Nutrition and Wellness Exam #1 Part 2

What artery is known as the widow maker?

left anterior descending artery (coronary)

What causes damage to the endothelium?

dyslipidemia (especially high LDL), chronic hypertension, and smoking/vaping

How does artherosclerosis develop?

LDL particles enter artery wall (happens most when LDL is high and/or the artery wall is injured) - get stuck

monocytes follow LDL and turn into macrophages that eat oxidized cholesterol in the LDLs

inflammation occurs

further artery wall injury and plaque accumulation

Vessel narrowing and stiffening

Possible rupture → complete blockage or thrombosis

What factors increase the arterial wall permeability to LDL?

hypertension, smoking, genetics, atherosclerosis, and small size of LDL

Possible results of atherosclerosis

clot, ischemia, intermittent claudication (pain caused by too little blood flow; mostly during exercise), and aneurysm

What is a prospective cohort study?

observational, forward looking

Assesses a person’s diet/lifestyle at a given point and follows them over time to see who develops condition(s) of interest

What does eating meat do to your risk of dying from CHD?

increases it

What does eating nut >4x a week do to your risk of IHD?

linked to lowering it

What results were seen in non-SDA cohorts of vegetarian diets in reference to CVD?

mixed, likely from small number of vegetarians and large variations in diet/life style

What effect does eating meat have on dying of CVD?

dose-response increase in risk of dying from CVD

Normal and optimal total cholesterol levels

N: <200 mg/dL

O: <150

Normal and optimal LDL-C

N: <100 mg/dL

O: lower is better

Normal and optimal HDL - C

N: >50 for women and >40 for women

O: >60

Normal and optimal triglycerides

N: <150

O: <150

What is lipoprotein(a)?

extra sticky LDL

LDL particle bound to a molecule of apoprotein(a)

Risk factor for ASCVD

What raises LDL-C levels?

saturated fat, trans fat, dietary cholesterol, and obesity

Major sources of saturated fat

cheese, ice cream, eggs, burritos/tacos, chicken, butter and animal fats, burgers, cakes and pies, nuts/seeds

Major sources of trans fat

hamburger, butter, cheese, and margarine

Nutrients that decrease LDL-C

mono- and polyunsatsurated fats, soluble fiber, nuts and plant sterols

Why does central adiposity increase the risk for ASCVD?

increases inflammation and release of adipocytokines → damages endothelium of arteries → plaque progression and instability

Why does T2D increase the risk for ASCVD?

high blood sugar → inflammation and oxidative stress

Why does hypertension increase the risk for ASCVD?

injuries to artery walls → atherosclerosis

How do leafy greens compensate for enothelial dysfunction?

healthy enothelium makes nitric oxide that protects the artery walls

leafy green veggies and beets have nitrates that the body turns into NO via a pathway that bypasses the enothelium

Why does inflammation increase the risk for ASCVD?

injury to artery → WBC respond → inflammation and plaque formation

Common biomarkers for inflammation

C-reactive protein, interleukin-6, and tumor necrosis factor alpha (TNF-alpha)

How can diet help with LDL oxidation?

Oxidized LDL promotes plaque formation → antioxidant vitamins and phytonutritents in plant food protect LDL (supplements do not work)

What are some non-food, modifiable risk factors for ASCVD?

drinking, smoking, inactivity, loneliness/social isolation

What are some non-food, non-modifiable risk factors for ASCVD?

family history, age, race, and sex

How do statins work?

decrease production of cholesterol in the liver

DASH diet

low fat, low sodium, low-fat dairy products, and high veggies/fruits

Modified to include meat for acceptance

Lowers LDL by 6 mg/dL and hypertension

Mediterranean diet and CVD

little effect on LDL-C

lower risk of CVD

Portfolio diet and CVD

designed to lower LDL-C

very-low-saturated-fat vegetarian diet plus: margarine with plant sterols, viscous fibers (oats, barley, okra, egg plant), soy protein, and almonds

More effective than low-sat-fat diet alone; may be as effective as adding a statin

Stanford twin study

one twin healthy vegan diet; other twin healthy omnivorous diet

vegan twin had lower LDL, fasting insulin, and body weight

Dean Ornish diet

very-low-fat vegetarian diet

less than 10% calories from fat, whole foods, no calorie restriction

only animal products: egg white and 1 c nonfat milk or yogurt daily

10-15% protein, 70-75% complex carbs

<5 mg cholesterol per day

no salt restrictions unless HTN

no caffeine, </= 2 alcoholic drinks

supplement B12

What percentage of calories come from fat in the Dean Ornish diet?

less than 10%

Lifestyle element of Dean Ornish diet

moderate aerobic exercise (walking), stress management training, no smoking, and group psychosocial support

What was the result of the Dean Ornish study?

experimental group had less clogged (reversal) arteries and less cardiovascular events

control group had arteries that had clogged more and more cardiovascular events

Esselstyn Heart Disease Program (Cleveland Clinic)

