The Heart of the Matter: A Guide to Heart-Healthy Nutrition

Maintaining a healthy heart starts with the food we eat. Common staples in the American diet include lots of salt and foods high in saturated fat, making it difficult to maintain a heart-healthy diet. However, with some additional knowledge and intentional eating strategies, we can take easy steps to prevent the risk of cardiovascular diseases.

Sodium
Sodium, consumed as salt, is naturally found in many foods and is an important electrolyte for our bodies to function. While we need some sodium, excess sodium intake can lead to high blood pressure and greater cardiovascular disease risk. Excess sodium intake is extremely common for Americans, with the average intake being 3393 mg per day. In comparison, the recommended amount is no more than 2300 mg according to the Dietary Guidelines for Americans (DGA). There are several ways to habitually lower our sodium intake, such as:

• Reduce the salt added to food while cooking; taste at the end and adjust.
• Explore new spices and herbs when seasoning home-cooked meals. 
• Create homemade spice blends, dressings, and sauces.
• Be mindful when eating away from home. Most restaurants serve high-sodium foods; bring this up to your server and see if low-sodium options are available.
• Implement a DASH diet (Dietary Approach to Stop Hypertension), a diet meant for those wanting to prevent or manage hypertension. Visit this page by the National Institutes of Health for more information on the DASH diet.
• Grocery shop for low-sodium foods​

When grocery shopping for foods, we can be mindful of sodium intake by reading labels. One useful technique is observing the calorie-to-sodium content ratio. Generally, a 1:1 ratio is ideal (e.g.100 calories:100 mg sodium per serving). An even better ratio is if the calories are higher than the sodium (e.g.100 calories:75 mg sodium per serving). By taking this approach, we can decrease our daily sodium intake from the groceries we buy. Here is a list of common groceries that are low in sodium:

• Fruits and vegetables (fresh or frozen)
• Fresh raw meat
• Whole grains
• Unsalted nuts and seeds
• Oats
• Rice

Here is a list of typical groceries that may be high in sodium:

• Canned foods
• Deli meats and cheeses
• Frozen dinners
• Frozen pizza
• Packaged snack foods

Cholesterol
Cholesterol is a sterol ester lipid; a waxy, fat-like substance formed in our liver as well as absorbed from some of the foods we eat. While cholesterol gets a bad rap, our bodies need it to function properly. They serve us in many ways, such as hormone creation, cell formation, vitamin D production, and bile production in our gallbladders. However, cholesterol is a non-essential nutrient, meaning that we do not need cholesterol from food since we create enough internally to serve all the functions described above.
While we need cholesterol, too much of it, along with high serum fat (circulating excess fat in our bloodstream), can increase plaque buildup in our arteries, leading to cardiovascular diseases such as heart attacks or strokes.
Cholesterol can be separated into two categories: HDL (high-density lipoprotein) and LDL (low-density lipoprotein):

• HDL: This is generally seen as the “good” cholesterol. Its primary role is to clear free cholesterol from our cells and other places in our bodies and transport it to our liver to be excreted, essentially clearing our arteries of excess plaque buildup.
• LDL: This is generally seen as the “bad” cholesterol. LDLs are a major carrier and depositor of cholesterol to cells, causing plaque formation within our arteries.

Dietary fat: Unsaturated Fat
Our dietary fat influences our total HDL and LDL, the two cholesterol categories affecting heart health. There are three types of fats we consume: unsaturated fat, saturated fat, and trans fat.

• Unsaturated fat: considered the heart-healthy fats. However, not all these fats are the same. These can be classified into two categories: polyunsaturated fat (PUFA) and monounsaturated fat (MUFA); PUFAs are liquid at room and cold temperatures, whereas MUFAs are liquid at room temperature but solid at cold temperatures. These similarly affect cholesterol, as they help raise HDL and lower LDL.
  • Sources of Monounsaturated fats
    • Olive oil
    • Avocado
    • Sesame seeds
    • Almonds and almond butter
    • Peanuts and peanut butter
• Polyunsaturated fats can be broken down into several categories, including omega-6 and omega-3 fats. We tend to consume enough omega-6s in our diet but often fall short in omega-3s. Omega-3 fatty acids are crucial for heart health as they can reduce the risk of sudden cardiac death and have anti-inflammatory properties, while also stabilizing artery plaque. Being intentional about the foods we eat can address the common imbalance of fats within our diet. EPA and DHA, specific types of omega-3s, contribute to brain health by supporting brain cells and nerve coating. On the other hand, ALA, another type of omega-3, aids in lowering serum fat levels.
  • Sourced of ALA:
    •  Ground flaxseed
    • Pumpkin and chia seeds
    • Walnuts
    • Soybean and canola oil

• Sources of EPA and DHA:
  • Salmon
  • Tuna
  • Sardines
  • Anchovies

Dietary fat: Saturated and Trans Fat

• Saturated fat: commonly consumed in the American diet, typically found in animal protein sources. These are solid at room temperature. Saturated fats tend to raise both HDL and LDL. We should strive to limit our intake of these fats, such as:
  •  Chicken with skin
  •  Beef
  • Pork
  • Butter
  • Cheese
  • Coconut and palm oil
• Trans fat: Trans fat, or partially hydrogenated oils (PHOs), are chemically modified versions of unsaturated fat used to make sweets and commercial baked goods to increase their shelf life and cost efficiency. However, this fat has negative effects on our bodies. They tend to lower HDL and raise LDL, greatly raising the risk of cardiovascular diseases. Because of this, the FDA has determined that they are no longer Generally Recognized as Safe (GRAS) and have been banned in the U.S. since 2020.

Fiber
Fiber is the indigestible portion of plant foods that feeds our healthy gut bacteria and regulates our digestive system. Fiber has been shown to have many beneficial effects on heart health, including lowering cholesterol and controlling blood sugar. Soluble fiber (found in oats, chia seeds, insides of fruits, etc.) can also interfere with cholesterol absorption. To enjoy the benefits from fiber, include plenty of fruits, vegetables & whole grains in your diet.

In conclusion, prioritizing heart-healthy nutrition is essential for overall well-being. By understanding the impact of sodium, cholesterol (LDL and HDL), different fat types, and the importance of fiber, we empower ourselves to make informed dietary choices. Small changes can lead to significant improvements in heart health. Let's embrace these nutritional principles and take proactive steps towards a healthier heart and life.

Daniel Chambers, SPU Dietetic Intern

References

1. Dietary Guidelines for Americans, 2020-2025 and Online Materials | Dietary Guidelines for Americans. Accessed February 2, 2024. https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials
2. DASH Eating Plan | NHLBI, NIH. Published January 4, 2021. Accessed February 2, 2024. https://www.nhlbi.nih.gov/education/dash-eating-plan
3. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. www.heart.org. Accessed February 2, 2024. https://www.heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides
4. Attia P. Measuring cardiovascular disease risk and the importance of apoB. Peter Attia. Published December 22, 2019. Accessed February 2, 2024. https://peterattiamd.com/measuring-cardiovascular-disease-risk-and-the-importance-of-apob-part-1/

Nutrition C for FS and A. FDA Completes Final Administrative Actions on Partially Hydrogenated Oils in Foods. FDA. Published online December 13, 2023. Accessed February 2, 2024. https://www.fda.gov/food/cfsan-constituent-updates/fda-completes-final-administrative-actions-partially-hydrogenated-oils-foods