What to eat to beat heart disease 

All this week, we are highlighting the power of food to stop major preventable killers. Dr Michael Greger is the leading voice for the healing power of diet and lifestyle, and when we serialised his book How Not To Die in 2016, it became a UK bestseller. Now he’s released a recipe book packed with tasty meals to make it easier to eat a wholefood, plant-based diet. On Saturday we outlined his Daily Dozen — the blueprint for a disease-busting diet — with recipes that even meat-eaters are sure to love. Today, he shows how a plant-based diet can protect you and your family against one of the UK’s biggest killers: heart disease.

Heart disease is one of the top three reasons that we and most of our loved ones will die, and I am convinced our poor Western diet has a lot to answer for.

The biggest true risk factor for coronary heart disease is cholesterol.

Indeed, it’s been convincingly argued that you could be an obese, diabetic, smoking couch potato and still not develop the disease — provided the cholesterol level in your blood is low enough.

But far too many people have raised cholesterol levels because of their poor diets.

For most people raised on a conventional Western diet, cholesterol-rich gunk (plaque) accumulates inside the blood vessels that supply the heart with oxygen-rich blood.

This can lead to chest pain and pressure, known as angina. And if the plaque ruptures, a blood clot can form within the artery and cause a heart attack.

High cholesterol levels are raised by eating a diet packed with specific types of fats. These include trans fats, which you find in processed foods, meat and dairy products; saturated fat, found chiefly in animal products and junk foods; and, to a lesser extent, dietary cholesterol, which is found exclusively in animal-derived foods such as eggs.

The problem is, unhealthy, fatty meals don’t only cause internal damage decades into the future — they can trigger problems within hours of going into your mouth.

We’ve known for nearly two decades, for instance, that a single fast-food meal (Sausage & Egg McMuffins were used in the original study) is enough to stiffen your arteries within hours, halving their ability to relax normally.

But the good news is that you can reverse this damaging process just as swiftly.

There have been studies of patients with advanced heart disease who switched to plant-based diets in the hope this would stop the disease progressing further. But instead, something miraculous happened: the patients’ heart disease actually started to reverse.

They weren’t simply slowing the condition, they were actually getting better!

It seems that as soon as they stopped eating artery-clogging diets, their bodies were able to start dissolving some of the plaque that had built up.

Dr Dean Ornish, a clinical professor of medicine at the University of California, was the first scientist to prove in a randomised controlled trial that a plant-based diet and other healthy lifestyle changes could actually reverse heart disease.

Your body will regain health if you let it. But if you reinjure yourself three times a day at every mealtime, you interrupt the healing process.

It is clear that, given the right conditions, the body really can heal itself. This helps to explain why cardiac patients quickly experience relief when put on a diet made up of plant foods including fruit, vegetables, whole grains and beans.

One study reported a 91 per cent reduction in angina attacks within just a few weeks of patients starting plant-based diets.

This occurred well before their bodies could have cleared the plaque from their arteries.

In contrast, patients who didn’t change their diets had a 186 per cent increase in angina attacks.

Most GPs prescribe cholesterol- lowering statins if you’re at risk of heart attacks, so why change your diet if you can simply pop a pill?

Unfortunately, these drugs may cause undesirable side-effects, such as liver and muscle damage.

A better question to ask might be: why accept any risk if you can lower your cholesterol naturally?

Numerous studies show that many of our Western epidemics of chronic disease, including coronary heart disease, simply didn’t occur in Chinese or rural African populations who ate plant-based diets.

But when you look at populations from these countries who came to live in the West, disease rates skyrocketed as they adopted our meat-based, sugar-laced, junk- food diet.

So what did the Africans and Chinese have in common? Simple: their diets were centred on plant-derived grains and vegetables.

This means heart disease could be a choice, not a genetic inevitability.

If you are worried about your heart health, it is certainly worth considering cutting down on your consumption of meat — and it’s not only for the fat content, meat also appears to harbour endotoxin-laden bacteria, which can trigger inflammation in your arteries, even when food is fully cooked.

You should also start striving to meet my Daily Dozen recommendations (see box below), which will help improve your heart’s health.

Even if your parents died from heart disease, you should be able to eat your way to a healthy heart.

You share 50 per cent of your genes with each parent, so if one dies of a heart attack, you might have inherited some of that susceptibility. However, one reason why certain diseases tend to run in families may be that diets tend to run in families, too.

With a good diet, your family history does not have to become your destiny.

You can choose to stop hurting yourself and let your body’s natural healing process succeed.

Cut your blood pressure… with flaxseeds

High blood pressure is the number-one risk factor for death and disability worldwide, killing nine million people each year.

