Eating for Heart Health After 60

The big picture

For most older adults, a heart-healthy pattern includes:

• Plenty of vegetables and fruit, in colours and variety.
• Whole grains and millets in place of refined grains.
• Pulses and legumes as a main protein.
• Nuts and seeds in small handfuls.
• Fish, especially oily fish, twice a week if eaten; eggs and lean poultry in moderation; dairy in sensible amounts.
• Healthy cooking oils in measured quantities.
• Less salt, sugar, processed meats, deep-fried and bakery foods.
• Enough calories and protein to maintain weight and muscle, especially if frail.
• Regular meals and good hydration.

See balanced diet chart plan for elderly people and best diets for seniors.

Salt and blood pressure

High blood pressure is a leading driver of heart attack, stroke, heart failure and kidney disease. Salt is a major contributor. The World Health Organization advises adults to eat less than 5 grams of salt (about one level teaspoon) a day, counting all sources, and Indian surveys show average intakes well above this.

Where the salt hides in Indian diets: added salt in cooking, pickles, papad, chutneys, namkeen, bhujia, chips, instant noodles, biscuits, bread, cheese, sauces, ketchup, ready-to-cook masalas, packaged soups, fish and meat that are salted or dried (such as dry fish), restaurant and street food.

Practical steps: - Cut added salt gradually; the palate adapts in a few weeks. - Add salt at the end of cooking, measure it with a spoon and avoid adding extra at the table. - Flavour with lemon, ginger, garlic, onion, cumin, coriander, pepper, mint, curry leaves, tamarind, amchur and herbs. - Limit pickles, papad and salted snacks to small portions, occasionally. - Read packaged food labels for sodium (1 gram of salt contains about 400 mg of sodium). - Beware of salt substitutes (potassium chloride): unsafe in kidney disease or with some blood pressure medicines; ask the doctor. - Monitor blood pressure at home; see how to measure blood pressure at home accurately. - In heart failure or kidney disease, salt limits may be stricter; see heart failure at home: daily checks and warning signs.

Also see high blood pressure after 60: a home care guide and 5 tips to lower blood pressure.

Fats and oils

The type of fat matters more than the total for most people.

• Prefer unsaturated fats: groundnut, mustard, rice bran, sesame, olive, sunflower, soybean and canola oils; nuts, seeds and oily fish. Use varied oils, and measure: about 3 to 5 teaspoons of cooking oil per person per day is a common advice, adjusted by the dietician.
• Limit saturated fat: ghee, butter, coconut oil and palm oil in large amounts, fatty meats, full-fat dairy in excess, and fried foods. Small amounts of ghee in moderation can fit in a healthy diet for many people, but heavy use raises LDL cholesterol; people with high cholesterol, heart disease or after a heart attack should discuss amounts with the doctor.
• Avoid trans fats: vanaspati (hydrogenated vegetable fat), margarine with partially hydrogenated oils, and bakery and fried snacks made with them. India has moved to limit industrial trans fat; check labels.
• Do not reuse cooking oil repeatedly, which creates harmful compounds; avoid smoking oil.
• Cooking methods: steam, boil, pressure cook, grill, bake, sauté with minimal oil, air fry; avoid deep frying.
• Omega-3 fats: oily fish twice a week, flaxseed, walnuts; supplements only if advised; see omega-3 supplements for seniors: evidence and cautions.
• Healthy fats in appropriate amounts are not the enemy for a thin older adult; see 7 healthy fats for cooking and when to use and benefits of olive oil.

Fibre, whole grains and millets

Fibre, particularly soluble fibre from oats, barley, pulses, fruit and psyllium, lowers LDL cholesterol modestly and helps blood sugar and bowels. Choose whole wheat atta, ragi, jowar, bajra, oats, brown or red rice, dalia, and whole pulses. See 10 high-fibre foods to keep gut healthy and constipation in older adults: fibre, fluids and movement.

