How to Prevent a Heart Attack

How to Prevent a Heart Attack.jpeg

In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy, but then the saturated fat, trans fat, and cholesterol in the standard American diet increases the cholesterol in our blood, which accumulates in the artery wall. This triggers an inflammatory response. This so-called fatty streak can then grow into an atherosclerotic plaque, which has the potential to rupture into our artery. If that happens, a blood clot forms, shutting off blood flow to a part of our heart, which can then die off and ultimately kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque. So, the researchers wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point where it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open.

To test out this theory they first made a supersaturated solution of cholesterol in a test tube to see if it expanded when it crystallized, and indeed it did-just like how water expands when it crystallizes into ice. In my video Cholesterol Crystals May Tear Through Our Artery Lining, you can see a massive cholesterol crystal shooting out the top of a test tube. Under a microscope, the tips of the cholesterol crystals were sharp jagged needles.

The researchers tried placing a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. This suggested that the crystallization of supersaturated cholesterol in atherosclerotic plaques could indeed induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks, with extensive protrusions of cholesterol crystals into the middle of the artery.

What makes us think it was the crystals that actually burst the plaque? All those studied who died of acute heart attacks had perforating cholesterol crystals sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes.

This can explain why dramatically lowering cholesterol levels with diet (and drugs, if necessary) can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

Given the powerful visuals, my Cholesterol Crystals May Tear Through Our Artery Lining video might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.

Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Swapping red meat for white won't do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol

Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See my video Does Cholesterol Size Matter?

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

How to Prevent a Heart Attack

How to Prevent a Heart Attack.jpeg

In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy, but then the saturated fat, trans fat, and cholesterol in the standard American diet increases the cholesterol in our blood, which accumulates in the artery wall. This triggers an inflammatory response. This so-called fatty streak can then grow into an atherosclerotic plaque, which has the potential to rupture into our artery. If that happens, a blood clot forms, shutting off blood flow to a part of our heart, which can then die off and ultimately kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque. So, the researchers wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point where it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open.

To test out this theory they first made a supersaturated solution of cholesterol in a test tube to see if it expanded when it crystallized, and indeed it did-just like how water expands when it crystallizes into ice. In my video Cholesterol Crystals May Tear Through Our Artery Lining, you can see a massive cholesterol crystal shooting out the top of a test tube. Under a microscope, the tips of the cholesterol crystals were sharp jagged needles.

The researchers tried placing a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. This suggested that the crystallization of supersaturated cholesterol in atherosclerotic plaques could indeed induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks, with extensive protrusions of cholesterol crystals into the middle of the artery.

What makes us think it was the crystals that actually burst the plaque? All those studied who died of acute heart attacks had perforating cholesterol crystals sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes.

This can explain why dramatically lowering cholesterol levels with diet (and drugs, if necessary) can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

Given the powerful visuals, my Cholesterol Crystals May Tear Through Our Artery Lining video might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.

Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Swapping red meat for white won't do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol

Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See my video Does Cholesterol Size Matter?

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

The Saturated Fat Studies: Buttering Up the Public

NF-Sept29 The Saturated Fat Studies Buttering Up the Public.jpeg

Time magazine's cover exhorting people to eat butter could be viewed as a desperate attempt to revive dwindling print sales, but they claimed to be reporting on real science--a systematic review and meta-analysis published in a prestigious journal that concluded that current evidence does not clearly support cardiovascular guidelines that encourage cutting down on saturated fat, like the kind found in meat and dairy products like butter.

No wonder it got so much press, since reducing saturated fat intake is a major focus of most dietary recommendations worldwide, aiming to prevent chronic diseases including coronary heart disease. So, to quote the Center for Science in the Public Interest, "What gives? Evidently, shaky science...and a mission by the global dairy industry to boost sales."

They interviewed an academic insider, who noted that some researchers are intent on showing saturated fat does not cause heart disease, which can be seen in my video The Saturated Fat Studies: Buttering Up the Public. In 2008, the global dairy industry held a meeting where they decided that one of their main priorities was to "neutralize the negative impact of milk fat by regulators and medical professionals." And when they want to do something, they get it done. So they set up a major, well-funded campaign to come up with proof that saturated fat does not cause heart disease. They assembled scientists who were sympathetic to the dairy industry, provided them with funding, encouraged them to put out statements on milk fat and heart disease, and arranged to have them speak at scientific meetings. And the scientific publications we've seen emerging since the Mexico meeting have done just what they set out to do.

During this meeting, the dairy industry discussed what is the key barrier to increasing worldwide demand for dairy. There's global warming issues and other milks competing out there, but number one on the list is the "Negative messages and intense pressure to reduce saturated fats by governments and non- governmental organizations." In short, the negative messages are outweighing the positive, so indeed, their number one priority is to neutralize the negative image of milk fat among regulators and health professionals as related to heart disease.

So if we are the dairy industry, how are we going to do it? Imagine we work for Big Butter. We've got quite the challenge ahead of us. If we look at recommendations from around the globe, there is a global scientific consensus to limit saturated fat intake with most authoritative bodies recommending getting saturated fat at least under 10% of calories, with the prestigious U.S. Institute of Medicine and the European Food Safety Authority recommending to push saturated fat consumption down as low as possible.

