By Dr. Mercola
Heart disease claims the lives of about 1 million Americans every year, making it the leading cause of death for both men and women. The most common form of heart disease is coronary artery disease (CAD), which can lead to a heart attack.
This year alone, 920,000 Americans will have a heart attack, and close to half of them will occur suddenly without any prior warning signs.1
A heart attack occurs when blood flow to a part of your heart becomes blocked. This is often the result of plaque build-up inside your arteries (atherosclerosis), which may rupture and form a blood clot that blocks blood flow.
If the blockage isn't cleared quickly, a portion of your heart muscle will begin to die and be replaced with scar tissue, which can cause severe problems in the future.
For instance, a previous heart attack (especially if a large area of your heart was damaged) is a risk factor for sudden cardiac arrest,2 which is caused by abnormal heart rhythms and can be fatal.
5 Lifestyle Changes Could Prevent 80 Percent of Heart Attacks
It's remarkable that heart attacks are so common and cause so much pain (emotional and physical) and disability when they are nearly always preventable. You're probably already aware that your lifestyle plays a role in your risk of heart disease (and heart attacks), but perhaps you've not yet taken it to heart…
If you need some motivation, consider a new study conducted at the Karolinska Institute. It found that engaging in five healthy lifestyle habits could prevent nearly 80 percent of first-time heart attacks in men. Even the researchers were surprised at how powerful a healthy lifestyle could be, noting:3
"It is not surprising that healthy lifestyle choices would lead to a reduction in heart attacks… What is surprising is how drastically the risk dropped due to these factors."
Still, this isn't the first time such a drastic risk reduction has been uncovered. The 2004 INTERHEART study, which looked at heart disease risk factors in over 50 countries around the world, found that 90 percent of heart disease cases are completely preventable by modifying diet and lifestyle factors.4
Unfortunately, most people are not using lifestyle habits to their advantage. The featured study involved men aged 45 to 79… and only 1 percent of them engaged in all five of the "low-risk" behaviors that could prevent a heart attack. So what are the five healthy lifestyle habits?
- A healthy diet
- Being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week)
- Healthy waist circumference (waist circumference <95 cm or 37.4 inches)
- Moderate alcohol consumption (10 to 30 g/day)
- No smoking
What Is a Healthy Diet for Your Heart?
Most of the heart-healthy lifestyle habits are self-explanatory, but the term "healthy diet" is ambiguous… and when it comes to heart health, it is probably not what you think. Contrary to popular belief, refined carbs, sugar, and processed foods are the real enemy—not the saturated fats found in foods such as butter, lard, or eggs.
Part of the confusion on fats revolves around its impact on LDL cholesterol, often referred to as "bad" cholesterol. According to the conventional view, high LDL is correlated with heart disease, and saturated fat does tend to raise LDL. However, we now understand that there are TWO kinds of LDL cholesterol particles:
- Small, dense LDL cholesterol
- Large, "fluffy" LDL cholesterol
The latter is not "bad" at all. Research has confirmed that large LDL particles do not contribute to heart disease. The small, dense LDL particles, however, do contribute to the build-up of plaque in your arteries, and trans fat increases small, dense LDL. Saturated fat, on the other hand, increases large, fluffy—and benign—LDL.
More importantly, research has also shown that small, dense LDL particles are increased by eating refined sugar and carbohydrates, such as bread, bagels, and soda. Together, trans fats and refined carbs do far more harm than saturated fat ever possibly could.
Unfortunately, when the cholesterol hypothesis took hold, the food industry switched over to low-fat foods, replacing healthy saturated fats like butter and lard with harmful trans fats (vegetables oils, margarine, etc.), and lots of refined sugar and processed fructose.
Ever-rising obesity and heart disease rates clearly illustrate the ramifications of this flawed approach. I recently interviewed Dr. Fred Kummerow on this topic. If you missed it, I highly recommend taking a moment to listen to it now.
Download Interview Transcript
A True Heart-Healthy Diet Plan
If you want to protect your heart, you need to avoid trans fats by eliminating all processed foods (which would also include most restaurant food). You also need to address your insulin and leptin resistance, which is the result of eating a diet too high in sugars and grains. To lower your heart disease risk, you need to adhere to the following suggestions, which are explained in detail in my nutrition plan.
