Category Archives: Heart Disease

High-Carb Diet Linked to Cardiovascular Disease

These cows may give you cancer

Carcinogenic cows?

The idea that heart attacks and other cardiovascular diseases are caused by dietary saturated fats is losing credibility. I lost faith in that theory in 2009.

Instead, cardiovascular disease is now linked to high consumption of carbohydrates, particularly those carbs that are rapidly absorbed and turned into blood sugar.

Unfortunately, the diet that reduces risk of cardiovascular disease may increase your risk of cancer. Keep reading.

If you’re a nutrition science nerd, here’s a pertinent report from researchers at Masaryk University in the Czech Republic:

“The results of our study show that high-glycaemic carbohydrates or a high overall proportion of carbohydrates in the diet are the key ecological correlates of cardiovascular disease (CVD) risk. These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs. The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products, which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.The role of the high glycaemic index/load can be explained by the hypothesis linking CVD risk to inflammation resulting from the excessive spikes of blood glucose (‘post-prandial hyperglycaemia’). Furthermore, multiple clinical trials have demonstrated that when compared with low-carbohydrate diets, a low-fat diet increases plasma triglyceride levels and decreases total cholesterol and HDL-cholesterol, which generally indicates a higher CVD risk. Simultaneously, LDL-cholesterol decreases as well and the number of dense, small LDL particles increases at the expense of less dense, large LDL particles, which also indicates increased CVD risk. These findings are mirrored even in the present study because cereals and carbohydrates in general emerge as the strongest correlates of low cholesterol levels.

In light of these findings, the negative correlation of refined sugar with CVD risk may seem surprising, but the mean daily consumption of refined sugar in Europe is quite low (~84 g/day), when compared with potato and cereal carbohydrates (~235 g/day), and makes up only ~20% of CA energy. Refined sugar is also positively tied to many animal products such as animal fat and total fat and animal protein, and negatively to % PC CARB energy and % CA energy. Therefore, a high consumption of refined sugar is accompanied by a high consumption of animal products and lower intakes of other carbohydrates. Furthermore, the glycaemic index of refined sugar (sucrose) is rather moderate (~65).”

Source: Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries | Grasgruber | Food & Nutrition Research

Elsewhere in this long article:

“Current rates of cancer incidence in Europe are namely the exact geographical opposite of CVDs. In sharp contrast to CVDs, cancer correlates with the consumption of animal food (particularly animal fat), alcohol, a high dietary protein quality, high cholesterol levels, high health expenditure, and above average height. These contrasting patterns mirror physiological mechanisms underlying physical growth and the development of cancer and CVDs. The best example of this health paradox is again that of French men, who have the lowest rates of CVD mortality in Europe, but the highest rates of cancer incidence. In other words, cancer and CVDs appear to express two extremes of a fundamental metabolic disbalance that is related to factors such as cholesterol and IGF-1 (insulin-like growth factor).”

I wish these researchers had looked at over death rates associated with various ways of eating. Perhaps that will be in a future paper.

I’d rather die of a heart attack than cancer.

Steve Parker, M.D.

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Filed under coronary heart disease, Heart Disease

FDA Says Jardiance Can Claim Cardiovascular Death Prevention 

Jardiance is a diabetes drug in the class called SGLT2 inhibitors.

How do they work? Our kidneys filter glucose (sugar) out of our bloodstream, then reabsorb that glucose back into the bloodstream. SGLT2 inhibitors impair that reabsorption process, allowing some glucose to be excreted in our urine. You could call it a diuretic effect. For example, an SGLT 2 inhibitor called dapagliflozin, at a dose of 10 mg/day, causes the urinary loss of 70 grams of glucose daily.

How drugs like this could prevent cardiovascular disease in type 2 diabetics is a mystery to me.

From MPT:

“The diabetes drug empagliflozin (Jardiance) may be marketed for prevention of cardiovascular death in patients with type 2 diabetes and co-existing cardiovascular disease, the FDA said Friday.

It’s the first such claim ever allowed for a diabetes drug.

Empagliflozin, first approved in 2014, is an inhibitor of the sodium-glucose co-transporter 2 (SGLT2) pathway, reducing blood glucose by causing it to be excreted in urine.Its benefit for cardiovascular risk reduction was demonstrated in the so-called EMPA-REG trial, results of which were reported in 2015.”

Source: Jardiance Wins CV Prevention Indication | Medpage Today

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Filed under Drugs for Diabetes, Heart Disease

From P.D. Mangan: Higher Altitude Means Much Lower Death Rates

Adult life is a battle against gravity. Eventually we all lose.

Adult life is a battle against gravity. Eventually we all lose.

