Terry Shintani, M.D., M.P.H., J.D. here discusses ways to prevent and reverse heart disease in this presentation. He is is the author of the Eat More, Weigh Less Diet, The Hawaii Diet, and The Good Carbohydrate Revolution.
I want to thank you for coming this evening. It’s a very nice crowd this evening. The topic tonight is How to Prevent and Reverse Heart Disease. Well, it’s February, so because of Valentine’s Day I guess they call this heart month. And so all the health organizations try to deal with heart disease this month. And to me every month is heart month, because heart disease as you all know is the number one killer of all Americans. Today roughly 30% of us die of coronary heart disease.
If you look at other countries, some places heart disease is almost non-existent. For example, in parts of China – in rural China where their diet is nearly all plant based, heart disease rates are, believe it or not, 1%. In parts of Africa in the rural areas, heart disease rates are about 1%. And it should let people realize that coronary heart disease is well 90% preventable. I’m here to talk to you about ways that you can prevent and even reverse heart disease even if you’ve got it.
How many of you are interested in learning how to control cholesterol with your diet? Well, that’s about everybody. How many of you interested in controlling blood pressure with diet? How about dealing with blood sugar and diet? And why do I say blood sugar? Well, it’s because diabetes is actually a risk factor for heart disease as well. How many just want to learn how to eat twice as much food and still lose weight? Isn’t that funny? It’s funny. I say that at many of my lectures and I get the same reaction.
People are interested in their health but when it comes to losing weight and looking good, they’re even more interested in that. Everybody has the same interest. And you’ll see that in some of my statistics that in this way in terms of heart disease, people all around the world are actually more similar than they are different. The reason we talk about prevention of heart disease is that of all of the diseases that plague America today, the most common ones heart disease which is the number-one cause of death in America, some cancers, diabetes which is actually rising to epidemic levels, and strokes. These are actually very preventable diseases. And so it’s really important to deal with the now rather than later.
One of the great frustrations I have is that people often come to me when it’s too late. But actually with heart disease what’s really interesting is that it’s not necessarily too late. Much of what I do is through the Hawaii Health Foundation, which is a non-profit. I donate all my royalties from the books. How many of you tried Shintani Cuisine at Zippy’s? I donate all the royalties into the non-profit so we can promote health in Hawaii of that and off the proceeds from the book the Hawaii Diet and actually all of my other books.
And we’ve conducted over 700 community programs and presentation of some sort over the many years. So we’ve really tried to reach every level of Hawaii society. I’ve done lectures from elementary school to senior housing to university. Of course, I’m a professor, I am associate chair of complementary medicine at the school of medicine. So I lecture at the medical school. I’ve lectured at conferences, [molly lifest] and all the way up to the NIH trying to get people to improve their diet and help to reverse heart disease. And this is one of the books the Hawaii Diet.
Prevalence of obesity in the U.S.
I’m going to start by talking about the prevalence of obesity in the U.S. and looking at it from an epidemiological perspective. Heart disease, of course, starts in the arteries in your heart. But I want everybody to take a holistic perspective looking at the whole country. Look at what’s happening in terms of obesity in this country, because obesity is one of the more important risk factors for coronary heart disease. And this is 1985 – this is from the Center for Disease Control, which means this is the best data in the world for this kind of information. That blue represents obesity rates and the darker the blue the more obesity.
Now this is about 20 years ago. Watch what happens in 20 years. There is an epidemic happening right before eyes. They ran out of blue you can see. And now they ran out of red. And today we have 6 million kids who are overweight. Now these are 6 million kids who are in the pipeline to get heart disease when they become adults. And if you look up here, it says July 2000. I just read the statistics for this year. It’s actually 9 million now. It’s increased 50% in five years; those are statistics for 2005.
Imagine what tsunami of health problems we are in for as these kids become adults. Some people are saying that because of the high rate of obesity among the kids, they’re getting onset diabetes when they’re children. So they no longer really want to call it adult onset anymore. Not only that their diets are getting worse and worse and they’re saying that nowadays some of the parents are going to outlive the kids because of this wave of obesity that’s taking over this country. And the interesting thing is if you look down here you know what I found interesting since I mentioned tsunami, you know when I saw the tsunami refugees, they are all slim people.
