Antioxidants Studies

As everyone knows, eating and drinking are necessary for life. Less well known, however, is the fact that the body generates what are called free radicals in the process of turning food into energy. Free radicals are chemicals that are capable of damaging cells and genetic material. But eating is not the only way free radicals spring into being. The food we eat and the sunlight we feel also generate free radicals.

To be sure, free radicals come in many shapes, sizes, and chemical configurations. The characteristic feature of this chemical is that it soaks up electrons from bodily substances that yield them, which can leave the “loser’s” structure or function radically altered. Free radical damage can change the instructions coded in a strand of DNA; it can also make a circulating low-density lipoprotein (LDL, sometimes called bad cholesterol) molecule more likely to get trapped in an artery wall. Free radicals also have the potential to alter a cell’s membrane, changing the flow of what enters the cell and what leaves it.

Fortunately, we aren’t defenseless against free radicals. The body puts up natural defenses against free radicals by making molecules that smothers the errant chemicals. We also extract free-radical fighters from food. Often called “antioxidants”, certain kinds of food give electrons to free-radicals without themselves turning into electron-scavenging substances. There are many different substances that can act as antioxidants. The most familiar ones are vitamin C, vitamin E, beta-carotene, and other related carotenoids, along with the minerals selenium and manganese. They’re joined by glutathione, coenzyme Q10, lipoic acid, flavonoids, phenols, polyphenols, phytoestrogens, and many more.

However, the term “antioxidant” can be misleading. These substances do not emit chemical properties that fight so much as they emit properties that facilitate. Indeed, some substances that act as antioxidants in one situation may be prooxidants—electron grabbers—in a different chemical milieu. Another big misconception is that antioxidants are interchangeable. This is not true. Each anti-oxidant has unique chemical behaviors and biological properties. It is believed, and has been strongly corroborated through scientific study, that anti-oxidants evolved as parts of elaborate networks, each substance having a different role to play. It follows that no single substance can fulfill the function of every other substance.

Health Benefits of Antioxidants: What’s the Buzz?

Antioxidants came to public attention in the 1990s. It was then that scientists began to understand that free radical damage was involved in the early stages of artery-clogging atherosclerosis, and that the chemicals may contribute to cancer, vision loss, and a host of other chronic conditions. A number of studies stated that people with low intakes of antioxidant-rich fruits and vegetables were at greater risk for developing these chronic conditions than were people who ate sufficient amounts fruits and vegetables. Clinical trials tested the impact of single substances, especially beta-carotene and vitamin E, on cancer, heart disease, and similar maladies. But even before the results of these trials were in, the media, and the dietary supplement and food industries began promoting the benefits of “antioxidants.” Foods such as frozen berries and green tea were hyped as being rich in antioxidants. The consequences of this publicity were predictable: certain foods were labeled as rich in antioxidants and were marketed as such in stores; the makers of dietary supplements began touting the disease-fighting properties of all sorts of antioxidants.

In the meantime, the results of the actual trials were mixed. Most have not found the hoped-for benefits. And research teams reported that vitamin E and other antioxidant supplements didn’t protect against heart disease or cancer. One study even showed that taking beta-carotene may actually increase the chances of developing lung cancer in smokers. However, some of the trials reported benefits. One such study found that taking beta-carotene is associated with a modest reduction in the rate of cognitive decline.

The rather most, if not downright disappointing, results of the antioxidant trials have not stopped the commercial interests from misrepresenting the benefits of antioxidants in order to make money. Antioxidant supplements are a $500 million dollar industry that continues to grow. Antioxidants are still added to breakfast cereals, sports bars, energy drinks, and other processed foods, and they are promoted as additives that can prevent heart disease, cancer, cataracts, memory loss, and a host of other conditions. The claims made by the food and dietary supplement industries often distort the data. It is true that the package of antioxidants, minerals, fiber, and other substances found naturally in fruits, vegetables, and whole grains help prevent a variety of chronic diseases; but there is no solid evidence that high doses of antioxidants can accomplish the same feat. The conclusion is clear: randomized, placebo-controlled trials—which, when performed well, provide the strongest evidence—offer little support that taking vitamin C, vitamin E, beta-carotene, or other single antioxidants provides substantial protection against heart disease, cancer, or other chronic conditions. The results of the largest such trials have been mostly negative.

