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Posts Tagged ‘Dietary Fats’

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How Do You Prevent Heart Disease? (Vitamin D might not help, but there’s plenty you can do)

Monday, January 28th, 2013
Today we feature a new article from, JD Moyer of the blog Systems for Living Well: Recently one of my favorite bloggers, Ferrett Steinmetz, had some chest pain, and as a precautionary measure went to the ER to get checked out. His initial tests came back normal, but the chest pain continued, and his blood work showed abnormal results. Ferrett had experienced a heart attack, and was immediately scheduled for surgery.

It got me thinking about heart disease.

Heart disease is incredibly common. It’s the leading cause of death in the United States.

So what can we do to prevent it?

 

For years the medical establishment told us that eating a low-fat, low-cholesterol diet was the best thing we could do to prevent heart disease. Even my last doctor tried to peddle this advice. I changed doctors.

Cardiologists who have been paying attention to the research now associate heart disease with factors like lack of exercise, diets high in refined carbohydrates, poor blood sugar control, inflammation, and sedentary lifestyle (lots of sitting — see infographic below). Dietary cholesterol doesn’t matter so much, and a moderate intake of saturated fat is probably not harmful (though monosaturated fats like olive oil may be preferable). Healthy fats (butter from grass-fed cows, olive oil, coconut oil, fatty fish) are a more “heart-healthy” source of fuel than grain products (even whole grains).

Bill Davis (author of Track Your Plaque and Wheat Belly) is one such forward-thinking cardiologist. Davis recommends a wheat-free, no refined vegetable oil (corn/sunflower/soy/canola), low-carbohydrate diet, as well as certain supplements (which he also sells) including vitamin D, fish oil, niacin, and coenzyme Q10. He also recommends foods such as olive oil, garlic, and tea (all associated with lower heart disease). Is he peddling products? Sure … but his approach is still leagues ahead of the conventional wisdom on heart disease.

Ferrett had to undergo triple bypass surgery. Thankfully, he survived, and is now recovering at home.

 

Cholesterol and Genetics

23andMe.com tracks fifteen SNP’s that are related to an increased or decreased risk of coronary heart disease (if you have a 23andMe account you can click here to see your heart disease risk profile).

The most significant SNP is rs3798220 (snpedia/23andMe). People carrying the C allele produce higher levels of lipoprotein(a), and have more than a twofold increased risk of heart disease. I feel fortunate to carry TT, but C carriers get a compliment from Dr. Davis. He calls them the “perfect carnivores” in this post, and claims this variant is more resistant to dehydration, tropical disease, and is more likely to be intelligent (I’m not sure what Davis is basing these claims on, but they’re interesting).

AG or GG at rs10455872 is also associated with higher Lp(a) levels and increased risk of coronary heart disease. 23andMe users can see their genotype for this SNP here.

Heart disease risk for rs3798220-C carriers can be somewhat mitigated by low-dose aspirin therapy, at least in women. Estrogen HRT also lowers lipoprotein-a/Lp(a) levels. Among Bantu fishermen, higher fish intake was also associated with lower Lp(a).

Why are elevated Lp(a) levels associated with coronary heart disease? Lp(a) is similar to low-density lipoprotein (LDL), which is more likely to stick to arterial walls and clog them up (while the big HDL molecules bounce around harmlessly).

 

Environmental Risk Factors

In addition to genetic risk, these environmental risk factors are pretty well established. Unlike diet, there is little controversy around these risk factors for coronary heart disease:

We’re stuck with our genes, but these factors are avoidable. Don’t buy a house next to a freeway. If you smoke, making quitting a priority (if you’re under 40, the damage may be largely reversible). And get a standing desk (or convert — I added eight 12″ dowels to my IKEA desk — now it’s a standing desk).

 

Dietary Fat and Cholesterol

For decades, both fat intake and lipid cholesterol levels were associated with heart disease, but neither has been shown to be causative. The most famous high-fat diet correlation turned out to be Ancel Keys cherry-picking data for one of his presentations (though Keys may have been unfairly maligned by the paleo community, as this post explains).

