Tag Archives: heart disease

December 10, 2010 · 2:00 AM

Heart Patients, Listen Up: Mediterranean Diet to the Rescue

The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010. 

Reuters and other news services have covered the story.

The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes.  Most of the studies in support of the heart-healthy diet looked at development of disease in general populations.  The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.

How Was the Study Done? 

 The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009.  In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris.  Acute heart attacks and unstable angina are “acute coronary syndromes.”  Average age was 64.  Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke).  Thirty percent had diabetes.  At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function.  Men totalled 788; women 212.

On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year.  If a potential enrollee died in the first two hospital days, he was not included in the study.  A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet.  Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol. 

Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge.  Systolic dysfunction was defined as an ejection fraction of under 40%.  [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]

Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function. 

They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.

Results

  • Four percent of participants died during the initial hospitalization.
  • At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
  • At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
  • Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
  • During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
  • Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
  • Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad”  and nut consumption.  No significant effect was found for other components of the Mediterranean diet score.
  • Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years.  Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.   

The Authors’ Conclusion

Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.

My Comments

I agree with the authors’ conclusion.

We’re assuming these patients didn’t change their way of eating after the initial hospitalization.  We don’t know that.  No information is given regarding dietary instruction of these patients while they were hospitalized.  In the U.S., such instruction is usually given, and it varies quite a bit.

In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay.  Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years.  Mysteriously, the authors don’t bother to discuss this finding.

For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without  alcohol.  A 2009 study by Trichopoulou et al suggests otherwise.

Steve Parker, M.D.

Reference: Chrysohoou, C., et al.  The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event.  American Journal of Clinical Nutrition, May 10, 2010.  doi:10.3945/ajcn.2009.28982

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November 20, 2010 · 6:15 AM

High-Carbohydrate Eating Promotes Heart Disease in Women

Women double their risk of developing coronary heart disease if they have high consumption of carbohydrates, according to research recently published in the Archives of Internal Medicine. 

Men’s hearts, however, didn’t seem to be affected by carb consumption. I mention this crucial difference because I see a growing trend to believe that “replacing saturated fat with carbohydrates is a major cause of heart disease.”  If true, it seems to apply only to women.

We’ve known for a while that high-glycemic-index eating was linked to heart disease in women but not men.  Glycemic index is a measure of how much effect a carbohydrate-containing food has on blood glucose levels.  High-glycemic-index foods raise blood sugar higher and for longer duration in the bloodstream.

High-glycemic-index foods include potatoes, white bread, and pasta, for example.

The study at hand includes over 47,000 Italians who were interrogated via questionnaire as to their food intake, then onset of coronary heart disease—the cause of heart attacks—was measured over the next eight years. 

Among the 32,500 women, 158 new cases of coronary heart disease were found.

ResearchBlogging.orgResearchers doing this sort of study typically compare the people eating the least carbs with those eating the most.  The highest quartile of carb consumers and glycemic load had twice the rate of heart disease compared to the lowest quartile. 

The Cleave-Yudkin theory of the mid-20th century proposed that excessive amounts of refined carbohydrates cause heart disease and certain other chronic systemic diseases.  Gary Taubes has also written extensively about this.  Theresearch results at hand support that theory in women, but not in men. 

Practical Applications

Do these research results apply to non-Italian women and men?  Probably to some, but not all.  More research is needed.

Women with a family history coronary heart disease—or other CHD risk factors—might be well-advised to put a limit on total carbs, high-glycemic-index foods, and glycemic load.  I’d stay out of that “highest quartile.”  Don’t forget: heart disease is the No. 1 killer of women.

See NutritionData’s Glycemic Index page for information you can apply today.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References: Sieri, S., Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., Pellegrini, N., Palli, D., Masala, G., Sacerdote, C., Veglia, F., Tumino, R., Frasca, G., Grioni, S., Pala, V., Mattiello, A., Chiodini, P., & Panico, S. (2010). Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study Archives of Internal Medicine, 170 (7), 640-647 DOI: 10.1001/archinternmed.2010.15

Barclay, Alan, et al.  Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies [of mostly women].  American Journal of Clinical Nutrition, 87 (2008): 627-637.

