Reducing risk of CVD in your T1 child

[Eric]

A while back, Tia mentioned a study about increased heart disease risk in T1Ds.

This advisory from the American Heart Association spells out one of the most important things you can do to reduce the risk of cardiovascular disease.

There are many things you can do to keep your heart healthy. Reducing saturated fats is something that is a good idea for everyone, T1 or not.
(also exercise, but I may have already mentioned that )

I am putting this in the parent category, because starting early is the best thing to do. Not because eating a few hamburgers is going to mess up a child’s heart. Generally the build-up of plaque on the artery walls starts to happen when we get older. But the eating habits we develop as children stay with us! Learning healthy eating is very important.

Anyway, as much as the T1 parents have to juggle with their kid’s diets, I feel this is one of the most important things to work on, so I wanted to share it.

Who are all the parents? @TiaG, @Michel, @Chris, @Thomas, @ClaudnDaye, @Aaron @Bradford - who am I missing? I want them all to see this.

Sorry, it’s not happy fun talk that makes life easier for any of you. But it is important, so I wanted to post it.

Here is the link:
https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000000510

In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality.

How can you tell the difference between saturated (bad) fat and unsaturated (good) fat? It is actually very easy. If it is delicious - ice cream, hotdogs, hamburgers, cheese, butter - it’s saturated.

[Michel]

Well, mono and poly unsaturated fat can also be delicious! We use EVFCP olive oil with practically everything we eat, and we have avocado three or four times a week

I am not even mentioning the almonds and various nuts we have practically every day, in salads or just to munch on. Healthy fats are wonderful!

[TiaG]

I actually prefer the taste of the unsaturated fat – love olive oil and find that butter is only sometimes tasty. I think it’s just what your tastebuds are use to.

[mike_g]

Good old AHA, doubling down on “saturated fat causes heart disease”. I’ve read a number of folks questioning the widely held belief that saturated fat causes heart disease. Since Ancel Keys published his study making fat the boogey man(with cherry picked data, it turns out), we’ve reduced fat consumption by 20-30% over 30 years in this country, and replaced them with carbs. And reduced saturated fats, and replaced them with vegetable oils. And we’ve medicated a large portion of folks with statins, because of the cholesterol hypothesis. And what has been the result? Less heart disease? Less T2 diabetes? Less obesity? Less strokes?

[jim26]

Personally I believe average BS has more impact on heart health than fat in the diet.

[Eric]

@mike_g

Good old AHA, doubling down on “saturated fat causes heart disease”.

Most authorities on the subject agree that saturated fat is a significant risk factor for CVD.

Here are some of the other organizations besides The American Heart Association that recommend lowering the consumption of saturated fats in order to reduce risk:

• The World Health Organization
• The Dietitians of Canada
• The British National Health Service
• The European Food Safety Authority
• The British Heart Foundation
• The United States Food and Drug Administration
• The British Dietetic Association
• The Food and Nutrition Board of the National Academy of Medicine
• The Heart and Stroke Foundation of Canada
• The World Heart Federation
• The American Dietetic Association

@mike_g

we’ve reduced fat consumption by 20-30% over 30 years in this country, and replaced them with carbs. And reduced saturated fats, and replaced them with vegetable oils.

But replacing them with carbs is not the solution. The link explains that replacing saturated fats with unsaturated fats is the key, because it is the HDL that is involved in the reverse cholesterol transport, where excess cholesterol is eliminated from the body via the liver.

@mike_g

And we’ve medicated a large portion of folks with statins, because of the cholesterol hypothesis. And what has been the result? Less heart disease? Less T2 diabetes? Less obesity? Less strokes?

Here are numbers from the Population Reference Bureau

@jim26

Personally I believe average BS has more impact on heart health than fat in the diet.

But they are not mutually exclusive. You can do both.

Smoking also increases the risk of heart disease. There are a lot of contributing factors, but it is possible to simultaneously try to improve all of the areas. I am not giving up my blood sugar control just because I am lowering the intake of saturated fats. Nobody should do that.

[mike_g]

Hi Eric, good response. It is an interesting topic.

I take advice from these organizations (and the ADA) with a grain of salt, given their propensity to be politically influenced, and to maintain their status quo (AHA has said this about heart disease, beginning in 1961). However, it’s clear I don’t have a handle on the statistics regarding strokes and heart disease, after looking at your chart. These have clearly declined, contemporaneously with decrease in fat consumption, and probably also a similar decrease in saturated fat consumption during the same period. Does this mean causation? How about other factors, such as smoking declining over the same period from 45% to 20 ish%? Might be a factor.

I noted you don’t show incidence of T2 diabetes and obesity in your charts. I presume these would show the opposite trend. Although, these are probably related to the increase of carbs and sugar mentioned in my earlier post. And I see the AHA commentary also said outcomes weren’t good if fat was replaced with carbs. However, the issue of carbs is mostly a separate issue from the issue of saturated fat consumption.

There are a variety of opinions on this topic, and regarding fat consumption in general. In much reading today, I ran across this counterpoint: https://www.medscape.com/viewarticle/882564 Raises some interesting points to me.

