Category Archives: Heart Disease

Minimize Mercury and Maximize Health With These Fish

Posted on April 17, 2014 | Comments Off on Minimize Mercury and Maximize Health With These Fish
paleo diet, low-carb, Steve Parker MD

This hunter-gatherer snagged himself a brown trout

The Environmental Working Group has a fresh article reviewing the risk of mercury poisoning from seafood consumption. I’m not familiar with EWG. I’m trying not to hold it against them that Dr. Mark Hyman is on the board of directors.

Anyway, the EWG has some advice for you if you worry about mercury toxicity from fish. I try to stay up to date on the issue since I’m convinced that consumption of cold-water fatty fish twice a week is good for your health, in general. If the mercury doesn’t kill you.

Here are some quotes from the EWG article:

…EWG has compiled a list of “moderate mercury” species that would pose a mercury risk for pregnant woman and children who eat fish regularly. This list is more comprehensive than the 2004 EPA/FDA advisory, which warned that women of childbearing age and young children, who are most susceptible to the damage done by mercury, should eat only six ounces a week of albacore tuna and should avoid four other high-mercury species – swordfish, tilefish, king mackerel and shark.

EWG rightly points out that much of the “seafood” consumed in the U.S. really doesn’t provide much of the healthful omega-3 fatty acids.

Among popular seafood species, salmon stands out as an excellent choice.  Four to eight ounces of salmon weekly, depending on the species, can provide 100 percent of the recommended amount of omega-3s. Some types of farmed salmon present significant environmental health concerns. EWG recommends that people choose wild salmon instead.

EWG’s analysis highlights several other affordable and sustainably produced species, including anchovies, sardines, farmed trout, and mussels.  Just four to eight ounces of these species weekly would meet recommended omega-3 requirements for pregnant women and people with heart disease.

***

Americans eat more than 400 million pounds of canned imported tuna because it is affordable and can be stored for a long time. Canned tuna is the second most popular seafood in the U.S., after shrimp.  An average American eats an average of 2.5 pounds of tuna every year (NOAA 2012).  Albacore tuna, also called “white” tuna, contains significant amounts of omega-3s, but tests indicate that it also contains significant amounts of mercury. “Light” tuna is usually skipjack tuna but can also contain yellowfin tuna. Skipjack and yellowfin have lower mercury levels than albacore, but fewer omega-3s.

As Jim Gaffigan asked, “Has anyone even bothered to ask why the tuna are eating mercury?”

In 30 years of practicing medicine, including 12 years right on the U.S. Gulf Coast, I’ve never seen a case of mercury toxicity. Maybe I’ve missed it. Maybe it’s quite rare.

Read the whole enchilada.

Steve Parker, M.D.

h/t Conner Middelmann-Whitney

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Your Heart Works Fine on a Low-Carb Diet

Posted on March 16, 2014 | 2 comments

Amber Wilcox-O’Hearn explains why.

Paleobetic diet, low-carb,paleo diet, Steve Parker MD, cabbage soup, diabetic diet

This cabbage soup only has 9 grams of digestible carbohydrate per 2-cup serving

Your heart beats 100,000 times a day, every day, without rest. You’d think it needs a reliable energy source, and you’d be right. One of Amber’s references (#4) reminds me that, “Fatty acids are the heart’s main source of fuel, although ketone bodies as well as lactate can serve as fuel for heart muscle. In fact, heart muscle consumes acetoacetate in preference to glucose.”

Steve Parker, M.D.

PS: Paleo-compliant Cabbage soup recipe

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What’s Pure, White, and Deadly?

Posted on February 13, 2014 | Comments Off on What’s Pure, White, and Deadly?

Sugar, according to John Yudkin and Robert Lustig, among others. The Age has the details. A quote:

[Robert] Lustig is one of a growing number of scientists who don’t just believe sugar makes you fat and rots teeth. They’re convinced it’s the cause of several chronic and very common illnesses, including heart disease, cancer, Alzheimer’s and diabetes. It’s also addictive, since it interferes with our appetites and creates an irresistible urge to eat.

