Eating for a Healthy Heart
Trying to prevent heart disease by lowering cholesterol is like trying to prevent obesity by cutting out lettuce.
In 2012, cardiologist Stephen Sinatra and I came together to write a book, The Great Cholesterol Myth: Why Lowering Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will. We believe that a weird admixture of misinformation, scientifically questionable studies, corporate greed, and deceptive marketing has conspired to create one of the most indestructible and damaging myths in medical history: that cholesterol causes heart disease.
By focusing on cholesterol, we’ve virtually ignored the real causes of heart disease: inflammation, oxidative damage, stress, and sugar. These are things we can actually do something about using food, supplements, and lifestyle changes, none of which has the costs—or the side effects—of drugs.
Surprising facts about cholesterol
First, let’s start with some surprising facts. Cholesterol is a minor player in heart disease. Cholesterol levels are a poor predictor of heart attacks, since half of heart attacks happen to people with normal cholesterol, and half the people with elevated cholesterol have healthy hearts. Due to this, lowering cholesterol has an extremely limited benefit.
I haven’t come to these conclusions lightly, and I wouldn’t expect you to take them at face value. Though the case against cholesterol as a cause of heart disease (or even as an important marker for it) has been crumbling steadily for decades, getting the information out there is difficult. (The two top cholesterol lowering medications, Lipitor and Zocor, together bring in roughly $34 billion a year for their makers, who have a strong vested interest in keeping the cholesterol theory alive. And they’re hardly the only ones who do.)
But if you’re willing to consider breaking with conventional thinking for a minute, consider the following study, one of the many we discuss in the book.
The Lyon Diet Heart Study
In the 1990s, French researchers decided to run an experiment—known as the Lyon Diet Heart Study—to test the effects of different diets on heart disease. They took two groups of men who had every risk factor for heart disease imaginable. All of them had survived a heart attack. They had high cholesterol, they smoked, they didn’t exercise, and they had high levels of stress. Half the men were advised to eat the American Heart Association “prudent diet” (low saturated fat and cholesterol), while the other half were advised to eat a Mediterranean diet high in fish, omega-3s, vegetables, and monounsaturated fat like olive oil.
The study was stopped midway because the reduction in heart attacks in the Mediterranean group was so pronounced—70 percent!—that researchers decided it was unethical to continue.
The cholesterol levels of the men who ate the Mediterranean diet didn’t budge—they were just as high when the study was stopped as they were when the study began. The men just stopped dying, and cholesterol had nothing to do with it.
The real causes of heart disease
The primary causes of heart disease are inflammation and oxidative damage, which feed on each other in a chicken-and- egg scenario. It starts with small injuries to the vascular wall (inflammation) that can be caused by anything from high blood pressure to toxins. Then, oxidized (damaged) LDL-B particles take up residence in the neighborhood. The immune system sends inflammatory cytokines to the area, creating more inflammation which creates more oxidative damage in a vicious cycle that eventually results in plaque and an increased risk for heart disease. If there was no inflammation, there would be no plaque.
Updating good and bad cholesterol
Note that I mentioned something called LDL-B particles. Perhaps you’re not familiar with those, but you should be soon. The old “good” and “bad” cholesterol tests are woefully out-of-date. We now know that LDL cholesterol—the so-called “bad” cholesterol—comes in several flavors, and not all of them are bad at all.
LDL-A cholesterol is relatively harmless. LDL-B is not. Your doctor can easily determine which type of LDL you have with a simple test called a particle test. (Google it—it’s offered by several different companies, and insurance sometimes covers it.)
The particle test will also tell you the number of particles you have, a number which trumps LDL as a predictor of heart disease any day of the week.
Any other cholesterol test is out-of-date and useless.
And here’s the good news: You’re not “stuck” with the bad kind (LDL-B). Particle size, number, and distribution can change dramatically in response to the right diet. (Hint: the “right diet” is not low-fat!)
The role of stress and sugar
The other two major promoters of heart disease are stress and sugar. Stress releases hormones that harm the artery walls and increase blood pressure. (Stress may be the explanation for why 40 percent of patients with hardening arteries have no other risk factors.)
