While kicking tobacco addiction still remains the single most effective way to avoid heart disease, medical and scientific research point directly to:
-- moderate, regular wine consumption with meals,
-- moderate exercise and
-- the consumption of lowfat, healthy foods -- especially fruits and vegetables,
as the most identifiable pro-active factors in reducing the chances of having a heart attack. Diet is also crucial in reducing the risks of getting other serious diseases like cancer.
But forgotten by Americans, who like quick, easy fixes to problems, is the pattern of consumption. And the pattern of eating and drinking way be as important for health as what is eaten or drunk.
In addition to consumption patterns, moderation is frequently ignored by Americans who feel that if a little of something is good for you, then a lot must be better. We all know people who believe that if slim (or bulked up) is healthy, then really slim/bulked up is even better. Regardless of the behavior, Americans seem driven to excess.
Psychiatrists and other researchers are increasingly learning that the near-obsessive attitudes that drive these behaviors create an unhealthy stress that may negate whatever benefits might otherwise have been achieved.
Here are some of the moderation and pattern-related facts and hypotheses that scientists feel help explain the French Paradox. It's important to remember that a scientific hypothesis is not yet proven but is the formulation of a conclusion based on (and not conflicting with) existing research. These hypotheses are first attempts to explain the scientific mechanisms behind some observed facts.
BACKGROUND FACTS: This practice preserves vitamins (most notably Vitamins C and E and beta-carotene which are anti-oxidants) and which are thought to decrease the development of atherosclerosis and some cancers.
DISCUSSION: Adequate consumption of fresh fruits and vegetables is important not only for the vitamins and minerals they contain, but also for the fiber they add to the diet. In addition, nutritionists and diet researchers increasingly believe that the "active ingredient" in a particular food (such as sulforaphane in broccoli, a potential cancer inhibitor) may not perform as promised when isolated from other component organic chemicals in the food.
Eating fresh fruits and vegetables (or fresh frozen which are very close in nutritional content) not only tastes better and is more fun than taking a supplement, it can be healthier.
But taking fresh foods and cooking the life out of them defeats the purpose. It's been known for decades that the over-cooked styles of American food destroy many of the healthy nutrients and leave many more leached out in the cooking water.
The French and Mediterranean styles of cooking leave vegetables bright in color, firm and full of nutrients.
Fortunately, vegetables are tailor-made for microwave preparation which cooks vegetables quickly throughout, usually without added water.
HYPOTHESIS:Longer meals slow the absorption and metabolism of fats, which may affect insulin levels and the effects of fats on blood platelets.
HYPOTHESIS: Longer meals decrease emotional stress by providing a break from daily events and by fostering conversation and human interaction.
DISCUSSION:The human body has a remarkable ability to cope with tens of thousands of chemical compounds ranging from the healthy to the toxic. Small amounts of toxins, for example, can be scavenged, neutralized and excreted by the liver. But if the blood concentration of these chemicals increases too fast or reaches too high a concentration, the liver -- or other mechanisms -- become overwhelmed and health suffers.
Fat is needed in the human diet, but in far smaller concentrations than are normally found in the American diet -- or the French and Mediterranean diet for that matter. Like fat, many other healthful compounds -- ranging from Vitamin A and aspirin to alcohol and most therapeutic drugs -- can be toxic when the doses rise too high.
The fast, on-the-run meals consumed by Americans are usually very high in fat and sugar, causing insulin levels to skyrocket.
Scientists have found that bouncing insulin levels (like those found in diabetics who take their insulin via syringe rather than by implanted pump) damage many of the body's tissues, especially blood vessels, and alter the way that cells metabolize food.
Insulin damage may promote the build-up of cholesterol in the artery walls leading to atherosclerosis.
In addition, high concentrations of fats in the blood may also increase the stickiness of platelets which promotes clotting.
Finally, some scientists have theorized that saturated fats may form "free radicals" (oxidant compounds which can damage normal tissues and even attack DNA) in the blood which aggravates the other factors.
The stressed-out, hurried nature of American meals also may contribute to our heart attack rate. For centuries, "breaking bread together" has been one of the foundations of family, friendship and communal bonding. It is a time to unite against the stresses of the rest of the world.
But in America today, meals have become tools of business -- "power" breakfasts/lunches, "rubber-chicken" dinners. They have fallen victim to the fragmented interests of today's modern one- parent/two-income families.
BACKGROUND FACTS: Red meats, especially beef, contain saturated fats (specifically lauric, mystric, palmitic and stearic fatty acids) that promote atherosclerosis and increase the tendency for blood to clot and cause thrombosis.
DISCUSSION: Cheap and available beef has made us a nation of red meat lovers. We often eat half a pound or more at one sitting, and there are still people who lust for a "well-marbled" steak. That marbling is mostly saturated fat and it can act like a stone wall in your coronary arteries.
Ground beef is especially bad; by most state laws, it can contain 25 to 30 percent fat by weight. But since fat has more than twice the calories (9 per gram) than the same weight of protein or carbohydrates (4 per gram), this means that 50 to 60 percent of the calories from that hamburger comes from fat! Nutritionists recommend eating no more than 30 percent (and less if possible) of your calories from fat.
But, you might ask yourself, "If I drink a couple of glasses of beer or wine, I'll protect myself, right?"
