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  Last updated: 5/2/2016

(Proven Strategies to Decrease Cardiac & Diabetic Risk Factors)

I recently attended an interesting conference on the effects of diet on cardiovascular risk facotrs. I was impressed with both the benefits of diet on vascular disease risk factors as well as the data that demonstrated diet to be even more effective than many "high powered" prescription medications in reversing the metabolic changes of abnormal glucose and lipid metabolism. I thought it would be fun to summarize a few of the ideas and then to speculate on what lifestyle changes one might easily make to keep themselves healthy. But before we go further, I want to stress again that this is about a baseline healthy lifestyle - and all evidence continues to point towards carbohydrates alone as the underpinning for the energy needs of the cyclist while on their bike.

Abnormal lipids, probably as a result of abnormal glucose metabolism (insulin resistance or pre diabetes) are a significant factor in the development of cardiovascular disease. There are proven dietary and life style strategies that are proven to help pts with severe vascular disease (prior MI, stroke, etc.), so it would seem safe to speculate that the same strategies would be beneficial for everyone (but especially if they had undiagnosed insulin resistance). The current presumption is that this "prediabetic" condition can be present for years before full fledged diabetes with an elevated blood sugar is diagnosed - and the entire time blood vessel damage is ongoing.

Here is another way to look at this. There are multiple risk factors:

which are factors in aggravating insulin resistance. And the more severe the insulin resistance the greater the odds of Improve any of the multiple risk factors and the odds of developing blood vessel disease decreases.

In reviewing the literature, it is extremely common to note that certain dietary changes improve both the risk of DM and risk of heart disease in the same direction and by the same relative amount. Again, strong suggestive evidence that it is insulin resistance that is the common factor for both development of overt diabetes mellitus and cardiovascular disease. In fact, I heard one lecturere say that if one followed all the dietary and life style recommendations that follow, the chances of developing diabetes type 2 were almost nil.

The dyslipidemia CV risk factors include

Focusing on changing the balance of these three is the goal. Statin drugs will lower the LDL, but have no effect on the other two. Dietary changes will affect the balance in a way that is actually more effective than statins alone, and will allow one to decrease their statin dosages if adopted. An increase in the HDL/LDL ratio is a well know predictor of a decrease in cardiac risk factors while the LDL alone seems to be a weak one. And the triglyceride/HDL (TC/HDL) ratio is a superior predictor for (IHD) ischemic heart disease compared to LDL alone (Am J Cardiol 1997:79:756).

Many of these dietary recommendations are elements of the Mediterranean diet (actually Cretan diet as that island is the locale where it is eaten most consistently). The Med Diet stresses increasing the intake of fruits, vegetables, whole grains, olive oil, omega 3 fatty acids, nuts, beans/legumes, and minimizing saturated and trans fats.

Does the Mediterranean Diet work? The EPIC study (NEJM 2003:348:2599-608) followed 22, 0423 people over 44 months. Adherence to a Med Diet was rated on a scale of 0 to 9. For each 2 point improvement in adherence, there were 33% fewer deaths from heart disease and 24% less from cancer.

Why do we think a Mediterranean diet is so effective in decreasing cardiovascular and cancer risk factors?

Here are several resources available to those interested in learning more about the Mediterranean Diet: Here are the keys to improving your risk factor profile

How to eat

There is evidence that carbohydrates eaten at night will form fat more easily than those eaten at noon (when you are still more active). It is reasonable to speculate that as you are using CHO for energy, they are selectively metabolized (over glycogen stores) in the afternoon, while at night instead of replacing glycogen stores, absorbed carbohydrates are converted into fat. Emphasize lean meat and vegetables at night - carbs in the morning or midday.

Life style Issues

Bottom Line - how could these facts work for you in your daily nutrition program?

  1. Eat breakfast
  2. Eat the bulk of your carbohydrates at breakfast and lunch
  3. Take those vitamins with a glass of cranberry juice
  4. Take a multivitamin daily - and be sure it has have 800 units of vitamin D; add in 1 gram of fish oil as a capsule and also magnesium supplements
  5. Eliminate as much as reasonable all white flour, white rice, and potatoes - use brown rice and whole grain breads.
  6. Eat a cooked whole grain cereal or steel rolled oats when possible for breakfast (cold cereals are not comparable, even granolas).
  7. Use only low fat milk
  8. Peanut butter on a piece of 100% whole grain toast is a quick breakfast
  9. A couple of cups of coffee a day can be a good thing - even three or four
  10. A snack during the day might be a handful of almonds (raw or at least not roasted in transfats)
  11. 1 alcoholic drink a day - make it red wine if possible
  12. Use olive oil whenever feasible (canola is second)
  13. The more vegetables the better.
  14. Sweets only for special occasions - grab the dark chocolate if you have it handy
  15. Have fish as often as possible (see below)
  16. Blue cheese and other aged cheeses are better than processed cheeses
  17. Fat Calories are not necessarily bad - even if you want to loose weight - and may be better than an equivalent number of CHO calories

The Mukilteo Diet

Over the years, my thoughts as how this all might come together have evolved. The result is what I will call "The Mukilteo Diet" which I first put to paper (computer screen actually) in May of 2016. The final piece was an article that stressed a point not often mentioned in other diets, that when you eat is as important as total caloric balance.

I was a gastroenterologist, seeing patients with liver and other digestive tract complaints for 35 years. (And for those of you wondering about the name of the diet, I live in Mukilteo.) Over the years, I noticed a dramatic increase in the number of patients referred with the diagnosis of "fatty liver". A fatty liver refers to the increase of fat in the liver cells which in turn can produce inflammation and ultimately scarring (cirrhosis) in a small percentage. Fatty liver is seen in metabolic syndrome and pre-diabetes/diabetes, both more common in overweight individuals. By some estimates fatty liver now affects upwards of 25% of the population. Fatty liver, diabetes, and obesity overlap in their underlying physiology and are all impacted (both positively and negatively) by diet. When I explained this to patients, that a change in diet was a simple start to impact the liver fat accumulation, the next question was predictably "what can I do ?" The following summary of my answer to them is not only a reasonable first step in treating these 3 conditions, but also a set of guidelines for healthy eating.

Although the traditional dietary approach to "too much fat" has been an emphasis on losing weight, it is not quite that simple. Carbohydrates, and the insulin release they stimulate, are a more important factor than previously suspected. Thus the source of one's daily calories (carbohydrate versus fat) and when they are eaten during the day are equally as significant as the total daily calorie balance.

These five factors all play a role in any healthy diet but need special attention in any comprehensive dietary approach to the weight loss as well as the treatment of glucose intolerance and fatty liver (steato-hepatitis).