The latest guidelines from the American Heart Association and the American College of Cardiology recommend reducing trans fat intake, giving it their strongest A-grade level of evidence. And they say the same same for reducing saturated fat intake. Since saturated and trans fats are found in the same place, meat and dairy, cutting down on foods with saturated fat will have the additional benefit of lowering trans fat intake. They recommend pushing saturated fat intake down to 5 or 6%. People don't realize how small that is. One KFC chicken breast could take us over the top. Or, two pats of butter and two cubes of cheese and we're done for the day--no more dairy, meat, or eggs. That'd be about 200 calories, so they are in effect saying 90% of our diet should be free of saturated fat-containing foods. That's like the American Heart Association saying, "two meals a week can be packed with meat, dairy, and junk, but the entire rest of the week should be unprocessed plant-foods." That's how stringent the new recommendations are.

So this poses a problem for Big Cheese and Chicken. The top contributors of cholesterol-raising saturated fat is cheese, ice cream, chicken, non-ice cream desserts like cake and pie, and then pork. So what are these industries to do? See The Saturated Fat Studies: Set Up to Fail.

For those unfamiliar with Trans Fat in Meat and Dairy (and refined vegetable oils), that's why I made a video about it.

The U.S. National Academy of Sciences Institute of Medicine "as low as possible" position, echoed by the European Food Safety Authority, is described in my video: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What happened when a country tried to put the lower saturated fat guidance into practice? See the remarkable results in Dietary Guidelines: From Dairies to Berries.

Don't think the dietary guidelines process could be undermined by underhanded corporate tactics? Sad but true:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: Johnathan Nightingale / Flickr

Original Link

Trans Fat in Animal Fat

 

 

 

 

 

 

 

 

Trans Fat in Meat and Dairy

Trans fats are bad. They may increase one’s risks of heart disease, sudden death, diabetes—and perhaps even aggression. Trans fat intake has been associated with overt aggressive behavior, impatience, and irritability.

Trans fats are basically found in only one place in nature: animal fat. The food industry, however, found a way to synthetically create these toxic fats by hardening vegetable oil in a process called hydrogenation, which rearranges their atoms to make them behave more like animal fats.

Although most of America’s trans fat intake has traditionally come from processed foods containing partially-hydrogenated oils, a fifth of the trans fats in the American diet used to come from animal products—1.2 grams out of the 5.8 total consumed daily. Now that trans fat labeling has been mandated, however, and places like New York City have banned the use of partially hydrogenated oils, the intake of industrial-produced trans fat is down to about 1.3, so about 50 percent of America’s trans fats come now from animal products.

Which foods naturally have significant amounts of trans fat? According to the official USDA nutrient database, cheese, milk, yogurt, burgers, chicken fat, turkey meat, bologna, and hot dogs contain about 1 to 5 percent trans fats (see the USDA chart in Trans Fat In Meat And Dairy). There are also tiny amounts of trans fats in non-hydrogenated vegetable oils due to steam deodorization or stripping during the refining process.

Is getting a few percent trans fats a problem, though? The most prestigious scientific body in the United States, the National Academies of Science (NAS), concluded that the only safe intake of trans fats is zero. In their report condemning trans fats, they couldn’t even assign a Tolerable Upper Daily Limit of intake because “any incremental increase in trans fatty acid intake increases coronary heart disease risk.” There may also be no safe intake of dietary cholesterol, which underscores the importance of reducing animal product consumption. See my video Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

There’s been controversy, though, as to whether the trans fats naturally found in animal products are as bad as the synthetic fats in partially hydrogenated junk food. The latest study supports the notion that trans fat intake, irrespective of source—animal or industrial—increases cardiovascular disease risk, especially, it appears, in women.

“Because trans fats are unavoidable on ordinary, non-vegan diets, getting down to zero percent trans fats would require significant changes in patterns of dietary intake,” reads the NAS report. One of the authors, the Director of Harvard’s Cardiovascular Epidemiology Program, famously explained why—despite this—they didn’t recommend a vegan diet: “We can’t tell people to stop eating all meat and all dairy products,” he said. “Well, we could tell people to become vegetarians,” he added. “If we were truly basing this only on science, we would, but it is a bit extreme.”  

Wouldn’t want scientists basing anything on science now would we?

“Nevertheless,” the report concludes, “it is recommended that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet.”

Even if you eat vegan, though, there’s a loophole in labeling regulations that allows foods with a trans fats content of less than 0.5 grams per serving to be listed as having—you guessed it—zero grams of trans fat. This labeling is misguiding the public by allowing foods to be labeled as ”trans fat free” when they are, in fact, not. So to avoid all trans fats, avoid meat and dairy, refined oils, and anything that says partially hydrogenated in the ingredients list, regardless of what it says on the Nutrition Facts label.

More on trans fat can be found in my videos Blocking the First Step of Heart Disease and Breast Cancer Survival and Trans Fat.