Did you ever notice refugees from hurricane Katrina? You know that’s this area down here, right? That’s where the rates of obesity are highest. And you know they didn’t look like refugees. They looked like they could survive quite a while without food and not have much problem. And I say that and it is funny but in the long run it’s not funny at all, because these are the people who are going to fill our hospitals with coronary heart disease, diabetes. I’m sure many of them already have diabetes and the early signs of heart disease.
But here you see that heart disease kills about a third of Americans. Cancer kills about a quarter of us. Stroke kills about 7%. Diabetes has actually risen; it’s about 3.5% now. And I mark the red bars to indicate those diseases that are diet related. And clearly heart disease and cancer and stroke and diabetes are certainly diet related diseases. And remember I said that heart disease in some parts of the world is only like 1%. So again most of these diseases are indeed preventable.
Why is America getting fat?
Well, I call this the Hawaiian paradox. In Hawaii, we have the healthiest state in the U.S. because people live the longest here. But native Hawaiians have the worst cell in the nation and as you know I spent most of my career working with native Hawaiians in YNI. And this is the national rate that I just showed you. Well this is the mortality rate for pure Hawaiians. It’s more than double for heart disease, more than double for cancer, more than double for stroke.
And if you look at diabetes, the quintessential nutrition-related disease, it’s actually 588% higher in terms of mortality and this is a hard end point; it’s deaths, it’s not just incidents which may be reported or not. These are hard endpoints. And obesity among native Hawaiians is double that of the national average but these figures are rising as well. So how many of you think Hawaiians are naturally overweight? You would think so, right? I mean if you ever came out to see my patients with me in YNI, I have 300 pound patients by the dozens. I’ve had 400, 500, 600, 700, 800 pound patients. My biggest patient was 890 pounds. And you know I have a practice in town and in town I never see people that large. But out in [YNI] we have the largest concentration of native Hawaiians. It’s actually all too common.
I’ve heard people say well it’s all in the genes. How many of you have heard, well it’s all in the genes? So if it’s all in the genes, then 200 years ago when Captain Cook arrived the genes were pure. Most of the people aren’t pure Hawaiian these days. So then if it was all in the genes, then they should have been even more obese back then, right? Well let’s see if that’s true. This is Captain Cook’s artist. How many obese individuals do you see here? Well I don’t see any frankly and today the rate is here at actually 64% and this was measured on the homestead, so the people had to be half Hawaiian or more but these are all pure Hawaiians and you don’t see any.
And the question is why? And the answer to that may be the answer as to how we can avoid obesity and heart disease because of course heart disease comes along with obesity. And if you don’t believe a drawing, well his photographs from a hundred years ago, this in the 1800s,you know you don’t see overweight Hawaiians. It’s really stunning.
In 1823, world traveler [Ian Stewart] said that the common people are thin, I’m talking about Hawaiian people. When’s the last time you heard of Hawaiians referred to as thin? Maybe 1823 or so I suppose, right? When I first showed this statement in YNI I would get this kind of reaction. Aren’t you shocked? I mean when I saw it myself I said “Is this for real?” I mean somebody who travel around the world, who have seen people from all countries referred to Hawaiians as thin.
And I thought that everyone should realize that, because there is an important lesson. The lesson is that here’s a population who today we have so much trouble keeping them from becoming obese, when in the old days there was no trouble at all. So what’s changed? It certainly wasn’t the genes, and if anything the genes are less likely to do that.
So what changed? Well, they ate taro, which is 1% fat, which is mostly an unrefined complex carbohydrate food. It’s got lots of fiber and its calorie density is very low. And by the way Hawaiians never wasted anything. They would eat the tops too. So they actually eat lots of vegetables too. I don’t want anybody to forget that part of it because that’s actually as important. But grains were the world’s cheap foods throughout history. A starchy high-fiber low-fat staple, and of course in Europe there was some rye and wheat. In Asia, it was rice; in the Americas, it was maize or corn. This is mayan which is Central America.
In Egypt, what do you suppose this is? Looks like another grain, right? Well we know at least one of the grains that they ate in Egypt, which is of course Africa, was barley. How do we know? This was actually found in King Tut’s tomb. So it was actually considered very important food, if they read translations they called it the gift of Sirius, it was a gift of life. So in the old days a staple used to be taro, what’s the staple for Hawaii today? Spam maybe. Well here’s the big difference and this is part of the clue. By the way you can see this wasn’t my idea. This is Hawaiian staple food. Somebody drew this cartoon ,somebody else had the idea about this.
