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Beyond Cholesterol: The Real Link Between Diet and Heart Disease

One of the best ways to live longer is to reduce your likelihood of dying from a heart attack since it continues to be the #1 killer in America. If we could prevent heart disease tomorrow, it is estimated that the average life expectancy of every American would increase by ten years.

We are led to believe by extensive drug marketing that elevated cholesterol is the cause of heart disease.  Unfortunately, about 50 percent of the people who are hospitalized with heart attacks have normal cholesterol levels. What’s more, 25 percent of people who develop premature heart attacks have no traditional cardiovascular risk factors at all.  So what if cholesterol was only a minor, secondary player in developing heart disease?

 The Cholesterol Hype

Cholesterol does have a role in heart disease, but it is a secondary factor that plays a far lesser role in fatal heart attacks than the marketing of drug companies leads you to believe.

It has been known since 2001 that oxidized LDL is a far better predictor for the development of atherosclerotic lesions than the traditional measurement of LDL (1). But it was also at this time that the first statin studies began to appear. This gave the pharmaceutical industry a patented drug to “prevent” heart disease but unfortunately statins could not specifically lower oxidized LDL.  Furthermore, the LDL story was such an easy story to tell because it could be summarized “if your cholesterol levels are high, you are going to die”.  That marketing statement ignored the fact that the most common drug (i.e. aspirin) to prevent heart attacks had no effect on reducing cholesterol. Today lowering LDL cholesterol (but not necessarily lowering oxidized LDL) is the number-one priority of every cardiologist in America.

Various epidemiological studies have found that increased serum cholesterol levels occur more often in heart disease patients. But that increase is only 5 to 10 percent higher in those who develop heart disease than those who don’t. This doesn’t help explain why about half the people who die from heart disease don’t have elevated LDL cholesterol levels (less than 130 mg/dl). It also means that high LDL cholesterol is not a very good predictor of heart disease. On the other hand, a very different picture emerges if you look at the levels of oxidized LDL levels. You can see a very striking relationship in the prediction of heart disease with increasing levels of oxidized LDL levels (1).  Even so the best way to lower oxidized LDL is not a statin, but high-dose polyphenol extracts (2), since they have anti-oxidant properties to help combat oxidation.

 Unresolved Cellular Inflammation: The Reason Heart Disease Kills

A heart attack is simply the death of the muscle cells in the heart due to lack of oxygen caused by a constriction in blood flow. If this lack of oxygen is prolonged, and enough heart muscle cells die, your heart attack becomes a fatal one. What causes that constriction in blood flow is the rupture of soft vulnerable plaques that line the artery.  Although you can’t see them, when they rupture they release a mass of cellular debris that accelerates the clotting process to stop blood flow and therefore stop oxygen from being delivered to the heart.

The reason heart disease remains the primary killer of Americans is not due to cholesterol, but unresolved chronic inflammation in the arteries that causes these soft vulnerable plaques to rupture.  You may be asking yourself, “What on earth is unresolved cellular inflammation?” This is simply inflammation that falls below the threshold of perceived pain. That’s what makes it so dangerous. You have no indication it is present and therefore you make no effort to reduce it.  This inflammation results from an increased production of inflammatory mediators such as eicosanoids. Statins have no effect on reducing eicosanoid levels in the body.

Eicosanoids, Resolvins, and Heart Disease

Eicosanoids are the hormones that intensify inflammation.  You need some to activate the immune system, but in excess they promote cellular inflammation.  These hormones are generated by the combination of high levels of insulin and omega-6 fatty acids in your blood.  On the other hand, resolvins are the hormones that resolve inflammation. These hormones are generated by the levels of omega-3 fatty acids in your blood. You need to have both eicosanoids and resolvins in the proper balance in order to be in a state of wellness because you have to turn on inflammation as well as turn it off. Unfortunately, most of us produce too many eicosanoids, which leads to increasing levels of unresolved cellular inflammation and eventually to chronic diseases like heart disease.

Managing Unresolved Cellular Inflammation

The Zone Diet was developed primarily to reduce the overproduction of eicosanoids. Adequate levels of omega-3 fatty acids in the diet (usually requiring supplementation) will ensure adequate levels to promote the formation of resolvins.

A variety of factors forge the linkage between unresolved cellular inflammation and fatal heart attacks. First of all, eicosanoids make soft vulnerable plaque more likely to rupture. Eicosanoids act as powerful constrictors of your arteries and can lead to a vasospasm, a potentially fatal cramp or “charley horse” that prevents blood flow to the heart. Vasospasm is the second cause of fatal heart attacks. In addition, lack of sufficient levels of omega-3 fatty acids in the heart muscle can also lead to a fatal heart attack caused by chaotic electric rhythms in the heart. This condition, called sudden death, accounts for more than 50 percent of all fatal heart attacks.

