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Encyclopedia > Diet and heart disease

Diet may play an important role in causing or preventing heart disease. Doctors and nutritionists have studied numerous diets and dietary components in an effort to minimise the risk of heart diseases. It has been suggested that this article or section be merged into Nutrition. ... Heart disease is an umbrella term for a number of different diseases which affect the heart. ... This article or section does not cite its references or sources. ...

Contents

Misconceptions

Saturated fats & Cholesterol

One of the earliest suggestions that saturated fats and cholesterol could be related to heart disease was proposed by Ancel Keys in the late 1950s. While this and other similar studies were eagerly received by commercial beneficiaries such as the processed oil and food industries, other scientific studies have cast doubts on whether saturated fats should be demonised. Saturated fat is fat that consists of triglycerides containing only saturated fatty acids. ... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... Ancel Benjamin Keys ( January 26, 1904 - November 20, 2004) was an American scientist who studied the influence of diet on health. ... The 1950s was the decade spanning from the 1st of January, 1950 to the 31st December, 1959. ...


An analysis of American statistics covering the sixty year period from 1910 to 1970 found that the proportion of traditional animal fats in the American diet declined from 83% to 62%, and the annual consumption of butter in particular declined from 18 pounds to 4 pounds per person. The study also found that over the past eighty years, the percentage of vegetable oil consumption in the form of margarine, vegetable shortening and other refined oils has increased by around 400%, with the consumption of sugar and processed foods by 60%.[1] This suggests that hydrogenated oils (which contain trans fat, not saturated fat) and sugar should be suspected to be more at fault than saturated fats. 1910 (MCMX) was a common year starting on Saturday (see link for calendar) of the Gregorian calendar or a common year starting on Sunday of the 13-day slower Julian calendar. ... 1970 (MCMLXX) was a common year starting on Thursday (the link is to a full 1970 calendar). ... Margarine, as a generic term, can indicate any of a wide range of butter-substitutes. ... Shortening is a semisolid fat used in food preparation, especially baked goods, and is so called because it inhibits the formation of long gluten strands in wheat-based doughs, giving them a short texture (as in shortbread). ... Magnification of typical sugar showing monoclinic hemihedral crystal stucture. ... Hydrogenation is a chemical reaction in which unsaturated bonds between carbon atoms are reduced by attachment of a hydrogen atom to each carbon. ... A trans fatty acid (commonly shortened to trans fat) is an unsaturated fatty acid molecule that contains a trans double bond between carbon atoms, which makes the molecule less kinked compared to cis fat. Research suggests a correlation between diets high in trans fats and diseases like atherosclerosis and coronary...


A famous project called the Framingham Heart Study, started in 1948, found after 40 years of testing that while those who weighed more and had abnormally high blood cholesterol levels were slightly more at risk of developing heart disease, weight gain and cholesterol levels had an inverse correlation with saturated fat and cholesterol intake in the diet.[2] It was also found that the subjects with the highest saturated fat consumption weighed the least, but also happened to be the most physically active of the population under study. A director of the Framingham Heart Study, Dr William Castelli, wrote in 1992[1] The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... 1992 (MCMXCII) was a leap year starting on Wednesday. ...

   
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For example, in Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol... In view of this, this study fails to describe a relationship of those traditional dietary constituents, saturated fat and cholesterol, known to have an adverse effect on blood lipids, and thereby, on the subsequent development of coronary disease end points.[3]
   
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One large trial, the Multiple Risk Factor Intervention Trial (MRFIT) produced surprising results. It compared the death rates and eating habits of 12,000 men, and treated certain individuals by controlling high blood pressure with medicines, preventing smoking, and stipulating a low fat, low cholesterol diet. The MRFIT trial found that while those on the low fat diet had a slightly decreased mortality from Coronary heart disease, the overall mortality from all causes for those who were treated and obeyed the suggested diet was higher.[4] Image File history File links Cquote1. ...   Settled: 1650 â€“ Incorporated: 1700 Zip Code(s): 01701, 01702, 01703, 01704, 01705 â€“ Area Code(s): 508 / 774 Official website: http://www. ... Image File history File links Cquote2. ... This article or section does not cite its references or sources. ...


