Dr Dingle's Blog / cholesterol
A recent large study of 2500 participants (mean age 66 years, 54% women), a higher Omega-3 Index was associated with significantly lower risks for total mortality, for non-CVD and non-cancer mortality, and for total CVD events. Those in the highest omega 3 levels compared to those in the lowest had a 34% lower risk for death from any cause and 39% lower risk for incident CVD. These associations were generally stronger for docosahexaenoic acid than for eicosapentaenoic acid. When total cholesterol was compared it was not significantly related with the health outcomes.
Early studies in the 1980s investigating Greenland Eskimos began the research into the benefits of the omega 3 fatty acids. In Greenland, the fatty acid intake from seafood is high and there is a lower prevalence of autoimmune and inflammatory conditions. Omega 3 has been shown in many studies to help inhibit and even reverse inflammation. The omega 3 fatty acids found in walnuts, flaxseed, butternuts, and fish oils have anti-inflammatory properties, decreasing the amount of arachidonic acid in cell membranes.
Several recent studies have linked higher blood levels and/or dietary intakes of the long-chain n-3 polyunsaturated fatty acids (PUFAs) with greater longevity. Blood omega 3 levels were inversely associated with total mortality rates in the Cardiovascular Health Study, and similar results were seen in the Heart and Soul Study. Consistent with this, there is an inverse relationship between the Omega-3 Index and the rate of telomere attrition, a marker of cellular aging.
Omega 3 fatty acids work through a number of mechanisms, each having different effects, to reduce inflammation. As well recent studies suggest that some of the beneficial effects of fish oil are due, in part, to their antioxidant benefit.
I have been researching and writing on cholesterol and statin drugs for more than 10 years and millions of people still take them. Cholesterol is not the killer it is inflammation, oxidation and acidosis. No one has ever died from cholesterol. It is associated with CVD but not the cause. So if you lower cholesterol you do not lower the risk of CVD more than 1%.
The statin drugs are at best ineffective but in reality are dangerous. The real cause of heart attacks and strokes, Cardiovascular disease is inflammation and oxidation. If you want to lower your risk of these conditions lower your inflammation, oxidation and acidosis.
In support of this a recent study out of Oxford University showed that one apple a day out performs the statin drugs without the side effects of diabetes, muscle disease, dementia and other serous side effects.
Using mathematical modelling, the researchers say that eating an apple a day could prevent 8,500 deaths from heart disease every year if 70 per cent of the total population of over-50s ate one, compared to 9,400 saved lives if everyone took a statin.
Source: BMJ, 2013; 347: f7267. A statin a day keeps the doctor away: comparative proverb assessment modelling study. BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7267
While another study in the Journal of Functional Foods back in 2012 found the consumption of just one apple/day for 4 weeks drastically lowered plasma concentrations of oxidized low-density lipoprotein and showed that an easily accomplished dietary intervention had a major effect on an atherosclerosis risk factor, in part via polyphenols. (http://dx.doi.org/10.1016/j.jff.2012.08.010)
Unlike stain drugs apples are full of nutrients that lower inflammation and your risk of all forms of chronic illness.
Apples are rich in polyphenols, which provide antioxidant and anti inflammatory properties and modulation of gut microbiota.
Cholesterol is not the killer it is inflammation.
For information on inflammation and how to lower it
The current medical model, which focuses on treating the symptoms with toxic pharmaceuticals, rather than preventing illness, is simply not working. We use more drugs than ever before and we are sicker than ever before. Unfortunately, most of us are very sick by the time we recognise we are ill or decide to do anything about our health. It is never too late, but it is more difficult. By comparison, if you have not serviced your car for 20 years, you don’t expect to repair the damage with one oil change.
The key to treating chronic illness is to act sooner rather than later. As the adage goes, “Prevention is better than cure.” You can, however, take important, health-saving steps at any time.
We need a paradigm shift when it comes to our lifestyle and nutrition. Previously we thought of “nutrition” as the Food Pyramid, 2&5, the RDI (recommended daily intake/allowance) of vitamin C, B vitamins, iron and calcium, counting calories and choosing “low-fat” foods. This approach is outdated and extremely dangerous, and in fact is contributing significantly to the level of chronic illness we have today. We need a lot more nutrition and a great deal more variety—not just the minimum amount to prevent scurvy or beriberi, but the right amounts for optimal health.
