Lifestyle Impact on Heart Health

Healthy lifestyle is a roadmap to disease prevention

Heart disease numbers are mounting high, particularly in younger population owing to the changes in lifestyle. Causative lifestyle changes point towards an unhealthy diet, lack of physical activity, inadequate sleep, stress & harmful personal habits (smoking, alcohol consumption). Heart disease risk factors including unhealthy lifestyle, obesity (excess fat accumulation), hypertension (high blood pressure) and dyslipidemia (abnormal blood lipid levels) rapidly escalate by the age of 30 to 39 years in Asian Indians. No doubt India is termed as the heart disease capital. Isn’t it a tough challenge for the sufferers to manage the disease? Now instead of thinking about management, why don’t we think of prevention? As we strongly believe prevention is better than cure!

The greatest wealth that one can ever earn is good health

  • Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  • We view wellness as much more than just a state of physical health. It also encompasses emotional stability, clear thinking, the ability to love, create, embrace change, exercise perceptions and experience a continuing sense of spirituality.
  • Wellness is an active process of becoming aware of and making choices towards a more successful existence. Lifestyle is an important factor in the promotion and maintenance of good health.
  • Lifestyle is a comprehensive approach featuring diet, physical activity, sleep, stress management and personal habits (smoking & alcohol consumption).

An ounce of prevention is worth a pound of cure!

Deviate a while from your routine schedule and answer a simple question, do you spend some quality time on yourself?

Or is there a time allotted for your health betterment?Ok, for now let’s excuse a negative answer, for we are sure that after understanding the essence of a healthy lifestyle your answer will positively change. Chronic diseases like heart disease and diabetes which are on the rise in our country are linked to an improper diet and inadequate physical activity. When a balanced diet takes the company of exercise, stress relievers and healthy personal habits the risks for such diseases can be prevented. So all you have to do is realize their importance in making your life healthier!

Triglyceride levels can be reduced through lifestyle modifications!437-438
  • 5% to 10% reduction in body weight anticipates a triglyceride-lowering response of 20%. Meta-analyses have reported that for every kilogram of weight loss, triglyceride levels decrease 2%.
  • For every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL /0.03 mmol/L.
  • Reducing carbohydrates particularly added sugars and fructose while increasing unsaturated fat intake may contribute an additional 10% to 20% reduction in triglyceride levels.
  • Elimination of trans fats, restriction of saturated fats, and increasing consumption of marine-based omega-3 products, coupled with aerobic activity, will further optimize triglyceride-lowering efforts.

Dietary influence on heart health

Diet is a contributing factor in the risk, development, and progression of cardiovascular disease!

Let food be thy medicine and medicine be thy food

  • The effect of diet and other lifestyle factors on health status has been recognized since antiquity.
  • When the current science of food and the nutrition it provides is applied mindfully, food has a myriad restorative and therapeutic capacity to cure heart health disorders.
  • An age old idiom which stands good till date says “You are what you eat”. Each and every cell of our body is constructed with the nutrition derived from the foods that we consume.
  • One cannot think well, work well, and sleep well, if one has not dined well.
  • Balanced diet is a recognized health savior! The three golden rules for a balanced diet, which say that every meal should be nutritious in quality, moderate in quantity and eaten in regular meal timings.
A healthy meal pattern can keep your cholesterol levels in check!305-313
  • Meal pattern is when and how often you eat and the interval you leave between each meal.
  • Meal pattern influences your body weight and blood cholesterol levels. Bad cholesterol levels can rise in response to an irregular meal pattern.305-306
  • A healthy nutritious breakfast, a tasty yet filling lunch and a light healthy dinner timed at equal intervals can bring down the bad cholesterol levels while maintaining your good cholesterol score.
  • Eating less than three times a day will make a person thin is just a myth! Reducing eating frequency to less than three meals per day impaired appetite control307-308. So if you desire to reduce your body weight and bring down your blood cholesterol levels then eat three healthy meals daily and remember to stick on to your meal timings.
  • Data from cross-sectional studies consistently show that skipping breakfast is associated with excess body weight and markers of insulin resistance. Insulin resistance causes a rise in serum triglyceride levels, which in turn is a risk factor for heart disease.309-310
  • A nutritious breakfast is a key factor in promoting healthy body weight, chronic disease risk reduction and positive mental health.311-312
  • Dietary factors can moderate the rate of progression and development of the atherosclerotic lesions which play a vital role in the pathogenesis of CHD.313
  • Large portion sizes and high energy density are common features of foods eaten away from home. Most foods are also high in saturated fat and sodium, and low in micronutrients. There is also a positive association seen between frequency of meal consumption at quick-serve restaurants and total energy intake, weight gain and insulin resistance.310
Dietary carbohydrates and heart health314-340
  • High carbohydrate diets (that is, a high intake of simple or refined carbohydrates) were recognized as contributing factors for abnormal blood lipid levels (dyslipidemia), especially abnormally high triglyceride levels in blood (hypertriglyceridemia).314-315
  • In people with abnormal blood lipid levels (hyperlipidemic subjects) serum triglycerides correlated positively with carbohydrate intake.316
  • An increase in the consumption of tuberous vegetables can bring about a rise in the serum triglyceride levels and a decrease in HDL-C concentration.317
Complex carbohydrates are heart healthy!318-326

Whole grain cereals, fruits and vegetables are rich in dietary fiber which is a healthy, complex carbohydrate. This healthy carbohydrate when consumed adequately on a regular basis can maintain optimal blood cholesterol levels.

