Tags Posts tagged with "Heart Disease"

Heart Disease

The effects of high sodium are insidious

By David Dunaief, M.D.

Dr. David Dunaief

By now, most of us have been hit over the head with the fact that too much salt in our diets is unhealthy. Still, we respond with “I don’t use salt,” “I use very little,” or “I don’t have high blood pressure, so I don’t have to worry.” Unfortunately, these are myths. All of us should be concerned about salt or, more specifically, our sodium intake.

Excessive sodium in the diet does increase the risk of high blood pressure (hypertension); the consequences are stroke or heart disease. Approximately 90 percent of Americans consume too much sodium (1).

Now comes the interesting part. Sodium has a nefarious effect on the kidneys. In the Nurses Health Study, approximately 3,200 women were evaluated in terms of kidney function, looking at the estimated glomerular filtration rate (GFR) as related to sodium intake (2). Over 14 years, those with a sodium intake of 2,300 mg had a much greater chance of an at least 30 percent reduction in kidney function, compared to those who consumed 1,700 mg per day.

Why is this study important? Kidneys are one of our main systems for removing toxins and waste. The kidneys are where many initial high blood pressure medications work, including ACE inhibitors, such as lisinopril; ARBs, such as Diovan or Cozaar; and diuretics (water pills). If the kidney loses function, it may be harder to treat high blood pressure. Worse, it could lead to chronic kidney disease and dialysis. Once someone has reached dialysis, most blood pressure medications are not very effective.

Ironically, the current recommended maximum sodium intake is 2,300 mg per day, or one teaspoon, the same level that led to negative effects in the study. However, Americans’ mean intake is twice that level.

Excessive sodium in one’s diet can increase the risk of high blood pressure, which can lead to a stroke or heart disease. Stock photo

If we reduced our consumption by even a modest 20 percent, we could reduce the incidence of heart disease dramatically. Current recommendations from the American Heart Association indicate an upper limit of 2,300 mg per day, with an “ideal” limit of no more than 1,500 mg per day (3).

If the salt shaker is not the problem, what is? Most of our sodium comes from processed foods, packaged foods and restaurants. There is nothing wrong with eating out on occasion, but you can’t control how much salt goes into your food. My wife is a great barometer of restaurant salt use. If food from the night before was salty, she complains of not being able to get her rings off.

Do you want to lose 5 to 10 pounds quickly? Decreasing your salt intake will allow you to achieve this goal. Excess sodium causes the body to retain fluids. 

One approach is to choose products that have 200 mg or fewer per serving indicated on the label. Foods labeled “low sodium” have fewer than 140 mg of sodium, but foods labeled “reduced sodium” have 25 percent less than the full-sodium version, which doesn’t necessarily mean much. Soy sauce has 1,000 mg of sodium per tablespoon, but low-sodium soy sauce still has about 600 mg per tablespoon. Salad dressings and other condiments, where serving sizes are small, add up very quickly. Mustard has 120 mg per teaspoon. Most of us use far more than one teaspoon of mustard. Caveat emptor: Make sure to read labels on all packaged foods very carefully.

Is sea salt better than table salt? High amounts of salt are harmful, and the type is not as important. The only difference between them is slight taste and texture variation. I recommend not buying either. In addition to the health issues, salt tends to dampen your taste buds, masking the flavors of food.

If you are working to decrease your sodium intake, become an avid label reader. Sodium hides in all kinds of foods that don’t necessarily taste salty, such as breads, soups, cheeses and salad dressings. I also recommend getting all sauces on the side, so you can control how much — if any — you choose to use.

As you reduce your sodium intake, you might be surprised at how quickly your taste buds adjust. In just a few weeks, foods you previously thought didn’t taste salty will seem overwhelmingly salty, and you will notice new flavors in unsalted foods.

If you have a salt shaker and don’t know what to do with all the excess salt, don’t despair. There are several uses for salt that are actually beneficial. According to the Mayo Clinic, gargling with ¼ to ½ teaspoon of salt in eight ounces of warm water significantly reduces symptoms of a sore throat from infectious disease, such as mononucleosis, strep throat and the common cold. Having had mono, I can attest that this works.

Remember, if you want to season your food at a meal, you are much better off asking for the pepper than the salt.

References:

(1) cdc.gov. (2) Clin J Am Soc Nephrol. 2010;5:836-843. (3) heart.org.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Different types of exercise have different impacts

By David Dunaief, M.D.