This year, Lustig’s message has gone mainstream; many of the New Year diet books focused not on fat or carbohydrates, but on cutting out sugar and the everyday foods (soups, fruit juices, bread) that contain high levels of sucrose. The anti-sugar camp is not celebrating yet, however. They know what happened to Yudkin and what a ruthless and unscrupulous adversary the sugar industry proved to be.

In 1822, we in the U.S. ate 6.2 pounds of sugar per person per year. By 1999, we were up to 108 pounds.

An occasional teaspoon of sugar probably won't hurt you

An occasional teaspoon of sugar probably won’t hurt you

The U.S. Department of Agriculture estimates that added sugars provide 17% of the total calories in the average American diet.  A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.  The average U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.

On the other hand, Fanatic Cook Bix found a study linking higher sugar consumption with lower body weight, which you might think would protect against type 2 diabetes, heart disease, and some cancers.

Read the rest at The Age. It’s mostly about John Yudkin.

Steve Parker, M.D.

h/t Jamie Scott

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Posted in Dementia, Dietary Carbohydrate, Glucose, Heart Disease, Overweight, Teeth

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Mouth Bacteria May Be an Important Cause of Heart Disease

Posted on December 1, 2013 | 4 comments

…according to an article at University Herald.

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That milk mustache is a tell-tale sign she’s not eating pure paleo

The idea is that nasty bacteria around your gums somehow cause arterial inflammation in your heart arteries, which could lead to heart attacks. I’ve written about this before.

A quote from the article:

The researchers followed 420 adults as part of the Oral Infections and Vascular Disease Epidemiology Study (INVEST), a randomly sampled prospective cohort of Northern Manhattan residents. Participants were examined for periodontal infection. Overall, 5,008 plaque samples were taken from several teeth, beneath the gum, and analyzed for 11 bacterial strains linked to periodontal disease and seven control bacteria. Fluid around the gums was sampled to assess levels of Interleukin-1β, a marker of inflammation. Atherosclerosis in both carotid arteries was measured using high-resolution ultrasound.

Over a median follow-up period of three years, the researchers found that improvement in periodontal health-health of the gums-and a reduction in the proportion of specific bacteria linked to periodontal disease correlated to a slower intima-medial thickness (IMT) progression, and worsening periodontal infections paralleled the progression of IMT. Results were adjusted for potential confounders such as body mass index, cholesterol levels, diabetes, and smoking status.

Thickening of the arterial lining is linked to higher rates of heart attack and stroke.

It remains to be seen whether alteration of gum bacteria and periodontal disease via oral self-care and dental care will reduce cardiovascular risk going forward. Stay tuned.

Read more at http://www.universityherald.com/articles/5322/20131101/brushing-your-teeth-could-prevent-heart-disease.htm#rvx294vC7VKJ6Qu3.99

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High Carbohydrate Diet May Cause Atherosclerosis

Posted on November 23, 2013 | Comments Off on High Carbohydrate Diet May Cause Atherosclerosis

…and that condition underlies most heart attacks, strokes, and poor circulation to limbs. Here’s the conclusion from an abstract:

High-carbohydrate diets, particularly in the form of high-glycemic index carbohydrate, have the ability to directly induce atherosclerosis. Based on anthropologic facts, the reason for these dietary-induced, insulin-mediated, atherogenic metabolic perturbations are suggested to be an insufficient adaptation to starch and sugars during human evolution. Restriction of insulinogenic food (starch and sugars) may help to prevent the development of atherosclerosis, one of the most common and costliest human diseases.

medical clearance, treadmill stress test

This treadmill stress test is looking for atherosclerotic heart disease, aka coronary artery disease and coronary heart disease

The article was published in 2006. In 2007, Harvard’s Dr. Frank Hu  was singing the same tune about carbohydrates. Jenny Brand-Miller and associates implicate high-glycemic-index carbohydrates as a cause of atherosclerotic heart disease in women, but I don’t recall any similar evidence in men. Yet.

I know many diabetics hate to cut dietary carbohydrates. If this new theory of atherosclerosis pans out, maybe carb restriction will be easier to stomach.