Another study from the 1960s which examined the health of Yemenite Jews found that the diet of the subjects living in Yemen contained no sugar and obtained all its fat from animal sources. The subjects who had moved from Yemen to Israel altered their diets so that 25-30 percent of their carbohydrate intake was derived from sugar, and they obtained their fat from the consumption of margarine and vegetable oils. The Yemenite group was found to have few examples of heart disease and diabetes, whereas incidences of these disorders were far higher in the Israeli group.[5] The 1960s decade refers to the years from January 1, 1960 to December 31, 1969, inclusive. ... Yemenite Jews (תֵּימָנִי, Standard Hebrew Temani, Tiberian Hebrew Têmānî; plural תֵּימָנִים, Standard Hebrew Temanim, Tiberian Hebrew Têmānîm) are those Jews who live, or whose recent ancestors lived, in Yemen (תֵּימָן far south, Standard Hebrew Teman, Tiberian Hebrew Têmān), on the southern tip of the Arabian peninsula. ...


Saturated fats have gained an unjust notoriety by being confused with trans fats, both in early studies from the mid 20th century, and also as they were long grouped together in various U.S. databases used by researchers to correlate dietary trends with disease conditions.[6][7][8] (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999...


Dietary factors that may increase risk

Trans fats

Main article: Trans fat

While both saturated and trans fats increase levels of LDL cholesterol (so-called "bad" cholesterol), trans fats also lower the levels of HDL cholesterol (so-called "good" cholesterol) [2]; this increases the risk of coronary heart disease (CHD). The NAS is concerned "that dietary trans fatty acids are more deleterious with respect to CHD than saturated fatty acids" [3]. A trans fatty acid (commonly shortened to trans fat) is an unsaturated fatty acid molecule that contains a trans double bond between carbon atoms, which makes the molecule less kinked compared to cis fat. Research suggests a correlation between diets high in trans fats and diseases like atherosclerosis and coronary... Low-density lipoprotein (LDL) refers to a class and range of lipoprotein particles, varying somewhat in their size and contents, which carry cholesterol in the blood and around the body, for use by various cells. ... High density lipoproteins (HDL) form a class of lipoproteins, varying somewhat in their size and contents, that carry cholesterol from the bodys tissues to the liver. ... This article or section does not cite its references or sources. ...


The Harvard Medical School has shown that phytosterol-rich oils reduce blood cholesterol. However, more importantly they showed that hydrogenated, or trans fats, which are present in margarine and are extensively used for packaged food manufacturing, may be harmful. One of their studies published in 2005 has determined that a positive relationship exists between the consumption of trans fat and the development of endothelial dysfunction, a precursor to atherosclerosis.[9] Shield of Harvard Medical School Harvard Medical School (HMS) is one of the graduate schools of Harvard University. ... β-sitosterol Ergosterol. ... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... Hydrogenation is a chemical reaction in which unsaturated bonds between carbon atoms are reduced by attachment of a hydrogen atom to each carbon. ... Margarine, as a generic term, can indicate any of a wide range of butter-substitutes. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... A trans fatty acid (commonly shortened to trans fat) is an unsaturated fatty acid molecule that contains a trans double bond between carbon atoms, which makes the molecule less kinked compared to cis fat. Research suggests a correlation between diets high in trans fats and diseases like atherosclerosis and coronary... Endothelial dysfunction is a physiological dysfunction of normal biochemical processes carried out by endothelial cell, the cells that line the inner surface of all blood vessels, arteries and veins. ...


Trans fats are harmful because they are absorbed by the body's cell membranes as if they were cis fats, causing the cells to become partially hydrogenated, which disrupts cell metabolism.[4] CIS usually refers to: Commonwealth of Independent States, a modern-day political entity consisting of 11 former Soviet Union Republics CIS is also an acronym for: Canadian Interuniversity Sport Cancer Information Service Carcinoma in situ Centre for Independent Studies Center for Immigration Studies Chinese International School Cisalpino Citizenship & Immigration Services... In chemistry, especially biochemistry, a fatty acid is a carboxylic acid often with a long unbranched aliphatic tail (chain), which is either saturated or unsaturated. ... Hydrogenation is a chemical reaction in which unsaturated bonds between carbon atoms are reduced by attachment of a hydrogen atom to each carbon. ... Overview of the citric acid cycle The citric acid cycle, one of the central metabolic pathways in aerobic organisms. ...