Dr. David Dunaief

Mild cognitive impairment (MCI) is one of the more common disorders that occurs as we age. But age is not the only determinant. There are a number of modifiable risk factors. MCI is feared, not only for its own challenges but also because it may lead to dementia, with Alzheimer’s disease and vascular dementia being the more common forms. Prevalence of MCI may be as high as one-in-five in those over age 70 (1). It is thought that those with MCI may have a 10 percent chance of developing Alzheimer’s disease (2).

Since there are very few medications presently that help prevent cognitive decline, the most compelling questions are: What increases risk and what can we do to minimize the risk of developing cognitive impairment? These are the important questions.

Many chronic diseases and disorders contribute to MCI risk. These include diabetes, heart disease, Parkinson’s disease and strokes. If we can control these maladies, we may reduce the risk of cognitive decline. This involves making lifestyle modifications such as exercise and diet. We know that we can’t stop aging, but we can age gracefully.

Heart disease’s impact

Although we have made great strides, heart disease continues to be prevalent in America. In an observational study, results demonstrated that those suffering from years of heart disease are at a substantial risk of developing MCI (3). The study involved 1,450 participants who were between the ages of 70 and 89 and were not afflicted by cognitive decline at the beginning of the study. Patients with a history of cardiac disease had an almost two times greater risk of developing nonamnestic MCI, compared to those individuals without cardiac disease. Women with cardiac disease were affected even more, with a three times increased risk of cognitive impairment.

Nonamnestic MCI affects executive functioning — decision-making abilities, spatial relations, problem-solving capabilities, judgments and language. It is a more subtle form of impairment that may be more frustrating because of its subtlety. It may lead to vascular dementia and may be a result of clots. This gives us yet another reason to treat and prevent cardiac disease.

Stroke location vs. frequency

Not surprisingly, stroke may have a role in cognitive impairment. Stroke is also referred to as a type of vascular brain injury. But what is surprising is that in a study, results showed that the location of the stroke was more relevant than the frequency or the multitude of strokes (4). If strokes occurred in the cortical and subcortical gray matter regions of the brain, executive functioning and memory were affected, respectively. Thus, the locations of strokes may be better predictors of subsequent cognitive decline than the number of strokes. Clinically silent strokes that were found incidentally by MRI scans had no direct effect on cognition, according to the authors.

Exercise’s effects

Studies have shown that aerobic exercise improves brain function. Stock photo

Exercise may play a significant role in potentially preventing cognitive decline and possibly even improving MCI in patients who have the disorder. Interestingly, different types of exercise have different effects on the brain. Aerobic exercise may stimulate one type of neuronal development, while resistance training or weight lifting another.

In an animal study involving rats, researchers compared aerobic exercise to weight lifting (5). Weight lifting was simulated by attaching weights to the tails of rats while they climbed ladders. Both groups showed improvements in memory tests, however, there was an interesting divergence.

With aerobic exercise, the level of the protein BDNF (brain-derived neurotrophic factor) increased significantly. This is important, because BDNF is involved in neurons and the connections among them, called synapses, related mostly to the hippocampus, or memory center. The rats that “lifted weights” had an increase in another protein, IGF (insulin growth factor), that promotes the development of neurons in a different area of the brain. The authors stressed the most important thing is to exercise, regardless of the type.

In another study that complements the previous study, women were found to have improved spatial memory when they exercised — either aerobic or weight lifting (6). Interestingly, verbal memory was improved more by aerobic exercise than by weight lifting. Spatial memory is the ability to recall where items were arranged, and verbal memory is the ability to recall words. The authors suggest that aerobic exercise and weight lifting affect different parts of the brain, which corroborates the animal study findings above.

This was a randomized controlled trial that was six months in duration and involved women, ages 70 to 80, who had MCI at the trial’s start. There were three groups in the study: aerobic, weight lifting and stretching and toning. Those who did stretches or toning alone experienced deterioration in memory skills over the same period.

Here is the catch with exercise: We know exercise is valuable in preventing disorders like cardiovascular disease and cognitive decline, but are Americans doing enough? A Centers for Disease Control and Prevention report claims the majority of the adult population is woefully deficient in exercise: Only about 1 in 5 Americans exercise regularly, both using weights and doing aerobic exercise (7).

