The Dash Diet Weight Loss Solution: 2 Weeks to Drop Pounds, Boost Metabolism, and Get Healthy (A DASH Diet Book) (13 page)

LDL Cholesterol

Desirable with CVD: <70

Optimal: <100

Near or above optimal: 100–129

Borderline high: 130–159

High: 160–189

Very high: 190+

HDL Cholesterol

Low: <40

High (desirable): 60+

Triglycerides (Triacylglyerols)

Normal: <150

Borderline high: 150–199

High: 200–499

Very high: 500+

Triglycerides are other types of fats that are concerning for heart health. They tend to deposit in veins and arteries, similar to LDL. Further, elevated triglycerides can be an early warning sign that you are at higher risk for developing type 2 diabetes. When your blood sugar stays higher than normal for an extended time, the liver will pick up some of the excess sugar. After the liver has enough sugar stored as glycogen, it will then start converting the excess sugar into fatty acids, which are combined into triglycerides, much of which are packaged and pumped back out into the bloodstream. Unfortunately, these

packaged triglycerides soak up cholesterol from the HDL, reducing its ability to send the cholesterol back to the liver for elimination. Thus, triglycerides are both a symptom of developing insulin resistance and a problem for heart health.

Your physician may have different goals for you than the general population

guidelines. However, these are the standard goals for blood lipids. People with higher risks for heart disease may be asked to reduce their LDL lower than the standard

guidelines. Having diabetes is one of the factors that increase your risk for heart disease, so there are stricter guidelines for people with diabetes.

Having elevated levels of blood lipids goes hand in hand with high blood pressure to

damage arteries and veins, and increases the risk for all of the same diseases as

hypertension. It is important for us to emphasize the higher risk for heart attack, fatal or not, associated with high cholesterol.

Fortunately, the DASH diet supports improving cholesterol levels through lower

intake of saturated fats, increased intake of calcium, and higher intake of fiber. The body uses saturated fats and trans fats to make cholesterol. Fiber and calcium can help reduce the amount of fat that your body absorbs. Choosing lean meats, limiting dairy fat, and avoiding plant sources of saturated fats (such as palm oil and coconut oil) are all key DASH strategies for lower cholesterol. We worry more about the intake of these

unhealthy fats than we do about dietary cholesterol, since we consume about 100 times more saturated fat than we do cholesterol. Additionally, the reduced starch intake from the DASH Diet Weight Loss Solution will help lower triglycerides and reduce the

amount of cholesterol that your body makes. Who knew? A high-carb diet fires up

production of the enzyme (HMG CoA reductase) that helps in the production of

cholesterol in your liver. A higher-carb diet depresses the level of good cholesterol and raises the level of bad cholesterol. None of these are desired, so cutting back on those starchy foods will have many benefits for heart health.

Reducing Your Personal Risk for Heart Disease

Most of the heart disease risks are under your control. Family history, sex, and age are not. So focus on the things that you can change, most of which are addressed with the DASH Diet Weight Loss Solution. Follow this plan and work in concert with your

physician to control your blood pressure, cholesterol and triglycerides, and blood sugar.

Reach and maintain a healthy weight. Become more physically active and quit smoking.

CHAPTER 12

DASHing Your Risk of Diabetes

There are three blood sugar diseases that go together: insulin resistance, metabolic

syndrome, and type 2 diabetes. Insulin resistance sounds like “medical talk,” which it is, but it is very important to understand the process that can lead to developing type 2

diabetes. About 25 million Americans have the disease. Another 35% of adult Americans have prediabetes. That figure jumps to 50% of people who are 65 or older. In the United States in 2007, diabetes was estimated to have cost $175 billion. It is associated with increased risk of kidney failure, blindness, heart disease, and amputations.