Heart Disease and Antioxidants

Vitamin E, beta-carotene, and other so-called antioxidants are not a panacea for heart disease and should not be promoted as such. In the Women’s Health Study, 39,876 initially healthy women took 600 IU of natural source vitamin E or a placebo every other day for 10 years. The results of the study showed that the rates of major cardiovascular events and cancer were no lower among those taking vitamin E than they were among those taking the placebo; however, a 24 percent reduction in total cardiovascular mortality was observed, which can be considered a quite significant result.

Earlier large vitamin E trials, conducted among individuals with previously diagnosed coronary disease or at high risk for it, generally showed no benefit. In the Heart Outcomes Prevention Evaluation (HOPE) trial, the rates of major cardiovascular events were essentially the same in the vitamin E (21.5 percent) and placebo (20.6 percent) groups, although participants taking vitamin E had higher risks of heart failure and hospitalization for heart failure. (3) Another trial, the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI), showed mixed results; there were no preventive effects after more than three years of treatment with vitamin E among 11,000 heart attack survivors. Nevertheless, some studies suggest potential benefits among certain subgroups. A recent trial of vitamin E in Israel, for example, showed a marked reduction in coronary heart disease among people with type 2 diabetes who have a common genetic predisposition for greater oxidative stress. In any case, Beta-carotene, as was shown in the Physicians’s Health Study, does not provide any protection against heart disease or stroke.

There have been combinations, but the findings are complicated and unclear. In the Supplementation en Vitamins et Mineraux Antioxydants (SU.VI.MAX) study, 13,017 French men and women took a single daily capsule that contained 120 milligrams of vitamin C, 30 milligrams of vitamin E, 6 milligrams of beta-carotene, 100 micrograms of selenium, and 20 milligrams of zinc, or a placebo, for seven and a half years. The vitamins had no effect on overall rates of cardiovascular disease. In the Women’s Antioxidant Cardiovascular Study, vitamin E, vitamin C, and/or beta-carotene had much the same effect as a placebo on myocardial infarction, stroke, coronary revascularization, or cardiovascular death, although there was a modest and significant benefit for vitamin E among women with existing cardiovascular disease.

Cancer and Antioxidants

There is also no conclusive proof that antioxidants help prevent cancer. Scientists need more time to determine the impact of antioxidants on the risk of getting cancer. In the long-term Physicians’ Health Study, cancer rates were similar among men taking beta-carotene and among those taking a placebo. Other trials have also largely showed no effect, including HOPE. The SU.VI.MAX trial showed a reduction in cancer risk and all-cause mortality among men taking an antioxidant cocktail but no apparent effect in women; it is possible that this is a result of the men in the study having low blood levels of beta-carotene at its beginning. A randomized trial of selenium in people with skin cancer demonstrated significant reductions in cancer and cancer mortality at various sites, including colon, lung, and prostate. The effects were strongest among those with low selenium levels at baseline.

Age-Related Eye Disease and Antioxidants

The effects of antioxidants on age-related eye disease may be one of the most hopeful leads scientists have. A six-year trial, the Age-Related Eye Disease Study (AREDS), found that a combination of vitamin C, vitamin E, beta-carotene, and zinc provided some protection against the development of advanced age-related macular degeneration in people who were at high risk of the disease. Lutein, a naturally occurring carotenoid found in green, leafy vegetables such as spinach and kale, may also protect vision. It is too early to tell what the impact of lutein supplements may be. The trials of such substances have been relatively short, and their ability to slow or prevent age-related macular degeneration has not been ascertained. A new trial of the AREDS supplement regimen plus lutein, zeaxanthin, and fish oil is underway, and it could yield better information.

