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Nutritional Program for Cardiovascular Disease Prevention

Well, this is the biggie! With a little effort on each of our parts and a willingness to change, we can make a big difference in the incidence of this nation's number one killer, cardiovascular disease (CVD). Heart and blood vessel disease are not inevitable; in fact, they are preventable in most cases. It is very clear from every major study in the last decade that diets high in saturated fats and cholesterol, which would consist of regular intake of red meats, dairy foods, and eggs, are directly correlated to the incidence of CVD and its complications, whereas a low saturated fat, low cholesterol diet greatly lowers the risk of these diseases.

The main disease process at the base of the cardiovascular diseases is atherosclerosis, or hardening and clogging of the arteries. (Arteriosclerosis is the generic term referring to hardening of the arteries. Atherosclerosis refers to the disease process of artery plaqueing and is the term I will use in this text.) Atherosclerosis involves the thickening and narrowing of our blood vessels that occurs somewhat in most people, but with certain risk factors it can progress very rapidly and lead to early demise, even in their 40s or 50s. Atherosclerosis commonly affects the coronary arteries, which deliver blood to the heart muscle itself. This biggest cardiovascular concern causes a great deal of limitation and chest pain, or angina pectoris. When advanced, this coronary artery disease can result in a myocardial infarction (MI, heart attack, or "coronary"). Heart attacks are clearly the most common cause of death in the United States and the Western world. Other areas of the body may also be affected with atherosclerosis. Disease of the carotid arteries of the neck affects our mental faculties; atherosclerosis of the leg arteries decreases our ability to walk without pain; and clogging of the pelvic arteries affects our sexual performance.

Hypertension, or high blood pressure, is often a hidden multifactorial problem and the most common CVD; the main pathologic process involved in hypertension is atherosclerosis. The narrowing and hardening of the arteries increase their resistance and pressure and makes the heart work harder, which can then wear down this vital muscle. Untreated hypertension may lead to further heart disease including heart attacks and congestive heart failure, as well as to cerebrovascular accidents (stroke).

For nearly half a century, cardiovascular disease has been the number one cause of mortality and morbidity in the United States and in most of the Western world. At the turn of the century, it was not even in the top ten. In underdeveloped countries where people live on a more natural, "native" diet, there is a low incidence of CVD. In the United States, the many CVDs account for over 50 percent of all deaths. Of course, people live longer now, which allows for the development of more degenerative disease, but there is also more middle-age weight gain in a more sedentary population that eats more fats and refined foods than in the past. These last three factors are fairly easy to change (if change is ever easy) and form the basis of preventing these now common diseases.
Circulation and heart disease are not inevitable results of aging. In countries where populations eat a diet low in fats, cholesterol, and salt there is very little or no hypertension in comparison to countries whose people eat those richer foods. The 90-year-olds in Hunza society appear to be free of CVD and have normal blood pressure. To keep the blood pressure low with age and minimize the atherosclerotic process we need to do the following:
•Eat a diet low in saturated fats, cholesterol, salt, and processed, refined foods (both fats and sugars).
•Eat high-fiber foods.
•Eat plenty of whole grains, fruits, and vegetables.
•Exercise or have a regular, active lifestyle, especially including walking.
•Keep body fat low.

There has already been some progress; in the last twenty years, the previous rapidly rising death rate from CVDs began leveling off and decreasing, likely due to better coronary care, CPR education, public education, and drug control of high blood pressure. Since 1968, there has also been greater dietary awareness, an interest in exercise, and an effort to diminish cigarette smoking. It is clear that a good (lower fat, more vegetarian) diet, regular exercise, weight reduction, and stress modification can reduce the symptoms of atherosclerosis, hypertension, and angina pectoris as well as decrease the risk and incidence of CVD in general. So why is it still so prevalent? Often, people must be hit over the head before they will acknowledge new information and change long-term patterns. On both an economical and educational level, the big industries fight changes that might affect their status and income.

The meat, dairy, and egg megabusinesses still try to deny the relationship between their foods and high cholesterol levels and cardiovascular disease?advertising their products as being good for everybody and providing literature to young children to encourage the regular use of their foods. Now other businesses, such as fast food chains, are getting into the educational act claiming that a hamburger, fries, and a milkshake are a balanced meal. Kids are already influenced by advertising for sugary and refined food products.

Even with the improvement of the last 20 years, there are still well over a half million deaths per year from heart attacks and strokes (down from the previous 1 million yearly). About a third of the 1.5 million people who have "coronaries" each year die from those attacks. Nearly 50 million Americans have some CVD, mostly high blood pressure (over 35 million) and coronary artery disease (CAD, about 5 million), with many more people who are undiagnosed. Our cholesterol level, a key contributing factor in CVDs, can only be determined with a blood chemistry analysis, while hypertension often does not reveal itself prior to its being found on a physical exam. When either elevated cholesterol levels or high blood pressure are found, cardiovascular damage may already have begun. Because it is difficult for people to know if they have high blood pressure, it has been labeled the "silent killer." Here, we will first look at the many risk factors for CVD, and then examine the underlying disease process, atherosclerosis.

The cardiovascular risk factors are commonly classified into the primary factors?of which there are three: cigarette smoking, high cholesterol, and high blood pressure?and the secondary of which there are many. Some of these significant factors in the genesis of CVD include obesity and being overweight, genetics, stress, a sedentary lifestyle, diabetes, and alcohol abuse. Many authorities feel that, even more than the moderate or high fat and cholesterol intake, it is the many nutritional deficiencies that arise from our present-day nutrition and that affect our cholesterol metabolism which lead to increased atherosclerosis. Deficiencies of vitamins C, E, and B6 and selenium are the main concerns. Other relevant nutrients are magnesium, chromium, niacin, essential fatty acids, and fiber. The types of fats consumed in the diet and the deficiency of the essential fatty acids, linoleic and linolenic, are felt by some authorities to be the source of the CVD problem. Udo Erasmus describes this in his book, Fats and Oils, in which he also suggests that the heated and hydro-genated "modern" oils used for cooking and frying are a big concern.

Thus, margarines are a concern in regard to the atherosclerotic process. The increased consumption of homogenized milk fat in the standard milk appears to be linked with cardiovascular problems. An article by Wayne Martin in the November 1989 Townsend Newsletter for Doctors provides a great deal of support for the theory that cholesterol itself is not the culprit it is thought to be in the atherosclerotic process, but it is the hydrogenated and homogenized fats used and consumed in so many foods that are the disease-causing factors.

© Elson M. Haas MD

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