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Dr. Jim Painter University of Texas –Houston, School of Public Health

Finding Truth in the Failed Theories of Heart Disease – 10 Foods to Reduce the Risk of Heart Disease. Dr. Jim Painter University of Texas –Houston, School of Public Health. Outline. - Review dietary fat, saturated fat, cholesterol& CHD etiology - Dairy Fat a review Dairy fat 2018 update

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Dr. Jim Painter University of Texas –Houston, School of Public Health

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  1. Finding Truth in the Failed Theories of Heart Disease – 10 Foods to Reduce the Risk of Heart Disease Dr. Jim Painter University of Texas –Houston, School of Public Health

  2. Outline - Review dietary fat, saturated fat, cholesterol& CHD etiology - Dairy Fat a review • Dairy fat 2018 update • Omega 3 fatty acids, Fish • Wine or Grape Juice • Garlic • Chocolate • Portfolio of Foods: • Nuts/Almonds • Plant sterols • Soy protein • Viscous Fibers (e.g. Oats)

  3. II. Balance Omega-3 and Omega-6 Fatty Acids • Effects: • Reduction of high blood pressure • Prevents vascular clotting • Lowers triglyceride levels • Reduction of atherosclerosis • Anti-inflammatory effects

  4. Process of Inflammation Omega-6 Omega-3 Arachidonic Acid EPA/DHA Cyclooxygenase pathway PGE2 PGE3 Pro-inflammatory anti-inflammatory

  5. Omega-3 Intervention Studies Study NTreatmentResults

  6. Sources: Omega-3 Fatty Acids • Common sources: • Fatty fish and fish oil • Marine plants • Canola oil • Flaxseed • Soybeans • Many nuts and seeds

  7. Sources: Fish and Seafood Omega-3’s in 3.5oz, raw • Sardines (in oil, cooked) 3.3g • Mackerel, Atlantic 2.5g • Trout, lake 1.6g • Salmon, pink 1.0g • Oysters, Pacific 0.6g • Tuna 0.5g • Shrimp 0.3g • Lobster 0.2g

  8. III. Purple grape juice/wine • Purple grape juice contains polyphenolic compounds • Many health-promoting compounds are found in the seeds and the skin

  9. Wine as a Medicine • One of the earliest admonitions to drink wine as remedy for disease was given by the Apostle Paul when he told Timothy to “Stop drinking only water, and use a little wine because of your stomach and your frequent illnesses” (New International Version, 1985) Saint Paul delivering the Areopagus sermon in Athens, by Raphael, 1515 A.D. Victoria and Albert Museum, London

  10. Effects: Grapes • Grapes contain a variety of antioxidants in both the skin and the seeds • The antioxidants in the skin have been shown to • inhibit the oxidation of low-density lipoproteins(LDLs) • inhibit the stickiness of platelets that leads to blood clotting • promoting the relaxation of blood vessel walls (dilation)

  11. Circumflex Coronary Artery Blood Flow ml/min Red Wine Infusion Demrow 1995 100% Blood Flow 0% |---------12 min--------| Demrow, HS, et. al., 1995 Circulation 91:4, 1182-1188

  12. Circumflex Coronary Artery Blood Flow ml/min Red Wine Intragastric Demrow 1995 100% Blood Flow 0% |---------12 min--------| Demrow, HS, et. al., 1995 Circulation 91:4, 1182-1188

  13. Ischaemic Heart Disease Mortality/1000 Men St. Ledger, et. Al, 1979

  14. Platelet Aggregation Response in Humans after Drinking Grape, Orange or Grapefruit Juices for 1 wk *Significantly different from baseline, P = 0.0002. Values are means ± SD, n = 10. Source: Keevil et al., J Nutr, 2000

  15. Antioxidant Power A study from the US Department of Agriculture found that Purple 100% Grape Juice has more than three times the antioxidant power of popular juices as grapefruit, orange, tomato and apple. Source: J. Agr. Food Chem. 1996

  16. Inverse Relationship Between Drinking Frequency and One Estimate of Platelet Coagulability Goldberg, DM, et. al., 1995

  17. Budak, H.N., & Guzel-Seydim. (2010).

  18. Recommendations: Grapes and Grape Juice • Most studies suggest drinking 1-2 cups (8-16 oz) of purple grape juice per day may have cardiovascular benefits • 170 calories in 8 oz. Purple 100% Grape Juice • Make sure you’re drinking 100% juice

  19. IV. Garlic • Garlic has been used in traditional and folk medicine for over 4,000 years • Garlic contains sulfur compounds • Eating one clove of garlic per day may help decrease blood cholesterol levels

  20. Effect of diallyl disulfide on growth suppression of Prostate cancer cells • In vitro test • Of aged garlic at various levels • Prostate cancer cells • Growth suppression • As measured by Thymidine uptake Arunkumar et al 2005.

