Dr. Jim Painter PhD, University of Texas, School of Public Health

Transcription

1 Dr. Jim Painter PhD, University of Texas, School of Public Health Four pillars of the prevention of heart disease 1. Reduce total dietary fat 2. Reduce dietary saturated fat 3. Reduce dietary cholesterol 4. Reduce sodium 5. Reduce weight, if over weight Which of these are true in practice only 5 Which are partially true 2 & 4

2 Dr. Ancel Keys influential, Seven Countries Study 1961 Keys persuaded AHA to release 1 st guidelines targeting saturated fat 1970 Congressional hearings on low-fat anti-saturated fat campaign; many scientists opposed it Why do we still have fat recommendations? Keys aggressively discredited opposition (sugar causes HD) Current health authorities are too embarrassed or too loyal Based on Key s research, drug companies created the most lucrative drug ever: statins Andrade, 2009 British physician Malcolm Kendrick used same data available to Keys and discovered that by choosing different countries you can prove an inverse Bowden, relationship J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press. Fat and cholester ol intake Risk of Heart Disease

3 The Seven Countries Study is the cornerstone of current cholesterol and fat recommendations and official government policies Keys had data available from 22 countries only used data from 7 countries that supported his hypothesis Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press. Removing total fat is generally harmful (doesn t lower CVD risk) Why Replaced with refined CHO and sugar 2010 Dietary Guidelines:... Dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat. (DGAC Grade: Strong) The Snackwell Phenomenon Food companies rushed to create low-fat versions of all foods and market it as heart healthy Butter was replaced with margarine which is high in trans fat! Vegetable oils were aggressively promoted as a healthy alternative to saturated fat most vegetable oils are highly processed, pro-inflammatory, and easily damaged when reheated repeatedly Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.

4 IOM, At 12 months: Low-carbohydrate diet: 42% calories from fat Showed overall -1.4% risk reduction in 10- year Framingham CHD risk score Low-fat diet: 30.8% calories from fat

5 2015 Dietary Guidelines: Relationship between Consumption of Total Fat and Risk of CVD:...these results suggest that simply reducing SFA or total fat in the diet by replacing it with any type of carbohydrates is not effective in reducing risk of CVD. But the panel left the 20%-35% guideline Mixed message 2015 Dietary Guidelines Expert Panel Chpt Heart Disease Risk Factors Perceptions- Total Dietary Fat Dietary Fat as a Major Contributor of Heart Disease 100% 90% 80% 70% 60% 50% 40% 30% Dietary Fat as a Major Contributor of Heart Disease 20% 10% 0% Consumers (n=39) Students (n=40) Faculty (n=17) Are they really the villains everyone says?

6 Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials 1-3 Ronald P Mensink, Peter L Zock, Arnold DM Kester, and Martijn B Katan 2003 Change in: Bad Cholesterol: LDL Good Cholesterol: HDL Total HDL Cholesterol Change

7 Change in risk(lowest to highest) Trans Sats Mono Poly Intake (lowest to highest) 2010

8 In 1977 the USDA did not agree with the US Senate Committee position on saturated fat, the USDA said that there was no absolute scientific proof of the danger and risk posed by dietary fat and saturated fat. Steric acid (C18:0) should not be categorized as a cholesterolraising fatty acid, unlike lauric (C12:0), myristic ( C 14:0) and palmitic (C16:0) acids and industrially produced trans-fatty acids. Lamarche, 2014 Lamarche, 2014

9 History of Cholesterol Dietary Guidelines Dietary Guidelines- 2015?

10 FDA Nutrition Label Guidelines- Instilled in 1990 FDA set recommended value at 300 mg to be consistent with the recommendations issued by the 1989 National Research Council s Report. Where did the Cholesterol Recommendations come from? Based on animal studies Studies did not take into account other risk factors Cholesterol Recommendations Studies provided excessive amounts of DC Brownawell, A. M., & Falk, M. (2010). Cholesterol: where science and public health policy intersect. Nutrition Reviews, 68(6), In 1912 Anichkov discovered that feeding cholesterol to rabbits led to atherosclerosis. * Rabbits are herbivores- metabolize cholesterol differently Konstantinov, I., Mejevoi, N., & Anichkov, N. (2006). Nikolai N. Anichkov and his theory of atherosclerosis. Texas Heart Institute Journal, 33(4),

