"Functional foods," "nutraceuticals," "designer
foods" and "medicinal foods" are terms that describe
foods, and key ingredients isolated from foods, that have non-nutritive
or tertiary functional properties. Researchers, healthcare practitioners,
laypersons, and the popular media use these words interchangeably.
The purpose of this article is to detail valid scientific and pertinent
clinical information on whole foods and accompanying lifestyle modifications
recognized for their ability to prevent and treat cardiovascular disease
Whole Food Therapeutics and Lifestyle Change in the Treatment of Cardiovascular
Disease in Men
Guest Author, David Minzel, PhD, CNC
An Enormous Problem
Simply and tragically, there are no statistics in health care today
more staggering than those for cardiovascular disease (CVD). According
to current estimates,
61.8 million Americans have one or more types of cardiovascular disease.1
Thirty million men, or one in five, suffer from high blood pressure, coronary
artery disease, myocardial infarction, angina pectoris, stroke, congenital
cardiovascular defects, or congestive heart failure.
CVD claimed 958,775 American lives in 1999, according to the American Heart
Association.2 That is the equivalent of more than 2,600 deaths each day from
CVD, or an average of one death every 33 seconds; 46.5% of these deaths, about
one every minute, were in men. Deaths associated with CVD are by far the number
one cause of death, not only in the US, but globally as well. CVD claims more
lives annually than the next seven leading causes of death combined.
Since 1900, CVD has been the top killer in the
United States every year except
1918 (when World War I was the top killer).2 Although the death rate (number
of deaths per 100,000 people) from CVD declined from 1989 to 1999, the total
number of deaths actually increased by over 2% during that period.
Based on data from the National Heart, Lung, and Blood Institute,3 there
has been an alarming increase in sudden cardiac deaths – 50% of men with
CVD die suddenly from heart failure, without any previous symptoms of disease,3
making it difficult to diagnose and prevent. A large number of men who are
diagnosed with CVD require long-term medical care and hospitalization. Although
25% of these men will die within the first year following an initial recognized
myocardial infarction,3 the annual direct and indirect costs of treatment for
cardiovascular diseases in the U.S. were estimated to be $329.2 billion dollars
in 2002.2 (This figure includes the cost of physicians and other professionals,
hospital and nursing home services, medications, home health care and other
medical durables, and lost productivity resulting from morbidity and mortality).
By comparison, the estimated medical costs for all cancers in 2001 was $156.7
billion and the estimated costs for treating HIV infection was $28.9 billion.
Conventional Medical Intervention
Medical intervention for these coronary
diseases has focused on downstream treatment with cardiovascular procedures
like cardiac catheterization, coronary
artery bypass surgery, heart transplants, and percutaneous transluminal coronary
angioplasty (so-called "balloon angioplasty"). Additionally,
CVD symptoms are treated with targeted pharmaceutical drug interventions.
The number of cardiovascular operations and procedures performed each year
has increased over 400% from 1979-1999,2 and of the top 25 prescribed medications
in 2001, seven were for the treatment of problems associated with CVD, such
as high cholesterol and high blood pressure.4 The National Committee for
Quality Assurance has emphasized prevention and treatment of cardiovascular
diseases by advising smokers to quit, promoting the use of beta blocking
medications following a heart attack, and recommending cholesterol and high
blood pressure control in patients with coronary artery disease.5 Yet clearly
the enormous number of deaths associated with CVD warrants more investigation
into the prevention and treatment of CVD.
Answers to reducing the overall incidence of cardiovascular disease and death
cannot lie only in developing costly complex technological treatments and procedures
to alleviate the symptoms and end results of the disease state. The health
care profession must focus its attention on prevention of CVD before it begins,
and assist individuals in taking deeper responsibility for their health through
lifestyle, diet, and education.
Time for a New Approach?
It seems reasonable to ask:
• If the conventional medical approach to CVD treatment is failing to
stop the ravages of the disease, is there a better way?
• What do we know about the relationship of diet to the risk of heart
• Can dietary and/or supplement therapies help lower the risks or reverse
the progression of CVD?
• What part does genetics and family history play in CVD?