Diet’s effects

Several studies show that the Mediterranean diet helps prevent MCI and possibly prevents conversion from MCI to Alzheimer’s (8, 9). In addition, a study showed that high levels of carbohydrates and sugars, when compared to lower levels, increased the risk of cognitive decline by more than three times (5). The authors surmise that carbohydrates have a negative impact on insulin and glucose utilization in the brain.

Cognitive decline is a disorder that should be taken very seriously, and everything that can be done to prevent it should be utilized. Though the number of Americans exercising regularly is woefully deficient, the silver lining is that there is substantial room for improvement. Exercise has potentially positive effects on neuron growth and development. We need more campaigns like the NFL’s Play 60, which entices children to be active at least 60 minutes every day, but we also need to target adults of all ages. Let’s not squander the opportunity to reduce the risk of MCI, a potentially life-altering disorder.

References: (1) Ann Intern Med. 2008;148:427-434. (2) uptodate.com. (3) JAMA Neurol. 2013;70:374-382. (4) JAMA Neurol. 2013;70:488-495. (5) J Alzheimers Dis. 2012;32:329-339. (6) J Aging Res. 2013;2013:861893. (7) Morb Mortal Wkly Rep. 2013;62:326-330. (8) Neurology 2013;80:1684-1692. (9) Arch Neurol. 2009 Feb.;66:216-225.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Added sugar increases risk of many diseases

By David Dunaief, M.D.

Dr. David Dunaief

We should all reduce the amount of added sugar we consume because of its negative effects on our health. It is recommended that we get no more than 10 percent of our diet from added sugars (1). However, approximately 14 percent of our diet is from added sugars alone (2).

Is all sugar bad for us? The answer is not straightforward. It really depends on the source, and when I mention source, my meaning may surprise you.

We know that white, processed sugar is bad. But I am constantly asked: Which sugar source is better — honey, agave, raw sugar, brown sugar or maple syrup? None are really good for us; they all raise the level of glucose (a type of sugar) in our blood. Forty-seven percent of our added sugar intake comes from processed food, while 39 percent comes from sweetened beverages, according to the most recent report from the Centers for Disease Control and Prevention (2). Sweetened beverages are defined as soft drinks, sports and energy drinks and fruit drinks. Even 100 percent fruit juice can raise our glucose levels. Don’t be deceived because it says it’s natural and doesn’t include “added” sugar.

These sugars increase the risk of, and may exacerbate, chronic diseases such as diabetes, heart disease, high blood pressure, cancer and obesity. This is such a significant problem that municipal legislatures have considered adding warning labels to sweetened drinks (3).

However, I did say that sugar’s source impacts its effect. Most fruits have beneficial effects in preventing disease, including diabetes, and do not raise sugar levels, even in patients with diabetes. It is a myth that whole fruit raises your sugar levels. However, dried fruits, fruit juice and fruit concentrate do raise your sugar levels. Note that sugar extracted from fruit has an effect similar to that of sugar added to foods and sweetened beverages.

Let’s look at the evidence.

Heart disease

When we think of sugar’s effects, heart disease is not usually the first disease that comes to mind. However, results from a 20-year study of 31,000 U.S. adults showed that, when comparing those who consumed the least amount of added sugar (less than 10 percent of calories daily) with those who consumed 10 to 25 percent and those who consumed more than 25 percent of daily calories from sugar, there were significant increases in risk of death from heart disease (4). The added sugar was from foods and sweetened beverages, not from fruit and fruit juices.

This was not just an increased risk of heart disease but an increased risk of cardiovascular death. This is a wake-up call to rein in our sugar consumption.

Obesity and weight gain

Does soda increase obesity risk? An assessment published in PLoS One, a highly respected, peer-reviewed journal, showed that it depends whether studies were funded by the beverage industry or had no ties to any lobbying groups (5). Study results were mirror images of each other: Studies not affiliated with the industry show that soda may increase obesity risk, while studies funded by the beverage industry show there may not be any association.

In studies without beverage industry funding, greater than 80 percent (10 of 12) showed associations between sugary drinks and increased weight or obesity, whereas with the beverage industry-funded studies, greater than 80 percent of them did not show this result (5 of 6). The moral of the story is that patients must be diligent in understanding studies’ funding and, if the results sound odd, they probably are. If this is the case, make sure to ask your doctor about the studies’ findings. Not all studies are equally well designed.

Diabetes and the benefits of fruit

Diabetes requires the patient to limit or avoid fruit altogether. Correct? This may not be true. Several studies may help change the long-standing, commonly held paradigm that fruit should be restricted in patients with diabetes and to prevent development of diabetes.

