Does Red Wine Protect the Cardiovascular System?

The 'French paradox' rears its ugly head again. The reasoning goes something like this: French people eat more saturated animal fat than any other affluent nation, and have the second-lowest rate of coronary heart disease (only after Japan, which has a much higher stroke rate than France). French people drink red wine. Therefore, red wine must be protecting them against the artery-clogging yogurt, beef and butter.

The latest study to fall into this myth was published in the AJCN recently (1). Investigators showed that 1/3 bottle of red wine per day for 21 days increased blood flow in forearm vessels of healthy volunteers, which they interpreted as "enhanced vascular endothelial function"*. The novel finding in this paper is that red wine consumption increases the migration of certain cells into blood vessels that are thought to maintain and repair the vessels. There were no control groups for comparison, neither abstainers nor a group drinking a different type of alcohol.

The investigators then went on to speculate that the various antioxidant polyphenols in red wine, such as the trendy molecule resveratrol, could be involved. Even though you have to give animals 500 bottles' worth of resveratrol per day to see any effect. But there's another little problem with this hypothesis...

Ethanol-- plain old alcohol. You could drink a 40 oz bottle of malt liquor every night and it would probably do the exact same thing.

No matter what the source, alcohol consumption is associated with a lower risk of cardiovascular disease out to about 3-4 drinks per day, after which the risk goes back up (2, 3)**. The association is not trivial-- up to a 62% lower risk associated with alcohol use. Controlled trials have shown that alcohol, regardless of the source, increases HDL cholesterol and reduces the tendency to clot (4).

Should we all start downing three drinks a day? Not so fast. Although alcohol does probably decrease heart attack risk, the effect on total mortality is equivocal. That's because it increases the risk of cancers and accidents. Alcohol is a drug, and my opinion is that like all drugs, overall it will not benefit the health of a person with an otherwise good diet and lifestyle. That being said, it's enjoyable, so I have no problem with drinking it in moderation. Just don't think you're doing it for your health.

So does red wine decrease the risk of having a heart attack? Yes, just as effectively as malt liquor. It's not the antioxidants and resveratrol, it's the ethanol. The reason the French avoid heart attacks is not because of some fancy compound in their wine that protects them from a high saturated fat intake. It's because they have preserved their diet traditions to a greater degree than most industrialized nations.

I do think it's interesting to speculate about why alcohol (probably) reduces heart attack risk. As far as I know, the mechanism is unknown. Could it be because it relaxes us? I'm going to ponder that over a glass of whiskey...


* It may well represent an improvement of endothelial function, but that's an assumption on the part of the investigators. It belongs in the discussion section, if anywhere, and not in the results section.

** The first study is really interesting. For once, I see no evidence of "healthy user bias". Rates of healthy behaviors were virtually identical across quintiles of alcohol intake. This gives me a much higher degree of confidence in the results.

Sweet Potatoes

We can measure the nutrient and toxin content of a food, and debate the health effects of each of its constituents until we're out of breath. But in the end, we still won't have a very accurate prediction of the health effects of that food. The question we need to answer is this one: has this food sustained healthy traditional cultures?

I'm currently reading a great book edited by Drs. Hugh Trowell and Denis Burkitt, titled Western Diseases: Their Emergence and Prevention. It's a compilation of chapters describing the diet and health of traditional populations around the world as they modernize.

The book contains a chapter on Papua New Guinea highlanders. Here's a description of their diet:

A diet survey was undertaken involving 90 subjects, in which all food consumed by each individual was weighed over a period of seven consecutive days. Sweet potato supplied over 90 percent of their total food intake, while non-tuberous vegetables accounted for less than 5 percent of the food consumed and the intake of meat was negligible... Extensive herds of pigs are maintained and, during exchange ceremonies, large amounts of pork are consumed.

They ate no salt. Their calories were almost entirely supplied by sweet potatoes, with occasional feasts on pork.

How was their health? Like many non-industrial societies, they had a high infant/child mortality rate, such that 43 percent of children died before growing old enough to marry. Surprisingly, protein deficiency was rare. No obvious malnutrition was observed in this population, although iodine-deficiency cretinism occurs in some highlands populations:

Young adults were well built and physically fit and had normal levels of haemoglobin and serum albumin. Further, adult females showed no evidence of malnutrition in spite of the demands by repeated cycles of pregnancy and lactation. On the basis of American standards (Society of Actuaries, 1959), both sexes were close to 100 percent standard weight in their twenties.

The Harvard Pack Test carried out on 152 consecutive subjects demonstrated a high level of physical fitness which was maintained well into middle-age. Use of a bicycle ergometer gave an estimated maximum oxygen uptake of 45.2 ml per kilogram per minute and thus confirmed the high level of cardiopulmonary fitness in this group.

Body weight decreased with age, which is typical of many non-industrial cultures and reflects declining muscle mass but continued leanness.

There was no evidence of coronary heart disease or diabetes. Average blood pressure was on the high side, but did not increase with age. Investigators administered 100 gram glucose tolerance tests and only 3.8 percent of the population had glucose readings above 160 mg/dL, compared to 21 percent of Americans. A study of 7,512 Papuans from several regions with minimal European contact indicated a diabetes prevalence of 0.1 percent, a strikingly low rate. For comparison, in 2007, 10.7 percent of American adults had diabetes (1).