• Can dietary and nutrient therapeutics change the risk-associated genetic
expressions of heart disease? Can we more effectively treat these diseases
by affecting biochemical processes upstream of the genetic expression
• What part does lifestyle play in the development and prevention of
Smoking, Dietary Change, CVD, Deaths and Cost
Twenty-five million American men over 18 years of age are smokers, and therefore
at increased risk for heart attacks and strokes. About one in five deaths
from CVD is attributed to smoking with an annual estimated cost for medical
care of $130 billion.6 This would suggest that a recommendation by health
care practitioners for their patients to quit smoking would be a very high
priority. Yet in 1996, only 61% of smokers were advised to quit smoking by
their health care practitioners and that number had only increased to 65%
It has been estimated that reducing meat intake, increasing intake of antioxidant-rich
fruits and vegetables, eating fiber-rich complex carbohydrates, and consuming
low-fat dairy products can reduce CVD risk by as much as 90%.7,8 This
suggests other recommendations that health care practitioners might make to
to alleviate the health care burden of CVD. At best, however, doctors promote
the common "Food Pyramid," a dietary recommendation system where
simple, low-fiber carbohydrates are the staple of the diet. The Food Pyramid,
incidentally, was devised by General Mills, a company that manufactures food
products consisting largely of refined, simple carbohydrates.
The impact of CVD is not limited to mortality. Thus, men in their prime productive
years (40-60 years old) are often crippled by CVD, unable to work and enjoy
life, resulting in enormous social and economic losses. CVD is the single largest
contributor to permanent disability in male workers under the age of 65 and
is responsible for more hospitalization days than any other illness.2
If dietary and lifestyle changes alone could prevent lives from being prematurely
ruined or lost, and at the same time reduce the enormous health care costs
of CVD, it would provide hope that this tragic disease could be prevented and
Dietary Nutrient Insufficiency
Data from the Third National Health and Nutrition Examination Survey of 1988-19949
clearly shows serious dietary and nutrient deficits in certain populations
in the US. More than 10 million people in the US often do not have enough
food to eat, leaving them at great risk for the development of nutrition-related
health problems. The NHANES III study revealed many cardiovascular risks
for the older population. Nearly 90% of Americans over the age of 65 have
been found to have one or more nutrition-related cardiovascular risk factors.10
The future development of nutrition-related cardiovascular risk factors in
children seems assured unless measures are taken to prevent it. Researchers
studying over 3000 children in the U.S. ranging in ages from 2-19 found only
1% met all recommendations for food group and nutrient intake.11
Of the leading risk factors for the development of CVD, diet and lifestyle
are at or near the top of the list. With clear dietary and nutrient insufficiency
occurring, the place to begin prevention of CVD is with the intake of real,
Amino Acid Composition of Diet and CVD
The amino acid composition of dietary intake contributes to the modulation
of arterial physiology. Soy protein intake containing a high arginine-to-lysine
ratio has been shown to produce lower postprandial insulin-to-glucagon ratios
and lower serum cholesterol than casein intake, higher in lysine that produces
high insulin-to-glucagon ratios and an increase in serum cholesterol levels.12,13
More importantly, the arginine-rich protein intake modulated the concentration
of low-density lipoprotein (LDL) which has been shown to increase the production
of nitrous oxide (NO) that beneficially alters arterial compliance, LDL inhibiting
the formation of NO.13,14 A change to a more plant-based diet then, higher
in arginine, may contribute to improved arterial health and a reduction in
CVD and hypertension.
Calcium and High Blood Pressure
Hypertension, or high blood pressure (HBP), was listed as a primary cause of
death on the death certificates of over 42,000 Americans in 1999, and was
a contributing cause of death in over 225,000. A higher percentage of men
than women have HBP until the age of 55, when the percentage of women is
slightly higher. The 1999 mortality numbers in the US showed 17,194 male
deaths associated to HBP, 40% of the total deaths from HBP.2
Epidemiological studies show that people consuming low calcium-rich diets exhibit
a higher incidence of HBP,15,16 and data from the Health and Nutrition Examination
Survey I undertaken by the National Center for Health Statistics revealed that
people with HBP consumed less dietary calcium than those with normal blood
Magnesium and HBP
A number of studies have shown that increased dietary magnesium is associated
with lower blood pressure.18-20 The principal source of magnesium is water
and an inverse correlation has been found between water hardness due to magnesium
and blood pressure. Additional dietary studies have looked at the association
between HBP and magnesium intake from food. High blood pressure was found
to be lower in segments of the population for which dietary magnesium levels
Investigative trials on magnesium supplementation, however, have yielded
mixed results, suggesting that food sources of magnesium may be more beneficial
supplements. There are likely numerous nutrients in whole foods that complement
magnesium's anti-HBP role, making dietary magnesium more useful than
elemental supplements in fighting the disease. Some of the richest food sources
of magnesium are:
• Wheat Bran
• Wheat Germ
• Blackstrap molasses
• Beet greens
Potassium and HBP
Many studies show that potassium deficiency in the diet leads to HBP and ultimately
CVD.22-28 Increasing dietary intakes of potassium-rich foods can lower blood
pressure.22,28-30 A wide variety of foods are rich in potassium, particularly
fruits and vegetables, suggesting that a diet rich in potassium may help
decrease the risk of developing HBP.