One study found that whole fruit may reduce the risk of diabetes by reducing inflammation and reducing insulin resistance (6). Specifically, results demonstrated a reduction in the inflammatory biomarker hsCRP. Ultimately, this may result in better glucose control. A potential reason for these impressive results may be the high levels of flavonoids, specifically anthocyanins and flavones. Flavonoids, as a class, are phytochemicals (plant nutrients) that provide pigment to fruits and vegetables and may have substantial antioxidant activities. Substances that are high in these two flavonoids include red grapes, berries, tea and wine.

Another study, a meta-analysis that looked at three large studies, including the Nurses’ Health Study, NHS II, and the Health Professionals Follow-up Study, showed that those who consumed the highest amount of anthocyanins were likely to experience a 15 percent reduction in the development of type 2 diabetes (7). Researchers compared those in the highest quintile of anthocyanin consumption with those in the lowest quintile.

Specifically, at least two servings of blueberries per week were shown to reduce the risk of diabetes by 23 percent, and at least five servings of apples and pears per week were also shown to reduce the risk by 23 percent. These were compared to those who consumed less than one serving per month. This is a small amount of fruit for a significant reduction.

From the same three studies, it was also shown that grapes, bananas and grapefruit reduce the risk of diabetes, while fruit juice and cantaloupe may increase risk (8).

In still another diabetes study, involving those who were newly diagnosed with type 2 diabetes, the risk of increasing glucose levels was no greater in those who consumed more than two servings of fruit per day compared to those who consumed fewer than two servings per day (9). The properties of flavonoids, for example, those found in whole fruit, may also result in anticancer and anticardiovascular disease properties, the opposite of added sugars (10).

Chronic disease incidence and complications from these diseases have skyrocketed in the last several decades. Therefore, any modifiable risk factor should be utilized to decrease our risk. By keeping added sugar to a minimum in our diets, we could make great strides in the fight to maintain our quality of life as we age.

We don’t have to avoid sugar completely; we still can satiate a sweet tooth by eating ripe fruits. Our access to fruit, even off-season, has expanded considerably. The most amazing thing is that fruit may actually reduce the risk of diabetes, something for years we thought might exacerbate it.

References: (1) 2015-2020 Dietary Guidelines for Americans. (2) cdc.gov. (3) reuters.com. (4) JAMA Intern Med. online Feb 03, 2014. (5) PLoS Med. 2013 Dec;10(12):e1001578. (6) J Nutr. 2014 Feb;144(2):202-208. (7) Am J Clin Nutr. 2012 Apr;95(4):925-933. (8) BMJ. online Aug 29, 2013. (9) Nutr J. published online March 5, 2013. (10) Plant Foods Hum Nutr. 2004 Summer;59(3):113-122.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Studies have shown that eating grapefruit reduces your risk of developing diabetes.
Be wary of ‘no sugar added’ labels

By David Dunaief, M.D.

Dr. David Dunaif

We should all reduce the amount of added sugar we consume because of its negative effects on our health. It is recommended that we get no more than 10 percent of our diet from added sugars (1). However, we are consuming at least 30 percent more added sugar than is recommended (2).

Is all sugar bad for us? The answer is not straightforward. It really depends on the source, and when I mention “source,” my meaning may surprise you.

We know that white, processed sugar is bad. But, I am constantly asked which sugar source is better: honey, agave, raw sugar, brown sugar or maple syrup. None are really good for us; they all raise the level of glucose (a type of sugar) in our blood.

Two-thirds of our sugar intake comes from processed food, while one-third comes from sweetened beverages, according to the most recent report from the Centers for Disease Control and Prevention. (2) Sweetened beverages are defined as sodas, sports drinks, energy drinks and fruit juices. That’s right: Even 100 percent fruit juice can raise glucose levels. Don’t be deceived by “no added sugar” labels.

These sugars increase the risk of, and may exacerbate, chronic diseases, such as diabetes, heart disease, high blood pressure, cancer and obesity. This is such a significant problem that several legislative initiatives have been introduced that would require a warning label on sweetened drinks (3).

However, I did say that sugar’s source impacts its effect. Most fruits have beneficial effects in preventing disease, including diabetes, and do not raise sugar levels, even in patients with diabetes. It is a myth that whole fruit raises your sugar levels. However, dried fruits, fruit juice and fruit juice concentrate do raise your sugar levels. Note that sugar extracted from fruit has an effect similar to that of sugar added to foods and sweetened beverages. Let’s look at the evidence.

