Dark chocolate, the varieties containing 85% -90% cocoa solids, is something that I really do enjoy (as regular readers of my blog will already know)!  I take comfort in knowing that this treat is also quite healthy.  Numerous studies have now linked the eating of dark chocolate to a reduced risk of heart disease and cancers, as well as other conditions.  The health benefits appear to come from the antioxidant flavonoids (bioactive plant nutrients) contained within the cocoa and also from the many minerals that cocoa contains such as magnesium.  Dark chocolate also contains fibre and is much lower in sugar than milk chocolate, so most people find that they need far less to satisfy their chocolate cravings.

As a child I remember being told not to spoil my appetite by eating too much chocolate before the Christmas meal so I was pleased to read a report produced by the Faculty of Life Sciences (LIFE) at the University of Copenhagen, the paper details some research that the scientists there have carried out on dark chocolate and appetite (1).

The scientists have found that dark chocolate is far more filling than milk chocolate and may lessen our craving for milk chocolate which is sweet, salty and provides very little in the way of nutrition.  Eating a few squares of good quality dark chocolate, 70% cocoa solids or over, may well satisfy chocolate cravings and hence prevent further binges and large Christmas weight gains.

To compare the effects of dark and milk chocolate on both appetite and subsequent calorie intake, 16 young, healthy men of normal weight who all liked both dark and milk chocolate took part in an experiment over two separate sessions.  In the first instance dark chocolate was tested and in the second stage, occurring on a different day, milk chocolate was tested.  Prior to the experiment all the participants fasted for 12 hours, so they were hungry.  They were than given 100g of chocolate to consume within 15 minutes.  The calorie content of both the dark and milk chocolate was the same.  After they had eaten the chocolate they were asked to register their appetite every half an hour for the next five hours.  Two and a half hours after having eaten the chocolate the individuals were offered pizza and instructed to eat until they felt comfortably satisfied.  The results were analysed by the scientists and were significant in that after eating dark chocolate the individuals consumed 15% fewer calories from the pizza than when they had eaten milk chocolate.  The participants also recorded that they felt less like eating after consuming the dark chocolate, it made them feel fuller for longer. 

So, in addition to providing us with nutrients and antioxidant, dark chocolate may well help to fill us up and prevent us from over-indulging on unhealthier foods this Christmas.  The appetite controlling effects of the dark chocolate could be down to the nutrients it contains or perhaps the fibre content.  Of course, I am not suggesting gorging on dark chocolate but a few pieces may not be as bad as you once thought!!

Nuts are another Christmas food that some people tend to avoid, thinking they are fatty and full of calories.  As I mentioned last week, nuts are a healthy natural food and we could all do well from eating a regular handful of unsalted, unroasted nuts.

Nuts are packed with nutrients, fibre and healthy fats.  Numerous studies suggest that people who regularly consume nuts (around 30g per day) are slimmer than those who do not.  Nuts also make a great snack as they help dampen the appetite and prevent later overeating.  The fat in nuts is mainly monounsaturated fat, the same as olive oil, which appears to reduce risk of heart disease.  Nuts are also rich in vitamin E, magnesium, potassium and fibre - all of these nutrients are great for heart health.  Brazil nuts are also very high in selenium which is linked to a reduced risk of cancer and walnuts contain omega 3 fatty acids which have many health properties.

Previously I posted a blog dedicated to the health benefits of almonds.  A recent review (2) summarised the available evidence on nuts and body weight and weight loss.  The authors write  “There are claims that energy-dense foods are especially problematic for weight loss and maintenance. Nuts are among the most energy-dense foods consumed, yet the literature consistently documents little impact of their ingestion on body weight”  Nuts seem to satisfy the appetite, they make us feel full and may therefore prevent us overeating on other, less nutritious foods.  This could be due to the fact that, as well as healthy fats, nuts also contain protein and release their energy very slowly into the bloodstream,they have a very low glycaemic index or GI. Evidence also suggests that not all of the fat in nuts is absorbed into the body, much of it being passed out in the stool. 

Cracking a few nuts this Christmas may be a great way to boost health!

