Simple lifestyle changes could halt the progression of heart disease for many Kiwis. It all starts with eating well and exercising regularly, writes dietitian Kate Marsh.
Looking after our hearts has never been so important. Every 90 minutes a New Zealander dies of heart disease. Cardiovascular disease (heart, stroke and blood vessel disease) is still the leading cause of death in New Zealand, accounting for 30 per cent of deaths each year.
Most of the risk factors for heart disease are lifestyle-related. They are a result of the everyday choices we make about what to eat, how much to exercise, and whether to smoke.
Going about our busy lives, we make these choices without much conscious effort. And yet, over time, making unhealthy choices each and every day is what leads to conditions such as high blood pressure, high cholesterol, and being overweight. The good news is we can change these habits, and doing so can have big pay-offs.
When things go wrong …
The major cause of heart disease is a build-up of fatty material inside the artery walls, known as atherosclerosis. The fatty deposits gradually clog up the arteries, reducing blood flow to the heart. A similar process can occur in the blood vessels to the brain, and is the major cause of stroke.
For your heart to continue beating, it needs a constant supply of oxygen from the lungs, which flows into the coronary arteries that feed the heart muscle. When there is narrowing or blockage of these arteries, blood flow and oxygen to the heart is reduced, causing angina or chest pain. If the flow stops completely, a heart attack results. If not treated quickly, this can result in permanent damage to the heart muscle.
The good news is there are many things we can do to reduce the risk of developing atherosclerosis and the narrowing of the arteries.
Target your risk factors
While there are a number of risk factors we can’t change, such as genetics, age and gender, there are some we can address:
- Smoking — both active smoking and exposure to second-hand smoke.
- High blood cholesterol
- High blood pressure
- Type 2 diabetes
- Physical inactivity
- Being overweight
- Depression, social isolation and a lack of social support
While medications to control cholesterol and blood pressure, and surgery (including cardiac stents and bypass surgery) are the mainstay of treatment for many, research by US cardiologist Dean Ornish found that a programme of diet, exercise and stress management can lower blood pressure and cholesterol levels.
Dr Ornish, Professor of Medicine at the University of California in San Francisco, demonstrated that an intensive 30-day lifestyle modification programme among 23 people with heart disease led to a 91 per cent reduction in the number of chest pains reported.
His Lifestyle Heart Trial, which looked at the impact of a low-fat vegetarian diet, moderate exercise, no smoking and stress management training, led to a 4.5 per cent reduction in the narrowing of coronary arteries after a year. For the 20 people following the programme for five years, an average eight per cent improvement was achieved. In contrast, the arteries of the patients who received standard medical treatment had narrowed a further 28 per cent after five years. It is important to note that those in the group who modified their lifestyle showed this improvement without taking any cholesterol-lowering medications. Those outside the group experienced more than twice as many cardiac events, such as heart attacks and the need for heart surgery, even though they were on cholesterol-lowering medications during this period.
More heartfelt benefits
Further studies by Dr Ornish and his collaborators have found that the same lifestyle changes can improve blood glucose control in people with type 2 diabetes, and potentially slow or stop the progression of early-stage, low-risk prostate cancer in men, change gene expression in over 500 genes (meaning that even if you’ve inherited some ‘at risk’ genes, you can change how these genes ‘act’ to cause disease), and possibly even lengthen telomeres, the ends of our chromosomes that control the ageing process.
Halt the progress of heart disease
Research has found that focusing on these four key lifestyle areas could halt the progress of heart disease:
- rethinking dietary choices
- increasing daily exercise
- decreasing stress
- improving support from friends and family
Similar to Dr Ornish’s programme, the Complete Health Improvement Program (CHIP), developed by the Seventh-Day Adventist Church, focuses on these four areas. Results from the CHIP programme in the US, Australia and New Zealand show that making positive changes in these areas can reduce the need for medication in people with diabetes, reduce stroke risk, lower blood pressure and cholesterol, reduce weight, and improve depression — all heart disease risk factors.
