How to Avoid Inflammation of Your Arteries

Tweet
Inflammation of the blood vessels and other bodily tissue has become increasingly recognized as being complicit in heart disease, arthritis, and decline of mental capacity. Fortunately, the choices we make concerning what and how much we eat and drink, and how much exercise we do, can dramatically influence the degree of inflammation we experience. The information presented herein concerning lifestyle factors that affect inflammation, comes from a review article by O’Keefe, Gheewala, and O’Keefe in the Journal of the American College of Cardiology (vol. 51, no. 3, 2008).

Meals that are high in calories, and/or contain easily digestible, quickly absorbable, calorie-dense processed food and drink result in spikes in blood glucose and triglycerides (blood-borne fats), overwhelming the body’s ability to process them. Oxidative free radicals are then produced which attack the lining of the arteries (endothelium), inflaming them, causing them to constrict, and building up fatty deposits (atherosclerosis). In contrast, smaller meals containing ingredients that digest more slowly (e.g. fiber) produce smaller surges in blood sugar and triglycerides, and are thus not inflammatory.

Even a single meal high in saturated fat results in an increase of triglycerides, oxidative free radicals and inflammation, which negatively affects the function of the endothelium, causing constriction of the arteries, and raising systolic blood pressure.

A high glycemic meal is one that causes a spike in blood glucose. The Glycemic Index rates foods in comparison to glucose. Foods scoring closer to 100 cause relatively large spikes in blood sugar, while foods scoring closer to zero produce relatively small spikes. See a table listing the glycemic index of various foods from Harvard medical school. The body often responds to high glycemic index foods with insulin surges that remove sugar from the blood and can actually result in low blood sugar (hypoglycemia), an ebb in energy, and hunger. Regularly eating this way predisposes one to excess fat on and around the organs below the abdominal muscles (visceral fat) which, in turn, leads to inflammation and insulin resistance and raises the risks of diabetes, high blood pressure, and cardiovascular disease.

Dietary changes that reduce the magnitude of the triglyceride spike following meals by 20% and 40% respectively have been shown to reduce the risk of coronary artery disease by 30% and 40%. In addition to avoiding foods with a high glycemic index, adding certain foods to the diet can slow down digestion and reduce the spikes in glucose, insulin, and triglycerides. For example, nuts eaten along with a high-carbohydrate meal slow digestion and reduces blood sugar spikes by 30-50%. This both reduces oxidative stress, and provides antioxidants that combat such stress. In fact, a Mediterranean diet supplemented with either 30 grams of nuts or olive oil was found to reduce systolic blood pressure, blood sugar, and biomarkers of inflammation significantly better than a low-fat diet. Eating nuts 5 times per week was found to reduce risk of diabetes and cardiovascular disease by 20-50%. Quality protein sources low in saturated fat have a similar beneficial effect. These include egg-whites, lean meats, fish, casein, and whey protein, among others. Fish oil lowers triglyceride levels by 16-40%.

As expected, physical exercise has a positive effect, reducing post-meal spikes in blood sugar and triglycerides. Exercise is most beneficial in this regard if it is done within 2 hours before or after a large meal. Loss of body fat by diet control and/or exercise can also reduce post-meal spiking of blood sugar and triglycerides.

Alcohol consumption shows a J-shaped relationship with inflammation and blood sugar spiking, in addition to various other health problems such as coronary artery disease, diabetes, stroke, dementia, and all-cause death, with the lowest levels of these problems at 1-2 drinks per day for men and 0.5-1 drink a day for women. The J-shape means that drinking no alcohol increases the risk of these problems somewhat, while drinking in excess greatly increases the risks of these problems.