It puts strain on your heart, can damage sensitive blood vessels in the eyes and kidneys and can cause bleeding in the brain.

Many doctors consider increased blood pressure a natural result of ageing, just like grey hair and wrinkles — after all, more than one in four adults in the UK has high blood pressure. But we’ve known for nearly a century that blood pressure can remain stable throughout life, or even decrease after middle-age.

Commonly prescribed blood pressure pills can reduce the risk of heart attack by 15 per cent and the risk of stroke by about 25 per cent, but in one robust study, three portions of whole grains a day were shown to help people achieve this same benefit without medication.

Patients who consumed a few spoonfuls of flaxseeds every day for six months lowered their blood pressure to a degree that could be expected to result in 46 per cent fewer strokes and 29 per cent fewer instances of heart disease over time. This is one of the most potent changes ever to come from dietary intervention, and is two to three times more effective at lowering blood pressure than exercise (not that you shouldn’t do both).

It’s one reason why flaxseeds hold a vital place in my Daily Dozen (overleaf). Sprinkle a spoonful over cereal, soups, salads and stews every day.

FOOD FOCUS… BEETROOT

Beetroot is a concentrated source of vegetable nitrates, which can lower blood pressure and improve blood flow.

In one study, men and women who ate 300g of baked beetroot before a race improved their running performance while maintaining the same heart rate and even reporting less exertion. And one little shot of beetroot juice has been found to allow free-divers to hold their breath for half a minute longer than usual.

This has implications for blood pressure control. A 2015 study found people who drank a 250ml glass of beetroot juice daily for four weeks reduced the top number of their blood pressure by eight points.

Better still, the benefits grew week by week, suggesting their blood pressure might have continued to improve even further.

The scientists concluded that ‘nitrate-rich vegetables may prove to be cost-effective, affordable and favourable for a public health approach to hypertension [high blood pressure]’.

The optimal dose appears to be 125ml, but beetroot juice is perishable, processed, and hard to find, so enjoy the vegetable roasted in as many meals as you can.

For best results, whip up a rocket and beetroot salad. Rocket contains a whopping 480mg of nitrates per 100g serving, so together they create a powerful dish.

Tasty beetroot veggie burgers 

Makes 6 burgers

Provides: Beans, other veg, nuts and seeds, herbs and spices, whole grains.

• 75g minced red onion
• 2 garlic cloves, minced
• 150g grated raw beetroot
• 100g minced mushrooms
• ½ tsp smoked paprika
• ½ tsp mustard powder
• ½ tsp ground cumin
• ½ tsp ground coriander
• ¼ tsp turmeric powder
• 425g black beans, rinsed
• 250g cooked brown, red or black rice, teff or quinoa, well drained and blotted dry
• 1 tbsp ground flaxseeds (or linseeds)
• 1 tbsp white miso paste
• 50g rolled oats, blitzed into a coarse flour
• 55g ground walnuts
• 6 x 100 per cent whole grain rolls
• Salad leaves and extra toppings, to serve

Heat 60ml water in a large frying pan over a medium heat. Add the onion and cook for about 5 minutes until softened. Stir in the garlic, then add the beetroot and mushrooms and sprinkle on the paprika, mustard powder, cumin, coriander and turmeric. Mix well. Cook until the vegetables are soft and the liquid is absorbed — about 4 minutes.

In a large bowl, mash the black beans well to break them up. Add the cooked grains, flaxseeds and miso paste. Mash to combine, then add the oats and walnuts, then the cooked vegetables. Combine until the mixture holds together when pressed between your thumb and forefinger.

Divide into six equal portions and use your hands to shape them into balls. Press the balls into patties and transfer them to a plate. Refrigerate for a minimum of 30 minutes. Preheat the oven to 190c/170c fan/gas 5. Line a baking sheet and arrange the burgers on top. Bake for 30 minutes, gently flipping the patties about halfway through. Serve in a bun with green leaves, and add extra salad toppings if you wish.

Tender roasted beetroot with balsamic braised greens

Serves 4

Provides: Greens, other veg, herbs and spices.

• 1 bunch medium beetroot with greens, if possible
• 1 red onion, cut into 1cm wedges
• 1 tsp dried oregano
• 120ml balsamic vinegar
• 2 tsp date sugar/syrup
• 1 tsp grated orange zest
• Ground black pepper

Preheat the oven to 200c/180c fan/gas 6. Remove greens from beetroot and rinse, discarding large stems. Trim ends of beetroots, leaving skins on, and scrub well, cutting large ones in half lengthways.

