kris ulland

Your Nutrition Partner

February is National Heart Month. Most families have at least one member who struggles to keep their heart healthy. But, even if you have a family history of heart disease, healthy eating can make a major difference. Lifestyle plays a role in whether an inherited tendency actually leads to heart disease, according to Sekar Kathiresan, MD, a cardiologist and human geneticist and Director of Preventive Cardiology at Massachusetts General Hospital’s Heart Center. In his research, he shows that although some people are at high risk from a single gene, most inherited heart disease risk stems from a combination of multiple genes. Among these people, Dr. Kathiresan discovered, a healthy lifestyle can can cut risk of heart attacks by nearly 50 percent.

The heart beats about 2.5 billion times over the average lifetime, pushing millions of gallons of blood to every part of the body. This steady flow carries with it oxygen, fuel, hormones, other compounds, and a host of essential cells. It also whisks away the waste products of metabolism. When the heart stops, essential functions falter, some almost instantly.

Given the heart’s never-ending workload, it’s a wonder it performs so well, for so long, for so many people. But it can also fail, brought down by a poor diet and lack of exercise, smoking, infection, unlucky genes, and more.

A key problem is atherosclerosis. This is the accumulation of pockets of cholesterol-rich plaque inside the arteries. These pockets can limit blood flow through arteries that nourish the heart, the coronary arteries, and other arteries throughout the body. When a plaque breaks apart, it can cause a heart attack or stroke.

Although many people develop some form of cardiovascular disease (a catch-all term for all of the diseases affecting the heart and blood vessels) as they get older, it isn’t inevitable. A healthy lifestyle, especially when started at a young age, goes a long way to preventing cardiovascular disease.

The American Heart Association (AHA) suggests four steps you can take to eat to protect your heart.

  • Cut Sodium  Cutting out 1,000 milligrams of sodium per day lowers heart risk. Boost your intake of vegetables, fruits, whole grains, and nuts while reducing saturated fats, red meat, sweets, and sugar. Most sodium comes from processed foods. Taste your food before you use the salt shaker.  Make your own soup with low-sodium broth or use no-salt-added canned tomatoes. Season with herbs and spices. Leave the salt out of recipes but double the herb suggestions. Use raw vegetables for dipping instead of chips or crackers. Carrots, pepper strips, celery, cauliflower!
  • Maintain a Healthy Weight  20-50 percent of people who are overweight or obese have Nonalcoholic Fatty Liver Disease (NAFLD). Weight reduction of five percent reduces NAFLD. 10 percent is even better. Don’t aim for a target that feels unattainable. Instead, do weight loss in increments. Remember that the 10 pounds you keep off will reduce the risk of heart disease. Slowly attain your weight goals. Cutting just 200-400 calories a day and adding a short walk can accomplish this over time. Drink more water. If you drink sugar-sweetened drinks, swap them out for unsweetened tea, coffee, or sparkling water. Use portion control by cutting everything except vegetables to 3/4 of what you are used to. And, then, add more vegetables! Taking a brief walk will burn calories and decrease liver fat and insulin resistance.
  • Limit Added Sugar The empty calories in sugar-sweetened drinks add or keep extra weight on. These excess added sugars may increase your risk of type 2 diabetes even beyond gaining weight. Evidence suggests that added sugars can raise blood pressure and blood triglycerides. Excess sugar is also linked to increased risk of stroke and heart disease. The AHA recommends no more than 100 calories, 25 grams, of sugar per day for women and 150 calories, 36 grams, per day for men. Nearly half the added sugars in an average American diet comes from beverages. Skip sweets and opt for nutrient-rich snacks like fruit, nuts, seeds and whole grains. 
  • Chose Quality Carbs and Fats Triglycerides are a type of fat found in your blood. Your body uses them for energy. You need some triglycerides for good health. But high triglycerides might raise your risk of heart disease and may be a sign of metabolic syndrome. A blood test that measures your cholesterol also measures your triglycerides. Regularly eating more calories than you burn will cause your triglycerides to rise. Limit sweets and refined grains. High fiber foods (fruits, veggies, whole grains) raise your blood sugar more gradually. Mediterranean-style eating which includes moderate amounts of fat from healthy oils and nuts can help reduce elevated triglycerides. Limiting alcohol to no more than one drink per day for women (a serving of wine is 5 ounces) and two for men will help reduce triglycerides.

Many vegetables contain naturally occurring nitrates, which your body transforms into nitric oxide (NO), a soluble gas continually produced from the amino acid L-arginine inside your cells. NO supports healthy endothelial function and protects your mitochondria. NO is a potent vasodilator, relaxing and widening your blood vessels, improving blood flow and reducing blood pressure.

