Take Charge of Your Heart Health

Is alcohol good for heart health?
It was once thought that alcohol may be protective for heart health. However, updated research shows it does not provide any protection. In fact, alcohol consumption increases cardiovascular and chronic disease risk. As a result, Canada has updated their guidelines on alcohol intake related to health risk:

• 0 drinks per week - no risk
• 1-2 standard drinks per week - low risk
• 3-6 standard drinks per week - moderate risk
• 7+ standard drinks per week - increasingly high risk

A standard drink is:

• 12-ounce bottle of beer
• 5-ounce glass of wine
• 1.5-ounce shot of spirits

However, alcohol consumption is not advised with some medication. Please check with your pharmacist if you are advised to restrict alcohol consumption.

Is it okay to have caffeine?
Unless your doctor has recommended against it, you can safely have up to 300 mg a day of caffeine – about the amount in 2 cups (16 ounces or 500 mL) of coffee.

However, even small amounts of caffeine may interfere with sleep for some people, and good sleep is important for heart health.  Remember to avoid caffeine three hours before and one hour after exercise, including an exercise stress test.

Is sea salt better than table salt?
Both sea and table salt are mostly sodium chloride, containing similar amounts of sodium. Sea salt is often marketed as healthier because of its mineral content, but the amount of such minerals is so small it doesn't have a positive effect on health.

You may prefer the taste or texture of one over the other. Both should be used in moderation.

What about coconut oil?
Coconut oil is promoted for everything from weight loss to Alzheimer’s disease. Unfortunately, there is little research to back up these claims.

We do know that coconut oil raises low-density lipoproteins or LDL cholesterol levels, so suggest limiting its use. Extra virgin olive, canola, and other oils containing mostly unsaturated fats are preferred for heart health.

Should I choose butter or margarine?
Small amounts of butter or margarine are not likely to make much difference one way or the other. Butter is rich in saturated fats, which raise LDL cholesterol, whereas most margarine today is primarily unsaturated fat, which helps lower LDL cholesterol.

In the past, margarine contained harmful trans fats, which were banned from the Canadian food supply in 2018. Today’s margarine is non-hydrogenated and the heart healthier choice. However, if you prefer butter, that’s fine too, ideally in small amounts. When possible, use a healthy fat like olive oil or natural peanut butter instead.

Should I choose sugar substitutes over sugar?
Choosing sugar substitutes such as aspartame, sucralose, and Stevia can help to reduce sugar in the diet. However, all sweeteners, including natural ones like Stevia, are highly processed and primarily found in highly processed food products such as pop, candy, and cookies. If possible, try to limit highly processed foods and reduce both sugar and sugar substitutes in the diet.

Is it okay to take supplements?
We suggest discussing all supplements, including vitamins and herbal remedies, with your healthcare team. Some products can interact with your medications or cause harmful side effects. Unfortunately, research into many natural products is limited.

The Poison And Drug Information Service (PADIS) is also available to answer questions about how supplements and complementary medicines interact with your prescription medications, 24 hours a day, 7 days a week. You can reach their pharmacists and/or nurses by calling 1-800-332-1414.

Should I take fish oil (omega-3) supplements?
Omega-3 supplements are generally not recommended to reduce risk of future heart problems. Usually the best way to get your nutrients is by eating whole foods, and fish is no exception.

Do I need a protein powder to meet my protein needs?
Many people worry that if they reduce their meat portion or choose more plant-based proteins they won’t get enough protein. However, by filling ¼ of your plate with protein foods and choosing a variety of protein options at each meal and snack, most people can meet their protein needs through food alone.

Protein powders can be a convenient option, but whole foods are preferred because they give you more vitamins, minerals and other nutrients. If you do buy protein powder, be sure to check the product’s sugar content. Other convenient, nutritious protein boosters include Greek yogurt, peanut butter, or hemp seeds.

I want to lose weight. How much should I aim for and how should I change my diet?
A common goal coming into cardiac rehab is weight loss. However, while diets for weight loss work for some people in the short term, research shows that most people regain the weight within 2-5 years. Stalled weight loss or weight regain is discouraging and often causes a return to previous habits. Shifting the focus from weight loss to health behaviour change allows you to develop long-lasting, health-boosting behaviours.

Focus on changing dietary and lifestyle habits one at a time – allowing each change to become habit before moving onto the next. This will help provide lasting benefits to your health and ultimately be better for helping you to feel better and live longer. If you’re struggling to make sense of weight loss versus behaviour change, speak with your rehab team, family doctor, or a dietitian.

Should I consider a diet plan like ketogenic diet or intermittent fasting?
Any diet plan that restricts categories of food or times in which you can eat may result in short-term weight loss. However, weight regain is likely and these diets may impair your ability to eat mindfully, find satisfaction in food, and regulate your hunger/fullness.

The ketogenic diet restricts entire categories of foods including fruit, whole grains, and legumes which have been proven to help prevent and protect against heart disease. Instead of focusing on what to cut out of your diet, focus on what you can add in!

How can I prevent weight gain when I quit smoking?
After quitting smoking many people experience an increased appetite and, as a result, weight gain. Research shows that the benefit obtained from quitting smoking outweighs any risk you might add by gaining some weight.  

If you’re concerned about weight gain after quitting smoking, ask a member of your rehab team or the program dietitian for support.

Why is nutrition information always changing?
Nutrition science is complicated because we do not eat foods in isolation and how or what we eat is affected by other factors including stress and sleep (which are also risk factors for many chronic diseases). As more research is done, our understanding of nutrition evolves and small shifts in recommendations and guidelines occur.

Adding to the confusion, many online sources sensationalize or misinterpret nutrition information to create headlines or sell products. When reading nutrition information, take time to ask yourself these questions:

• Is it written by a nutrition expert (i.e., a registered dietitian)?
• Are they trying to sell a product, increase readership, etc.?
• Is the article discussing a single study or considering the entire body of evidence?

Go to organizations such as Dietitians of Canada, Heart and Stroke Foundation or the American Heart Association for trusted advice.

I’ve heard eggs are high in cholesterol, should I avoid them?
For a long time, guidelines suggested strictly limiting eggs in the diet due to their high cholesterol content. However, we now know that, for most people, dietary cholesterol has a limited impact on blood cholesterol levels. While some studies suggest that people who eat a lot of eggs experience more heart problems, particularly if they have diabetes, the evidence is not conclusive.

Eggs are a nutritious, convenient, and affordable protein source that can be chosen as one of your protein options.

Should I avoid fish because of mercury?
For adults with heart concerns, the benefits of fish far outweigh the risk of consuming too much mercury. To limit your intake of mercury and other potential contaminants, you can vary the fish you eat, limit your intake of high mercury fish (e.g., fresh/frozen albacore tuna, shark and swordfish), and eat no more than 4-5 servings of fish a week.

If you are or might become pregnant, are breastfeeding, or are feeding young children, limiting mercury is more important, although most commonly consumed fish are low in mercury.