Preventing and Healing Heart Disease and Stroke:

What is the cause of heart disease?

Coronary heart disease is caused by blockages in the arteries that supply blood to the heart. When the blood supply is obstructed, the heart muscle becomes deprived of oxygen and essential nutrients needed to function properly, which can result in angina (chest pains) or a heart attack. The primary substances responsible for narrowing of the arteries are cholesterol and fatty deposits. Cholesterol is a waxy substance present throughout the body, and is involved in the production of hormones, Vitamin D, and the bile acids used for digestion. However, when it occurs in excess of what the body needs for its natural maintenance processes, the remainder gets deposited in the arteries. Since the body can manufacture all the cholesterol it needs, a heart-healthy diet includes foods low in cholesterol—specifically LDL levels, which have been identified as the main cholesterol-induced risk factor.

Lowering cholesterol levels

A healthy amount of LDL in the blood is less than 100 mg/dL. The National Heart, Lung, and Blood Institute recommends the following dietary guidelines to keep LDL levels low:

• Less than 200 milligrams of dietary cholesterol a day
• Less than 7% of the day's total calories from saturated fat
• 30% or less of the day’s total calories from fat (10% if heart disease is already present)
• Sodium intake of 2400 milligrams a day or less
• Just enough calories to achieve or maintain a healthy weight and reduce your blood cholesterol level

Foods to be avoided for a healthy heart

As stated, foods high in cholesterol and saturated fat should be drastically reduced or eliminated from your diet. The worst offenders are:

• Red meat, pork, or bacon
• Liver and other organ meats
• Egg yolks
• Full-fat dairy products, such as milk, butter, and ice cream
• Coconut oil, palm oil, and palm kernel oil

In addition, foods that do not support a healthy heart for reasons other than cholesterol content should also be avoided or used in moderation:

• Simple carbohydrates such as breads, bagels, and pasta increase the calorie count and stimulate an insulin response, which increases the likelihood that those calories will be converted into fat.
• Alcohol and refined sugar likewise fill you up with empty calories and are not recommended, except in limited quantities.
• Trans fatty acids, which have been shown to spike LDL levels even more than saturated fats, are very detrimental. These are found in cookies and crackers, fried fast foods such as french fries and onion rings, microwave popcorn, and in vegetable shortening and some margarines (except those labeled as “non-hydrogenated”). Any manufactured food that lists “partially-hydrogenated vegetable oil” as an ingredient probably contains trans fatty acids.

Foods that should be eaten for a healthy heart

A heart-healthy diet is filled with complex carbohydrates that are low in total fat, saturated fat, and sugar content:

• Vegetables, fruit, and whole grains in their natural forms
• Legumes, nonfat dairy products, soy products, and egg whites
• Moderate amounts of lean meat, skinless poultry, and fish with low mercury content, such as wild salmon, cod, and trout
• Moderate amounts of nuts, seeds, and avocados

Essential fatty acids (EFAs) and a heart-healthy diet

The human body needs fat for normal cellular functioning. So when you eat fat, replace saturated fats with unsaturated fats. Two of the most heralded fats are omega-6s and omega-3s. These are known as essential fatty acids (EFAs) because the body cannot manufacture them and they must be provided through the diet. Both fats reduce LDL and total cholesterol, but should be consumed in a balanced ratio since they often have opposing effects. It is widely recommended that we significantly reduce our intake of omega-6, found in abundance in vegetable oils, margarines, mayonnaise, and salad dressings, and increase our intake of omega-3 from fish, fish oil, and green plant food sources. Some estimates put the imbalance between omega-6 and omega-3 fats in the western diet as high as 20:1, which has been linked to high blood pressure, water retention, and increased blood clotting. Therefore, these highly beneficial oils need to be consumed smartly.

When cooking, choose oils like canola, olive, walnut, rapeseed, and soybean, which have a healthier balance of omega-6 to omega-3 fats than do oils like safflower, sunflower, and corn. Also, read labels! Choose margarines and salad dressings that are low-fat and contain the beneficial oils. Since much of the fish we consume today has a high mercury content, omega-3 fish oil can be taken in supplement form with all the same benefits. Finally, while flaxseed is a good source of omega-3 fats for women, men should avoid using it as their sole source of fats, since it has been implicated in some studies as a contributing factor to prostate cancer.

