How to Survive Heart Disease

It creeps into your life slowly when you least expect it – silent and sometimes deadly. You might be at your son’s swimming class cheering him on, or you might be out with your friends enjoying a beer and watching the game. You might feel a sudden shortness of breath or tightening of your chest…

Nausea could kick in and beads of sweat might roll down your forehead. You brush it off; ‘she’ll be right,’ you think. But the truth is, the way you act now could change everything. In 90 minutes you could go for a run, read this article, make a coffee, hug your partner and devour a delicious but greasy burger. During this time, one New Zealander will have died from heart disease, leaving a child alone and friends in shock.

The facts are here; heart disease is a silent killer. As the leading killer of men in New Zealand, heart disease accounts for 30 percent of deaths annually. Many of these deaths are preventable; whether it requires a small lifestyle change or a complete overhaul of your life, we need to open our eyes to the truth – too many men and women are dying prematurely. Almost one in 20 adults have been diagnosed with heart disease; look around your office, look around your group of friends – who will it be?

Heart disease is not one size fits all; there are over 13 different heart conditions, including angina, heart attacks, high blood pressure and high cholesterol. It really is a minefield of terms and the facts are as terrifying as the statistics. Especially now that more and more of us are suffering from high cholesterol or high blood pressure – knowing someone who has cholesterol-free butter in their house is becoming more and more common.

By now, everyone should know that we have to take heart health seriously. New Zealand Heart Foundation medical director and associate professor at the University of Auckland, Gerry Devlin, has one more message that might help it sink in. He said that one in three New Zealanders will die of heart disease and we need to acknowledge that. “Heart health is important because it is New Zealand’s single biggest killer,” he said. “Please don’t ignore the symptoms that might be coming from your heart.”

As Kiwis we are known for our laid-back attitudes and our unique take on the world. It’s one that does not see us heading to the doctor at the first sign of heart pain. “The [myth] that we are trying to dispel is the one when kiwi males get a little bit of chest discomfort and say ‘she’ll be right mate’, when it might not be… As we grow up we need to realise we are not bulletproof.”

Aging is sadly an undeniable part of life, no matter what we eat, do or apply to our skin. Men and women alike hope to age gracefully, but as Devlin said, “a lot of the people we see (as we all get older) will be living with heart disease… [it is] more prevalent as we get older, it increases [and] men are more likely to get heart disease than women.”

So what does it all come down to? It is actually incredibly simple. “All of us can reduce our risk of having a heart-related illness by being more active. We would recommend exercise where you get your heart rate up for about 30 minutes five to six days a week. We also advise healthy eating, [which] is a very confusing area but for most of us, what we are talking about is a balanced, commonsense diet and sensible eating.”

When you take a look online, you will be faced with various controversial topics surrounding prevention of heart diseases. One of the most common is the idea that if you are over 55 years old, you should take aspirin for prevention, as it is believed aspirin can interfere with your blood’s clotting action, which can in turn prevent a heart attack. Devlin said that this is very controversial and it has everything to do with your absolute risk. “If you are a middle-aged man and you’ve got a bit of diabetes, high blood pressure and your cholesterol is up, then yes, aspirin is probably good for you to take. There is also evidence coming out to say that aspirin may reduce our likelihood of developing bowel cancer. So I think there are other bits in the whole equation. But, if I am 55 and my only risk factor is a bit of blood pressure or a family history, then maybe the risk of taking an aspirin is higher than the potential benefits [so] it’s just trying to tease that out.”

Considering heart disease is such a significant issue in New Zealand, there should be an assumption that the healthcare available is up to standard. Devlin said that something they have been quite passionate about is improving access to cardiovascular healthcare in New Zealand. He said that in the past 20 years he has seen a significant improvement in access to heart health in here, and said we are in a much better place than we have ever been. In other words, people are much more likely to be put on waiting lists that move quickly today than even five years ago and there are better drugs available. Of course, in a sector that is rapidly changing – with population shifts and aging – Devlin admits that there are still issues to address. “If you live in a rural area such as Taranaki, Gisborne or Rotorua you are less likely to be seen as quickly than if you live in the Waikato where we have got a lot of cardiologists. It is much better than it was.” As the health sector continues to strive for better healthcare opportunities for New Zealanders, it is up to us to work on prevention.

Now that more Kiwis are living with heart disease than ever before, there is a finger (rightly) being pointed at our lifestyle. Alcohol, processed foods, stress and less movement are all culprits in poor heart health. We spoke with three nutritionists and raised a few somewhat controversial topics surrounding heart health.

Are there any messages being distributed that you think lead people astray?

Dane Fuller, Weight Loss Coach (Reg Nut, BSc, BPhEd, NLP cert).

If it’s natural, it’s good for you. If it is processed in any way, it is bad for you. For example, people may believe full fat milk or yoghurt is better than low fat even though the lower fat version has fewer calories and less saturated fat. The argument ‘that consuming foods that are higher in fat means we eat less because we feel more satisfied’ is flawed in the thinking that satiation come purely from speed of digestion. Our habits, eating style and visual cues also contribute to how much we eat. If you have a pottle of high fat yoghurt, are you going to leave a quarter in the bottom or eat the lot? There is some debate that saturated fat is not as bad for us as was once thought, but it sure as hell has not been shown to be good for us! So why encourage people to eat more of it, replacing unsaturated fats, which, there is no doubt, are good for us?

