Don't be so inflammatory!
Over one half of individuals with heart attacks have normal cholesterol levels. So why are these people getting heart attacks? When your body is subject to trauma, injury or infection it sets off a cascade of immunologic responses which collectively is called inflammation. Acutely inflammation heals but in the chronic setting it can accelerate aging and promote a host of diseases.
We can measure inflammation with a sensitive blood test called CRP which stands for C reactive protein. CRP is actually a stronger predictor of heart attacks than traditionally used cholesterol levels. Individuals who have higher blood CRP levels are at increased risk for not only for heart disease but also cancer, stroke, dementia, and diabetes. Higher CRP levels are also found in individuals suffering from depression.
So what causes inflammation? Smoking stokes inflammatory processes so it comes as no surprise that it is a risk factor for a host of chronic diseases including heart disease and cancer. Adipose (fat) tissue releases pro-inflammatory cytokines so any extra weight you may be carrying will accelerate aging. Chronic diseases such as periodontal disease have also been associated with increased inflammation and heart disease.
Things that lower inflammation include aspirin which we know lowers your risk of heart disease, stroke and even colon cancer. Statin drugs not only lower cholesterol levels but also decrease CRP levels so this may be an unexpected mechanism by which these drugs work to help lower heart disease risk. Exercise and losing any extra pounds will also help you drop CRP levels and inflammation.
I'll take that anti-inflammatory please
But let's get to the food shall we? Foods that will help reduce inflammation include fruits and vegetables, whole grains, spices and omega-3 fats.
By now we have all heard that moderate drinking plays a protective role against heart disease. Moderate levels of drinking, about 1 drink per day, is associated with lower CRP values. Alcohol's anti-inflammatory effects may be at least partly responsible for its cardio-protective effects. However, more frequent drinking is associated with higher CRP levels and an increased risk of heart disease. As with life, moderation is the rule to live by.
The bad actors that incite inflammation and disease include refined carbohydrates, saturated fats, and trans-fats. You have all heard the popular refrain "good fats, bad fats" well I want to tell you that trans fats are pure evil. Trans fats will raise bad cholesterol, LDL, and lower good cholesterol, HDL. Just a 2% reduction in trans fat consumption has been associated with a 95% risk reduction in heart disease.
So where do you find trans fats? Everywhere. They are found in practically every baked good you buy and fried food you eat. Trans-fats are beloved by food manufacturers because they extend shelf life. A tub of shortening will last you well into the next century. Unfortunately the same can not be said of your coronaries. Look on the label of the foods you buy and anything that says "hydrogenated" or "partially hydrogenated" is a trans fat and should be avoided like the plague. The FDA has mandated that all nutrition labels have trans fat listed along with the saturated fat content of a product. However, trans-fat does not have to be listed on the nutrition panel if the product has less than 0.5 grams per serving which is why it is important to always read the list of ingredients. The next time you wander the supermarket aisle read some labels and see for yourself just how pervasive trans fats are.
Inflammatory Carbs, Non-inflammatory Carbs
Traditional thinking held that complex carbs such as potatoes and starches were good because they were "complex" and slowly digested. Simple sugars were bad because they were quickly digested. While this made sense in theory, it did not play out in the real world. A baked potato, for instance, will raise your blood sugar more profoundly than eating pure cane sugar.
Help was on the way. Dr. David Jenkins, from the University of Toronto, actually started to measure blood sugar levels of individuals fed different carbohydrates. He than ranked carbs based on this blood sugar response and called it the glycemic index. Generally, the more processed or refined a carbohydrate is, the more quickly it is converted into blood glucose and the higher its glycemic index. White bread has a high glycemic index: it is made from processed white flour that has the protective fiber removed and is more readily digested and converted into sugar. Wheat bread that is made from stone ground whole wheat leaves part of the protective fiber intact and slows digestion resulting in lower blood sugar levels and a lower glycemic index.
The drawback of the glycemic index is that it does not take serving size into consideration so a more practical reference is the glycemic load (GL). Some popular diet plans did not realize this short coming and started to make ridiculous recommendations based on glycemic index alone. One was to avoid carrots. As Bugs Bunny enjoying the beaches of South Beach would say "what's up doc?" Besides being high in beneficial beta-carotene, carrots actually have a very minimal impact on your blood sugar despite a high glycemic index.
To better understand why glycemic load is a better measure of a carbs impact on blood sugar, let's continue with the carrot example. While carrots have a high GI (93), that number is based on eight or 10 fasting subjects who had to eat 1 ½ pounds of carrots because it takes that that many carrots to total 50 grams of digestible carbohydrates. Fifty grams is the reference amount of carbs used to measure the Glycemic index of each food and since carrots have very little carbs you have to eat 1 ½ lbs to get to this reference amount. When you consider serving size (nobody is going to eat 1 ½ lbs of carrots at a sitting), carrots' impact on your blood sugar is actually very low. This is reflected by a very low glycemic load of 4 for carrots (a glycemic load below 10 is considered low). This is good news for watermelon too; although the GI is high, at 72, the GL for a four-ounce serving is also low at 4. Do you really think you are going to develop love handles by eating carrots? That said I would focus on the glycemic load and not the glycemic index.
So why all this talk about blood sugar? The higher the glycemic the diet, the more insulin is released leading to a pro-inflammatory state and higher levels of CRP. By elevating your blood sugar, high glycemic foods also promote oxygen free radical processes. Free radicals are highly reactive molecules which can damage DNA, cause cancer growth and incite more inflammation.
Americans are gorging themselves on high glycemic, pro-inflammatory sugars and refined carbohydrates; yeast bread comprises 15% of total carbohydrates, soft drinks/soda 9%, cakes/cookies/quick breads/doughnuts 7%, sugar/syrup/jams 6%, white potatoes 5% and ready-to-eat cereal 5%. These high glycemic diets have been linked to an increased risk of developing heart disease and diabetes. They also adversely affect cardiac risk markers by lowering HDL (good cholesterol) and elevating LDL (bad cholesterol).
If you look at Glycemic Load values you'll notice that vegetables, fruits, and whole grain products have low values, and refined foods have high values. Don't get hung up all the numbers, just remember that eliminating highly processed foods and replacing them with whole or minimally processed foods such as vegetables and fruits are a great way to control blood sugar and to lower CRP levels. Diets rich in low glycemic foods are associated with less inflammation, lower CRP levels and a reduced incidence of heart disease, stroke, diabetes and cancer.