This is the final article in the Diet-Heart Myth series I’ve been writing over the past several weeks. If you missed the previous articles, you can find them compiled into an eBook on the Diet–Heart Myth.
Ben Franklin said, “An ounce of prevention is worth a pound of cure.” Heart disease is no exception. According to the INTERHEART study, which examined cardiovascular risk factors in 51 countries, 9 out of the 10 strongest risk factors for heart disease are modifiable by changes in diet and lifestyle. (1)
While taking action now does not guarantee that you’ll never get heart disease (as age is perhaps the strongest risk factor), it does vastly improve your chances of avoiding it or at least delaying it significantly. In this article, I’ll teach you how to do that in three simple steps:
- Eat a heart-healthy diet
- Live a heart-healthy lifestyle
- Boost your heart-healthy nutrients
3 simple steps to living a heart-healthy lifestyle that your doctor has never told you about.
Eat a Heart-Healthy Diet
The “Paleo Template” approach I’ve written about here is an excellent starting place to improve your heart health. It includes all of the necessary micronutrients in their most bioavailable form, emphasizes an optimal balance of fats, eliminates highly processed and refined foods, and reduces other food toxins that interfere with nutrient absorption. On the other hand, the American Heart Association’s “heart-healthy” diet emphasizes nutrient-poor foods such as whole grains and vegetable oil, and unnecessarily restricts nutrient-dense foods like red meat, animal fat and cholesterol.
But which version of the “Paleo Template” is best for preventing heart disease? In this series we’ve been focusing on LDL particle number as one of the primary drivers of atherosclerosis. We also discussed the five main causes of elevated LDL-P, including insulin/leptin resistance, genetics, poor thyroid function, infections and leaky gut. If you have elevated LDL-P while on a Paleo diet, the key is to first discover what’s causing it and then tailor your diet accordingly. In this article, I’m going to focus on insulin/leptin resistance and genetics, since those are the two most common causes of elevated LDL-P that I see in my practice.
In this case, the best approach is often a low-carb Paleo diet. When I say low carb, I generally mean between 50–100 grams of carbohydrate per day in the form of fruit and starchy vegetables like sweet potatoes, potatoes, plantain, yuca and taro. I do not count non-starchy vegetables toward the carbohydrate intake, because I don’t believe they make a significant enough contribution to matter. The purpose of this approach is to improve insulin and leptin sensitivity and promote weight loss, which will in turn decrease LDL-P.
If you have high LDL-P, but normal triglycerides, HDL, small LDL-P and your lipoprotein insulin resistance (LP-IR) score on the NMR LipoProfile is normal, and you’ve ruled out thyroid problems, infections and leaky gut, than it’s very likely that you have one of the many genetic variants that can lead to increased LDL particle number. In this case, a low-carb Paleo diet will often increase—rather than decrease—LDL-P. In my practice I will often recommend what I call a “Mediterranean Paleo diet” in these cases. This means following the basic Paleo approach, but reducing intake of fat and increasing intake of fruit and starchy vegetables. You can still eat fat as it naturally occurs in food, but try not adding as much additional fat to meals, and using more monounsaturated fat than saturated fat. In many cases this will decrease LDL-P quite significantly.
The trickiest situation is when someone has both insulin and leptin resistance and a genetic issue. A low-carb diet will usually drive up LDL-P in that situation, but it will improve many other markers that are also risk factors for heart disease, including triglycerides, HDL, fasting insulin, fasting glucose, etc. So I will usually recommend a low-carb diet for these patients, and if their LDL-P goes up, try to use natural therapies to bring it down.
Live a Heart-Healthy Lifestyle
Exercise has been shown to reduce LDL particle concentration even independently of diet. (1) Regular exercise prevents the development and progression of atherosclerosis, improves lipids, and reduces vascular symptoms in patients that already have heart disease. The benefits of exercise are related to maintenance of body weight or weight loss, blood pressure control, return of insulin sensitivity, and beneficial changes in lipids, all of which in turn promote endothelial stabilization and vascular health.
In addition to distinct periods of exercise, it’s also important to sit less and stand and walk more. In fact, some research suggests that this “non-exercise” physical activity may have a greater impact on our cardiovascular health than exercise. Dan’s Plan has some fantastic recommendations for physical activity, as well as a great software and hardware-based tracking system.
I have come to believe that chronic sleep deprivation is one of the most pernicious—yet under-recognized—contributors to the modern disease epidemic. Sleep deprivation has been associated with weight gain, insulin resistance, increased appetite and caloric intake, overconsumption of highly palatable and rewarding food, decreased energy expenditure and a reduced likelihood of sticking with healthy lifestyle behaviors. Sleep duration and quality are inversely associated with blood pressure in epidemiological studies, and high blood pressure is one of the strongest independent risk factors for cardiovascular disease (CVD). (2) Finally, the Nurses Health Study found that those who reported fewer than 5 hours of sleep at night had a 38% greater risk of coronary heart disease (CHD) than those reporting 8 hours of sleep. (3)
For tips on how to improve your sleep, see my article “Sleep More Deeply“.