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October 22, 2010 · 2:00 AM

THIS Is Why I Love the Mediterranean Diet

Italian researchers reviewed the medical/nutrition literature of the last three years and confirmed that the Mediterranean diet 1) reduces the risk of death, 2) reduces  heart disease illness and death, 3) cuts the risk of getting or dying from cancer, and 4) diminishes the odds of developing dementia, Parkinsons disease, stroke, and mild cognitive impairment.

These same investigators published a similar meta-analysis in 2008, looking at 12 studies.  Over the ensuing three years (as of June, 2010), seven new prospective cohort studies looked at the health benefits of the Mediterranean diet.  The report at hand is a combination of all 19 studies, covering over 2,000,000 participants followed for four to 20 years.  Nine of the 19 Mediterranean diet studies were done in Europe.

The newer studies, in particular, firmed up the diet’s protective effect against stroke, and added protection against mild cognitive impairment.

So What?

The Mediterranean diet: No other way of eating has so much scientific evidence that it’s healthy and worthy of adoption by the general population.  Not the DASH diet, not the “prudent diet,” not the American Heart Association diet, not vegetarian diets, not vegan diets, not raw-food diets, not Esselstyne’s diet, not Ornish’s diet, not Atkins diet, not Oprah’s latest diet, not the Standard American Diet, not the  . . . you name it. 

Not even the Low-Carb Mediterranean Diet.

Just as important, the research shows you don’t have to go full-bore Mediterranean to gain a health and longevity benefit.  Adopting  just a couple Mediterranean diet features yeilds a modest but sigificant gain.  For a list of Mediterranean diet components, visit Oldways or the Advanced Mediterranean Diet website. 

Steve Parker, M.D.

Reference:  Sofi, Francesco, et al.  Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis.  American Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010.  doi: 10.3945/ajcn.2010.29673

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August 25, 2010 · 2:00 AM

Do Calcium Supplements Cause Heart Attacks?

They might, if you’re a woman over 50 taking over 500 mg elemental calcium daily without a vitamin D supplement.

Details are at my recent Self/NutritionData Heart Health Blog post.

Steve Parker, M.D.

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August 18, 2010 · 7:53 AM

Whole Grains Lower Blood Pressure: So What?

The American Journal of Clinical Nutrition earlier this month published a research report on whole grain consumption and various cardiovascular disease risk factors.  U.K. investigators compared the effects of refined grains versus whole grains in healthy middle-aged adults.  The strongest finding was that three servings a day of whole grains—wheat and oats in this instance—reduced systolic blood pressure by 5 mmHg. 

The investigators suggest this BP lowering may be responsible for the reduced risk of heart attack and stroke associated with whole grain consumption in observational studies.

Additional details are at my Self/NutritionData Heart Health Blog post of August 17, 2010.  The researchers noted a three or four percent reduction in LDL cholesterol (“bad cholesterol”) in study participants eating refined grains, yet , mysteriously, had nothing to say about that.

Steve Parker, M.D.

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June 28, 2010 · 2:00 AM

MSDP Protects Against MetSyn (NCEP ATP-III Criteria) in FHSOC

ResearchBlogging.orgTranslation:  A Mediterranean-style dietary pattern protected against onset of metabolic syndrome (as defined by National Cholesterol Education Program Adult Treatment Panel III) in the Framingham Heart Study Offspring Cohort.

Made you look! 

Don’t you just love acronyms?  Lately it seems you gotta have a clever acronym for your scientific study or it won’t get published or remembered. 

Metabolic syndrome is a constellation of clinical traits that are associated with increased risk for developing cardiovascular disease (two-fold increased risk) and type 2 diabetes (six-fold increased risk).  It’squite common—about 47 million in the U.S. have it.  Metabolic syndrome features include insulin resistance, large waist circumference, low HDL cholesterol, elevated fasting blood sugar, high triglycerides, and elevated blood pressure. 

For optimal health, you want to avoid metabolic syndrome.

Boston-based researchers reported in American Journal of Clinical Nutrition last December that followers of the the Mediterranean diet had less risk of developing metabolic syndrome; not by much, but it was statistically significant.  The study population was the Framingham (Massachusetts) Heart Study Offspring Cohort.

Several thousand men and women were studied via food frequency questionnaires, lab work, and physical exams.  Adherence to the Mediterranean diet was measured via a calculated score ranging from zero to 100.  No diabetics were enrolled.  Average age was 54.  Follow-up time averaged seven years.

