• Eating and P.A.D.

    By: Dr. Michael Dansinger

    Dr. Michael Dansinger is Wellness Director at Boston Heart Diagnostics and Founding Director of the Diabetes Reversal Program at Tufts Medical Center in Boston . He also serves on the CDC’s Expert Panel for Worksite Wellness Programs and on the Council of Directors for the True Health Initiative, a leading international voice for health and wellness. Dr. Dansinger previously served as the Nutrition and Obesity Editor for Medscape Journal of Medicine and was the principal investigator of the Tufts Popular Diet Trial comparing the Atkins, Zone, Weight Watchers and Ornish eating plans for weight loss and heart disease risk-factor reduction (published in JAMA). Dansinger was the nutrition doctor for NBC's The Biggest Loser for 10 years and designer of the Biggest Loser Diet, which won top awards from U.S. News & World Report (including No. 1 Best Diet for Diabetes).

  • How Food Damages and Heals Arteries

    The food you eat has a huge effect on your artery health—for better or for worse. What follows is a guide to help you understand some of the ways that food harms your arteries or even helps them heal and stay healthy.

     

    Your body digests or “takes apart” the food you eat into component parts or “nutrients”. Different component parts have different health effects that impact the health of your arteries either directly or indirectly. If you gain a good understanding of the health effects various component nutrients in foods, then you can better understand the health effects of different foods and different eating strategies.

     

    The nutrients I’ll be discussing are:

    Calories

    Proteins

    Saturated and trans fats

    Unsaturated fats

    Omega 3 fats

    Cholesterol

    Carbohydrates (sugars and starches)

    Fiber

    Antioxidants

    Vitamins and minerals

    Sodium and potassium

    Preservatives and chemicals

    Calories:

    Calories tell how much energy is in the food. A person’s body weight is affected by how many calories they eat. Eating too many calories results in too much body fat, which is one of the causes of arterial damage. Calories in food come from protein, fats, and carbohydrates.

    Protein:

    Animal proteins are found in red meat, poultry, seafood, eggs, and dairy foods such as milk, cheese, and yogurt. Vegetable proteins are found in beans, legumes, soy foods, tofu, nuts/seeds, whole grains, greens, and many other vegetables. Proteins often have fats with them. The amount and kinds of fat carried within the protein has a lot to do with how healthy a protein source is. Proteins with a lot of saturated fat mixed in are the least favorable for artery health. During the digestion process in the intestines, the body breaks down dietary proteins into “amino acids” which are absorbed into the blood stream and used by cells to make whatever proteins are needed by your body. Almost everybody eats somewhere between 12% and 35% of calories from protein. Patients with advanced kidney disease or uncontrolled gout are often advised to keep their protein intake on the lower end of that range to avoid worsening their condition.

    Saturated fats:

    The healthiness or unhealthiness of fats has a lot to do with how liquid or solid they are. Solid fats, including saturated fats, tend to stiffen the arteries and create an unhealthy balance of fats in the body. Saturated fats are found mostly in red meat, poultry, eggs, cheese, butter, ice cream, and other dairy foods that contain fat. They are also in chocolate, coconut oil, and palm oil. Saturated fats increase the blood levels of unfavorable cholesterol-containing particles (LDL “bad” cholesterol) by slowing their removal from the blood stream. Everybody knows cheeseburgers raise cholesterol, and now you know why—because the saturated fat delays the clearance of dangerous LDL particles allowing them a greater chance to penetrate into arteries.

    Trans fat:

    These very unhealthy fats are created in a factory and used in certain processed foods. Trans fats were once very commonly used fats for a wide range of foods and recipes (as “shortening” and stick margarine), but once it became clear they were a major cause of artery and heart damage, they were gradually phased out of the food supply. They might still show up in some cake frostings and old-style margarines and shortenings. Trans fats stiffen arteries, raise LDL “bad” cholesterol, and lower HDL “good” cholesterol.

