Statistics tell us that over the last 50 years we have been getting a lot better at keeping people with heart disease alive – but we don’t seem to have made much progress in preventing its occurrence in the first place. That seems odd, considering that everybody knows about cholesterol and saturated fat, and millions of people are taking cholesterol-lowering drugs. What’s going on?

Is it, perhaps, that people are not listening to the warnings? They might know that they are not supposed to eat so much saturated fat but they are just not doing it. Or could it be that the advice we have been receiving and are continuing to receive from health and nutrition experts is not giving us the whole picture?

Cardiovascular disease, cholesterol, saturated fat and lifestyle factors have been extensively researched over the last 50 to 60 years, but despite this it has yet to be conclusively proven that cholesterol and saturated fat cause heart disease.

So if cholesterol doesn’t cause heart disease, what does? Cardiovascular disease is now understood to be caused by systemic inflammation. In simple terms, constant low-grade inflammation irritates the lining of the arteries, causing lesions. Cholesterol does play a role, but its importance may have been overstated. It is not the only risk factor, nor the most important one and may not even be the best predictor of heart disease risk.

Here are our three top tips for a heart-healthy diet.

1. Cut out sugar

Diabetes is a much more significant risk factor for cardiovascular disease than high cholesterol. Diabetes, in particular type 2, is still on the rise and most people who have heart disease have – diagnosed or undiagnosed – diabetes or pre-diabetes.
In diabetes, blood glucose levels are out of control, and the excess sugar circulating in the body damages proteins (and thus potentially any kind of cell) and fuels inflammation. It also raises insulin levels due to a state called insulin resistance. For diagnosed diabetics, insulin levels are high at times when it is injected by the patient. Like sugar itself, insulin triggers inflammation, and while it is a vital hormone, we should aim to keep our insulin levels low and our cells responsive to it. The first step to achieving improved insulin sensitivity and lower blood sugar levels is not to eat sugar.

For sugar addicts, this is not going to happen overnight, and you may find it very hard. Sugar withdrawal is not pleasant, and for the first 3-7 days, you may experience symptoms such as tiredness, headaches, cravings and even backache. If you are an all-or-nothing person, go cold turkey. If you think that you couldn’t do that, ease yourself in. The most important thing is that you start.

As well as avoiding the obvious sweet treats, you may want to start reading labels on the foods you buy. A 2016 US study found that 60 per cent of packaged foods in US supermarkets contain added sugar. That may be more than in the UK, but usually we are not lagging very far behind. Read the labels of anything packaged for a while. If it contains more than 10g sugar per 100g, that’s a lot. Low-sugar foods have less than 5g/100g.

2. Choose your starchy carbohydrates wisely

All carbohydrates are chains of glucose, i.e. sugar. The difference between different types of starchy foods – bread, pasta, rice, cakes, wraps etc. – lies merely in the length and complexity of their glucose chains. Refined carbohydrates, such as white flour products, white bread, white rice, consist of short chains that break down fast, whereas complex, unrefined carbohydrates, such as a coarse wholegrain rye bread, wheat berries, or brown rice, consist of long- and sometimes branched chains that release their sugar slowly. Refined carbohydrates can raise blood glucose and insulin levels as fast as table sugar. Complex carbohydrates provide a slow and steady energy supply, which you can slow down even further by pairing them with protein, such as meat, fish, eggs, cheese, nuts or nut butters. A welcome side-effect of following a low-sugar and low-carb diet is the dramatic reduction of sweet cravings.

If you wanted to, you could ditch starchy carbohydrates altogether, and replace them with a rainbow of vegetables. These have the added bonus of providing us with nutrients that help combat inflammation, such as vitamins A and C. Nutrition science tells us there are essential amino acids (building blocks of protein) and essential fats, but there are no essential carbohydrates. The body needs glucose, but it can make it from other nutrients.

3. Know your fats

For many years we have been warned to avoid saturated fats, as they supposedly increase cholesterol levels in the blood, causing heart disease. We were advised to favour vegetable oils instead because they contain the heart-healthy polyunsaturated fats – omega-3 and omega-6 – that we need more of. With regard to heart health, this advice may be misleading. Vegetable oils are not made from vegetables, but seeds: sunflower, rapeseed, flaxseed, cottonseed (mainly US), corn, soya bean etc. Some of them – e.g. sunflower, rapeseed and flaxseed oils – are excellent oils, just so long as they are mechanically extracted (“cold pressed”), kept in opaque glass bottles, refrigerated and never heated. This is because polyunsaturated fatty acids (PUFA) are susceptible to light and heat.

But those are not the seed oils we are talking about. The seed oils nutrition practitioners do not recommend are industrially manufactured, highly processed cooking oils. They are chemically extracted using solvents, stored in clear plastic bottles, and used in high-heat cooking, including deep-frying. The extraction, processing and later use entirely destroys any health benefits the PUFA might have had and, in fact, turns them into toxic substances. Processed seed oils are now known to contribute to inflammation. The very oils that have been recommended for half a century may be the most damaging of cooking fats. Also undesirable are transfats, which are also processed (hydrogenated) seed oils, which occur mainly in margarines, processed foods, and baked goods.

The healthy fats we should be eating are the natural fats, including moderate amounts of saturated fats (e.g. butter, ghee, lard, coconut oil). Other recommended fats are monounsaturated fats (e.g. olive oil, avocado oil) and cold-pressed seed oils as described above. Saturated fats are the most stable at high temperatures, so those are best for frying.

If you are only going to make three changes to your diet for better heart health, these three are the most important. Your lifestyle, of course, plays a vital role, too.

Our one hour seminar The Heart of the Matter: top tips for cardiovascular health, is a great way to educate your employees about heart health, and you can schedule it to coincide with National Heart Month in February.

Sign-up to our newsletter, which this month will feature our top 3 lifestyle tips for a healthy heart as well as a heart-healthy recipe.

For a referenced version of this article please email

According to the British Heart Foundation:

  • Around 7.4 million people in the UK have cardiovascular disease.
  • Around twice as many people are living with cardiovascular disease than with cancer and Alzheimer’s disease combined.
  • Cardiovascular diseases cause more than a quarter (27 per cent) of all deaths in the UK; that’s nearly 170,000 deaths each year – an average of 460 people each day or one death every three minutes.
  • Deaths from cardiovascular have declined by 68 per cent since 1980, while the prevalence has remained constant at approx. 3 per cent in that same period.
  • Around 44,000 people under the age of 75 in the UK die from heart and circulatory diseases each year.
  • Around 80 per cent of people with heart and circulatory diseases have at least one other health condition, most often, that is diabetes.

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