In the beginning, there were healthy, whole foods and healthy lifestyles; people took responsibility for their own health. Now most of the world is dying from food-related illness. Half the world is dying from not enough food and the other half from too much nutrient-depleted, calorie-dense, contaminated food. Times have changed and so has the way we need to look at food, nutrition and our health. Chronic illnesses such as diabetes, cardiovascular disease and cancer are now the biggest killers in developed countries with the developing world rapidly catching up. Obesity has overtaken smoking as the single biggest cause of avoidable death in many developed countries.
Understanding some basics of chronic illness is the key to fixing the problem. The simplest place to start is with the underlying conditions that lead to chronic illness. This is what I call the “disease triad” of oxidation, inflammation, and acidosis. The triad, which you will read about in this book, is the underlying cause of all chronic illness in our bodies. The root cause of the illness, however, is what causes these three conditions, which are present in every form of chronic illness and prevent the body from healing and recovering. If we reduce them or even stop them from being out of control, then we can allow our bodies to heal. But the more advanced the chronic illness, the more we have to do in order to slow down and rebalance the triad. By the time modern medicine recognises that you have diabetes, blocked arteries or cancer, you have already had possibly decades of high inflammation, oxidation and acidosis.
History tells us that when money is involved the medical establishments will do anything to keep profits and power. Good examples of this include tobacco and alcohol. Most people may not remember but the various medical associations around the world have been prominent supporters of these deadly products in the pursuit of profit. All too often our memories are too short or we think the basic behaviours of people will change.
While evidence of the toxic effects of tobacco smoke has been around for hundreds of years, the correlation between tobacco and cancer was first officially reported in 1939 in a study published in the Journal of the American Medical Association. It took until 1962 before any action was taken. However, even after being exposed, the tobacco industry has continued to survive and even thrive in some places. They even continue to produce evidence to show that tobacco smoke is not bad for you and fund medical and health journals to print these studies.
Prior to 1962, the American Cancer Society would admit only a possible link between smoking and lung cancer and was associated with many aspects of the tobacco industry including marketing products and trying to make a “safer cigarette.” The medical establishments including the AMA continued to back the tobacco industry even under an avalanche of evidence and ran prominent ads in their medical journals. The ACS, like governments around the world today, including state and federal here in Australia, have delayed tobacco controls that could have helped and could still help a lot of people. A prominent Australian premier repeatedly blocked tobacco control legislation in the early 2000s only to take a lucrative position as a director in a major tobacco company when he retired from politics. This political corruption was and still is rampant in all Western nations. I saw firsthand the delaying tactics of governments to introduce tobacco control legislation despite more than 50 years of good science and thousands of studies—even a couple of studies I did with my students.
The U.S. Department of Agriculture to this day continues to support tobacco growing and export to third world nations. This is the same organisation that gave us the food pyramid, which was created for the sole purpose of selling more grain products (at any expense) and classified pizza as a vegetable in 2012 so it could be sold to American schools.
We learnt from smoking. Stop smoking and you reduce mortality and morbidity. It was hard but we educated the public against the vested interests of the tobacco lobby and we started to really win the war on cancer.
Along with the forebears of modern medicine like Hippocrates and Galen, in 1676 Richard Wiseman, a prominent English surgeon, wrote that diet could promote cancer especially the consumption of alcohol and meat. Despite this knowledge hundreds and even thousands of years earlier, for the past three decades health and medical professionals have been promoting wine as a healthful drink based on no science whatsoever and going against more than 50 years of good science.
This myth was started when early studies showed that the highest consumer of saturated fat in Europe was the French but they also has the lowest death rate from cardiovascular disease with four per 100,000 for women and 22 per 100,000 for men. For years this was called the “French paradox,” which I’ll write more about in the chapter on saturated fats. In fact what it showed was that most of the countries in that region had high fat and low CVD so maybe fat was not linked with CVD. This did not fit the current medical myth, as fat and cholesterol were the number one enemies. So they made up a myth and said wine was good for you because the French drink more wine, despite 50 years of good science linking all forms of alcohol with mortality and morbidity. The myth also failed to mention the low-key and relaxed, low-stress lifestyle of the French, the long lunches and sipping on wine over a long meal talking with friends. There are so many factors to consider but wine was the simplest and most easily understood by the public and the most profitable. Very wrong but easily understood. Now, 30 years later the ads tell people that any alcohol is bad for you and we are supposed to ignore the 30 years of poor advice that spawned a generation of people justifying drinking more alcohol.