While unrefined oils such as extra virgin olive should not contain trans fats, to boost the absorption of carotenoids in your salad why not add olives themselves or whole food sources of fat such as nuts or seeds? Other videos on oils include:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: PKMousie / Flickr

Original Link

My Testimony Before the 2015 Dietary Guidelines Committee

 

 

 

 

 

 

 

 

My Testimony Before the 2015 Dietary Guidelines Committee

This week I had the honor of speaking before the 2015 Dietary Guidelines Advisory Committee, which is responsible for making evidence-based recommendations on the next round of federal nutrition advice. Normally such meetings devolve into a platform for moneyed interests to lobby on behalf of their corporate clients, but if you watch the video, I think you'll be as surprised as I at the number of presenters pushing sane, healthy choices. For example, four out of the first five speakers promoted a plant-based diet. Kathy Freston closed out the morning session (min. 1:55:52) and actress Marilu Henner shares a heartfelt appeal at 2:23:10.

The entire video is worth watching if just for the political education value. Big Sugar and Big Meat were on hand. You (almost) feel bad for the representative from the National Confectioner's (candy) Association. A good sign was how defensive the industry lobbyists sounded, encapsulated in press releases such as "Keep Dairy in the American Diet, National Milk Producers Federation Urges."

The morning's highlight can be seen at 1:31:05. Dr. Mona Sigal had just gotten through condemning the USDA for their cheese-pushing scandal at the behest of the dairy lobby, decrying the inordinate role Big Dairy has played in manipulating the dietary guidelines. The audience broke out into laughter as the next speaker was introduced: Jill Nicholls from the National Dairy Council.

Here's a transcript of my comments (min. 17:18):

In the Permanente Journal last year, the official peer-reviewed publication of our nations largest managed care organization, a “Nutrition Update for Physicians” was published, which concluded that “Healthy eating maybe best achieved with a plant-based diet,” which they defined as a diet that encourages whole plant-based foods and discourages meat, dairy products, and eggs as well as empty calorie junk. To quote their conclusion: "Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels. They may also reduce the number of medications needed to treat chronic diseases and lower ischemic heart disease mortality rates. Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity," which of course describes a bulk of our population.

This sentiment was echoed last summer by the American Institute for Cancer Research—probably the most preeminent institution on diet and cancer risk—when they explicitly endorsed a diet revolving around whole plant foods: vegetables, whole grains, fruits and beans.

I’ve personally been eating a plant-rich diet since 1990, when Dr. Dean Ornish published his Lifestyle Heart Trial in The Lancet, angiographically proving that heart disease could be reversed with the help of a plant-based diet, opening up arteries without drugs, without surgery. If that’s all a plant-based diet could do, reverse our number one killer of men and women, then shouldn’t that be our default dietary recommendation until proven otherwise? And the fact that plant-based diets can also be effective in preventing, treating, and arresting other leading killers, such as type 2 diabetes and hypertension, would seem to make the case for plant-based eating overwhelming.

Now to the last Guideline Committee’s great credit, the 2010 guidelines were a leap in the right direction, recognizing food as a package deal. Yes there’s calcium in dairy, protein in pork, iron in beef, but because of the baggage that comes along (like the saturated fat and cholesterol), plant sources are preferable, because then the “baggage’ we get is the fiber, the folate, the phytonutrients, etc.

I would like to see the committee be more explicit, though. When “eat-more” recommendations are issued, the messaging is clear—for example, “Increase vegetable and fruit intake.” But when there’s a conflict between USDA’s dual role to protect the public while at the same time promoting agricultural products, recommendations often resort to speaking in cryptic biochemical components, such as “Reduce intake of solid fats (major sources of saturated and trans fatty acids).” How about instead, eat less cheese. Or messages like drink less soda.  Eat less meat, particularly processed meat. The American Institute for Cancer Research just comes out and says it: “Processed meat like bacon, sausage, and cold cuts should be avoided.” Period. They don’t need to sell food; they just want to prevent cancer.

I am not here today on behalf of the broccoli lobby (though I'd be honored to represent big broccoli). I am not here representing any financial interest. I am here as a physician, representing the interests of the hundreds of thousands of Americans that continue to suffer and die every year from chronic disease. And you can help them by recommending a more plant-based diet.

For those interested in my thoughts about the last round of federal dietary guidelines I've compiled them into a 14 part video series:

  1. Nation’s Diet in Crisis
  2. Dietary Guidelines: Corporate Guidance
  3. Dietary Guidelines: With a Grain of Big Salt
  4. Dietary Guidelines: USDA Conflicts of Interest
  5. Dietary Guidelines: Just Say No
  6. Dietary Guidelines: The First 25 Years
  7. Dietary Guidelines: From Dairies to Berries
  8. Dietary Guidelines: It’s All Greek to the USDA
  9. Plant Protein Preferable
  10. Dietary Guidelines: Science Versus Corporate Interests
  11. Dietary Guidelines: Advisory Committee Conflicts of Interest
  12. New Dietary Guidelines for Americans
  13. Dietary Guidelines: Progressing From Pyramid to Plate
  14. Dietary Guidelines: Pushback From the Sugar, Salt, and Meat Industries

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: tfengreen / Flickr

Original Link