86Thousand400: Fat & Heart Attacks Cont.

Factors predicting risk of future heart attack (Hazard Ratio - Relative Risk)

- Diabetes 2.04

- Age 1.87

- Smoking 1.79

- High Blood Pressure 1.31

- Total blood cholesterol concentration 1.22

- Blood triglyceride concentration 1.19

- Blood HDL-cholesterol concentration 0.83

- Diabetes really stands out as a powerful predictor of heart attack risk

Why do abnormalities in carbohydrate metabolism elevate the risk of arterial damage and heart disease in persons with Insulin Resistance (IR) and Type 2 Diabetes (T2DM)

- It is the abnormally elevated blood glucose concentrations that explain why diabetics are at such high risk for developing arterial damage arterial damage leading to heart disease

- Single best predictor of heart attack risk is the blood concentration of glycosylated haemoglobin. Indicator of the extent to which elevated blood glucose concentrations have damaged key body proteins by adding glucose (glycosylatin) to any proteins in direct contact with the blood. Glycosylation alters protein function, making them less effective in their various functions. Since haemoglobin is one of the most abundant proteins in blood, the extent to which it is glycosylated gives a good indication of the extent to which other critical body proteins have been damaged by too high blood glucose concentrations

- Deaths from all-causes (all cause mortality) rises with increasing blood HbA1c concentrations. HbA1c values above 6.4% are associated with a sudden exponential increase in risk for heart disease

- By age 60, 30% of those with random blood glucose concentrations greater than 11mol/L (indicating the presence of T2DM) had already been diagnosed with coronary heart disease, whereas only by age 80 had the same percentage of those with a random blood glucose concentration below 5mmol/L received the same diagnosis. By age 93 only 30% of those with a blood glucose concentration below 5mmol/L had suffered heart attack whereas already by age 68, 30% of those with blood glucose concentrations greater than 11mmol/L had suffered the same fate

- This evidence suggests that high blood glucose concentrations are the single most important factor predicting risk that arterial damage causing heart disease will develop. It seems that glucose damages arteries directly through the glcosylation effect on key proteins and also by promoting oxidation of the small, dense LDL-cholesterol particles

- High carbohydrate diets in those with IR cause elevated blood glucose concentrations and high HbA1c concentrations, ultimately leading to T2DM. High carbohydrate diets also cause elevated blood triglyceride concentrations and lower HDL-cholesterol concentrations in those with IR

- Common factor linking the findings are high carbohydrate diets

The studies of Dr Jeff Volek, Stephen Phinney and Eric Westman show that all risk factors improve on a low carbohydrate diet

- The Art and Science of Low-carbohydrate Living

- The Art and Science of Low Carbohydrate performance

- Subjects who were placed on HCLF or Banting whilst their responses were carefully measured

- Banting subjects showed more advantageous changes

- With Banting, all risk factors moved in the same direction

- In contrast, ingestion of an HCLF diet increases fat production in the liver. It raises blood triglyceride concentrations and lowers blood HDL-cholesterol concentrations. (Promote arterial damage and are associated with reduced long term survival)

- Destroys the prejudice that a high-fat diet is a dangerous "fad". Logical conclusion must be that Banting is the safer option

- Morbid obesity, diabetes, hypertension and hypercholesterolaemia a result of more severe IR