This first section is heavy on the nutrition recommendations and the solid science behind them.
There are mountains of scientific studies showing that the more fruits and vegetables we eat, the lower our risk for developing heart disease. Eating more fruits and vegetables can also help prevent heart attacks, strokes, and heart-related deaths in people who are at high risk. According to recent data, 1.7 million deaths per year (including 11 percent of coronary heart disease and 9 percent of stroke deaths) could be prevented if people ate more fruits and vegetables. This is why the World Health Organization and the American Heart Association recommend eight servings (about 4 or 5 cups) of fruits and vegetables daily. Some researchers suggest aiming for ten—yes, ten!—servings of fruits and veggies per day. An analysis of almost one hundred studies and more than two hundred thousand participants found that eating ten servings (about 8 cups) of fruits and vegetables a day was associated with significantly lower risks of premature death from any cause (31 percent), as well as heart disease (24 percent) and stroke (33 percent). Can’t do that much? Even two and a half servings of fruits and vegetables per day (about 11/2 cups) had some benefits.
So start with at least two and a half, aim for eight, and ideally consume ten servings of fruits and vegetables daily.
Here’s where my doctor advice comes in. Many guidelines include fruit juice as “fruit.” Science (and logic) begs to differ: fruit juice does not count as fruit.
If counting servings is too cumbersome, then use this visual aid: Picture a plate. If your daily food intake sits on that plate, then ideally, at least half of it will be all fruits and veggies. For an image of this, check out the Harvard School of Public Health’s “Healthy Eating Plate” at www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ or the USDA’s MyPlate at www.choosemyplate.gov.
Per the American Heart Association:
Fruits
Whole fresh fruit = 1 piece approximately the size of a baseball. Examples are 1 apple, 1 peach, 1 orange, 1/2 a banana.
Fresh, frozen, or canned fruit (unsweetened) = 1/2 cup. Examples are berries, diced peaches, pineapple, mango.
Dried fruit = 1/4 cup. Examples are raisins, cherries, dates.
Vegetables
Raw leafy vegetables = 1 cup. Examples are lettuces, kale.
Fresh, frozen, or canned vegetables = 1/2 cup. Examples are chopped vegetables, unseasoned plain frozen vegetables, and cooked beans.
Based on this, eight servings of fruits and vegetables could look like:
Breakfast: 1 cup of berries
Lunch: 2 cups of lettuce + 1/2 cup tomatoes + 1/2 cup cucumbers + an orange for dessert
If you wanted to get to ten servings, then add:
Dinner: 1 cup broccoli + 1/2 cup diced peppers + 1/2 cup snow peas (in a stir fry)
• Start with at least one serving of fruits and/or vegetables with every meal and snack, and increase over time to two or three. You’ll be up to ten in a matter of weeks!
• It’s fine to use frozen fruits and vegetables. High-quality berries, tropical fruits, and mixed vegetables are cheaper than fresh and can be bought in bulk from the grocery store and stored in the freezer for long periods.
• Make breakfast with two (or more) servings of fruits and/or veggies. This gets the good stuff in early in the day. Try Filling Fruit and Nut Bowl with Greek Yogurt in Appendix A.
• Free meal tracker apps like MyFitnessPal or Dr. Michael Greger’s Daily Dozen app can help you get your ten servings of fruits and veggies daily.
Particularly healthy for your heart are colorful fruits and vegetables (red, orange, yellow, green, blue, and purple), as well as cruciferous vegetables (such as broccoli and cauliflower). These contain natural plant nutrients (like antioxidants) that neutralize toxins and lower inflammation in the body, protecting and healing our arteries and heart. These plant nutrients include carotenoids, flavonoids, glucosinolates, resveratrol, nitrates, and omega-3 fatty acids, as well as vitamins and minerals, fiber, and more. Plant nutrients can’t be extracted from plants and stuffed into a pill or capsule, despite the multibillion-dollar health supplement industry’s claims. Science says eat the plant. Studies have shown that the more colorful varieties of fruits and vegetables and cruciferous vegetables we eat, the lower our risk of all kinds of cardiovascular disease (including coronary heart disease, heart attacks, strokes, and microvascular disease).
Here is a rainbow of examples of these heart-healthy plant foods:
• Red: apples, grapes, peppers, tomatoes, strawberries, raspberries, cranberries
• Orange: pumpkins, butternut squash, carrots, sweet potatoes, apricots
• Yellow: spaghetti squash, peppers, tomatoes
• Green: spinach, collard greens, chard, lettuce (the greener the better)
• Blue: blueberries, elderberries, plums, figs
• Purple: grapes, cabbage, peppers, carrots, blackberries
• Cruciferous vegetables: broccoli, cauliflower, Brussels sprouts, kale, cabbage, mustard and turnip greens
White veggies are good for you as well! Cauliflower, onions, garlic, white potatoes, and tofu all contain important plant nutrients too.
