IN the second of a series of pieces about health and older people I’m looking here at cardiovascular disease or CVD, which is an umbrella term. CVD affects more than a third of men and a quarter of women over sixty-five, but it’s worth noting that increasingly it has its roots in much earlier years.
The good news is that Ireland is among the countries in which the death toll from CVD is falling, but it remains the most common cause of death across Europe. The Irish Heart Foundation reports that ‘some 80% of premature heart disease is preventable’, and when it comes to the central role of nutrition, heart health is perhaps the area in which the science is evolving most rapidly. With that in mind, here’s a roundup of all the latest.
Yet more evidence that a Mediterranean style diet is the gold standard, due to its healthy fats, vast range of antioxidants, fibre and prebiotic foods for the promotion of good gut bacteria which controls the inflammation that is key here. It can cut the risk of heart disease in half, of stroke by 39%, and of a second heart attack by 72%; and is more protective than statins and aspirin. A July review of 50 years of research shows that even though the Mediterranean diet is far higher in fat than is sometimes still advised, it radically reduces the incidence of death from all causes. The omega-3 oils in the oily fish are highly protective and lower the chance of a second heart attack by 44%, while the olive oil actually switches off genes that are responsible for that inflammation. Oily fish also contains vitamin D and co enzyme Q-10, which is vital for heart health.
Other typical foods in this diet include avocado, which lowers LDL cholesterol and other blood fats, citrus fruit which benefits the lining of blood vessels and reduces inflammation, and tart cherries which lower blood pressure as effectively as medication, reducing the risk of heart disease by 23% and of stroke by 38%. US research shows that those eating the most berries were ‘significantly less likely to die of CVD’, and regular consumption of raw nuts lowers LDL cholesterol and slashes the risk of heart disease by up to 75%, as do dark chocolate and small amounts of red wine.
Similarly powerful antioxidant content means that women drinking just one cup of green tea a day had a 10% lower risk of premature death from CVD. And in people who’ve had a heart attack, two or more cups of coffee a day (which is also protective against stroke) made them half as likely to die in the following months.
The active compound in nuts (and dark chocolate) is arginine, needed to make nitric oxide which both protects and relaxes the blood vessels, preventing clots and lowering blood pressure. Nitrates in celery and beetroot are similarly converted into nitric oxide, and beets also contain betaine, a nutrient also found in eggs and liver that works with folic acid, B6 and B12 to reduce blood levels of homocysteine, which many scientists now believe to be a far more relevant indicator of heart health than overall cholesterol levels.
The focus on cholesterol (which we need for many different processes) is increasingly being proven misguided—very high levels are definitely dangerous, but many studies have now shown that levels of heart disease are unaffected or even rise where overall cholesterol levels fall, and that ‘all cause mortality is highest in the lowest cholesterol groups.’ There remains no doubt though that high blood pressure is what the Irish Heart Foundation calls the country’s ‘silent killer’. Eating more plants would go a long way here, as well as tackling the epidemic of obesity and diabetes that feeds directly into CVD. Greens and other vegetables, seaweeds, wholegrains, nuts and seeds and oily fish are the best sources of beneficial fibre, calcium and magnesium, protein, essential fats, and potassium, which competes with sodium; in fact there’s little point lowering your salt intake without increasing potassium intake.
Another major shift, which has emerged in tandem with the ‘decriminalisation’ of butter and other natural fats, is the recognition that pro-inflammatory trans/hydrogenated fats (in some margarines and processed foods), sugars and other refined (white) grains are the real villains when it comes to obesity, diabetes and CVD. Diets high in sugar ‘significantly raised blood pressure in just a few weeks—by about twice what you’d see from a high salt intake’, and refined carbs also raise levels of artery blocking blood fats, triglycerides. Women eating a lot of white bread, cornflakes and pasta were found to run double the risk of heart disease in one study, and those foods were shown to damage the arteries in another. In yet another, participants eating a high calorie but low sugar diet saw a sharp drop in diastolic blood pressure, blood fats, blood sugar and (fat storing, pro-inflammatory) insulin levels. Just one can of sweetened drink a day increases heart attack risk by 20%.
The prescription is simple really: proteins (fish, grass fed meat, full fat dairy, organic eggs, nuts and seeds, beans and lentils, quinoa) which we now know can reduce blood pressure and arterial stiffness, along with plenty of veg, a little in the way of low sugar fruits and wholegrains. And all of the following are of proven benefit: lots of exercise/not sitting down for too long, volunteering/acts of kindness, letting go of resentment, sex, sleep and relaxation, whatever that means to you.
These include oily fish, nuts, olive oil for drizzling (coconut oil or butter for cooking); all green veg, brightly coloured veg and low sugar fruit especially beetroot, peppers, aubergines, celery, onions, garlic, olives, avocado, tomatoes, berries, cherries, apples, pears and citrus; free range eggs, grass fed red meat, organic liver; beans, lentils, chickpeas; oats and other wholegrains; ginger, chilli, turmeric, cinnamon, cocoa/dark chocolate, tea and coffee.