Kate Morland, Dietitian, Sports Nutritionist & Exercise Specialist.

I believe the ‘cut out sugar and carbohydrates message’ is leading people astray. It’s one thing to suggest cutting down on processed foods high in added sugar (which I agree with), but many people are taking it to the extreme and cutting out whole foods like fruits, whole grains and milk products. The media in general jumps on a topic, usually with very little context and sound research and by making it sound compelling; the public generally believes it. And another thing: we’ve lived in a ‘low fat’ world for some time, and I think we’ve done a poor job at promoting healthy fats in our diet. We should be encouraging people to eat a variety of raw nuts, seeds, oily fish, avocado and some oils. The message to avoid fat in order to lose weight or improve health has not been explained well enough.

Angela Berrill. National Nutrition Advisor for the New Zealand Heart Foundation.

Science is a continually evolving process, and we continue to learn more about the impact of food on health all the time. However, that can mean it’s a confusing time for the public, where some nutrition messages are not put into context with regards to the totality of evidence. It is important that any new study is reviewed in context and that the results are not looked at in isolation.
Despite sensational news headlines, the few recent studies that promote saturated fat are not sufficient to refute the large existing body of evidence that shows a strong link between a higher intake of saturated fats, elevated blood cholesterol and heart disease. There is clear evidence to show that replacing saturated fat with unsaturated fats, particularly polyunsaturated fats, has benefits for heart health. The Heart Foundation’s position remains the same – that we should replace saturated fats in our diets with unsaturated fats. That means getting our fats from foods like avocado, oily fish, nuts and seeds, and plant oils like olive and canola oils, instead of foods like butter, cream, meat fat and coconut.

What type of diet plans actually work?

DF: Programmes and coaching that focus on habits, routines and changing behaviour from the inside out – values, beliefs and goal setting.

KM: Those that are individualised to a person, taking into account their nutritional needs in terms of life stage, activity levels, goals and health status.

AB: Because foods and nutrients are not eaten in isolation, it’s important to focus on the overall dietary pattern. There are many ways we can eat to support our health and all of them are simple variations on a common dietary theme.

The Heart Foundation’s advice emphasises eating a dietary pattern based largely on whole and less-processed foods with plenty of vegetables and fruit. Include some whole grains or, in place of refined grains; legumes; nuts; seeds; and other sources of healthy fats such as oily fish. It may also contain non-processed lean meats or poultry and/or dairy. By focusing on a dietary pattern such as this, the nutrients will take care of themselves.

When it comes to food what are the main culprits?

DF: Processed and packaged food. Eat simple, fresh and whole foods and plenty of fruit and veges.

KM: In regards to health issues and diseases in general, highly processed, energy-dense foods are contributing to excess energy intakes. People are also justifying high-energy foods that preach health messages – e.g. gluten-free, sugar-free – and eating them with no regard to whether or not they need the extra energy. I often work with clients who rarely ever experience hunger. We’re snacking our way to obesity, fearful of going without. From experience, I see people restricting whole foods like brown rice because it contains ‘carbs’, but then chowing down on chocolate or chippies after dinner.

AB: The Heart Foundation’s advice recommends that we cut back on junk foods, takeaways,and foods or drinks high in sugar, salt, saturated or trans fats. The link between a higher intake of saturated fats, elevated blood cholesterol and heart disease is well established. The current body of evidence supports replacing saturated fats with polyunsaturated fats, to reduce the risk of heart disease. The healthy fats are unsaturated fats found in higher amounts in plant foods like nuts, seeds, plant oils and avocado, as well as in oily fish. Eating these in place of animal fats is one part of a heart-healthy way of eating that improves cholesterol levels and reduces risk of heart disease. Evidence also shows that replacing saturated fats with more refined carbs (e.g. sugar, white flour products, refined cereals etc.) is not good, in terms of heart disease risk. Evidence shows that eating too much salt (sodium) can raise blood pressure, which is a leading risk factor for heart disease and stroke. Cutting down on the amount of salt we eat helps reduce blood pressure. However, our whole diet is also important, as is being a healthy body weight and, if drinking alcohol, doing so in moderation. If we follow a heart-healthy way of eating and [keep it to] the right amount, then the foods and nutrients will ultimately take care of themselves.

What is the deal with cholesterol free food? Is it really effective?

DF: The main source of cholesterol in our body is what our body makes cholesterol from – saturated fat in our diet.

AB: There are two types of cholesterol. The first is made by our bodies or recycled by our liver – blood cholesterol. The second is called dietary cholesterol, which is found in the foods we eat. While some cholesterol in our body is essential, the type and amount of cholesterol in our blood correlates with heart disease risk. Cholesterol in food only has a small effect on the level of cholesterol in your blood. It is saturated fatty acids that have a greater effect on blood cholesterol levels and, therefore, heart disease risk. Rather than choosing foods that are ‘cholesterol-free’, there are more important changes people should be focusing on, such as increasing vegetable intake, eating more whole and less-processed foods and further reducing saturated intake. Foods high in saturated fat include, butter, lard, cream, cheese, coconut oil and palm oil.

