Update: How Heart Health Impacts Covid-19 (below)
Heart disease is the leading cause of death in the US for both men and women. If you have high cholesterol, diabetes, blood pressure, a history of heart disease or engage in smoking you are at increased risk for heart disease. And new data shows that having heart disease also puts you at higher risk of severe Covid-19. The good news is a healthy diet may help to lower your risk of heart disease, especially a plant-based one. Thus by keeping your heart healthy, you may help to improve the outcome of a Covid-19 infection. But do all plant-based diets benefit your heart? Can vegan protein powders help? And how exactly does heart health impact a coronavirus infection?
Benefits of a Nutritious Plant-Based Diet
There are many known health-related benefits to a plant based diet ranging from longer lives to happier moods. But not all plant-based diets are created equal. What makes a beneficial plant-based diet and what does the research say specifically about their relation to heart health?
When we think of vegans and plant-based diets we might automatically assume a very nutritious diet consisting of mostly vegetables and fruit with some grains and legumes on the side. But that’s not necessarily true. You could easily be an unhealthy vegan/vegetarian if your diet consisted mainly of mac and cheese, potatoes or fries, cereal, along with an occasional veggie patty and banana. Though this diet is indeed vegetarian, it is probably lacking in several essential (required) nutrients, some of which are needed for normal heart function and blood circulation (e.g. vitamin B12, potassium, magnesium and calcium). In fact, B12 is a common deficiency among plant-based diets and its deficiency is linked to increased homocysteine levels. Homocysteine is a compound produced in the body normally as a result of dietary protein metabolism, and B12 helps to eliminate homocysteine from the body. Without enough B12, the body can accumulate high levels of homocysteine. And high homocysteine levels have been tied to increased risk for heart disease.
Ultimately, any deficiency can lead to multiple negative health effects in the long-run. Careful planning and understanding is required to ensure that you are getting all your essential nutrients from a plant-based diet. On top of providing your required nutrients, a properly planned plant-based diet can offer added health-benefit when it is heavy on fruits and especially vegetables.
Fruits and vegetables are a rich source of required vitamins and minerals, but they are also a rich source of fiber and phytonutrients! Phytonutrients are not required by the body, unlike vitamins and minerals—but they are unique substances which can provide protective effects against disease, including heart disease.
Nutrients that Support Heart Health
| Essential Nutrients | Sources | Role in the Cardiovascular system |
| Potassium | Beet greens, swiss chard, lima beans, sweet potato, soybeans, spinach, pinto beans, lentils | Supports the nerves needed to regulate the heart beat; works with calcium and magnesium |
| Calcium | Tofu, sesame seeds, collard greens, spinach, mustard greens or any dark leafy greens, broccoli, asparagus | Triggers contraction of the heart beat along with potassium and magnesium |
| Magnesium | Pumpkin seeds, spinach, swiss chard, black beans, quinoa, cashews, sunflower seeds | Supports the nerves needed to regulate the heart beat along with potassium and calcium |
| B6 & B12 | B6: most meat and poultry, sweet potato, sunflower seeds, spinach, banana. B12: most seafood and meat, nutritional yeast, fortified cereal, fortified milk or milk-substitute | With folate, both b6 and b12 help to regulate levels of homocysteine in the body. Homocysteine is produced as a result of protein metabolism and too high levels can put you at risk for heart disease |
| Folate | Lentils, pinto beans, garbanzo beans, asparagus, spinach, black beans, broccoli, avocado, peanuts | Helps protect against high levels of homocysteine which can be a risk factor of heart disease; works with b6 and b12 |
| Fiber | Chia seeds, brussel sprouts, legumes/beans, raspberries, oats/oatmeal, brown rice | Helps to regulate cholesterol levels and keep blood vessels from hardening or plugging up |
| Beneficial Plant Compounds (non-essential) | Sources | Function |
| Sterols & Stanols | Wheat germ, rice bran oil, sesame oil, canola oil, peanuts, almonds, brussel sprouts, olive oil | Helps to regulate cholesterol levels. Block the absorption of animal cholesterol, thereby reducing/regulating blood levels |
| Isoflavones | Soybeans or soy products | Some preliminary research shows it can help to lower the “bad” cholesterol |
| Antioxidants | Berries (all types), cherries, dark chocolate (cacao powder), tree nuts, green tea, red wine, dark leafy greens, citrus fruits, beans | Reduces the oxidation of “bad” LDL cholesterol (which can otherwise cause plaque buildup); can help to lower inflammation and promotes healthy lining of arteries |
At this point there have not been any studies looking directly at the relationship of heart disease in vegans/vegetarians. However, studies on disease risk among large populations of vegans/vegetarians suggest that these dietary habits are protective against heart disease.
Two studies have found that vegans have considerably lower rates of hypertension compared to non-vegans. The scientists believed part of the reason for this lower incidence of high blood pressure is linked to the subjects’ lower body mass index (BMI) –a value estimating body fatness. Then again, the lower BMI could also be linked to their eating habits. Another study found that majority of subjects with heart disease were able to reduce lesions on arteries leading to the heart when they followed a comprehensive lifestyle program including exercise, stress management and a “mostly vegan diet” (1-2 servings of low-fat dairy and egg whites allowed per day). Those participants with heart disease who did not make the lifestyle or diet changes (control group) experienced progression of their artery lesions instead.
