Reference: March 2025 | Issue 3 | Vol 11 | Page 54
Heart health can be highly impacted by nutrition – both positively and negatively. A major barrier to an optimal diet is misinformation. People will often search the internet for fast-fixing dietary tips, and much of this information is inaccurate and misleading. It is important that healthcare providers can dispel misconceptions about food and heart disease to promote a balanced, healthy diet. This article describes the current evidence, or lack of, surrounding the most common questions and queries about a heart healthy diet.
Eggs, how many and how often, if any?
We now know that foods containing cholesterol, like eggs, only raise blood cholesterol slightly, and no study has shown that eggs increase heart disease risk. Some have even suggested that eggs may actually raise high density lipoprotein (HDL) levels. Many of the early studies on eggs did not take into account the saturated fat in people’sdiets, and that many foods often consumed with eggs are high in saturated fat, such as bacon and sausages.
Healthcare providers need to take into account the diet as a whole. The first step is to lower the intake of saturated fat, such as reducing animal fats, avoiding frying, and reducing the intake of unhealthy fat sources like cakes, pies, and pastries.
The scientific consensus is that eggs do not increase the risks for cardiovascular disease or mortality. There are also multiple benefits of eating eggs for general health. They contain high-quality protein, lutein, zeaxanthin for eye health, and choline for memory – not forgetting their notable B vitamins and fat-soluble vitamins A, D, and K content. Eggs are also cheap, versatile, widely available, and their production generally has a lower environmental impact compared to other types of animal protein.
Will nuts raise cholesterol levels?
Nuts refer to both tree nuts and peanuts, and are preferably unsalted for optimal nutrition. The confusion lies within the fact that nuts are very high energy, and hence considered ‘bad for health’ by some people. However, there is a wealth of evidence that nuts, when consumed in moderation of one handful (28g) per day, will lower low density lipoprotein (LDL) cholesterol and reduce the risk of cardiovascular disease (CVD) by up to 21 per cent compared to non-nut consumers.
Of interest also is that the type of nut does not appear to make a significant difference; various varieties show a positive impact on heart health, likely due to their rich content of unsaturated fats, fibres, and antioxidants.
Yes, nuts are a high energy food source, but they are also satiating, which may help to reduce overall snack intake, as well as containing a variety of additional nutrients like potassium, magnesium, and vitamin E.
Is chocolate heart healthy?
Chocolate, aside from its obvious sugar and other unfavourable ingredients, is often promoted as containing heart healthy components. In reality, intake depends on the amount of cocoa solids contained in the food. The more cocoa solids, the greater the number of flavonoids – the antioxidant component linked to a lower risk of heart disease.
Both milk and white chocolate contain very little cocoa solids. Dark chocolate does contain more flavonoids than other types of chocolate and is often assumed to be ‘good for the heart’. However, there is no data to suggest that there are enough flavonoids present to have a positive health effect.
Is butter better than margarine?
The butter vs margarine debate has existed for decades. Butter is, quite simply, churned cream with removal of the buttermilk. One teaspoon contains 5g of saturated fat, which is a large amount and will contribute to raising LDL cholesterol, increasing the risk of heart attack or stroke. Margarines are made by combining unsaturated vegetable oils like olive and sunflower, and end up being about 50 per cent lower in saturated fat compared to butter.
Concern did exist about the heart harmful trans-fats in margarines, but there are now new ways of manufacturing that avoid forming trans fats. Both are processed foods, and the current advice still remains that people should be cutting down saturated fat intake, which means reducing butter intake and swapping for unsaturated fat spreads.
However, as dietitians we look at the whole diet. If patients have a diet that is already low in saturated fat like fatty meats, pastries, and biscuits, then a little bit of lightly buttered toast can absolutely be a part of a healthy diet and is unlikely to be a problem. It is also important to remember that both butter and margarine are calorific, one teaspoon of each contain 35kcal, so we advise using either sparingly.
Is coconut oil a heart healthy alternative?