1. Avoid sugar, processed fructose, and grains. This effectively means you must avoid most processed foods
2. Eat a healthy diet of whole foods, ideally organic, and replace the grain carbswith:
• Large amounts of vegetables
• Low-to-moderate amount of high-quality protein (think organically raised, -pastured animals)
• High-quality healthy fat (saturated and monounsaturated from animal and tropical oil sources). Most people actually need upward of 50-85 percent fats in their diet for optimal health—a far cry from the 10 percent currently recommended. Sources of healthy fats to add to your diet include:
✓ Butter made from raw grass-fed organic milk
✓ Raw dairy
✓ Organic pastured egg yolks
✓ Coconuts and coconut oil
✓ Unheated organic nut oils
✓ Raw nuts, such as almonds, pecans, macadamia, and seeds
✓ Grass-fed meats
Balancing your omega-3 to omega-6 ratio is also key for heart health, as these fatty acids help build the cells in your arteries that make the prostacyclin that keeps your blood flowing smoothly. Omega-3 deficiency can cause or contribute to very serious health problems, both mental and physical, and may be a significant underlying factor in up to 96,000 premature deaths each year. You can do this by avoiding most vegetable oils and increasing your intake of small wild-caught oily fish (sardines and anchovies) or taking a high-quality krill oil supplement.
Should You Eat More Fruit for Your Heart?
A study presented this year at the ESC Congress in Barcelona, Spain found that people who ate fruit daily had a 40 percent lower risk of heart disease, and a 32 percent lower risk of death from any cause, than those who did not. Further, the more fruit they ate, the lower their risk of heart disease became.5 Fruit can be an excellent source of antioxidants, vitamins, minerals, and other phytochemicals, many of which have heart-healthy anti-inflammatory effects. For instance, research published in the British Medical Journal (BMJ)6 found that simply eating an apple a day might help prevent cardiovascular-related deaths in those over 50 to a similar degree as using a daily statin.7
I would caution against eating too much fruit, however, especially the sweeter fruits that are commonplace today. Many of the most beneficial phytonutrients found in fruits actually have bitter, sour, or astringent taste, and are found in the skin and seeds. To satisfy the modern palate, farmers have, throughout time, opted to selectively breed the sweetest varieties, which makes fruit far less nutritious than it once was. Still, carefully chosen fruit – such as organic apples, blueberries, or cherries – can certainly be beneficial when eaten in moderation. Fruit contains varying levels of fructose, and you will want to avoid over-consuming fructose to protect your heart. My recommendations on fruit (and fructose consumption) are as follows:
- If you're insulin or leptin resistant (are overweight, diabetic, hypertensive, or have high cholesterol), which includes about 80 percent of Americans, then it would be advisable for you to limit your fruit intake. As a general rule, I recommend limiting your fructose intake to a maximum of 15 grams of fructose per day from ALL sources, including whole fruit. You can find a chart of fructose levels in common fruits here.
- If you are not insulin/leptin resistant, (are normal weight without diabetes, hypertension, or high cholesterol) and regularly engage in strenuous physical activity or manual labor, then higher fructose intake is unlikely to cause any health problems. In this case, you can probably eat more fruit without giving it much thought.
- However, if you are in category two above, you might benefit from a further refinement. Fruit will still increase your blood sugar and many experts believe this will increase your protein glycosylation. So my approach is to consume the fruit typically after a workout, as your body will use the sugar as fuel rather than raise your blood sugar.
- Additionally, if you're an endurance athlete, you can probably get away with eating fairly large amounts of fruits since your body will use most of the glucose during exercise, and it won't be stored as fat. (That said, I still believe athletes would be well-advised to consider becoming fat adapted rather than relying on quick sugars).
- If you're still unsure of just how stringent you need to be, get your uric acid levels checked and use that as a guide.
Diabetes Drug Increases Heart Disease Risk
Metformin, a drug that makes your body's tissues more sensitive to insulin, is one of the most common diabetes drugs on the market. However, new research shows that among people with hypothyroidism, the use of metformin was associated with an increased risk of low thyroid-stimulating hormone (TSH) levels.8 If your TSH levels become too low, it may lead to serious damage, including heart problems such as atrial fibrillation, which in turn could lead to congestive heart failure.9 Separate research has also shown that treating type 2 diabetes with glucose-lowering drugs actually showed the potential to increase your risk of death from heart-related and all other causes. Researchers noted:10
"The overall results of this meta-analysis do not show a benefit of intensive glucose lowering treatment on all cause mortality or cardiovascular death. A 19% increase in all cause mortality and a 43% increase in cardiovascular mortality cannot be excluded."
