About the Author
ELAINE MAGEE, MPH, RD, is the author of more than 25 books on nutrition and healthy cooking. Her medical nutrition series, Tell Me What to Eat If I Have..., has sold hundreds of thousands of copies. She has conducted healthy cooking segments on various television shows and her weekly Q&A column, "The Recipe Doctor," is distributed to newspapers nationally. She lives in Northern California.
Excerpt. © Reprinted by permission. All rights reserved.
Harnessing Food Power to Fight the Big Four: Heart Disease, Stroke, Cancer, and Diabetes
"I bought a book about food synergy to be inspired to eat better, not to focus on heart disease or cancer!" Is that what you thought when you read this chapter's title? After all, why would a book about food synergy begin with a discussion of diseases?
Actually, given the strong connection between food and health, it should come as no surprise that within the field of food synergy, most of the research thus far shows enormous benefits in reducing the risk of heart disease, stroke, cancer, and diabetes. If you are already well versed in the inherent role food plays in the development and reversal of these conditions, feel free to fast-forward to Chapter 2 and get started on your food synergy adventure. Otherwise, it's helpful to begin with a basic overview of these diseases and how diet can affect the risk of developing them. Whether we are talking about food pairs or food patterns, whole foods or combinations of nutrients or phytochemicals, there are countless examples of food synergy--when components within or between foods work together in the body for maximum health benefit.
DIET AND HEART DISEASE
Heart disease kills more men and women than any other disease. Close to half a million American women die of heart disease each year, more than from all cancers combined. While many factors besides food increase our risk of heart disease--including smoking, chronic stress, and an inactive lifestyle--a healthy diet's effect on both our blood chemistry and vascular system can help decrease our risk. Following the right eating plan can:
.Lessen the narrowing of the arteries by lowering the amount of fat in the blood that leads to plaque deposits
.Make components in blood less likely to stick together so clots are less likely to form
.Improve flexibility in artery walls so the circulatory system runs smoothly
With every passing year, there is more good news to report. For example, simply incorporating four cholesterol-lowering foods into your diet has been shown to lower cholesterol levels up to 30 percent, reducing the need for cholesterol-lowering drugs (statins) according to studies conducted at the University of Toronto. Researchers say we can benefit from eating:
.Soy, including soy-based meat substitutes and soy milk
.Sticky fiber (also known as viscous or soluble fiber), found in foods such as oats and oat bran and barley-based soups, as well as psyllium products
.Plant sterol-enriched margarine, such as Take Control, which was used in the study
.Nuts (participants ate a handful of almonds each day)
EVALUATING THE RISK FACTORS
In a landmark international study led by Canadian heart researcher Salim Yusuf, MD, which included almost 30,000 people from 52 countries, researchers concluded that close to 90 percent of first heart attacks can be attributed to nine risk factors, including five (identified in boldface type below) that have a direct link to what we eat.
1. Abnormal cholesterol
3. Chronic stress
5. High blood pressure (Many lifestyle factors can lead to high blood pressure, including what we eat--like high-salt foods--and don't eat--like fruits and vegetables and low-fat dairy foods.)
6. Abdominal obesity (A waist circumference of more than 32 inches in women and more than 34 inches in men is linked to an increased risk of heart attacks. Measuring the waist is a better predictor of heart attack than is BMI--body mass index--because it measures abdominal fat, the fat most closely associated with heart attacks.)
7. A sedentary lifestyle
8. Eating too few fruits and vegetables
9. Abstaining from alcohol (Studies have shown that men who have up to two alcohol drinks a day and women who drink up to one a day have a lower risk of heart disease.)
So what's a more positive way of looking at this list of heart-attack risk factors? A good diet, regular exercise, and moderate alcohol intake reduced the risk of heart disease for the people in this study! According to Dr. Yusuf, poor diet as a whole accounts for about 35 percent of the risk of heart attack. "This includes too few fruits and vegetables and too many fried foods, meats, and salty foods," he explains. In this chapter, we'll cover what you need to know to harness the power of food synergy to fight high cholesterol, high blood pressure (also a leading risk factor for stroke), and diabetes.
The Six Steps to a Heart Attack
Step 1.Cells that line the walls of the coronary artery are damaged. These endothelial cells can be injured by debris (such as cholesterol), by a type of white blood cell that engulfs foreign matter, or from low or turbulent bloodflow in the arteries. (Narrowed arteries from atherosclerosis can cause turbulent bloodflow.)
Step 2.Inflammation occurs in the artery.
Step 3.LDL cholesterol becomes oxidized and flows through the bloodstream.
Step 4.Plaque from cholesterol sticks to the lining of the arteries.
Step 5.Arteries constrict, and plaque ruptures and breaks off the artery wall. A blood clot forms.