What about cholesterol? As of 2010, the U.S. government was still recommending that we consume no more than 300mg of cholesterol a day (2 eggs contain about 370mg), even though a large body of research has failed to find any connection between dietary cholesterol and coronary heart disease. We’ll see if the 2015 guidelines update this recommendation.

Chris Kesser has written a number of articles debunking the idea that dietary cholesterol and saturated fat cause heart disease. I recommend his site.

Still, certain types of lipid cholesterol measurements are associated with an increased risk of coronary heart disease, specifically LDL-P (low-density-lipoprotein particle number). We don’t want large numbers of tiny cholesterol particles floating about in our bloodstreams — they tend to clog up the works.

What raises LDL levels? While Lp(a) levels (discussed above) are related primarily to genetics, LDL levels are highly influenced by diet. High carbohydrate/high sugar diets seem to be the main culprit.

 

Cholesterol, Vitamin D, Sunlight, and Nitric Oxide

Some researchers believe that high cholesterol levels are merely a biomarker for coronary heart disease risk, and don’t cause heart disease at all. Chris Masterjohn explains how cholesterol is converted to vitamin D, and that sunlight is necessary for this process. So high lipid cholesterol might simply indicate that you aren’t getting enough sun, and that your vitamin D levels are too low. Low vitamin D levels are associated with a higher risk of coronary heart disease.

So all we have to do is take supplemental vitamin D, and we should reduce our risk of heart disease, right?

 

Not so fast.

 

In terms of heart disease, blood levels of vitamin D may be a red herring biomarker, just like high cholesterol levels.

Dermatologist Richard Weller has done some fascinating research in this area. He found that people from northern latitudes with less sun exposure generally experience more heart disease. Even after controlling for smoking, diet, and socioeconomic factors, people from sunnier areas experience markedly less heart disease.

Weller discovered that the skin stores large amounts of nitrates and nitrites, which are converted to nitric oxide by exposure to sunlight. Nitric oxide released into the bloodstream lowers blood pressure and dilates (relaxes and opens) blood vessels. Weller showed that this effect was not related to vitamin D levels; the amount and intensity of sunlight (about 30 minutes of sun in Edinburgh, during the summer) was not sufficient to raise vitamin D levels. But it was enough to convert skin nitrates and nitrites into nitric oxide, and lower blood pressure.

It’s not that vitamin D isn’t good for you. We know vitamin D increases calcium absorption, prevent rickets, and reduces the risk of many cancers (especially colon cancer). But in terms of heart disease, low vitamin D may just be a biomarker for low sun exposure, and therefore low plasma nitric oxide levels.

How does nitric oxide prevent heart disease? In addition to lowering blood pressure, nitric oxide inhibits the oxidation of low-density lipoprotein, which is a known risk factor for heart disease.

What about skin cancer risk? Weller, a dermatologist, points out that heart disease is a much bigger killer than skin cancer (by a factor of 100). And thirty minutes of Scottish sunlight is probably not going to cause much skin damage.

I live in the Bay Area and we get plenty of sun, but I’m rarely in it. My calves are British-schoolboy white. Moving forward, that’s going to change. According to Weller, even ten minutes of California winter sunshine is enough to activate nitric oxide (NO) release. I won’t be sporting a tan anytime soon, but I might be moving into a light beige.

 

Other Ways To Raise Nitric Oxide Levels

What if sunlight exposure isn’t an option, either due to latitude or lifestyle?

There are other ways to boost nitric oxide. The primary one is exercise, which has shown to be heart-protective.

Dark chocolate also boosts NO levels and reduces blood pressure.

So does red wine.

 

So there are options to boost nitric oxide levels. And more than heart health is at stake; adequate NO levels are vital for sexual response in both men and women.

 

What About Supplements and Medications?

Which supplements and medications have the best evidence for protecting against heart disease?