    Unsaturated fats:

    These fats are healthier than saturated fat, because they don’t harden your arteries. The most favorable unsaturated fats come from fish (see below), or non-animal sources such as nuts, seeds, avocados, and olives. Olive oil is a good example of a healthy fat, but all oils and fats are high in calories, so if you’re watching your weight be careful about how much fat you eat.

    Omega-3 fats:

    These are the healthiest of all fats, and the hardest ones to get enough of. They’re found in a wide variety of fish and shellfish, and salmon is a very popular source. Wild game, and certain plant foods like flax oil also have omega 3 fats, but small fatty fish (like herring, sardines, and anchovies) are the ideal source. Another very popular way to get omega-3 fats is from fish oil capsules, but the more you can get from food the better. Omega-3 fats help keep the arteries relaxed (rather than stiff), which is what you want.

    Cholesterol:

    Cholesterol is found in certain foods and is also made by your liver. If you absorb too much cholesterol from your food, or if your liver makes too much cholesterol, it can build up in your blood and cause artery damage and stiffening. Major dietary sources of cholesterol include burgers, hot dogs, meatballs, steak, pork, chicken, egg yolks, cheese, butter, cream, and other foods containing meat or dairy ingredients. Your liver probably makes too much cholesterol if your liver has too much fat in it as a result of abdominal obesity. Do you know your blood cholesterol levels? Work with your healthcare team to aggressively manage your cholesterol levels by minimizing cholesterol production by your liver, and dietary cholesterol absorption by your intestines. Sometimes this requires a combination of the right eating strategy, supplements, and medications.

    Carbohydrates:

    Carbohydrates can be healthy or unhealthy, depending on how close they are to their natural healthy state. Carbohydrates are sugars, starches, and fibers that come mostly from plants and plant foods. Healthy sources of carbohydrates are vegetables, legumes, fruits, and grains in their natural state with the least amount of machine processing. Unhealthy sources of carbohydrates are manufactured food products containing sugars and/or refined starches (such as white flour) as ingredients. These processed starchy or sugary carbohydrate-containing foods raise the blood sugar level very quickly after meals, which acts like a toxin in people with cardiovascular disease, diabetes/prediabetes, and/or obesity. In these people, the liver turns excess unhealthy carbohydrates into excess unhealthy fat, which gets stored in the liver and throughout the body causing damage.

    Fiber:

    Fiber is healthy and you want as much as you can get. It is found in vegetables, legumes, fruits, and grains. The process of removing the fiber from those foods makes them less healthy. The healthiest carbohydrate foods have more than 1 gram of fiber for each 10 grams of total carbohydrate. For example, if a food serving has 30 grams of total carbohydrate, you would want it to have MORE than 3 grams of fiber, otherwise it’s too processed or sugary. Fiber helps decrease the amount of cholesterol absorbed by the intestines, and makes the healthy bacteria who live there very happy.

    Antioxidants:

    Your body likes foods with antioxidants, which are compounds that help protect your arteries from damage. Antioxidant compounds provide the beautiful color to many vegetables and fruits. The best strategy to get antioxidants is not to focus on a few food sources, but instead to eat a “rainbow” of red, orange, yellow, green, blue, and purple vegetables and fruits. Examples of great choices include dark leafy greens, red cabbage, beets, carrots, beans, nuts, berries, plums, dark chocolate, green tea, and coffee.

    Vitamins and minerals:

    When you eat a “rainbow” of fruits and vegetables, plus legumes, nuts, whole grains, and fish, then you are well situated to get the vitamins and minerals your body needs. For the cells of your body to work right they need you to choose healthy foods. You can get your vitamins and minerals from supplements, but getting them from healthy food choices is definitely best.

    Antioxidants:

    When you eat a “rainbow” of fruits and vegetables, plus legumes, nuts, whole grains, and fish, then you are well situated to get the vitamins and minerals your body needs. For the cells of your body to work right they need you to choose healthy foods. You can get your vitamins and minerals from supplements, but getting them from healthy food choices is definitely best.