Sugar—a far worse dietary danger than fat—is inflammatory on its own, but also contributes to insulin resistance and fat gain. Again, it’s a vicious circle. Sugar causes insulin resistance, which causes you to accumulate more fat, and more fat equals more inflammation. Fat cells are tiny hormone factories spitting out inflammatory cytokines and increasing overall inflammation and arterial damage.
Seven point program to reduce heart disease risk
The following is my seven point program for reducing the risk of heart disease. Note that lowering cholesterol isn’t on it, but managing stress is. Pay attention to these seven action items, and you just may find that you don’t need to worry quite so much about cholesterol after all.
>> Eat an anti-inflammatory diet.
>> Reduce grains, starches, sugar, and omega-6s.
>> Manage your stress.
>> Drink only in moderation.
>> Don’t smoke.
>> Supplement with antioxidants, vitamin C, coenzyme Q10, and omega-3s.
The bottom line
Lowering cholesterol and lowering the risk of heart disease are very far from the same thing: The latter is important, and the former is almost irrelevant.
Heart Health Supplements
Many supplements are particularly important for heart health. Here’s a short guide to the most important ones. If you’re not taking these, perhaps you should be.
OMEGA-3s are among the most anti-inflammatory substances on the planet and should be part of everyone’s heart-healthy supplement program.
COENZYME Q10 is needed to make cellular energy. Organs that require a lot of energy—like the heart—need the most. It’s made in every cell in the body, your ability to make it diminishes with age, and it’s virtually unavailable in any meaningful amount from food. (It’s also depleted by cholesterol-lowering medications, so if you’re on one of those you simply must supplement with coenzyme Q10 on a daily basis!)
D-RIBOSE is a five-carbon sugar and is one of the components of ATP, the energy molecule the body uses to power all activities. Without D-ribose, there is no ATP. Without ATP, there is no energy.
L-CARNITINE acts as a kind of shuttle bus, loading up fatty acids and transporting them into tiny structures within the cell called the mitochondria, where they can be burned for energy. Because the heart gets 60 percent of its energy from fat, it’s very important that the body have enough L-carnitine to shuttle the fatty acids into the heart’s muscle cells.
MAGNESIUM lowers blood pressure, helps control blood sugar, relaxes the lining of the blood vessels, and helps prevent clots. Dietary surveys show that Americans aren’t getting nearly enough.
PANTETHINE is a metabolically active (and somewhat more expensive) form of vitamin B5, or pantothenic acid. Pantethine produces significant positive changes in triglycerides, LDL cholesterol (it reduces oxidation), and HDL cholesterol.
VITAMIN C is one of the most powerful antioxidants in the world. Because heart disease is initiated by damage caused by free radicals (or oxidative damage), any help you can get in the antioxidant department is a good thing indeed. A large 2011 study in the American Heart Journal found that the lower the level of vitamin C in the blood, the higher the risk for heart failure.
CURCUMIN is an extract from the Indian spice turmeric. Scientific research has demonstrated its anti-inflammatory, antioxidant, antithrombotic, and cardiovascular protective effects. It also reduces oxidized LDL cholesterol. Curcumin is not generally well-absorbed, so source is important. One particularly well-absorbed form is called BCM-95 curcumin, available in supplements like Terry Naturally.
RESVERATROL is the ingredient in red wine that’s best known for its “anti-aging” activity. It’s both a strong antioxidant and a strong anti-inflammatory, inhibiting a number of inflammatory enzymes that can contribute to heart disease. The recommended dose is at least 250 mg a day of trans-resveratrol, the active component of resveratrol. One brand I particularly like is Reserveage, which comes in two strengths and provides either 250 mg or 500 mg of the trans- form in every capsule.
COCOA FLAVANOLS help the body synthesize a compound called nitric oxide, which is critical for healthy blood flow and healthy blood pressure. You can get these heart healthy flavanols in dark chocolate containing at least 60 percent cocoa. One manufacturer, CocoaWell, provides cocoa flavanols in several excellent formulas, including one that incorporates 100 mg of coenzyme Q10.
