The Okinawa Diet: Living to 100

What would happen if you centered your diet around vegetables, the most nutrient-dense food group?

“The plant-based nature of the diet may trump the caloric restriction, though, since the one population that lives even longer than the Okinawa Japanese don’t just eat a 98% meat-free diet, they eat 100% meat-free. The Adventist vegetarians in California, with perhaps the highest life expectancy of any formally described population.”

The Reversal on Fish Oil

The Reversal on Fish Oil
Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease just a “fish tale“? Thanks torecommendations from organizations such as the American Heart Association that individuals at high risk for heart disease ask their physicians about fish oil supplementation, fish oil has grown into a multibillion dollar industry. We now consume over 100,000 tons of fish oil every year.

But what does the science say? A systematic review and meta-analysis published in the Journal of the American Medical Association,highlighted in my video Is Fish Oil Just Snake Oil? looked at all the best “randomized clinical trials evaluating the effects of omega-3’s on lifespan, cardiac death, sudden death, heart attack, and stroke.” The studies told the subjects to either eat more oily fish or to take fish oil capsules. What did the study find? Overall, the researchers found no protective benefit for all-cause mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.

What about for those who already had a heart attack and are trying to prevent another? Still no benefit. Where did we even get this idea that omega 3’s were good for the heart? If we look at some of the older studies, the results seemed promising. For example, there was the famous DART trial back in the 80s involving 2,000 men. Those advised to eat fatty fish had a 29% reduction in mortality. Pretty impressive—no wonder it got a lot of attention. But people seemed to have forgotten the sequel, the DART-2 trial. The same group of researchers, and an even bigger study (3,000 men). In DART-2 “those advised to eat oily fish and particularly those supplied with fish oil capsules had a higher risk of cardiac death.”

Put all the studies together, and there’s no justification for the use of omega 3s as a structured intervention in everyday clinical practice or for guidelines supporting more dietary omega-3’s. So what should doctors say when their patients follow the American Heart Association advice to ask them about fish oil supplements? Given this and other negative meta-analyses, “our job as doctors should be to stop highly marketed fish oil supplementation in all of our patients.”

I’ve previously discussed fish oil supplements in the context of risks versus purported cardiovascular benefits:

But if the benefits aren’t there, then all one is left with are concerns over the industrial pollutants that concentrate in the fish fat (even in distilled fish oil, see Is Distilled Fish Oil Toxin-Free?).

These same contaminants are found in the fish themselves. This raises concern for adults (Fish Fog), children (Nerves of Mercury), and pregnant moms:

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day ,and From Table to Able.

Image Credit: Jo Christian Oterhals / Flickr

Are Multivitamins Just a Waste of Money?

Are Multivitamins Just a Waste of Money?

About one in three Americans take a multivitamin. Is that helpful, harmful, or just a harmless waste of money? In 2011, the Iowa Women’s Health Study reported that multivitamin use was associated with a higher risk of total mortality, meaning that women who took a multivitamin appeared to be paying to live shorter lives. But this was just an observational study—researchers didn’t split women up into two groups and put half on multivitamins to see who lived longer. All they did was follow a large population of women over time, and found that those that happened to be taking multivitamins were more likely to die. But maybe they were taking multivitamins because they were sick. The researchers didn’t find any evidence of that, but ideally we’d have a randomized, double-blind, placebo controlled trial, where thousands were followed for over a decade, with half given a multivitamin and half a placebo. That’s what we got the following year in 2012 with theHarvard Physicians’ Study II. And after a decade, the researchers found no effect on heart attack, stroke, or mortality.

The accompanying editorial concluded that multivitamins are a distraction from effective cardiovascular disease prevention. The message needs to remain simple and focused: heart disease can be largely prevented by healthy lifestyle changes.

The researchers did, however, find that for men with a history of cancer, the multivitamin appeared to be protective against getting cancer again, though there was no significant difference in cancer mortality or cancer protection in those who’ve never had cancer before. Still, that’s pretty exciting. It is just one study, though. Ideally we’d have maybe 20 of these placebo-controlled trials and then compile all the results together. That’s what we got in 2013—a meta-analysis of randomized controlled trials that analyzed twenty-one trials and more than 90,000 individuals. The analysis found no influence on mortality either way. Some found more cancer mortality, some found less cancer mortality, but all in all it was a wash.

And that was heralded as good news. After the Iowa Women’s Health Study came out we were worried multivitamins could be harming millions of people, but instead they don’t appear to have much effect either way. The accompanying editorial asked whether meta-analyses trump observational studies. The Iowa Women’s Health Study followed tens of thousands of women for nearly 20 years. What if we put all the studies together, the big observational studies along with the experimental trials? And that’s what we got in December 2013. The reviewfor the U.S. Preventive Services Task Force, highlighted in my video, Should We Take a Multivitamin? found that multivitamins appear to offer no consistent evidence of benefit for heart disease, cancer, or living longer.