11 Country/Region Dietary Fat Guidelines Dietary Cholesterol Guidelines Australia Limit saturated and total fat None Canada Limit saturated fat to <10% None In the 2000 the AHA states that there is no precise basis for selecting a target level for dietary cholesterol for all individuals but recommends 300 mg/day on average. European Union India Korea Limit saturated fat to <10% Limit saturated and total fat Limit saturated fat to <20% None None None New Zealand Limit saturated fat to <12% None United States Limit saturated and trans fat <300mg Fernandez, M.L., &Calle, M. Revisiting dietary cholesterol recommendations: does the evidence support a limit of 300 mg/d? Curr Atheroscler Rep Nov;12(6): Framingham Heart Study Written by nutritionist Jonny Bowden, Ph.D. and cardiologist Stephen Sinatra M.D. 16 yr study that began in 1948 and monitored heart disease in > 5000 residents of Framingham, Massachusetts Residents who developed heart disease and residents who did not, had NO differences in serum cholesterol ranges Clarifies the misinformation surrounding cholesterol Residents >48 yrs old with high cholesterol lived just as long as those with Low cholesterol Bowden, J., & Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press.

12 EGG STUDIES Eggs are often used to study cholesterol due to their high content of cholesterol and low content of saturated fat Change in LDL, HDL, and LDL Size as a Response to DC provided by Egg in Various Populations POPULATION DURATION ADDT L DC CHILDREN 4 wk 518 mg/d WOMEN 4 wk 640 mg/d MEN 12 wk 640 mg/d MEN/WOMEN 12 wk 215 mg/d MEN/WOMEN 4 wk 640 mg/d MEN/WOMEN 12 wk 250 mg/d MEN/WOMEN 12 wk 400 mg/d No Change No Change No Change No Change LDL HDL LDL:HDL RATIO No Change No Change No Change No Change LDL SIZE No Change No Change N/A N/A Americans Concerned About Dietary Cholesterol 25% 20% 20% 15% 14% 10% 5% 0% % of Americans Concerned About DC Brownawell, A. M., & Falk, M. (2010). Cholesterol: where science and public health policy intersect. Nutrition Reviews, 68(6), Heart Disease Risk Factors Perceptions- Cholesterol Dietary Cholesterol as a Major Contributor of Heart Disease 100% 95% 90% Dietary Cholesterol 85% as a Major 80% Contributor of Heart Disease 75% 70% Consumers Students Faculty (n=39) (n=40) (n=17)

13 10% of population is sodium sensitive For public health recommendations, everyone reduce But for the individual, if BP is normal it is not an issue Obesity Trends Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person)

14 I. Lack of exercise II. Sedentary lifestyles III. Stress/pressure IV. Advertising V. Genetic VI. Deep emotional needs, Dr Phil VII. Haven t found the right diet Premise for today! We lose track of how much we are eating Gary Foster Penn State ADA 1. Restaurants

15 Portion size me Web video 300 Calories Gulp (20oz) Big Gulp (30oz) Super Gulp (40oz) Double Gulp (50oz) 7 video Gas stations, remember when someone else pumped the gas Fast food, remember when you had to go in

16 Refillable Soup Bowls Increase Consumption, but Not Perception of Consumption Number of candies consumed on desk in desk 2 meters from desk on desk in desk 2 meters from desk Painter, J., Wansink, B., Hieggelki, J. (2002). How Visibility and Convenience Influence Candy Consumption. Appetite 38, Calories Normal Soup Bowls Refillable Soup Bowls Wansink, B., Painter, JE., North, J Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake. Obesity Research, 13,1, Actual Calories Consumed Estimated Calories Consumed 150 Percentage Correct Percentage Correct

17 Reducing inflammation Include foods high in antioxidants Balancing omega 3 and omega 6 Lower oxidized LDL Reduce blood pressure High in FOS High in antioxidants Lower oxidized LDL Reduce blood pressure Fructans (g/100g as is) None detected Natural Dipped Golden Raw Grapes Totals phenols (mg/kg) Camire & Dougherty, Karakaya et al, 2001.

18 69 Bays H, Anderson J. A Randomized Study of Raisins Versus Alternative Snacks on Cardiovascular Risk Factors. Am Diab Assoc. Abstract, June 2012 Bays H, Anderson J. A Randomized Study of Raisins Versus Alternative Snacks on Cardiovascular Risk Factors. Am Diab Assoc. Abstract, June 2012 Raisins Compared to 100 calorie Snack Packs Raisins Cookies Cheese nips Chocolate Covered Pretzels Potassium Sodium Bays H, Anderson J. A Randomized Study of Raisins Versus Alternative Snacks on Cardiovascular Risk Factors. Am Diab Assoc. Abstract, June 2012