(1)University of Copenhagen
(2) Mattes RD et al.  2008.  Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr 2008;138:1741S-1745S

Written by Ani Kowal

My last few blog posts have had a Mediterranean theme so I decided to continue it through to this post.....last week I mentioned the Mediterranean diet in relation to prevention of heart disease, cholesterol lowering and the reduction of triglyceride levels, a risk factor for heart disease.  I also mentioned that low fat, high carbohydrate diets were not necessarily successful in reducing the overall risk of heart disease and could often contribute to an increase in triglyceride levels.  A study published in the December issue of the Archives of Internal Medicine (1) found that a Mediterranean diet supplemented with nuts could potentially play a significant role in reducing in the risks of heart disease.

The researchers were investigating the effects of a Mediterranean diet on the metabolic syndrome.  Metabolic syndrome is a term used to describe a cluster of risk factors for heart disease, diabetes and stroke which includes: high blood pressure, abdominal obesity (excess weight around the waist), high triglyceride levels, high blood sugar levels and high levels of SD-LDL cholesterol (a particularly damaging form of cholesterol) as well as other factors.

The study (1) lasted for a year and included a total of 1224 participants aged 55-80 which were split into 3 groups.  The aim was to determine the efficacy of diet on the prevention of cardiovascular/heart disease.  One group was given information about the Mediterranean diet including the use of 1L of virgin olive oil per week, the second group was advised to consume a Mediterranean diet including 30g of mixed nuts per day and the third group acted as a control group and advised to eat a low-fat diet.

After a year the prevalence of metabolic syndrome among the participants was reduced by almost 7% in the Mediterranean + olive oil group, almost 14% in the Mediterranean + nuts group and only 2% in the low fat group.  In the nut group there was also a significant drop in the number of participants with abdominal obesity, high blood triglyceride levels or high blood pressure when compared to the low fat diet (control group).  The authors conclude that “A traditional Mediterranean diet enriched with nuts could be a useful tool in the management of the metabolic syndrome”

The benefits of a Mediterranean diet may be greater when nuts are included as a fat source since nuts also provide nutrients, in addition to healthy fats, such as fibre, potassium, calcium and magnesium – which are linked to a reduction in blood pressure and may also help to regulate blood sugar levels through an effect on the hormone insulin.  Walnuts are also fairly rich in omega 3 fatty acids, not provided by olive oil, which are known to help reduce the risk of heart disease. 

Typically a Mediterranean diet is rich in olive oil, vegetables, fruits, oily fish (a great source of omega 3 fatty acids) and low in refined carbohydrates, sugar and processed foods.  I have written extensively about the Mediterranean diet previously so please search through my blog posts for further information.

The study did not assess the dietary potential for weight loss nor did the scientists look at advising an increase in physical activity.  The results were achieved with diet alone.  In combination with education on increasing physical activity I expect that the results could have been further improved.  Just 30 minutes of walking a day seems to be highly beneficial to health, even if this is broken down into two fifteen minute sessions. 

From this study and from my previous posts I think it is important to note that dietary fat is not necessarily the ‘bad guy’ that many people assume.  Perhaps refined carbohydrates, foods with a low GI (glycaemic index) which release sugar quickly into the blood stream and sugar represent huge problems to health.  Naturally high-fat foods such as nuts and seeds, avocados, olives and oily fish are great for our health and, I would suggest, far more nutritious than many of the low fat refined cereal foods that are on offer in our supermarkets.

(1)Salas-Salvado J et al.  2008.  Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status one-year results of the PREDIMED randomized trial.  Arch Intern Med.  168:2449-2458

Written by Ani Kowal

Back in July I wrote about the potential of artichoke leaf extract to lower cholesterol levels.  There have been many papers written about natural alternatives to statins, the commonly prescribed drug for the lowering of cholesterol levels.  Many individuals prefer not to take statin medication due to the potential adverse effects and the fact that it is still not entirely known why it seems to be useful in the prevention of heart disease.  There also seems to be some concern that statins, such as simvastatin and ezetimbe, appear to be linked to an increased risk of cancer(1).

