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British Heart Foundation
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Mediterranean diet:

We have had a few discussions on here about diet. This video discusses the Mediterranean and vegetarian diets. It is only a few minutes long and worth watching if you are changing your lifestyle. I think that the Mediterranean diet: is good if you swap the white bread and pasta for wholemeal but if you want to live as long as possible the Whole Food Plant Based diet is the way forward:

nutritionfacts.org/video/fl...

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Cardiologist Dr William Davis followed Dean Ornish's plant based vegetarian diet, ate "healthy whole grains" and fruit and veg, cut out animal products & oils, ran 5 miles or so each day... and ended up with Type 2 Diabetes.

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If you watch the video, it shows that all the info is from meddical trials. Perhaps he was heading for T2D before he started and the increase in carbs. Just a thought!

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I was already familiar with him and what he advocates.

Davis says 'when I switched to the Ornish diet I promptly became diabetic' - type 2 diabetes doesn't happen promptly! He also says he put on 31 lb, which is pretty odd if he was actually following the Ornish diet. But Davis is of course selling his own fad diet ( and making a nice lot of money doing so) so he has a vested interest in attacking other diets.

I'm not vegetarian myself, but I'd take Ornish and plant-based any day, over fad diet gurus like Davis.

Incidentally Davis advocated statins and low saturated fat before he discovered grain-bashing was much more profitable!

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According to you, others are vociferous conspiracy theorists, vociferous cholesterol deniers, cultists, fad diet pushers, fad diet gurus, grain bashers, have vested interests, etc, etc, etc.

You, on the other hand, have absolutely no bias whatsoever. 👏👏 And Big Pharma are angels who have no interest in sales or profit. 👏👏

I indeed have a bias in favour of randomised controlled trials and the scientific consensus because that's what science is all about! I also have spent my working life evaluating real academic research.

I consider strongly that those on this forum who give advice that is in opposition to standard medical advice and the BHF should at the very least make that clear. I consider giving such advice on a BHF forum is unethical.

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We all have opinions and exchange opinions, and no one is anyone's personal physician on any forum. It's just that when anyone's opinion differs from yours, you then call them unethical. You want your opinion to be heard, and anyone with a different opinion/experience to be silenced. That's hardly mature. You are not the lone supporter or bearer of scientific research/evidence here.

sciencedirect.com/science/a...

I attend conferences where heart surgeons, cardiologists, and many doctors and professors speak. I also watch such conferences online. I, therefore, don't appreciate aggressive and condescending language and name-calling.

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My point is that these are not my opinions but BHF guidance.

I agree that noone is anyone's personal physician here - that's precisely why I never give advice which goes against the BHF and consider it unethical and irresponsible to do so.

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Whenever considering making a decision about any treatment I am offered I make the following assessment.

B - benefit of the treatment

R- Risks involved

I- instincts what do I feel about the advice

A- alternative options

N- what happens if I do nothing.

All the BHF information is thoroughly researched and updated frequently. They also use expert patients with a lived experience of the condition as advisors as well as leading Cardiologists and researchers.

Yes, and I do the same (B.R.I.A.N.) 👏👏

Please refer to my previous reply.

I have read your previous responses.

Everyone has bias that's the nature of being human. However strongly an individual feels something is 'correct ' does not make it so for others.

This forum is I hope for all of us to discuss the many issues we face openly without judgement.

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That's my view as well. I just don't appreciate people berating and name-calling. It's disrespectful and immature.

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Perhaps Fortepiano and yourself need to sit down over a nice plate of tofu and a small side of fish and make your peace :)

Will give this forum dinner a miss. I am soya intolerant!

How about fresh pan fried tuna in olive oil , salad and new potatoes?

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That's a goer but prefer salmon - got a wild Alaskan one in the oven! 😁

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That is an atypical result for a healthy vegetarian diet. Diabetes is far more prevalent amongst omnivores.

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So the interest is in why those minority of vegetarians develop type 2 diabetes, particularly the ones with a 'healthy' BMI?

Many diagnosed with Type II diabetes are actually Type 1.5. Type 1.5 is used to refer to a form of Type I diabetes known as Latent Autoimmune Diabetes in Adults (LADA), i.e. like Type I it is an autoimmune issue and not a metabolic issue. A friend suffered awful side effects from ever increasing doses of Metformin until he was correctly diagnosed.

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There are always variables in every population. Genetics. Also, you can be a vegetarian and still eat a lousy diet.

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Interesting article.

When I was in hospital with my HA, the blood tests suggested I was type 2 diabetic (total news to me, had no symptoms). On discharge hospital advised GP to get me re-tested for type 2. In the meantime I followed the standard advice re diet post HA, I stopped eating most processed stuff, stopped eating cakes, chocolate, red meat, fried food, started eating more good fibre - wholegrain bread and rice etc. potatoes, fruit etc.

Then I got results of blood test, type 2 confirmed - Diet needs to change again, beans on toast, wholegrain rice, boiled potatoes all now bad - basically carbs bad!

So new diet involves meat - chicken, turkey lean pork, no red meat. Potatoes rice reduced as much as possible, plate piled high with veg. No cakes/sweets/choc. All meals prepared from scratch, microwave now almost redundant.

