Parameter

Goal

Current

Date

BMI (Weight)⁴

17 (115 lbs)

20 (138 lbs)

2006-07-15

Blood pressure⁵

< 115/75

114/66

2006-05-11

LDL cholesterol⁶

< 80

83

2006-05-05

HDL cholesterol⁷

> 50

70

2006-05-05

HbA1c⁸

< 5.0

5.5

2001-10-01

Fasting glucose⁹

< 90 or < 81

88

2006-05-05

Fasting triglyceride⁹

< 150

58

2006-05-05

Rating

Intervention

What I do or think should be done

1

Caloric restriction with optimal nutrition (abbreviated CR or CRON)

Note well: this is approximately twice as important as everything else put together!

Goal body mass index approximately 17, by reducing calories, not just by exercise.

N.b., Exercise is very good, but exercising without dieting is not the best way to live longer or slow the aging process.

1

Modify fat intake, including increasing Omega-3 fat & monounsaturated fats (MUFAs)

Caloric restriction

Completely avoid partially hydrogenated oils (trans fats)

Avoid saturated fats, avoid most animal fat

Eat moderate amounts of: tree nuts (unsalted & raw), wild salmon, freshly ground flaxseed, extra virgin olive oil, avocado

Cook with olive oil, preferably extra virgin

1

Reduce cholesterol and triglyceride levels

Caloric restriction

Avoid trans-saturated fats, animal fat

Eat flax meal, fruits & vegetables, tree nuts, high-fiber foods, orange peel

Avoid most carbs (rice, plain bread, sugar, potatoes, pasta, foods made largely of white flour, etc.)

Consider statin drugs (only if cholesterol is too high and other things fail)

1

Keep blood pressure low (less than 115/75)

Caloric restriction

Low salt intake, exercise daily, use potassium chloride (instead of salt, or 50/50 with salt if needed), limit alcohol intake, high folic acid (4 mg/day), take 6 mg of melatonin each night, eat a high protein diet (mostly vegetable-based), soluble fiber, magnesium

1

Take safety precautions

Drive safely, use seat belts, drive in a safe car with air bags, fire safety, follow government hazard preparation recommendations, hip protectors for the elderly

1

Take certain supplements

Vitamins D, B12, folate (about 4 mg / day vs. HTN), magnesium, benfotiamine, green tea extract, melatonin, glucosamine & chondroitin

A little zinc & selenium; iron if really needed

Avoid vitamin E supplements (alpha tocopherol)

Possibly: R(+) ALA

1

Exercise daily

Run 1 mile each day, do calisthenics and stretching.

2

Reduction of homocysteine (a major risk factor for heart disease & Alzheimer’s)

Caloric restriction

Eat a low-methionine diet: this can be done by getting protein from vegetables instead of animals (milk, eggs or meat)

Take supplemental vitamins: folate & B12

2

Reduce glycation (damages proteins & hardens arteries)

Caloric restriction
Reduce or eliminate “useless” carbohydrates, cook meat at low temperatures, reduce mixing sugar and protein in cooked foods, benfotiamine

Possibly: R(+) ALA

2

Avoid sun damage

Clothes, zinc oxide- or titanium dioxide- based sun block, hat, UV-protection sunglasses, eat orange peel

But, be sure to take 800 units/day of supplemental vitamin D in the form of D3

Caloric restriction (Perhaps - it reduces the area exposed to the sun)

2

Reduce inflammation

Caloric restriction

Floss & brush teeth, treat infections and skin problems

If you have risk factors for heart attack (especially older men), take a baby aspirin each day or every other day

2

Vaccinations – keep up to date

Influenza shot yearly, Pneumovax, hepatitis B, chickenpox / shingles, tetanus, etc. In short, take all that are recommended

2

Eat a high-fiber diet

Fruit & vegetables; bran (insoluble fiber), whole grains, freshly ground flax seed

Soluble fibers: glucomannan, psyllium, methylcellulose and guar (these are concentrated sources of soluble fiber, shown to lower cholesterol levels by 10%)

2

Medical tests periodically

Blood pressure, CBC, HbA1C, colonoscopy (starting at age 50), PSA, cholesterol (HDL & LDL) & lipids, CRP, eye exam for glaucoma, breast & pelvic exams for women

2

Greatly reduce in diet

Food! (i.e., caloric restriction)

Salt, red meat (worst if grilled, charred or cooked at high temperatures), omega-6 fat (corn, soy & cottonseed oils etc.), cured meats, excess fluoride, saturated and trans-saturated fats

Possibly: soy, peanuts

2

Increase the proportion of certain foods

Eat a variety of tree nuts, berries, spinach, kale, sprouts, broccoli & related veggies, tomato paste, coffee, green tea (only as extract capsules), pomegranate juice, fruit

3

Reduce iron load

Caloric restriction (less total iron intake)

Give blood if you are a man, avoid iron supplements, reduce or eliminate red (mammal) meat

However, take care to avoid iron deficiency

3

Avoid certain cooking techniques

Charred meat, over-cooking of fish or meat, high-temperature cooking of most foods, cooking with polyunsaturated oils such as canola, sunflower or flax oil, cooking sugars and meats together

4

Eat more than the RDA of protein

From vegetable sources such as broccoli, spinach, lentils, peas and tree nuts (n.b., vegetables like broccoli & spinach have far more protein per calorie than do beans and nuts)

5

Avoid aluminum (possible cause of Alzheimer’s disease)

Use non-aluminum-based deodorants, minimize foods that use alum-based baking powder (read the label), drink reverse-osmosis filtered water, avoid certain foods with aluminum (some pickles), avoid aluminum foil on foods, etc.

Possibly avoid antacids such as Mylanta (most are made with aluminum)

Category

Effect

Finding

Ref

Fig

Vegetarianism

Probably has a small beneficial effect on lifespan

From a well-thought out 2002 summary of many studies:
”- vegetarians have low mortality compared with the general population
- much of this benefit is attributable to non-dietary lifestyle factors such as the avoidance of smoking and a high socio-economic status
- vegetarians have similar mortality to comparable non-vegetarians, although a vegetarian diet may confer an additional 1-2 years of life (at least among US Adventists).”

¹⁹

Less risk of one type of kidney stones

About 12% of kidney stones are from uric acid; gout is also caused by this. Uric acid comes mostly from meat. “The results indicate that the intake of a balanced vegetarian diet with a moderate animal protein and purine content, an adequate fluid intake and a high alkali-load with fruits and vegetables results in the lowest risk of uric acid crystallization compared to the omnivorous diets.”

²⁰

Meat

Increased risk cardiovascular mortality from meat

A meta-analysis of 5 large prospective “Western diet” vegetarian studies showed that cardiovascular mortality is about 24% lower in vegetarians. (from other studies, part of this may be due to lower BMI)

²¹

Very low meat intake is associated with longer life expectancy

Review article: Very low meat intake is associated with longer life by 3.6 years. This effect may be at least partially due to factors other than meat: those with low meat intake also tend to be thinner and eat more healthy vegetables & nuts.

²²

Increased risk of gout, especially from red meat and beer; skim milk decreases the risk.

“The multivariate relative risk of gout among men in the highest quintile of meat intake, as compared with those in the lowest quintile, was 1.41… and the corresponding relative risk associated with seafood intake was 1.51 … In contrast, the incidence of gout decreased with increasing intake of [low fat] dairy products; the multivariate relative risk among men in the highest quintile, as compared with those in the lowest quintile, was 0.56…The level of consumption of purine-rich vegetables and the total protein intake were not associated with an increased risk of gout.”

From the 2004-03-13 Science News summary of the article, each daily serving of meat increased gout risk by 21%, while each daily fish serving increased the risk by 7%. In addition, each daily serving of beer increased risk by 49%. Skim milk decreases the risk by 21% per daily serving.

²³

Increased risk for diabetes (type 2, adult onset)

“We prospectively assessed the associations between major dietary patterns and risk of type 2 diabetes in women. Dietary information was collected in 1984, 1986, 1990, and 1994 from 69 554 women aged 38 to 63 years without a history of diabetes, cardiovascular disease, or cancer in 1984. We conducted factor analysis and identified 2 major dietary patterns: "prudent" and "Western." We then calculated pattern scores for each participant and examined prospectively the associations between dietary pattern scores and type 2 diabetes risks. RESULTS: The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern included higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. During 14 years of follow-up, we identified 2699 incident cases of type 2 diabetes. After adjusting for potential confounders, we observed a relative risk for diabetes of 1.49 (95% confidence interval [CI], 1.26-1.76, P for trend, <.001) when comparing the highest to lowest quintiles of the Western pattern. Positive associations were also observed between type 2 diabetes and red meat and other processed meats. The relative risk for diabetes for every 1-serving increase in intake is 1.26 (95% CI, 1.21-1.42) for red meat, 1.38 (95% CI, 1.23-1.56) for total processed meats, 1.73 (95% CI, 1.39-2.16) for bacon, 1.49 (95% CI, 1.04-2.11) for hot dogs, and 1.43 (95% CI, 1.22-1.69) for processed meats.”

²⁴

Hypertension

“Compared with quintile 1, the relative hazards of EBP for quintiles 2–5 of plant food intake were 0.83 (95% CI: 0.68, 1.01), 0.83 (0.67, 1.02), 0.82 (0.65, 1.03), and 0.64 (0.53, 0.90), respectively; P for trend = 0.01… positive dose-response relations for EBP were observed across increasing quintiles of meat intake (P for trend = 0.004).”

²⁵

Red meat

Colorectal cancer

“N-Nitroso compounds are suspected colorectal cancer (CRC) carcinogens to which individuals on a diet high in red meat (RM) may be particularly exposed… These data provide additional support for the hypothesis that nitrosamines are carcinogenic to the rectum in humans and that RM and, in particular, [processed meats] are significant sources of exposure for these compounds.”

²⁶

Increases risk of colorectal cancer

An NIH study found that the factors making the most difference are eating red meat (OR [odds ratio] = 2.0), pan-fried red meat (OR = 2.0) and well-done meat (OR = 1.7)

²⁷

Increases risk of colorectal cancer

A meta-analysis of 13 studies found that “a daily increase of 100 g of all meat or red meat is associated with a significant 12–17% increased risk of colorectal cancer” and that the risk for processed meat was greater: “A significant 49% increased risk was found for a daily increase of 25 g of processed meat.”

²⁸

Increased risk of diabetes type 2

“Heme-iron intake from red meat sources is positively associated with the risk of type 2 diabetes. Total iron intake, heme-iron intake from non-red meat sources, and blood donations are not related to the risk of type 2 diabetes.” (relative risk = 1.63, i.e. a 63% increased risk)

²⁹

Increased risk of rheumatoid arthritis

“A study of 25 000 people living in Europe shows that those who ate the most red meat had double the risk of rheumatoid arthritis, compared to those who ate the least amount. And people who ate more protein overall, including other forms of meat and plant protein, also had a higher risk of the disease while eating fat did not seem to raise the risk, the researchers found.”

³⁰

US Government collusion in disinformation

“I first became aware of the food industry as an influence on government nutrition policies and on the opinions of nutrition experts when I moved to Washington, DC, in 1986 to work for the Public Health Service. My job was to manage the editorial production of the first-and as yet only-Surgeon General's Report on Nutrition and Health, which appeared as a 700-page book in the summer of 1988. This report was an ambitious government effort to summarize the entire body of research linking dietary factors such as fat, saturated fat, cholesterol, salt, sugar, and alcohol to leading chronic diseases. My first day on the job, I was given the rules: No matter what the research indicated, the report could not recommend "eat less meat" as a way to reduce intake of saturated fat, nor could it suggest restrictions on intake of any other category of food. In the industry-friendly climate of the Reagan administration, the producers of foods that might be affected by such advice would complain to their beneficiaries in Congress, and the report would never be published.

This scenario was no paranoid fantasy; federal health officials had endured a decade of almost constant congressional interference with their dietary recommendations. As I discuss in Part I, agency officials had learned to avoid such interference by resorting to euphemisms, focusing recommendations on nutrients rather than on the foods that contain them, and giving a positive spin to any restrictive advice about food. Whereas "eat less beef" called the industry to arms, "eat less saturated fat" did not. "Eat less sugar" sent sugar producers right to Congress, but that industry could live with "choose a diet moderate in sugar." When released in 1988, the Surgeon General's Report recommended "choose lean meats" and suggested limitations on sugar intake only for people particularly vulnerable to dental cavities.”

³¹

Bacon

Increased risk of bladder cancer

“In these 2 cohorts combined, frequent consumption of bacon was associated with an elevated risk of bladder cancer.” (about double)

³²

Category

Effect

Finding

Ref

Fig

Aspirin

Cardiovascular disease

There is no evidence that aspirin helps if you have low cardiovascular risk factors.

³³

Cardiovascular disease

Aspirin only helps those with high risk factors for MI. “For 1000 patients with a 5% risk for coronary heart disease events over 5 years, aspirin would prevent 6 to 20 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events. For patients with a risk of 1% over 5 years, aspirin would prevent 1 to 4 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events.”

³⁴

Cancer (colon etc.)

Aspirin may help prevent digestive tract cancer. “The role of aspirin on the risk of cancers of the upper aerodigestive tract was investigated in the combined data of three Italian case-control studies, including 965 cases and 1779 hospital controls. The odds ratio was 0.33 for users of >/=5 years, and 0.51 for >/=5 years since first use.”

³⁵

Colon cancer

A randomized trial of patients who had previous colon adenomas showed that “Low-dose aspirin has a moderate chemopreventive effect on adenomas in the large bowel.” However, as noted in an editorial in the same journal “The cumulative risk of major adverse effects most likely outweighs any benefit in the prevention of colorectal cancer, particularly when prevention due to screening is considered.”

³⁶

Glycation related to aging

“Glycation, a deleterious form of post-translational modification of macromolecules has been linked to diseases such as diabetes, cataract, Alzheimer's, dialysis related amyloidosis (DRA), atherosclerosis and Parkinson's as well as physiological aging… Macromolecular damage and biochemical changes that occur in aging and age-related disorders point to the process of glycation as the common event in all of them. This is supported by the fact that several age-related diseases show symptoms manifested by hyperglycemia.”