I quote:

“Death rates from both of these cancers [breast in women, colon in men] were about half as high at an altitude of greater than 1000 meters (3300 feet).  The study also found about a 30% reduction in deaths from coronary artery disease at >1000 meters.

This accords well with a number of other studies. For example, “Lower Mortality From Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland“. This study found 22% less heart disease death for every +1000 meters in altitude, and 12% less stroke death.

“Association Between Alzheimer Dementia Mortality Rate and Altitude in California Counties“: This study found about half the death rate from Alzheimer’s at an altitude of 1600 meters vs that at sea level.

There’s less diabetes at high altitude.”

Source: Higher Altitude Means Much Lower Death Rates – Rogue Health and Fitness

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Filed under cancer, Causes of Diabetes, Dementia, Heart Disease

New research: Mediterranean diet linked to reduced risk of cardiovascular disease and death

This tower is in Pisa, Italy

This tower is in Pisa, Italy

This won’t surprise you if you’ve been reading this blog for a while:

“Heart disease is the leading cause of death for both men and women in the United States, killing around 610,000 people annually. Heart attack affects around 735,000 Americans each year, while around 800,000 people are affected by stroke.

Adopting a healthy diet is considered key for reducing the risk of CVD, and numerous studies have suggested the Mediterranean diet fits the bill.

A study published in the European Heart Journal earlier this year, for example, found older adults who adhered to the Mediterranean diet were at lower risk of heart attack, stroke, and cardiovascular death than those who followed a Western diet.”

Source: Mediterranean diet linked to reduced risk of CVD – Medical News Today

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Filed under Health Benefits, Heart Disease, Longevity, Mediterranean Diet

Strength Training Cuts the Risk of Type 2 Diabetes and Cardiovascular Disease In Women

That's a dumbbell in her right hand. I work-out with those myself.

That’s a dumbbell in her right hand. I work-out with those myself.

I don’t have access to the full scientific report, but I’ve posted part of the abstract below.

The biggest problem with the study at hand is that physical activity apparently was surveyed only at the start of this 14-year study. Results would be much more robust if activity was surveyed every year or two. My overall activity level seems to change every two or three years. How about you?

Moving on.

“Compared to women who reported no strength training, women engaging in any strength training experienced a reduced rate of type 2 diabetes of 30% when controlling for time spent in other activities and other confounders. A risk reduction of 17% was observed for cardiovascular disease among women engaging in strength training. Participation in both strength training and aerobic activity was associated with additional risk reductions for both type 2 diabetes and cardiovascular disease compared to participation in aerobic activity only.

CONCLUSIONS: These data support the inclusion of muscle-strengthening exercises in physical activity regimens for reduced risk of type 2 diabetes and cardiovascular disease, independent of aerobic exercise. Further research is needed to determine the optimum dose and intensity of muscle-strengthening exercises.”

PMID 27580152

Source: Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease. – PubMed – NCBI

Steve Parker, M.D.

PS: Cardiovascular disease includes heart attack, cardiac death, stroke, coronary angioplasty, and coronary artery bypass grafting.

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Filed under Causes of Diabetes, Exercise, Heart Disease, Stroke

Heresy!? Dietary Cholesterol Is Unrelated to Heart Disease Risk

…according to this article at American Journal of Clinical Nutrition.

This is quite contrary to the  party line spread by public health authorities for the last 40 years.

Enjoy your eggs! (If you can afford them.)

Steve Parker, M.D.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That's where statin drugs work.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That’s where statin drugs work.

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Filed under Heart Disease

Sugar Industry Made Dietary Fat the Villain

See Larry Husten’s article for MedPageToday”

“Newly uncovered documents reveal that 50 years ago the sugar industry gave secret support to prominent Harvard researchers to write an influential series of articles in the New England Journal of Medicine that downplayed the negative effects of sugar.Instead, the articles shifted the blame from sugar to fat as the “dietary culprit” behind heart disease.

In recent years there has been growing awareness that decades of dietary policy demonized fat and ignored or played down the dangers of increased consumption of carbohydrates and sugars. Many believe this policy had a significant adverse effect on public health, contributing to the obesity and diabetes epidemics.”

Source: How Sweet: Sugar Industry Made Fat the Villain | Medpage Today

Remember that sugar doesn’t always refer to just table sugar. Starches -as in bread, potatoes, and peas – are easily and quickly broken down by the body into simple sugars.

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Filed under coronary heart disease, Heart Disease, Sugar

Adverse Muscle Effects of Statin Drugs More Common If You Have Metabolic Syndrome

Your friendly neighborhood drug supplier

Your friendly neighborhood drug supplier

I bet many of my readers are taking statin drugs to lower their cholesterol levels. Drugs like Lipitor, Mevacor, Crestor, and Leschol.