The whole cholesterol issue is one that is filled with contention.  A few years ago I was working with Dr Briffa(a fantastic experience!) and I was surprised to find that cholesterol levels were not necessarily something to worry about and that low levels have been linked to all sorts of other problems.  There are so many types and classes of cholesterol, some of which are seen as ‘good’ and others ‘bad’!  Then there is a type of fat found in blood called triglycerides, these really do seem to be linked to an increased risk of heart disease and should be seen, perhaps, as more of a worry than cholesterol.  The slight problem here is that most people looking to reduce their cholesterol levels adopted a very low fat diet, this generally means that they increase their carbohydrate intake – but carbohydrates, especially refined carbohydrates and sugar, are what increase the triglyceride levels in the body!!  Certain fats, especially omega 3 fatty acids (found in oily fish such as salmon, trout and mackerel as well as flaxseeds), are known to reduce these triglyceride levels and are essential for health!  I wrote in some depth about carbohydrates, sugar, triglycerides, omega 3 fatty acids and heart disease in September and I would recommend that you read the post in order to gain a little more understanding of this complex issue.

Personally I think that a low fat diet is certainly not a good idea, especially if it leads to over consumption of refined carbohydrates and sugar.  Certain fats, such as the omega 3 fatty acids mentioned above, are essential to our health.  The body cannot make these essential fats, they must be provided through the diet.  My interest and enthusiasm lies in the promotion of a healthy, balanced diet rich in vegetables and fruits, which are fantastic sources of nutrients and unrefined carbohydrate, healthy fats from fish, nuts and seeds and olives, and protein from unprocessed meat, fish and beans/legumes/nuts.  Exercise is also a crucial part of a healthy lifestyle.  Just 30-40 minutes of accumulated walking in a day would provide some benefit to health.

Anyway, back to the cholesterol issue.  For those wishing to adopt a different strategy to the use of statins I would like to draw your attention to a recent study (2) which looked at natural alternatives.  The researchers involved with this study wanted to compare the LDL-cholesterol (one of the types of cholesterol frequently seen as ‘bad’) lowering effects of a standard statin (simvastatin) to an alternative regimen which involved lifestyle changes in combination with a fish oil supplement and a red yeast rice supplement for 12 weeks.  The statin group also received standard printed materials about diet and exercise recommendations.  The study was small and involved 74 patients, men and women aged 18-80, with high cholesterol levels. 

The lifestyle program involved weekly 3 and a half hour educational meetings led by a cardiologist (specialist heart doctor), dietician, exercise physiologist and several alternative or relaxation practitioners. The dietician encouraged the group to follow a Mediterranean diet (which I have previously written about in relation to asthma and arthritis) which is low in sugars and refined carbohydrates but not specifically low in fat. An exercise physiologist instructed the group to gradually increase their exercise regimen to 5 or 6 times per week, especially encouraging aerobic exercise including walking, swimming, or jogging for 30 to 45 minutes at a time. The alternative practitioners exposed patients to various relaxation methods including yoga and tai chi.

The results of the study were very interesting.  There was a statistically significant reduction in the LDL-cholesterol levels in both groups.  Neither ‘treatment’ showed better results than the other, indicating that the alternative ‘natural’ regiment was as good as the medication.  However, in addition to reducing the cholesterol levels the alternative/natural group ALSO had a significant reduction in their blood triglyceride levels and a significant reduction in their weight – this was NOT seen in the group who received the statin drug.

The authors conclude: “Lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL-Cholesterol in proportions similar to standard therapy with simvastatin. Pending confirmation in larger trials, this multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins”

Red yeast rice, also called hong qu, is a Chinese herbal medication first described in 800 AD.  It contains many active substances that may be responsible for its health benefits.  In the study the dose used was 2.4-3.6g a day.  Fish oil is something I often write about.  It has been linked to the reduction of so many health problems and appears to be very beneficial in the prevention of many heart conditions.  The Mediterranean diet is rich in fish, especially oily fish as well as being abundant in vegetables and fruits which provide a whole array of nutrients and fibre.  If oil fish does not figure highly in your diet, at least two portions per week, you may like to consider taking a supplement providing 250-350mg of EPA and the same of DHA.  Vegetarians and vegans may wish to take a flaxseed oil supplement providing 500mg - 1000mg of alpha linolenic acid a day. 