  • Whole grains/cereals & millets- cardiovascular benefits318-324
    • Whole grains (or foods made from them) contain all the essential parts and naturally-occurring nutrients of the entire grain seed in their original proportions.
    • The 2005 Dietary Guidelines for Americans recommends at least 3 servings of whole-grain foods each day.
    • Whole grains/cereals include amaranth, barley (Jau), buckwheat, corn, millets, oats, quinoa, brown rice, rye, sorghum/jowar, wheat, ragi.
    • Millets include Pearl millet (bajra/kambu), Foxtail millet (Quinoa/Thinai/kangni/Kakum), proso millet (Barri/Panivaragu), finger millet (ragi/mandua/kelvaragu), Sorghum (Jowar/cholam), Little millet (kutki/samai), Kodo millet (Kodra/varagu), Barnyard millet (Jhangora/kuthiravaali).
    • Millet (especially ragi) consumption has a blood sugar lowering effect.320
    • Daily consumption of 3 portions of whole-grain foods can significantly reduce cardiovascular disease risk in middle-aged people mainly through blood pressure–lowering mechanisms. The observed decrease in systolic blood pressure (nearly 5-6 mmHg) could decrease the incidence of coronary artery disease and stroke by ≥15% and 25%.321-322
    • For each gram of soluble fiber from oats, psyllium, or pectin, total cholesterol and LDL-cholesterol concentrations decreased by approximately 1.55 mg/dL (0.04 mmol/L).323-324
  • Fruits & vegetables- cardiovascular benefits325-326
    • Daily consumption of 8 servings of vegetables and fruits significantly reduced CRP concentrations (an inflammatory marker for heart disease) compared with consumption of 2 servings per day.
Refined grain Vs Whole grain327-328

Refined grains like maida are tasty but do they serve any purpose in heart health? It’s worth finding out

  • I am sure all of us are familiar with the taste of refined grain products like white bread, naan and pizza to name a few delicacies. Aren’t we? But have you ever thought deeper about its health impacts? If not so far then here is a chance.
  • Refining is a process of making food appealing, but are you aware that 90% of the essential nutrients (including dietary fiber & B vitamins), apart from the starchy carbohydrates are lost during this process? Wondering how you are losing these nutrients every day? It’s through the refined grains like maida and white rice which are very low in cholesterol-reducing dietary fiber.
  • A comparison of whole & refined grain intake (whole wheat vs. refined wheat) for 12 weeks revealed that, a 5–6% increase from baseline in both total & LDL cholesterol levels occurred in the refined grain group but not in the whole grain group.327-328
  • 4–7 daily servings of mixed whole grain foods for 12 weeks resulted in a significant reduction in the fat percentage of abdominal region.327-328
  • So it’s the right time to make a transition from maida to whole wheat flour, replace white rice with unpolished/brown rice and give space for oats and ragi atleast twice a week.
Evidence-based facts on whole grain intake and weight reduction331-340

Obesity is a risk factor for heart disease; weight reduction brings down the risk!

  • Whole grains (or foods made from them) contain all the essential parts and naturally-occurring nutrients of the entire grain seed in their original proportions.
  • The 2005 Dietary Guidelines for Americans recommends at least 3 servings of whole-grain foods each day.
  • Replacing refined grains (approximately 20% of energy) with whole wheat or brown rice, barley, or half whole wheat-rice and half barley, for five weeks each, resulted in an approximate 1 kg weight loss.331
  • Intake of Breakfast cereals containing at least 25% whole grain resulted in the following332
    • BMI reduction (0.630kg/m2).
    • waist circumference reduction (by 2.7cm).
    • waist:hip ratio reduction by 0.023.
  • Consumption of approximately five servings of whole grains per day resulted in a significant reduction in body weight, waist circumference and percent body fat.333
  • Intake of whole grains including whole grain breakfast cereal, oatmeal, dark bread, bran muffins, brown or wild rice, in amounts approximating to two servings per day resulted in significant BMI reduction (by 0.6kg/m2).334
  • Breakfast cereal is considered whole grain if it contains 25% or more whole grain or bran by weight. Whole-grain intake was inversely associated with BMI, fat mass & body fat percentage.335
  • For each additional 1g intake of whole grains like bran, wheat germs, muesli, porridge (oats or whole wheat), brown rice, obesity risk significantly reduced. Each kg/m2 reduction in BMI corresponded to a 33g per day increase in whole grain intake (dry weight).336
  • Greater weight loss with higher whole grain intake.336
  • Insoluble non-viscous dietary carbohydrates obtained from whole grains, have always been shown to be associated with the greatest protection from chronic diseases, mainly heart disease and type 2 diabetes.338
  • Fiber intake from whole grains is significantly associated with weight reduction. Fiber intake is positively associated with adiponectin and may promote the clearance of lipids and thus reduce free fatty acids available for storage in adipose tissue.339
  • A randomized clinical trial conducted on middle-aged, obese (BMI =30.9+/-2.4) adults revealed that whole grain intake combined with adequate physical activity and a low calorie diet resulted in significant weight loss.340
Dietary fats and heart health341-376

Fats that heal & fats that harm: the choice of fats determines whether they are a fortune or fate to your heart health!

