September 26, 2004

Avoiding a heart attack is one of the basic efforts of every person’s existence. Going for the right fats is the key to such efforts

FATS are bad for the heart. This is known fact. However, a lesser known fact is that Fats also include saturated and trans fatty acids.

Saturated fats constitute the main ingredient of our traditional delicious diet, which is a factor responsible for the rising incidence of Ischaemic Heart Disease (IHD) in the community. At the same time, not all fats are bad for the heart. We have bad fats in the form of saturated fats and we have good fats in the form of poly-unsaturated and monounsaturated fatty oils. Unfortunately, very few of us have adequate knowledge of these favourable fats and therefore, most of our diet is deficient of these healthy oils.

This is now well-established that saturated fats and trans-fatty acids are a rich source of low density lipoprotein (LDL) cholesterol. They are therefore highly atherogenic and are responsible for the development of atherosclesosis with their well known clinical consequences in the form of angina, heart attack and sudden cardiac death.

There has been a lot of discussion on the undisputed role of saturated fats in the causation of cardiovascular (heart attack, angina, sudden death) cerbrovascular (strokes) and peripheral vascular diseases.

But lets leave that aside and dwell upon some of the good fats that are easily available for our consumption. Their use can give us a balanced ratio of bad and good cholesterol in the diet.

Flaxseed is one such nutrient which has two main components; the flax oil which is a rich source of alpha linolenic acid (ALA) and lignans. Flaxseed is derived from the flax plant, an annual herb believed to have originated in Egypt. Ancient Egyptians used flaxseed both for nutritional as well as medical purposes. The fibre contained in the flax plant was used to make clothes.

In the 8BC, King Charlemagne of France passed laws requiring the consumption of flaxseed by his subjects to ensure their good health. Over the centuries, the use of flaxseed has grown across Europe, Africa as well as North America. Yet, flaxseed remains a mystery to many. It along with soy, is just starting to gain popularity in the world of nutrition.

Recently the White House’s Office of Management and Budget (OMB) sent a letter to Health and Human services (HHS) and the U.S. Department of Agriculture (USDA) requesting the departments to promote the consumption of omega3 fatty acids. OMB requested HHS consider incorporating this advice in its Dietary Guidelines for Americans, scheduled for a 2005 release, and that USDA update its 1992 Food Guide Pyramid with this recommendation.

Flax plant thrives in deep moist soils rich in sand, silt and clay. The small oval shaped seeds of the flax plant contains oil.

Flaxseed has a nutty, butter flavour and is a virtual powerhouse of nutrients. It is one of the richest sources of alpha-linolenic acid, (ALA) one type of fatty acid in the omega-3 family, considered super-unsaturated fat or a “good” fat. The omega-3 fatty acids, also found in salmon, leafy vegetables and nuts, help reduce the risk of heart disease by lowering elevated blood fat and reducing blood pressure. Flaxseed is also a great source of insoluble and soluble fiber, which helps reduce cholesterol levels.

Good health requires the right ratio of omega-3 fatty acids to omega-6 fatty acids in the diet. The ideal ratio is around 1:2. The average American diet is more around 1:20 to 1:50, with too much omega-6 and not enough omega-3. The ratio present in flaxseed oil is about 4:1. So flaxseed oil is a good source of omega-3.

Flaxseed besides being the richest source of alpha-linolenic acid also contains lignans, which may have antioxidant actions. There are many health issues that appear to be helped with the consumption of flaxseed. Among them are cardiovascular, digestion, the inhibition of tumor formation, a decrease in the symptoms of menopause and increase in stamina. Reduction of the inflammation of arthritis and even the production of silky smooth skin and shiny hair is attributed to it.

Dietary interventions to reduce ischaernic heart disease (IHD) focuses mainly on decreasing the intake of saturated and trans-fatty acids to lower blood cholesterol. Trans-fatty acids are formed when vegetable oils are processed to make them more stable or solid. Trans-fatty acids behave somewhat like saturated fat in that they can raise blood LDL cholesterol. Reducing the intake of saturated fat and trans-fatty acids and increasing the intake of polyunsaturated fat, monounsaturated fat and dietary fibre helps lower blood total cholesterol and LDL cholesterol. Diets rich in ALA, found abundantly in flax, appear to offer protection against IHD and stroke. It also provides protection against sudden cardiac death due to ischaernic induced arrhythmias.