But aren’t vitamins and minerals good for us? One explanation for this result could be that our bodies are so complex that the effects of supplementing with only one or two components is generally ineffective or actually does harm. Maybe we should get our nutrients in the way nature intended, in food.

The accompanying editorial to the December 2013 review concluded that enough is enough. We should stop wasting our money on vitamin and mineral supplements. Americans spend billions on vitamin and mineral supplements. A better investment in health would be eating more fruits and vegetables. Imagine if instead we spent those billions on broccoli?

I’ve previously addressed multivitamins in my videos Are Multivitamins Good For You? and Multivitamin Supplements and Breast Cancer (with a follow-up in my Q&A Is multivitamin use really associated to an increased risk of breast cancer?). I also touched on potential risks in Dietary Theory of Alzheimer’s.

With the exception of vitamins D and B12 (Vitamin Supplements Worth Taking), we should strive to get our nutrients from produce, not pills.

What about fish oil supplements? Check out Is Fish Oil Just Snake Oil?

-Michael Greger, M.D.

Treat snoring to avoid deadly heart failure

snoring

Patients with obstructive sleep apnea have the same early cardiovascular damage as diabetics, according to research presented at EUROECHO and other Imaging Modalities 2012. The study ¹ was presented by Dr Raluca Mincu from Bucharest, Romania.

EUROECHO and other Imaging Modalities 2012 is the annual meeting of the European Association of Cardiovascular Imaging (EACVI) ², a registered branch of the European Society of Cardiology (ESC)3.

Obstructive sleep apnea (OSA) is a common sleep disorder that has been associated with cardiovascular disease. OSA increases the risk of hypertension, arrhythmias, myocardial infarction, stroke, sudden cardiac death and heart failure. Dr Mincu said: “There are not enough studies in the medical literature on early cardiovascular dysfunction in patients with OSA, when active steps can be taken to prevent progression to heart failure.” She added: “Because OSA leads to so many cardiovascular disorders, we compared early cardiovascular dysfunction in OSA patients and patients with diabetes mellitus, which is a typical risk factor for cardiovascular disease.”

The study assessed endothelial and arterial function in 20 patients with moderate to severe OSA (and no diabetes), 20 patients with treated type 2 diabetes mellitus (matched for age, sex and cardiovascular risk factors), and 20 healthy controls (age and sex matched). In all subjects, arterial function was assessed by intima-media thickness (IMT). Arterial stiffness was measured by young elastic modulus, beta stiffness index, arterial compliance, first systolic peak and second systolic peak. Endothelial function was assessed by flow mediated dilatation (FMD).

Dr Mincu said: “Patients with moderate to severe OSA had endothelial dysfunction and higher arterial stiffness than controls, and their results were similar to patients with diabetes mellitus. This suggests that OSA is associated with a high risk for cardiovascular disease.” She added: “Patients in the OSA and diabetes groups had a higher intima-media thickness, which shows that their arteries are remodelled in a pathological way.”

All five parameters of arterial stiffness were significantly higher in the OSA and diabetes mellitus groups compared to controls. FMD was lower in these groups, meaning they had poorer endothelial function than controls.

Dr Mincu said: “Patients should realise that behind snoring there can be a serious cardiac pathology and they should get referred to a sleep specialist. If they are diagnosed with obstructive sleep apnea, they are at increased risk of cardiovascular disease and need to adopt a heart healthy lifestyle to reduce that risk.” She added: “Although OSA treatment with continuous positive airway pressure (CPAP) is inconvenient – it requires sleeping with a mask – patients should use it because it can reverse the parameters measured in our study.”

Dr Mincu concluded: “Our study is a signal for cardiologists, pneumologists and general practitioners to work together to actively diagnose obstructive sleep apnea, administer the appropriate treatment (CPAP) and assess arterial function. This will help avoid progression of early cardiovascular dysfunction through to heart failure, the final stage of heart disease.”

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¹ Obstructive sleep apnea determines endothelial dysfunction and increased arterial stiffness, similarly with diabetes mellitus (abstract 50318)

² About the European Association of Cardiovascular Imaging (EACVI):
The European Association of Cardiovascular Imaging (EACVI) is a registered branch of the ESC. Its aim is to promote excellence in clinical diagnosis, research, technical development and education in cardiovascular ultrasound and other imaging modalities in Europe. It was formerly called the European Association of Echocardiography (EAE).

