Heart Disease Archives - Page 6 of 6 - Health Tips From The Professor

Best Diet For Heart Disease Prevention

July 9, 2019 by Dr. Steve Chaney

Are The American Heart Association’s Recommendations Correct?

Author: Dr. Stephen Chaney

What is the best diet for heart disease prevention?

Heart disease is a killer. It continues to be the leading cause of death – both worldwide and in industrialized countries like the United States and the European Union. When we look at heart disease trends, it is a good news – bad news situation.

The good news is that heart disease deaths are continuing to decline in adults over 70.
The decline among senior citizens is attributed to improved treatment of heart disease and more seniors following heart-healthy diets.
The bad news is that heart disease deaths are starting to increase in younger adults, something I reported in an earlier issue, Heart Attacks Increasing in Young Women of “Health Tips From the Professor.”
The reason for the rise in heart disease deaths in young people is less clear. However, the obesity epidemic, junk and convenience foods, and the popularity of fad diets all likely play a role.

Everyone has a magic diet for reducing heart disease risk. The American Heart Association tells us to avoid fats, especially saturated fats. Vegans tell us to avoid animal protein. Paleo and keto enthusiasts tell us carbs are the problem. Who is correct?

Of course, we don’t eat fats, carbohydrates, or proteins. We eat foods. That is why a recent study (T Meier et al, European Journal of Epidemiology, 34: 37-45, 2019) is so important. It reported which foods increase and which decrease the risk of premature heart disease deaths.

How Was The Study Done?

The authors of the current study analyzed data from the “Global Burden of Diseases (GBD) Study”, a major world-wide effort designed to estimate the portions of deaths caused by various risk factors.

The current study focused on the impact of 12 dietary risk factors on heart disease deaths between 1990 and 2016 for 51 countries in four regions (Western Europe, Central Europe, Eastern Europe, and Central Asia).

The dietary risk factors were:

Diets low in fiber, fruits, vegetables, legumes, nuts and seeds, polyunsaturated fatty acids, omega-3 fatty acids, and whole grains.
Diets high in sodium, processed meats, sugar-sweetened beverages, and trans fatty acids.

Saturated fat and meat were not explicitly included in the GBS Study data. However, diets low in polyunsaturated fats and omega-3 fats are likely high in saturated fats. Similarly, diets low in fruits, vegetables, whole grains, and legumes are likely higher in meats. The study also did not include dairy, and some recent studies suggest that some dairy foods may decrease heart disease risk.

For simplicity I will only consider the findings from Western Europe because their diet and heart disease death trends are similar to those in the United States.

Best Diet for Heart Disease Prevention?

The study found that in 2016 (the last year for which data were available):

Dietary risk factors were responsible for 49.2% of heart disease deaths.
6% of all diet-related heart disease deaths occurred in adults younger than 70, and that percentage has been increasing in recent years.

When they looked at the contribution of individual foods to diet related heart disease deaths, the percentages were:

Diets low in whole grains = 20.4%
Diets low in nuts and seeds = 16.2%
Diets low in fruits = 12.5%
Diets high in sodium = 12.0%
Diets low in omega-3s = 10.8%
Diets low in vegetables = 9.0%
Diets low in legumes = 7.0%
Diets low in fiber = 5.7%
Diets low in polyunsaturated fats = 3.7%
Diets high in processed meats = 1.6%
Diets high in trans fatty acids = 0.8%
Diets high in sugar-sweetened beverages = 0.1%

So, what is the best diet for heart disease prevention?

In short, this study concluded:

A primarily plant-based diet is the best protection against premature death due to heart disease.
All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
Meat was not included in the analysis, but it is likely that most people’s diets in this region of the world contained some meat. The most likely take-away is that meat does not affect heart disease risk in the context of a primarily plant-based diet.
Dairy was not included in the analysis either, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease in Western Europe.”

While every study has its weaknesses, this study is consistent with multiple previous studies showing that primarily plant-based diets are best for reducing heart disease risk. You will find a more complete discussion of these studies in my book “Slaying The Food Myths.”

Are the American Heart Association’s Recommendations Correct?

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
This study also supports the heart-health benefits of the Mediterranean and DASH diets.
Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

The Bottom Line

A recent study provides some important clues. It looked at dietary patterns associated with reduced risk of premature death from heart disease in Western Europe. The study concluded:

A primarily plant-based diet is the best protection against premature death due to heart disease.
All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
Meat did not appear to affect heart disease risk in the context of a primarily plant-based diet.
Dairy was not included in the analysis, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease.”

