In The News: Cardiovascular Precociousness

Troubling news courtesy of the latest National Health and Nutrition Examination Survey: "overweight children as young as age 3 can begin to show signs of cardiovascular disease risk factors."

Yikes.

The study specifically analyzed levels of HDL ("good") cholesterol and C-reactive protein (an inflammation marker that accurately predicts cardiovascular disease) in 3,098 children between the ages of 3 and 6.

Results? Low HDL and high C-reactive protein levels were found in children with high BMIs and large waist circumferences.

This is particularly disturbing since 24 percent of children in the United States between the ages of 2 and 5 are overweight, and 12 percent classify as obese.

Additionally, while it is common knowledge that heart disease is a "pediatric" disease in the sense that the damage often begins in childhood, many people don't see clinical markers until later in life. This certainly begs for a different viewpoint.

One also can't help but wonder about possible health consequences when obesity begins as early as age three.

You Ask, I Answer: Hydrogenated/Interesterified Fats

Thanks for explaining all about trans fats.

I have a question, though.

I have recently seen hydrogenated oils on Crisco food labels (not "partially hydrogenated", but "hydrogenated".)

Are these also trans fats?

-- Patrick Altug
Boulder, CO

No, they are not.

Whereas the partial hydrogenation of a liquid oil transforms its chemical structure in such a way that yields a solid, yet pliable texture (i.e.: easy to spread on toast,) full hydrogenation results in a solid mass that you can't do much with.

So, in an attempt to remove trans fat from their formulations, many products will interesterify fats.

In this process, solid oils and liquid oils are combined in vats, hydrogenated, broken down to their most basic form (triglycerides) and later manipulated/reconstructed in order to to achieve a desired consistency.

Unfortunately, these fats come at a price.

Recent research studies in the United Kingdom and Malaysia have found that interesterified fats decrease HDL ("good" cholesterol), raise blood sugar, and, perhaps more worrying, suppress the secretion of insulin.

Why the worry?

Raising blood sugar while lowering levels of insulin (the hormone that moves glucose out of the bloodstream and into cells) is certainly a rather powerful risk factor for the development of Type 2 diabetes.

Although many people roll their eyes at this bit of news and often make statements like, "Are these dietitians EVER satisfied with anything? If it's not trans fats, it's something else," there is an important lesson in all of this -- stick with unadulterated fats!

Whether partially or fully hydrogenated, those fat molecules have been chemically altered.

A diet rich in minimally processed foods (whole grains, vegetables, fruits, lean protein, and heart-healthy fats) won't include either type of hydrogenated oils.

Numbers Game: Answer

After controlling for confounding variables, the HDL (protective cholesterol) levels of women who smoke a pack of cigarettes a day are, on average, 17 percent lower than those of their non-smoking counterparts.

Source: The National Heart, Lung, and Blood Institute Family Heart

"Controlling for confounding variables" means that, in this study, cigarette smoking was isolated as a singular factor.

Although it is common knowledge that smoking contributes to atherosclerosis (hardening of the arteries), its HDL cholesterol-lowering properties are not as widely publicized.

The best news? As the Harvard Medical School so effectively summarizes it, "every 1% increase in HDL is associated with a 1%–3% reduction in heart attack risk."

Numbers Game: Pack Attack

After controlling for confounding variables, the HDL (protective cholesterol) levels of women who smoke a pack of cigarettes a day are, on average, _________ lower than those of their non-smoking counterparts.

Source: The National Heart, Lung, and Blood Institute Family Heart Study

a) 25
b) 8
c) 17
d) 10

Leave your guess in the "comments" section and come back on Friday for the answer.

In The News: For A Healthy Heart, Watch Your Waist

Tim Russert's death last week was shocking on many levels.

From a health standpoint, the NBC news anchor -- who had been diagnosed with coronary artery disease -- certainly didn't appear to be a high-risk patient.

He didn't have any troubling symptoms and, as The New York Times reports, "he was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight."

Pay special attention to the last six words of that quote.

As much as Mr. Russert was medicated and his LDL cholesterol was kept in check, the main risk factor here was, simply, his weight.

Dr. Michael A. Newman, Mr. Russert's internist, tells the Times that “if there’s one number that’s a predictor of mortality, it’s waist circumference.”

Thank you, thank you, thank you.

This is why weight control is at the pinnacle of health promotion.

It's simple. Plenty of evidence supports that when overweight people reduce those excess pounds, they also lower the risk and prevalence of a variety of diseases, including diabetes, certain cancers, and heart disease.

What is frightening is that many people with heart disease appear to incorrectly think that taking cholesterol-lowering medications are "sufficient," forgetting that reaching their desirable body weight is crucial.