 

h/t Mangan

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Omega-3 Supplements Fail to Prevent Age-Related Cognitive Decline

Posted on September 16, 2013 | 4 comments
I like fish, but cold whole dead fish leave me cold

Consumption of omega-4 fatty acids, mainly from fish, is thought to prevent dementia and certain types of heart disease such as heart attacks and dangerous rhythm disturbances. For those who don’t like fish or can’t afford it, would taking omega-3 fatty acid supplements be just as effective?

Unfortunately, supplementation does not help prevent age-related cognitive decline and dementia, according to an article at MedPage Today.

The respected Cochrane organization did a meta-analysis of three pertinent studies done in several countries (Holland, UK, and ?).

The investigators leave open the possibility that longer-term studies—over three years—may show some benefit.

I leave you with a quote from the MedPage Today article:

And while cognitive benefits were not demonstrated in this review, Sydenham and colleagues emphasized that consumption of two servings of fish each week, with one being an oily fish such as salmon or sardines, is widely recommended for overall health benefits.

Consumption of cold-water fatty fish also helps return our dietary omega-6/omega-3 fatty acid ratio toward our ancestral level.

Steve Parker, M.D.

Reference:
Sydenham E, et al “Omega 3 fatty acid for the prevention of cognitive decline and dementia” Cochrane Database of Systematic Reviews 2012; DOI: 10.1002/14651858.CD005379.pub3.

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Heart Attacks Hinge on LDL Cholesterol Particle Number (LDL-P)

Posted on July 19, 2013 | 3 comments
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This treadmill stress test is looking for hidden heart disease

…according to Drs. Thomas Dayspring and James Underberg. I don’t know if these guys are right or not. I bet it’s more complicated than LDL particle number. I’m always skeptical of grand unification theories.

People with diabetes tend to have shorter life spans than average. One reason is a predisposition to heart disease, specifically coronary artery disease that leads to heart attacks.

Most heart attacks (aka myocardial infarctions) do indeed seem to be caused by acute rupture of an atherosclerotic plaque that’s been present for years. Two key questions are:

  1. What causes the plaque?
  2. Why causes it to rupture?

Underberg and Dayspring write:

The only absolute requirement for plaque development is the presence of cholesterol in the artery: although there are additional heart risk factors like smoking, hypertension, obesity, family history, diabetes, kidney disease, etc., none of those need to be present. Unfortunately, measuring cholesterol in the blood, where it cannot cause plaque, until recently has been the standard of risk-testing. That belief was erroneous and we now have much better biomarkers to use for CV risk-assessment. The graveyard and coronary care units are filled with individuals whose pre-death cholesterol levels were perfect. We now understand that the major way cholesterol gets into the arteries is as a passenger, in protein-enwrapped particles, called lipoproteins.

Particle entry into the artery wall is driven by the amount of particles (particle number) not by how much cholesterol they contain. Coronary heart disease is very often found in those with normal total or LDL-cholesterol (LDL-C) levels in the presence of a high LDL particle number (LDL-P). By far, the most common underlying condition that increases LDL particle concentration is insulin resistance, or prediabetes, a state where the body actually resists the action of the sugar controlling hormone insulin. This is the most common scenario where patients have significant heart attack risk with perfectly normal cholesterol levels. The good news is that we can easily fix this, sometimes without medication. The key to understanding how comes with the knowledge that the driving forces are dietary carbohydrates, especially fructose and high-fructose corn syrup. In the past, we’ve often been told that elimination of saturated fats from the diet would help solve the problem. That was bad advice. The fact is that until those predisposed to insulin resistance drastically reduce their carbohydrate intake, sudden deaths from coronary heart disease and the exploding diabetes epidemic will continue to prematurely kill those so afflicted.

***

 And for goodness’ sake, if you want to live longer, start reducing the amount of dietary carbohydrates, including bread, potatoes, rice, soda and sweetened beverages (including fruit juices), cereal, candy – the list is large).

Read the whole enchilada.

Offhand, I don’t recall any clinical study looking at LDL cholesterol particle number in folks who switched to a paleo diet. Given the prominence of coronary heart disease, I’m sure Dayspring and Underberg would favor a low-carb version of the paleo diet for anyone going the paleo route. Here’s my version of low-carb paleo.

