Reversing heart disease with lifestyle changes

Heart disease is something we all need to take seriously.

According to the Heart Foundation, one Australian dies of heart disease every 30 minutes – that’s 52 deaths every day.

Nine out of 10 Australian adults have at least one risk factor for heart disease and one in four have three or more risk factors.  Many of these risk factors are lifestyle-related including high blood pressure, high cholesterol, overweight and obesity, physical inactivity, poor diet, alcohol and smoking.

The good news is that these are things we can change, and doing so can have big pay-offs.

When things go wrong…

The major cause of heart disease is a build-up of fatty material inside the artery walls, which is known as atherosclerosis. The fatty deposits gradually clog up the arteries, reducing blood flow to the heart.  A similar process can occur in the blood vessels to the brain, and is the major cause of stroke.

For your heart to continue beating, it needs a constant supply of oxygen from the lungs, which flows into the coronary arteries that feed the heart muscle. When there is narrowing or blockage of these arteries, blood flow and oxygen to the heart is reduced, causing angina or chest pain. If the flow stops completely, a heart attack results. If not treated quickly, this can result in permanent damage to the heart muscle.

The good news is that there are many things we can do to reduce the risk of developing atherosclerosis and even to reverse this narrowing of the arteries if it has already occurred.

Target your risk factors

While there are a number of risk factors we can’t change such as genetics, age and gender, the Heart Foundation lists a number of ‘modifiable’ risk factors we can take steps to address:

  • Smoking – both active smoking and being exposed to second-hand smoke.
  • High blood cholesterol
  • High blood pressure
  • Diabetes
  • Physical inactivity
  • Being overweight
  • Depression, social isolation and a lack of social support

Undoing the damage

While medications to control cholesterol and blood pressure, and surgery (including cardiac stents and bypass surgery) are the mainstays of treatment and life savers for many, research by US cardiologist Dr Dean Ornish has shown that a program of diet, exercise and stress management can reverse the damage.

In 1983, Ornish and colleagues published the results of the first randomised controlled trial showing improved heart function after 30 days of a lifestyle program targeting dietary changes and stress management.  Participants also had a 91% reduction in frequency of angina episodes compared to a control group.

Following this, in the 1990s, they conducted the Lifestyle Heart Trial, which looked at impact of comprehensive lifestyle changes (a low fat vegetarian diet, moderate exercise, smoking cessation and stress management training) over a longer time period in participants with existing heart disease.  The group taking part in the lifestyle program experienced a 4.5% relative improvement in the narrowing of their coronary arteries after one year and 7.9% relative improvement after five years.  In contrast, the control group, who were given usual care (they were asked to follow the lifestyle recommendations of their  doctor and take medication), had a 5.4% relative worsening at one year and 27.7% relative worsening after five years..

The lifestyle change group experienced more regression of their atherosclerosis without the use of cholesterol-lowering medications than the control participants who were taking medication.  Even more important was the fact that more than twice as many cardiac events (such as heart attacks and the need for cardiac surgery) occurred in the control versus the lifestyle intervention group.

The ‘Undo It’ program

Undo It with Ornish’ is the new name given to Dr. Ornish’s Program for Reversing Heart Disease. It’s described as the first program scientifically proven to reverse heart disease by optimising four important areas of your life, and is now covered by Medicare in the US. The comprehensive program involves 18 sessions of 4 hours each, and unlike most quick-fix diet programs, 88% of participants remain committed to the program after a year.

While the Ornish program isn’t available here in Australia, we have a similar program, called ‘Complete Health Improvement Program’ (CHIP). This program focuses on the same four key lifestyle areas as the Ornish program: revising dietary choices; increasing daily exercise; improving support from friends and family; and decreasing stress.

Results of the CHIP program have found that it reduces the need for medication in people with diabetes, reduces stroke risk, lowers blood pressure and cholesterol, reduces weight and improves depression — all factors which are known to reduce heart disease risk.

The CHIP programs are conducted by trained and licensed CHIP facilitators. According to facilitator Dr Darren Morton, who helped to develop the program, “CHIP is not simply a diet and exercise plan, it’s about moving towards an optimal lifestyle — one that promotes health and discourages disease”.