Niacin has a decent track record, though a large trial by Merck combining statins and niacin showed no benefit. Personally I can’t tolerate large doses of niacin — the flush response is too much, and it messes with my digestion. Niacin may be especially effective for rs3798220-C carriers who produce higher levels of Lp(a), but low-dose aspirin is also effective.

Statins are often prescribed, but show no benefit for people who don’t already have coronary heart disease. Low-dose daily aspirin is just as (or more) effective, and much cheaper. Both statins and low-dose aspirin can have serious side effects, including internal bleeding and increased risk of macular degeneration for the latter.

Coenzyme Q-10 may be heart protective, and can help lower blood pressure. Oily fish like salmon is a good source, but since levels decrease with age, those of us over 40 might consider taking supplemental CoQ10. Statins tend to lower levels of coenzyme Q-10, and supplemental CoQ10 may protect against some of the side effects of statins.

Of all the supplements I have considered, vitamin K2 (found in fermented foods, aged cheeses, poultry liver, and grass-fed dairy products) seems to be the most promising in terms of actually preventing coronary heart disease. This study found an inverse relationships between dietary vitamin K2 and heart disease in older women.

I eat most of those foods, and recently I also started taking 50mcg of vitamin K2 (the Mk-7 form, derived from nattō) several times a week (I’ve tried actually eating nattō, but I can’t stand the taste).

Vitamin K2 controls where calcium goes in the body via modulation of the hormone osteocalcin. How exactly does this process work? Here’s a excerpt from this article.

The possible role of vitamin K2 in preventing coronary plaque development has emerged from observations of its effects on several bone proteins, whose main function is to keep calcium where it belongs in the body.

Osteocalcin is a calcium-regulating protein that is controlled by vitamin K2. When vitamin K is present, osteocalcin normally undergoes a process called carboxylation, which binds osteocalcin to the mineral portion of bone. However, in vitamin K2 deficiency, osteocalcin cannot perform this function, resulting in unrestrained calcium resorption (removal) from bone tissue that leads to osteoporosis.

The opposite situation seems to occur in the arteries. Calcium is deposited because another protein called matrix GLA-protein, which is a calcification inhibitor and is also K2-controlled, cannot undergo the process of carboxylation in a vitamin K-deficient state. Because only carboxylated matrix GLA-protein inhibits calcification, undercarboxylated matrix GLA-protein has been found to occur in unusually high concentration at the edge of calcified and atherosclerotic plaques, suggesting it plays an active role in depositing calcium in plaque.4 Impairment of the function of osteocalcin and matrix GLA-protein due to incomplete carboxy-lation results in an increased risk for developing osteoporosis and vascular calcification, respectively.

So if you want your arteries to remain uncalcified, you should absolutely make sure you are consuming enough vitamin K2.

What about fish oil? Consuming fatty fish multiple times a week is clearly associated with reduced risk of coronary heart disease, but it’s less clear if supplemental fish oil is beneficial. I do both, but use a lower dose of fish oil (only 2-3g on most days).

Linus Pauling hypothesized that arterial plaque is only created in the absence of adequate vitamin C levels. Researchers at the Linus Pauling Institute make a strong case for raising the RDA to 200mg a day (high enough not only to prevent scurvy, but to reduce mortality from a wide range of diseases). Other research has shown that vitamin C supplementation lowers levels of C-reactive protein (CRP is a biomarker of inflammation that is linked to heart disease). Population studies in the 1990′s found that vitamin C supplementation is associated with increased longevity, specifically from reduced cardiovascular disease. I’ve taken vitamin C for decades (though I no longer megadose, as very large doses of vitamin C can reduce copper absorption).

