It's just one meal. How bad could it be?

Whether you are taking the Holiday Challenge for the first time or you are a veteran nutritarian, rich holiday foods packed with oils, animal products, white flour, and sugar may look tempting to you. Maybe tempting enough for you to say to yourself “It’s just for today, just this one meal. I’ll go back to my healthy nutritarian diet tomorrow – one unhealthy meal can’t possibly harm me.” Is that true?

Aside from the fact that a single low-nutrient meal may awaken old addictive drives that could then lead to many more low-nutrient meals, a single meal is enough to cause damage to your cardiovascular system. As Dr. Fuhrman mentioned in his recent Twitter chat, there are more cardiac deaths on December 25, 26, and January 1 than any other days of the year.1 This sobering observation suggests that overindulging at a holiday meal can be extremely hazardous to your heart.

First, I’d like to define the phrase “endothelial function,” which will be used frequently in this post: The endothelium is a specialized layer of cells that forms the inner lining of all blood vessels. Endothelial cells produce nitric oxide and other substances that regulate blood pressure, maintain balance between pro-thrombotic (blood clotting) and anti-thrombotic mechanisms, and act as a selective barrier between the blood and surrounding tissues. The functions of the endothelium are crucial; endothelial dysfunction is an early event in atherosclerotic plaque development and cardiovascular disease.2

Now let’s take a look at the traditional components of a holiday meal, and how they affect our cardiovascular system…

Meat, cheese, and oils. Fifteen years ago, a study reported that eating a high saturated fat, high animal product meal impaired endothelial function for four hours following the meal, and this effect has been confirmed in the literature over and over.3,4 For example, a study presented earlier this year reported the detrimental effects of a sausage, egg and cheese breakfast sandwich on endothelial function.5 In addition to impaired endothelial function, single low-nutrient, high fat meals have been reported to induce insulin resistance, increase circulating adhesion molecules (which allows excess LDL and inflammatory cells to enter the vessel wall – a contributor to atherosclerosis), induce oxidative stress, and deplete the body’s circulating antioxidants.6-8  The detrimental effects of a high saturated fat meal on endothelial function are believed to occur via oxidative stress and activation of pro-inflammatory pathways.4,9 Although most of the studies have focused on high saturated fat meals, there is also evidence that animal protein and excess oils (high in omega-6 fatty acids) may also negatively affect the endothelium and induce oxidative stress.10,11

Bread, pasta, and sugary desserts. For a refresher on some of the harms of added sugar, revisit Dr. Klaper’s post from last year’s Holiday Challenge. In addition to those effects, refined carbohydrate is just as harmful to endothelial function as saturated fat. Refined carbohydrates cause dangerous spikes in blood glucose – repeated spikes over time promote diabetes and other chronic diseases, but what about a single high glycemic meal? Acute hyperglycemia (short term elevated blood glucose after a single refined carbohydrate-rich meal) has been shown to impair endothelial function, promote blood clotting (which increases heart attack risk), induce oxidative stress and deplete circulating antioxidants, increase blood pressure, increase circulating adhesion molecules, impair the body’s ability to fight infection, and decrease blood flow to the heart.7,12-17

Salty snacks, beer, and wine. A single high salt meal impairs endothelial function, just like high saturated fat or high sugar meals, and alcohol magnifies the increase in blood glucose from a refined carbohydrate-rich meal.18,19

The point: A SINGLE unhealthy holiday meal inflicts damage on the cardiovascular system, contributes to atherosclerotic plaque development, and in susceptible individuals may even provoke a cardiac event.

When I see a fatty, sugary dessert, I try to think up some scary images to deter myself from indulging – here are some examples:

  • Sugar crystals floating around in my bloodstream, scratching up the delicate surface of my endothelium.
  • All the circulating antioxidants from my previous nutritarian meals being used up and destroyed.
  • My vessels constricting, failing to deliver adequate blood to my heart muscle.
  • My blood pressure rising, and my heart becoming fatigued from pumping against that extra pressure.
  • LDL cholesterol and inflammatory cells pouring through the gaps in my compromised endothelial barrier and building the beginnings of atherosclerotic plaque.

