For The Love of Food

Welcome to Friday’s For The Love of Food, Summer Tomato’s weekly link roundup.

Some great reads this week. There’s scary news for those of us who spend a lot of time at the computer, as well as a terrifying example of what it means to be a food-like product. On the other side, there’s some good news about cholesterol.

I’m still participating in the Inkwell interview at The Well with David Gans and Diane Brown until June 23. Have questions for me or just want to eavesdrop? Come join us! http://bit.ly/9n1v8O

I read many more wonderful articles than I post here each week. If you’d like to see more or just don’t want to wait until Friday, be sure to follow me on Twitter (@summertomato) or the Summer Tomato Facebook fan page. For complete reading lists join me on the social bookmarking sites StumbleUpon and Delicious. I’m very active on all these sites and would love to connect with you there. (Note: If you want a follow back on Twitter introduce yourself with an @ message).

Links of the week

• Your Office Chair Is Killing You <<New research suggests that you can’t make up for a full day of sitting by heading to the gym. In the eloquent words of Homer Simpson, “D’OH!!” (Bloomberg Businessweek)
• Horrifying 12-day Cool Whip Experiment <<I believe it was Michael Pollan who first said, “If it doesn’t rot it isn’t food.” That means even bugs won’t eat it. (Jonathan Fields)
• Higher ‘good’ cholesterol linked to lower cancer risk <<We already knew that higher HDL cholesterol is one of the strongest protective measures against heart disease, but new data suggests it is also linked to less cancer. Correlation is not causation, but this is cool news. (CNN)
• Slim chips: no fat, no calories <<BS of the week. Don’t get your hopes up, these are flavored paper. Seriously. (Sydney Morning Herald)
• Foods that cut sugar aren’t necessarily a sweet choice <<Eeewwwww. Diet foods give you diarrhea. I’ll stick to fruit and real desserts, thanks. (Los Angeles Times)
• Twin study shows Mediterranean-style diet improves heart function <<Twin studies are awesome because you can test the effect of genetics versus environment, which is often confounding in diet experiments. Even in the case of bad genetics, diet was helpful for heart function. (American Heart Association)
• Kitchen gadgets nirvana: Yes, you must eat your veggies — but do it with cool tools <<For you geeks out there. C’mon, you know you wanna look. (Culturemap)
• In defense of (some) processed foods <<Short, insightful post by Ezra Klein about discriminating between processed foods. I agree whole-heartedly. You should read the Bittman post he links to as well. (Washington Post)
• The two questions to ask before you indulge <<I’m a big fan of the occasional food indulgence. These two tips can help you do it right. (Weighty Matters)
• Love salt? You might be a ‘supertaster’ <<Another factor that might affect how you tailor your healthstyle. Are you a supertaster? I would bet that I am. (CNN)

What inspired you this week?

Enough people have asked me if the kind of cholesterol in egg yolks is good or bad (hint: it’s neither) that I think it is time for a brief tutorial on this misunderstood molecule.

Rather than put you to sleep with a watered down version of a Wikipedia article I decided to explain the interaction of diet and cholesterol in a short video. Hopefully this will help clear up what cholesterol is and how you should eat to minimize your risk of heart disease.

As always, feel free to drop me questions in the comments.

If you like this story follow me on the new Digg!

http://forms.aweber.com/form/30/split_210533730.htm

Further reading:

• How To Raise Your HDL Cholesterol
• Intact Grains vs Whole Grains
• How To Make Eggs Taste As Good As Bacon
• Book Review: Good Calories, Bad Calories

Drug treatments that raise the “good” high density lipoprotein (HDL) cholesterol do not improve health outcomes, according to a new analysis. But some researchers suspect raising HDL through lifestyle changes may still be effective in treating heart disease.

HDL is the form of cholesterol that actively removes dangerous lipids from the blood, and has long been thought to be protective against heart disease. This form of cholesterol is believed to work in opposition to low density lipoprotein (LDL) cholesterol, which is strongly correlated with heart disease and cardiovascular mortality. Thus the ratio of HDL to LDL cholesterols is often considered the most important indicator of heart disease risk.

Strong clinical evidence shows that LDL lowering drugs like statins can protect against heart disease and cardiovascular mortality. However there is still no effective way of improving cardiovascular outcomes by directly targeting HDL cholesterol.

Pharmacological treatments that raise HDL cholesterol levels include fibrates, niacin and a Pfizer drug called Torcetrapib. However, trials that tested these drugs for improved cardiovascular outcome have yielded mixed results. Rather than lowering mortality risk, evidence suggests that fibrates and Torcetrapib actually increase mortality in patients. Some trials have shown niacin to be effective at reducing cardiovascular events, but the data are inconsistent.

A new meta-analysis published in the British Medical Journal asked whether pharmacological treatments that are known to raise HDL can improve cardiovascular outcomes. After adjusting for several known confounders (including the effect of LDL cholesterol) pharmacological treatments that raise HDL were not effective at protecting against heart disease.