³⁷

AGE formation

CR is the most effective way to reduce this

“…These results suggest that long-term feeding of specific dietary carbohydrates does not alter serum glucose concentrations or the rate of collagen glycation. Rather, age-related accumulation of AGE is more closely related to caloric intake.”

³⁸

Advanced glycosylation end-products (AGEs) in the diet

AGEs can be absorbed when taken orally, and cause reduced insulin sensitivity in mice

“AGEs are abundant in exogenous sources such as foods, especially when prepared under elevated temperatures (11,12). After ingestion, 10% of preformed AGEs are absorbed into the human or rodent circulation (13,14), of which two-thirds are retained in tissues… reduced intake of dietary AGEs has been recently shown to decrease the incidence of type 1 diabetes in NOD mice (26) as well as the formation of atherosclerotic lesions in diabetic apolipoprotein E-deficient mice”

³⁹

Dietary AGE has a large effect

Low AGE in the diet was achieved by using different cooking methods: “To vary the AGE content, foods, particularly meat, were exposed to different cooking methods. L-AGE subjects were instructed to boil, poach, stew or steam, avoid fried entrees, and reheat food indirectly using steam in a double boiler.” This cut their circulating AGE levels by 55%.
“…dietary glycotoxins contribute significantly to the elevated AGE levels in renal failure patients. Moreover, dietary restriction of AGE is an effective and feasible method to reduce excess toxic AGE and possibly cardiovascular associated mortality.”

⁴⁰

“Foods of the fat group showed the highest amount of AGE content with a mean of 100+/-19 kU/g. High values were also observed for the meat and meat-substitute group, 43+/-7 kU/g. The carbohydrate group contained the lowest values of AGEs, 3.4+/-1.8 kU/g. The amount of AGEs present in all food categories was related to cooking temperature, length of cooking time, and presence of moisture. Broiling (225 degrees C) and frying (177 degrees C) resulted in the highest levels of AGEs, followed by roasting (177 degrees C) and boiling (100 degrees C).”

⁴¹

Dietary AGE impairs wound healing

“Advanced glycoxidation end products (AGEs) are implicated in delayed diabetic wound healing. To test the role of diet-derived AGE on the rate of wound healing, we placed female db/db (+/+) (n = 55, 12 weeks old) and age-matched control db/db (+/-) mice (n = 45) on two diets that differed only in AGE content (high [H-AGE] versus low [L-AGE] ratio, 5:1) for 3 months. Full-thickness skin wounds (1 cm) were examined histologically and for wound closure... L-AGE-fed mice displayed more rapid wound closure at days 7 and 14 (P < 0.005) and were closed completely by day 21 compared with H-AGE nonhealed wounds. Serum AGE levels increased by 53% in H-AGE mice and decreased by 7.8% in L-AGE mice (P < 0.04) from baseline. L-AGE mice wounds exhibited lower skin AGE deposits, increased epithelialization, angiogenesis, inflammation, granulation tissue deposition, and enhanced collagen organization up to day 21, compared with H-AGE mice. Reepithelialization was the dominant mode of wound closure in H-AGE mice compared with wound contraction that prevailed in L-AGE mice. Thus, increased diet-derived AGE intake may be a significant retardant of wound closure in diabetic mice; dietary AGE restriction may improve impaired diabetic wound healing.”

⁴²

AGE absorption from foods

Cooking at high temperatures or with simple sugars produces absorbable AGEs

“To assess the kinetics of ingested AGEs, investigators at this center recently prepared, for five healthy persons and 38 diabetic patients with or without overt renal disease, a breakfast consisting of 56 gm of egg white cooked with or without 100 gm of fructose for one to three hours at 90°C. In the cooked fructose-containing mixture, the AGE content was more than 200 times that of the other food. Over the ensuing 48 hours, blood and urine were sampled. The high-AGE meal produced serum AGE elevations well correlated with severity of renal disease. In particular, renal clearance ranged from about 30% of absorbed AGEs in controls to less than 5% in diabetic patients with renal failure. The rest was retained in the body. Serum AGE analyses confirmed the ability of the absorbed AGEs to crosslink biologic macromolecules (in this case, radiolabeled fibronectin).

It must immediately be said that the AGE content of one or another food has no simple relation to its sugar content. The more important relation is with the method of food preparation. Since the turn of the 20th century, food chemists have appreciated that the changes responsible for increasing the AGE content of a food--changes known to them as the Maillard reaction and to the rest of us, less formally, as the browning of raw foods by methods such as roasting or braising--depend directly on temperature and are greatly heightened by long exposure to high heat. Unfortunately, heat creates tastes that humans enjoy, or at least tastes for which humans in Western societies have developed an appetite. In recent decades, food manufacturers have been using their knowledge of Maillard chemistry to add appeal to natural foods and even to incorporate such appeal into synthetic foods (an example being the use of caramelized sugars in beverages such as Coca Cola). In consequence, the AGE content of the Western diet has increased vastly in the past 50 years.

A few representative measurements may serve to illustrate the importance of cooking method. So far, our group has analyzed 300 to 400 foods, using an immunoassay that assesses a few of the many lipid- and protein-bound AGEs. By this test, roasted duck skin (220°C for 110 minutes) exhibited, weight for weight, almost 15 times the AGE content of a doughnut (160°C for five minutes). Cooking increased the doughnut's AGE content 24-fold and the duck skin's 101-fold.”

⁴³

Technical discussion of AGE

Free pdf paper at http://www.mssm.edu/msjournal/70/70_4_pages_232_241.pdf

A popular discussion from the same author is at CBSnews: “The key to lowering AGEs, said Vlassara, is to cook for a short time in the presence of high humidity. This means either boiling or steaming meats for the minimum time required. Meat can be sautéed, she said, but it should be cut very thin and cooked quickly with a small amount of oil.
She said one of the worst AGE offenders is turkey cooked in the traditional American way.
"We cook for many hours," she said. "That would tend to make a tremendous number of AGEs.”

⁴⁴

High AGE diet led to kidney damage in diabetic and normal mice.

⁴⁵

High HbA1c is associated with vessel disease

Glycosylation results in carotid plaques, even in normal, non-diabetic people

“HbA1c measurements and ultrasonography of the carotid artery were performed in 5960 subjects (3026 women, 2934 men) 25 to 84 years of age...HbA1c was categorized into 5 groups: <5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4% and >6.4%. Carotid plaque prevalence increased with increasing HbA1c level (P for linear trend=0.002). The OR for hard plaques versus no plaques was 5.8 in the highest HbA1c group (>6.4%) compared with subjects in the lowest group (<5.0%) after adjustment for several possible confounders. The risk of predominantly hard plaques was also significantly associated with HbA1c levels, although the ORs at each level were somewhat lower than for hard plaques… CONCLUSIONS: Metabolic changes reflected by HbA1c levels may contribute to the development of hard carotid artery plaques, even at modestly elevated levels.”

⁴⁶

“Glycosylated hemoglobin is an easily measured bio-chemical marker that strongly correlates with the level of ambient glycemia during a 2- to 3-month period… Khaw and colleagues (14) carefully analyzed the relationship of 1 hemoglobin A1c measurement to incident cardiovascular events in a 6-year cohort study of 10 232 diabetic and nondiabetic men and women age 45 to 79 years. After adjustment for systolic blood pressure, cholesterol level, body mass index, waist-to-hip ratio, smoking, and previous myocardial infarction or stroke, there was a 21% increase in cardiovascular events for every 1–percent-age point increase in hemoglobin A1c level above 5% (P 0.001). Similar relationships were observed for total mortality (22% for men [P   0.001] and 28% for women [P 0.01] per 1–percentage point increase in hemoglobin A1c level).”

⁴⁷

⁴⁸

High-normal glucose levels

Associated with higher risk of death

“Using the Framingham Heart Study data... After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality… For men, adjusted mortality risk increased very rapidly through the normal range (from 4.12% at 3.89 mmol/liter (70 mg/dl) to 12.26% at 5.55 mmol/liter (100 mg/dl)) and was flat at 12.26% thereafter. For women, risk was flat at 3.65% through the normal range and then increased rapidly, reaching 8.34% at 6.99 mmol/liter (126 mg/d), but increased much more slowly thereafter. Exactly analogous relations held for cardiovascular mortality. For men and women combined, noncardiovascular mortality increased from 1.82% at 3.89 mmol/liter to 2.06% at 5.55 mmol/liter to 2.29% at 6.99 mmol/liter (p for trend = 0.009). These findings suggest that although 5.55 mmol/liter (normal) may be a useful mortality risk division (albeit with different implications for the two sexes), 6.99 mmol/liter (diabetic) is not, especially for men.”

⁴⁹

Pyridoxamine

Inhibits AGE formation

“[Pyridoxamine (PM)] has a strong lipid-lowering effect in streptozotocin (STZ)-induced diabetic and Zucker obese rats, and protects against the development of nephropathy in both animal models. PM also inhibits the development of retinopathy and neuropathy in the STZ-diabetic rat.”

⁵⁰

Benfotiamine (a thiamine derivative)

AGE prevention

Benfotiamine blocks the formation of intracellular Advanced Glycation Endproducts (AGE), through boosting the activity of the enzyme transkelotase sufficiently to provide a metabolic "shunt" for excess intracellular (as opposed to blood) glucose, reducing the formation of highly reactive glycolytic intermediates called triosephosphates. “…benfotiamine treatment … prevented experimental diabetic retinopathy. The ability of benfotiamine to inhibit three major pathways simultaneously might be clinically useful in preventing the development and progression of diabetic complications.”

⁵¹

Glucose

Alpha lipoic acid

Increases blood pressure & insulin resistance in rats

alpha lipoic acid blocks this effect

Message: avoid glucose (sugars & starches); consider using alpha lipoic acid. “Chronic administration of glucose resulted in a 29% increase in blood pressure, 30% increase in glycemia, 286% increase in insulinemia, and 408% increase in insulin resistance index. Chronic glucose feeding also resulted in a 22% greater mitochondrial superoxide anion production in heart and in an increase of 63% in AGE content in aorta. Increases in blood pressure, aorta AGE content and heart mitochondrial superoxide production were prevented in the rats fed glucose supplemented with lipoic acid.”

⁵²

Glycation

Strongly correlated with carotid plaques

“HbA1c was categorized into 5 groups: <5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4% and >6.4%. Carotid plaque prevalence increased with increasing HbA1c level (P for linear trend=0.002). The OR for hard plaques versus no plaques was 5.8 in the highest HbA1c group (>6.4%) compared with subjects in the lowest group (<5.0%) after adjustment for several possible confounders… Metabolic changes reflected by HbA_1c levels may contribute to the development of hard carotid artery plaques, even at modestly elevated levels.”

⁵³

Category

Effect

Finding

Ref

Fig

Carbohydrates

Colon cancer

There may be an increased risk of colorectal cancer with high carbohydrate intake. “increased eCarb and total carbohydrate consumption are both associated with increased risk of CRC [colorectal cancer] in both sexes, and that among women, relative risk appears greatest for the right colon, whereas among men, relative risk appears greatest for the rectum” (note: in another careful case-control study, carbohydrates dropped out as a risk factor in favor of calories)

⁵⁴

Low-carbohydrate, low iron, vegetable diet helps prevent progression of kidney damage

“In conclusion, [carbohydrate-restricted, low-iron-available, polyphenol-enriched] CR-LIPE was 40-50% more effective than standard protein restriction in improving renal and overall survival rates.” (Polyphenols are found in tea, wine, etc.) Although this is a study of kidney failure patients, the implications may be much more widespread. Perhaps this type of diet is healthy for other organs as well.

⁵⁵

Blood glucose level

Post-prandial glucose level is more important than average

“Most epidemiological data implicate postprandial hyperglycemia in the development of cardiovascular disease, whereas the link between fasting glycemia and diabetic complications is inconclusive. Moreover, in many studies, postprandial glycemia is a better predictor of cardiovascular risk than HbA(1c) level. Postprandial glucose may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress that is independent of other cardiovascular risk factors such as hyperlipidemia.”

⁵⁶

High levels damage mitochondria

“Four main molecular mechanisms have been implicated in glucose-mediated vascular damage. All seem to reflect a single hyperglycaemia-induced process of overproduction of superoxide by the mitochondrial electron-transport chain.”

⁵⁷

Fasting glucose >90, BMI >30, and triglyceride >150 => increased rate of subsequent diabetes

“We obtained blood measurements, data from physical examinations, and medical and lifestyle information from men in the Israel Defense Forces who were 26 to 45 years of age. RESULTS: A total of 208 incident cases of type 2 diabetes occurred during 74,309 person-years of follow-up (from 1992 through 2004) among 13,163 subjects who had baseline fasting plasma glucose levels of less than 100 mg per deciliter. A multivariate model, adjusted for age, family history of diabetes, body-mass index, physical-activity level, smoking status, and serum triglyceride levels, revealed a progressively increased risk of type 2 diabetes in men with fasting plasma glucose levels of 87 mg per deciliter (4.83 mmol per liter) or more, as compared with those whose levels were in the bottom quintile (less than 81 mg per deciliter [4.5 mmol per liter], P for trend <0.001). In multivariate models, men with serum triglyceride levels of 150 mg per deciliter … combined with fasting plasma glucose levels of 91 to 99 mg per deciliter …had a hazard ratio of 8.23 … for diabetes, as compared with men with a combined triglyceride level of less than 150 mg per deciliter and fasting glucose levels of less than 86 mg per deciliter … The joint effect of a body-mass index … of 30 or more and a fasting plasma glucose level of 91 to 99 mg per deciliter resulted in a hazard ratio of 8….as compared with a [BMI <] 25 and a fasting plasma glucose level of less than 86 mg per deciliter. CONCLUSIONS: Higher fasting plasma glucose levels within the normoglycemic range constitute an independent risk factor for type 2 diabetes among young men, and such levels may help, along with body-mass index and triglyceride levels, to identify apparently healthy men at increased risk for diabetes.”

