First the bad news: If you're female and human, you've got more than a 50 percent chance of dying from heart or blood vessel problems. In fact, cardiovascular disease is the number one killer of women—as well as men—and is responsible for more premature deaths every year than just about everything else combined.
Now the good news: For the most part, heart disease is preventable. If we put into practice what we already know, it would be as rare as malaria—and that's especially true for women.
Eating to Your Heart's Content
Some people can eat almost anything without ever getting heart disease; others have to be careful. For starters, being overweight is one of the most important predictors of heart disease. There is also a genetic variability in how efficiently people metabolize cholesterol and saturated fat in their diets. No matter what your make-up is, here are the ingredients of a diet that every heart will love:
Skim the fat: If your total cholesterol level is consistently below 150 milligrams per deciliter, or your LDL ("bad") cholesterol is below 95, then either you're not eating much fat and cholesterol or your body is efficient at metabolizing it. Either way, your risk of coronary heart disease is low, so whatever you're doing is probably okay, at least as far as your heart is concerned. If your numbers are above these levels, you might try reducing the fat and cholesterol in your diet. One tablespoon of oil has almost as much fat as a scoop (about 3 ounces) of premium ice cream. So avoid fried foods and most oils, with the exception of flaxseed and fish oils, which contain omega-3 fatty acids.
If the changes you make over a month or two are enough to bring your cholesterol down, great. If not, don't give up: You may need to cut back more to see a result. The ten-percent-fat diet used in Dean Ornish's heart-disease-reversal studies was basically vegetarian, since cholesterol is only found in animal products; 70 to 75 percent of calories came from complex carbohydrates and 15 to 20 percent from protein. It's true that people eating this little fat often get hungry between meals, but the upside is that you can eat as much as you want, as long as you stay within the food choices—vegetables, whole grains (including whole-grain breads and pasta), fruits (no avocado, nuts, olives or coconut), egg whites, 1 cup per day of nonfat milk or yogurt—and limit sugar, alcohol and fat.
Veg out: For everyone, there are many benefits to eating a low-fat, plant-based diet featuring whole grains, fresh fruits and vegetables, beans, soy and fish: You lower saturated fat and cholesterol while increasing antioxidants and other protective substances that fight heart disease, cancer and even aging. You also lose weight and feel more energized. At the very least you may want to minimize red meat, which is linked to heart disease and various cancers, and try adding soy—it comes in burgers, milk, cheese, edamame (if you haven't heard of the tasty soybean, ask for it the next time you're at a Japanese store or restaurant), and tofu. We also encourage consumption of tea instead of other caffeinated beverages for its antioxidant content.
Chuck the white stuff: Sugar, white flour, white rice, white noodles—these are all "simple" carbohydrates because they've been refined and stripped of their healthy attributes, including fiber. Such foods are absorbed quickly, causing blood sugar to spike, which in turn provokes an insulin response that accelerates the conversion of calories to fat. Carbs are fine as long as they're "complex," i.e., unrefined—fruits, vegetables, beans, and grains in their natural forms (whole wheat bread, brown rice). Complex carbs are high in fiber, which slows their absorption, preventing a rapid rise in blood sugar. While you can eat large amounts of sugar without feeling full, fiber fills you up quickly.
Turn off the TV: No doubt you've eaten while reading the newspaper or watching television, then looked down at the empty plate or wrapper and wondered, 'Who ate this?' You didn't even taste it. Experiment with a ripe piece of fruit or a small piece of high-quality chocolate: Put it in your mouth and close your eyes. Savor the texture, the flavor, the temperature. Notice how the flavors change and linger as the food goes down your throat. Even a single bite can be exquisitely satisfying. When you pay attention to what you eat, you enjoy it more. And you're likely to sense when you're full—before you've eaten too much.
When to Slow Down and Speed Up Know How To Slow We all have stress in our lives, but teaching yourself to react calmly and clearly versus going into a panic can help save your heart. Meditation, the practice and process of focusing your awareness, works like a surge protector. Those who try it often find that their "short fuse" gets longer and everyday stresses don't bother them as much. When you meditate, a number of desirable things begin to happen—slowly at first and deepening over time.
Meditation is simple in concept but difficult to master. Fortunately, you don't have to master it (no one ever really does) to benefit from it. In most forms of meditation, you repeat a sound or a phrase or a verse from a prayer. Out loud—or to yourself. Over and over again. Or you can simply observe your breathing. In and out. Over and over. When you become aware that you are thinking about something else, gently but firmly bring your attention back to the repetition without judging or berating yourself. With practice, your mind will wander a little less than before. Some people find it easier to meditate while moving—walking slowly or doing tai chi.
If you feel too pressured to practice formally, ask yourself if you have time to meditate for one minute. It's hard to tell yourself you don't have 60 seconds. Even a minute of meditation has benefits (the consistency is more important than the duration, and once you start, you'll probably keep going a little longer).
Get Some Action Many people think that if you don't run at least five miles three times a week, then you might as well roll over and go back to sleep. Actually, it turns out that moderate exercise provides most of the health benefits of more intensive exercise in staving off heart disease. Just walking 30 minutes a day can reduce premature death rates from virtually all causes by half. It doesn't even have to be all at once, or even all that fast. You need only to raise your heart rate (pulse) by at least 10 beats per minute (check it by putting your finger on your neck or wrist), which, for most people, means going about two miles per half hour.
It doesn't matter if you walk, swim, perform calisthenics, or do yoga. The best kind of exercise is one that you enjoy, because you're most likely to keep doing it. Try for at least four times a week. Sex counts, too.
Using Your Head to Help Your Heart Make a Connection Study after study has shown that people who feel lonely, depressed and isolated are three to five times more likely to get sick and die prematurely—not only from heart disease, but from all causes—than those who have feelings of love, connection and community. In one study of heart attack survivors, those suffering from depression were five times more likely to die within six months than the subjects who were not depressed, similar to what we have found in our own patients.
You can start by speaking with one stranger per day. Call one old friend per week. Join a support group like Overeaters Anonymous or a quit-smoking club, or organize some friends to meet regularly and cheer one another on. Learn some communication skills. Get a massage, manicure or shampoo, and give someone a hug when she's done a good job—or even when she hasn't. There are dozens of studies demonstrating the healing value of touch.
Altruism, compassion and service also protect the heart. Find one charitable endeavor per season. We are hard-wired to support each other—the trait has helped us survive as a species for the past several hundred thousand years. If none of these efforts help, talk to a doctor or therapist.
Have a Helping of Attitude People who are "glass half-full" types may not need another reason to be positive, but the latest studies show that those of us with a more optimistic view of the world tend to live longer and have fewer heart attacks. The good news for the "half-empties": Optimism can be learned.
Appreciation of others and of yourself is strongly correlated with happiness and health. Nobody lives forever, so you might as well try to get the most fun and enjoyment out of life for as long as it lasts. The choices you make each day—in terms of your diet, exercise, attitude and behavior toward others—are much more powerful determinants of your health than anything we or any other doctor can provide. As one of our patients once told us, "Now that I'm making these changes, not only are my arteries more open, but I'm more open." A little love and appreciation, when all is said and done, may be the heart's best medicine.