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The Ultimate Guide to Heart Health
from Webber Naturals

Every year in Canada there are an estimated 70,000 heart attacks. That’s one every seven minutes! Do you know how to detect a heart attack or stroke? How about how best to care for your heart? Your Heart – a User’s Guide offers invaluable insight into how your heart works and what it needs to stay healthy, including diet, lifestyle, and natural health products to support cardiovascular health.

Factors Affecting Heart Health

Your heart is a major part of your cardiovascular system, which also includes small blood vessels called capillaries and major arteries such as your aorta. A healthy cardiovascular system enables your body to circulate blood to all your tissues and cells, providing vital nutrients, oxygen, and fuel.

Keeping your heart and blood vessels in good condition means you’re more likely to feel energetic, healthy, and happy. Unfortunately, most Canadians have at least one risk factor for heart disease or stroke. These risk factors include:

  • Smoking
  • Excess alcohol intake
  • Physical inactivity
  • Obesity
  • High blood pressure
  • High blood cholesterol
  • Uncontrolled diabetes

We will look at ways to improve heart health below, but first let’s look at how diet affects heart health. If you’re curious about cholesterol or feeling bamboozled by blood pressure, we’re here to help, with a simple guide to how sugar and fats work – in food and in your body – as well as the lowdown on LDL cholesterol, triglycerides, and blood pressure.

Fat and Sugar in Food

We can’t talk about heart health without talking about lipids (fats) and sugar. Dietary fats (that is, the fats we get from our food) are an important source of energy and nutrients, and are essential for good health. The same goes for carbohydrates.

The problem, though, is that not all fats and carbohydrates are the same: Some support heart health, while others can be harmful. Being heart smart means learning your lipids and categorizing your carbs!

First, let’s face fats.

What are trans fats?

One of the best things you can do for the health of your heart is to cut out trans fatty acids (trans fats). Why are trans fats so bad? Well, they not only raise the bad kind of cholesterol, low-density lipoprotein (LDL) and triglycerides, they also lower HDL cholesterol (the good kind!), which can dramatically increase your risk of cardiovascular disease by blocking blood vessels and making arteries stiff and weak.

Trans fats occur naturally in some meat and dairy products, but most dietary trans fats are found in baked goods, snacks, fried foods, and spreads that contain partially hydrogenated vegetable oils. Cutting out highly processed foods and cooking from scratch can make a significant difference to heart health by helping you remove trans fats.

What are saturated fats?

Saturated fats are usually solid at room temperature and are found predominantly in animal-derived foods, although some nuts also contain saturated fats. These fats are so called because their carbon chains are saturated with hydrogen atoms, which makes them less flexible than unsaturated fats.

A diet high in saturated fats can increase levels of LDL cholesterol and triglycerides, raising the risk of heart disease and stroke.

Coconut oil also contains saturated fat, but in the form of medium-chain triglycerides, which the body prefers to use directly for energy rather than storing it as fat. It is best to use it in moderation though, like other saturated fats.

What are unsaturated fats?

Unsaturated fats include monounsaturated and polyunsaturated fatty acids (MUFAs and PUFAs). These fats are usually liquid at room temperature because their carbon chains are not saturated with hydrogen. They are found in seeds, nuts, olives, fish, and non-hydrogenated, raw vegetable oils.

PUFAs and MUFAs are vital for flexible, functional cell membranes, without which cells would struggle to perform all their vital functions such as producing energy and responding to chemical messengers like insulin, other hormones, and neurotransmitters needed for cognitive function.

What is sugar?

Saturated and trans fats have long had a bad rap when it comes to heart health, but sugar is also a major contributor to cardiovascular problems.

Sugar is a type of saccharide or carbohydrate. As with fats, our bodies need carbohydrates to survive and thrive, but getting the right kind is key.

