Ughh
The American Journal of Medicine has an article entitled “Diets to Prevent Coronary Heart Disease 1957- 2013: What Have We Learned?” The authors conclude:
The Mediterranean-style diet, with a focus on vegetables, fruit, fish, whole grains and olive oil, has proven to reduce cardiovascular events to a degree greater than low fat diets, and equal to or greater than the benefit observed in statin trials.
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Posted in Coronary Heart Disease, Heart Disease
…to prevent future events—like heart attacks and strokes—and to prolong life. Details are at the American Journal of Clinical Nutrition.
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Posted in Coronary Heart Disease, Heart Disease, Longevity, Stroke
More evidence in favor of the Mediterranean diet as the healthiest around
We’ve known for years that the Mediterranean diet helps prolong life and prevent heart attacks, cancer, and strokes in folks who start out healthy.
What about patients with existing cardiovascular disease? I’m talking about history of heart attacks, strokes, angina, and coronary artery disease.
Yep. The Mediterranean diet helps them live longer, too.
Details of the study are at the American Journal of Clinical Nutrition. The research was done at Harvard.
Posted in Coronary Heart Disease, Heart Disease, Longevity
Tagged heart disease, longevity, Mediterranean diet, stroke
…according to Drs. Thomas Dayspring and JamesUnderberg. By LDL-P, they mean LDL cholesterol particle number. I don’t know if these guys are right or not. I bet it’s more complicated than LDL particle number.
Most heart attacks (aka myocardial infarctions) indeed seem to be caused by acute rupture of an atherosclerotic plaque that’s been present for years. Two key questions are:
Underberg and Dayspring write:
The only absolute requirement for plaque development is the presence of cholesterol in the artery: although there are additional heart risk factors like smoking, hypertension, obesity, family history, diabetes, kidney disease, etc., none of those need to be present. Unfortunately, measuring cholesterol in the blood, where it cannot cause plaque, until recently has been the standard of risk-testing. That belief was erroneous and we now have much better biomarkers to use for CV risk-assessment. The graveyard and coronary care units are filled with individuals whose pre-death cholesterol levels were perfect. We now understand that the major way cholesterol gets into the arteries is as a passenger, in protein-enwrapped particles, called lipoproteins.
Particle entry into the artery wall is driven by the amount of particles (particle number) not by how much cholesterol they contain. Coronary heart disease is very often found in those with normal total or LDL-cholesterol (LDL-C) levels in the presence of a high LDL particle number (LDL-P). By far, the most common underlying condition that increases LDL particle concentration is insulin resistance, or prediabetes, a state where the body actually resists the action of the sugar controlling hormone insulin. This is the most common scenario where patients have significant heart attack risk with perfectly normal cholesterol levels. The good news is that we can easily fix this, sometimes without medication. The key to understanding how comes with the knowledge that the driving forces are dietary carbohydrates, especially fructose and high-fructose corn syrup. In the past, we’ve often been told that elimination of saturated fats from the diet would help solve the problem. That was bad advice. The fact is that until those predisposed to insulin resistance drastically reduce their carbohydrate intake, sudden deaths from coronary heart disease and the exploding diabetes epidemic will continue to prematurely kill those so afflicted.
***
And for goodness’ sake, if you want to live longer, start reducing the amount of dietary carbohydrates, including bread, potatoes, rice, soda and sweetened beverages (including fruit juices), cereal, candy – the list is large).
Underberg and Dayspring don’t mention don’t mention LDL particle size, such as small/dense and large/fluffy; the former are thought by many to be much more highly atherogenic. Is that outdated?
Whoever figures out the immediate cause of plaque rupture and how to reliably prevent it will win a Nobel Prize in Medicine.
Steve Parker, M.D.
About Dayspring and Underberg:
Thomas Dayspring MD, FACP, FNLA Director of Cardiovascular Education, The Foundation for Health Improvement and Technology, Richmond, VA. Clinical Assistant Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School.