But the idea is that nowadays we eat too much spam. I mean we have spam festivals, heaven forbid and is the quintessential junk food and it’s a quintessential example of what is happening and why we have so much heart disease now, because – what is spam? It’s protein, right? It comes from meat. How many see it as a meat product? Right, I mean who doesn’t see it as a meat product? So it should be in protein, right? But how many of you knew it’s only 17% protein? You know what the 83% is right; it’s fat. And that has a lot to do with why people are fat and getting heart disease these days, because of course this is animal product. So lot of the fat comes from saturated fat and of course saturated fat, you will see in later part of my lecture, it’s actually the worst kind of fat you can eat.
So what’s happened is humans used to eat this way, this ancient times, not much fat, not much sugar, not much refined flour, mostly whole plant based carbohydrates. Animal product was very small in intake and in some areas, for example, rural China they’re almost bacon unless once in awhile they have access to animal products. Today we eat nearly 40% fat, a 400% increase; sugar is way out of whack. We eat a record amount, over 150 pounds of sugar per person per year. That translates to 35 teaspoons of sugar per person per year.
And personally I hardly use any sugar, so somebody’s eating 70 teaspoons of sugar. And most of our flour is refined. So what used to be our main food whole unprocessed plant based foods is now little side dish, right? And we eat a huge amount of animal product. And the problem with this is if you change a body that’s been eating this way for millennia and over in the last 100 years you start eating this way, something is bound to go wrong. You’d be a fool to not think that.
Why is it so important? This is heart disease rates in different countries. You see Finland, such a high rate. Japan and Greece both have rising rates of heart disease. But if you look at how different the heart disease rates among different countries are, you can see that most of it is preventable. And in terms of life expectancy, Japan has the longest life expectancy for males and females and it has a lot to do again with coronary heart disease.
The other thing is today we are deluged with misinformation and I’m so glad that the whole Atkins thing has wound itself down because I think it was doing a great deal of harm in this country, so much misinformation which I’ll try to dispel in tonight’s lecture. I flunked my nutrition test. I thought the four food groups are canned, frozen, light and instant. No wonder people think that because if you walk into a supermarket, if an alien being walked into a supermarket, that’s what they would think. 80% or 90% of the supermarket is packaged, is processed. It sits on a shelf in a box or a bag. And the real food is just the produce section pretty much, and the whole grain section. These are very small sections in the supermarket.
Protein Carbohydrate Controversy
And there is this protein carbohydrate controversy which I’ll try to dispel as well. Let me just throw this one in there just so that people don’t get put an end to this. We have a trend in obesity that’s going up. And the part of the controversy occurred because sugar as I mentioned to you is rising out of control. It’s actually at an all-time high. And so you know what they were saying, right? They’re saying carbohydrate causes obesity, because sugar and carbohydrate intake is way up. How many have heard that? Carbohydrates make you fat.
Well, they started then recommending. First of all, that’s nonsense because the slimmest countries in the world are the ones that eat the most carbohydrates; just think about it. If carbohydrate made you fat how come – let’s look at China, they eat lots of carbs; are they fat? No, they come to the U.S. and do exactly what Atkins would have said eat more meat and fat. And you know what do the Chinese people come to Hawaii gets skinnier or fatter? It’s pretty obvious. The native Hawaiians in the old days were slim. Today you know what they’re doing, they’re eating just what Atkins said: more meat and more fat. Are they getting skinnier or fatter? Well, we already answered that question.
Well what the protein proponents never told you is even though sugar is at an all-time high, so is meat and fat at an all-time high. Well if they’re saying don’t eat carbs because of obesity, they should also say don’t eat meat and fat because of obesity. If they were being honest in terms of statistics, because this is what I’m saying. Don’t eat too much meat, don’t eat too much fat or sugar. And if you can eliminate all of these, I mean when I say fat, I mean added fat, you will be better off.