The take home message, in my opinion, is to eat well and move the body.  Hectic lives often mean we neglect health but just a few short walks a day can easily add up to 40mins and a little meal planning can lead to improvements in diet.

(1) Rossebø AB, et al. Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. NEJM Published on-line 2nd September 2008.
(2) Becker DJ et al.  2008.  Simvastatin vs Therapeutic Lifestyle Changes and Supplements: Randomized Primary Prevention Trial.  Mayo Clin Proc.  83:758-764

Written by Ani Kowal

As you are aware from my previous posts I champion vegetable and fruit consumption.  These treasures are abundant in taste, texture, vitamins, mineral and fibre.....but they are also full of bioflavonoids, or flavanoids (members of the polyphenol family).  Flavonoids are bioactive plant compounds which have gained increasing amount of publicity over the last few years.  Scientists have been looking into the health benefits of these plant compounds and quite a lot of interesting data has been coming to light.

A yet to be published review article(1) looked at polyphenols (mainly found in grapes) and their role in health and found that these compounds may help to reduce the risk of heart disease.  The authors of the study state that “Consumption of grape and grape extracts and/or grape products such as red wine may be beneficial in preventing the development of chronic degenerative diseases such as cardiovascular disease".  Grape seeds, grape skin and grape juice contain many different polyphenols including; resveratrol, anthocyanins and flavonoids – you may be familiar with these names as they are widely available as supplements.  In conclusion to this review the authors say "supplementation with grape seed, grape skin or red wine products may be a useful adjunct to consider for a dietary approach in the prevention of cardiovascular diseases, although additional research is required to support such a strategy"

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals' (I have mentioned antioxidants and their role in health previously a number of times).  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

Another recently published study(2) looked at the association between a variety of flavonoids and the risk of cardiovascular disease and stroke.  The scientists studied 1950 Finish men aged between 42-60 who were free from prior heart disease or stroke.  Participants were followed for an average of 15 years and during this time over 100 strokes and 150 cardiovascular disease deaths occurred.  Data analysis revealed that men who consumed the highest amounts of flavonoids had a greatly reduced risk of stroke and there was also a reduced risk of death from cardiovascular disease.  The results are unsurprising as fruit and vegetables are the major sources of flavonoids and there is plenty of data to show that these foods protect us from all kinds of diseases including stroke and heart disease.  The interesting point comes from the fact that the analysis took into account various vitamin intakes suggesting that the flavonoids themselves make a real impact on health.

Yet another study published just this month (3) highlights the health benefits of flavonoids, this time their potential role in weight maintenance and prevention of weight gain.  The researchers of this study looked at the association between flavonoids and BMI (body mass index, a measure of overweight) over a 14 year period in 4280 men and women aged between 55-69 years.  The results showed that women with the highest intake of flavonoids experienced a significantly lower increase in BMI over the study period.  Again, this is not surprising.  Individuals who eat a lot of vegetables and fruits tend not to fluctuate in weight and stay leaner.   

Now onto two pieces of research (4,5) which I am particularly fond of as they involve dark chocolate!  Readers of my blog will know my penchant for dark chocolate.  Dark chocolate containing 85%+ cocoa solids is something I truly adore and really savour the moment of one bitter square slowly melting over my tongue!  Drinking black cocoa is also something I enjoy.  The health benefits of cocoa have been publicised over the last few years and evidence that cocoa may help in the prevention of many conditions, such as cancer and heart disease, is mounting.  Cocoa is packed with great minerals such as magnesium and is also ‘choc’ full of flavonoids.

A very recent study(4) suggests that cocoa consumption may be good for the heart (great news since I would have trouble giving it up!).  The researchers investigated the short-term effects of eating either solid dark chocolate or drinking liquid cocoa on blood vessel function and blood pressure.  The small study included 45 adults who were overweight but healthy (and not obese) who were, on average, 53 years old.  In the first stage of the trial the participants consumed a bar of dark chocolate containing 22g of cocoa powder or a cocoa-free bar.  In the second stage the participants drank sugar-free cocoa containing 22g cocoa powder, cocoa containing sugar or a placebo containing no cocoa.

