Lifestyle changes put you in control
By David Dunaief, M.D.
Even though cardiovascular disease has been on the decline, it is still the number one killer of Americans, responsible for almost 30 percent of deaths per year (1). Let’s start with a quiz of your cardiovascular disease IQ. The questions below are either true or false. The answers and evidence are provided after.
1. Fish oil supplements help reduce the risk of cardiovascular disease and mortality.
2. Fiber has significant beneficial effects on heart disease prevention.
3. Unlike sugary sodas and drinks, diet soda is most likely not a contributor to this disease.
4. Vitamin D deficiency may contribute to cardiovascular disease.
Now that was not so difficult. Or was it? The answers are as follows: 1-F, 2-T, 3-F, 4-T. Regardless of whether you know the answers, the reasons are even more important to know. Let’s look at the evidence.
There is a whole industry built around fish oil and reducing the risk of cardiovascular disease. Yet the data don’t seem to confirm this theory. In the age-related eye disease study 2 (AREDS2), unfortunately, 1 gram of fish oil (long chain omega-3 fatty acids) daily did not demonstrate any benefit in the prevention of cardiovascular disease nor its resultant mortality (2). This study was done over a five-year period in the elderly with macular degeneration. The cardiovascular primary endpoint was a tangential portion of the ophthalmic AREDS2. This does not mean that fish, itself, falls into that same category, but for now there does not seem to be a need to take fish oil supplements for heart disease, except potentially for those with very high triglycerides. Fish oil, at best, is controversial; at worst, it has no benefit with cardiovascular disease.
We know that fiber tends to be important for a number of diseases, and cardiovascular disease does not appear to be an exception. In a meta-analysis involving 22 observational studies, the results showed a linear relationship between fiber intake and a decreased risk for developing cardiovascular disease (3). In other words, for every 7 grams of fiber consumed, there was a 9 percent reduced risk of developing the disease. It did not matter the source of the fiber from plant foods; vegetables, grains and fruit all decreased the risk of cardiovascular disease. This did not involve supplemental fiber, like that found in Fiber One or Metamucil. To give you an idea about how easy it is to get a significant amount of fiber, one cup of lentils has 15.6 grams of fiber, one cup of raspberries or green peas has almost 9 grams and one medium-size apple has 4.4 grams. Americans are sorely deficient in fiber (4).
Analysis of the Northern Manhattan study, a population-based study of 4,400 adults in New York City suggests that daily diet soda intake may increase the risk of heart disease and other cardiovascular events, such as stroke (5). In those drinking diet soda daily, there was an increased likelihood they experienced a cardiovascular event, such as a stroke or heart attack during the study period. These results took into account confounding factors like smoking, diabetes, high blood pressure and obesity. Interestingly, the same effect was not found with lower levels of diet soda or sugared soda consumption.
The results of an observational study in the elderly suggest that vitamin D deficiency may be associated with cardiovascular disease risk. The study showed that those whose vitamin D levels were low had increased inflammation, demonstrated by elevated biomarkers including C-reactive protein (CRP) (6). This biomarker is related to inflammation of the heart, though it is not as specific as one would hope.
What have we learned?
Study after study has shown benefit with fiber. So if you want to reduce the risk of cardiovascular disease, consume as much whole food fiber as possible. While the effects of diet soda are still being studied, early results suggest we should limit or eliminate our intake. Also, since we live in the Northeast, consider taking at least 1,000 IUs of vitamin D daily. This is a simple way to help thwart the risk of the number one killer.
(1) hhs.gov. (2) JAMA Intern Med. Online March 17, 2014. (3) BMJ 2013; 347:f6879. (4) Am J Med. 2013 Dec;126(12):1059-67.e1-4. (5) J Gen Intern Med. 2012 Sep;27(9):1120-6. (6) J Clin Endocrinol Metab online February 24, 2014.
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.