They found that those adhering closely to the Mediterranean diet had fewer metabolic syndrome traits at baseline: less insulin resistance, lower waist size,  lower fasting blood sugar, lower triglycerides, and higher HDL cholesterol levels.

Not only that, the Mediterranean dieters developed less metabolic syndrome over time.  Over seven years, 38% of the folks with least compliance to the Mediterranean diet developed metabolic syndrome.  Of those with highest adherence, only 30% developed it.

This is the first study to show a prospective association between the Mediterranean diet and improved insulin resistance.  Avoiding insulin resistance is a good thing, and may help explain the Spanish study that found lower incidence of type 2 diabetes in Mediterranean diet followers.

Why didn’t the investigators report on the incidence of diabetes that developed over the course of the study?  Surely some of these folks developed diabetes.  Are they saving that for another report?  “Publish or perish,” you know.

You can start to see why the Mediterranean diet has a reputation as one of the healthiest around. 

It would be interesting to score these study participants with a very low-carb diet score (VLCDS—yeah, baby!).  Such diets are associated with lower blood pressure, lower blood sugars, lower triglycerides, and higher HDL cholesterol.  Like Mediterranean diet followers, I bet low-carbers would demonstrate lower prevalence of metabolic syndrome at baseline and lower incidence over time. 

Reference: Rumawas, M., Meigs, J., Dwyer, J., McKeown, N., & Jacques, P. (2009). Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort American Journal of Clinical Nutrition, 90 (6), 1608-1614 DOI: 10.3945/ajcn.2009.27908

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May 31, 2010 · 6:10 PM

Documented Health Benefits of the Mediterranean Diet

The enduring popularity of the Mediterranean diet is attributable to three things:

  1. Taste
  2. Variety
  3. Health benefits

 For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.

The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption.  He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too.  Dietary saturated fat does tend to raise cholesterol levels, both LDL and HDL.

Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around.  See References below for the most recent studies.

Relatively strong evidence supports the Mediterranean diet’s association with:

■ increased lifespan

■ lower rates of cardiovascular disease such as heart attacks and strokes

■ lower rates of cancer (prostate, breast, uterus, colon)

■ lower rates of dementia

■ lower incidence of type 2 diabetes

 

Weaker supporting evidence links the Mediterranean diet with:

■ slowed progression of dementia

■ prevention of cutaneous melanoma

■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars

■ less risk of developing obesity

■ better blood pressure control in the elderly

■ improved weight loss and weight control in type 2 diabetics

■ improved control of asthma

■  reduced risk of developing diabetes after a heart attack

■ reduced risk of mild cognitive impairment

■  prolonged life of Alzheimer disease patients

■ lower rates and severity of chronic obstructive pulmonary disease

■ lower risk of gastric (stomach) cancer

■ less risk of macular degeneration

■ less Parkinsons disease

■ increased chance of pregnancy in women undergoing fertility treatment

■  reduced prevalence of metabolic syndrome (when supplemented with nuts)

■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant

Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes?  Association, of course, is not causation. 

The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individuals  in an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death.  Make sure they stay on the assigned test diet.  Then you’d have an answer for that population and those two diets.  Then you have to compare the winning diet to yet other diets.  And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.

Now you begin to see why scientists tend to rely on observational  rather than interventional diet studies.

I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases.  At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all prevalent.  And you couldn’t pick three programs with more differences!  So I had my work cut out for me. 

After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population.  People with particular medical problems or ethnicities may do better on another diet.  A low-carb Mediterranean diet should be healthier for type 2 diabetics.  Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones.  The traditional Mediterranean diet qualifies as plant-based.

What do you consider the overall healthiest diet, and why?

Steve Parker, M.D.

References:

Buckland, Genevieve, et al.  Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.  American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print.  doi: 10.3945/ajcn.2009.28209

Fortes, C., et al.  A protective effect of the Mediterraenan diet for cutaneous melanoma.  International Journal of Epidmiology, 37 (2008): 1,018-1,029.

Sofi, Francesco, et al.  Adherence to Mediterranean diet and health status: Meta-analysis.  British Medical Journal, 337; a1344.  Published online September 11, 2008.  doi:10.1136/bmj.a1344

Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.

