The leading cause of death in the United States, and the rest of the world, is heart disease (1). While there is some genetic risk for developing heart disease, much of the risk is due to lifestyle, which means you can actively manage a lot of your risk for heart disease.
Almost 80 years of nutrition research has been conducted, and as a result, we have developed a pretty good idea of what impacts heart disease. Your diet is one of the lifestyle factors that heavily influence your risk of developing heart disease. Despite the random things that may appear on social media or tabloids, there are not foods that immediately cause heart disease or foods that prevent it. Instead, there are key concepts to understand.
Here are four principles you can use to construct a heart-healthy diet.
Managing Energy Balance
Obesity is one of the most significant risk factors for heart disease. Individuals who are obese have twice the risk of heart failure compared to individuals who are not overweight (2). As such, one of the most effective ways to improve heart health is to maintain healthy body weight.
Maintaining healthy body weight, or losing weight, can be achieved through a variety of diets, as long as they either promote energy balance over the long term and/or lead to weight loss in the short-term. Decades of nutrition research has taught us that there are a wide variety of diets that can be used to lose weight or gain weight. Low-carb diets, high-carb diets, vegan diets, high-fat diets, and calorie counting diets can all lead to weight loss (3). Adhering to a diet over the long term and maintaining energy balance is one of the most effective ways to increase and/or maintain heart health.
Constructing a diet around weight loss or weight maintenance begins with either having a calorie deficit (for weight loss) or maintaining a calorie balance (for weight maintenance). There are several ways to figure out how to achieve a calorie deficit or weight maintenance, but one of the easiest ways is to use a calorie calculator like the NASM EDGE App or the NIH Body Weight Planner. You can use these tools to help you determine your calorie needs at every stage of your life.
Mind Your Fruits and Veggies
Interestingly, one of the most consistent findings in all of nutrition science is that the more fruits and veggies you consume, the lower your risk of heart disease. In a meta-analysis examining 1.5 million people, those who consumed the most fruits and vegetables per day had ~15% less likelihood of developing heart disease than the people who consumed the lower amount of fruits and vegetables (4). The amount of fruits and vegetables that were associated with the lowest risk of heart disease was 800 grams per day. This equates to ~4-5 servings of fruits and vegetables per day.
Know Thy Fats
The role of dietary fat in heart disease has been studied in great detail since the 1940s. There has been much debate and discussion around this topic; there are some key concepts we can take away from the decades of research.
First, we know that trans fats are associated with an increased risk of heart disease, and careful scientific studies have also shown that trans fats can cause heart disease (5,6). In one study, a 2% increase in total calories from trans fat increased the risk of having a major cardiac event by 62% (7). So limiting or reducing trans fats in your diet is an excellent way to reduce the risk of developing heart disease.
Second, we know that saturated fats and polyunsaturated fats play a role in heart disease, but they have very different effects. Most of what we know here is that if you replace saturated fats with polyunsaturated fats, you can reduce the risk of heart disease very slightly. However, saturated fat consumption alone doesn't appear to be a significant issue. The advice here is to be mindful of how much saturated fat you are consuming and try and keep it roughly close to the American Heart Association guidelines (8).
Watch Your Salt Intake… Maybe.
For decades there has been a lot of discussion about the role of salt, specifically sodium, on blood pressure and heart disease. There is a lot of debate around this topic, but here is what we know based on the most up-to-date scientific evidence. Sodium can alter blood pressure, but the body appears to be able to handle sodium well and without much risk for heart disease if you have normal blood pressure. However, if you have hypertension (elevated blood pressure), then you do benefit from lowering salt intake. If you have hypertension, reducing sodium intake to ~1200mg can reduce your risk of developing heart disease quite substantially.
Constructing a heart-healthy diet comes down to four major principles:
1) maintaining healthy body weight through balancing calorie intake and calorie expenditure
2) consume an adequate amount of fruits and vegetables (4-5 servings per day)
3) limit trans fats and keep saturated fat intake near the American Heart Association Guidelines
4) if you have high blood pressure, keep sodium (i.e., salt) intake at modest levels