A diet rich in fruits, vegetables, nuts, and whole grains, including olive oil and salmon, can support heart health. Photo / 123rf
Heart disease is often linked to poor diet, but apples, grapes, tea and – yes – chocolate can all help protect your health.
One of the best things you can do to avoid heart disease and limit your likelihood of suffering a heart attack is to eat well, with your heart in mind. Fruits and vegetables, lean proteins and a low amount of sugar are key to a heart-healthy diet, as they are to a healthy diet in general, but new research suggests that some foods hold special importance in the prevention of heart attacks. This is thanks to a chemical called flavan-3-ols, a plant chemical that occurs naturally in some fruits such as apples and grapes and, in what is perhaps more welcome news, the plants that also produce tea and chocolate.
Flavan-3-ols are “a kind of polyphenol, which are bioactive compounds that occur naturally in plant foods and have been shown in some studies to be linked to better heart and circulatory health”, says Dell Stanford, a senior dietitian at the British Heart Foundation.
A recent study, from the University of Surrey, found that a diet high in flavan-3-ols can lead to reduced blood pressure, particularly in people who have high blood pressure and so are at greater risk of a heart attack. What’s more, the flavan-3-ols were also found to improve the health of the inner lining of participants’ blood vessels, which is crucial to overall heart and cardiovascular health. This research looked at the health impacts of eating apples, grapes and chocolate and drinking tea, in particular.
Another piece of recent research, from Harvard University in the US, found that another plant compound known as phytosterol could also be responsible for reducing the risk of both heart disease and Type 2 diabetes. Phytosterol has a chemical structure similar to cholesterol and is found in large amounts in nuts, seeds, fruits, vegetables and whole grains.
Forty-nine per cent of heart disease deaths are linked to poor diet. Eating grapes, apples and chocolate every day won’t “outdo the effects of a bad diet on your heart health”, says Sam Rice, The Telegraph’s nutritionist, but incorporating them into good healthy meals might just save your life. Stanford agrees: “The health benefits of eating a wide variety of plant-based foods are likely to be attributable to the interaction of bioactive compounds and nutrients in whole foods – they work together to help protect your heart.” Here are the best foods to add to your diet to lower your risk of a heart attack and how much of them to eat (or drink).
The old adage that an apple a day keeps the doctor away is more than a neat rhyme. A small apple contains around 15mg of flavan-3-ols, as well as quercetin, another flavonoid known to reduce inflammation, protect against frailty and lower blood pressure.
Apples “also contain a good amount of fibre, which binds with cholesterol and basically takes it out of your bloodstream when you excrete it”, says Rice. They also contain pectin, a prebiotic, which can boost your gut health; another factor that can reduce your risk of heart disease. There is a little bit of fructose, a natural sugar, “but this is bound up with so many other healthy things that it won’t give you the same negative effects of sugar on its own, like blood-sugar spikes”.
One a day is fine, or more, says Rice. “They’re a very healthy little snack, so feel free to have more than one if you enjoy them,” she says. Just be sure to eat them skin-on and to have the core too if you can stomach it, as this is where most of the good stuff is stored.
A bunch of grapes makes for a refreshing and moreish treat, especially in the summer months while they’re in season. Their bright green or red colours – or the dense black of the kind of grape you might pair with a creamy cheese – indicate “that the polyphenols and flavonoids that are good for your health are there”, Rice says. Indeed, “you should aim to eat the different-coloured fruits and vegetables”, says Stanford, as each colour indicates the presence of different potentially health-boosting plant chemicals.
An 80g portion, the size recommended by the NHS as one of your five a day, “is a small bunch that fits into the palm of your hand”, says Rice, and such a bunch would contain about 6mg of flavan-3-ols. They must be fresh, however. Raisins don’t count where your heart health is concerned as “drying out grapes makes them much smaller, so you’ll probably consume a lot more of them, meaning that you’re consuming much more sugar than you otherwise would”, Rice says. Grapes are also much more hydrating. “There’s no need to be afraid of dried fruits – they are still full of polyphenols and fibre – but they’re best eaten in moderation,” she adds.
Crucial to a heart-healthy diet is “the interaction of the different nutrients that exist inside whole foods”, says Rice, and a cornerstone of a whole-food-based diet is grains. The one you’re probably most familiar with is the humble oat, which, in a porridge or overnight oats, will provide us with heaps of beta-glucan. This is a sort of soluble fibre that “is important for lowering bad cholesterol”, says Rice – our “bad” LDL cholesterol levels being a key risk factor for heart disease.
Oats also contain magnesium and potassium, Rice points out, both of which “are key minerals that we need for good blood-pressure control”. While oats are high in calories compared with fruit and vegetables, the fibre they contain “will help to keep you fuller for longer, which can help you to manage your weight”, with obesity being another heart disease risk factor.
