Heart Healthy Diet Guidelines: What is the Best Heart Healthy Diet?

“Whenever people talk about what’s healthy for your heart, they tell you what you shouldn’t be eating,” sighed a middle-aged woman with a family history of heart disease. “I wish someone would tell me what I should eat.”

It’s true that eating for a healthy heart has usually been presented in terms of what to avoid. However, as research turns more towards uncovering the positive benefits of various foods, it’s becoming clear that increasing your intake of certain items can make a genuine contribution to your cardiovascular health. For instance, one of the most consistent conclusions of dietary studies through the years has been that people who eat large amounts of fruits and vegetables have lower rates of heart disease, stroke, and certain types of cancer. Recent studies have shown that such a diet reduces the risk of heart disease by 20 to 40 percent. A diet made up largely of fruits, vegetables, grains, and nuts succeeded in reversing heart disease in one recent five-year trial. And lately we’ve begun to learn about the benefits of less obvious choices such as garlic, vegetable oil, and even wine.

Indeed, the weight of evidence has grown so great that the American Academy of Family Physicians now formally recommends addition of the following to everybody’s diet in order to fend off heart disease:

Five to seven servings of vegetables and fruit every day
Soy products and legumes every day
Oils with monounsaturated and omega-3 fatty acids (for example, canola and olive oils)
Garlic, on a regular basis
Soluble fiber

The fact is, a heart-healthy diet doesn’t have to be boring. For most of us, it does mean cutting back on the animal fat and cholesterol that can lead to clogged arteries (see “What to Do About Fat.”). But it can also mean adding an exciting array of delicious new recipes to your weekly menu—with fish, vegetables, and seasonings that you might otherwise have missed. The secret is in knowing what to add; and on that score, the experts now have plenty to tell us.

 

Heart-healthy Foods to Focus On

Add more of these foods to your everyday diet for a healthier heart—and extra variety, too.

Beans Green leafy vegetables
Bran Orange vegetables
Citrus fruits Oatmeal
Garlic Potatoes

Fish

Anchovies Salmon
Bluefish Sardines
Herring Tuna
Mackerel Whitefish

 

Some Clues from the Mediterranean

In the 1950s, scientists began studying the diet and health of almost 13,000 men in seven countries: Greece, Italy, Finland, Japan, the Netherlands, Yugoslavia, and the United States. The result of their 15-year investigation was the Seven Countries Study. One of the most notable findings of this study was the remarkably low rate of heart disease among people living on the island of Crete in the Mediterranean Sea off the coast of Greece. Only 4 percent of the deaths of middle-aged men in Crete were from heart disease, compared to 46 percent of the deaths of their counterparts in the United States.

These statistics sent scientists hunting for explanations. One of the factors scrutinized most closely was what the men were eating, and what the scientists found was a diet very different from that of most Americans. It featured large amounts of vegetables, fruits, grains, and fish. Olive oil was used extensively in food preparation and as an accompaniment to some foods; garlic was often used for seasoning; wine was frequently drunk with meals; meat rarely appeared.

The benefits of this diet probably come from a combination of factors. Omega-3 fatty acids found in some fish help prevent blood clots that can lead to heart attacks and strokes. Many studies have linked moderate wine drinking to increased levels of HDL, the cleansing “good” form of cholesterol that helps keep arteries clear. Fruits and grains are rich in vitamins called antioxidants that have been found to discourage clogged arteries and may have an anticlotting effect as well. Olive oil is one of several unsaturated fats that lower LDL, the “bad” cholesterol that leaves fatty deposits on the walls of arteries. Garlic has been shown to lower triglyceride (fatty acid) and total cholesterol levels, while leaving “good” HDL levels undisturbed.

With all these elements as the foundation of a diet, the healthy hearts of the people of Crete no longer seem such a mystery. Other things may also be involved, such as exercise and lifestyle, but subsequent studies testing this type of diet against others continue to show the same indisputable cardiovascular benefits. Indeed, the latest research has shown that the Mediterranean diet does in fact reduce the odds of a heart attack and other cardiac complications in people who have already had one attack. In one recent study, it reduced the risk of a recurrence by 50 to 70 percent, and slashed the risk of heart failure as well. Diets laden with fruits and vegetables and low in saturated fats have also been found to substantially lower blood pressure, further reducing the risk of cardiovascular disease.

