Ten top tips for great heart health and lower cholesterol
Posted: November 2, 2016
Cardiovascular disease is the number one killer in the UK, but it doesn’t have to be this way. We don’t have to have chronic disease as we age – the Longevity Hot Spots are proof of that. And if you have high cholesterol, as millions of people in the US and the UK do, you may feel confused and alarmed by varying reports about cholesterol-lowering statin drugs (1). Read on, because you may find the alternatives a pleasant surprise.
As far as statins go, studies seem to show one week that they can ruin your health, the next that they are safe and effective and that they might save your life (2), (3). Doctors are urged to prescribe them widely, yet many refuse to do so or to take them themselves (4). What are we supposed to think – if you have high cholesterol, do you gamble on the pros outweighing the cons?
First of all it is important to know that high LDL cholesterol levels aren’t actually that significant in themselves. A recent review indicated that high LDL cholesterol is not linked with increased mortality at all, whilst another study showed that half of patients hospitalised with coronary artery disease had healthy LDL cholesterol levels (5),(6).We should be worrying just as much, if not more, about inflammation, homocysteine, and how our LDL cholesterol actually behaves in blood vessels, since these are all clearly linked with heart health.
Statins may be effective in lowering cholesterol, and they may even save lives, but they do not necessarily make people healthy. In fact, they may contribute to ill-health and poor heart health, since they reduce the function of our mitochondria (the energy-making ‘factories’ in our cells), block the use of Coenzyme Q10 in the heart, and increase calcification of arteries by inhibiting vitamin K2 use (7).
The good news is that cholesterol-lowering foods are not only highly effective, but that a diet which gives you good cholesterol levels will also deal with inflammation, homocysteine, high blood pressure, the oxidation of LDL cholesterol, and more. And two heart-friendly diets, the Portfolio Diet and the Mediterranean diet, have been found to be just as effective at lowering LDL cholesterol as statins, if not more so, without the side-effects (8), (9). It seems that if we do it with diet, along with a handful of lifestyle habits, we’re in a win-win situation.
We also don’t need to go on strict diets or feel deprived in order to have good heart health. These sweet potato brownies (taken from the Deliciously Ella ‘new improved sweet potato brownies’ recipe) are proof of that – these taste 100% indulgent, but are made with all good things – sweet potatoes, healthy proteins, and beneficial fats.
So here’s what to eat and do in order to improve heart health, avoid the side-effects of drugs, and lower ALL the major risk factors for heart disease:
1. Eat breakfast
Eating a good breakfast which includes lean proteins and beneficial fats (from, for example, nuts, soy yogurt or eggs) will get your blood sugar levels off on the right foot for the day. This means you can avoid the blood glucose spikes which lead to formation of triglycerides, a blood lipid which can be more damaging than LDL cholesterol. Breakfast-skippers have been found to have a significantly increased risk of cardiovascular disease (10).
2. Eat fruit
Fruit is a source of vitamin C, antioxidants and potent plant chemicals called polyphenols which keep blood vessels healthy, dampen inflammation, and prevent cholesterol from oxidising and becoming atherosclerotic plaque. Vitamin C is particularly important as it helps to make collagen, which keeps blood vessel walls elastic. Fruit also contains soluble fibre which helps lower cholesterol by reducing reabsorption of bile in the intestines.
Avoid fruit juice as it is high in fructose, and go for whole fruit instead; fruit juice is linked with a raised risk of diabetes, which relates to heart health, whilst eating whole fruit regularly is linked with a lower risk (11).
3. Heap your plate with vegetables twice daily
A central part of the traditional Mediterranean diet, vegetables are a rich source of antioxidant, anti-inflammatory vitamins, minerals and phytochemicals, which means they help keep blood vessels healthy and prevent the formation of plaque. They also contain top-quality soluble fibre, and they help steady blood sugar levels, both of which keep cholesterol levels down.
On top of that, vegetables provide magnesium which relaxes blood vessels, folic acid which helps lower homocysteine levels, and potassium which reduces blood pressure. Cabbage contains phytosterols which displace cholesterol in the gut; it has been found to lower cholesterol seventeen per cent more effectively than cholesterol-lowering drugs (12).
Garlic and onions are anti-inflammatory, whilst garlic helps thin the blood and has been found to benefit heart health in a variety of ways (13).
4. Eat protein foods with every meal
Protein foods balance blood sugar, which means fewer triglycerides as well as less damaging glucose and insulin bouncing around in your blood vessels. Aim to fill around a quarter to one-third of your plate with a protein source at your midday and evening meal, and to include a protein at breakfast too.
