February is the time when we tend to think a little more about matters of the heart, albeit the focus is generally more around celebrating our relationships than health. This month, Mindful Chef Dietician Clare talks a little more about our cardiac health, the important functions the heart has within the body, how our diet and lifestyle can impact upon it, and strategies to look after the health of our heart.

The heart and cardiovascular system

The heart is a muscle, around the size of a fist, located roughly in the middle of the chest. It is composed of four chambers, two on the left side and two on the right side; the left and right side of the heart are separated by a wall of muscle called the septum. The upper chambers are called the left and right atrium. The lower chambers, which are larger, are called the left and right ventricles. The heart’s regular beat is on account of electrical signals that make it contract and relax, forcing blood through its chambers and into the main arteries. This electrical signal is generated by the sino atrial node, in the right atrium. This electrical signal then travels across the heart, enabling the entire muscle to contract. The heart beats between 60-100 times per minute, this increases as we exercise.

As the heart beats,  blood (approximately five litres of it) is pumped through blood vessels around the body, this is referred to as circulation. This blood carries oxygen and essential nutrients to organs and tissues, it also carries away waste products such as carbon dioxide that need to be removed from the body. The heart, blood and blood  vessels (known as arteries, veins and capillaries) make up the cardiovascular system.

Common heart problems 

Cardiovascular disease (CVD ) is an umbrella term that can be used to describe a number of disorders that affect the heart and circulatory system. These conditions all tend to be associated with the formation of fatty plaques on the walls of blood vessels (known as atherosclerosis) that obstruct blood vessels, causing them to harden and restrict blood flow. This condition increases risk of blood clots, which can lead to restricted blood flow to vital organs such as the heart or brain.

1. Coronary heart disease 

This occurs when the flow of oxygenated blood to the heart  is blocked or reduced. This can lead to angina , myocardial infarction (heart attack) and heart failure.

2. Stroke and transient ischaemic attacks (TIA)

A stroke occurs when the blood supply to the brain is cut off, this is caused either due to a blood clot preventing blood and oxygen getting to the brain (An ischemic stroke) or a blood vessel bursting which leads to bleeding in and around the brain (A hemorrhagic stroke).

Transient Ischaemic Attacks (TIA) are similar to a stroke, however blood supply to the brain is only temporarily disturbed.

3. Peripheral arterial disease

This condition is related to a blood vessel in the limbs (typically in the legs) being blocked by fatty plaques.

4. Aortic disease

These conditions affect the aorta, the largest blood vessels. The aorta can be weakened and may burst (aneurysm).

5. Vascular dementia

A type of dementia caused by reduced blood flow to the brain.

According to NHS England, cardiovascular disease affects around 7 million people in the United Kingdom and has a significant impact on our quality of life and life expectancy. It accounts for around 1 in 4 premature deaths in the UK. 

Risk of developing Cardiovascular disease increases if:

1. You have hypertension (high blood pressure)

High blood pressure, this is the force of your blood moving against your blood vessels. When blood pressure is high it puts your blood vessels and organs, particularly your heart under strain. Consistently high blood pressure increases risk of a number of health issues including cardiovascular disease. Blood pressure is recorded with two numbers. The systolic pressure (higher number) is the force at which your heart pumps blood around your body. The diastolic pressure (lower number) is the period when your heart muscle relaxes and the chambers of the heart fill with blood, this measurement looks at resistance to the blood flow in the blood vessels. A high blood count is considered to be 140/90 or higher mmHg. A normal blood pressure is between 90/60mmHg and 120/80mmHg.

2. You have high hyperlipidaemia (high cholesterol)

Within our blood there are a number of lipids (forms of fat), called cholesterol (which there are several different types of) and triglycerides. Cholesterol is carried around the body in a molecule called a lipoprotein, when looking to measure the amount of cholesterol in our blood we actually measure different types of lipoproteins.  When considering levels of cholesterol in our blood and heart disease, it is important to remember that cholesterol levels are an indicator of risk not a sign of disease.