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
This study also supports the heart-health benefits of the Mediterranean and DASH diets.
Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

The Truth About Vitamin D

December 11, 2018 by Dr. Steve Chaney

Does Vitamin D Reduce Risk Of Heart Disease & Cancer?

Author: Dr. Stephen Chaney

You have every right to be confused. One day you are told that vitamin D reduces your risk of heart disease and cancer. The next day you are told vitamin D makes has no effect on those diseases. You are told vitamin D is a waste of money. What should you believe? What is the truth about vitamin D?

In mid-November a major clinical study called VITAL was published. It examined the effect of vitamin D and omega-3s on heart disease and cancer risk. Last week I wrote about the omega-3 portion of the study. This week I will cover the vitamin D portion of the study.

Once again, if you rely on the media for your information on supplementation, you are probably confused. Headlines ranged from “Vitamin D Is Ineffective For Preventing Cancer And Heart Disease to “Vitamin D Lowers Odds Of Cancer Death.” What is the truth?

The problem is that reporters aren’t scientists. They don’t know how to interpret clinical studies. What they report is filtered through their personal biases. That is why I take the time to carefully evaluate the clinical studies, so I can provide you with accurate information. Let me sort through the dueling headlines and give you the truth about vitamin D, cancer, and heart disease.

How Was The Study Designed?

The VITAL study (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403) enrolled 25,871 healthy adults (average age = 67) in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had preexisting cancer or heart disease. The characteristics of the study group were typical of the American population at that age, namely:

The average BMI was 28, which means that most of the participants were significantly overweight.
7% of them had diabetes.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 65% of the participants to determine 25-hydroxyvitamin D levels (a measure of vitamin D status) at baseline and at the end of the first year. The participants were given either 2,000 IU of vitamin D/day or a placebo and followed for an average of 5.3 years.

There were two important characteristics of the participants in this study that may have influenced the outcome.

The average 25-hydroxyvitamin D level of participants at the beginning of the study was 31 ng/ml (78 nmol/L). The NIH considers 20-50 ng/ml (50-125 nmol/L) to be the optimal level of 25-hydroxyvitamin D for most physiological functions. This means that study participants started in the middle of the optimal range with respect to vitamin D status.

[Note: The NIH defines the 20-50 ng/ml range as “adequate.” However, I know many of my readers like to aim beyond adequate to reach what they consider to be “optimal.” In the case of vitamin D, that might not be a good idea. The NIH considers anything above 50 ng/ml as associated “with potentially adverse effects.” For that reason, I will refer to the 20-50 ng/ml range as optimal for this article. I wouldn’t want to encourage my readers to be aiming for above 50 ng/ml.]

Only 12.7% of participants had 25-hydroxyvitamin D levels below 20 ng/ml, which the NIH considers to be inadequate. The results with this group were not statistically different from the study participants with optimal vitamin D status, but it is not clear that there were enough people in this subgroup for a statistically valid comparison with participants starting with an optimal vitamin D status.
At the end of the first year, 25-hydroxyvitamin D levels in the treatment group increased to 42 ng/ml (105 nmol/L), which is near the upper end of the optimal range. Thus, for most of the participants, the study was evaluating whether there was a benefit of increasing vitamin D status from the middle to the upper end of the optimal range.
The study allowed subjects to continue taking supplements that contained up to 800 IU of vitamin D. While the authors tried to correct for this statistically, it is a confounding variable.

Does Vitamin D Reduce The Risk Of Cancer?

You may remember from last week that omega-3s were more effective for reducing heart disease risk than for reducing cancer risk. What is the truth about vitamin D and cancer risk? The results are reversed for vitamin D, so I will discuss cancer first.

The study reported that vitamin D supplementation did not reduce a diagnosis of invasive cancer of any type, breast cancer, prostate cancer, or colon cancer during the 5.3-year time-period of this study. This was the result that was reported in the abstract and was what lazy journalists, who never read past the abstract, reported.

However, the rest of the study was more positive. For example, occurrence of invasive cancer of any type was reduced by:

23% in African-Americans.
24% in patients with a healthy body weight.