You don’t have to adopt the cuisine of Crete to realize these benefits, either. Since we now know exactly which nutrients are responsible, you can choose among a variety of ways to add or increase them in your diet. Here’s a closer look at the items to focus on.

Antioxidants: A New Twist on Some Old Vitamins

Oxidation can be very harmful, as we know from reactions that occur outside our bodies. For example, when metal is exposed to oxygen the result is rust; when butter oxidizes it becomes rancid.

Oxidation also happens within the human body. The compounds that cause oxidation are called free radicals. These unstable molecules scavenge the body, combining with molecules from healthy cells. Oxygen is the most common of the free radicals. While these compounds do perform a number of useful functions, a surplus can damage cells. Some of the harm caused by free radicals is thought to lead to heart disease and cancer.

A number of factors such as cigarette smoke, excessive consumption of alcohol, polluted air, and radiation can promote excessive formation of free radicals. The body counters this process by producing antioxidants. These compounds combine with free radicals to keep the oxidation process in check.

Scientists have theorized that the antioxidants we eat serve the same role as internally manufactured antioxidants—they, too, may inactivate free radicals. Among the best dietary sources of antioxidants are vitamin C; vitamin E; vitamin A; and beta-carotene, a form of vitamin A found in plants. Each of these acts in a different way and seems to have its own protective role to play. While opinion is not unanimous, many experts are coming to believe that daily intake of these vitamins should be increased considerably to take full advantage of their antioxidant properties. However, there is no general agreement on what the best amount should be, and even the most beneficial vitamins can be toxic if the dose is too high.

Other antioxidants may also play a role in cardiovascular health. Selenium is an essential mineral that works as an antioxidant. Glutathione, which is found in plant and animal tissue, is thought to be one of the key players in the antioxidant protection process.

Flavinoids or isoflavones—natural components of all plants—are being studied for their antioxidant properties. Some researchers have theorized that they may be as effective as vitamins C and E in stabilizing free radicals. There are thousands of different flavinoids, and one research project has narrowed its examination to five that seem to have an antioxidant effect. A good source of flavinoids is kale, which also has high levels of vitamin C and beta-carotene. In a study of more than 800 elderly men in the Netherlands, higher flavinoid intake corresponded with lower rates of heart disease. Major sources of flavinoids in their diets were tea, onions, and apples.

Likewise, a recently concluded 10-year examination of nearly 35,000 postmenopausal women found that increased intake of flavinoids was associated with lower odds of death from coronary heart disease. (In this study, broccoli was the flavinoid-rich food shown to reduce risk.) Flavinoids may also be responsible for the cholesterol-lowering benefits of soy. Some researchers are now testing soy products as an alternative to hormone replacement therapy for postmenopausal women who want to fend off heart disease without taking estrogen.

The isoflavones in soy products are, in fact, called plant estrogens or phytoestrogens because of their estrogen-like activity. They are being studied alone and in combination with estrogen replacement, since the substances may enhance each other. Large amounts of phytoestrogens, particularly from soy products, have been shown in some studies to reduce women’s risk of heart disease. And other investigations into the properties of phytoestrogens are showing how these substances work to clear artery-clogging buildups.

The mounting evidence for the benefits of soy has been sufficient to prompt the FDA into allowing manufacturers of certain soy products to label their products as “heart-healthy.” The American Heart Association also identifies soy as part of a heart-healthy diet. Specifically, soy has been shown to lower levels of LDL, the component of cholesterol that causes plaque buildup in the arteries. The isoflavones in soy also seem to block the action of substances called C-reactive proteins. These proteins are associated with inflammation within blood vessels, a condition that many researchers now believe contributes to coronary heart disease.

Vitamins and Minerals That Help Your Heart

Along with their antioxidant properties, Vitamins C and E and beta-carotene have been associated with a wide range of other protective characteristics. Other vitamins and minerals, such as the B vitamins and potassium, also appear to help maintain a healthy heart. All of these nutrients are readily available in heart-healthy amounts from a wide array of common foods.

Vitamin C

Nearly 50 years of research have linked vitamin C to positive health benefits. Much attention has been given to the role of vitamin C in staving off colds and other infections. However, some studies now suggest cardiovascular benefits as well: Researchers have found that heart disease patients tend to be deficient in vitamin C, while patients taking vitamin C supplements are less likely to develop clogged arteries.

