Who are our experts?
PHOTO MARCO CAMPANOZZI, THE PRESS
Martin Juneau
Martin Juneau is a cardiologist and director of the Prevention Observatory at the Montreal Heart Institute. He has been interested in global cardiovascular prevention for 40 years.
PHOTO PROVIDED BY ANNE-JULIE TESSIER
Anne-Julie Tessier
Anne-Julie Tessier is a registered dietitian-nutritionist, PhD in nutrition and research associate in the Department of Nutrition at Harvard University. Her research focuses on nutrition and healthy aging.
There is a certain distrust of nutrition science, partly because it sometimes seems contradictory. Can we really say that certain diets or foods are good or bad for the heart?
AJT: Without classifying foods as good or bad, there are certainly types of diets that are better for the heart. Several studies support this. Beyond the food itself, the frequency of consumption is also important.
MJ: In the scientific literature, we’ve been saying pretty much the same thing for the last 25, 30 years: more fruits, vegetables and whole grains, and less added sugar, salt, bad fats and ultra-processed foods. The problem is the small studies on the fringe, not very well done, which are clickbait and which too often make the headlines, unfortunately.
What is the most important thing to eat to maintain heart health?
AJT: Fruits and vegetables stand out, among other things because they are rich in fiber, but also in potassium, a mineral that helps regulate blood pressure. Then, vegetable oils, with their interesting content of fatty acids, omega-3, omega-6, legumes, oats, seeds for their fibers…
Anne-Julie Tessier, you recently participated in studies that evaluated the ratio of plant-to-animal proteins in the diet and heart health. Should we completely replace animal proteins with plant proteins?
AJT: Not necessarily. When we discuss nutrition, we have to take into account our culture, our preferences and the environment. Recently, we did analyses in two Harvard cohorts with a follow-up of more than 30 years. We found that the more people consumed plant proteins compared to animal proteins, the lower their risk of having cardiovascular diseases. The lowest risk was observed at a ratio of 1 to 2. Beyond this ratio, we observed more of a plateau. Increasing our intake of plant proteins can therefore be beneficial, without having to completely eliminate animal proteins.
MJ: I think we need to distinguish the general population from recommendations for cardiac patients. In the past, famous studies have shown that with a strictly plant-based diet, we can reverse coronary lesions – not just prevent them, but treat them. Among patients who are truly afraid of having another cardiovascular event, many agree to drastic changes to their diet. In over 35 years of practice, I have rarely seen a patient who has become vegan return to the emergency room.
We know that red meat isn’t very good for your heart, but what about chicken, eggs, fish and dairy?
AJT: In moderation, these foods have their place in a healthy diet. When you put them together, studies show that greater adherence to a plant-based diet is associated with about a 15% lower risk of cardiovascular disease. But diets like the Mediterranean diet, which includes fish, eggs, and some dairy, or the DASH diet, which incorporates animal protein in moderation, are also associated with a lower risk of cardiovascular disease.
MJ: Our general recommendation is the Mediterranean diet. The vegan diet is suggested to highly motivated people who have a particularly nasty disease. But I would add this: vegetarian, but good quality.
Precisely, a study published in the spring in theAmerican Journal of Clinical Nutrition showed that meat substitutes like the Beyond Burger and Impossible Beef are no better than meat for heart health, at least in the short term…
MJ: We really don’t recommend these things because they’re full of salt and the list of ingredients is so long that you’d need a PhD to read them. Same thing for spaghetti with white pasta and tomato sauce with fries and a Coke: it’s vegetarian, but it’s junk food.
The American Heart Association recommends choosing foods with little or no salt. Should you really not add any?
MJ: A tomato with basil, no salt, for someone who is not used to it, it tastes nothing. But I guarantee you that after a month, you will find that it is even better without salt! Many organizations recommend 1.5 grams, 2 grams per day, but Canadians eat 5 or 6. That is way too much. Almost 50% of Canadians aged 50 and over suffer from hypertension, and most are poorly or poorly treated. […] If you eliminate ultra-processed foods and cook your own food, you may not exceed the recommendations. Added table salt may only account for 15% of salt intake.
AJT: The general population does not necessarily have to abstain from adding salt. Our sodium intake comes largely from processed foods and restaurant meals. According to the Institut national de santé publique du Québec, the main foods contributing to sodium are breads, followed by deli meats, cheeses, sausages, refrigerated meals, pizzas and chips.
And what about the ketogenic, low-carb, high-fat diet?
AJT: The ketogenic diet certainly does not align with the recommendations of the American Heart Association, but some studies show that compared to a low-fat diet, a ketogenic diet could have some health benefits (blood sugar control, triglycerides, etc.), but in the short term. These are all short studies. And in some individuals, we see an increase in bad cholesterol. We can also question the nutritional deficiencies and the long-term adherence to this very restrictive diet.
MJ: When patients absolutely want to try it, I tell them that we can guide them, but that it will be an extremely restrictive diet, with good fats like avocado, olive oil, nuts, fish… Vegetables are fine, but very little fruit. For very targeted cases of type 2 diabetics, perhaps, but it is far from being our first choice.