Diet and Chronic Disease: Type 2 Diabetes and Heart Disease

Written by Dr. Steve Chaney on . Posted in Chronic Disease, Diabetes, Diets, Heart Disease

Can You Cut Your Risk Of Heart Disease And Diabetes In Half?

Author: Dr. Stephen Chaney

 

diet and chronic disease heart attackIt is no secret that heart disease and diabetes are among the top two causes of death in this country. They are killers. Even worse, they can affect your quality of life for years before they kill you. Finally, they are bankrupting our health care system. Anything we can do to reduce the toll of these diseases would be of great benefit.

Is there a connection between diet and chronic disease, specifically type 2 diabetes, stroke, and heart disease?

That is why recent headlines suggesting that deaths due to heart disease, stroke, and diabetes could be cut almost in half simply by changing our diet caught my attention. Of course, those headlines came as no surprise. It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes.

 

How Was The Study Done?

diet and chronic disease heart diseaseThis was a major study (R. Micha et al, JAMA, 317: 912-924, 2017 ). They started by using something called the National Health and Nutrition Examination Survey (NHANES). NHANES is a major survey conducted approximately every 10 years by the US government to collect data on demographics, disease, and diet from a cross section of the US population. They used this database to determine how frequently Americans consumed various heart-healthy and heart-unhealthy foods. They collected data from two surveys conducted in 1999-2002 and 2009-2012 to determine how consumption of those foods had changed over that 10-year period.

  • The heart-healthy foods they included in their study were fruits, vegetables, nuts & seeds, whole grains, and seafood omega-3s (long chain omega-3s).
  • The heart-unhealthy foods they included in their study were red meats, processed meats, sugar-sweetened beverages, and sodium.

They then did a meta-analysis of high quality clinical studies measuring the effects of those foods on deaths due to heart disease, stroke, and diabetes. They combined the data from all these studies to calculate the deaths due to all three causes combined, something they called deaths due to cardiometabolic disease.

Diet and Chronic Disease, Preventing Type 2 Diabetes and Heart Disease

diet and chronic disease lifestyleWhen the investigators combined all the data, they estimated that changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes) by 45.4%. That is an almost 50% reduction just by eating a healthier diet.

  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sweets, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
  • Decreasing sodium intake gives a 9.5% reduction in deaths.
  • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
  • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
  • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
  • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
  • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
  • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
  • Decreasing red meat consumption gives a 4.2% decease in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

diet and chronic disease heartHolistic changes are best: It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show a relationship between diet and chronic disease:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The good news is that Americans have made some positive changes in their diet between the first and second NHANES survey, and, as a result, cardiometabolic deaths declined by 26.5%. The biggest contributors to this improvement were:

  • Increased polyunsaturated fat consumption (-20.8%).
  • Increased nut and seed consumption (-18%).
  • Decreased sugar sweetened beverage consumption (-14.5%).
  • This was partially offset by increased processed meat consumption (+14.4%)

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”  Below is a summary of the relationship between diet and chronic disease (specifically type 2 diabetes, stroke, and heart disease).

 

The Bottom Line

It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes. A recent study looked at the effect of a healthier diet on what they called cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes). They concluded:

  • changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths by 45.4%. That is an almost 50% reduction just by eating a healthier diet.
  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sugary foods, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
    • Decreasing sodium intake gives a 9.5% reduction in deaths.
    • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
    • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
    • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
    • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
    • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
    • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
    • Decreasing red meat consumption gives a 4.2% reduction in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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