Very-Low-Fat, Whole-Food, Vegan Diet

fat = less than 10% of calories

included multivitamin and B12

avoid added oils/processed foods with them, avacado, nuts, excess sugar, and caffine

exercise encourage - not required

Some patient’s experienced reversal; majority stable or improved

10 nutrition tips for cardiovascular health

favor whole-food, plant-based diets

minimize saturated fat

avoid trans fat (occur in animal products and deep fried foods)

include portfolio foods (viscous fiber, soy products, nuts and seeds, and sterol-enriched margarine)

dark leafy greens daily

colorful produce

beans

nuts in moderation

minimize sugar-sweetened drinks

if drink coffee, make it filtered

Benefits of the Mediterranean Diet and CHD in people at high risk (Primary prevention)

slightly lower LDL-C, lower # of strokes

not significant reduction in CVD mortality

Benefits of the Mediterranean Diet and CHD in people with CVD (secondary prevention)

reduced risk of CVD mortality

little effect on blood lipids or BP vs other healthy diets

Advantages of Mediterranean diets

lower risk of stroke, obesity/metabolic syndrome, cancer, alzheimer’s, parkinsons’s

Linked to longevity, healthier aging, and slowed cognitive decline

Why is olive oil a “healthier for you” fat?

monounsaturated fat, low in saturated fat, polyphenolics, antioxidants, and high smoke point

What do polyphenolics do?

antioxidants, anti-inflammatory, anti-thrombotic, inhibits LDL-oxidation, improves endothelial function

Does adding extra-virgin olive oil to your diet help you lower your LDL?

may have some positive effect, but on a vegan diet, may decrease LDL lowering power

need more research

How much nuts/seeds should we eat a day?

1 oz (1/4 cup or small handful) 4+ times a week

How do regular American, whole-food plant based, and Mediterranean diets rank on protecting the heart?

WFPB > Mediterranean > typical American

How does nut consumption impact CVD risk?

lowers it

What are legumes?

plants of the leguminosae family

What are the three types of legumes?

fresh legumes: used as veggies; green beans, snow peas

oilseed legumes: peanuts and soybeans

pulses: dried seeds, eaten cooked; beans, split peas, lentils, and chickpeas

Nutritional make-up of pulses?

21-26% calories from protein

low in fat (5% of calories)

rich in complex carbs (low glycemic index)

high in fiber

What foods are high vs low in methionin, cysteine, and lysine?

pulses: methionine and cysteine low; lysine high

grains: methionine and cysteine high; lysine low

What are phytic acid (phytate) and lectins?

anti-nutrients in beans

phytate bind minerals, but it’s also an antioxidant that may lower risk of caner, kidney stones, and CVD

Lectin can cause GI issues, but proper cooking deactivates

How much protein is in one servings of beans? (how big is the serving?)

1 cup of beans = 7-8 g of protein

How to minimize the effects of anti-nutrients in pulses?

soak, cooks, sprouting, and fermenting

Eating beans with vit-c rich foods enhance non-heme iron absorption

What micronutrients are pulses high in?

folate, other b-vitamins, iron, zinc, magnesium, potassium, calcium, polyphenols, and saponin

What are the benefits of diets lower in methionine? What kind of diet is lower?

more legumes and less animal products

lower methionine intake may reduce oxidative stress leading to lower rates of chronic disease and increased longevity in vegetarians and vegans

How does legume intake related to longevity in older adults?

higher bean intake = most important predictor of survival

every 20 g of beans daily = 8% decrease in risk of premature death

Effects of pulses on metabolic syndrome, hypertension, cardiovascular disease, obesity, T2D diabetes, cancer risk (colorectal and pancreatic)

lower risk of everything

hypertension - modest reduction

legumes are largely related to weight loss, more than other vegetarian whole foods

Tips for preparing pulses

sort and rinse, optional soak, pressure cooking, boil for 10 minutes then simmer, canned beans

slow cooking not recommended

People who should not eat beans

IBS: assess tolerance

CKD and dialysis: if they have potassium issues

Sources of DHA, EPA, and ALA

ALA: walnuts, flax seeds, chia seeds

DHA and EPA: fatty fish/fish oil, krill, algae, and fortified foods

Benefits of omega-3s

lower risk of heart disease, depression, dementia, and arthritis

your body cannot make them

Inuit paradox issues

study was flawed, traditional Inuit have the same or higher rates of heart disease, more strokes, and shorter life expectancy

What part of the body are omega-3s especially important for?

brain - especially during development and aging

What were omega-3s shown to have an effect on?

10% lower CHD mortality and 9% lower CHD events

What do omega-3 supplements increase the risk of? At what dose?

a-fib, >1,000 mg daily

Pregnancy omega-3 recommendations

8-12 oz/week of low mercury sea food

add an extra 100-200 mg DHA/d to the normal 250/day

Vegetarian sources of Omega-3s

plant foods contain ALA: especially flax seed, walnuts, canola oil, wheat germ oil, soy oil, soybeans, pecans

Supplements of DHA for pregnant/lactating

Normal veg/vegans can supplement with DHA and EPA to optimize levels, but not essential

(Algae supplements)