Cardiovascular Risk Factors on Kitava, Part II: Blood Lipids

The findings in the previous post are all pretty much expected in a population that doesn't get heart disease. However, things started to get interesting when Lindeberg's group measured the Kitavans' serum lipids ("cholesterol"). Kitavan and Swedish total cholesterol is about the same in young men, around 174 mg/dL (4.5 mmol/L). It rises with age in older Swedish men but not Kitavans.

Doctors commonly refer to total cholesterol over 200 mg/dL (5.2 mmol/L) as "high", so Kitavan men are in the clear. On the other hand, Kitavan women should be dying of heart disease left and right with their high middle-age cholesterol of 247 mg/dL (6.4 mmol/L)! That's actually higher than the value for Swedish women of the same age, who are far more prone to heart disease than Kitavans.

The fun doesn't stop there. Total cholesterol isn't a good predictor of heart attack risk, but there are better measures. Some of the best predictors in Western populations are low HDL and high triglycerides (these are also markers of the metabolic syndrome). It's well established that HDL goes down on a high-carbohydrate diet, and triglycerides go up. That's exactly what we see in Kitavans. Their HDL is slightly lower than Swedes' at middle and old age, and their triglycerides are higher on average. Judging by these numbers, Kitavans should have cardiovascular disease (CVD) equal to or worse than Swedes, who suffer from a high rate of cardiovascular mortality.

Kitavan smokers had a lower HDL than nonsmokers, yet still did not develop CVD. Smoking is considered one of the most powerful risk factors for cardiovascular disease in Western populations.

I won't discuss LDL much because it's a weak predictor, but in case you're interested, it's lower in Kitavan males than Swedish males. It's about the same in Kitavan and Swedish females until old age, when Swedish LDL goes up.

These data seriously challenge the theory that certain patterns of blood lipids cause CVD. Kitavans, particularly the women, have a blood lipid profile that should have them clutching their chests, yet they remain healthy.

I have a theory of the relationship between blood lipids and CVD that can explain these data. I believe that blood lipids, rather than causing CVD, simply reflect diet composition and other lifestyle factors. Both on Kitava and in the West, low HDL and elevated triglycerides imply a high carbohydrate intake. Low-carbohydrate diets consistently raise HDL and lower triglycerides. On Kitava, carbohydrate comes mostly from root crops. In the West, it comes mostly from processed grains (typically wheat) and sugar. So the blood lipid pattern that associates best with CVD and the metabolic syndrome in the West is simply a marker of grain and sugar intake.

Cardiovascular Risk Factors on Kitava, Part I: Weight and Blood Pressure

The Kitavans are an isolated population free of cardiovascular disease and stroke, despite the fact that more than three quarters of them smoke cigarettes. They eat a carbohydrate-heavy, whole-foods diet that is uninfluenced by modern food habits and consists mostly of starchy root crops, fruit, vegetables, coconut and fish. Their intake of grains and processed foods is negligible.

Naturally, when Dr. Lindeberg's group discovered that Kitavans don't suffer from heart disease or stroke, they investigated further. In the second paper of the series, they analyzed the Kitavans' "cardiovascular risk factors" that sometimes associate with heart disease in Western populations, such as overweight, hypertension, elevated total cholesterol and other blood lipid markers.

Kitavans are lean. Adult male body mass index (BMI) starts out at 22, and diminishes with age. For comparison, Swedes begin at a BMI of 25 and stay that way. Both populations lose muscle mass with age, so Kitavans are staying lean while Swedes are gaining fat. The average American has a BMI of about 28, which is considered overweight and 2 points away from being obese.

Kitavans also have a low blood pressure that rises modestly with age. This is actually a bit surprising to me, since other non-industrial groups like the Kuna do not experience a rise in blood pressure with age. Compared with Swedes, Kitavans' blood pressure is considerably lower at all ages.

In the next post, I'll discuss the Kitavans' blood lipid numbers ("cholesterol"), which challenge current thinking about heart disease risk factors.

The Kitavans: Wisdom from the Pacific Islands

There are very few cultures left on this planet that have not been affected by modern food habits. There are even fewer that have been studied thoroughly. The island of Kitava in Papua New Guinea is host to one such culture, and its inhabitants have many profound things to teach us about diet and health.