Step 6.Arrhythmia, or a chaotic heartbeat, interrupts or stops the flow of blood and oxygen to the heart and body. This ultimately leads to:
HEART ATTACK (also known as a myocardial infarction)
HEADING OFF HEART DISEASE
Of the primary risk factors for heart disease, high cholesterol is one of the most widespread conditions. Almost 54 million women and just over 48 million men have total cholesterol levels higher than 200 milligrams per deciliter (mg/dL). That's more than 100 million people! Even more alarming, most people who suffer a heart attack have only mildly elevated cholesterol levels. (Borderline high cholesterol is between 200 and 239 mg/dL; desirable levels are lower than 200 mg/dL.) These 100 million people can all benefit from even a 10 to 20 percent reduction in total cholesterol. Two simple steps to follow:
Take saturated fat down a few notches. The first thing many experts advise when you need to lower your cholesterol? Eat less saturated fat, which is found in animal products and dairy foods. This has long been known as an effective way to help lower your cholesterol because saturated fat raises harmful low-density lipoprotein (LDL) cholesterol levels.
Make the most of good fats. Next, boost your intake of healthful or "smart" fats, such as plant and fish omega-3s and monounsaturated fats (like olive and canola oil, ground flaxseed, and avocados), and your plant sterols and plant stanol esters--conveniently available in margarines such as Take Control or Benecol. When you use these in place of regular margarine, studies suggest, you can lower total cholesterol and LDL by about 10 percent. Plant sterols and stanol esters, which come to us courtesy of pinewood pulp and soybean extract, work by blocking cholesterol absorption in the digestive tract.
THE LOWDOWN ON BAD CHOLESTEROL
You may not know low-density lipoprotein by name; most people know it by its nickname, "bad cholesterol." LDL has a nasty habit of attaching to the artery walls as it travels through the bloodstream. As it builds up, it creates hard deposits that can restrict bloodflow and eventually lead to blockages associated with heart attacks and strokes. Therefore, if we are going to study the way diet influences heart disease risk, a good place to start is by evaluating how what we eat raises or lowers LDL and triglyceride levels. In addition to losing weight if you're heavy and increasing physical activity, you can lower LDL levels with some dietary changes.
Limit saturated and trans fats. Saturated fats, which we just discussed, are easy to identify because they're solid at room temperature (think butter). Trans fats, a once popular additive in many packaged foods, may be even worse for you than saturated fats. The good news is that new labeling laws let you know how much trans fat is in a product. And by limiting full- fat dairy products, higher-fat red meats, poultry skin, stick margarine (except cholesterol-lowering types), cookies, crackers, and fast-food french fries, you can significantly reduce your risk of heart disease. Try to keep saturated fat to less than 7 percent of your total calories per day (about 15 grams for a 2,000-calorie diet), and try to eliminate trans fats completely.
Experiment with a vegetarian diet. A typical vegetarian diet includes many cholesterol-lowering foods, such as soy milk, soy burgers, oats, almonds, beans, and plenty of fruits and vegetables, all of which have been individually found to lower cholesterol levels. In one study, after 1 month, participants' LDL levels fell by 29 percent--a drop similar to that seen with some statin drugs. Other cholesterol-lowering benefits of a vegetarian diet include a higher consumption of plant stanols (2 grams a day is ideal) and soluble fiber (reaching the recommended 25 grams a day is relatively easy on a vegetarian diet). You don't have to become a full- fledged vegetarian to see results, however. Try to replace meat-based dishes with vegetarian entrees a few times a week.
Focus on flaxseed. According to Diane Morris, PhD, nutrition consultant to the Flax Council of Canada, clinical studies show that eating between 2 and 6 tablespoons of ground flaxseed daily for as little as 4 weeks lowers blood cholesterol 6 to 9 percent and LDL cholesterol by 9 to 18 percent. "However, I should point out that most clinical trials use amounts closer to 4 to 6 tablespoons of ground flax daily," notes Dr. Morris.
Enjoy almonds. A recent study found that when people with elevated blood lipids snacked on almonds, their coronary heart disease risk fell significantly, probably due in part to the fiber and monounsaturated fat components of almonds.
Size Matters When It Comes to Cholesterol
Canadian heart researcher Salim Yusuf, MD, suggests that cholesterol particle size also helps determine risk of heart attack. The smaller, heavier cholesterol molecules (a protein linked to LDL and other bad cholesterol particles) increase the risk of heart disease because they can more easily invade the artery wall, causing inflammation and atherosclerosis plaque, he explains. This factor alone may increase your risk of heart attack by as much as 54 percent. Blood tests such as the apoB (apolipoprotein B) can help measure the amount of these smaller, denser cholesterol particles.