Characteristics of Inflammatory Meals

• High in calories
• High in calorically-dense foods
• High in saturated fat
• High in refined carbohydrates
• Contain foods with high glycemic index

Characteristics of Diets That are Not Inflammatory

• Smaller meals spread over the day
• Low in saturated fat
• Low in, or free of trans fats
• Low in processed carbohydrates
• Low in foods with high glycemic index
• High in unprocessed fruits and vegetables rich in antioxidants
• High in nuts, seeds, and whole grains
• Contain vinegar (1-2 tbsp eaten with a meal high in refined carbohydrates reduces the blood sugar spike by 25-35% and reduces hunger)
• Moderate amounts of lean animal protein
• Moderate amounts of beneficial fats such as fish oil and monounsaturated oils (e.g. olive,canola)

The following Foods High in Antioxidants Help Prevent Oxidative Damage to the Endothelium

• Berries
• Red wine
• Chocolate
• Tea
• Pomegranates
• Cinnamon (also reduces glucose spike caused by high-glycemic-index meal)

If you are concerned about the possibility of inflammation in your arteries, you can ask your doctor about testing the C-reactive protein level in your blood when you get a checkup. However, if your total cholesterol level is below 200 and your HDL level is above 55, it is very unlikely that you have a problem with arterial inflammation. If your C-reactive protein level is above 1.0 or the ratio of your total cholesterol level to your HDL level is above 4.0, you would likely benefit from following an anti-inflammatory diet and exercising regularly.

Cold Weather and Air Conditioning Can Raise Your Blood Pressure

High blood pressure, also called hypertension, is defined as a systolic pressure above 140 mm of mercury (mmHg) and/or a diastolic pressure above 90 mmHg. Hypertension increases the risk of several major health problems, including heart disease, stroke, and kidney disease. While it is widely recognized that excess sodium intake increases the risk of hypertension, few people know that the ambient temperature at which people live affects the risk of hypertension. And ambient temperature varies with the seasons of the year. The following studies provide evidence for the seasonal variation in blood pressure and risk of hypertension.

In a study by Woodhouse, Khaw, and Plummer, 96 men and women, aged 65-74 years had their blood pressure taken for a full year. It was found that both systolic (SBP) and diastolic blood pressure (DBP) were greatest during the winter for people with both normal and high blood pressure. There was four times the incidence of blood pressures above 160/90 mmHg in winter than in summer. In a strong seasonal trend, a 1 deg C (1.8 deg F) decrease in living-room temperature was associated with increases of 1.3 mmHg in SBP and 0.6 mmHg in DBP. The authors linked this to the greater incidence of cardiac-related deaths of the elderly in winter.

In a study by Brennan, Greenberg and Miall, blood pressure measurements taken for the Medical Research Council's treatment trial for mild hypertension were analyzed according to the month in which the readings were made. For all age, sex, and treatment groups, both systolic and diastolic pressures were higher in winter than in summer. Blood pressure was also highly and significantly related to maximum and minimum daily air temperature. The seasonal variations in blood pressure were greater in older than in younger people.

In a study by Fujiwara et al., blood pressure was measured on 25 hypertensive outpatients (mean age 57), who spent virtually the entire day indoors in both summer and winter. Both systolic and diastolic blood pressure in the morning and night-time periods were significantly higher in winter than in summer (respective differences of 7.5 and 4.1 mmHg in the morning and 8.2 and 4.5 mmHg at night). Despite the fact that the patients lived essentially indoors at a relatively stable environmental temperature, the seasonal variation in blood pressure was statistically significant.

In a study by Kimura et al. of the Department of Integrated Medicine, Kagawa University, Japan, 15 healthy elderly Japanese (mean age 79) measured their blood pressure at home each morning more than 25 times per month for 3 years. The highest levels of both systolic and diastolic blood pressures (129 and 81 mmHg) occurred in February, the coldest month (avg temp. 5.0 deg C, 41 deg F), while the lowest levels (117 and 73 mmHg) were observed in August, the hottest month (mean temp 29.2 deg C, 84.6 deg F). Thus, both systolic and diastolic blood pressure demonstrated a close inverse relationship to outdoor temperature. A one degree C (1.8 deg F) decrease in the mean outdoor temperature was associated with rises of 0.43 mmHg in systolic blood pressure (SBP) and 0.29 mmHg in diastolic blood pressure (DBP).