Vitamin C is also important for the production of collagen, the fiber that reinforces blood vessel walls and other parts of the body. If the body perceives a shortage of vitamin C, it compensates by producing a form of LDL to repair blood vessels that have been weakened by the vitamin shortage. This can lead to high LDL counts, which we know are linked to clogging of the arteries.

Vitamin C is considered a first line of antioxidant defense. Vitamin C molecules, which are water soluble, scavenge free radicals before they can enter cells and begin their damage.

Vitamin C can be found in a variety of foods, particularly citrus fruits, green vegetables such as broccoli and kale, and potatoes. A diet that includes the minimum daily recommendation of five servings of fruits and vegetables probably includes enough vitamin C to realize its benefits to the heart.

Vitamin E

Several studies of people taking large doses of vitamin E have linked it with reduced rates of heart disease. Harvard Medical School’s Nurses Health Study, which tracked 87,000 women for up to eight years, found that women who took vitamin E supplements for over two years had 41 percent fewer heart attacks than women who did not. Another study of 39,000 men found that those who took at least 100 International Units (IUs) a day of vitamin E (more than three times the current RDA of 30 IUs) for at least two years, had 37 percent fewer heart attacks and bypass surgery procedures than men who got vitamin E only from their diets.

Vitamin E is fat-soluble. It is carried in LDL, and does most of its work within the cell. It has been shown to have a potent antioxidant effect, and has been linked to reduced plaque buildup in coronary arteries. It has also demonstrated its ability to reduce the stickiness of blood platelets, which may help prevent blood clots from forming. However, some scientists caution that finding a reduced rate of heart disease among people who take large doses of vitamin E doesn’t prove the vitamin is the cause. And in fact, some studies have shown no protective effect, even among people at high risk of the disease. So before changing your diet, you might want to wait for more research.

If you do want to increase your vitamin E intake, good dietary sources include vegetable oils, nuts, wheat germ, egg yolks, margarine, tuna fish, oatmeal, and a few vegetables such as asparagus and turnip greens. However, most vegetables are not a major source of vitamin E. In fact, it is very difficult to get from food alone the 100-plus IUs of vitamin E thought to be beneficial for the heart. This is particularly true in a low-fat, low- cholesterol diet, which is not likely to include large amounts of eggs and seed oils (such as sunflower or sesame-seed), the best sources for vitamin E. Vitamin supplements can provide the difference, and are increasingly recommended for their cardiovascular benefits. There have, however, been some negative effects associated with supplemental doses of vitamin E (for example, acceleration of an hereditary eye disease called retinitis pigmentosa was seen in one study, and increased rates of stroke and lung cancer were seen in another). So if you’re thinking about adding a vitamin E supplement to your diet, it would be wise to talk to your doctor first about risks, benefits, and your optimal dosage.

Beta-carotene

Beta-carotene is a substance found in plants that is converted to vitamin A by the liver. Some studies have shown that beta-carotene provides benefits of its own, aside from its role as vitamin A. Scientists are investigating its effects not only on heart disease but also on cancer, cataracts, and various aspects of aging. Studies have found reduced rates of heart disease in groups with high dietary beta-carotene intake and in groups taking beta-carotene supplements. For example, a six-year study of 300 male physicians showed that those taking beta-carotene supplements had 50 percent fewer strokes, heart attacks, cardiac deaths, and angioplasties, compared with those taking dummy pills instead. Another study found reduced risk of angina—the chest pain that signals heart problems—in people taking beta-carotene and related nutrients. However, other studies have failed to show any benefits of beta-carotene supplementation, and experts are divided about just what the effects may be.

Beta-carotene—which is a form of an orange pigment called carotenoid—is found in large amounts in orange vegetables and fruits, such as carrots, sweet potatoes, butternut squash, pumpkin, cantaloupe, and papaya. It is also present in dark green, leafy vegetables like kale, spinach, collard greens, and leaf lettuces. If you include generous portions of these vegetables in your diet, you are probably getting the amount of beta-carotene that you need to help keep your heart healthy.

B Vitamins

Several recent studies have found that increased levels of heart disease are associated with high blood levels of a chemical called homocysteine, and with each passing year the evidence of this link grows stronger. One study of 15,000 men over a 13-year period found that those with the highest levels of homocysteine were three times more likely to get heart attacks than those with lower levels.