On a more practical level, most of us are fearful of developing diabetes. While it is becoming more common and treatable, and almost all of us know someone dear to us

who has diabetes, we still don’t want to have it controlling our lives. If you have a strong family history of diabetes, or if you have some of the early warning signs, such as high triglycerides, expanding waistline, or a diagnosis of prediabetes, then you will appreciate having a plan to do something about it.

Genetics or heredity can play a strong factor in whether you are likely to develop

diabetes. Beyond a family history of diabetes, several racial and ethnic groups are at higher risk for developing type 2 diabetes, including Latinos and Hispanics, Native

Americans and Alaskan Natives, African-Americans, South Asians, and Pacific Islanders.

Fortunately, research has shown that improving eating habits and exercising moderately can reverse or prevent the onset of diabetes. Knowing that you are at risk can help

motivate you to move more and eat better.

How Are Type 1 and Type 2 Diabetes Different?

With type 1 diabetes, the body quickly and completely loses the ability to produce

insulin. Typically, this happens in childhood, but it can strike at any age. It is also known as juvenile diabetes or insulin-dependent diabetes. People with type 1 diabetes have to use insulin with every meal. It is also possible for people with type 1 diabetes to develop insulin resistance later in life.

With type 2 diabetes, the body slowly stops being able to produce enough insulin.

Insulin resistance is a hallmark. Most often it develops later in life. It is also known as adult-onset diabetes and non-insulin-dependent diabetes (even though some people with type 2 will need insulin).

Insulin is the body’s hormone that helps to move blood sugar into the cells,

particularly into muscles. When you have a meal with sugar or starch, your blood

glucose (blood sugar) rises and triggers the pancreas to produce insulin. Insulin

resistance is the condition in which your body stops responding to insulin as efficiently as it did when you were younger (although, unfortunately, this condition can occur in children and teens). When your body doesn’t respond as well to the insulin, your

pancreas pumps out higher levels to try to keep blood sugar under control. Over time, this overproduction can wear out the cells that produce insulin, and then you won’t be able to produce enough to keep blood sugar under control.

The liver normally contains some sugar stored as glycogen, but it can hold only a

limited amount. If blood sugar is still high, the liver will convert the excess into

triglycerides (see
Chapter 11)
. Some of these triglycerides are stored in the liver, which can cause fatty liver disease. And some get packaged into particles and sent back into the bloodstream, where they can soak up cholesterol from the HDL (good cholesterol),

reducing its ability to send the cholesterol to the liver for elimination.

Some of the first symptoms that will be noticed by your doctor might be slightly high glucose and/or high triglycerides. You might have noticed that you have gained extra

weight around the middle. Sorry, but yes, that is an important sign that you are at risk for developing diabetes. Sadly, the one area where your body still responds well to insulin is in the fat cells around your belly region. Excess sugar gets soaked up by these fat cells, and gets converted into more fat.

Some of the lifestyle factors that can provoke insulin resistance are physical inactivity and long-term consumption of excess calories, especially from sugar and starch, both of which would, of course, be related to overweight and obesity. The good news is that

research has shown that getting on track with healthy eating, losing as little as 7% of body weight, and adding moderate activity (30 minutes five times per week) can reverse or prevent insulin resistance.

Definitions of Diabetes and Insulin Resistance

Normal blood sugar is less than 100 when fasting, and optimal healthy blood sugar is

about 75 to 80. Prediabetes is when the blood sugar is between 100 and 125 when

fasting. This can also be called insulin resistance, impaired glucose tolerance, or impaired fasting glucose, depending on which test was used to diagnose it. People are diagnosed with diabetes if their fasting blood sugar has been 126 or higher on one or more

occasions, or if their nonfasting blood sugar is over 200. Another measure is A1c (which is glycosylated hemoglobin), which if over 6.5 is considered to be indicative of diabetes.

A1c measures the level of sugar attached to your blood hemoglobin, which is related to how high your blood sugar has been over the past three months.

