Heart disease runs in my family, like it does in many families. Few people are immune to the insidious accumulation of arterial plaque. Known risk factors include smoking, a sedentary lifestyle, age, and type-2 diabetes. Dietary factors are acknowledged, but there is no consensus regarding which dietary factors are actually risky. The stale conventional wisdom regarding cholesterol, meat, and saturated fat being bad for your heart is rapidly giving way to a more nuanced view that considers systemic inflammation, blood sugar regulation, and calcium metabolism. Starchy foods (bread, pasta, rice, potatoes), fructose, and other high glycemic-index foods are now viewed with more suspicion than the once-maligned rib-eye steak and scrambled eggs. Many doctors still consider arterial hardening to be irreversible, but a new breed of cardiologists has a different view; arterial plaque can be measured, controlled, and even reversed.
What can you do to reduce your own risk of heart disease (or even reverse it if it has already progressed)? Well, don’t listen to me — I have no medical credentials whatsoever. But you might talk to your doctor about some of the evidence presented below.
1) EAT FOIE GRAS
An acquaintance who used to work at an extremely fancy restaurant once received a complaint from a patron; “This foie gras tastes like liver.” The consummate professional, my acquaintance apologized and took the dish back without comment.
Foie gras is, of course, made from the fattened liver of ducks or geese. Gavage, or force-feeding of corn, is the controversial (and in many areas illegal) method of fattening the fowl. I support the ban against gavage, in large part because it is unnecessary. As this farmer recounts, it’s not hard to get geese to overeat.
But just north of Seville is a unique Spanish farmer, Eduardo de Sousa, who produces foie gras without force-feeding. In autumn, in preparation for migration, his 2,000 geese gorge themselves silly on figs, acorns, lupins and olives left in tempting piles around the 30 acre farm.
After 14 days of feasting, their bellies touch the ground and their livers are deemed big enough.
In addition to the delicious, buttery taste, there is another compelling reason to consume foie gras. It is the food with the highest concentration of vitamin K2. Ah, you say, you’re forgetting nattō (fermented soy bean paste). Nattō is technically higher in K2, but I don’t consider it food. By all accounts it is intolerably slimy and has a dirty-sock-like taste incompatible with the western palate.
Vitamin K2 (menaquinone) is not a widely understood nutrient. Vitamin K1 is more well-known; it’s found in green leafy vegetables and helps blood to clot. Vitamin K2 is synthesized in the gut, to some extent, from vitamin K1. At least one study has found an inverse association between dietary vitamin K2 intake and coronary heart disease. Is one study — one that shows no causative effect but merely an association — enough to change your dietary habits? Usually it wouldn’t be, but foie gras is exceptionally delicious. If you can find a humane source, I say go for it.
There is also strong evidence that vitamin K2 deficiency is associated with osteoporosis, and some evidence that increasing K2 intake (from supplements and/or diet) can strengthen bones. K2 seems to be involved in moving excessive calcium out of the bloodstream and into the bones. The conventional wisdom regarding osteoporosis (consume more calcium) is now being superseded by a more nuanced, holistic approach that includes raising vitamin D levels to the optimum range (which increases calcium absorption up to fourfold), making the diet more alkaline so that less calcium is leeched from the bones to balance blood pH (eat more vegetables, smaller amounts of meat and grain, no soda), increasing dietary K2 (for proper calcium metabolism), doing “bone-bending” exercises like jumping and sprinting (which sends signals to the bones to become more dense), and adequate dietary intake of not only calcium, but also magnesium, silica, and numerous other important micronutrients.
Vitamin K2 deficiency may be widespread. Few people consume large amounts of kale, parsley, broccoli, and other foods abundant in K1. Even if you do, absorption of K1 can be as low as 10% (though absorption is increased by eating your vegetables with oil — another reason to slather on that olive oil). The K1 that does make it to your gut may not be properly synthesized into K2. If you’ve taken antibiotics within the last year or two, your biotic community may not be up to the task. It makes sense to be on the safe side and consume dietary K2.