• Try new varieties of fruits and vegetables every week. When you shop, pick up something new.
• Aim to have at least three different colors of plants on your plate at every meal.
• Don’t like the slightly bitter taste of some veggies, like Brussels sprouts, broccoli, or cauliflower? Try roasting them, which brings out their natural (and good-for-you) sweetness.
• Consider subscribing to a healthy food magazine or look at recipes on apps such as Pinterest for colorful and cruciferous plant recipe ideas. Or try these recipes: Filling Fruit and Nut Bowl with Greek Yogurt, Superfood Lentil Soup, or Super-Simple Cashew Stir-Fry (all in Appendix A).
A whole-foods approach for best health means eating the whole fruit or vegetable to get the most nutritional benefit. Fruits and vegetables contain water, natural plant sugars and fibers, and many nutrients. Juicing crushes the fruit or vegetable in order to extract the liquid and sugars but leaves many nutrients and all the healthy fiber behind.
Blending (as in smoothies) is moderately better, but we still tend to drink faster than we chew, which allows us to take in more food (and calories) than maybe we intended. The best solution is to eat the food. Chew the fruits and vegetables, the way nature intended. After all, juicers and blenders are modern inventions, and juices and smoothies are faddish.
• Stock up on fruits and vegetables that travel well, like apples, oranges, peaches, plums, baby carrots, or peppers (for slicing).
• Always bring fresh fruits and/or veggies to work, and eat them first when you are hungriest so you get in your servings and in the best form.
• At home, don’t hide your beautiful colorful produce. Set a bowl full of gorgeous fruit on your kitchen counter or dining room table. If you can see it, you’re more likely to eat it.
• If you bring home melon or pineapple, slice it up and store it in the fridge for easy access. If it’s already cut up, you’re more likely to eat it.
• Set a platter of fresh sliced fruit out for dessert after dinner. It will likely satisfy cravings for sweets.
Studies show that regular intake of whole grains decreases the risk of diabetes and heart disease. But what are whole grains? These are unrefined grains with all parts intact (bran, germ, and endosperm).
The bran is the fiber-rich outer layer. The germ is full of nutrients, including vitamins, minerals, protein, and healthy fats. The endosperm is empty starchy carbohydrate.
Refined white flour and white rice have had all the good parts removed (the bran and germ) and so are missing all the fiber, protein, healthy fats, vitamins, and minerals. They’re just empty starchy endosperm.
It’s good to know your flours: “enriched flour” is refined white flour that’s had some vitamins added to it after processing. This does not make it healthy. As a matter of fact, enriched flour is absolutely the worst choice for you, as it’s immediately converted to sugar in your body. This can be bleached or unbleached or organic, but it’s still refined flour with all the good parts removed, i.e., empty starchy endosperm.
One hundred percent whole-grain flours are a much healthier choice of flours. If you’re going to have pasta or bread, make sure the label lists “100 percent whole wheat” as the first ingredient and does not list any “enriched flour.” It’s important to note, however, that while 100 percent whole-grain flours are better than refined white flour, the best choice is the intact, unprocessed grain. The more intact the grains are, the slower the carbohydrates are absorbed by the body, which can help prevent weight gain and diabetes.
The bottom line is to avoid white rice and refined white flour and replace them with brown rice and flours made from whole grains (100 percent whole wheat, quinoa, or others). The best choice, though, is the intact whole grain.
Here are examples of some of the more commonly found intact whole grains:
Corn: Corn can be eaten on the cob; kernels can be steamed or roasted; popcorn can be popped (air-popped or with minimal oil). Masa, the fortified flour made from corn and used to make tortillas, counts as a whole-grain flour.
Oats: Yes, oats are a whole grain! The less processed the oats, the better they are for you. So whole oats (also called groats) are better than steel-cut oats, which are better than regular oats, which are better than quick-cooking oats. But they all count as whole grains.
Brown rice: Brown rice is real rice that hasn’t had the germ and bran removed. This is always better than white rice.
Quinoa: This tiny fast-cooking grain is boiled and then served. It makes a wonderful addition to salads or replacement for white rice.
Farro: This is the whole intact wheat grain berry. It cooks up just like pasta, though it can take 20–30 minutes. Then it’s drained and served.
Bulgur: This is cracked wheat, made by cooking, drying, then chopping up the whole-wheat kernels. It’s very fast and easy to prepare, and is commonly used in Middle Eastern cooking.
The nonprofit consumer advocacy group Whole Grains Council lists more types of whole grains, along with loads of helpful information and recipes: https://wholegrainscouncil.org/whole-grains-101.
