Heart is a vital organ that pumps blood throughout our body. This blood carries oxygen, nutrients to each cell keeping them alive and functioning at optimal levels.
Heart diseases are on the rise in our country. Wrong eating habits, increased intake of high salt, fat and sugar foods, moving away from traditional whole grains and home cooked food, lack of exercise, smoking and increased stress are all adding to the burden of cardiovascular diseases and non-communicable diseases.
While speaking of the organ , heart, we mean diseases that affect the structure of the organ alone. However medical terminology uses Cardio Vascular diseases (CVD), to refer to a group of medical problems that include disorders of the heart and blood vessels, coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism.
Risk factors that increase our possibility for a CVD have been clubbed as:
Non-modifiable risk factors
- Age: Aging brings with it changes that may lead to health issues , including those of the heart. Good habits and healthy lifestyle can prevent adverse out comes.
- Family History:Genetic factor plays a role in the predisposition to CVD. If a first relative male (Father/ Brother) has had an event at the age of 55 or below or a female relative (Mother/ sister) at an age of less than 65 , then the risk is said to be high.
- Ethnicity: Asians are at a higher probability of getting CVD as per statistical data. DM type 2, a major risk factor for CVD is very prevelant in our country, increasing the risk.
- Sex: Women tend to develop CVD at a later age then men. Men with CVD are seen more probably because they get medical treatment more actively and the symptoms in women may go unrecognized. Also women are protected by their hormones and hence the onset is delayed.
Modifiable risk factors
- Diet: Eating a healthy meal containing whole grains, legumes, nuts and seeds, vegetables and fruits, healthy oils and limited saturated fat will protect against CVD. Today’s meal pattern of increased consumption of high salt, high fat, high sugar food, increased intake of refined cereals is a perfect cocktail for causing CVD.
- Physical activity: Long working hours and mostly sedentary lives also increase the risk of heart diseases. WHO recommends 30-45 minutes of daily exercise for atleast 3-4 days a week. Exercise helps control risk factors like obesity, insulin resistance, and HT. In addition, being physically active through the day also adds to fitness.
While the former are something we cannot change but by concentrating on the latter we can mitigate the risk of CVD.
As a Nutritionist I target the risk factors using foods that contain nutrients which work for better overall health and protect the body against CVD.
- Healthy weight
BMI is an indicator of obesity but what is more important is the total body fat and the waist/ hip ratio. Losing even 5% of weight improves the risk of diabetes and CVD. Waist to Hip ratio has been found to be more significant as far as non communicable diseases risk is concerned.
Carrying more fat in the abdomen, especially visceral fat increases the risk of CVD. Visceralfat is associated with and increased free fatty acid FFA production which leads to insulin resistance ,hyperinsulemia and this increases the risk of dyslipidemia. Increased visceral fat also causes Leptinresistance which leads to an increased and chronic inflammatory state. This may cause calcification of the arteries, cholesterol accumulation, oxidative stress, and increase in BP.
Take away: Not just weight, measuring waist and hip is also essential. Foods that help reduce belly fat include healthy plant proteins from legumes. Proteins from fatty fish, walnuts are rich sources of omega -3 which has strong anti-inflammatory properties. Nuts and seeds add fibre, protein and important vitamin E which is also heart healthy. Vegetables and whole fruits are great additions for their fibre to control appetite, for the antioxidants to control oxidative stress, especially green leafy vegetables. Spices like cinnamon and fenugreek help with insulin resistance.
Dietary cholesterol intake has been removed as a restricted nutrient from the 2020 dietary guide lines as the evidence for this practise is very low and not conclusive inspite of major studies. However the caution that all cholesterol containing foods are also high in saturated fat content remains. Saturated fats increase LDL (BAD) Cholesterol as evidenced in all major studies.
American Heart association, after reviewing literature recommended that replacing saturated fat with healthy monounsaturated fats and poly unsaturated fats lowered risk of CVD. HDL (GOOD) Cholesterol protects against CVD as it is the carrier of cholesterol away from the arteries to the liver for removal. Higher the better.
