1) How does diet and exercise play a role in heart health? What are the top steps a person can take to get heart healthy?

Diet and exercise play a huge role in cardiovascular health. Fortunately, we are learning more and more about what aspects of diet are most helpful for cardiovascular health. The most important new study in this area was the PREDIMED clinical trial, which assessed the impact of a Mediterranean diet supplemented with olive oil or nuts compared to a control diet that was low in dietary fat1.

The investigators found significant reductions in heart attack and stroke among patients randomly assigned to a Mediterranean diet. This is very important information; however, I have found that it is not always easy to determine what is meant by a Mediterranean diet. To clarify, here are the directions that the investigators gave to the patients that were assigned to the Mediterranean diet: fresh fruit ≥ 3 servings per day, fresh vegetables ≥ 2 servings per day, fish ≥ 3 servings per week, a preference for white meat instead of red meat, and optional intake of 1-2 glasses of wine per day. Study participants were told to consume high-quality olive oil or nuts every day. For olive oil, they were instructed to eat four tablespoons per day, which is a lot! For nuts, the recommended “dose” was about 20-30 nuts per day. Soda, commercial baked goods (such as muffins and pastries), spread fats (such as margarine), and red meat were discouraged. Overall, these recommendations are important guidelines for what constitutes a heart-healthy Mediterranean diet.

Regarding olive oil, not all olive oil is the same. I recently read a fascinating book, Extra Virginity: The Sublime and Scandalous World of Olive Oil by Tom Mueller, about the problems of poor quality and adulterated oil in the olive oil industry. In general, you want a fresh olive oil—look for a stamped harvest date on the bottle—and you want to consume the olive oil within a year or less of the harvest date. Also, look for olive oil with high polyphenol content. Polyphenols are the plant compounds in the olive oil that are thought to have biological effects that protect against heart disease. Information on polyphenol content is hard to find, but the UC Davis Olive Center2 has published some findings regarding polyphenol content in various commercially available olive oils. Quality olive oil with high polyphenol content tends to have a “peppery” taste and cause a mild burning feeling in the back of your throat, which are signs that the oil is potent. You should expect to pay $12-$25 for a liter of good olive oil. At lower price points, you are probably not getting a high-quality olive oil. I have ordered from Bariani, but you are free to do your own research to identify a good brand. Some other brands that I have seen with high polyphenol content include McEvoy Ranch and Kirkland Organic3

Olive oil is best consumed fresh—within 6 months to one year of harvest—and raw. Heating the oil may reduce some of the beneficial components. I mainly use high-quality olive oil as a dressing for salads, pastas, meat dishes, and especially on vegetables, such as broccoli and kale. Olive oil and fresh-squeezed lemon make a great finishing touch for roasted or sautéed green vegetables, while olive oil and balsamic vinegar add the perfect note to oven-roasted root vegetables.

Regarding nuts, almost all nuts have been found to be beneficial for cardiovascular health. The ones that I usually recommend are walnuts, almonds, pistachios, hazelnuts, and pecans. I suggest you eat raw, unroasted, uncoated nuts, because I have found that roasted nuts are often roasted in undesirable oils. For pistachios, it’s ok to eat the dry roasted and salted type. Even though they may taste salty, the sodium content from a handful of pistachios is fairly low. A handful of nuts is a healthy snack and should be a daily addition to a heart-healthy lifestyle.

Fish can be a healthy part of your diet, but there are caveats. The fish you choose should have high omega-3 fatty acid content and low mercury contamination. Furthermore, there is increasing awareness of problems related to overfishing, so the fish should ideally be from sustainable sources. The best fish of this type are Alaskan wild salmon, sardines, and anchovies. Watch the sodium content of the anchovies, though.

2) What are the recommended exercises someone should do, if any, for their heart?

Exercise is a critical part of a heart-healthy lifestyle. The American Heart Association recommends exercising 5 days per week for at least 30 minutes per day.

There is some interesting information coming out about high-intensity exercise regimens. These involve doing short bursts of high-intensity exercise alternating with a brief rest period. High-intensity exercise routines are not for everyone, but if you are able to do them, they may provide an extra fitness benefit.
As always with exercise, please use common sense. Start slowly and increase the intensity gradually. Always talk to your doctor if you are not sure if you can participate in exercise or if you don’t feel well while exercising.

The most important thing is to remain active as you age. We all have to keep moving forward!

3) Are women more prone to heart disease than men? Do you have any thoughts about women and heart disease?

Both women and men are at increasing risk for heart disease as they age. In recent years, the cardiology community has realized that women may not exhibit the classic chest pain that we think of with heart disease. Instead, they may have other symptoms, such as shortness of breath or fatigue. I encourage both men and women with any symptoms of heart disease to talk to their doctors.

Best wishes for your heart health!

Rajesh Gupta, M.D. Assistant Professor of Medicine Division of Cardiovascular Medicine University of Toledo Medical Center
Rajesh Gupta, M.D.

Assistant Professor of Medicine
Division of Cardiovascular Medicine
University of Toledo Medical Center


1. Ramón Estruch, Emilio Ros, Jordi Salas-Salvadó, Maria-Isabel Covas, D. Pharm., Dolores Corella, Fernando Arós, Enrique Gómez-Gracia, Valentina Ruiz-Gutiérrez, Miquel Fiol, José Lapetra, Rosa Maria Lamuela-Raventos, Lluís Serra-Majem, Xavier Pintó, Josep Basora, Miguel Angel Muñoz, José V. Sorlí, José Alfredo Martínez, Miguel Angel Martínez-González, “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.” New England Journal of Medicine, April 4, 2013; 368(14): 1279-90.

2. http://olivecenter.ucdavis.edu/

3. http://olivecenter.ucdavis.edu/research/files/oliveoilfinal071410updated.pdf

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