Per the American Heart Association:
Intact Whole Grains
1/2 cup cooked corn, oats, brown rice, quinoa, farro*, bulgur*, amaranth, millet
3 cups unsalted, air-popped popcorn
Whole-Grain Products
1/2 cup whole-wheat pasta*
1 slice whole-grain bread (such as 100 percent whole-wheat bread)*
1 (6-inch) whole-wheat* or corn tortilla
5 whole-grain crackers*
1 cup ready-to-eat, whole-grain cold cereal*
(*These contain gluten.)
• If you’re going to eat bread or pasta, always buy 100 percent whole wheat and check the label to ensure there’s no “enriched” wheat flour added.
• Consider buying grains in bulk. It’s cheaper. Even better: order whole grains in bulk from an online source (like www.nuts.com) and have them delivered right to your home.
• When you prepare whole grains for a recipe, make more than you need and freeze in portion-sized bags for the next recipe. This works very well with brown rice, quinoa, and farro.
• Adding whole grains to a salad makes it a meal! Try these easy salads: Nutty Tabbouleh Salad; Summer Corn, Tomato, Spinach, and Basil Salad (in Appendix A).
The American Heart Association recommends about 30 grams of dietary fiber per day for the average person (based on a 2,000 calorie/day diet). But what is dietary fiber, and how do we know how many grams we’re getting?
Dietary fiber, also known as roughage, is a carbohydrate found in plants. We can’t absorb fiber, yet it has many beneficial health effects. There are two kinds, soluble or insoluble, and both are good for us. In our intestines, soluble fiber becomes a thick gel that traps fats so they can’t be absorbed, which lowers cholesterol levels and slows digestion, which in turn keeps blood sugars from spiking. Good sources include oatmeal, beans, lentils, and many fruits. Insoluble fiber helps keep our stools regular and soft; good sources include whole grains, beans, lentils, and many vegetables. Both make us feel full, which helps us eat less.
Many of these fiber-rich foods are a part of the Mediterranean diet, which is long associated with lower risk of heart disease. Legumes, which include beans, lentils, and peas, are a staple of the Mediterranean diet and are particularly rich in both soluble and insoluble fiber and are also a fantastic source of plant protein and nutrients. A cup of cooked garbanzo beans has about 14 grams of protein as well as 12 grams of fiber. These beans are a great source of folate, iron, magnesium, vitamin A, and calcium. People who eat legumes daily are more likely to have a smaller waistline and are less likely to be overweight or obese, or to develop diabetes or metabolic syndrome. Basically, legumes are really good for you in many ways, but especially for your heart.
• Add beans to a salad for a boost of heart and gastrointestinal nutrition. They count as both protein and fiber.
• No time? It’s fine to use canned. Choose unsalted or if the fruits, vegetables, or legumes have salt, rinse them in running water (rinsing can remove up to half of the added salt). Or try quick-cooking red lentils, which can be ready to eat in less than 10 minutes.
• If you’re going to make the longer-cooking versions, make extra and freeze some for another meal. They thaw perfectly and can be easily added to soups or salads.
• If you’re not used to eating a lot of fiber, then start with a little and increase over time. This will minimize gas and bloating, and your body will adjust if you keep it up.
• When you’re increasing the amount of fiber you eat, you also need to increase the amount of water you drink. Fiber soaks up fluids (think sawdust on a barroom floor . . . ). If there isn’t enough water in your intestines, fiber won’t pass through very well, which can lead to constipation. Hydrate!
• Try these recipes: Overnight Oats; Superfood Lentil Soup; Antioxidant Chili (in Appendix A).
Here’s where we get into the heart-healthy fats. Unsaturated fats are healthy, and these can be monounsaturated or polyunsaturated (PUFAs). Certain PUFAs, the omega-3 fats DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), and ALA (alpha-linolenic acid), are associated with a significantly lower risk of heart and related diseases, and it’s recommended to increase the amount of these in our diet. DHA and EPA are found mainly in seafood, while ALA is found mainly in plants (though our liver does convert some ALA into EPA and DHA). Regular intake of a small amount (approximately 200 mg) of omega-3 fats daily is associated with a significantly lower risk of heart and related diseases. This effect has primarily been seen with food sources, not supplements.
You may have also read about other PUFAs, the omega-6 fats. Though some research suggests that these are not as healthy as omega-3 fats, they are a heck of a lot healthier than most saturated fats and trans fats, and it’s not worth fretting over.
• If you’re in the habit of eating meats like beef, chicken, and pork, try switching some of those meals to seafood instead.
• Fresh seafood can be expensive. Many canned varieties provide the same health benefits but at a far lower price. Good for your heart and your budget!
• Try these recipes: Niçoise-Style Sardine Salad and Secret Ingredient Baltimore-Style Salmon Patties with Not-Oily Aioli (in Appendix A).
• Research does not show a benefit to taking omega-3 supplements (such as fish oil and krill oil). Supplements can be contaminated with toxins and are expensive. It’s better to get your omega-3 fats in your food.
