Heart disease is the number one cause of death in the United States. It is considered a “lifestyle disease,” caused by choices we make that damage our hearts. Poor diet and lack of exercise often lead to atherosclerosis, or hardening of the arteries.
People at highest risk include those with high blood pressure, high blood cholesterol level, obesity, and diabetes.
Prioritizing heart-healthy eating today can lead to a healthier future.
The story of Nathan Pritikin
Thanks to a man named Nathan Pritikin, we now know that atherosclerosis can be reversed with diet and exercise.
Pritikin was an engineer and inventor, born in 1915. In his early forties he was diagnosed with advanced heart disease, with a blood cholesterol of 280 mg/dl. For reference, anything over 200 is considered high.
He put himself on a low fat, low salt, low sugar diet, along with an exercise program, and lowered his cholesterol to 150 mg/dl, reversing all signs and symptoms of heart disease. He wrote a book which outlined his regimen, called “The Pritikin Program for Diet and Exercise,” first published in 1979.
Because Pritikin had no formal medical training, he was ridiculed by the medical profession for his theories.
After his death an autopsy was performed, and the results were published in the New England Journal of Medicine. His heart was remarkably free of disease and the coronary arteries were completely open, proving once and for all that he was right. In October 2024 he was posthumously awarded the Lifetime Achievement Award by the American College of Lifestyle Medicine at their annual conference in Orlando, Florida.
Cholesterol
Cholesterol enters the blood stream through our digestive tract from the food we eat, and from our liver which produces cholesterol.
All animal products, including meat, poultry, fish, dairy, and eggs, contain cholesterol. If we overconsume these foods, the excess cholesterol builds up in our arteries and can create blockages.
It is recommended that a normal healthy person consume no more than 300 mg of dietary cholesterol per day. To put that in perspective, one ounce of meat, eight ounces of milk, or one ounce of cheese, all contain 25 mg of cholesterol. If a person has existing heart disease or risk factors, daily consumption should be 200 mg or less per day.
Saturated fat
Saturated fat is converted by the body into cholesterol. Saturated fats are solid at room temperature. Examples are bacon fat, butter, cream cheese, shortening, coconut oil, and the fat in meat.
No more than 7% of our total calories should be consumed as saturated fat. For a standard 2000 calorie diet, this translates into 15 grams per day or less. Food labels list saturated fat content per serving. As a guide, choose foods containing no more than 2 grams of saturated fat per serving.
Sodium
Too much sodium in the diet can cause high blood pressure, put a strain on the heart, arteries, kidneys, and brain, and lead to heart attack, stroke, dementia and kidney disease.
The US Dietary Guidelines recommends a limit of 2300 mg of sodium per day. Our bodies require only about 180 mg per day. The average American adult consumption is 3000-4000 mg per day.
The major contributors to sodium in the diet include restaurant foods, pizza, frozen entrees, processed chicken products, sandwiches, canned soups and canned tomato products.
Read food labels to determine how much sodium is in the food you eat. Look for items containing no more than 300 mg/serving. More than 400 mg per serving is considered high sodium.
What about salt?
Salt is made up of 40% sodium and 60% chloride. Just one teaspoon of salt contains 2360 mg of sodium. Table salt, sea salt, pink Himalayan salt, and kosher salt all contain the same amount of sodium. Salt is salt, no matter what form it comes in.
Salt substitute is made from potassium and chloride and contains no sodium. Another option is “light salt,” which contains 50% sodium chloride and 50% potassium chloride, so it contains half of the usual amount of sodium.
Sugar
Excess sugar in the diet can lead to high blood pressure, inflammation, weight gain, fatty liver disease, and increased risk for heart attack and stroke.
It is important to differentiate between natural sugar and added sugar. Natural sugars are found in fruit and dairy products.
It’s the added sugar that gets us in trouble. These are sugars added either by the manufacturer, like in candy, cakes, pies, sodas, soups, salad dressings and ketchup, or sugars we add ourselves, like sugar in our coffee or tea, cereal or oatmeal, and syrup on pancakes and waffles.
According to the American Heart Association, women should consume no more than 24 grams of added sugar per day; men should limit added sugar to no more than 36 grams per day. Check food labels to determine how much added sugar is contained per serving. A reasonable limit is 5 grams of added sugar per serving.
One 20-ounce bottle of sweetened soda (any kind) contains 64 grams of added sugar. If you drink just one bottle per day, you will end up consuming 52 pounds of added sugar per year, just from your soda alone.
There are many things we can include in our diets that can help lower risk of heart disease. These include unsaturated fats, omega-3 fatty acids, soluble fiber, soy products, nuts and plant sterols.
Unsaturated fats
Unsaturated fats are considered heart-healthy, as they don’t raise blood cholesterol levels. These fats are liquid at room temperature, and include all vegetable oils, avocados, nuts and seeds, mayonnaise and nut butters.
Omega-3 fatty acids
Omega-3 fatty acids are found primarily in fish and seafood. We can also get them from some plant foods, such as flaxseed, soy, walnuts, canola oil, nuts and seeds, and green leafy vegetables. However, we only absorb about 10% of the omega-3 from these foods.
The American Heart Association recommends we consume an average of 1000 mg of omega-3s per day. Two four-ounce servings of fish per week will provide enough omega-3 to meet our body’s needs.
Fish oil supplements can provide the omega-3 you need if you don’t eat fish or seafood. Vegan supplements made from algae are also available. The recommended dosage is 1000 mg per day.
Soluble fiber
Soluble fiber is the type of fiber that dissolves in liquid to create a gel-like consistency. It works in the body by binding the cholesterol in the intestinal tract, preventing its absorption.
The major sources of soluble fiber include legumes, oats, barley, Brussels sprouts, apples, pears, figs, sweet potatoes, and prunes. Two servings per day of these foods will provide enough to effectively reduce the amount of cholesterol absorbed by the body.
Soy products
Soy helps reduce risk of heart disease by keeping the blood vessels flexible, preventing blood clots, and halting the oxidation of LDL.
Food sources include fresh soybeans (edamame), dried soybeans, soy milk, tofu, veggie burgers, and roasted soybeans.
Nuts
Nuts of all kinds are good sources of arginine, which helps relax and widen blood vessels, improving blood flow. Enjoy an ounce of nuts daily for heart health benefits. Visually, one ounce of nuts is about one-fourth cup.
Plant sterols
Plant sterols are natural compounds found in plants. They work similarly to soluble fiber, by binding to cholesterol Dosages of 2000 mg per day can lower LDL (the bad cholesterol) by up to 17%. The small amounts we get in plant foods add up to about 300 mg per day, and aren’t nearly enough to have a therapeutic effect. Plant sterol supplements are available over the counter. Look for those containing 2000 mg per dose.
Incorporating heart-healthy eating habits into your daily routine doesn’t have to be complicated. Small, consistent choices, such as reducing processed foods, watching your sodium intake and enjoying heart-friendly fat, can have a lasting impact on long-term well-being. Prioritizing heart-healthy eating today can lead to a healthier future.
Susie Bond is a registered and licensed dietitian in private practice. Visit susiebondnutrition.com or email [email protected].
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This article originally appeared on Florida Today: Nutrition for Today: A dietitian’s guide to heart-healthy eating