I think I'm OK when it comes to absorbing information, but diet/nutrition is a minefield. For example, if you have type 2 - boiled potatoes bad as the glucose is released too quickly, however if boiled potatoes are cooked then eaten cold rather than hot, glucose is released more slowly!

I'm getting there, my weight is steadily going down, started off at 12st 12lbs (which is overweight for 5ft 7in, giving me a BMI of 28) currently down to 10st 7lbs, I've set a target of 10st by the end of June which will give me a BMI of 21.9. It's not been easy at times to maintain the discipline but I think I'm winning. I know that i definitely feel a lot better on my current diet than I did pre HA.Once I get to my target weight and have kept it there for a while I'll probably add the odd treat back into the diet.

One thought on the Mediterranean diet, while we can adopt the diet, we can't adopt the lifestyle of the Med, I've spent a lot of time there over the years and their whole attitude and outlook is so different to us. The stress and pressure of life in this country has a bearing on our health to some degree, one which we have limited control over.

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Sorry to disappoint you but despite appearances both pork and lamb are classified as red meat as they contain more myoglobin than chicken or fish.

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Hi MichaelJH

I know, I only have the odd piece of very lean pork with all the fat cut off. Definitely avoid lamb - any that was in my freezer was gifted to family and friends long ago

I think you've nailed the key issue.

If you believe cholesterol is the critical factor behind your heart disease you'll be more likely to embrace a plant based diet. If however you believe insulin resistance/T2 diabetes is the primary cause then you'll be more likely to want a low carb diet.

A low carb diet doesn't preclude plant based, but from a practical menu planning perspective it's just easier to go low carb with Mediterranean or Paleo style diets.

I very much get the sense that the cholesterol explanation for heart disease is beginning to fade. And while cholesterol as an explanation wanes, so insulin resistance waxes. My guess is that over the next decade we'll see a corresponding reduction in the popularity of plant based diets for heart disease. The medical world is extremely conservative and attitudes change slowly, but I think the super tanker is now turning away from cholesterol.

Regarding the link that JimmyQ posted (the link's broken by the way Jimmy). It's to a group called "Nutrition Facts Organisation" headed by Michael Greger.

I don't think Dr Greger is a snake oil selling fraud in the way so many diet gurus are. However I do think he's pretty blinkered. The reality is that he's so deeply invested in plant based dieting that although he references (at least as far as I can see) credible research, he's extremely partisan and selective in his choice of data. The mass of evidence that might favour alternatives to plant based diets is just ignored.

So if you're serious about investigating diet options then by all means look at Nutrition Facts Org, but be aware of its bias and make sure you cast your net wider to get a more balanced view before deciding what's best for you.

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Medical consensus is still firmly on the side of cholesterol and statins. The internet and media is however awash with vociferous cholesterol deniers fuelled by a tiny group of doctors who have found it very profitable.

While I'm not a vegetarian myself ( I follow the Mediterranean diet), Greger does not advocate an unhealthy diet, unlike the LCHF devotees. The more vegetables the better, and we would all be healthier for including vegan meals in our diets, as the BHF says.

I feel medical consensus is changing radically although not very quickly towards cholesterol and statins. It’s widely acknowledged now even with my own GP practice plus 2 vascular surgeons I’ve seen that it’s inflammation that causes heart disease not cholesterol. The only clue cholesterol gives us is with small and large particle size, Lp(a) etc and yet we don’t get this test result unless we push for it. I feel we need an anti inflammatory diet which is low carb unfortunately.

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Why "unfortunately"? 🤔

Because we have always been told to eat loads of fruit and veg a day, it went from 5 portions to 10 portions optimally! That won’t be low carb though, in fact if I ate 10 portions I’d have no room for any other food either 😂

Unhealthy levels of cholesterol, glucose, and inflammation are all contributors to heart disease. In addition, managing blood pressure is critical imo. I've been eating a very low fat plant based diet, primarily vegan with the exception of the occasional egg whites or a bit of non fat dairy. My lipid profile is outstanding with HDL more than 80 and LDL just over 50. Since adopting this diet nearly 15 years ago my blood sugar has never been close to being elevated, however my most recent blood work indicated C-Reactive protien, was mildy elevated coming in at 3.8, soon I am reluctantly going to start taking a low dose statin to keep a handle on inflammation. This diet works for me but it's not for everyone. I believe in addition to diet that vigorous exercise approximately 5 hours per week is a big part of what has elevated my HDL and helped to maintain low blood sugar, although it could be contributing to inflammation. Other diets can work as well, but the ultra low-fat vegetarian diet has worked wonders for me.

Read up on how the body works, how your body makes cholesterol, what are essential nutrients for the human health. We have all been told what is good for us for the last 50 odd years, and the current biological advances in our understanding on nutrition has clearly demonstrated that the current dietary advice is doing much more harm to human health than good. You can open your self to world of scientific research doing whatever they can to correct the mess that's been created by the Diet Heart hypothesis started in America in the 1970's.

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I'll stick to the BHF, British Cardiovascular Society, ACC, European Society for Cardiology etc , not a tiny handful of maverick doctors and their associates.

I keep having to reiterate - real scientific research is based on randomised controlled trials and scientific consensus i.e what most experts agree on. This is why the ACC and ESC committees look at all the research, not just odd articles, to evaluate the totality of evidence and then produce the guidelines which help to save our lives. Of course these scientific bodies know about cholesterol and its role in the human body! Education is also about knowing which are the reputable sources in the google internet maelstrom, and they rarely have a book to sell.