Does this mean that HDL is not important for heart disease? Not necessarily.

The original studies that implicated HDL in heart protection were observational. For example, it was shown in the Framington Heart Study that people with HDL levels greater than 60 mg/dL have a reduced risk of heart disease compared to individuals with lower HDL. Likewise, individuals with less than 40 mg/dL of blood HDL are considered at risk for coronary heart disease, even when LDL cholesterol is relatively low.

Additionally, lifestyle choices that contribute to raising HDL are associated with a lower risk of heart disease. Examples of these are physical activity, weight loss, not smoking, increased omega-3 fatty acid consumption, decreased trans fat consumption, alcohol consumption and dietary soluble fiber. Also, diets low in saturated fat but relatively high in unsaturated fats have been shown to raise HDL and decrease heart disease risk.

All these HDL raising activities can improve cardiovascular outcome. However, this does not mean that HDL itself prevents heart disease. Rather, it seems to be a good biomarker (observational correlate) of heart disease.

Why are pharmacological methods of raising HDL not helpful (and possibly even harmful) at treating heart disease?

One possible explanation for this discrepancy is the observation that HDL has different forms, some that are protective and others that are harmful. For instance, some interventions may raise HDL cholesterol by limiting its breakdown (harmful), while others raise it by increasing HDL production (more beneficial). Also, some methods that increase HDL do so in a way that creates new problems, such as increased blood pressure.

The complex interaction between pharmacological interventions, HDL metabolism and cardiovascular outcome may have made it difficult to detect any benefit of raising HDL cholesterol in this meta-analysis. Since pharmacological intervention for raising HDL does not consistently help (and sometimes harms) cardiovascular outcome, lifestyle changes remain the most promising target for raising HDL to protect against heart disease.

Anyone want to guess how high my HDL cholesterol is??

Today I have an article out in Synapse called “Wine May Increase Heart Healthy Fats in the Blood.” I am making an executive decision that it is too science-y for this blog, so instead I would like to open a discussion about how doctors should treat information like this.

For you uber-nerds (like me), here is the PubMed link to the original paper.

Let’s start with some excerpts from my article:

• “The beauty of this finding is that the improvement in fatty acid profile from wine consumption seems to be clinically relevant. Based on the current consensus, small dietary changes in fatty acid consumption have a large clinical effect, so a 38% to 50% increase in EPA levels among moderate wine drinkers is noteworthy. Similar levels of improvement in lipid profiles from studies of fish consumption have shown considerable benefit for cardiovascular outcome.”

• “Thus, the present finding may offer dietary intervention as a possible method of cardiovascular protection, particularly when combined with increased omega-3 consumption.”

• “In the present study, the difference between participants in the low fatty acid group who did not drink and those in the high fatty acid group who drank the most was an 83% increase in blood EPA, a change associated with a 50% to 75% reduced risk of heart attack. Such a dramatic difference represents a useful alternative to fish consumption for those who may not have access to seafood for whatever reason.”

• “Thus, increasing both dietary omega-3 fatty acids and wine consumption may be helpful to protect against cardiovascular events. Plant-derived omega-3 fatty acids are abundant in walnuts, soy, flax and canola oils, and one gram per day is the current recommendation for heart protection. “Moderate” alcohol intake is one glass per day for women and two for men.”

From a clinical perspective, the evidence that alcohol provides a tremendous protection against mortality from heart disease is undeniable. It is thought to work by both raising good HDL cholesterol and reducing blood clotting.

This effect is not limited to red wine, all spirits elicit substantial protection.

Despite these benefits, there are also a number of obvious reasons to avoid alcohol, particularly excessive consumption. Excessive alcohol consumption is associated with addiction, liver disease, stroke and can cause accidents and other behavioral problems.

Notably, benefits similar to those seen with alcohol can be conferred by increasing exercise amount or intensity.

If you want to experience the benefits of alcohol you need to use it in moderation, which is 1 drink per day for women and 2 for men, or possibly slightly more. More than one drink per day for women is associated with an increased risk of breast cancer, however this effect is attenuated by sufficient folate intake.

Doctors have been recommending increasing exercise for decades, but only a small percentage of the population makes an effort to get enough to make it as valuable against heart disease as alcohol. Also, there is a large population of individuals that have physical ailments that prevent them from performing vigorous cardiovascular exercise.

But to this day the American Heart Association–the same agency that recommended the low-fat, high-carb diet that many argue actually promotes heart disease–refuses to recommend moderate alcohol consumption. The basic tenet of their argument is that alcohol is not necessary because heart protection can be achieved in other ways, and the risks outweigh the benefits.

Is this right? I’m not so convinced.

Do you think doctors should discuss the potential benefits of alcohol with their patients? Should the AHA change their recommendation?