…and I stick with my G-BOMBS. But that doesn’t mean that I have to choose between excellent health and tasty food. I get the best of both worlds - I enjoy preparing and serving a special dish for the holidays, while sharing health-promoting foods with my friends and family.  And if I bring a nutritarian dessert, I don’t have to conjure up scary images of what an unhealthy dessert will do to my body; the nutritarian option is always far more appetizing! For the past few family holidays, I’ve made apple pie, key lime pie, raw chocolate pudding pie, and pumpkin chai ice cream. Trust me – no one missed the sugar, oil, or white flour!

This year I’m excited to share a new main dish recipe I created: Layered Sweet Potatoes with Rosemary Cream Sauce. Seasonal winter squash and rosemary make it perfect for the holidays!

Layered Sweet Potatoes with Rosemary Cream Sauce

Layered Sweet Potatoes with Rosemary Cream Sauce

(Serves 6)

Ingredients:

1 medium sweet potato

1 small winter squash, such as butternut or dumpling

1 large red onion

16 ounces cremini mushrooms

1.5 cups cooked white beans

2 tablespoons raw tahini or cashew butter

5 cloves garlic

1/3 cup nutritional yeast

1 cup water

2 teaspoons dried rosemary (or 1-2 Tablespoons fresh rosemary)

1/2 teaspoon dried sage

1/4 teaspoon black pepper

 

Instructions:

1. Preheat oven to 350 F

2. Slice the sweet potato, squash, red onion, and mushrooms thinly (preferably with a mandoline).

3. Combine the remaining ingredients in a high-power blender and blend until creamy.

4. Spread a thin layer of rosemary cream sauce on the bottom of a 9x13 pan.

5. Layer one-third of each ingredient, and repeat to make three layers.

6. Bake at 350 for 40 minutes, then turn down heat to 300 and bake an additional 30 minutes.

 

 

References:

1. Kloner RA. The "Merry Christmas Coronary" and "Happy New Year Heart Attack" phenomenon. Circulation 2004;110:3744-3745.
2. Higashi Y, Noma K, Yoshizumi M, et al. Endothelial function and oxidative stress in cardiovascular diseases. Circ J 2009;73:411-418.
3. Vogel RA, Corretti MC, Plotnick GD. Effect of a single high-fat meal on endothelial function in healthy subjects. Am J Cardiol 1997;79:350-354.
4. Hall WL. Dietary saturated and unsaturated fats as determinants of blood pressure and vascular function. Nutr Res Rev 2009;22:18-38.
5. Lacroix S, Des Rosiers C, Gayda M, et al: Abstract 752: Baseline Triglyceridemia Influences Postprandial Endothelial Response to a Single Mixed Mediterranean-type Meal Compared to a High-saturated fat meal. In Canadian Cardiovascular Congress. Toronto, Canada; 2012.
6. Ramirez-Velez R. [Postprandial lipemia induces endothelial dysfunction and higher insulin resistance in healthy subjects]. Endocrinol Nutr 2011;58:529-535.
7. Ceriello A, Quagliaro L, Piconi L, et al. Effect of postprandial hypertriglyceridemia and hyperglycemia on circulating adhesion molecules and oxidative stress generation and the possible role of simvastatin treatment. Diabetes 2004;53:701-710.
8. Tsai WC, Li YH, Lin CC, et al. Effects of oxidative stress on endothelial function after a high-fat meal. Clin Sci (Lond) 2004;106:315-319.
9. Lacroix S, Rosiers CD, Tardif JC, et al. The role of oxidative stress in postprandial endothelial dysfunction. Nutr Res Rev 2012;25:288-301.
10. Mohanty P, Ghanim H, Hamouda W, et al. Both lipid and protein intakes stimulate increased generation of reactive oxygen species by polymorphonuclear leukocytes and mononuclear cells. Am J Clin Nutr 2002;75:767-772.
11. Hennig B, Toborek M, McClain CJ. High-energy diets, fatty acids and endothelial cell function: implications for atherosclerosis. J Am Coll Nutr 2001;20:97-105.
12. Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost 2010;8:1663-1669.
13. Mohanty P, Hamouda W, Garg R, et al. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes. J Clin Endocrinol Metab 2000;85:2970-2973.
14. Turina M, Fry DE, Polk HC, Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med 2005;33:1624-1633.
15. Fujimoto K, Hozumi T, Watanabe H, et al. Acute hyperglycemia induced by oral glucose loading suppresses coronary microcirculation on transthoracic Doppler echocardiography in healthy young adults. Echocardiography 2006;23:829-834.
16. Rammos G, Peppes V, Zakopoulos N. Transient insulin resistance in normal subjects: acute hyperglycemia inhibits endothelial-dependent vasodilatation in normal subjects. Metab Syndr Relat Disord 2008;6:159-170.
17. Lee IK, Kim HS, Bae JH. Endothelial dysfunction: its relationship with acute hyperglycaemia and hyperlipidemia. Int J Clin Pract Suppl 2002:59-64.
18. Hatonen KA, Virtamo J, Eriksson JG, et al. Modifying effects of alcohol on the postprandial glucose and insulin responses in healthy subjects. Am J Clin Nutr 2012;96:44-49.
19. Dickinson KM, Clifton PM, Keogh JB. Endothelial function is impaired after a high-salt meal in healthy subjects. The American journal of clinical nutrition 2011.