Feart, Catherine, et al.  Adherence to a Mediterranean diet, cognitive decline, and risk of dementia.  Journal of the American Medical Association, 302 (2009): 638-648.

Scarmeas, Nikolaos, et al.  Physical activity, diet, and risk of Alzheimer Disease.  Journal of the American Medical Association, 302 (2009): 627-637.

Scarmeas, Nikolaos, et al.  Mediterranean Diet and Mild Cognitive Impairment.  Archives of Neurology, 66 (2009): 216-225.

Scarmeas, N., et al.  Mediterranean diet and Alzheimer disease mortality.  Neurology, 69 (2007):1,084-1,093.

Fung, Teresa, et al.  Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women.  Circulation, 119 (2009): 1,093-1,100.

Mente, Andrew, et al.  A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease.  Archives of Internal Medicine, 169 (2009): 659-669.

Salas-Salvado, Jordi, et al.  Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial.  Archives of Internal Medicine, 168 (2008): 2,449-2,458.

Mozaffarian, Dariush, et al.  Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors.  Lancet, 370 (2007) 667-675.

Esposito, Katherine, et al.  Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.  Annals of Internal Medicine, 151 (2009): 306-314.

Shai, Iris, et al.  Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.  New England Journal of Medicine, 359 (2008): 229-241.

Martinez-Gonzalez, M.A., et al.  Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.  British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).

Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study.  British Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

Barros, R., et al.  Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.  Allergy, vol. 63 (2008): 917-923.

Varraso, Raphaelle, et al.  Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men.  Thorax, vol. 62, (2007): 786-791

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January 18, 2010 · 2:00 AM

Grains and Legumes: Any Effect on Heart Disease and Stroke?

Several scientific studies published in the first five years of this century suggest that whole grain consumption protects agains coronary heart disease and possibly other types of cardiovascular disease, such as stroke. 

Note that researchers in this field, especially outside the U.S., use the term “cereal” to mean “a grass such as wheat, oats, or corn, the starchy grains of which are used as food.”  They also refer frequently to glycemic index and glycemic load, spelled “glycaemic” outside the U.S.  Most of the pertinent studies are observational (aka epidmiologic): groups of people were surveyed on food consumption, then rates of diseases were associated with various food types and amounts.  “Association” is not proof of causation. 

Here are highlights from a 2006 review article in the European Journal of Clinical Nutrition: 

The researchers concluded that a relationship between whole grain intake and coronary heart disease is seen with at least a 20% and perhaps a 40% reduction in risk for those who eat whole grain food habitually vs those who eat them rarely.

Whole grain products have strong antioxidant activity and contain phytoestrogens, but there is insufficient evidence to determine whether this is beneficial in coronary heart disease prevention.

Countering the positive evidence for whole grain and legume intake has been the Nurses Health Study in 2000 that showed women who were overweight or obese consuming a high glycaemic load (GL) diet doubled their relative risk of coronary heart disease compared with those consuming a low GL diet.

The intake of high GI carbohydrates (from both grain and non-grain sources) in large amounts is associatied with an increased risk of heart disease in overweight and obese women even when fiber intake is high but this requires further confirmation in normal-weight women.

Promotion of carbohydrate foods should befocused on whole grain cereals because these have proven to be associatied with health benefits.

Whether adding bran to refined carbohydrate foods can improve the situation is also not clear, and it was found that added bran lowered heart disease risk in men by 30%.

Recommendation:  Carbohydrate-rich foods should be whole grain and if theyare not, then the lowest GI product available should be consumed.

My Comments

This journal article focuses on whole grains rather than legumes, and promotes whole grains more than legumes.  For people with diabetes, this may be a bit of a problem since grains—whole or not—generally have a higher glycemic index than legumes, which may have adverse effects on blood sugar control.  Keep in mind that highly refined grain products, like white bread, have a higher glycemic index than whole grain versions.

Did you notice that the abstract doesn’t recommend a specific amount of whole grains for the general population?  My educated guess would be one or two servings a day. 

Grains are high in carbohydrate, so anyone on a low-carb diet may have to cut carbs elsewhere. 

Diabetes predisoses to development of coronary heart disease.  Whole grains seem to help prevent heart disease, yet may adversely affect glucose control, contributing to diabetic complications.  It’s a quandary.  “Caught between the horns of a dilemma,” you might say.  So, what should a diabetic do with this information in 2010, while we await additional research results?