Stress increases the risk of cardiovascular disease in numerous ways. It increases intestinal permeability, impairs blood sugar control, depresses immunity (which increases the risk of infection), contributes to fat storage in the liver, and promotes consumption of comfort and junk foods. But perhaps the most significant contribution stress makes to CVD is that it promotes inflammation. Stress has been shown to increase circulating inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6), both of which are associated with heart disease (4). On the other hand, stress management can have a profound impact on heart disease risk. One recent randomized trial showed that regular meditation decreased the risk of death from heart attack, stroke and all causes by 48%—a much greater reduction than what is observed with statins even in the highest risk population. (5)
Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!
Boost Your Heart-Healthy Nutrients
In addition to the basic heart-healthy versions of the Paleo template I mentioned above, there are several specific foods/nutrients that have been shown to improve cardiovascular health.
Cold-water, fatty fish
Cold-water, fatty fish are an excellent source of EPA and DHA, long-chain omega-3 fats with several cardiovascular benefits. An analysis of randomized trials since 2003 suggests that regular fish consumption or consumption of fish oil would reduce total mortality or deaths from all cause by 17%. (6) This is remarkable when you consider the fact that statin drugs only reduce total mortality by 15%, and even then, only in certain populations.
Monounsaturated fats have been shown to reduce LDL and triglycerides and increase HDL. They also decrease oxidized LDL, reduce oxidation and inflammation in general, lower blood pressure, decrease thrombosis, and they may reduce the incidence of heart disease. (7) The best sources of monounsaturated fat are olives, olive oil, macadamia nuts, and avocados.
Antioxidant-rich foods protect against heart disease in a number of important ways. Our antioxidant defense system is what protects us from oxidative damage, which as you now know is a major risk factor for heart disease. Strengthening this system has two sides: reducing our exposure to oxidative stress and increasing our intake of antioxidant-rich foods. When most people think of antioxidants, they think of fruits and vegetables like dark, leafy greens and fruits like berries. But while it’s true that these foods are rich in antioxidants, what a lot of people don’t know is that red meat and organ meats are also very rich in important antioxidants that aren’t found in significant amounts in plant foods, like CoQ10 and retinol, which is preformed vitamin A. A good rule of thumb is to eat the rainbow, choosing a variety of colors of fruits and vegetables, as well as organ meats, meats, eggs, and grass-fed dairy.
Polyphenols are a diverse class of molecules made by plants, certain fungi, and a few animals. They serve a lot of purposes including defense against predators and infections, defense against sunlight damage, chemical oxidation, and coloration. The color, in fact, of many fruits and vegetables like blueberries, eggplants, red potatoes, and apples comes from polyphenols. Some of the best studied polyphenol-rich foods are tea, especially green tea; blueberries; extra-virgin olive oil; red wine; citrus fruits; hibiscus tea; dark chocolate; coffee; turmeric; and other herbs and spices. Polyphenol-rich foods have been shown to have a number of beneficial health effects. For example, dark chocolate has been shown to lower blood pressure and LDL cholesterol and improve insulin sensitivity, red wine has been shown to prevent the increase in oxidized fats that occur after consuming a meal high in oxidized and potentially oxidizable fats, several studies have shown that hibiscus tea lowers blood pressure in people with hypertension, and blueberries have been shown to lower blood pressure and oxidized LDL in men and women with metabolic syndrome. (8)
Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!
Some studies have shown that nut consumption may reduce the risk of cardiovascular disease. In a recent analysis of NHANES data from 1999 to 2004, investigators found that nut consumption was associated with a decrease in a wide range of cardiovascular disease risk markers, including body mass index, waist circumference, and systolic blood pressure, compared to non-consumers of nuts. (9) This is observational data so we can’t be sure that it was the nuts, rather than some other factor that wasn’t adequately controlled for, that led to the improvements. That said, a review of five large prospective studies (including NHANES) as well as clinical trials examining the effects of nut consumption on lipid parameters found similar results. (10) I favor macadamia nuts, almonds and hazelnuts because they are lower in omega-6 linoleic acid, which research suggests may contribute to CVD when consumed in excess.