Large randomised trials - the gold standard - have shown the benefit of the Mediterranean diet, which is recommended by the BHF.

I recommend anyone who wants a heart-healthy diet to look at the excellent BHF recipes, and indeed their entire trustworthy site.

Current dietary advice basically recommends eating plenty of vegetables, oily fish, pulses, fruit, nuts, replacing refined carbohydrates with wholegrains, and replacing saturated fats with monounsaturated oils, eating plenty of fibre and reducing free sugar, red and processed meat. Shock horror stuff indeed!

Any look at supermarket shelves and people's supermarket trolleys and fast food restaurants will show this is not being followed. It's like current exercise recommendations - a tiny minority does them. Obesity and consequently type 2 diabetes is a huge problem but it is ludicrous to suggest it's because people are following the guidelines and have overdosed on brown rice - they are more likely to be sitting in front of the telly and eating a giant bowl of icecream after ordering a pepperoni pizza with added cheese . Sedentary lifestyles and gradual over-eating also catches up with many people in middle life. 


Despite an American population which is extraordinarily inactive, supersizes portions, and guzzles soda and fast food ( I have lived there), cardiac mortality in the USA and Canada has gone down over 50% since the 1970s, and statins have played a big part in this. Now PCSK9 inhibitors have also shown in similar randomised controlled trials that reducing LDL reduces heart attacks and strokes.

Now if you'll excuse me I have friends to dinner and am preparing to poison them with a delicious fish and chickpea stew containing carrots and potatoes. They may even mop it up with some bread.

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Ah the importance of quality of life.

Mediterranean diet for me too, wish we could have the weather as well.

Enjoy the pleasure of sharing a meal in good company 😁

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Would that tiny group of dissent include the ICS-NHS Diabetes Prevention Programme, that has been approved by the NHS?

Not this old chestnut again - I'm beginning to think you work for them.

The NHS does not recommend a diet high in saturated fat for either diabetes or heart disease.

The NHS diabetes programme NHSDPP supports the Eatwell guide, and all providers of the programme signed up to implement this - it is part of the contract. If the ICS ( a private company which is indeed linked to Malhotra, Harcombe and the rest of that little gang ) does not do this they are going against their contract.

In type 2 diabetes weight-loss is extremely important and any restrictive diet can succeed in weight-loss. In fact the ICS puts forward 4 weight loss diets including low-fat, but we never hear you talk about that as it doesn't fit your agenda. We never hear either about the other providers of the programme who don't fit with your agenda either.

The Mediterranean diet is a set of healthy dietary principles proven to help heart disease through the Predimed randomised control trial.

The Mediterranean diet, supported by the BHF, is low in saturated fat and wholegrains form an important part of it.

The Eatwell guide is fully compatible with the Mediterranean diet.

You are welcome to eat your peculiar tub of mascarpone for breakfast diet, but one has to wonder why you constantly push the private ICS company and a diet opposed to BHF and NHS advice for heart patients on a BHF heart forum.

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The reason I 'constantly push' the ICS-NHS DPP is that I believe in most of their principles, not least because they are proven effective in preventing many chronic ill-health conditions.

To lower expectations by comparing the low-fat dogma that we've all been subjected to is insulting. What was the least effective dietary intervention in the PREDIMED study you mention?

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I'm no proponent of low-fat, the Mediterranean diet is low in saturated fat. But it shows the extremely selective way you represent the ICS Diabetes prevention programme.

The LCHF diet is not proven effective in preventing any ill-health conditions, least of all heart disease. Unlike of course the proven by PREDIMED Mediterranean diet, which is why the latter has been accepted by the scientific cardiac consensus and the BHF, and the LCHF diet hasn't.

Belief is not scientific proof.

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That's true; Zoe Harcombe and associates proved that the evidence was never there to vilify saturated fat, and international guidance stuck to their unsubstantiated beliefs :-)

This is so old hat - there is very clear trial evidence now on what constitutes a healthy diet and it's not LHCF despite what Harcombe would like.

As I said, current dietary advice from every reputable source including the BHF recommends eating plenty of vegetables, oily fish, pulses, fruit, nuts, replacing refined carbohydrates with wholegrains, and replacing saturated fats with monounsaturated oils, eating plenty of fibre and reducing free sugar, red and processed meat.

If you are going to give dietary advice opposed to the BHF and all cardiovascular societies you should make that clear in all your posts.

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The BHF welcomes patients' views and input on the information on the website. Sometimes the BHF is not always as up to date as it could be.

The information on the BHF regarding angina has been updated recently.

If you look at the animation below you will see it now shows the causes of angina...microvascular angina, vasospastic angina and the most common due to coronary heart disease.

2 years ago the BHF adopted the term Microvascular angina and has just started using the term vasospastic angina.

This was in response to the request of an expert patient who provided BHF funded researchers and others research as evidence to support this change.

What is needed is more research about lifestyle and diet and how it affects our well being.

Also how we can understand 'risk' after an open and honest discussion with our healthcare professionals is important. We can say we are comfortable with some risks that is our priverledge. All care and advice is offered and not compulsory.