The B vitamins, particularly B6, B12, and folate (also called folic acid), act on this chemical to keep it from accumulating in the blood. A 14-year study of more than 80,000 women determined that those with the highest levels of folate and vitamin B6 had half the risk of coronary heart disease faced by women with the lowest levels. The researchers concluded that, for every 200 micrograms of folate ingested daily, heart disease risk fell by 11 percent, and that each 2-milligram increase in daily consumption of vitamin B6 yielded a 17-percent reduction in risk. Unfortunately, nutritional surveys show that Americans typically have diets low in B6 and folate; and many people have difficulty absorbing B12, especially as they get older.

The richest sources of B vitamins are liver and kidney. However, these are not recommended in a low-fat, low-cholesterol diet. B vitamins are also found in a number of fruits, vegetables, and grains. Folate—which is also important in the diet of women of child-bearing age because it helps prevent congenital defects such as spina bifida—is found in dark green leafy vegetables, citrus fruits and juices, dried beans, nuts, oatmeal, wheat germ, and brewer’s yeast. Some cereals are fortified with folate (usually listed in the ingredients as folic acid), and many scientists advocate even wider use of supplementation, including the fortification of kitchen staples such as flour. Some studies now implicate elevated homocysteine as the actual cause (rather than merely a marker) of heart disease and suggest that folic acid supplementation in sufficient doses could cut the rate of heart disease by as much as 40 percent.

Vitamin supplements are another way to get adequate amounts of B vitamins in your diet. In particular taking B12 in pill form may be a way to get around any absorption problems that you may have.

Potassium

Potassium-rich foods have been found to help your heart and cardiovascular system by lowering blood pressure. This can be an important factor in reducing the risk of strokes, and is discussed in detail “The Dietary Approach to High Blood Pressure.” Potassium is thought to promote heart health in other ways as well. It works as an antioxidant, inhibiting the formation of free radicals. And in animal studies, it has been found to hinder the formation of blood clots.

Good dietary sources of potassium include bananas, beans, potatoes, grapefruit, peppers, squash, grapes, and apples. Most high-potassium foods have the added benefit of being high in fiber and low in sodium and fat.

The Virtues of Garlic

Healing, strengthening, and preventive powers have been attributed to garlic through the ages. Garlic, ancient historians reported, was an important food in the diet of the Egyptian pyramid builders. Greek athletes ate garlic before their competitions. French priests chewed garlic to ward off the bubonic plague, and European soldiers of later generations ate it and rubbed it into their wounds to prevent battlefield infections. And, of course, the most enduring lore about the effectiveness of garlic concerns its ability to protect against vampires.

Studies on vampires are still pretty inconclusive, but garlic has convincingly proved its worth in a number of areas where scientific study can yield measurable results. In laboratory testing, it has destroyed a wide range of organisms that cause human disease: bacteria, viruses, fungi, parasites, and protozoa. It has even been effective in destroying bacteria that have become resistant to antibiotics. Around the world, garlic supplements have become best-selling over-the-counter drugs.

As garlic has drawn increasing scientific attention, researchers have observed a number of benefits to the cardiovascular system. The chemicals in garlic seem to work in at least three ways to protect against heart disease: by lowering total cholesterol and raising HDL; by lowering blood pressure; and by making platelets less sticky, which can help prevent blood clots from forming. Both laboratory and human tests have shown positive results from garlic in a variety of forms: raw, cooked, concentrated in supplements, and in powders and oils. Onions, have been found to have similar beneficial effects.

A compound known as allicin is suspected to be the source of garlic’s benefits. However, it is only one of several active ingredients in garlic (and onion) and knowledge about the way these ingredients actually work on the cardiovascular system is still preliminary. Studies on garlic have not yet been large or long enough for researchers to make definitive recommendations about the amounts to include in your diet or what form is most beneficial. Allicin, which is released by cutting or crushing a clove of garlic, is destroyed by heat, suggesting that raw garlic may have more potent effects than cooked garlic.

The situation becomes more confusing when you look at the many forms of garlic supplements that are currently on the market. These garlic pills, powders, and capsules are not regulated, not always labeled for potency, and not standard in composition. The amount of allicin and other ingredients released by garlic powder tablets, for example, has been found to vary nearly 20-fold among different products. The chemical composition of fresh garlic also varies, depending on growing conditions and variety.

