May 13, 2008
New York Times

Eating Your Way to a Sturdy Heart

By TARA PARKER-POPE

MOST people think heart-healthy living involves sacrifice. Give up your favorite foods. Break a sweat. Lose weight. But some of the best things you can do for your heart do not involve deprivation or medication. Simple and even pleasurable changes in the foods you eat can rival medication in terms of the benefit to your heart.

"Almost everyone has something they can do in their diet or activity that will impact their risk of heart disease,” said Dr. Graham Colditz, adjunct professor of epidemiology at Washington University in St. Louis. “It’s not about taking anything to the extremes of major deprivation, extreme marathon running or becoming a vegetarian."

Even so, many people are not getting the message. While doctors still advise patients to diet, exercise and stop smoking, the medical community has adopted an almost singular focus on cholesterol-lowering drugs as the fastest and best way to battle heart disease. Americans spend $18 billion a year on cholesterol-reducing drugs, making them the nation’s biggest-selling class of drugs.

Clearly, drug treatments have played a role in the health of American hearts. Since 1950, age-adjusted death rates from cardiovascular disease have dropped 60 percent, a statistic praised by government health officials.

Average blood pressure and cholesterol levels are dropping, partly because of drug treatments. But drugs don’t get all the credit. A sharp drop in smoking has had a huge impact on heart health. And major changes in diet have also played a role. Surveys of the food supply suggest that consumption of saturated fat and cholesterol has decreased since the early 1900s. Medical care has also improved.

But an important lesson from the last 50 years is that when it comes to improving heart health, it is important to look beyond the medicine cabinet.

Just a few small changes — eating more fish, vegetables, nuts and fiber — can have a major impact on your risk for heart problems. For some people, drinking moderate amounts of wine may offer additional benefits. Even a 55-year-old man who is about 20 pounds overweight and does not exercise regularly will have a heart-disease risk far below average if he regularly consumes fish, nuts, fiber and vegetables and drinks moderate amounts of wine.

It’s hard to believe that such simple food changes can make a meaningful difference, but data from hundreds of studies show they can.

For instance, a review of nearly 100 studies evaluating various cholesterol-lowering agents and diets showed just how potent fish can be as a heart protector. In studies of people who consume diets rich in omega-3 fatty acids like those found in fish, heart risk was 23 percent lower compared with a control group. The 2005 review appeared in The Archives of Internal Medicine.

The same report also reviewed studies of statin use and showed a 13 percent lower heart risk. Because it was not a head-to-head comparison, it cannot be concluded that eating fish is better than using statins. But the results clearly show the powerful effect of fish in the diet.

Many studies of fish consumption and heart health are based on observation of Eskimos and people in Mediterranean regions. And random clinical trials have shown that consuming omega-3 fatty acids can reduce heart attacks and cardiovascular death. These fatty acids can also slow the progress of atherosclerosis in coronary patients, according to the American Heart Association.

Several studies now show that regular consumption of omega-3s from a variety of sources, including fish, nuts and soybean oil, can lower cardiovascular risk as much as 60 percent, according to a 2006 review in The American Journal of Cardiology.

It doesn’t take much fish. Doctors recommend eating it, particularly fatty kinds like mackerel, lake trout, herring, sardines, albacore tuna and salmon, just twice a week.

People worry about exposure to mercury and toxins from fish, but experts say that for middle-age and older men and postmenopausal women, the benefits of fish far outweigh the risks of exposure to environmental pollutants.

The data on increasing consumption of fiber-rich foods, vegetables and nuts is also compelling. A 2001 report in Nutrition Reviews concluded that eating just a handful of nuts (about three to four tablespoons) five times a week can reduce risk of coronary artery disease between 25 and 40 percent.

And while everyone knows it is good to eat your vegetables, many people do not realize how easy it really is to consume five to nine servings of fruits and vegetables a day. Just having a salad of leafy greens (two cups) with tomatoes and half a cup of broccoli, for instance, totals four servings. If you had juice with breakfast, you’re already up to five by lunchtime.

Whether to add alcohol to your daily diet is more controversial. Increasingly, studies support the idea that drinking a small amount each day — no more than one to two servings — is better for you than not drinking. Large observational studies show that drinking moderate amounts of alcohol can lower the risk of dying in a given year by about 25 percent, compared with those who rarely drink. But it’s not true for everyone. Excessive use of alcohol can lead to addiction, traffic accidents and potentially fatal medical problems.

Even small amounts of alcohol can increase risk for certain health worries, like breast and colon cancer. Although those risks are generally offset by the extra heart benefits, some people may decide it is not worth it. Much of the research on alcohol’s benefit comes from studies that observe people over time rather than from controlled clinical trials, which are more reliable. So while there is a strong association with moderate alcohol consumption and better health, the results are not conclusive.

Making better food choices won’t always produce obvious results, like weight loss. But substituting fish for red meat, high-fiber foods for processed pastries and eating more vegetables may push more fattening foods off your plate, and at the least, prevent weight gain. Add a half-hour walk after dinner and you have gone a long way toward lowering heart risk.