Healthy cholesterol levels typically look like this

Type of Lipoprotein/ cholesterol	Level (mmol/l)
Total Cholesterol/ Serum Cholesterol (overall level of cholesterol in the blood)	5 or below
Non-HDL This is your total cholesterol minus your HDL cholesterol and includes LDL Cholesterol. This is sometimes referred to as “ bad” cholesterol as it increases risk of CVD. If there’s too much Non – HDL cholesterol in your blood it can build up in the arteries, clogging them up.The lower this figure is the better.	4 or below
LDL  Another cholesterol that increases risk of CVD.	3 or below
HDL  This is often referred to as “good” cholesterol, it is considered to be protective against CVD  as it helps to remove non -HDL cholesterol after it has been used , back to the liver where it can be broken down and removed from the body	1 or above
Triglycerides Another form of blood fat, high levels of which are associated with a number of diseases including CVD, liver disease and diabetes	2.3 or below
TC:HDL Ratio The ratio of total cholesterol to HDL	Less than 6

3. You smoke

Smoking and other tobacco use significantly impacts on our cardiovascular health, the substances found in tobacco have been shown to damage blood vessels.

4. You have poorly controlled diabetes

Consistently high blood glucose levels can also damage the walls of blood vessels and increase risk of blockage and narrowing.

5. You have a family history of cardiovascular disease

If you have a family history of CVD, there may be genetic factors (such as familial hyperlipidemia) that make you more prone to developing cardiovascular disease. 

6. You drink excessive amounts of alcohol 

Alcohol intake has been shown to increase levels of blood cholesterol and blood pressure. 

7. You are inactive

Being sedentary can increase risk of CVD as it increases risk of fatty deposits building up in the blood vessels. As the heart is a muscle, like all muscles the more it is exercised the more efficient it is.

8. You are  from certain ethnic backgrounds

In the UK, CVD is more prevalent  in people of South Asian and African or Caribbean backgrounds. This is due to people from these backgrounds being more  likely to have other risk factors for CVD, such as high blood pressure or type 2 diabetes.

9. You are over 50

Cardiovascular disease is more common in people over 50 years of age and risk increases as we get older.

How to take care of our cardiovascular health

Cardiovascular health goes well beyond our heart, and involves taking care of our circulatory system, our blood pressure, and our blood cholesterol levels. 

The development of complex illnesses like cardiovascular disease is rarely dependent upon one single risk factor in isolation and more related to multiple facets of risk, such as genetics, environment and lifestyle choices interconnecting.  

Although cardiovascular disease can have some incredibly serious consequences, the good news is that there are many things we can do, through diet and lifestyle, to improve the health of our cardiovascular system and minimise our risk of becoming unwell.

Part One: the truth about fats

1. Try to get most fat from your diet from unsaturated sources

With the low fat diet crazes of the 80s and 90s thankfully behind us, fat appears to be back on the menu. However, there is still huge amounts of confusion and controversy around fats, partially because they come in several different forms and are found in lots of foods. What types should we be eating and avoiding? Should we try to keep our fat intake as low as possible or should we be adding in as much as possible?

When talking about different types of dietary fat, saturated, unsaturated and trans fats are often mentioned. These terms are referring to the biochemical structure of the different types of fat we consume. 

Food sources of fat are a combination of saturated and unsaturated fats, with one type of fat tending to be more abundant. For example, olive oil, which is typically referred to as unsaturated fat, contains around 73% monounsaturated fat, 8% polyunsaturated fat and 14% saturated fat.

Saturated fats 

Foods containing mostly saturated fat tend to be solid at room temperature and are predominantly from animal sources (although there are exceptions from plant sources such as coconut oil, which is mainly made up of saturated fat).  Examples of foods that are mainly saturated fat include the fat found in dairy products, on meat, butter and lard. 

A history of fat

Saturated fats have long been a fat we have been advised to avoid. As far back as the 1950s, studies started to show an association between higher intakes of dietary saturated fat and increased cholesterol levels, thus potentially increasing risk of cardiovascular disease. Several large pieces of observational research including The Seven Countries Study, The Framingham Heart Study and the NiHonSan Study were used to inform dietary guidance throughout the world. In the United Kingdom, guidance was introduced in the 1980s to recommend we reduce the total fat content of our diet to 30 percent of our total energy intake, with no more than 10% of our energy intake coming from saturated fat. The introduction of this advice led to significant changes within our food systems and diets, with low-fat products being produced in abundance. It is argued that these changes led to a detrimental effect on dietary quality, promoting the false idea that lower-fat foods are by default nutritious and beneficial for health.