Garlic and garlic supplements probably pose little risk for most people and can be a health-promoting addition to your diet. However, because of garlic’s apparent blood-thinning properties, if you regularly take aspirin or another anticoagulant drug, you should consult your doctor before adding large amounts of garlic to your diet.

Garlic is a very pungent herb, and the side effect that people complain about most is bad breath. You may be able to avoid this with synthesized forms of garlic in pills or capsules, but reactions to these are not always predictable, since individual body chemistries react in different ways to the chemicals responsible for bad breath. In addition, these chemicals travel through the bloodstream after garlic is ingested, even if you take it in concentrated pill form, so this side effect is very difficult to avoid. (Even garlic rubbed on the skin is likely to eventually show up on your breath.) As you might expect, work is underway to develop a smell-free or less odoriferous form of garlic.

 

Blood Clots: The Greatest Danger To Your Heart

A buildup of cholesterol inside the arteries sets the stage for trouble; but it’s usually a blood clot that finishes off the job. If a clot develops or lodges inside an already fat-clogged coronary artery, the situation is especially grave. These arteries supply the heart muscle itself with oxygen rich blood. Denied this life-giving source of energy, the patch of heart muscle served by the artery quickly weakens and dies (note pale area in diagram).

Such a blockage is called a myocardial infarction. Clot-busting drugs such as Activase and Streptase are now used to reestablish blood flow to the heart muscle. But the best treatment is prevention, including a low-fat diet, blood-thinners like the omega-3 fish oils, and, if necessary, cholesterol-lowering drugs and blood thinners, like aspirin.

 

Foods That Fight Clots

One way in which heart-healthy foods can improve cardiovascular health is their blood-thinning effect, which can help prevent the formation of blood clots. Clotting is a crucial function of blood, necessary for healing cuts and scrapes. It is caused by tiny blood cells called platelets that stick together to begin building a clot. But when platelets become too sticky, clots may form within the bloodstream, preventing the flow of blood to the heart or brain, and leading to heart attacks and strokes. Many people take aspirin regularly for its blood-thinning properties, and there are some foods that may offer similar benefits. Both garlic and some of the antioxidant vitamins are thought to have some ability to make platelets less sticky.

There are other foods that have also been shown to have blood-thinning effects. In generations past, a popular tonic thought to cure many ills was cod-liver oil. It turns out that grandmother’s home remedy may actually have had a scientific basis. Research over the past 20 years has shown that omega-3 fatty acids—which are abundant in fish oils and fatty fish—may have important blood-thinning properties and work in other beneficial ways on the heart. These acids are thought to be one of the significant health-promoting elements of a Mediterranean-style diet.

Omega-3s (also called n-3 fatty acids) are a type of polyunsaturated fat found in large quantities in fatty fish like salmon, mackerel, sardines, herring, anchovies, whitefish, and bluefish. Other fish and shellfish also have fair amounts of omega-3s. Scientists became interested in these fish oils in the early 1970s when Danish scientists found that the Eskimos of Greenland had very low rates of heart disease despite their high-fat, high-cholesterol diets. When some of the subsequent research results proved contradictory, interest in fish oil waned. However, recent studies have done much to restore its reputation. One recent analysis found that as fish consumption goes up, mortality from heart attack, stroke, and other causes of death goes down.

Researchers are continuing to investigate the way omega-3s work. One analysis found that they are beneficial for people at high risk of coronary heart disease, but not for those at low risk. In another study, they seemed to help prevent second heart attacks. A third found that the omega-3s have anti-inflammatory effects, help reduce elevated triglyceride levels, and may prevent plaque buildup in arteries.

Other sources of omega-3 have also been identified. Linolenic acid is a fatty acid, found in some plants, that the body can convert to the omega-3 chemicals. This acid is present in linseed oil, walnuts and walnut oil, soybeans, spinach, and mustard greens. It is also found in rapeseed, which is used to make canola oil, an increasingly popular cooking ingredient.

While the exact mechanisms of omega-3 fatty acids are not yet completely understood, they are thought to displace another, less beneficial type of fatty acid called omega-6 for control of certain biochemical reactions in the body. Besides working as a blood-thinner, the omega-3s have been shown to reduce blood pressure, total cholesterol and LDL levels, and fatty acid (triglyceride) counts, while also working to keep the heartbeat regular. Studies have shown that they combat dangerous irregularities and can reduce the risk of sudden cardiac death.