Top protein choices are lean Mediterranean-style proteins: fish, nuts, beans and seeds, which have been found to be heart-protective (14), (15), (16). Free-range poultry or game and eggs can also be included. Red meat and dairy products should be kept to a minimum since they are high in saturated fats which are pro-inflammatory; studies have found that high saturated fat intake may increase heart disease risk (17), (18).
5. Go for good carbs, not bad
Sugar and refined carbohydrates, such as white flour products, chips, and white rice, are the ‘bad carbs’ which cause blood sugar spikes, which has any number of repercussions for health, including heart health. Excess glucose is converted to triglycerides and it also leads ultimately to glucose and insulin circulating in the bloodstream which damages blood vessel walls. In fact, the wrong types of carbs have been found to be more of a hazard to heart health than saturated fats (19).
If you have a starchy carb, make it a ‘pseudo-grain’ such as quinoa or buckwheat, a whole grain such as oats or brown rice, or a root vegetable with skin such as potatoes or sweet potatoes, rather than white bread or white rice, and keep it to a quarter of the plate only. And remember that veg are a source of good carbohydrate too; you aren’t missing out on a food group if you don’t have cake or pasta.
6. Get good fats
A heart-friendly diet is not a diet of deprivation, especially when you add good fats to the mix. Olive oil, fish, nuts, seeds and avocados are all sources of beneficial fats which help lower LDL cholesterol levels, are anti-inflammatory, and help transport fat-soluble vitamins to cells. The omega-3 fats in oily fish such as salmon, mackerel and sardines also help prevent blood from clotting. Foods which contain beneficial fats are also often good sources of vitamin E, which helps prevent blood clots and the oxidation of LDL cholesterol.
In one study it was found that people who had had heart attacks were far less likely to suffer a second heart attack if they followed a Mediterranean-style diet rich in omega-3 fats (20). Avoid cheap cooking oils and hydrogenated fats as these will have the reverse effect.
7. Think about what you drink
Water is the most important drink; the one we humans drank as our main form of hydration for two and a half million years. Water keeps blood flowing, and aids circulation, getting nutrients into cells where they belong. One large study has even shown a specific link between water intake and lower risk of heart disease (21). A water filter jug is a good investment as it removes chlorine and fluoride which will oxidise LDL cholesterol to form plaque.
Red wine seems to be heart-protective in moderate amounts, most likely because it contains powerful antioxidants such as resveratrol which lower inflammation and protect blood vessels from free radical damage; polyphenols in red wine also help relax the blood vessels (22). And good news for steak-lovers is that drinking a glass of red with a steak has been found to neutralise the steak’s cholesterol-raising effect (23).
Green tea is a wonderful heart-friendly drink since it helps balance blood glucose and insulin levels and has been found in many studies to lower LDL cholesterol levels (24). Green tea also contains powerful antioxidants which help prevent inflammation and free radical damage to blood vessels.
8. Be a home for friendly bacteria
It is well-known that ‘friendly’ bacteria, or ‘probiotics’, are good for the gut, but they are also good for the heart. Probiotics lower LDL cholesterol and they also keep levels of inflammation down via the immune system, which is good news for blood vessels. Good bacteria also break down bile acids which lowers overall cholesterol levels, and they even feed directly off cholesterol (25).
Rich sources of probiotics are fermented foods such as sauerkraut and marinated vegetables, kefir, and live yoghurt; you can also top up your population once or twice a year with a good probiotic supplement.
9. Keep moving
The dramatic effect exercise can have on heart health was first observed in London in the 1950s during an epidemic of heart attacks. Researchers noted that bus conductors, who ran up and down the stairs of double-decker buses all day, did not succumb to cardiovascular disease, whilst the sedentary bus drivers did. We now know that not exercising is as dangerous as smoking, with a study in the Lancet in 2012 showing that lack of exercise causes 5.3 million deaths annually worldwide (26).
You don’t have to join an expensive gym – experts concur that we need just twenty minutes of brisk exercise daily to make a big difference – that’s a ten-minute walk twice a day. Exercising outdoors is probably best, especially in summer, as this increases the amount of vitamin D your body makes; it is thought that vitamin D may be beneficial for heart health. Walking around the block at work once or twice a day is a good place to start.