I'm not claiming it's optimal to eat nothing but sweet potatoes. But this is the strongest evidence we're going to come by that sweet potatoes can be eaten in quantity as part of a healthy diet. However, I wish I knew more about the varieties this group ate. Sweet potatoes aren't necessarily sweet. Caribbean 'boniato' sweet potatoes are dry, starchy and off-white. In the US, I prefer the yellow sweet potatoes to the orange variety of sweet potato labeled 'yams', because the former are starchier and less sweet. If I could get my hands on locally grown boniatos here, I'd eat those, but boniatos are decidedly tropical.

Instead, I eat potatoes, but I'm reluctant to recommend them whole-heartedly because I don't know enough about the traditional cultures that consumed them. I believe there are some low-CHD, low-obesity African populations that eat potatoes as part of a starch-based diet, but I haven't looked into it closely enough to make any broad statements. Potatoes have some nutritional advantages over sweet potatoes (higher protein content, better amino acid profile), but also some disadvantages (lower fiber, lower in most micronutrients, toxic glycoalkaloids).

COBRA versus Subsidy for COBRA (18 vs 15 months)

This week I have been asked about this so many times that I wanted to address some confusion concerning federal COBRA.Federal COBRA runs a standard 18 months, not 15 months. There are cases where it can be 29 months (disability extension) or 36 months (divorce, separation, death of the employee, state extension or dependent age-off of parent's plan). Generally it runs 18 months for most

Pastured Dairy may Prevent Heart Attacks

Not all dairy is created equal. Dairy from grain-fed and pasture-fed cows differs in a number of ways. Pastured dairy contains more fat-soluble nutrients such as vitamin K2, vitamin A, vitamin E, carotenes and omega-3 fatty acids. It also contains more conjugated linoleic acid, a fat-soluble molecule that has been under intense study due to its ability to inhibit obesity and cancer in animals. The findings in human supplementation trials have been mixed, some confirming the animal studies and others not. In feeding experiments in cows, Dr. T. R. Dhiman and colleagues found the following (1):

Cows grazing pasture and receiving no supplemental feed had 500% more conjugated linoleic acid in milk fat than cows fed typical dairy diets.

Fat from ruminants such as cows, sheep and goats is the main source of CLA in the human diet. CLA is fat-soluble. Therefore, skim milk doesn't contain any. It's also present in human body fat in proportion to dietary intake. This can come from dairy or flesh.

In a recent article from the AJCN, Dr. Liesbeth Smit and colleagues examined the level of CLA in the body fat of Costa Rican adults who had suffered a heart attack, and compared it to another group who had not (a case-control study, for the aficionados). People with the highest level of CLA in their body fat were 49% less likely to have had a heart attack, compared to those with the lowest level (2).

Since dairy was the main source of CLA in this population, the association between CLA and heart attack risk is inextricable from the other components in pastured dairy fat. In other words, CLA is simply a marker of pastured dairy fat intake in this population, and the (possible) benefit could just as easily have come from vitamin K2 or something else in the fat.

This study isn't the first one to suggest that pastured dairy fat may be uniquely protective. The Rotterdam and EPIC studies found that a higher vitamin K2 intake is associated with a lower risk of heart attack, cancer and overall mortality (3, 4, 5). In the 1940s, Dr. Weston Price estimated that pastured dairy contains up to 50 times more vitamin K2 than grain-fed dairy. He summarized his findings in the classic book Nutrition and Physical Degeneration. This finding has not been repeated in recent times, but I have a little hunch that may change soon...

Vitamin K2
Cardiovascular Disease and Vitamin K2
Can Vitamin K2 Reverse Arterial Calcification?

10 Types of Food That Can Make You Sick

The riskiest foodsFood poisoning is a horrible, even potentially life-threatening experience. But it’s hard to determine if food is safe to eat, partly because problems are relatively rare.But knowing which foods are potentially risky can help.The Center for Science in the Public Interest has issued a list of the top 10 FDA-regulated foods linked to outbreaks since 1990. (That includes produce,

Malocclusion Posts Translated into German

It's nice to see on my website statistics program that Whole Health Source has a solid international following. As commonly as English is spoken throughout the world however, there are many people who do not have access to this blog due to a language barrier.

A gentleman by the name of Bertram has translated/summarized my series on the causes and prevention of malocclusion (misaligned teeth) into German. His site is OriginalHealth.net, and you can find the first post here, with links to the subsequent 8. It looks like an interesting site-- I wish I could read German. Thanks Bertram!

Health Exchanges and Independent Agents

I am hearing and reading so much lately from the health insurance agent community about the future of agents under healthcare reform. Specifically as relates to the health insurance exchanges set for 2014. A minority believe that independent agents will have a place in the system while a majority, it seems, are suffering from "Chicken Little Syndrome". Truthfully, no one knows yet what place

MRMIP Clears Backlog (No Enrollment Waiting Period)

The California MRMIP (Major Risk Medical Insurance Program) has apparently received some additional funding and has cleared the backlog of applications.As of today (5/19/10) there is no waiting list for MRMIP enrollments. I am working on obtaining specific information regarding the federal temporary risk pool which is scheduled to open July 1. In the meantime eligible uninsurables may enroll in

A Little Know About Eyelid Surgery