Saccharides are divided into four groups:

  • Monosaccharides
  • Disaccharides
  • Oligosaccharides
  • Polysaccharides

Oligo- and polysaccharides are large and complex carbohydrates and include starch, which we use for energy; fibre (cellulose), which is indigestible but necessary for healthy bowel function; and inulin and other types of prebiotic polysaccharides, which feed intestinal microflora to support good health. Polysaccharides also act as important energy stores in the body, and play a role in the production of DNA, as well as immune function, fertility, and tissue repair and growth.

So, if carbohydrates are important for health in general, why is sugar such a problem?

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Sugar, Fats, and Cardiovascular Health

Now you know which types of fat and carbohydrates are best included in a heart-healthy diet, let’s take a closer look at triglycerides and cholesterol, as well as sugar, inflammation, and blood pressure.

What are triglycerides?

Triglycerides are made up of three fatty acids and a glycerol (sugar) molecule. They are the most common type of fat in the body and are created to store excess energy when we consume more calories than we need.

Small amounts of triglycerides are necessary for good health, but high triglyceride levels can increase LDL cholesterol, arterial plaque formation, and your risk of heart disease.

Dietary trans fats, refined carbohydrates, sugar, alcohol, and saturated fats all increase triglyceride levels. Getting good sleep, managing stress effectively, and exercising regularly all help to keep triglycerides in check.

What is cholesterol?

Cholesterol is a waxy substance that the body uses as a base for making hormones, vitamin D, and cell membranes. While some cholesterol is essential for good health, too much can damage and block arteries and increase your risk of heart attack and stroke.

In their pure state, cholesterol and triglycerides cannot mix with blood, so the body pairs them with proteins to form lipoproteins that can circulate in the blood to where they are needed.

Low-density and very-low-density lipoproteins (LDL and VLDL) are the “bad” kind of cholesterol as they can build up in the arteries, oxidize, and cause damage and blockages. High-density lipoprotein (HDL) helps remove LDL and VLDL from circulation and keep arteries clear.

How does blood pressure work?

Blood pressure is a measure of the circulatory pressure felt in the walls of blood vessels as the heart pumps and relaxes. It is usually given as one number over another (systolic over diastolic) to reflect both the highest and lowest pressure during a heartbeat.

The circulatory system moves blood around our bodies to provide oxygen, energy, and nutrients to cells and to remove metabolic waste products and toxins. As the heart pumps blood around the body, healthy blood vessels respond to changes in blood volume, posture, and activity to maintain the steady pressure and flow in this blood “stream”.

When arteries, veins, and smaller blood vessels stiffen, narrow, or become blocked, it is harder for them to respond to changing needs. Blood pressure may rise and remain elevated, which can then further damage blood vessels and increase the risk of heart attack and stroke.

Sugar and cardiovascular health

Dietary sugar is quickly and easily digested by the body, leading to a rapid rise in blood glucose. Because the body works hard to maintain a stable blood glucose level, a sudden rush of sugar into the blood increases demand for the hormone insulin which helps get sugar out of the blood and into our cells to be used as energy.

If sugar intake continues to be high, the increased demand for insulin can burn out the cells that produce the hormone. Over time, other cells in the body might also become resistant to insulin, meaning that blood glucose and insulin levels remain elevated. This can increase inflammation and eventually lead to oxidative damage to cells and tissues, including blood vessels and the heart.

A diet that remains high in sugar can also put you at risk of increased blood pressure and weight gain. As we’ve just seen, sugar molecules (as glycerol) can be combined with fatty acids to form triglycerides, which can further have an impact on cardiovascular health.

Other factors in heart health

Dietary fats and sugars are not the only factors affecting cardiovascular health, of course. Your age, sex, and certain lifestyle factors can all influence the health of your heart and blood vessels.

For instance, the risk of heart disease is higher in males than in premenopausal females. This is thought to be due to a protective effect related to estrogen as well as potential adverse effects of elevated testosterone. However, when estrogen levels decline after menopause, the risk of heart disease increases in females.