Fat vs carbs

In more recent years, health policies recommending low fat dietary intakes and the studies that underpin advice around saturated fat have been reconsidered, as new research has yielded conflicting results. A meta analysis carried out in 2010 found that saturated fat was not meaningfully related to an increased risk of heart disease. It was also suggested that replacing saturated fats in the diet with carbohydrates, which has occurred following guidance to decrease fat intakes, may actually increase risk of heart health issues. Pretty soon the media picked up on results and headlines with titles like “butter is back” were all over the press. 

A complex issue

However, it is argued that these more recent studies are misleading and flawed. This is because this more recent research has been meta-analysed and has looked at the affects of individual fatty acids. The key issue with this is we don’t eat nutrients in isolation, we eat foods that are composed of a variety of nutrients and interact with one another throughout the processes of digestion and absorption. Considering any nutrient in isolation does not account for the intricacies and interactions that occur when we consume nutrients as part of a meal, it also does not account for the complexities that exist within habitual dietary patterns and the many factors that impact on a disease process. We need to ensure we consider the foods providing particular nutrients and representative dietary patterns when giving advice.

Interestingly research indicates that the saturated fat found in dairy products may not have the same association with increased risk of heart disease that other types of saturated fat have. Fats in milk are held in a suspension called the milk fat protein globule. Scientists think this affects the way we absorb the fats in milk. 

Trans Fats

Trans fats do not naturally occur in foods. Processing liquid oils to produce hard fats, through a chemical process called hydrogenation (which uses large amounts of pressure and heat), changes the biochemical structure of the fat, from cis to trans.

There is a significant amount of evidence linking trans fats to an increased risk of cardiovascular disease. Trans fats have been shown to decrease levels of HDL lipoproteins (cardioprotective or “good cholesterol”) and increase triglyceride levels.

• Trans fats are predominantly found in processed foods containing hydrogenated oils, such as confectionary and baked items. 
• Check the ingredients of products you are purchasing to see if they contain partially hydrogenated or hydrogenated fats or oils. There is currently no legislation in the UK that requires trans fats to be labelled on foods.

Unsaturated Fat (Poly or Monounsaturated fats)

Foods containing mostly unsaturated fats tend to come from plants and are typically liquid at room temperature.

Although the studies around saturated fat have appeared to have made previous guidance more ambiguous, research has consistently shown that eating foods containing unsaturated fats are more likely to be of benefit to our heart health and overall wellbeing. This doesn’t mean that foods containing saturated fat should be completely avoided, but generally speaking choosing unsaturated sources of fat most of the time is ideal. 

• Foods that are mostly made up of unsaturated fats include olive oil, vegetable or rapeseed oil, sesame oil, peanut oil, Avocado, olives, nuts, seeds, oily fish, and marine algae.

2. Include sources of long chain Omega 3 fatty acids in your diet

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are forms of unsaturated fat, known as long chain omega 3 fatty acids. Alpha linolenic acid (ALA)  is a shorter chain omega 3 fatty acid.  

The majority of health benefits associated with Omega 3 fatty acids are related to EPA and DHA. Shorter chain ALA can be converted in the body to EPA and DHA, but only in small quantities and this process is very inefficient.

The benefits of long-chain omega 3 fatty acids include:

• Reducing triglyceride levels in the bloodstream 
• Being anti inflammatory and anti thrombotic which reduces risk of fatty plaques developing in the blood vessels (atherosclerosis)
• Reduces blood pressure
• Decreases risk of mortality related to cardiovascular disease.

Food sources of long chain omega 3 fats are: 

• Anchovies
• Carp
• Herring
• Mackerel
• Pilchards
• Salmon 
• Trout. 

Aim to include at least one portion of oily fish a week as part of your balanced meals will help take care of your cardiovascular health. 

For vegans and vegetarians, forms of sea vegetables such as nori, spirulina and chlorella contain long chain omega 3 fatty acids. Also make sure you are including sources of ALA in your diet such as nuts and seeds, soybeans and hemp.

Part Two: Salt

1. Be conscious of your salt intake!

A high salt intake of (also known as sodium chloride) can contribute to high blood pressure. 

Higher salt consumption disrupts the natural sodium balance in our bodies and leads to us retaining more fluid, which means there is increased pressure exerted by blood against our blood vessels. Current recommendations for adults is that we should have no more than 6g of salt a day.

Around 75% of the salt we consume is from processed foods like:

• Ready meals
• Soups
• Snacks such as crisps
• Bread
• Processed meats
• Cakes
• Biscuits
• Ready made sauces 

…all contain salt, sometimes in significant quantities!