Heart disease

When we think of sugar’s effects, heart disease is not usually the first disease that comes to mind. However, results from a 20-year study of 31,000 U.S. adults showed that, when comparing those who consumed the least amount of added sugar (less than 10 percent of calories daily) with those who consumed 10 to 25 percent and those who consumed more than 25 percent of daily calories from sugar, there were significant increases in risk of death from heart disease (4). The added sugar was from foods and sweetened beverages, not from fruit and fruit juices. This was not just an increased risk of heart disease, but an increased risk of cardiovascular death. This is a wake-up call to rein in our sugar consumption.

Obesity and weight gain

Does soda increase obesity risk? An assessment published in PLoS One, a highly respected, peer-reviewed journal, showed that it depends on whether studies were funded by the beverage industry or had no ties to any lobbying groups (5). Study results were mirror images of each other: Studies not affiliated with the industry show that soda may increase obesity risk, while studies funded by the beverage industry show there may not be any association.

In studies without beverage industry funding, greater than 80 percent (10 of 12) showed associations between sugary drinks and increased weight or obesity, whereas with the beverage industry-funded studies, greater than 80 percent of them did not show this result (5 of 6). The moral of the story is that patients must be diligent in understanding how studies are funded; and if the results sound odd, they probably are. If this is the case, make sure to ask your doctor about the studies’ findings. Not all studies are equally well designed.

Diabetes and the benefits of fruit

Diabetes requires the patient to limit or avoid fruit altogether. Correct? This may not be true. Several studies may help change the long-standing, commonly held paradigm that fruit should be restricted in patients with diabetes and to prevent development of diabetes.

One study found that whole fruit may reduce the risk of diabetes by reducing inflammation and reducing insulin resistance (6). Specifically, results demonstrated a reduction in the inflammatory biomarker hsCRP. Ultimately, this may result in better glucose control. A potential reason for these impressive results may be the high levels of flavonoids, specifically anthocyanins and flavones.

Flavonoids, as a class, are phytochemicals (plant nutrients) that provide pigment to fruits and vegetables and may have substantial antioxidant activities. Substances that are high in these two flavonoids include red grapes, berries, tea and wine.

Another study, a meta-analysis that looked at three large studies, including the Nurses’ Health Study, NHS II, and the Health Professionals Follow-up Study, showed that those who consumed the highest amount of anthocyanins were likely to experience a 15 percent reduction in the development of type 2 diabetes (7). Researchers compared those in the highest quintile of anthocyanin consumption with those in the lowest quintile.

Specifically, at least two servings of blueberries per week were shown to reduce the risk of diabetes by 23 percent, and at least five servings of apples and pears per week were also shown to reduce the risk by 23 percent. These were compared to those who consumed less than one serving per month. This is a small amount of fruit for a significant reduction.

From the same three studies, it was also shown that grapes, bananas and grapefruit reduce the risk of diabetes, while fruit juice and cantaloupe may increase risk (8).

In still another diabetes study, involving those who were newly diagnosed with type 2 diabetes, the risk of increasing glucose levels was no greater in those who consumed more than two servings of fruit per day, when compared to those who consumed fewer than two servings per day (9).

The properties of flavonoids, which are found in whole fruit, may also result in anticancer and anticardiovascular disease properties, the opposite effect of added sugars (10).

Chronic disease incidence and complications from these diseases have skyrocketed in the last several decades. Therefore, any modifiable risk factor should be utilized to decrease our risk. By keeping added sugar to a minimum in our diets, we could make great strides in the fight to maintain our quality of life as we age.

We don’t have to avoid sugar completely; we still can satiate a sweet tooth by eating ripe fruits. Our access to fruit, even off-season, has expanded considerably. The most amazing thing is that fruit may actually reduce the risk of diabetes, something we thought for years might exacerbate it.

References: (1) health.gov: Dietary Guidelines for Americans 2015-2020, eighth edition. (2) cdc.gov. (3) reuters.com. (4) JAMA Intern Med. online Feb 3, 2014. (5) PLoS Med. 2013 Dec;10(12):e1001578. (6) J Nutr. 2014 Feb;144(2):202-208. (7) Am J Clin Nutr. 2012 Apr;95(4):925-933. (8) BMJ. online Aug 29, 2013. (9) Nutr J. published online March 5, 2013. (10) Plant Foods Hum Nutr. 2004 Summer;59(3):113-122.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

The types, quantity and quality of dietary fat all matter. Stock photo

Dietary fat is one of the most controversial and complicated topics in medicine. Experts have debated this topic for years, ever since we were told that a low-fat diet was important. There are enumerable questions, such as: Is a high-fat diet good for you? What about low-fat diets? If this is not enough, what type of fats should we be consuming?