In the NHANES study, subjects followed for more than 19 years with the highest quartile of dietary soluble fiber intake had a 15% lower risk of heart disease and had a 10% lower risk of cardiovascular events. (11) Soluble fiber binds bile acids or cholesterol; upregulates LDL receptors in the liver; increases clearance of LDL; inhibits fatty acid synthesis by producing short-chain fatty acids like acetate, butyrate, and propionate; improves insulin sensitivity; and increases satiety with lower overall energy intake. (12)
I hope you’ve enjoyed the Diet-Heart Myth series, and that the information I’ve presented will help protect you and those you love against heart disease. I’ve done my best to cover the most important steps you can take, both in terms of diagnosis and treatment.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
To all the haters of paleo, if you don’t want to eat paleo than don’t! Wow! Can’t imagine going on to some vegan website and ranting and raving about what a nutrient deficient diet it is. Get a life!
Are you paleo people being paid off to spout your dangerous nonsense by the animal agriculture industry? The science is very clear, there is only ONE diet proven to prevent and reverse heart disease and it isn’t the imaginary BS you push. You pervert and twist reality to suit your whacked agenda, whatever the hell it is, and you are killing people. Sure people love to hear good news about their bad habits, but I wonder if Mark Sisson and Bob Harper are going to help your mission?
This emotional outburst says nothing. What do you recommend that is better?
I don’t normally comment on diet issues, having genetic high cholesterol because of faulty LDL receptors, I find myself the exception to many diet generalities. That is why I like the fact that he made a specific exception for people with genetic problems who cannot tolerate the recommended 30% fat. (they say its 1 in every 250 people in USA). I so rarely hear anyone acknowledge this even though doctors are well aware of it.
I have a daughter with the same problem only lupus as well which might be managed by aspects of the paleo diet that pertain to lectins and plant induced allergies. All that said, I think genetic testing and personalized diet is the way of the future. Paleo sounds cool, but only 100 years ago people ate real unprocessed food and did not have the “food industry” trying to profit off of feeding people junk with artificial flavors and gmos.
Do you feel that carbohydrates and higher triglyceride levels are the answer? I am assuming you take a ststin as well.
I have 2 stents in my heart, hardened aorta and blood vessels, painful, worsening varicose veins that blowout and leave huge black and blue elevations that take months to disappear. I often worry about an internal blood vessel rupturing and bleeding uncontrollably. Is there any hope for a reversal at 65 years of age using diet and exercise? I’m on 7 medications!
I read that clay you can buy at natural food store can strengthen the aorta. You may research it.
Yes look up the esselstyn diet
OMG. He may be a very good suegeon but his “no more oil” is what keeps his business alive and not those he is preaching too. Worse than Ancel Keys!!
Switch to a low carbohydrate / high fat / moderate protein diet to reduce triglycerides and small dense LDL. Younshould also be taking a statin. While there are side effects it is effective in reducing SDLDL. Once eliminated theough diet you can discontinue the statin.
Best source of nutritional myths is on a Paleo site like this one.
There is no food or medicine better for your arteries than a whole plant-based diet. One can discuss about how much avocado, nuts and seeds to include but the mountains of evidence and healthy populations show that avoiding even moderate amounts of animal products like meat, fish, dairy and eggs is a problem somewhere in your body.
Good advice, however the British Heart Foundation suggest atherosclerosis can’t be reversed, only slowed or probability of heart attack greatly reduced: https://www.bhf.org.uk/heart-matters-magazine/medical/blocked-arterieshttps://www.bhf.org.uk/heart-matters-magazine/medical/blocked-arteries
So the prevent / reverse part of your title is false. You can’t prevent it, even if you had the perfect diet and lifestyle you would still get damage to your heart and arteries over time as a natural part of the ageing process. Also reversing is false because it can only be slowed. If you have any STRONG SCIENTIFIC evidence that it can be reversed or prevented let us all know in the comments. Maybe you know something the experts don’t… but I doubt it!
You are wrong Mike. I have 3 arteries 95 percent blocked and the fourth artery is totally blocked and is scheduled for a open heartbypass surgery within the week. Except that the event was 7 years ago. I went a diet of ZERO oil for 9 months and gradually added back some fish protein, having mainly starches and green leafy vegetables and B12 supplement. If you are in my shoes, you would know that heart blockage reversal is possible but very slow. But the alternative is a open heart surgery. Read the following doctor’s diets : Dr Mcdougall, Dr Esselstyne, Dr Ornish. Every information you get there is free
and it works.
@ bigwalk that’s awesome I suffered a mild ha in April 2017. Have two other blockages no damage thank the Lord and started on esselstyn although not getting enough greens I have often wondered if its working to reverse just haven’t had pain lately but don’t know yours is a great testimonial thanks
What you did was eliminate the small dense LDL particles by reducing triglycerides. There are several ways to do that but I suspect you eliminated more tham just oils from your diet that comtributed to higher triglyceride levels. Reducing the oils likely didn’t help unless they were trans fats.
There is evidence of heart disease reversal, by two doctors using a whole plant-based diet, one using 100% plant-based vegan diet with no oils. See Dr. Caldwell Esselstyn’s work and Dr. Dean Ornish