Whether you prefer porridge or overnight oats, “both are equally healthy for your heart, bearing in mind the sugar content in any ready-made options you might buy”, says Rice. Gentle cooking “won’t destroy the beta-glucan in your oats”, but perhaps avoid stewing your porridge for hours on the stove or blending the oats, as this can break down the fibre.
“A heart-healthy diet is essentially a Mediterranean-style diet,” says Stanford. “There’s limited evidence for the benefit of any specific food, but we know that the key ingredients of a Mediterranean diet in combination – lots of fruit and vegetables, pulses, nuts and seeds, oily fish with moderate amounts of lean meat, dairy foods and unsaturated fats – are good for your heart.”
The cornerstone of the Mediterranean diet is, of course, olive oil. “Too much saturated fat from foods such as butter, ghee, lard and cheese can increase your cholesterol, so switching to unsaturated fats like olive oil or rapeseed oil, often known as vegetable oil, can help bring your cholesterol levels down and lower your risk of heart disease,” Stanford explains.
Olive oil in particular contains oleic acid, which is “particularly good at helping to improve your blood lipid [fat] profile”, Rice adds. Using it to fry your eggs, vegetables or meat is safe, “contrary to what many people think”, says Rice, but “doing this will reduce the polyphenol content”. For this reason, it may be better added to salads or pasta dishes at the end of cooking. One to two tablespoons per day is a good amount for the health of your heart, within a healthy diet, Rice advises.
When it comes to your heart health, aim to eat unsalted nuts and seeds most days, says Stanford (provided you aren’t allergic). They are high in fat, but largely the healthier unsaturated kind, “and they are also high in fibre, protein, vitamins and minerals that are important to your overall health”, Stanford says.
The best thing for your health is to get a range of nuts in your diet, Stanford reiterates, but if you’re going to pick one type to try to incorporate, you might be wise to make it almonds. Aside from containing a high concentration of flavan-3-ols, almonds contain so much fibre that your stomach has to work harder to break them down, meaning that you may not absorb all of the calories contained in every nut. Almonds also contain linoleic acid, another compound that can reduce bad cholesterol in the bloodstream, as well as vitamin E, an antioxidant that can protect your heart from damage.
That said, whichever nut you choose, it’s best to stick to “a small handful, around 25 to 30 grams, otherwise you would be consuming a lot of calories”, says Stanford. Still, that’s more than enough to whip up into a homemade pesto with heart-healthy olive oil and plenty of fresh green herbs.
Omega-3 is another nutrient that’s famous for its heart-protective qualities. “The omega-3 fats in oily fish have been shown to reduce the level of triglyceride fats in your blood, which lowers your risk of heart disease,” says Rice. This is one of many reasons why the NHS recommends that people eat at least one serving of oily fish every week.
While vegetarians can still get a heart-healthy diet in the absence of fish, by eating plant-based sources of omega-3s like nuts and seeds, “only the type of omega-3 found in oily fish has been linked to a reduction in the risk of heart disease”, says Stanford. Of all the oily fish in the sea, mackerel contains the most omega-3 per gram, but it is also relatively high in mercury, which when consumed regularly can worsen heart health in the long run. Salmon may be a better option, as it is also very high in omega-3 but is considered a low-mercury fish.
Whether taken black or green, with milk or without, tea is excellent for the health of your heart. A number of wide-ranging studies have indicated that drinking tea daily may cut heart disease risk by up to 20%. This is in part because tea is very high in those all-important flavan-3-ols. One cup of black tea contains around 280mg of flavan-3-ols – the amount found in more than a dozen apples.
Green tea may be particularly good for your heart “as it contains a compound called EGCG”, a powerful antioxidant that has been shown to have specific links to reduced heart disease risk, Rice says. “But all teas have benefits, as long as they are unsweetened and use the tea plant, rather than being herbal teas, which are a different thing,” says Rice. A few cups a day are fine, “and it doesn’t matter whether you’re having them with or without milk”, though Stanford adds that milk would come with the added benefit of calcium intake, which is also important for heart health.
It might not be a standard part of our five a day, but chocolate – the dark, bitter kind at least – is rich in polyphenols. Three squares of dark chocolate contains around 30mg of flavan-3-ols, around the same as is found in two small apples, with many other heart-friendly compounds to boot.
To feel the benefits however, your chocolate must be “at least 70% cocoa solids, and really as high in cocoa solids as you can eat and still enjoy it”, says Rice. “Any less, and those benefits will probably be outweighed by the amount of sugar in the chocolate bar.” Even a very dark chocolate bar will be high in sugar however, Stanford points out, and “the amount of polyphenols present in dark chocolate will depend on how the chocolate is processed”.
About three squares of dark chocolate, once or twice a week, makes for a heart-healthy treat. “But there are plenty of healthier sources of polyphenols such as berries, nuts and tea. Make sure your occasional chocolate treat is part of an overall healthy, balanced diet,” Stanford adds.