How to reverse heart disease

The Ornish program and CHIP focus on four key lifestyle areas:

  1. What you eat. Eat a plant-based diet of vegetables, fruits, wholegrains, legumes, nuts and seeds. If you are not quite ready to go vego, then just cutting down on animal foods and incorporating some plant-based meals is a good start.
  2. How much you move. Do regular, moderate intensity exercise. The ‘Undo It’ program recommends a minimum of 30 minutes per day or one hour every second day of aerobic exercise per week. More intense exercise will give additional benefits, as will strength training two–three times a week.
  3. How you manage stress. Better stress management is key. The programs encourage you to learn relaxation and stress management techniques.
  4. How much love and support you have. Love and support help to make you healthier and happier. Having people around you who care about you is a key component of good health.

The bottom line

Keeping your heart healthy is about more than just cutting out a few foods and taking medication. Making lasting changes in these four areas will benefit your heart and — literally — give you a new lease of life.

This blog post is an edited version of the article The Diet that Mends Broken Hearts, written by Dr Kate Marsh and originally published by Healthy Food Guide in March 2016.  Read the full article here.

 

How do I get iron without red meat?

Iron is a key component of haemoglobin in red blood cells, which transport oxygen around the body. A deficiency can cause tiredness, fatigue, lowered immunity and a reduced capacity to exercise.

While red meat is an important source of iron, this important mineral is also widespread in plant foods including grains, nuts, seeds, dried fruit and green leafy vegetables.  The iron in plant foods (called non-haem) iron is not as well absorbed by the body as the haem iron in meat, chicken and fish, but its absorption can be increased by the presence of vitamin C.  Tannins (in tea and coffee) on the other hand, can reduce the absorption of non-haem iron.  This means that including vitamin C rich fruit and vegetables along with iron rich meals, having tea and coffee between rather than with meals can help to maximise iron absorption.

The best iron-rich foods on a meat-free diet include:

  • legumes (lentils, chickpeas and dried or canned beans)
  • tofu and tempeh
  • wholegrains, particularly quinoa, buckwheat and amaranth
  • dark green leafy vegetables
  • nuts and seeds
  • dried fruit, particularly dried apricots, dates and prunes
  • eggs (for lacto-ovo vegetarians)

And don’t forget to include a vitamin C-rich fruit or vegetable such as citrus fruits, berries, kiwi fruit, tomato, capsicum, spinach, broccoli and cabbage to your meals.

Good examples would be natural muesli with nuts, seeds and berries, a wholegrain wrap with felafel, hummus, tomato and baby spinach and a tofu and vegetable stir-fry (including capsicum, green leafy vegetables and broccoli) with quinoa and cashew nuts.

Your Diet and Kidney Health

One in three Australians is at risk of developing kidney disease, yet most of us don’t do anything to prevent it. We explain how to make sure your kidneys last a lifetime.

Most of us don’t give our kidneys much thought, but we can’t survive without them. According to Kidney Health Australia, one in 10 Australians over the age of 18 have at least one clinical sign of chronic kidney disease, and this is on the increase. At the end of 2016, more than 12400 Australians were receiving dialysis and in January 2018 almost 1000 Australians were waiting for a kidney transplant.

Fortunately, there are many things we can do to keep our kidneys functioning as they should.

The facts

  • You can lose up to 90 per cent of kidney function before you have any symptoms.
  • By the time you realise there’s something wrong, it may already be too late.
  • Once the kidneys are damaged, this usually cannot be reversed. But if detected early enough, the progress of kidney disease can often be slowed and sometimes even halted or reversed.
  • Diabetes and high blood pressure are two of the most common causes of kidney disease.

What is kidney disease?

The main role of our kidneys is to remove waste from the blood and return the cleaned blood back to the body. They do this via tiny filtering units, called nephrons. Each kidney contains about one million nephrons which filter and clean about 200 litres of blood every day. When blood passes through the nephrons, fluid and waste products are filtered, with the waste products concentrated in any extra fluid and removed from the body as urine.

When the kidneys are damaged, however, waste products can no longer be removed from the body so they build up and become toxic. Urea (produced when the body breaks down protein), creatinine (a waste product made by the muscles) and minerals including sodium, potassium and phosphate can all build to dangerous levels. The kidneys also become unable to remove excess fluid from the body, resulting in fluid retention.

Eating to protect your kidneys

Fruit and vegies. Eat plenty of fresh fruit, vegetables and salads – these are packed with important vitamins and minerals, are low in kilojoules, fat-free (apart from avocados) and contain little sodium. Research has shown that eating more fruits and vegetables can help to reduce blood pressure, which in turns reduces the workload on the kidneys.