THE TROUBLE WITH TRIGLYCERIDES
Like measuring LDL cholesterol, taking note of triglyceride levels in the blood can shed light on heart health. People can have high triglyceride levels even when their cholesterol levels are normal. Blood triglycerides come mainly from the fat we eat in foods. But when we eat more calories than our body needs, no matter whether carbohydrate or fat, these excess calories are converted in the liver to triglycerides and stored in fat cells.
Higher blood levels of triglycerides increase the concentrations of two types of fat particles: chylomicrons and very low-density lipoproteins. These fat particles show up in the fat deposits in the arteries that eventually obstruct bloodflow. It's no surprise, then, that high triglyceride levels are a strong, independent predictor of personal risk for stroke. A study led by David Tanne, MD, with the Sheba Medical Center in Israel, followed more than 11,000 people with coronary heart disease and found that those with triglyceride levels of 200 mg/dL or higher had an almost 30 percent higher risk for stroke. High triglyceride levels are associated with higher rates of heart disease. The following shows what the numbers mean.
150-199 mg/dL = borderline high
200-499 mg/dL = high
500+ mg/dL = very high
If you want to lower your triglyceride levels, much of the same advice for lowering cholesterol applies. You should also consider the following:
Cut back on refined carbohydrates. Opt to enjoy sweets, soft drinks, and white bread only occasionally, and try to choose carbs that are lower on the glycemic index, or GI. (Choosing foods at least 12 points lower on the index reduced triglycerides by approximately 9 percent in 10 out of 11 studies.) Instead of processed carbohydrates, choose whole grain foods such as brown rice, whole grain cereals, and whole grain pasta.
Seek omega-3 fatty acids from fish. Start by eating fish a couple times a week. This may help lower triglycerides, especially if fish replaces other foods containing saturated and trans fats.
Add omega-3 fatty acids from plant foods, too. Switch to canola oil in your cooking. Other top plant sources of omega-3s are ground flaxseed, broccoli, cauliflower, cantaloupe, and red kidney beans. (Talk to your doctor about adding a tablespoon of ground flaxseed a day.) This may help reduce serum triglycerides along with total and LDL cholesterol.
Add soluble fiber. This strategy may rein in the potential increase in serum triglycerides and other blood fats in some people with diabetes who eat a high-carbohydrate diet. You'll find soluble fiber in beans, oats and oat bran, barley, psyllium products, some fruits (apples, mangoes, plums, kiwifruit, pears, berries, citrus, and peaches), and some vegetables (artichokes, celery root, sweet potatoes, parsnips, turnips, acorn squash, potatoes with skin, Brussels sprouts, cabbage, green peas, broccoli, carrots, green beans, cauliflower, asparagus, and beets).
THE KEY TO LOWER HOMOCYSTEINE LEVELS
Homocysteine is an amino acid in the blood that at high levels may be related to a higher risk of coronary heart disease and stroke. According to the American Heart Association (AHA), homocysteine may play a role in atherosclerosis (blood plaque deposits in the arteries) by damaging the inner lining of arteries and promoting blood clots. According to a report in Stroke: Journal of the American Heart Association, high levels of homocysteine may be significantly associated with an increased risk of stroke in people who already have coronary heart disease.
Two things are thought to influence homocysteine levels: genetics and diet. Some researchers suspect that folic acid and other B vitamins help break down homocysteine in the body. To help lower homocysteine levels:
.Get more folic acid by eating dark leafy greens, dried beans, asparagus, and spinach and drinking orange juice.
.Eat bananas, whole grains, nuts, and seeds for vitamin B6.
.Take in B12 through low-fat dairy foods and fortified cereals.
A few other factors are also known regarding homocysteine levels.
.Men tend to have higher levels than women, and both sexes tend to show increasing levels as they age.
.Smoking is associated with higher levels.
.Higher coffee consumption is associated with higher homocysteine levels.
.Alcoholics have highly elevated homocysteine concentrations. Wine and hard liquor have been shown to raise concentrations--but there seems to be a loophole for beer, which seems to have no effect. Some researchers have suggested that the folate (folic acid) and B6 in beer might help counteract the homocysteine-raising effects of the alcohol.
IS THERE REALLY "GOOD" CHOLESTEROL?
Recent advances in research have only brought more attention to the blood lipid awarded the nickname "good cholesterol," so known because high- density lipoprotein (HDL) cholesterol levels are associated with lower incidence of heart disease. Although many people still pay more attention to their LDL levels when they get a blood lipid test, there's growing evidence that HDL is just as important a factor in the development of heart disease.
"Boosting HDL is the next frontier in heart disease prevention," says P. K. Shah, MD, director of cardiology at Cedars-Sinai Medical Center in Los Angeles. Dr. Shah believes that if the new drugs that increase levels of HDL work, we could potentially reduce the number of heart attacks and strokes by 80 to 90 percent and save millions of lives.