Several previous studies have suggested that vitamin D may be more effective at preventing cancer in people with a healthy body weight, but the mechanism of this effect is currently unknown.

Most previous studies have not included enough African-Americans to determine whether they respond more favorably to vitamin D supplementation. However, African-Americans have a higher risk of cancer, so this finding deserves follow-up.

In addition, when the study looked at deaths from cancer, the results were very positive. For example:

Cancer deaths during the 5.3-year study period were reduced by 17%.
The longer vitamin D supplementation was continued the more effective it became at reducing cancer deaths. For example,
When the authors excluded cancer deaths occurring during the first year of supplementation, vitamin D reduced cancer deaths by 21%.
When the authors excluded cancer deaths occurring during the first two years of supplementation, vitamin D reduced cancer deaths by 25%.

Finally, no side effects were noted in the vitamin D group.

Does Vitamin D Reduce The Risk Of Heart Disease?

The VITAL study also looked at the effect of vitamin D on heart disease risk. What is the truth about vitamin D and heart disease? The results from this study were uniformly negative. There was no effect of vitamin D supplementation on all major cardiovascular events combined, heart attack, stroke, or death from heart disease. Does that mean vitamin D has no role in reducing heart disease risk? That’s not clear.

The authors had a thought-provoking explanation for why the results were negative for heart disease, but positive for cancer. Remember that the participants in this trial started with a 25-hydroxyvitamin D level of 31 ng/ml and increased it to at least 42 ng/ml with vitamin D supplementation.

The authors stated that previous studies have suggested the 25-hydroxyvitamin D level associated with the lowest risk for heart disease is between 20 and 25 ng/ml. If that is true, most of the participants in this trial were already in the lowest possible risk for heart disease with respect to vitamin D status before the study even started. There would be no reason to expect additional vitamin D to further reduce their risk of heart disease.

In contrast, the authors said that previous studies suggest the 25-hydroxyvitamin D level associated with the lowest risk of cancer deaths is above 30 ng/ml. If that is true, it would explain why vitamin D supplementation in this study was effective at reducing cancer deaths.

However, previous placebo-controlled clinical studies have also been inconclusive with respect to vitamin D and heart disease. My recommendation would be to think of adequate vitamin D status as part of a holistic approach to reducing heart disease – one that includes a heart-healthy diet and a heart-healthy lifestyle – rather than a “magic bullet” that decreases heart disease risk by itself.

As for heart-healthy diets, I discuss the pros and cons of various diets in my book, “Slaying The Food Myths.” As I discuss in my book, the weight of scientific evidence supports primarily plant-based diets that include omega-3s as heart healthy. As an example, the Mediterranean diet is primarily plant-based and is rich in healthy oils like olive oil and omega-3s. It is associated with reduced risk of both heart disease and cancer.

What Is The Truth About Vitamin D?

There is a lot of confusion around the question of whether vitamin D reduces the risk of cancer. This study strengthened previous observation suggesting that vitamin D supplementation decreases cancer deaths. However, it is also consistent with previous studies that have failed to find an effect of vitamin D on cancer development. How can we understand this apparent discrepancy? The authors provided a logical explanation. They pointed out that:

Cancer development takes 20-30 years while this clinical study lasted only 5.3 years. That means that vitamin D supplementation only occurred at the tail end of the cancer development process. In fact, the cancer was already there in most of the patients in the study who developed cancer. It just had not been diagnosed yet. In the words of the authors: “Given the long latency for cancer development, extended follow-up is necessary to fully ascertain potential effects [of vitamin D supplementation].”
In contrast, none of the patients had been diagnosed with cancer when they entered the trial. That means that the patients were diagnosed with cancer during the 5.3-year study period. They were receiving extra vitamin D during the entire period of cancer treatment. Thus, the effect of vitamin D on reducing cancer deaths was easier to detect.

What Does This Study Mean For You?

Vitamin D Is Likely To Decrease Your Risk Of Dying From Cancer: When you combine the results of this study with what we already know about vitamin D and cancer, the results are clear. Vitamin D appears to reduce your risk of dying from cancer. More importantly, the longer you have been supplementing with vitamin D, the greater your risk reduction is likely to be.

Vitamin D May Decrease Your Risk Of Developing Cancer: Association studies suggest that optimal vitamin D status is associated with decreased cancer risk, especially colon cancer risk. However, the long time for cancer development means that we may never be able to prove this effect through double-blind, placebo-controlled clinical trials.