Role of Cholesterol in Heart Disease
So let’s talk about heart disease now. This is what the doctors say – 20,679 physicians say luckies are less irritating. Urethral protection against irritation and cough. And actually if you could read this, it says this figure was audited by the Lybrand Corporation. This is a smoke-free environment; it was in a restaurant. But isn’t this kind of amazing that the physicians would recommend this? And this is my lead into heart disease because of course cigarettes are one of the worst risk factors for heart disease, just goes to show you doctors don’t know everything. But this was the punchline, right around the corner this is a smoke-free environment; it was in a restaurant.
Well, besides smoking, of course cholesterol is the most important risk factor for coronary heart disease. Now they’re saying there are other factors like C-reactive protein, insulin, homocysteine. I mean they’re understanding coronary heart disease much better these days but still cholesterol is the most important factor, which is why they tell you to keep your cholesterol levels low et cetera. And this is the reason – when you measure coronary heart disease compared to cholesterol levels, there is really a direct correlation between cholesterol levels. This is so well documented, nobody ever questions this.
For every 1% increase in cholesterol, you have a 2% increase in coronary heart disease. And if you measure this epidemiologically, you see the same thing: higher the cholesterol level, the higher the heart disease rate.
Now one thing I want you to see, which is actually quite important is that if you draw a line through this, it kind of zeroes out at 150. And do you know when I studied nutrition in Boston, the people there were conducting the Framingham Heart Study, which is the longest most respected nutrition and heart study in history in the world. And William Castelli, its principal investigator was one of my professors and he said, “We have never seen a heart attack in Framingham in anybody with a cholesterol below 150.
So if you can get your cholesterol in that range, you are virtually protected from heart disease. Now I say virtually because there are instances, if you smoke a lot, if you do all the other wrong things, yes you could wind up with coronary heart disease. But when you see this confluence of evidence between epidemiological figures zeroing out at 150 and then the Framingham study, and then T. Colin Campbell measured cholesterol levels in China, and that village where they had 1% heart disease, well the average cholesterol was 127. And probably the 1% was probably the wealthy people who had cholesterols above 150 because of course at 127 was an average.
So where do you find cholesterol in your diet? How many know one rule? Well a lot of you probably heard my lecture, so you probably know it. This is the clue: anything with a face on it has cholesterol in it. And I put a nice frown on this to let you know it’s not a good thing. You know chicken has a face, it’s got cholesterol. It lays an egg, it’s got cholesterol. Pig, it’s got a face and you make bacon, it’s got a cholesterol; it’s got lots of cholesterol. Animals, all of them have cholesterol. Beef, chicken, fish all have cholesterol. Potatoes, apples, beans, corn, brown rice, zero zero zero zero zero. Plans do not have cholesterol. There’s actually a very tiny amount of microscopic amount in terms of plant sterols but it’s essentially zero. So you know what and I say this because this is the vegetarian society.
And let’s face it, cheese comes from a cow which has a face and it’s got cholesterol in it. So just remember and by the way when you do skim milk products, it doesn’t have cholesterol. If they skim virtually all the fat and cholesterol off. But there are other problems with animal protein in dairy and if I don’t get a chance to, I just want folks to know that the science behind dairy preventing osteoporosis is so lousy. There is actually very little research that suggests that dairy will prevent osteoporosis. Now calcium will prevent it but dairy does not seem to, and in fact, the countries that eat the most dairy have the most osteoporosis. So there is actually evidence showing that the other way around.
Role in Fats in Heart Disease
But cholesterol in food is only one factor. Fat is another more important factor. If you can see down here these are the percentage of calories from fat, and this is total cholesterol levels. And you can see here in these villages cholesterol levels were under 150 and heart disease rates were extremely low. These are villages in Okinawa by the way which is part of the basis of Ancel Keys’ Seven Countries Study where they found very little heart disease in Okinawa. But if you look in Japan, in Tokyo, you see them eating higher fat, you have higher cholesterol level. You see Japanese in Hawaii – higher fat diet, higher cholesterol. You see this in LA, higher fat, higher cholesterol. And if you see here is African, an Italian and Spanish and British, and Swedish, it doesn’t matter. We are all the same in this way. Everybody is influenced by their high-fat high-cholesterol diet in virtually the same way and you plot all these races on this line and they all fit right on that line where too much fat yields a lot of cholesterol in the blood.