Metabolic Syndrome

Metabolic syndrome is related to insulin resistance. It is also called Syndrome X, insulin resistance syndrome, or dysmetabolic syndrome. The cluster of symptoms, including

elevated blood pressure, elevated blood sugar, high triglycerides, low HDL, and high

waist circumference, are related to how your body processes blood sugar. Fortunately, the lifestyle changes to manage this syndrome are exactly the same as for improving

insulin sensitivity, lowering blood pressure, and improving blood lipids. Controlling all these issues reduces your risk of heart disease and diabetes. The DASH Diet Weight Loss Solution, with lower levels of starchy foods and plenty of exercise, will help improve the symptoms and interrelated physical problems at their most fundamental level.

Metabolic Syndrome Diagnosis (U.S.) Includes 3 or More of the Following

Triglycerides

Over 150

Over 40 inches (102 cm) for men

Waist circumference Over 35 inches (88 cm) for women

Less than 40 mg/dL for men

Low HDL

Less than 50 mg/dL for women

Elevated blood

Greater than 130 SBP or 85 DBP or on medication for

pressure

blood pressure

Elevated blood

Fasting glucose greater than 110 mg/dL

glucose

CHAPTER 13

The DASH Diet for the Science Geeks

While the DASH Diet Weight Loss Solution is relatively intuitive to follow, many

people still want to get into the details of why and how it works.

The original premise of the DASH diet was to lower blood pressure. The research

study was called Dietary Approaches to Stop Hypertension. One of the guiding

principles was that vegetarian diets were known to be associated with lower blood

pressure. The researchers wanted to take the best elements of vegetarian diets and

develop a dietary pattern that would be flexible enough to accommodate the food

preferences of most Americans, while still being a very healthy diet.

Eating patterns that were rich in potassium, magnesium, and calcium were known to

be associated with lower blood pressure. It would seem to be an easy solution to just add dietary supplements containing these minerals in order to promote healthier blood

pressure. In fact, many studies had been done looking at the effect of dietary supplements with these minerals. Unfortunately, these studies did not show a consistent benefit from pills.

When you look at dietary patterns that are abundant in potassium, calcium, and

magnesium, they also tend to be rich in vitamins C and D and high in fiber. The

researchers decided to develop a program based on food patterns, rather than dietary

components.

When the first DASH diet studies were being developed in the early 1990s, the

conventional nutrition wisdom held that diets rich in starches, especially from grains, and lower in fats and proteins were the key to health and reduced obesity. Of course, we now know that didn’t work out so well. But this philosophy shaped the original design of the DASH diet.

For the initial studies, the targets for caloric contributions for the DASH diet were 55% carbohydrate, 18% protein, and 27% fat. The salt content at 3,000 milligrams per

day was much higher than would be used today, since there was no RDA for sodium at

that time—there was just a recommendation for a minimum amount that was deemed to

be adequate and safe. Further, the researchers wanted to evaluate the effect of the dietary pattern, not sodium reduction, on blood pressure.

The key daily nutrient targets were to have at least 4,700 milligrams of potassium,

1,250 milligrams of calcium, 500 milligrams of magnesium, and 31 grams of fiber. In

practice, the research diet was only able to reach 4,500 milligrams of potassium. The targets for calcium and magnesium were much easier to reach, and the target for fiber was exceeded.

Another concern of the researchers was that certain ethnic groups had higher rates of hypertension, and were more likely to have serious health complications from elevated blood pressure.
1
So when choosing study subjects, they included African-Americans at numbers higher than their representation in the general population. And certain regions of the country are more likely to be affected by consequences of hypertension. A region of the country, mostly in the Southeast, following the lower Appalachian Mountains over toward Texas, is called the Stroke Belt
.2
Fortunately, two of the sites chosen for the study were in the Stroke Belt, at Duke University in North Carolina and the Pennington

Biomedical Research Center in Louisiana. Thus, the DASH diet was tested with the aim

of targeting the groups that were especially hard hit with high blood pressure. If it could work for the most vulnerable people, then the DASH diet would certainly be a valuable diet plan.