• People who do not or cannot eat fish can get plenty of omega-3 fats through other food sources. The ALA in plants has health benefits, and some is converted to DHA and EPA in our body. Walnuts, flax and chia seeds, and edamame (soybeans) are excellent food sources of ALA.
• Try the Apple Cinnamon Walnut Overnight Oats recipe in Appendix A.
There has been some controversy over fats in the news, with headlines declaring “Butter Is Back,” citing studies that showed no difference between saturated and unsaturated fats for heart disease risk. Here’s the problem with that research: years ago when low-fat foods hit the market, companies had to do something to make the foods taste good, so they added sugar. A lot of sugar. People who ate these low-saturated-fat foods still got heart disease, and butter didn’t look like the bad guy. The science community howled in outrage over the unhealthy misconceptions being spread around, hitting back with headlines like “No, Butter Is Not Back: Eat in Moderation, Please.” Research backs this up. A study of fifty-nine thousand participants at risk for heart disease found that when saturated fat was replaced with sugars, there was no heart benefit. When saturated fat was replaced by polyunsaturated fats, there was a 17 percent lower risk of heart attacks and sudden cardiac death.
When we directly compare saturated versus unsaturated fats, things are much clearer. High-quality research looking at more than thirteen thousand participants with risk factors for heart disease found that when saturated fats were replaced with polyunsaturated fats, there was a 19 percent lower risk of having a heart attack or sudden cardiac death. Another study followed more than seven thousand participants with significant risk for heart disease over a period of five years. Participants were given either the Mediterranean diet plus olive oil or nuts or a regular diet. The Mediterranean diet plus olive oil or nuts was associated with a 30 percent lower risk of heart attacks, strokes, or cardiac death compared to the regular diet (and these results stood when the study was reexamined in 2018).
If we add up all the data, it’s clear we should aim for healthier polyunsaturated and monounsaturated fats and less of other fats. The best and easiest way to do this is to steer clear of packaged, processed foods and all fast foods. Those are the biggest sources of unhealthy fats in our diets.
In summary, if we replace the less-healthy and harmful fats in our diet with healthier ones, we can lower our risk for cardiovascular disease (heart attacks, strokes) by 30 percent. That’s just as powerful as a cholesterol-lowering medication!
• Avoid processed foods, especially processed meats and fast foods.
• Stock up on healthy oils so that you’ll have them when you need them. Extra-virgin olive, flaxseed, walnut, almond, canola, corn, sunflower, and safflower oils are fine. Sesame oil is especially useful for flavoring Asian salads or stir-fries. Keep a few in your pantry, ready for recipes.
• Always choose extra-virgin olive oil. Other olive oils, like “light” and “organic,” are less healthy because they’re made from super-processing the olives or from adding other oils, which may not be unsaturated.
Nuts are good for your heart and your life. Research shows that eating four servings of nuts per week was associated with a significantly lower risk of having coronary heart disease (19 percent) or any type of cardiovascular disease (28 percent). There was also a significantly lower risk of dying from coronary heart disease (22 percent), cardiovascular disease (22 percent), sudden cardiac death (75 percent), or anything at all (19 percent). The studies looked at tree nuts (which include almonds, walnuts, pistachios, and hazelnuts) as well as peanuts (which are technically a legume but nutritionally similar to tree nuts).
Another study found that for every one serving per week increase in nuts, there was a 10 percent lower risk of having coronary heart disease. This may be due to the fact that nuts are a rich source of healthy oils. Nuts also are great sources of both soluble and insoluble fiber, as well as vitamins and minerals. Nuts are an important part of the classic Mediterranean diet, which we know is a very good diet for heart health. (Allergies are a consideration here. For people who are allergic to nuts, this habit doesn’t apply. As a doctor, I’m going to remind you to update your epinephrine auto-injector and carry it with you at all times!)
Per the National Heart, Lung, and Blood Institute (NHLBI):
• 1/3 cup nuts (equal to 11/2 ounces)
• 2 tablespoons nut butter
• Regularly stock up on nuts, but keep budget in mind. Nuts are cheaper when bought in larger quantities or ordered online. Shop around for your favorite sources.
• Nuts can go rancid. Store them in airtight containers. Glass is ideal.
• Make a portion of your favorite nuts a regular go-to snack. Have some in your bag or desk at work at all times.
• Get in the habit of adding a handful of nuts to your meals, be it yogurt, oatmeal, salads, or stir-fries.
• Try these recipes: Apple Cinnamon Walnut Overnight Oats; Filling Fruit and Nut Bowl with Greek Yogurt; Nutty Tabbouleh Salad (in Appendix A).