How can you tell if you have the right balance of eicosanoids to resolvins for heart health?  That knowledge comes from the AA/EPA ratio in the blood.  Arachidonic acid (AA) is the building block of eicosanoids and eicosapentaenoic acid (EPA) is the building block of resolvins.  You want to maintain that AA/EPA ratio close to 1.5, and ideally have about 4 percent of your total fatty acids in the blood consisting of EPA (3-5)

How The Zone Can Help Promote A Healthy Heart

For optimal heart health you need the appropriate balance of eicosanoids to resolvins. This is why I recommend a multi-factorial dietary approach. This entails the Zone Diet, omega-3 fatty acids, and polyphenol extracts. The Zone Diet can help reduce the overproduction of eicosanoids. Consuming adequate levels of omega-3 fatty acids can help increase the production of resolvins and the use of maqui polyphenol extracts can help minimize oxidized LDL (2).  This three-part dietary system or what I call the Zone Pro-Resolution Nutrition system will all be described in greater detail in my upcoming book, The Resolution Zone.{{cta('14dee37e-1816-403a-a6e8-a67c8b9cf45b')}} References

  1. Holvoet P, Mertens A, Verhamme P, Bogaerts K, Beyens G, Verhaeghe R, Collen D, Muls E, and Van de Werf F. “Circulating oxidized LDL is a useful marker for identifying patients with coronary artery disease.”  Arterioscler Thromb Vasc Biol 21:844-848 (2001)
  2. Davinelli S, Bertoglio JC, Zarrelli A, Pina R, and Scapagnini G. “A Randomized Clinical Trial Evaluating the Efficacy of an Anthocyanin-Maqui Berry Extract on Oxidative Stress Biomarkers.”  J Am Coll Nutr 34 Suppl 1:28-33 (2015)
  3. Sears B. “Omega-3 fatty acids and cardiovascular disease:  Do placebo doses give placebo results?”  CellR4 5:e2302 (2017)
  4.  Sears B. “Omega-3 fatty acids and cardiovascular disease: Dose and AA/EPA ratio determine the therapeutic outcome.”  CellR4 6:e2531 (2018)
  5. Sears B. “Appropriate doses of omega-3 fatty acids for therapeutic results.” CellR4 6: e2578 (2018) 

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Tofu: Tips and Recipes Ideas

I have been eating tofu for a very long time, much longer than the 30 or so years I have been following the Zone Diet. Back then many of my favorite recipes came from the Tassajara cookbooks by Edward Espe Brown, the celebrated chef from the kitchen at California’s famous Zen Mountain Center, and cookbooks by Louise Hagler, a.k.a. Wendy Louise, a well-known authority on vegetarian cooking who is associated with a community in Tennessee known as The Farm. Those books are still among the best resources for tofu recipes. My mantra has always been if you don’t like something, don’t eat it. Keep this in mind if you’re new to tofu, start slowly by combining it with flavors and foods you like.    Tips and Suggestions    Firm-sprouted tofu is my preference for the Zone Diet. Unlike traditional tofu, which contains significant amounts of both protein and carbohydrate, sprouted has almost no carbohydrates. It’s lighter tasting, refreshing, and very filling.   Freezing tofu results in a chewy, sponge-like texture. I don’t recommend freezing, but some people prefer it when using tofu to substitute for meat in a recipe.    Baked tofu comes in a variety of flavors and makes an excellent quick meal with some vegetables and fruit added. It’s also great in salads.     Tofu made it into the book “The Top 100 Zone Foods” by Barry Sears.    Some recipes call for draining the tofu first. I find that usually isn’t necessary.   Tofu takes on the flavor of whatever is added to it.    Add nutritional yeast flakes to give a cheesy flavor to vegan tofu scrambles and dips. It’s also rich in protein and vitamin B12.   Cherry Vanilla Tofu “Ice Cream”   Tip: This doesn’t freeze or store well, so prepare only the amount you plan to serve immediately.   Using an immersion blender or a food processor blend equal parts of frozen dark cherries and firm tofu, plus some vanilla extract (preferably alcohol-free for best flavor). Serve immediately.  Tofu Scramble  This is great for breakfast, lunch, or dinner, and we’ve even brought it on long day hikes for a snack.   Crumble some firm tofu and stir in a generous amount of seasonings, taking care not to overdo it with the salt. Heat in a well-seasoned or nonstick skillet with a little Zone-friendly oil to the desired doneness.    Optional: If time allows, sauté some chopped onion in the skillet before adding the tofu and seasonings.    My favorite seasoning combination for this dish at my house is onion powder, garlic powder, turmeric, paprika, some oregano or thyme, nutritional yeast flakes, salt, and ground black pepper. The yellow color of the turmeric makes it somewhat like scrambled eggs.   Tofu Veggie Almond Pasta Salad   Dressing: Thin some smooth almond butter by stirring in some water, a little vinegar, and either soy sauce or Bragg’s Liquid Aminos (an unfermented soy sauce found in the health food section of most grocery stores).    Toss together cooked Dr. Sears’ Zone PastaRx Fusilli, tofu cut into cubes, matchstick cut red bell pepper, chopped green parts of scallions (a.k.a. green onions), and the almond butter dressing. Serve immediately or chill to serve later. It will keep well in the fridge for two or three days.   Use your imagination and see what you can come up with.  Experiment and have fun with it. Try using tofu to make cheesecakes, whipped desserts, tofu chocolate pudding, tofu “cream” based soups, tofu pot pie (think chicken pot pie), tofu burgers, tofu burritos, Buffalo tofu (like Buffalo wings), layered Mediterranean dips, tofu “meatballs”, grilled tofu, and more.    Enjoy! 