Holistic Is Best: When you combine the VITAL study results with what we already know about vitamin D and heart disease, it appears that supplementing with vitamin D is unlikely to reduce your risk of developing heart disease unless you are vitamin D deficient. However, a holistic approach that starts with a healthy, primarily plant-based diet and makes sure your vitamin D status is adequate is likely to be effective.

The same is likely true for cancer. While the latest study suggests that vitamin D supplementation reduces your risk of dying from cancer, those vitamin D supplements are likely to be even more effective if you also adopt a healthy diet and lifestyle.

How Much Vitamin D Do You Need? The optimal dose of vitamin D is likely to be different for each of us. One of the things we have learned in recent years is that there are significant differences in the efficiency with which we convert vitamin D from diet and/or sun exposure into the active form of vitamin D in our cells. Fortunately, the blood test for 25-hydroxyvitamin D is readily available and is widely considered to be an excellent measure of our vitamin D status.

I recommend that you have your blood level of 25-hydroxyvitamin D tested on an annual basis. Based on the best currently available data, I recommend you aim for >20 ng/ml (50 nmol/L) if you wish to minimize your risk of heart disease and >30 ng/ml (75 nmol/L) if you wish to minimize your risk of cancer. If you can achieve those levels through diet and a multivitamin supplement, that is great. If not, I would recommend adding a vitamin D supplement until those levels are achieved.

Finally, you shouldn’t think of vitamin D as a magic bullet. If you are a couch potato and eat sodas and junk food, don’t expect vitamin D to protect you from cancer and heart disease. You should think of maintaining adequate 25-hydroxyvitamin D levels as just one component of a holistic approach to healthy, disease-free living.

The Bottom Line

There is a lot of confusion around the question of whether vitamin D reduces the risk of cancer and heart disease. A major clinical study has just been published that sheds light on these important questions. It reported:

Vitamin D did not decrease the risk of developing cancer during the 5.3-year study duration. The authors pointed out that cancer takes 20-30 years to develop, which means their study was probably too short to detect an effect of vitamin D on the risk of developing cancer.
Vitamin D did decrease the risk of dying from cancer, and the longer people were supplementing with vitamin D the bigger the protective effect of vitamin D was.
Vitamin D did not decrease the risk of heart disease. However, most study participants had a level of 25-hydroxyvitamin D that was optimal for reducing the risk of heart disease at the beginning of the study. There was no reason to expect that extra vitamin D would provide additional benefit.
With respect to both cancer and heart disease the best advice is to:
- Get your 25-hydroxyvitamin D levels tested on an annual basis and supplement, if necessary, to keep your 25-hydroxyvitamin D levels in what the NIH considers to be an adequate range (20-50 ng/ml).
- We do not have good dose response data for the beneficial effects of vitamin D on heart disease and cancer. However, according to this article, previous studies suggest you may want to am for 25-hydroxyvitamin D levels above 20 ng/ml to reduce the risk of heart disease and above 30 ng/ml to reduce your risk of cancer.
- Consider vitamin D as just one component of a holistic approach to healthy, disease-free living.

For more details about the interpretation of these studies and what they mean for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Diet and Chronic Disease: Type 2 Diabetes and Heart Disease

January 30, 2018 by Dr. Steve Chaney

Can You Cut Your Risk Of Heart Disease And Diabetes In Half?

Author: Dr. Stephen Chaney

It is no secret that heart disease and diabetes are among the top two causes of death in this country. They are killers. Even worse, they can affect your quality of life for years before they kill you. Finally, they are bankrupting our health care system. Anything we can do to reduce the toll of these diseases would be of great benefit.

Is there a connection between diet and chronic disease, specifically type 2 diabetes, stroke, and heart disease?

That is why recent headlines suggesting that deaths due to heart disease, stroke, and diabetes could be cut almost in half simply by changing our diet caught my attention. Of course, those headlines came as no surprise. It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes.

How Was The Study Done?

This was a major study (R. Micha et al, JAMA, 317: 912-924, 2017 ). They started by using something called the National Health and Nutrition Examination Survey (NHANES). NHANES is a major survey conducted approximately every 10 years by the US government to collect data on demographics, disease, and diet from a cross section of the US population. They used this database to determine how frequently Americans consumed various heart-healthy and heart-unhealthy foods. They collected data from two surveys conducted in 1999-2002 and 2009-2012 to determine how consumption of those foods had changed over that 10-year period.