Also, although many cardiologists -- and their patients -- become fixated on lowering LDL's (the "bad" cholesterol), many of them forget that increasing HDL's (protective, "good" cholesterol) is just as important.

In Mr. Russert's case, autopsy findings revealed that his HDL figures were low.

The procedure also concluded that there were "significant blockages in several coronary arteries."

This is why heart disease, in my opinion, should be in parents' minds as they help develop their children's eating habits.

These conditions develop over decades. Mr. Russert's health was not the product of the last 5 years, but of 25, 30, 35 years of consistent dietary patterns.

Many people often comment that nutrition and health are complicated subjects, full of rules, numbers, facts, and figures.

However, the best dietary advice is usually quite simple. In my case, one of the best recommendations I can make is to always be mindful of your ideal body weight and stay as close to it (no more than 5% above or below) as possible while consuming little junk food.

Survey Results: Nutrition Labels, Part Deux

The latest Small Bites survey asked readers what values they paid most attention to when reading food labels.

The most important figure on a label relates to calories per serving -- at least that's how seventy-five percent of respondents voted.

The ingredients list (32%), fiber content (30%), and serving size (29%) also received a good deal of votes.

While saturated fat was considered important by 23% of readers, total fat content received a significant 40% of votes.

I'm not too sure why this is the case.

Fat content in and of itself doesn't tell us much about the food that we can't already gauge by taking a look at calories per serving (since fat contributes 9 calories per gram, foods with higher fat contents provide more calories than lower-fat ones).

If you only look at total fat values, wonderfully healthy foods like guacamole or walnuts appear no different than brownies or ice cream sandwiches.

When it comes to fat content, saturated fat (and trans fat, although once food companies were mandated to display trans fat figures on their products they miraculously found new trans-fat-free formulas for their products) is the value to keep your eye on.

Remember, high intakes of saturated fat are linked to higher risks of heart disease and a decrease in HDL (or "good") cholesterol.

Guacamole, though, is mostly composed of monounsaturated fats (the kind that help lower LDL -- or "bad" -- cholesterol).

This is why fat content -- without a more specific breakdown -- isn't an appropriate factor to base food purchases on (unless, as previously mentioned, you are trying to gauge calories).

I was surprised to see that vitamin and mineral values are largely considered irrelevant. Only 5 percent of respondents consider vitamin content to be important, and a measly 4 percent feel that way about mineral figures.

A huge thank you to those of you who took a minute to participate!

Please leave comments and thoughts on the results in the "comments" section.

You Ask, I Answer: Cholesterol

No one can explain WHY cholesterol builds up in our arteries around the heart and not in other veins in the body - after all aren't they all the same thing, just different sizes?

There is a growing body of evidence to suggest that cholesterol is actually a healing agent - cholesterol is building up at points in the arteries because they are DAMAGED.

Why are they damaged? What causes this damage in the arteries?

If cholesterol is viewed as a healing agent to heal the damage points in the arteries, then the risk levels associated with high total cholesterol levels seems to diminish, if not disappear.

There is also a growing body of evidence to suggest that LOW cholesterol levels in the body is a risk factor for cancers and other diseases since the body is depleted of cholesterol as a healing agent.

Interested in your views on this.

-- David (last name unknown)
Via the blog

Great questions, David. Let’s take them one at a time.

Since this answer involves the nitty gritty, and often convoluted, world of nutritional biochemistry, I will try my hardest to make it easy to follow.

Let’s start at the beginning.

You are right; cholesterol is absolutely necessary.

We need it for arterial protection as well as vitamin D synthesis and the production of hormones, including testosterone and estrogen.

However, cholesterol is not essential. If we were never to get it from our diet it wouldn’t be an issue because our body produces it.

Just like with vitamins and minerals, though, a certain amount is beneficial and health-promoting, but excess amounts are detrimental.

The large majority of cholesterol is produced in the liver.

Since cholesterol is not water soluble, it can not freely travel to other tissues through the blood.

Remember, cholesterol needs to be transported to other tissues so it can help repair membranes and aid in hormone production and vitamin D synthesis.

Instead, it has different “cars” to choose from.

These “cars” are called lipoproteins. As the name states, they are proteins that carry lipids (fats) inside of them.

The two most famous lipoproteins are HDL (high-density lipoprotein, commonly referred to as ‘good cholesterol’) and LDL (low-density lipoprotein, commonly referred to as ‘bad cholesterol’).

What determines whether a lipoprotein is high or low in density is the amount of cholesterol it contains in relation to its protein content.

Low-density lipoproteins carry lots of cholesterol.

As low-density lipoprotein travels through the blood, it looks for LDL receptors (since we are using the car analogy, think of LDL receptors as designated parking spaces or garages).

