A guide to healthy hearts

by Dr Sherina Fernandes


It’s February, the month where we see hearts in shops and send Valentines’ cards to our loved ones. So, this would be a good month to think about showing some love to our own hearts and talk about heart health. 

By now up to 80% of New Year’s resolutions have started to lapse, we want to exercise more, eat healthier, but why is it so hard to do and sustain? Perhaps we need to look more at small easier lifestyle changes that become more about habit and take less will power. Knowing why we need to make changes can help to motivate us to make these changes. 

Coronary Heart disease (CHD) is known as a leading cause of death worldwide. This is caused by many factors, and we know that changes in lifestyle can reduce our risk of a heart attack by 80% so let's look at some of these lifestyle changes that can help our heart. 

1) Diet and your heart 

Diet is key when it comes to heart health. There are many “diets” talked about and this can be an emotive topic. One undisputed fact is that processed and convenience foods that contain high levels of certain bad fats known as trans fats as well as salt and other chemicals which have a detrimental effect not just on your heart but also are linked to the generation of multiple other chronic diseases and cancers. 

If looking at your food intake in general, try to make it full of “nutrient dense” foods: 

  • Vegetables 
  • Herbs and spices 
  • Fruits 
  • Legumes 
  • Wholegrains 
  • Nuts and seeds 

Keeping this group as your main food source is key to a healthy heart and healthy body. 

Foods to avoid are those considered to have minimal nutrients such as: 

  • Sugary drinks 
  • Desserts and sweets 
  • Fried foods 
  • Red and processed meats 
  • Refined grains – i.e., white rice, pasta or flour 
  • Alcohol

Aiming for a plant predominant diet, where sources of protein include beans, lentils, soya, nuts, and where fat is mainly from nuts and seeds rather than regular animal sources, can support heart health. Following this way of eating tends to lead to more control of weight, lower blood pressure and more fibre in the diet, which helps our bacteria in our gut to keep the body healthy. 

There are some clinical trials and study which support this. The Lyon diet heart study showed that a Mediterranean diet (i.e., diet mainly of fruit, vegetables wholegrains and oily fish) reduced the risk of death after heart attack even after 4 years, compared to following the typical American Heart Association “Step 1” diet given to patients in the USA after heart attack. The Lifestyle heart trial done in the USA by Dean Ornish, had impressive results with patients who had moderate to severe heart disease. He took a group of patients and gave them a whole food plant-based diet, smoking cessation and stress management and found with this group, the degree of stenosis (how much blockage was present in their vessels, causing heart disease) not only didn’t progress but started to reverse at 1 year follow up and even further at 5 years follow up. 

With diet, balance and moderation are key, it is also important to watch portions and be more mindful of eating cues such as when you are hungry and when you feel full. Being aware of how stress and your environment affect you, slowing down chewing and paying attention to how you eat can make a huge difference to your eating habits. 

2) Exercise and heart health 

Physical inactivity is the cause of 1 in 10 premature deaths and 6% of coronary heart disease worldwide. Current recommendations are: 

  • 150 minutes of moderate intensity exercise per week – moderate intensity means you can talk, but couldn’t sing so a brisk walk for 30 minutes, 5 days a week, would meet this. 
  • Resistance exercises at least twice a week – this is due to muscle mass decreasing from the age of 30. Building lean muscle is associated with a lower cardiovascular disease risk. 

Moderate intensity exercise reduces the risk of primary coronary heart disease in active men and women by 10-20%, compared to inactive men and women. 

In a trial looking at 339,274 participants, there was no statistical difference between physical activity as an intervention, and drug interventions for the secondary prevention of coronary heart disease and prediabetes. This emphasised the importance of physical activity and its role in health. 

The Women’s Health Initiative study also found that the more physically active women were, the less coronary heart disease they experienced. 