The Kitava study, a series of papers produced primarily by Dr. Staffan Lindeberg and his collaborators, offers a glimpse into the nutrition and health of an ancient society, using modern scientific methods. This study is one of the most complete and useful characterizations of the diet and health of a non-industrial society I have come across. It's also the study that created, and ultimately resolved, my cognitive dissonance over the health effects of carbohydrate.

From the photos I've seen, the Kitavans are beautiful people. They have the broad, attractive faces, smooth skin and excellent teeth typical of healthy non-industrial peoples.

Like the Kuna, Kitavans straddle the line between agricultural and hunter-gatherer lifestyles. They eat a diet primarily composed of tubers (yam, sweet potato, taro and cassava), fruit, vegetables, coconut and fish, in order of calories. This is typical of traditional Pacific island cultures, although the relative amounts differ.

Grains, refined sugar, vegetable oils and other processed foods are virtually nonexistent on Kitava. They get an estimated 69% of their calories from carbohydrate, 21% from fat, 17% from saturated fat and 10% from protein. Most of their fat intake is saturated because it comes from coconuts. They have an omega-6 : omega-3 ratio of approximately 1:2. Average caloric intake is 2,200 calories per day (9,200 kJ). By Western standards, their diet is high in carbohydrate, high in saturated fat, low in total fat, a bit low in protein and high in calories.

Now for a few relevant facts before we really start diving in:

• Kitavans are not particularly active. They have an activity level comparable to a moderately active Swede, the population to which Dr. Lindeberg draws frequent comparisons.
  
• They have abundant food, and shortage is practically unknown.
  
• Their good health is probably not related to genetics, since genetically similar groups in the same region are exquisitely sensitive to the ravages of industrial food. Furthermore, the only Kitavan who moved away from the island to live a modern life is also the only fat Kitavan.
  
• Their life expectancy at birth is estimated at 45 years (includes infant mortality), and life expectancy at age 50 is an additional 25 years. This is remarkable for a culture with limited access to modern medicine.
  
• Over 75% of Kitavans smoke cigarettes. Even the most isolated societies have their modern vices.

The first study in the series is provocatively titled "Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava." In it, Dr. Lindeberg presents data from interviews and electrocardiograms (ECG) suggesting that heart disease and stroke are absent or extremely rare on Kitava. The inhabitants are entirely unfamiliar with the (characteristic) symptoms of heart attack and stroke, despite the sizable elderly population. This is confirmed by the ECG findings, which indicate remarkable cardiovascular health. It also agrees with data from other traditional cultures in Papua New Guinea. Lindeberg states:

For the whole of PNG, no case of IHD or atherothrombotic stroke has been reported in clinical investigations and autopsy studies among traditionally living Melanesians for more than seven decades, though an increasing number of myocardial infarctions [heart attacks] and angina pectoris in urbanized populations have been reported since the 1960s.

Dementia was not found except in in two young Kitavans, who were born handicapped. The elderly remained sharp until death, including one man who reached 100 years of age. Kitavans are also unfamiliar with external cancers, with the exception of one possible case of breast cancer in an elderly woman.

Overall, Kitavans possess a resistance to degenerative diseases that is baffling to industrialized societies. Not only is this typical of non-industrial cultures, I believe it represents the natural state of existence for Homo sapiens. Like all other animals, humans are healthy and robust when occupying their preferred ecological niche. Our niche happens to be a particularly broad one, ranging from complete carnivory to plant-rich omnivory. But it does not include large amounts of grains or modern industrial foods.

In the next few posts, I'll discuss more specific data about the health of the Kitavans, including their body composition, serum lipids, and hormone profile. These data challenge the theory of an "atherogenic lipid profile", the idea that certain blood lipid patterns cause heart disease.

Recipe for a Veggie Burger

Holly shows us how to make delicious veggie burgers at home. It's an easy recipe and the two key ingredients are lentils and walnuts - two of the most nutritious foods that most people don't eat enough of.



From Before and After TV;

Veggie burgers are a nutritional alternative to beef burgers. Many people don't think of making their own veggie burgers but they are really easy to make at home. Store bought veggie burgers are nutritional but often very high in sodium and preservatives.

Lentils are high in fiber which makes them a good protector against bowel cancer. They are an excellent source of protein and are an important source of B vitamins, especially B3, which is essential for both a healthy nervous system and digestive system. They are high in iron, zinc and calcium and are a good replacement for red meat. Like meat, the iron in lentils is better absorbed when they are eaten with a good source of vitamin C like leafy green vegetables.

