As new studies emerge and what was once scientific doctrine evolves, it can be a challenge to keep track of what practices make a healthy heart. Some findings on the ways diet, exercise and oral health affect the heart suggest that keeping an eye on these elements of a person’s daily routine may contribute to a reduction in the likelihood of developing heart disease and thereby living a longer, healthier life.
Fuel the furnace
In the realm of heart health, coffee is one item that tends to consistently crop up in the news. Whether modest coffee intake contributes to good health seems to be debated frequently, as the effects of caffeine can interfere with restful sleep.
Several studies suggest that coffee may decrease the chance of developing heart disease. One study published in the American Heart Association journal Circulation contends that people who drink one to four cups of coffee per day have a lower risk of dying from cardiac disease.
John “Chad” Teeters M.D., chief of cardiology at Highland Hospital, agrees that coffee may have a heart-healthy component.
“Unfortunately, there’s been good and bad and indifferent about coffee and caffeine, and there’s always been some thought that caffeine is a slight stimulant, so it makes the heart work a little bit harder and dilates the blood vessels,” says Teeters. “But coffee seems to have other properties to it that appear to be cardio-protective by decreasing inflammation in the heart and arteries. Inflammation is the precursor to blockage formation and tension in the walls of the vessels, so by relaxing that you’re improving your heart.”
But other doctors are not as certain that coffee benefits the heart.
“I would stress that the association between caffeine and a reduced risk of heart disease is small, modest at best,” says Nicholas Venci M.D., cardiologist at the University of Rochester Medical Center. “The links are associated, meaning it may not necessarily be a causal relationship between caffeine and a reduced risk of cardiac disease.”
One choice that remains prominent in the dietary landscape is the Mediterranean diet, which has long been labeled heart-healthy. The Mediterranean diet primarily consists of fresh fruits and vegetables, beans, nuts, whole grains, fish and lean poultry.
“For patients who are looking to go on a heart-healthy diet, the Mediterranean is definitely a smart choice,” says Venci. “I think one of the benefits of this diet is that it moderates cholesterol and high fat foods, and that has been shown to reduce the development of cardiovascular disease.”
Teeters agrees that the Mediterranean diet is among the heart-healthiest diets, but he recommends going a few steps further to an entirely plant-based diet.
“The Mediterranean diet got its juice because they compared it against the standard American diet, and there’s almost nothing that you can’t compare to the standard American diet and find out that it’s better,” says Teeters. “But, if you look at the data, the net benefit went from a 32 to 33 percent risk of cardiovascular disease in the standard American diet, down to a 26 to 28 percent risk on the Mediterranean diet.”
Teeters adds: “We don’t have a head-to-head comparison for plant-based versus Mediterranean, but if you look at plant-based versus standard American and Mediterranean versus standard American, the plant-based diet more significantly beats the standard American than the Mediterranean.”
Teeters also warns against obsessing over fat, protein and carbs. Complex carbohydrates tend to be fine since most people make their bodies work to release those carbs, says Teeters. Too many simple sugars, however, are where people run into trouble.
“People should be focusing on diversifying their diet, preferably with fruits and vegetables, so that they’re getting plenty of micro and macronutrients,” says Teeters.
Calorie intake is another dietary element that has piqued the interest of researchers examining heart health.
According to a study from the American Heart Association, the heart benefits when people consume more calories earlier in the day and spread calories across small, frequent meals throughout the day.
“There’s a Sardinian reference that you eat like a king at breakfast, a prince at lunch and a pauper at dinner,” says Teeters.
Teeters asserts that it is advantageous to the heart to eat five or six small meals a day in order to maintain a stable metabolic rate. Otherwise, people tend to engorge themselves when they only eat a couple of large meals a day.
“I tell my patients that if you eat until you’re about 80 percent full, and you do that five times a day, then the furnace never turns off,” says Teeters. “So your metabolic rate stays high and you don’t get that hungry sensation because you’re constantly filling the tank a little bit.”
Some activity better than no activity
It’s no surprise that our society has grown increasingly sedentary over the years. Between sitting at a desk all day and then sitting in front of the television at home, a lot of people struggle to fit exercise into their schedules.
According to the American Heart Association, people should be exercising for at least 150 minutes per week. Teeters and Venci concur, suggesting 30 minutes of physical activity five days a week.
“I tell patients that you need to go at a pace where you can’t sing or hum a tune because you’re breathing so hard, but you can still speak in complete sentences while you’re moving,” says Teeters.
Venci recommends setting the bar at a reasonable height so that patients can achieve their goals and have the motivation to continue exercising.
“Not everyone can exercise for 30 minutes a day or 30 minutes a day for five days,” says Venci. “That’s a lot of exercise. So, starting small with some activity is better than no activity. With time and perseverance, you can build up to that ultimate exercise goal.”
For people who loathe exercising or have a hard time pushing themselves to get active, the American Heart Association suggests walking throughout the day as a simple yet effective component of living a heart-healthy lifestyle.
Over the years, there have been signs that point to an increased risk of heart disease in patients with gum disease or other oral health issues. Studies continue, and while there is no substantial causal evidence that dental disease causes heart disease, there is a strong association between the two.
“I think there’s compelling evidence that points to an association between moderate and severe periodontal disease—basically infection around the teeth, in the bone and gum tissue—and cardiovascular disease, including heart attack, stroke and fatality,” says Jack Caton DDS, periodontist at the University of Rochester Medical Center.
Studies observing the link between gum disease and heart disease typically differentiate between the severity of the oral disease rather than the type of disease.
“There are a lot of risk factors, but if you adjust epidemiological studies so that people with normal or near-normal health of the gum versus those with moderate or severe periodontal disease, it increases the risk of heart attack by 30 to 70 percent, which is a huge increase,” Caton says.
There are several ways that oral disease may lead to a cardiovascular episode. One pathway is through infection. If there is an infection in the mouth, it can lead to inflammation. When the inflammatory response travels through the bloodstream, the walls of the blood vessels thicken over time and may form atherosclerotic plaques. These plaques narrow the vessels even further, and when they break off they can block the coronary artery and lead to a heart attack, says Caton.
Another common way that oral health may affect the heart is through bacteria. When bacteria around the teeth enter the bloodstream, they can get tangled up and grow in the atherosclerotic plaques, again leading to blockages and eventually a possible heart attack, according to Caton.
“The take-home message is that you really increase the risk for heart disease and stroke if you don’t have preventive methods of keeping gums healthy,” says Caton.
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