Top seven tips to halt heart disease
- Eat a largely plant-based diet
- Exercise daily and limit time spent sitting
- Maintain a healthy weight
- Don’t smoke
- If you drink, do so in moderation
- Learn to manage stress
- Build a good support team
Get started on a plant-based diet
Here are some tips for moving to a plant-based eating approach:
- Stock your pantry with legumes, wholegrains, nuts and seeds
- Seek out delicious plant-based recipes from friends, or attend cooking classes to upskill
- Try ‘meat-free Mondays’ (click here for delicious vegetarian recipes), or become a ‘weekday vegetarian’
- Aim to add an extra serving of veges to every meal, even the meat-based ones
A sample heart-healthy day
- 6am: Start the day with stress-reducing meditation, stretching or yoga. If that’s not your cup of tea, try walking or more active exercise; the benefits of exercise are both physical and mental.
- 7am: Enjoy breakfast of a bowl of oats with low-fat milk and fresh fruit, such as berries or sliced banana. Follow with a slice of wholegrain toast thinly spread with almond or peanut butter, and a cup of green or herbal tea.
- 10am: Snack on a small handful of nuts.
- 12.30pm: Break for lunch and try a wholegrain wrap with falafel, hummus and tabouli, a bowl of minestrone soup with a wholegrain roll, or a roasted vegetable and quinoa salad with chickpeas and lemon tahini dressing.
- 3.30pm: Have an afternoon snack of a low-fat yoghurt and a cup of green tea.
- 5.30pm: Take time out with a 30-minute brisk walk with a friend or partner to chat about your day. Or, if you prefer, have an earlier dinner and make it a post-dinner walk.
- 7pm: Where possible, sit at the table and share the evening meal with others. Balance your plate with lots of vegetables and salads, some wholegrains and a portion of lean protein. Try a marinated tofu and vegetable stir-fry with brown rice; Moroccan chickpea and vegetable tagine with quinoa; wholegrain tortillas with Mexican beans, salad, salsa and guacamole; grilled salmon with brown rice and sautéed Asian greens; lentil, lean beef and vegetable shepherd’s pie; or barley and vegetable risotto with lean chicken breast. Finish with fresh fruit salad or baked apple with a dollop of reduced-fat yoghurt.
- 8.30pm: Wind down and relax before bedtime with a mug of warm low-fat milk or herbal tea, and a good book or relaxing music.
How to love your heart
Focus on these four key lifestyle areas:
1. What we eat
- Eat a largely plant-based diet of vegetables, fruits, wholegrains, legumes, nuts and seeds. Incorporating some wholly plant-based meals is a good start. Many healthy diets around the world use meat as a garnish rather than the main event.
- Include oily fish 2—3 times a week for their heart-healthy, long-chain omega-3 fats.
- When preparing or eating meat and poultry always trim the visible fat to minimise saturated fat intake.
- For the same reason, always choose low-fat varieties of milk and yoghurt. Remember, our tastebuds can be retrained to develop a preference for lower-fat foods, even if it’s not our current preference. For those choosing non-dairy alternatives to cow’s milk, be sure to choose products with added calcium.
- Although coconut products are popular at present and plenty of people will tell you the saturated fat in them is not harmful, the experts disagree. So keep coconut (desiccated or shaved), coconut oil and milk to a minimum. Your heart will thank you.
- Excess salt in our diets can raise blood pressure, a key risk factor for heart disease. While most of us have learned to add little salt at the table, we also need to reduce the amount of processed foods we eat as these are now our main source of salt. When we do have processed foods, compare products and choose those with less sodium listed on the nutrition information panel.
2. How much we move
- Aerobic activities that make us puff, even a little, are good for our hearts. If you’re up for some vigorous activity, aim for at least 1 1/4 hours every week. Otherwise at least 2 1/2 hours of moderate-intensity exercise is recommended.