    Sodium and potassium:

    Think of these minerals as being in competition with one another. Your body wants you to eat natural foods with potassium rather than processed foods with sodium. As dietary sodium goes up, potassium goes down, which is bad for blood pressure and artery health (see https://www.cdc.gov/salt/potassium.htm for more information).

    Preservatives and chemicals:

    Preservatives and chemicals added to foods are a “mixed blessing”. They help processed foods last longer, look more appetizing, and taste better. It is hard to prove, but many experts suspect that the cumulative effect of certain chemical “food additives” may contribute to the negative health effects of highly processed foods. Artificial sweeteners are good examples of chemicals which may be a “mixed blessing” with no proof of harm, but nobody would be shocked if we someday learned they have unintended negative health consequences. This type of uncertainty about the ingredients in processed foods adds to the concerns about eating “unnatural” food including junk food and fast food.

    Summary and conclusions:

    Foods are complex mixtures of compounds that affect your body in different ways—for better or for worse. By understanding the effects of different component “nutrients” you are in a good position to understand the various health effects and limitations of a wide variety of food options. Your body is affected by the flow of nutrients entering the body from day to day. The overall effect on your arteries depends mostly on your overall eating style or eating “strategy”. There are many different types of healthy eating strategies. Each eating style or strategy has strengths and limitations. There is no one best eating strategy for everybody, but finding the right strategy for your specific set of health issues can make a tremendous difference in preventing ongoing artery damage and maximizing your cardiovascular and overall health.

  • So Many Diets, So Little Time!

    Everywhere you look there's a different diet to follow with different claims. One might help you lose weight. One might help lower blood sugar. Another is geared towards low fat or lowering carbs. Others with claims to reverse heart disease. It's overwhelming. And so many diets, while they are all well-intentioned, may be tough tough to sustain long-term. We develop habits and cravings over time that are tough to break. We also have favorite recipes and family traditions that we are emotionally attached to and want to continue to celebrate. Even more, we may have a family to cook for, time constraints, social obligations that require eating out -- all of which could cause you to fail in diet compliance.

     

    So, what should you do?

     

    • First, ask your physician for critical blood work to determine if the foods you are currently eating might be leading to artery damage and inflamation. See critical bloodwork on page ( ).
    • Secondly, ask your physician for a referral to a certified dietitian to have a candid discussion about your dietary needs.
    • Third, Read the pros and cons of each of the 'popular' diets below as explained by Dr. Michael Dansinger.
    • Fourth, ease yourself into any diet for more sustainable results. Making healthier substitutions for meals and recipes you are already used to making can be easier to stick with and make the biggest difference in your health because of it.

    My goal is to help you navigate the landscape of “popular diets” and maybe even help find the right eating style for you.

     

    I’ll be discussing the following topics:

    No one best diet

    The “Popular Diet Spectrum”

    Low-carb diets

    Moderate-carb diets

    Moderate-fat diets

    Low-fat diets

    Putting it all together

    The “Popular Diet Spectrum”:

    There are hundreds of thousands of diet books that form what I call the “popular diet spectrum”. In their totality, these books form a symmetrical pattern that beautifully reflects some principles of human nutrition. Some scientists and nutrition experts emphasize the dangers of certain (or most) fats, while others emphasize the dangers of certain (or most) carbohydrates, or they emphasize that both unhealthy fats and unhealthy carbs are bad. Some are saying “don’t eat fat with your carbs” and others are saying “don’t eat carbs with your fat” and every possible variation of the middle ground. The result is a broad diversity of options that fall symmetrically along a spectrum, and the science indicates they are all “equivalently” correct and incorrect for health improvement.

     

    In my own research study, published in 2005, my colleagues at Tufts Medical School and I showed that the Low Carb, Moderate Carb, Moderate Fat, and Low Fat eating strategies all improved cardiovascular risk factors to a similar extent according to how closely a person followed their assigned diet. Adherence level, rather than diet type, was the greatest determinant of health improvements. Each eating strategy had strengths and drawbacks, and each diet type had the same rates of adherence (and non-adherence) over time. This was a groundbreaking study result at the time, and there have been many more research studies that have confirmed and reinforced this concept. Since then, I’ve focused my interest on the matchmaking process, which aims to help people figure out which is the best eating strategy for them specifically.

