Read The Great Cholesterol Myth Online
Authors: Jonny Bowden
The Great Cholesterol Myth (33 page)
As far back as 1991, cardiologist Stephen Seely, M.D., published a paper in the
International Journal of Cardiology
titled “Is Calcium Excess in the Western Diet a Major Cause of Arterial Disease?” He pointed out that cholesterol only makes up 3 percent of arterial plaque while calcium makes up 50 percent!
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The Florida cardiologist Arthur Agatston, M.D., is best known for his wildly popular South Beach diet, but what many people don’t know is that he also developed a widely accepted test for coronary calcification known as the
Agatston test
. Individuals who score less than 10 on the Agatston test have minimal calcification; those with Agatston scores of 11 to 99 have moderate calcification; those with scores of 100 to 400 have increased calcification; and those with scores above 400 have extensive calcification.
It is well established that individuals with Agatston scores above 400 have an increased occurrence of coronary procedures (bypass, stent placement, and angioplasty) and events (myocardial infarction and cardiac death) within the two to five years following the test. Individuals with very high Agatston scores (over 1,000) have a 20 percent chance of suffering a heart attack or cardiac death within a year. Even among patients over the age of seventy who frequently have calcification, an Agatston Score above 400 was associated with a higher risk of death.
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The American Heart Association and the American College of Cardiology provide guidelines for coronary calcification testing, available online,
www.ahajournals.org/misc/sci-stmts_topindex.shtml
. These guidelines currently suggest—and we agree—that screening for calcification is of value for an individual who is considered to be at intermediate ten-year risk, which means that he or she has a 10 to 20 percent likelihood of experiencing a cardiac event within the next ten years.
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WHAT YOU NEED TO KNOW
Ask your doctor for the following tests, which are more important than the standard test for cholesterol:
• LDL particle size
• Hs-CRP
• Fibrinogen
• Serum ferritin (iron)
• Lp(a)
• Homocysteine
• Interleukin-6
• Coronary calcium scan
Eliminate these foods:
• Sugar
• Soda
• Processed carbs
• Trans fats
• Processed meats
• Excess vegetable oils
Eat more of these foods:
• Wild salmon
• Berries and cherries
• Grass-fed meat
• Vegetables
• Nuts
• Beans
• Dark chocolate
• Garlic and turmeric
• Pomegranate juice, green tea, and red wine
• Extra-virgin olive oil
Make these lifestyle changes to reduce stress:
• Meditate or practice deep breathing
• Express your emotions
• Play
• Cultivate intimacy and pleasure
• And most of all . . . enjoy your life!
This section is divided into two parts—what to eat and what
not
to eat for optimal heart health. Fortunately, the list of what not to eat is fairly short, so let’s get that one out of the way first. We call it the “Dump It!” list and provide you with specific “fast action plans” to help you remove these nutritionally empty, heart-unfriendly foods from your diet. The second section is called “Eat This!” and reveals some of the healthiest foods on the planet.
As we’ve said throughout this book (see
chapter 4
), sugar is a far worse threat to your heart than fat ever was.
The 2010 Dietary Guidelines for Americans suggest that no more than 25 percent of your calories should come from added sugars, but we think that’s a ridiculously high amount. (The American Heart Association recommends no more than 5 percent.) Research by Kimber Stanhope, Ph.D., at the University of California, Davis, has shown that when people consume 25 percent of their calories from fructose or high-fructose corn syrup, several factors associated with an increased risk for heart disease—including triglycerides and a nasty little substance called
apolipoprotein B
—escalate.
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(Remember, it’s the fructose in sugar that’s the problem. High-fructose corn syrup is 55 percent fructose, and regular sugar is 50 percent fructose, so for all intents and purposes, they have the same bad effect on your heart and your health.)
Fast Action Plan:
Cut out soda. Soda is probably the worst offender in this category, but not by much. Fruit juices are loaded with sugar and only marginally better than soda. “Energy drinks” aren’t any better. Most are loaded with sugar, and the sugar-free versions are loaded with chemicals. Many processed carbs (see below) are also full of sugar, and virtually all cakes, candies, pastries, doughnuts, and other sources of empty calories are also sugar heavyweights.
Processed carbs include almost any carbohydrate food that comes in a package: cereals, pasta, bread, minute rice, you name it. These foods are almost always high-glycemic, meaning they quickly and dramatically raise your blood sugar, which is exactly what you do not want. A 2010 study in the
Archives of Internal Medicine
demonstrated that women who ate the highest amount of carbohydrates had a significantly greater risk of coronary heart disease than those who ate the lowest amount, and that carbohydrates from high-glycemic carbs were particularly associated with significantly greater risk for heart disease.
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(This association was not confirmed for men in this particular study, but we suspect that future studies will discover that it’s true for both sexes.)
If any of you out there still think cornflakes are a great, wholesome breakfast, read on.
A landmark research study conducted by Michael Shechter, M.D., of Tel Aviv University’s Sackler School of Medicine and the Heart Institute of Sheba Medical Center, with collaboration from the Endocrinology Institute, shows exactly how high-carbohydrate foods increase the risk for heart problems.
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Researchers looked at four groups of volunteers who were given different breakfasts. The first group was given a cornflake mush mixed with milk, not unlike the typical American breakfast. The second group was given a pure sugar mixture. The third group was given bran flakes. And the fourth group was given a placebo (water).
Over four weeks, Shechter applied a test that allows researchers to visualize how the arteries are functioning. It’s called
brachial reactive testing
, and it uses a cuff on the arm (similar to those used for measuring blood pressure) that can visualize arterial function in real time.
