Med’Diet V Statins

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/

“Recently, researchers in Lyon, France, prospectively studied the effects of the Cretan Mediterranean diet on a group of 605 postmyocardial infarction patients (9). Patients were randomized either to the Cretan diet or to a “prudent” diet similar in composition to the American Heart Association Step 1 diet (control group). All other aspects of the patients’ health care were identical. An astonishing 70% reduction in the incidence of subsequent death and nonfatal myocardial infarction was reported in patients on the Mediterranean diet after a mean follow-up of 27 months, a ratio that was maintained through a final 48-month mean follow-up (10). Even more remarkable is that this mortality benefit occurred despite no difference between the study and the control populations in follow-up LDL and HDL cholesterol levels and only a very modest 6% drop in total cholesterol levels in both groups from 250 mg/dL to 237 mg/dL. The magnitude of benefit reported with the diet alone should be contrasted with that achievable by other routine secondary prevention therapies, including statin drugs (35% event reduction) (11), beta-blockers (15% reduction), and angiotensin-converting enzyme inhibitors (20% reduction) (12).”

Pescitarians are the longest living amongst dietary categories. The success of the Med’ diet may have something to do with fish.

“Two large prospective studies have reviewed the benefit of fish oil. The Diet and Reinfarction Trial (DART) randomized 2033 men to either a low-fat diet, a high-fiber diet, or a 200- to 400-g per week fish diet (30). There was a remarkable 29% reduction in all-cause mortality at 2 years in the fish diet group vs the other 2 groups. An even larger 62% reduction in ischemic heart disease death was noted in those patients who chose to take fish oil tablets (900 mg omega-3 per day) rather than eat fish. Fish oil has antithrombotic, antiarrhythmic, and anti-inflammatory properties in addition to lipid-lowering effects, which probably account for these results. This may help explain the beneficial results found in the a-linolenic acid–rich Mediterranean diet, as alinolenic acid is converted to DHA and EPA in the body. DART, however, had a number of confounding factors in its intricate multifactorial design, and the results are tantalizing but not convincing.

The larger GISSI Prevention Study randomized 11,324 Italians with recent myocardial infarctions to 850 mg of omega-3 fatty acids per day, 300 mg of vitamin E per day, neither, or both (31). In the fish oil group there was a statistically significant 20% reduction in total mortality at 3.5 years and a more striking 45% reduction in sudden death, reinforcing a possible antiarrhythmic property of omega-3 fatty acids. Although this study was not designed to investigate this hypothesis, a large majority of the study subjects appeared to be eating components of a Mediterranean diet at baseline, and the extra fish oil produced additive benefits.”

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Machine Learning Takes on Heart Disease Risk

Machine learning is a process where computers are used to analyse past data in the hope of predicting outcomes from future data. These outcomes can be anything in the modern world of Machine Learning, ranging from what type of book or CD you are likely to buy to predicting the outcomes of sports events such as horse racing. Various different Machine Learning methods have been devised each with different strengths that can make them more applicable to different types of problems. So a Neural Network may perform better on one kind of problem than say a Random Forest algorithm, but less efficiently on another kind of problem. Risk factor calculators that you plug your data into on the web are based on simpler models which assume a linear relationship between the factors eg LDL, blood pressure etc. Machine learning algorithms can dig deeper so to speak and amongst other things, uncover weightings to various factors. Figure out which are most important and weight them accordingly.

Such an approach was taken with a 10 year project tracking people with 48 factors. Four different algorithms were employed on the data. The data was split into 75% to find out what the relationships were within the data, usually called ‘training’ the model in machine learning parlance. The remaining 25% was used to test how well the model could predict cardio events such as heart attacks. The results were pretty good, out performing conventional risk assessors. Taking an average of how the four methods ranked the different factors we can see that LDL is well behind HDL, Trig’s and HbA1c as a risk factor. Here is an ordered table of those averages showing that age (not surprisingly) was the most impactful feature. Note that some are negatively significant eg Women are significantly less likely to have an event). ‘Missing’ means within the data a patient had this data missing. here is a link to the report