Walnuts are an excellent source of omega-3 fatty acids, a special type of fat that is essential for our bodies, but that the body cannot produce. Walnuts are also a very good source of monounsaturated fats.

Walnuts contain many powerful antioxidants, including ellagic and gallic acids, pus antioxidant phenols and vitamin E. The minerals copper and manganese are also found in abundance in these tasty nuts.

Blessed relief

My brothers wedding was fabulous, and we had such a lovely time. They were so cute and in love and I am thrilled for them. The above was DS in his penguin suit as Paige Boy and Ring Bearer, and then one of my get up...

Check out the wedding 'cake'. What a nightmare for us bandsters huh? Thank goodness I hadn't had my band relaxed at the time of the wedding!! there was 240 Krispy Kreme Donuts and even a chocolate fountain in the evening. No I didn't succumb!

But back to banding... My appointment with Wendy went well on Sunday. I had a WHOLE millilitre out of my band.

I cant tell you how wonderful it feels. Strangely enough, although I never thought I could feel my band inside me, I must have been able to in some way because my chest actually feels different.

When I hopped on the table I told her I wanted all the fluid - everything - out of my band because I couldn't take it any more. she told me that 1 ml would be fine.

She said that when people are too tight she can tell. Its in their eyes and skin condition and general behaviour... lethargic and lacklustre all around. She said that I wasn't that tight because I looked healthy, rosy cheeks and was bright and attentive etc. Apparently some people are literally starving themselves and think they are going to be able to lose weight, but in fact the very opposite is true and they are seriously jeopardising their bands and the integrity of their stomach.

So when she stuck in the needle it immediately popped out fluid - a clear indication of tightness. She drew all 6.5mls out of my band to check for leaks, fluid loss, colouration etc and all was fine, then she just put 5.5mls back in.

I felt the relief immediately. I was hungry before having the fluid out as she doesn't like you to eat before a fill, so we went straight to KFC afterwards. I was able to COMFORTABLY eat half a twister. That was unbelievable. No puking, no worries, and a natural full feeling where I just wanted to stop eating.

I actually didn't eat anything else the rest of the day as it was about 5pm when we had the KFC anyway.

Yesterday I had a bit of crap carb day, and spent a lot of time in bed with horrible period pain, but today I am determined to not think about having a band and try and eat to satisfaction and stop. I don't want to push the band, and I don't want to overeat just because I might be able to.

So today's day started off with 28g muesli and skimmed milk - a previously unimagined delight.

Weight wise I was 15stone 8 according to the scales at the weightloss surgery group appointment. So that's good. Last time I weighed 16 stone 4, so at least I have lost 10 pounds since April.

Anyway, I am gonna crack on with this band lark and start behaving myself. No wine, no junk. Actually, it feels great to know I DON'T have to eat junk. I was relying on it to keep me going for the last couple of months, but now I can eat regular food its a real relief.

Letter to the Editor

I wrote a letter to the New York Times about their recent article "The Overflowing American Dinnerplate", which I trashed here. The letter didn't get accepted, so I will publish it here:

In the article "The Overflowing American Dinner Plate", Bill Marsh cites USDA data showing a 59% increase in fat consumption from 1970 to 2006, coinciding with the doubling of the obesity rate in America. However, according to Centers for Disease Control NHANES nutrition survey data, total fat intake in the US has remained relatively constant since 1971, and has actually decreased as a percentage of calories. The apparent discrepancy disappears when we understand that the USDA data Marsh cites are not comprehensive. They do not include the fat contained in milk and meat, which have been steadily decreasing since 1970.

The change Marsh reported refers primarily to the increasing use of industrially processed vegetable oils such as soybean oil. These have gradually replaced animal fats in our diet over the last 30 years. Since overall fat intake has changed little since the 1970s, it cannot be blamed for rising obesity.

Losing 45 Pounds Since January

Catie has lost 45 pounds since January. She used to weigh 173 pounds and now weighs 128 pounds.

She says the best moment, that she will never forget, is when she was picking up her sister at the airport and her sister didn't recognize her.

Catie lost the weight with the help of Weight Watchers and a regular exercise program. Check out her before and after photos and her weight loss story here.