Similarly the Japanese are one of the longest-lived populations in the world despite their high rates of smoking and stress. They also eat a little bit of fermented soya bean in the form of tempeh and soya sauce. So in the manufacturing of another health myth, the food industry, which was already feeding vast amounts of soya to cattle, along with the medical industry, saw an opportunity to tell everyone to eat more soya products because they contain some “phyto estrogens” and because women in Asia have very low levels of breast cancer. Asian culture has a little bit of fermented soya along with lots of green vegetables and a large amount of fish and seafood including seaweed. Only now we are starting to wake up to the fact that soya milk and soya products are toxic to the body if they are not fermented. Not to mention all the chemicals in our Western lifestyle that mimic oestrogen and that are linked to breast and prostate cancers.
Once started, a myth is hard to break down especially with billions of dollars of funding behind it. But even people with the best intentions can get caught up in it. At one point everyone thought the world was flat and the sun rotated around it. If it were not for science and some very courageous people, some who lost their lives because of their convictions, we would still be thinking the same.
We continually hear about the miracle cure that is just around the corner. Every month a current affairs program introduces the next one. Ninety-nine percent go no further than an initial media blitz and at best one percent have a minimal, if any, effect. But it is an attempt by the drug industry and media to convince the public they need to put more money into research to find a cure—even when we already know how to prevent the illness and in many cases reverse the condition. Unfortunately none of these miracle drugs have ever come to fruition and billions of dollars are wasted, but even more unfortunate is that people don’t hear the real solutions such as healthy nutritious lifestyles.
The drug companies spend billions of dollars trying to convince people that they are sicker than they actually are and are very ill or have an illness that has only just been made up. They seem to be able to turn almost anything into a disease as long as there is a drug to treat it. Suddenly all the normal conditions we suffer and learn to get over are life-threatening illnesses that need to be medicated. We are literally creating diseases that we need to treat with drugs. In psychiatry the new manual, the “DSM-5,” labels practically every human emotion a mental disorder and all those modern disorders require treatment with high-profit pharmaceuticals. Recently they classified caffeine withdrawal, restless leg, and too much online activity each as a disease but not self-harm?
We have created illnesses out of normal conditions and require specialists to manipulate and control some of the most natural aspects of life, such as giving birth, ageing and menopause. Accepting them would be too simple. Better still, we can approach them by making healthy lifestyle and nutrition choices.
Here is another nail in the coffin of the cholesterol theory. For the last 40 years the cholesterol theory (yes theory) has continued to change to suit the growing evidence against it. In science if a theory is disproved it is tossed out. Not this one. It keeps being reborn and of course you are now told it is the oxidized LDL cholesterol. And it is. But the problem is not the cholesterol it is the oxidation which leads to inflammation. Stop the oxidation and stop the inflammation.
The study—which monitored more than 10,000 heart patients—was inspired by the observation that around half of the people who suffer a heart attack have normal cholesterol levels and that lowering cholesterol has no significant reduction in mortality. The study showed that reducing inflammation without affecting lipid (cholesterol) levels reduces the risk of cardiovascular disease.
In the study they used a drug, canakinumab, involving 10,061 patients with previous heart attack (myocardial infarction) and a high-sensitivity C-reactive protein- inflammation. At a follow-up of 3.7 years, the incidence rate for heart attacks was 4.50 percent in the placebo group, 4.11 and about 3.90 percent for the higher dose groups. In medicine this is seen as breakthrough and a 16% reduction. The need for by-pass surgery and angioplasty was also reduced by 30 per cent. Cholesterol-lowering statins have a far lower success rate.
However, Canakinumab was associated with a higher incidence of fatal infection than was placebo, that is one in every 1,000 participants suffered a fatal infection. In other words, 10 people died as a direct result of taking the drug. There was no significant difference in all-cause mortality (canakinumab vs. placebo). The cost of the drug treatment is estimated to be more than $65000 US a year.