⁵⁸

Reduce glycemic load (eat less non-fiber carbohydrates)

Reduces heart attack risk

A prospective study of 75,521 American women showed that those with the lowest glycemic load had half the risk for heart attack of women with the highest glycemic load.

⁵⁹

Reduced CRP level

Another study showed that high glycemic load caused raised C-reactive protein (CRP) levels. CRP is strongly correlated with heart attack risk.

⁶⁰

High glycemic index and low cereal fiber diet are associated with Type 2 DM

From the nurses health study: “After adjustment for age, body mass index, family history of diabetes, and other potential confounders, glycemic index was significantly associated with an increased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 1.15, 1.07, 1.27, and 1.59; 95% CI: 1.21, 2.10; P for trend = 0.001). Conversely, cereal fiber intake was associated with a decreased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 0.85, 0.87, 0.82, and 0.64; 95% CI: 0.48, 0.86; P for trend = 0.004). Glycemic load was not significantly associated with risk … CONCLUSIONS: A diet high in rapidly absorbed carbohydrates and low in cereal fiber is associated with an increased risk of type 2 diabetes.”

⁶¹

High GI and GL are associated with increased risk of prostate cancer

“ORs [odds ratios] of prostate cancer and the corresponding 95% CIs were derived using unconditional multiple logistic regression, including terms for age, study center, education, family history of prostate cancer, smoking, body mass index, physical activity, alcohol consumption, intake of energy, fiber and lycopenes. Compared to the lowest quintile of GI, the ORs were 1.23, 1.24, 1.47 and 1.57 for subsequent levels of GI. The corresponding values for GL were 0.91, 1.00, 1.20 and 1.41…We found direct relations between dietary GI and GL and prostate cancer risk.”

⁶²

High GL lowers HDL even in young people

“The only significant correlations evident were negative correlations between HDL cholesterol and glycemic load (in relation to white bread), percentage carbohydrate, total dietary sugar, total carbohydrate, and fructose. On stepwise multiple regression analysis, glycemic load accounted for 21.1% of the variation in HDL cholesterol.”

⁶³

Reduces stroke risk

“Cereal fiber intake was inversely associated with total and hemorrhagic stroke risk; for total stroke, relative risk = 0.66 (95% confidence interval: 0.52, 0.83; p(trend) = 0.001) and for hemorrhagic stroke, relative risk = 0.51 (95% confidence interval: 0.33, 0.78; p(trend) = 0.01). Findings suggest that high intake of refined carbohydrate is associated with hemorrhagic stroke risk, particularly among overweight or obese women. In addition, high consumption of cereal fiber was associated with lower risk of total and hemorrhagic stroke.”

Note: The lifetime risk for stroke is about 20% for women and 10% for men.

⁶⁴

⁶⁵

High GI and GL (carbohydrate intake) ó higher rate of cataracts

… Maybe. I am not sure if they controlled for BMI etc.

“A modified Block food-frequency questionnaire was used to obtain dietary information from 3377 participants (aged 60-80 y; 56% were women) in the Age-Related Eye Disease Study (AREDS)... RESULTS: For participants in the highest quartile, dietary GI was associated with a higher prevalence of all pure nuclear opacities [grade >2; odds ratio (OR): 1.29; 95% CI: 1.04, 1.59; P for trend = 0.02] and moderate nuclear opacities (grade >/=4; OR: 1.43; 95% CI: 0.96, 2.14; P for trend = 0.052). The OR in a comparison of the highest with the lowest quartile of intake was 1.27 (95% CI: 0.99, 1.63; P for trend = 0.09) for cortical opacities of any severity (>0% of area opaque), and the OR increased somewhat for moderate cortical opacities (>5% of area opaque; OR: 1.71; 95% CI: 1.00, 2.95; P for trend = 0.056).”

“Subjects were 417 Boston-area members of the Nurses' Health Study cohort aged 53-73 y... RESULTS: After multivariate adjustment, the odds of cortical opacities (LOCS III >/=1.0) among women in the highest tertile of carbohydrate intake (>/=200 g/d) was 2.46 times (95% CI: 1.30, 4.64; P for trend = 0.005) that among women in the lowest tertile (<185 g/d).”

⁶⁶

⁶⁷

Glycemic load

Increases level of glucose in blood (bad)

“Stepwise increases in glycemic load produced significant and predictable increases in both glycemia (P < 0.001) and insulinemia (P < 0.001).”

An interesting note: pasta has a relatively low glycemic index, while potatoes and rice are very high.

⁶⁸

Fructose

Causes diabetes in rats

“Sprague-Dawley rats fed a fructose-rich diet exhibit insulin resistance and hypertension, a pathologic status resembling human type II diabetes mellitus”

⁶⁹

Insulin score

Insulin Index

Reducing insulin response to foods may be as important as or more important than reducing glycemic index.

⁷⁰

Figure

Cut down on sugars and fats

May delay or reduce the disease of aging

“Simultaneous consideration of the influence of the different types of carbohydrates and fats in human diets on mortality rates (especially the diseases of aging), and the probable retardation of such diseases by caloric restriction (CR) leads to the hypothesis that restriction of foods with a high glycemic index and saturated or hydrogenated fats would avoid or delay many diseases of aging and might result in life extension.”

⁷¹

May reduce pancreas cancer risk

“The objective of the study was to examine prospectively the association of the consumption of added sugar (ie, sugar added to coffee, tea, cereals, etc) and of high-sugar foods with the risk of pancreatic cancer in a population-based cohort study of Swedish women and men. DESIGN: A food-frequency questionnaire was completed in 1997 by 77 797 women and men aged 45-83 y who had no previous diagnosis of cancer or history of diabetes. The participants were followed through June 2005. RESULTS: During a mean follow-up of 7.2 y, we identified 131 incident cases of pancreatic cancer. The consumption of added sugar, soft drinks, and sweetened fruit soups or stewed fruit was positively associated with the risk of pancreatic cancer. The multivariate hazard ratios for the highest compared with the lowest consumption categories were 1.69 (95% CI: 0.99, 2.89; P for trend = 0.06) for sugar, 1.93 (1.18, 3.14; P for trend = 0.02) for soft drinks, and 1.51 (0.97, 2.36; P for trend = 0.05) for sweetened fruit soups or stewed fruit. CONCLUSION: High consumption of sugar and high-sugar foods may be associated with a greater risk of pancreatic cancer.”

⁷²

Category

Effect

Finding

Ref

Fig

Omega-3 fats

Cardiovascular disease

“Randomized trials have convincingly documented that omega-3 fatty acids can significantly reduce the occurrence of CVD events in patients with coronary artery disease. The strongest evidence to date is from studies in which marine-derived omega-3 fatty acids have been consumed as supplements or fish.”

⁷³

The AHA recommends that all adults eat fish (particularly fatty fish) at least two times a week (fatty fish have the omega-3 fats DHA and EPA). The AHA also recommends eating plant-derived omega-3 fatty acids (ALA, found in flax seed, canola oil, and walnuts).

⁷⁴

Protect against sudden death, NOT vs. atherosclerosis

“Both clinical and animal-experimental evidence suggests that the effect of n-3 PUFAs on the risk of sudden cardiac death relates primarily to reduced vulnerability to ventricular fibrillation, rather than to a reduction in atherosclerosis or nonfatal myocardial infarction..”

⁷⁵

Depression

“…percentages of n-3 PUFAs and ratios of n-6 to n-3 PUFAs were significantly lower and higher, respectively, in subjects with depressive disorders than in control subjects…”

⁷⁶

Fish intake

Protects against death in those with cardiovascular disease

“Compared with no consumption, consumption of fish tended to be associated with a lower risk of death [1–57 g/d, RR = 0.50 (0.20, 1.28); > 57 g/d, RR = 0.37 (0.14, 1.00); P for trend = 0.059].”

I.e., if you have CAD, eat ~3 oz of fish each day.

⁷⁷

DHA and EPA (long-chain omega 3 fats)

Help infants develop neurologically

“A prospective, double-blind, randomized controlled study was conducted with 2 groups of healthy term infants [showed that] Supplementation of healthy term infants with [long-chain polyunsaturated fatty acids] during the first 2 mo of life reduces the occurrence of mildly abnormal [general movements].”

⁷⁸

Intake of fish oil during pregnancy and lactation increases child’s IQ

A randomized and double-blinded study of the effect of cod liver oil supplementation (with DHA and EPA) “Children who were born to mothers who had taken cod liver oil (n = 48) during pregnancy and lactation scored higher on the Mental Processing Composite of the K-ABC at 4 years of age as compared with children whose mothers had taken corn oil (n = 36; 106.4 [7.4] vs 102.3 [11.3])… The children's mental processing scores at 4 years of age correlated significantly with maternal intake of DHA and eicosapentaenoic acid during pregnancy… Maternal intake of very-long-chain n-3 PUFAs during pregnancy and lactation may be favorable for later mental development of children.”

⁷⁹

Help prevent breast cancer

High marine omega-3 (DHA and EPA) diet => 26% lesser risk of breast cancer; high n-6 fat diet (e.g., corn oil) => 87% greater risk of breast cancer.

⁸⁰

DHA

Depression

The omega-3 fat DHA found in fish may help prevent depression. “Mildly depressed subjects had significantly reduced (-34.6%) adipose tissue docosahexaenoic acid (DHA) levels than non-depressed subjects. Multiple linear regression analysis indicated that depression related negatively to adipose tissue DHA levels.”

⁸¹

Category

Effect

Finding

Ref

Fig

Nuts and monounsaturated fats

Cardiovascular disease

“Nuts such as pecans that are rich in monounsaturated fat may therefore be recommended as part of prescribed cholesterol-lowering diet of patients or habitual diet of healthy individuals.”

⁸²

All-cause mortality and ischemic heart disease (IHD)

“The protective effect of nut consumption on IHD is not offset by increased mortality from other causes. Moreover, frequency of nut consumption has been found to be inversely related to all-cause mortality in several population groups such as whites, blacks, and the elderly. Thus, nut consumption may not only offer protection against IHD, but also increase longevity.” This protection is 18% for those eating 1 oz of nuts every day, even after all other factors are controlled for.

⁸³

Nuts

Interesting botany web site

Lots of information and pictures at http://waynesword.palomar.edu/ecoph8.htm

⁸⁴

Reduce incidence of gallstones

From the Nurses’ Health Study: eating more than 5 oz of nuts/week (either peanuts or other nuts) reduced the risk of cholecystectomy by 25%.

⁸⁵

In a prospective long-term study, nuts and peanuts were both found to be associated with reduced incidence of gallstones. “After adjustment for age and other known or suspected risk factors, men consuming 5 or more units of nuts per week… had a significantly lower risk of gallstone disease (relative risk = 0.70…) than did men who never ate or who ate less than 1 unit per month … (1 unit = 1 ounce (0.028 kg) of nuts).”

⁸⁶

Reduce bad lipids (LDL cholesterol)

A systematic review of human studies showed: ^“The results of 3 almond (50–100 g/d), 2 peanut (35–68 g/d), 1 pecan nut (72 g/d), and 4 walnut (40–84 g/d) studies showed decreases in total cholesterol between 2 and 16% and LDL cholesterol between 2 and 19% compared with subjects consuming control diets. Consumption of macadamia nuts (50–100 g/d) produced less convincing results. In conclusion, consumption of 50–100 g (1.5–3.5 servings) of nuts 5 times/wk as part of a heart-healthy diet with total fat content (high in mono- and/or polyunsaturated fatty acids) of 35% of energy may significantly decrease total cholesterol and LDL cholesterol in normo- and hyperlipidemic individuals.”

⁸⁷

Eating nuts does NOT tend to cause weight gain

“Review of the available data to date suggests that adding nuts to habitual diets of free-living individuals does not cause weight gain. In fact, nuts have a tendency to lower body weight and fat mass. In the context of calorie-restricted diets, adding nuts produces a more lasting and greater magnitude of weight loss among obese subjects while improving insulin sensitivity… there is sufficient evidence to promote the inclusion of nuts as part of healthy diets.”

⁸⁸

Walnuts

Cardiovascular disease

Walnuts help prevent cardiovascular disease. “This study demonstrated that walnuts, when consumed as part of a low fat, low-cholesterol diet, have a beneficial effect on serum cardiovascular risk factors.”

⁸⁹

Protects the heart

“Substituting walnuts for monounsaturated fat in a Mediterranean diet improves endothelium-dependent vasodilation in hypercholesterolemic subjects. This finding might explain the cardioprotective effect of nut intake beyond cholesterol lowering.”

⁹⁰

Almonds

Almond intake improves lipid profile

“Isoenergetic incorporation of 68 g of almonds (20% of energy) into an 8368-kJ (2000-kcal) Step I diet markedly improved the serum lipid profile of healthy and mildly hypercholesterolemic adults.”

⁹¹

Help with dieting

“[Low calorie diet] supplementation with almonds, in contrast to complex carbohydrates, was associated with greater reductions in weight/BMI (-18 vs -11%), waist circumference (WC) (-14 vs -9%), fat mass (FM) (-30 vs -20%) … and systolic blood pressure (-11 vs 0%)”

⁹²

Macadamia nuts

Favorably affect blood lipid levels, and cholesterol in particular

My take: nuts help against cholesterol, but you have to eat a lot. “…macadamia nuts (40-90 g/d), equivalent to 15% energy intake… Plasma total cholesterol and LDL cholesterol concentrations decreased by 3.0 and 5.3%, respectively, and HDL cholesterol levels increased by 7.9% in hypercholesterolemic men after macadamia nut consumption.”

⁹³

Peanuts

Cause atherosclerosis in animals

“Peanut oil is unexpectedly atherogenic for rats, rabbits, and primates.” This is probably from the lectin content.

Additional note: relative to other nuts, peanuts have less good MUFA and more bad omega-6 fats.