Working extra hours and stressing out over everything we have to achieve will have limited value if it ends up making us ill. Stress is bad for heart health because it triggers the formation of oxidised cholesterol, it raises blood pressure, it causes spikes in blood glucose, and it uses up important nutrients required for cardiovascular health such as magnesium, vitamin C, and B vitamins.
Try to take time to rest, nap, meditate, go for a walk somewhere pretty, have reflexology or whatever it takes to stay chilled. Getting enough good-quality sleep is also good, as it can reduce the risk of cardiovascular disease by a whopping sixty-five per cent (20).
It’s no coincidence that this list matches up neatly with what is done in the ultra-healthy, ultra-long-lived populations I have studied, and also with basic nutrition protocol for overall great health. My book, The Stacking Plan, guides you through adding in all the main good nutrition habits we need – and it’s good to know that Ollie, one of my ‘human guinea pigs’, who features in the book, was able easily to lower his cholesterol levels so that his doctor no longer wanted him to take cholesterol-lowering drugs. What’s good for one part of the body is bound to be good for another, so by eating and doing the right things you are not masking symptoms, as medical drugs do, you are making the whole body well.
Note: if you are currently taking statins and are considering replacing them with good diet and lifestyle habits, please make sure to do so under medical supervision.
(1) From heartuk.org.uk and http://www.cdc.gov/cholesterol/facts.htm
(2) NISSEN, Steven E, MD et al (2016). Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance. JAMA 315(15)
(3) COLLINS R, REITH C, EMBERSON J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. The Lancet. Published online September 8 2016
(4) As reported in: http://www.telegraph.co.uk/news/health/news/11201669/GPs-refusing-to-prescribe-statins.html
(5) RAVNSCOFF Utte et al (2016). Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open; 6(6)
(6) SACHDEVA A et al (2009). Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. American Heart Journal 157(1):111-117
(7) OKAYAMA H et al (2015). Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Review of Clinical Pharmacology 8(2):189-99
(8) JENKINS, David JA (2005). Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants 1,2,3. American Journal of Clinical Nutrition 81(2):380-387.
(9) ESTRUCH, R, MD et al (2013). Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New England Journal of Medicine. 368:1279-1290.
(10) CAHILL, Leah E (2013). Prospective Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health Professionals. Circulation, July 23.
(11) MURAKI, Isao (2013). Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 347:f5001.
(12) KAHLON TS, CHIU MC, Chapman MH (2008). Steam cooking significant improves in vitro bile acid binding of collard greens, kale, mustard greens, broccoli, green bell pepper and cabbage. Nutr Res 28(6):351-7.
(13) QIDWAI, Waris & ASHFAQ, Tabinda (2013). Role of Garlic Usage in Cardiovascular Disease Prevention: An Evidence-Based Approach. Evid Based Complement Alt Med v 2013.
(14) BAZZANO LA et al (2001). Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. 161(21):2573-2578.
(15) STAMPFER et al (1999). Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep: 1(3)204-9.
(16) MOZAFFARIAN D; RIMM EB (2006). Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 296(15): 1885-9.
(17) FAGHIHNI N et al (2012). Effects of dietary saturated fat on LDL subclasses and apolipoprotein C III in men. European Journal of Clinical Nutrition 66(11): 1229-33.
(18) MUSTAD, VA et al (1997). Reducing saturated fat intake is associated with increased levels of LDL receptors on mononuclear cells in healthy men and women. J Lipid Res 38(3): 459-68.
(19) SIRI-TARINO, Patty W et al (2010). Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr 91(3): 502-509.
(20) DE LORGERIL et al (1998). Mediterranean dietary pattern in a randomised trial: prolonged survival and possible reduced cancer rate. Arch Intern Med; 158 (11): 1181-7.
(21) CHAN, J et al (2002). Water, Other Fluids, and Fatal Coronary Heart Disease. American Journal of Epidemiology. 155(9): 827-833.
(22) SZMITKO, Paul E, et al (2005). Red Wine and Your Heart. Circulation 111:e10-e11.
(23) GORELIK, Schlomit et al (2013). A rational approach to prevent postprandial modification of LDL by dietary polyphenols. Journal of Functional Foods 5(1):163-169.
(24) ZHENG XX (2011). Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr 94(2): 601-10.
(25) SAINI,Rajiv et al (2010). Potential of probiotics in controlling cardiovascular disease. Journal of Cardiovascular Disease Research. 1(4):213-214.
(26) LEE, IM (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and ice expectancy. The Lancet 380(9838): 219-229.
(27) VERSCHUREN, M et al (2013). Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study. European Journal of Preventive Cardiology 0(00) 1-9.