The results were dramatic. Before any of the patients ate, their arterial function was basically the same. After eating, all had reduced functioning except for the patients in the water-drinking placebo group. Enormous peaks indicating arterial stress were found in the high GI groups: the cornflakes and sugar groups.
“We knew high glycemic foods were bad for the heart. Now we have a mechanism that shows how,” Shechter wrote. “Foods like cornflakes, white bread, French fries, and sweetened soda all put undue stress on our arteries. We’ve explained for the first time how high-glycemic carbs can affect the progression of heart disease.”
During the consumption of foods high in sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the arteries. Endothelial health can be traced back to almost every disorder and disease in the body. According to Shechter, it is the “riskiest of the risk factors.”
Shechter recommended sticking to foods such as oatmeal, fruits and vegetables, and legumes and nuts, which all have a low glycemic index. Exercising every day for at least thirty minutes, he added, is an extra heart-smart action to take.
There’s no two ways about it—high-glycemic carbohydrates are inflammatory. As researchers from Harvard Medical School and the Harvard School of Public Health noted, quickly digested and absorbed carbs (i.e., those with a high glycemic load) are associated with an increased risk of heart disease.
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These same researchers examined the diets of 244 apparently healthy women to evaluate the association between glycemic load and blood levels of CRP (C-reactive protein, the systemic measure of inflammation discussed earlier in this chapter). They found “a strong and statistically significant positive association between dietary glycemic load and [blood levels of] CRP.”
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And that’s putting it mildly. Women whose diets were highest in glycemic load had almost twice the amount of CRP in their blood as women whose diets were lowest in glycemic load (3.7 for high–glycemic load ladies, 1.9 for low–glycemic load ladies). The difference in inflammation levels was even more pronounced for overweight women. Among women with a body mass index (BMI) greater than 25, those whose diets were lowest in glycemic load had an average CRP reading of 1.6, but those whose diets were highest in glycemic load had a CRP reading more than three times that amount (average measurement: 5.0 mg/L).
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Full disclosure: We don’t much buy into the argument that “whole grains” eliminate all the problems associated with processed carbs, and here’s why: Number one, most commercial products that are made with whole grains don’t contain all that much of them. Number two, whole grains raise blood sugar almost as much as processed grains do. Number three, whole grains still contain gluten, which can be very inflammatory for people who are gluten-sensitive. That said, real whole grain products (Ezekiel 4:9 breads, for example) are way better than their processed counterparts. But be a careful consumer—just because a label says “wheat” instead of “white,” don’t assume it’s good for you.
Fast Action Plan:
Reduce (or eliminate) consumption of processed carbohydrates. At the same time, increase non-processed carbohydrates such as vegetables and low-sugar fruits. Replace your bagel and orange juice with some eggs, veggies, and a slice of avocado. Have berries for dessert. When eating out, say “no” to the breadbasket.
According to findings presented at the annual meeting of the American Heart Association in 2006, women who ate the most trans fats were more than three times as likely to develop heart disease as women who ate the least.
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Harvard researcher Charlene Hu examined data from the long-running Nurses’ Health Study, which has followed 120,000 female nurses for more than thirty years. His research shows that for each 2 percent increase in trans fat calories consumed, the risk for coronary heart disease roughly doubles!
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Trans fats raise LDL cholesterol levels, which doesn’t mean very much by itself, but at high intakes they also reduce HDL levels, which definitely isn’t good.
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The worst offenders include nondairy “creamers,” most margarines, cake mixes, ramen noodles, soup cups, virtually all packaged baked goods (e.g., Twinkies,
chips, and crackers), doughnuts, many breakfast cereals, “energy” bars, cookies, and definitely fast food. (Just for example, a medium order of fries contains an incredible 14.5 g of trans fat, and a Kentucky Fried Chicken Original Recipe chicken dinner has 7 g. The ideal intake for humans is 0 g.)
When the government mandated that trans fats be listed on the nutrition facts label of food, big food lobbyists sprang into action. They somehow created a loophole that lets manufacturers use trans fats while legally claiming “no trans fats!” on their packaging. Here’s how:
Manufacturers can claim “no trans fats” as long as there is less than half a gram of the stuff per serving. Sounds reasonable, until you remember how clever and ruthless Big Food can be. By making “serving sizes” ridiculously small, and by keeping trans fats to just under half a gram per “serving,” they were able to technically comply with the rules. But the end result is that if each artificially small “serving” contains, say 0.4 g of trans fats, you could quite easily consume a gram or two of the stuff just by eating what most people would consider a “normal” serving size. Do that a few times a day and before you know it you’ve raised your heart disease risk by quite a few percentage points.
What to do? Simple. Ignore the “no trans fats!” legend on the front of the package and read the ingredients list instead. No matter what the label says, if the list of ingredients contains partially hydrogenated oil or hydrogenated oil, the product has trans fats. Period. (Typically, you’ll see partially hydrogenated soybean oil in the ingredients list, but it could be any type of oil at all. What you’re looking for are the keywords
hydrogenated
and
partially hydrogenated
.)
Worth knowing: There is one exception to the don’t-eat-trans-fats rule, and that’s something called
conjugated linoleic acid
, or CLA. CLA is a trans fat that’s not man-made; rather, it’s made naturally in the bodies of ruminants (cows). Factory-farmed meat doesn’t have any, but grass-fed meat—and products
that come from pasture-raised animals—do. CLA has both anticancer and antiobesity properties. CLA is good for you, unlike hydrogenated or Partially hydrogenated oils—the very definition of man-made trans fats—which are definitely
not
good for you.