Eating dark chocolate and drinking sugar-free cocoa improved blood vessel function compared to placebo and blood pressure decreased in individuals who ate the dark chocolate bar or drank the sugar-free cocoa, compared to those who consumed the placebo.  The researchers conclude by saying “The acute [short term] ingestion of both solid dark chocolate and liquid cocoa improved endothelial [lining of the blood vessels] function and lowered blood pressure in overweight adults. Sugar content may attenuate [reduce] these effects, and sugar-free preparations may augment [improve] them”

The other small study(5) found that flavonoid rich cocoa was associated with a significant increase in blood flow to the brain, as measured via a special sort of ultrasound (Transcranial dopler ultrasound).  The authors suggest that their data could indicate a promising role for regular cocoa consumption in the treatment and prevention of stroke and dementia.

These studies were very small and preliminary but I found them interesting!!  I would like to add that this is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!). 

Flavonoids and polyphenols in general are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)http://www.elsevier.com/wps/find/authored_newsitem.cws_home/companynews05_01042 Mounting evidence shows health benefits of grape polyphenols.  Philadelphia October 28.  Due to be published in the November issue of Nutrition Research
(2)Mursu J et al.  2008.  Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study.  BJN.  100:890-895
(3)Hughes L et al.  2008.  Higher dietary flavone, flavonol, and catechin intakes are associated with less of an increase in BMI over time in women: a longitudinal analysis from the Netherlands Cohort Study.  Am J Clin Nutr.  88:1341-1352
(4)Faridi Z et al.  2008.  Acute dark chocolate and cocoa ingestion and endothelial function:a randomised controlled crossover trial.  Am J Clin Nutr.  88:58-63
(5) Sorond FA et al.  2008. Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans. Neuropsychiatric Disease and Treatment. 4:433-440

Written by Ani Kowal

Sugar, carbohydrates and balancing blood sugar levels
You may well be wondering what sugar and blood sugar levels have to do with heart disease.  A lot!  Unfortunately over the years ultra low fat diets have been touted as being the major players in the protection against heart disease, this led many people to eat diets that were high in sugar and/or high in (non-vegetable and fruit) carbohydrates.  Many low-fat foods contain ample amounts of added sugar and are often highly refined/processed.  Previously (see posts dated 8th September and 9th September) I mentioned the importance of providing the body with a steady supply of energy and preventing blood sugar imbalances in order to prevent fatigue.  Well, balanced blood sugar levels also seem to be incredibly important in preventing heart disease (and don’t just affect diabetics as you may well have thought).  Simply lowering the total amount of fat in the diet is unlikely to improve fat (lipid and cholesterol) profiles or reduce coronary heart disease (CHD) risk (1). 

Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  To identify foods with a high glycaemic index that will contribute to increasing the GL of a meal please view the website The Glycemic Index, there you will find a database where you can search for specific foods and find out more about GI and health. 

Unbalanced blood sugar levels following a meal (post-prandial dysmetabolism) can cause havoc in the body.  A high post-meal blood sugar level can lead to damaging free radicals (reactive oxygen molecules) being released which are a risk for atherosclerosis (damage to blood vessels) and metabolic syndrome (a big risk factor for heart disease).  The high blood sugar can lead to internal inflammation, dysfunction in the lining of the blood vessels and may also lead to an increase in triglycerides (blood fats) - all risk factors for heart disease (2,3).  A recent review paper(3) looked at how the current western diet, which favours meals that cause spikes in blood glucose, can be improved in order to exert immediate favourable changes in post-meal glucose dysregulation.  The authors found that: 

“Specifically, a diet high in minimally processed, high-fiber, plant-based foods such as vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-meal increase in glucose, triglycerides (blood fats), and inflammation”.  Additionally they found that lean protein, fish oil, weight loss and exercise also prevent post-meal glucose spikes.

Eat healthy fats to protect the heart.
You guessed it, I am going to talk about omega 3 fatty acids and fish oils again!  Omega 3 fatty acids are essential to the body and so following a fat-free diet really isn’t clever for health reasons.