Stress is another major factor in cardiovascular health. While some stress is unavoidable, it’s important to find healthy ways to manage stress, such as yoga, exercise, reading, meditation, and walks in nature. This can help keep blood pressure in check and support overall good health, including heart health.

Can you spot a stroke? A stroke is where a bleed or a blockage in a blood vessel cuts off circulation to part of the brain. Think of it as being a ‘brain attack’ instead of a heart attack and remember the acronym FAST:

Face – is it drooping?

Arms – can you raise both?

Speech – is it slurred?

Time – call 911 right away.

While the signs of stroke are the same in males and females, stroke is more common in females and is more often associated with worse outcomes. The risk of stroke is higher during pregnancy, after menopause, and when taking certain oral contraceptives.

Since most medical conditions develop slowly over several years, paying close attention to known risk factors during regular check-ups or with home monitoring will allow you to take charge of your health.

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Ways to Improve Your Heart Health

1. Check Yourself (for Cholesterol)

Adults with an average risk of heart disease are recommended to have their cholesterol levels checked every five years from the age of eighteen. However, you may need to get tested more often if your risk of heart disease is higher due to any of the following criteria:

[] Family history
[] Being overweight

[] Eating a high-fat diet
[] Smoking

[] Age (for men over 45 and women over 55)
[] Low levels of physical activity

2. Quit Smoking

If there’s one thing you do today to support your health and wellbeing – quit smoking! Non-smokers have a much lower risk of heart problems, and have both more years in life and more life in those years.

Related Reading from our Be Well Blog:

9 Steps to Quit Smoking

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3. Increase Fibre Intake

Happily, some healthy habits compound one another, such as eating a high-fibre diet.

To eat more fibre, increase your intake of fresh fruit, vegetables, and healthy whole grains. In addition to getting more fibre in your diet, you will also find it easier to satisfy your appetite, maintain blood glucose regulation, and minimize the absorption of dietary fat and cholesterol.

You’ll also be increasing your intake of vitamins, minerals, and other nutrients that are unique to plant foods.

4. Cut Down on Salt and Sugar

Salt and sugar in your food can be a recipe for poor heart health. Both are linked to increased blood pressure and systemic inflammation, and a diet high in sugar increases your risk of diabetes (itself a risk factor for cardiovascular disease) and can increase levels of triglycerides and LDL cholesterol, as we saw earlier.

The best way to limit sugar and salt in your diet is to cook from scratch as often as possible. Food manufacturers like to add sugar and salt to highly processed foods in order to try to make them palatable. Don’t be fooled! Watch out for excess salt and sugar in chips, pizzas, canned soups and vegetables, pies, breakfast cereals, bread and microwaveable meals. Even savoury foods are often high in simple carbohydrates. Cut them out to cut your risk of heart disease.

5. Maintain a Healthy Body Weight

Being overweight is an independent risk factor for heart disease. This means that even if you conquered every other risk factor, that excess weight is still associated with an increased risk of heart attack, stroke, and premature death.

Being overweight or obese also raises your risk of sleep apnea, which can itself increase the risk of heart attack, stroke, and hypertension.[1]

Your waist circumference is thought to be an important indicator of heart disease risk because it reflects abdominal fat, a predictor of health complications such as heart disease and diabetes.

If you’re male, aim to have a waist circumference of less than 40 inches (102 cm). If you’re female, aim for a measurement no greater than 35 inches (89 cm). [2]

Even a 5–10% reduction in body weight can help lower the risk of developing health conditions associated with being overweight, such as elevated blood pressure, LDL cholesterol and triglyceride levels, and blood sugars. [3

Maintaining a healthy body weight is an important part of overall health maintenance, including supporting cardiovascular health. The following strategies could help you achieve and maintain a healthy body weight:

  • Consume 500–1000 calories less per day to achieve a healthy, gradual weight loss of 1–2 pounds per week [3
  • Eat a heart-healthy diet (see the next section)
  • Avoid being sedentary – don’t sit for longer than 30 minutes at a time if possible, and exercise for at least 150 minutes per week to help burn excess fat and improve metabolic activity [4
  • Drink plenty of water – dehydration is a common cause of overeating. Aim for at least six to eight 250 mL (8 fl oz) glasses of water per day. If your urine is dark yellow in colour, your body needs even more water to maintain hydration [5

6. Reduce Stress

We often overeat, eat unhealthy foods, consume too much alcohol, or smoke when we are under stress. Finding ways to reduce stress and manage stress more effectively is important for heart health and overall health and happiness.

Reduce stress by identifying avoidable stressors and making changes that are practical and sustainable. This might be as simple as making your lunch the night before so you’re not rushing in the morning or as big as moving closer to work, so your commute is shorter and walking distance.

For those unavoidable stressors, find healthy stress-busting techniques that work for you and your schedule. These include being physically active, eating well, sharing your feelings, making time for yourself, and taking time-off when possible.

7. Exercise Regularly

Just keep moving! Exercising regularly and avoiding being sedentary are two of the best things you can do for your heart, and the great thing is that exercise is free! There’s no need to train for an ultramarathon (unless you want to) or to spend your next paycheck on an expensive home gym.

In fact, it’s much more sustainable to incorporate physical activity into your day in such a way that exercise feels almost effortless. For example:

  • Take the stairs instead of the elevator or escalator
  • Bike to work
  • Take a walk with friends instead of going for dinner or drinks
  • Play in the park with the kids or your dog instead of sitting to watch a movie.

To be heart smart, aim for 150 minutes of moderate physical activity every week. That might mean a 30-minute walk five days a week, three 50-minute bike rides, or any combination of activities you enjoy and that work up a bit of a sweat. The key thing is to get moving and keep moving, whatever your age and current fitness level!

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8. Natural Health Products

Carefully selected natural health products, such as Omega-3 and Coenzyme Q10, can offer additional support for cardiovascular health. In fact, Omega 3 fatty acids have been shown to reduce serum triglyceride levels and provide a source of omega-3 fatty acids for the maintenance of good health.

Find out more about Heart Health Supplements.

Heart Healthy Diet

What you eat has a profound effect on the health of your heart. Several dietary strategies have been shown to support heart health, including:

  • Eating a predominantly whole food plant-based diet As recommended in the latest Health Canada Food Guide, a diet made up of mostly fruits, vegetables, nuts, seeds, legumes, and healthy whole grains, with limited intake of animal-derived foods high in saturated fat and cholesterol, can help support all-round good health. Aim for half your plate to be fruits and vegetables, a quarter to feature sources of plant protein (see below), and the other quarter to comprise whole grains such as quinoa, rice, buckwheat, or whole wheat pasta.
  • Minimize meat and dairy animal-derived foods lack fibre and other key nutrients and may be high in saturated fat as well as trans fats, and cholesterol. Avoid processed meats such as hotdogs, sausage, and deli meats that are associated with an increased risk of serious health issues. Healthier choices of protein include beans, lentils, chickpeas, tofu, tempeh. And, don’t forget, there’s also protein in nuts, seeds, whole grains, fruits and vegetables!
  • Favouring fruits and vegetables – whether you’re partial to pears, or besotted with broccoli, fresh, frozen, or canned fruits and veggies (without added sugar or syrup!) provide key antioxidant and bioflavonoid nutrients that help protect the heart and blood vessels. Aim to eat 7-10 servings per day to support good health; one serving is half a cup [6].
  • Focusing on fibre – a high intake of fruits, vegetables, nuts, seeds, legumes, and whole grains also boosts your fibre intake. This helps to maintain healthy cholesterol and blood sugar levels already within the normal range in addition to supporting digestive health. Healthy adults should aim to get 21–38 grams of fibre per day [5].
  • Make water your drink of choice – As recommended in the Canada Food Guide, water is the best beverage choice for good health. Soda, alcohol, and fruit juices add extra calories we often don’t need and often don’t realize we’re consuming. The sugar in these drinks can also damage tooth and gum health, which is a risk factor for heart disease. Drinking water regularly throughout the day can help you stay hydrated and supports appetite management, without any extra calories or sugar! Aim for 6-8 glasses of water per day.