In a study by Hozawa et al. at the Tohoku School of Medicine in Japan, 79 male and female volunteers (mean age 72.7 years) measured their blood pressure at least once a month for 3 years beginning in September 2000. The mean number of measurements was 19.0 times per month. Blood pressure levels were lowest in the warmest months. A clear inverse association between temperature and blood pressure values was evident when the outside temperatures was above 10°C, producing a respective decrease in systolic and diastolic blood pressure of 0.40 and 0.28 mmHg for each 1 deg C (1.8 deg F) increment of outside temperature.

A study by Sinha et al. at Maulana Azad Medical College, in India, 275 females 18-40 years of age showed that the prevalence of hypertension based on SBP was 12.7% in summer and 22.2% in winter. The prevalence of hypertension based on DBP was 11.3% in summer vs. 26.6% in winter, a highly statistically significant difference. Overall prevalence of hypertension (SBP = 140 or DBP = 90 mm of Hg) was 1.9 times greater in winter than in summer.

Bottom Line
The temperature at which we live can affect our blood pressure. This is likely related to the fact that, when we are cold, the small arteries in our skin constrict to avoid loss of body heat. That creates resistance to blood flow, thus increasing pressure. When we are hot, the small arteries in the skin widen to allow more heat dissipation, thereby reducing resistance to blood flow. Also, we tend to perspire more when we are hot, thereby losing water and salt, both of which tend to increase blood pressure. The most common medications for reduction of blood pressure are diuretics, which promote loss of water and salt through urination. Sweating can accomplish similar results.

People with hypertension or prehypertension (systolic pressure 120-140) can help control their blood pressure by avoiding being cold. In summer, air conditioning use should be minimized. Most people can adjust to a room temperature of 77 degrees without feeling uncomfortable, and even higher temperatures in locales with low humidity. In winter, the home can be kept warm and, if that is not economically feasible, dressing warmly indoors is a viable alternative. Exercise can be used to warm the body as well.

References

Brennan, P.J., G. Greenberg, W.E. Miall, S.G. Thompson. Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed) 285 : 919, 2 October 1982.

Fujiwara, T., M. Kawamura, J. Nakajima, Jun, T. Adachi, K. Hiramori. Seasonal differences in diurnal blood pressure of hypertensive patients living in a stable environmental temperature. Journal of Hypertension, vol. 13, no. 12, 1995.

Hozawa A., S. Kuriyama, T. Shimazu, K. Ohmori-Matsuda, I. Tsuji. Seasonal variation in home blood pressure measurements and relation to outside temperature in Japan. Clin Exp Hypertens, vol. 33, no. 3, pp. 153-8, 2011.

Kimura, T., S. Senda, H. Masugata, A. Yamagami, H. Okuyama, T. Kohno, T. Hirao, M. Fukunaga, H. Okada, F. Goda. Seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese studied by home measurements.Clin Exp Hypertens. 2010 Jan;32(1):8-12.

Sinha P, D.K. Taneja, N.P. Singh, R. Saha. Seasonal variation in prevalence of hypertension: Implications for interpretation.Indian J Public Health, vol. 54, no. 1, pp. 7-10, 2010.

Woodhouse, P.R., K.T. Khaw, M. Plummer. Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. Journal of Hypertension, vol. 11, no. 11, 1993.

Updated List of the Most-Contaminated Fruits and Vegetables

We have all been well-informed that eating plenty of fruits and vegetables is good for our health. Yet there is a continuing problem with pesticide contamination. It is recommended that we avoid pesticide exposures that are more than a thousandth of the levels known to be toxic. Yet, a 2009 study by the Environmental Protection Agency found that about 40% of U.S. children have levels of at least one pesticide well above this limit.

The nonprofit organization, Environmental Working Group, while reaffirming that eating a lot of fruits and vegetables is good for our health, suggested that by avoiding the most pesticide-contaminated fruits and vegetables, and choosing the least-contaminated ones, we can lower pesticide residues in our bodies. To assist us in making such choices, the organization just published a list of the dozen most pesticide-contaminated fruits and vegetables, based on testing done in 2009 by the U.S. Department of Agriculture and the Food and Drug Administration. It also published a list of the 15 least-contaminated fruits and vegetables to provide us with healthy alternatives. The group estimates that by avoiding the “Dirty Dozen” (or buying organic versions of these items) and selecting from the “Clean 15” we can cut our pesticide exposure by 92%.

