Nutrition after a heart attack

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The Internet is a very confusing space when it comes to nutrition and even worse if you need specific advice for a chronic illness like heart disease.

There are thousands of fad diets that prey on the insecurities of people who have had a heart attack wanting to improve their health and lose a bit of weight.

If you have experienced a heart attack or stroke and are over weight, often your doctor will suggest lifestyle modifications to reduce your risk of further heart events. Lifestyle recommendations may include:

  • Losing weight
  • Quit smoking
  • Limiting alcohol consumption
  • Regular exercise
  • Healthy eating

All of the above points will reduce your risk of another cardiovascular event so it’s in your best interest to try your best at all five points. When it comes to weight loss and healthy eating though, navigating nutrition can be tricky.

What is cardiovascular disease?

It’s a term used to describe a range of disorders related to the vascular system (your arteries and heart), which range from (but not limited to) coronary heart diseases (heart attack), cerebrovascular disease (stroke).

A heart attack is when then is a blockage in one of the arteries leading to the heart causing part of the heart muscle to die. A stroke is similar, except it involves the brain. Arteries leading to the brain become blocked and part of the brain dies.

Depending on the severity of the heart attack or stroke will depend if a person survives through and how much disability they are left with. The most fortunate situation is when the heart attack or stroke is minor. The person gets to a hospital early and can undergo rehabilitation and have no visible signs of the event.

According to the World Health Organization 17.5 million people each year die from cardiovascular disease, 80% of deaths are due to heart attacks and strokes, a majority of which comes from low to middle income countries.

There are a few reasons for this such as:

  • Affordability and accessibility of hospital care
  • Health education and knowledge
  • Lack of physical activity and poor eating patterns.

We are fortunate in Australia that our health care system prioritizes heart and stroke cases in the emergency room, so survival rates are quite high. But we shouldn’t be complacent about this, prevention is always better than cure!

Poor nutrition is a big problem amongst poorer families and countries, but it is also becoming a problem of the affluent too. Accessibility to energy rich and nutrient poor foods like soda, fast food and processed goods is easier than ever.

The bottom line is Junk food is often cheaper than nutritious food, so it’s no wonder cardiovascular disease is still one of the leading caused of death in Australia.

What diet is best for cardiovascular disease?

Despite what some dieters have you believe there is more than one-way to eat healthily. Ultimately there is no one single perfect diet that suits everyone. There are however, fundamental aspects of a variety of diets that are heart protective. This includes a diet consisting of lots of vegetables, whole foods, fibre, minimal salt and sugar intake, a higher proportion of mono and ploy unsaturated (omega-3 fats), consumed in an energy-controlled manner to maintain a healthy body weight.

What do all those big words mean?

If you eat a diet that has 5 serves of vegetables or salad, 2 fruit, mainly made from whole grain carbohydrates (whole wheat), lean protein (chicken, pork, fish) and vegetable based sources of fat (avocado), then you’re on the right track.

This can include and not exclusive to traditional diets such as the Mediterranean, Nordic and vegetarian style of eating. Although it is not necessary to label or affiliate yourself with one particular diet style it is good to look into what makes these particular diets beneficial to heart health and general wellbeing.

The benefits of the Mediterranean diet

Studies have shown that the Mediterranean diet may help with a reduction in cardiovascular disease. It’s also is known for its positive effects on many other health conditions like diabetes and cancer.

The diet consists of eating plenty of vegetables and whole grains, including the use of legumes wheat and barley. There is a high use of mono unsaturated fats; olive oil, lean meats, seafood and nuts and seeds.

It’s the combination of unsaturated fats and high fiber intake is what makes Mediterranean diet heart protective.

Heart disease is associated with high homocysteine levels, an inflammatory marker that’s thought to be a contributing factor to heart attacks and strokes. Unsaturated fats like mono unsaturated fats found in olive oil, avocado, nuts and seeds and omega-3 polyunsaturated fats helps to bring these levels down.

Understanding cholesterol

Cholesterol is a naturally occurring hormone in the human body. In fact the body actually produces cholesterol without the need of cholesterol coming from food. The problem is when cholesterol levels reach higher that it starts to affect our health.

High cholesterol is a known risk factor for heart disease and angina. Imagine cholesterol like glue to your arteries, as the cholesterol is transported through the blood it tries to sticks to the artery walls. Cells in the artery walls try to digest it. In doing this it converts the cholesterol into a toxic form. The body then sends immunity white blood cells to clear it up.

This whole process causes inflammation and it starts to create a bump in the artery wall called plaque. This eventually reduces blood flow in the artery. Angina is when there is a narrowing of the arteries of the heart causing temporary reduced blood supply to the heart.

Whereas, a heart attack or stroke is when a little bit of the plaque from anywhere in the body breaks off in the blood, travelling to the heart or brain causing a blockage in the system.