There are multiple types of fats and multiple fat sources. For instance, there are saturated fats and unsaturated fats, which include monounsaturated and polyunsaturated. There are also trans fats, which are man-made. However, there are several things that we can agree on, like we need fat since the brain is made of at least 60 percent fat (1), and trans fats are downright dangerous. Trans fats are the Frankenstein of fats; anything created in a lab when it comes to fats is not a good thing.

How have we evolved in the fat wars? Originally we were told that a low-fat diet was beneficial for heart disease and weight loss (2). This started in the 1940s but gained traction in the 1960s. By the 1980s, everyone from physicians to the government to food manufacturers was exclaiming about a low-fat diet’s benefits for overall health. But did they go too far trying to make one size fit all? The answer is a resounding YES!!

There are only three macronutrients: fats, carbohydrates and protein. Declaring that one of the three needed to be reduced for everyone did not have the results we wanted or expected. Americans were getting fatter, not thinner, heart disease was not becoming rare, and we were not becoming healthier.

Some fats more equal than others

The biggest debate recently has been over the amount of fats and saturated fats. The most recent 2015-2020 Dietary Guidelines for Americans do not limit the amount of fat, but do limit the amount of saturated fat to less than 10 percent of our diet (3). Does this apply to everyone? Not necessarily. Remember, it is very difficult to apply broad rules to the whole population.

However, the most recent research suggests that foods containing pure saturated fats are not useful, may be detrimental, and at best are neutral. Meanwhile, poly- and monounsaturated fats are potentially beneficial. You will want to read about the most recent study below.

Sources of fat

Pure saturated fats generally are found in animal products, specifically dairy and all meats. The exception is fish, which contains high levels of polyunsaturated fats. Interestingly, most foods that contain predominantly unsaturated fats have saturated fat as well, though the reverse is not typically true. There are also saturated plant oils, like coconut and palm. Processed foods also have saturated fats. Potentially beneficial polyunsaturated fats include fatty fish and some nuts, seeds and soybeans, while potentially beneficial monounsaturated fats are olive oil, avocados, peanut butter, some nuts and seeds (4). Let’s look at the research.

Saturated fat

takes a dive In the ongoing battle over saturated fats, the latest research suggests that it is harmful. In recent well-respected combined observational study (The Nurses’ Health Study and Health Professional Follow-up Study), results show that replacing just 5 percent of saturated fat with poly- or monounsaturated fats results in significant reductions in all-cause mortality, 27 and 13 percent, respectively (5). There were also significant reductions in neurodegenerative diseases, which include macular degeneration, Parkinson’s, Alzheimer’s and multiple sclerosis.

However, when reduced saturated fats were replaced with refined grains, there was no difference in mortality. There were over 126,000 participants with an approximate 30-year duration. Also, the highest quintile of poly- and monounsaturated fat intake compared to lowest showed reductions in mortality that were significant, 19 and 11 percent, respectively. Not surprisingly, trans fat increased the risk of mortality by 13 percent.

The polyunsaturated fats in this study included food such as fatty fish and walnuts, while the monounsaturated fats included foods such as avocado and olive oil. Eating fish had the modest reductions in mortality, 4 percent. The authors suggest replacing saturated fats with healthy poly- and monounsaturated fats that are mostly plant-based, but not with refined grains or trans fat.

Previous study showed neutrality

This was a meta-analysis (a group of 72 heterogeneous trials, some observational and others randomized controlled trials), with results showing that saturated fats were neither harmful nor beneficial, but rather neutral (6).

However, there were significant study weaknesses. The researchers may have used foods that include both saturated fats and unsaturated fats. This is not a pure saturated fat comparison. What did those who had less saturated fat eat instead — refined grains, maybe? Also, the results in the study’s abstract partially contradicted the results in the body of the study. Thus, I would pay a lot more attention to the above study than to this one. Again, though, even the best outcomes for saturated fats in this study did not provide a beneficial effect.

What about butter?