The heart-healthy foods they included in their study were fruits, vegetables, nuts & seeds, whole grains, and seafood omega-3s (long chain omega-3s).
The heart-unhealthy foods they included in their study were red meats, processed meats, sugar-sweetened beverages, and sodium.

They then did a meta-analysis of high quality clinical studies measuring the effects of those foods on deaths due to heart disease, stroke, and diabetes. They combined the data from all these studies to calculate the deaths due to all three causes combined, something they called deaths due to cardiometabolic disease.

Diet and Chronic Disease, Preventing Type 2 Diabetes and Heart Disease

When the investigators combined all the data, they estimated that changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes) by 45.4%. That is an almost 50% reduction just by eating a healthier diet.

This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sweets, and refined carbohydrates on cardiometabolic deaths.
The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
Decreasing sodium intake gives a 9.5% reduction in deaths.
Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
Decreasing red meat consumption gives a 4.2% decease in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

Holistic changes are best: It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show a relationship between diet and chronic disease:

A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The good news is that Americans have made some positive changes in their diet between the first and second NHANES survey, and, as a result, cardiometabolic deaths declined by 26.5%. The biggest contributors to this improvement were:

Increased polyunsaturated fat consumption (-20.8%).
Increased nut and seed consumption (-18%).
Decreased sugar sweetened beverage consumption (-14.5%).
This was partially offset by increased processed meat consumption (+14.4%)

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.” Below is a summary of the relationship between diet and chronic disease (specifically type 2 diabetes, stroke, and heart disease).

The Bottom Line

It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes. A recent study looked at the effect of a healthier diet on what they called cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes). They concluded:

changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths by 45.4%. That is an almost 50% reduction just by eating a healthier diet.
This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sugary foods, and refined carbohydrates on cardiometabolic deaths.
The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
- Decreasing sodium intake gives a 9.5% reduction in deaths.
- Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
- Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
- Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
- Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
- Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
- Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
- Decreasing red meat consumption gives a 4.2% reduction in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show:

A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Vitamin K And Heart Disease Deaths

January 23, 2018 by Dr. Steve Chaney

Does Vitamin K Reduce Heart Disease Risk?

Author: Dr. Stephen Chaney

You are trying to live a heart healthy lifestyle, but it is so confusing. It seems like there are new heart healthy diets, foods, and nutrients each week. How can you possibly keep up?

Some of those “heart healthy” recommendations contradict each other. They can’t all be true. Which should you believe? I will answer that question in my new books “Slaying the Food Myths” and “Slaying the Supplement Myths.”

Today, however, I am going to add to your confusion by adding another nutrient, vitamin K, to your “heart healthy” list. When it comes to heart health, vitamin K is a neglected nutrient. Most people think it is just needed for blood clotting. It doesn’t have the recognition and glamor of omega-3s, antioxidants, and polyphenols for heart health. However, recent research suggests it may play a crucial role in protecting your heart. So, I will explain how vitamin K and heart disease are related.

Before, I go into today’s study, let me give you some background information on vitamin K metabolism and heart health.

Metabolism 101: Vitamin K and Heart Disease

Vitamin K is a coenzyme for enzymes that add carboxyl groups to proteins. Without going into a lot of boring detail, carboxylated proteins:

Are more water soluble. That makes them more efficient at catalyzing metabolic reactions in our cells.
Chelate calcium. That allows them to catalyze calcium-dependent reactions.

For this discussion there are 3 kinds of calcium-dependent reactions catalyzed by carboxylated proteins that are important to know:

Reactions involved in blood clotting. Hence, vitamin K is essential for blood clotting.
Reactions involved in depositing calcium in our bones. Hence, vitamin K is essential for bone formation.
Reactions involved in removing calcium deposits from soft tissues. Hence, vitamin K is essential for keeping our arteries clear of calcium deposits.

If you think about those last two reactions, vitamin K deficiency is the worst of all possible worlds. Calcium in our bloodstream is less likely to be deposited in our bones and more likely to be deposited in our arteries. Vitamin K deficiency is bad for bone health and bad for heart health.

