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Less of This, More of That: Diet and Heart Failure
There are several major risk factors for heart failure, and all of them are related to diet: coronary artery disease, high blood pressure, insulin resistance or diabetes, and obesity. Lots of studies look at what we call micronutrients, such as specific vitamins or fiber or types of fats, but fewer seem to focus on more practical food choices. Regular or low-fat dairy? Eggs or no eggs? Worse, many studies have been limited to whites or to men or both.
The True "Heart Attack Proof" Diet
A couple of months ago a reader asked me for my opinion of Dr. Esselstyn's 'Heart Attack Proof' diet. This is essentially an extremely-low-fat diet that completely eliminates meat, fish, dairy, and all oils, including nuts. On the one hand, we know that extremely-low-fat diets are not the magic bullet in preventing heart disease that it once was thought to be (JAMA. 2006;295:655-666). On the other, adhering to this diet is extremely difficult for most people: simply avoiding any oil whatsoever (you can't use oil in pasta sauces, breads, or salad dressings, just as a start) is pretty difficult.
Shopping The Edges of the Grocery Store: Good For You or Myth?
I was thinking about the idea that shopping around the edges of the grocery store is better for you. It's an idea that makes sense on the face of it. You start in the fresh produce section, make your way along to the fish counter, maybe pick up some fresh meat or dairy products and then to the bakery counter. I even had a group of the first year medical students suggest this as a healthy strategy in a recent student project, but upon closer inspection I think that using this as a general suggestion does folks a disservice.
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Nutritionists and doctors have been saying for years to limite your intake of red meat. Certainly if you've used The Dr. Gourmet Diet Plan to plan your meals, you've seen that I recommend that you limit yourself to one red meat meal per week. In terms of nutrition, "red meat" includes unprocessed beef, pork and lamb. (Pork is not the "other white meat"!) "Processed meats" include items such as hot dogs, salami, bacon and other cured meats. These recommendations follow Mediterranean Diet guidelines that suggest that you limit the amount of red meat you eat and instead eat more fish and vegetarian meals. The issue, it has been said, is that eating red meat is associated with higher risk of heart disease, stroke and diabetes, along with certain types of cancers.
A recent study published in the journal of the American Heart Association, Circulation, takes a closer look at the connection between red meat, processed meats, and heart disease and diabetes (2010;121(21):2271-2283). With funding from The Bill and Melinda Gates Foundation and the National Institute of Health, among others, researchers from Harvard Medical School reviewed the data from 20 studies of red and processed meat consumption and the link to heart disease and diabetes. These studies included over 1.2 million people who were tracked between 4 and 18 years and provided dietary and health information through detailed questionnaires, telephone interviews, or a combination of both.
The researchers grouped the respondents into rising levels of red meat consumption, from less than 1 serving per week to 1 or more servings per day. They also created similar groups for amounts of processed meats as well as a combination of both red meat and processed meats as a total.
Their findings are particularly striking:
Those who ate 1 serving of red meat per day were at no greater risk of heart disease than those who ate less than 1 serving per week. The same was true of the risk of diabetes.
Each serving of processed meat (bacon, salami, hot dogs, etc.) eaten per day led to a 42% increase in risk of heart disease and a 19% increase in risk of diabetes.
Each serving per day of meat, both processed and unprocessed, tended to show a higher risk of heart disease, but these findings were strongly skewed by two studies. If those two studies were excluded, the risk fell to near normal. The risk of diabetes rose 12% for each serving of all types of meat (both red and processed, but not including poultry or fish).
One critical little item, here: the researchers defined 1 serving of red meat to be 100 grams. One serving of processed meat, however, was defined as just half that size: 50 grams. While this is not a license to eat red meat every day, it's clear that having red meat a couple of times a week is far better for you than having processed meats, such as bacon and hot dogs, every day. Better to save them for special occasions.
First posted: May 19, 2010