Heart Healthy Foods: Cardiologists' Latest Advice


Love, connection and gratitude are good for your heart, on that most people agree. But when it comes to food, there’s no shortage on controversy.

Studying the effect of food on health outcomes is difficult, because unlike medications that can be prescribed, and compared to a placebo, people eat whatever they choose over a lifetime, and the narrowing of arteries – atherosclerosis – develops over many decades, so even when the best studies are devised, they’re never long enough. On top of that, there are influences from many stakeholders, adding to both controversy and hype. Nevertheless, the accumulated research, which includes studies of many designs – epidemiological, case-control, cohort studies, randomized control studies etc. – have advanced our knowledge a whole lot.

A group of experts from the American College of Cardiology Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council studied the evidence, and debated the trending nutrition controversies last year.

And this summer, they’re back with a sequel. The new article in the Journal of the American College of Cardiology covers topics that doctors are asked about often, so the group gathered the evidence, reviewed, debated, and came up with conclusions to guide physicians' advice to their patients. Let’s take a look at some of them.

Nutrition hypes and controversies

Is dairy good for your heart?

The study of dairy products and heart health is fraught by industry-sponsored trials, and most studies are observational – which aren’t the best evidence. The bottom line:

“It appears that there is no clear consensus in the published data or among experts on the effects of dairy products on CVD (cardiovascular disease), although there seems to be a link between some dairy products and increases in LDL-C (the ‘bad’ cholesterol) concentration, fractures, and overall mortality, in addition to lowering of BP, but the magnitude of these effects is unclear. Importantly, however, there is general consensus that full-fat dairy products are major sources of saturated fat and sodium in the U.S. diet, and thus, should be limited; nevertheless, reduced fat dairy products remain a convenient source of some essential vitamins and minerals, as well as high-quality protein.”

Is sugar a problem?

People today eat 25 times the amount of sugar they did 250 years ago. Sugar is added to 75 percent of processed foods, but it’s the soda and soft drinks that supply about one half of all the added sugar in the US diet. Excess added sugar has been linked with heart disease and stroke, and this expert group joins many others with finding the evidence against added sugar conclusive, and it recommends:

“Individuals should limit added sugar to <10% of calories and preferably <100 calories daily for women and <150 calories daily for men. Clinicians should recommend consumption of a whole foods diet with a low intake of processed foods, careful selection of foods with no or low amounts of added sugars in any form, and elimination of SSB (sugar sweetened beverages).

Is coffee okay?

Coffee got a clearance from the heart experts, as long as you don’t add other things to it:

“Overall, large analyses indicate that coffee intake is correlated with a dose-response protective benefit: habitual consumption of coffee is associated with lower risks of all-cause mortality and CVD (cardiovascular disease) mortality, but not with an increased risk of arrhythmias, hypertension, or hyperlipidemia. It should be noted that coffee-based drinks may be loaded with sugars and fats that reduce their health benefits.”

Speaking of a pick-me-ups, are energy drinks safe?

Energy drinks are a mixture of caffeine (lots of it) or caffeine like compounds, vitamins, water and sweeteners. Energy drinks have been associated with high blood pressure, abnormal heat rhythms, seizures, agitation and even death. The American Academy of Pediatrics advises that kids and teens never consume them. This group advises:

“Energy drinks should be avoided until more definitive research can be conducted. For now, there appears to be some evidence of harm.”

How about alcohol?

The connection between alcohol and heart health is complicated, and although some studies have shown reduced heart disease with moderate wine intake, even moderate intake has been shown to increase the risk of breast cancer in women. The experts’ bottom line:

“There is not sufficient high-quality evidence to recommend specific alcoholic beverages for CV (cardiovascular) risk reduction. There is also some risk of falls, certain cancers, and liver disease. As such, it is not recommended that individuals initiate alcohol consumption for CV benefit, and for those already drinking, consumption should be limited to recommended amounts, preferably consumed with meals. Mixing of alcoholic beverages with sodas, creams, and sweeteners adversely affects their health benefits.”

Should I be eating mushrooms?

There’s growing interest in mushrooms, as, beyond their taste – delicious, in my opinion– studies have shown they can be heart protective, as they modulate the immune response, lower cholesterol levels and blood pressure. They can also provide vitamin D.

The experts’ bottom line:

“Although there is no high-quality evidence of improved CV (cardiovascular) health outcomes, mushrooms may be associated with improvement in inflammatory and antioxidative pathways and may have beneficial effects on known CVD (cardiovascular disease) comorbid risk factors. Caution should be made that some wild mushrooms are poisonous.”

What other heart friendly foods should get my attention?

Legumes. These include beans, chickpeas, lentils, peas and soybeans. They are inexpensive, rich in protein and fiber, and studies have linked their consumption with lower body weight, lower cholesterol, heart attack risk and blood pressure. The authors’ conclusion:

“Legumes are an affordable and sustainable source of protein and fiber. Consumption is associated with a reduction in CHD (coronary heart disease) incidence and improved blood glucose, LDL-C (low-density lipoprotein ‘bad’ cholesterol), systolic BP (blood pressure), and body weight. Western populations’ current consumption of pulses and derived products (bean dip, hummus, etc.) is very low despite their health benefits. Legumes should be part of any diet aimed at promoting cardiometabolic health.”

Heart disease is the leading cause of death for both men and women. Luckily the risk of heart disease is highly modified by healthy diet and lifestyle. A heart healthy diet – more plant food, whole grains, fiber and healthy fats, portion control, less added sugar etc. ­– combined with physical activity, are proven to keep your arteries and heart young, and are a remedy with no adverse side effects.

Quite the opposite: The side effects of a heart-healthy diet and physical activity include better mood, productivity, alertness and general well being.

Dr. Ayala

The only side effects of a heart-healthy diet are better mood, productivity, alertness and general well being.