⁹⁴

⁹⁵

Category

Effect

Finding

Ref

Fig

Fats

This web site is an OUTSTANDING scientific summary of the various types of fats, their sources, what fats are found in various foods, why trans fats (partially hydrogenated oils) are bad, etc.

http://www.scientificpsychic.com/fitness/fattyacids.html

⁹⁶

Use MUFA fats and avoid saturated and trans-fats

A meta-analysis of 60 controlled trials showed that the ratio of HDL to total cholesterol was influenced by the type of fat eaten. “Lauric acid [coconut oil] greatly increased total cholesterol, but much of its effect was on HDL cholesterol. Consequently, oils rich in lauric acid decreased the ratio of total to HDL cholesterol. “ “… risk is reduced most effectively when trans fatty acids and saturated fatty acids are replaced with cis unsaturated fatty acids.”

⁹⁷

Parkinson disease

“Estimating the association between PD [Parkinson disease] and risk of being in the highest versus the lowest intake quartile, there were elevated odds ratios for total fat (OR 1.94, 95% confidence interval [CI] : 1.05-3.58), cholesterol (OR 2.11, 95% CI: 1.14-3.90), lutein (OR 2.52, 95% CI: 1.32-4.84) and iron (OR 1.88, 95% CI: 1.05-3.38).” This study is from Detroit: most of the fat and cholesterol is from animal fat. The lutein (from broccoli and kale) correlation is somewhat worrisome.

⁹⁸

Saturated fat

Associated with reduced bone density

“These data indicate that [bone mineral density] is negatively associated with saturated fat intake, and that men may be particularly vulnerable to these effects.”

⁹⁹

Increases LDL cholesterol, worsens insulin resistance, increases cancer, may cause brain function problems

This site is a MSNBC nutrition article; basically a readable summary that emphasizes that saturated fat is bad for health.

¹⁰⁰

Raises cholesterol

“Regression analysis of the combined published data on the effects of dietary fatty acids and cholesterol on serum cholesterol and lipoprotein cholesterol evaluated with groups of human subjects shows that 1) saturated fatty acids increase and are the primary determinants of serum cholesterol, 2) polyunsaturated fatty acids actively lower serum cholesterol, 3) monounsaturated fatty acids have no independent effect on serum cholesterol and, 4) dietary cholesterol increases serum cholesterol”

¹⁰¹

Saturated and trans-fats

Alzheimer disease increased

Trans fats increase risk: “Risk … increased with consumption of trans-unsaturated fats” (relative risk = 2.4)

Saturated fats increase risk (relative risk = 2.2)

¹⁰²

Increase coronary heart disease

From the Nurses' Health Study. “We prospectively studied 80,082 women who were 34 to 59 years of age and had no known coronary disease, stroke, cancer, hypercholesterolemia, or diabetes in 1980. Information on diet was obtained at base line and updated during follow-up by means of validated questionnaires. During 14 years of follow-up, we documented 939 cases of nonfatal myocardial infarction or death from coronary heart disease. Mutivariate analyses included age, smoking status, total energy intake, dietary cholesterol intake, percentages of energy obtained from protein and specific types of fat, and other risk factors. RESULTS: Each increase of 5 percent of energy intake from saturated fat, as compared with equivalent energy intake from carbohydrates, was associated with a 17 percent increase in the risk of coronary disease (relative risk, 1.17; 95 percent confidence interval, 0.97 to 1.41; P=0.10). As compared with equivalent energy from carbohydrates, the relative risk for a 2 percent increment in energy intake from trans unsaturated fat was 1.93 (95 percent confidence interval, 1.43 to 2.61; P<0.001); that for a 5 percent increment in energy from monounsaturated fat was 0.81 (95 percent confidence interval, 0.65 to 1.00; P=0.05); and that for a 5 percent increment in energy from polyunsaturated fat was 0.62 (95 percent confidence interval, 0.46 to 0.85; P= 0.003). Total fat intake was not signficantly related to the risk of coronary disease (for a 5 percent increase in energy from fat, the relative risk was 1.02; 95 percent confidence interval, 0.97 to 1.07; P=0.55). We estimated that the replacement of 5 percent of energy from saturated fat with energy from unsaturated fats would reduce risk by 42 percent (95 percent confidence interval, 23 to 56; P<0.001) and that the replacement of 2 percent of energy from trans fat with energy from unhydrogenated, unsaturated fats would reduce risk by 53 percent (95 percent confidence interval, 34 to 67; P<.001). CONCLUSIONS: Our findings suggest that replacing saturated and trans unsaturated fats with unhydrogenated monounsaturated and polyunsaturated fats is more effective in preventing coronary heart disease in women than reducing overall fat intake.”

¹⁰³

Animal fat

Parkinson disease greatly increased

“…increasing intake of animal fats were strongly related to PD [Parkinson disease] (odds ratio, 5.3; 95% confidence interval, 1.8-15.5; p for trend = 0.001).”

¹⁰⁴

Saturated fats reduce insulin sensitivity

SFA (saturated fats) may thus be a cause of diabetes. “The plasma insulin response was significantly higher following the SFA meal than the other meals after both breakfast and lunch (P<0.006) although there was no effect of breakfast fatty acid composition on plasma glucose concentrations. Postprandial insulin sensitivity (SI(Oral)) was assessed for 180 min after each meal. SI(Oral) was significantly lower after lunch than after breakfast for all four test meals (P=0.019) following the same rank order (SFA < n-6 PUFA < n-3 PUFA < MUFA) for each meal. The present study demonstrates that a single meal rich in SFA reduces postprandial insulin sensitivity with 'carry-over' effects for the next meal.”

¹⁰⁵

Trans fat

Are 2.5 to 10 times worse for you than saturated fat!

“Compared to saturated fat, TFAs [trans fatty acids] are, gram to gram, associated with a considerably (2.5- to >10-fold) higher risk increment for IHD.” (IHD = Ischemic Heart Disease). “Danish government has decided that oils and fats containing more than 2% industrially produced TFAs will not be sold in Denmark after the January 1, 2004.”

¹⁰⁶

Trans fat sources

Margarine, frosting, crackers, biscuits, cookies, cakes and other baked goods all are bad sources. Approximately 21-36% of their fat is trans fat (from USDA analysis). Of course, margarine is the most concentrated form. If you use olive oil to bake something at home, this is not a problem.

Note: about 5% of fat from cows (in beef, milk, and butter) are trans fats! This is based on USDA data. Thus, cow fat has about 1/5 of the trans fat that margarine does. Even so, this trans fat accounts for a large fraction of the heart risks from butterfat.

Increases asthma

A German survey found that “Frequent intake of margarine of any kind was positively associated with current asthma during the past 12 months in young adults aged 18 to 29 years (aOR, 2.33; 95% CI, 1.03-5.26). In subgroup analysis, the positive association was confined to frequent intake of low-fat margarine (4.51; 1.78-11.43) or the combination of low-fat margarine and low-fat butter (4.79; 1.84-12.44). Consumption of margarine of any kind was not related to hay fever, atopic dermatitis, and atopic sensitization to inhalant allergens.” I do not know what “low-fat margarine” is in the German context.

¹⁰⁷

Bad fats: Trans and saturated

Fat should be 30-35% of energy intake

“there is a general consensus concerning the need to decrease the intake of trans and saturated fatty acids with regard to the risk of CHD” “A modest reduction in fat intake to 30-35% energy, with the bulk of carbohydrates being derived from complex carbohydrates from unrefined sources, would appear to be the best option for the prevention of obesity and cardiovascular disease.”

¹⁰⁸

Good fats: n-3, monounsaturated, CLA

n-6 is bad fats

Review: “The cardioprotective effects of the long chain n-3 PUFAs found in oily fish and fish oil [3] have been confirmed by recent studies.” “A recent study reported that the n-6 PUFA arachidonic acid can induce the production of damaging proinflammatory cytokines”

¹⁰⁹

Monounsaturated fats (MUFA)

High-MUFA diet helps lipid profiles in diabetics

“…17% to 20% [of calories from] monounsaturated fat… [resulted in] lower plasma total triglycerides by 18% (P=.027), lower very low-density lipoprotein triglycerides by 26% (P=.043), lower very low-density lipoprotein cholesterol by 48% (P=.043), higher apolipoprotein A1 by 7% (P=.018), smaller low-density lipoprotein particle size by 1% (P=.043), and longer low-density lipoprotein oxidation lag time by 25% (P=.043) were found after the high-monounsaturated-fat diet.”

¹¹⁰

Reduces LDL cholesterol

“Plasma cholesterol concentrations decreased in a dose-dependent manner with increasing intakes of dietary MUFAs. This change was entirely accounted for by reduced LDL cholesterol”

¹¹¹

Reduces clotting from two pathways

“In conclusion, a high-MUFA diet sustains potentially beneficial effects on platelet aggregation and postprandial activation of factor VII.”

¹¹²

Reduces lipid oxidation

Rats given olive oil (MUFA) had less lipid oxidation than those given sunflower seed oil (n-6 polyunsaturated). “In conclusion, the type of dietary fat should be considered in studies on aging, since oxidative stress is directly modulated by this factor.”

¹¹³

Reduced triglyceride (TG)

Calories from MUFA are better for you than calories from carbohydrate: “The MUFA-rich diet showed better effects on serum TG than the [carbohydrate]-rich diet, even with energy restriction and weight loss.”

¹¹⁴

Reduced arteriosclerosis risk

A review states that “many observational epidemiological studies suggest that a high intake of monounsaturated fat is associated with reduced coronary risk”

¹¹⁵

Olive oil

“Olive oil supplementation alone improved the lipid profile but was more effective when coupled with dietary restriction. There was a synergistic beneficial action of dietary restriction and olive oil on serum lipids and myocardial antioxidant defences.”

¹¹⁶

Reduced mortality rate

“After a median follow-up of 8.5 years, we investigated the possible role of MUFA, PUFA, and other selected food groups in protecting against all-causes mortality in a population-based, prospective study, conducted in one of the eight centers of the Italian Longitudinal Study on Aging (ILSA), Casamassima, Bari, Italy. Out of 704 elderly subjects (65-84 years), 278 nondemented persons agreed to participate at the first survey (1992-1993). During the follow-up, there were 91 deaths. A semi-quantitative food frequency questionnaire evaluating macronutrient daily intakes were performed at the first survey. Higher MUFA intake was associated with an increase of survival (hazard ratio 0.81, 95% CI 0.66-0.99),”

¹¹⁷

Reduced Parkinson Disease

“In the Rotterdam Study, a prospective population-based cohort study of people ages > or =55, the association between intake of unsaturated fatty acids and the risk of incident PD was evaluated among 5,289 subjects who were free of dementia and parkinsonism and underwent complete dietary assessment at baseline...After a mean follow-up of 6.0 years, 51 participants with incident PD were identified. Intakes of total fat, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) were significantly associated with a lower risk of PD, with an adjusted hazard ratio per SD increase of energy-adjusted intake of 0.69 (95% CI 0.52 to 0.91) for total fat, of 0.68 (95% CI 0.50 to 0.94) for MUFAs, and 0.66 (95% CI 0.46 to 0.96) for PUFAs. No associations were found for dietary saturated fat, cholesterol, or trans-fat. CONCLUSION: These findings suggest that high intake of unsaturated fatty acids might protect against Parkinson disease.”

¹¹⁸

Reduced blood pressure

“Randomized, 3-period, crossover feeding study … Participants were 164 adults with prehypertension or stage 1 hypertension. Each feeding period lasted 6 weeks and body weight was kept constant. INTERVENTIONS: A diet rich in carbohydrates; a diet rich in protein, about half from plant sources; and a diet rich in unsaturated fat, predominantly monounsaturated fat. MAIN OUTCOME MEASURES: Systolic blood pressure and low-density lipoprotein cholesterol. RESULTS: Blood pressure, low-density lipoprotein cholesterol, and estimated coronary heart disease risk were lower on each diet compared with baseline. Compared with the carbohydrate diet, the protein diet further decreased mean systolic blood pressure by 1.4 mm Hg (P = .002) and by 3.5 mm Hg (P = .006) among those with hypertension and decreased low-density lipoprotein cholesterol by 3.3 mg/dL (0.09 mmol/L; P = .01), high-density lipoprotein cholesterol by 1.3 mg/dL (0.03 mmol/L; P = .02), and triglycerides by 15.7 mg/dL (0.18 mmol/L; P<.001). Compared with the carbohydrate diet, the unsaturated fat diet decreased systolic blood pressure by 1.3 mm Hg (P = .005) and by 2.9 mm Hg among those with hypertension (P = .02), had no significant effect on low-density lipoprotein cholesterol, increased high-density lipoprotein cholesterol by 1.1 mg/dL (0.03 mmol/L; P = .03), and lowered triglycerides by 9.6 mg/dL (0.11 mmol/L; P = .02). Compared with the carbohydrate diet, estimated 10-year coronary heart disease risk was lower and similar on the protein and unsaturated fat diets.”

291²⁵⁹

-linolenic acid (GLA) from borage oil

Reduces atopic dermatitis

“In a double-blind, randomized, placebo-controlled trial… Early supplementation with GLA in children at high familial risk does not prevent the expression of atopy as reflected by total serum IgE, but it tends to alleviate the severity of atopic dermatitis in later infancy in these children.”

Note: GLA is also found in pecans and walnuts.

¹¹⁹

Lecithin

Mitochondria damage (aging)

Lecithin (in the form of phosphatidyl choline) may reduce mitochondrial DNA damage: if so, this one fact alone may be of great importance in reducing the rate of aging. HOWEVER, this is not easily obtained in the form and dosage used in the rodent experiments.

¹²⁰

Low insulin => low mitochondria ROS

In a rat experiment, CR => lower mitochondrial reactive oxygen species (mtROS); insulin reversed this. It MAY be that by keeping insulin low (CR, low glycemic index, small meals etc.) we can mimic or enhance the effects of CR

¹²¹

Omega 3

Omega 3 fats are associated with lower mortality in a very large meta-analysis “a systematic search of randomized controlled trials”; omega 3 fats out-performed statins! “Compared with control groups, risk ratios for overall mortality were 0.87 for statins (95% confidence interval [CI], 0.81-0.94), 1.00 for fibrates (95% CI, 0.91-1.11), 0.84 for resins (95% CI, 0.66-1.08), 0.96 for niacin (95% CI, 0.86-1.08), 0.77 for n-3 fatty acids (95% CI, 0.63-0.94), and 0.97 for diet (95% CI, 0.91-1.04)…CONCLUSIONS: Statins and n-3 fatty acids are the most favorable lipid-lowering interventions with reduced risks of overall and cardiac mortality.”