These risks are typically unnecessary, as type 2 diabetes is easy to reverse without drugs. If you want the short version… simply swapping processed foods for whole organic foods lower in sugar and sugar-forming carbohydrates -- combined with a few minutes of regular high-intensity exercises -- will quickly put you on the road to reversing diabetes. See my nutrition plan for a healthy eating guide and, for more specifics, read my diabetes prevention (and treatment) plan here.
A Warning About Beta-Blockers and Scientific Misconduct
Beta-blockers are drugs commonly used in the treatment of high blood pressure and congestive heart failure. They work primarily by blocking the neurotransmitters norepinephrine and epinephrine (adrenaline) from binding to beta receptors, thereby dilating blood vessels, which reduces your heart rate and blood pressure. Until recently, the European Society of Cardiology (ESC) recommended using beta-blockers in patients undergoing non-cardiac surgery. Earlier this year, however, researchers calculated that this guideline, which they found was based on "questionable and probably fraudulent research," may have caused up to 800,000 deaths over five years in Europe alone.11
The beta-blocker guidelines were based largely on research done by a scientist who was fired for scientific misconduct in 2011, and who was also the chairman of the committee that drafted the European treatment guideline. You would think that once this was known, immediate action would result. However, it took two years before the ESC withdrew the beta-blocker recommendation once the scandal had unraveled. This is absolutely scandalous as nearly a half of a million people died unnecessarily due to the delay.
In that two-year span, many European clinicians may have felt that their hands were tied, as failing to follow guidelines can lead to being penalized—even if the doctor knows the guidelines are likely to do more harm than good. Last month, a revised version of the article was published,12 which went into even more detail of the harms that occur when fraudulent research is published and put into clinical practice… even years after the fraud is uncovered. As Forbes reported:13
"They write about a culture of neglect in which few if any participants have anything to gain by finding or reporting scientific misconduct. They cite numerous examples in which misconduct has been alleged but the responsible actors– authors, home institutions, journals, and medical societies– have responded in only the most minimal and nonaggressive fashion. The portrait they paint is of a scientific and medical establishment devoted to not rocking the boat."
Avoid Becoming Another Heart Attack Statistic
There are many strategies that can protect your heart and virtually eliminate your risk of heart disease. Please don't wait until you experience heart attack symptoms to take action because the most common symptom of heart disease is sudden death, so you will be dead before you even know you have a problem. Do so now in order to prevent any long-lasting damage:
- Eat unprocessed saturated animal fats, and ignore the media, as you will benefit from these fats. Many may also benefit from increasing the healthy fat in their diet to 50-85 percent of daily calories
- Avoid all sugars, including processed fructose and grains if you are insulin and leptin resistant. It doesn't matter if they are conventional or organic, as a high-sugar diet promotes insulin and leptin resistance, which is a primary driver of heart disease
- Exercise regularly, as physical activity along with a healthy diet of whole, preferably organic, foods may be just as potent—if not more potent—than cholesterol-lowering drugs. Use a combination of high-intensity interval training, strength training, stretching, and core work.
- Avoid excess sitting; aim for three hours a day or less of sitting and try to take 10,000 steps a day (exclusive of your exercise).
- Avoid statins, as the side effects of these drugs are numerous, while the benefits are debatable. In my view, typically, the only group of people who may benefit from a cholesterol-lowering medication are those with genetic familial hypercholesterolemia. This is a condition characterized by abnormally high cholesterol, which tend to be resistant to lifestyle strategies like diet and exercise
- Optimize your vitamin D levels, either through appropriate sun exposure, a tanning bed, or as last resort an oral vitamin D3 supplement
- Regularly walk barefoot to ground with the earth. When you do, free electrons are transferred from the earth into your body, and this grounding effect is one of the most potent antioxidants we know of, and helps alleviate inflammation throughout your body
- Manage your stress daily. My favorite tool for stress management is the Emotional Freedom Technique (EFT).