In the same way that you can’t park your car where you please, LDL receptors can’t drop off cholesterol wherever they please.

It just so happens that one of the main sites of LDL receptors – other than the liver -- is coronary ("heart") artery endothelial tissue.

There's more.

Just like a parking garage has a “maximum capacity”, LDL receptors can only take up so much cholesterol.

Once LDL finds appropriate receptors, the liver knows to stop producing LDL.

Here's another twist.

High intakes of saturated fat decrease the number of LDL receptors.

A lack of receptors consequently increases hepatic (liver) production of LDL.

In turn, more LDL floats around in the blood, having nowhere to go.

High amounts of LDL in the blood have a propensity to build up in the inner walls of damaged arteries that feed into the heart and brain.

Why do arteries get damaged in the first place?

That is something that isn’t entirely known, but the main theories are cigarette smoke, high blood pressure, and high triglyceride levels.

For some reason, coronary arteries are more susceptible to damage.

When there is damage to an artery wall, LDL deposits, coalesces into liquid droplets, and becomes oxidized.

Macrophages (a type of white blood cell) take in the cholesterol and form fatty streaks.

As time goes on, more LDL collects, and the area grows in size.

Smooth muscle cells begin slipping into the area, forming a cap over the deposited LDL. This cap is what we know as plaque (the yellow substance you see in the photo accompanying this post; notice how clogged that artery is!).

With time, the cholesterol crystallizes, calcium starts to deposit at the area, and the vessel becomes rigid, thereby blocking blood flow.

Here’s another twist.

HDL (“good cholesterol”) can also bind to these LDL receptors.

This is why increasing your HDL levels (through exercise, consuming monounsaturated fats and soluble fiber, not smoking, and eliminating trans fat consumption) is so crucial.

Not only does HDL transport excess cholesterol back to the liver for excretion (via bile acids), it also -- and this is crucial -- prevents macrophages from engulfing LDL and saves LDL from oxidation (and thereby reducing plaque formation).

Thus, if not genetically predisposed to high cholesterol (due to insensitive LDL receptors), the healthier your diet and lifestyle, the higher your HDL -- and the more protection against plaque you have.

Research has provided strong evidence that weight loss itself increases HDL levels!

Hope this has shed some light on your questions.

Numbers Game: Answer

A 2007 Internet survey of 20,000 adults in the United States by the National Lipid Association found that three percent were able to identify the desired values for total cholesterol, HDL ("good") cholesterol and triglycerides.

A shockingly low figure.

I'm willing to bet that the remaining ninety-seven percent not only do not know what ideal values they should have, but are also unaware how nutrition affects those numbers!

As far as figures go, when it comes to total cholesterol, you want to be at less than 200 mg/dL.

A number between 200 and 239 is considered a moderate risk (this risk is lowered if the number is a result of low 'bad' cholesterol -- LDL -- and very high 'good' cholesterol -- HDL), and anything over 240 significantly increases your risk of developing coronary heart disease.

Moving on to HDL ('good cholesterol', which sucks up cholesterol in the body and transports it to the liver for processing), a value of at least 60 mg/dL is required for it to serve as a protective force against heart disease.

Anything below 40 men and 50 for women is considered low and another risk factor for coronary heart disease.

Although triglycerides are a lipid, high values are linked with excessive intake of refined carbohydrates (processed flours, sugar, etc.)

Anything below 150 mg/dL is great, while a number between 150 and 199 should raise the "Caution!" flag.

Triglyceride levels are considered high at anywhere between 200 and 499 mg/dL, and anything above 500 is cause for serious concern.

All-Star of the Day: Peanuts

Although almonds often take the “super nut” title, the peanut also needs to be recognized for its tremendous health benefits.

Peanuts are an excellent source of heart-healthy monounsaturated fats, the same ones that make olive oil and salmon such powerfoods. Remember, diet high in monounsaturated fats and low in saturated fats has been proven to reduce the risk of cardiovascular disease by as much as 20 percent. “Low-fat” is not the answer; “smart fat” is!

An ounce of peanuts contains 164 calories, 7 grams of protein, 10 percent of our daily folate recommendation, 29 percent of our managenese needs, and 19 percent of our suggested niacin (vitamin B-3) intake.

Although those figures themselves might not be groundbreaking, peanuts’ antioxidant level is extremely high, rivaling that of many fruits.

In fact, resveratrol (the antioxidant found in grapes -- and, thus, red wine -- that boasts tremendous heart-healthy properties) is found in significant quantities in peanuts!

A plant compound known as beta-sitosterol also exists naturally in peanuts, and recent research links it to reductions in rates of breast and prostate cancer.