¹²²

Omega 3: ALA (short-chain) (?)

“Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men.”

¹²³

Omega 3: DHA and EPA (long-chain)

DHA / fish oil may be harmful to lifespan, in theory

This CR society e-mail summary by Michael Rae (AOR, Canada) explains how DHA / fish oil may theoretically be harmful for life span of very long life expectancy people, even if it is helpful for cardiac disease in obese people. “Michael Rae's Fish oil Accelerated Aging" (MiRFAA) hypothesis is based on the mitochondrial free-radical theory of aging (MiFRA). I think this might apply most to those who have a very long life expectancy because of CR since youth combined with good nutrition and habits.

To quote Michael Rae from a CR Society post of 2004-05-11:

“1. Across species, double bond content in the mitochondrial (mt) inner membrane (MIM) - and especially DHA content - is inversely correlated with max LS.

2. Within a species, double bond content in MIM increases with aging.

3. CR, the only anti-aging therapy per se (only therapy which extends max LS, maintains molecular fidelity, extends physiological functioning, etc) in mammals, retards this increase, apparently by lowering delta-5 desaturase activity & perhaps by modulatings phospholipids acyltransferase activity.

4. Feeding all animals yet tested longer-chain PUFA, such as DHA, increases DHA content in MIM.

5. This increase in MIM DHA increases the actual peroxidation of the MIM.

Inductive conclusion, from the above & a few other tidbits: eating DHA will lead to more DHA in MIM; more DHA in MIM is in direct opposition to a known effect of CR, and correlates with aging within and across species.”

His advice to those who practice CR: “So: don't eat DHA. Avoid fatty fish, and don't take fish oil supplements.”

¹²⁴

Fish oil supplements do NOT have PCBs or mercury, two toxins present in fish meat

“In a previous study we showed that the amount of mercury in 5 over-the-counter brands of fish oil was negligible. …The levels of polychlorinated biphenyls and organochlorines were all below the detectable limit. CONCLUSIONS: Fish oil supplements are more healthful than the consumption of fish high in organochlorines. Fish oils provide the benefits of omega-3 fatty acids without the risk of toxicity. In addition, fish oil supplements have been helpful in a variety of diseases, including bipolar disorder and depression.”

¹²⁵

Fish consumption is associated with less hostility in young adulthood!

From an Oakland, California study: “…a sample of 3581 urban white and black young adults… Consumption of any fish rich in n-3 fatty acids, compared to no consumption, was also independently associated with lower odds of high hostility (OR=0.82; 95% CI=0.69-0.97; P=0.02). These results suggest that high dietary intake of DHA and consumption of fish rich in n-3 fatty acids may be related to lower likelihood of high hostility in young adulthood.”

¹²⁶

EPA may help treat depression and schizophrenia

“…we investigated whether membrane concentrations of these fatty acids might vary as a function of schizotypal traits in non-psychotic individuals… Our findings … are quite consistent with evidence that omega-3 fatty acids (notably EPA) can be useful in the treatment of schizophrenic illness.”

“Four out of five placebo-controlled double- blind trials of eicosapentaenoic acid (EPA) in the treatment of schizophrenia have given positive findings. In depression, two placebo-controlled trials have shown a strong therapeutic effect of ethyl-EPA added to existing medication.”

¹²⁷

Improves cardiovascular risk factors and disease

The AHRQ (Agency for Healthcare Research and Quality, http://www.ahrq.gov/clinic/epcindex.htm#dietsup) review of very many of the largest randomized clinical trials found that:

1. Triglycerides: there is strong evidence that fish oils have a strong beneficial effect on (10-30%) that is dose-dependent

2. Blood pressure: a very small beneficial effect (2 mm Hg)

3. Cardiovascular mortality: there is evidence to support the hypothesis that fish, fish oil, or ALA supplement consumption reduces all-cause mortality and various CVD outcomes, although the evidence is strongest for fish or fish oil.

It does NOT help with cholesterol, HDL cholesterol, LDL cholesterol, fasting blood sugar, or glycosylated hemoglobin or insulin.

“A meta-analysis of cohort studies was conducted to examine the association between fish intake and CHD mortality…A database was developed on the basis of 11 eligible studies and 13 cohorts, including 222 364 individuals with an average 11.8 years of follow-up… Each 20-g/d increase in fish intake was related to a 7% lower risk of CHD mortality (P for trend=0.03).”

¹²⁸

Fish decreases the risk of stroke

A meta-analysis of 9 cohort studies found that “intake of fish is inversely related to risk of stroke, particularly ischemic stroke.” “Compared with those who never consumed fish or ate fish less than once per month, the pooled [relative risks] for total stroke were 0.91 … for individuals with fish intake 1 to 3 times per month, 0.87 … for once per week, 0.82 … for 2 to 4 times per week, and 0.69 … for > or =5 times per week (P for trend=0.06).”

¹²⁹

Do not eat fried fish or fish sandwiches. “In multivariate analyses, tuna/other fish consumption was inversely associated with total stroke (P = .04) and ischemic stroke (P = .02), with 27% lower risk of ischemic stroke with an intake of 1 to 4 times per week (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.98) and 30% lower risk with intake of 5 or more times per week (HR, 0.70; 95% CI, 0.50-0.99) compared with an intake of less than once per month. In contrast, fried fish/fish sandwich consumption was positively associated with total stroke (P = .006) and ischemic stroke (P = .003), with a 44% higher risk of ischemic stroke with consumption of more than once per week (HR, 1.44; 95% CI, 1.12-1.85) compared with consumption of less than once per month… Among elderly individuals, consumption of tuna or other broiled or baked fish is associated with lower risk of ischemic stroke, while intake of fried fish or fish sandwiches is associated with higher risk.”

¹³⁰

Fish consumption lowers heart disease (CHD) rate

Fish consumption lowers many risk factors for heart disease (HTN, cholesterol etc.) After controlling for BMI, smoking etc, a lower heart rate remains statistically significant.

¹³¹

The AHA Scientific Statement of 2003 is available as full free text and is well-worth reading. It gives a readable summary of very good evidence, with recommendations:

“…0.3 to 0.5 g/d of EPA+DHA [from fish] and 0.8 to 1.1 g/d of -linolenic acid [e.g., from flax]. Recently, the Food and Nutrition Board, Institute of Medicine, and The National Academies, in collaboration with Health Canada, released the Dietary Reference Intakes for Energy and Macronutrients.¹⁰⁷ The Acceptable Macronutrient Distribution Range (AMDR) for -linolenic acid is estimated to be 0.6% to 1.2% of energy, or 1.3 to 2.7 g/d on the basis of a 2000-calorie diet. This is 10 times the current intake of EPA+DHA”

“Patients with CHD should be encouraged to increase their consumption of EPA and DHA to 1 g/d”

¹³²

Fish decreases dementia

There is some evidence that eating fish can reduce the incidence of dementia (Alzheimer’s disease and the like). One medium-term (approximately 5 yr. follow-up) study of >1000 French people found “a significant trend between increasing consumption of fish or seafood and decreasing incidence of dementia (P for trend = 0.0091)”

¹³³

Reduces risk of prostate cancer

A prospective population study of 47,866 men for 14 yr. found that “The multivariate [relative risks] of total and advanced prostate cancer from comparisons of extreme quintiles of the combination of EPA and DHA were 0.89 (0.77, 1.04) and 0.74 (0.49, 1.08), respectively.”

¹³⁴

Eating fish per se (better than fish oil) may reduce prostate cancer incidence. “We followed 47882 men participating in the Health Professionals Follow-up Study… Eating fish more than three times per week was associated with a reduced risk of prostate cancer, and the strongest association was for metastatic cancer (multivariate relative risk, 0.56; 95% confidence interval, 0.37-0.86, compared with infrequent consumption, i.e., less than twice per month).”

¹³⁵

Associated with better intelligence in old age

“This was an observational study of subjects born in 1936 whose mental ability was tested in 1947 and who were followed up in 2000–2001, at which time cognition, diet, food supplement use, and risk factors for vascular disease were assessed… Total erythrocyte n–3 fatty acids and the ratio of docosahexaenoic acid to arachidonic acid was associated with better cognitive function in late life before and after adjustment for childhood IQ.”

¹³⁶

Fish reduces risk of macula degeneration

“The US Twin Study of Age-Related Macular Degeneration comprises elderly male twins from the National Academy of Sciences-National Research Council World War II Veteran Twin Registry. To determine genetic and environmental risk factors for AMD, twins were surveyed for a prior diagnosis of AMD and underwent an eye examination, fundus photography, and food frequency and risk factor questionnaires. This environmental component of the study includes 681 twins: 222 twins with AMD (intermediate or late stages) and 459 twins with no maculopathy or early signs. Risk for AMD according to cigarette smoking and dietary fat intake was estimated using logistic regression analyses… dietary omega-3 fatty intake was inversely associated with AMD (odds ratio, 0.55; 95% confidence interval, 0.32-0.95) comparing the highest vs lowest quartile. Reduction in risk of AMD with higher intake of omega-3 fatty acids was seen primarily among subjects with low levels (below median) of linoleic acid intake, an omega-6 fatty acid (P trend<.001). The attributable risk percentage was 32% for smoking and the preventive fraction was 22% for higher omega-3 intake.”

¹³⁷

Sticking with the diet significantly reduces risk of heart disease, death and cancer.

“…a population-based, prospective investigation involving 22,043 adults in Greece who completed an extensive, validated, food-frequency questionnaire at base line. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet… A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality (adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score, 0.75 …). An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease (adjusted hazard ratio, 0.67 …) and death due to cancer (adjusted hazard ratio, 0.76 …)…Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality.”

¹³⁸

Lessens rates of all-cause mortality, coronary heart disease, cardiovascular diseases, and cancer

“Healthy Ageing: a Longitudinal study in Europe (HALE) population, comprising individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries. This cohort study was conducted between 1988 and 2000. MAIN OUTCOME MEASURES: Ten-year mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer. RESULTS: During follow-up, 935 participants died: 371 from cardiovascular diseases, 233 from cancer, and 145 from other causes; for 186, the cause of death was unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91), physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65; 95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality (HRs controlled for age, sex, years of education, body mass index, study, and other factors). Similar results were observed for mortality from coronary heart disease, cardiovascular diseases, and cancer. The combination of 4 low risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44).”

¹³⁹

Lessens risk of Alzheimer Disease

“There is converging evidence that composite dietary patterns such as the Mediterranean diet (MeDi) is related to lower risk for cardiovascular disease, several forms of cancer, and overall mortality…METHODS: A total of 2,258 community-based nondemented individuals in New York were prospectively evaluated every 1.5 years. Adherence to the MeDi (zero- to nine-point scale with higher scores indicating higher adherence) was the main predictor in models that were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical comorbidity index, and body mass index. RESULTS: There were 262 incident AD cases during the course of 4 (+/-3.0; range, 0.2-13.9) years of follow-up…Compared with subjects in the lowest MeDi tertile, subjects in the middle MeDi tertile had a hazard ratio of 0.85 (95% confidence interval, 0.63-1.16) and those at the highest tertile had a hazard ratio of 0.60 (95% confidence interval, 0.42-0.87) for AD (p for trend = 0.007). INTERPRETATION: We conclude that higher adherence to the MeDi is associated with a reduction in risk for AD.”

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Category

Effect

Finding

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Fig

Homocysteine

Associated with lower mental function in the elderly

“Elevated plasma tHcy has an independent, graded association with concurrent cognitive impairment as measured with the MMSE [Mini-Mental State Examination] in healthy elderly community dwellers.”

¹⁴¹

“Participants were from the Veterans Affairs Normative Aging Study. Cognitive function was assessed with the Mini-Mental State Examination and on the basis of measures of memory, verbal fluency, and constructional praxis, which were adapted from the revised Wechsler Adult Intelligence Scale and the Consortium to Establish a Registry for Alzheimer's Disease batteries at 2 time points. At baseline, dietary intakes were assessed with a food-frequency questionnaire, and blood was drawn for the measurement of B vitamins and homocysteine. Results: Over a mean 3-y follow-up, declines in constructional praxis, measured by spatial copying, were significantly associated with plasma homocysteine, folate, and vitamins B-6 and B-12 and with the dietary intake of each vitamin. Folate (plasma and dietary) remained independently protective against a decline in spatial copying score after adjustment for other vitamins and for plasma homocysteine. Dietary folate was also protective against a decline in verbal fluency. A high homocysteine concentration was associated with a decline in recall memory. Conclusions: Low B vitamin and high homocysteine concentrations predict cognitive decline. Spatial copying measures appear to be most sensitive to these effects in a general population of aging men.”

¹⁴²

Associated findings

More evidence that folate and B-12 may help: “The unadjusted mean tHcy was 21.5% ( approximately 1.9 micro mol/L) higher in men than in women, 11.8% ( approximately 1.1 micro mol/L) higher in non-Hispanic whites than in Mexican Americans, 42% ( approximately 3.7 micro mol/L) higher in persons aged >/= 70 y than in persons aged < 30 y, and 10.9% ( approximately 1.0 micro mol/L) higher in supplement nonusers than in supplement users. The tHcy concentration was negatively associated with serum folate (P < 0.0001 for trend), RBC folate (P < 0.0001 for trend), and serum vitamin B-12 (P < 0.0036 for trend)..”

¹⁴³

Associated quite high rates of death from heart disease

A 24-year study of 1368 middle-age women showed that elevated homocysteine levels (tHcy) were associated with much higher rates of heart attack (AMI) and death from heart attack. “For the fifth tHcy quintile, relative risk was 1.86 (95% CI 1.06 to 3.26) for AMI and 5.14 (95% CI 2.22 to 11.92) for death due to AMI.”