Of what predictive value is total cholesterol? How about HDL, LDL, triglycerides, ratios thereof, and, let’s not forget, LDL particle size?

Looking thru my diet, I do eat a lot of fat, probably 60-70%, and a lot of saturated fat. 6 eggs for breakfast, with a pint of whole milk, etc. A lot of cheese. Hot dogs. Brats. Etc, etc… If there is a kernel of truth in what AHA advocates,I probably ought to reduce this. Or as my wife said (specifically regarding my insistence on eating 6 eggs for breakfast, every day…“moderation in everything… Just because some is good, more isn’t necessarily better…”. So I’ll probably reduce this and try to make cardio a more consistent adjunct to my strength training.

In any case, I tend to agree with @jim26 that BG is the most important thing for a diabetic to manage.

[Eric]

@mike_g

These have clearly declined, contemporaneously with decrease in fat consumption, and probably also a similar decrease in saturated fat consumption during the same period. Does this mean causation? How about other factors, such as smoking declining over the same period from 45% to 20 ish%? Might be a factor.

You have raised some interesting points. Yes, there are other factors. The problem with finding causation simply from statistics is that there are so many factors at play. Smoking has decreased. But perhaps people have also become more sedentary.

So there is a problem with only using statistics. You can’t really have a single variable. It isn’t like you can have someone just reduce saturated fats. They will generally replace it with something else. Carbs, protein, unsaturated fats. So how do you know which thing is causing the change?

Also, clinical studies are often done as a double-blind, where neither the patient nor the researcher knows if the patient is taking the medicine or a placebo. But you can’t do that with a diet! You can’t eat “placebo” bacon. People know what they are eating. And people may not be completely honest about their diet.

So if you don’t pay as much attention to the big population studies, and just focus on the things they know about lipids and how plaque is formed in arteries:

Lipids are transported in the blood and packaged in lipoproteins.

Higher levels of certain types of lipoproteins are linked to an increased risk of atherosclerosis, in which lipids and inflammatory cells accumulate in the walls of blood vessels, in the form of plaque.

Plaque causes the vessel walls to narrow and it impedes blood flow and oxygen delivery, which can result in heart disease because of the lack of oxygen being delivered to the heart tissue.

The liver helps regulate cholesterol levels in the body. It both synthesizes cholesterol for export to the cells, and it also removes cholesterol from the body, by converting it to bile salts where it is eliminated as waste. Certain lipoproteins deliver cholesterol to the cells, and certain lipoproteins remove cholesterol.

I don’t think anyone is arguing any of that, are they?

@mike_g

And I see the AHA commentary also said outcomes weren’t good if fat was replaced with carbs.

Yes, because as I mentioned, the unsaturated fats help to counteract and remove the cholesterol. So the unsaturated fats help reduce the buildup that the saturated fats cause. If you only replace saturated fats with carbs, you don’t have this benefit.

@mike_g

Of what predictive value is total cholesterol? How about HDL, LDL, triglycerides, ratios thereof, and, let’s not forget, LDL particle size?

There are a lot of ratios doctors use.

Total / HDL ratio
Triglycerides / HDL ratio
LDL / HDL ratio

And that again points to the value of HDL (from unsaturated fats) in the diet. As you can see, all of the ratios use HDL. HDL is very important, which again emphasizes the fact that it helps counter the effect of the LDL.

And yes, particle size is also an important factor.

@mike_g

Looking thru my diet, I do eat a lot of fat

Genetics is a big factor. It may not affect you like it would other people. Some people can eat whatever they want and not have issues. Exercise is another factor that can reduce the impact. All of the things work together.

But the best thing for anyone to start with is to get a cholesterol test, and see where they stand. Because, like I said, it is not just what you eat, but all the factors together.

[Thomas]

@Eric - What was the test that gives info about particle size? I recall you mentioning it but don’t remember which test. Is that something worth getting or would you generally only get that if the standard lipid panel shows results that are out of range?

[TiaG]

i have a friend who studies cholesterol for her research – from what I understand the particle size tests are more for research purposes; they’re not part of the standard panel yet.

[bkh]

@Eric

Also, clinical studies are often done as a double-blind, where neither the patient nor the researcher knows if the patient is taking the medicine or a placebo. But you can’t do that with a diet! You can’t eat “placebo” bacon.

But apparently one can do a double-blinded controlled study that substitutes unsaturated fat for a portion of the saturated fat: this is described in the first core study on page e4 of the paper Eric linked.

@mike_g

we’ve reduced fat consumption by 20-30% over 30 years in this country, and replaced them with carbs.

As Eric has mentioned, the study Eric linked specifically says this doesn’t help. From page e8 column 2, “In summary, a dietary strategy of reducing intake of total dietary fat, including saturated fat, and replacing the fats mainly with unspecified carbohydrates does not prevent CHD.”

@mike_g

Good old AHA, doubling down on “saturated fat causes heart disease”. I’ve read a number of folks questioning the widely held belief that saturated fat causes heart disease.

