The medical community has recently seen a raft of literature instructing “aggressive” management of hypertension, diabetes and high cholesterol (the Big Three). The basic premise is to diagnose early and treat early, while at the same time lowering the upper limits of acceptability for these conditions. The aggressive intervention leads to polypharmacy, where a single one of these conditions is best managed with more than one medication, as conventional medical literature now recommends. In other words, if you have high blood pressure, your doctor has been instructed that control best comes from prescribing two medications. The goal is to reduce risk of death and morbidity due to heart disease, stroke and other complications.
The same literature often addresses lifestyle change, including nutrition considerations, as a footnote usually towards the end of a long article (similar to the proportion allocated to this topic when I was a medical student 25 years ago). Make no mistake: these three conditions do require the respect they deserve as risk factors for heart disease, the number one killer in North American society. But what do they have in common beyond the espoused aggressive management, and cardiac risk?
DIET, INSULIN AND METABOLIC SYNDROME
First line therapy in the management of these conditions comes through alteration of lifestyle habits – related to diet, exercise, and stress management. The fact that these conditions can be managed with a similar unifying approach tells us something about their commonality related to cause and biochemistry. The average North American diet, self-indulgent and high glycemic, triggers an insulin response that is self-destructive in many aspects. Consistently high levels of insulin, in and of itself, are damaging to the walls of arteries, leading to hardening and degeneration. Insulin is a fat-making hormone, explaining the relationship of each of the Big Three to obesity in many cases. In fact, diabetes, hypertension, obesity and heart disease, along with gout and hormone disturbances, can all be categorized into one syndrome: The Metabolic Syndrome.
At the core of Metabolic Syndrome is the high glycemic(sugar)-insulin connection, which leads to a cascade of biochemical disturbances. White sugar (and brown), white potatoes, white rice and white flour are all high glycemic foods that require restriction. The Glycemic Index of foods, gaining popularity worldwide in Westernized nations, was conceived by Toronto’s Dr. David Jenkins. Food lists can be consulted to ensure a low glycemic diet, aiming for carbohydrates that are below 55 on the glycemic index scale.
HEALTHY BODY COMPOSITION, EXERCISE AND STRESS
Of course, successful management of excess weight is imperative. The hallmark of a good weight loss program, in my opinion, is not to achieve loss of the greatest amount of weight in the shortest time possible as the goal, but rather, with an emphasis on patient education and involvement, establishing HEALTH as the focus.
Obesity is indeed related to the aforementioned high glycemic diet, but also linked are exposures to toxins, lack of healthy bowel flora and sleep disturbances. The approach to weight management requires a comprehensive approach – with a low glycemic diet, incorporated beyond a temporary period, the foundation. Of importance is getting an early start to healthy body composition – studies link later heart disease to obesity beginning in adolescence, as an independent risk factor http://bit.ly/iCA1A6. Indeed, pediatric obesity is one of the significant public health issues of our time.
Also of importance is the lack of exercise that aggravates the picture of Metabolic Syndrome. Exercise allows for better response of healthy cells to insulin itself, thereby improving blood sugar, fat and cholesterol metabolism. Exercise leads to the development of lean muscle mass, which has a higher level of cellular activity. Increased lean muscle is associated with decreased risk of acute and chronic illness, and healthier body composition long term due to less likelihood of regaining any lost weight. Simply put, exercise expends calories, lowers weight, increases muscle, lowers blood pressure, regulates blood sugar and improves the cholesterol profile, in addition to improving mood and sleep.
Stress chronically alters biochemistry as well, with increased output of cortisol long-term causing blood sugar disturbances and fat storage. Stress can heighten cholesterol levels through similar pathways, and is likely the single most important risk factor for heart disease.
High cholesterol is also an aspect of Metabolic Syndrome, and as a marker of the syndrome has been targeted for aggressive management mostly from a pharmacologic perspective. Sadly, when it comes to nutrition and cholesterol, if mentioned at all, the existence of myths remains pervasive in the medical mainstream.
Firstly, I am familiar with the school of thought that suggests cholesterol is misplaced as a dangerous chemical; that excessive lowering of cholesterol, which comprises 2 % of brain mass, is detrimental to neurologic health; that as a natural antioxidant substance, raised cholesterol is a programmed protective response to toxin exposure (suggesting a role for detoxification and antioxidant supplementation). Nonetheless, high cholesterol remains an entity most patients are not comfortable with, insomuch that treatment is desirable and requested.
Returning to the discussion of nutrition misperceptions, dietary cholesterol has virtually no effect on circulating levels of cholesterol in the bloodstream. Eggs are an excellent source of protein and nutrients, and should not be avoided for their cholesterol content. The lecithin that naturally occurs in the whole egg (with emphasis on whole) exists coincidentally with the egg’s cholesterol for good reason. Mother Nature once again gets it right.
The myth that cholesterol can only be lowered a small percentage solely through dietary management has also been dispelled. This was the mainstay of medical thinking for decades, seemingly necessitating drug research and application. Dr. Jenkins and his colleagues at St. Michael’s hospital constructed the Portfolio Diet, and showed results equal to the financially successful statin drugs in a study published by the prestigious Journal of the American Medical Association (JAMA) http://jama.ama-assn.org/content/290/4/502.full.pdf. http://bit.ly/iVcqqd. Statins lowered LDL by 30-33 percent and the Portfolio Diet lowered LDL by nearly 30 percent. The portfolio was rich in soymilk, soy burgers, almonds, oats, barley, psyllium seeds, okra and eggplant.
Interestingly, Reuters News agency reported: “… people who cannot tolerate the statin drugs because of side-effects can turn to the diet, which they [the researchers] said their volunteers could easily follow.” A worthwhile question might be why not use the diet as first line therapy, as has always been footnoted. We now have a study with clear results supporting dietary management of a common condition, and the advice is to consider it a secondary intervention.
THE BOTTOM LINE
Eat whole, choose low glycemic foods, exercise regularly, supplement thoughtfully and maintain healthy body composition. Your heart will be thankful.