Red beets are well-known for their high nitrate content, but leafy greens contain even more nitrates per serving; arugula contains the highest amounts, followed by rhubarb, cilantro, butter leaf lettuce, spring greens like a mesclun mix, basil, beet greens, and Swiss chard.

Research has shown that the more vegetables and fresh fruits you eat, the lower your risk of heart disease, with leafy greens being the most protective and the reason for this is likely their NO-boosting nitrates. This was confirmed in a May 2017 study published in The American Journal of Clinical Nutrition.

In this study, nearly 1,230 Australian seniors without atherosclerotic vascular disease (ASVD) or diabetes were followed for 15 years. A food-frequency questionnaire was used to evaluate food intake. Nitrate intake was calculated using a comprehensive food database. Data revealed that the higher an individual’s vegetable nitrate intake, the lower their risk for both ASVD and all-cause mortality.

Research shows raw beets can increase exercise stamina by as much as 16 percent, an effect attributed to increased NO. In a study conducted on nine patients diagnosed with heart failure who experienced loss of muscle strength and reduced ability to exercise, all benefited from beet juice. The patients were given about two-thirds of a cup of concentrated beet juice, followed by testing, which found an almost instantaneous increase in their muscle capacity by an average of 13 percent.

Don’t confuse NO with nitrous oxide, commonly known as laughing gas! NO is a signaling or messenger molecule that is in every cell of your body. It is involved in a wide variety of physiological and pathological processes. As mentioned, it causes arteries and bronchioles to expand, but it’s also needed for communication between brain cells, and causes immune cells to kill bacteria and cancer cells.

Because the body loses about 10 percent of its ability to make NO for every decade of life, it is very important to eat a nitrate-rich diet.

Problematically, when fluoride is present (such as when you’re drinking fluoridated water), the fluoride converts NO into the toxic and destructive nitric acid. Avoid damaging interaction with fluoridated water and other halide sources, such as brominated flour.  Avoid using mouthwashes or chewing gum, as this actually prevents the NO conversion from occurring. The reason for this is because the nitrate is converted into nitrite in your saliva by friendly bacteria.


Chocolate comes from cacao, a plant with high levels of minerals and antioxidants. Commercial milk chocolate contains cocoa butter, sugar, milk, and small quantities of cacao. In contrast, dark chocolate has much larger amounts of cacao and less sugar than milk chocolate. There are now plenty of companies that make delicious vegan chocolate – which is even better for you – dark and rich without dairy!

Regularly eating dark chocolate may help reduce a person’s likelihood of developing heart disease. Some of the compounds in dark chocolate, specifically flavanols, affect two major risk factors for heart disease: high blood pressure and high cholesterol.

I am always excited when I read studies like the one that showed that those who ate chocolate at least five times per week had a 57% lower risk of coronary heart disease than non-chocolate eaters. Another study found that eating chocolate at least twice per week was associated with a 32% lower risk of having calcified plaque in the arteries. (Keep in mind that these studies show an association but don’t necessarily account for other factors that may be involved.)

The flavanols in dark chocolate stimulate nitric oxide production in the body. Nitric oxide causes blood vessels to dilate, or widen, which improves blood flow and lowers blood pressure.

A 2015 study investigated the effects of chocolate consumption in 60 people with type 2 diabetes and high blood pressure. The researchers found that participants who ate 25 grams of dark chocolate daily for 8 weeks had significantly lower blood pressure than those who ate the same quantity of white chocolate.

The findings of a 2017 review showed that the beneficial effects of dark chocolate on blood pressure might be more significant in older people and those with a higher risk of cardiovascular disease, as opposed to younger, healthy individuals.

Dark chocolate also contains certain compounds, such as polyphenols and theobromine (a natural compound that lowers blood pressure), that may lower levels of low-density lipoprotein (LDL) cholesterol in the body and increase levels of high-density lipoprotein (HDL) cholesterol. Doctors often refer to LDL cholesterol as “bad cholesterol” and HDL cholesterol as “good cholesterol”, though we need both cholesterols in our diets.

Insulin resistance occurs when the body’s cells stop responding to the hormone insulin. Insulin resistance can cause abnormally high levels of blood glucose, which can lead to pre-diabetes and type 2 diabetes. A 6-month study from 2018 examined the relationship between regular dark chocolate consumption and blood glucose levels among Hispanic individuals. The research findings suggest that eating 48g of 70-percent dark chocolate each day may help lower fasting glucose levels and reduce insulin resistance.

