Every ten minutes in Australia someone has a heart attack. For 17% this will be fatal; the rest get a second chance. If you have had a close call, these five food tips will help get your health back on track.
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1. Eat more wholegrain cereals
There are heart health benefits from eating a range of wholegrain fibres. These include barley, buckwheat, bulgur wheat, corn and popcorn, millet, oats, quinoa, brown rice, wild rice, rye, triticale (a wheat-rye hybrid) and spelt wheat.
The health benefits of some fibres have been studied more extensively than others. Beta-glucan, for instance, is a soluble fibre found in oats and barley. It helps to lower total and LDL (bad) cholesterol.
Arabinoxylan is a wheat fibre that improves blood sugar levels and insulin sensitivity.
Psyllium, which comes from the the seed coat of the Plantago plant, can add an extra fibre boost. You buy it at the supermarket as a dry ingredient and it forms a gel when mixed with liquid. It works to reduce the absorption of bile acids in the small intestine, which helps lower blood fat levels, including total and LDL cholesterol and triglycerides.
A study of fibre intake in adults who survived an initial heart attack found those in the top 20% of cereal fibre intake had a 27% lower risk of death compared to the bottom 20%.
Those who increased their fibre intake after their heart attack had a 31% lower risk of death and a 35% lower risk of dying from heart disease compared to those who had the least improvement in fibre intake.
Higher-fibre intakes also fill you up, meaning you eat less.
2. Eat more fruit and vegetables
A 2014 review of six studies covering more than 670,000 people found that for each extra serve of fruit or vegetables eaten each day, the risk of dying from heart disease was reduced by an additional 4%.
Higher intakes of phytonutrients contained in fruits and vegetables, such as polyphenols, vitamin C, carotenoids and flavonoids, are thought to help slow hardening of arteries and blood clotting.
Eating more fruit and vegetables also increases your potassium intake, which helps reduce blood pressure by cancelling some of the harmful effect of salt.
3. Focus on healthy fats
For optimal heart health, it's important get the right balance of healthy fats versus unhealthy fats. This means avoiding fatty meats, commercial pastries, cakes and biscuits, fried, take-away and processed foods and commercial fats such as palm and coconut oil.
Instead, choose mono-unsaturated fats, long-chain polyunsaturated fats (including omega-3 fats), nuts and seeds, avocados, olives, oily fish, mono-unsaturated and polyunsaturated oils and margarine, including olive oil and canola. This helps to reduce total and LDL cholesterol and optimise HDL (good) cholesterol.
A recent American Heart Foundation study of more than 4,000 people who had survived a heart attack found that among those following low-carbohydrate diets, high intakes of animal fats and protein were harmful compared to fat and protein from plant-based diets.
Those with the highest intakes of protein and fat from animal sources had a 51% greater risk of death from heart disease compared to the lowest. Factoring in the change in diet following a heart attack, the excess risk of dying from heart disease was still 53%.
4. If you drink alcohol, have a moderate intake
While no alcohol is safest to reduce your risk of developing some cancers, there is a J-shaped relationship between alcohol consumption and death rates among people with heart disease: moderate intake is associated with the best survival rates.
In a 2013 study of more than 11,000 Italians who had recently had a heart attack, those who drank wine in moderation (up to 500 millilitres per day) had a 12-13% lower risk of heart attack, stroke or dying from heart disease over the next 3.5 years compared to non-drinkers.
Over seven years of follow-up, both moderate and heavy (more than 500 ml per day) wine drinkers had a 15-20% lower risk of dying compared to non-drinkers.
Some of the protective mechanisms include higher levels of HDL (good) cholesterol, better insulin sensitivity, less inflammation and lower tendency to blood clots. Wine, especially red wine, contains phytonutrients including flavonoids, tannin and other phenolic compounds.
However, for those who are non-drinkers, taking it up after a heart attack is not necessarily recommended, so check with your doctor. For those who are heavy drinkers, drinking less is wise.
5. Cut down on salt
Reducing salt lowers your blood pressure and this reduces your risk of heart disease and stroke.
About 75% of the salt we eat comes from processed foods such as potato crisps, salted nuts, packet soups and sauces, canned foods, pies, sausage rolls, hot chips and pizza. Cutting down processed foods and take-away will help reduce your salt intake from an average of nine grams a day to the recommended maximum of six grams (2300 mg sodium).
Choose foods that have less than 120 mg sodium per 100 grams of food on the nutrition information panel. Also avoid adding salt during cooking or at the table.
Putting it all together
Here's how you might put this information into practice:
- Start your day with a wholegrain breakfast cereal or rolled oats with psyllium sprinkled on top
- Munch on fruit, nuts or popcorn for snacks
- Make a salad sandwich on wholegrain bread with canned tuna or salmon for lunch
- At dinner, cover a quarter of your plate with a lean protein, legumes or a mix of both, cover half your plate with five or more brightly coloured vegetables and make the last quarter a grain like quinoa or wild rice.
Is it worth the effort?
It's not always easy changing dietary patterns established over a lifetime. Some might wonder whether eating more healthily after a heart attack is worth the effort.
It is. Consider the results of the Nurses' Health Study and Health Professional Follow-up Study, which tracked more than 4,000 adult men and women who had survived an initial heart attack over nine years. Those who improved their eating habits the most after the heart attack had a 29% lower risk of dying from anything and a 40% lower risk of dying from heart disease compared to those who did not improve their eating habits or ate worse.
The researchers also compared people's eating habits from baseline to after a heart attack. The biggest improvements made by men were for eating more wholegrains, omega-3 fats, fruits, vegetables and for reducing red/processed meat, trans fats and salt. For women it was increasing wholegrains and reducing trans fats, red/processed meat and salt.
If you have survived a heart attack, your doctor will prescribe medications to manage your risk factors. They might provide dietary advice, or you can see an accredited practising dietitian for a personalised plan.
Use your second chance to eat better as well. Any improvements you can make to what you eat and drink will help stack the odds in your favour.
Clare Collins is Professor in Nutrition and Dietetics at University of Newcastle. She receives funding from the NHMRC, ARC, National Heart Foundtion of Australia, Meat and Livestock Australia Human Nutrition Research Program, Hunter Medical Research Institute, Campbell Arnotts, Horticulture Australia Limited.