Just because a view is strongly felt

something is 'correct' doesn't make it so.

We are all effected by all sorts of bias both conscious and unconscious.

That is all part of being human and makes life so interesting😁

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I don't actually have strong views about diet but I do have strong views about scientific proof. As I've said before, I have a bias in favour of randomised controlled trials and scientific consensus.

It doesn't matter at all that I agree with the Mediterranean diet, what matters is that the scientific consensus, ACC, AHA, NHS, BHF, WHO and every reputable nutritional body agrees with it. That is why I follow it - if they recommended a different diet I would follow that one. So my bias is in favour of scientific consensus. Similarly that's why I accept climate change is real and vaccination is important, although all over the web you will find people who passionately argue the opposite.

I appreciate your points re microvascular angina but it really isn't analogous. The dietary research already exists - PREDIMED has been done - and the scientific consensus is agreed. BHF dietary advice is up to date and in line with cardiovascular and dietary research.

Of course individuals are free to eat LCHF just as they are free to abandon medical advice / take untested supplements / eat weird diets or follow any amount of pseudoscientific woo.

However, I consider strongly that those on this forum who give advice that is in opposition to accepted up-to-date medical advice and the BHF should at the very least make that clear. I consider giving such advice on a BHF forum is unethical.

Personally I would prefer not to have these wretched time wasting diet threads at all.

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Just to clarify; you think that the NHS approved structured education from the ICS-NHS Diabetes Prevention Programme is in opposition to accepted, up-to-date medical advice, whereas I believe it is more up-to-date and consequently corrective.

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I am happy to clarify that I consider the diet you describe as the ICS and are pushing for cardiovascular disease on this forum is not the up-to-date, accepted or in any way corrective diet for heart disease.

The up-to-date accepted diet for heart disease is that recommended by the BHF.

The NHS does not recommend a diet high in saturated fat for either heart disease or indeed diabetes.

There has been no change in this advice.

The NHS recommend switching from refined carbohydrates to wholegrains and increasing fibre as part of a healthy diet for everyone.

This is the up-to-date and accepted position.

Even in the ICS programme, LCHF is merely one of several weight - loss diets suggested for people with type 2 diabetes: nothing to do with a healthy diet for cardiovascular disease. Even the ICS programme isn't recommending it for anything other than diabetes. It's (and your) emphasis on saturated fat goes directly against the advice of Diabetes UK ( one of the organisations that actually set up the NHS DPP programme for which the ICS is one of the private providers) and the British Dietetic Association.

Their up-to -date position statement says :

'From the appraisal, it was concluded that there is no evidence that increasing saturated fat intake is beneficial in reducing risk of cardiovascular disease (CVD).

We also concluded that replacing saturated fats with unsaturated fats (polyunsaturated and monounsaturated) reduces the risk of CVD in general populations and in high-risk populations, including people with diabetes.

In addition, when saturated fat intake is replaced by carbohydrates (wholegrain and unrefined only), there is evidence for cardiovascular benefit. However, replacing saturated fats with refined carbohydrates, such as sugary drinks and white bread, appears to increase cardiovascular risk.'

This is in agreement with standard NHS and BHF advice.

They conclude:

' Diabetes UK and the British Dietetic Association are calling on healthcare professionals not to recommend diets that are high in saturated fats . . . Although this statement specifically looked at the role of dietary fat consumption in people with Type 2 diabetes, it is important to emphasise that the advice to reduce saturated fat intake also applies to people with Type 1 diabetes, and those without diabetes.'

One hopes the ICS - including you - will take note and stop pushing saturated fat.

I'm really really tired of this pointless thread and won't be bothering with it any more.

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The issue is one of emphasis. The nation only eats 1% more saturated fat than is recommended. It is the excess consumption of carbohydrate, that is all turned to glucose in our body, that is then converted to body-fat. Of that body-fat, about 40% is saturated fat. This de novo lipogenesis is the origin of dyslipidaemia.

Cholesterol used to be the villain, now it's saturated fat.

Silencing alternative points of view is not going help the health of our nation.

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No silencing alternative points of view will not help people but silencing people who constantly push the same unsubstantiated message may help.

You condemn carbohydrate but fail to ever make the difference between complex carbohydrate and the simple highly refined carbohydrate found in white bread, rice etc.

Eating 100% wholegrains oats for breakfast every day and increasing my intake of complex carbohydrate in the form of beans and legumes has significantly lowered my fasting and post prandial blood glucose level.

Also it's the type of fats found in nuts, olive oil and avacado that are cardio protective not saturated fat.

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The WHO said that the term complex carbohydrate is inappropriate glycemicindex.com/about.php

Glycaemic load (GL) is equal to the Gi divided by 100 multiplied by the amount of available carbohydrate (g), so the amount and quality are important, and I apologise if this hasn't come across.

Hi StillConerned

Have you personally followed your dietary advice etc and found it has

had the benefit of a demonstrable improvement in your coronary heart disease or diabetes?

I don't have heart disease or diabetes despite both of my parents having heart disease, my Mam also had type 2 diabetes, and most of my siblings now have prediabetes.

My cousin died of a stroke at 54.