Raised triglyceride (fat) levels in the blood are a risk for CHD, they often occur in conjunction with accumulation of central body fat, blood sugar and insulin problems and raised levels of what is known as SDLDL cholesterol (small dense low density lipoprotein cholesterol) a very destructive type of cholesterol.  Together these risk factors for CHD are known as the metabolic syndrome (or syndrome X).  Metabolic syndrome is present in about 25% of the UK middle aged population and its' importance as a risk for CHD development is now well established (4).  Raised blood fat levels can be lowered by losing weight and eating a diet that prevents blood sugar fluctuations, as mentioned above. 

Another way of reducing blood fat levels is by including oily fish (e.g. salmon, mackerel and sardines), a rich source the healthy omega 3 fats (EPA and DHA), in the diet or taking fish oil supplements.  Trials have confirmed the blood fat (triglyceride) lowering effects of fish oils.  In one study(5) supplementation with 3g/d reduced post-meal triglyceride rises by 26% and reduced fasting triglyceride levels by 35%.  Fish oils and consumption of oily fish also seem to provide many other benefits for CHD, there is evidence that they can, reduce blood pressure, prevent blood clotting, prevent abnormal heart beats (arrhythmias), reduce inflammation and reduce constriction in blood vessels – all factors that may reduce CHD risk (6,7). 

Very recently a study(8) found that the low risk of heart disease in the Japanese population may well be due to their high intakes of omega 3 fatty acids from fish oils.  Another large study (9), released only a few weeks ago, has found that an omega 3 fatty acid supplement reduced death and admission to hospital for all cardiovascular reasons in people with existing heart problems.  If you are vegetarian/vegan another recently published study paper (10) has found that flaxseed oil, a vegetarian oil rich in the omega 3 fatty acid alpha-linolenic acid, could be protective against heart problems and heart attacks.

If you do not regularly consume oily fish (at least twice per week) you may wish to consider a fish oil supplement providing around 250mg of EPA and 250mg of DHA daily.  For vegetarians a flaxseed oil supplement providing around 500-700mg of alpha linolenic acid could be considered.

While a lot of emphasis has been placed on the need to avoid saturated fat in the diet (red meat, diary, eggs), there is mounting evidence (e.g. 11,12,13) to suggest that the fats known as ‘partially hydrogenated’ and ‘trans fatty acids’ are more of a risk factor for CHD. These fats, found in many fast foods, baked goods, processed foods and margarine are associated with an increased risk of heart disease, it makes sense to avoid such ‘trans’ fatty acids.

Please look after your heart.  Eat healthy foods which are minimally processed and include plenty of fruits and vegetables into your daily meals, try to incorporate some form of exercise (walking counts) into your day, try and quit the cigarettes if you are a smoker and don’t let stress rule your life.  If you have any concerns regarding symptoms then speak to your GP.  Take some time to look at the British Heart Foundation website and become heart health aware!

(1)Hu FB & Willett WC.  2002.  Optimal diets for prevention of coronary heart disease.  JAMA.  288(20):2569-78.
(2)Livesey G et al.  Glycemic response and health--a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes.  Am J Clin Nutr.  87:258s-268s
(3)O’Keef JH et al.  2008.  Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health.  J Am Coll Cardiol. 51(3):249-55.
(4) Griffin BA & Fielding BA.  2001.  Postprandial lipid handling.  Curr Opin Clin Nutr Metab Care.  4:93-98.
(5) Minihane, AM. et al.  2000.  ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype.  Arterioscler Thromb Vasc Biol.  20:1990-1997.
(6) Kris-Etherton PM et al.  2003.  Fish consumption, fish oil, omega 3 fatty acids, and cardiovascular disease.  Circulation.  106:2747-2759
(7) Nordoy A et al.  2001.  n-3 Polyunsaturated Fatty Acids and Cardiovascular  Diseases.  Lipids.  (Suppl)36:S127-S129
(8)Sekikawa A et al.  2008.  Marine-Derived n-3 Fatty Acids and Atherosclerosis in Japanese, Japanese-American, and White Men: A Cross-Sectional Study.  J Am Coll Cardiol.  52:417-424
(9)GISSI-HF 2008.  Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.  The Lancet.  E-Pub ahead of print August 2008  DOI:10.1016/S0140-6736(08)61239-8
(10)Campos H et al.  2008.   -Linolenic Acid and Risk of Nonfatal Acute Myocardial Infarction.  Circulation.  E-Pub before print July 2008.   doi: 10.1161/CIRCULATIONAHA.107.762419
(11) Ascherio A.  2002.  Epidemiologic studies on dietary fats and coronary heart disease.  Am J Med.  30;113 Suppl 9B:9-12.
(12)Ascherio A & Willett WC.  1997.  Health effects of trans fatty acids.  Am J Clin Nutr.  66:1006s-1010s
(13) Oomen CM et al.  2001.  Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.  Lancet.  357(9258):746-51.

