Cholesterol-lowering foods even more cholesterol-lowering than first thought, but so what?

Posted May, Thu 24th, 2012
Dr John Briffa blog
www.drbriffa.com

Last year, I wrote a blog post about an advertorial which appeared in the Telegraph newspaper which featured the apparent effects Flora pro-activ drinks had on supposed ‘journalist’ Chris Jones’ cholesterol levels. I couldn’t trace Chris Jones, and although I was promised that her identity would be verified, this never happened. I did get an email purporting to know Chris Jones, but I’m afraid that won’t do.

But we’re getting side-tracked here, because the main issue for me is not whether Chris Jones exists or not, but the basis on which products like Flora pro-activ are marketed. In short, these and similar products (such as Benecol) contain ‘sterols’ or ‘stanols’ that block cholesterol absorption from the gut and can therefore lower blood cholesterol levels. Lowered cholesterol levels, we are led to believe, will help protect us against heart attacks and strokes. The marketing of products like Benecol and Flora pro.activ is based on these ideas.

But do these assumptions hold up to scrutiny? Do ‘beneficial’ changes in blood fat levels automatically lead to improved health? There’s plenty of evidence to suggest that the answer to this question is ‘no’. For example, here are five drugs or classes of drugs that have been found to ‘benefit’ blood fat levels, none of which have broad benefits for cardiovascular health, and some of which appear to damage health:

fibrates
resins
torcetrapib
ezetimibe
hormone replacement therapy

In fact, the only type of cholesterol-modifying drug that appears to improve cardiovascular outcomes are the statins. However, even these are pretty useless (see here for a recent blog post about this). Plus, questions have been raised about whether statins even exert their beneficial effects through cholesterol reduction. Statins have a number of different mechanisms of action in the body, including anti-inflammatory effects, which might account for their ability to reduce the risk of cardiovascular events. At least some supporting evidence for this idea comes in the form of studies which show that statins can reduce the risk of cardiovascular disease in people with normal or even low levels of cholesterol.

So, for me, the idea that products like Benecol and Flora pro.activ are good for the heart is not evidence-based. Oddly, even the PR representative (Clare Smith) for Flora pro.activ products seems to appreciate this when she comments after the original blog post that:

We absolutely agree that simply lowering cholesterol without making wider positive changes to one’s diet and lifestyle will not make a significant positive health impact.

The reason that I’m writing about this now is because I note that Raisio (manufacturer of Benecol range of foods) and Unilever (manufacturer of Flora pro.activ range of foods) have recently been petitioning the European Food Standards Agency (EFSA) regarding the claims that can be made over the cholesterol-lowering powers of their products. Previously, the claim was made that sterols and stanols can reduce LDL cholesterol by 7-10 per cent as part of a healthy diet. Now, EFSA is apparently happy with that claim be extended to say that these products can lower cholesterol ‘by up to 11.3 per cent’. You can read about this here.

So, these food conglomerates have managed to get the EFSA to up the stated maximum potency of these chemicals by 1.3 per cent (from 10.0 to 11.3 per cent). They’ve also managed to drop any reference to lower levels of benefit. And there’s no mention of average reductions either. Make no doubt about it, these food manufacturers here have done their level best to present their products’ effects in the best possible light.

And they’ve managed to do this by presenting the EFSA with new information, principally in the form of two ‘meta-analyses’ (grouping together of similar studies). These meta-analyses are not published, so you and I cannot read them. They have, most likely, been gathered together by employees of the food companies or ‘scientists’ in their pay. And it’s highly likely that the majority, if not all, of these studies was paid for by the food companies too. It’s well known that the source of funding can influence study design and influence results and how they are reported. Neither of these meta-analyses, by the way, will have been through the process of ‘peer review’ – the process by which researchers check studies for accuracy and veracity of their findings prior to publication.

But, all of this pales into insignificance when one considers the fact that there is simply no evidence that stanol- or sterol-enriched foods benefit health. We actually have some laboratory evidence that they may harm health. In fact, until 2010, sterol-enriched food products were banned in Canada because of concerns about their safety. So, when you see cholesterol-lowering foods being sold on the pretence of having benefits for health my advice is – don’t buy it.

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Higher protein diets proven better for a range of health measures

Posted by Dr John Briffa on Apr, Fri 20th, 2012

For some time now there has been debate in some nutritional circles about the relative merits of different ‘diets’. Certainly, there has been at least two factions here. One argues for a low-fat, high-carbohydrate diet which usually includes plenty of starchy carbohydrates such as bread, potato, rice, breakfast cereals and pasta. Others (including me) argue that all that carbohydrate is bad news for many people, and in general terms it helps to put more emphasis on fat and protein in the diet.