Research has consistently shown that people who regularly eat chocolate have lower blood pressure, blood sugars, and less heart disease. Chocolate comes from the toasted seeds of the cacao plant, which is rich in healthy plant chemicals called flavonoids, specifically cocoa flavanols. Cocoa flavanols have beneficial effects on our blood vessels by neutralizing toxins, which helps prevent stiffness and plaque buildup, as well as promoting healing.
The darker the chocolate, the more cocoa flavanols it has. Milk chocolate sometimes has barely any (it can range from 10–50 percent) and also tends to have more unhealthy fat added. For this reason, I recommend only dark chocolate (at least 60 percent cacao, though the darker the better) and only a small amount. One serving is two small squares (about 50–60 grams total), and science suggests that two or three servings per week provide the most benefit.
Do you like chocolate, but not dark chocolate? It is less sweet but definitely much better for you than milk chocolate. The intense cocoa taste is what can help prevent us from overeating this calorie-dense treat. Start with a small amount and build up over time. The less milk chocolate you eat, the more dark chocolate will begin to taste like normal chocolate to you.
• Add a teaspoon of pure unsweetened cocoa powder to your coffee in the morning for a mocha treat.
• Use only dark chocolate chips or chunks (60 percent or higher cacao) in baking and cooking.
• Try these recipes: Dark Chocolate–Dipped Strawberries; Orange Pistachio Dark Chocolate Bark; Cherry Chocolate Overnight Oats (in Appendix A).
• Use pure unsweetened cocoa powder in your savory cooking as well. Try the Antioxidant Chili recipe in Appendix A.
• If you have a tendency to eat more than a serving (two small squares), consider buying only small amounts at a time or dividing what you buy into serving sizes as soon as you get home.
Fruits and vegetables are not the only excellent sources of plant nutrients. Herbs (parts of leafy green plants used for flavoring or teas) and spices (roots, seeds, berries, or bark used for flavoring or teas) are also rich in these critically important healthy plant chemicals, including antioxidants, vitamins, and minerals. Many of these compounds have been shown to have antibacterial, antiviral, antioxidant, and anti-inflammatory properties. This suggests that they can help prevent or heal damage to the body. However, quality research studies on the health effects of herbs and spices in humans are lacking. Why is that? Well, for one, Big Pharma is not going to fund randomized clinical trials on compounds that are already widely available. No one can patent turmeric, or cinnamon, or ginger, or oregano . . . Attempts to isolate the “secret ingredient” in these plants, put it in a pill, and see what it does to people (so it can be patented and marketed) have failed to show any significant effects. Basically, there’s no profit.
The studies that have been done support using herbs and spices often, but in normal culinary amounts, like in everyday cooking. Promising herbs include chives, dill, thyme, sage, oregano, parsley, marjoram, rosemary, mint, lemongrass, and more. Spices include cinnamon, cloves, cumin, coriander, fennel, mustard, saffron, ginger, bay leaf, fenugreek, turmeric, poppy seed, red chili, and more. (Note: turmeric is especially promising as a powerful antioxidant and anti-inflammatory, but again, the official recommendation is to use everyday spice-aisle turmeric in normal cooking amounts.) I would also mention alliums like garlic and onions (okay, technically not herbs and spices, but they are also plant nutrient-rich and often used in cooking).
Extra herb and spice bonus: research shows that when we add flavorful herbs and spices to our food, we’re less likely to add salt (see Habit #39).
• Have fun in the spice aisle! Make it a goal to try different spices in your cooking.
• Try tea. Many teas are actually herbs and spices. Drinking a cup of tea in the afternoon or evening is calming, keeps us from snacking, and may provide us with additional benefits.
• Dried herbs and spices can get old and lose their benefits. If yours don’t smell fragrant and robust, consider replacing them.
• Grow an herb garden. Indoor herb gardens are widely available; you can order a small one online. Or plant a garden outdoors. Herb gardens are beautiful, fragrant, and provide an inexpensive source of herbs for cooking—much cheaper than buying herbs fresh at the grocery store.
• Buy herbs at farmers’ markets. Big bunches are available at far lower prices than at the grocery store. These can be used for tea—yes, fresh herbs can be used as tea—or dried at home for later use.
We’ve touched on some of these risky foods in Chapter 1. Here’s more practical advice for day-to-day healthy habit-forming:
There is ample high-quality scientific evidence showing a strong link between a diet high in processed foods and an increased risk of heart disease, as well as many other diseases. So we should make it a habit to stay away from processed foods as much as possible. The first step is to recognize processed foods when you see them. These include many foods in plastic packaging or boxes, anything made with bleached or enriched flour, most fast foods, and almost everything in the snack food and cereal aisles.
Not all processed foods are evil, however. Whole-grain pastas, breads, and cereals, and some other foods are fine when included as part of a diet high in plants. Canned, frozen, dried, and baked fruits and veggies may be minimally processed and pure (i.e., without added chemicals or salt).
