Some simple lifestyle changes could reverse heart disease for many Australians. It all starts with eating well and exercising regularly, writes Dr Kate Marsh.
Mending damaged hearts has never been so important. Every 27 minutes, an Australian dies of heart disease — that’s 54 deaths every day, according to the Heart Foundation.
Nine out of 10 Australian adults have at least one risk factor for heart disease and most of these risk factors are lifestyle-related. They are a result of the everyday choices we make about what to eat, how much to exercise, and whether to smoke.
Going about our busy lives, we make these choices without much conscious effort. And yet, over time, making unhealthy choices each and every day are what leads to conditions such as high blood pressure, high cholesterol, and being overweight. The good news is that we can change these habits, 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
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.
Dr Dean Ornish, who is Professor of Medicine at the University of California, San Francisco, demonstrated that an intensive 30-day lifestyle modification program among sufferers of heart disease led to a 91 per cent reduction in the number of chest pains reported His Lifestyle Heart Trial, which looked at the impact of a low-fat vegetarian diet, moderate exercise, no-smoking and stress management training, led to a 4.5 per cent reduction of the narrowing of coronary arteries after a year, and a 7.9 per cent improvement after five years. In contrast, the arteries of those who received standard medical treatment had almost a 28 per cent increased narrowing of their arteries after 5 years. It is important to note that those in the group who modified their lifestyle showed this improvement without taking any cholesterol-lowering medications. Those outside the group experienced more than twice as many cardiac events (such as heart attacks and the need for cardiac surgery), even though they were on cholesterol-lowering medications during this period.
A sample heart-healthy day
6am Meditation to start the day.
7am A relaxing breakfast of a bowl of oats with low-fat soy milk (fortified with calcium and vitamin B12) and fresh berries or sliced banana. Follow with a slice of wholegrain toast with a thin spread of almond butter or natural peanut butter, and a cup of herbal tea.
10am Enjoy a morning snack of fresh fruit and a cup of green tea.
12.30pm Break for lunch and try a wholegrain wrap with falafel (chickpea patties), hoummos and tabouli, a bowl of minestrone soup with a wholegrain roll, or a roasted vegetable and quinoa salad with chickpeas and lemon tahini dressing.
3.30pm Snack on fruit and a small handful of nuts.
5.30pm Enjoy a pre-dinner 30-minute brisk walk with a friend or partner and chat about your day. Or, if you prefer, have an earlier dinner and make it a post-dinner walk.
7pm Where possible, sit at the table and share this meal with others. Balance your plate with lots of vegetables and salads, some whole grains and a portion of plant protein (or some fish or lean poultry). Try a marinated tofu and vegetable stir-fry with brown rice; Moroccan chickpea and vegetable tagine with quinoa; wholegrain tortillas with Mexican beans, salad, salsa and guacamole; grilled salmon with brown rice and sautéed Asian greens; lentil and vegetable Shepherd’s pie; or barley and vegetable risotto with lean chicken breast. Finish with fresh fruit salad or baked apple with a dollop of reduced-fat yoghurt.
8.30pm Wind down and relax before bedtime with a mug of warm soy milk or herbal tea and a good book or relaxing music.
The 'Undo It' program
‘Undo It with Ornish’ is the new name given to Dr Ornish’s Program for Reversing Heart Disease. It’s the first program scientifically proven to reverse heart disease, and it does so by improving four important areas of your life. The program involves 18 sessions of four hours’ duration each, and unlike most quick-fix diet programs, 88 per cent of participants remain in 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”.
Ornish program eating guidelines
What to eat:
Vegetables and salads
Whole grains including oats, barley, quinoa, brown rice, freekeh, wholegrain pasta and wholegrain breads
Legumes including lentils, chickpeas and dried or canned beans
Soy foods (tofu, tempeh, soybeans, soymilk)
Nuts, seeds, avocado and plant oils such as olive and canola, used sparingly
For those who are not ready to go completely vegetarian, up to 2 servings of fish and egg whites, up to 1 serving of lean poultry, and 1–2 serves of non-fat dairy foods per day
Up to 2 cups of green tea a day
Water, herbal teas, grain-based coffee alternatives such as Caro, Ecco
What to avoid:
Trans fats, found in store-bought biscuits, pastries and fast foods
Refined carbohydrates found in foods such as biscuits, cakes, many processed cereals, crackers, white bread, white rice and pasta
Added sugars including lollies, cordials and soft drinks
Alcohol (limit to 1 standard drink a day)
Caffeine (limit to 1 cup a day)
How to reverse heart disease
The Ornish program and CHIP focus on four key lifestyle areas:
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.
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.
How you manage stress. Better stress management is key. The programs encourage you to learn relaxation and stress management techniques.
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.
More heartfelt benefits
The Ornish program benefits more than just your heart. Studies have found that the same lifestyle changes can reverse type 2 diabetes, stop and reverse early stage prostate cancer in men, change gene expression in over 500 genes (meaning that even if you've inherited some 'at risk' genes, you can change how these genes 'act' to cause disease) and even lengthen telomeres, the ends of our chromosomes that control the ageing process.
Top seven tips for reversing heart disease
Eat a mostly plant-based diet
Exercise daily and limit sedentary time
Maintain a healthy weight
If you drink, do so in moderation
Learn to manage stress
Build a good support team
Get started on plant-based foods
Sue Radd, a Sydney-based Accredited Practising Dietitian, gives these top tips:
Stock your pantry with dried legumes, whole grains, nuts and seeds.
Seek out delicious plant-based recipes from friends or attend cooking classes to upskill yourself.
Try ‘Meat-free Mondays’ first, or become a ‘Weekday vegetarian’ and gradually cook your way towards a total plant-based diet.
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.