    Low-carbohydrate diets:

    The most famous low-carb diet is the “Atkins diet”, which is one version of the “Keto diet”. Other variations of low-carb diets include “Protein Power”, “Carbohydrate Addict’s Diet” the “Dukan Diet”, and dozens of other variations. They all emphasize that too much sugar is harmful, and that starchy foods rapidly turn to sugar, which raise insulin levels, resulting in fat storage rather than fat-burning. They each have a prescribed method for substantially cutting and managing carbohydrate foods (like bread, cereal, pasta, rice, low-fat dairy, fruits, starchy vegetables), and tell you what to eat instead, especially fats and proteins (like meat, poultry, seafood, eggs, high-fat dairy). By doing so, your hunger and overall calories are reduced, and your body will burn fat for fuel resulting in weight loss.

     

    Research shows this strategy can reduce body fat at least as well as any other eating strategy. It improves (especially with weight loss) high blood sugar and insulin levels in people with diabetes/prediabetes, and high blood pressure levels in people with hypertension. It improves triglycerides, HDL cholesterol, and LDL particle size, at least as well as any other eating strategy, especially when accompanied by weight loss. Unfortunately this approach is highest in saturated fat and least effective for lowering LDL cholesterol, and not enough studies have looked carefully at the effects on artery health. Low-carb diets also have the highest rates of constipation and the highest carbon footprint. Many people find it counter-intuitive to lose weight by eating fat instead of fruits, vegetables, and whole grains, and start to question themselves. Or they “get tired of eating meat, cheese and eggs” or find it “too extreme”, and eventually slip off track (or discontinue abruptly). However, most low-carb eating strategies prescribe an approach to gradually moderate by gradually bringing in more vegetables and fruits over time once you have lost significant weight

    Moderate-carbohydrate diets:

    Some of the most famous examples of moderate carbohydrate eating plans include the “Zone diet”, “South-beach diet”, and “Paleo diet”. Others you may have heard of include “The glycemic index diet”, “SugarBusters”, “Suzanne Somers diet” “The Biggest Loser diet”, and there are scores of others. These eating plans all highlight concerns about sugar, starch, grains, and excess animal fat. They encourage low-starch vegetables, moderate fruit, nuts/seeds, seafood and lean proteins. They each have differing approaches to starchy vegetables, legumes, fruits, whole grains, and red meat depending on the specific diet rules. For example, the idea behind the Paleo diet is to use modern foods to mimic the “natural human diet” prior to farming (such as vegetables, fruits, nuts, meat, eggs, and seafood) and avoid grains, dairy, and legumes which were not eaten for the vast majority of human evolutionary history.

     

    Research shows that when people closely follow any of these moderate-carb eating strategies all the health indicators improve. People routinely lose excess body fat and improve elevated blood sugar, blood pressure, and/or blood test results. As with any eating strategy, these plans have specific “rules” that many people find hard to follow. These eating plans are sometimes less “black and white” or “all or none” when it comes to carbohydrates, which for some people makes it more realistic, while for others more “lenient” resulting in gradual backsliding and loss of focus. There are no significant health concerns with moderate-carb eating plans, and if you can find one that has a set of rules you can embrace and follow consistently then it can potentially improve your health dramatically.

    Moderate-fat diets:

    This type of eating plan fits best with “standard medical advice” and emphasizes calorie/portion control, moderation, balance, and flexibility. Famous examples of this eating strategy include the “American Heart Association diet”, “American Diabetes Association diet”, “DASH diet”, “Mediterranean diet”, “Volumetrics” and “Weight Watchers diet”. All of these variations emphasize that fats are loaded with calories (a gram of pure fat has more than twice the calories as an ounce of pure carbohydrate or protein). These eating plans encourage replacing fats, especially saturated animal fats, with whole grains, legumes, fruits, and vegetables. They generally favor small portions of unsaturated fats from vegetable oils, olives, nuts, avocados, and seafood. The Mediterranean diet is more liberal with olive oil and red wine than most other moderate-fat diets, while strongly emphasizing small portions and minimal snacking between meals, as is customary where this eating style originates.