Look at labels, and if you see an ingredient you cannot pronounce, chances are it is something that has been processed more than you need. Over time, as you grow accustomed to looking at labels and buying fresh foods as much as possible, grocery shopping will be easier and faster.
• When you go to the grocery store, buy less food from the middle (the snack food, cereal, and canned food aisles) and more from the outer edges (the produce and seafood sections).
• Look at labels and avoid foods with lots of chemical ingredients.
• Make a rough menu plan for the week or stick to a similar plan week to week. You’ll always know what you need from the grocery store, and you’ll be less likely to buy junk.
• Decide that you are not a person who eats processed foods and make it a part of your identity.
• Avoid fast foods as much as possible.
All animal-based products are associated with an increased risk of heart disease and premature death, but not to the same degree. The worst offenders include cured, smoked, and processed meats (like most bacon, sausage, and deli meats). The next is red meat (i.e., beef, veal, pork, lamb). Yes, despite ad campaigns funded by Big Agro, pork is classified as a red meat. The classification is based on the amount of myoglobin, which is the iron-carrying molecule in animals, not the color of the meat. White meats (poultry) follow, though the association with heart disease is far lower. Fish and other seafood, eggs, and dairy are largely without great risk, though the healthiest approach is to consume mostly plants. This is also best for the environment. There is plenty of protein in plant foods, especially beans, lentils, and peas. If you eat animals or animal products, aim for occasional chicken, eggs, seafood, and dairy.
• Consider being “vegan before 6,” a concept popularized by food journalist and cookbook author Mark Bittman. This means eating vegan for most of the day, then having an omnivorous dinner. I will point out, however, that it is possible to eat vegan and still be eating unhealthily. After all, breads, pastas, and sugars are all technically vegan. Rather, I recommend eating “plant-based before 6.”
• Make meat (or fish, or eggs . . . ) the side dish. A really effective strategy is to make your veggies the main attraction of your meal, filling the bulk of your plate. Really we should be aiming for half the plate to be veggies anyways (remember the Healthy Eating Plate visual from Habit #27).
A high-sodium diet is associated with high blood pressure and heart disease. We usually think of sodium and salt as being the same thing. But the table salt we add to our home-cooked food is not usually the culprit. There is sodium in table salt, but it’s the sodium in canned and processed foods as well as takeout that is far more likely to cause us problems. Limit the canned and processed foods and takeout in your diet, and you will also be limiting sodium. We should all eat less than 2,300 milligrams (mg) of sodium daily, though less than 1,500 mg daily is healthier. People with high blood pressure or heart conditions should eat even less. To put this in perspective: 1 teaspoon of table salt contains about 2,300 mg of sodium.
• Learn how to read food labels for sodium content. Aim for at least under 2,300 mg and ideally under 1,500 mg per day total. (If you have high blood pressure, ask your doctor what your daily limit of sodium is.)
• Canned foods, frozen entrées, and processed and cured meats tend to be highest in sodium in addition to takeout. Limit these foods.
• When you first cut down on sodium, food can taste different for a while. Your taste buds will adjust. Give it some time.
• Try adding more herbs and spices to your foods, which has the added bonus of giving you more detoxifying plant nutrients!
What we drink is just as important to our health as what we eat.
Drink plenty of water throughout the day. There are many reasons. One, it’s common to confuse thirst with hunger. Quench thirst first, before reaching for food. Two, we need to take in enough fluid with our food in order to help it pass through our bodies, especially if we’re increasing the amount of dietary fiber in our diets. Dehydration can cause constipation. Three, dehydration can also lead to urinary problems, such as urinary tract infections and kidney stones. Fill your glass with water often and flush everything through your system. Four, juices, sodas, and sweetened drinks are loaded with sugars. Drink water or seltzer instead. Tea and coffee are fine; actually, studies show that these contain antioxidants that may promote health (see Habit #41).
• Have a water bottle (a reusable one) with you always.
• When you go to a restaurant, always ask for water first before other beverages. Finish your glass before your meal and have more water with your meal.
Both green and black teas are loaded with healthy antioxidants. Both come from the same plants; green tea is minimally processed (steamed and dried), while black tea is lightly fermented. Studies have shown that consuming these teas regularly helps lower blood pressure and improve blood flow. Drink a cup or two of green or black tea daily.
For most people, coffee is also a heart-healthy antioxidant-rich beverage. Drinking about 3 to 4 cups of coffee a day is associated with a lower risk of heart disease or death from heart disease. Coffee is not recommended for pregnant women due to a slightly increased risk of miscarriage, preterm birth, and low-birth-weight babies. Drinking too much coffee or tea can cause anxiety, palpitations, and insomnia from the caffeine. Also keep in mind that if you drown your coffee or tea with cream and sugar or chemicals, you may lose any beneficial effect.
As with everything else, a normal, moderate intake is suggested. One to 2 cups of green or black tea and 3 to 4 cups of coffee seem to be beneficial for the heart (for people who can safely drink these beverages).
