The five big lifestyle changes for heart health
By Lionel Opie
Today’s problem for the health-conscious person is information overload; new health studies pour out daily from newspapers, radio stations, and television networks. Just how true are the studies? How compelling are the facts they claim? After reading countless scientific articles, listening to hundreds of international experts, and keeping an ear open when patients tell me about their experiences, I’ve identified the only five lifestyle changes with compelling evidence behind them. Taken together, these steps provide about 80% protection from heart attacks, as well as stroke and cancer, and this message comes from three major studies organized by the Harvard Medical School and published in highly rated journals.
(1) Unfortunately, the image of smoking as ‘sexy’, which was promoted for years in the USA and elsewhere, still lingers; young women remain the group least likely to give up smoking. But giving up smoking (or not starting in the first place) it essential. It confers just over one-third of the lifestyle benefits associated with healthy living.
(2) “Exercise is the elixir of life,” says Richard Verrier, from the Harvard School of Public Health. You need at least thirty minutes of moderate to vigorous exercise daily — ideally every day, but five days per week will do. How much effort should you put into it? A simple criterion: you should be sweating by the end of it.
(3) We know that the Western diet (with its high intake of fat, sugars, and calories) damages the arterial endothelium and promotes obesity, diabetes, and heart attacks. There are several validated, health promoting diets which counteract this, including the Prudent diet (which emphasises a high intake of vegetables, fruit, legumes, whole grains, fish and poultry), the DASH BP-reducing diet (similar, but with the addition of salt restriction; ideal for the many people with hypertension) and the Healthy Eating diet (again similar, but using a numerical index to score components). The Mediterranean diet may be the best of all of these, being immortalised by the declaration that it now belongs to the Intangible Cultural Heritage of Europe. Furthermore, in April 2013 in probably the largest and longest diet study ever undertaken, five years of the Mediterranean diet with high olive oil and nuts reduced heart attacks, strokes and (of note) total mortality in 7447 persons , all versus a standard low fat diet.
(4) Consistent studies show that fat around the middle — abdominal fat — is closely linked to increased heart disease and diabetes. Therefore a health body weight, indicated by a body mass index (BMI) of 25 or below, is vital for keeping the heart healthy. Fat tissue is not only cosmetically undesirable, but produces a variety of hormones, each of which is capable of adverse effects. For example, release of these hormones from fat tissue into the blood can trigger a series of chemical changes that eventually produce more fat. In brief, fat produces fat.
(5) Moderate alcohol, the fifth protective factor (and part of the Mediterranean diet) is a two-faced friend. A little helps, but more than that harms substantially. The ‘red wine’ hypothesis, which states that the beverage has benefits extending beyond its alcohol content, may also have some truth in it; deep red grape juice has the same effect of inhibiting blood clots, but only in higher doses. A fine Pinot Noir — the author’s favourite — may therefore be safely considered as one of the ‘big five’, but only in small doses.
Lionel Opie qualified as a medical doctor at the University of Cape Town, before winning a Rhodes Scholarship to Oxford University where he trained in heart research and later worked with leaders of thought at Harvard University. After the world’s first heart transplant in Cape Town, he was invited back to South Africa to develop heart research at Groote Schuur Hospital, where he still works. His book Living Better, Living Longer guides the reader through this morass of information with the message that just five key steps taken now will promote long-term health benefits for heart and mind and give protection from future heart disease and brain deterioration.
Oxford University Press is supporting Heart Failure Awareness Day with resources from across the press.
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Image credit: Rustic Italian Dinner with red wine olives and salad. Photo by edoneil, iStockphoto.