Dietary fats- an overview341-349
  • All of us enjoy a tasty meal, Don’t we? You’ll be surprised to know that fat is the main component which adds taste and flavor to a meal. Is that all? No, inside your body fat has a notable role...
  • Fat is one of the energy providing macronutrient that is essential for maintaining our body temperature within normal limits. It protects the vital organs from external stressors and helps in the absorption of fat soluble vitamins like vitamin A, D, E & K.
  • A dietary fat intake of approximately 25% of total calories is the recommendation given by renowned health organizations like the American Heart Association and National Cholesterol Education program.
  • If 55 grams of fat is what you eat in a day then 13 of saturated, 27 of monounsaturated and 15 of polyunsaturated is the ideal ratio you should look for. So, take the right fats in the right quantities!!!
  • Dietary fats are categorized as unhealthy (saturated & trans fats) and healthy fats (mono & poly –unsaturated fats) based on their impact on health.
  • Among fats there are fats that heal and fats that harm. Saturated fats and Trans fats are unhealthy as they can increase the level of LDL/bad cholesterol in the blood. Increased bad cholesterol levels in blood can clog blood vessels that feed the heart and brain, eventually leading to a heart attack or stroke.
  • But there are few good ones as well such as monounsaturated fats and polyunsaturated fats like the Omega-3s which are in favor of HDL/good cholesterol. Healthy fats also play a role in managing moods, fighting fatigue and even weight control.
  • Therefore the solution isn’t about cutting down fats but learning to make healthy choices and replace bad fats with good ones!!!
Healthy & Unhealthy fats- recommendations350-376
  • Saturated fats or the fats that are solid at room temperature are mainly found in organ meat, egg yolk, full fat dairy products (mainly butter & ghee), coconut oil, palm oil, hydrogenated vegetable oil (vanaspati) and processed foods like sweets and snacks.
  • Trans fats are obtained by structurally changing (partial hydrogenation) vegetable oils. These are added to processed foods & bakery varieties like puffs to give a crunchy texture. Its sources include, hydrogenated vegetable oil (vanaspati), spreads like margarine, baked foods (frozen pizza crust, puffs, cookies, pie crusts and crackers) and processed foods like fried snacks (potato/corn/tortilla chips, French fries, fried chicken).
  • Saturated fats & trans fats are considered unhealthy because when their intake exceeds the recommendation (> 7% for saturated fats & >1% for trans fats of your daily energy intake) they tend to cause weight gain, bad cholesterol (LDL) elevation and heart health disturbance.
  • Did you know these facts about saturated fats?360-362

    • Egg yolk contains myristic acid which is the most atherogenic (harmful in terms of causing heart attacks) among the saturated fatty acids.360
    • Intake of 100 grams of chicken with skin provides 18 grams of fat and 100 mg of cholesterol whereas, without skin it provides four grams of fat and 60 mg of cholesterol.361
    • For people who need to lower their cholesterol, the American Heart Association recommends reducing saturated fat to no more than 5 to 6 percent of total daily calories.362
  • Monounsaturated fatty acids (MUFA) belong to the family of healthy fats as they improve good cholesterol (HDL) levels and keep the bad cholesterol levels in check. Their richest food sources are olive oil, canola oil, nuts (like peanuts, pistachios, almonds and avocados) and low-fat dairy products.
  • Polyunsaturated fatty acids (PUFA) are healthy fats owing to their beneficial effects on heart health. They comprise of omega-3/n-3 and omega-6/n-6 essential elements which are required in an optimal ratio through diet for balancing inflammation and maintaining the blood vessels in good health.
  • Omega-6 PUFA induce inflammation and blood clotting which is needed during an injury (external or internal), while omega-3 PUFA have anti-inflammatory and anti blood clotting effects which is needed for a healthy heart.
  • Omega-6 PUFA is mainly present in vegetable oils like sunflower and safflower varieties.
  • Omega-3 PUFA is mainly present in flaxseeds (omega-3 PUFA type: Alpha linolenic acid or ALA), walnut (ALA) and fish (sardine, mackerel, salmon, tuna in the form of eicosapentaenoic acid or EPA & docosahexaenoic acid or DHA).
  • According to the American Heart Association, saturated fat intake should be restricted to less than 7% of your daily energy intake or <16 grams per day if it is 2000 Kilocalorie diet for saturated fats & >1% of total energy for trans fats. This recommendation can be achieved through the following guidelines
    • Opt for the low fat (<3% fat) milk & milk products.
    • Avoid coconut/coconut oil (92% saturated fat), palm oil (93% saturated fat), and foods processed in hydrogenated vegetable oil (vanaspati/dalda).
    • Intake of ghee should be restricted to not more than half teaspoon (2.5 grams; half a teaspoon ghee contains approximately 1.465 grams of saturated fat) in a day, and the frequency can be twice or thrice in a week. And if consumed on a daily basis, the quantity should be restricted to quarter teaspoon (1.25 grams) in a day.
    • One tablespoon of butter (14 grams) contains approximately 7.192 grams of saturated fat; hence restrict its usage in dishes to once in a month and keep the quantity to not more than half a tablespoon in a day.
    • 113 grams of cheese (nearly 4 regular slices) contain 3 grams of saturated fat; restrict the intake to not more than one slice in a day as frequently as once in two weeks.
    • Restrict the intake of trans fats to less than 1% of total calories. Foods rich in trans fats including french fries (4.2-6.1% saturated fat), aloo tikki (7.6% saturated fat), poori (7.6% saturated fat), paratha (7.8) and bhatura (9.5%) should be restricted to once in 20 days.
    • Consume approximately 15% (or 32 grams) of total energy (for a 2000kcal diet) from monounsaturated fat (MUFA) to maintain your BMI within normal limits. This daily recommendation can be achieved by
      • consuming nearly 15 grams of MUFA from one-and-a-half tablespoon olive oil (1 tablespoon of olive oil contains 9.85 grams MUFA; based on USDA, ndb.nal.usda.gov/ndb/foods/show/660?manu=&fgcd= ).
      • Olive oil (1-1.5 tablespoons in a day) can increase HDL cholesterol.363
      • The remaining 17 grams of MUFA can be obtained through nuts (based on the American Heart Association and Australian Dietary guidelines the daily allowance for nuts' intake is 30 grams).
      • Studies suggest that consuming about 30g (a handful) of nuts per day may reduce the risk of developing heart disease by 30-50% and reduce the risk of death from heart disease by around 20% (www.nutritionaustralia.org).
      • Almonds reduce LDL by upto 19%364-366
    • Daily recommended intake of cooking oil for an adult is about 20 grams which equates to approximately 4 teaspoons.
    • Alternate your cooking oil every month to achieve an optimal ratio of different fatty acids. Healthy options include sunflower oil, safflower oil, rice bran oil, corn oil, canola oil, gingelly/ sesame oil, groundnut oil, olive oil (only for shallow frying)
      • Rice bran oil amounting to 1/3 of the total dietary fat decreased LDL cholesterol by approximately 7%367
    • To achieve your daily omega-3 PUFA recommendation, the following are suggested - flaxseeds (1 teaspoon/day along with buttermilk), walnuts (4 kernels in a day) & fish (500 mg in a day, thrice a week)
    • Scientific facts relating omega-3 PUFA with heart health368-376