Potential Hazards of Antioxidants

There have been a few studies which showed that the consumption of antioxidants, as opposed to being beneficial in all instances or at least harmless in fact can interfere with the health of the consumer. The first trial which showed this possible negative effect was undertaken in Finland where heavy smokers were fed beta-carotene. Because of their smoking habits there was a already a lung cancer risk but it was noticed that a significant increase in the incidence of lung cancer amongst the trial group as opposed to the placebo. The trial was stopped so conclusive results are hard to deduce.

A different test which was conducted with heavy smokers exposed to asbestos being fed beta-carotene and vitamin A. This too shows an increase in the incidence of Lung cancer. It must be emphasized that not all trials of Beta-carotene have been negative. A physicians health study which only had a few smokers did not show any significant differences even when followed up after 18 years.

In a separate study showing possible negative effects of a variety of health supplements showed a higher incidence of skin cancer in women being fed supplements of Vitamins C & E, Beta-carotene, selenium and zinc.

Conclusions to be drawn from the above studies, amongst others, is that it is known that although free radicals have been shown to contribute to the incidence of heart disease, cancer, Alzheimer’s and even vision loss, there is no automatic conclusion that can be drawn that antioxidants will fix the problem. And certainly not when consumed away from their normal context.

Studies to date do not show conclusive evidence one way or another but there is certainly no strong evidence to suggest that antioxidants are effective against disease. A rider must be mentioned and that is that the trials conducted till now have been short in duration, conducted with people some of whom had an existing disease.

There has been a noticeable benefit to the consumption of beta-carotene on cognitive ability after 18 years. This is exceptional as it is the only study to have continued so long. (Physicians health follow up study) Nevertheless there is abundant evidence suggests that eating whole fruits, vegetables, and whole grains—all rich in networks of antioxidants and their helper molecules—provides protection against many of these scourges of aging.

Clarification with regard to supplemental studies

There are any number of studies conducted on any number of vitamins and other dietary supplements that are often contradictory. The picture presented to the consumer is confusing and will often seem frustrating in that instead of clarifying things these studies muddy the waters.

Examining exactly what the vitamins trial study did will often go some way to explaining the varying results. Here are a few items to check when looking at apparently conflicting vitamins studies.

  • What was the precise dosage taken by the participants and how long was the study’s duration. This is significant as few studies will have identical dosages and identical time spans. A study in Vitamin D showed that a dosage of 700 plus IU per day had a significant protection against fractures whereas a study of people taking only 400 IU per day showed no such effect. The same applies to the duration as the build up of the protective mechanisms is not a short process.
  • The age, health and life styles of the participants. Studies drawn from young, active gym going participants is likely to differ significantly from heavy drink and smoking office workers. Exercise and other lifestyle choices such as diet affect out health and how the body responds to vitamins.
  • At what stage is was the supplement fed to a study participant. If studying the effect of a supplement on someone already suffering from a disease it may be found that something taken at the onset has a differing effect from something taken when a disease is far advanced. An example being that Folate supplements are only effective against neural tube defects in the early stages of pregnancy.
  • How were the results tabulated and calculated. This is a significant problem as measurement as to benefit may and probably will vary widely. Heart disease is a wide subject and a measurement of coronary thrombosis may miss out on the incidence of strokes.

Low Vitamin D: A Global Concern

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

Type 2 diabetes and heart disease

What is the link between Type 2 diabetes and heart disease?

Type 2 diabetes is more than simply a raised blood glucose level. You are also likely to develop various problems related to your heart and blood vessels – for example, high blood pressure and high cholesterol levels. Although the link between high blood pressure and diabetes is not yet fully understood, it is thought that it may result from high levels of insulin circulation in your blood as a result of insulin resistance (which is usual in Type 2 diabetes). As a result, your blood vessels become scarred and hard plaques form – this causes narrowing of your blood vessels, which makes it more difficult for your blood to flow. The risk of blockages in your blood vessels also increases; these can cause angina (severe chest pain) or a heart attack.

What is cardiovascular disease?

“Cardio” means heart and “vascular” means blood vessels. If you have Type 2 diabetes, you are prone to a range of cardiovascular problems including high blood pressure, hyperlipidemia (a high level of fat in your blood), angina (severe chest pain), heart attack, stroke, peripheral vascular disease (pain in yoru legs when walking or resting due to reduced circulation), and heat failure. You are also two to four times more likely to develop cardiovascular disease (CVD) than someone without diabetes. CVD is one of the major problems associated with Type 2 diabetes.

