may need to consider supplements, although eggs, dairy products and brewer’s yeast are also good sources. Niacin can decrease LDL levels and increase HDL levels and is often prescribed in high doses for this purpose. Food sources of niacin include asparagus, bean sprouts and red raspberry (Rubus idaeus) leaf.
Because foods contain a wealth of plant chemicals, it’s difficult to determine which of them is individually responsible for specific activities. It appears that supplementation with antioxidant vitamins E and C is not as important in preventing heart disease as eating a variety of foods. People who eat foods high in these vitamins reduce their risk of heart disease, according to a 2004 article from Current Treatment Options in Cardiovascular Medicine. Food sources high in vitamin E include walnuts, green leafy vegetables, sunflower seeds, purslane, whole wheat and pansy flowers (Viola tricolor). Vitamin C-rich foods include kiwis, sweet peppers, cashews, watercress, rosehips and garden sorrel.
Besides their high levels of beneficial flavonoids, many herbs have additional properties that are good for the heart.
Hawthorn (Crataegus spp.) has a long history of use for heart disease. The leaves, flowers and berries have been used for treating congestive heart failure, high blood pressure and atherosclerosis. Several studies, including a meta-analysis published in The American Journal of Medicine in 2003, have found that hawthorn extracts can decrease the fatigue and breathing problems associated with mild to moderate chronic heart failure.
Asian ginseng (Panax ginseng) also has been used historically for treating heart and circulatory disease, especially in China. Some studies have shown that ginseng can improve aerobic capacity during exercise, in which heart function is very important. It may help the heart by inhibiting platelet activity, acting as an antioxidant, opening up the blood vessels and decreasing an elevated heart rate. Thorough clinical studies have not been conducted, however. Asian ginseng should not be taken with drugs intended to influence blood coagulation, especially warfarin.
All of the studies mentioned in this article indicate that good heart health is primarily a function of lifestyle. No single food or supplement can prevent heart disease. The triad of eating a healthy diet with a wide variety of minimally processed foods, not smoking and getting plenty of exercise is the best and most established way of preventing heart disease — and managing the disease if you already have it. These measures not only will go a long way in preventing heart disease but are also the cornerstone of preventing diabetes, cancer, obesity and other common diseases.
Cindy Jones, Ph.D., is a biochemist who works as a medical writer and health educator specializing in herbs and nutrition. She is the author of the Healthy Heart Guide (Woodland, 2004). Her website is www.sagescript.com.
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