The Atkins and other similar diets have often been classed as ‘high-protein’ diets. Some believe them to be high-fat too. Actually, when individuals adopt such diet they don’t tend to eat much more in the way of protein or fat – they just eat less carbohydrate. So, while the percentage of protein and fat will generally go up, the absolute amount of these ‘macronutrients’ stays more-or-less the same.

One of the rationales for eating a diet relatively rich in protein is that it is the macronutrient which, calorie-for-calorie, sates the appetite most effectively. What appears to be true is that individuals who adopt this type of diet almost always spontaneously eat less (often, several hundred calories a day less). This may have something to do with protein, but it might also have something to do with fat (which many people find is important for sating the appetite properly). It might also have something to do with the better blood sugar stability these diets tend to afford, which will help guard against episodes of low blood sugar which can trigger ‘false hunger’ and food cravings (usually for carbohydrate).

There is also a theory that higher protein diets may assist weight loss through increased ‘thermogenesis’. After eating, the metabolism will generally enjoy a ‘boost’ – a bit like what happens when you put fuel on a fire. The thermogenic effect of protein is greater for protein then it is for carbohydrate or fat. The effect is not huge, but might help weight control (and other things) over time.

This week, the European Journal of Clinical Nutrition published a review of the impact of protein content on a range of health parameters. The study was a ‘meta-analysis’ – a pooling together of similar studies. In this case, the results of 74 studies were lumped in together. These studies varied quite a lot in design. For example, in some studies individuals were left to fend for themselves food-wise, while in others they were supplied with food. Meta-analyses seem like a good idea, but something the fact that they lump together quite-different studies can make it hard to draw firm conclusions. Also, as usual, there can be a gap between what the diet was designed to test and what it actually tested, because not all people are utterly compliant of course. Many will misreport (deliberately or unconsciously) what they ate too.

Anyway, leaving these issues aside, what did the review find.

Well, overall, the prescribed diets has these macronutrient compositions (percentage of calories contributed by each macronutrient):

Lower protein:

protein – 18 per cent
carbohydrate – 55 per cent
fat – 26 per cent

Higher protein:

protein – 27 per cent
carbohydrate – 38 per cent
fat – 32 per cent

The diets in which higher protein was prescribed led to significant improvements, compared to lower protein, in a range of parameters, including:

Weight
Waist circumference
Systolic blood pressure (the higher of the two blood pressure readings)
Diastolic blood pressure (the lower of the two blood pressure readings)
HDL cholesterol levels
Triglyceride levels
Fasting insulin levels
Satiety

No parameter measured was improved by the lower-protein diet.

Overall adverse effects was the same between groups, and there was no difference detected in terms of bone and kidney health (high-protein diets are often claimed to be ‘bad for the bones’ or kidneys though, actually, there is no evidence for this for health people).

In general terms, one would have to chalk this up as a win for higher-protein, lower-carbohydrate diets. But actually, the authors of this review were quite dismissive of the results. They tell us that: “Higher-protein diets probably improve adiposity, blood pressure and triglyceride levels, but these effects are small and need to be weighed against the potential for harms.”

First of all, why “probably”? Their own meta-analysis shows that higher-protein diets do indeed induce these changes. And the authors left some of the other benefits out too. But what’s this “potential for harms” all about? The meta-analysis actually found these diets to be as safe as lower-protein ones, overall, so what could they be referring to?

When authors’ conclusions don’t match their very own results it sometimes pays to look for potential conflicts of interest (this can help explain authors’ bias). Well it turns out that one of the study authors is an employee of Barilla – an Italian company that makes pasta. Two of the other authors received “grant support” from Barilla to conduct the review.

Now, the relative popularity of ‘high-protein’ diets has not been particularly good news for companies like Barilla, essentially because these diets are lower in carbohydrate, and specifically encourage restraint in the consumption of starchy ‘staples’ including pasta.

My suspicion (this is just speculation) is that Barilla decided to go looking for evidence which was unsupportive of higher-protein and lower-carbohydrate diets. If so, it seems Barilla’s efforts here back-fired a bit it seems, so what to do? How about pouring cold water on the clearly positive findings and refer to the “hazards” of higher-protein diets for which there is no evidence?

References:

1. Santesso N, et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr Epub 18th April 2012

Power 9 show you how to live longer through the specific lifestyle habits shared by the world’s longest living people

Power 9® show you how to live longer through the specific lifestyle habits shared by the world's longest living people. These lessons emphasize making changes to your environment that will influence your habits.
 
