Understanding heart disease
Heart disease covers coronary artery disease (narrowed heart arteries, which cause angina and heart attacks), heart failure and heart rhythm problems such as atrial fibrillation. What you eat changes several of the things that drive it: LDL cholesterol, blood pressure, blood sugar and weight.
Nutrition does not replace your medications; it works alongside them. We see people after a heart attack, a stent or bypass surgery, during or after cardiac rehabilitation, with heart failure, on blood thinners such as warfarin, and with a family history of early heart disease.
How a dietitian helps with heart disease
Lowering LDL cholesterol with food: soluble fibre, nuts, soy and plant sterols, and unsaturated fats in place of saturated fat.
Bringing blood pressure down with a DASH-style pattern, less sodium and more potassium-rich foods, unless your kidneys or medications call for a potassium limit.
Planning around your medications: steady vitamin K intake on warfarin, potassium with some blood pressure drugs, grapefruit with some statins.
Heart failure: a sodium target and, when your cardiologist sets one, a fluid limit, while protecting your muscle and appetite.
After a heart attack or surgery: rebuilding appetite and strength, then long-term habits that lower the risk of another event.
What the evidence says
Mediterranean and DASH-style eating lower cardiovascular events and blood pressure in clinical trials. The Portfolio Diet, developed in Toronto, combines four cholesterol-lowering foods and is named in Canadian lipid guidelines.
Replacing saturated fat with unsaturated fats, rather than with refined starch and sugar, is what lowers heart risk. Total fat can sit anywhere in Health Canada's range of 20 to 35% of calories.
Health Canada sets 2,300 mg of sodium a day as the ceiling for healthy adults; with high blood pressure, Hypertension Canada recommends about 2,000 mg.
The adequate intake for fibre is 25 g a day for women and 38 g for men up to age 50 (21 g and 30 g after 50). Most Canadians eat about half of that.
Over-the-counter fish oil did not prevent heart attacks in large trials. One prescription omega-3 (icosapent ethyl) lowers events in people with high triglycerides who already take a statin.
Your nutrition care
Nutrition care for heart disease starts with a full assessment: your medical history, current medications, recent lab results, weight history and the way you actually eat. From there your Registered Dietitian builds a plan around your diagnosis, your treatment goals and the foods you like, and adjusts it at each follow-up as your results come in.
We see patients in person at our Ottawa and Gatineau clinics and by secure video across Ontario and Quebec, so you can keep appointments between medical visits without travelling. With your consent, we share the plan with your physician or specialist team so everyone is working from the same numbers.
Not sure where to start? Book a free initial consultation. We will go over your situation, answer your questions and tell you honestly whether nutrition therapy is likely to help.
Book NowQuestions about nutrition care for heart disease
Which eating pattern is best after a heart disease diagnosis?
The strongest evidence supports Mediterranean-style and DASH-style eating: vegetables, fruit, legumes, whole grains, nuts, fish and olive oil, with less processed meat, refined starch and sodium. Your dietitian adapts the pattern to your medications, your other conditions and the foods you grew up with, rather than handing you a generic diet sheet.
How much sodium should I aim for?
Health Canada's ceiling for healthy adults is 2,300 mg a day. With heart disease or high blood pressure the usual target is about 2,000 mg (Hypertension Canada), and in heart failure your cardiology team may set a different one. Since most sodium comes from packaged and restaurant foods, we focus on label reading and on the few items that make up most of your intake.
I take warfarin. Do I need to avoid foods with vitamin K?
No. The goal is consistency, not avoidance: keeping your intake of leafy greens and other vitamin K sources steady from week to week keeps your INR stable. Newer anticoagulants such as apixaban or rivaroxaban do not interact with vitamin K in the same way.
Should I take fish oil or other supplements for my heart?
Eating fatty fish about twice a week is recommended for most people. Prescription omega-3 products are used in specific situations your physician decides on, while over-the-counter fish oil capsules have not shown the same benefit. Your dietitian reviews every supplement you take for interactions with your heart medications.
Can I see a dietitian for heart disease online?
Yes. We offer secure video appointments across Ontario and Quebec, as well as in-person visits at our Ottawa and Gatineau clinics. Online visits include the same assessment, plan and follow-ups.
Sources and guidelines
- Estruch et al. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine.
- Appel et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure (DASH). New England Journal of Medicine.
- Jenkins et al. (2011). Effect of a dietary portfolio of cholesterol-lowering foods on serum lipids. JAMA.
- Pearson et al. (2021). Canadian Cardiovascular Society guidelines for the management of dyslipidemia. Canadian Journal of Cardiology.
- Sacks et al. (2017). Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation.
- Rabi et al. (2020). Hypertension Canada’s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension. Canadian Journal of Cardiology.
- National Academies of Sciences, Engineering, and Medicine (2019). Dietary Reference Intakes for Sodium and Potassium.
- Manson et al. (2019). Marine n-3 fatty acids and prevention of cardiovascular disease and cancer (VITAL). New England Journal of Medicine.
- Bhatt et al. (2019). Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia (REDUCE-IT). New England Journal of Medicine.
- Health Canada. Dietary Reference Intakes tables.
This page is general information, not individual advice. Your dietitian sets your own targets. Daily intake figures for healthy adults are Health Canada's Dietary Reference Intakes.