The European Society of Cardiology published a comprehensive review.
Diet is one of the pillars of heart care (along with exercise and not smoking). What, how much, and how often to eat each food is the objective that a team of researchers set out to establish based on the best available evidence. The results of their exhaustive review were published in Cardiovascular Research, a journal of the European Society of Cardiology.
“There is no indication that any food is poison in terms of cardiovascular risk. It’s a question of quantity and frequency of consumption,” said the paper’s first author, Professor Gabriele Riccardi of the University of Naples Federico II in Italy.
“A mistake we made in the past,” he admitted, “was to consider one component of the diet as the enemy and the only thing we had to change. Instead, we should consider diets as a whole and if we reduce the amount of food, it is important to find a healthy substitute.”
Less salt and more vegetables
Overall, there is strong evidence that for healthy adults, low intake of salt and animal foods and increased intake of plant-based foods (whole grains, fruits, vegetables, legumes, nuts) are associated with a lower risk of atherosclerosis.
Atherosclerosis involves the formation of plaques in the walls of the arteries (generated by an accumulation of fats, cholesterol, and other substances) that can restrict or block blood flow and thus increase the risk of stroke, heart attack, and cardiovascular disease.
Among heart-friendly practices, there is also consistent evidence of benefits in substituting butter and other animal fats for vegetable oils such as olive oil. And they clarify that they should not be tropical (such as coconut oil).
The new evidence differentiates processed and red meat, both associated with an increased risk of cardiovascular disease, from poultry (chicken, turkey, among others), which do not show this association if consumed in moderation (up to three 100-gram servings per week).
Red meat (i.e., beef, pork, lamb) should be limited to two 100-gram servings per week and processed meat (i.e., cold cuts, bacon, sausages) should be limited to occasional consumption.
Poultry may be a suitable protein alternative to red meat, but researchers stress the importance of moderation in quantity and frequency.
The authors suggest legumes as a protein substitute for red meat and on the quantity, they point out that they can be consumed up to four portions of 180 grams per week.
The moderate consumption of fish (two to four portions of 150 grams per week) is also supported by the most recent evidence for the prevention of heart disease. The problems, they clarify, would be linked to sustainability.
Fruits and vegetables
As for fruits and vegetables, given their strong association with a lower risk of atherosclerosis, daily consumption should be increased to 400 grams each. As for nuts, a handful, about 30 grams per day, is recommended.
The article notes that, for the healthy population, recent evidence does not support the requirement to use low-fat dairy products instead of the whole to prevent heart disease. On the contrary, both whole and low-fat dairy products, in moderate amounts and in the context of a balanced diet, are not associated with increased risk, they noted.
“Small amounts of cheese (three 50-gram servings per week) and regular consumption of yogurt (200 grams per day) are even linked to a protective effect due to the fact that they are fermented,” Riccardi noted.
“We now understand that gut bacteria play an important role in influencing cardiovascular risk. Fermented dairy products contain good bacteria that promote health,” he said.
About cereals, the indications are strongly linked to the glycemic index (GI) of the food. Those with a high GI raise blood sugar more rapidly than those with a low GI.
High GI foods (i.e. white bread, white rice) are associated with an elevated risk of atherosclerosis. Their consumption should be limited to two servings per week and should otherwise be replaced with whole-grain foods (i.e. bread, rice, oats, barley) and low-GI foods (i.e. pasta, parboiled – steamed – rice, corn tortilla).
As for infusions, coffee and tea (up to three cups daily) are associated with a lower cardiovascular risk.
Soft drinks, including low-calorie options, are associated with a higher risk and should be replaced with water, except on limited occasions.
Moderate alcohol consumption (wine: up to two glasses per day in men and one glass in women; or one can of beer) is associated with a lower risk of heart disease compared to higher amounts or abstinence.
However, about that, Riccardi said that “considering the overall impact of alcohol on health, this evidence should be interpreted as the maximum allowable intake rather than a recommended amount.”
As for chocolate, the available evidence allows up to 10 grams of dark chocolate per day. The authors state that “for this amount of consumption, the beneficial effects outweigh the risk of weight gain and its harmful consequences on cardiovascular health.”
The place of pleasure
According to Ricciardi, eating must be enjoyable to motivate healthy people to make long-term changes. “We need to rediscover culinary traditions such as the Mediterranean diet that has delicious recipes based on legumes, whole grains, nuts, fruits, and vegetables.”
“A strategy based exclusively on nutritional guidelines and education will not be enough to change the lifestyle of the population. Policies to be considered must necessarily include initiatives to facilitate the production, marketing, availability and affordability of foods that are not only healthy but also gastronomically attractive.”
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