 

Summary

Heart disease is the biggest killer in the United States, and most other developed countries. We can reduce our risk by doing the following:

  • - reduce sitting (get a standing desk and limit TV couch time)
  • - exercise daily (long walks and taking the stairs count)
  • - get some sun on your skin daily (but don’t burn)
  • - eat dark chocolate and drink red wine
  • - eat a low-grain, low refined vegetable oil, low-sugar diet (not necessarily low-carb; some foods containing carbohydrates like whole fruit and properly cooked beans probably have more benefits than drawbacks)
  • - eat “good fats” including olive oil, butter from grass-fed cows, coconut oil
  • - get enough dietary vitamin K2, and consider supplementing up to 100mcg/day
  • - eat oily wild-caught fish multiple times a week (canned salmon is a less expensive source)
  • - eat green leafy vegetables to supply nitrates for NO production
  • - consume at least 200mg of vitamin C a day from food and supplements
  • - have impeccable dental hygiene; periodontal disease is strongly linked to heart disease (brush and floss daily and thoroughly, don’t eat sticky carbs and acidic juice, chew xylitol gum, consume fat soluble vitamins [D, K2, A], and see a dentist on a regular basis — I’ll do a detailed post on this topic in the coming months)

Did I miss anything? May you all live long and prosper!

 

 

“Finishing” Cattle – 3 Thoughts for the Day

Thursday, July 7th, 2011

The National Cattlemen’s (do they not recognize women ranchers yet?) Beef Association provides a fact sheet on finishing cattle on feedlots on their website. So, what is “finishing” you might ask? This is what they have to say on the matter:

“Cattle are raised on range or pasture land for most of their lives (usually 12-18 months), then transported to a feedlot for finishing. These cattle usually spend about three to six months in a feedlot, during which time they gain between 2.5 and 4 pounds per day. The cattle are fed a scientifically formulated ration that averages 70 percent to 90 percent grain. On this special diet, cattle will gain about 1 pound for every 6 pounds of feed they consume.”

So, the cattle are moved from pasture to a feedlot and are fed grain to rapidly gain weight. “Finishing,” therefore means “fattening up.”

Thought #1: Eating a bunch of grain seems like a good way to gain weight (for cows, at least, who are actually better equipped than humans to digest grains).

But, how can feeding grain to cows be more profitable than letting them eat grass?

Another quote from the fact sheet: “The abundance of feed corn in this country contributes to the economic viability of producing grain-fed cattle. In fact, it will often cost more to raise cattle on pasture because it takes longer for the animal to reach market weight. That is why grass-finished beef can be more expensive than grain-fed product.”

Thought #2: Grains result in rapid weight gain and economic subsidies keep grains cheap and plentiful (not only for cows folks).

So, does finishing cattle on grain simply result in more meat, or are there other differences between grass-fed and grain-fed beef?

To answer this question, we go to a recent scientific review (note: the entire paper is available free of charge) of the fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. First, the abstract of the paper (emphasis added):

“Growing consumer interest in grass-fed beef products has raised a number of questions with regard to the perceived differences in nutritional quality between grass-fed and grain-fed cattle. Research spanning three decades suggests that grass-based diets can significantly improve the fatty acid (FA) composition and antioxidant content of beef, albeit with variable impacts on overall palatability. Grass-based diets have been shown to enhance total conjugated linoleic acid (CLA) (C18:2) isomers, trans vaccenic acid (TVA) (C18:1 t11), a precursor to CLA, and omega-3 (n-3) FAs on a g/g fat basis. While the overall concentration of total SFAs is not different between feeding regimens, grass-finished beef tends toward a higher proportion of cholesterol neutral stearic FA (C18:0), and less cholesterol-elevating SFAs such as myristic (C14:0) and palmitic (C16:0) FAs. Several studies suggest that grass-based diets elevate precursors for Vitamin A and E, as well as cancer fighting antioxidants such as glutathione (GT) and superoxide dismutase (SOD) activity as compared to grain-fed contemporaries. Fat conscious consumers will also prefer the overall lower fat content of a grass-fed beef product. However, consumers should be aware that the differences in FA content will also give grass-fed beef a distinct grass flavor and unique cooking qualities that should be considered when making the transition from grain-fed beef. In addition, the fat from grass-finished beef may have a yellowish appearance from the elevated carotenoid content (precursor to Vitamin A). It is also noted that grain-fed beef consumers may achieve similar intakes of both n-3 and CLA through the consumption of higher fat grain-fed portions.”