Line a baking dish with parchment and place beetroot and onions in a single layer. Season with oregano and cover tightly with foil. Roast for 30 minutes, then uncover, stir, and return to oven for 10 minutes until the beetroot is tender. Meanwhile, finely chop the beetroot greens and transfer to a frying pan with 60ml of water. Cook over a medium heat until tender. Stir in vinegar and date sugar or syrup, then increase heat to medium-high and cook until the vinegar has reduced to a syrup. When the beetroot is ready, cut into wedges and discard the outer skins. Transfer to a serving dish, top with the greens, and add orange zest, tossing lightly to coat. Sprinkle with pepper and serve.

Rocket pesto pasta with roasted veg 

Serves 4

Provides: Greens, other veg, nuts and seeds, herbs and spices, wholegrains.

• 3 garlic cloves
• 675g fresh rocket or spinach
• 30g fresh basil leaves
• 2 tbsp tahini
• 2 tbsp white miso paste
• 1 tbsp brown rice vinegar
• 4 shallots, halved or quartered
• 1 large red or yellow pepper, diced
• 2 courgettes, cut into 1cm slices
• 8 white mushrooms
• 8 cherry tomatoes
• ¼ tsp onion powder
• ¼ tsp garlic powder
• ¼ tsp ground black pepper
• 225g wholegrain pasta, bean noodles, vegetable noodles or rice
• Nutty Topping (optional)

Chop garlic cloves in a food processor, then add the rocket and basil and blitz. Tip in the tahini, miso paste and vinegar, and blitz again until smooth. Transfer to a bowl and set aside. Preheat oven to 220c/200c fan/gas 7. Place the shallots, pepper, courgettes, mushrooms and tomatoes in a large bowl and sprinkle with onion powder, garlic powder and black pepper, tossing to coat. Transfer the seasoned vegetables to a baking sheet lined with baking parchment and place in a single layer. Roast until tender for 20 to 25 minutes, turning halfway through. Meanwhile, cook the pasta then drain it, reserving 120ml liquid, and transfer to a large, shallow bowl. Blend the cooking liquid with the rocket pesto and mix into the pasta. Top with the roasted vegetables and Nutty Topping.

The other delicious veg that can help

Researchers have found that kale may help control cholesterol levels. In one study, it substantially lowered ‘bad’ LDL cholesterol and boosted ‘good’ HDL levels by the same amount as running 300 miles — kale certainly deserves its nickname, ‘queen of greens’.

Mango, avocado and kale salad 

Serves 4

Provides: Fruit, greens, nuts and seeds, herbs and spices.

For the dressing:

• ½ orange, peeled
• 1 tbsp rice vinegar
• 2 tbsp tahini
• 1 ½ tsp grated ginger
• 1 garlic clove, minced
• 1 tbsp minced spring onion
• 2 tsp minced fresh parsley or coriander
• 1 tsp white miso paste
• 1 tsp date syrup
• ¼ tsp turmeric
• Pinch cayenne pepper (optional)

For the salad:

• 335g kale or baby spinach
• 1 ripe mango, peeled, pitted and cut into 1cm dice
• 1 ripe avocado, peeled, pitted and cut into 1cm dice

Blitz all the dressing ingredients until smooth. Set aside. Then combine the kale, mango and avocado in a bowl. Pour on the dressing and toss gently to combine.

The yellow fluid around tomato seeds helps to stop the production of blood clots, which cause heart attacks. So if you eat only tomato sauce, juice or ketchup, you may be missing out because the seeds are removed. Choose whole, crushed or chopped tomatoes instead of tomato sauce, puree or paste.

Indian-style spinach and tomatoes 

Serves 4

Provides: Fruit, greens, other veg, herbs and spices.

• 450g fresh spinach
• 400g BPA-free tin or Tetra Pak tomatoes
• 1 ½ tsp grated fresh ginger
• 1 tsp ground coriander
• ¼ tsp turmeric
• ¼ tsp ground cumin
• ¼ tsp chilli flakes
• 225-350g chestnut mushrooms, sliced
• 1 tbsp white miso paste
• Quinoa or rice, to serve

Steam spinach, then drain and blitz in blender. Drain tomato liquid into a pan over medium heat. Add spices and mushrooms and cook for 1 minute. Mix in tomatoes and miso and cook for 3 minutes before adding spinach. Cook until well blended. Serve over quinoa or rice.

How your spice rack could stop you having a stroke

Can eating herbs and spices reduce your risk of having a stroke? More than 100,000 people in the UK are affected by a stroke each year, making it the third leading cause of death.

