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Authors: Carol Svec

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HEALTHY FATS

There was a time when heart researchers slapped the same label—
bad
—on every kind of fat. Now, we know that trans fats and saturated fats are amazingly dangerous for cardiovascular health, but omega-3 fats and monounsaturated fats are actually good for your heart.

Heart-healthy fish oils are especially rich in omega-3 fatty acids. In multiple studies over the past 15 years, people who ate diets high in omega-3s had 30 to 40 percent reductions in heart disease, and fewer cases of sudden death from arrhythmia. Although we don’t yet know why fish oil works so well, there are several possibilities. Omega-3s seem to reduce inflammation, reduce high blood pressure, decrease triglycerides, raise HDL cholesterol, and make blood thinner and less sticky so it is less likely to clot. So omega-3s affect nearly every risk factor for heart disease. It’s as close to a food prescription for heart health as it gets. I recommend eating at least three servings of one of the omega-3-rich fish every week. If you cannot manage to eat that much fish, try taking fish oil capsules, which have the same effect. (See the Supplements section, for more information.)

BEST FOODS FOR OMEGA-3 FATTY ACIDS:
Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, butternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans

Monounsaturated fats, found mainly in olive oil, are thought to protect people against heart disease by reducing blood pressure. Scientists discovered the benefits of olive oil by observing Mediterranean populations. They use olive oil more than any other form of fat and typically have low rates of coronary artery disease. Research shows it doesn’t help to just
add
monounsaturated fats to your diet—you need to replace some of the unhealthy fats that are already in your diet (all those saturated and trans fats mentioned earlier) with better choices. There is some evidence that substituting olive oil for some carbohydrates in your diet (particularly those unhealthy low-quality refined carbohydrates!) can increase HDL.

BEST FOODS FOR MONOUNSATURATED FATS:
Olive oil, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, Brazil nuts, pistachio nuts, pine nuts, peanut butter, olives

FAQS

I did everything right—I saw a nutritionist, I started exercising, and stopped smoking—but my LDL cholesterol is still high. My doctor put me on a statin medication. Is there anything I should do differently with my diet?

 

First, keep following all of your doctor’s advice. Second, follow all the diet recommendations in this chapter. If your cholesterol returns to normal levels, don’t stop—the change means the program is working, and it’s a lifestyle change not a temporary one-time fix. Statins are valuable medications, but they are just one tool for keeping cholesterol under control. The nutrition and lifestyle changes in this chapter can help turn your risk factors around, which will mean better health in the long run. However, some people have a genetic predisposition to make cholesterol and may still require medications in addition to lifestyle changes. Finally, many health experts (including me) recommend that their clients who take one of the cholesterol-lowering statin medications also take a supplement called
Coenzyme Q
10
. CoQ
10
is an antioxidant necessary for energy production in cells. Without CoQ
10
, cells can’t function properly. Our bodies usually make sufficient CoQ
10
to keep us healthy. Statins work by inhibiting the mechanism that allows the liver to make cholesterol, but they also slow the body’s production of CoQ
10
, leading to deficiency. To counteract these effects, I recommend taking 100 milligrams of CoQ
10
once a day in a soft gel formulation. Although most people can take CoQ
10
safely and without side effects, it is always a good idea to talk with your doctor before taking any supplement.

B VITAMINS: FOLATE, B
6
, B
12

If this book had been written just a year earlier, this section on B vitamins would have read much differently. Folate, vitamin B
6
, and vitamin B
12
are known to reduce levels of homocysteine, and high homocysteine often means a higher risk of coronary artery disease. So to reduce homocysteine, it is important to eat plenty of vitamin B-rich foods.

But then came three studies involving more than 9,000 participants who had a very high risk of a coronary artery event; they had either documented heart disease or a history of heart attack or stroke. This research showed that taking these vitamins in the form of supplements lowered homocysteine, but didn’t actually reduce the risk of heart attacks or strokes. Those who took the vitamins had the same number of heart attacks and strokes as those who did not. While some scientists believe that this casts doubt on the value of B vitamins for heart health, other experts still consider them essential. It could be that food will work where supplements don’t. Or perhaps the vitamins work best before cardiovascular disease is so advanced that it can’t be reversed. I believe that it is too early to cast the B vitamins aside. There’s more research underway, but in the meantime, I recommend getting your folate, vitamin B
6
, and vitamin B
12
from food sources, which are delicious and generally good for health. If they also help keep your heart pumping, that’s even better.

BEST FOODS FOR FOLATE:
Fortified whole grain cereals, lentils, black-eyed peas, soybeans, oatmeal, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges and juice, Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), beans (black, pinto, kidney, garbanzo, navy), cauliflower, Chinese cabbage, corn, whole grain bread, pasta (preferably whole wheat)

FAQS

I had blood tests done recently. My LDL cholesterol is normal, my triglycerides are normal, but my HDL cholesterol is abnormally low. Is there anything I can do to improve my HDLs?