Tests have shown that while taking fish oil supplements provides some of the cardiovascular benefits available from fish itself, eating the real thing seems to supply a broader range of protection. Similarly, recent trials of a dry fish powder laced with omega-3s failed to produce the beneficial effects of eating fresh fish.

Two or three servings of fish or shellfish a week is probably sufficient to supply beneficial amounts of omega-3 fatty acids. In fact, there are some indications that ingesting too much can be detrimental. Studies have found depressed immune functions and an increased risk of some types of stroke in people who eat fish more than once a day.

Most experts also advise against taking fish oil capsules, unless they are prescribed by your doctor. The capsules supply such concentrated forms of omega-3s that overdosing is possible. This can lead to excessive bleeding, undesirable interactions with other drugs, and other health problems. Diabetics, particularly, should consult with their doctors about the role of fish oil in their diet, because some studies have shown fewer benefits for them than for non-diabetics.

Through the years, there have been searches for other naturally-occurring food products that might bestow the blood- thinning benefits of fish oil. After all, aspirin, the most commonly used anticoagulant, comes from the bark of the willow tree. A form of Chinese mushroom called “tree ears” has been tested and found to have significant blood-thinning effects. However, since these are fairly rare in the U.S. not much further study has been done on them.

 

How Fiber Helps The Heart

Fiber, which passes through the digestive system, seems an unlikely candidate for helping the cardiovascular system. But, by removing the excess cholesterol from the body—and hence the blood—it does indeed help the heart. The key steps are shown here.

 

How Fiber Figures In

We’ve heard a lot about how important fiber is in our diets, particularly to prevent constipation and encourage regularity, and as protection against colon cancer. In recent years, fiber has also been promoted as a way of lowering cholesterol, thus helping prevent heart disease. A rush of excited publicity a few years ago about oat bran as a cholesterol-lowerer led to a flood of oat bran products on the supermarket shelves. The hype has settled and oat bran is now seen as just one of a number of fiber-rich foods that can promote heart health.

Now researchers are beginning to link high-fiber diets not only to lower cholesterol levels but also to an actual reduction in heart attacks and death from heart disease. In the Nurses’ Health Study, an ongoing long-term look at the health of more than 68,000 women, women who ate the most dietary fiber enjoyed a 50-percent lower risk of death from heart disease than those who ate the least. Cereal fiber, in particular, reduced the odds. (Women with higher intakes of whole grain also enjoyed a reduced risk of stroke.) Likewise, a study of 22,000 middle-aged men who smoked (and so were already more likely to develop heart disease) found that an increase in the intake of fiber, especially soluble fiber, decreased the risk of coronary heart disease and death. Whole grain fiber was found to be the healthiest.

Scientists theorize that bran, dried beans and other legumes, psyllium (a grain which is used to make some cereals), barley, and other foods high in soluble fibers (fibers that dissolve in water) all lower cholesterol by trapping bile acids in the digestive system. The liver manufactures bile acids from cholesterol. When fiber pulls these acids out of the digestive system, the liver draws cholesterol from the bloodstream to manufacture replacement acids.

Some fibers are more soluble than others, and more effective in lowering cholesterol. How much you can lower your cholesterol by including fiber in your diet also depends on how much fiber you eat. One study found that on average, you have to eat one cup of cooked oat bran or more than two cups of cooked beans a day to get a 5 to 10 percent drop in cholesterol. The FDA concludes from current research that an intake of at least 35 grams of fiber a day is needed for a meaningful improvement in your odds against heart disease. Many nutritionists insist that it is the combination of components in whole grain foods that provides protection against heart disease, rather than any single ingredient. Eating natural fiber—rather than fiber supplements or the refined fiber found in many breakfast cereals—is said to be the best way to get the health advantages of fiber in your diet.

How (A Little) Wine Can Help

The cardiovascular benefits of alcoholic beverages is a subject that immediately opens the doors to controversy. As we know, alcohol can be a dangerously addictive substance that is associated with a host of medical and social maladies. Alcoholism remains a serious and pervasive public health problem, and the suggestion that alcohol may be good for your health is bound to meet with resistance and skepticism.

However, years of research showing the same pattern of results cannot be ignored. The fact is that study after study has linked light or moderate drinking with reduced amounts of heart disease: Moderate drinkers have been found to have less heart disease than both heavy drinkers and non-drinkers. The phenomenon has been called “the French paradox,” from a study published in 1992 that found 40 percent lower rates of coronary heart disease among moderate wine drinkers, despite all the fat in French cuisine.

