Go for the Whole Program Friends

What I've said in previous chapters almost makes my general position on your heart health self-explanatory. The vast majority of you will find that on a controlled carbohydrate regimen your recognized risk factors for present and future heart problems will steadily improve and will remain good as long as you follow this nutritional approach.

Your total cholesterol will probably go down-that's the most common result-but even if it doesn't or if it increases slightly, your ratio of HDL to LDL cholesterol is more likely to get better and your ratio of triglycerides to HDL is even more likely to do so. Those ratios are the real McCoy in terms of determining risk of a future coronary event. And if you were progressing toward diabetes-one of the great, grand gateways to heart disease-the improvements in your blood-sugar and insulin levels should astonish and delight your physician.

Half of all Americans still die of some form of heart disease. 15 I hope you will take the malign potential of this disease so seriously that you will eat the Atkins way for a lifetime-and follow the other components of nutritional supplementation and exercise. These two factors are not merely gaudy ribbons that I wave in front of you to impress you with the fact that the Atkins plan isn't only about weight loss.

I have stubbornly insisted throughout this book that you should exercise. It's good for your mood, good for your muscles, good for your energy level, especially good for your heart. Even if you've never exercised, it is not too late. (And you'll probably enjoy it once you start.)

The same advice applies to supplemental nutrients. Only the most hidebound physicians have failed to appreciate their value by now. I've written whole books promoting vitanutrients, so I'm sure you know I'm serious. Supplementation can have major positive effects on heart function. For supplements that address cardiovascular disease, see Dr Atkins' Vita-Nutrient Solution.

The Atkins Nutritional Approach is like a three-legged stool, resting on a controlled carbohydrate way of eating, nutritional supplementation and exercise. Rely on just one or two of the legs, and the stool will not support you. But follow the whole plan faithfully, and you will be firmly positioned for ongoing cardiovascular health.

The Dangers of Trans Fats

Many Americans are still unaware that the most grossly harmful heart health trend of the last century was the gradual replacement of healthy natural fats and protein foods with foods such as margarine. They are constructed with hydrogenated and partially hydrogenated oils, which both contain fats never found in Nature. Called trans fats--meaning transformed from their natural state-they are manufactured by heating vegetable oils at a high temperature and bombarding them with hydrogen gas to form more stable oils. The process creates trans fats constructed of twisted, unnatural molecules that the body cannot process. The food industry sticks these hydrogenated and partially hydrogenated oils into virtually all baked goods and other junk food. The reasons are economic ones: Unlike butter, olive oil or other natural fats, trans fats have a shelf life from now to Doomsday.

Walter Willett, MD, chairman of the department of nutrition at the Harvard School of Public Health, was co-author of a 1993 report on the 85,095 women who were tracked in the Harvard Nurses Study. Women with a high intake of trans fats were one and a half times more likely to develop coronary heart disease than women with a low intake of these so-called "foods" Clearly this was not only due to the deleterious effects of eating junk food. For many people, the real shocker in this study was the statistic that women who ate the equivalent of four or more teaspoons of margarine per day had a sixty-six percent greater risk of heart disease than women who ate little or no margarine. But when it comes to butter, this vast study found no association between its consumption and the probability of contracting heart disease.

Willett's report is shocking only if you have not had an eye on the research. Other scientists have demonstrated that while saturated fat (fats that are solid at room temperature, such as butter or the fat marbling a steak) has been reported to have both good and bad effects on cholesterol levels, the effects of trans-fatty acids are purely negative. Research also has shown that lipoprotein(a), one of the more damaging forms of chemical substances in cholesterol, consistently increases as a result of eating trans-fatty acids."

This compelling research has had little effect on the packaged-food industry, but has, at least, persuaded some fast food chains to stop cooking with hydrogenated oils. And the FDA is considering mandating the listing of trans fats on the Nutrition Facts panel of food labels starting in 2002. Then, although foods would still contain these dangerous fats, you could choose to not purchase them. If enough consumers reject these foods, manufacturers would have to change their formulations.

In addition to boycotting junk foods, I strongly urge you to avoid cooking with margarine or vegetable shortening (that white, creamy stuff that comes in a can). Butter, olive oil and lard worked very well for our heart-healthy ancestors. Or if you find it difficult to resume eating saturated fat, use olive, canola or grape seed oil.

Food for Thought

If you've been saturated for years with old journalistic cliches about the terrors of fat and protein and the virtues of carbohydrate, try sinking your teeth into these crunchy little thought nuggets. Your physician might find them revealing as well.

• 1991: A Canadian team substituted meat and dairy protein for carbohydrate in the diets of ten men and women with high cholesterol. The group lowered their total cholesterol by an average of six and a half percent, lowered their average triglycerides by twenty-three percent and raised their HDL cholesterol by an average of twelve percent.

• 1996: The INTERSALT, an international blood pressure study comparing 10,020 men and women in thirty-two countries, found that people with a dietary protein intake of thirty percent above the average had lower blood pressure than people with a lower intake of protein.

• 1997: In a twenty-year follow-up of 832 men tracked in the world-famous Framingham Heart Study, re searchers matched incidence of stroke (there were sixty-one in all) with dietary intake. The men with the highest intake of dietary fat had the fewest strokes; the men with the lowest had the most strokes.

• 1998: A Seattle team analyzed the data from seventeen different population-based studies that reported the relationship between triglycerides and heart disease. Men with higher triglycerides had a thirty-two percent increased risk of heart disease; women with higher levels had a seventy-six percent increased risk.

