Over the last year I have researched and written widely on how pharmaceutical companies fool the public into thinking cholesterol lowering drugs work when, in fact, that's not the case. These companies benefit enormously from huge profits made by depicting high cholesterol as the cause of cardiovascular disease (CVD). However, this emphasis on lowering cholesterol has resulted in a deviation from the underlying problem of CVD and its real risk factors. It is not cholesterol levels that can cause harm to our hearts, but instead excessive inflammation and oxidisation of cholesterol that causes damage to the cardiovascular system. The problem is one of lifestyle and diet and needs to be fixed, not with a lifetime supply of drugs, but with lifestyle changes anyone can begin today.
CVD is a multidimensional disease, yet modern medicine looks at it through a one-dimensional microscope. It cannot be treated with a single magic bullet - none of the chronic illnesses can be. But a multi-dimensional approach incorporating diet, environment, attitude and lifestyle will work. The solution lies in changing our diet and our lifestyle. It is that simple. It takes just one step at time.
A nutritionally complete diet is plentiful in fruit, vegetables, beans, nuts, fibre, omega 3 fatty acids, unprocessed and wholegrain foods, adequate water, antioxidants, minerals, vitamins and phytochemicals; all are associated with a reduction in cardiovascular disease. While this might seem complex it is, in fact, easy to achieve with a few small changes. Our research has shown that you can get significantly greater benefits from simple lifestyle changes than from any drug. Just take one step at a time.
Many studies have confirmed the benefits of fruit and vegetables in reducing the risk of heart attack and stroke. In a study of 43,757 US male health professionals followed for six years, a daily intake of more than 100 grams (about a handful - not much eh) of vegetables was associated with 26% lower risk of coronary death (1). One study found that regular fruit consumers were 24% less likely to die of a heart attack and 32% less likely to die of a stroke compared to those people who eat fruit only rarely (2). I have at last 10 serves a day of fruit and vegetables. A study looking at apple consumption found that there was a 49% reduction in heart attacks for men who ate more than 110g of apples (one small apple) a day compared to men who ate less than 18g per day (about an apple a week). Perhaps we should introduce a new saying: "An apple a day keeps the heart attack away!" Most studies have found that the fruit and vegetables can be eaten raw or cooked, but dried or pickled foods seem to have little or no protective effect (3).
Legumes such as chickpeas, baked beans and lentils are some examples of plant protein products which benefit the heart and are also examples of soluble and insoluble fibre (4). Numerous studies have shown a significantly reduced risk of coronary disease, around 22%, as well as a reduced risk of coronary mortality when legumes were eaten at least four times a week (5,6). This is a real and absolute risk reduction, not relative risk reduction such as those in the statin statistics reported earlier. All you need to do is have baked beans for breakfast every day instead of overprocessed cereals. My preference is a bit of dahl or even some chick peas for breakfast.
Legumes are high in fibre, magnesium and potassium; they are low in cholesterol, fat and calories. Their rich fibre content reduces low density lipoproteins (LDLs) (7). Isoflavones, produced by the legume family, have significant cholesterol-reducing effects (8); they bind with cholesterols and stop the uptake of cholesterol from the gut (9). Legumes also have the ability to lower blood pressure (5,10). High ratios of potassium to sodium in legumes are linked to a reduction in blood pressure. An epidemiological study of middle aged men over the course of seven years found that a diet incorporating higher intakes of vegetables, inclusive of legumes, led to lower blood pressure over time, whereas higher intakes of meat and poultry led to higher blood pressure (11). There are more than 25 good studies showing the benefits of potassium (which is rich in most plant foods) for lowering high blood pressure. Maybe it's not the salt we always blame for hypertension, but the lack of potassium and other minerals in our modern diets.
A handful of mixed fresh nuts, or just some raw almonds, has only positive side effects including weight loss. Nuts provide the nutrients your body needs to function effectively, while lowering cholesterol, inflammation, fats such as triglycerides and every other risk factor for heart attack, stroke and other chronic illnesses. A study of 31,208 Seventh Day Adventists found that subjects who consumed nuts more than four times per week had an almost 50% reduction in CVD compared to those who consumed less than one serving of nuts per week. That is, the more nuts they consumed, the less death from heart attack and stroke. Just a handful each day can make a big difference.
