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CHAPTER 1
IN THE BEGINNING
So God created the great creatures of the sea and every living thing with which the water teems and that moves about in it ... and God saw that it was good.
— Genesis 1:21
Who would have thought that an editorial in an obscure Danish medical newspaper — unsigned and anonymous, no less — would start a revolution?
Yet that's exactly what happened.
The anonymous author began by pointing to studies showing that the native Inuit people of Greenland (then referred to as "Eskimos") had an exceedingly low incidence of death from myocardial infarction (heart attack). That alone would not have been surprising except for one inconvenient fact.
The Inuit ate a ton of fat.
And this did not fit well with conventional wisdom of the time.
It was 1968, and the low-fat forces were just gearing up for a battle that would ultimately divide the nutrition community into two factions, and make the partisanship of the US congress in the early twenty-first century look like a Disney movie. High-fat diets were not supposed to be healthy, let alone prevent heart disease. Yet the Inuit consumed a ton of fatty fish and fatty seal, and had vanishingly low levels of heart disease.
So our anonymous author issued a warning to the Danish medical community.
The warning was, "Time is running out." Western influences were changing the lifestyle and diet of the Inuits. Unless Danish researchers soon studied this issue, the opportunity to discover why Inuits had so little heart disease would be lost — and perhaps new insights into how to prevent heart attacks.
Why Danish researchers? Because Greenland — the scene of the paradox — was a colony of Denmark. (It's independent today, but still part of the "Kingdom of Denmark.") The startling fact was that 40 percent of deaths of males aged forty-five to sixty-five years living in Denmark resulted from heart attacks, while in Greenland, it was only 5.3 percent!
It was the responsibility, said the editorial — indeed it was the duty — of Danish scientists to take command of this endeavor.
Conventional wisdom at the time insisted that consuming a diet high in animal fat was the primary cause of cardiovascular disease. Many studies, including the famous Framingham Heart Study, which began in 1948 (and continues today), indicated at first that high-fat diets increased the risk of heart disease. Diets high in saturated animal fat, from bacon to butter to red meat, seemed to increase the odds, reducing not just the length but also the quality of life. Among other flaws, the Framingham researchers had no clue about the diversity of fats. While today we know some dietary fats are implicated in heart disease (trans fats), others are benign (monounsaturated fats), and some actually protect the heart — they reduce the risk of cardiovascular disease by suppressing inflammation, lowering triglycerides, and rendering cell membranes more fluid.
Fixated on the challenge of studying the epidemiological anomaly of Greenland's natives, a Danish physician, Hans Olaf Bang, told his young protégé, Jørn Dyerberg, "We simply have to go there and solve this riddle." As fate would have it, their opportunity to do just that came soon after.
And it happened when an outbreak of chicken pox threatened to decimate the Inuit population.
The Danish government asked for volunteer doctors to go to Greenland with medical supplies to fight the epidemic. Deciding to take advantage of the opportunity, Bang and Dyerberg not only volunteered, they also cobbled together $6,000 for the supplies they would need to collect and store 130 Inuit blood samples. Their plan was to bring these samples back to Denmark, and test them in the lab in the hopes of getting to the bottom of the mystery of why so few Inuits dropped dead from heart attacks.
The government asked the two doctors to set up a medical station in the village Igdlorssuit (translation, "The Big House"), located on an island off Greenland's western coastline. The problem was, the only way to get to Igdlorssuit was by dogsledding over one hundred miles of sea ice. Naively thinking they could ride in the sleds, Bang and Dyerberg hired experienced Inuits as drivers. But their equipment was much too heavy, so they had to run alongside the dogs. "This was not easy," Dyerberg recalls, "as we were in a dress that does not invite running."
Three days of dogsledding and two nights of sleeping outdoors in the cold tundra later, they found themselves living and working in very meager quarters — a building fashioned from piles of stones. There was no concrete to plug the cracks that let in cold drafts. But they were lucky; the temperatures at that time of year ranged from minus 4 to plus 10 degrees Fahrenheit. It was summer!
Weeks later, and back home in Denmark, Bang and Dyerberg were surprised to discover even though Inuits tended to be obese, their blood cholesterols were still lower than those of most Europeans, but not enough to explain the low rate of heart attacks. They published these results in The Lancet (1971). Next, using an old gas chromatograph, the two doctors began the tedious task of analyzing all the compounds in each Inuit blood sample. This process took two years, during which they found two compounds they had never heard of before, which they called "mystery X" and "mystery Y." At first, Bang and Dyerberg weren't sure, but they believed these compounds to be fats specifically from fish — compounds now called EPA and DHA.