Despite the results the take-home message is that it is not cholesterol it is inflammation, cholesterol, is associated with CVD but not the cause. The real take home message is that inflammation is best controlled through diet and lifestyle.
There were 15 million preterm births (PTB) (<37 weeks) worldwide and more than 1 million infant deaths from PTB complications each year. PTB is the leading cause of neonatal death and multiple short and long term health problems.
Multiple epidemiologic studies have found an association between higher levels of vitamin D ( 25-hydroxyvitamin D [25(OH)D] ) and lower PTB risk. In this study of 1,064 pregnancies with an overall rate of PTB of 13% women with higher vitamin D ≥40 ng/mL had a 62% lower risk of PTB compared to those <20 ng/mL. This is an outstanding finding and should be shared with everone
In clinical trials, 4000 IU/day of vitamin D was found to safely achieve a concentration of at least 32 ng/mL by early in the second trimester in a diverse group of pregnant women.
Unfortunately we are told to stay out of the sun and not to eat fat (which is why i recommend against both of these). The two major sources of vitamin D
Vitamin D is one of the essential nutrients required by the human body. Unlike most vitamins, it is one that we can manufacture on our own, given the right conditions. Despite this, vitamin D is showing up increasingly in populations as the most widespread and critical nutrient deficiency; this deficiency is linked to many diseases and disorders, costing billions of dollars each year. Our changing lifestyles, including increased indoor living and campaigns warning people to stay out of the sun have meant that most people don’t get enough vitamin D. The resulting deficiency is compounded by the consumption of modern and processed foods devoid of any vitamin D.
Vitamin D refers to two biologically inactive precursors: D3, also known as cholecalciferol (made from cholesterol), and D2, also known as ergocalciferol. Vitamin D is the only nutrient that can actually be synthesized by the human body, which technically means that it is not a vitamin. The synthesizing of vitamin D in the body can be achieved through contact with solar ultraviolet B radiation emitted by the sun. Without the presence of this solar radiation the only way to get vitamin D is through diet—hence, it is still classified as a “vitamin.”
In addition to vitamin D obtained through UVB exposure to the sun, this vitamin can be found in foods such as eggs, butter and fortified milk, with the highest levels found in fish. Remember, we evolved as fisher- hunter gatherers and fish used to be an essential part of our nutrition. Vitamin D can also be provided by supplements. Numerous studies have concluded that sensible sun exposure and supplementation are the most effective ways of increasing vitamin D levels.
Other deficiencies in vitamin D have been linked with a range of problems with the musculoskeletal system including low bone and muscle problems, as well as cardiovascular disease, diabetes and metabolic syndrome, cancer and impacts on the immune system, Parkinson’s Disease, asthma, pain, and pre eclampsia.
Studies have indicated that vitamin D supplementation may reduce the risk and difficulties associated with autoimmune disorders. In particular, there is strong evidence that vitamin D reduces the risk of multiple sclerosis and type 1 diabetes mellitus, and weaker evidence for rheumatoid arthritis, osteoarthritis, systematic lupus and erythematosusstar. There is no doubt about the link between vitamin D shortage and multiple sclerosis. There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in 1,25-hydroxyvitamin in the blood. Vitamin D deficiency also predisposes to insulin resistance and pancreatic beta cell dysfunction. In a study of 10,366 Finnish children those given 2,000 IU of vitamin D3 per day throughout the first year of life experienced a 78% reduced risk of type 1 diabetes.
Considering the evidence, there is an overwhelming agreement between vitamin D researchers that current recommendations of 200 IU per day for children and adults up to 50 years of age for vitamin D need to be increased to 800 IU to 1000 IU vitamin D3. Numerous studies have shown supplementation to be effective in raising blood levels of Vitamin D levels with no evidence of intoxication reported in either the short- or long-term trial.
Sensible sun exposure (or UVB irradiation) along with supplements are required to satisfy the body's vitamin D requirement. To achieve adequate levels of vitamin D we need to get one to two hours of sensible sun exposure a day. While it is prudent to avoid too much sun it is important to remember that the costs of vitamin D deficiency far outweigh the cost of skin cancer and some sun may also be necessary to reduce skin cancers. Remember, we did evolve in the sun but not all day, especially for those with fair skin.
