With heart disease the No. 1 killer of men and women in this country, you would think a cure that could dramatically reduce these deaths would be big news. And yet the most effective remedy is so simple that most people can't seem to believe it works.
"In traditional societies, where people don't eat processed foods, heart disease is rare," says cardiologist Dr. Arthur Agatston, author of The South Beach Wake-Up Call. "If you start with a healthy diet in childhood, heart attacks are almost completely preventable."
But even if you have downed a small army's worth of french fries, cleaning up your diet as an adult can still have a profound effect. Studies have shown that up to 70 percent of heart disease can be averted with the right regimen, according to Dr. Walter Willett, chair of nutrition at Harvard School of Public Health. But is diet alone as powerful as drugs? "Oh, no, it's much more powerful," says Willett. "Statins, the most effective single medications for reducing heart disease, only cut risk by 25 to 30 percent."
In fact, you would need a cabinet full of prescription drugs to bestow all the benefits of a serious heart-healthy meal plan. There's nothing a drug can do that foods can't do, too -- lower our blood pressure (like ACE inhibitors), slash "bad" LDL cholesterol (like statins), reduce harmful triglycerides (like fibrates), raise "good" HDL (like niacin tablets), and prevent the unwanted clotting that causes heart attacks and strokes (like aspirin).
Diet can be so effective that the British Medical Journal published a paper suggesting that doctors shelve the idea of developing a combination drug with multiple heart meds in it--the Polypill, as it has come to be known. Instead it recommended a Polymeal--a "tastier and safer alternative" that would include wine, fish, dark chocolate, garlic, almonds and heaping servings of fruits and vegetables. "But the longer you wait, the more likely you'll need drugs," warns Agatston.
In that spirit, here are nine top foods for the heart. But this list is only a beginning. A healthy diet features a broad range of fruits, vegetables, nuts and legumes. So while you're shopping for kale, don't neglect Swiss chard, arugula, spinach and romaine. An orange is great, but so are strawberries, apples, bananas and kiwifruit.
Hippocrates understood the concept more than 2,000 years ago: "Let your food be your medicine, and your medicine be your food."
Rx effect: Reduce blood pressure, cholesterol and heart failure
The evidence: Oranges contain a pharmacy's worth of salves for the heart. The soluble fiber pectin acts like a giant sponge, sopping up cholesterol in food and blocking its absorption -- just like a class of drugs known as bile acid sequestrants. And the potassium in oranges helps counterbalance salt, keeping blood pressure under control.
But new research shows something even more startling: Citrus pectin helps neutralize a protein called galectin-3 that causes scarring of heart tissue, leading to congestive heart failure -- a condition that is often difficult to treat with drugs. "Twenty percent of Americans over 50 have high galectin-3," says Dr. Pieter Muntendam, CEO of BG Medicine in Waltham, Md. "A 2009 study showed that a diet high in fruits and vegetables decreased the risk of heart failure by 37 percent."
Try: Pectin is contained in the pulp and pith. You'll get more of it in juice with pulp. Or better yet, eat your oranges.
Rx effect: Prevents atherosclerosis
The evidence: Your mom was right: You need to consume your dark leafy greens. "Kale has everything you would want in a superfood," says Dr. Joel Fuhrman, the author of the bestseller Eat to Live, who uses diet and exercise to help patients reverse their cardiovascular disease. For starters, kale boasts a bumper crop of heart-healthy antioxidants, omega-3 fatty acids, fiber, folate, potassium and vitamin E. It's also rich in lutein, which correlated in the Los Angeles Atherosclerosis Study with protection against early atherosclerosis. Kale even contains an unusual compound, glucoraphanin, that activates a special protective protein called Nrf2. "It creates a sort of Teflon coating in your arteries to keep plaque from adhering," says Fuhrman.
Try: For a snack, try Brad's Raw Leafy Kale -- actual kale that is dehydrated, then coated with ground cashews, sunflower seeds, lemon juice and garlic.
Rx effect: Reduces blood pressure and plaque
The evidence: Research suggests that, much like the ACE inhibitor drugs that fight high blood pressure, garlic ratchets down an enzyme called angiotensin, which constricts blood vessels. Though the effect is modest compared with medications, garlic seems to have a significant impact on the buildup of plaque. In three randomized trials, Dr. Matthew Budoff, professor of medicine at UCLA, found that plaque progression slowed by more than 50 percent in people taking garlic extract, compared with the nonvampire slayers-- "and the nongarlic group was on standard drugs," he says.