There has been popular media attention given to coconut oil in recent years, declaring that it is better for health than other fats. This popularity has been spurred on by marketing from coconut oil and related industries, touting coconut oil as natural and healthful.
Coconut oil is made up of almost 90 per cent saturated fat. The majority of existing data are from animal studies and high quality trials have not yet been conducted in human populations. Most studies found that coconut oil increased HDL levels but also significantly increased LDL cholesterol, and should therefore be avoided. If patients prefer the taste of coconut oil, advise them not to use it regularly for cooking, but to use sparingly for added flavour and texture.
Omega-3 supplements – the evidence
Two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found mainly in oily fish, are associated with a lower risk of cardiovascular disease. However, when looking at whether fish oil supplements can prevent heart disease, it is still unclear. It has been demonstrated that supervised omega-3 supplements for some people with raised blood triglyceride levels can be beneficial.
The ideal advice is to obtain omega-3 fats from a heart healthy diet that includes oily fish, avocados, nuts, flaxseed, and extra virgin olive oil, rather than taking fish oil supplements. There are also a few things to consider if patients are going down the route of omega-3 supplements. Current advice supports one that contains EPA and DHA 450mg in total, and not just fish liver oil.
Is honey better than sugar?
Sugar of any kind may add to cardiovascular risk by increasing fat synthesis by the liver, increased triglyceride and cholesterol levels, and the development of arterial plaque. The World Health Organisation recommends that people consume no more than 5-10 per cent of energy from sugar intake. Honey is a ‘natural’ sugar, but is another form of sugar all the same, which should be considered.
Most people in Ireland are eating too much sugar, which increases the risk of being overweight, which in turn, increases the risk of high blood pressure, atherosclerosis, and diabetes, all of which raise the risk of cardiovascular disease. Moving towards a more Mediterranean diet approach will help to reduce sugars and simultaneously increase the intake of heart healthy nutrients.
Pink Himalayan salt instead of regular salt
The gourmet pink Himalayan salt has become popular, being touted for its trace elements not found in regular table salt. The reality is that pink Himalayan salt only scratches the surface when it comes to levels of trace elements like magnesium, potassium, and zinc, which are too minimal to have positive benefits to health.
In fact, a study by Fayet et al in 2018 found that 30g of Himalayan salt would need to be consumed per day to provide a significant intake of any additional nutrients. Also of concern was the contaminants such as lead, mercury, and nickel found in some sources.
It is important to reinforce that this enticing pink salt, like its regular counterpart, contains sodium and chloride that can lead to high blood pressure, a leading risk factor for heart disease. When it comes to any type of salt, the maximum daily amount advised is 6g/day (1 teaspoon). Advise patients to opt for natural salt substitutes such as herbs and spices, as well as lemon and lime juice, for additional food flavouring.
Is milk heart healthy?
Not all fats are created equally, and emerging evidence shows that dairy fat is not detrimental to heart health, as was once thought. In fact, it may be beneficial, regardless of the fat level, and is associated with a lower blood pressure and a reduced risk of cardiovascular disease. Milk has been identified as having over 400 different fatty acids, which have distinct positive physiological effects. Most saturated fat in milk has no effect on circulating cholesterol and no negative implications for human health.
The saturated fat in milk may increase total and LDL cholesterol but may also raise HDL, thereby having a neutral effect. Milk also contains other essential nutrients including protein, calcium, and potassium, for example, which may in fact modulate the effect of fat on health. Therefore, the ‘choose low-fat milk’ message is not a wholly evidence-based one and people can be more flexible.
Bottom line
Nutrition can be confusing and many information sources are often full of myths and misinterpretations. It is important that healthcare providers can dispel common dietary myths and support patients towards a heart healthy diet. Dietitians possess the skills to guide people towards eating strategies that fit within their food preferences and lifestyles, at the same time helping to improve their lipid profiles, and are an important part of the multidisciplinary team.
References available on request
Inside Out Nutrition accepts referrals from healthcare providers, as well as self-referrals at www.insideoutnutrition.ie. Private consultations are available on a one-to-one basis, both in person and online.
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