About this time, Dyerberg recalls, "some new research came out indicating omega-6 fatty acids (AA and LA) cause blood to clot, so we suddenly got the idea that our fatty acids do the opposite." While in Igdlorssuit, they had observed that when an Inuit got a nosebleed (a frequent occurrence in extremely cold, dry air), the bleeding seemed to take longer to stop than what they remembered occurring back home. But this was only a casual observation. Measurements needed to be taken to find out how true it was. So, the two found themselves going back to Igdlorssuit. This time Bang and Dyerberg made tiny cuts on the arms of the same Inuits who earlier had provided them blood samples and timed how long it took for the bleeding to stop. The finding was it took an average of eight minutes, twice as long as it took when they performed the same experiment on fellow Danes. The only explanation was that omega-3 fatty acids decreased the speed of the clotting process.
The second discovery led Bang and Dyerberg to publish another paper in 1975 that appeared in the American Journal of Clinical Nutrition. For the first time they mentioned EPA and DHA and commented on the difference between the levels of these omega-3 fatty acids in the blood of Inuits compared to the blood of Danish people.
This article is historic; it marks the beginning of our realization that these omega-3 fatty acids are of primary importance to the development and health of humans.
Dyerberg led three more scientific expeditions to Greenland to further examine the association between fish oil intake and coronary heart disease. He discovered fish and seals don't make EPA and DHA by themselves; they consume them from the foods they eat. EPA and DHA are synthesized in the sea by algae and passed up the food chain via bigger and bigger organisms and finally by fish to humans. During one of his trips, Dyerberg asked the Inuits to prepare a double portion of their daily meals so he could freeze one portion for transportation back to Denmark. He subsequently measured how much EPA and DHA were in the meals, and was amazed to find the Inuits were eating approximately fourteen grams of omega-3 per day!
Most importantly, Bang and Dyerberg discovered the reason why the Inuits of the 1970s had such a low rate of fatal heart attacks. The high levels of DHA and EPA in their blood slowed the formation of blood clots that occur when the surface of cholesterol plaque in a coronary artery ruptures. And it is the formation of these clots that blocks the flow of blood and results in a heart attack. Inuits still had heart attacks, but much less frequently. Sadly, the Inuit advantage has since disappeared — today's Inuits smoke, drink alcohol, eat fast food, love pizza, and scarf down french fries like the rest of us.
The Truth about Fats
There are so many diverging misconceptions about dietary fats repeated so often, it seems nearly impossible to shed light on the real story, but let me try.
All dietary fats are a collection of substances called fatty acids. Each of these fatty acids belongs to one of four groups:
1. Saturated fat
2. Monounsaturated fat
3. Polyunsaturated fat
4. Trans fat
Most fats in food are a mixture of different fats, but we generally identify them by the fatty acid that is predominant. Fish oil contains the ultimate unsaturated fats, EPA and DHA, two omega-3 fats, but it also contains a significant amount (about 25 percent) of saturated fat. Sometimes foods contain mixtures of fats different from what you might expect. Believe it or not, a rib-eye steak actually has more monounsaturated fat than saturated.
Without getting too much into chemistry and molecular structure, every fatty acid is a chain of carbon atoms linked together by chemical bonds. Each of these carbon atoms has "two arms" or places that can potentially link to a hydrogen atom. When both arms are attached to hydrogen atoms, the fatty acid is "saturated." When one or more of the arms is not linked to a hydrogen atom, the fatty acid is "unsaturated."
When a carbon atom is not linked to two hydrogen atoms, it will instead link to another carbon atom forming what is called a double bond. When there is just one such double bond in a fatty acid chain, the fatty acid is called monounsaturated. When there is more than one, it is called polyunsaturated.
Purely an invention of the processed-food industry, the fourth dietary fat, trans fat (a.k.a. "hydrogenated" or "partially hydrogenated"), is a polyunsaturated fat that has been turned from a liquid to a solid or semi-liquid form (think Crisco). This is accomplished through a chemical process whereby hydrogen atoms are forced to bond with carbon atoms.
Not long ago, trans fatty acids were used in almost every processed food from soups to chips, margarine, vegetable shortening, crackers, cookies, pastries, and mixes of all kinds, even some pasta and rice mixes. And they are still widely used in deepfried foods, especially some foods from fast-food outlets. Overall, however, trans fats are not as prevalent as they once were because the word has gotten out — they are really, really bad for you. Many of the processed foods that once contained trans fat are now labeled "no trans fat" or "zero g trans fat." There is no doubt that trans fats cause obesity, diabetes, and heart disease — you should avoid them at all costs.
