Interview with Dr Caldwell Esselstyn Jr.

A four part interview with Dr. Caldwell Esselstyn Jr.

Part 1

Part 2

Part 3

Part 4

Dietary Fat and Insulin Resistance

The influence of dietary fat on insulin resistance.

Dietary fat has been implicated in the development of insulin resistance in both animals and humans. Most, although not all, studies suggest that higher levels of total fat in the diet result in greater whole-body insulin resistance. Although, in practice, obesity may complicate the relationship between fat intake and insulin resistance, clinical trials demonstrate that high levels of dietary fat can impair insulin sensitivity independent of body weight changes. In addition, it appears that different types of fat have different effects on insulin action. Saturated and certain monounsaturated fats have been implicated in causing insulin resistance, whereas polyunsaturated and omega-3 fatty acids largely do not appear to have adverse effects on insulin action. Given the importance of insulin resistance in the development of diabetes and heart disease, establishing appropriate levels of fat in the diet is an important clinical goal.

The Influence of Different Fats and Fatty Acids on Obesity, Insulin Resistance and Inflammation

Dietary fat and its relation to obesity has been a controversial issue for several years. In this review, several kinds of data relating to this issue are presented. There are epidemiological cross-country data and data within countries showing an effect. However, in the United States, the intake of fat appears to be declining, whereas the prevalence of obesity rises—the American Paradox. Clinical studies show that trans fatty acids can increase insulin resistance and that exercise can enhance the rate of adaptation to a high fat diet by increasing the rate of fat oxidation. The differences in response of inflammatory signals and of insulin resistance to different fatty acids indicate that not all fatty acids are the same. There are also experimental data showing that most, but not all, animals consuming a high fat diet will become obese. A number of mechanisms have been postulated for this difference, including differential sensitivities to neurotransmitters, to the intestinal peptide, enterostatin, and to individual fatty acids. One important conclusion from this review is that both total fat and individual fatty acids have to be considered when reaching conclusions about dietary fat and obesity.

Hydrolyzed Milk Formula and Autoimmune Disease

Researchers hail ‘stunning’ breakthrough in childhood diabetes study

The majority of children who develop type 1 diabetes can avoid or significantly delay the ailment simply by switching formulas in infancy, a new Hospital for Sick Children study suggests.

Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity

Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.

Serum lipids in the People's Republic of China

Comparison of Western and Eastern populations

Serum lipids in the People's Republic of China

Serum cholesterol and HDL cholesterol levels were measured in an urban and a rural population of the People's Republic of China and compared with cholesterol values obtained in Belgium and in the Republic of Korea, with use of the same methodology. Total cholesterol levels were markedly lower in the People's Republic of China than in Belgium and generally lower than in Korea, both in male and female subjects. However, the differences in HDL cholesterol levels among the three populations were small in males and only significantly higher in Belgium in the age classes below 34 years. In women of all age groups, HDL cholesterol values were significantly higher in Belgium than in China and Korea. Total cholesterol levels below 100 mg/dl were found in the People's Republic of China in about 2% of the participants. Apolipoprotein B was significantly lower, and the apolipoprotein A1/B ratio was significantly higher, in China and Korea compared to Belgium.

Bone Loss, Hip Fracture and Protein

From the January 2001 edition of the American Journal of Clinical Nutrition.

A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women

Background: Different sources of dietary protein may have different effects on bone metabolism. Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone.

Objective: We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods, quantified by protein content, increases bone loss and the risk of fracture.

Design: This was a prospective cohort study with a mean (±SD) of 7.0 ± 1.5 y of follow-up of 1035 community-dwelling white women aged >65 y. Protein intake was measured by using a food-frequency questionnaire and bone mineral density was measured by dual-energy X-ray absorptiometry.

Results: Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake. Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio (P = 0.02) and a greater risk of hip fracture (relative risk = 3.7, P = 0.04). These associations were unaffected by adjustment for age, weight, estrogen use, tobacco use, exercise, total calcium intake, and total protein intake.

Conclusions: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial.

Baltimore Longitudinal Study of Aging

The Combination of High Fruit and Vegetable and Low Saturated Fat Intakes Is More Protective against Mortality in Aging Men than Is Either Alone: The Baltimore Longitudinal Study of Aging

Fruits and Vegetables, Saturated Fat intake

Saturated fat (SF) intake contributes to the risk of coronary heart disease (CHD) mortality. Recently, the protective effects of fruit and vegetable (FV) intake on both CHD and all-cause mortality were documented. However, individuals consuming more FV may be displacing higher-fat foods. Therefore, we investigated the individual and combined effects of FV and SF consumption on total and CHD mortality among 501 initially healthy men in the Baltimore Longitudinal Study of Aging (BLSA). Over a mean 18 y of follow-up, 7-d diet records were taken at 1–7 visits. Cause of death was ascertained from death certificates, hospital records, and autopsy data. After adjustment for age, total energy intake, BMI, smoking, alcohol use, dietary supplements, and physical activity score, FV and SF intakes were individually associated with lower all-cause and CHD mortality (P < 0.05). When both FV and SF were included in the same model, associations of each were attenuated with CHD mortality, and no longer significant for all-cause mortality. Men consuming the combination of ≥5 servings of FV/d and ≤12% energy from SF were 31% less likely to die of any cause (P < 0.05), and 76% less likely to die from CHD (P < 0.001), relative to those consuming <5 FV and >12% SF. Men consuming either low SF or high FV, but not both, did not have a significantly lower risk of total mortality; but did have 64–67% lower risk of CHD mortality (P < 0.05) relative to those doing neither. These results confirm the protective effects of low SF and high FV intake against CHD mortality. In addition, they extend these findings by demonstrating that the combination of both behaviors is more protective than either alone, suggesting that their beneficial effects are mediated by different mechanisms.

French Paradox

The French Paradox is perhaps the most confusing issue surrounding the debate over diet and health.  The French and the Finnish consume similar amounts of saturated fat and dietary cholesterol.  Yet, the French have a much lower rate of heart attacks than do the Finnish.  Fortunately, we have this scientific study of 40 nations which goes a long way towards understanding the reason behind this.

Click the link below. The entire text is available for free.

The French and Finnish Paradox

After adjusting for cholesterol and saturated fat, milk and many components of milk (butterfat, milk protein, calcium from milk, and riboflavin) and total calcium remained positively related to CHD mortality for all 40 countries. There were differences in the consumption of these foods and nutrients in France and Finland. Milk and butterfat (fat from milk, cream, cheese, and butter) consumption was higher in Finland than in France. The consumption of plant foods, recently shown to be protective against CHD (vegetables and vegetable oils containing monounsaturated and polyunsaturated fatty acids), was greater in France than in Finland.