A 10-year study in Taiwan involving over 20,000 subjects (published in the January 2006 issue of the World Journal of Gastroenterology) found that the average participant who ate an ounce of peanuts twice a week lowered their risk of colon cancer by 34 percent!

Additionally, studies at Pennsylvania State University’s nutrition department found that regular consumption of foods high in monounsaturated fats -- such as peanuts -- lowered triglycerides while keeping heart-healty HDL cholesterol stable, whereas a low-fat diet LOWERED HDL levels.

Yes, peanuts are high in fat (one ounce provides 14 grams of fat), but this has proven to be a positive attribute.

Studies at Harvard, Penn State, and even countries like Israel and Papua New Guinea all came to the same conclusion. When subjects were allowed to eat an ounce of peanuts as a snack twice a day, they reported feeling fuller and therefore eating less total calories a day!

So, yes, you can most certainly enjoy peanut butter as a grown adult. However, be sure to buy “natural” peanut butter (Smuckers is my favorite). The ingredients? Just two – peanuts and salt.

Most conventional peanut butter adds “partially hydrogenated oils” (the always evil trans-fats) and added sugars, which turn this all-star into a fallen celestial body.

Simply Said: Cholesterol (Part 2)

Part One introduced the main concept; now let's talk figures. If you have your last bloodwork results handy, pull them out before continuing.

When it comes to total cholesterol, you ideally want a number below 200. If you are between the 200 and 240 mark, you are in the "caution" zone. Anything above 240 is cause for concern.

When it comes to HDL (the "good cholesterol" that takes extra cholesterol lingering around in places where it shouldn't be back to the liver for processing), you want as high a number as possible. Anything below 40 is low (and indicates a higher risk of developing heart disease), whereas a number between 40 and 60 is OK. For maximum heart-healthy benefits, though, you want a number above 60.

Onto the "bad cholesterol" (LDL). You definitely want this low, since high numbers up the risk of heart attacks and strokes.

Less than 100? Perfection! Between 100 and 130? You're still in safe territory. If you are between 130 and 160, consider yourself warned. If between 160 and 190, you are just a few numbers away from real trouble. If your LDL is above 190, this is a threat to your cardiovascular health that needs to be addressed.

Simply Said: Cholesterol (Part 1)

Welcome to yet another new section of the Small Bites blog. "Simply Said" will help you understand confusing or overwhelming nutrition topics.

We begin with cholesterol. Our livers and cells produce about 80% of our body's cholesterol, a precursor to hormones like estrogen and testosterone and necessary for producing vitamin D out of the sunlight that hits our skin. That being said, cholesterol is not essential (meaning it is not necessary to get additional amounts from our diet).

There are four types of cholesterol, but the two you want to think about are low density (LDL) and high density (HDL). The four variations combined make up what is known as your total cholesterol.

LDL is the bad (or "lame") cholesterol. What's so bad about it? Well, the higher your LDL cholesterol, the higher your risk of strokes, heart attacks, and blood clots.

Why is this? LDL cholesterol ends up being deposited on the walls of our arteries, where it turns into hard plaque and restricts bloodflow.

HDL is the good (or "healthy") cholesterol that helps prevent plaque deposits by taking them to the liver for processing and removal when it spots them.

If your body were a town, LDL would be the litterbugs and HDL would be the sanitation workers.

Now, it is true that genes play a somewhat significant role in this. Some people -- no matter how healthy they eat -- have high levels of LDL, while others can go through life eating junk and still boast high HDL numbers.

Although the drug companies would love for all us to be on statins (cholesterol-lowering medication), the majority of us are in that middle area where our cholesterol profiles can be modified by diet.

Let's get this straight once and for all. It is not cholesterol in foods that raises our bad cholesterol, but saturated fat, found only in animal products (except those that are non-fat). So, when a package of bread boasts a "cholesterol-free" label on it, you can reply back, "well, duh!" and dismiss it as semi-dishonest marketing rather than groundbreaking nutritional information.

So how do you lower cholesterol? Physical activity is a must, but when it comes to food, your best weapon is soluble fiber (found in fruits, vegetables, nuts, and oatmeal), which bundles up and flushes out excess cholesterol.

(Note: physical activity does not have to mean a busy gym or loud spinning class. Simply increasing the distance you walk every day is enough to have an effect on your cholesterol levels).

Back to the nutrition factor. Going low-fat is NOT the answer to lowering your cholesterol. Rather, you want to go smart-fat. Monounsaturated fats (found in olive oil, walnuts, almonds, hazelnuts, sunflower seeds, avocados, and flaxseed) are helpful at maintaining our good cholesterol levels (a low-fat diet can actually lower it). Remember, the goal isn't just to lower bad cholesterol, but to increase the good one, too.

Tomorrow we'll finish up this segment with some numbers to help you make sense of your next blood lab results.