Potassium has shown efficacy in treating and reducing HBP31,32 and the results
compare favorably with drug treatments for HBP without the negative side effects
often associated with these medications.33 Some of the richest food sources
of potassium are:
• Sunflower seeds
• Wheat germ
• Swiss chard
Fish Oils & Coronary Artery Disease
Coronary artery disease (CAD) is the advanced form of atherosclerosis of the
arteries that supply blood and oxygen to the heart muscle itself. Long-term
damage to vascular biology leads to eventual blockage of these arteries,
diminishing the blood and oxygen supply to the heart and damaging heart tissue.
This damage further diminishes the supply of oxygen and nutrients to the
heart, eventually leading to heart attack or myocardial infarction (MI).
Whole food and nutrient therapies have been aimed at lowering platelet aggregation
or interrupting the biochemical chain of events that leads to atherosclerosis.
Many studies have clearly shown the beneficial effects of consuming fish,
fish oils, and flaxseed oil.34-35 The antiatherosclerotic effect of these
foods has been attributed to the high levels of omega-3 fatty acids they
contain, which inhibit or delay thrombus formation by reducing platelet aggregation
and oxidative stress-related arterial injury. Recent trials have shown a
modest reduction in atherosclerotic plaque formation and hypertension with
intake of omega-3 fatty acid-rich fish oils.36
Garlic & CAD
Dietary intake or supplementation with garlic has been effectively used to
reduce the incidence of CAD by inhibiting platelet aggregation.37 Other
foods," foods considered physiologically active, provide health benefits
beyond basic nutrition and have been found to be potentially beneficial in
the prevention and treatment of cardiovascular disease. These foods include
soybeans, oats, Psyllium, flaxseed, garlic, tea, fish, grapes, and nuts,
which act to improve arterial compliance, reduce low-density lipoprotein
oxidation, decrease plaque formation, scavenge free radicals, and inhibit
LDL, or low-density lipoprotein, cholesterol is one of three major lipoproteins
in the body and is the primary way in which cholesterol manufactured in the
liver and absorbed through the intestinal lining is transported to cells.
LDL is the major source of cholesterol in atherosclerotic plaques. As a result,
elevations in LDL-cholesterol are associated with the development of atherosclerosis
and significant increases in the risk of developing CVD. Researchers in the
Lipid Research Clinics Coronary Primary Prevention Trial38 found that with
a 10-15% reduction in dietary LDL levels, the estimated incidence of heart
attacks declined by approximately 20-30%.38
Oxidation of LDL plays a major role in the development of atherosclerosis because
it is far more reactive than unaltered LDL. Oxidation of LDL is a significant
step in the process of vascular damage. There are basically two ways to reduce
the damaging effects of oxidized LDL. One is to reduce the amount of LDL in
the bloodstream by decreasing dietary fat intake. The other way is to increase
the intake of antioxidant-rich fruits and vegetables that have been shown in
animal and human studies to reduce the oxidation of LDL by at least 30%.39-41
A number of food substances have shown efficacy in reducing levels of LDL in
human trials, including fish and flax seed oil,42-43 garlic,44-45 lecithin,46
and fiber.47-49 Increasing physical activity/exercise and decreasing smoking,
excess alcohol, and coffee consumption have by far the greatest effect in lowering
excess LDL and oxidative stress associated with vascular damage.50-57
In this author's opinion, optimal cardiovascular health lies not in post
facto treatment of downstream biochemical events after a lifetime of poor diet
and poor lifestyle, but in the early optimization and customization to the
patient of the diet and lifestyle through education from those of us in the
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