Another telling finding is the last column in Table 2 of this paper, which summarizes the differences in the omega-6 to omega-3 fatty acid ratios across the studies reviewed.

Table_2_-_mod

Here, what you see in each case, is a significantly lower ratio (which is what you want) of omega-6 (less desirable) to omega-3 (more desirable) fatty acids when the animals are raised on a grass-based diet as compared to grain. So, it does appear that a grain-based diet makes a difference in both the quantity (i.e., greater weight) and the quality (i.e., lower quality) of beef as compared to a grass-based diet.

Thought #3: I don’t want to be “finished off,” thank you very much. So, I think I will be avoiding the grains that so rapidly pack on the pounds for our bovine friends. I also want to eat the healthiest types of meat that I can. For that, I will be choosing grass-fed beef whenever possible.

CONFLICTS OF INTEREST AND THE USDA

Tuesday, June 7th, 2011

The USDA is a Department within the US government that oversees agricultural and nutrition policies and programs. Recently, the USDA released a new icon (see above) to replace the older “food pyramid.” The USDA also included several guidelines which are listed below:

Balancing Calories

  • Enjoy your food, but eat less
  • Avoid oversized portions

Foods to Increase

  • Make half your plate fruits and vegetables
  • Make at least half your grains whole grains
  • Switch to fat-free or low-fat (1%) milk

Foods to Reduce

  • Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers
  • Drink water instead of sugary drinks

In general, there is a lot of good stuff here. We like the idea of using a plate (although the size of the plate matters) to depict appropriate serving sizes as opposed to the old pyramid. The plate is easier to understand and is likely more memorable. We also like the idea of using the majority of your plate for vegetables and protein – hard to go wrong there. We certainly agree that folks should enjoy their food – some people could use to eat less, but portion size should likely vary with your activity level. Lastly, comparing sodium in prepared foods might help people avoid overly processed and preserved foods. Avoiding sugary drinks is almost always a good idea.

However, there are also some aspects of this new guidance on which we disagree. First, there is no reason that grains should make up approximately 25% of your diet and in fact grains can be eliminated from your diet entirely. If this statement made you gasp, please bear in mind that although there are essential amino acids (building blocks of proteins) and essential fatty acids (building blocks of fats and triglycerides), there is no such thing as an essential sugar (building blocks of carbs) (“essential” here means something that you have to eat because your body cannot make it). Moreover, there is evidence that grains might actually be unhealthy by interfering with the digestion and absorption of nutrients. Second, individuals who are looking to lose weight might want to restrict their fruit and dairy consumption. A diet consisting of 25%+ of fruit and dairy can add up to a heck of a lot of sugar pretty quickly. Third, and this is a big oversight, we don’t see healthy fats explicitly included anywhere. Perhaps these are implied under protein and dairy, but we feel that healthy fats and oils from beef, lamb, salmon, butter, coconut, and olives, for example, are absolutely critical for good health and for satisfying meals. Science is finally putting to rest the notion that people get fat from eating fat (as opposed to eating excess grains and sugars). As an historical aside, it is interesting to us that the 1943 version of the food pyramid called “The Basic Seven” listed fruits and vegetables as three out of the seven groups, meats and dairy as three out of the seven groups (butter had its own group!), and bread, flour, and cereals as one-seventh of a healthy diet.

So, what has happened in the intervening years to make grains so highly recommended by the USDA? Does it have to do with USDA Agencies such as the Agricultural Marketing Service; the Farm Service Agency; and the Grain Inspection, Packers and Stockyards Administration being under the same roof as the Center for Nutrition Policy and Promotion and the Food and Nutrition Service? I don’t know, but recommending so much grain consumption does not appear to be supported by the scientific evidence. Over the next few weeks, we’ll review some of that evidence in detail. In the meantime, we propose the plate below for a modified approach to eating a healthy diet.

Myplate_-_choose_better
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