A Healthy Diet For Your Heart: A Doctor’s Expert Advice

Dr. Leor Perl

Dr. Perl is a Cardiology Fellow at Israel’s Rabin Medical Center since 2011 under the distinguished Chief of Cardiology, Professor Ran Kornowski. Dr. Perl completed his one Month Fellowship in Cardiology at Stanford University Medical Center, March 2014 thanks to supporters of the Abraham & Yvonne Cohen Cardiac & Medical Research Fund.

Throughout his residency, Dr. Perl has chosen to focus on interventional cardiology, due to its tremendous possibilities and significant impact on patients' well-being. Upon completion of his Rabin Medical Exchange Fellowship, he was accepted to the prestigious Stanford Medical Center two-year Fellowship for interventional cardiology fellowship, which he attributes to his Rabin Medical Exchange Fellowship. His Fellowship will begin July 2015 with his first year in clinical studies and the most crucial for his career. Following his first year, Dr. Perl will complete a second year of research, and possibly a third one for the biodesign program.

Below are a few healthy living and diet tips for your heart from our Rabin Fellow, Dr. Perl!

We are surrounded by information regarding the risk of cardiovascular disease, and the best way to prevent it in our daily lives. One may be overwhelmed with the infinite number of opinions advocated in the media, much of it based on personal experience and "locker-room science." We have decided to look into the most established scientific data, gathered from the two major cardiovascular organizations- the American Heart Association and the European Society of Cardiology, and to concisely explain current recommendations, based on recent research in this field.

The first thing to remember is that prevention works: over 50% of the reductions seen in coronary heart disease mortality relate to changes in risk factors, and 40% to improved treatments. Also, despite having a reputation of being relatively protected from heart disease, women are in danger of dying of it- of all deaths that occur before the age of 75 years, 42% are due to cardiovascular disease in women and 38% in men.

A healthy diet is recommended as being the cornerstone of CVD prevention:

  • In general, our dietary pattern should emphasize intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limit intake of sweets, sugar-sweetened beverages, and red meats.
  • Reduce saturated fatty acids (mostly from meat and dairy products) to account for <10% of total energy intake, through replacement by polyunsaturated fatty acids (from fish and vegetables).
  • Trans unsaturated fatty acids (found in processed food, specifically margarine): as little as possible, preferably no intake from processed food, and <1% of total energy intake from natural origin.
  • <5 g of salt (sodium) per day. For hypertensive patients, an even lower level of salt is recommended- 1.5 to 2.4 grams of salt per day.
  • 30–45 g of dietary fiber per day, from wholegrain products, fruits and vegetables.
  • 200 g of fruit per day (2-3 servings).
  • 200 g of vegetables per day (2-3 servings).
  • Eat fish at least twice a week, one of which to be oily fish.
  • Consumption of alcoholic beverages should be limited to 2 glasses per day (20 g/d of alcohol) for men and 1 glass per day (10 g/d of alcohol) for women.

Weight reduction:

Reduction of weight is recommended in overweight and obese people, as this is associated with favorable effects on blood pressure and dyslipidemia, which may lead to less CVD. Increased body weight is thought to account for increased blood pressure, insulin resistance (which may cause diabetes), abnormalities in the inflammatory state, heart function, vascular and renal disease.

The goal is a reduction in the BMI (body mass index= weight/height^2) between 20 and 25 kg/m2 and waist circumference under 94 cm in men and 80 cm in women.

Physical Activity:

Healthy adults of all ages have to spend 2.5-5 hours a week on physical activity of at least moderate intensity, or 1-2.5 hours a week on vigorous intense exercise. Sedentary subjects should be strongly encouraged to start light-intensity exercise programs. Aerobic exercise is the foundation of physical activity, but ideally should be combined with resistance training.


Smoking kills in more than just one way and is an established cause of a plethora of diseases. As for the cardiovascular field, the relative risk of having a heart attack in smokers over 60 years of age is doubled, but the is five-fold higher in smokers under 50 years than in non-smokers. Importantly, exposure to passive smoking increases risk of cardiovascular disease and has to be avoided. A non-smoker living with a smoking spouse has an estimated 30% higher risk of cardiovascular disease. Smoking cessation with pharmacological and nicotine replacement therapy aid improves the rate of success. Cessation reduces the risk of cardiovascular disease immediately, approaching the risk of never-smokers within 10–15 years, without ever quite reaching the same level.

Blood Pressure:

Elevated blood pressure is a major risk factor for heart disease of all sorts, as well as for stroke, peripheral artery disease and renal failure. Diagnosis of hypertension is made when repeated measurements show values above 140 mmHg systolic and 90 mmHg diastolic blood pressures, although the optimal range is lower- 120/80 mmHg and below.

While lifestyle measures, such as weight control, increased physical activity, and an adequate diet ( alcohol moderation, sodium restriction, increased consumption of fruits, vegetables, and low-fat dairy products) are recommended in all patients with hypertension, medical treatment is very effective and may be necessary as well.

Cholesterol Levels:

Increased plasma cholesterol and LDL cholesterol are among the main risk factors for cardiovascular disease. High levels of triglycerides and low HDL cholesterol are other independent risk factors. The recommended target levels are less than 5 mmol/L (~190 mg/dL) for total plasma cholesterol and less than 3 mmol/L (~115 mg/dL) for LDL cholesterol for subjects at low or moderate risk. Patients with established heart disease should aim for even lower levels of LDL (less than 70 mg/dL). Research shows a clear dose-dependent relative reduction in CVD with LDL cholesterol lowering. Every 1.0 mmol/L reduction in LDL cholesterol is associated with a corresponding 20–25% reduction in cardiovascular mortality and heart attacks.

Psychological and social stress reduction:

The following factors area also associated with increased risk of cardiovascular disease: low socio-economic status, lack of social support, stress at work and in family life, depression, anxiety, hostility, and the type D personality. Whenever possible, these factors should be accounted for and dealt with seriously.

In summary, risk for heart disease is multi-factorial, and is very dependent upon modifiable factors. This was only a brief reminder of the different risk factors and the corresponding recommendations. For more information, please consult with your physician, you may also e-mail me (at leorperl@gmail.com?) and look for further information in the following recommended professional websites:



*Adapted from the Practice Guidelines Report of the American College of Cardiology/American Heart Association Task Force on 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A and the European Guidelines on cardiovascular disease prevention in clinical practice (version 2012).

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