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Simple Homemade Zone Meals

Simple Homemade Zone Meals

  Even people who swear by Dr. Sears' new pasta meals should create one homemade Zone meal just about every day. Cooking in the Zone isn't hard to do, especially if Zoners keep packages of frozen chopped onion and chopped peppers in their freezers. If a cup of chopped onion is needed, it's ready to go. Also keep sacks of frozen vegetables, including broccoli florets, handy.   Here are some meals, shown for both women and men, that are a snap to make for people on the go.   Ginger Chicken Ingredients:   Dinner for women 1 teaspoon olive oil 3 ounces boneless, skinless chicken breast 2 cups broccoli florets 1 ½ cups snow peas ¾ cup yellow onion, peeled and chopped 1 teaspoon fresh ginger, grated ¼ cup water ½ cup seedless grapes Dinner for men 1 1/3 teaspoons olive oil 4 ounces boneless, skinless chicken breast 2 cups broccoli florets 1 ½ cups snow peas ¾ cup yellow onion, peeled and chopped 1 teaspoon fresh ginger, grated ¼ cup water 1 cup seedless grapes Directions: In a wok or large nonstick pan, heat oil over medium-high heat. Add chicken and saute, turning frequently, until lightly browned, about five minutes. Add broccoli, snow peas, onion, ginger and water. Continue cooking, stirring often, until chicken is done, water is reduced to a glaze and vegetables are tender, about 20 minutes. If the pan dries out during cooking, add water in tablespoon increments to keep moist. Serve grapes for dessert or garnish dish with grapes. Salmon Patties Ingredients:   Dinner for women 3 ounces canned pink salmon 2 egg whites 1/3 cup slow-cooking oatmeal, cooked Quarter of an onion, diced 1 teaspoon dill Garlic salt and pepper 1 teaspoon refined olive oil ½ apple Dinner for men 4 1/2 ounces canned pink salmon 2 egg whites 1/3 cup slow-cooking oatmeal, cooked Quarter of an onion, diced 1 teaspoon dill Garlic salt and pepper 1 1/3 teaspoons refined olive oil 1 apple Directions: Flake salmon in a medium bowl. Combine all ingredients except olive oil and mix well with hands. Heat olive oil in pan at medium heat. Shape mixture into a patty and cook for about three to five minutes on each side (or until golden brown). Serve immediately. Have apple for dessert. Tuna and Three Bean Salad Ingredients:   Dinner for women 3 ounces canned tuna ¼ cup kidney beans, canned, drained and rinsed ¼ cup garbanzo beans, canned, drained and rinsed ¼ cup black beans, canned, drained and rinsed 1 teaspoon olive oil Rice vinegar to taste 1 teaspoon onion powder or to taste ¼ teaspoon garlic powder or to taste Bed of lettuce Dinner for Men 4 ounces canned tuna ¼ cup kidney beans, canned, drained and rinsed ¼ cup garbanzo beans, canned, drained and rinsed ¼ cup black beans, canned, drained and rinsed 1 1/3 teaspoons olive oil Rice vinegar to taste 1 teaspoon onion powder or to taste ¼ teaspoon garlic powder or to taste Bed of lettuce ½ apple Directions: Mix together tuna and beans. Whisk together olive oil, rice vinegar, onion powder and garlic powder. Pour over tuna mixture and toss. Serve over a bed of lettuce. Have fruit for dessert. Chicken and Green Beans Italian Style Ingredients:   Dinner for Women 1 teaspoon olive oil 3/4 cup onions, chopped 1 14.5-oz can diced tomatoes 1 teaspoon bay leaf (1 small) Italian seasoning to taste Salt and pepper to taste 3/4 cup green beans cut into 1-inch pieces 3 ounces precooked chicken Dinner for Men 1 1/3 teaspoons olive oil 1 1/2 cups onions, chopped 1 14.5-oz can diced tomatoes 1 teaspoon bay leaf (1 small) Italian seasoning to taste Salt and pepper to taste 1 1/2 cups green beans cut into 1-inch pieces 4 ounces precooked chicken Directions: Cook the green beans to your liking - boil or steam. Heat the olive oil in a medium-size saucepan. Add onion and saute until tender. Add tomatoes, bay leaf, Italian seasoning, salt, pepper and chicken. Cover and simmer for 10 minutes. Drain excess liquid from beans, add to the tomatoes and onion mixture and cook for an additional 5 minutes. Remove bay leaf before serving.

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