Yet another study looked at the effect of a high fat vegan diet (43% fat) versus a lower fat, lacto-ovo vegetarian diet (25% fat) on overweight individuals with high cholesterol levels. After 4 weeks, both groups had experienced weight loss and reduced levels of “bad” cholesterol but the high fat vegan group had greater reductions in cholesterol overall. These findings to date are not surprising considering, a balanced and varied plant-based diet will typically be cholesterol-free, low fat, high fiber and contain all the needed and added nutrients for healthy heart functioning.
Fats, Cholesterol & Heart Health
The dietary guidelines released in 2016 eliminated the limit on the amount of cholesterol that should be consumed each day. Although this may seem like a free-pass to eat unlimited amounts of cholesterol rich foods (for you omnivores)--it's really not. And especially if you are already at an increased risk for heart disease. Either way, there's definitely some fine print to go with this guideline that should be clarified.
Scientists agree that elevated blood cholesterol is a risk factor for heart disease. However, there is controversy on whether limiting your cholesterol consumption actually does anything to improve blood levels of "bad" cholesterol (LDL). The thing is some high cholesterol foods are pretty nutritious and low in saturated fat (such as eggs and shellfish). Saturated fat and trans fat are far bigger culprits of raising cholesterol levels and heart disease risk--so the thought process is that perhaps we shouldn't worry so much about the amount of cholesterol we consume, but rather the amount of saturated and trans fat we consume.
Think of foods as package of nutrients, rather than as a source of a single-nutrient. Foods high in both saturated fat and cholesterol are mainly animal-based red meats--so those are the ones that should be consumed in smaller quantities or even switched out for less fattier counterparts including plant-based proteins.
Plant Protein Powders: the Cholesterol-free Choice
Unlike dairy-based proteins (casein and whey), Growing Naturals' rice and pea protein are naturally cholesterol-free and very low in fat. Being made from animals, all dairy proteins contain some amount of cholesterol, with some being lower than others. GN pea proteins have only 1.5 grams of fat per serving, whereas the rice proteins have 0.5 grams of fat per serving. This is also why plant protein powders are typically lower in calorie than dairy proteins--because they don't have as much fat. This makes both rice protein and pea protein excellent choices for a heart healthy diet.
Interestingly enough, preliminary research has shown that rice protein might be protective of the heart in two different ways. Scientists at Jiangxi Agricultural University in China found an anti-hypertensive effect from rice protein in hypertensive animals. This was apparently due to the presence of a unique peptide (small chain of amino acids) within the rice protein which is known to reduce high blood pressure.
In two additional but separate studies, rice protein appears to have cholesterol-lowering potential in animals as well. One study showed that cholesterol absorption was significantly reduced by rice protein compared to casein (a dairy-based protein) in animals fed a cholesterol free diet. Another, demonstrated rice protein can reduce triglyceride metabolism such that it leads to improved body weight and fat storage.
Coronavirus and Heart Health
With coronavirus around, heart health is even more important as it has become a predictor of Covid-19 outcomes. According to Harvard Health blog, data thus far has indicated that pre-existing heart conditions and poor metabolic health increase the risk for severe Covid-19. In other words, the virus appears to be more harmful to those with heart disease rather than those with a healthy heart. Health experts have come up with two reasons for this: One is that the stress of the illness (covid-19) is too much for a heart with weakened muscles or damaged arteries and "is more likely to succumb to the effects of fever, low oxygen levels, unstable blood pressures, and blood clotting disorders — all possible consequences of COVID-19." The other reason is due to poor underlying metabolic health, which seems to be more common in those with heart disease. Metabolic health refers to those conditions that cause chronic inflammation in the body such as type 2 diabetes, prediabetes and obesity. These things make it more likely to increase the complications of covid-19. Coronavirus (SARS-CoV-2) also appears to cause damage to the heart a few different ways. In severe cases of Covid-19 infection, the immune system can overreact and release inflammatory molecules called cytokines into the bloodstream. The overabundance of cytokines can damage and weaken organs including the heart. This can lead to myocarditis or inflammation of the heart. Alternately, in those who develop pneumonia, fever and infection can stress the heart and lead to a increased demand of oxygen to exceed its supply and thus cause heart damage.
Bottom Line
One things for sure, (well-planned and balanced) vegan and vegetarian diets are consistently associated to a lower risk of heart disease and are a valuable approach for reversing risk factors of heart disease. So keep on veggin' on.
By: Scarlett Full, in-house Registered Dietitian
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References:
- Koebnick C, et al. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans. J Nutr 2005;135:2372-8. Crowe FL, et al.
- Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr 2013;97:597-603. Orlich MJ PS, et al. Vegetarian dietary patterns and mortality in Adventist Health Study-2. JAMA Intern Med 2013. Spencer EA, et al.
- Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord 2003;27:728-34. Yang L, et al. Rice protein extracted by different methods affects cholesterol metabolism in rats due to its lower digestibility. Int J Mol Sci. 2011; 12: 7594-7608. Yang L, et al.
- Rice protein improves adiposity, body weight and reduces lipid levels in rats through modification of triglyceride metabolism. Lipids Health Dis. 2012; 11: 24
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