The findings of a small 2018 study suggest that the flavanols present in dark chocolate may enhance neuroplasticity, which is the brain’s ability to reorganize itself, particularly in response to injury and disease. A study from 2016 identified a positive association between regular chocolate consumption and cognitive performance.

The health benefits of dark chocolate come primarily from the flavanols present in the cacao solids. Flavanol content varies among dark chocolate products. Processing methods also differ between manufacturers, and this can affect the flavanol content of the chocolate. There is no legal requirement for chocolate manufacturers to report the flavanol content in their products. However, dark chocolate products with a higher percentage of cacao solids should generally contain more flavanols.

Although dark chocolate contains beneficial antioxidants and minerals, it is a very calorie-dense food. So, chocolate can be high in sugar and calories, which can negate many of its health-promoting properties. In general, dark chocolate contains less sugar than milk chocolate and white chocolate. Dark chocolate with higher percentages of cacao solids typically contains even less sugar. Sugar content varies among chocolate manufacturers, so it is advisable to check the nutrition label.

Be sure to pick a high-quality dark chocolate with a cocoa content of at least 70%, and moderate your intake to make the most of its heart-healthy benefits.

How to Buy

Dark chocolate with higher percentages of cacao solids typically contains less sugar but more fat. More cacao also means more flavanols, so it is best to choose dark chocolate that includes at least 70 percent cacao solids. So, when buying chocolate, be sure to choose chocolate that has a high percentage of cacao like 50-90% along with something that doesn’t have a long list of ingredients that sometimes are derived from milk/dairy products such as casein, whey and other ingredients.

The vegan brands I like the best are:

Hu Kitchen

Alter Eco

Equal Exchange

Endangered Species

How to Store

You can store your chocolate in the refrigerator but chocolate stored in the refrigerator might “sweat”. This means that a layer of moisture could form on the surface of the chocolate, and when cooled, it will become sticky. This doesn’t affect the taste, just the texture. The temperature in a refrigerator is too low and humidity too high for ideal chocolate storage. I eat enough chocolate that it works to store mine in the fridge, but if you take longer to get through a bar of chocolate, find a dry place in your home such as a cupboard or pantry to keep chocolate. When storing chocolate it is important to remember that chocolate absorbs any nearby smells or flavors which can negatively affect its taste.

How to Cook

When cooking with chocolate, finely chop it for melting, and heat it slowly. Place it in a bowl over a saucepan of simmering water. The small pieces will help the chocolate melt evenly, and the low heat will make sure it won’t burn.

Pay attention to cacao percentages. They tell you how much of the chocolate is made from the cocoa bean (including the chocolate liquor and the cocoa butter). The rest is made up of anything from sugar to milk to flavorings to emulsifiers.

Don’t buy chocolate chips if you plan to melt them. They often contain stabilizers that help them hold their shape, which can make melted chocolate lumpy.

Don’t be afraid to use chocolate that looks like it’s covered in white dust. That’s probably just cocoa butter that collected on the surface when the chocolate got too warm. The film doesn’t affect the flavor of the chocolate or make it unsafe to eat.

Vegan and Gluten-free Chocolate Chip Cookies

Angela Liddon, Oh She Glows/ photo credit: Oh She Glows

18-20 Cookies


  • 7 tbsp Earth Balance + 1 tbsp extra virgin olive oil
  • 1/2 cup packed brown sugar (I used organic)
  • 1/4 cup organic cane sugar (I use coconut sugar)
  • 1 flax egg: (1 tbsp ground flax mixed with 3 tbsp water)
  • 1 tsp vanilla extract
  • 1/2 tsp baking soda
  • 1/2 tsp kosher salt
  • 1 cup gluten-free oat flour (I processed 1 cup certified gf rolled oats into flour)
  • 1 cup Bob’s Red Mill Almond Flour (add 2 tbsp Bob’s Red Mill Almond Flour if you want a thicker cookie)
  • 1/4 tsp cinnamon – I always double or triple the cinnamon
  • 1/2 cup dark chocolate chips


1. Preheat oven to 350 and line a baking sheet with parchment paper. In a small bowl, mix together the flax egg and set aside.

2. With an electric mixer or in a stand mixer, beat the Earth Balance and oil until fluffy. Add the sugars and beat for 1-2 minutes until creamy. Beat in the flax egg and vanilla extract.

3. Beat in the remaining ingredients and fold in the chocolate chips.

4. With wet fingers, shape balls of dough and place on the baking sheet. The dough will be very sticky but don’t worry! No need to flatten the balls down! Bake for about 10-11 minutes until slightly golden along edges. Allow to cool for 5-10 mins. on the baking sheet and then transfer to a cooling rack for another 10 minutes.

Earth Balance  products are gluten-free.



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