Editor’s Note: Part 1 of this article appeared in the April issue. Part 2 continues Dr. Tucker’s recommendations for helping patients optimize their heart health.
Protein
I want people to get their protein amounts dialed in. I still use body composition analysis measurement to guide my protein recommendations. Suggest at least 1 gram of protein per pound of lean body mass. Depending on diet preferences (keto, Mediterranean, vegetarian, Paleo, etc.), age, current health status, and health goals, we discuss meat, fish, chicken, fowl, turkey, eggs, etc.
I find many patients need help in understanding how much protein they need and what they are actually getting. Meat, poultry, and seafood are excellent sources of coenzyme Q10, which may help preserve nitric oxide.2-3
Some people need to eliminate dairy milk, cream, cheese, ice cream, and yogurt. Why? Because those foods injure endothelial cells and take away your nitric oxide. Regarding diet, I think this is where knowing your genetics is helpful. Understanding what your ancestors ate gives you a clue as to what you should eat.
Anti-Inflammatory Diet
I am a big proponent of anti-inflammatory foods, using curcuminoids as supplements, and a plant-based forward diet for nutrition. Getting people to accept an anti-inflammatory diet can absolutely destroy diabetes, hypertension, vascular issues, dementia, Crohn’s disease, ulcerative colitis, rheumatoid and immune arthritis, lupus, multiple sclerosis, allergies, and asthma. The list goes on.
Sleep
Deep sleep is the most restorative and rejuvenating sleep stage. Adults spend 1-1.5 hours, on average, of their total sleep time in deep sleep. When we are in deep sleep, blood pressure drops, heart and breathing rates are steady, arm and leg muscles relax, and the brain flushes out toxins. These patterns affect our cardiovascular health regardless of whether we exercise and what kind of diet we eat.4
Oils
This can get really confusing because several oils have been shown to damage or impair endothelial function. Olive oil seems to have the most support for nitric oxide production, particularly extra virgin olive oil which contains polyphenols like hydroxytyrosol and oleuropein, which have been shown to increase nitric oxide production.
Flaxseed oil, walnut oil, hemp seed oil and pumpkin seed oil can also protect nitric oxide.
Olive oil obviously gets the most attention because consuming olive oil instead of animal fats may lower the risk of premature death from CVD. The PREDIMED trial showed a Mediterranean diet supplemented with EVOO reduced CVD risk by 31%. Extra-virgin olive oil (EVOO) consumption may improve glucose metabolism and prevent diabetes onset.
Olive oil intake is linked to improvements in lipid profiles, including increased HDL and reduced LDL oxidation. EVOO may help manage components of metabolic syndrome, including blood pressure and insulin sensitivity.
Higher olive oil consumption (more than half a tablespoon daily) is associated with a lower risk of premature death from various causes. A dose-response relationship was observed, with benefits seen at intakes up to 20 g/day. 5-7
Some functional nutritionists and health influencers currently advise against consuming seed oils, often referred to as “vegetable oils.” They make the point that there is a higher omega-6:omega-3 ratio. Seed oils like soybean, corn, sunflower, safflower, and cottonseed oil are high in omega-6 fatty acids.
While omega-6s are essential, an imbalance whereby they significantly outnumber omega-3 fatty acids can promote inflammation in the body. No one disputes that chronic inflammation is linked to various health issues, including cardiovascular disease, diabetes, and autoimmune conditions.
Furthermore, seed oils are often highly refined, which involves high heat, solvents, and bleaching agents. This process can make the oils more prone to oxidation, especially when exposed to heat, light, or air. Oxidized fats can produce free radicals, which contribute to oxidative stress and cellular damage.
During the refining process, some seed oils can form trans fats, even if they are not intentionally hydrogenated. Trans fats are known to increase bad LDL cholesterol, decrease good HDL cholesterol, and increase the risk of heart disease. Even small amounts of trans fats can have a detrimental effect on health. The recommendation is to eliminate fried foods. It’s going to be tough for Americans to eliminate French fries, but you get the point.
Here’s where I currently stand. While seed oils are not inherently “bad,” the concerns stem from their processing methods, potential for oxidation, high omega-6 content, and role in displacing more nutrient-dense fats in the diet. I encourage a return to traditional fats like olive oil, coconut oil, butter from grass-fed cows, or animal fats like lard or tallow for those who tolerate them well. We still must advocate for individual health goals and conditions.
Nuts and Seeds
I don’t like peanuts and peanut butter, because they contain toxins and too much saturated fat. Walnuts, flaxseed and meal, and chia seeds are OK because they have omega-3s and don’t seem to have as much saturated fat.
Other Recommendations
Eliminate sugar as much as possible. Drinks like Cola, Pepsi, Coke, cakes, pies, cookies, stevia, agaves, maple syrup, and molasses. Even diet cola is off the list.
Remove processed foods, period. Patients need a lot of help here.
Promote nasal breathing. It is one of the most overlooked fitness and wellness practices to recommend. Nasal breathing triggers receptors in the body that effect hormones, HR, body temp, blood pressure and acidity.
Minimize fluoride exposure. Toothpaste with fluoride, public drinking water with fluoride, and mouthwash will injure the beneficial bacteria in your mouth (and I don’t mean acids because antacids will reduce your gastric acidity), and you will be unable to reduce the nitrate and more nitric oxide.
Get a water filter. I encourage all patients, regardless of where they live, to filter their water.
Supplements: Along with the above, I’m pushing red ginseng and red sage. Our recommendations need to improve nitric oxide production for healthy blood flow and circulation, strong, flexible blood vessels and arteries, energy for muscles (especially the heart), healthy blood pressure levels, and cholesterol balance.
An Issue Worth Attention
Are you with me helping people prevent cardiovascular disease? No one ever says, “When I had my first low back attack, that was exciting! I think I’ll destroy some more disc space and herniate a little more!” We are good at talking about posture and biomechanics, but people don’t even know about endothelial cells.
If you look at the risk of having a heart attack, your genes aren’t predicting it; it’s how you respond to a variety of behavioral aspects of your life: diet, exercise, sleep, whether you use tobacco, blood pressure, blood sugar, exercise and weight. These variables explain about 90% of the risk of having a heart attack at the population level.1
With that said, talk about prevention of coronary artery disease. It is preventable. Is it completely preventable? Probably not, but if we had perfect adherence to suggestions, we would have far less global burden of coronary artery disease and by extension, other cardiovascular diseases.
References
- “More Than Half of U.S. Adults Don’t Know Heart Disease Is Leading Cause of Death, Despite 100-Year Reign.” American Heart Association, Jan. 24, 2024.
- Olas B. The cardioprotective role of nitrate-rich vegetables. Foods, 2024 Feb 24;13(5):691.
- Al Saadi T, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev, 2021 Feb 3;2021(2):CD008684.
- About Sleep and Your Heart Health. Centers for Disease Control and Prevention, May 15, 2024.
- Xia M, et al. Olive oil consumption and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Front Nutr, 2022 Oct 18:9:1041203.
- Tsimihodimos V, et al. Extra virgin olive oil and metabolic diseases. Int J Mol Sci, 2024 Jul 25;25(15):8117.
- Fernández-Lázaro CI, et al. Deep dive to the secrets of the PREDIMED trial. Curr Opin Lipidol, 2021 Feb 1;32(1):62-69.