James Underberg MD, FACP, FNLA Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School and the NYU Center for Cardiovascular Disease Prevention . Director of the Bellevue Hospital Primary Care Lipid Management Clinic.
![MPj04384870000[1]](http://diabeticmediterraneandiet.files.wordpress.com/2010/03/mpj043848700001.jpg)
A recent Swedish study suggests that low-carbohydrate/high protein diets increase the risk of cardiovascular disease in women. I’m not convinced, but will keep an eye on future developments. This is a critical issue since many women eat low-carb/high protein for weight loss and management.
Researchers followed 43,000 women, 30–49 years of age at enrollment, over the course of 16 years. In that span, they had 1,270 cardiovascular events: ischemic heart disease (heart attacks and blocked heart arteries), strokes, subarachnoid brain hemorrhages, and peripheral arterial disease. Food consumption was estimated from a questionnaire filled out by study participants at the time of enrollment (and never repeated).
In practical terms, … a 20 gram decrease in daily carbohydrate intake and a 5 gram increase in daily protein intake would correspond to a 5% increase in the overall risk of cardiovascular disease.
So What?
To their credit, the researchers note that a similar analysis of the Women’s Health Study in the U.S. found no such linkage between cardiovascular disease and low-carb/high protein eating.
The results are questionably reliable since diet was only assessed once during the entire 16-year span.
I’m certain the investigators had access to overall death rates. Why didn’t they bother to report those? Your guess is as good as mine. Even if low-carb/high protein eating increases the rate of cardiovascular events, it’s entirely possible that overall deaths could be lower, the same, or higher than average. That’s important information.
I don’t want to get too far into the weeds here, but must point out that the type of carbohydrate consumed is probably important. For instance, easily digested carbs that raise blood sugar higher than other carbs are associated with increased heart disease in women. “Bad carbs” in this respect would be simple sugars and refined grains.
In a 2004 study, higher carbohydrate consumption was linked to progression of blocked heart arteries in postmenopausal women.
It’s complicated.
PS: I figure Swedish diet doctor Andreas Eenfeldt would have some great comments on this study, but can’t find them at his blog.
Reference: Lagiou, Pagona, et al. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. British Medical Journal, June 26, 2012. doi: 10.1136/bmj.e4026
Posted in Coronary Heart Disease, Heart Disease, Low-Carb Eating
…according to a report in MedPageToday.
I’m still not convinced that severe sodium restriction is necessary or even possible for most people
The American Heart Association has published guidelines aiming to reduce premature death and illness caused by cardiovascular diseases such as heart attacks, high blood pressure, and strokes.
The guidelines focus on seven factors critical to cardiovascular health:
Using data from the Atherosclerosis Risk In Communities study (almost two decades’ follow-up), researchers found that those who maintained goals for six or seven of the American Heart Association critical factors had a 51% lower risk of cancer compared with those meeting no goals.
For detailed information about the specific goals, click here.
As you might expect, I was curious about what the American Heart Association considered a heart-healthy diet. I quote the AHA summary:
The recommendation for the definition of the dietary goals and metric, therefore, is as follows: “In the context of a diet that is appropriate in energy balance, pursuing an overall dietary pattern that is consistent with a DASH [Dietary Approaches to Stop Hypertension]-type eating plan, including but not limited to:
Intake goals are expressed for a 2000-kcal diet and should be scaled accordingly for other levels of caloric intake. For example, ≤ 450 calories per week represents only up to one quarter of discretionary calories (as recommended) coming from any types of sugar intake for a 2000-kcal diet.
Diet recommendations are more complicated than that; read the full report for details. Only 5% of study participants ate the “ideal diet.” The Mediterranean diet easily meets four out of five of those diet goals; you’d have to be extremely careful to reach the sodium goal on most any diet.
Cardiovascular diseases and cancer are among the top causes of death in Western societies. Adhering to the guidelines above may kill two birds with one stone.
Potential answers are in the American Journal of Clinical Nutrition (2012). I quote:
For hypertension, coronary heart disease, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For inflammatory bowel disease, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.