So, find an activity that you enjoy that will raise your heart rate and get you a little out of breath. This could be brisk walking, dancing, swimming, climbing, joining a local sports team or a class at the local gym – anything goes but you are more likely to keep it up if you enjoy it or have someone to join you. 

3) Sleep and your heart 

When we sleep, we switch from our sympathetic nervous system to our parasympathetic system; meaning our blood pressure reduces and our heart rate slows down. Good sleep helps to increase stamina and cardiovascular response times and is essential for our heart health. Not prioritising sleep, so we have poor or shorter sleep, has implications such as raised blood pressure increased risk of heart attacks and cardiovascular disease. In fact, in Matthew Walker’s book “Why We Sleep”, he states that during the switch from daylight savings time in March in the Northern Hemisphere, the 1-hour loss of sleep comes with a spike in hospital records of heart attacks the following day. Conversely in autumn when the clocks go back and we gain an hour of sleep opportunity, the rate of heart attacks significantly decrease. Sleep is so important not just for our heart health and this is not stressed enough in the medical profession. 

We should aim for 7-9 hours per evening, try to have a bedtime routine where the lights are dimmed and there are no screens 1 hour before bed. Get natural daylight in the morning and try and do most of your physical activity in the morning or by late afternoon if possible. Ensure you are well hydrated in the day and avoid large starchy and high sodium meals late in the evening. 

4) Stress and heart health 

Stress is a part of life, and our stress response has allowed us to survive from the beginning of time when we needed our “fight, flight or freeze” response to escape danger. This is our sympathetic nervous system, useful in short bursts. For example, if we are in danger we need our heart rate, breathing rate and blood pressure to rise, we need more sugar for energy and increased focus or alertness. However, modern life has led to overactivation of our sympathetic drive from how we process external events happening daily. What is perceived as stressful for some people may not be to others and how people deal with stress can influence their health. 

70% of primary care visits are often related to stress and lifestyle. Stress not only effects heart and blood pressure but influences our hormones and increases our risk of diabetes, inflammation and all associated with that inflammation. 

Hence, learning to deal with stress and having downtime is essential for your heart health. Remember that a poor diet puts the body under stress and, as stated above, so does poor sleep. Regular exercise helps us to deal with chronic stress.  

Mindfulness and meditation are coming to the forefront to help us cope with our increasingly stressful lives and it has been shown to help lower heart rate and breathing rates, switching us to our parasympathetic nervous system 

There is an emerging field looking at the benefits of positive psychology. This includes gratitude practice and having a sense of purpose and optimism. There are many studies, including those of the blue zones (pockets of areas in the world where people live the longest) that have concluded that having a sense of purpose will reduce your risk of cardiovascular disease. It is becoming clearer that we should not just be paying attention to our mental and physical health but also to our social and spiritual health as they all contribute to our overall health, wellbeing quality of life and life expectancy. 

A sense of community can help - laughter helps to decrease risk of heart attack by lowering blood pressure and increases your immunity! 

5) Looking after your heart 

When you look after your physical, mental, spiritual and social health, you will be looking after your heart. If you want to start embracing healthy habits for you heart, try the following: 

  • Clear out the minimal nutrient foods listed above and stock up on nutrient dense foods
  • Snack on nuts rather than processed snacks crisps or sweets 
  • Get more active - as simple as a walk at lunch time 
  • Prioritise sleep - make sure you’re in bed by a certain time to allow for 8 hours of sleep 
  • Try meditation, or mindfulness, if you are feeling stressed, build it into your day. There are numerous types of breathing exercises such as box breathing. Box breathing involves the following steps:  
       1) Breathe in through your nose deeply and slowly for 4 seconds,  feel your lungs expand 
       2) Hold your breath there for 4 seconds 
       3) Slowly exhale for 4 seconds

       4) Hold for 4 seconds and then repeat 
  • Don’t forget to smile, laugh, socialise with friends and prioritise what is important to you 
  • Stop smoking! 
  • Limit alcohol intake 

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