Several options come to mind:

  1. Eat whatever you want and forget about it.
  2. Note whether coronary heart disease runs in your family.  If so, try to incorporate one or two servings of whole grains daily, noting and addressing effects on your blood sugar.
  3. Try to eat one or two servings of whole grains a day, noting and addressing effects on your blood sugar.  Then decide if it’s worth it.  Is there any effect?  Do you have to increase your diabetic drug dosages or add a new drug?  Are you tolerating the drugs?    
  4. Assess all your risk factors for developing heart disease: smoking, sedentary lifestyle, high blood pressure, age, high LDL cholesterol, family history, etc.  If you have multiple risk factors, see Option #3.  And modify the risk factors under your control.   
  5. Get your personal physician’s advice.    

Before you stress out over this, be aware that we don’t really know whether a diabetic who doesn’t eat grains will have a longer healthier life by starting a daily whole grain habit.  Maybe . . . maybe not.  The study hasn’t been done.    

Steve Parker, M.D.

References:

Flight, I. and Clifton, P.  Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature.  European Journal of Clinical Nutrition, 60 (2006): 1,145-1,159.

Malik, V. and Hu, Frank.  Dietary prevention of atherosclerosis: go with whole grains.  American Journal of Clinical Nutrition, 85 (2007): 1,444-1,445.

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January 16, 2010 · 2:00 AM

Eat the Right Carbs to Alleviate Diabetes and Heart Disease

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. 

Steve Parker, M.D.

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.

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January 4, 2010 · 2:00 AM

Do Fruits and Vegetables Really Help Prevent Disease?

How many times have you heard how important it is to eat fruits  and vegetables?  Now, is it five or nine servings a day?  Why are fruits and veggies always lumped together?  What does a watermelon have in common with spinach?

The author of a 2004 article in the Journal of Postgraduate Medicine answered some of these questions.  Here are a few quotes from from the summary:

The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer, and diets rich in plant foods are also associated with a reduced risk of heart disease and many chronic diseases of ageing.

These foods contain phytochemicals that have anti-cancer and anti-inflammatory properties which confer many health benefits. Many phytochemicals are colourful, and recommending a wide array of colourful fruits and vegetables is an easy way to communicate increased diversity of intake to the consumer. For example, red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health, and which has also been linked with a decreased risk of cardiovascular disease. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates which have also been associated with a decreased risk of cancer. Garlic and other white-green foods in the onion family contain allyl sulphides which may inhibit cancer cell growth. Other bioactive substances in green tea and soybeans have health benefits as well.

Consumers are advised to ingest one serving of each of the seven colour groups daily, putting this recommendation within the United States National Cancer Institute and American Institute for Cancer Research guidelines of five to nine servings per day. Grouping plant foods by colour provides simplification, but it is also important as a method to help consumers make wise food choices and promote health.

Asking U.S. consumers to eat one serving from each of seven fruit and vegetable color groups daily is a bit much.  I don’t see that happening.  But the suggestion is a start.  Darya Pino (Summer Tomato blog) probably does it every day, but I don’t know any others.  My simplified message: Eat a variety of colorful fruits and veggies daily.

Note that the very low-carb Ketogenic Mediterranean Diet provides 400 grams of vegetables and fruits daily, and I count seven colors (assuming you allow me to include black olives).  On the KMD document I list avocado, cucumber, and tomato under “vegetables,” but they are indeed fruits.  Heck, I guess olives are fruit, too.

“So, what’s your point, Parker,” you might well ask.  I don’t expect anyone to follow the Ketogenic Mediterranean Diet for life.  When it’s time to move on to a “Diabetic Mediterranean Diet,” I’m considering adding more options: traditional fruits and some colorful vegetables like purple beets, yellow corn, and orange carrots and sweet potatoes.

I still don’t know why “fruits and vegetables” are joined at the hip.  Legumes, grains, and dairy products all rate their very own category.  It’s just not fair.

Steve Parker, M.D.

Reference:  Heber, D.  Vegetables, fruits and phytoestrogens in the prevention of diseases.  Journal of  Postgraduate Medicine, 50 (2004): 145-9.

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