¹⁴⁴

Associated with depression

“Those in the upper tertile for serum tHcy had a more than twofold (odds ratio: 2.30; 95% CI: 1.35, 3.90; P = 0.002) higher risk of being depressed than did those in the lowest tertile for serum tHcy. The results remained significant after adjustment for the month of study, history of ischemic heart disease, smoking habits, alcohol consumption, marital status, education, and socioeconomic status in adulthood (odds ratio: 2.23; 95% CI: 1.30, 3.83; P = 0.004).”

¹⁴⁵

Reduced by folate supplements

“From the dose-response curve, the adequate daily dose of folic acid was estimated to be 392 micro g [mcg], which decreased plasma homocysteine concentrations 22%.” (note: standard folate pills and vitamins are at 400 mcg)

¹⁴⁶

Category

Effect

Finding

Ref

Fig

HDL cholesterol level

Brain function

Longevity

“Plasma HDL levels correlated significantly with MMSE (r =.32; p <.0001). Each decrease in plasma HDL tertile (74.9 +/- 2.1, 50.6 +/- 0.5, and 36.8 +/- 1.0 mg/dl) was associated with a significant decrease in MMSE (23.4 +/- 1.5, 17.7 +/- 1.8, and 12.4 +/- 1.8; p <.04 for each plasma HDL tertile)… This underscores the protective effects of increased plasma HDL and its role in maintaining superior cognition in longevity.”

“Families of centenarians have high levels of plasma high-density lipoprotein (HDL) cholesterol”

¹⁴⁷

High non-HDL cholesterol is bad for the heart

“SUMMARY Non-HDL cholesterol is a potent predictor of cardiovascular risk among a broad range of individuals with and without cardiovascular disease and is prognostic over a wide range of follow-up periods.”

¹⁴⁸

LDL level

Should be below 100, perhaps below 80

Intensive statin therapy => LDL average = 79 => no progression of atheroma burden, while those with LDL = 110 => progression. In other words, this is good evidence that LDL cholesterol should be very low indeed.

¹⁴⁹

Cholesterol-lowering diet

Diet is as good as statin drugs

A cholesterol-lowering diet (“a diet high in plant sterols …, soy protein…, viscous fibers… and almonds…”) works as well as statins in a controlled, prospective study. Both interventions reduced cholesterol and CRP by about 30%.

But note: phytoestrogens per se from soy & other plant foods do not seem to lower heart disease risk

¹⁵⁰

¹⁵¹

¹⁵²

Statins

C E & β-carotene do NOT help;

statins do

Long PDF file summarizing the results of a study: vitamins C, E & β-carotene do not reduce risk of cancer, cardiovascular disease or any other major outcome.

On the other hand, the statins substantially reduce the risk for vascular events (stroke or heart attack)

¹⁵³

Lower risk of POAG glaucoma

“…Longer duration of statin use was associated with a lower risk of open-angle glaucoma (P for trend =.04) primarily among subjects with 24 months or more of use (OR, 0.60) …a protective association was also observed among those who used nonstatin cholesterol-lowering agents (OR, 0.59)”

¹⁵⁴

Category

Effect

Finding

Ref

Fig

Whole grains

Whole grains are associated with lower mortality and heart disease

“Whole-grain breakfast cereal intake was inversely associated with total and CVD-specific mortality, independent of age; body mass index; smoking; alcohol intake; physical activity; history of diabetes, hypertension, or high cholesterol; and use of multivitamins. Compared with men who rarely or never consumed whole-grain cereal, men in the highest category of whole-grain cereal intake (>/= 1 serving/d) had multivariate-estimated relative risks of total and CVD-specific mortality of 0.83…”

¹⁵⁵

Associated with lower risk for adult-onset diabetes

“An inverse association between whole-grain intake and the risk of type 2 diabetes was found. The similar result for cereal fiber intake suggests that the whole-grain association is due to cereal fiber or another factor related to cereal fiber intake.”

¹⁵⁶

Good for bowel health and lower blood glucose

“High-fiber rye and wheat food consumption improved several markers of bowel and metabolic health relative to that of low-fiber food. Fiber from rye appears more effective than that from wheat in overall improvement of biomarkers of bowel health.”

¹⁵⁷

Diabetes type 2

Whole grains and grain fiber may help prevent diabetes. “An inverse association between whole-grain intake and the risk of type 2 diabetes was found. The similar result for cereal fiber intake suggests that the whole-grain association is due to cereal fiber or another factor related to cereal fiber intake.”

¹⁵⁸

“cross-sectional association between whole- and refined-grain intake, cardiovascular disease risk factors, prevalence of the metabolic syndrome, and the incidence of cardiovascular disease mortality in the same cohort of older adults. DESIGN: The nutritional status of 535 healthy persons aged 60-98 y…The results showed a significant inverse trend between whole-grain intake and the metabolic syndrome (P for trend = 0.005) and mortality from cardiovascular disease (P for trend = 0.04), independent of demographic, lifestyle, and dietary factors. Fasting glucose concentrations and body mass index decreased across increasing quartile categories of whole-grain intake (P for trend = 0.01 and 0.03, respectively), independent of confounders, whereas intake of refined grain was positively associated with higher fasting glucose concentrations (P for trend = 0.04) and a higher prevalence of the metabolic syndrome (P for trend = 0.01). CONCLUSION: Whole-grain intake is a modifiable dietary risk factor, and older and young adults should be encouraged to increase their daily intake to >/=3 servings/d.”

¹⁵⁹

Helps to prevent obesity

“Women who consumed more whole grains consistently weighed less than did women who consumed less whole grains (P for trend < 0.0001). Over 12 y, those with the greatest increase in intake of dietary fiber gained an average of 1.52 kg less than did those with the smallest increase in intake of dietary fiber (P for trend < 0.0001) independent of body weight at baseline, age, and changes in covariate status. Women in the highest quintile of dietary fiber intake had a 49% lower risk of major weight gain than did women in the highest quintile (OR = 0.51; 95% CI: 0.39, 0.67; P < 0.0001 for trend).”

¹⁶⁰

A prospective study of whole grain intake and development of diabetes type II found a 30% reduced risk after adjusting for BMI.

¹⁶¹

Reduces periodontitis risk

“We prospectively followed 34 160 male US health professionals aged 40-75 y at the outset. We updated medical and lifestyle information biennially with questionnaires and diet every 4 y by using a validated food-frequency questionnaire…Men in the highest quintile of whole-grain intake were 23% less likely to get periodontitis than were those in the lowest quintile”

¹⁶²

Associated with lower rate of heart disease

Bran may be the active part

“This was a prospective cohort study of 42 850 male health professionals aged 40–75 y at baseline in 1986 who were free from cardiovascular disease, cancer, and diabetes. Daily whole-grain, bran, and germ intakes were derived in grams per day from a detailed semiquantitative dietary questionnaire… The hazard ratio of CHD in men with the highest intake of added bran was 0.70 (95% CI: 0.60, 0.82) compared with men with no intake of added bran (P for trend 0.001). Added germ was not associated with CHD risk…This study … suggests that the bran component of whole grains could be a key factor in this relation.”

¹⁶³

Oat bran

Reduces cholesterol

“The most significant decreases in total cholesterol (-67.7 +/- 37.2 mg/dl; p < 0.01), low-density lipoprotein cholesterol (-56.3 +/- 35.1 mg/dl; p < 0.01), and apolipoprotein B (-42.4 +/- 34.1 mg/dl; p < 0.01) were found with the combination of the fat-modified and oat bran enriched food.”

“The oat bran was incorporated into the daily cooking process (bread and bread rolls 20-30 g, sauces and desserts 15-20 g), not detectable for the patients at all.”

¹⁶⁴

“34 premenopausal women (age: 22-53 years) were randomly assigned either to the control group (no supplement) or to the treatment group, which received 2 oat bran-enriched muffins per day (28 g/day of oat bran) during 4 weeks. RESULTS: Supplementation with oat bran had a beneficial effect on plasma HDL-C levels. Indeed, compared to the control group (n = 16), a mean increase in plasma HDL-C levels of 11.2% was observed in women eating the oat bran supplement (n = 18) (p = 0.01), whereas the total cholesterol/HDL-C ratio decreased by 7.0% (p = 0.002).”

¹⁶⁵

Category

Effect

Finding

Ref

Fig

Flax

Enterolactones lower the rate of cardiovascular disease and death

Flax seed intake increases enterolactones

“Owing to its phenolic structure, enterolactone and its plant lignan precursors, which are converted by intestinal bacteria to enterolactone, are potential antioxidants… Our data suggest that a high serum enterolactone level is associated with reduced CHD- and CVD-related mortality in middle-aged Finnish men. These results add to the evidence supporting the importance of whole grain foods, fruits, and vegetables in the prevention of premature death from CVD.” And "…death decreased linearly across quartiles of serum enterolactone concentration.”

“The percentage of flaxseed supplemented test food out of total dietary intake was 20% of energy… Serum enterolactone concentration was doubled during flaxseed supplementation.”

¹⁶⁶

¹⁶⁷

Flax lowers cholesterol and triglycerides dramatically, and better than soy

From a USDA study, where 20% of calories were from ground flax seed: “In obese rats flaxseed meal had significant cholesterol lowering effect compared to control rats (41%).” “The marked hypotriglyceridemic and hypocholesterolemic effects of flaxseed meal may have important therapeutic implications in patients with hypertriglyceridemia and hypercholesterolemia…”

¹⁶⁸

Category

Effect

Finding

Ref

Fig

Exercise

Cardiovascular disease

“There is an inverse association between relative intensity of physical activity (an individual’s perceived level of exertion) and risk of CHD”

¹⁶⁹

Helps prevent strokes

“Low cardiorespiratory fitness was comparable with systolic blood pressure, obesity, alcohol consumption, smoking, and serum low-density lipoprotein cholesterol level as a risk factor for stroke.”

¹⁷⁰

Reduces visceral fat (a risk factor for diabetes)

“participants who exercised at a level equivalent to 17 miles of jogging each week saw significant declines in visceral fat, subcutaneous abdominal fat and total abdominal fat”…” participants who did not exercise had an 8.6 percent increase in visceral fat after eight months, while those participants who exercised at the highest amount saw a 8.1 percent decrease in visceral fat.”

¹⁷¹

Greatly reduced risk of hypertension

“We prospectively followed 8302 Finnish men and 9139 women aged 25 to 64 years without a history of antihypertensive drug use, coronary heart disease, stroke, and heart failure at baseline… Multivariate-adjusted hazards ratios of hypertension associated with light, moderate, and high physical activity were 1.00, 0.63, and 0.59 in men (Ptrend<0.001), and 1.00, 0.82, and 0.71 in women (Ptrend=0.005), respectively. This association persisted both in subjects who were overweight and in those who were not. Multivariate-adjusted hazards ratios of hypertension based at different levels of body mass index (<25, 25 to 29.9, and >/=30) were 1.00, 1.18, and 1.66 for men (Ptrend<0.001), and 1.00, 1.24, and 1.32 for women (Ptrend=0.007), respectively.”

¹⁷²

Helps keep bones tough and prevent fractures

The primary factor determining bone density and mass is body weight. However, bone mass does not necessarily prevent fractures: thin runners have thin but tough bones. http://www.usc.edu/projects/nexus/faculty/dept-ldsg/wiswell/article.htm

Reduces the risk of stroke (CVA) by 27%

“a meta-analysis… [of] 23 studies… For cohort studies, highly active individuals” (equivalent to running 15-20 min/day, or exercising 30 min/day) “had a 27% lower risk of stroke incidence or mortality … than did low-active individuals. We observed similar results in moderately active individuals compared with inactive persons (RRs =0.80 …)… We conclude that moderate and high levels of physical activity are associated with reduced risk of total, ischemic, and hemorrhagic strokes.”

¹⁷³

Increases longevity by 9% in rats, but not maximum life span

“As in previous studies, wheel running modestly increased average longevity (approximately 9%), but had no effect on maximal life span.”

HOWEVER, from the same author in an earlier paper “the beneficial effects of food restriction and exercise on survival are not additive or synergistic.”

Steven Spindler’s studies of mice show a “squaring of the longevity curve” with exercise; CR however has a far greater effect.

¹⁷⁴

¹⁷⁵

Fig

Reduces mortality

“A cohort study of vegetarians and health-conscious persons in Germany was followed-up prospectively for 21 years, including 1,225 vegetarians and 679 health-conscious nonvegetarians. Standardized mortality ratios compared with the German general population were calculated for all causes and specific causes… RESULTS: Standardized mortality ratios for all-cause mortality was significantly below 100: 59 [95% confidence interval (95% CI), 54-64], predominantly due to a deficit of deaths from circulatory diseases. Within the cohort, vegetarian compared with nonvegetarian diet had no effect on overall mortality [rate ratio (RR), 1.10; 95% CI, 0.89-1.36], whereas moderate and high physical activity significantly reduced risk of death (RR, 0.62, 0.64), adjusted for age, sex, smoking, alcohol intake, body mass index, and educational level.”

¹⁷⁶

Too much exercise may have a long-term detrimental effect

“We conclude that the rate of decline in maximal aerobic capacity during middle and older age is greater in endurance-trained men than in their sedentary peers”

¹⁷⁷

Improves insulin sensitivity

A randomized controlled trial of diet and exercise in 45 obese women found that “Body weight decreased by approximately 6.5% within both weight loss groups and was unchanged in the exercise without weight loss and control groups. In comparison with controls, cardiorespiratory fitness improved within the exercise groups only (p < 0.01). Reduction in total, abdominal, and abdominal subcutaneous fat within the exercise weight loss group was greater (p < 0.001) than within all other groups… In comparison with the control group, insulin sensitivity improved within the exercise weight loss group alone (p < 0.001). DISCUSSION: Daily exercise without caloric restriction was associated with substantial reductions in total fat, abdominal fat, visceral fat, and insulin resistance in women. Exercise without weight loss was also associated with a substantial reduction in total and abdominal obesity.”