Move Naturally – Gain 4 Years

1. Just Move
The world's longest-lived people don't pump iron, run marathons or join gyms.  Instead, they live in environments that constantly nudge them into moving without thinking about it.  They live in places where they can walk to the store, to their friends house or places of worship, their houses have stairs, they have gardens in their yards.
Consider making things a little inconvenient.  Make that extra trip up or down the stairs instead of loading things at the top or bottom to take up later, walk to your airport gate instead of taking the moving walkway, park far from the entrance, walk a dog, do your own yard and house work, get rid of some the time saving electronics and power equipment that have "simplified" your life.
Right Outlook – Gain 4 Years

2. Purpose Now
Knowing your sense of purpose is worth up to seven years of extra life expectancy. The Okinawans call it "ikigai" and the Nicoyans call it "plan de vida;" for both it translates to "why I wake up in the morning."  Do an internal inventory. Be able to articulate your values, passions, gifts and talents.  What are the things you like to do and the things you don't? Then incorporate ways to put your skills into action.

3. Down Shift
Even people in the Blue Zones experience  stress.  Stress leads to chronic inflammation which is associated with every major age-related disease.  What the world's longest-lived people have that we don't are routines to shed that stress.  Okinawans take a few moments each day to remember their ancestors, Adventists pray, Ikarians take a nap and Sardinians do happy hour.  Find a stress shedding strategy that works for you and make it routine.
Eat Wisely – Gain 8 Years

4. 80% Rule
Marketers tell us we can eat our way to health.  America has been eating its way well beyond health.  Our strategy focuses on taking things out — instead of putting more things in — our diet.   "Hara hachi bu"  – the Okianawan, 2500-year old Confucian mantra said before meals reminds them to stop eating when their stomach is 80 percent full.  The 20% gap between not being hungry and feeling full could be the difference between losing weight or gaining it.  Serve food at the counter, store leftovers, then sit down to enjoy the meal. Replace your big dishes with 10" plates. Remove TV's from the kitchen.  People in the Blue Zones eat their smallest meal in the late afternoon or early evening and then they don't eat any more the rest of the day.

5. Plant Slant
Go ahead and eat meat if you want.  But consider it a condiment and try the leanest, finest meat you can afford. Try to limit it to a portion the size of a deck of cards and only twice per week.  Beans, including fava, black and soy and lentils are the cornerstone of most centenarian diets.  Snacking on nuts–about a handful a day has been associated with and extra 2-3 years of life expectancy.

6. Wine @ 5
Moderate drinkers outlive non-drinkers.  The trick is to drink 1-2 drinks per day (preferably Sardinian Cannonau wine), with friends and/or with food.  And no, you can't save up all weekend and have 14 drinks on Saturday.
Connect – Gain 4 Years

7. Belong
All but five of the 263 centenarians we interviewed belonged to some faith-based community.  It doesn't matter if you're Christian, Buddhist, Muslim, Jewish or some other religion that meets as a community.  Research shows that attending faith-based services four times per month will add 4-14 years of life expectancy.

8. Loved Ones First
Successful centenarians in the Blue Zones put their families first. This means keeping your aging parents and grandparents near by or in your home. (It lowers disease and mortality rates of children in the home too.) Work on being in a positive, committed relationship (which can add up to 3 years of life expectancy)  and invest in your children with time and love. (They'll be more likely to care for you when the time comes.)

9. Right Tribe
The world's longest lived people chose–or were born into–social circles that supported healthy behaviors,   Okinawans created "moais"–groups of five friends that committed to each other for life.  Research from the Framingham Studies show that smoking, obesity, happiness, and  even loneliness is contagious.   Assessing who you hang out with, and then proactively surrounding yourself with the right friends, will do more to add years to your life than just about anything else.

Leaky Gut Induces Visceral Obesity

From http://www.nleducation.co.uk/resources/abstracts/leaky-gut-induces-visceral-obesity/

From its dark days as a concept dismissed by most Drs and scientists as being suitable only for the more eccentric alternative medicine crowd, the idea that the gastrointestinal tract may have varying levels and quality of exclusionary capacity has slowly become mainstream-ish.

A paper out in the prestigious Nature Journal – Obesity, has raised the question that altered visceral adiposity – ‘fat around the middle’ may be initiated and promoted by altered barrier integrity.[1]

The author’s state:

Increased visceral fat, as opposed to subcutaneous/gluteal, most strongly relates to key metabolic dysfunctions including insulin resistance, hepatic steatosis, and inflammation. Mesenteric fat hypertrophy in patients with Crohn’s disease and in experimental rodent models of gut inflammation suggest that impaired gut barrier function with increased leakage of gut-derived antigens may drive visceral lipid deposition.