Try: The trials used 250-milligram tablets of Kyolic aged garlic extract to standardize the dose. "But it's always better to eat the real food," says Gayl Canfield, director of nutrition at Pritikin Longevity Center in Miami.
Rx effect: Boosts HDL, reduces unwanted clotting
The evidence: Any alcohol nudges up HDL, the "good" cholesterol that helps prevent plaque. But red wine may offer additional benefits, says John Folts, professor emeritus of cardiovascular medicine and nutrition at the University of Wisconsin - Madison. "The key is not resveratrol -- you would need 16 bottles a day," he says. Instead, compounds called polyphenols help keep blood vessels flexible and reduce the risk of unwanted clotting. "They're nearly as effective as aspirin," he says. But note: More than one glass of vino a day ups the risk of breast cancer for women, and chronic heavy drinking damages the heart, so this is a case where more is not better.
Try: Dark beer such as Guinness stout delivers many of the same beneficial polyphenols.
Rx effect: Reduces blood pressure
The evidence: The Kuna Indians off the coast of Panama have enviably low blood pressure -- and unlike the rest of us, they don't develop hypertension as they age. When a Harvard cardiologist, Dr. Norman Hollenberg, set out to unravel their secret, he assumed they carried some rare genetic trait. Instead he found they drink enormous quantities of minimally processed cocoa. It's rich in compounds called flavanols, which improve blood vessel flexibility. We can all get them from chocolate -- a few squares a day. Dark chocolate is likely to have more, because it starts with a higher cocoa content -- but that's no guarantee, since different processing methods can destroy them.
Try: Dove Dark has been shown to have high levels of flavanols.
Rx effect: Lower triglycerides, raise HDL
The evidence: The omega-3 fatty acids in cold-water fish are crucial for heart health, and sardines have among the highest levels. These "good fats" lower harmful triglycerides, raise protective HDL, reduce potentially fatal heart arrhythmias and tamp down inflammation. It is inflammation that ultimately destabilizes plaque, causing it to rupture and produce a heart-attack-inducing clot. Though you can get omega-3s from plant sources such as flaxseed, the "long chain" omega-3s in fish are far more powerful. A large Danish study last year in the American Journal of Clinical Nutrition found a 38 percent reduction in ischemic heart disease among women who consumed the most.
Try: Wild Planet sells wild sardines in extra-virgin olive oil with lemon.
Rx effect: Reduce blood pressure
The evidence: One international study followed 12,763 people in the United States, Japan and six European countries for 25 years. When the results were tallied, legumes -- such as lentils -- were associated with an 82 percent reduction in the risk of death from heart disease. The reasons include not only lean vegetable protein and fiber but also folate, magnesium and potassium. George Mateljan, the author of The World's Healthiest Foods, calls magnesium "nature's own calcium channel blocker" -- a type of drug that fights hypertension. And by counterbalancing salt, potassium is crucial for keeping blood pressure under control.
Try: TruRoots's new Sprouted Lentil Trio cooks in just 5 to 7 minutes.
Rx effect: Reduce LDL and fatal arrhythmias
The evidence: "You don't have to be miserable to bring your cholesterol down," says Dr. David Jenkins, professor of medicine and nutritional sciences at the University of Toronto. The plant sterols in almonds reduce the absorption of cholesterol from the diet, while the unsaturated oils encourage the liver to make less LDL and more "good" HDL. When Jenkins gave patients a vegetarian diet including almonds (along with other cholesterol-lowering foods, such as lentils, eggplant and soy) for a month, he found LDL reductions of 28.6 percent -- comparable to those on 20 milligrams of lovastatin (Mevacor). Just 22 almonds a day will do. Another study found major declines in fatal arrhythmias with two servings of nuts a week.
Try: Don't limit yourself to almonds. Walnuts, pistachios and peanuts are also great.
Rx effect: Reduce atherosclerosis
The evidence: Bringing down LDL is important, but so is preventing the oxidation of that cholesterol. When LDL is oxidized, it tends to get stuck in arterial walls, initiating the formation of plaque. But Michael Aviram, professor of biochemistry at the Technion-Israel Institute of Technology in Haifa, found that pomegranate juice, with its unique antioxidants, not only blocked the progression of plaque, but actually reversed some of the buildup when patients drank 8 ounces a day for a year. How does it do this? In later studies, Aviram learned that pomegranates activate an enzyme that breaks down oxidized cholesterol.
Try: For those who love pomegranates but not the messy job of cracking them open, Pom Wonderful does the work for you. Look for the fruit-covered seeds (or "arils") in clear plastic cups under the brand name Pom Poms.