Although it is on the decline, heart disease is still the number one cause of death in the UK, especially in men. Over the past year, I have conducted in-depth face to face interviews with three internationally renowned heart experts; Cardiologist Dr Aseem Malhotra, author Dr Malcolm Kendrick and Ivor Cummins.
From listening to their independent and impartial views, I can honestly say that neither cholesterol (unless you suffer from familial hypercholesterolaemia) nor the consumption of saturated fat, play any significant role in heart disease. Now I know that flies in the face of current thinking, thinking that is very convenient for both the multi-billion statin and sugar industries, but infuriatingly that’s just the truth.
Dr Malcolm Kendrick
Throughout history, there have been huge spikes in the rate of death, particularly for men, from heart attacks, linked to social upheaval. There have been many examples where gigantic social upheaval is followed by enormous rates of heart disease. In Scotland, when I was doing medicine, Scotland had the highest rate of heart disease in the world. What happened in the late 1950s and into the 60s, was that half a million people were moved out of Glasgow and deposited in new towns, and the rate of heart disease went through the roof. Then in the 1960s, Finland had the highest rate of heart disease in the world, when in percentage terms it had the largest forced migration of people the world had ever seen. More recently, if you looked around the world and said which countries had the highest rates of heart disease, then many of the top countries are the previous states of the Soviet Union. And then if you say which countries are currently developing a rate of heart disease that is going up and up, it is those countries that are rapidly becoming more modernised such as China and India, where sadly the rate of heart diseases is already exploding. Quite simply, if you take populations and subject them to an enormous degree of stress, heart disease rates go up.
Dr Aseem Malhotra
What are the top five things we can do to avoid having a heart attack? When it comes to food, cut out the ultra-processed food. How do you define ultra-processed? The thing I tell my patients is that if it comes out of a packet and it has five or more ingredients, best avoid it, it’s an occasional treat. The reason I mention it is that 50% of our diet in the UK is now ultra- processed, microwaved stuff, stuff out of a packet.
Instead eat whole foods, vegetables, oily fish, olive oil, and a handful of nuts every day. Don’t fear fat in the sense of full-fat dairy, cheese, yoghurt and all that kind of stuff. These are the things that should be the base; these are good nutrition. Avoid and cut out refined sugars and refined carbohydrates, and the rest doesn’t matter. So, if you get the diet right, you are most of the way there.
Next things, avoid stress. While stress is subjective, if you feel stressed, then you are stressed. Are you getting seven hours of sleep at night? If not, why not? Do something about it! I like meditation, and there is an app I use called Calm. I try and do 20 to 30 minutes every morning. There is good evidence it is anti-inflammatory, it reduces cortisol, stress responses and all of the things that contribute to insulin resistance and inflammation. It is very powerful. I see it with my patients, some of them heart attack patients who transform their lives. They say for them it gives a sense of wellbeing and happiness. So it is also about feeling good.
Get out in the sunshine and then look at your social life. We find when you have a good sense of community, it helps protect against all the other things we have already discussed. I also talk in my book The Pioppi Diet, that it helps to have an intimate relationship. For example, we know that middle-aged men who have sex with their partners twice a week, rather than once a month, are 50% less likely to get heart disease. And it isn’t about being promiscuous or anything; it’s something that reflects a strong relationship with someone who is close to you.
Dr Malcolm Kendrick
Nitric oxide is the single biggest protective substance in heart disease. It sits inside the glycocalyx, which lines the inside of the endothelium (the internal lining our arteries). In Alfred Nobel’s (founder of the Nobel Prize) factory, where he invented and manufactured dynamite (which uses nitro-glycerine) they noticed how many of his workers suffering from angina, which is caused by the narrowing of the arteries and reduced blood supply (it’s like cramp in your heart), their angina went away. The nitro-glycerine was converted to nitric oxide in the glycocalyx, which relaxes and expands the arteries. And also, nitric oxide is the single most powerful anticoagulant (helps to prevent blood clots) agent known to nature. Anything that boosts nitric oxide is good for cardiovascular health. Interestingly, Viagra does that. In fact, initially, it was developed as a heart drug for angina. Sunshine is one of the very best ways to generate nitric oxide. Exercise increases nitric oxide. L-citrulline and L-arginine increase nitric oxide synthesis, L-arginine is found in meats. Also, beetroot, garlic, dark chocolate, nuts and seeds, spinach, kale, cabbage etc, are packed with nitrates, which are converted into nitric oxide in the body.