Wholegrains. Choose wholegrain breads and cereals, particularly those with a low glycaemic index (GI). These are a good source of important vitamins and minerals to help keep blood pressure in check and are high in fibre, which can help to lower cholesterol. Low-GI foods also help manage blood glucose levels in those with diabetes, and can reduce the risk of diabetes in those who don’t have it.

Healthy fats. Limit saturated and trans fats – these are found in fatty meats, full-fat dairy products, biscuits, pies, pastries and many fast foods. Trans fats increase cholesterol levels in the blood and can increase the risk of type 2 diabetes. Instead, choose foods rich in healthy fats such as nuts, seeds, avocados and olive oil, which also have other health benefits.

Animal protein. Avoid excess protein, particularly from meat. Research has shown that a high intake of animal protein can accelerate the loss of kidney function in those with early kidney disease. Since most people have no symptoms in the early stages, this means that following a high-protein diet could be unknowingly damaging your kidneys. If you want to follow a high-protein diet, have your kidney function checked first. For those with early kidney disease, appropriate protein restriction may slow down the progression but should always be done under the supervision of an Accredited Practising Dietitian.

Plant protein. Swap some animal protein for plant protein such as legumes and soy foods including tofu, tempeh and soybeans. Research suggests that high intakes of animal protein increase the workload on the kidneys, while soy protein has a lesser effect. A number of studies of people with diabetes have found that diets in which animal protein is replaced with soy protein can reduce the progression of kidney disease.

Water. Drink water – but there’s no need to overdue it. According to Kidney Health Australia, there is a lack of evidence to suggest that most of us need to drink water in excess of our thirst, unless we are living in hot climates or exercising excessively. Instead, they recommend drinking water according to thirst, limiting drinks containing sugar, caffeine and alcohol which may cause or worsen health problems.

Reduce salt intake. Skip the salt shaker – salt increases blood pressure, and estimates suggest that high blood pressure causes around 15 per cent of new cases of chronic kidney disease. High blood pressure damages the blood vessels in the kidneys, which prevents the kidneys from doing their job of removing waste and extra fluid from the body. The extra fluid in the blood vessels can then raise blood pressure even further, becoming a vicious cycle. High blood pressure can also develop as a result of kidney disease or a narrowing of the main artery to one or both kidneys, called renal artery stenosis. Replace salt in your cooking with flavoursome herbs and spices and choose no-added salt or low-salt foods when shopping, particularly when it come to canned foods and sauces. As a rough guide, look for foods with less than 120mg sodium per 100g.

Keeping your kidneys healthy

  • Exercise regularly – regular activity can help with weight control and managing blood pressure and blood glucose levels.
  • Eat a healthy diet based around plenty of fruit, vegetables and wholegrains, moderate amounts of lean protein foods and only small amounts of foods high in fat, sugar and salt.
  • Don’t smoke.
  • Drink plenty of water and limit sugary drinks.
  • Drink alcohol only in moderation – this means no more than two standard drinks per day for men and one for women, with a few alcohol-free days each week.
  • Maintain a healthy weight – being overweight increases the risk of high blood pressure and diabetes, both of which are major risk factors for kidney disease.
  • Keep your blood pressure well controlled – this means a blood pressure reading below 120/80.
  • Maintain a normal cholesterol level – under 5.5mmol/L.
  • Keep blood glucose levels under control if you have diabetes.

How can I tell if I have kidney disease?

One of the problems with kidney disease is that there are often no symptoms in the early stages. However, some early signs are:

  • Changes to urine, such as the quantity passed, especially at night.
  • Blood in the urine.
  • Foaming urine.
  • Puffy eyes and ankles due to fluid retention.
  • Back pain (under the lower ribs, where the kidneys are located).
  • Pain or burning when passing urine.

Once the kidneys begin to fail, the build-up of waste products and extra fluid in the blood can lead to:

  • Tiredness and poor concentration.
  • A general feeling of being unwell.
  • Loss of appetite.
  • Nausea and vomiting.
  • Shortness of breath.

Consult your doctor if you have any of these symptoms – early detection is key to managing kidney disease. For more information, see www.kidney.org.au.

This article has been updated from an article originally published by Australian Healthy Food Guide. The original article appears here.

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