2. How to be more conscious of your salt intake:

• Avoid processed foods and cook from scratch! 

Your Mindful Chef recipe boxes make cooking your meals from scratch quick and easy, they also allow you to control how much salt is added to your meal!

• Read the labels 

Foods containing more than 1.5g per 100g of salt (or 0.6g of sodium) are classed as being high in salt. That’s not to say you can never have these foods, but having a lot of them on a regular basis is likely to lead to you eating too much salt.

• Add flavour to your dish., not just salt 

Seasoning should enhance the flavour of your dish, but it shouldn’t taste salty. Try adding chilli flakes, spices such as cumin or coriander, fresh herbs such as parsley or mint, or the juice or zest of a lemon to enhance the flavour of your meal without adding additional salt

• Make your own stock

Use the leftover bones of your Sunday roast, or fresh veg stock. Stock cubes often contain large amounts of salt! If you don’t have time to make your own fresh stick, try buying very low salt stock cubes!

• Watch the sauce

Be conscious of your use of soy sauce or pre-made sauces; these tend to be very high in salt!

Part Three: Fibre

1. Enjoy plenty of fibre rich foods!

Fibre has so many benefits for our health and wellbeing – from looking after our gut to helping keep our blood glucose levels stable It can also contribute to our cardiovascular health. 

A form of  fibre, found in oats and barley, called Beta Glucans has been shown to decrease levels of LDL and total cholesterol. It works by forming a gel in the gut which binds with cholesterol rich bile salts and prevents them from being reabsorbed into the body. Consumption of 3g of beta glucans a day (35g of porridge oats contains approximately 1g) has been shown to bring about these benefits for cholesterol levels and heart health.

Fibre is also fermented by microbes in the gut, to produce substances called short chain fatty acids (such as butyrate, propionate, and acetate). These short chain fatty acids are thought to suppress cholesterol production, thereby reducing levels of cholesterol in the bloodstream and lowering risk of cardiovascular issues.

Current recommendations for fibre intake are 30g per day. This can be achieved by including a wide variety of fruit and vegetables (where possible with the skin left on), whole grains, beans, pulses, nuts and seeds as part of your balanced diet. The table below provides an approximate  indication of how much fibre is in  some everyday foods

Type of food	Foods	Typical portion size	Fibre content*
Starchy foods	Bran Flakes wheat, biscuit, breakfast cereals oats wholemeal bread wholewheat spaghetti brown rice barley quinoa baked potato with skin on	40g 2 30g 2 medium slices 75g raw 75g raw 25g raw 30g raw medium	5.4g 3.9g 2.3g 5.2g 8.8g 3.8g 3.1g 2.1g 4.3g
Fruits & veg	Apple banana strawberries dried raisins dried apricots prunes broccoli carrots	medium medium 80g 30g 30g 30g 80g, steamed 80g, boiled	2.1g 1.4g 3.0g 1.8g 6.5g 1.7g 2.2g 2.2g
Lentils, beans & peas	Peas baked beans kidney beans red lentils chickpeas	80g, cooked 200g 100g, cooked 100g, cooked 100g, cooked	4.4g 9.8g 8.5g 4.1g 4.8g
Nuts & seeds	Unsalted peanuts peanut butter almonds walnuts sunflower seeds chia seeds linseeds	a handful, 30g 1 tbsp a handful, 30g a handful, 30g 25g 1 tbsp 1 tbsp	2.2g 1.4g 4.8g 1.8g 1.8g 3.9g 2.6g

2. Include a wide variety of fruit and vegetables every day!

Aim for a minimum of 5 portions of fruit and vegetables a day, with more emphasis on vegetables than fruit. 

Not only do fruit and vegetables contain heart healthy fibre, vitamins, minerals and antioxidants they also contain substances called stanols and sterols. These substances are very similar to cholesterol in their structure, they help to reduce the amount of cholesterol absorbed in the gut  and have been associated with lower amounts of total and LDL cholesterol in the bloodstream. 

It’s estimated that average diets provide around 300mg of plant stanols and sterols per day, with people consuming a plant-based diet having as much as double this amount.

For those with significant cardiovascular risk factors, especially those with high blood cholesterol levels, eating foods that have added (fortified) plant stanols and sterols may also be beneficial. Data from clinical trials show that an intake of 1.5 to 2.4g per day can lower cholesterol by seven to ten per cent in people with high cholesterol.