There are two important points to emphasize about these findings:

Moderation is key. There is no evidence that increased alcohol intake leads to increased benefits. Levels that have been found beneficial are one to two drinks a day. (A standard drink is defined as 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of 80-proof spirits.) Drinking in excess of these amounts may lead to serious health problems—including heart disease.
There are some people who should never drink, including recovering alcoholics and pregnant women.

There are several theories about the mechanism by which alcohol reduces the risk of heart disease. Some scientists have suggested that alcohol raises artery-cleansing HDL levels; others have observed that it has an anticoagulant effect on platelets. Recently, some have speculated that betaine, a chemical additive used in many wines, may be responsible. This additive reduces blood levels of a natural compound called homocysteine, high levels of which appear to promote heart disease. In the end, we may find that all of these mechanisms contribute to some extent.

The alcohol that was consumed in the “French paradox” was primarily red wine, but other studies have found similar protective results from white wine, beer, and distilled spirits. It has been suggested that drinking with meals, with the balancing caloric intake of food—as is the custom with wine—is healthier than drinking cocktails or beer without a meal. Another theory about the benefits of wine concerns resveratrol, a substance in grapes that may have protective cardiovascular effects. Other compounds called phenolics are also part of the nonalcoholic content of wine and may have antioxidant effects. Several studies have now found that grape juice or wine with the alcohol removed is capable of discouraging platelet coagulation, thus reducing the risk of blood clots. So it is possible that some of the positive effects of drinking could come from nonalcoholic grape juice as well.

Whether to drink or not, and how much, is an individual decision. No one should view scientific findings about possible benefits of drinking as a license for irresponsible behavior, or even permission to begin a habit that could potentially be destructive. These findings are just one small part of a much larger picture. You need to weigh risks and benefits of all your options in a comparative way.

Try Nuts and Yogurt Too

A staple of the Mediterranean diet, yogurt has long been associated with good health and longevity. Now recent studies have produced evidence that a serving a day of acidophilus yogurt can effectively lower cholesterol. Subjects who ate the yogurt enjoyed a 2.9 percent reduction in serum cholesterol levels—and for every 1 percent reduction in cholesterol there’s a 2- to 3-percent decline in the risk of heart disease.

Nuts are another important part of the Mediterranean diet, although scientists have tended to ignore them due to their high fat content. Now, however, researchers are beginning to turn up some interesting and surprising facts. Two large dietary studies in the U.S., one of men, the other of women, found that high nut consumption was related to lower levels of heart attack and death from heart disease to a “highly significant” degree. The nuts were found to be protective in both vegetarians and non-vegetarians. Another study found that people eating a diet based on macadamia nuts had lower cholesterol than those eating a typical American diet. Not only that, but in some studies the nuts also seemed to be linked to an overall lower rate of mortality, hinting that generous servings of nuts could add years to your life.

A New Medley for the Health of Your Heart

It is almost surely a combination of several factors, each contributing in its own way, that will lead to maximum health for your heart. The key to building a heart-healthy diet is to creatively combine as many of the different elements described here as you find you are comfortable with.

Clearly, frequent and substantial servings of fresh fruits, vegetables, beans, and grains are a critical element of a heart-healthy diet. And while the focus of this overview has been on what is good for you, not what is bad, it is equally important to minimize high-fat and high-cholesterol foods in your diet.

Since meat is a major source of saturated fat and cholesterol, some people advocate vegetarianism as an obvious path to heart health. However, most nutritionists agree that small and well-spaced amounts of meat and dairy products are an efficient way to supply a number of necessary nutrients without any significant increase in your risk of heart disease. If you center most of your meals around large servings of meat, you should probably re-think your menu planning, but there’s no need to eliminate meat altogether.

It is also important to remember that none of the foods suggested here are panaceas that will single-handedly solve all of your cardiovascular problems. Nor are they antidotes for bad habits. Don’t think, for example, that if you drink wine with dinner, it will offset the harm done by cigarette smoking, or that eating lots of garlic means you can eat all the red meat and ice cream that you want. Instead, take what we know about heart-healthy eating as an opportunity to expand the variety in your diet, working all the best foods into a menu plan that’s not only good, but good for you.

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