 

Some people have a genetic tendency to low HDL, even when all their other cardiovascular risk factors are normal. Although this might seem harmless, it can throw off your cholesterol ratio, and may indicate a future risk of heart problems. I recommend you incorporate a daily exercise regimen (exercise has been shown to boost HDL levels) and follow the diet and lifestyle recommendations in this chapter—these steps will help assure that your blood vessels stay as healthy as possible.

In addition, I recommend taking low dosages of omega-3 fatty acids (see Supplements section, Chapter 7, for more information), and extended release formulations of niacin (such as Niaspan, which is only available by prescription). Extended-release niacin has been shown to raise HDL cholesterol by about 14 percent in men, and by about 20 percent in women. In addition, niacin can help lower triglycerides and LDL cholesterol.

It is important to talk with your doctor before beginning niacin treatment. Although niacin is a powerful treatment for boosting HDL cholesterol, it can be dangerous for people with diabetes, gallbladder disease, gout, glaucoma, peptic ulcer, or impaired liver function, or who are pregnant or have had a recent heart attack. In addition, niacin can interact with other medications, and it may cause some uncomfortable side effects, including flu-like symptoms, rash, and flushing so intense that it can temporarily leave you looking sunburned and feeling like you’re having a hot flash.

Ask your doctor for a specific recommendation for the type of niacin to choose—it comes in extended-release, controlled-release, sustained-release, or regular formulations, so it isn’t as easy as picking just any supplement off the shelf.

BEST FOODS FOR VITAMIN B
6
:
Fortified whole grain cereals, chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, chicken breast, white potatoes (with skin), oatmeal, bananas, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, sweet potatoes, winter squash (acorn), broccoli, broccoli raab, carrots, Brussels sprouts, peanut butter, eggs, shrimp, tofu, apricots, watermelon, avocado, strawberries, whole grain bread

BEST FOODS FOR VITAMIN B
12
:
Shellfish (clams, oysters, crab), wild salmon (fresh, canned), fortified whole grain cereal, enriched/fortified soy milk, trout (rainbow, wild), tuna (canned light), lean beef, veggie burgers, cottage cheese (fat-free, 1% reduced-fat), yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), eggs, cheese (fat-free, reduced-fat)

CALCIUM AND VITAMIN D

Calcium and vitamin D work as a team—vitamin D helps the body absorb and use calcium. These two nutrients have been shown to help reduce blood pressure by 3 to 10 percent. Although this doesn’t sound like much, it could add up to about 15 percent reduction in risk for cardiovascular disease. Some research suggests that milk proteins may act similarly to antihypertensive (blood pressure-lowering) medications called
ACE inhibitors
.

BEST FOODS FOR CALCIUM:
Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, frozen yogurt, low-fat ice cream, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds

BEST FOODS FOR VITAMIN D:
Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereal

MAGNESIUM

Although more research is needed, magnesium may turn out to be a potent ally for reducing the risk of cardiovascular disease. In lab animals, magnesium reduces inflammation and alters the way fats are metabolized. Human studies suggest that eating lots of magnesium-rich foods may reduce triglycerides, lower blood pressure, and increase HDL cholesterol. In a long-term, 15-year study, eating plenty of magnesium-rich foods reduced the risk of developing the metabolic syndrome by about 30 percent.

BEST FOODS FOR MAGNESIUM:
Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut butter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed

POTASSIUM

Your blood levels of potassium and sodium are inextricably linked. When potassium is low, the body retains sodium (and, as discussed above, too much sodium raises blood pressure). When potassium is high, the body gets rid of sodium. Eating potassium-rich foods is important for maintaining a healthy balance of both minerals, and, by extension, for keeping blood pressure low.
Important note:
Do
not
take potassium supplements unless specifically prescribed by your doctor. Too much potassium will upset the balance, and could have serious, even life-threatening consequences.

BEST FOODS FOR POTASSIUM:
White potatoes, yams, fat-free and low-fat yogurt, soybeans, Swiss chard, snapper, sweet potatoes, avocado, cantaloupe, artichokes, bananas, spinach, lettuce (especially romaine), radicchio, arugula, endive, black cod (sablefish), honeydew melon, pumpkin, milk (fat-free, 1% reduced-fat), carrots, beans (white, black, navy, kidney, pinto), lentils, lima beans, apricots, papaya, split peas, pistachio nuts, winter squash (acorn, butternut), enriched/fortified soy milk, watermelon, beets, tomatoes (including sauce, juice), kale, mushrooms, raisins, peanuts, plums, almonds, sunflower seeds, prunes (and juice), chickpeas (garbanzo beans), oranges (and juice), broccoli

GARLIC

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