There is only one other factoid you need to know to understand the study I will discuss below. Because vitamin K is essential for the carboxylation of certain proteins, the uncarboxylated level of those proteins in the bloodstream can be used as an indirect assay for vitamin K deficiency. That is the assay that was used in this study.

How Was The Study Performed?

In this study (I.J. Riphagen et al, Nutrients, 9, 1334; doi: 10.3390/nu9121334, 2017 ) the investigators studied 4275 subjects enrolled in a clinical trial called PREVEND (Prevention of Renal and Vascular End-Stage Disease). The study population was recruited from the city of Groningen in the Netherlands.

In terms of study population characteristics, the average age was 53, the population was 46% male, 94% Caucasian, and 60% of the population already had renal disease at the time of enrollment (The significance of this will be discussed later).

Study participants were followed for 10 years. By then 279 had died, with 74 deaths attributable to heart disease. Here are the results of the study:

30% of the population was vitamin K deficient.
Vitamin K deficiency was close to 50% for the elderly and for subjects with hypertension, diabetes, kidney disease, and cardiovascular disease.
Vitamin K deficiency was significantly correlated with all-cause mortality and cardiovascular mortality.

The authors concluded: “Importantly, a low vitamin K status is not only a clinically relevant risk factor for adverse health outcomes, but it may be a modifiable risk factor. Given the availability of vitamin K supplements, vitamin K insufficiency seems an attractive target for preventative intervention. Future prospective clinical trials are needed to investigate whether correction of low vitamin K status can indeed improve health outcomes.”

Pros and Cons of This Study

Cons:

This is an association study. It showed that vitamin K deficiency was associated with cardiovascular mortality, but it didn’t show that vitamin K deficiency caused cardiovascular mortality.
Kidney disease reduces the efficiency of vitamin K-dependent carboxylation of proteins. This study relied on levels of uncarboxylated protein for determining vitamin K status, and 60% of the subjects had kidney disease. The study might have overestimated the prevalence of vitamin K deficiency.
The population of the study were primarily Caucasian from one city in the Netherlands. It is not clear whether these findings would be equally true for other population groups.

Pros:

This study is consistent with previous studies. Several other studies have reported a correlation between vitamin K deficiency and either arterial calcification or heart disease risk. At least one study has shown that vitamin K supplementation can reverse arterial calcification.
The levels of vitamin K deficiency seen in this study are consistent with previous studies that have measured blood levels of vitamin K directly.

Vitamin K1 Versus K2: What Happens Naturally?

There are two forms of vitamin K, vitamin K1 and vitamin K2. Vitamin K1 is used for the blood clotting reactions. Vitamin K2 is used for the reactions involving bone formation and removal of calcium from soft tissues. That has led to a vigorous debate about whether vitamin K1 or K2 supplements are better. I won’t get into that debate, because the data aren’t conclusive yet. However, I will point out that there is a natural relationship between vitamin K1 and K2 that has existed for thousands of years.

Vitamin K1 is the primary dietary form of vitamin K. It is found in heart-healthy foods like green leafy vegetables; cruciferous vegetables like broccoli, Brussels sprouts and cabbage; and other healthy foods like carrots, blueberries, and asparagus. It is converted to vitamin K2 by our intestinal bacteria. Small amounts of vitamin K2 can also be found in less heart-healthy foods like cheeses, egg yolks, butter, chicken liver, and salami.

Simply put, if we eat healthy foods and have healthy gut bacteria, we get vitamin K1 from our diet, and our gut bacteria make all the vitamin K2 we need. This is a system that has worked well for humankind since the dawn of time. It’s only when we start messing up our diet and our gut bacteria that we need to start arguing about whether vitamin K1 or K2 supplements are better. It’s not nice to mess with Mother Nature.

The Bottom Line

A recent study in the Netherlands found that:

30% of the population was vitamin K deficient.
Vitamin K deficiency was close to 50% for the elderly and for subjects with hypertension, diabetes, kidney disease, and cardiovascular disease.
Vitamin K deficiency was significantly correlated with all-cause mortality and cardiovascular mortality.

The authors concluded: “…a low vitamin K status is not only a clinically relevant risk factor for adverse health outcomes, but it may be a modifiable risk factor. Given the availability of vitamin K supplements, vitamin K insufficiency seems an attractive target for preventative intervention.”

For more details about vitamin K and heart disease and a brief discussion of vitamin K1 and vitamin K2, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.