I'm a 5'5" working class bloke; far from a genetic freak, but I'm sure there will still be plenty of people who will believe that my 'paradox' and that of others is not evidence, and I can't know the reason for my own good health. A bit like when they did the Okinawa Study, asked what they considered health foods, the reply included 'pork', and the researchers informed the Okinawans that pork isn't healthy.

Thank you for asking.

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Thank you for making that clear, I appreciate it.

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You're most welcome.

Basically increasing body weight is directly caused by excess calories be they taken as carbohydrates, fat or alcohol. Complex carbohydrates are healthier than simple ones (like sugar) as they cause less of a blood glucose spike, which is beneficial as it reduces irritation. It is, however, not the only cause of irritation.

In simple terms obesity (unless there is an underlying medical reason) is caused by gluttony! The promotion of meal deals and "go big" is irresponsible behaviour by manufacturers and sellers.

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H. L. Mencken There is always an easy solution to every human problem—neat plausible and wrong.

Excellent points and well discussed as ever Chappychap.

I always enjoy reading your informative replies.

"One thought on the Mediterranean diet, while we can adopt the diet, we can't adopt the lifestyle of the Med, I've spent a lot of time there over the years and their whole attitude and outlook is so different to us."

Living abroad/in different cultures give you a special perspective.

Wasn't that why British exodus into the Continent had occurred for the past decade or so, looking for QOL?

I often think it's not JUST food. It's a whole lifestyle, cultural factors, attitude, society as a whole etc. In other older cultures, raw materials are prepared, using "nature" and cooked to taste wonderful whilst these dishes remain very healthy.

These methods were never found by supermarkets, it was always the way they prepped and cooked. Nobody thought twice about it. Then once the same "raw materials" get "imported" to UK, supermarket expects consumers to just cook it and enjoy it without any sort of prepping it was meant to undergo first. Nobody wants to eat it, unsurprisingly. They eventually add some unhealthy flavouring to mask the awfulness, but it's not meant to be eaten like that at all.

A positive thing about this "plant-based" movement by supermarket is at least, they are trying to provide something else in response to their marketing and consumers concerns.

How safe is our food, really? This seems to be a bigger question.

How much antibiotic residues in the "healthy" chicken fillets we eat? Do you buy organic/free range fillets?

Plant-based is fine but kale is one of the worst veggies for the amount of pesticide, apparently.

The underlying cause for any diseases are inflammation. These toxins won't help us, as we are vaguely aware. They are saying about pollutions & heart disease (likely many other diseases) linked.

Now, they are saying heart disease and Alzheimer's are related.

Having said that, there is so much more awareness these days and people started to have far more understanding and insights.

I guess it is possible to do low carb and plant based together as a belt and braces approach? i know that might sound a bit severe but occasional treats (for me its beer and wine) are of course possible. I'm checking my own blood sugar at the moment and keeping a record to show the doc. I can't do cholesterol checking myself ( I know it was high before Statins) but the thing I've learnt over the past 6 weeks since i had two stents fitted out of the blue is that whatever paradigm of thinking you are in, you need to customise to any data you get PERSONALLY. Obvious I know, but the human body is complex as are the social circumstances we live in aso what is right for me as a 62 year old 6' 1" 73kg cyclist with no history of illness won't have been right for my Dad who was type 1 diabetic who smoked 20 a day for years and years and exercise for his generation was a total luxury. Diets that people make money from might fit your personal circumstances but I don't trust any of them to follow exclusively though I'm open to what they have to say. If you can, find a dietician who knows about heart health and see if his/her advice fits with one of the diets you trust.

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I agree, it's taking all the data that's out there and applying what works for us PERSONALLY. We are all different in some respects, and what works for one person may not work for another.

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Love your answer!

The short answer is yes.

I wonder how he manipulated the data to support his theories?

The vegetarian diet does not work long-term if you do not know what you are doing - and make sure that you are getting enough essential amino acids, e.g. Lysine.

All grains and carbohydrates are bad for you.

What works for weight-loss, longevity, and keeping disease free is a combination of the Low-Carbohydrate, High-Fat diet (LCHF, see the forum here on Health Unlocked) and Not Eating All Day, aka (Intermittent) Fasting. See:

healthunlocked.com/fasting-...

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One size does not fit all.

That's true, but if you need more calories they can generally be obtained from natural fat, the ideal proportions being that of our own body's fat; 57% monounsaturated, 40% saturated, and only 3% EFAs.

The ideal amount of carbohydrate for many is between 120g and 160g per day. Less than that and the body attempts to make up the deficit; ketosis. More than that, and the excess is converted to fat; de novo lipogenesis (DNL). This is why hyperinsulinaemia, insulin-resistance, dyslipidaemia, visceral fat and a host of associated chronic ill-health conditions are rife in the developed world.

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If I lose any more weight I'll disappear. It isn't an issue for me yet I still have high cholesterol and sometimes high blood sugar. I exercise a lot so I need carb. What else am I going to burn? just an example of how I might be different to you :-)

So… a good diet is important to you.

I eat carbs because I have no gall bladder, so I cannot eat much fat.

I am at my ideal weight, so I have to eat to maintain my weight.

The longer you can exercise, the more fat you can burn.

Intense exercise has to be brief. If you continually deplete/exhaust glycogen, you are over-training. Three-mile runners tend to be healthier than long distance runners. It can take months to recover from a marathon. You don't even get fit to run a marathon by running marathons; you do shorter runs, and less intense distance runs (which would facilitate burning mostly fat).