      • Walnuts are shown to reduce LDL-C by 10%.368-369
      • Flaxseed lowers total cholesterol by approximately 4 mg/dl and LDL-C by approximately 3mg/dl.370-371
      • People who increased their intake of fish to a minimum of 3-4 weekly meals had more large HDL particles in their blood.
      • Consumption of one to two servings of fatty fish per week providing approximately 250 mg/d of EPA plus DHA resulted in a 50 per cent lower risk of fatal CHD compared to fish intake providing 40 mg/d of EPA plus DHA.372
      • In a meta-analysis of prospective cohort studies, it was estimated that eating fish once per week was associated with a 15 per cent lower risk of coronary death compared with a fish intake of less than once per month.373-374
      • Each 20 g/d increase in fish consumption was related to a seven per cent lower risk of CHD mortality.374
      • In Dutch population with a low habitual fish intake, dietary EPA and DHA levels were inversely associated with fatal CHD375-376
Foods/beverages that render heart health benefits
  • Oats329-330
    • 75 grams of oats contain 3 grams of beta-glucan, a soluble fiber which lowers LDL or bad cholesterol levels.329
    • Adding ≥3 g of oat beta-glucan/d to the diet reduces LDL & total cholesterol by 0.25mmol/L (9.7mg/dl) & 0.30mmol/L (11.6mg/dl).330
  • Quinoa (thinnai/bathua)
  • Quinoa is digested slowly and with its low glycemic index slows down glucose release into the blood.

    • Half a cup of quinoa can surprise you with 2.6 grams of heart-healthy soluble fiber which guarantees bad cholesterol reduction.
  • Ragi
    • Ragi is extremely nutritious with good amounts of Calcium, Iron and Protein.
    • Its calorie content is lower while its fiber content is higher compared to wheat and rice.
    • Certain essential amino acids present in ragi reduce the production of cholesterol in the body, enhance skin health and relax your mind.
    • Ragi keeps body weight, blood sugar and blood cholesterol levels in control. Ragi is the best plant-based food for bone health.
  • Brown rice
    • Brown rice has a mild, nutty flavor, and is more nutritious than white rice.
    • The main difference between the two forms of rice lie in their nutritional content which is decided by the type of processing they undergo.
    • When only the outermost layer of the rice grain is removed, brown rice is produced. While, to produce white rice, the next layers underneath containing healthy fiber, rice bran oil and essential B vitamins are also removed, leaving only the starch behind.
    • The adequate fiber and rice bran oil present in brown rice can lower your blood cholesterol levels.
    • Replace white rice with brown rice at least thrice in a week to stay heart healthy!
  • Green tea
  • Is rich in an antioxidant called catechin polyphenol which is effective in reducing the total cholesterol levels in blood.