The majority of strokes happen when blood flow to part of the brain is cut off by a clogged artery, depriving that part of the brain of oxygen.

There are links with heart disease here. Most strokes can be thought of as ‘brain attacks’ — in a similar style to heart attacks — because they happen when fatty deposits in arteries break off and travel to the brain, or when poor blood flow caused by an irregular heartbeat forms a blood clot.

A massive stroke may kill you instantly, while a series of mini-strokes may gradually disable and kill you over several years.

But just as a plant-based diet reduces your risk of heart disease, the studies show it can lessen your stroke risk, too.

Try bright, fibre-rich grains to banish clogged arteries 

A number of studies have shown that eating more fibre may ward off strokes, but our modern diet is woefully lacking in roughage, chiefly found in plant foods (there is less in processed foods and meat and dairy products contain none at all).

A Harvard University analysis recently found that people who eat more whole grains live significantly longer. This is no surprise, given that whole grains appear to reduce the risk of heart disease, type 2 diabetes, obesity and stroke.

But eating these should involve more than simply swapping white bread for wholewheat, white rice for brown and ordinary pasta for the wholewheat variety. Try less familiar grains such as quinoa, wild rice, buckwheat, barley and millet.

And go for the most colourful variety on the shelves — such as red quinoa (above) — because high colour usually indicates a higher density of antioxidants.

Fibre helps to control your cholesterol and blood sugar levels, which can help reduce the amount of artery-clogging plaque in your brain’s blood vessels.

Aim to meet the three portions of whole grains as recommended in my Daily Dozen. 

That’s in part because plant foods are packed with antioxidants, which fight the free radicals that trigger damage throughout your body.

Free radicals are bad molecules that form as part of the ageing process, accumulating in your cells over your lifetime and causing damage (it’s similar to a rusting process).

However, you can slow this process by eating foods containing lots of antioxidants. Plant-rich diets appear to protect against stroke by preventing the circulation of oxidised fats (free radical-damaged fatty molecules) in the bloodstream. And you certainly don’t want these free-wheeling fats because they can damage the sensitive walls of small blood vessels in your brain.

Antioxidants can also help decrease inflammation and artery stiffness, preventing blood clots from forming. One Swedish study followed more than 30,000 older women over the course of 12 years and found that those who ate the most antioxidant-rich foods had the lowest stroke risk.

On average, plant foods contain 64 times more antioxidants than meat, fish or other animal-derived foods. Cherries can have up to 714 units of antioxidant, for example, while salmon has just three. But the food category that packs the biggest antioxidant punch is herbs and spices — and that’s why it forms part of my Daily Dozen.

Plant-based meals tend to be rich in antioxidants on their own, but taking a moment to spice up your life may make your dishes even healthier.

For instance, a bowl of wholewheat pasta with marinara sauce might notch up an antioxidant score of 80 units (20 units from the pasta and 60 from the sauce). Add a handful of steamed broccoli florets and you could end up with a delicious 150-unit meal. Not bad.

Now sprinkle on a teaspoonful of dried oregano or marjoram (oregano’s sweeter and milder twin). That alone could double your meal’s antioxidant power, up to more than 300 units.

Snack on sweet potatoes – and never leave the skins 

Sweet potatoes are one of my favorite snacks. During harsh winters while I was in medical school, I would take two freshly microwaved sweet potatoes and pop them in my coat pockets as natural hand warmers. When they had cooled down, my hand warmers became instant healthy snacks!

Regardless of your cooking method, be sure to keep the skins on. The peel has nearly ten times as much antioxidant power as the inner flesh (by weight), giving them an antioxidant capacity approaching that of blueberries.

Sweet potatoes can be considered a superfood. They’re among the healthiest and cheapest wholefoods, with one of the highest nutrient-rich scores per pound.

When picking out varieties at the supermarket, remember that its nutritional content is tied directly to the intensity of its colour. The more yellow or orange its flesh, the healthier it may be.

Colourful foods are often healthier because they contain antioxidant pigments, whether it’s the beta-carotene that makes carrots and sweet potatoes orange, the lycopene antioxidant that makes tomatoes red, or anthocyanin, which makes blueberries blue. That knowledge alone should revolutionise your stroll down the produce aisle. 

Adapted by LOUISE ATKINSON from How Not To Die and How Not To Die Cookbook by Michael Greger with Gene Stone, published by Pan Macmillan, priced £9.99 and £16.99. To order copies with a 30 per cent discount (£6.99 and £11.89), visit mailshop.co.uk/books or call 0844 571 0640. P&P is free on orders over £15. Offers valid until February 17, 2018. Additional photography: Will Heap.