Fruit and vegetables are also rich in the mineral Potassium, potassium has many important roles throughout the body. One of these is acting as a vasodilator, it relaxes the walls of the blood vessels, thereby lowering blood pressure.

3. Include a variety of dairy foods throughout the day

Include 2-3 portions of dairy food or fortified dairy free alternatives in your diet each day. 

Dairy products are rich sources of the mineral calcium, which also plays an important role in blood pressure regulation and vascular health, it is responsible for blood vessels constricting and relaxing.

Part Four: General tips for heart health

1. Avoid yo-yo dieting or weight cycling!

As discussed in January’s blog, being in a dieting cycle has many detrimental effects for our psychological and physical health. Research has shown that repeated dieting may also be damaging to our heart health as well. It has been shown to increase inflammation, which in turn is known to increase risk for many chronic diseases, including hypertension and insulin resistance. Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk.

Ditch the extreme diets and work towards eating in an enjoyable,  balanced, sustainable way!

2. Get active

Being regularly active is an important way of looking after our cardiovascular health. 

Research by Public Health England indicates that 22% of adults in the UK are getting less than 30 minutes of moderate exercise a week. Current recommendations state that each week, adults should accumulate at least 150 minutes (2 1/2 hours) of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity.

 If you feel like your activity level at the moment is below the recommendations, start making some gradual changes to increase the amount of exercise you are doing. Try experimenting with different things to see what you enjoy and what feels good for you! 

• Do a classes or exercise with a friend 
• Try participating in team sports
• Or fun solo activities like cycling. 

The key to keeping it up is making sure you are having fun! Incidental activity can also be really valuable, walking upstairs instead of getting the lift or walking home instead of getting the bus are also great ways to up your activity level!

3. Consider your gut health

A number of animal studies have shown that polyphenols (a type of antioxidant found in plants) are linked to heart and circulatory health, however approximately 90 percent of them can’t be digested by human cells. Instead, we rely on the microbes in our gut to ferment them, so they can be absorbed into the body.

Research has  shown that the typical mediterranean diet is beneficial  for heart and circulatory health, as well as gut health. The mediterranean diet has been shown to increase the diversity of our microbes in our gut, and it’s this diversity that is linked to a lower risk of chronic conditions, including heart and circulatory diseases.

4. Limit alcohol 

It’s recommended we drink no more than 14 units of alcohol a week, spread across at least 3 days. That’s around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer. There’s no completely safe level of drinking, but sticking within these guidelines lowers your risk of harming your health. Aim for at least 3 alcohol free days a week 

5. Stop smoking or using tobacco products

Stopping smoking is described by the British Heart Foundation as the single best thing you can do for your heart! If you are currently a smoker or using alternative tobacco products, visit your GP and ask for advice and support about how to quit.

6. Take care of your mental health!

Research increasingly shows the importance of taking care of our emotional well-being, and the impact this can have on physical health. 

Mental health conditions such as anxiety, depression, stress and PTSD have been associated with increased heart rate, increased blood pressure, increased levels of the stress hormone cortisol and reduced blood flow to the heart. 

Over time, these physiologic effects can develop into cardiovascular disease. Mental health disorders may increase the chance of adopting behaviours such as smoking, being less active, or failure to take prescribed medications. This is because people experiencing mental health issues may have fewer healthy coping strategies for stressful situations, making it difficult for them to make healthy lifestyle choices to reduce their risk for heart disease.

Useful strategies:

• Support from trained mental health and medical professionals
• CBT
• Meditation
• Mindfulness techniques
• Prescribed medication
• Regular exercise 

are just some of the strategies that can be useful. 1 in 4 people experience some kind of mental health concern each year in England, these issues are incredibly common but unfortunately aren’t always readily discussed. If you are struggling with mental health concerns, don’t struggle alone, confide in friends and family and seek help and support from your GP or a trained mental health professional.

7. See your doctor and have regular checks 

Lastly, many risk factors for cardiovascular disease, such as high blood pressure, high blood cholesterol and diabetes, occur gradually over time. Very often people don’t discover they have these conditions till later in life when they are visiting medical professionals on a more regular basis. Regular visits to be screened by your GP (especially if you have a family history of cardiovascular disease, hyperlipidaemia or high blood pressure) can be a way to identify any trends or changes  and to make adaptations in advance of more serious conditions developing.

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