In a meta-analysis (group of nine observational studies), results showed that butter was neither beneficial nor harmful, but rather neutral in effect (7). Then is it okay to eat butter? Not so fast! Remember, the above study showed that saturated fat was potentially harmful, and butter is pure saturated animal fat. Also, there are study weaknesses. It is not clear what participants were eating in place of butter, possibly refined grains, which would obfuscate the potential harms. It was also unclear whether there were poly- and monounsaturated fats in the diet and what effect this might have on making butter look neutral.

Unearthing a saturated fat study

In a randomized controlled trial (Minnesota Coronary Experiment), this one from 1968 to 1973 and not fully analyzed until recently, results showed that polyunsaturated fat from corn oil, compared to a diet with higher saturated fat, reduced cholesterol level while increasing the risk of mortality (8).

The researchers expected the opposite result. Is this a paradox? Fortunately, no! Corn oil is used in processed foods and has a high amount of inflammatory omega-6 fatty acids that may negate the positive results of reducing cholesterol. Plus, the patients were only consuming the corn oil for a short 15-month period, which is unlikely to be long enough to show beneficial effects on mortality.

The bottom line is this: It’s not about low-fat diets! Saturated fats have not shown any benefits, and could be potentially harmful, but at best, they are neutral. However, foods that contain high amounts of poly- or monounsaturated fats that are mostly plant-based have shown significant benefit in reducing the risk of death and neurodegenerative diseases.

However, there are several caveats. Not all unsaturated fats are beneficial. For instance, some like corn oil may contain too many omega-6 fatty acids, which could contribute to inflammation. Also, replacing saturated fats with carbohydrates, especially refined grains, does not improve health. I told you fats are not easy to understand. It can be helpful to change our perception of fats: They are not “good and bad.” Instead, think of them as “useful and useless.” For our health, we should be focused on the “useful.”

References: (1) Acta Neurol Taiwan. 2009;18(4):231-241. (2) J Hist Med Allied Sci 2008;63(2):139-177. (3) health.gov/dietaryguidelines/2015. (4) http://www.heart.org. (5) JAMA Intern Med. 2016;176(8):1134-1145. (6) Ann Intern Med. 2014;160(6):398-406. (7) PLoS ONE 11(6):e0158118. (8) BMJ 2016;353:i1246.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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By Javed Butler, MD

February means heart health awareness, but taking care of your heart requires a year-round commitment that has lifelong benefits. What will you do differently to take better care of your heart?

Heart disease can affect anyone, regardless of gender, age or background. That’s why all of our cardiac care experts at Stony Brook University Heart Institute remain focused on how to best prevent heart disease and heal the heart.

We fight cardiovascular disease from every angle, using the best that cardiovascular medicine can offer: risk factor prevention; state-of-the-art diagnostics, such as 3D cardiovascular imaging; advanced minimally invasive procedures with robotic assistance; and transcatheter aortic valve replacement (TAVR) for inoperable aortic stenosis. In the hands of our cardiac experts, these and other cardiac advancements are used to address each patient’s unique situation.

Our ventricular assist device (VAD) program is the most experienced program on Long Island and the first to achieve national accreditation. It offers patients who are ineligible for a heart transplant a way to temporarily or permanently support heart function and heart flow. Patients who are eligible for a heart transplant but are too sick to wait for a suitable donor can also be helped by a VAD device.

The Heart Institute also features both a Valve Center and an Aortic Center where patients are evaluated by multiple cardiac specialists who create individualized treatment plans. Our Chest Pain Center is one of the few accredited centers in New York State. Our Endovascular Rapid Response Team is available 24/7 to treat aortic dissections/ruptures. Stony Brook is consistently recognized by the American Heart Association/American Stroke Association’s Get With The Guidelines® Heart Failure Gold Quality Performance Achievement Award.

Do something good for your heart by getting involved in your own heart health. On Feb. 24, join us at Smith Haven Mall food court for blood pressure screenings at 8 a.m. and a heart health lecture at 9 a.m.

Our popular spring event, Keeping Your Heart Healthy at Any Age dinner and panel discussion will be held on Wednesday, May 11, at 5:30 p.m. at Stony Brook University. Register now at www.stonybookmedicine.edu/hearthealthy.

Have a question about heart disease prevention? Seeking a solution to a cardiac problem? Call us at 631-44-HEART (444-3278). We’re ready to help.

Dr. Javed Butler is co-director of the Heart Institute and chief of the Division of Cardiology at Stony Brook Medicine.

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