    • 2 to 4 cups of green tea in a day can maintain a healthy ratio between the good and bad cholesterol levels in turn preventing the blood vessel from getting clogged.
    • Remember, if you are someone who is in the habit of consuming coffee/tea, then maintain your daily caffeine intake with 2 cups of coffee/tea and 2 cups of green tea.
    • When blood flows smoothly through the blood vessels blood pressure remains normal and less is the risk for heart disease.
    • When Japanese can lower the risk of heart disease with green tea why don’t we also try? So take green tea as an alternative to caffeine rich beverages!
  • Garlic377-382
    • Garlic (atleast 5 cloves a day) is shown to reduce LDL-C by 10% & total cholesterol by 7%.377
    • Garlic is shown to reduce triglycerides by 6.5%.378
    • The sulphur-containing compounds in garlic(alliin, allicin, diallyl sulfide, diallyl disulfide, diallyl trisulfide, ajoene, and S-allylcysteine380-382) expand the blood vessels thus reducing your blood pressure.379
    • The active compound in garlic called allicin lowers the triglyceride and LDL cholesterol levels and prevents blood clot formation in the blood vessels380-382
    • Blood pressure and blood cholesterol determine your heart health as the bad cholesterol components have a tendency to stick on to the blood vessel wall hindering the blood flow through them.
  • Onion
    • Onions are tagged with powerful antioxidant properties and among them quercitin and phenolic compounds can make your good cholesterol better while preventing the LDL or bad cholesterol from getting oxidized or worse.
  • Broccoli dually benefits you with blood pressure & cholesterol control
    • One cup broccoli gives you nearly 6 grams of fiber, in which the soluble fiber portion is 3 grams.
    • Soluble fiber prolongs the feeling of fullness and helps you maintain optimal intervals between meals which mean no excess weight gain.
    • Excess of bad cholesterol gets tied up with broccoli’s soluble fiber and is eventually removed. Thus it maintains your blood cholesterol levels favorably and prevents heart disease.
    • The potassium, magnesium and calcium in broccoli make way for a smooth blood flow through blood vessels and thereby control blood pressure. Broccoli is healthier in raw form, so add it to your salad. Such a heart-healthy vegetable, better don’t miss!
  • Celery’s goodness is evident from its low-calorie, high-fiber health mantra
    • Celery is extremely low in calories and has high fiber content. So here is a reason for its efficiency in preventing Obesity, Diabetes, high blood pressure and high blood cholesterol levels.
    • Celery has a good amount of B vitamins and essential minerals including potassium, sodium, calcium, magnesium, phosphorous and iron which have vital health benefits.
    • Presence of vitamin C, vitamin E and zinc in trace amounts renders it antioxidant properties. Include at least four celery stalks daily to keep your blood pressure and cholesterol levels in check.
  • Lady’s finger (Bhindi/Okra)
    • One cup of cooked lady’s finger will give you four grams of healthy fiber, of which nearly three grams is soluble fiber.
  • Carrots
    • Half a cup of grated or sliced carrot gives you one gram of soluble fiber which assures blood cholesterol reduction.
  • Cluster beans
    • Cluster beans or kothavangai or gawarfali is a green vegetable which is low in calories and rich in a type of soluble fiber called guar gum.
    • A cup of cooked cluster beans will surprise you with five grams of soluble fiber which removes excess bad cholesterol from the blood. By doing this, the cluster beans make the blood vessels healthy and as the blood flow through them is smooth your blood pressure is also maintained within normal limits.
    • Guar gum is also known to reduce excess body weight and high blood sugar levels.
      • Clean cluster beans and remove their strings by stripping the ends.
      • Pressure cook it in water for 2 whistles.
      • Mix curd, coriander powder, chilli powder, gram flour and salt in a bowl.
      • Heat olive oil in a frying pan and season with cumin, mustard, sesame, asafoetida and fennel seeds.
      • When the seeds crackle, add the curd mixture, curry leaves and ¼ cup of water and mix well. Bring to a boil and simmer for 4 to 5 minutes, while stirring continuously. Add the cooked cluster beans and mix well. Simmer for another 2 to 3 minutes. Serve hot with rotis!
  • Apple
    • This healthy fruit has a dual benefit that is the edible skin is a rich source of insoluble fiber while the inner flesh is rich in pectin, a soluble fiber.
    • Soluble fiber is the hidden angel in apple that is responsible for lowering LDL or bad cholesterol levels in blood.
    • The phenolic antioxidants in apple prevent the LDL cholesterol from getting oxidized, as oxidized LDL is even more powerful in damaging blood vessels.
    • An apple a day preferably eaten during mid-morning can give you 1.5 grams of soluble fiber and 1.8 grams of insoluble fiber. Start now!
  • Papaya
    • Papaya is rich in soluble fiber and therefore it is known to lower bad cholesterol levels.
    • Presence of folate in papaya reduces homocysteine levels in the blood, a substance that can cause heart disease.
  • Blackberries
    • Blackberries are rich in nutrients and provide more stamina to the heart muscles.
    • Blackberries are rich in ‘pectin’ that has been proven to reduce LDL cholesterol levels. For each gram of soluble fiber from pectin, total cholesterol and LDL-cholesterol concentrations decreased by approximately 1.55 mg/dL.
  • Guava
    • Guava is rich in pectin, which controls body weight, and disposes excess bad cholesterol from the blood.
    • For each gram of soluble fiber from pectin, total cholesterol and LDL-cholesterol concentrations decreased by approximately 1.55 mg/dL.
    • Guava also contains good amounts of potassium which controls blood pressure.
    • This fruit is a storehouse of vitamin C which has a role in reducing blood cholesterol levels. Doesn’t it sound heart healthy?
  • Strawberry
    • Eight medium sized strawberries contain two grams of healthy fiber which removes excess bad cholesterol from the blood.
    • This tiny red fruit also stocks folate and potassium which are needed to control blood pressure and keep your blood vessels healthy.
    • Strawberries are an excellent source of vitamin C and an antioxidant called flavanoids.
  • Raisins
  • A raisin is a dried grape which is ranked high globally among the most delicious dry fruits owing to its taste and health benefits.

    • Raisins are low in fat and are packed with fiber, essential vitamins, minerals and antioxidants.
    • Half a cup of raisin contains nearly three grams of soluble fiber and 420 milligrams of an antioxidant called polyphenols. Believe me, both these super nutrients guarantee cholesterol reduction.
    • The polyphenols in raisins doesn’t permit excess LDL or bad cholesterol to travel in the blood, while the soluble fiber disposes the excess bad cholesterol from the blood.
  • Prunes
    • Prune is low in calories and stocks good amounts of antioxidant vitamins and essential minerals like potassium, manganese, magnesium and iron.
    • Prune is a rich source of both soluble and insoluble fiber.
    • Four to five prunes can benefit you with nearly three grams of healthy fiber. The soluble part handles weight reduction and maintenance of blood sugar and cholesterol levels within normal limits, while the insoluble part is recognized for its role in aiding digestion and preventing constipation.
  • Hazelnuts
    • These crunchy nuts are a rich source of healthy fats mainly the monounsaturated one which improves the good cholesterol levels in the blood.
    • 10 to 15 kernels or 20 grams of hazelnuts in a day, can guarantee bad cholesterol clearance.
  • Soybean
    • These wonder beans are a storehouse of good quality protein, heart healthy fatty acids, fiber and phytochemicals.
    • Each of the above nutrients has a recognized role in blood cholesterol reduction. Soy Isoflavones reduce total cholesterol by upto 4% or 3.9 mg/dL and LDL-C by upto 5% or 5.0 mg/dL
  • Rajma
    • Include rajma or red beans at least once in a week to lower your blood cholesterol levels.
    • In addition to lowering blood cholesterol levels, the high fiber content in rajma prevents blood sugar levels from rising too rapidly after a meal, making these beans a good choice for individuals with diabetes.
    • The fiber in rajma prevents clogging of the blood vessels while the proteins in it improve muscle strength. Additionally rajma improves cognitive functions.
  • Sesame seeds
    • Sesame seeds are rich in a monounsaturated fatty acid called oleic acid, lignin a dietary fiber and glucoside antioxidants. These super nutrients lower LDL or "bad cholesterol" and increase HDL or "good cholesterol" levels in the blood.
    • The seeds are incredibly rich in many essential minerals like calcium, iron, manganese, zinc, magnesium, selenium, and copper which have a vital role in regulation of heart muscle activities.
  • Psyllium husk
    • A teaspoon of psyllium husk gives you nearly five grams of healthy fiber.
    • Psyllium husk a plant food is a concentrated source of soluble fiber. Hence it is important to drink plenty of fluids when you consume psyllium.
Role of salt in heart health385-395

Just a pinch is enough!