Takeaway: Cholesterol enters our meals only from animal products. Out of all, eggs are the safest to have as their sat fat content is low compared to meats. Fatty fish are good sources of omega -3 which is beneficial for heart health. Soluble fibre from whole grains like barley ,oats help in lowering LDL . Legumes like Rajmah ,another source of soluble fibre and proteins help weight management to. Walnuts have a positive effect on LDL as do Almonds probably because of their polyphenols and healthy monounsaturated fats. Cinnamon is also seen to lower LDL cholesterol.
- Healthy fats
Fat is an essential nutrient for our body to function optimally, it also adds flavour to our food. Fats can be invisible- present in foods naturally,or as hidden fats in processed food and visible- what we add in our cooking i.e oil, ghee, butter etc. Fat free food is not healthy, what we need is to make the right choice as far as the quality and quantity is concerned.
Fats come in three forms, Saturated, monounsaturated and poly unsaturated. These are present in all fat, visible and invisible, in varied proportion. Saturated fats are linked to an increase in LDL cholesterol, increased Insulin resistance and the thrombogenicity. Trans fatty acids are another red flag for CVD , these may be present in naturally occurring fats but they enter our food mostly from processed food especially those that use hydrogenated oils.
FSSAI has issued guidelines for reduction/ removal of all sources of TFA’s while processing. TFA’s don’t only increase LDL but also decrease HDL cholesterol. Poly and monounsaturated oils and fats are recommended. MUFA has been linked to lower cholesterol levels as evidenced by the landmark Seven Countries study. Data analysis from the another significant study, Nurses Health study, that followed 80082 women for 14 years showed that MUFA lowered the risk of chronic heart diseases.
Takeaway: Keep the total calorific intake from fats to 25-30% of total calories. Of these SFA should not contribute more than 7-10%. Choice of cooking medium should be a combination of oils to ensure adequate MUFA & PUFA . No one oil will provide the right quality , so a combination of oils should be used. A) Groundnut / rice bran along with Mustard oil or cannola or soybean. B) Safflower/sunflower with groundnut/sesame/rice bran in 1:1 proportion.
- Minerals of significance
Sodium and potassium are complementary minerals. Both are very critical for maintaining the fluid balance in our body. Sodium intake in high amounts has been linked to high BP which is a risk factor for CVD. Potassium on the other hand lowers BP by relaxing the blood vessel and excreting excess sodium. Sodium is consumed as salt that we add to our diet and also from natural food. Potassium is also found both in salts and natural foods. Calcium is also important for heart muscles, it forms soaps with fats in the intestines preventing absorption, and helps increase the formation of bile in the liver.
Takeaway: Food cooked with fresh ingredients is low in sodium, the excess comes from packaged food. To ensure low sodium intake eat fresh seasonal food. Low sodium salts are high in potassium and should replace normal salt under your doctor’s guidance if you are on HT medication. Potassium rich foods like fruits, especially citrus fruits should be included more often. Calcium is most easily available from dairy, skimmed milk and its products must be included in adequate amounts for overall health.
Oxidation and production of free radicals is a normal daily response. When this becomes uncontrolled or chronic then it has a detrimental effect on our health. Free radicals attack our cells destroying our DNA. Excessive reactive oxygen species (ROS) can lead to low Nitric oxide causing a constriction of the arteries and high BP. It also enhances plaque formation causing the narrowing of the blood vessels. Our food is the best source of antioxidants. Vitamin E, C and beta-carotene, are strong antioxidants, as also minerals like selenium and zinc and polyphenols.
Takeaway: Fill half your plate with colourful vegetables. Make fruits and nuts the preferred snacks. Each colour of food gives you a specific antioxidant. Quercetin (apples, red wine, onions), catechins (tea, cocoa, berries), resveratrol (red and white wine, grapes, peanuts, berries), coumaric acid (spices, berries), anthocyanins(blueberries, strawberries) are specifically good for CVD.
All in all eat , exercise, sleep and stay happy.