Many sleep problems but by far the biggest is sleep deprivation and poor sleep. However too much sleep can also be a problem. Over sleeping may also be a problem. In one study sleeping 10 hours or more also increased the mortality rates by one and a half times.
Sleep is as important to the human body as food and water, but most of us don't get enough sleep. Dysoninia (poor sleep) related sleep disorders alone are broken into Intrinsic, Extrinsic and Circadian‑Rhythm sleep disorders including disorders such as but not limited to: "Psychophysiologic Insomnia, Sleep State Misperception Idiopathic Insomnia, Narcolepsy, Recurrent Hypersomnia, Idiopathic Hypersomnia...Restless Legs Syndrome & Intrinsic Sleep Disorder NOS" (MSM, 2001, pp. 27).
Risk factors for sleep related illness are diet, lifestyle, occupation, stress and grief, amongst many others (Helmanis, 2006 pp. 24‑25).
Almost 90 per cent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 per cent suffer from severe sleep disorders. Very few people regularly enjoy the amount, or quality of sleep that they need. The estimated economic costs to the country from this are between 3 and 7 billion dollars annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Causative factors for insomnia may be multifaceted but generally include some psycho physiologic hyperarousal or emotional distress. Other precursors may be pain, movement disorders, psychiatric disorders, circadium rhythm dysfunction, medication and substance abuse (Billiard and Bentley, 2004). In some cases, the risk of insomnia is subject to a genetic bias. However, specific physiologic indicators for the familial influence have not been fully identified (Parkes and Lock, 2009).
Insomnia is the difficulty initiating or maintaining sleep or both resulting in inadequate quality or quantity of sleep (Tomoda et al, 2009). Insomnia can manifest itself by many symptoms from not being able to sleep at normal hours and low quality and quantity of sleep to sleeping but not finding it refreshing. Other symptoms may include daytime sleepiness, frequent waking, early morning waking and difficulty retuning to sleep (Cureresearch.com, 2005).
Most adults have experienced insomnia or sleeplessness at one time or another in their lives (Straker, 2008). It is estimated that insomnia effects around 30-50% of the general population with 10% experiencing chronic insomnia (Straker, 2008). It has been estimated that in the US that 70 million people suffer sleep problems, and of these, 30 million suffer chronic insomnia (Stahura and Martin, 2006). Recently a survey showed that 1046 of the 2000 adults surveyed experience at least one night of lost sleep due to insomnia symptoms; the survey also concluded that insomnia is a growing issue of concern (Goolsby, 2006).
Insomnia generally affects women more than men and the incidence rate tends to increase with age (Straker, 2008).
There is a clear correlation of age to insomnia (Curless et a!. 1993). A number of surveys have reported between 28% and 64% of post menopausal women suffer from insomnia (Hachul de Campos et al. 2006).
Insomnia can be classified into three categories transient, short-term and chronic insomnia (Tomoda et al, 2009). Transient insomnia are symptoms lasting less than one week, short term insomnia are symptoms lasting between one-three weeks and chronic insomnia are those symptoms lasting longer than three weeks (Tomoda, 2009).
Narcolepsy is a sleep disorder that causes overwhelming and severe day time sleepiness (Retsas et al, 2000). Pathologic sleepiness is characterised by the fact that it occurs at inappropriate times and places (Retsas et al, 2000). These daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day (Edgar et al, 2006). People who suffer from Narcolepsy often have fragmented night time sleep with frequent brief awakenings (Edgar et al, 2006).
Narcolepsy is typically characterised by the following four symptoms:
Excessive daytime sleepiness (90%)
Cataplexy: A sudden and temporary loss of muscle tone often triggered by emotions such as laughter. (75%)
Hallucinations: Vivid dreamlike experiences that occur while falling asleep or upon wakening. (30%)
Sleep paralysis: Paralysis that occurs most often upon falling asleep or waking up. The person is unable to move for a few minutes. (25%) (Retsas et al, 2000)
Interestingly, regular night time sleep schedule and scheduled naps during the day is required for favourable outcomes (Edgar et al, 2006).