Fundamentally, the need for carbohydrate in endurance exercise has been overemphasised, as it has for the population as a whole.

Professor Noakes was a world class endurance athlete that developed type 2 diabetes from eating a high carbohydrate diet that he himself used to advocate, and now readily admits his error, and how the tests he used to do to improve his performance showed early signs of insulin resistance.

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I don’t cycle 100k for example cos it’s good for me. I do it cos I love it 😀 I agree that I burn fat but that is a more complex process.

I cycled mostly because I enjoyed it - I rarely got on my bike without cycling 100 miles - but I did do the 60-miles-in-two-hours training ride with the 25 year-olds - when I was 45.

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It depends what you call "endurance".

I was a "world class" amateur endurance athlete - and I completed the 1,200km Paris-Brest-Paris cycle ride in 87 hours, and I could not have done it without carbohydrate... but one could run half a marathon on glycogen reserves.

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You are evidence that the cause of insulin-resistance/prediabetes/diabetes is not obesity.

The ICS-NHS Diabetes Prevention Programme assert that excess carbohydrate forms VLDL. Dyslipidaemia is underpinned by insulin-resistance.

Surely you don't believe obesity does not play a major role in the development of diabetes? The statistics state otherwise.

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Insulin-resistance underpins type 2 diabetes and makes people susceptible to fat deposition resulting in obesity. That's not the same thing as obesity causing type 2, which explains why about 15% of type 2s are not overweight.

Most people who develop in middle-age are by default diagnosed Type II. The 15% - 20% who are not overweight include a goodly percentage who are Type 1.5. Like Type I this is an auto-immune issue. The main difference is that it has a slower onset than Type I. However, like Type I it does not respond to Metformin and insulin treatment is required. It has nothing to do with insulin resistance but due to the body decreasing insulin production until it ceases all together!

I've had type 2 clients that struggled to maintain their weight because they'd had the sense to limit their carbohydrate intake to normalise their blood glucose. The natural fats of the Mediterranean (majority monounsaturated including meat fats, plus whole-fat dairy) enabled them to obtain sufficient energy without jeopardising that control.

The vast majority of type 2s are overweight. Obesity lends itself to insulin resistance.

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And a significant minority are not, suggesting that insulin resistance causes obesity and type 2, unless one gets wrapped up in another paradigm.

Peculiar how obesity usually precedes diabetes.. And all these years I thought overeating and a sedentary lifestyle were the primary causes of obesity. Silly me. (:

Dr. Unwin aptly put it that advising people who are carbohydrate intolerant a moderate amount of carbohydrate is moderately poisoning them.

Appreciating that, most people can probably tolerate some grains or carbohydrates; its overemphasis has been potentially deadly, especially when people have been lulled into thinking it is a 'safe' alternative to fat.

That makes sense but cyclists out riding for the day cld burn 3-4,000 calories. Do that with low carb intake?

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Well, again it depends on the intensity.

Ken Cooper established that an average heart rate of 110 beats per minute necessitates 3 hours of training to elicit a training effect (or 90 minutes @ 120 bpm for example). The first thing we have to do following an activity is recover, so significantly exceeding this would result in over-training, impaired immunity and ill-health.

If you were to ride for six hours for example, the extrapolation would indicate that your average heart rate should be around 100 beats per minute, and of course at such low heart rates most of the energy can be derived from natural fat; ingested or stored body-fat.

If you enrol for free for a month, on a well-known low-carb site, you can watch 'The Big Fat Fix', and 'Cereal Killers 2: Running on Fat', that refer to ultra-endurance events.

Don't get me wrong, I'm not saying that a very-low carb diet is best for performance, but neither is a traditional high-carbohydrate diet. Between 1/4 and 1/3 of calories from carbohydrate is likely to be better for health for someone so active.

BTW, circadian rhythm dictates that a minimum recovery period of 24.2 hours is necessary between finishing a session that is sufficient enough to elicit a training effect and starting another.

110 bpm is not typical for a cycling enthusiast, nor a runner like myself. 80-85% mhr is where I like to be, and brief periods at 90-95% mhr each week. The body is remarkably adept at adapting and recovery time is markedly reduced if you are properly trained in your craft. The brief periods at near mhr can give a good boost to ones overall pace over time.

You're right, the body is remarkably adept, and as Scotty said, I canno' change the laws of physics cyclingweekly.com/fitness/c...

I could have sworn it was 24.1 hours. I stand corrected.

I now use HRV4Training to monitor my "training". I was disabled for five years, but I have built up to walking 30 to 35 km per week.

The professionals gave up the Paris-Brest-Paris cycling race as they would not have had enough time to recover for the next event... I found that it seemed like bedtime at 20:00 every night for weeks after it.

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It shots up to 7,000 per day for a mountain stage in the Tour de France! Impossible on low carb!

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I try to avoid grains - I eat gluten-free, grain-free muesli for breakfast... I would like to cut my consumption, but I need the fibre.

I do get "moderately poisoned" by a sandwich now and again. I try to avoid cake.

Unfortunately, removing the gluten tends to raise the glycaemic-load.

I am more intolerant of "gluten free" than gluten, so I (try to only) eat non-wheat, non-oat non-grain stuff that no gluten to remove or replace.