There is another word you'll be reading about in this book: triglycerides. Triglycerides are the main form of fat in meat, fish, and your body (and in the bloodstream) and are used by the body. If you have extra triglycerides, they are stored in fat cells in case they are needed later. When you think of fat developing and being stored in your hips or belly (adipose tissue), you're thinking of triglycerides. Triglycerides are one of the end products of digestion. While some triglycerides come from fats we eat, most triglycerides are made in the body from carbohydrates, including alcohol, starch, and sugar. Thus fat tissue that everyone worries about can be viewed as storage of unused energy and is primarily from carbs and saturated fat we consume.
By the way, as long as we're on the subject, cholesterol is not a fat. It is a waxy, odorless substance made by the liver that is an essential part of cell walls (also known as cell membranes). It also plays an important role in bodily functions such as digestion and hormone production. As with dietary fats, there are many misconceptions about cholesterol — you'll be reading a lot about them in this book as well.
Bogeyman Fat
For many years it was thought eating too much saturated fat resulted in elevated levels of a type of cholesterol called LDL (low-density lipoprotein) cholesterol. This elevated LDL was believed to be one of the primary causes of heart disease. Many doctors still believe saturated fat is the main culprit, which is why some of them advocate a low-fat diet. It turns out the metabolic fate of saturated fat — what it actually does and does not do in the body — depends mostly on what else is eaten and how much. Scientists who research low-carbohydrate diets are finding higher levels of saturated fat alone aren't such a problem if your diet doesn't include high levels of sugar, processed carbs, fast food, and trans fat. The key is moderation and the appropriate balance of complex carbohydrates like those found in vegetables, and good fats like those found in fish and a diet rich in protein.
A PARTICLE CALLED LOW DENSITY LIPOPROTEIN (LDL)
Did you know that when you have a cholesterol test, LDL is not measured but is calculated? The lab measures the total cholesterol in your blood, HDL (the "good" cholesterol), and your triglyceride level. It then calculates or approximates your LDL level as follows:
Estimated LDL = Total Cholesterol – HDL – 1/5 Triglycerides
The real enemy is not saturated fat and it is not all cholesterols; it is circulating levels of a particle called LDL. Half of people with heart disease have "normal" cholesterol levels and half have what are considered "elevated" levels. A high level of triglycerides — and especially a high ratio of triglycerides to HDL — is a much better predictor of heart disease than cholesterol is. I will explain this in more detail in the next chapter, "Conquering Heart Disease." You'll also learn why consuming EPA and DHA is one of the best ways to lower triglycerides, which, as you'll see, automatically lowers the all-important triglyceride-to-HDL ratio.
Along Come the Good Fats: EPA and DHA
There are only three types of omega fatty acids you need to ever think or worry about: omega-3s, omega-6s, and omega-9s. Omega3 is a polyunsaturated fat — it has more than one double bond, and the first double bond is in the third position on the carbon chain. Omega-6 is also a polyunsaturated fat, but its first double bond is in the sixth position. Omega-9 is different; it is a monounsaturated fat, with only one double bond, which happens to be in the ninth position.
Omega-9 is the monounsaturated fat found in olive oil. It is generally considered a "good" fat, or at least not a bad fat. Unlike omega-3 and omega-6, though, it is not an essential fatty acid because your body can produce it. Essential fatty acids are ones that can only be obtained from food. Analysis of human fat tissue shows it to be made of saturated fat, like those made from simple carbs and omega-9.
Many people think omega-3 is good for you, while omega-6 is bad. However, both are building blocks from which your body makes other materials one of which is called prostaglandin. Omega-3s are the building blocks for anti-inflammatory prostaglandins while omega-6s are the building blocks for inflammatory or proinflammatory ones. We've all heard inflammation is a bad thing, which is probably the reason some of us think omega-6 is bad. However, our bodies need both substances. It is the balance between the two that is all important.
Inflammation is a natural part of the healing process. When you accidentally cut your finger, your body rushes in white blood cells to surround the injured area in order to destroy any pathogens or bacteria that may have gotten into the wound. The signal your body uses to trigger this process requires omega-6's inflammatory prostaglandins. This inflammation is an attempt to prevent infection and alert you of an injury. You need the building blocks from omega-6 so that your body can defend itself from what it perceives to be an attack or damage. But your pro-inflammatory prostaglandins need to be in balance with the anti-inflammatory prostaglandins in order for you to have an optimally functioning immune system, and a way of turning off the inflammation when it is no longer needed.
You can think of it like this: Inside your body you have the army and the "Red Cross." The army seeks out and destroys enemy germs but in the process it causes a significant amount of collateral damage. The Red Cross comes along to provide medicine, food, and shelter for refugees. Now if you overnourish the army at the expense of the Red Cross you create a problem — the army does more damage than the Red Cross can ever hope to repair!
(Continues…)
Excerpted from "Prevention is the Cure!"
by .
Copyright © 2015 Dr. Frederick D. Sancilio, Ph.D..
Excerpted by permission of Morgan James Publishing.
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