The Dirty Dozen - Most Contaminated Fruits and Vegetables (number 1 is the worst)

1. Apples
2. Celery
3. Strawberries
4. Peaches
5. Spinach
6. Nectarines (imported)
7. Grapes (imported)
8. Sweet bell peppers
9. Potatoes
10. Blueberries (domestic)
11. Lettuce
12. Kale/collard greens

The Clean 15 - Least Contaminated Fruits and Vegetables (Number 1 is the best)

1. Onions
2. Sweet corn
3. Pineapples
4. Avocados
5. Asparagus
6. Sweet peas
7. Mangoes
8. Eggplant
9. Cantaloupe (domestic)
10. Kiwi
11. Cabbage
12. Watermelon
13. Sweet potatoes
14. Grapefruit
15. Mushrooms

Bottom Line
Obviously, buying all organic produce is the best alternative for health. However, most of us cannot or choose not to incur the major budget hit it would entail. So the next best alternative is to avoid the “dirty dozen” while selecting more items from the “clean 15 “ list. Going organic for selected items can still keep our food budgets from skyrocketing.

Drinking Too Much Water Can Be Harmful And Even Fatal

Drinking large quantities of water has been widely promoted over the past few years as a means of maintaining health, improving appearance, controlling weight, and preventing dehydration. It is now not unusual to see people regularly carrying and sipping from water bottles. Eight 8-ounce glasses of water a day has been commonly recommended as the minimum requirement. However, the evidence shows that this recommendation has little scientific basis. In addition, excess water consumption can be harmful and even fatal.

A June 4, 2009 article by Karen Bellenir, in the online Scientific American, a highly-respected journal, analyzed the origins of the 8 glass a day recommendation and presented the opinions of scientists in the area of hydration. The conclusion was that there was no scientific basis for the recommendation. Some key points from the article:

• Most people do not have to drink 64 ounces of water per day.
• Water needs differ widely among individuals and depends on many factors including body size, physical activity, ambient temperature and humidity.
• Much of our fluid needs are met from the water content in food.
• The only people who benefit from drinking large amounts of water are those who sweat a lot due to their participation in heavy physical activity, especially in hot environments, and people with specific medical conditions such as kidney stones or urinary tract infections.
• For hydration purposes, all drinks composed largely of water, including milk, juice, coffee, and tea are roughly equivalent to drinking plain water. While caffeine does somewhat stimulate urination, the net effect of these drinks is to provide the body with water. Only alcoholic beverages cause a net water loss.
• Drinking when thirsty is the best means of meeting our physiological need for fluid.
• Drinking water before meals does not reduce appetite or food consumption. However, eating foods that contain a lot of water but few calories (e.g. salad vegetables, fruit) can help control appetite.

One might think that excessive water-drinking is relatively harmless, with the only downsides being a bloated stomach, frequent urination, the expense of buying water and the inconvenience of carrying it. However, excessive water-drinking can actually be harmful and even fatal, as revealed in a June 21, 2007 article by Coco Ballentyne in the Scientific American online. Fatalities cited in the article include those of a woman who died after drinking 6 liters of water in a radio-station sponsored contest to see who could hold their urine the longest and an aspirant to a college fraternity who was prompted to drink excessive amounts of water. In addition, several athletes and military personnel have died after drinking excessive quantities of water in an effort to avoid dehydration.

The cause of these deaths is hyponatremia, which is a dangerously low concentration of sodium in the blood. Warning symptoms of this disorder include frequent urination, fatigue, headache, nausea, vomiting, and disorientation. Much of the damage is caused by entry of the excessive water into brain cells, with resultant brain swelling and damage.

It particularly dangerous for people engaged in endurance sports to drink excessive water because such physical activity stimulates the secretion of a hormone that tends to conserve water in the body by reducing excretion, even when drinking is excessive. This can reduce the kidneys’ ability to remove water from the bloodstream by 90%. Sport drinks, which contain sodium and other electrolytes as well as carbohydrates can help in preventing dangerous dilution of the blood, yet even excessive drinking of these fluids can cause hyponatremia. Drinking to thirst is still seen as the best recommendation.