And I put this slide up because somebody asked me, oh I thought cholesterol doesn’t raise cholesterol at all and this is just a very complicated slide. This is just for the scientists. If you look at the Keys formula and the Hague State formula, this is just scientific gibberish, cholesterol is in there. The C stands for cholesterol and anybody who wants to ask me, it’s been proven so often that it really doesn’t bear any debate anymore.
The other thing is remember there were some studies that said eggs don’t raise cholesterol. How many of you have heard that? Well, there’s a threshold. If you have somebody who is already on a high cholesterol diet, you feed him additional cholesterol, their cholesterol is not going to go up anymore. It’s already too high and it’s already getting set them up for heart disease because it has this kind of graded curve where if you increase your cholesterol levels, if you increase from 100 to 400 cholesterol levels will go up. And by the way an egg has about 250 milligrams of cholesterol per yoke.
So it’s not hard to reach this level if you’re eating egg. So they do this egg study and they say well we’ll take six days. Well six eggs are six times — that’s 1,200 milligrams of cholesterol, that’s up here. It’s not really going to raise the cholesterol that much more because it’s already high. When people are already eating cholesterol diet that’s already high to begin with.
So the point is eggs do indeed raise cholesterol levels. So don’t be fooled by those kinds of studies. Now what about fat because fat is actually more the issue. Fat has the most calories; it’s 9 calories a gram; carbohydrate, it’s 4; protein, 4, alcohol is 7. Don’t we need fat? Yes, absolutely. But we only need a very small amount. The essential fats are linoleic and linoleic acid. You only need like 1% to 2% of your calories from essential fats. And it’s like three to six grams of fat per day. So yes, we need fat but you don’t need to pour oil – you don’t say well I need my fat, so you go out and eat a bunch of French fry saying it’s an essential nutrient; I don’t think so.
So you’ve heard of saturated fat, unsaturated. The main types are saturated fat and I throw in here the new category known as trans fats because trans fats behave very similarly to saturated fats. And these are fats that promote cholesterol a great deal. And then you have the unsaturated fats, mono unsaturated which is found in large amounts in olive oil, and polyunsaturated in other vegetable oils are also 9 calories a gram. They’ll make you fat but they won’t raise cholesterol as much. And then within the polyunsaturated group there’s omega six and omega three, which you’ve probably already heard of.
This is what happens when you replace saturated fat with other fats. And I think this is a really important question and say what kind of fat should I eat? Well, first of all, remember that it would be best not to eat much fat at all. But of course saturated raises cholesterol the most; if you replace saturated fat with this blue grey color is monounsaturated, LDL will go down a fair amount but HDL won’t go down very much. The ratio actually goes up a little bit which is actually pretty good. And total cholesterol goes down.
If you look at polyunsaturated fats that will lower cholesterol actually a little bit more and you might be thinking well but I thought monounsaturated was better and the reason monounsaturated is better – polyunsaturateds will also lower HDL, so actually ratio comes out a little bit better. And total cholesterol is lower by polyunsaturates. And this is triglycerides which is a co-risk factor. Triglycerides are blood fats. By the way if you replace saturated fat with carbohydrates, it will lower LDL but it’ll also lower HDL. That’s why there is this controversy about HDL.
Well let me tell you what the problem with this research is, is that in America, carbohydrates are usually in the form of bread, something refined or maybe sugar. I think they will find a different result if they use unprocessed carbohydrates because it won’t lower HDL that much. But when you replace saturated fat with carbohydrate, you will lower total cholesterol but to me they need to do a different study showing what type of carbohydrate, because in this study they also show that triglycerides, which is the risk factor for heart disease goes up. And that’s why there’s so much controversy. That’s why they are saying if you eat too many carbs, your heart disease risk goes up. And I’ll show you our statistics where actually triglycerides go in the opposite direction. And that’s because we use whole unprocessed carbohydrates.
So again it’s important to replace saturated fat but the best thing to do it with is going to be and I’ll show you why whole unprocessed carbohydrates. If you want to know which oils have the most monounsaturated or polyunsaturated fats, you see this red – of all the oils this is probably the better oil and here is olive oil. And olive oil has a very high content of monounsaturated fat. One thing that most people are not aware of is that all of these fats have poly, mono and saturated fats. Even butter fat has monounsaturated fat. But look how much saturated fat it is. So that’s why they tell you to avoid butter fat, beef fat and chicken fat.