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I agree with Michael. That’s my choice. :-) I know that Tour cyclists take in shedloads of carbs in many forms. Perhaps thy are diabetics too but I haven’t heard that.

Blood glucose is the last thing the body wants to go awry, yet it's what we measure. People can have insulin-resistance for decades without it being detected, yet they suffer other idiosyncrasies; weaker links in the chain.

We frequently hear of sports people having heart attacks (following a 'healthy', low-fat diet) for instance, and if they truly were congenital/hereditary they would manifest themselves in childhood.

Barry Sears points out that ancient Egyptian mummies provide evidence of chronic ill-health, despite having little refined sugar such as honey. They had a heavily grain-based diet. If we don't learn from the past, we are doomed to repeat the mistakes of history.

Modern society has been duped by vested interests, consequently having skewed comprehension of what a balanced way of eating is. They avoid eating natural fat that satiates and demands less insulin, then instead their body makes visceral fat in a battle to cope with the daily onslaught of excess carbohydrate.

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Contrary to what your statement implies, Sports People, as you say, eating a healthy low fat diet, are far less likely to have a heart attack than the population as a whole.

I'm sorry if that is what looked like was being inferred. Exercise/activity is actually vital to health. However, too much is as bad as too little.

As for healthy eating, I think we could agree that this would provide everything the body needs, and not too much of anything. Where we would disagree is the assertion that a low-fat diet could fulfil that criteria.

Think of food like a (yummy) medicine, and carbohydrate is an active ingredient. Societally, we're being encouraged to overdose. Exercise increases our tolerance, but there's only so much it can do.

Agreed, that too much exercise can be a bad thing. The question is, how much is too much? That answer is different for each of us. Those of us that engage in endurance type sports, may very well develop athletic heart syndrome, hypertrophy to parts of the heart as part of physyological adaptation which is usually a benign condition in athletes.

All carbohydrates are not created equally. My diet consists of 75% or more from carbs, perhaps 15% protein, and less than 10% from fats. My blood work invariably comes back with low blood sugar, and lipid numbers consistently has my HDL in the 70's or 80s, and LDL in the 40's. This type of vegetarian, primarily vegan whole food diet has dramatically improved my cardiovascular health. It may not be for everyone, but it has certainly worked for me.

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The cautious thought I have from that is that if your blood glucose comes back low, how high is the insulin level causing that?

I wish you all the best!

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My glucose is within normal ranges on the low end of the scale, right where it needs to be.

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We are essentially all the same but all very different just as well. What has been a healthy diet for may not be for someone else. I do know that diabetes and obesity are less prevalent in the vegetarian/vegan population, and with the majority of plant based diets carbohydrate intake is on the high side. A proper and healthy plant based usually includes loads of complex carbohydrates yet prevalence of insulin resistance is low amongst this segment of the population. Statistically vegetarians have lower rates of disease in general than other segments of the population. There are certainly omnivore diets that are very healthy as well, but one can also derive a good health from a low fat vegetarian diet. It's certainly not for everyone, but it is at least as viable option as any other for someone that wishes to maintain or improve upon there health.

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People stop debating the cause of heart disease. There is not one cause, there are many.

If it was inflammation and insulin resistance how come so many T2 diabetics don't have heart disease?

If it's cholestrol, how come so many people with low or normal cholestrol have heart disease?

It is a combination of factors, smoking, high blood pressure, insulin resistance etc causing damage to the arterial well that then allows cholesterol to enter into the wall and begin to form the blockages so YES it is a cholesterol problem as well.

By controlling all your risk factors,

Insulin resistance, blood pressure, weight, cholestrol, not smoking, taking medication etc, etc you can maybe, just maybe be lucky enough that something works to stop the progression of your heart disease and allow you to live long enough to die from something else.

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Yep 👍

Actually, uncontrolled T2 diabetes and heart disease go hand-in-hand. The ACCORD study also established that if high amounts of insulin/medication are used to achieve normal blood glucose levels, people still suffer chronic ill-health.

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Actually all that shows is that T2 diabetes is just one of the many risk factors for heart disease otherwise surely everyone with T2 would have heart disease and they don't.

Insulin resistance causes inflammation, and impairs the body's ability to repair itself. So, whilst you're right that a number of things such as smoking also cause damage, doing what you can to keep your repair mechanism working well is kind of a summary of the common link.

Certainly, having a divide and conquer attitude of 'we're all victims of fate eventually' doesn't really impart any preventative wisdom.

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Mate you clearly don't understand my original post. From a preventive point of view, what I'm saying is that heart disease has so many causes that to just focus on one is wrong and the best thing you can do for your health is try to minimize all your risk factors as much as possible.

Sadly you seem to think there is only the T2, inflammation cause.

I am not diabetic but have heart disease like so many others who are not diabetic so going on about this as the only cause and not acknowledging all the others makes any advice you give very blinkered .

If no one had diabetes a lot of people would still have heart disease.

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And I'm not disagreeing with you entirely, just pointing out that many people are unaware they have insulin-resistance because we don't measure it, and the vast majority don't go on to develop T2.