 

Interview with a Nutritarian: David

David was your typical, athletic American who thought he was relatively “healthy” . . . until he had his first heart-related incident before the age of sixty. Thankfully he heard Dr. Fuhrman on the radio, and today his health and energy have been restored. Welcome to Disease Proof David! 

 

What was your life like before discovering Dr. Fuhrman’s nutritarian eating-style?

At age 59, I’ve lived a good life; happily married, manager for a Plastics Company, and a daily runner for the past 30 years. I’m also a golfer and very active as my wife and I have three grown sons who keep us pretty busy! I lost my father to a massive heart attack when I was young so I’ve always been aware that my health was important. However, I felt fairly invincible since I exercised so much, and I thought I was eating pretty healthy. 

However, as a runner I knew I was getting out-of-shape, because it was getting harder for me to run each day. I was slowly gaining weight despite running six mile runs everyday. Then in September 2010, I had chest pains that led to the installation of a stent in my right coronary artery that was 100% blocked. Fortunately, the other two arteries were 100% clear, and I didn’t have a heart attack. This experience was a wake-up call, and I struggled for answers as to how this could have happened. Plus, I did not like all of the drugs I was suddenly required to take. 

 

How did you find out about Eat to Live?

In late January 2011, I was in the middle of a long drive home from a business meeting, and by sheer chance I heard Dr. Fuhrman on Sirius radio having a discussion on the NYC Docs show about nutrition. His message on eating high-nutrient foods hit me hard. When the show was over I immediately called my son in California, who is a vegetarian and nutritionally committed, and asked him about what I had just heard. He said that what Dr. Fuhrman was talking about was the same thing that he’d been trying to get his mother and me to listen to for years. When I got home I ordered the book. 

 

How do you feel now?

Today I’m 44 lbs lighter and still losing – which is about a 30% weight reduction so far! I now weigh what I did in high school, and I can run like the wind, which is basically effortlessly! My cholesterol numbers have nose dived, my angina is gone, my energy level is up, and I‘ve cut back on many drugs and expect to eliminate all of them shortly. I’ve discovered Dr. Fuhrman's predictions in Eat to Live to be totally true; and it’s only been five months! 

 

Do you have any success tip(s) to share with others?

  • Get the refined sugar out of your life, along with the Diet Coke.

  • Eat all of the vegetables, beans and fresh fruits that you want – don't worry about calories or counting things, except for the limited amounts of nuts and seeds.

  • Give this nutritional eating style a chance to take hold. The first few weeks are tough, but hang in there, because the results are worth it.  

 

In a nutshell, what has nutritarian eating done for you?

It’s given me a chance to help my body and has produced a lot of physical freedom. (The compliments on my weight reduction are pretty fun as well!) Plus, I now have new clothes to wear that were sitting around unused for a long time! More seriously, I don't worry about having a heart attack any longer. 

At 5’8” my weight has dropped from 190 to 145, and my goal was 165 lbs! 

 

before

after

Total cholesterol

166

 98

LDL

121

 49

HDL

 32

 62

Triglycerides

173

 87

 

Congratulations David ~ keep up the great work!

Angioplasty and stents offer no advantage over medications alone

Our society has been falsely led to believe that only highly technological interventions and drugs are effective at treating disease. In many cases, however, these interventions merely act as band-aids – temporarily relieving symptoms while the disease process continues to progress.