But olive oil has some saturated fat but it’s mostly mono. Canola is touted because it’s the lowest in saturated fat and it’s got a lot of mono but not quite as much as olive or macadamia. And macadamia nut touts that they have the most monounsaturated fats but they have a little bit more saturated fat than say canola oil. So these are the ones that they say are pretty good. And corn oil is considered not quite as good because of the low content of monounsaturated fat.
So now if you replace carbohydrate with fat, in other words, if you do an Atkins diet, if you say don’t eat carbs and eat fat instead, well if you use saturated fat, well, look what happens. LDL goes way up. Total cholesterol goes way up. HDL goes up a little bit but not enough to compensate. And in these studies monounsaturated fats, poly actually lowered LDL levels, raised HDL levels a bit but again this is a little bit misleading because carbohydrates in the U.S. are mostly refined carbohydrates. So these are the kinds of studies that need to be redone considering different types of carbohydrates. But the main point here is that when you need saturated fat you really shoot your cholesterol levels high.
Now this is what I wanted to show you about one of the research projects that I did. Because of these kinds of studies, people say mono unsaturates lower cholesterol, right? How many of you heard that? Well, this is what I wanted to show you. I think that they’ve got to correct the way they say that because if you really want to lower cholesterol, you’ve got the limit your fat intake. And the reason for that is this: we did a study comparing a Hawaii diet.
We took two groups of 20 – I think there were 24 people in each group. And one group was put on a Mediterranean diet. One group was put on what they called Hawaii Pacific, you know the Hawaii diet; in other words a diet that was low in fat, high in fiber et cetera. I actually see one of our participants here. So predictably when they ate the Mediterranean diet, high mono unsaturated diet, indeed cholesterol went down. But when they did the Hawaii diet, cholesterol went down even more. You can see it dropped more than 50 points whereas the Mediterranean diet dropped somewhere around 25 points.
Now remember you’ve heard that mono unsaturated fat olive oil lowers cholesterol, right? What happens if you add olive oil to a Hawaii diet? Do you think it’s going to go down anymore? Well we did that. We switched them over. It was a crossover trial, that’s a study design that they do, it’s a crossover trial. So we put the people on a Mediterranean diet on the Hawaii diet and the Hawaii diet on a Mediterranean diet. In other words, we added olive oil to the Hawaii Pacific diet.
Well, look what happened. Cholesterol went straight up. So when they say olive oil lowers your cholesterol, remember the question should say compared to what? Because it will lower it from that of standard American diet, definitely. But if you’re on a Hawaii style diet, cholesterol is going to go in the wrong direction. By the way those who are on the Mediterranean diet, who started following the Hawaii diet dropped their cholesterol even more.
So again this is a valuable lesson saying that if you look at all of these studies, just remember this is a study done in the U.S. with the baseline as people who are eating lots of saturated fat, lots of meat, lots of cheese, lots of refined carbohydrates. And so sometimes the answers they come up with may not be interpreted in a very good way. It’s just like – how many of you have heard that report that low-fat diets don’t prevent cancer and all that, how many of you heard that? It was laughable because I want you all to know that this because the university was one of the 41 centers that participated in and I’m associate chair of complementary medicine.
The chair Dr. Rosanne Harrigan was one of the co-authors. And so I talked to her and I said why did you guys say this and she said we didn’t. It’s the newspapers that said all this. And I read the paper and they were actually very reasonable in their interpretation but the newspapers jumped on it saying low-fat diets don’t work. The diet turned out to be 29% fat. In my book that’s a high-fat diet. What they should say is high-fat diets don’t work. It’s totally opposite. Because to me a low-fat diet is 10-15% maybe, and here they are, they were shooting for 20% which is pretty close but they wound up with 20%. You know what a 29% fat diet, it’s like a 30% heart association diet.
And years ago and I’ll show you a slide heart association diet was proven to promote heart disease. And I’ll show you that slide in a little bit. I just wanted to add that they actually found that people who ate the most Vitamin E beta carotene and Vitamin C showed a good reduction in corner heart disease. Vitamin C was kind of hard to interpret because it kind of went up and down.
So this was not statistically significant but when they actually did the trials, they didn’t show a beneficial effect of Vitamin E and beta carotene. And you know what it’s because these are fruits and vegetables. And these are whole grain Vitamin E and fruits and vegetables beta carotene. You can’t mess with Mother Nature and expect to get the best results. What they should have done was gotten people to eat lots of whole grain and lots of fruits and vegetables and then see what happen.