Goals to keep in mind when it comes to protein selection:

  • Try to keep the total amount of meat in your diet to 10-15% of your total calories.
  • Eat red meat only occasionally and buy grass-fed beef where possible.
  • Keep your portion size to fit in the palm of your hand.
  • Choose leaner meats, such as fish, chicken, or turkey. If possible, buy organic.
  • Add beans and other plant-based protein sources to your meals.
  • Avoid processed meats such as hotdogs, sausage, and deli meats 

Heart Healthy Foods

A heart healthy diet is one where daily food choices help support the whole cardiovascular system. What does such a diet actually look like though, and how can you tell the size of a serving and how many servings you need? Here’s the lowdown on some key heart-healthy foods.

Nuts and seeds – Walnuts, almonds, and other nuts, as well as flaxseeds, chia, and hemp seeds provide healthy fats, vitamins, minerals, fibre, and phytonutrients that support heart health.

Snack on unsalted and raw nuts and seeds between meals, add them to oatmeal and cereal, make a nut paella, and sprinkle them on salads to get your daily servings! A quarter cup is one serving. Aim for 2-3 per day.

Fruits – Berries, bananas, oranges, apples, papaya, and cantaloupe all provide soluble fibre and phytonutrients, including antioxidants, as well as minerals such as potassium and magnesium to support heart health.

Make a fruit salad, a healthy breakfast smoothie, or a delicious sorbet, or cook up a tandoori fruit curry to help you get your 3-5 servings a day. Half a cup is one serving.

Vegetables – Brightly coloured vegetables such as sweet potatoes, peppers, radish, kale, and eggplant are packed with antioxidant carotenoids, as well as fibre, and other vitamins, minerals, and phytonutrients – and they’re delicious!

Eat the rainbow and get your 3-5 portions a day by making a delicious veggie and tempeh stir-fry, a roasted veggie salad with chickpeas and quinoa, or a greens smoothie! Half a cup is one serving.

Whole grains – Oatmeal, quinoa, brown rice, millet, teff, and other whole grains are excellent sources of complex carbohydrates including soluble and insoluble fibre, and provide protein, vitamins, and minerals.

Cook whole grains from scratch to avoid added sodium and sugar. Enjoy a variety of whole grains by whipping up a quinoa pilaf, overnight oats, brown rice and Thai green curry, or a lunchtime beans and veggie injera wrap! Half a cup of cooked grains is one serving.

Legumes – Beans, lentils, and peas are fantastic sources of lean protein, fibre, and a variety of minerals and vitamins, including B vitamins.

Aim to have a quarter of your plate made up of these plant-based protein sources by including refried black and pinto beans, marinated tempeh, peanut butter baked tofu, lentil dhal, or minted peas. One serving is three quarters of a cup. Aim for 2-3 servings per day.

Heart Helpers

Consider including the following in your diet for a little extra support for heart health:

  • Dark chocolate – a source of antioxidants! Choose dark chocolate (70% cocoa at least) to avoid excess sugar.
  • Garlic – contains compounds that help reduce elevated blood lipid levels.
  • Sunflower Seeds – a great source of antioxidant vitamin E which supports heart health by protecting against cholesterol oxidation, as well as magnesium, which helps maintain proper muscle function.
  • Dark Leafy Greens – a source of vitamin K, B vitamins, and antioxidants to support heart health! Eat spinach, kale, Swiss chard, arugula, collard greens and other veggies to support your cardiovascular system.
  • Cold-water fish – Salmon, mackerel, sardines, anchovies and trout are rich in omega-3 fatty acids which support cardiovascular health.