Super-Energized Baked Beans
2 cups dried navy beans
2 tablespoons extra virgin olive oil or ghee
2 cups chopped onions
1 clove garlic, minced
2 cups tomato purée
1/2 cup organic honey
2 tablespoons apple cider vinegar
1/4 teaspoon ground nutmeg
1/2 teaspoon ground cinnamon
3 bay leaves
1/2 teaspoon each ground turmeric and cumin
1/4 teaspoon salt (Celtic or sea)
1/4 teaspoon black pepper
Soak the beans overnight. Drain and rinse under cold water. Add the beans to a large pot, cover with water, and bring to a boil. Reduce the heat to a simmer and cook for up to two hours. Preheat the oven to 300 degrees. Drain the beans and place them in a large casserole dish. In a small skillet, heat the oil or ghee and sauté the onions and garlic until browned, about three to four minutes. Add the onions and garlic to the beans and mix together. Add all the other ingredients and stir to combine. With the lid on, bake the beans for three hours, stirring frequently. Check the moisture level and add water if needed. After 3 1/2 hours, remove the cover and bake for another 30 minutes. Refrigerate the beans in an airtight jar, where they will keep for up to one week.
Easy Beef Sauté with Fresh Herbs
2 tablespoons extra virgin olive oil
2 cloves garlic, minced
1 medium onion, minced
1 small chile pepper, minced
4 to 6 ounces lean grass-fed beef, chopped into
1- to 2-inch cubes
1 cup sliced zucchini
3 large carrots, sliced
8 cremini or shiitake mushrooms, sliced
1 large green bell pepper, chopped
2 tablespoons tamari
1/2 teaspoon salt (Celtic or sea)
1/2 teaspoon black pepper
2 tablespoons chopped fresh parsley
In a skillet over medium-high heat, add the oil and sauté the garlic, onion, and chile pepper until softened, about five minutes. Add the beef and cook until tender, about three to five minutes. Add the remaining ingredients except the parsley. Cook, stirring often, until the vegetables are crisp and tender, about two to three minutes. Add the fresh parsley at the end. Serve immediately.
Stress-Less Shiitake and Asparagus Risotto
1 teaspoon saffron threads
4 cups vegetable stock
1 tablespoon extra virgin olive oil or coconut oil
1 small onion, chopped
2 cloves garlic, chopped
1 teaspoon dried basil
1 teaspoon chopped fresh basil
2 sprigs fresh thyme
1 teaspoon salt, Celtic or sea
1 1/2 cups brown rice
1/2 cup dry white or red wine
6 asparagus spears cut into 1-inch lengths
1 cup sliced shiitake mushrooms
1/4 cup fresh or frozen peas
1 teaspoon grated lemon zest
1 tablespoon chopped fresh basil
1/2 cup chopped fresh parsley
Dash of black pepper
Place the saffron and stock in a medium pot and warm over low heat. In a large pan, heat the oil over medium to high heat and add the onion and garlic until transparent, about three to four minutes. Add the dry and fresh basil, thyme sprigs, and salt and sauté for about one minute. Add the rice and stir and cook for several minutes. Add the wine and stir for two minutes. Add the asparagus, mushrooms, and peas and stir them into mixture. Add the saffron and vegetable stock, one cup at a time, and stir continuously. Remove the thyme sprigs and cook uncovered, stirring often, until most of the water is absorbed and the rice is thickened and slightly creamy, about two to three minutes. Add more stock if the rice is dry and needs it. Stir in the lemon zest, fresh basil, parsley, and black pepper. Serve immediately.
Jonny Bowden, PhD, CNS, also known as “The Rogue Nutritionist,” is a board-certified nutritionist and the best-selling author of 13 books on health. This article is adapted from his latest book, The Great Cholesterol Myth, co-written with cardiologist Stephen Sinatra, MD. Recipes are courtesy of The Great Cholesterol Myth Cookbook.