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Diet, Blood Lipids and Coronary Artery Disease

Diet, Blood Lipids and Coronary Artery Disease. James J. Kenney, PhD, RD/LN, FACN. Modern Diets Cause Atherosclerosis. The Typical American Diet Promotes Atherosclerosis.

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Diet, Blood Lipids and Coronary Artery Disease

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  1. Diet, Blood Lipids and Coronary Artery Disease James J. Kenney, PhD, RD/LN, FACN

  2. Modern Diets Cause Atherosclerosis.

  3. The Typical American Diet Promotes Atherosclerosis • “If the LDL-receptor hypothesis is correct, the human receptor system is designed to function in the presence of an exceedingly low LDL level.” * * Quote from Michael Brown & Joseph Goldstein in November 1984 Scientific American, page 65. Brown & Goldstein later won the Nobel Prize for Medicine for their work on the LDL-receptor and how it regulates blood cholesterol

  4. Brown & Goldstein Continue: • “The kind of diet necessary to maintain such a level [of LDL-C] would be markedly different from the customary diet in Western industrial countries (and much more stringent than the moderate low-cholesterol diets of the kind recommended by the American Heart Association).”* * Scientific American, Novemeber 1984

  5. Brown & Goldstein Continue: • “It would call for the the total elimination of dairy products as well as eggs, and for a severely limited intake of meat and other sources of saturated fat.”* * Brown & Goldstein in November 1984 Scientific American.

  6. Dietary Factors that Raise LDL-C • Saturated fatty acids (C-12, C-14, C-16) • Trans fatty acids (Hydrogenated oils) • Cholesterol • Excess calories (weight gain) • Fructose • Diterpenes (Unfiltered Coffee)

  7. Dietary Factors that Reduce LDL-C • Fiber (especially soluble fibers) • Plant sterols and stanols • Polyunsaturated fatty acids (omega-6) • Vegetable proteins (esp. from legumes) • Reduced calorie intake (weight loss)

  8. Relative Risk of Developing Heart Disease Cholesterol Level (mg/dl) Framingham Study* Chicago Heart Assn.** 140-159 (114-193) 1 1 160-179 4.5 195-218 5.3 6.3 219-240 6.7 7.5 241-268 12.4 8.5 268+ 15.3 16.5 Heart Disease & Serum Cholesterol *Lancet, Aug 1982 **Medical World News, April 1983

  9. High-Dose Statin Drugs Lower LDL more than Pritikin Program: • Statin drugs alone only reduce CAD events and mortality about 20-30% compared to a placebo in most studies. • Studies Show Statin drugs alone or with AHA Diet rarely reverse atherosclerosis and relieve angina. • Only a very-low-fat, near vegetarian diet has been shown to reverse atherosclerosis and angina in human subjects.

  10. The Lifestyle Heart Trial Results after One Year Showed: • 91% reduction in frequency of angina in the experimental group but 165% increase in control group • Significant regression of coronary atherosclerosis in the experimental group but progression in the control group • 40% reduction in LDL-cholesterol Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. The Lancet. 1990; 336:129-133.

  11. Coronary Artery Surgical Study (CASS) • 24,958 patients with ischemic CAD • Randomized to CABG & medical therapy • 16 year follow up • Only 2.1% of bypasses yield improved mortality – only in those with left main and left main equivalent disease and poor left ventricular function Caracciolo EA, Davis KB, Sopko G, et al. Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience. Circulation. 1995;91:2325-34.

  12. According to Dr. Nissen (Head of Cardiology at the Cleveland Clinic): • “So you can put a stent in a coronary artery, but unless … you change the metabolic melieu that caused this disease to develop, you will not change the outcome.” • “The risk of death from MI is exactly the same after the intervention as it was before intervention.” Nissen S. www.medscape.com/viewprogram.2590?mpid=18]

  13. Impact of Moderate Diet + Drugs, Maximal VLFNV Diet + Drugs or Poor Diet and no drugs on 409 Patients with CVD Sdringola S, et al. J Am Coll Cardiol. 2003;41:263-72.