     

    Research shows these types of moderate-fat diets improve all health indicators, including lifespan. Communities and societies throughout the world that closely follow such eating styles are healthy and enjoy excellent longevity and reduced risk of cardiovascular disease, diabetes, obesity, and related conditions. Unfortunately, in America and other countries that are becoming more “Americanized”, too many people are not following standard medical/nutrion advice. Many people have tried unsuccessfully to cut calories and portion sizes, or use “moderation” to limit how much unhealthy food they eat. A major criticism of this dietary strategy is that most people aren’t nearly strict enough when they try to follow a moderate-fat eating plan. Cardiovascular disease remains the leading cause of death in America, which has also had a growing obesity and diabetes problem over the past half-century despite long-standing advice to limit fat and calories.

    Low-fat diets:

    Unlike moderate-fat diets, which typically aim for 25-35% of calories from fat, low-fat diets aim for closer to 15-25% of calories from fat. We’re talking about a whole different level of fat awareness and strictness. Famous examples of low-fat diets include the “Pritikin diet”, “Ornish diet”, “Low-fat vegan diet”, and “Japanese diet”. A core principle of such eating strategies is that pushing the dietary fat level very low allows for great abundance of very low-fat foods (as long as they are not sugary processed foods). People who successfully follow a low-fat eating plan typically keep track of their daily fat intake (for example 25 to 50 grams per day), and eat lots of fiber from vegetables, legumes, fruits, and whole grains. Soy foods are common, and egg whites and non-fat dairy products are usually popular with non-vegans. Some low-fat eating strategies may include low-fat seafood and/or poultry breast in moderation. This eating style has a relatively low carbon footprint, which is a very important feature to many advocates.

     

    Research shows significant improvements in major health measures. When followed properly, a low-fat eating strategy improves obesity, diabetes, hypertension, and cardiovascular disease risk. It improves LDL-cholesterol better than any other eating style, although it can worsen HDL-cholesterol, triglycerides, and LDL particle size in the absence of significant weight loss. It requires a level of commitment, focus, strictness, and advanced planning that exceeds what most people are ready or able to achieve on a long-term basis. For others, the clear strict rules are exactly what they need in order to break the cycle of disease caused by counter-productive eating habits.

    Putting it all together:

    The vast body of existing nutrition research strongly supports the concept of “many effective eating strategies”, each with their own set of strengths and drawbacks. Like many aspects of life, a variety of options can be both a blessing and curse. Finding a good eating style that is a proper fit for your specific health goals, medical situation, and food preferences, is all about finding an effective approach you can stick to on a long-term basis. This always requires commitment, focus, persistence and lots of advanced planning until the eating style becomes a normal automatic part of your everyday life. It’s even possible to switch between different types of eating plans, as long as you’re carefully following the “rules” of whatever plan you are following at the time. It’s the fact that you’re carefully following a set of rules that makes the plan work. All effective plans help protect their followers, in one way or another, from certain unhealthy aspects of the “standard American diet” which is ultimately how any good eating strategy gets the job done.

     

    Research shows significant improvements in major health measures. When followed properly, a low-fat eating strategy improves obesity, diabetes, hypertension, and cardiovascular disease risk. It improves LDL-cholesterol better than any other eating style, although it can worsen HDL-cholesterol, triglycerides, and LDL particle size in the absence of significant weight loss. It requires a level of commitment, focus, strictness, and advanced planning that exceeds what most people are ready or able to achieve on a long-term basis. For others, the clear strict rules are exactly what they need in order to break the cycle of disease caused by counter-productive eating habits.

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