Effects of dietary fiber on cholesterol
Well, what about fiber which is the rest of what’s in food? Fiber will lower cholesterol as well. This is actually a very interesting study of the effects of dietary fiber on cholesterol. And this is the controlled group and it showed that – if you look at this is a hundred percent – this is locust bean fiber, pectin, psyllium, guar gum and for some reason I don’t have this one. But anyway all of these are soluble fibers that will lower cholesterol levels and the reason for that is fiber and by the way and this is HDL and it shows that locust bean will actually help raise HDL and so will oat bran fiber. So that’s why they say oat bran is so good but locust bean, I don’t know where I guess you can get in health food store. But these are fibers that bind cholesterol in the intestine.
How does it do that? Well, not only when you eat animal products but if you’re vegetarian they say well this isn’t going to help if I am vegetarian because there is no cholesterol to bind in your stomach if you are vegan that is. And I say no, that’s not the point. The point is that cholesterol is in the nucleus of bile. You know what bile is. It’s in the gallbladder and it’s greenish substance and when you eat fat, you squirt bile out into the intestine and it emulsifies the fats. So you can digest it.
Well, the nucleus of bile is cholesterol. So and it’s what makes you stool this brownish color because when people have a gallstones stuck in their gallbladder, one way we can tell that if it’s totally impacted, and they are getting pain the stool comes out gray, it’s really strange. But I’ve seen it; it’s really strange when you have stool with no bile which is this greenish color, it comes out gray. But the point is that when you have lots of fiber in your intestine, it holds onto the bile and the bile is taken out of the system. And that way you don’t get cholesterol circulating back into your body and it’s actually a fairly effective way of – you can see it lowers LDL and in some cases raises HDL.
And maybe I should have shown this first but just realize that they estimate that 10,000 years ago people ate nearly 100 grams of fiber because frankly there was no refined food. And today we’re eating like 8 grams. And they’re trying to get people to eat even 20 grams but that’s a very difficult. But if humans have GI tracts, intestinal tracts that are meant to eat lots of fiber in bulk. And here’s a pretty confusing slide but I just wanted to show you that these are other things that could change cholesterol.
Other things that change cholesterol levels
Niacin is actually known to lower triglycerides and cholesterol and actually will raise HDL a bit. So niacin is used therapeutically. Just remember if you take niacin in large amounts, it might affect your liver. It actually works a little bit like Mevacor and it’ll damage the liver if you’re not careful when you take it in doses that are therapeutic. And therapeutic doses are around one gram or higher. Actually for some people even 500 milligrams will cause a problem.
Garlic will lower cholesterol and triglycerides. This blue is cholesterol and the red is triglycerides. [Google] lipid, it’s interesting because it actually showed a good profile of lowering cholesterol and raising HDL. [Google] lipid is a nerve that you find in the health food store. Soluble fiber just like… well what I showed you in general will lower cholesterol. And exercise is interesting. Exercise by itself, unless it causes weight loss, doesn’t lower cholesterol appreciably. But what it does is it raises HDL a fair amount. And so that’s a good thing. But just remember Jim Fixx, he thought exercise could cure everything and he still had a heart attack. You know a marathoner; if you don’t eat right, that’s still not enough. Omega-three fats actually drop triglycerides a lot but could raise cholesterol in some people and coffee will actually raise cholesterol a bit and smoking of all things raises cholesterol.
By the way alcohol raises HDL a bit. And part of the problem with that is that it does it by raising oxygen levels. Homocysteine is also associated with heart disease. Homocysteine comes from degradation of sulfur containing amino acids. So where do you find that? Of course in protein but largely animal protein. The higher the Homocysteine, higher the heart disease rate. So how do you lower Homocysteine? Well, eat vegetables because the folic acid will start to break it down.
Serum iron – my professor like chair of our department at Harvard Dr. Walt Willett, one of the best nutrition researchers in the world opened a lecture saying two things good about meat is high in iron, high in zinc. There’s two things about meat is high in iron, high in zinc. And what he was trying to say is that unless you’re deficient in iron and zinc, it’s really not going to help you. You know somebody’s starving and they are anemic, yes, maybe meat might be helpful but for most people the higher the iron in your blood – iron is a very powerful oxidant. It won’t raise your cholesterol by itself but it’ll make the oxidation of your LDL more likely and that’s the kind of cholesterol that gets grabbed by your macrophage in your cell walls and deposit it into your arteries.