  21. Effect of diallyl disulfide on growth suppression of Prostate cancer cells Arunkumar et al 2005.

  22. Tumors Diagnosed by Biopsy January 1990-December 2000 Hao et al, 2004

  23. Component Responsible for Lipid Lowering • Allicin, a sulfur compound • Volatile sulfur compounds are not present in intact cells • Release by: • chopping • steaming • crushing

  24. Recommendations: Garlic • Experts still researching optimal dose • Conservative estimate = 1-3 cloves per day

  25. V. Chocolate • Cocoa processed with alkali is not beneficial • High fat chocolate is not beneficial • High sugar chocolate is not beneficial • Cocoa is beneficial

  26. Effects: CocoaComparison of Antioxidant Content • Black tea (2gm bag) 1000 C for 2 min. • Green tea (2gm bag) 1000 C for 2 min. • Wine 140 ml. California Merlot. • 2 tbs. commercial Cocoa pwd. 200 ml H20

  27. Total Flavonoid and Phenolic Content of Tea, Wine and Cocoa (per serving) 700 600 500 400 GAE mg 300 ECE 200 100 0 Black Tea Green Tea Wine cocoa Gallic acid equivalents (GAE), phenolic Epicatechin equivalents (ECE), flavonoid Lee et al. (2003). Cocoa Has More Phenolic Phytochemicals and Higher Antioxidant Capacity the Teas and Red Wine. Journal of Agriculture and Food Chemistry, 51, 7292-7295.

  28. Cocoa Inhibits Blood flow and Vessel Dilation • Subjects 20 individuals at risk of CHD • Consumed a cocoa drink • 2 groups high and low flavanol • Brachial artery flow and dilation were measured Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.

  29. Vaso-dilation with Cocoa Flavanols 7 6 5 % FMD 4 Before 2 hr After 3 2 1 0 Low flavanol High flavanol cocoa cocoa FMD (Flow-mediated Dilation) Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.

  30. 500 mg polyphenols from dark chocolate/day for 15 days Cocoa Lowers Systolic Blood Pressure Ried, K., Sullivan, T., Fakler, P., Frank, O. R., & Stocks, N. P. (2010). Does chocolate reduce blood pressure? A meta-analysis. BMC Medicine, 839-49. doi:10.1186/1741-7015-8-39

  31. 500 mg polyphenols from dark chocolate/day for 15 days Ried, K., Sullivan, T., Fakler, P., Frank, O. R., & Stocks, N. P. (2010). Does chocolate reduce blood pressure? A meta-analysis. BMC Medicine, 839-49. doi:10.1186/1741-7015-8-39

  32. Cocoa Lowers Diastolic Blood Pressure 500 mg polyphenols from dark chocolate/day for 15 days Ried, K., Sullivan, T., Fakler, P., Frank, O. R., & Stocks, N. P. (2010). Does chocolate reduce blood pressure? A meta-analysis. BMC Medicine, 839-49. doi:10.1186/1741-7015-8-39

  33. 1,000 mg polyphenols from dark chocolate taken twice daily over 14 days Ried, K., Sullivan, T., Fakler, P., Frank, O. R., & Stocks, N. P. (2010). Does chocolate reduce blood pressure? A meta-analysis. BMC Medicine, 839-49. doi:10.1186/1741-7015-8-39

  34. A portfolio of LDL and inflammation reducing foods

  35. LDL Cholesterol lowering effects of a dietary portfolio of foods • Plant sterols (1.0 g/1000 kcal) • Soy protein foods including soy milks and soy burgers, (21.4 g/1000 kcal) • Almonds (14 g/1000 kcal) • Viscous fibers from oats, barley, psyllium, okra and eggplant (10 g/1000 kcal) Jenkins, et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants, Am J ClinNutr2005;81:380 –7.

  36. Stanol/Sterol Esters • (Sterols) • (Stanols) • Stanol/Sterol esters work by increasing cholesterol output into the bile and by transferring cholesterol back into the intestinal track.

  37. Plat & Mensink, 2002; FASEB J 16:1248-1253

  38. Products • http://1.

  39. Recommendations Usual dose is 800 mg – 6.0 grams/d Divided equally and given before meals Doses above 2.0 g/day do not appear to add additional benefits. Nies, 2006. Complimentary and Alternative Therapies for the Management of Dyslipidemias

  40. Soy/ legumes • Low in saturated fat • Contains protein and other compounds that help lower blood cholesterol Effect = reduced risk of heart disease

  41. Reduction of Total Cholesterol by Soy >335 259-332 201-255 (mg/dl) Initial Cholesterol 127-198 0 20 40 60 Average Total Cholesterol Reduction (mg/dl)

  42. Reduction of Blood Cholesterol with Soy Consumption 30 25 20 15 Reduction in Blood Cholesterol mg. 10 5 0 25 50 75 Soy Intake (grams)

  43. Sources: Soy Protein Source: United Soybean Board

  44. Nuts Effects: • Lower the risk of coronary heart disease • Lower TC and LDL when consumed in moderation as part of a low fat diet • Fiber • Phytosterols • MUFA/PUFA • Antioxidants • Amino Acids

  45. Research studies: Nuts

  46. Individual Research Studies: Nuts

  47. Soluble (Viscous) Fiber Effects: • Reduces total and LDL cholesterol • Reduces CHD risk

  48. Wei et al., 2009, Euro J Clin Nutr, 63: 821-827.

  49. LIVER Mechanism: Soluble Fiber LDL Receptor Bile Salt Hepatic Portal Vein Psyllium Bile Duct Duodenum Ileum Anderson, et al., Am. J. Clin. Nutr. 71:472, 2000

  50. Sources: Fiber • oatmeal, cooked • peas • kidney beans • potato, baked with skin • whole wheat bread • bran flake cereal • spinach • certain fruits • apples • bananas • oranges • pears • psyllium (grain found in some cereal products)

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