Adverse muscle effects—aching, easy fatigue, and weakness—are relatively common in statin users. After stopping the offending drug, it may take several weeks or up to a month for the muscle effects to resolve.

A recent study found that metabolic syndrome patients are more likely to suffer bothersome muscle effects from statins, compared to the general population. Search this site for the five components of metabolic syndrome. For our purposes, only three components are linked to statin-related muscle effects: high triglycerides, low HDL-cholesterol, and excess body weight.

From the study at hand:

“Muscle symptoms, primarily pain or weakness, are reported commonly with statin use in clinical practice and may result in changes in, or discontinuation of, statin treatment.1 The high frequency of muscle symptoms with clinical use of statin was highlighted by the results from the Understanding Statin Use in America and Gaps in Education (USAGE) study, an Internet-based survey of 10,138 adult US subjects who had been prescribed statins.2 Fully 29% of study participants reported new or worsening muscle symptoms while taking a statin.”

Source: Metabolic syndrome is associated with muscle symptoms among statin users – Journal of Clinical Lipidology

Steve Parker, M.D.

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Filed under Heart Disease

Should You Reduce Saturated Fat Consumption If You Have Heart Disease?

kkk

Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years

For the bulk of my medical career, physicians thought that saturated fat caused heart disease, specifically coronary artery disease and heart attacks. Most doctors still think that. In 2009, I spent 80 hours reviewing the scientific literature supporting the saturated fat/heart disease connection. The evidence was very weak, if not nonexistent.

But what if you are already a heart disease patient? Would continuing saturated fat consumption have any effect on your longevity and risk of future heart attacks? If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.

Dr. Sigurdsson is a cardiologist in Iceland.

Some quotes from his blog:

For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.

The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.

*   *   *

Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.

Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.

It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.

Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.

These recent scientific data don’t imply that we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.

So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.

On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.

It appears the jury is still out…

RTWT.

Steve Parker, M.D.

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Filed under Fat in Diet, Heart Disease

New Study Suggests Low-Carb Diet Healthier Than Low-Fat in T2 Diabetes

This is an important report because most diet studies last much less than one year. Details are in the American Journal of Clinical Nutrition.

Study participants were 115 obese (BMI 35) type 2 diabetics with hemoglobin A1c averaging 7.3%. Average age was 58. So pretty typical patients, although perhaps better controlled than average.

They were randomized to follow for 52 weeks either a very low-carbohydrate or a high-carbohydrate “low-fat” diet. Both diets were designed to by hypocaloric, meaning that they provided fewer calories than the patients were eating at baseline, presumably with a goal of weight loss. The article abstract implies the diets overall each provided the same number of calories. They probably adjusted the calories for each patient individually. (I haven’t seen the full text of the article.) Participants were also enrolled in a serious exercise program: 60 minutes of aerobic and resistance training thrice weekly.

Kayaking is an aerobic exercise if done seriously

Kayaking is an aerobic exercise if done seriously

The very low-carb diet (LC diet) provided 14% of total calories as carbohydrate (under 50 grams/day). The high-carb diet (HC diet) provided 53% of total calories as carbohydrate and 30% of calories as fat. The typical Western diet has about 35% of calories from fat.

Both groups lost weight, about 10 kg (22 lb) on average. Hemoglobin A1c, a reflection of glucose control over the previous three months, dropped about 1% (absolute reduction) in both groups.

Compared to the HC diet group, the LC dieters were able to reduce more diabetes medications, lower their triglycerides more, and increase their HDL cholesterol (“good cholesterol”). These triglyceride and HDL changes would tend to protect against heart disease.

SO WHAT?

You can lose weight and improve blood sugar control with reduced-calorie diets—whether very low-carb or high-carb—combined with an exercise program. No surprise there.

I’m surprised that the low-carb group didn’t lose more weight. I suspect after two months of dieting, the low-carbers started drifting back to their usual diet which likely was similar to the high-carb diet. Numerous studies show superior weight loss with low-carb eating, but those studies are usually 12 weeks or less in duration.

The low-carb diet improved improved lipid levels that might reduce risk of future heart disease, and allowed reduction of diabetes drug use. Given that we don’t know the long-term side effects of many of our drugs, that’s good.

If I have a chance to review the full text of the paper, I’ll report back here.

Steve Parker, M.D.

Reference: Jeannie Tay, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. First published July 29, 2015, doi: 10.3945/​ajcn.115.112581    Am J Clin Nutr

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Filed under Carbohydrate, Heart Disease, Weight Loss