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944#pone-0174944-t003

Age*
Ethnicitya: South Asian
Female*
SESb: 2nd Townsend quintile
Smoking*
Ethnicitya: Black/Afro-Caribbean
SESb: 3rd Townsend quintile
SESb: 4th Townsend quintile
HDL cholesterol*
Oral corticosteroid prescribed
HbA1c missing
Total cholesterol*
COPD
Systolic blood pressure*
Ethnicitya: Other/Mixed
SESb: 5th Townsend quintile (most deprived)
Atrial fibrillation
Triglycerides
Family history of CHD < 60 years
SESb: Unknown
HbA1c
AST/ALT ratio missing
Ethnicitya: Chinese/East Asian
BMI missing
Ethnicitya: Unknown
Serum creatinine
Immunosuppressant prescribed
gamma GT
Diabetes
Chronic kidney disease
BMI
Anti-psychotic drug prescribed
Severe mental illness
Rheumatoid arthritis
Blood pressure treatment*
Hypertension
LDL cholesterol
gamma GT missing
CRP
AST/ALT ratio
Serum creatinine missing
FEV1 missing
Serum fibrinogen
CRP missing
FEV1
Serum fibrinogen missing
LDL cholesterol missing
Triglycerides missing

Over the Pasta and discovering NLR

During February I had a reminder of the dangers of over consumption of simple Carb’s. I spent a week in Rome and if you have been there you will know its wall to wall Pasta and Pizza. After a couple of days I just gave up and decided to eat the stuff for the remaining 5 days. I normally never touch Pizza and Pasta but made an exception in Rome. Now I normally spend a few months away in the winter and return to the UK exactly the same weight courtesy of the excellent dietary habits of the Portugese. A week in Rome however found me 7lbs overweight. This was a stark reminder of how damaging these products are.
Perhaps on a more interesting note I have just stumbled upon an inflamatory marker that has been shown to be a very good predictor of future or current heart disease. It is called the Neutrophil to Lymphocyte ratio and has been show to improve the Framingham risk score for any one who believes in the Framingham score (probably the people from Framinghan do). As usual this test can be obtained cheaply in Portugal for 6 euros. More details on the ratio can be obtained from the link below.

https://www.ncbi.nlm.nih.gov/pubmed/24388541

Just got my NLR results back. My Neurtrophil reading is 3.57 whilst my Lymphocyte reading is 2.08 giving a ratio of 3.57 / 2.08 = 1.71. The acceptable range is 0.78 to 3.53. Higher than 3.53 would be considered a problematic reading.

HDL Efflux

Higher HDL levels are generally associated with decreased risk for heart disease because of its role in transporting cholesterol away from macrophages within the artery wall back to the liver for recycling. However it seems that the amount of HDL is not the primary driver of improvement in this area. HDL Efflux appears to be the main driver and refers to how good HDL is at ‘sucking’ up cholesterol. You can have HDL C levels above 2.0 mmol but if your Efflux is low the hoover just ain’t picking up the bits. This may explain why very high levels of HDL dont seem to be better than just above average levels.

How can we improve HDL Efflux, well it seems the good old Med’ diet comes to fore once again along with a moderate (glass with a meal) amount of red wine. More controversially for me and other more expert in the field is the advocacy of extra virgin olive oil. Nothing seems to split the heart health community like this ingredient. Some research swear by it whilst others clearly show it creates endothelial disfunction. My feelings are that when confronted with split opinions like this I prefer to leave it out of my diet especially when its non essential. I will stick with a med’ based diet and a handful of nuts each day.

http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00126-6/abstract

http://www.medscape.com/viewarticle/875713#vp_2

LCHF and Cholesterol Profile

You may have come across the talks by Ivor Cummings on cholesterol. Ivor is a chemical engineer by trade and after receiving some personal alarming blood readings he decided to drill down into the meaning of what his readings actually meant. Applying his engineering rigour to the problem he quickly discovered that the emperor was wearing no clothes or the doctor in this case. I came across another engineer Dave Feldman, that has also gone into even more detail to extrapolate the real relationships between what we eat and how it effects cholesterol and associated lipid readings. It is a real beauty of a presentation which if you are new to the subject might take more than one listening. You can also easily replicate the experiment yourself, in fact he is appealing for people to try it and log their results on his blog.