• 1999: The Harvard Nurses Study did a fourteen year follow-up on 80,082 women, comparing incidence of heart disease. Findings show that the higher the intake of protein, the lower the risk of heart disease in this group of women who were 34 to 59 years old at the outset of the study.

Twenty-First Century Diagnosis and Treatment

If you have any combination of risk factors, symptoms or family history that makes you wonder about your longterm prospects for heart disease, look for a physician with a really up-to-date approach. I recommend that he or she not only understand the conventional risk factors that we've talked about in this chapter, but also be familiar with other indicators of cardiac risk and test you for them. Note: These ranges are based on our forty years of clinical experience. The indicators include:

• Total cholesterol: Normal is considered 120 to 240 mg/dL; ideal is less than 200 mg/dL.

• Low-density lipoprotein (LDL) is the bad cholesterol. Normal levels range between 60 and 160 mg/dL; ideal is less than 130 mg/dL (the lower the better).

• High-density lipoprotein (HDL) is known as the good cholesterol. Normal levels range between 35 and 80 mg/dL; ideal is more than 50 mg/dL (the higher the better).

• Triglyceride levels range normally between 30 and 160 mg/dL; ideal is less than 100 mg/dL (the lower the better).

• HDL to total cholesterol ratio: A measurement of your cardiovascular risk; average risk females: 4.4; average risk males: 4.9. (Ideal is to be below average. For both, the lower the better.)

• Homocysteine is a by-product of defective protein metabolism. An elevated level is a powerful marker for heart disease and stroke risk. High homocysteine levels also indicate a deficiency of folic acid, a B vitamin. (Homocysteine level can be reduced with the intake of vitamins B6, B12, and folic acid.) A normal level is 5 to 15 mmol/L; ideal is less than 8 mmol/L.

• Lipoprotein(a) is a high-risk component of LDL cholesterol. In the last ten years it has been recognized as a strong risk factor for heart disease and stroke. Elevated levels may indicate insufficient intake of vitamin C, which is needed to maintain healthy blood vessels. A normal level is below 20 mg/L; ideal is less than 15 mg/L.

• C-reactive protein is an antibody. It appears that some heart attack victims actually have an infectious component to their disease, which has little to do with following a sound dietary approach. The result is chronically inflamed blood vessels that are widely regarded as part of the atherosclerotic disease process. High levels of C-reactive protein have been found to increase the risk of heart disease by four and a half times. The ideal is less than .55 mg/dL. Elevated levels would indicate you are at risk.

Therapy for heart disease goes far beyond bypass surgery and stents. I hope that your doctor will be open to the virtues of a less invasive but highly effective procedure called EECP.

Enhanced External Counter Pulsation (EECP). If you have diagnosed heart problems and a positive stress test, EECP is used to create collateral blood vessels supplying the heart muscle. Sometimes called a "natural bypass," EECP uses blood pressure cuffs applied to the patient's legs, which are repeatedly inflated and deflated, to force blood up from the legs to the heart. It has been government tested and funded, is currently being administered at four hundred sites in the United States and is reimbursed by health insurers. I strongly recommend it for our heart patients, so much so that the cardiology unit at The Atkins Center for Complementary Medicine provides about one hundred EECP treatments weekly.

The Lessons of History

Why did heart disease become a major problem when it did, and why is it so much more common in certain countries? Those questions have significant nutritional implications. Forty years ago, Ancel Keys, PhD, a prominent American nutritionist, argued that heart disease was common in countries that had high-fat diets. He drew a graph of seven nations to show that more fat meant more heart attacks. This was an influential finding until a few years ago when George V. Mann, of Vanderbilt University, discovered that Keys had carefully selected those nations to make his case but suppressed the data in his preliminary report that showed exercise had a far more significant correlation with coronary heart disease risk than did any other factor.

A famous British nutritionist of the same period, Dr. John Yudkin, took a different view. He thought heart disease correlated with sugar consumption. It's difficult to isolate information on food habits in different nations. Nearly all developed nations have high fat consumption and high sugar consumption. And nearly all underdeveloped nations have neither. Heart disease is high in the developed nations, but why?

One explanation proposed by T L. Cleave, MD, in his book Saccharine Disease: The Master Disease of Our Time, argues that increases in the incidence of coronary artery disease could be traced to increases in refined carbohydrate intake 26 He noted that diabetes, hypertension, ulcers, colitis and heart disease, to name a few, were all virtually nonexistent in primitive cultures until refined carbohydrates were introduced. He proposed his "Rule of Twenty Years;' noting that it took that long after the introduction of refined carbohydrates before diabetes and heart disease began to appear.

Cleave's hypothesis does give one explanation of what brought about the heart disease epidemic in the industrialized world. Let's look at a couple of atypical western countries. In Iceland, heart disease (and diabetes) was almost unheard of until the 1930s, although the Icelanders ate a diet tremendously high in fat. In the early 1920s, however, refined carbohydrates and sugar arrived in the Icelandic diet, and true to Cleave's Rule of Twenty Years, the degenerative diseases arrived on schedule. Likewise, in the former Yugoslavia and in Poland, the development of high heart disease rates in the mid-twentieth century occurred in decades when the sugar rate was quadrupling and the animal fat intake was falling.

I wouldn't regard these national trends as proof, but they certainly are suggestive. Suggestive also is the fact that in the Mediterranean countries fat consumption has been steadily increasing for the past thirty years and heart attack rates have been steadily falling. The hypothesis that blames heart disease on high fat diets is not on the ropes just yet, but it has taken some hard body blows, and is looking distinctly wobbly on its pins.

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