Related Reading from our Be Well Blog:

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Heart Healthy Recipes

Best Supplements for Heart Health

Eating well, engaging in regular physical activity, and managing stress create a solid foundation of support for cardiovascular health.

In addition, certain natural health products have been found to support heart health by maintaining antioxidant status, blood pressure, triglycerides, and cholesterol.

It’s advisable to consult with your physician prior to use if you are pregnant or breastfeeding, or if you are taking any prescription medication.

Omega-3

Consuming eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids supports cardiovascular health[7,8] and helps reduce serum triglycerides. [9,10]

The most protective effects of omega-3 fatty acids for the heart are provided by marine sources such as fish or krill, which provide EPA and DHA.

In fact, krill oil contains phospholipid-bound omega-3 fatty acid for more efficient absorption and bioavailability of EPA and DHA, while providing natural sources of important antioxidants such as astaxanthin [11].

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a fat-soluble molecule that is important for cellular energy and heart health. This coenzyme is produced via the same pathway as cholesterol and, when we are young, our bodies are generally able to keep up with demand. As we age, however, CoQ10 production is less efficient and our blood levels begin to decline [12]. Older adults are also more likely to be prescribed statins and beta blockers to inhibit cholesterol production. Unfortunately, these medications also reduce CoQ10 production.

In supplement form, CoQ10 is best provided as ubiquinol, the active form of the nutrient as produced by the body itself. Ubiquinol is better absorbed and can produce higher concentrations of CoQ10 in the blood than regular CoQ10 (ubiquinone). This makes it especially helpful for seniors or anyone looking to support and maintain cardiovascular health.

Plant Sterols

Plant sterols, also called phytosterols, are cholesterol-like compounds found in plant cell membranes. Plants sterols can naturally be found in vegetables, fruits, and grains. Research shows that plant sterols help block the absorption of cholesterol in the small intestine, thereby helping to lower blood total and LDL cholesterol, and reduce triglycerides levels. An intake of 2 g of phytosterols per day with meals, as part of a diet low in saturated fat and cholesterol, is associated with an 8–10% decrease in LDL cholesterol [13].

Magnesium

Magnesium is an important mineral and electrolyte. It is a factor in the maintenance of good health and is needed to maintain proper muscle function, including the strength of heart muscle contractions [14].

Vitamins B6, B12, and Folate

B vitamins are essential for energy metabolism and a range of other physiological functions, including the metabolism of homocysteine into methionine or cystathionine. Homocysteine is a sulphur amino acid that when blood levels are elevated, has been linked to an increased risk of cardiovascular disease.

Eating a diet high in vitamins B6, B12, and folic acid or folate, or meeting daily recommendations with the help of a B-vitamin supplement can help support normal homocysteine metabolism and heart health.

Resveratrol

Resveratrol first gained attention in the early 1990s when researchers uncovered the antioxidant compound while investigating the so-called “French paradox” whereby people living in France had healthy hearts despite eating diets high in saturated fats.

Resveratrol is a type of polyphenol antioxidant found naturally in a variety of foods that also feature in traditional diets in France, such as red wine, red grape skins, purple grape juice, berries, peanuts, dark chocolate, and tea. This naturally occurring antioxidant is helpful for the maintenance of good health.

Vitamin E

Vitamin E is a fat-soluble antioxidant that helps protect cell membranes against damage caused by free radicals. The function of vitamin E is to help with structural and functional maintenance of skeletal, cardiac, and smooth muscle. It also assists in the formation of red blood cells and helps maintain stores of vitamins A and K, iron, and selenium in the body.

 

Disclaimer: This information is provided for educational purposes only and is not intended for self-diagnosis or self-treatment of conditions that should be interpreted and managed by a qualified health care provider.