Written by Ani Kowal

Coronary heart disease (CHD) is the leading cause of death in the UK, looking after our hearts is very important!  However, at recent conference(1) it was disclosed that almost half of us (48%) do not know what CHD is, recognise the symptoms or know what increases the risk.  I hope to provide a little insight here.

CHD covers two main issues, heart attack and angina (severe chest pain).  “Coronary heart disease occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) become narrowed by a gradual build-up of fatty material within their walls.  This condition is called atherosclerosis and the fatty material is called atheroma.  In time, the artery may become so narrow that it cannot deliver enough oxygen containing blood to the heart muscle, particularly at times when there is more demand -such as when you are exerting yourself. The pain or discomfort that happens as a result is called angina.  If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen and may become permanently damaged. This is known as a heart attack.”(2)

The symptoms of CHD are varied and can include: shortness of breath, palpitations/irregular heartbeat, chest pain, jaw pain, arm pain, dizziness, fainting. 

Risk factors are also varied and include: smoking, unhealthy/unbalanced diet, overweight, obesity, lack of exercise, excessive alcohol consumption, emotional/psychological stress, social isolation, diabetes and high blood pressure.  The good news is that relatively simple dietary and lifestyle changes can protect the heart.

A fantastic resource that I highly recommend is The British Heart Foundation website.  There you can read, in detail, about risk factors, dietary advice and you can also download factsheets and information booklets.  There is a section dedicated to CHD prevention, which is key, it covers diet, weight, diabetes, cholesterol, smoking, diabetes, family history, stress and counselling.

Today I just wanted to cover a few points in relation to diet and heart health.

Fruit and Vegetables
The recommendation to consume vegetables and fruit for protection from heart disease is supported by an ever-growing body of evidence.  Much evidence is drawn from studies linking higher consumption of vegetables and fruit to a lower risk of CHD (e.g. 3,4,5).  I would like to highlight one of the most recent studies(6).  The researchers found that that the benefit of fruit or vegetable consumption in reducing the risk of CHD increased proportionally by the number of servings consumed. Those consuming the most fruit (more than five portions per day) had a 60% lower risk for coronary heart disease when compared to those eating one or fewer portions per day.  Consumption of vegetables more than three times daily was associated with a 70% lower risk of CHD compared to individuals who did not eat vegetables.  Consumption of fruits and vegetables really does seem to provide significant protection against coronary heart disease!  So Tuck in! 

Vegetables and fruit are probably acting to protect against CHD through a variety of relevant substances including numerous vitamins and carotenoids, minerals, phytonutrients (bioactive plant chemicals) and fibre.  Many plausible mechanisms can explain how these various nutrients or bioactive constituents in vegetables and fruit can prevent CHD.  Try and include a variety of different vegetables and fruits in your daily diet.  Each meal can contain a portion or two e.g. chop fresh fruit, or sprinkle a handful of unsweetened dried fruit into museli or yoghurt at breakfast time, include a side salad with lunch, snack on fruit or vegetable sticks rather than cereal bars, biscuits or other refined foods and aim to include at least two types of vegetable with your evening meal.
 

Supplemental vitamins and minerals
Taking vitamin and mineral supplements should not be seen as a substitute for a healthy diet.  Supplements are void of many other substances found within fruit and vegetables which may be useful in CHD prevention such as phytochemicals (bioactive plant chemicals) and fibre.  However, there is a lot of evidence that has looked at specific nutrients in the prevention of CHD (too much evidence to list), vitamins such as the B vitamins, vitamin E and D, antioxidant vitamins such as vitamin C and many carotenoids and minerals such as magnesium and selenium may be useful protective agents.  If you feel that your diet is not rich in a variety of vegetables and fruits (at least 5 a day) you may wish to consider taking a broad-spectrum multivitamin and mineral supplement to ensure an adequate supply.  There are so many available supplements, it can be a mind-boggling experience trying to choose a product!  If you do decide to go down the supplement route I would recommend what are known as ‘food state’ multivitamin and mineral supplements.  These are easily absorbed by the body and are produced from food sources, rather than the usual chemical-isolate form of product.

