The role of nutrition for heart health through a doctor’s lens – Q&A with Dr. Michael Roizen, MD

To celebrate Heart Health Month, the Talking Nutrition editorial team connected with Dr. Michael Roizen to have a heart-to-heart conversation about the key nutrients he recommends to his patients for overall heart health. Michael F. Roizen, MD is the Chief Wellness Officer Emeritus and was the Founding Chair of the Wellness Institute at Cleveland Clinic in Ohio, USA. Check out his full bio at the end of the article.

TN: Let’s get right to it…which nutrients are at the top of your list for heart health?
MR: I’ve got an easy way for anyone to remember what to eat: LUV-U Foods.

• Lean protein, with an emphasis on plant-based protein (even non-lean seeds and nuts); I totally avoid all red meat, and do enjoy salmon and ocean trout.
• Unsaturated fats (especially omegas like omega-3 EPA and DHA, as well as omega-7 (found in fatty fish and oils) and omega-9 (found in e.g. extra-virgin olive oil)
• Vegetables and fruits
• Unprocessed grains

The LUV-U foods have been shown to have a whole host of benefits. Vegetables and fruits contain phytochemicals and other disease-fighting compounds, not to mention fiber, which supports a healthy heart. Plus, vegetables and fruits have a plethora of vitamins and minerals.

Unsaturated fats help to lower levels of harmful LDL cholesterol and triglycerides, decrease inflammation, and raise levels of good HDL cholesterol in your blood, and unprocessed grains (100 percent whole wheat and whole grains) are good for fiber, lasting energy and satiety. Lean protein—in the form of non-mercury-laden fish (especially salmon, ocean trout, anchovies and sardines), skinless white meat chicken, and skinless white meat turkey, and especially plant-based proteins like beans (any type, prepared just about any healthy way), quinoa, chia, nuts and seeds, and many greens like spinach and kale - also provides lasting energy and satiety, as well as contributing to repairing muscles when they’re broken down. If you regularly balance your meals with these foods, you’re well on your way to fuelling your body with heart-healthy nutrients.

TN: If you’re working with a patient who has a heart condition, what do you recommend for their daily diet?
MR: One of the most interesting facts about the human body is that food choices can turn genes on and off. For instance, there are several foods (the LUV-U foods) that literally turn off genes that promote inflammation and atherosclerotic disease and obesity. 

The vital rule of nutrition is this: the best foods you can eat have the fewest ingredients. Single ingredients foods like fruits, vegetables, lean proteins and whole grains are what you should be eating 90 percent of the time. It doesn’t need to be complicated. For patients who do not consume all of the heart-healthy nutrients they need through their diet, I often recommend supplementation to fill the nutrient gap.

TN: Which nutrients or foods should not be a part of a heart-healthy diet?
MR: I advise and plan with patients to avoid the Snake Oil Foods:

• Saturated and trans fats – including most four-legged animal fat and tropical oils, such as palm and coconut oil and partially hydrogenated fats.  The amino acids associated with these fats change the bacteria inside the gut to produce inflammatory products that you absorb, and thus promote inflammation.
• Simple sugars – such as brown sugar, dextrose, sucrose and raw sugar.
• Simple syrups – such as fructose (high fructose corn syrup), malt syrup and molasses.
• Stripped carbs -  that is, processed carbs stripped of their whole grains, like white flour.

If any of the first five ingredients on any package is or contains these ingredients, I advise patients to reject it. That means any saturated fat, trans fat, added sugar, non-whole-grain carbohydrate, or added syrup. Packaged foods that lead with whole grains (like oats or brown rice), fruits, vegetables and other LUV-U foods are okay, even better if they are fortified with essential micronutrients.

TN: How important are omega-3s for the heart?
MR: First you should know that not all fish oil is created equal. I tell patients to look for omega-3 EPA and DHA, and not generic processed fish oils.  The data from analysis of many studies and many different levels do not indicate that generic fish oil reduces heart attacks or dementia. (1)

But specifically, omega-3 EPA and DHA seems in my examination of the data to help prevent atherosclerotic heart disease. (2,3). And as stated above, unsaturated fats, especially the odd numbered omega’s like omega-3s, help support heart
health by a number of mechanisms, including lowering levels of harmful LDL cholesterol and triglycerides, decreasing inflammation, and raising levels of good HDL cholesterol in your blood.

TN: How can people tell if they are low in omega-3s?
MR: It is really hard to judge food and even supplement intake, but really important for brain and heart and vessel functioning. Therefore, to be truly accurate you can do a blood test (like getting a finger pricked for your blood glucose level) and have it analyzed for omega-3 levels (check out OmegaQuant for your own test!).  I do this about twice a year, and despite high walnut and salmon intakes, I am surprised my level doesn’t stay as high as I want unless I add a EPA/DHA supplement as well.  

TN: What do you recommend to patients who want to increase their omega-3 levels?
MR: Not all omega-3’s are converted to EPA or DHA, which are the active omega-3s in supporting your heart health, so you need to make sure you’re getting the right ones. For my patients,  I advise them to eat more salmon (I love salmon  burgers for breakfast and lunch—when buying pre-made, check the label for EPA/DHA levels). And because it can be very challenging to obtain optimal omega-3 levels through diet alone, I suggest they supplement, as I do, with 600 mg (or 900 mg if they do not regularly eat salmon or ocean trout) of EPA/DHA every day.  

Our guest expert

Dr. Roizen is the Chief Wellness Officer Emeritus and was the Founding Chair of the Wellness Institute at Cleveland Clinic in Ohio, USA. He is a Past Chair of a Food and Drug Administration advisory committee and a former editor for six medical journals. He has published more than 190 peer-reviewed scientific papers, 100 textbook chapters, 30 editorials, and four medical books (one, a medicalbest-seller), 22 including 2 to be published this year) books on health for the law audience including 4 #1 NY Times Bestsellers and 10 overall top 10 NY Times Bestsellers, and has received 13 U.S. and many foreign patents.  He has received an Emmy, an Elle, and the Paul G. Rogers Award from the National Library of Medicine as Best Medical Communicator.