High cholesterol, in particular high LDL “bad” cholesterol is associated with an increased risk of heart disease. It is recommended than if you already have been diagnosed with heart disease or type 2 diabetes, levels of LDL cholesterol should be kept at lower levels than normal.

Low density lipoprotein (LDL) the bad cholesterol. It is affected in some people by saturated fat intake coupled with a diet high in processed foods.

Triglycerides is a sneaky piece to the cholesterol puzzle that is often forgotten. Triglycerides are responsible for the stickiness of blood. It can contribute to heart disease risk if your HDL is low. Typically triglycerides increase with a diet filled with processed refined grains and sugar. It can be reduced by switching to whole grains, and limiting sweets, soft drink and fruit juice.

Is there a benefit to turning vegan or vegetarian?

Vegetarian and vegan diets have often been associated with better health amongst lay people. Data from observational studies have shown only a small cardiovascular benefit to plant based diets.

Don’t get me wrong if you want to be vegan or vegetarian for ethical reasons that ok, but the evidence shows its not superior to other healthy dietary changes. In other words you don’t need to turn vegan to improve your heart health.

Similar improvements can be seen in diets that also contain small amounts of animal proteins such a in the Mediterranean and Nordic diets. Eating more plants such as vegetables and switching to whole grains will certainly improve your health, however you don’t need to give up meat entirely if you aren’t that way inclined.

If you do tend to consume a lot of animal products you may benefit from swapping some meat for vegetarian alternatives. You might want to try a few meat free days in an attempt to reduce total fat and energy intake.

The benefit of vegan and vegetarian diets is that, naturally they promote high consumption of nuts and legumes as protein alternatives. Regular consumption of nuts and legumes has been shown to decrease the risk of ischemic heart disease.

Can I eat salt if I have heart disease?

Salt has been coined the silent killer because its effects on the cardiovascular system. Another name for salt is sodium, and it is often found in processed foods, sauces, stocks, bread, sodas and takeaway food.

Sodium can place additional pressure on the heart by increasing blood pressure in some people. This is an issue because it means the heart has to pump harder to move more fluid around the system.

What happens over time the constant high pressures in the system, the arteries or the tubes become stiffened and develop scar tissue. In addition, your heart becomes fatigued. Having excess salt in your diet can increase your risk of developing high blood pressure. People with high blood pressure are more prone to developing heart disease and having strokes.

On average western diets typically provide 3000-4000mg of sodium daily. This is well above the recommended level you are supposed to be at 2000mg daily, less (1500mg) if you have had a prior cardiovascular event. In order to reduce your sodium intake aim to choose packaged products consisting of <250mg/100g of sodium. Better yet, avoid packaged food all together. A diet rich in vegetables and fruit will balance sodium content.

Fruits and vegetables are high in potassium. Potassium can help balance out high sodium intakes and improve blood pressure. This is one of the reasons why plant based diets such as the Mediterranean and vegetarian diets are so successful in reducing heart disease.

Can I eat grains?

Grains are a highly nutritious food source and have been included in many heart protective traditional diets like the Mediterranean diet. In many observational studies have shown that diets containing high whole-grain intakes, compared to lower grain intakes are associated with reduced risk of coronary heart disease.

Whole grain sources include; wild rice, quinoa, seeded or rye bread, whole wheat, spelt, millet, oats amaranth, corn, buckwheat and barley. Including wholegrain in your diet daily will aid in the reduction of cholesterol due to their high fiber and low fat content, in turn reducing your risk of heart disease.

What’s the best type of fat to eat if I have heart disease?  

It is fashionable amongst wellness circles to reintroduce saturated fat back into the diet claiming that it is heart protective. These claims are not backed by sound science and this is not advised.

A recent paper in 2014 that caused confusion showed that saturated fat intake had a neutral, affect on cholesterol and heart disease. It also did not support the current recommendations to swap saturated fats for unsaturated fats. However, a month later the data was re-analysed and the statement was removed by the authors.

It seems that it is not just the fat type you should be worried about, but the total composition of the diet.

For example consuming a diet high in saturated fats, along with processed carbohydrates and refined sugar is the worst combination of macronutrients you can consume for your waistline and heart.

However, including some natural sources of saturated fat, such as the small amounts found naturally in meat and chicken, coupled with a high fibre, wholegrain diet, can be heart healthy.

Are there any supplements I can take to keep my heart healthy?

Media hype on certain supplements used for prevention and treatment of heart disease changes with fashion. There have been many studies done using varying different types of supplements and heart disease with little to no benefit.

At this stage supplementation of any sort is not viewed as an effective way to reduce the risk of heart disease or prevention of further heart events. Supplements are a multibillion dollar industry, which is largely a waste of money.

Changing your diet to include more plants, whole foods, good fats, whilst simultaneously reducing salt, saturated fat and maintaining a healthy body weight, is the best way to reduce heart disease risk and prevent further heart events.

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