Research suggests that you will decrease your heart attack risks by 20 to 50 percent over a person who eats exactly the same as you do but who abstains or drinks heavily. BUT! You will still face a greater risk than a person who consumes alcohol moderately and reduces saturated fat intake.
HYPOTHESIS: Cheese butter fat is not as atherosclerotic as the fat in butter and milk.
The French eat about 40 pounds of cheese every year for every man, woman and child; Americans eat only half of that. Dr. Serge Renaud, head of the Lyon unit of INSERM, says that all dairy fat is not equal. His research indicates that in cheese, the calcium binds with the dairy fat and prevents it from contributing to heart disease. In milk, on the other hand, the fat binds with milk proteins, leaving the fat free to park itself in your arteries.
BACKGROUND FACT: Olive oil is a monounsaturated vegetable oil which contains very little saturated fat and no cholesterol and helps increase the "good" HDL cholesterol in the blood.
BACKGROUND FACT: Goose and duck fat have far less saturated fat than that from most other animals and have at least one half as much monounsaturated fat as olive and other vegetable oils.
DISCUSSION: Saturated fats tend to promote the body's production of LDL "bad" cholesterol which leads to hardening of the arteries. Fat from different animals differs widely in degrees of saturation. As you'll learn in greater detail in a later chapter on fats, saturation has to do with how loaded the fat molecules are with hydrogen.
Except for tropical oils like coconut and palm, vegetable oils (olive, corn, safflower etc.) tend to be high in polyunsaturated or monounsaturated fats that tend to lower cholesterol. However, even here the playing field isn't level.
Research by Dr. Scott Grundy, M.D., of the University of Texas Health Science Center indicates that diets high in polyunsaturated oils, such as those from corn, safflowers and sunflowers, decreased cholesterol overall -- including the "good" HDL cholesterol. As we'll learn later, the ratio of "bad" LDL to good HDL may be as important to heart health as the overall cholesterol level.
Enter olive oil, the star of the Mediterranean. Olive oil is very high in monounsaturated fat which research has found decreases the bad LDL cholesterol without lowering the good HDL levels.
Research shows that HDL cholesterol can actually scavenge cholesterol deposits from artery walls, which contributes to reversing heart disease.
BACKGROUND FACTS: As you'll learn in following chapters, the regular, moderate consumption of alcohol
-- increases good HDL and reduces bad LDL cholesterols,
-- decreases the tendency of blood platelets to stick together (aggregation), thus decreasing the chances of blood clot formation and
-- decreases clotting by altering the production of fibrinogen, a key clotting protein.
HYPOTHESES: In addition to those three scientifically proven mechanisms for the protective effects of moderate alcohol consumption, scientists have identified four other possible mechanisms which are backed by existing research, but which need further study before stating conclusively. Scientists believe alcohol:
-- reduces the tendency of coronary arteries to constrict during times of stress. This constriction can slow or stop blood flow (especially in an artery already narrowed by atherosclerosis);
-- increases coronary artery diameter and blood flow;
-- increases the ability of blood to dissolve blood clots that have formed (a process known as fibrinolysis) and
-- lowers blood pressure (for moderate consumption only; heavy drinking raises blood pressure).
DISCUSSION: The cardio-protective effects of moderate alcohol consumption have been demonstrated in hundreds of scientific studies and are generally accepted by the medical establishment. That the American people have heard so little about this until recently because of a large and growing anti-alcohol movement, those who believe that alcohol in any amount is evil and unhealthy.
Medical evidence on alcohol's protective effects has been known at least since the 1920s and has steadily accumulated since then. Unfortunately, a strong and close-minded group both inside and outside the U.S. government has, to a great extent, suppressed information and in some cases has outright lied to the American people about alcohol.
These people believe -- rightly -- that alcohol abuse is a serious problem in the United States and must be addressed. We agree. However, the anti-alcohol coalition is so intent on saving people from abuse that they have left the truth about moderate drinking trampled in the dust.
Further, in their efforts to help the 7 to 10 percent of the population who are prone to abuse and addiction, they have suppressed information that could help prevent many of the 1,000,000 heart attacks and 500,000 deaths every year. The human suffering from alcohol abuse must be addressed, but so must the death and suffering from coronary artery disease.
You have a right to know the scientific truth even if it runs counter to the "no-use" government policy message. Because alcohol research has been so determinedly kept from the American people, we will spend most of this book discussing the benefits and risks of alcohol.
And now a final word about wine and alcohol before we launch into the details: throughout the rest of this book, we will refer mostly to wine. However, the scientific and medical research differentiating wine, beer and distilled spirits is far from conclusive. Some research indicates that wine may have an edge; other research indicates that beer or liquor may have a slight edge. At present, there are more studies that lean toward wine, but we don't believe that a firm conclusion can yet be drawn.
Regardless of the type of beverage, moderate drinkers have fewer heart attacks and live longer than either abstainers or heavy drinkers. New research may find that alcoholic beverages are all equal and that the most important factor lies in the pattern of consumption.
Medical research shows that alcohol's cardio-protective effect is dose-related. Research on people who tend to abstain during the week and binge on the weekends indicates that, while 14 drinks a week may be protective taken two drinks a day, 14 drinks all on Friday or Saturday night are not.
The trick, then, is not to drink too much; on the other hand, don't drink too little.