If you can’t stomach foie gras, or feel that all foie gras is inhumane, there are other options. Fermented or aged cheeses from grass-fed cows have a fair amount of K2, and the dietary intake of K2 cited in the Rotterdam study was almost exclusively from Dutch cheeses that fit these category (Gouda, Edam, Leyden, etc.). How can you tell if cheese is fermented? Fermented cheese has holes in it; the air bubbles are created via the metabolic processes of the bacteria. Feta and blue cheese are moderately high in K2. As cheese goes, the stinkier-the-better is probably a good rule if you are trying to up your K2 intake. The cheese doesn’t need to be raw — K2 is heat resistant (and most of it forms after pasteurization anyway). Eggs yolks and butter from grass-fed animals also have a bit of K2, as do chicken livers.
Why is grass-fed important in terms of K2 levels in dairy products? I couldn’t find an answer to this, but I have a guess. K2 results from bacterial fermentation, in animals, humans, soybeans or cheese. Grain-fed cows are known to have terrible digestive problems, and they are routinely fed antibiotics to help compensate for the health problems that go along with this. Grass-fed cows, on the other hand, are eating what they evolved to eat, and have much healthier biotic communities thriving in their guts. Thus, higher K2 levels in the milk (and to some extent meat) of grass-fed animals.
Still not convinced foie gras is good for your health? Here’s the kicker; those regions of France where the most foie gras is produced and consumed have freakishly low rates of cardiovascular disease. This article, published in 1991 (before anyone knew much about vitamin K2), discusses this association. K2 could be the mystery variable mentioned in the article, as well as a possible factor in the more widely observed French Paradox.
2) STAND AROUND
Who has a greater risk of heart disease, the 9-5 office worker who hits the gym 5 days a week, or the doorman who hits the gym exactly never? According to studies cited in this nytimes article, as well as this one, the doorman will generally have a better health health profile. The desk job is a killer.
That’s right, if you have a desk job (and/or watch a lot of TV), even if you run, lift weights, or play sports on the weekend, you’re worse off than the guy or gal who just stands around in their line of work. To some extent, you can mitigate the effects of a desk job by taking frequent breaks, walking as much as possible, climbing stairs, gardening, and otherwise increasing the amount of “incidental” low-impact exercise in your life (I’m writing this post standing up). But you can’t fix a basically sedentary life by working out like crazy once or twice a week.
I read somewhere (but can’t find the reference) that the muscles closest to your spine function differently than other skeletal muscles. They never tire, and metabolize low density lipoprotein (LDL cholesterol) for fuel. Thus, when you’re standing up, and these muscles are engaged, you’re actively improving your lipid profile (if you know more about this, please explain it to me or send me a link — I’m curious to understand exactly how this works).
3) REDUCE THE JUICE
I’m not referring to steroids here, but regular ol’ fruit juice. High fructose consumption is linked to increased belly fat, higher triglycerides, higher LDL levels, and higher risk of cardiovascular disease. High-fructose corn syrup is the main culprit in the Standard American Diet, and it makes sense to cut that out before cutting out fruit juice. But regular fructose is a problem too. When consuming whole fruit, you get fiber, intact vitamins and healthful phytochemicals, and no appreciable spike in blood sugar. With “healthy” OJ, you get a giant shot of fructose, and a frikking beer belly to boot. It’s not fair, but it’s real.
The other problem with juice is that many juices (especially OJ) can dramatically increase iron absorption (due to both vitamin C and sugar content). For menstruating women, this usually isn’t a problem. For older women, and all men (at least men who don’t give blood regularly, or frequently bleed from combat activities), too much iron can easily accumulate in the body, leading to free radical damage, heart attack, premature aging, hair loss, joint problems, liver damage, and a host of other problems. It’s safe to say that excess iron can completely ruin health — it’s not something you want to mess with.
If you like fruit juice, consider a 2-3oz serving size instead of a tall glass. It’s concentrated stuff, and not necessarily good for you. In most cases water, tea, coffee, or even wine or beer will probably do you more good. Low-sugar juices, like 100% cranberry juice (which is only consumable, IMO, greatly diluted with water), are the exception.