Wholegrain cereals
Incorporating wholegrain foods into the diet may help to reduce the risk of CHD.  Whole grain foods (e.g. corn, barley, rye, oats & rice) in their most un-refined and natural form are rich sources of fibre, antioxidants, vitamins, minerals and phytonutrients, all of these probably act together to help protect the body against CHD.  Many studies demonstrate that the consumption of whole grain foods may help to reduce the risk of CHD (e.g. 7,8,9).  I would like to stress the importance of UN-REFINED foods.  There are many products that now advertise the fact that they are wholegrain but they may also be loaded with added sugar and have a high GI, high glycaemic index (i.e. they release sugar quickly into the bloodstream) and I certainly wouldn’t recommend their inclusion into the daily diet.  Be label savvy and look at the ingredients to see what you are buying.

Check back later this week for more heart healthy tips in Part II 

(1)British Pharmaceutical Conference 2008 http://www.bpc2008.org/
(2)British Heart Foundation http://www.bhf.org.uk/
(3) Rissanen TH et al.  2003.  Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study.  J Nutr.  133(1):199-204.
(4) Liu S et al.  2000.  Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study.  Am J Clin Nutr.  72(4):922-8
(5) Joshipura KJ et al.  2001.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med.  134(12):1106-14
(6)Nikolic M et al.  2008.  Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 16(1):17-20.
(7)Jacobs DR et al.  1999.  Is whole grain intake associated with reduced total and cause-specific death rates in older women?  The Iowa Women’s Health Study.  Am J Public Health.  89:1-8
(8)Rimm EB et al.  1996.  Vegetable, fruit and cereal fibre intake and risk of coronary heart disease among men.  JAMA.  275:447-451
(9)Liu S et al.  1999.  Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study.  Am J Clin Nutr.  70:412-419

Written by Ani Kowal

Autumn is here and the rain and wind may have you retreating to the sofa to snuggle with hot drinks rather than get out and about walking or exercising.  However, the benefits of braving the cold may actually warm the heart!  A new study (1) has found that any amount of physical activity appears to lower the risk of death among women and men with already diagnosed coronary heart disease.  On the 31st July I wrote about physical activity and the prevention of cancer and with World Heart Day fast approaching (28th September) I thought it apt to mention this newly published study.

Individuals with heart disease frequently limit the amount of physical activity they partake in due to symptoms such as shortness of breath, chronic fatigue and circulatory problems.  The researchers of this study wanted to investigate the long-term effects of exercise in individuals with existing heart disease.  The study involved 14,021 people followed for an average of 14.7 years.  The researchers categorised their physical activity into four levels – sedentary, mild, moderate and strenuous.

The results showed that the risk of death from cardiovascular problems increased significantly with less physical activity.  The more active an individual was, the lower the risk of death from cardiovascular problems.  This trend was similar in men and women.  Over the course of the study, the death rate was lowest among men and women involved in strenuous recreation such as endurance activities or competitive team sports.  The death rate was highest among men and women reporting sedentary leisure activities that primarily involved sitting.  Sedentary individuals were 1.6 times more likely to die from cardiovascular disease or other causes over the long term compared to those more physically active.

The study concluded that “leisure-time physical activity independently predicted long-term survival in men and women with chronic stable CHD[coronary heart disease]”

If you suffer from heart problems ALWAYS make sure that you check with your GP or specialist before embarking on a new exercise regimen and seek advice on the best form of exercise for you to try.  Walking and swimming are often recommended as good, gentle, ways to get started. 

(1) Apullan MD et al.  2008.  Usefulness of Self-Reported Leisure-Time Physical Activity to Predict Long-Term Survival in Patients With Coronary Heart Disease.  Am J Cardiol. 102:375-379

Written by Ani Kowal