Another possible negative effect of drinking too much water is the effect on blood pressure. A study by Callegaro et al. published in the Journal of Human Hypertension (vol. 21, pp. 564-570, July 2007) concluded that, after ingesting 500 ml (a little over 2 cups) of water, the systolic blood pressure of both subjects with and without high blood pressure rose 17-19 points and the diastolic blood pressure rose 14 points. These are major increases. While other studies did not observe this effect, it appears that excess water consumption may increase the possibility of high blood pressure. Thus, drinking to thirst is the best means of taking an amount of water that will avoid both dehydration and hyponatremia.

Omega-3 Fats from Fish Oil Raise Risk of High-Grade Prostate Cancer

It has been increasingly evident that there are trade-offs in the quest to get and stay healthy. In other words, there are actions we can take that will reduce the risk of one health problem, but increase the risk of another. One example is playing high-impact sports such as basketball, which is great for improving and maintaining physical fitness while having fun, but also increases the risk of sprains, strains and other musculoskeletal problems. Now, an article by Brasky et al. in the American Journal of epidemiology (published online April 24, 2011)  points up a trade-off involved in taking fish-oil supplements, which have been widely recommended for reducing the risk of cardiovascular diseases and other health problems.

The researchers analyzed blood samples of 3,461 men to measure levels of omega-3 fats (DHA and EPA from fish consumption), omega-6 fats (from common vegetable oils), and trans-fats (from hydrogenated oils in margarine, shortening, and processed foods). The men were then followed over a 7-year period in order to see the association of the different fat types to the incidence of prostate cancer. The hypotheses were that:

• Because of the anti-inflammatory effect of the omega-3 fats, men with the highest blood levels of them would have a lower incidence of prostate cancer
• Because of the inflammatory effect of the trans- fats, men with the highest blood levels of them would have a higher incidence of prostate cancer

Results
The statistical analysis produced the following surprising results:

   > There were no effects of any of the fat types on overall incidence of prostate cancer.
   > When looking at the high-grade form of prostate cancer that progresses rapidly and is the most lethal:

• Those men with the highest blood levels of DHA from fish oil had more than twice the risk of contracting high-grade prostate cancer as men with the lowest blood levels of DHA.
• EPA from fish oil had no effect on the incidence of high-grade prostate cancer.
• Those men with the highest blood levels of trans-fats had about half the risk of contracting high-grade prostate cancer as men with the lowest blood levels of trans-fats
• Blood levels of the type of omega-3 fat from vegetable sources (e.g. flax seeds, walnuts) had no effect on the incidence of high-grade prostate cancer.

Bottom Line
The results of highly surprising, given the widespread view of fish oil as all-good and trans-fats as all-bad. Here is a clear case of trade-off. There is considerable evidence that fish-oil is good for the heart and cardiovascular system and reduces the incidence of heart attacks. Yet, here we see that it increases the risk of high-grade prostate cancer. Eating omega-3 fats from flax-seeds or other vegetable sources is not a solution because that type of omega-3 fat has not been proven to reduce the risk of cardiovascular disease. The good news is that most prostate cancer is of the low-grade variety. Given that heart disease remains the number one killer of both men and women, it doesn’t appear that fish and fish-oil be abandoned as a health-promoting dietary elements. Yet men must be aware of the trade-off in risk of eating fatty fish or taking fish-oil supplements in order to make an informed decision about how best to promote their health.

Update (May 8, 2011):
Consumerlab.com, a company that tests the quality of supplements from various companies, contacted Dr. Theodore Brasky, the lead author of the study described herein. He stated that the blood levels of DHA and EPA measured in the study were largely based on fish consumption rather than fish-oil supplements. However, a recent study of his, soon to be published, shows no link between fish oil supplementation and risk of prostate cancer. He also noted another study (Szymanski, Am J Clin Nutr 2010) that found fish consumption associated with a large reduction in late state or fatal prostate cancer.