Heart.  Flickr: Vintage Collective
Percutaneous coronary intervention (PCI), a term that refers to angioplasty and stent placement procedures, is already known to have no advantage over optimal medical therapy (OMT); which refers to modest lifestyle changes plus anti-platelet, blood pressure-lowering, and cholesterol-lowering medications) for reducing heart attack incidence or cardiac mortality. This information made headlines in 2007; the COURAGE trial compared PCI plus OMT to OMT alone, and found no advantage associated with PCI procedures. [1] Since that time, literature reviews have confirmed that PCI did not decrease the rate of heart attack or cardiac death compared to OMT. [2]


Considering that PCI only treats a small portion of a blood vessel, but coronary artery disease affects the entire vasculature, this is not a surprising finding. Because of this finding, the indications for PCI evolved. Now, these interventions are indicated only for the purpose of relieving angina (chest pain caused by restricted blood flow to the heart) symptoms in coronary artery disease patients.


However, a recent review of several clinical trials in patients with stable coronary artery disease has revealed that PCI does not lessen angina any more than medical therapy either. [3] The researchers analyzed human trials that compared either angioplasty or stent placement to OMT with respect to angina symptoms. In 5 clinical trials conducted since 2000, 77% of patients were free of angina after PCI, and 75% of patients were free of angina after OMT, suggesting that PCI does not provide enhanced symptom relief compared to OMT. [4]


We must remember that aggressive interventions like angioplasty and stent placement have serious potential adverse outcomes, such as bleeding complications, heart attack, stroke, and death. [5]  Approximately 25% of angioplasties and 21% of stent placements clog up again (called restenosis) within 6 months, and about 60% of arteries treated by angioplasty will undergo restenosis eventually.[6, 7] These data tell us that PCI is not a long-term solution. Diet and lifestyle changes, however, are long-term solutions because they remove the cause of the heart disease. A low-fat, plant-based diet plus exercise and stress management has been shown to reverse atherosclerotic plaque progression. In addition, 74% of the coronary artery disease patients who had angina and made these lifestyle changes were free of angina after only 12 weeks. [8, 9] This is equivalent to the figures cited above for OMT – except of course, without drugs.


Despite the evidence, cardiologists continue to rationalize that angioplasty and stent placements are essential for their patients. The reality is that modern interventional cardiology should be stopped and medical and nutritional cardiology should be the standard of care. Everyone who has heart disease deserves to know that they have safer, noninvasive alternatives to stents and angioplasty.


In spite of the research we already have documenting the dramatic effectiveness of nutritional interventions [8, 10-12] and the futility of angioplasty and stent placement, this obviously still has not been sufficient to change the practices of conventional cardiologists. There are too many economic forces working against it. Nevertheless, for optimal atherosclerosis reversal and angina relief, my clinical experience with hundreds of patients with advanced heart disease, (confirmed by nutritional intervention studies) demonstrates that optimal nutritional therapy (ONT), with a vegetable-based, high-nutrient (nutritarian) diet – focused on vegetables, beans, fresh fruit, seeds and nuts - is dramatically more effective than PCI or OMT. This approach has already been demonstrated to be more effective than other nutritional interventions at lowering cholesterol; if we compare the published effects of dietary interventions on LDL cholesterol levels, a low-fat plant-based diet reduced LDL by 16%, but a nutritarian diet reduced LDL cholesterol by 33%.[13, 14] This data and my results offer more evidence to suggest that a nutritarian diet is ideal and by including more greens, beans, seeds and nuts leads to even more dramatic results and long-term benefits for heart disease patients.


Of course, larger more definitive studies are needed - exactly one of the initial goals of the Nutritional Research Project. Only with better controlled and documented research results can we foster increased awareness and acceptance of the therapeutic effects of a nutritarian diet for heart disease patients.

 

 

References:

1. Boden, W.E., et al., Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med, 2007. 356(15): p. 1503-16.
2. Trikalinos, T.A., et al., Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet, 2009. 373(9667): p. 911-8.
3. Wijeysundera, H.C., et al., Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief. Ann Intern Med, 2010. 152(6): p. 370-9.
4. Relief from Angina Symptoms: Percutaneous Coronary Intervention Not a Clear Winner. Journal Watch General Medicine, 2010.
5. Angioplasty and stent placement - heart. MedlinePlus.
6. Agostoni, P., et al., Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J, 2006. 151(3): p. 682-9.
7. Hanekamp, C., et al., Randomized comparison of balloon angioplasty versus silicon carbon-coated stent implantation for de novo lesions in small coronary arteries. Am J Cardiol, 2004. 93(10): p. 1233-7.
8. Ornish, D., et al., Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet, 1990. 336(8708): p. 129-33.
9. Frattaroli, J., et al., Angina pectoris and atherosclerotic risk factors in the multisite cardiac lifestyle intervention program. Am J Cardiol, 2008. 101(7): p. 911-8.
10. Esselstyn, C.B., Jr., et al., A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract, 1995. 41(6): p. 560-8.
11. Esselstyn, C.B., Jr., Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol, 1999. 84(3): p. 339-41, A8.
12. Ornish, D., Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol, 1998. 82(10B): p. 72T-76T.
13. Barnard, N.D., et al., Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol, 2000. 85(8): p. 969-72.
14. Jenkins, D.J., et al., Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism, 2001. 50(4): p. 494-503.