  • Salt, an age old seasoning is an inevitable part of our diet as it relates to the sense of taste. Sodium, a component of common salt is a very important electrolyte in the body owing to its role in maintaining fluid and electrolyte balance. Sodium regulates blood pressure; hence its normal levels are focused upon.
  • Increased sodium levels in the blood can lead to an elevation in the blood pressure and also result in false weight gain (weight gain due to water and salt retention).
  • In 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/sodium intake.385
  • Angiotensinogen is a protein that causes sodium retention in the body.
  • According to the American Heart Association (AHA), sodium consumption should not exceed 1.5g per day (3.75g of salt), and this holds good even for people without high blood pressure, diabetes or cardiovascular diseases.
  • To achieve this recommendation follow the below mentioned guidelines
    • Everyday measure a few teaspoons of salt in an air-tight container and add from this for cooking. Though the meal is usually cooked for the entire family, this routine can help you in understanding the amount of salt (approximately) that you are consuming in a day.
    • try limiting the intake of canned, processed, salt-dried and pickled foods to not more than once in a month.
    • moderately consume (not more than once in a fortnight) salt-preserved foods like sauces, ketchup.
    • Also consider the sodium content of any packed food that you are consuming, and here is a guideline stating how to read a food product’s nutritional label-
      • if sodium is listed on the label's nutritional information instead of salt you have to multiply the amount by 2.5 to get the equivalent salt content. For example, if a portion of food contains 1g of sodium per 100g, you will know it contains 2.5g of salt per 100g.
      • You should check the labels of foods to find out which ones are high and low in salt content, and avoid the ones that are high in salt content.
      • High salt content food = 1.5g of salt (or 0.6g of sodium) per 100g.
      • Medium salt content food = between the High and Low figure.
      • Low salt content food = 0.3g of salt (0.1g of sodium) per 100g.
    • According to ‘The American Heart Association’ (2013), "potassium is important for controlling blood pressure because it lessens the effects of sodium retention. Foods rich in potassium are guava, custard apple, broccoli, celery, lady’s finger, radish, guava, blueberries, cherries, pista (unsalted), oregano, & pepper; include at least one of their food source everyday.

Limit salt, add more herbs & spices

  • Pepper
    • Piperine is the hidden angel in black pepper which is responsible for reducing blood cholesterol levels.
  • Ginger
    • The active ingredient in ginger is gingerol, a compound that's thought to relax blood vessels, stimulate smooth blood flow and maintain blood pressure.
    • Ginger lowers bad cholesterol, removes clogs from blood vessels promoting a smooth blood flow through them and thereby reduces blood pressure and heart disease risk.
Role of caffeine in heart health396-434
  • Caffeine is one of the most widely consumed stimulants worldwide. Caffeine is found in coffee, tea, chocolate, and a number of soft drinks and energy drinks.
  • Caffeine (a non-nutrient) is metabolized in the liver by an enzyme called CYP1A2 (cytochrome series enzyme).
  • If caffeine is retained in the blood for a longer time, it can constrict (narrow down) blood vessels and thereby increase the risk for health disturbances like rise in blood pressure (hypertension) and heart ailments.
  • That’s why it’s extremely important for us to restrict our caffeine intake to the acceptable levels of our body.
  • Scientific evidence based on Food Standards Agency (2008) recommends 400mg of caffeine a day being perfectly safe for the general population.

Scientific evidence blaming caffeine as the main culprit for health risks associated with coffee intake404-434

  • Caffeine stimulates the release of stress hormones including adrenalin and cortisol. This may lead to palpitations, anxiety, insomnia, and even spikes in blood sugar and insulin. Caffeine has an acute unfavorable effect on arterial function.
  • Caffeine intake has been associated with several risk factors for coronary heart disease, including increased serum total cholesterol, increased blood pressure, and increased plasma total homocysteine levels.
  • A meta-analysis of 11 controlled clinical trials showed that a median dose of five cups per day of caffeinated coffee consumed for a median duration of 56 days increased the systolic and diastolic blood pressure by approximately 2.4 and 1.2 mm Hg.
  • A high intake of caffeinated coffee was associated with steeper age-related increases in systolic blood pressure and pulse pressure levels in elderly men who are overweight or obese.
  • Randomized controlled trials, which are mostly of short duration (1-12 weeks), have shown that caffeinated coffee intake around 5 cups per day causes a small elevation in BP (approximately 2/1 mmHg) when compared to abstinence or use of decaffeinated coffee.
  • There was a marked positive dose-response relation between caffeine intake and plasma homocysteine levels (a risk factor for cardiovascular disease).
  • Plasma homocysteine concentrations in coffee drinkers are up to 2-μmol/L higher than those in coffee abstainers.
  • Along with caffeine, the chlorogenic acid present in coffee might also be partly responsible for the higher plasma homocysteine concentrations of coffee drinkers.
  • The combination of cigarette smoking and high coffee intake was associated with particularly high plasma homocysteine concentrations.
  • Plasma glucose concentrations were significantly higher after consumption of caffeinated coffee compared to decaffeinated coffee.
  • Caffeine is an adenosine receptor antagonist and therefore can inhibit muscle glucose uptake, even in the presence of insulin.
  • Caffeine is also proven to reduce insulin sensitivity. The risk of developing clinical type 2 diabetes was 0.5 times higher in individuals who drank ≥ 7 cups (1659 mL) coffee/d than in those who drank ≤ 2 cups (474 mL) coffee/d.
Nutrients that preserve the health of blood vessels435-436