Sleep apnoea affects over 12 million Americans with it being more prevalent in men than women (Sjosten et al, 2009). Sleep apnoea not only deprives sleep from the individual but their partners too (Yip, 2001). Sleep apnoea is defined as frequent and loud snoring and breathing cessation for at least 10 second for five or more episodes per hour followed by awakening abruptly with a loud snort as the blood oxygen level drops (Sjorsten et al, 2009). People with sleep apnoea can experience anywhere between 5 apnoeic episodes per hour to several hundred per night (Sjorsten et al, 2009).
Symptoms of sleep apnoea are:
Excessive daytime sleepiness
Obesity is the major cause of sleep apnoea often losing weight is all that is need to treat this disorder (Yip, 2001).
Part 3 and more coming
Chronic overconsumption of sugar-sweetened beverages (SSBs) is amongst the dietary factors most consistently found to be associated with obesity, type 2 diabetes (T2D) and cardiovascular disease (CVD) risk in large epidemiological studies. Studies have shown that SSB overconsumption increases intra-abdominal obesity and ectopic lipid deposition in the liver, and also exacerbates cardiometabolic risk. Similar to the prevalence of obesity and T2D, national surveys of food consumption have shown that chronic overconsumption of SSBs is skyrocketing in many parts of the world,
SSB overconsumption is also particularly worrisome among children and adolescents. SSBs typically include carbonated soft drinks, juice drinks (with added sugars), sports drinks, energy drinks, milkshakes, and iced tea or coffee.
The epidemics of obesity, type 2 diabetes (T2D), and cardiovascular diseases (CVD) are affecting most if not all developed countries around the world. While the prevalence of overweight, obesity, and T2D remain high in North America and Western Europe, obesity rates and T2D rates are increasing at a stunning pace in developing countries. In Mexico City inhabitants aged between 35 and 74 years, the excess mortality associated with previously diagnosed T2D accounted for one third of all deaths between 1998 to 2004.
In some countries such as the Unites States, sugar-sweetened beverages (SSBs) account for almost half of the added sugar consumed nationally and consumption around the world has reached unprecedented proportions, and the rise in the prevalence of cardiometabolic risk factors in children such as abdominal obesity and insulin resistance has increased in parallel.
A recent modelling study performed by the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE) estimated that up to 184,000 deaths per year could be attributed to the chronic overconsumption of SSBs . Similar to the prevalence of obesity and T2D, studies analysing national surveys of food consumption have shown that the chronic overconsumption of SSBs is also skyrocketing in many parts of the world.
SSBs are the single greatest source of added sugars in most Western countries. SSBs are typically sweetened with high-fructose corn syrup (HFCS) in the US or sucrose. Sucrose, also often referred to as table sugar, is a disaccharide composed of glucose and fructose linked via a glycoside bond.
One study showed in a six-month parallel intervention study of 47 overweight individuals that the consumption of 1 L/day of sucrose-sweetened beverages (cola) significantly increased visceral adipose tissue and hepatic fat accumulation compared to the consumption of 1 L/day of semi-skimmed milk or water. Although not associated with increases in body weight or total fat mass, the consumption of cola was linked with increases in plasma triglyceride and cholesterol levels. Interestingly, daily total energy intake did not appear to differ across subgroups, thereby suggesting that energy included in beverages could have been compensated for by reductions in energy from other sources.
HFCS is produced by industrial processing of corn starch. It contains two monosaccharides, free fructose, and glucose in various proportions. Both fructose and glucose have different metabolic fates, an observation that has encouraged many to suggest that fructose may have a unique role in the pathogenesis of cardiometabolic diseases. This hypothesis has been supported by well-designed controlled studies
In a 10-week randomized clinical trial fed an ad libitum diet with 25% of calories originating from glucose- or fructose-sweetened beverages. Although both diets increased body weight, only participants in the HFCS group had increased visceral adipose tissue accumulation at the end of the trial. Insulin levels during a 3-h oral glucose tolerance test increased by 27% in the fructose group (significant) and by approximately 14% in the glucose group (nonsignificant). Similarly, 24-h post-meal triglyceride and fasting apolipoprotein B levels, as well as small, dense low-density lipoprotein (LDL) levels and triglyceride levels all increased in the fructose but not in the glucose group following the intervention.
About a dozen large prospective epidemiological studies have documented the association between SSB consumption and the risk of cardiometabolic diseases such as obesity, metabolic syndrome, T2D, and CVD.
