These 6 foods help fight artery plaque and keep your heart young

Plaque does not sit on the inside of your arteries like grease in a drain. It grows inside the wall, and a handful of trials suggest certain foods may change the conditions it grows in. Here are six foods, from flax and walnuts to berries and extra virgin olive oil, what each trial found, how big the effects were, and the limits of the evidence. (Based on the insights of Ben Azadi)

How Plaque Really Forms

Many people picture plaque like grease coating the inside of a kitchen drain. That is not how it works. Plaque grows inside the artery wall. Cholesterol travels through the blood in particles, and the main one is LDL (low-density lipoprotein). Each LDL particle carries one tag called apoB, so apoB is essentially a count of the delivery trucks on the road. The more trucks, the more cholesterol can slip into the wall.

If the wall is already irritated by high blood pressure, high blood sugar, high insulin, smoking or inflammation, the trucks get stuck and become oxidized. The immune system sends in cells to clean up, but those cells die there, and the body walls the area off, a bit like swelling around a splinter. Later, calcium is laid down like scar tissue. Many heart attacks come from a soft, inflamed plaque and not the largest one.

No food works like a drain cleaner for your arteries. You cannot simply fight plaque, but you can change the conditions it grows in. In a trial in Spain, 1,000 people who already had heart disease ate one of two diets for seven years. Ultrasound of the neck arteries showed little change in one group, while in the other the artery walls got thinner and the plaque got smaller. The main fat in the second group’s diet was extra virgin olive oil. Here are six foods, each working from a different angle.

6. Ground Flaxseed: Less Pressure in the Pipe

Every heartbeat pushes on the artery wall, and years of high pressure damage it. Flax provides a plant omega-3, gel-forming fiber and lignans, and has almost no sugar. In a Canadian trial, people with blocked leg arteries, most already on blood pressure medicine, ate about 3 tablespoons of milled flax a day, baked into food. After six months their top blood pressure number was about 10 points lower than in the placebo group, and about 15 points lower in those who started highest. It was one trial in one group, but a drop that size is comparable to a medicine.

Raw flax contains small amounts of antinutrients, which the body clears in normal amounts and heat reduces. Around 2 tablespoons of raw ground flax is considered fine, and for more it is better to bake or simmer it. Buy it ground and organic, keep it in the fridge and use it in place of boxed cereal.

5. Arugula, Other Leafy Greens and Beets: Nitrates for Nitric Oxide

These foods are rich in nitrates, which the body turns into nitric oxide, the signal that tells arteries to relax and open. The conversion needs bacteria on the tongue. In a London study, people with high blood pressure, about half already on medicine, drank a glass of beetroot juice daily for four weeks. Their blood pressure dropped about eight points and their blood vessels opened about 20% better. The placebo was the same juice with the nitrate removed, and it had no effect. In the same research group, healthy people who used a strong antiseptic mouthwash twice a day for a week saw their blood pressure rise, because killing the bacteria loses the conversion. If you use an antiseptic mouthwash, or one prescribed by your dentist, ask your dentist or doctor before changing anything.

Some nitrate-rich greens, including spinach, Swiss chard and beet greens, are very high in oxalates, and beets run high too. Oxalates bind calcium and in susceptible people can contribute to kidney stones. Arugula is one of the richest nitrate foods and is low in oxalates. Two big handfuls most days, and a few roasted beets now and then, are suggested, though people prone to kidney stones should ask their doctor.

4. Small Fatty Fish: EPA and DHA

Omega-3 fats from fish may help lower inflammation and triglycerides. Many online claims are exaggerated, though. The large triglyceride drop of 20 to 30% came from prescription doses of EPA and DHA, about 4 grams a day, which a few servings of small fish will not match. Fish a few times a week is long-term protection, not a quick fix. The SMASH acronym lists wild-caught options: salmon, mackerel, anchovies, sardines and herring. A can of sardines in olive oil provides close to a gram of omega-3s, and it is a fine swap for deli meat.

3. Walnuts: A Modest Win From a Snack

In a two-year trial of 708 adults aged 63 to 79, eating a handful of walnuts a day lowered LDL, and the small, dense LDL particles that slip into the wall most easily fell by 6%. That is modest, but it came from a snack and lasted two years. Replace, do not add: an ounce, or 14 halves, is about 185 calories, so swap it for chips. Raw nuts are preferred over dry roasted.

2. Berries: Pigments That Help Make Nitric Oxide

The deep blue and red pigments in berries help the artery lining make nitric oxide. In a six-month trial, adults with metabolic syndrome who ate the equivalent of about a cup of blueberries a day had vessels that opened better, less stiff arteries, and HDL rose in those not on a statin. Half a cup did not do it. A full cup a day did. Frozen berries work and often cost less, and strawberries and blackberries can be mixed in. Eat the fruit, not the juice, because fiber acts as the brakes and juice is sugar without them.

1. Extra Virgin Olive Oil

The PREDIMED study followed more than 7,400 people aged 55 to 80 at high risk of heart disease but without it. One group received about a liter of extra virgin olive oil a week. Over roughly five years, they had about 30% fewer heart attacks, strokes and heart disease deaths combined than a group told to cut fat. In absolute terms that was about 3.8% of people versus 4.4%, and when the trial was reanalyzed in 2018 after randomization problems, the result held.

Extra virgin matters because light or refined olive oil has most of its polyphenols stripped out, and polyphenols help protect LDL from oxidizing. A good extra virgin oil should leave a peppery sting in the back of the throat, from a compound called oleocanthal. If it tastes like nothing, that is a warning sign. When shopping:

• Look for a harvest date, not just a best-by date.
• Choose dark glass, not clear plastic.
• Prefer single origin over blends.
• Store it away from the stove and use an open bottle within a couple of months.

PREDIMED aimed for about four tablespoons a day, and the suggested range is two to four. It is best used for salad dressings and dips, for example with lemon, vinegar, salt and pepper, in place of other dressings. It is also higher in calories, so use it in place of other fats and not on top of them.

Numbers Worth Taking to Your Doctor

• Blood pressure: get an at-home cuff. Under 120/80 consistently is the goal mentioned.
• Cholesterol particles: total LDL is a less informative marker than apoB, which counts the particles, and oxidized LDL.
• Other targets mentioned: triglycerides under 90, HDL over 60, fasting insulin under 7, fasting glucose under 90 and A1C under 5.2%. These are tighter than standard reference ranges, so ask your doctor what is right for you.
• Lp(a): mostly genetic, high in about one in five people, and food barely changes it for many. European guidelines recommend every adult be tested at least once, and yearly if there is heart disease in the family.

Putting All Six in Two Meals

• Breakfast: Greek yogurt with a cup of blueberries, walnuts and two tablespoons of ground flax, or eggs with blueberries on the side, with olive oil drizzled on top.
• Dinner: salmon or sardines over arugula and roasted beets, dressed with extra virgin olive oil and lemon.

Foods like these support, and do not replace, the care your doctor recommends for blood pressure, cholesterol and heart disease. Do not stop or change any medicine on your own.

Frequently Asked Questions

This article is for general educational purposes and is not a substitute for personalized medical advice. No food can remove plaque or replace heart care. Do not stop or change any prescribed medicine without your doctor, and ask your doctor or dentist before changing antiseptic mouthwash use. People prone to kidney stones should ask about oxalates.