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A Heart-Healthy Diet: Wining and Dining the HeartBy Katherine Kam Reviewed by Brunilda Nazario, MD Wine and chocolate conjure up images of the good life, but they may also be part of a heart- healthy diet. Given the high rates of heart disease among Americans, researchers have taken a close look at numerous foods and supplements -- from fatty fish to vitamin E -- to analyze the ideal ingredients for a heart-healthy diet. "I don't think it's out of the realm of possibility that we will ultimately find some magic food that's really going to make a difference," says Alice Lichtenstein, DSc, professor of nutrition science and policy at the Friedman School of Nutrition at Tufts University in Boston. But she cautions against a false sense of security. For instance, pouring a fish oil capsule over your hot fudge sundae won't protect your heart, she says. It's still best to follow a heart-healthy diet and lifestyle. That means nutritious eating, as well as maintaining a healthy weight, controlling blood pressure and cholesterol, avoiding smoking, and staying physically active. "We've had high hopes for individual foods for a long time, but also, we're going to have to bite the bullet," she tells us. So keep hitting the gym -- and reward yourself afterward with a glass of red wine or a piece of chocolate. Red Wine and the Heart-Healthy DietDoes drinking red wine reduce the risk of heart disease? Some studies have shown that people who drink moderate amounts of alcohol have less heart disease risk than nondrinkers, and some research suggests that red wine may offer extra health benefits. It contains compounds, such as flavonoids and resveratrol, that may help to limit atherosclerosis, or hardening of the arteries. Drinking alcohol regularly, including red wine, may boost levels of "good" HDL cholesterol. One to two drinks per day have been shown to increase HDL by about 12%, according to the American Heart Association. The extra HDL can help to remove bad "LDL" cholesterol, meaning that there's less of the material to contribute to fatty plaques inside arteries. Moderate alcohol consumption may also reduce the risk of blood clots. If you drink wine or alcohol, the American Heart Association urges moderation: no more than two drinks per day for men and one for women. And if you don't drink alcohol, the AHA warns against starting in order to prevent heart disease, especially when you can take so many other preventive measures. Drinking alcohol increases the risk of addiction, high blood pressure, obesity, breast cancer, and accidents. Chocolate and the Heart-Healthy DietDark chocolate and cocoa are rich in antioxidants called flavonoids. Research suggests that eating flavonoid-rich chocolate helps to keep blood vessels healthier by improving their ability to expand. One small study showed that eating high-flavonoid dark chocolate daily helped high blood pressure patients lower their blood pressure and reduce LDL. Patients who ate white chocolate got no beneficial effects. Eating chocolate in moderation is fine, Lichtenstein says. But be aware that flavonoid levels differ in various chocolate products, so there's no guarantee that you'll get a dose large enough for health benefits. Also, too much chocolate has no place in a heart-healthy diet because the extra calories can lead to weight gain. Fish Oil and the Heart-Healthy DietEating fish rich in omega-3 fatty acids may help prevent heart disease. Good choices include fatty fish such as salmon, lake trout, mackerel, sardines, and albacore tuna, according to the AHA. Fish oil contains docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Lichenstein has reviewed many studies on fish oil and cardiovascular disease, and most of the evidence associates DHA and EPA with decreased risk of cardiovascular disease, she says. People who report eating two or more servings of fish per week have a lower risk, she adds. How do omega-3 fatty acids help to promote heart health? Experts don't know for sure. "It's still open to debate," Lichenstein says. But whatever the reason, there is evidence that omega-3 fatty acids cut risk of death, heart attack, and dangerous heart rhythms in people with cardiovascular disease, according to the NIH. Omega-3 fatty acids also lower "bad" LDL levels, mildly decrease blood pressure, and lower levels of a blood fat called triglycerides. Getting omega-3 fatty acids from food is best, the AHA says. It recommends at least two servings of fish per week. But people with coronary artery disease or high triglycerides may want to talk to their doctor about taking a supplement if they're not getting enough omega-3 fatty acids in their diet. Cholesterol-Lowering Foods and the Heart-Healthy DietCholesterol-lowering margarines that contain plant sterols have been shown to decrease "bad" LDL cholesterol levels. Other foods that are sterol-fortified include some orange juices, chocolate bars, yogurt, and more. Though these cholesterol-lowering products seem to be effective, they should be part of a comprehensive heart-healthy diet, one that is low in saturated fat and cholesterol, experts say. Fruits, Vegetables, and the Heart-Healthy DietMany people take antioxidant supplements, such as vitamin E, vitamin C, and beta-carotene, to prevent heart disease, but there's no proof that dietary supplements help, experts tell WebMD. "We've been very disappointed with supplements in general, especially with respect to cardiovascular disease, in the past three or four years," says Lichtenstein, who co-wrote the AHA's scientific advisory on antioxidant vitamin supplements and cardiovascular disease. "All the major vitamin E intervention studies have shown no significant effects," she adds. Many people take vitamin E on the widely held belief that it may help prevent or delay heart disease. Instead of relying on diet supplements, you should follow a heart-healthy diet, Lichtenstein says. "We know that diets high in fruits and vegetables are associated with decreased risk of cardiovascular disease and cancer." Why the benefit? It could be substances in the fruits and vegetables themselves. Or people who eat a lot of fruits and vegetables may be eating fewer unhealthy foods, or perhaps they're more likely to exercise and not smoke, Lichtenstein says. To make sure you eat a wide variety of foods, aim for "a rainbow of fruits and veggies," says Judith Levine, RD, MS, a registered dietitian with the American Heart Association's San Francisco office. Some examples:
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