It bothers me that vegetables and fruits are lumped together: they’re not the same.
All of my diets—Advanced Mediterranean, Low-Carb Mediterranean, and Ketogenic Mediterranean—provide plenty of fruits and vegetables.
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Posted in Coronary Heart Disease, Dementia, Diabetes, Heart Disease, Low-Carb Mediterranean Diet, Lungs, Osteoporosis, Stroke
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Nut consumption is strongly linked to reduced coronary heart disease, with less rigorous evidence for several other health benefits, according to the American Journal of Clinical Nutrition.
This is why I’ve included nuts as integral components of the Ketogenic Mediterranean Diet and the Advanced Mediterranean Diet.
Regular nut consumption is associated with health benefits in observational studies of various populations, within which are people eating few nuts and others eating nuts frequently. Health outcomes of the two groups are compared over time. Frequent and long-term nut consumption is linked to:
The heart-protective dose of nuts is three to five 1-ounce servings a week.
Reference: Sabaté, Joan and Ang, Yen. Nuts and health outcomes: New epidemiologic evidence. American Journal of Clinical Nutrition, 89 (2009): 1,643S-1,648S.
Posted in Coronary Heart Disease, Diabetes, Nuts
Tagged coronary heart disease, diabetes, nuts
No doubt you have noticed the expanding girths of U.S. yoots. What are the health implications? Research published in the New England Journal of Medicine suggests a disturbing answer.
Heavy youths tend to stay heavy as they age. Researchers looked at the incidence of overweight adolescents in the year 2000 and then estimated the prevalence of obesity in the year 2020. Thirty to 44% of 35-year-olds in 2020 are expected to be obese.
Using computer simulation, investigators estimated that by 2035 the prevalence of coronary heart disease will increase by 5 to 16% because of the increased obesity. In other words, the increasing obesity in these young and middle-aged adults will result in over 100,000 excess cases of coronary heart disease.
That is, if current trends continue. But I see nothing on the horizon likely to alter that societal trend in the near future. I’m doing my part. How about you?
Steve Parker, M.D.
References: Bibbins-Domingo, K, et al. Adolescent Overweight and Future Adult Coronary Heart Disease. New England Journal of Medicine, 357 (2007): 2,371-2,379.
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Posted in Coronary Heart Disease, Heart Disease, Overweight & Obesity
Tagged adolescent obesity, childhood obesity, coronary heart disease, heart disease, overweight youths
Researchers studied 24,444 Swedish women over the course of 6.2 years, analyzing dietary patterns, healthy lifestyle choices, and body weight. Information on the women was obtained mostly by surveys at the start and end of the study. The women were aged 48 to 83 at the start of the study and were free of diabetes mellitus, cardiovascular disease, cancer, and coronary artery disease.
Heart attacks in the study cohort were identified in the Swedish Hospital Discharge Registry and the Cause of Death Registry. Over the course of six years there were 308 heart attacks.
The study authors noted a greatly reduced incidence of heart attacks in women with the following characteristics:
Women meeting these criteria had a 92% lower risk of having a heart attack! Such women were only 5% of the cohort, however. I suspect the physical activity criterion knocked a lot of women out of the super heart-healthy subset.
The authors conclude that “most [heart attacks] in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.”
I see little reason to doubt that these findings apply to the typical woman in the U.S. or Europe, and not just to Swedes. The traditional Mediterranean diet of the mid-20th century fulfills the dietary prescription for a healthy heart. The Advanced Mediterranean Diet incorporates these healthy diet and lifestyle choices while simultaneously working to control weight.
Steve Parker, M.D.
Reference: Akesson, Agneta, et al. Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women. Archives of Internal Medicine, 167 (2007): 2,122-2,127.
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Posted in Alcohol, Coronary Heart Disease, Exercise, Heart Disease
Tagged alcohol, exercise, healthy diet, heart disease in women, prevent heart disease
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