Wholegrains, not wholemeal, are rich in essential fatty acid, fibre, selenium, folate, vitamin E and much more (12). Increasing an individual's intake of wholegrains and dietary fibre, especially those found in oats, barley and rice bran, reduces LDL cholesterol and increases HDL cholesterol levels; the increase of these wholegrains also inhibits the reabsorption of cholesterol, which consequently improves insulin sensitivity by lowering the rate of carbohydrate reabsorption (4,13,14). Fibre also acts as a prebiotic to feed the good gut bacteria, the probiotics, to help digestion and further reduce inflammation. By contrast, refined grains, such as the ones in breakfast foods, pasta, white bread and white flour, contribute to diabetes and subsequent heart disease, as well as to fat (triglyceride) imbalances (4).
Fish and fish oils
The risk of cardiovascular disease can be significantly reduced by increasing an individual's intake of omega 3 fatty acids from fish or plant sources. (15,16). In fact, the level of omega 3 in the blood is a good indicator of one's risk of CVD. The average Western diet is not balanced, with reference to omega 3 and omega 6 fats, with an elevated ratio of omega 6s to omega 3s 4. The major omega 3 oils, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), inhibit the inflammatory immune response and the aggregation of platelets, that is it makes them less sticky and a lot less dangerous, which consequently reduces the risk of cardiovascular disease. There are hundreds of studies on the benefits of fish oils relating to CVD and just as many on the benefits for reducing other inflammatory diseases such as arthritis, cancer and Alzheimer's. Fish oils have also been shown to improve brain function. Besides fish, other foods containing high amounts of polyunsaturated omega 3 fatty acids include chia seed, flaxseed and fermented soybeans.
Numerous studies have found an inverse association between intake of flavinols found in tea and incidence of CVD (17,18,19,20,21). That is, the more tea drunk, the lower the risk. In a study of male health professionals (22) as part of the Rotterdam study, researchers found that tea protected against the development of severe atherosclerosis in population-based follow-up research on more than 6,000 men and women (23). These findings suggest that an increased intake of tea and flavonoids may contribute to the primary prevention of heart disease. Perhaps it is not just the antioxidants in tea, but also the increased consumption of liquids. Have lots of tea and drink lots of water.
A high fibre diet is also associated with a lower risk of heart disease, high blood pressure, gallbladder disease, obesity and diabetes and much more. One major study reported a relative risk for total heart attack of almost half among men in the highest total dietary fibre intake compared with men in the lowest in a study of 43,757 US male health professionals followed up for 6 years (1). A daily intake of 10 grams of fibre appeared to lower the risk of coronary death by 17%, with cereal fibre having a stronger association with reduced coronary death than vegetable or fruit fibre. This is pretty amazing when you consider that 10 grams of fibre is still really low. Ideally, we should be having more than 35g of fibre a day. This means having a lot more fruit, vegetables, beans and whole grains (seeds). Soluble fibre, also known as digestible fibre, lowers cholesterol (eg pectin, guar gum and beta-D-glucan in oats) and non digestible fibre is great for healthy digestion including preventing constipation and abnormal stool frequency. Non digestible fibre also has a prebiotic (feed the good bacteria in the gut) effect, by which the numbers and activity of bifidobacteria and lactic acid bacteria are increased, giving extra health effects in intestine.
Supplements can help
First, get your nutrients from your food but we need to acknowledge that, while the typical Western diet is rich in sugar and fat, it is nutrient-poor. White processed foods not only add no nutrition to the diet, but also actually deplete the body. There is no doubt in my mind for the need to supplement our diet for our overall wellbeing. Even a balanced diet is almost impossible in the 21st century. There are also supplements such as vitamin E, C, niacin, lycopene, quercetin, red rice yeast and others that have been specifically linked with reduced CVD - but first get your nutrients from your food.