Other studies have found that hydrogenated fats made from vegetable oils block the use of essential fatty acids, which could contribute to sexual dysfunction, increased blood cholesterol and negatively affect the immune system.[10][11][12][13][14]


Salt

Main article: Edible salt

The UK Scientific Advisory Committee on Nutrition (SACN) review Salt and Health is probably the most authoritative single document on its stated topic. It concludes: Edible salt is mostly sodium chloride (NaCl). ...

  • Hypertension (high blood pressure). "Since 1994, the evidence of an association between dietary salt intakes and blood pressure has increased. The data have been consistent in various study populations and across the age range in adults." (SACN, p3).
  • Left Ventricular Hypertrophy (LVH). "Evidence suggests that high salt intake causes left ventricular hypertrophy, a strong risk factor for cardiovascular disease, independently of blood pressure effects." (SACN, p3)

Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...

Homogenised milk

Main Articles: Unpasteurised milk: Homogenisation & heart disease; also Milk: Creaming & homogenisation

In recent years, there has been increased attention placed on potential health concerns relating to the homogenisation of milk and other dairy products. Studies conducted by Dr Kurt A Oster and his colleague D.J. Ross from the early 1960s to the mid 1980s suggested that homogenised milk could be a major factor in arterial plaque formation, causing heart disease. Raw milk is milk that has not been processed via pasteurization (heating) or homogenization before consumption by humans. ... A glass of cows milk Milk is the nutrient fluid produced by the mammary glands of female mammals (including monotremes). ... A glass of cows milk Milk is the nutrient fluid produced by the mammary glands of female mammals (including monotremes). ... A glass of cows milk Milk is the nutrient fluid produced by the mammary glands of female mammals (including monotremes). ... The 1960s decade refers to the years from January 1, 1960 to December 31, 1969, inclusive. ... The 1980s refers to the years of 1980 to 1989. ... In pathology, an atheroma (plural: atheromata) is an abnormal accumulation of inflammatory cells (macrophage white blood cells), lipids and a variable amount of connective tissue within the walls of arteries. ... Heart disease is an umbrella term for a number of different diseases which affect the heart. ...


Oster and Ross hypothesised that the homogenisation of milk increased the dietary availability of xanthine oxidase, which could lead to the formation of arterial, or atheromatous, plaque. However a team lead by A.J. Clifford in the early 1980s asserted that Oster and Ross had not sufficiently established their arguments.[15] A hypothesis (from Greek ) is a suggested explanation of a phenomenon or reasoned proposal suggesting a possible correlation between multiple phenomena. ... Xanthine Oxidase The enzyme xanthine oxidase, or XO, (bovine milk enzyme is PDB 1FIQ, EC 1. ... An Atheroma (plural: atheromata) is an unhealthy tissue growth which develops within the walls of arteries over time. ... The 1980s refers to the years of 1980 to 1989. ...


While the xanthine oxidase/plasmalogen hypothesis has been disproved, the debate is hardly over. Lipids expert Mary Enig has remarked that while Oster's work has been discounted, it does not prove that the homogenisation process is benign, as it vastly increases the surface area of fat globules, and causes new globule mebranes to be formed which have a different composition to raw milk fat globules.[5] Examination of the xanthine oxidase issue has continued, with recent research by R.J. Hajjar and J.A. Leopold, "Xanthine oxidase inhibition and heart failure: novel therapeutic strategy for ventricular dysfunction", published in Circulation Research (2006) (journal of the American Heart Association). Figure 1: Basic lipid structure. ... 2006 (MMVI) is a common year starting on Sunday of the Gregorian calendar. ... The American Heart Association (AHA) is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. ...


Preventive diets

Vegetarian diet

Vegetarians have been shown to have a 24% reduced risk of dying of heart disease.[16] Wikiquote has a collection of quotations related to: Vegetarianism For plant-eating, non-human animals, see Herbivore. ...


One of the earliest and well-known popularizers of a diet approach to heart disease was the Pritikin diet. The Pritikin Plan was created by a non-physician, Nathan Pritikin, and consisted of diet and exercise changes in a residential program. The Pritikin Diet was created by Nathan Pritikin and enhanced by his son Robert Pritikin. ...