³ About the European Society of Cardiology (ESC): The European Society of Cardiology (ESC) represents more than 75,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

Source: Innovations Report

Showdown: Vegetarier vs Fleischesser – ZDF

Amüsante Sendung mit überraschenden Ergebnissen:

Ist fleischlos leben wirklich gesünder und besser für die Umwelt? ZDFzeit macht den Test: Vier leidenschaftliche Fleischesser und vier überzeugte Vegetarier müssen gegeneinander antreten.

vvf2

Pills vs. Diet For Erectile Dysfunction

NF-May15-Don’t-Pop-Pills-For-Erectile-Dysfunction.-Help-Your-Heart-Instead

Erectile dysfunction is the recurrent or persistent inability to attain and/or maintain an erection in order for satisfactory sexual performance. It is present in up to 30 million men in the U.S. and approximately 100 million men worldwide. The U.S. has less than 8% of the world’s population, yet up to 30% of the impotence? We’re #1!

But hey, we’ve got red, white, and blue pills like Viagra. The problem is that the pills just cover up the symptoms of vascular disease and don’t do anything for the underlying pathology. Erectile dysfunction and our #1 killer, coronary artery disease, are just two manifestations of the same disease: inflamed, clogged, and crippled arteries, regardless of which organ it affects (See Survival of the Firmest: Erectile Dysfunction and Death).

Atherosclerosis is considered a systemic disorder that uniformly affects all major blood vessels in the body. Hardening of the arteries can lead to softening of the penis because stiffened arteries can’t relax, open wide, and let the blood flow. Thus erectile dysfunction may just be the flaccid “tip of an iceberg” in terms of a systemic disorder. For two-thirds of men showing up to emergency rooms for the first time with crushing chest pain, their penis had been trying to warn them for years that something was wrong with their circulation.

Why does it hit the penis first? Because the penile arteries in the penis are half the size of the coronary artery in our heart. So the amount of plaque we wouldn’t even feel in the heart could clog half the penile artery, causing symptomatic restriction in blood flow. That’s why erectile dysfunction has been called “penile angina.” In fact, by measuring blood flow in a man’s penis we can predict the results of his cardiac stress test with an accuracy of 80%. Male sexual function is like a penile stress test, a “window into the hearts of men.”

Forty percent of men over age forty have erectile dysfunction. 40 over 40. Men with erection difficulties in their 40s have a 50-fold increased risk of having a cardiac event (like sudden death). I said before that various things increase heart disease risk by 20% or 30%. That’s nearly 5000%, leading the latest review to ask, “is there any risk greater?” That’s because it’s not so much a risk factor for atherosclerosis as atherosclerosis itself. A man “with erectile dysfunction (even if he doesn’t have cardiac symptoms) should be considered a cardiac patient until proven otherwise.”

Erectile dysfunction is considered to be a cardiac equivalent; it’s a marker of the coronary artery one likely already has. Thus, there’s more to treating ED than establishing an erect penis; it offers an opportunity for reducing cardiovascular risk. The reason even young men should care about their cholesterol is because itpredicts erectile dysfunction later in life, which in turn predicts heart attacks, strokes, and a shortened lifespan.

May 20, 2014 by Michael Greger M.D.

Bill Clinton declares Vegan Victory!

Bill Clinton

The former president, known for his love of burgers, barbecue and junk food, has gone from a meat lover to a vegan, the strictest form of a vegetarian diet. He says he eats fruits, vegetables and beans, but no red meat, chicken or dairy.

Clinton, 65, who had quadruple bypass surgery in 2004 and then stent surgery in 2010, is following this eating plan to improve his heart health. He talked about his plant-based diet last year, saying he lost 24 pounds on it for his daughter Chelsea’s wedding, and he chatted about it again recently on TV, drawing national attention to the potential health benefits of this type of diet.

Read more.

Harvard: Heart attack risk rises after anger outbursts

heart-attack

Harvard researchers who analyzed decades of evidence on links between anger and cardiovascular events, concluded that in the 2 hours following an outburst of anger, there is a higher risk of heart attack, stroke or other cardiovascular event.

The systematic review and meta-analysis – thought to be the first to examine links between anger and cardiovascular outcomes – is published in the European Heart Journal.First author Dr. Elizabeth Mostofsky and colleagues found that – compared with when they are not angry – a person’s risk of heart attack rises nearly five-fold, and the risk of stroke more than three-fold, in the 2 hours following an outburst of anger. Their risk of abnormal heartbeat or ventricular arrhythmia also goes up.

The absolute risk of heart attack, stroke or arrhythmia increased in people who already had a previous history of heart problems, and it also increased the more frequently they were angry. Heart attack includes myocardial infarction (MI) and acute coronary syndrome (ACS). Read more.

 

Source: Medical News Today

Photo Credit: Shutterstock