Book review
These are some snippets from Part 2 of The Eskimo Diet: How to Avoid Heart Attack by Dr. Reg Saynor and Dr. Franklin Ryan reviewed below: “Compared to cholesterol research, the work done on the beneficial effects of fish oil has seen very little disagreement. A single review article published in 1988 in the prestigious Journal of the American Medical Association referred to 119 separate scientific studies of the properties of fish or fish oil, conducted in the most respected hospitals and university centers in the world and by the most eminent doctors and scientists – and almost every study pointed to some unusual and potential beneficial effects.” “Everybody should be screened, including children, especially if there is a strong family history of coronary heart disease or known high risk of atheroma. All the big atheroma trials have indicated that it starts early in childhood, so the sooner we spot the high risk people and do something about it the better.” “Problems arise if there are too few sites in the tissues for the LDL to dock at, and so it starts to dump its load in all sorts of areas where this really shouldn’t happen. This is why doctors are more interested in a high level of LDL-cholesterol than in a high level of whole-blood cholesterol. One of these unwelcome dumping grounds is the lining of the coronary arteries. The frightening thing for us in the Western world is that this excessive dumping of fat, or atheroma, starts so early in life; the very first evidence of the process can be seen in the coronary arteries of young children.”
THE ESKIMO DIET
HOW TO AVOID HEART ATTACK
Dr. REG SAYNOR & Dr. FRANK RYAN
EBURY PRESS, LONDON 1990
PART II
Chapter 3: How to Cope with a Heart Attack
Chapter 4: The Importance of Diet
• Compared to cholesterol research, the work done on the beneficial effects of fish oil has seen very little disagreement. A single review article published in 1988 in the prestigious Journal of the American Medical Association referred to 119 separate scientific studies of the properties of fish or fish oil, conducted in the most respected hospitals and university centers in the world and by the most eminent doctors and scientists – and almost every study pointed to some unusual and potential beneficial effects.
What is cholesterol?
• Cholesterol is found as a natural substance in all animal cells and blood. It is an essential element in our body chemistry. It is more a question of balance – and we have got the balance wrong.
• In countries such as the UK, with a high average level of total blood cholesterol, the population runs a high risk of a heart attack.
Inherited raised blood cholesterol
• If several members of your family have suffered heart attacks (a history of sudden death is often very indicative), particularly in their forties, thirties or even younger, then you might be suffering from hereditary raised cholesterol. This affects about one person in five hundred and is referred to medically as hereditary or familial hypercholesterolaemia.
• The risk of a heart attack for a patient with familial raised blood cholesterol is eight times the normal. If you suspect you may have inherited this problem, it is simple to have the fat levels in your blood tested.
Who should have their blood fats screened?
• Everybody should be screened, including children, especially if there is a strong family history of coronary heart disease or known high risk of atheroma.
• All the big atheroma trials have indicated that it starts early in childhood, so the sooner we spot the high risk people and do something about it the better.
What are HDL-cholesterol and LDL-cholesterol?
• Cholesterol is manufactured mainly in our livers – and is a vital chemical for our body cells.
• As it is insoluble in water it has to be kept in solution by some tricky chemistry inside our vital organs.
• The main particle involved in ferrying cholesterol is low density lipoprotein or LDL.
• Problems arise if there are too few sites in the tissues for the LDL to dock at, and so it starts to dump its load in all sorts of areas where this really shouldn’t happen.
• This is why doctors are more interested in a high level of LDL-cholesterol than in a high level of whole-blood cholesterol.
• One of these unwelcome dumping grounds is the lining of the coronary arteries.
• The frightening thing for us in the Western world is that this excessive dumping of fat, or atheroma, starts so early in life; the very first evidence of the process can be seen in the coronary arteries of young children.
• The way to deal with this situation is not an obsessive preoccupation with every milligram of cholesterol in our diet. The problem has more to do with saturated fat than with cholesterol, and this will be explained later.
• In the human body, providence has provided a counter to excess cholesterol in another small particle called high density lipoprotein or HDL. This, too, is produced in the liver.
• As the HDL circulates, its main function is to scavenge excess tissue cholesterol, which it picks up and returns to the liver for disposal.
• If you have a low HDL-cholesterol you are at a greater risk of a heart attack.
Your total cholesterol/HDL-cholesterol ratio
• Divide your HDL-cholesterol count into your total cholesterol count. 4.95 is an average risk. If the figure is higher your risk increases.
• Dietary advice is dealt with fully in Chapter 8.
• Adding oily fish or pure fish oil to your diet can increase your level of protective HDL-cholesterol. Your body does this by modifying the chemistry of another fat called triglyceride.
What are triglycerides?
• Examples are the white ‘lardy’ fat you see on meat, on top of a pint of fresh full-cream milk, or floating in the pan as all-too-delicious melting butter! This is the kind of fat that contains those well-known risk factors referred to as saturates and unsaturates, which will be explained below.
• Triglycerides, gram for gram, are more energy-rich than sugar or carbohydrate. They can be taken directly from the food we eat or can be manufactured in the liver.
• When Hugh Sinclair examined Eskimos in their natural environment he found that, although they were virtually free of heart attacks, their blood cholesterol level was quite close to that in the United Kingdom. What was different was the level of their triglycerides.
• In spite of their very high intake of animal fat, the level of their triglycerides was only a quarter of the average level in the UK.
• There are fatty acids unique to fish which actually lower triglycerides in our blood. We shall return to this topic shortly.
General advice about being overweight
• Unwanted body fat is stored triglyceride. In women fat is preferentially distributed to the bust, bottom, abdomen and thighs; in men in the big elastic space between the chest and the pelvis.