The other thing is insulin; it’s also found to be a risk factor. So when you have high insulin levels, you have high risk of heart disease. Now that led to the controversy about whether carbohydrates promoted heart disease. Well, insulin levels aren’t only raised by carbohydrate. They are also raised by protein. This is insulin levels in response to the same number of calories of oat meal, pasta, beef and white bread. Well, Atkins was saying don’t eat pasta and even Barry Sears was saying don’t eat pasta, eat beef, because of the insulin. Well, beef raised insulin more than pasta; what nonsense is that. So there is another reason why beef was not very good. Of course, if you eat white bread it goes up even higher. But what I’m trying to point out is that protein – animal protein is not the great thing that a lot of people were saying that it was.
And insulin responds to the different forms of carbohydrate. If you take rice and turn it into flour, insulin response goes way up, so is potatoes and actually all carbohydrates act that way. If you grind them up they’re absorbed too quickly and your insulin goes up and it actually increase your risk of heart disease by dropping your HDL. That’s why it’s so important to eat whole unprocessed carbohydrates. And that’s why it’s so important to have fiber in your diet so that sugar doesn’t hit your bloodstream too fast. Well, the carbs make you fat. Well it’s important because obesity increases risk of heart disease. I said this already. Eat lots of carb in China and they have very little heart disease, I mean very little obesity.
How many of you have heard that fats are more satisfying? I just want to show you this. They did studies on this. They actually showed that foods that were high in fat were the least satisfying of all. So that should just end that controversy; I shouldn’t say that anymore.
What about diabetes? Of course, diabetes is a risk factor because diabetes accelerates atherosclerosis and the people who have diabetes tend to die of heart disease more than anything. I wanted to show this because – this is a big myth. Well, first of all, it’s totally misleading if people say well carbs do this, carbs do that. You’ve got to ask what form it’s in. And I’m not saying what type because that’s also misleading. How many of you have heard, oh, you’ve got to eat your complex carbohydrates? I want you to watch this very carefully. Complex carbohydrates are starch; simple carbohydrates are sugars.
Well this is a complex carbohydrate (white bread) compared to (glucose) simple carbohydrate is worse. But you compare it to the table sugar, wait a minute. Whole wheat bread little worse than table sugar, wait a minute. Apple is simple sugar; wait a minute. The point is if you look at these figures, the things that are whole and unprocessed are the ones that actually are better than the ones that are ground-up and processed. It doesn’t matter that it’s simple or complex as much as it does what form it’s in.
The best form of carbohydrates are those that are whole unprocessed carbohydrates whether it’s simple or complex. This is why they have that mythology that high carb diets cause diabetes and in a very good study by Colson who used to be chair of the American Dietetic Association. Her studies showed that high carb diet increased blood sugar. Well my study showed that it decreased blood sugar. Wait a minute, right? What’s going on here? And the difference is this is Colson study. This is what they call carbs: bread, orange juice, banana, rolls, muffins. They are all refined; they’re all flour products. Whereas in our study, our carbohydrates were brown rice and taro, oat meal, those kind of things. It’s very, very different. So don’t be misled when they say carbs do this, carbs do that.
I just want to say one thing, then I will open up for questions. If you think it’s too late, heart disease is imminently reversible. Yeah I just wanted to show this. This is a study I have been talking about. If you look at this study they took people who had heart disease and they started one group on a 10% fat plant based diet. And the other group was on 30% heart association diet. Blue is a 10% fat diet and this is a start point. After one year, the atherosclerosis started disappearing. The diameter of the artery actually started opening up.
What people didn’t realize was the heart association diet, their diameter started closing up. So you see that when you do a plant based diet that’s as low as 10% fat, you actually can reverse this thing. So it’s not too late. Of course, there are some people who if it’s very risky, I mean there are reasons to do procedures and everything. But just remember that you can improve your situation even if you already have heart disease. How come the heart association diet doesn’t get it? That’s a really good question. A heart association – there’s too many people with too many other interests.
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