The Heart and Stroke Foundation does not endorse any Webber Naturals products and does not make any claims about their efficacy or health benefits. The Heart and Stroke Foundation is a recipient of sponsorship money raised through the sale of these Webber Naturals products.

™The heart and / Icon and the Heart & Stroke and Heart Smart word marks are trademarks of the Heart and Stroke Foundation of Canada used under license.

Proceeds from the sale of Webber Naturals products will go towards supporting the Heart and Stroke Foundation in 2019 and 2020 to a maximum of $120,000.

Check Out Our Other Guides

Couple hiking in the woods without tummy troubles.

The Ultimate Guide to CoQ10

CoQ10 plays a vital role in your health. As a naturally produced nutrient, it is best known for cell growth and maintenance. As you age, CoQ10 levels decrease, therefore supplementation is often recommended. In the Ultimate Guide to CoQ10, you can learn about the role it plays in your body, and how to choose the right product for your specific needs.  Read More

Woman sleeping peacefully in bed.

The Ultimate Guide to Omega-3

The word “fat” usually depicts a negative connotation, but Omega-3 fats are anything but negative. They are healthy fats that deliver many health benefits. In this Ultimate Guide to Omega-3, you’ll learn more about the types of omega-3 fats, and how to choose the right omega-3 supplement that’s right for you.. Read More

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References :

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[2] Heart and Stroke Foundation of Canada. Healthy weight and waist. Health Seekers. Available from: http://www.heartandstroke.ca/get-healthy/healthy-weight/healthy-weight-and-waist [Accessed 11th October 2018].

[3] Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007; 176(8):S1-13.

[4] Canadian Society for Exercise Physiology (CSEP). Canadian Physical Activity Guidelines. Available from: http://www.csep.ca/en/guidelines/guidelines-other-languages [Accessed 11th October 2018].

[5] Amos B, Cronin C, Ellig E, et al. Drinking enough water. HealthLinkBC. Updated 4 May 2017. Available from: https://www.healthlinkbc.ca/health-topics/abk5466 [Accessed 11th October 2018].

[6] Heart and Stroke Foundation of Canada. Get healthy/healthy eating. Health Seekers. Available from: http://www.heartandstroke.ca/get-healthy/healthy-eating [Accessed 11th October 2018].

[7] Delgado-Lista J, Perez-Martinez P, Lopez-Miranda J. et al. Long chain omega-3 fatty acid and cardiovascular disease: a systematic review. British Journal of Nutrition. 2012; 107:S201-S213.

[8] Mozaffarian D & Wu JH. Omega-3 fatty acids and cardiovascular disease. Effects on risk factors, molecular pathways, and clinical events. Journal of the American College of Cardiology. 2011; 58(20):2047-67.

[9] Weitz D, Weintraub H, Fisher E, et al. Fish oil for the treatment of cardiovascular disease. Cardiology Review. 2010; 18(5):258-63.

[10] Abeywardena MY & Patten GS. Role of omega-3 long-chain polyunsaturated fatty acids in reducing cardio-metabolic risk factors. Endocrine, Metabolic & Immune Disorders Drug Targets. 2011; 11(3):232-46.

[11] Ramprasath VR, Eyal I, Zchut S, et al. Enhanced increase of omega-3 index in healthy individuals with response to 4-week n-3 fatty acid supplementation from krill oil versus fish oil. Lipids Health Dis. 2013;12:178.

[12] Garrido-Maraver J, Cordero MD, Oropesa-Avila M, et al. Coenzyme Q10 therapy. Mol Syndromol. 2014; 5(3-4):187-97.

[13] Cabral CE, Klein MR. Phytosterols in the treatment of hypercholesterolemia and prevention of cardiovascular disease. Arg Bras Cardiol. 2017;109(5):475-482.

[14] Tangvoraphonkchai K, Davenport A. Magnesium and cardiovascular disease. Adv Chronic Kidney Dis. 2018;25(3):251-260.