One, in particular, that is of interest and has been used by the medical profession around the world except in Australia is niacin. Niacin has been used since 1955 to reduce total cholesterol and LDL-C, while raising HDL-C. It not only lowers total cholesterol levels, but also lowers triglyceride and fibrinogen levels and reduces levels of small-particle LDL-C and lipoprotein A, which are important risk indicators for CVD. In recent studies comparing it to statins, the niacin groups not only had lowered LDL and higher HDL cholesterol, but also had a reversal of the atherosclerosis plaque, which the statin drug groups did not display (24,25,26). Niacin was treating the problem, not just the symptoms. It is much cheaper than statin drugs and has many other benefits throughout the body. But there is not much money to be made in using it, as it cannot be patented. Next time your doctor says you have high cholesterol, ask them about niacin.
Exercise is essential: even a little bit will help!
There is strong evidence that lifestyle factors such as physical activity reduce the risk of CVD (27,28). Epidemiological studies also confirm that a physically inactive lifestyle is associated with twice the likelihood of developing cardiovascular disease. Make a commitment to walk rather than drive on those quick errands. Walk with your kids to model a healthy lifestyle and enjoy real quality time together.
Things to cut out
You can cut out some of the items most closely associated with CVD and take an important, proactive step in protecting your life. Cut out animal proteins and fats from meat and dairy. Both the fat and protein are linked with increased inflammation and higher risk of CVD. If you have read my earlier articles on cholesterol, you know sugar and high GI foods increase oxidised cholesterol and should be reduced to reduce your risk of CVD. Stop smoking. Cigarette smoking increases free radicals in the blood (29). This contributes to the oxidation of LDL cholesterol and the increased risk of CVD. If stopping seems overwhelming, start small and cut down! Every step counts. Rather than taking an "I cannot do it" stand, ask a friend to help you quit. Your life is worth it.
Stress and other psychosocial factors such as depression, anxiety and personality factors can have a major impact on CVD. If these persist, they can also affect lifestyle, leading to an unhealthy diet, smoking and direct pathophysiological mechanisms (30). Many techniques, including exercise, meditation and cognitive behavioural therapy can assist with stress and depression. A healthy diet is also essential to build the neurotransmitters for the brain to function healthily.
If you look at it like this it does not take much to really reduce your risk of a heart attack and stroke. The answer does not lie in any drug, but instead in changes you make to your diet and lifestyle. I know you have heard it before, but it really is more fruit vegetables, beans, nuts, seeds, tea, water and fish. Simple eh.
1 Rimm et al. 1996
2 Vines 1996
3 Ness and Powles 1996
4 Olendzki et al. 2006
5 Bazzano et al. 2001
6 Kok and Kromhout 2004
7 Samsonov and Meshcheryakova 1992
8 Lipkin 1995
9 Gardner et al. 2005
10 Lin et al. 2003
11 Miura et al. 2004
12 Truswell 2002
13 Leinonen et al. 2000
14 Behall et al. 2004
15 Hu 2001
16 da Silva 1997
17 Kelly et al. 1996
18 Arts et al. 2000
19 Hertog et al. 1993
20 Knekt et al. 1996
21 Hertog et al. 1995
22 Geleijnse 1999
23 Geleijnse et al. 2002
24 Kastelein et al 2009
25 Taylor et al 2009
26 Lindsay et al 2010
27 Thompson 2003
28 Miller, Balady and Fletcher 1997
29 Weng et al. 2002
30 Rozanski et al. 1999
Dr Peter Dingle PhD is an associate professor and researcher who has researched nutritional toxicology for the past 10 or more years. He is not a medical doctor. After completing his honours in environmental toxicology in 1988, he went on to complete his PhD in the same field in 1994. The information he presents is based on the research he and his students carry out at Murdoch University where he is Associate Professor in Health and the Environment.
Dr Peter Dingle (PhD) has spent the past 30 years as a researcher, educator, author and advocate for a common sense approach to health and wellbeing. He has a PhD in the field of environmental toxicology and is not a medical doctor. He is Australia’s leading motivational health speaker and has 14 books in publication.