• An electric kettle at home or work makes tea preparation much easier and faster. Bring your tea bags with you to save money.
• Keep your tea fresh. Tea, just like any other herb or spice, can get old and lose its health benefits.
• Enjoy a cup of tea or coffee in the morning, when it can become part of your morning routine (if it isn’t already), but avoid it at bedtime when the caffeine content can keep you awake.
• Have a travel mug or two so that you can brew coffee or tea at home and bring it with you to save money.
People who drink a small amount of alcohol every day tend to have lower risk of coronary heart disease when compared to people who don’t drink or to people who drink heavily. Research shows that light drinking can lower the risk of developing heart disease a great deal (between 40 and 70 percent) and also lower the risk of related diseases such as strokes, aortic aneurysms, and peripheral arterial disease. Wine (red wine especially) seems to be the best choice, though the protective effect is seen with all types of alcohol. The active component in red wine is thought to be an antioxidant plant nutrient called resveratrol, but studies that have isolated this compound and given it to participants as a supplement have not shown any promising results to date. (Of note, that seems to be the case with all supplements.)
But this doesn’t mean it’s advisable to pick up a drinking habit. Alcohol won’t erase the risk brought on by other factors. Drinking any amount over what’s recommended will actually increase the risk of heart disease by causing high triglycerides (a form of cholesterol), high blood pressure, and weight gain. Alcohol can also be directly toxic to the heart and is associated with arrhythmias like atrial fibrillation. Drinking too much—even just a little too much—also increases the risk of cancer (particularly breast cancer), liver disease, and, obviously, alcohol addiction.
For all of these reasons, the American Heart Association recommends that people do not start drinking alcohol as a means to lower their heart disease risk.
For people who can safely drink, and who partake regularly, here is what is recommended:
Men: No more than one to two drinks per day
Women: No more than one drink per day
• Hydrate well before you have any alcohol. If you’re thirsty, you may unintentionally drink too much too quickly.
• Measure out your drink (5 ounces of wine, 12 ounces of beer) and then put the bottle or six-pack away.
• If you’re having mixed drinks, specify how much hard liquor you want and watch the bartender measure. Some bartenders are a little heavy-handed with the bottle.
• If you’re entertaining, mix up a pitcher of a tempting mocktail and have plenty of healthy and delicious appetizers on hand. It’s good for you and everyone else as well.
• Try the Bubbly Minty Mojito Mocktail recipe in Appendix A.
In order to eat healthy for life, we must learn to shop healthy too.
Plants should make up the bulk of your groceries. Whether fresh/frozen or healthy canned, it’s all good. As a matter of fact, fruits and vegetables are typically harvested at their peak of ripeness just prior to being frozen, so they can be an excellent source of vital antioxidants. Buy beans, dry or canned (no-salt is the best). Aim for whole grains: brown rice, oats, quinoa, farro (my favorite), and corn. Yes, remember, corn is a whole grain!
Consider ordering your groceries online. This is a surefire way to avoid being near any unhealthy foods and will help you to always choose healthy foods. If you can, it’s a potentially diet-saving option to make a list and order it online for pickup or delivery, rather than expose yourself to all the sights and scents of the grocery store. Even better, support your local farmers by joining a community-supported agriculture (CSA) program.
• Use a list when you shop. There are apps you can use so that you can build up your list over a few days.
• Make it easy to order groceries. If you have a grocery app on your phone, you can place your order anytime, like while on the StairMaster at the gym or on the train.
• Set a regular ordering schedule for your CSA farm delivery. Maybe even put it into your smartphone calendar.
Big business wants to derail your healthy eating plans. They’re the ones who invented habit science because they want you to be in the habit of buying their products. But if you know their tricks, you won’t fall for them.
For starters, don’t go food shopping when you’re hungry. Many a well-intentioned healthy eating plan has been derailed by the trip to the grocery store on an empty stomach. If you’re starving and you enter the place where all kinds of foods are readily available, you are more likely to make poor choices. Millions of dollars of marketing research have gone into product advertising and placement for exactly this reason. More and more grocery chains also feature restaurants, with a dizzying array of takeout options. In short, if you walk in famished, you’ll walk out full. It’s a minefield out there, folks. Don’t let big business win the grocery games. Stick to your list and ignore their displays. Make sure you’ve eaten something healthy and satisfying before you go grocery shopping.
• Have an apple before you go to the grocery store.
• Always shop with a list and get in the habit of sticking to it.
• Keep a secret stash of portion-sized nut snacks in your backpack or purse. That healthy snack can protect you from giving in to unhealthy temptations.
• See Habit #43: consider ordering groceries online for pickup or delivery and eliminate this issue altogether!
Now you have a lot of suggestions about what to eat and drink and how to grocery shop. Here are some action suggestions for meal preparation and consumption.