Exercise and heart health

Exercise- an overview
  • The balance between calorie/energy intake and energy expenditure is an important determining factor for health & wellness.
  • Exercise habits impact health by positively altering energy expenditure.
  • Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure.
  • Exercise is a type of physical activity that's planned and structured.
  • Regular exercise is one of the best ways to keep our body healthy. Only a few lifestyle choices have as large an impact on our health as physical activity. People who are physically active for about 7 hours a week have a 40 percent lower risk of dying early (due to lifestyle-related health disorders) than those who are active for less than 30 minutes a week.
  • About 3.2 million deaths annually can be attributed to insufficient physical activity.443
  • Women who take less than an hour a week of physical activity have 60% higher risk of developing CVD compared to women who do more than three hours a week activity439
  • Being physically active is important to prevent heart disease and stroke, the nation’s leading killers. The American Heart Association (AHA) recommends the following-
For overall cardiovascular health

at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). Thirty minutes a day, five times a week is an easy goal to remember. You will also experience benefits even if you divide your time into two or three segments of 10 to 15 minutes per day.

For lowering blood pressure & cholesterol

For people who would benefit from lowering their blood pressure or cholesterol, an average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week is the recommendation to lower the risk for heart attack and stroke.

For overall health betterment

Thirty minutes a day, five times a week or two/ three segments of 10 to 15 minutes per day.

Other health benefits of exercise...
  • To maintain your weight- Work your way up to 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent mix of the two each week. Strong scientific evidence shows that physical activity can help you maintain your weight over time. And this is important because overweight & obesity are top-ranked, modifiable risk factors for heart disease.
  • To prevent type 2 diabetes & metabolic syndrome- Regular physical activity can reduce your risk of developing type 2 diabetes and metabolic syndrome. Metabolic syndrome is a condition in which you have some combination of too much fat around the waist, high blood pressure, low HDL cholesterol, high triglycerides, or high blood sugar. Research shows that lower rates of these conditions are seen with 120 to 150 minutes (2 hours to 2 hours and 30 minutes) a week of at least moderate-intensity aerobic activity. And the more physical activity you do, the lower your risk will be.
  • Hip fracture is a serious health condition that can have life-changing negative effects, especially in late adulthood. Scientific evidence shows that people who do 120 to 300 minutes of at least moderate-intensity aerobic activity each week have a lower risk of hip fracture.
  • Regular physical activity helps with arthritis and other conditions affecting the joints. For people with arthritis, 130 to 150 minutes (2 hours and 10 minutes to 2 hours and 30 minutes) a week of moderate-intensity, low-impact aerobic activity can improve their ability to manage pain and do everyday tasks, alongside improving their quality of life.
  • Improve Your Mental Health and Mood- Regular physical activity can help keep your thinking, learning, and judgment skills sharp as you age. It can also reduce your risk of depression and may help you sleep better. Research has shown that doing aerobic or a mix of aerobic and muscle-strengthening activities 3 to 5 times a week for 30 to 60 minutes can give you these mental health benefits.

Sleep well to keep your heart healthy467-467

Get in sync with body’s natural sleep-wake cycle and track a healthy beat!

When we say lifestyle changes, you mostly think of healthy eating and exercise, but what about the night sleep? Sleep is called the "third pillar" of health, in addition to diet and exercise as it plays a crucial role in metabolism.

  • Sleep is important for proper functioning of the body.
  • Studies have shown that 6-8 hours of sleep duration characterized with a sound & refreshing pattern (without frequent disturbances) is sufficient for best health benefits, and keeps you energized throughout the day as opposed to >8 hours sleep duration which can make you sedentary.
  • A few minutes meditation before bedtime usually helps in having a restful sleep.
  • Lack of sleep can lead to eye disorders, lack of concentration, digestive disorders and weight fluctuations.
  • Irregular sleep pattern causes an imbalance in the levels of hormones like epinephrine and norepinephrine which in turn raise triglyceride and reduce good cholesterol levels in the blood.
  • If you maintain a regular sleep schedule that is, going to bed and getting up at the same time every day, you can maintain normal blood cholesterol and triglyceride levels than if you sleep for the same duration yet at irregular timings.
Poor sleep is linked with risk factors for heart attack & stroke- Scientific evidence467-467
  • Not getting the right amount of sleep can compromise brain functioning and emotional wellbeing. In addition to this, inadequate sleep is a likely source of poor health and could also reflect an underlying health issue (for instance, early sign of premature heart disease)
  • Inadequate sleep is associated with several cardiovascular health problems such as elevated blood pressure and impaired glucose metabolism.
  • Researchers found that extreme sleep durations and poor quality of sleep were linked with elevated coronary artery calcium levels and arterial stiffness. Arterial stiffness or hardening of the arterial wall (probably due to calcium deposition) renders lack of flexibility in the vessel wall causing high blood pressure and making the heart work harder.
  • A study, published in the journal Arteriosclerosis, Thrombosis and Vascular Biology, revealed that, getting too much sleep, too little sleep or poor quality sleep was associated with raised levels of calcium in the coronary arteries and arterial stiffness.
    • A total of 47,309 young and middle-aged adults had their sleep duration and sleep quality assessed with a sleep questionnaire.
    • Each participant also underwent a health examination to measure coronary artery calcium and arterial stiffness, two subclinical measures of CVD.
    • The presence of calcium in the coronary arteries indicated the presence of early coronary lesions.
    • Researchers measured arterial stiffness by observing the speed of the pulse between the arteries of the upper arm and the ankle.
    • Inadequate sleep was linked to raised levels of coronary artery calcium. Participants who slept 5 or fewer hours a day had 50% more coronary artery calcium than those who reported sleeping 7 hours a day.
    • Likewise, participants who reported sleeping 9 or more hours a day had more than 70% more coronary artery calcium compared with those who slept 7 hours a day.
    • Participants reporting poor quality of sleep had over 20% more coronary artery calcium than those who reported good sleep quality.
  • Poor sleep quality and short sleep durations are linked to higher levels of inflammation, a known risk factor for heart disease & stroke.
  • High levels of inflammation could also be a route through which poor sleep quality increases the risk of heart disease and stroke.
  • In a study conducted by Morris et al (2010), 525 middle-aged participants of the META-Health study filled in the Pittsburgh Sleep Quality Index (PSQI) questionnaire.
    • Participants with poor sleep quality had significantly higher levels of fibrinogen, IL-6, and CRP than participants with good sleep quality.