A meta-analysis on 2013 that included 25,745 children and adolescents from 15 prospective studies and 174,252 adults from in seven prospective studies suggest that a one serving per day increase in SSB is associated with a 0.06 unit increase in body mass index (BMI) per year in children and adolescent and with a 0.12 to 0.22 kg yearly weight gain in adults. The same group also published evidence that SSBs overconsumption is linked with the onset of the metabolic syndrome (a constellation of CVD and T2D risk factors associated with abdominal obesity and insulin resistance) and T2D.
A variety of natural vinegar products are found in civilizations around the world. It is a sour traditional fermented food that is used in pickles, sauces and beverages, as well as in various food-processing procedures and as a specialty food ingredient. Vinegar is produced from fruit juices such as grape, apple, plum, coconut, and tomato, rice, and potato. It is made by crushing the fruit and squeezing out the liquid. Bacteria and yeast are added to the liquid to start the alcoholic fermentation process, and the sugars are turned into alcohol. In a second fermentation process, the alcohol is converted into vinegar by acetic acid-forming bacteria.
Although vinegar can be made from any fruit, apple cider vinegar is the most common vinegar used in western folk medicine. Traditionally, apple cider vinegar is made with a long fermentation of apple juices and pulp, of around 1 month, and is fuelled by species of acetic acid bacteria from the fruit and the environment. As a result, acetic acid is the main ingredient of apple cider vinegar, around 3–10% and gives vinegar its characteristic taste and smell. In addition, some of the other ingredients include, polyphenols, like carotenoids, catechin, ephicatechin, as well as gallic acid, citric, lactic, malic and tartaric acids, chlorogenic acid, caffeic acid, p-coumaric acid, ferulic acid, pectin, probiotics and prebiotics 1-5. Vinegar also contains various minerals such copper, potassium, sodium, chloride, phosphorus, calcium, magnesium, as well as vitamins A, B1, B2, B6, C, E and, complex carbohydrates and fiber, amino acids and numerous beneficial enzymes to help with digestion. Many of the ingredients in vinegar such as the phenolic compounds are also found in the starting material (i.e., the fruit), or may be introduced to it by aging the vinegar so large differences exist in content of phenolic compounds among vinegars. Overall vinegar is an extremely well rounded nutritious food.
While vinegar products are widely used around the world, the scientific information about the health effects of vinegar as a traditional medicine is only now catching up and supported by many scientific studies. Over the past 20 years the research on vinegar has shown many positive effects on health 2,3 such as an antibacterial effect, cardiovascular benefits, reduction in blood pressure, an antioxidant and anti inflammatory effect, regulation of blood sugar and anti-diabetic effect, reduction and prevention of obesity 6-8, a healing effect on injuries, and a positive effect on brain and cognitive functions 1,9 and on bone health 10.
Historically vinegar was used in the treatment of diabetes before any pharmacologic glucose-lowering therapy 11,12. Recent studies indicate that vinegar improves insulin sensitivity in healthy volunteers, diabetics and obese individuals 8,13,14. In type 2 diabetics vinegar reduces the after meal peak in circulating sugar (hyperglycaemia), insulin and fatty acids (triglycerides) 11,12,16, which in turn reduces the level of blood sugar reacting with the red blood cells (haemoglobin A1c) which is damaging to the blood cells in patients with type 2 diabetes 17.
More specifically the blood glucose/sugar-lowering effect of vinegar was evident when vinegar was ingested with complex carbohydrates, but to a lesser extent with simple sugars (monosaccharides) 13,18 and vinegar reduced the after meal sugar spike (postprandial glycaemia) in patients with type 2 diabetes when added to a high, but not to a low, glycaemic index meal 15. This suggests that vinegar is more effective in controlling blood sugar and triglycerides best in the processed carb rich diet compared to when you just take it with simple healthy meals.
