Harvard’s Dr. Frank Hu in 2007 called for a paradigm shift in dietary prevention of heart disease, de-emphasizing the original diet-heart hypothesis and noting instead that “. . . reducing dietary GL [glycemic load] should be made a top public health priority.” Jim Mann at the University of Otago (Dunedin, New Zealand) authored a 2007 review of carbohydrates and effects on heart disease and diabetes. Here are highlights from the article summary in the European Journal of Clinical Nutrition:
The nature of carbohydrate is of considerable importance when recommending diets intended to reduce the risk of type II diabetes and cardiovascular disease and in the treatment of patients who already have established diseases. Intact fruits, vegetables, legumes and whole grains are the most appropriate sources of carbohydrate. Most are rich in [fiber] and other potentially cardioprotective components. Many of these foods, especially those that are high in dietary fibre, will reduce total and low-density lipoprotein cholesterol and help to improve glycaemic control in those with diabetes.
Frequent consumption of low glycaemic index foods has been reported to confer similar benefits, but it is not clear whether such benefits are independent of the dietary fibre content of these foods or the fact that low glycaemic index foods tend to have intact plant cell walls.
A wide range of carbohydrate intake is acceptable, provided the nature of carbohydrate is appropriate. Failure to emphasize the need for carbohydrate to be derived principally from whole grain cereals, fruits, vegetables and legumes may result in increased lipoprotein-mediated risk of cardiovascular disease, especially in overweight and obese individuals who are insulin resistant.
Why does this matter to me and readers of this blog? Dietary carbohydrates are a major determinant of blood sugar levels, tending to elevate them. Chronically high blood sugar levels are associated with increased complication rates from diabetes. People with diabetes are prone to develop heart disease, namely coronary artery disease, which causes heart attacks, weakness of the heart muscle, and premature death.
References:
Mann, J. Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. European Journal of Clinical Nutrition, 61 (2007): Supplement 1: S100-11.
Hu, Frank. Diet and cardiovascular disease prevention: The need for a paradigm shift. Journal of the American College of Cardiology, 50 (2007): 22-24.
Diabetic Mediterranean Diet 
Enjoyed reading this. It re-enforces what I’m currently coming to understand in a deeper way: you cannot overemphasise the “what” of what we’re eating. I suspect this to be the case with protein and fat as well.
The dilema: we can all paint a picture of the ideal – i.e. growing own produce (or in a community) and preparing whole food and enjoying in a social/family atmostphere. Great? Yeah! But that ain’t my life! Not at this juncture anyway.
And so…we’ve got to deal with life (and this dilema) where we’re at. At the moment, all I can think of is, make small step by step improvements toward the ideal.
Steve
Australia
Hi, Steve.
Sometimes it seems that the “ideal” diet is a moving target, difficult to wrap our arms around!
-Steve
Carbohydrates, it is well researched and documented, are the base cause of type 2 diabetes, cardiovascular disease and obesity in the Western World, so why would any doctor advise his/her patients to consume;
” Intact fruits, vegetables, legumes and whole grains are the most appropriate sources of carbohydrate. Most are rich in [fiber] and other potentially cardioprotective components. “?
This is nonsense! Carbohydrates, especially grains are what causes the inflammation leading to heart diseases and the spiking of insulin in pre-diabetes. What doctors are still scared of is promoting fat as the replacement of carbohydrates – why?
Hi, Maureen.
Most physicians still believe to old theory that dietary fat and especially satruated fat cause or contribute to coronary atherosclerosis. That’s why they hesitate to recommend fats over carbs.
The old diet-heart theory is fading away, however, as news of the latest research filters down to docs in the trenches.