  14. Effect of Pritikin Program on People Taking Statin Drugs 325 300 275 250 225 200 175 150 125 100 Pre Drug Drug Drug + Pritikin mg/dl Primary N = 40 Secondary N = 53 Am.J.Cardiol. 79:1112,1997

  15. Postprandial Lipemia Appears to Promote Atherosclerosis • Insulin Resistance slows the clearance of Chylomicron Remnants* • Chylomicron Remnants get into artery walls and much more likely to stay there than LDL particles.** • A single high-fat meals impair endothelial function*** *Oliveira MRM, et al. Int J Obes 2004;28:1471-8 **Proctor S, et al. Arterioscler Thromb Vasc Biol 2004;24:1-6 ***Tomaino RM, et al. Nutr Rev 1998;56:182-5

  16. Impact of Diabetes and Other CVD Risk Factors on CVD Death Rate

  17. Effect of Adding Fat to a High Carbohydrate Meal on Postprandial Triglyceride Levels

  18. The Effects Of One High Fat Meal15 Young Heart Healthy Men Hi Fat Meal Low Fat Meal Ann Intern Med. 2002:136:523-528

  19. A Single High-Fat Meal Impairs Blood Flow Vogel RA, et.al. Am J Cardiol. 1997;79:350-354.

  20. High-Fat Diets Cause C.A.D.

  21. Postmenopausal Women Day 1 Day 14 5 4 CRP mg/L 3 2 1 0 Diabetic HRT Statin N=8 N=12 N=4 Effect of 12 Days on Pritikin Program on C-Reactive Protein Level * P < 0.05 * * * Wegge JK, et. al. Metabolism, 2004;53:377-81

  22. The Pritikin Program reverses atherosclerosis and angina & improves nearly all known and suspected atherosclerosis risk factors.Bypass and Angioplasty treat the symptom (angina) but do nothing to treat the underlying disease of atherosclerosis.

  23. Impact of a Ketogenic Diet on Plasma Lipoprotein Levels

  24. Pritikin Program Reverses Angina & Need For Heart Surgery • 64 Participants • Chose To “Bypass the Bypass” • 62% Left Program Medication Free • 5 yr Follow Up • 81% Had Not Needed Heart Surgery • 80% Had Angina on Entry but Only 32% Still Had Angina 5 Years Later Barnard JB, et al. J Cardiac Rehab 1983;3:183-90

  25. Nurses Health Study Data in Women with Type 2 DM • Each 5% increase in SFA at the expense of Carbohydrate increases CVD Risk by 29% • Increasing Dietary Cholesterol by 200mg/1000kcal increased CVD Risk by 37% Tanasescu M, et al. Am J Clin Nutr 2004;79:999-1005

  26. Do High-CHO Diets Promote CVD If HDL-C Levels Drop and Fasting Triglyceride Levels Increase? • Dr. Ornish Showed Regression of Atherosclerosis Despite Increased TG and Decreases HDL-C* • “…inappropriate to conclude that diet-induced decreases in HDL are equivalent to low HDL within a given diet.”** * Ornish D. et al. JAMA 1998;280:2001-7 ** Brinton EA, et al. J Clin Invest 1990;85-144-5

  27. Is Atherosclerosis Promoted by Low-fat Diets if HDL-C Drops? • SR-BI is a liver protein that removes cholesterol from HDL • Very-low-fat diets increase SR-BI • This speeds the uptake of HDL-C • Very-low-fat diets increase the transport of cholesterol from the periphery to the liver • This is why lower HDL-C on a low-fat diet doesn’t promote atherosclerosis

  28. Impact of Dietary Composition on Fasting Triglyceride Levels Parks EJ. Am J Clin Nutr 2000;71:424

  29. WHO Recommendations for a Diet To Prevent Chronic Diseases* *Report of the Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (Geneva, 28 January 1 February 2002) - WHO Technical Report Series No. 916

  30. Dr. Stern’s Conclusion: “Weight loss was similar between groups, but effects on atherogenic dyslipidemia and glycemic control were still more favorable with a low-carbohydrate diet…” Stern L. et al. Ann Intern Med 2004;140:778-85

  31. Percent Change from Baseline at 1 Year Stern L. et al. Ann Intern Med 2004;140:778-85

  32. Estimated Dietary Intake on “Atkins” and “Low-Fat” Diets

  33. Both Atkins and Pritikin Claimed their Diets Reversed Heart Disease. Who Was Right?

  34. Pritikin Eating Plan: The Basics • A Very-Low-Fat Diet that Emphasizes: • At least 5 servings of Whole grains per day • Modest amount of Omega-3 rich Seafood (10-12oz/week) • Very Low in Saturated Fat & Cholesterol • NF Milk or Soymilk (2 servings/d) • Low Salt (<1500mg Sodium/day) • At least 3 Whole Fruit servings/day • At least 4 Vegetable servings/day

  35. Low-Fat Diet Lowers Fasting Cholesterol & Triglyceride Levels • 4587 Subjects • 3 Weeks on Pritikin Program • Total Cholesterol & LDL Dropped 23% • Triglycerides Dropped 33% Barnard JB. Arch Intern Med 1991;151:1389-94