The Ornish Diet is widely believed to have proven that a low fat, low cholesterol diet prevents heart disease.[citation needed] The AHA-1 Diet is recommended by the American Heart Association. Some food manufacturers produce cholesterol-reducing products which they suggest may help to reduce the risk of heart disease. [citation needed] The Ornish Diet is a somewhat popular diet that was developed by Dr. Dean Ornish M.D. in his book A Program for Reversing Heart Disease. ... The AHA-1 diet is a healthy eating diet propossed by the American Heart Association. ... The American Heart Association (AHA) is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. ...


In addition to Ornish, Dr. Gabe Mirkin and Dr. John McDougall have been proponents of a diet approach to avoiding heart disease. McDougall sells "just add water" vegetarian meals in a cup on his rightfoods site.


The most powerful cholesterol-lowering agents are soluble fiber, unsaturated fats, and phytochemicals, all of which are found almost exclusively in plant foods. In the seventeen studies conducted between 1978 and 2002, the average vegan’s cholesterol level was 160 mg/dl, while the average non-vegetarian’s cholesterol was 202 mg/dl.[17] Dietary fibers are long-chain carbohydrates (polysaccharides) that are indigestible by the human digestive tract. ...


Despite the benefits of a vegetarian diet, it is likely that with a few changes to the typical vegetarian diet, the risks of heart disease could be reduced even further. Vegetarian diets are sometimes low in Vitamin B12, which can lead to increased homocysteine levels--a risk factor for heart diease. Since vegetarians do not eat fish, some vegetarians don't have high intakes of Omega-3 fatty acids. There is strong evidence that higher intakes of Omega-3 fatty acids reduce the risk of heart disease. Both of these shortcomings can easily be overcome by taking a vitamin B12 supplement, along with spirulina or fermented soy products and increasing intake of omega-3 fatty acids via ground flax seeds or flax seed oil, soy products, and walnuts. There is some evidence that flax may be even more beneficial than fish oil in its effectiveness in reducing C-reactive protein, an indicator of heart disease.[citation needed] It should also be noted that while canola oil contains Omega-3 fatty acids, it has a high sulphur content and goes rancid easily. If canola oil is deodorised, these Omega-3 fatty acids are transformed into trans fatty acids, which are harmful.[6] Cyanocobalamin is a vitamin commonly known as vitamin B12 (or B12 for short). ... Homocysteine is a variant of the amino acid cysteine, differing in that its side-chain contains an additional methylene (-CH2-) group before the thiol (-SH) group. ... Omega-3 fatty acids are polyunsaturated fatty acids classified as essential because they cannot be synthesized in the body; they must be obtained from food. ... Species Spirulina is the common name for human and animal food supplements produced primarily from two species of cyanobacteria: Arthrospira platensis, and These and other Arthrospira species were once classified in the genus Spirulina. ... Binomial name Glycine max Soybeans (US) or soya beans (UK) (Glycine max) are a high-protein legume (Family Fabaceae) grown as food for both humans and livestock. ... Flax seed oil, often used as a popular Nutritional Supplement is an oil extracted from the stems of the plant flax. ... For the figure in Celtic mythology see agriculture, canola are certain varieties of plants from which we get rapeseed oil, or the oil produced from those varieties. ...


Cretan Mediterranean-style diet

The Seven Country Study[18] found that Cretan men had exceptionally low death rates from heart disease, despite moderate to high intake of fat. The Cretan diet is similar to other traditional Mediterranean diets: consisting mostly of olive oil, bread, abundant fruit and vegetables, a moderate amount of wine, and fat-rich animal products such as lamb, sausage and goat cheese.[19][20][21] However, the Cretan diet consisted of less fish and wine consumption than some other Mediterranean-style diets, such as the diet in Corfu, another region of Greece, which had higher death rates.[citation needed]


The Lyon Heart Study[22] set out to mimic the Cretan diet, but adopted a pragmatic approach. Realizing that some of the people in the study would be reluctant to move from butter to olive oil, they used a margarine based on rapeseed (canola) oil. The dietary change also included 20% increases in vitamin C rich fruit and bread and decreases in processed and red meat. On this diet, mortality from all causes was reduced by 70%. This study was so successful that the ethics committee decided to stop the study prematurely so that the results of the study could be made available to the public immediately.[23]


Alcohol

The World Health Organization (WHO) states there is convincing evidence that "low to moderate alcohol intake" reduces the risk of coronary heart disease but also that "high alcohol intake" increases the risk of stroke.[24]. The subject of alcohol and heart attacks is important because the major cause of death in the United States and many other countries is heart disease. ...