• The more we eat of foods containing triglyceride, the more fat is stored. If we do no more exercise than walking to the television set, then we won’t burn up a great deal of fat.
• There is a vicious circle in which we continue to eat food at a rate laid down in our more energetic youth, fat builds up, we get slower and feel less like exercising.
• Being fat does not itself lead directly to a heart attack, although it is linked closely with several factors that do increase the risk, such as hypertension, raised blood triglyceride levels, raised blood cholesterol levels and reduced physical activity.
• If these other factors are not present, obesity in itself is not a risk factor.
• Those people who can binge on food to their heart’s desire and still remain reed-slim are not immune to heart attacks.
How does this relate to heart attacks?
• People with a higher than normal triglyceride level, tested while they are fasting, the HDL is usually lower than it should be.
• If we reduce our blood triglyceride by cutting down on saturated fat in our food, the HDL in our blood will probably increase.
• Here we encounter another of those wonderful properties of fish oil. Although it is a fatty acid, it has powerful protective effects on the level of triglycerides in our blood.
Alcohol and sugar
• Alcohol raises fat levels in the blood; and so, if indulged to excess, does sugar. Its all a matter of balance and common sense.
• Taken in moderate quantities, alcohol increases our enjoyment of life and certainly does not cause the vast majority of the population any harm.
• Nor do we say you cannot have any butter, cheese, meat, milk or sugar. What we are saying is that in the United Kingdom we consume too much of these products.
Oral contraceptives
• Some pills increase cholesterol and triglycerids, while others are actually beneficial.
Exercise
• Other activities to increase the protective levels of HDL in our blood include exercise, weight reduction, and in general a healthier life style.
What are fatty acids?
• There are three common types of fatty acids, saturated, polyunsaturated and monounsaturated. The physical differences between these three types may appear to be trivial, but in the internal chemistry of our bodies such differences are devastatingly vital.
Saturated fats
• A fatty acid is basically like an open necklace of carbon atoms (like little black pearls) with an acid chemical group at one end of it. If the chemical links between the carbon pearls are single, the fat is saturated.
Unsaturated fats
• If any of the links are double, the fat is unsaturated. One double link (called a chemical double bond) and it’s a monounsaturated. Two or more along the necklace (chemical chain) and it’s a polyunsaturated fatty acid.
Hydrogenated fats
• Saturated is a chemical term referring to whether or not you can attach any more hydrogen atoms. If there are no double links left, you cannot. If there are, you can break a double link into a single, releasing two more chemical positions to which hydrogen atoms can be attached.
• A hydrogenated vegetable oil may have started out life as a polyunsaturated, but hydrogenation means the double links have been broken and hydrogen added. The vegetable oil is therefore no longer a polyunsaturate but a saturate.
Examples of saturated and unsaturated fats
• Lard or dripping is composed mainly of saturated fatty acids (the ones that are bad for us) and this results in a hard fat.
• Olive oil is composed mainly of monounsaturated fatty acids and is quite fluid in warm temperatures, but can become thick and less runny when cold.
• Corn and vegetable oils are mostly polyunsaturated fatty acids and remain fluid at quite low temperatures. All these are listed and described in Chapter 8.
• For many years we have indulged ourselves in large quantities of saturated fats in the form of chips, Sunday joints and roast potatoes cooked in the meat dripping, not to mention the tasty traditional bacon, eggs, fried bread and black and white puddings which are enormously high in saturated fat.
• If you knew how much saturated fat beef and pork sausages contain, you would be very surprised!
Why saturated fat is bad for modern man
• There was a roar behind an ancient man and, fearing attack by a wild animal, immediately his heart started to race as the adrenaline flowed. At the same time triglyceride was released from his fat stores and converted into free fatty acids to supply energy for his escape.
• In running he used up the released triglyceride and his heart slowed down as the adrenalin supply decreased. As well as increasing the heart rate, adrenaline also increases blood triglyceride levels.
• His modern counterpart is likely to be sitting in his office when his boss complains and adrenaline flows, the heart rate goes up and his triglyceride level is raised.
• Instead of all-out exercise, he is more likely to tense up over his desk, light a cigarette and stew in adrenaline, persistently raised triglyceride, ongoing high heart rate and raised blood pressure.
• Our grandparents ate dripping and cream all their lives and lived to old age. True. But they worked very hard physically.
• There is a balance between fat consumed and energy output, and today we exercise a great deal less than our parents and grandparents.
So what is special about fish?
• Imagine what would happen if fish, living in cold waters, were fed the saturated fat we tend to eat! The cold would make the fats in their blood congeal, and the blood flow would slow down until the fish became as stiff as a board.
• Clearly they must eat polyunsaturates of a special kind which remain fluid at cold temperatures.
• Fish contain special fats because they themselves eat polyunsaturated fats of a very special type. These fats have a double link between the third and forth carbon pearl, the so-called ‘3’ position, and so they are called n-3 (or Omega 3) fatty acids.
The vital Omega-3 fatty acids in fish oil
The vital ingredients in fish oil, EPA and DHA, which are much easier to remember than what they stand for, the tongue-twisting eicosapentanoic acid and docosahexaenoic acid, are two of those n-3 polyunsaturated fatty acids. But they are very special ones, known as ‘essential’ fatty acids. Indeed your body cannot make them on its own (no more than the fish can – they eat it in plankton), so the only way you can get them into your cells is by eating them in your diet. And the only food that contains these very special ingredients in any significant quantity is oily fish. If EPA and DHA are only found in oily fish, what will be the consequences of not eating fish as part of our normal diet?