Smoking, pollution and lead are three of the worst causes for reducing amounts of nitric oxide in the arteries.
Another thing that can damage the glycocalyx is a raised blood sugar level. People suffering from Diabetes, let’s imagine if say the glycocalyx was three feet thick, then if you have high blood sugar levels its now one foot thick. And in fact, spikes of blood sugar really tear it off. Raised insulin levels also damage it too.
My tips to reduce the risk of heart disease:
Avoid stress (causes narrowing of arteries and increased blood pressure)
Exercise (creates nitric oxide)
Sunshine (creates nitric oxide and reduces blood pressure)
Eat food rich in nitrates (creates nitric oxide)
Meditation, mindfulness etc
Reduce sugar and carb intake
Avoid fake foods
Heart disease is an inflammatory problem. Hyperinsulinemia and insulin resistance, high blood glucose and spikes in your blood glucose after a meal, are the top problem in the world driving heart disease. It’s not the whole cause. A huge amount of cardiac disease victims, from ages 18 to 80 in recent studies in Europe, across 25 countries, over 70% were essentially diabetic when they looked closely. So, problems with blood glucose, high insulin, high blood glucose and glucose spikes, is the big heavy hitter. There are other things, such as nutrient deficiencies like magnesium, which is a very important nutrient. It’s believed that about 70 to 80% of modern western humans, due to depletion in the soil and the foods we are eating, are kind of magnesium insufficient. Magnesium participates in around 300 functions in the body; it regulates blood pressure and countless other things that relate to vascular health. So, I would say low magnesium is another one to really watch out for.
Excessive refined carbs, excessive sugars and I would say excessive seed oils and vegetable oils, poly-unsaturated industrial products, which are in all the processed foods, that triad I would say is the big food problem. And this triad, of course, matches all of the processed and ultra-processed foods, where they use the sugar, refined carbs and seed oils for palatability, extended shelf-life and because they are dirt cheap to produce. And that’s where the industry has pushed us over recent decades, into the worst three food types we can eat, because that’s where all the profit is.
Eat only natural, wholesome food, eaten in a mixed diet - perfect. But eating processed foods, where the ratios have gone horribly wrong, and all the damage to the molecules and everything else like refined carbs and sugars, you are entering into the synergy which has really driven chronic disease over the past 100 years. You kind of have a fork in the road. Am I going all real food? Whether you do vegetarian with supplements, and that’s your choice, or whether you do really heavy meat-eating, either of those are going to separate you from the people who are eating lots of processed food. Choosing real food over processed food is the single big thing that you have got to do. And it’s the fact that the three main ingredients of processed foods, refined carbs, sugars and seed oils (which includes vegetable oil) are the three worst things you can eat.
Deborah Colson MSc
What foods are good for a healthy heart? Foods that are important for a healthy heart? I would say the omega 3 fatty acids are very good and as they increase the good HDL cholesterol. Magnesium and taurine are very important for a healthy heart. If you actually look to find where taurine exists in food, it’s in the hearts of animals. So it’s no surprise that it’s also important for the proper function of our own heart. Magnesium is really important for the normal rhythm of the heart. Vitamin E is very important as an antioxidant. Also, you need to look at levels of homocysteine which requires certain B vitamins to keep it under control. Some people have a naturally low homocysteine, but for people who have a higher homocysteine, then they require B vitamins to bring it down. It’s probably a more important factor for heart health than the ‘cholesterol’ story.