Re: Whole dietary patterns vs. reductionist approach
From: cde (cde_at_cde.org)
Date: 08/02/04
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Date: Mon, 02 Aug 2004 00:50:07 GMT
Mirek Fidler wrote:
>And those calories
> are from sugars, so they are more likely to spike BG/insulin and cause
> high TG / low HDL.
The magnitude of the sugar effect depends on other aspects of the diet,
the type of fat, the type of carbohydrate, and fiber.
(American Journal of Clinical Nutrition, Vol. 78, No. 4, 873S-880S,
October 2003)
There is a big difference between refined sugars and unprocessed fruits.
Refined sugars are known to have adverse effects on lipid profiles. We know
this from the Twenty Countries Study. (Stamler J. Population studies.
In: Levy R,
Dennis BR, Ernst N, eds. Nutrition, lipids, and coronary heart disease.
New York:
Raven, 1979:25–88).The same is not true of fruits. People with the
highest
consumption of fruits are known to have significantly reduced risks for
CHD.
http://www.nutritionj.com/content/2/1/2
"After adjusting for the conventional cardiovascular risk factors, those
in the upper quintile of fruit consumption (5 or more items/day) had
72% lower risk for CHD (odds ratio = 0.28, 95% CI 0.11 – 0.54, P < 0.001),
compared with those in the lowest quintile of intake (<1 items/day)."
http://www.ajcn.org/cgi/content/full/72/4/922
"intake beyond the highest quintile (median: 10 servings
[fruits + vegetables] /d) appeared to afford the greatest reduction
in risk of CVD (Table 4)."
> Even Ornish admits that his diet increases TG. And LDL/TG ratio seems to
> be the best predictor for LDL particle size, while LDL particle size is
> the best predictor of oxLDL (large LDL is less prone to oxidation).
In his excellent review on lipoproteins and CHD,
http://www.ajcn.org/cgi/content/full/75/2/191
Schaefer states:
"an elevated remnant-like particle cholesterol value is a better CHD risk
marker than is total serum triacylglycerol, especially in women
(Atherosclerosis 2001;154:229–36)"
He also states:
"We found that whereas CHD patients have smaller LDL particles than do
control subjects, LDL particle size is not an independent predictor of CHD
risk after other established risk factors are controlled for.
(Arterioscler Thromb 1992;12:187–95)"
> Research also that type 'A' persons with large LDL particle size (70%
> population, in low risk for CVD) are "converted" to dangerous type 'B'
> (with small LDL size) when going on low-fat/high-carb diet; while type
> 'B' does well on this diet. So perhaps high-carb diet works well, but
> just for 30% of population.
These are not very high fiber fruit/vegetable carbohydrates. None of the
studies finding such dangerous conversions employed a high fruit, high
vegetable, high fiber diet.
> As I have said, I completely agree with very high vegetables
> consumption, but I am not that enthusiastic about fruit. I think that
> world can enjoy some good fat as well :)
Perhaps not as much as some schools are currently suggesting. In their
2003 report, WHO/FAO suggested that there is no convincing benefit
beyond 20% fat intake, and that intakes higher than 30% are acceptable
only in the relatively thin and healthy and only when their intakes of
nonstarchy vegetables are adequate.
Again, from Schaefer:
"An article by Katan et al has created controversy over the recommendation
for dietary fat restriction in the prevention of CHD. The controversy
involves
whether a diet in which the total fat content is held constant, but is
relatively
enriched in monounsaturated fatty acids, offers better protection
against CHD
than does a low-fat diet. This argument has stemmed primarily from the
observation that low-fat diets often reduce both HDL-cholesterol and
LDL-cholesterol concentrations.
"However, a study of coronary artery atherosclerosis in African Green
monkeys showed that, when isoenergetically substituted for saturated fat,
monounsaturated fat failed to provide protection against the development of
atherosclerosis.
"This was despite the fact that the monounsaturated fat diet was associated
with the most favorable plasma lipoprotein profile, specifically, the
lowest ratio
of LDL to HDL cholesterol.
"Because nonhuman primate models of atherosclerosis have been good
predictors of human outcomes, we believe that the recommendation to
increase dietary monounsaturated fat content, as made by Katan and
colleagues, is not justified."
It seems clear enough that for people coming from SAD, a switch to
increase MUFA while decreasing most saturated fats, refined grains,
and refined sugars is a good thing. We have seen this in many large-scale
studies. But, a very high fiber fruit and vegetable diet with a more
moderate MUFA intake may prove to be the most therapeutic of all.
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