- Upping the exercise to 2 1/2 hours of vigorous exercise or 5 hours of moderate exercise is even better, but be sure to start with realistic goals. Strength training two to three times a week will provide other benefits too.
- If you have a heart condition, check with your GP or a physical activity specialist about appropriate activities before you start a new exercise regime. You could also ask your GP about a Green Prescription, which can provide personal advice and support to becoming more physically active.
3. How we manage stress
Better stress management is key. Just like exercise, it may be about trying a few different things to see what works for you.
- Any form of exercise will help manage stress; even a brisk walk around the block will help if that’s all you can manage.
- Specific techniques that focus on clearing the mind, like meditation or yoga, have benefits beyond stress relief.
- Listening to music or a meditation recording, doing breathing exercises or getting a massage are a few other ways of taking time out.
4. How much love and support we have
Love and support helps make us healthier and happier. Having people around who care about us is key to good health.
- Make an effort to keep in touch with family and friends. They can be a good sounding board when we need to talk things through.
- We needn’t be afraid to ask for help when we need it. Our support group will want to help.
The bottom line
Keeping your heart healthy is about more than just cutting out a few foods and taking medication. Making lasting changes in these four areas will benefit your heart and — literally — give a new lease of life.
Article sources and references
- Aldana et al. 2008. A video-based lifestyle intervention and changes in coronary risk. Health Education Research 23:115-24https://academic.oup.com/her/article/23/1/115/837580
- de Feyter et al. 1995. Progression and regression of the atherosclerotic plaque. European Heart Journal 16:S26-30https://www.ncbi.nlm.nih.gov/pubmed/8829954
- Heart Foundation www.heartfoundation.org.nzhttps://www.heartfoundation.org.nz/
- Kent et al. 2013 Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: A cohort study. BMJ Open 3:e003751https://bmjopen.bmj.com/content/3/11/e003751
- Ministry of Health. 2015. Eating and Activity Guidelines for New Zealand Adults. Wellington: Ministry of Healthhttps://www.health.govt.nz/publication/eating-and-activity-guidelines-new-zealand-adults
- Ministry of Health. 2015. Mortality and Demographic Data 2012. Wellington: Ministry of Healthhttps://www.health.govt.nz/publication/mortality-and-demographic-data-2012
- Ministry of Health. 2015. NZ Health Survey: Annual update of key results 2014-2015. Wellington: Ministry of Healthhttps://www.health.govt.nz/publication/annual-update-key-results-2015-16-new-zealand-health-survey
- Morton et al. 2013. The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility study. NZ Medical Journal 126: 43-54https://www.ncbi.nlm.nih.gov/pubmed/23474512
- Ornish et al. 1983. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA 249:54-9https://www.ncbi.nlm.nih.gov/pubmed/6336794
- Ornish et al. 1990. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336: 129-33https://www.ncbi.nlm.nih.gov/pubmed/1973470
- Ornish et al. 1998. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 280:2001-7https://www.ncbi.nlm.nih.gov/pubmed/9863851
- Ornish et al. 2006. Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus without diabetes mellitus. American Journal of Cardiology 97:1267-73https://www.semanticscholar.org/paper/Comparison-of-coronary-risk-factors-and-quality-of-Pischke-Weidner/46477a3b7c28e9a8a45742ba397a20a1fbd0f555
- Ornish et al. 2008. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academies of Sciences 105:8369-74https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430265/
- Ornish et al. 2010. The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sires. American Journal of Health Promotion 24:260-6https://www.ncbi.nlm.nih.gov/pubmed/20232608
- Shurney et al. 2012. CHIP lifestyle program at Vanderbilt University demonstrates an early ROI for a diabetic cohort in a workplace setting: A case study. Journal of Managed Care Medicine 15:5-15https://chiphealth.com/Global/Publications/Shurney%202012.pdf
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