 

Vitamin D and Omega-3 fatty acids work together to reduce coronary calcification

Coronary artery calcification is essentially the beginning of bone formation – except it’s happening in the arteries.1-2 Sound scary? It is. Calcification is associated with a 3-4 fold increased risk of death from cardiovascular disease.3 And strangely enough, those who have vascular calcification usually have low bone density or even osteoporosis4 – hard arteries and weak bones??

Previous studies had tested the effects of cholesterol-lowering drugs (statins) on the progression of arterial calcification, and they were found to be ineffective. These scientists were looking for another solution. Vitamin D deficiency is known to produce a risk of cardiovascular disease, but had not been investigated for effects on arterial calcification. Because of the protective effect of Vitamin D on both bone and cardiovascular tissues, scientists thought that Vitamin D might be a player in this complex interplay between bone precursors and blood vessel walls.

Subjects with no previous heart disease symptoms but a high coronary calcium score (CCS) were included in the study. They supplemented with omega-3 fatty acids  and sufficient Vitamin D3 to achieve greater than 50ng/ml serum levels of 25(OH) Vitamin D. The response of these subjects to these therapies varied 18 months later. About half saw a decrease in CCS, and about half experienced no change or a small increase in CCS. Also about half of the subjects experienced slowed atherosclerotic plaque growth.5

What do these results tell us? It is difficult to interpret these results because of the lack of a control (no treatment) group, but it definitely opens the door to more studies on the role of Vitamin D in coronary artery calcification. 

We also don’t know anything about the diets of the subjects of the study. A phytochemical-rich diet plus Vitamin D and omega-3 supplementation could have achieved dramatic improvements in calcium score!

For now, we can now tentatively add coronary calcification to the long list of detrimental consequences of Vitamin D deficiency. Our best protection against these consequences, in addition of course to a high nutrient diet, is a good Vitamin D supplement.

 

References:

1. Fitzpatrick LA et al. Endochondral bone formation in the heart: a possible mechanism of coronary calcification. Endocrinology. 2003 Jun;144(6):2214-9.

2. Aigner T et al. Expression of cartilage-specific markers in calcified and non-calcified

atherosclerotic lesions. Atherosclerosis. 2008 Jan;196(1):37-41. Epub 2007 Feb 28.

3. Rennenberg RJ et al. Vascular calcifications as a marker of increased cardiovascular risk: a meta-analysis. Vasc Health Risk Manag. 2009;5(1):185-97. Epub 2009 Apr 8.

4. Hmamouchi I et al. Low bone mineral density is related to atherosclerosis in postmenopausal Moroccan women. BMC Public Health. 2009 Oct 14;9:388.

5. Davis W et al. Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults. Am J Ther. 2009 Jul-Aug;16(4):326-32.

 

 

Avandia Linked to Congestive Heart Failure and Death

In 2007 researchers believed the diabetes drug Avandia might triple heart risks. And now they know for sure! A new study in the Archives of Internal Medicine reveals elderly diabetics taking rosiglitazone, the other name for Avandia, were more likely to suffer congestive heart failure and more likely to die; The New York Times reports.

U.S. Cholesterol: LDL Down, Triglycerides Up

At the American Heart Association's annual meeting researchers revealed LDL cholesterol levels in U.S. adults have dropped since 1980, but triglyceride levels are 5 times higher. Scientists cite increased awareness of the dangers of high-fat diets and statins for the drop in LDL and the surge in obesity for the jump in triglycerides; Reuters reports.

Okay, it’s good to hear people are getting wise to high-fat diets. Diets rich in saturated fat are linked to heart disease, but statins are no saving grace. They have serious side effects and only offer a band aid solution. However, plant-based diets lower cholesterol, improve triglycerides, reverse cardiovascular disease and promote healthy bodyweight.