December 26, 2022 · 7 min · 1319 words · Selena Coren
You beat yourself up about the wrong things when you grab something to eat. Two of the main pillars of the “heart-healthy diet” are crumbling, as new science casts doubt on what we thought we knew:
Sodium: Once and for all, it’s not the blood pressure bogeyman you still hear about from doctors. Several studies show that you could double the American Heart Association’s suggested daily limit—1,500 mg—before your blood pressure would start to climb. And a 2014 study in the American Journal of Hypertension found no link between sodium and blood pressure. “If you don’t have hypertension, you don’t have to be fanatical about resisting sodium,” says cardiologist Steven E. Nissen, MD, chair of the department of cardiovascular medicine at Cleveland Clinic. “There’s no specific limit for healthy people.”
Fat: “The AHA’s recommended diet—a standard low-fat regimen—is actually not particularly heart healthy,” Nissen says. (If you’re a regular Prevention reader, you likely know this already; consider yourself way ahead of the scores of heart docs still preaching low-fat to their unwitting patients.) Say it along with us: Unsaturated fats—especially monounsaturated fats, such as those in olive oil, avocado, peanut butter, and some nuts and seeds—can actually slash your risk of heart disease, and the true villain (besides trans fats, of course) is sugar, which raises triglycerides, lowers good cholesterol, and contributes to diabetes, obesity, and heart disease. Limiting sugar—both added sugars and simple carbs like pasta, which turn to sugar in the body—may well be the next chapter for heart-healthy dietary guidelines.
MORE: 9 Disturbing Facts About Sugar You Need To Know
You’re probably not getting the heart test you need. Media Platforms Design Team
Photo by Claire Benoist
It’s called the EndoPAT—and it’s a fast, noninvasive way to tell if you’re at risk of the hard-to-detect type of heart attacks that women often have. Traditional screenings like stress tests and angiograms look for major blockages in large arteries—the ones behind Hollywood-style, chest-clutching kinds of attacks. But women’s heart trouble often stems from the far less dramatic microvascular disease, which involves problems with the smaller arteries. “This is the first step to heart disease, and most tests miss it,” says Suzanne Steinbaum, director of Women’s Heart Health at Lenox Hill Hospital in New York City.
EndoPAT, in which a doctor cuffs your arm and measures blood flow to your fingertip, isn’t commonly offered—it was approved by the FDA in 2005, and it often takes 10 or more years for new tests to go mainstream. Steinbaum suggests seeking it out if you have any heart-disease risk factors: a family history; diabetes; high blood pressure, cholesterol, or stress; smoking; obesity; or a history of preeclampsia (high blood pressure in pregnancy) or gestational diabetes (high blood sugar in pregnancy).
You focus on not cheating when cheating is irrelevant. They may be big on vegetarianism, but even cardiologists take an imperfect approach to health. “The bottom line is that you do your best, and consistent, small changes matter—it’s not all-or-none,” says cardiologist Stacey Rosen, MD, vice president of women’s health at the North Shore LIJ Health System in New York, who cops to stocking her office with dark chocolate and de-stressing with wine. As proof, Rosen points to a 2014 study in which people who lived cleanly—eating a nutritious diet, drinking moderately, staying active, maintaining a healthy BMI, and never smoking—slashed stroke risk by 86%. “What’s encouraging here is that doing even one of the five recommended ‘ideal lifestyle choices’ had a significant impact,” she says. “Anytime you move the needle in the right direction even the slightest bit, it makes a big difference.” (These 9 easy ways to clean up your diet will help get you started.)
You think Paleo will make you thin and healthy.Media Platforms Design Team
Photo by Claire Benoist
Fit celebrities make high protein/low carb look like a direct route to healthytown. But it’s telling that most of the cardiologists we spoke with never touch red meat, and very few eat chicken. Strong evidence shows that too much animal protein—especially from processed meats—increases the risk of coronary heart disease. A 2014 study showed that people 50 to 65 who ate an animal-protein-rich diet had 75% higher premature mortality, with a 400% increase in cancer and a 500% increase in type 2 diabetes, a risk factor for heart disease. “On a typical American diet, arteries are partially clogged, but on an Atkins or Paleo-style diet, they’re severely clogged, even when cholesterol levels are not high,” says Dean Ornish, MD, president of the Preventive Medicine Research Institute. Ornish has sworn off red meat, but if you can’t give up your T-bone, replacing just one daily serving of red meat with fish, poultry, nuts, legumes, low-fat dairy, or whole grains may lower your mortality risk by up to 19%, say scientists from the Harvard School of Public Health.
You treat your heart like a pump.The whole pump thing is old thinking, says Thomas Cowan, MD, a family physician and the author of The Four-fold Path to Healing, a holistic guide to health. “The heart does not pump the blood—it’s more like the blood pumps the heart,” he says. Here’s how it works: When blood moves through veins, it picks up speed as it approaches the heart, the same way rivulets gain momentum as they come together into a larger stream. The heart then acts as a dam, holding back the onrush. When enough pressure builds in the heart’s chambers, that energy bursts open the gates, or valves. “The heart doesn’t contract as much as it collapses into itself when the blood rushes out,” Cowan says. Thinking of the heart as a muscular dam that syncs the functions of all the other organs, Cowan says, gives you a more accurate rationale for both regular exercise (which encourages your heart and whole body into a healthy, consistent rhythm) and eating healthy fats (which releases water into your blood for more rushing action). Cool, huh?
You are of little faith that heart disease will be vanquished.New innovations point to faster diagnoses, gold-standard cures, and great reductions in death. Some of the stuff to look forward to:Checkmate for cholesterol: Available now: a new pill that significantly enhances statins’ cholesterol-lowering power. Recent research shows that people who took ezetimibe (Zetia) with statins had fewer heart attacks, strokes, and severe chest pains than those who took statins alone. Available soon: the catchily named PCSK9 Inhibitor. It’s an injection that can lower LDL (“bad”) cholesterol a whopping 50 to 80% for statin users. (Compare that with using only statins, which lower cholesterol by 30 to 50%.) “It’s so powerful, it’s unbelievable,” Nissen says. The drug, which helps the liver remove LDL cholesterol, can also be taken alone by people who can’t tolerate statins.Lifesaving selfies: A 15-second scan of your face using a webcam identifies atrial fibrillation, a condition of irregular heartbeats that kills 3 million people a year. The technology, developed by scientists at the University of Rochester School of Medicine and Dentistry, records subtle, otherwise unnoticeable skin-color changes that reflect uneven blood flow through facial veins. Before you get too snap-happy: It must first prove itself in trials, so diagnosis via video is still several years out. Hearts of gold: Damaged hearts may soon be able to produce their own fresh tissue with the help of a patch threaded with gold. Developed by bioengineers at Tel Aviv University, the treatment combines patients’ own tissue with nanoparticles of gold to increase the electrical signaling capacity of their cells.
You find statins to be too complicated to understand. As you’ve heard, they’re being promoted more than ever since 2013, when new AHA guidelines expanded who should get them. Confusing controversy ensued, but you can sort through the mess using our Statin Decision Tree—though note that these guidelines aren’t the last word. Be sure your doc weighs in on the matter.
MORE: Is Your Heart Older Than You Are?