Fruit and vegetables

Aim for at least five servings a day (a serving is about a handful or a katori), including leafy greens, orange and red vegetables, and a variety of fruit. They provide fibre, potassium, antioxidants and little energy. Choose whole fruit over juice. Potassium caution: potassium-rich foods lower blood pressure for most people, but in kidney disease or with certain medicines (ACE inhibitors, angiotensin blockers, potassium-sparing diuretics), high potassium can be dangerous; follow the doctor's blood test advice; see eating with chronic kidney disease: a family guide.

Protein choices

• Pulses, dals, soya, sprouts, nuts: cornerstone for vegetarians.
• Fish: two portions a week, grilled, steamed or in a light curry.
• Eggs: generally acceptable in moderate numbers for most people; people with high cholesterol or diabetes can discuss with the doctor; often egg whites are suggested in some conditions.
• Poultry without skin, lean meats in small portions; limit red meat, organ meats, processed meats (sausages, salami) and fatty cuts.
• Dairy: low-fat or toned milk and curd; paneer in moderation.

See how much protein do older adults need. Older adults at risk of malnutrition should not cut protein or fat so far that they lose weight.

Sugar and refined carbohydrates

Limit sugar, sweets, sugary drinks, packaged juices, refined flour products (maida, white bread, biscuits, cakes) and large portions of white rice. These contribute to weight gain, high triglycerides and diabetes. See eating for diabetes after 60.

Cholesterol, medicines and diet

Dietary cholesterol (from eggs and shellfish) has less effect on blood cholesterol than saturated and trans fats. If your parent takes statins or other cholesterol-lowering medicines, diet complements but does not replace them; do not stop medicines because of diet changes or fear of side effects; discuss any concerns with the doctor. Avoid large amounts of grapefruit with some statins (ask the pharmacist). Red yeast rice supplements contain statin-like compounds and should not be combined with statins; see supplements and medicine interactions: a safety guide.

Blood thinners and food

• Warfarin: vitamin K in green leafy vegetables (spinach, methi, cabbage, broccoli, coriander leaves) affects INR. Do not avoid them; keep intake consistent, and tell the anticoagulation clinic if diet changes. Alcohol, cranberry juice in large amounts, and many herbal supplements interact.
• Newer anticoagulants (apixaban, rivaroxaban, dabigatran): less affected by vitamin K, but supplements such as fish oil, turmeric, ginkgo and garlic in high doses may raise bleeding risk; ask the doctor.
• See atrial fibrillation and blood thinners: a family guide.

Drinks

• Water, buttermilk, plain curd drinks, lemon water without much sugar, coconut water in moderation (potassium), unsweetened tea and coffee in moderation, and soups.
• Alcohol: best avoided or kept to very small amounts as the doctor allows; it raises blood pressure, interacts with many medicines and causes falls.
• Soft drinks and energy drinks: avoid.
• See hydration for older adults: how much and how to remember. In heart failure, follow fluid limits.

Weight and activity

Maintain a healthy weight. For overweight older adults, modest weight loss under supervision improves blood pressure and cholesterol; avoid crash diets that burn muscle. For underweight or frail people, gaining or maintaining weight and muscle is the priority; see malnutrition in older adults: signs and prevention. Regular activity suited to the person, such as walking, supports the heart; see exercise with heart disease and walking programme for older adults.

Special situations

In heart failure, salt and fluid limits and daily weights apply; see daily weights in heart failure: why and how. In kidney disease, see eating with chronic kidney disease: a family guide; with diabetes, see eating for diabetes after 60. For poor appetite or frailty, relax restrictions; see loss of appetite in older adults: causes and practical fixes.

Warning signs

Seek urgent help (call 112) for chest pain or pressure, severe breathlessness, fainting, sudden weakness on one side or speech difficulty. Call the doctor for new swelling, rapid weight gain, palpitations, dizziness or a big change in blood pressure.

When to ask a professional

Ask the doctor about targets for blood pressure and cholesterol and interactions with heart medicines. Ask a dietician for a culturally suited, personalised plan with measured oil and salt. Ask a pharmacist about supplements. Seek help for chest pain, breathlessness, palpitations or swelling.