Influence of smoking & alcohol consumption on heart health

Is cigarette smoke deleterious to your heart? Check out why470-480
  • Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars.
  • Casual smoking is the act of smoking only occasionally, usually in a social situation or to relievestress.
  • A smoking habit is a physical addiction to tobacco products. Manyhealth experts now regard habitual smoking as a psychological addiction, too, and one with serious health consequences.
  • Smoking is the primary cause of lung disorders, cardiovascular diseases, skin diseases and respiratory tract disorders, and is a well-recognized risk factor in cancer, hypertension and nervous weakness.
  • Tobacco accounts for around 6 million deaths every year (including from the effects of exposure to second-hand smoke), and is projected to increase to 8 million by 2030.
  • Nicotine and carbon-monoxide from cigarette smoke increase serum cholesterol levels by 3%, triglycerides by 9% and decrease HDL-C by 6%.470-471
  • By saying no to smoking, you can give yourself a tremendous advantage. Avoid social situations where smoking is likely to take place as second hand smoke is also harmful.
  • Scientific evidence confirms that smokers face significantly increased risks of death and or illness from numerous cancers, heart disease, stroke, atherosclerosis, abdominal aortic aneurysm, emphysema and other respiratory diseases. Quitting at any age has health benefits, with the largest reduction in health risks in those who quit at the earliest.
  • Most people are well aware of the harmful effects of smoking and make attempts to quit. If you are exploring ways to get rid of this habit, the following steps will help-
    • Mentally resolve to quit and avoid social situations which increase your likelihood for smoking.
    • Take small steps- cut down gradually from your current levels of smoking.
    • Alternate cigarettes with nicotine free gums, tablets and inhalers that are available upon prescription."
  • It is noteworthy that cigarette smoke is a scientifically proven risk factor for sudden cardiac death.
    • According to the American Heart Association, even light-to-moderate cigarette smoking is associated with a significant increase in the risk of sudden cardiac death.
    • The risk of sudden cardiac death rose 8 percent for each five years of smoking. However, within 15-20 years of smoking cessation the risk of sudden cardiac death drops to that of a nonsmoker.
    • The above inferences are from the Nurses’ Health study wherein the association between cigarette smoking and smoking cessation on the risk of SCD was studied in 101,018 women.473-474
  • Secondhand Smoke
    • Secondhand smoke causes approximately 33,950 deaths from heart disease each year, and is a definitive cause of stroke478
    • There is no risk-free level of exposure to secondhand smoke and even short-term exposure potentially can increase the risk of heart attacks.
Alcohol consumption & heart health481-486
  • Over centuries, alcohol has become one of the most socially accepted drugs worldwide.
  • Alcoholic beverages have long been known for their rather important role in social gatherings.
  • Drinking alcoholic beverages is a common feature of social gatherings, yet alcohol overconsumption can undoubtedly lead to adverse reactions from the body, predisposing an individual to health disturbances.
  • In 2012, about 3.3 million deaths, or 5.9 % of all global deaths, were attributable to alcohol consumption.
  • The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.
  • Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability- adjusted life years (DALYs).
  • Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25 % of the total deaths are alcohol-attributable.
  • Alcohol is a well-recognized risk factor in cardiovascular, liver and kidney disorders. By saying no to alcohol, you can give yourself a healthy head-start in the journey towards a hale & heart healthy life.
  • The upper level for alcohol intake is not more than 1 unit in a day.

Stress, stresses your heart!487-508

Unlike Stone Age, the present era is a ‘stress age’ how does stress impact heart health? Find out

  • A healthy body and a sound mind go hand in hand for wellbeing. But the modern life is sedentary and stressful.
  • Stress is an important factor in determining the onset and progression of various diseases (including obesity, type 2 diabetes, high blood pressure & heart disease).
  • Stress can cause an undesirable increase in the bad cholesterol, especially LDL levels.
  • People who are easily disturbed by environmental stress are highly predisposed to CHD due to increased sympathetic nervous system activity which increases heart rate, blood pressure and leads to endothelial (blood vessel) injury and platelet aggregation.
  • Stress causes an increase in the secretion of angiotensin which is a blood vessel constrictor and increases blood pressure.
  • All these lead to a rise in serum cholesterol level as well as blood pressure, which ultimately result in an increase in fat deposition in arteries, thereby increasing the incidence of myocardial infarction and stroke.
  • By keeping stress levels under control you can give yourself a healthy & relaxing start.
  • Have suitable coping strategies including exercise, meditation, relaxation techniques, breathing exercises & spending time on your favourites/hobbies to manage this health risk.
  • Apart from having numerous health benefits, exercise has shown to relieve stress .
  • Laughter is an ever ready destressor. It is the best medicine which can reduce the activity of stress hormones. So keep your stress at bay in a healthy way! Relax and Laugh away at your bad cholesterol!