Summary

Current indications suggest that the best way forward at present may be to be wary of manufactured foods (especially those containing hydrogenated oils), to increase intakes of fresh fruits and vegetables, and to consider eating unrefined foods including dairy products, meats, nuts and grains.


Avoiding smoking and homogenised milk, reducing salt and sugar consumption, and adopting regular physical activity are also likely to be beneficial.


See also

This article or section does not cite its references or sources. ... It has been suggested that this article or section be merged with Coronary heart disease. ...

External links

Government advice

The Food Standards Agency is a non-ministerial government department of the Government of the United Kingdom. ...

Science sites

  • Review of from Harvard School of Health Low-Fat Diet Not a Cure-All

Other sites

Dr Uffe Ravnskov (circa 2005). ...

References

  1. ^ Enig, Mary G, PhD, "Trans Fatty Acids in the Food Supply: A Comprehensive Report Covering 60 Years of Research", 2nd Ed., Silver Spring MD, (1995), pp. 4-8.
  2. ^ Hubert H., et.al., Circulation (the journal of the American Heart Association), (1983), 67:968; Smith, R. and E.R. Pinckney, "Diet, Blood Cholesterol and Coronary Heart Disease: A Critical Review of the Literature", Vol.2, 1991, Sherman Oaks, CA.
  3. ^ Castelli, William, "Concerning the possibility of a nut...", Archives of Internal Medicine, Jul 1992, 152:7:1371-1372.
  4. ^ Multiple Risk Factor Intervention Trial Research Group 1982, "Multiple risk factor intervention trial. Risk factor changes and mortality results", Journal of the American Medical Association, 1982; 248:1465-77.
  5. ^ Cohen, A, American Heart Journal, (1963), 65:291
  6. ^ Enig, Mary G., Nutr Quarterly, (1993), 17:(4):79-95
  7. ^ Enig, Mary G., "Trans Fatty Acids in the Food Supply: A Comprehensive Report Covering 60 Years of Research", 2nd Ed., Silver Spring MD, (1995), pp. 148-154.
  8. ^ Enig, Mary G., et.al., Journal of the American College of Nutrition, (1990), 9:471-86.
  9. ^ Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB, "Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction", Journal of Nutrition, Mar 2005;135(3):562-6.
  10. ^ Holman, R.T., "Geometrical and Positional Fatty Acid Isomers", E.A. Emkin and H.J. Dutton, eds., (1979), Champaign IL, pp. 283-302
  11. ^ Science News Letter, Feb 1956
  12. ^ Schantz, E.J., et.al., Journal of Dairy Science, (1940), 23:181-89
  13. ^ Enig, Mary G., "Trans Fatty Acids in the Food Supply: A Comprehensive Report Covering 60 Years of Research", 2nd Ed., Silver Spring MD, (1995)
  14. ^ Watkins, B.A., et.al., British Poultry Science, (Dec 1991), 32(5):1109-1119.
  15. ^ Clifford A.J., Ho C.Y., Swenerton H., "Homogenized bovine milk xanthine oxidase: a critique of the hypothesis relating to plasmalogen depletion and cardiovascular disease", American Journal of Clinical Nutrition, (1983) 38;327-332.
  16. ^ Key TJ, Fraser GE, et al., "Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of five prospective studies", American Journal of Clinical Nutrition, Sep 1999, 70:516S-524S)
  17. ^ Norris, J., "Making Sense of Nutritional Research", (2003)
  18. ^ "Coronary Heart Disease in Seven Countries," Circulation, (1970), 41(Suppl I):I-1--I-211.
  19. ^ Willett, W.C., et al, American Journal of Clinical Nutrition, June 1995, 61(6S):1402S - 1406S
  20. ^ Perez-Llamas, F., et.al., J Hum Nutr Diet, Dec 1996, 9:6:463-471
  21. ^ Alberti-Fidanza, A., et.al., European Journal of Clinical Nutrition, Feb 1994, 48:2:85-91
  22. ^ Lyon Heart Study
  23. ^ de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. (1999). "Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.". Circulation 99 (6): 779-85. PMID 9989963.
  24. ^ World Health Organization Population nutrient intake goals for preventing diet-related chronic diseases

 
 

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