Soy Products Have a Negative Effect on Masculinity

Because it is a relatively inexpensive source of protein, soy is widely used to fortify many high-protein foods such as bars, cereals and shakes. However, as detailed on our website, the estrogen-like qualities of soy proteins (isoflavones) have a negative effect on masculinity.

A recent study by Wada et al. in the American Journal of Epidemiology (vol. 173, no. 9, pp. 998-1003, 2011) indicates that such demasculinizing effects can begin very early. The researchers collected dietary histories and urinary testosterone levels from 230 Japanese boys aged 3-6 years. When the boys were divided into 4 groups based on the quantity of soy they ate, the group that consumed the least soy had a notably mean higher testosterone level than the other 3 groups. The same was true when the grouping was made based on isoflavone consumption.

The American Academy of Pediatrics, but not the U.S. government, has recommended that infants who cannot be breastfed be nourished with formula based on cow milk rather than soy. Also, several countries including Israel, France, New Zealand, and Australia have officially recommended against soy-based baby formula. While the U.S. has made no such official recommendation, parents here would do best to avoid soy-based infant formula as well as soy-containing foods for their older children.

Bottom Line
Men should carefully read nutrition labels and avoid foods containing soy or isolated soy protein. Preferable sources of protein include fish and lean meats, low-fat dairy products, and eggs in moderation. Acceptable protein supplements include whey protein and casein, both derived from milk. Some men avoid milk because they believe they are intolerant of lactose (milk sugar). Yet many of these men are not actually lactose intolerant. For those who really are, there are many alternatives. Whey protein and casein do not contain lactose, and have shown in studies to be very effective for muscle building. Most cheeses are made up mainly of protein and fat, with very little lactose, but should be eaten in moderation because of the high saturated fat and cholesterol content. Milk products should be of the low-fat or non-fat varieties to limit saturated fat and cholesterol. Lactose-free milk is also available in most supermarkets.

Our Changing Eating Patterns

The U.S. Department of Agriculture recently published information on the sources of our daily caloric intake between 1970 and 2008, a time period in which our daily caloric consumption increased by 23.2% from 2,169 cals to 2,672 cals, and rates of overweight and obesity have risen sharply. An interactive graphic was created from the data that allows users to scroll along a time-line to see how the amount of daily calories in each food category has changed over time. The following are the percentage changes in calories coming from each food category:

meat, eggs, and nuts: +4.1%
fruit:                         +22.9%
added fat:                 +56.3%
dairy:                          -3.7%
grains:                      +44.7%
vegetables                   -2.4%
added sugar              +14.2%

Some Observations on the Data

In Terms of Absolute Calories

• The biggest contributors by far to our increased daily caloric intake are added fat (231 cals) and grains (193 cals).
• Much more modest contributors to our increased daily caloric intake are added sugar (57 cals), meat/eggs/nuts (19 cals), and fruit (16 calories).
• Our daily consumption of dairy actually decreased by 10 calories and of vegetables by 3 calories.

In Terms of Percentage of Daily Calories

• The only foods that increased as percentages of our diet from 1970 to 2008 are added fats (from 18.9% to 24.0% of daily calories) and grains (from 19.9 % to 23.4% of daily calories).
• Caloric consumption from fruit was steady at 3.2 % of calories.
• All other foods declined as percentages of our daily calories including meat/nuts/eggs (from 21.3% to 18.0% of daily calories), dairy (from 12.3% to 9.6% of daily calories), added sugar (from 18.5% to 17.2% of daily calories), and vegetables (from 5.8% to 4.6% of daily calories).

Bottom Line
The greatest contributors to our increase in caloric consumption are grains and added fat. While we have increased our intake of all other foods except vegetables, grains and fat together account for 84% of our increase in caloric consumption and should therefore be the prime focus of cutting back calories. This makes it clear that the low-fat and low-carb diets are both missing something because the intake of both must be reduced. Any diet that emphasizes what you eat rather than how much you eat is bound to fail. Overweight and obese people who seek to attain a healthy body weight must face the reality that total intake must be lessened. Focusing on eating both fewer grain-based foods and fewer added fats is a good start.