Underberg and Dayspring don’t mention LDL particle size, such as small/dense and large/fluffy; the former are thought by many to be much more highly atherogenic, while the latter may not be at all. Is this idea outdated?

Whoever figures out the immediate cause of plaque rupture and how to reliably prevent it will win a Nobel Prize in Medicine.

Steve Parker, M.D.

About Dayspring and Underberg:

Thomas Dayspring MD, FACP, FNLA   Director of Cardiovascular Education, The Foundation for Health Improvement and Technology, Richmond, VA. Clinical Assistant Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School.

James Underberg MD, FACP, FNLA   Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School and the NYU Center for Cardiovascular Disease Prevention . Director of the Bellevue Hospital Primary Care Lipid Management Clinic.

h/t Dr. Axel Sigurdsson

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Do Vegetables and Fruits Prevent Disease?

Posted on June 29, 2013 | Comments Off on Do Vegetables and Fruits Prevent Disease?
Switching to the paleo diet often leads to increased vegetable and fruit consumption

Switching to the paleo diet often leads to increased vegetable and fruit consumption

Potential answers are in the American Journal of Clinical Nutrition (2012).  I quote:

For hypertension, coronary heart disease, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For inflammatory bowel disease, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

It bothers me that vegetables and fruits are lumped together: they’re not the same.

The paleo diet is unfairly characterized as meat-centric. It can certainly provide beaucoup vegetables and fruits. Diabetics should be careful which ones they choose, to avoid spikes in blood sugar.

Steve Parker, M.D.

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Scientific Reviews Support the Paleo Prescription for Potassium and Sodium

Posted on June 26, 2013 | Comments Off on Scientific Reviews Support the Paleo Prescription for Potassium and Sodium
A pinch of salt helps reduce bitterness in coffee

A pinch of salt helps reduce bitterness in coffee

Most of us have heard that reducing salt (sodium) intake is supposed to be good for us, although even that’s debatable. Fewer have heard that higher potassium may healthful. Those diet characteristics—low sodium and high potassium—are naturally incorporated into the Paleolithic diet (aka Stone Age, caveman, hunter-gatherer or paleo diet).

Read MedPageToday for details.

The association between sodium restriction and lower rates of cardiovascular disease and mortality is a confusing mess. My gut feeling is that strict sodium avoidance is important for only 20% of the population, at most.

But make no mistake: If I were on the cusp of drug therapy for high blood pressure, I’d cut my sodium to 3 grams a day, lose excess weight, increase my potassium consumption, and get regular exercise, all in an effort to avoid drugs. (If my blood pressure was 170/103 or higher, I’d go on drugs, make all those lifestyle changes, then try to reduce my drugs later.)

From MedPageToday:

However, the assertion that reduced salt intake will have beneficial effects on disease outcomes contradicts the results of a 2011 meta-analysis, which failed to show significant relationships between reduced salt intake and mortality or cardiovascular outcomes.

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Dr. Georgie Ede Defends Meat-Based Diets

Posted on April 7, 2013 | 2 comments

…in an interesting blog post on the health of traditional meat-eating cultures such as the Masai and Inuits.

Of the Canadian Eskimos of a century ago, Dr. Ede writes:

Their diets were therefore extremely low in fiber most of the time, and very high in animal protein and animal fat.  These traditional ways of eating would terrify the USDA, the American Heart Association, the American Cancer Society, not to mention the Harvard School of Public Health, which remains a staunchly anti-meat, anti-saturated fat, anti-cholesterol institution.  How in the world did these uninformed fringe types manage to get all their vitamins and minerals without the heaping helpings of colorful fruits, vegetables, and whole grains without which we are told we shall surely perish?

Weren’t they cancer-riddled, heart-clenching, constipated, fat slobs who died young from scary deficiency diseases like rickets and scurvy?

[Apparently not.]

…

This post was not designed to provide an airtight argument for meat and health, but I do hope that it has at least prompted those of you who remain skeptical about meat to rethink what you’ve been led to believe. If you’ve got a hankerin’ for more information about meat and health, take a look at my meat page.

Check it out.

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