While there appear to be many mechanisms by which vinegar reduces glucose levels not everything is fully understood yet. However, what we do know is that vinegar/acetic acid delays gastric emptying, slowing down the digestion and absorption of sugars and fats 19,20; it slows the breaking down of more complex sugars (disaccharide) in the small intestine and suppresses the absorption of carbohydrate 21; lowers free fatty acid in the blood leading to improved insulin sensitivity, increased blood flow to the peripheral tissues and increased satiety, leading to lower food intake 22. In a study of 12 healthy volunteers vinegar served with a portion of white wheat bread containing 50 g available carbohydrates reported a significant dose-response relation for blood glucose and serum insulin; the higher the acetic acid level, the lower the glucose and insulin. Furthermore, the rating of stomach fullness was directly related to the acetic acid level 8.
Vinegar also increases glucose uptake in skeletal muscles 23 and ingestion at bedtime has also been shown to decrease fasting glucose levels in the morning in humans with type 2 diabetes, suggesting an effect of acetic acid on reducing glucose production and increasing the rates of glycogen synthesis (storage) in the cells 24. Vinegar also stimulates the blood flow and capillary recruitment to the muscles 25,26. Much of this occurs through epigenetic processes and induced gene expression 27.
Apple cider vinegar and other fruit vinegars also have a protective effect on the liver, protecting it from metabolic damage associated with metabolic syndrome and diabetes type 2 28-31. These findings suggest that these vinegars may prevent high fat diet-induced obesity and obesity-related cardiac complications 32.
A large number of studies have also shown the cardiovascular benefits of vinegar 33. In a study of rats with high blood pressure both vinegar and acetic acid decreased blood pressure 34. The studies show that even acute consumption of apple cider vinegar (which is rich in antioxidants and anti inflammatories) causes significant reduction on some risk factors around the build up of plaque in the arteries 35 and reduced atherosclerotic lesions in the aorta, among rabbits on fat diets 36. Vinegar also decreases circulating blood fat (triglyceride) levels 37,38,39 and protect from fat accumulation in liver 40,41 in obese 38and/or type 2 diabetic 42 humans . It also decreases fat levels in skeletal muscle 43 which is a common feature in diabetes and insulin resistance. Apple cider vinegars, regardless of the production method, decreases triglyceride and very low density lipoproteins (VLDL) levels in all groups when compared to controls without vinegar supplementation. A number of studies have also shown the benefits of vinegar on the cholesterol profile even in animals consuming a high cholesterol diet 36,37 and the polyphenols (catechins) present in apple vinegar have been shown to inhibit the LDL oxidation in endothelial cells 44 which make up the lining of the cell wall and may be the precondition for plaque build up.
As a result of its improvement on blood circulation vinegar is likely to have a benefits for many cardio vascular illnesses, even Alzheimer’s (which is just another cardio vascular disease), but as yet the research is only circumstantial. Vinegar has also been shown to be an effective treatment for varicose veins taken internally and applied externally. In a study randomized controlled trial of 120 patients application of vinegar lead to reduction in cramps, pain, leg fatigue perception, edema, itching, pigmentation, weight feelings in the leg, and visual ratings 45. Even though vinegar does not remove the problem veins entirely, the effects they have can reduce symptoms, reduce complication development, or reduce aesthetic concerns.
Vinegar has been shown to reduce osteoporosis 46. Vinegar is a rich source of minerals, such as calcium, manganese and magnesium, which are important in sustaining optimal bone mass. Moreover, the acetic acid content in vinegar has also been shown to promote the absorption and retention of calcium 47.
Consuming apple cider vinegar has also been shown to to have many anti oxidative effects throughout the body including reducing eye lens oxidative injury, a characteristic of the developments of cataracts, by stimulating one of the main antioxidant systems in the body called glutathione peroxidase in mice 48.
Vinegar also helps with digestion and has been recommended to people with digestive troubles for hundreds of years. Common thought is that it helps to prime the gastro-intestinal system for digestion and experience shows that people suffering from reflux (GORD) are more likely to have low levels of gastric acid, not too much acid and one teaspoon (diluted) of vinegar before a meal can assist with digestion. However, this is unlikely to be a result of the pH of the vinegar but may be due to other compounds such as enzymes, prebiotics and probiotics to assist digestion or that it promotes the release of bile acids to assist with the digestion of fats.
In the future our medical doctors will tell their patients to go and have 30-50 ml of organic apple cider vinegar a day spread over two meals to prevent and help treat the major health conditions we are confronted with today rather than put them on multiple drugs that have deadly side effects.
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