How would I know if I have CVD?

CVD does not necessarily cause any symptoms and may only become apparent when you have a heart attack or a stroke. But it is possible for your health professional to look for signs of CVD, such as high blood pressure and high levels of cholesterol in your blood. If tests are positive, you can have treatment for these conditions even though they do not make you feel ill. This is why you need to have your blood pressure and blood cholesterol levels checked regularly.

Can I take drugs to prevent CVD?

Taking regular low doses of aspirin (or other blood-thinning tablets if you can’t take aspirin) can help reduce your risk. You may also be prescribed pills to reduce your cholesterol level if you need them. Even if you need pills, eating healthily and becoming or staying active will play an important role in lowering your risk of CVD.

What exactly are “raised blood lipids”?

When you have Type 2 diabetes, your levels of cholesterol and triglycerides – two types of lipids (fats) in the blood – are likely to be raised, a condition known as hyperlipidemia. Both of these fats are essential in small amounts, but when their levels are raised they can damage your arteries. There are two types of cholesterol in your blood: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). In a healthy person, the proportion of HDL to LDL is higher than it is in a person with Type 2 diabetes. Elevated levels of lipids in the blood are treated in order to lower your blood fats and to correct the ratio of HDL to LDL. This in turn prevents your arteries from narrowing.

How can losing weight prevent CVD?

If you are overweight, losing even a few pounds is one of the most important things you can do if you have Type 2 diabetes. Losing weight and becoming more active will help to lower your blood cholesterol levels and blood pressure. Your body will also become more responsive to the insulin you produce, and your heart will be under less strain.

Will physical activity help me prevent CVD?

Yes, just 30 minutes of moderate activity five times a week will help you control your blood pressure and reduce your cholesterol level, which in turn reduces your risk of CVD. Physical activity helps you lose weight because you not only burn more calories while you are active but you also speed up your metabolic rate so that your body uses up more calories even when you are less active.

How important is it to stop smoking now I have Type 2 diabetes?

Very important; if you smoke, you have a far higher risk of CVD, heart attack, and stroke. Having Type 2 diabetes further increases the risk. Going to smoking cessation clinics and using nicotine replacement therapy such as patches or chewing gum can help you give up.

My Type 2 diabetes was diagnosed after a heart attack. How can I prevent another?

Taking any medication you have been prescribed to reduce your blood pressure and cholesterol level, increase your blood flow, and control your blood glucose level will make a big difference. Relaxation therapy and attending your cardiac rehabilitation meetings will help to reduce your risk. Stopping smoking and being active – for example, walking every day – are also important.

Diet and Lifestyle Prevention Recommendations for Cardiovascular Disease

In 2006, the AHA created diet and lifestyle recommendations to reduce the risk for or manage cardiovascular disease in adults and children over the age of 2. Here are some highlights of their recommendations:

• Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
• Consume a diet rich in fruits, vegetables, whole grains, and other high-fiber foods; high-fiber diets can reduce cardiovascular disease risk by decreasing cholesterol production in the body and increasing removal of harmful cholesterol from the body. High-fiber diets can also slow the progression of cardiovascular disease in those at high risk.
• Eat fish, especially oily fish, at least twice a week (for a total of about 8 ouces); fish provides the omega-3 fats EPA and DHA, which can lower the risk of both sudden death and death from cardiovascular disease. For those with cardiovascular disease, the AHA recommends 1 gram of EPA and DHA from fish and/or fish oil supplements. For those with hypertriglyceridemia, the AHA recommends 2-4 grams of EPA and DHA from supplements (in capsule form). Be sure to consult a physician before you take fish oil supplements.
• Limit saturated fat intake to less than 7 percent of total calories, trans fat intake to less than 1 percent of total calories, and dietary cholesterol to less than 30 mg per day.
• Minimize intake of beverages and foods with added sugars.
• Choose and prepare foods with little or no sodium.
• If you consume alcohol, so in moderation (up to 1 drink per day for women and up to 2 drinks per day for men).