The importance of fiber and heart health

Water soluble dietary fiber (WSDF) is an important component to the heart healthy eating program. Studies have shown that a diet rich in soluble fiber reduces blood cholesterol levels. Food sources high in WSDF include the following:

• Barley, oats, and oat bran
• Apples, bananas, blackberries, pears, and prunes
• Lima, kidney, pinto, and navy beans, chick peas, black-eyed peas, and especially lentils
• Brussel sprouts, carrots, and broccoli

The American Dietetic Association recommends 20-35 grams of fiber per day. To meet this intake, supplementation is often necessary. Psyllium Husk, Pectin, Guar Gum, Locust Bean Gum, and Acacia can be bought in various combinations in powder or pill form in natural food stores.

A final caveat: the suggested diet for those at risk of heart disease is different from the diet for those who have already been diagnosed with the condition. For a diet designed to help reverse heart disease, Dr. Dean Ornish recommends more stringent modifications. Please see Dr. Ornish’s recommendations in References and resources.

Cause of stroke

A stroke occurs when the flow of blood to the brain is interrupted due to blocked arteries or a ruptured blood vessel. The part of the brain that was supplied by the clotted blood vessel is then deprived of blood and oxygen, and the cells die as a result. Hypertension, or high blood pressure, wears down the artery walls over time, and is the most important modifiable risk factor for stroke. Therefore, a diet that controls for high blood pressure also controls for stroke.

The DASH diet

The “DASH” eating plan came out of a clinical study funded by the National Institutes of Health that tested the effects of nutrients in food on blood pressure. DASH stands for Dietary Approaches to Stop Hypertension, and the study found that blood pressure levels dropped without the use of medication when the participants followed certain eating guidelines. The DASH recommendations are nearly identical to the heart diet already discussed: eat more fruit and vegetables, use only low- or non-fat dairy products, eat less meat, and limit or avoid sugar, sweetened beverages, and alcohol.

The daily serving recommendations are based on a 2,000-calorie diet, and should be modified as needed according to caloric requirements:

• Grains and grain products—7 or 8 servings per day
• Vegetables—4 or 5 servings per day
• Fruit—4 or 5 servings per day
• Low-fat or fat-free dairy foods—2 or 3 servings per day
• Lean meats, poultry, and fish— 2 or fewer servings per day
• Nuts, seeds, and dry beans—4 or 5 servings per week
• Fats or oils—2 or 3 servings per day
• Sweets—5 servings per week

How much sodium should I have in my diet?

Reducing sodium in the diet is also crucial for the prevention of stroke. A second study similar to DASH was undertaken to determine the effects of sodium intake on high blood pressure. “DASH-Sodium” tested participants from the DASH group as well as those following a typical American diet. The results showed that restricting sodium to less than 2,400 mg per day—the equivalent of 6 grams (about 1 teaspoon) of table salt—significantly lowered blood pressure. The 6 grams includes all salt and sodium consumed, including that used in cooking. The study further found that those following the DASH diet at the lowest sodium level of 1,500 mg had even lower blood pressure as a result.

What are some tips for reducing my intake of sodium?

The National Heart, Lung, and Blood Institute’s website gives practical tips on keeping sodium levels low:

• Buy fresh, plain frozen, or canned "with no salt added" vegetables
• Use fresh poultry, fish, and lean meat, rather than canned or processed types
• Use herbs, spices, and salt-free seasoning blends in cooking and at the table
• Cook rice, pasta, and hot cereals without salt; cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt
• Rinse salt from canned foods Related links for preventing and healing heart disease and stroke

Related links for preventing heart disease and stroke

Heart disease

Heart Healthy Diet – Eating guidelines to lower your cholesterol and reduce your risk of heart disease. (National Heart, Lung and Blood Institute)

Dr. Dean Ornish Lifestyle Modification – Nutritional and dietary guidelines, including a “reversal” diet for those diagnosed with heart disease and a prevention food pyramid. (Preventative Medicine Research Institute)

Therapeutic Lifestyle Changes (TLC) Diet – A look at how a low-saturated fat, low- cholesterol diet plus regular physical activity can improve your heart health. Includes a Virtual Grocery Store that teaches you how to read food labels, and a Cyber Kitchen where you can calculate the calories and cholesterol level in your diet. (National Heart, Lung and Blood Institute)

Fiber Facts: Soluble Fiber & Heart Disease – Fiber facts and advice, including a fiber drink recipe. (American Dietetic Association)

High blood pressure

Your Guide to Lowering High Blood Pressure – Overview of the DASH (Dietary Approaches to Stop Hypertension) program, with six additional links offering specific guidance on portions and fats, recipes, and preparing healthier meals. (National Heart, Lung and Blood Institute)

DASH Eating Plan (PDF) – A detailed user's manual (24 pgs) for reducing high blood pressure through diet. (National Heart, Lung and Blood Institute)

John Dorsey created this article with contributions from Gina Kemp, M.A. Last modified: February 07.