They confirm this via two groups of female subjects and conclude that in relation to visceral adiposity and metabolic syndrome that improving the quality of gut permeability may help in the management of these conditions.

Comment

Practitioner used to the functional medicine approach to patient management and well-being promotion have utilised this concept for over 20 years and have demonstrated many times that the reduction of antigen exposure via bacterial and food matter translocation across the delicate mucous membranes has a positive effect in many often diverse areas of symptomatology.

In part the resolution of barrier integrity has become a mainstay of the management of chronic non infectious diseases as well as the assistive resolution of post infectious dysbiotic changes to the bacterial mileau in the gut that either contributes to altered permeability or in some cases drives it.

Reference

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[1] Gummesson A, Carlsson LM, Storlien LH, Bäckhed F, Lundin P, Löfgren L, Stenlöf K, Lam YY, Fagerberg B, Carlsson B. Intestinal permeability is associated with visceral adiposity in healthy women. Obesity (Silver Spring). 2011 Nov;19(11):2280-2. doi: 10.1038/oby.2011.251. Epub 2011 Aug 18.

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Herbal Tea Recipes To Relieve A Cold

Some of nature's best natural remedies to keep the winter bugs at bay
are herbal teas that are made from common herbs that you may use in
cooking every day. Sage, thyme, oregano, and rosemary are herbs that
have all been used traditionally by herbalists in herbal tea recipes to
treat the symptoms of colds & flu.

These herbs contain strong essential oils that can potentially fight
against colds and flu. They are powerful antioxidants as well. So
instead of rushing out to buy expensive over the counter cold remedies
look in your garden or kitchen cupboard for the herbal cold cures.

Here are some herbal tea recipes:

Sage

Sage, whose Latin name salvia means to heal, was considered to be one of
four sacred plants by Native Americans . For irritations or inflammation
of the throat try gargling with a mixture of sage and apple cider
vinegar sweetened, if you must, with a little good quality honey or sip
a soothing hot infusion.

Recipe for a herbal tea infusion:

Pour a pint of boiling water onto 1oz of dried sage leaves or 1 tbsp of
fresh and leave for 5 - 10 minutes. Drink a small glassful of the
strained tea throughout the day. Sage can help to restore appetite as well.

Thyme

There are many varieties of thyme but common garden thyme will be
effective for helping you fight off sore throats and colds. Try it when
you have a cough or to clear mucus from your chest. It was once used on
bandages to prevent infection and is even reputed to be a hangover cure
and can lift your spirits.

Thymol the active ingredient in thyme is one of the strongest
antiseptics known. It has also been used to treat fungal problems such
as athletes' foot and is reputed to be a hangover cure.

Thyme herbal tea recipe:

Use 1 tsp of dried leaves or a couple of sprigs of fresh leaves for each
cup of boiling water. The time you leave it to infuse is a matter of
personal taste and can be from 5 - 15 minutes. Strain and slowly sip 3
cups a day inhaling the vapors until your symptoms improve. You can also
crush some fresh leaves gently in your hands and inhale the vapors.

Oregano

Oregano also known as pot marjoram has a high thymol content too. It is
one of Nature's most powerful natural health remedies against bacteria,
viruses, yeast and fungi and has been used as a natural herbal remedy
since ancient times. It can be used to treat sore throat, coughs and
colds as as well as loosening phlegm in the bronchial tubes.

Oregano is used extensively in cooking throughout the Mediterranean
especially as an ingredient of pizza and combines well with thyme and
rosemary.

Oregano herbal tea recipe:

Infuse 1 tsp dried oregano or 3 tbsp fresh leaves in 8 oz boiling water
for 10 minutes, strain and sweeten with a little good quality honey if
wanted.

Rosemary

Rosemary or Rosmarinus officinalis is related to the mint family of
plants and is one of the oldest Mediterranean aromatic shrubs in
cultivation. With it's attractive leaves and pretty blue flowers it is a
favorite for kitchen gardens.

Rosemary tea can help bring relief for colds, catarrh, wheezing and
bronchitis clearing phlegm from the chest. good as a gargle for a sore
throat. Infuse sage with rosemary and use as a gargle for a sore throat.

Rosemary herbal tea recipe:

Use 2 tsp of dried rosemary to a cup of boiling water. The addition of
fresh ginger root and lemon peel makes this a delicious healthy herbal
drink.