  36. Pritikin Program Reduces Need for Diabetes Medications • 652 Adult Onset Diabetics • 3 Weeks on Pritikin Program • 39% On Insulin Left off Insulin with blood sugar levels controlled • 71% On Oral Agents Left Medication-free and with blood sugar levels as low or lower than when they arrived Barnard JB, et al. Diabetes Care 1994;17:1469-72

  37. Pritikin Program & the Metabolic Syndrome • 29 Subjects with High Insulin Levels • 3 Weeks on the Pritikin Program • Fasting Insulin levels Were Reduced 36% • Other CVD risk factors also improved Barnard JB, et al. Am J Cardiol 1992 69: 440-4

  38. Impact of a Very Low-fat or a High-fat Diet on CVD Risk Factors After 1year Diet Wt Loss TC LDL HDL TG Low-Fat-12.6% -30.4% -38.8% +3.6% -36.9% High-Fat-13.7% +4.3% +6.0% -5.8% +9.8% Fleming R. Prev Cardiol 2002; 5:110-8

  39. Impact of a Very Low-fat or a High-fat Diet on CVD Risk Factors After 1year Diet Wt Hcy Lp(a) Fibrinogen Low-Fat-12.6% -14.6% -10.8% -6.3% High-Fat-13.7% +12.4% +31.0% +11.9% Fleming R. Prev Cardiol 2002; 5:110-8

  40. Dr. Atkins’ New Diet Revolution • p.151 “I have seen so many thousands of people eating ...[my diet]... reversing their heart disease! • p.146 “Carbohydrate… can raise the cholesterol much more readily than can a high fat intake” • p. 135 “Patients with chest pain found their angina clearing up, often within days of going on the diet.” Paperback Edition published by M. Evans & Co. Inc., 1992

  41. Nathan Pritikin: The Autopsy • Nathan Pritikin • Diagnosed with Advanced CAD at age 41 • Experimented On Himself • Followed a very-low-fat, near vegetarian diet for the rest of his lifetime • His Autopsy were Published in N. Engl. J. Med: • “in a man 69 years old, the near absence of atherosclerosis and the complete absence of its effects are remarkable.”* * Hubbard et al. N Engl J Med 1985;313:52

  42. Medical Examiner’s Report on Robert Atkins • BMI = 35: Height = 6” Weight = 258lbs • History of Myocardial Infarct • History of Hypertension • Congestive Heart Failure • Death Caused by Cerebral Bleeding Office of Chief Medical Examiner, The City of New York, April 17, 2003

  43. Veronica Atkins“Confessions” • “Robert did have some progression of his coronary artery disease in the last three years including some new blockage of a secondary artery that was remedied.…..” • She did not permit an autopsy that could have established the cause of his cerebral bleeding, which may have been due to a hemorrhagic stroke.

  44. National Weight Control Registry • Documented Cases of LT Weight Loss & Control • 4500+ Cases • Lost 65 lbs on Average • Maintained Weight loss for average of nearly 6 years • How Did They Do It? • Most Followed Low Fat, High Fiber Diet • Vast Majority Also Exercised Regularly • <1% Followed a High Protein, High Fat, Low Carb Diet • Only 1% used exercise alone Wing R, Hill JO, Annu Rev Nutr 2001;21:323-41

  45. In Summary • A healthy weight control diet is not the same as a quick weight loss fad diet • Smoking and amphetamines cause weight loss but they kill you faster than being overweight • Anybody can promote pseudoscientific mumbo jumbo promising quick and easy weight loss • Look for a weight loss program that has documented scientific evidence demonstrating it is both safe and effective. • The Atkins diet is high in saturated fat and cholesterol and is neither safe nor effective.

  46. Zone Diet Based on Pseudoscience • Sears claims 40/30/30 ratio of CHO/FAT/PRO is the key to optimal health and athletic performance. • “...review of the literature suggests that there are scientific contradictions in the Zone Diet hypothesis….” • “…the Zone clearly and selectively ignores the known effects of macronutrients and hormones that contradict the Zone theory.” Cheuvront SN. The Zone Diet Phenomenon: A Closer Look at the Science behind the Claims. J Am Coll Nutr 2003;22:9-17

  47. For More Information www.pritikin.com www.foodandhealth.com www.quackwatch.org

  48. Blood Flow DiagramsLow-Fat, Hi-Carb vs. High-Protein Diagrams collected by Richard M. Fleming MD, FICA, FACA, FASNC, Fleming Heart and Health Institute, Omaha, Nebraska

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