¹⁷⁸

Reduces risk for Alzheimer Disease and dementia

“Participants were randomly selected from the survivors of a population-based cohort previously surveyed in 1972, 1977, 1982, or 1987. 1449 persons (72.5%) age 65-79 years participated in the re-examination in 1998 (mean follow-up, 21 years). 117 persons had dementia and 76 had AD. Multiple logistic regression methods were used to analyse the association between leisure-time physical activity and dementia or AD. FINDINGS: Leisure-time physical activity at midlife at least twice a week was associated with a reduced risk of dementia and AD (odds ratio [OR] 0.48 [95% CI 0.25-0.91] and 0.38 [0.17-0.85], respectively), even after adjustments for age, sex, education, follow-up time, locomotor disorders, APOE genotype, vascular disorders, smoking, and alcohol drinking. The associations were more pronounced among the APOE varepsilon4 carriers. INTERPRETATION: Leisure-time physical activity at midlife is associated with a decreased risk of dementia and AD later in life. Regular physical activity may reduce the risk or delay the onset of dementia and AD, especially among genetically susceptible individuals.”

¹⁷⁹

“1740 persons older than age 65 years without cognitive impairment …were followed biennially to identify incident dementia… During a mean follow-up of 6.2 years (SD, 2.0), 158 participants developed dementia (107 developed Alzheimer disease). The incidence rate of dementia was 13.0 per 1000 person-years for participants who exercised 3 or more times per week compared with 19.7 per 1000 person-years for those who exercised fewer than 3 times per week. The age- and sex-adjusted hazard ratio of dementia was 0.62 (95% CI, 0.44 to 0.86; P = 0.004). The interaction between exercise and performance-based physical function was statistically significant (P = 0.013). The risk reduction associated with exercise was greater in those with lower performance levels. Similar results were observed in analyses restricted to participants with incident Alzheimer disease.”

¹⁸⁰

Reduces risk of macula degeneration (AMD)

“The 15-year cumulative incidence of AMD was determined through four examination phases at five-year intervals of a population-based study conducted in Beaver Dam, Wisconsin, initiated in 1988-1990 (n=3,874 men and women between ages of 43-86 years)… After controlling for age, gender, arthritis history, systolic blood pressure, body mass index, smoking history, and education, persons with an active lifestyle (defined as regular activity >/= 3 times/week) at baseline were less likely to develop exudative AMD (odds ratio [OR]= 0.3, 95% confidence interval [CI]=0.1-0.7) compared to persons without an active lifestyle. After multivariate adjustment, increased categories of number of blocks walked per day decreased the risk of exudative AMD (OR=0.7, 95% CI=0.6-0.97). Physical activity was not related to the incidence of early AMD or pure geographic atrophy. CONCLUSIONS: These data show a protective effect of physical activity for incident exudative AMD, independent of body mass index and other confounders.”

¹⁸¹

Reduced risk of colon cancer

“We investigated several aspects of the role of physical activity in colon and rectal cancer etiology that remain unclear in the European Prospective Investigation into Nutrition and Cancer. This cohort of 413,044 men and women had 1,094 cases of colon and 599 cases of rectal cancer diagnosed during an average of 6.4 years of follow-up. We analyzed baseline data on occupational, household, and recreational activity to examine associations by type of activity, tumor subsite, body mass index (BMI), and energy intake. The multivariate hazard ratio for colon cancer was 0.78 [95% confidence interval (95% CI), 0.59-1.03] among the most active participants when compared with the inactive, with evidence of a dose-response effect (P(trend) = 0.04). For right-sided colon tumors, the risk was 0.65 (95% CI, 0.43-1.00) in the highest quartile of activity with evidence of a linear trend (P(trend) = 0.004). Active participants with a BMI under 25 had a risk of 0.63 (95% CI, 0.39-1.01) for colon cancer compared with the inactive.”

¹⁸²

Category

Effect

Finding

Ref

Fig

Caffeine

Raises intraocular pressure (IOP)

“In patients with normotensive glaucoma who drank regular coffee, the mean +/- SD changes in IOP at 30, 60, and 90 minutes were 0.9 +/- 0.5, 3.6 +/- 1.1, and 2.3 +/- 0.66 mm Hg, respectively; in those who drank decaffeinated coffee, they were 0.75 +/- 0.36, 0.70 +/- 0.4, and 0.4 +/- 0.6 mm Hg, respectively.”

¹⁸³

May help prevent Alzheimer disease

A retrospective, case control study of 54 AD pts and 54 controls found that “Using a logistic regression model, caffeine exposure during this period was found to be significantly inversely associated with AD (odds ratio=0.40, 95% confidence interval=0.25-0.67), whereas hypertension, diabetes, stroke, head trauma, smoking habits, alcohol consumption, non-steroid anti-inflammatory drugs, vitamin E, gastric disorders, heart disease, education and family history of dementia were not statistically significantly associated with AD.”

¹⁸⁴

Tea

Lowers BP in rats

In rats “systolic and diastolic BP were significantly lower in the BTP and GTP groups than in the controls… because the amounts of polyphenols used in this experiment correspond to those in approximately 1 L of tea, the regular consumption of black and green tea may also provide some protection against hypertension in humans.”

¹⁸⁵

Lowers BP in people

“Compared with nonhabitual tea drinkers, the risk of developing hypertension decreased by 46% for those who drank 120 to 599 mL/d and was further reduced by 65% for those who drank 600 mL/d or more after carefully adjusting for age, sex, socioeconomic status, family history of hypertension, body mass index, waist-hip ratio, lifestyle factors (total physical activity, high sodium intake, cigarette smoking, alcohol consumption, and coffee drinking), and dietary factors (vegetable, fruit, unrefined grain, fish, milk, visible-fat food, and deep fried food intake)… CONCLUSION: Habitual moderate strength green or oolong tea consumption, 120 mL/d or more for 1 year, significantly reduces the risk of developing hypertension in the Chinese population.”

¹⁸⁶

Benefits may be eliminated if you drink milk at the same time

“Experimental and clinical studies indicate that tea exerts protection against cardiovascular diseases…METHODS AND RESULTS: A total of 16 healthy female volunteers consumed either 500 mL of freshly brewed black tea, black tea with 10% skimmed milk, or boiled water as control. Flow-mediated dilation (FMD) was measured by high-resolution vascular ultrasound before and 2 h after consumption. Black tea significantly improved FMD in humans compared with water, whereas addition of milk completely blunted the effects of tea. To support these findings, similar experiments were performed in isolated rat aortic rings and endothelial cells. Tea induced vasorelaxation in rat aortic rings and increased the activity of endothelial nitric oxide synthase by phosphorylation of the enzyme in endothelial cells. All effects were completely inhibited by the addition of milk to tea. Of the various kinds of milk proteins, the caseins accounted for these inhibiting effects of milk, probably by formation of complexes with tea catechins. CONCLUSION: Milk counteracts the favourable health effects of tea on vascular function. This finding indicates the need for particular awareness in the interpretation and design of studies comprising nutritional flavonoids.”

¹⁸⁷

Green tea

Cancer

Green tea helps prevent cancer

BUT YOU NEED 10+ CUPS PER DAY!! You can get this much EGCG with supplement capsules, such as two of AOR’s EGCG MAX capsules per day.

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Breast cancer

“Compared to women who did not drink green tea regularly (i.e., less than once a month), there was a significant trend of decreasing risk with increasing amount of green tea intake, adjusted odds ratios being 1.00, 0.71 (95% confidence interval [CI] 0.51-0.99) and 0.53 (95% CI 0.35-0.78), respectively, in association with no, 0-85.7 and >85.7 ml of green tea per day.”

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Green tea extract

Flavenols are absorbed as well as from green tea itself

“Our observations suggest that green tea extract supplements retain the beneficial effects of green and black tea and may be used in future chemoprevention studies to provide a large dose of tea polyphenols without the side effects of caffeine associated with green and black tea beverages.”

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Helps you lose weight

“After a 2-wk diet run-in period, healthy Japanese men were divided into 2 groups with similar BMI and waist circumference distributions. A 12-wk double-blind study was performed in which the subjects ingested 1 bottle oolong tea/d containing 690 mg catechins (green tea extract group; n = 17) or 1 bottle oolong tea/d containing 22 mg catechins (control group; n = 18). Results: Body weight, BMI, waist circumference, body fat mass, and subcutaneous fat area were significantly lower in the green tea extract group than in the control group.”

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Coffee

High intake appears associated with heart attack

A case control study showed “…the odds ratios for moderate (<300 mL/d), heavy (300-600 mL/d), and very heavy (>600 mL/d), consumption, relative to no consumption, were 0.69 (95% CI, 0.50-0.86), 1.56 (95% CI, 1.10-2.34) and 3.10 (95% CI, 1.82-5.26), respectively, after controlling for the presence of hypertension, hypercholesterolemia, diabetes mellitus, family history of premature coronary heart disease, physical activity status, smoking habits, BMI, alcohol consumption, triglycerides, consumption of several food items, depression scale score and education status.”

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“A total of 41 836 postmenopausal women aged 55-69 y at baseline were followed for 15 y. After exclusions for cardiovascular disease, cancer, diabetes, colitis, and liver cirrhosis at baseline, 27 312 participants remained, resulting in 410 235 person-years of follow-up and 4265 deaths. The major outcome measure was disease-specific mortality. RESULTS: … the hazard ratio of death attributed to cardiovascular disease was 0.76 (95% CI: 0.64, 0.91) for consumption of 1-3 cups/d, 0.81 (95% CI: 0.66, 0.99) for 4-5 cups/d, and 0.87 (95% CI: 0.69, 1.09) for >/=6 cups/d. The hazard ratio for death from other inflammatory diseases was 0.72 (95% CI: 0.55, 0.93) for consumption of 1-3 cups/d, 0.67 (95% CI: 0.50, 0.90) for 4-5 cups/d, and 0.68 (95% CI: 0.49, 0.94) for >/=6 cups/d.”

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Not associated with hypertension

A 2002 analysis of recent studies of coffee and hypertension found no association.

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“Prospective cohort study conducted in the Nurses' Health Studies (NHSs) I and II of 155,594 US women free from physician-diagnosed hypertension followed up over 12 years …no linear association between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment”

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Homocysteine

“The increase in homocysteine concentrations 4 h after consumption of [two cups of] coffee relative to consumption of 3 placebo capsules was 19% (P = 0.0001). Caffeine treatment had a much weaker acute effect on homocysteine (4%; P = 0.09). Effects of caffeine were stronger in women than in men, but the effects of coffee did not differ significantly between men and women. CONCLUSIONS: Caffeine is partly responsible for the homocysteine-raising effect of coffee. Coffee, but not caffeine, affects homocysteine metabolism within hours after intake, although the effect is still substantial after an overnight fast.”

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May protect against stroke and all-cause mortality

A Japanese study of “2,855 men and women aged 40-79 years in 1989, and during the subsequent 9.9 years of follow-up. Using the Cox regression model to adjust for potential confounding factors, we calculated the multivariate hazard ratios of death from all causes separately for men and women. The multivariate hazard ratio of mortality for men who consumed two or more cups of coffee per day, compared with those who consumed less than half a cup per day, was 0.43 (95% confidence interval, 0.30-0.63), and the ratio for those who consumed half to one cup of coffee per day was 0.70 (95% confidence interval, 0.52-0.94).”

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Appears to protect against diabetes type 2

Drinking 6 cups/day reduces risk by about 30%

A large, prospective 18-year Swedish follow-up study showed that “Associated hazard ratios, after adjustment for age, smoking, low physical activity, education and body mass index were 0.55 (0.32-0.95), 0.39 (0.20-0.77) and 0.48 (0.22-1.06) for daily consumption of three to four, five to six and seven cups or more, respectively, with a consumption of less than two per day as reference.”

A large, prospective Dutch study showed that “After adjustment for potential confounders, individuals who drank at least seven cups of coffee a day were 0.50 (95% CI 0.35-0.72, p=0.0002) times as likely as those who drank two cups or fewer a day to develop type 2 diabetes.”

This was also found in the Nurses’ Health Study: “The authors found an inverse association between coffee intake and type 2 diabetes after adjustment for age, body mass index, and other risk factors. The multivariate relative risks for diabetes according to regular coffee consumption categories (0, <1, 1 to 3, 4 to 5, or > or =6 cups per day) in men were 1.00, 0.98, 0.93, 0.71, and 0.46 (95% CI, 0.26 to 0.82; P = 0.007 for trend), respectively. The corresponding multivariate relative risks in women were 1.00, 1.16, 0.99, 0.70, and 0.71 (CI, 0.56 to 0.89; P < 0.001 for trend), respectively. For decaffeinated coffee, the multivariate relative risks comparing persons who drank 4 cups or more per day with nondrinkers were 0.74 (CI, 0.48 to 1.12) for men and 0.85 (CI, 0.61 to 1.17) for women. Total caffeine intake from coffee and other sources was associated with a statistically significantly lower risk for diabetes in both men and women. CONCLUSIONS: These data suggest that long-term coffee consumption is associated with a statistically significantly lower risk for type 2 diabetes.”

And again in a study from Finland in JAMA: “After adjustment for confounding factors (age, study year, body mass index, systolic blood pressure, education, occupational, commuting and leisure-time physical activity, alcohol and tea consumption, and smoking), the HRs [Hazard Ratios] of DM associated with the amount of coffee consumed daily (0-2, 3-4, 5-6, 7-9, > or =10 cups) were 1.00, 0.71 … 0.39 … 0.39 … and 0.21 …(P for trend<.001) in women, and 1.00, 0.73 …0.70 … 0.67 … and 0.45 … (P for trend =.12) in men, respectively. In both sexes combined, the multivariate-adjusted inverse association was significant (P for trend <.001) and persisted when stratified by younger and older than 50 years; smokers and never smokers; healthy weight, overweight, and obese participants; alcohol drinker and nondrinker; and participants drinking filtered and nonfiltered coffee. CONCLUSION: Coffee drinking has a graded inverse association with the risk of type 2 DM”

A large review in JAMA (2005) of 9 cohort studies found that “The [Relative Risk] of type 2 diabetes was 0.65 (95% confidence interval [CI], 0.54-0.78) for the highest (>or=6 or >or=7 cups per day) and 0.72 (95% CI, 0.62-0.83) for the second highest (4-6 cups per day) category of coffee consumption compared with the lowest consumption category (0 or <or=2 cups per day).”