http://cholesterolcode.com/about/

Sugar and Oil

The two things that have exploded in consumption along side the widespread development of heart disease are the consumption of these two food sources. We were all advised by the diet guideline experts in the 70’s to switch from saturated fat to vegetable oils and veg’ oil even today is common place in UK kitchens. Restaurants not only use it but to save money only change it when its oxidized to exhaustion. This study, until recently kept hidden, makes you wonder how we ever got on this path. It also suggests that what we eat is a bigger threat than cholesterol per se.

http://www.bmj.com/content/353/bmj.i1246

A Must Watch

During the Vietnam war the US realized that they could create more damage to the opposition forces by inventing a bullet that would maim opposing soldiers rather than kill them. Why was this and what does it have to do with the staggering increase in Autism we have experience in just one generation. Mercola talks this interview up in the introduction but he is not hyping, its simply a must watch, pass it on to others

http://articles.mercola.com/sites/articles/archive/2017/04/09/soil-microbes-intracellular-communication-affects-health.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170409Z2&et_cid=DM140360&et_rid=1960696579

Selenium Vit C and Dr Porter

I recently had an exchange with Dr Mark Porter. I took exception to his recent article in the Times which more or less trashed the idea of people using Vitamin supp’s to combat disease. I challenged this firstly on the Vit C front (but also on others) and I am glad I did because you always learn something when you talk to people with opposing views. It gets you off your backside to investigate. Dr Porter kindly replied and sent me a link to a meta analysis that essentially showed that no Vitamin was beneficial in a statistically significant way in relation to heart disease amongst other diseases, when supplemented, although selenium came pretty close. A meta analysis by the way is when a researcher takes all the research papers done on a topic and then pools together all the results to form one overall result. It also enables them to filter out badly designed studies. I decided to dig a little deeper into the meta analysis and in particular the heart disease and Vit C category. I am convinced that Vit C can impact Lp(a) and hence CVD. When I looked closely at the 7 studies forming the meta analysis on Vit C I noticed that they had weighted them. Now I forget the exact method of weighting but it sure wasn’t based on dosage because one study was weighted with 78%!! of the overall value of the analysis and this study only used 250mg of Vit C per day on people with heart disease. This study came out as pretty much neutral on Vit C and given that the overall score OR was 0.99 for Vit C (the more below 1 the better) you can see that this one study had massive or should I say 78% effect on the overall outcome of the meta analysis. As I said to Dr Porter, Linus Pauling would have laughed at 250mg even for healthy subjects. Incidently getting back to Selenium there is an interesting Swedish study that showed in subjects over 60 that a combo of Selenium and Coq10 slashed risk by 50%.

Footnote – Just discovered that Dr Porter has recently adopted a similar attitude to Carb’s as myself

https://web.archive.org/web/20160526203646/http://drmarkporter.co.uk/low-carb-diet-my-6-week-experiment-to-see-how-cutting-back-on-carbs-impacted-on-my-blood-cholesterol-lipid-profile

Japanese Total to HDL ratio

Over the last three decades total cholesterol has risen in japan but Heart disease has dropped. The linked report suggests that the reason for this may be their higher than average HDL and healthy Total to HDL ratios. The other interesting aspect of the report was the differences logged in Dietary intake between the Japanese, American and Australian subjects monitored. The main differences were

Fats significantly lower in Japanese
Fish and sea food much higher in Japanese
Eggs much higher in Japanese
Tofu and related products much higher in Japanese
Mushrooms much higher in Japanese
Fruits higher in Japanese

Cereals
Potatoes
Meats
Milk
Vegetables

were pretty much the same across the three countries.

Report http://circ.ahajournals.org/content/96/9/2830

Magnesium and CVD

With soil being continually depleted of magnesium we are getting less and less in our food supply. The research list connecting Magnesium deficiency and heart disease is long. here are just a few

https://www.ncbi.nlm.nih.gov/pubmed/21849940

https://www.ncbi.nlm.nih.gov/pubmed/24436973

https://www.ncbi.nlm.nih.gov/pubmed/26729158

https://www.ncbi.nlm.nih.gov/pubmed/26802105

Lazy solution – Eat a handful of almonds and or pumpkin seeds with your breakfast