Here is the recipe:

1 small bunch of rosemary, leaves gently bruised with a spoon.
1 inch thumb of ginger, sliced into rounds
The peel of two unwaxed or organic lemons
6-8 cups of boiling water

Place the rosemary, ginger and lemon peel in a large teapot. Add the
boiling water and leave to infuse for approximately five minutes. Strain
and sip slowly. You can add a little good quality honey or stevia if you
need to sweeten.

While modern medicine is still searching for a cure for a cold the
history of healing herbs goes back thousands of years. Give these herbal
tea recipes a try next time you are trying to shake off the winter bugs.

Posted Dec 20 2008 6:50pm on
http://www.wellsphere.com/complementary-alternative-medicine-article/herbal-tea-recipes-to-cure-a-cold/537003

Preliminary Study Shows Fish Oil Favourably Affects Prostate Cancer Cells

From Nutri Newsletter, Jan 3 2011

A new study, published in Cancer Prevention Research has found that a low fat diet supplemented with fish oil may help to slow the growth of prostate cancer cells compared to a traditional high-fat Western diet.

In the study, 48 men undergoing prostatectomy were randomly assigned to receive either a low fat diet with 5g fish oil daily – a dietary omega 6: omega 3 ratio of 2:1, or a control Western diet, with an omega 6: omega 3 ratio of 15:1, for 4 – 6 weeks prior to the operation.

The researchers found that:

• Although serum markers of prostate cancer were unaltered, the fish oil supplementation reduced benign and malignant prostate tissue omega 6: omega 3 ratios and was shown to reduce and slow cell growth proliferation in vivo.
  
  
• Results also showed that blood from patients receiving fish oil slowed the growth of prostate cancer cells in vivo when compared to blood from men assigned to the Western diet, which did not slow cancer growth.
  

Study author, Dr William Aronson commented, “The finding that the low-fat, fish oil diet reduced the number of rapidly dividing cells in the prostate cancer tissue is important because the rate at which the cells are dividing can be predictive of future cancer progression.”

“The lower the rate of proliferation, the lesser the chances that the cancer will spread outside the prostate, where it is much harder to treat.”

He added, “You truly are what you eat, we are extremely pleased about our findings, which suggest that by altering the diet, we may favourably affect the biology of prostate cancer.”

The researchers added that because of the short duration and small sample size of the study, further research was needed before dietary changes could be fully recommended.  A larger study following 100 men over the course of a year is now planned.

by Rachel Bartholomew Dip ION MBANT

 

References:

Cancer Prevention Research
Published online ahead of print, doi: 10.1158/1940-6207.CAPR-11-0298
Aronson, W.J. Kobayashi, N. et al. Phase II Prospective Randomised Trial of a Low-Fat Diet with Fish Oil Supplementation in Men Undergoing Radical Prostatectomy

Prevent a Heart Attack: Know Your Triglyceride/HDL Ratio

The published evidence is quite clear in documenting that the actual total cholesterol level itself is not the most important risk factor of cardiovascular disease.

 

It is the ratio between the level of HDL-"good" cholesterol and total cholesterol that we need to be concerned about.

 

Therefore, in adults, the HDL-"good" cholesterol/total cholesterol ratio should be higher than 0.24 (just divide your HDL level by your cholesterol).

 

Or more precisely, the HDL/total cholesterol ratio:

• 0.24 or higher is considered ideal
• under 0.24 - low
• less than 0.10 - very dangerous.

Generally speaking, the higher the ratio, the better (the lower your risk of a heart attack).

 

However, HDL is closely related to triglycerides. 

 

It appears common for people with high triglycerides to have low HDL's, and these same people also tend to have high levels of clotting factors in their blood stream, which is unhealthy in protecting against heart disease.

Therefore, in adults, the triglyceride/HDL-"good" cholesterol ratio should be below 2  (just divide your triglycerides level by your HDL).

 

Or more precisely, the triglyceride/HDL ratio:

• 2 or less is considered ideal
• 4 - high
• 6 - much too high

And, since HDL (high density lipoprotein) is protective against heart disease, the lower the ratio, the better. In other words, the lower your triglycerides, or the higher your HDL, the smaller this ratio becomes.

 

It is now believed that the triglycerides/HDL ratio is one of the most potent predictors of heart disease. 

 

A Harvard-lead study author reported:

 

"High triglycerides alone increased the risk of heart attack nearly three-fold.

And people with the highest ratio of triglycerides to HDL -- the "good" cholesterol -- had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.

The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio (Circulation 1997;96:2520-2525)."

 

 

Taken from http://www.functionalmedicineuniversity.com/public/796.cfm on Jan 3 2011.