Prepare your own food as much as possible. People who make their own meals tend to eat healthier foods and fewer calories. Restaurant food is typically loaded with extra calories in the form of fat, as well as sodium. In addition, home-cooked meals cost far less than restaurant food.
Make your homemade meals well-balanced. Meals that are high in fiber and complex carbohydrates and include healthy protein and fat can keep you full and satisfied for longer, so you eat less during your day. Fruits and vegetables contain plant nutrients that help protect and heal your blood vessels (Habits #27 and #28). Not only does fiber fill you up, but it is also good for you (remember Habit #31). Healthy fats are also heart-protective (Habits #32 and #33). If you can imagine your food on a plate, use this formula as a guide: your plate should be half (or more) fruits and veggies, a quarter or so whole grains, and a quarter or so lean protein, with some healthy fat.
• A well-balanced home-cooked meal does not need to be complicated or fancy. My breakfast takes all of 3 minutes to prepare: 21/2 to 3 cups of frozen berries topped with nuts and served alongside a low-sugar yogurt.
• Try these recipes: Superfood Lentil Soup, Antioxidant Chili, or Nutty Tabbouleh Salad (in Appendix A).
Become a creature of habit when it comes to food. Repeating the same rotation of healthy meal choices over and over helps reinforce them. The fewer things you have to choose between, the less you have to think about them. If your meal choices rarely vary, then even when you’re at a restaurant or traveling, your eyes will seek out similar items on any menu: fruit, nuts, yogurt; salads and seafood; healthy soups and snacks. You’re less likely to get sidetracked by unhealthy offerings.
Think about your usual day and when you want (and don’t want) to eat, and then create a reasonable eating schedule. Studies show that people with a stable eating pattern are better able to maintain a healthy weight. The schedule helps you eat when you’re supposed to and not eat when you’re not supposed to, so you will be less likely to snack. This is particularly key for work settings, where tempting treats may be sitting around.
• Cultivate a list of your favorite meals and rotate these throughout the week. As time goes on, your favorite meals will become easier and easier to shop for and prepare, which will further reinforce your healthy eating habits.
• Establish a regular meal and snack schedule. It doesn’t have to be the same every day. For many people their workweek schedule will differ from their weekend schedule. That’s okay—just have an idea of what your schedule will be and stick to it.
• Apps such as MyFitnessPal and SparkPeople help you keep your meal choices and schedule on track and are free.
People who eat while driving, walking, working at their desk, or watching TV tend to eat more. Studies show that when we sit down to eat, we eat more slowly, make better food choices, and tend to eat less. Sit at a table, spread out your food, and enjoy. Being mindful and present when you eat will help you eat better.
• Always sit down to eat, ideally with other people.
• Try not to eat at your work desk.
• Definitely don’t eat in your car.
• Make it a habit never to eat in front of a screen. That means the computer, TV, and movies. (Seriously, when was the last time you ate something healthy at the movie theater?)
Dental habits are very important for heart heath. There is a link between poor dental hygiene and gum disease to heart and related diseases. Scientists think this is because bacteria in the gums trigger inflammation throughout the body. Inflammation in the blood promotes arterial plaque and atherosclerosis. Your dental hygienist who encourages you to brush effectively and floss consistently is supporting your heart and your dental health!
• Bring a toothbrush and toothpaste to work and make it a habit to brush after eating. This also has the bonus of fresh breath.
• Bring a toothbrush and toothpaste when you’ll be out and about for the day or while traveling. It’s more and more common to see people brushing in public restrooms. Inspire others!
• Brushing and flossing after a meal is not only good for your gums, but it also helps signal the end of eating. You’re less likely to continue eating if you just made the effort to clean your teeth.
When you put all of these recommendations together, you get an evidence-based, doctor-approved eating plan: a heart-healthy, well-balanced, varied, and interesting diet made up of fruits and vegetables, whole grains, legumes, maybe some seafood, chicken and eggs, low-fat dairy, herbs and spices, and healthy fats, with plenty of water, some tea and coffee, and maybe some red wine. This will give you all the plant nutrients, healthy complex carbohydrates, dietary fiber, unsaturated fats, lean protein, and fluids you need and will be heart-protective. In addition, you’ll be avoiding processed foods such as refined grains, added sugars and chemicals, saturated and trans fats, unhealthy meats and meat products, or too much of anything. You have recommendations to plan, shop, prepare for, and cook consistently balanced and enjoyably mindful meals. You also have the suggestions and recipes to make these recommendations your daily habits.
For best results pick one or a couple habits and try them out. All are doable and can be adjusted to your own life. If you’re struggling, look at the suggestions in Chapter 3. Think about why you’re getting derailed and use the strategies presented to get yourself back on track. If you’re really struggling, ask for help from a healthcare provider or mental health professional.