This paper breaks that into two parts by evaluating what is known from highly-credible studies (and they discuss the properties that make these particular studies credible.) The first part is that substituting unsaturated fat for saturated fat significantly reduces LDL. I can’t find any weakness in their analysis of the studies establishing that result. The second part is that reducing LDL reduces coronary heart disease. They summarize the strength of that result with: “Taking into consideration the totality of evidence, LDL cholesterol links saturated fat and its replacement macronutrients to CVD by very strong scientific evidence that satisfies rigorous criteria for causality.[60] Three independent guidelines committees rated this evidence as Level A, Strong.[3,13,61]”

In recent years I’d been accepting the scuttlebutt that full-fat dairy is not a problem. Well, this study seems to make a more careful statement. The overall assortment of fats we eat should be tilted towards the unsaturated fats. Olive oil is better than butter or tallow. And some kinds of polyunsaturated fats are even better (see the table on page e4 for nutrient analysis of fats.) Now for me personally the need for dietary change is not urgent: with a low-dose statin my LDL generally runs around 70 and my HDL is in the same neighborhood with low triglycerides. But if my LDL were over 100 the study that Eric showed us would have me looking at replacing some saturated fat with unsaturated, because the results are clear.

[Eric]

@Thomas

@Eric - What was the test that gives info about particle size? I recall you mentioning it but don’t remember which test. Is that something worth getting or would you generally only get that if the standard lipid panel shows results that are out of range?

Worth getting, yes because it is a tube of blood either way, so the “cost” to your body is the same. And I don’t believe it cost me any more from insurance.

It’s called an NMR-lipoprofile. I got one and I loved it (because I got good news).

Here is a thread with some info on it.

New insights into the role of HDL in heart disease risk of T1D

Ask for an NMR-lipoprofile. NMR stands for “Nuclear Magnetic Resonance” Here is some information on it: http://requestatest.com/nmr-lipoprofile-testing And here is a sample one that is on the LabCorp website.

[Eric]

@bkh

But apparently one can do a double-blinded controlled study that substitutes unsaturated fat for a portion of the saturated fat: this is described in the first core study on page e4 of the paper Eric linked.

Yeah, on that one they actually served people meals instead of it being self-reported.

If you were doing that for every meal, I do not know how long you could do something like that though. Certainly would be tough to do that for years.

That’s what makes double-blind so tough for something like this.

[Tapestry]

@Thomas

What was the test that gives info about particle size?

VAP Cholesterol. My husband and I have had one done about three years ago. If I can put my fingers on the results, I’ll reply back. Our local area was not able to run the test, so it had to be sent out. I recall it took quite a while to get the results.

@Eric

Worth getting, yes because it is a tube of blood either way, so the “cost” to your body is the same. And I don’t believe it cost me any more from insurance.

It’s called an NMR-lipoprofile. I got one and I loved it (because I got good news).

I’ll have to look into this one myself. It may be newer than the one we had.

[Eric]

@Tapestry

VAP Cholesterol.

@Tapestry

I’ll have to look into this one myself. It may be newer than the one we had.

The information they try to give you is basically the same between NMR-lipoprofile and VAP. They just use a different technique.

NMR-lipoprofile analyzes the size by measuring their magnetic properties. VAP separates the particles by size using a centrifuge.

[Tapestry]

@Eric

The information they try to give you is basically the same between NMR-lipoprofile and VAP. They just use a different technique.

NMR-lipoprofile analyzes the size by measuring their magnetic properties. VAP separates the particles by size using a centrifuge.

Thank you for the information; it’s much appreciated!

I just came back to post a link to the site I had for VAP. I clicked on the link in my pdf and the page opened to an announcement that the company has closed as of February 28, 2016. www.thevaptest.com

Our results are packed away in a box somewhere; and I want to read them again, now, but can’t. Oh well, there’s always … tomorrow!

[Jen]

I just saw a cardiologist who.said to do the following to reduce risk:

• Don’t smoke or drink alcohol
• Eat lots and lots fruits amd veggies
• Don’t eat red meat frequently
• Control diabetes, hypertension, and cholesterol
• Do some sort of sustained moderate exercise most days

[Michel]

@Jen

• Don’t smoke or drink alcohol
• Eat lots and lots fruits amd veggies
• Don’t eat red meat frequently
• Control diabetes, hypertension, and cholesterol
• Do some sort of sustained moderate exercise most days

Like many, I am frustrated that science has done so poorly lately in guiding us towasrds healthy living (remember margerine, the great fat vs sugar debate, and many more?). So I am now a real cynic about such advice. But I must say that I can’t find anything to disagree with in your cardio’s advice

We don’t follow it perfectly in the red meat area though…

[Jen]

Oh, and she also said to reduce or manage stress.

I try to avoid processed meat already (immediate family history of colon cancer). And I generally am scared to cook red meat. And I eat out only very, very rarely. So I do mostly avoid it. I eat a lot of chicken, salmon, and tuna.

I have been confused for years. But she prescribed a statin, and I think this time around I’m going to take it. (My endocrinologist has prescribed one twice before that I never filled.)

[jim26]

@Jen

Don’t smoke or drink alcohol

I thought moderate alcohol consumption could reduce some risks (i.e. red wine).