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Associated with lower risk of breast cancer

“A hospital-based, case-control study … 1932 cases with primary, incident breast cancer and 1895 hospital controls with nonneoplastic conditions… Among premenopausal women, consumption of regular coffee was associated with linear declines in breast cancer risk (P for trend = 0.03); consumers of >/=4 cups/d experienced a 40% risk reduction (odds ratio = 0.62, 95% CI 0.39-0.98).”

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Carbonated soft drinks

Associated with lower risk of esophageal cancer

“we examined CSD [Carbonated soft drinks] as a risk factor for esophageal and gastric cancers in a U.S. multicenter, population-based case-control study. Associations between CSD intake and risk were estimated by adjusted odds ratios (ORs), comparing the highest versus lowest quartiles of intake. All statistical tests were two-sided. Contrary to the proposed hypothesis, CSD consumption was inversely associated with esophageal adenocarcinoma risk (highest versus lowest quartiles, OR = 0.47, 95% confidence interval = 0.29 to 0.76; Ptrend = .005)”

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Effect

Finding

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Antioxidants

Link to a table

USDA web site with list of flavenoid content of many foods, such as berries, tea, etc. Of interest is that green tea has much more of many flavenoids than prepared tea powders etc.

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ORAC is NOT the best measure of effect

Well thought out quote from Michael Rae: “I've often ranted about people citing ORAC and other test-tube measures of alleged antioxidant capacity to draw conclusions about the health value of various foods. In brief, the 2 biggest issues are that (1) because different kinds of antioxidants quench different kinds of radicals, any existing measure of 'antioxidant capacity' can only represent a narrow range of a given substance's antioxidant effects; [ORAC only measures phenolic antioxidant donor capacity. So for example, gamma tocopherol has a much lower ORAC than alpha, which against SOME ROS (say, hydroxyl radical) is an accurate assay of their relative potency -- but gamma is much more powerful against peroxynitrite and other nitrogen-based "free radicals," and ORAC totally misses this. It also can't account for the compartmentalization & distribution of specific antioxidant molecules: whether they work in the fluids of the body or in the membranes, whether they can be transported actively into various key compartments or are only able to dissolve & diffuse, etc]; and (2) because of different absorption & metabolism of various antioxidant compounds (esp phenolics [which are the antioxidants whose value is always put in the most impressive light by ORAC and in which fruit is rich]), something can have gangbuster antioxidant activity in a test tube & be irrelevant in vivo because the compound in the food just doesn't get into your system. (There is also the whole question of whether something's simply being an antioxidant actually constitutes a health benefit).”

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Which flavenoids matter for heart disease?

A case-control study from Greece found that only “Flavan-3-ols, which are largely found in wine and tea, are inversely associated with, and may be protective against, coronary heart disease.” Also, “an increase of about 21 mg per day corresponding to a 24% decrease in CHD risk. The inverse association between flavan-3-ols and CHD risk was largely accounted for by the intake of wine and to a lesser extent tea.” Flavan-3-ols, specifically the catechins, are abundant in ripe fruits, leaves, tea and red wine.

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Numerous antioxidant data

FDA (PDF-format) document lists a large number of antioxidant compounds and activity in foods. Note: this does NOT necessarily correspond with benefit to humans.

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Do NOT affect lifespan

Two of the most touted antioxidants do not improve lifespan of mice. “…alpha-lipoic acid or coenzyme Q(10)… had no impact on longevity or tumor patterns compared with control mice fed the same number of calories, whereas [caloric restriction] increased maximum life span by 13% (p <.0001) and reduced tumor incidence.”

n.b., this has been confirmed elsewhere with these and other supplements.

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Dietary beta carotene, vitamin C & E, and zinc

Linked to slightly lower macula degeneration rates

“Recently, high-dose supplementation with beta carotene, vitamins C and E, and zinc was shown to slow the progression of AMD. OBJECTIVE: To investigate whether regular dietary intake of antioxidants is associated with a lower risk of incident AMD. DESIGN: Dietary intake was assessed at baseline in the Rotterdam Study (1990-1993) using a semiquantitative food frequency questionnaire. Incident AMD until final follow-up in 2004 was determined by grading fundus color transparencies in a masked way according to the International Classification and Grading System. SETTING: Population-based cohort of all inhabitants aged 55 years or older in a middle-class suburb of Rotterdam, the Netherlands. PARTICIPANTS: Of 5836 persons at risk of AMD at baseline, 4765 had reliable dietary data and 4170 participated in the follow-up. MAIN OUTCOME MEASURE: Incident AMD, defined as soft distinct drusen with pigment alterations, indistinct or reticular drusen, geographic atrophy, or choroidal neovascularization. RESULTS: Incident AMD occurred in 560 participants after a mean follow-up of 8.0 years (range, 0.3-13.9 years). Dietary intake of both vitamin E and zinc was inversely associated with incident AMD. The hazard ratio (HR) per standard deviation increase of intake for vitamin E was 0.92 (95% confidence interval [CI], 0.84-1.00) and for zinc was 0.91 (95% CI, 0.83-0.98). An above-median intake of all 4 nutrients, beta carotene, vitamin C, vitamin E, and zinc, was associated with a 35% reduced risk (HR, 0.65; 95% CI, 0.46-0.92) of AMD. Exclusion of supplement users did not affect the results. CONCLUSION: In this study, a high dietary intake of beta carotene, vitamins C and E, and zinc was associated with a substantially reduced risk of AMD in elderly persons.”

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A popularized summary website of AMD macula degeneration risk factors.

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How to eat

Eat with oil for absorption of carotenoids

No oil => no absorption!

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Vegetables

High intake is associated with longer lifespan

A 30-year follow-up study of 1536 Italian males showed a 1-year gain in lifespan of non-smokers (2 years in smokers).

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Associated with a reduced rate of cognitive decline

“a prospective cohort study of 3,718 participants, aged 65 years and older of the Chicago Health and Aging Project. Participants completed a food frequency questionnaire and were administered at least two of three cognitive assessments at baseline, 3-year, and 6-year follow-ups. … The mean cognitive score at baseline for the analyzed cohort was 0.18 (range: -3.5 to 1.6), and the overall mean change in score per year was a decline of 0.04 standardized units. In mixed effects models adjusted for age, sex, race, and education, compared with the rate of cognitive decline among persons in the lowest quintile of vegetable intake (median of 0.9 servings/day), the rate for persons in the fourth quintile (median, 2.8 servings/day) was slower by 0.019 standardized units per year (p = 0.01), a 40% decrease, and by 0.018 standardized units per year (p = 0.02) for the fifth quintile (median, 4.1 servings/day), or a 38% decrease in rates. The association remained significant (p for linear trend = 0.02) with further control of cardiovascular-related conditions and risk factors. Fruit consumption was not associated with cognitive change. CONCLUSION: High vegetable but not fruit consumption may be associated with slower rate of cognitive decline with older age.”

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Reduces kidney stones from uric acid

Uric acid (think gout, kidney stones) comes from purine metabolism; purine comes from DNA in cells, most concentrated in meat. Thus meat => these problems. “The ingestion of the vegetarian diet … led to a further significant reduction in the risk of uric acid crystallization by 93% compared to [the Western type diet].”

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Some people are sensitive to the bitter taste of some vegetables. It turns out that the gene (TAS2R38) that is associated with being a “PTC taster” (phenylthiocarbamide) correlates well with avoiding vegetables in children! PTC strips is the common test often used in high school genetics.

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Fruit and vegetables

May help prevent dementia

Fruit (blueberries and strawberries) and vegetables (spinach) may help prevent neuronal aging (dementia), perhaps via anti-oxidant properties.

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From Reuters: [Researchers] “divided the dogs into four groups that got either standard care; a diet supplemented with tomatoes, carrot granules, citrus pulp, spinach flakes and supplements; standard care plus extra exercise and play; or the special diet and the special play and exercise regime. A second set of 17 dogs aged 1 to 3 got either a standard or fortified diet. Tests included having to find a hidden treat. The older dogs clearly benefited from the special diet and the special exercise program, the researchers said. All 12 of the older beagles that got a supplemented diet and exercise could solve a difficult problem, compared to eight of 10 dogs that got the enriched diet alone and two of eight dogs that got no special treatment.”

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Lower LDL levels

“Fruit and vegetable consumption was inversely related to LDL: in the categories 0–1.9, 2.0–2.9, 3.0–3.9, and 4 servings/d, multivariate-adjusted mean (95% CI) LDL concentrations were 3.36 (3.28, 3.44), 3.35 (3.27, 3.43), 3.26 (3.17, 3.35), and 3.17 (3.09, 3.25) mmol/L, respectively, for men (P for trend < 0.0001) and 3.35 (3.26, 3.44), 3.22 (3.14, 3.30), 3.21 (3.13, 3.29), and 3.11 (3.04, 3.18), respectively, for women (P for trend < 0.0001).”

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Improve bone health in girls

“High fruit and vegetable intakes have beneficial effects on the bone area of the radius and whole body in early pubertal girls.”

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There is only a modest effect on chronic disease

“Of the food groups analyzed, green leafy vegetable intake showed the strongest inverse association with major chronic disease and cardiovascular disease. For an increment of one serving per day of green leafy vegetables, relative risks were 0.95 (95% CI = 0.92 to 0.99) for major chronic disease and 0.89 (95% CI = 0.83 to 0.96) for cardiovascular disease. CONCLUSIONS: Increased fruit and vegetable consumption was associated with a modest although not statistically significant reduction in the development of major chronic disease. The benefits appeared to be primarily for cardiovascular disease and not for cancer.”

My thoughts: there still may be some fruit and vegetables that are good at preventing certain types of cancer.

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“Current evidence supports the inclusion of whole grains, fruits and vegetables, and lean sources of animal proteins including low-fat dairy products in dietary therapies for insulin resistance. Those who wish to follow a low-carbohydrate diet should be encouraged to follow a new menu low in fat, and with most of the protein derived from plant sources.”

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Lower C-Reactive Protein (CRP)

“…high intake (8 servings/d) of vegetables and fruit significantly increased total carotenoid concentrations in plasma … C-reactive protein was significantly reduced at week 8 in the subjects who consumed 8 servings/d of vegetables and fruit compared with those who consumed 2 servings/d.”

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Reduced risk of stroke

A meta-analysis of prospective studies “including 90,513 men, 141,536 women, and 2,955 strokes” showed “The risk of stroke was decreased by 11%... for each additional portion per day of fruit, by 5% ... for fruit and vegetables, and by 3% ... for vegetables.”

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A meta-analysis in Lancet “Eight studies, consisting of nine independent cohorts, met the inclusion criteria. These groups included 257,551 individuals (4917 stroke events) with an average follow-up of 13 years. Compared with individuals who had less than three servings of fruit and vegetables per day, the pooled relative risk of stroke was 0.89 (95% CI 0.83-0.97) for those with three to five servings per day, and 0.74 (0.69-0.79) for those with more than five servings per day. Subgroup analyses showed that fruit and vegetables had a significant protective effect on both ischaemic and haemorrhagic stroke…Our results provide strong support for the recommendations to consume more than five servings of fruit and vegetables per day, which is likely to cause a major reduction in strokes.”

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Associated with reduced risk of oral cancer

Meta-analysis: “A comprehensive, systematic bibliographic search of medical literature published up to September 2005 was conducted to identify relevant studies. Separate meta-analyses were conducted for fruit and vegetable consumption. The effect of portion or daily intake of fruit or vegetables on the risk of oral cancer was calculated. A multivariate meta-regression analysis was performed to explore heterogeneity. This multivariate meta-regression analysis examined the effect of quality score, the type of cancers included, citrus fruit and green vegetable consumption, and the time interval for dietary recall of the studies on the role of fruit or vegetable consumption in the risk of oral cancer. The presence of publication bias was assessed with a funnel plot for asymmetry. RESULTS: Sixteen studies (15 case-control studies and 1 cohort study) met the inclusion criteria and were included in the meta-analysis. The combined adjusted odds ratio (OR) estimates showed that each portion of fruit consumed per day significantly reduced the risk of oral cancer by 49% (OR: 0.51; 95% CI: 0.40, 0.65). For vegetable consumption, the meta-analysis showed a significant reduction in the overall risk of oral cancer of 50% (OR: 0.50; 95% CI: 0.38, 0.65)…The consumption of fruit and vegetables is associated with a reduced risk of oral cancer.”

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Reduces risk of coronary heart disease (CHD)

A meta-analysis of studies found “The pooled RRs were calculated for each additional portion of fruit and/or vegetables consumed per day, and the linearity of the associations were examined. Nine studies were eligible for inclusion in the meta-analysis that consisted of 91,379 men, 129,701 women, and 5,007 CHD events. The risk of CHD was decreased by 4% …for each additional portion per day of fruit and vegetable intake and by 7% … for fruit intake…This meta-analysis of cohort studies shows that fruit and vegetable consumption is inversely associated with the risk of CHD. The causal mechanism of this association, however, remains to be demonstrated.”

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Broccoli & other crucifers (Brussels sprouts, cauliflower, etc.)

Helps prevent certain cancer

Broccoli and related vegetables have been shown to reduce the rate of certain cancers. This is NOT because of antioxidant activity; instead they contain certain molecules (glucosinolate, isothiocyanates (ITC) and indoles) that induce an increase in the body’s production of what is called “Phase 2 enzymes”. These enzymes detoxify certain carcinogens by causing an increase in glutathione-S-transferase (GST) activity. The response to these vegetables appears to be dependent on your genes. The most potent vegetable inducer of this is broccoli sprouts, easily grown at home (I do).