What to eat for a healthy heart

Is there such a thing as a heart-healthy diet? To what extent should we give up animal protein, salt and carbohydrates? We discuss this with cardiologist Martin Juneau and nutritionist Anne-Julie Tessier.

Who are our experts?

Martin Juneau is a cardiologist and director of the Prevention Observatory at the Montreal Heart Institute. He has been interested in cardiovascular prevention worldwide for 40 years.

Anne-Julie Tessier is a registered dietitian-nutritionist, PhD in nutrition, and a research associate in the Department of Nutrition at Harvard University. Her research focuses on nutrition and healthy aging.

There is a certain distrust of nutritional science, partly because it sometimes seems contradictory. Can we really say that certain diets or foods are good or bad for the heart?

Answer from AJT: Without classifying foods as good or bad, there are certainly types of diets that are better for the heart. Several studies support this. In addition to the food itself, the frequency of consumption is also important.

MJ: In the scientific literature, we’ve been saying pretty much the same thing for 25, 30 years: more fruits, vegetables and whole grains, and less added sugar, salt, bad fats and ultra-processed foods. The problem is the small studies on the fringe, that are not very well done, that are clickbait and that unfortunately make the news too often.

What is the most important thing to eat to maintain a healthy heart?

Answer from AJT: Fruits and vegetables stand out, among other things because they are rich in fiber, but also in potassium, a mineral that helps regulate blood pressure. And vegetable oils, with their interesting content of fatty acids, omega-3, omega-6, legumes, oats, seeds for their fiber…

Anne-Julie Tessier, you recently participated in studies evaluating the ratio of plant to animal proteins in the diet and heart health. Should we replace animal proteins entirely with plant proteins?

Answer from AJT: Not necessarily. When we talk about nutrition, we have to take into account our culture, our preferences, and the environment. We recently conducted analyses in two Harvard cohorts with a follow-up of more than 30 years. We found that the more people consumed plant proteins compared to animal proteins, the lower their risk of cardiovascular disease. The lowest risk was observed at a ratio of 1:2. Above this ratio, we saw more of a plateau. Increasing our intake of plant proteins can therefore be beneficial, without having to eliminate animal proteins completely.

MJ: I think we need to separate the general population from recommendations for heart patients. In the past, famous studies have shown that with a strict plant-based diet, we can reverse coronary artery disease—not just prevent it, but treat it. Of the patients who are truly afraid of having another cardiovascular event, many agree to drastic changes in their diet. In over 35 years of practice, I have rarely seen a patient who has gone vegan return to the emergency room.

We know that red meat is bad for your heart, but what about chicken, eggs, fish and dairy?

Answer from AJT: In moderation, these foods have their place in a healthy diet. When you put them together, studies show that greater adherence to a plant-based diet is associated with about a 15% lower risk of heart disease. But diets like the Mediterranean diet, which includes fish, eggs, and some dairy, or the DASH diet, which includes animal protein in moderation, are also associated with a lower risk of heart disease.

MJ: Our general recommendation is the Mediterranean diet. The vegan diet is suggested to highly motivated people who have a particularly nasty disease. But I would like to add this: vegetarian, but of good quality.

Exactly, as shown by a study conducted in the springAmerican Journal of Clinical Nutrition showed that meat substitutes like the Beyond Burger and Impossible Beef are no better for heart health than meat, at least in the short term…

MJ: We really don’t recommend these things because they are full of salt and the list of ingredients is so long you need a PhD to read them. Same goes for spaghetti with white pasta and tomato sauce with fries and a coke: it’s vegetarian, but it’s junk food.

The American Heart Association recommends choosing foods with little or no salt. Do you really not need to add salt?

MJ: A tomato with basil, without salt, for someone who is not used to it, it tastes nothing. But I guarantee you that after a month you will notice that it tastes even better without salt! Many organizations recommend 1.5 grams, 2 grams a day, but Canadians eat 5 or 6. That is way too much. Almost 50% of Canadians aged 50 and over suffer from hypertension, and most are poorly or poorly treated. (…) If you eliminate ultra-processed foods and cook your own food, you may not exceed the recommendations. Added table salt can only account for 15% of salt intake.

Answer from AJT: The general population doesn’t necessarily need to forgo adding salt. Our sodium intake comes largely from processed foods and restaurant meals. According to the Institut national de santé publique du Québec, the top foods that contribute sodium are bread, followed by deli meats, cheese, sausage, chilled meals, pizza and chips.

And what about the ketogenic diet, low in carbs and high in fat?

Answer from AJT: The ketogenic diet certainly does not meet the recommendations of the American Heart Association, but some studies show that a ketogenic diet may have some health benefits (control of blood sugar, triglycerides, etc.) compared to a low-fat diet, but in the short term. These are all short-term studies. And in some people we see an increase in bad cholesterol. We can also question the nutritional deficiencies and the long-term adherence to this very restrictive diet.

MJ: If patients absolutely want to try it, I tell them that we can guide them, but it will be an extremely restrictive diet, with good fats like avocado, olive oil, nuts, fish… Vegetables are fine, but very little fruit. For very specific cases of type 2 diabetics maybe, but it is far from our first choice.