Consuming foods that are naturally rich in and enriched with plant stanols / sterols can reduce the absorption of cholesterol to lower total and LDL cholesterol levels. According to the AHA, maximum effects are seen with intakes of 2 grams per day of plant stanols. Those who reduce their cholesterol levels by taking plant stanols and sterols will need to consume them each day to maintain their benefits.

Following the previous recommendations and those of MyPyramid can reduce the risk for cardiovascular and other diet-related diseases by promoting weight loss, reducing LDL cholesterol and triglycerides, and raising HDL cholesterol.

Those with diagnosed cardiovascular diseases or with risk factors such as high total and/or LDL cholesterol levels can also be prescribed medications as part of treatment, and many (or all) work more effectively when taken as part of an overall healthful dietary pattern.

Coronary heart disease (CHD) is a condition in which coronary arteries, which carry blood to the heart, are narrowed so much they may slow or stop blood flow to the heart.

Myocardial infarction (MI), or heart attack, occurs when blood flow to the heart is blocked.

Angina pectoris, or angina, is chest pain that occurs when the heart can’t get enough oxygen from the blood. It is a common symptom of CHD.

Heart failure resulting from a cardiac disease, which compromises ventricular systolic or diastolic function, or both. Heart failure results when the heart is unable to generate a cardiac output sufficient to meet the demands of the body without unduly increasing diastolic pressure. Heart failure can be of the body without unduly increasing diastolic pressure. Heart failure can be manifested by symptoms of poor tissue perfusion alone (for example, fatigue, poor exercise tolerance, and confusion) or by both symptoms of poor tissue perfusion and congestion of vascular beds (for example, dyspnea, chest rales, pleural effusion, pulmonary edema, distended neck veins, congested liver, and peripheral edema).

Plaque is made up of cholesterol, fat, and other substances that build up on the inner walls of blood vessels.

Cardiomyopathy is a weakening or change in the structure of the heart muscle; it often manifests as inadequate heart pumping or other problems with heart function.

Lipoproteins are made up of lipids, and protein; they dissolve in water and carry cholesterol through the blood and around the body either to or from blood vessels.

Refined carbohydrates are simple sugars or starches that have undergone processing.

The National Cholesterol Education Program (NCEP) – created in 1985 by the National Heart, Lung, and Blood Institute (NHLB) – provides information for educators and the public to reduce the number of Americans with high blood cholesterol and prevent illness and death from CHD.

Inflammation is the body’s response to injury or infection both externally and internally.

Hypertriglyceridemia is elevated blood triglycerides (blood fats).

Plant Stanols / Sterols are beneficial compounds found naturally in small amounts in plant foods that block cholesterol absorption.

Cardiovascular Disease

Cardiovascular disease (CVD) is an umbrella term used to describe any abnormal condition characterized by dysfunction of the heart and blood vessels (including arteries and veins).

The most common cardiovascular diseases in the United States include

• Coronary heart disease (including myocardial infarction or heart attack, and angina pectoris, or chest pain)
• Stroke
• Heart failure

Most cardiovascular diseases are associated with atherosclerosis, a slow and progressive process in which arteries narrow and harden. During atherosclerosis, excess amounts of fat, cholesterol, calcium, and other substances build up beneath the cells that line artery walls and contribute to the formation of plaque. Over time, as plaque builds up, it narrows the opening of blood vessels, limiting the amount of oxygen-rich blood and nutrients that can flow to the heat or the brain. When blood flow to the heart is blocked, a heart attack occurs; when blood flow to the brain is blocked, a stroke occurs. Harmful blood clots can also break off and block a vessel.

Although they’re much less common, some forms of cardiovascular disease are caused by abnormal heart rhythm or heart valve function, or infection or toxins that make it harder for the heart to pump blood (as in cariomyopathy).

Cardiovascular disease (including high blood pressure) affects an estimated 81 million people in the United States. It is the leading cause of death and a major cause of disability among both men and women in the Unties States; it causes an estimated 700,000 deaths each year.