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I have been Type I for over half a century. My CVD was initially blamed on diabetes despite my father, his brother and their father all dying prematurely from heart attacks. My surgeon said diabetes complicated the issue but was not the root cause. I suspect my grandfather was undiagnosed Type II but his sons definitely were not.

In recent years I have known two Type IIs die from heart attacks. However, I suspect their lifestyle pre diabetes was a major factor. One weighed 50% more than me at his heaviest and the other was overweight and smoked.

As Fergus says there are multiple causes. Focusing on one aspect alone achieves next to nothing.

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Perhaps a holistic approach with treatment tailored to each individual.

There is no one size fits all.

The BHF launched the Big Beat Challenge last year a single £ 30 award to fund a single project which hopefully will lead to a groundbreaking innovative approach to cardiovascular disease.

It will be fascinating to see which big idea wins.

I don't suppose the ICS-NHS Diabetes Prevention Programme was nominated?

Hi StillConcerned

Out of curiosity I looked up the inclusion criteria for referral to the

The ICS-NHS Diabetes Prevention Programme . I am excluded my HbA1c, fasting bloods sugars and BMI all low.

The programme looks really interesting. I already use CBT and Mindfulness meditation to manage my pain so it was great to see the mind and body approach.

How to change our habitual behaviour is a tough nut to crack.

However I am content with my Mediterranean diet, I'll keep eating full fat yoghurt etc to avoid added sugar, exercise as much as I can and do stuff to improve my quality of life.

😁

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Right on the money!

jimmyq

You might like this research article recently published about the

Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort

ahajournals.org/doi/10.1161...

Conclusion of the 12 year study was the 'Risk for IHD ( Ischaemic heart disease) was positively associated with consumption of red and processed meat, and inversely associated with consumption of yogurt, cheese and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias.'

Cohorts studies show associations that cannot confirm causal links.

Any study that groups red meat with processed meat is severely flawed, as it is akin to grouping water with vodka as they are both clear liquids.

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Totally agree!

Bearing in mind that the glycaemic-load from wholemeal is virtually the same as the white versions glycemicindex.com/about.php

You know, we've been focussed for over 50 years on a failed low-fat diet, and now people are so disillusioned by this they don't realise the real effectiveness of stimulating less insulin.

PHE still advises people to have reduced-fat versions of dairy for instance, because it is lower in calories and saturated fat, whereas skimmed milk stimulates two and a half times the amount of insulin that whole milk does, exacerbating insulin resistance.

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In my opinion, any threads are useful.

When people expect "perfection" in someone's thread, posted, based entirely on goodwill, things get complicated.

People who go on disagreeing so passionately ought to start their own threads once rather than banging on about how "wrong" the original thread, posted by someone else is. I find it simply petty and it is a form of schoolyard bullying.

I bet JQ had already left the building, and doing something far more rewarding in his real time. :)

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Ha ha! I am still here. I have had a few days looking after grandchildren so no time for the computer. I am amazed at the number and quality of responses. A lot of us are doing our homework and I find that inspiring. I have read them all and I have a lot of food for thought and requirements for further research, for my own benefit. If I turn up anything exciting I will post it on here.

Thanks for your input everyone!

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I look forward to you posting the results of your research and if you discover the cause of heart disease I would like to invest in the company that you establish.

There are currently over 10,000 genetic mutations linked to heart disease so anyone that supports a one size fits all approach to treatment and focuses on one cause will very probably fail for most people.

Unfortunately until we enter an age of tailored individual treatment I think the best we can do is control all our modifiable risk factors, take the available medications and keep your fingers crossed.

Happy researching!

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Fergusthegreat,

The BHF launched their Big Beat Challenge a single £30 million funding award to address the many issues you raised. The winner will be announced next year.

blog.bhf.org.uk/its-time-fo...

Has the ICS-NHS DPP been nominated?

The closing date for the applications is end of June I think.

There then will be a long process of the applications being evaluated by the BHF .

I expect there will be a great number of applications as this award is open to any team in the world.

How would I find out if they were nominated? Could I nominate them?

This is what the BHF say about the award

'In order to be considered, all proposals will need to meet our judging criteria. This ensures the ideas are truly transformative, are milestone-led, foster international and inter-disciplinary collaboration, and cover the sort of scale and scope that couldn’t achieved without this level of funding.

The winning team can come from any country, sector or discipline, working on a level that is above and beyond traditional research schemes to achieve a truly revolutionary breakthrough in any heart or circulatory disease.'

The team will have to make an application to the BHF it is not by nomination.

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What if, despite all those individual differences, most people did prevent heart disease by not overdosing on insulin, enabling their body to repair itself for instance?

Thanks for caring, JQ!

Have a fabulous day! :)

JQ is right after all!

"BY --ALAN MOZES, HealthDay Reporter

(HEALTHDAY)

TUESDAY, June 4, 2019 (HealthDay News) -- Flying in the face of popular belief, new research suggests both red meat and white meat can drive up your cholesterol levels.

The study was conducted by researchers from the Children's Hospital Oakland Research Institute (CHORI), part of the University of California, San Francisco. The analysis is reportedly the first to comprehensively compare the impact that red and white meat have on cholesterol.

"Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol," Krauss noted in a university news release. "Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health."

The findings were published June 4 in the American Journal of Clinical Nutrition."

usnews.com/news/health-news...

Video: abcnews.go.com/WNT/video/wh...

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