How should you lower your cholesterol?

DF: Replace saturated and trans fat foods with unsaturated fat foods – for example eat less deep-fried foods, baking, biscuits and animal fats. Eat more vegetable oils, nuts and seafood. Exercise to increase HDL cholesterol, which will help to clean up the LDL cholesterol. Eat less food!

KM: I suggest to my clients that they aim for a balanced intake of whole foods, including a variety of healthy fats such as salmon, nuts, seeds and plant oils. Include plenty of fibre from vegetables and whole grains, lean protein sources and, of course, include the odd treat for a sustainable and happy relationship with food. Portion control and eating swithin your energy needs is essential. Lastly, daily exercise is essential to overall health. For some people, cholesterol may not be lowered through lifestyle measures and therefore may require a pharmacological approach.

AB: Your body needs some cholesterol to work properly, but too much cholesterol in the blood can create a fatty build-up in your artery walls, narrowing arteries and restricting blood flow. This can lead to a heart attack. Making healthy changes to your lifestyle will help you lower your cholesterol and risk of having a heart attack. This includes:

• Following a heart-healthy dietary pattern (see above)
• Maintaining a healthy weight
• Exercising regularly
• Being smoke-free
• Managing blood pressure
• Managing diabetes
• Managing stress
• Taking any medications prescribed by a doctor

What are messages that some nutritionists are sending out that you disagree with?

DF: That we can eat our way out of poor health. If you have a poor diet and poor health, you are kidding the public by advising them to eat certain ‘superfoods’ and everything will be OK. This is a soft, sticking plaster approach that wants to appease the public by giving them something easy. The nutritionist is putting their own agenda before the public’s. If people want to become healthy they must start by doing something that has the biggest impact on their health (get rid of the crap) and then work their way towards these smaller changes that a ‘superfood’ may bring. Would you put spoilers on your car to make it go faster after you redo the engine or before? But the spoilers sure are an easier sell, especially if you sell them… [Also] the term ‘nutritionist’ has been bastardised to refer to a very wide variety of clinicians, all with very different educational backgrounds, competing in an unregulated environment. It is the Wild West, where science is up against natural health, and with no sheriff in town, natural health is winning, sometimes to the peril of the public.

KM: It depends who you are calling a nutritionist. There are registered nutritionists and dietitians, who are required to adhere to a code of ethics, and then there are those not regulated who are free to share whichever dietary messages they see fit. There are loads of messages out there in the media that are not only unfounded, but also detrimental to people’s health. The obsession with sugar-free diets is one particular message I am very anti; as I am seeing increasing numbers of people, both men and women, with developing disordered eating, restrictive diets and anxiety around eating. Other messages I disagree with are going on detoxes and juice cleanses and restricting whole food groups in general.

AB: Rather than focusing on the differences, it is important to look at the common elements where most nutritionists would agree. Around the world, we see various dietary patterns that support a long and healthy life. Well-known examples include: the traditional Mediterranean diet, the vegetarian diet of the Seventh-Day Adventists and the largely plant-based diet of the Okinawans in Japan. These dietary patterns all reflect a range of fat, carbohydrate and protein intakes but share some common themes:

• Eating mostly whole and less-processed foods
• Largely plant-based, with plenty of vegetables and fruit
• Includes plant foods like nuts, legumes and intact, whole grains
• Often feature fish, seafood +/- unprocessed meats
• Including healthy sources of fats – like nuts, seeds, avocado, healthy oils, oily fish

All foods can be a part of a healthy diet; it’s simply that some of us need to eat more of some and less of others. If we focus on the consistent themes of healthy eating, we can each apply them in the way that suits us best, without going to extremes. By following a heart-healthy way of eating and in the right amounts, then the nutrients will ultimately take care of themselves.

The experts have spoken, and all views have been covered and no matter what their methods may be, they are want to create a healthier New Zealand. You may be sitting there having read all of this, thinking you are not at risk. You do not smoke, you get 30 minutes of exercise a day and you eat five or more servings of fruit and vegetables in a day. But remember, each year 3464 men die from heart disease.

• Cardiovascular disease (heart, stroke and blood vessel disease) is still the leading cause of death in NZ, accounting for 30 percent of deaths annually
• Every 90 minutes a New Zealander dies from heart disease
• Many of these deaths are premature and preventable
• Almost one in 20 adults have been diagnosed with heart disease. That’s 169,000 New Zealand adults
• It is estimated that 5000 people die prematurely from smoking each year – this equates to around 12 people a day dying from smoking
• 3464 male deaths from heart disease, 1305 of which are heart attacks
• 647 male deaths from prostate cancer
• Are you over 55 (or 45 for Maori and Pasifika men)? If so, are you getting a blood pressure and cholesterol check?