Although specific genes contribute to the development of some forms of cardiovascular disease (including congenital heart disease, an inherited condition present at birth), most often genetic tendencies (including family history), environment, and individual lifestyle factors interact and contribute to the development of cardiovascular diseases. Key risk factors for cardiovascular disease include

• High blood pressure
• Overweight and obesity
• High total or LDL cholesterol
• Low HDL cholesterol
• High triglycerides
• Diabetes
• Smoking
• Physical inactivity

How to Interpret Blood Values

A simple blood test taken after 9- to 12-hour fast can reveal your total, LDL, and HDL cholesterol and triglyceride levels.

Because cholesterol and triglycerides cannot dissolve in blood, they are carried in the blood and throughout the body by lipoproteins. The three main types of lipoproteins are as follows:

• Low-density lipoprotein (LDL)
• Very low-density lipoprotein (VLDL)
• High-density lipoprotein (HDL)

LDL cholesterol makes up most of the cholesterol found in the blood. It is known as “bad” cholesterol because high levels indicate an unhealthy buildup of cholesterol in the arteries; the more LDL in the blood, the greater the risk for heart disease. Too much saturated fat, trans fats, and (to a lesser extent) dietary cholesterol can contribute to high LDL levels.

HDL cholesterol, also known as “good cholesterol”, carries cholesterol from other parts of the body back to the liver; the liver is in charge of moving “bad” LDL cholesterol out of the body. Having low HDL cholesterol levels increases the risk of cardiovascular disease. Consuming too little dietary fat (less than 15 percent of total calories), having high triglycerides, being overweight or obese, and having hyperglycemia or diabetes all contribute to low HDL levels.

Almost all the lipids found in foods and in our bodies are in the form of triglycerides (made up of a molecule of glycerol attached to three fatty acids). Having a high triglyceride level increases the risk of cardiovascular diseases. Uncontrolled diabetes, kidney or thyroid problems, or a diet that’s low in protein and high in refined carbohydrates or alcohol can contribute to high triglyceride levels.

Some experts recommend using a ratio of total cholesterol to HDL cholesterol to estimate risk of cardiovascular disease. The goal is to keep your ratio below 5:1, but 3.5:1 is considered desirable. The National Cholesterol Education Program (NCEP) recommends that the following children be screened for high cholesterol starting at age 2 but no later than age 10:

• Those with a parent whose total cholesterol level is > 240 mg/dL
• Those with a family history of cardiovascular disease before age 55 in men and 65 in women
• Those who are overweight or obese or have diabetes, high blood pressure, or other risk factors

Children with “acceptable” cholesterol levels should be rechecked in 3-5 years; those with “borderline” levels should have their levels rechecked in 1 year.

Two other measurements that can be useful in determining a person’s cardiovascular risk include C-reactive protein (CRP) and homocysteine.

C-reactive protein is one of the proteins release by the body in response to an injury, an infection, or anything that causes inflammation. There’s evidence that high CRP levels predict future heart attacks or other cardiovascular events. A blood test called a high sensitivity C-reactie protein (hsCRP) assay is currently available. This test is used with people who have already suffered from a cardiovascular “event” (e.g., heart attack, stroke) to predict their risk for additional events or in those at high risk for them. If after consulting with a doctor you decide to have your hsCRP measured, what your values indicate:

• hsCRP < 1.0 mg/L – Low risk for cardiocascualr disease • hsCRP between 1.0 and 3.0 mg/L – Average risk for cardiovascular disease • hsCRP > 3.0 mg/L – High risk of cardiovascular disease

it’s important to note that those with autoimmune diseases, cancer, or other infectious diseases can have falsely elevated hsCRP levels.

Homocysteine is an amino acid that may provide you with a glimpse of your future risk for cardiovascular disease. Recent research has linked high homocysteine levels to a greater incidence of stroke and chronic heart failure, increased death from cardiovascular disease and other adverse diseases and conditions. Although population-wide testing of homocysteine levels is not currently recommended by the American Heart Association (AHA), many researchers and practitioners believe it can be quite useful for those at high risk for cardiovascular disease; discuss it with your physician.