People who follow a Mediterranean diet tend to have higher HDL (good cholesterol levels). The Mediterranean diet consists of healthy balance between omega-3 and omega-6 fatty acids. It emphasizes the use of whole grains, root and green vegetables. Daily intake of fruit, fish and poultry olive and canola oils, and ALA (from flaxseed oil and walnuts) along with discouragement of ingestion of red meat and total avoidance of butter and cream.

CLINICAL STUDIES: Eating two to six tablespoons of ground flax, daily for as little as four weeks reduced blood total and LDL cholesterol significantly in clinical trials. Blood total cholesterol decreased six to nine per cent and LDL cholesterol decreases nine to eighteen per cent in studies of healthy young adults men and women with moderately high levels of blood cholesterol who ate ground flax.

High-density lipoprotein (HDL) cholesterol and triglyceride levels were not affected by diets containing ground flax. ALA has been reported to decrease blood cholesterol levels in animals and humans. In humans, ALA obtained from a mixture of vegetable oils, including flax oil, was equally effective as oleic acid and linoleic acid in lowering plasma total cholesterol by 18 per cent and LDL cholesterol by 22 per cent. So, ground flax and flax oil may both favourably improve IHD risk. The fibre in ground flax may work cooperatively with ALA in lowering blood cholesterol. ALA also helps limit inflammatory reactions that contribute to atherosclerosis.

EPIDEMIOLOGIC STUDIES: Epidemiologic studies are concerned with determining how many people in the community have a certain disease and identifying the risk factors associated with its development. Measurements are made on hundreds, sometimes thousands of individuals and then the data re-examined for trends and links between diet or lifestyle and the presence of diseases.

Several epidemiologic studies suggest that diets rich in ALA reduce IHD risk. For example, the Health Professionals Follow-up study, which began in 1986 with a group of more than 51000 middle-aged and elderly men found a specific preventive effect of ALA. Those men with the highest ALA intakes had the lowest risk of heart attack and fatal heat disease. The effect of ALA was independent of other dietary and non-dietary risk factors. Other large-scale population studies such as the Family Heart Study and the Nurses Health Study, found the risk of having a fatal heart attack and IHD decreased as the intake of ALA increased.

HIGH BLOOD PRESSURE: Several studies suggest that diets rich in omega-3 fatty acids (including ALA) lower blood pressure significantly in people with hypertension.

PREVENTION TRIALS: The Lyon Diet Heart Study was a prevention trial designed to reduce the risk of IHD deaths in survivors of a heart attack. The key finding of this study was that the 302 men and women who had the Mediterranean type diet rich in ALA had 79 per cent reduction in their risk of heart attack compared with the 303 men and women in the control group who ate a prudent diet that resembled the American Heart Association diet.

This result was achieved without a reduction in blood cholesterol. In a follow-up after 46 months, ALA continued to be the key fatty acid whose presence in the diet was associated with a good prognosis for preventing a second, more fatal heart attack.

The famous Multiple Risk Factor Intervention Trial (MRFTT) showed that the higher the ALA intake, the lower the risk of death from IHA strokes and all causes of death combined. MRFTT was a study of more than 12,000 men aged 35-57 years who were followed for six to eight years.

STROKE: A small group of men who participated in the Multiple Risk Factor Intervention Trial (MRFTT) were examined separately for risk of stroke. Among the 96 men, each increased of 0.06 per cent in the ALA content of serum phospholipids was associated with a 28 per cent decrease in risk of stroke.

After controlling for risk factors of stroke like smoking and blood pressure, ALA emerged as an independent predictor of stroke risk — that is men with higher levels of ALA in their serum phospholipids had a lower stroke risk.

Beside cholesterol and blood pressure lowering ALA has anti-thrombotic, anti-platlet and Anti-inflammantory actions as well. These properties in combination provide cardio-protection.

Summary of heart disease prevention and epidemiologic studies:

AVAILABLE FORMS: Ripe seeds linseed cakes, powder, capsules and flaxseed oil are all available at health food and medical stores. Flaxseed and flaxseed oil should be kept refrigerated.

A simple and cheap nutritional supplement flaxseed can offer a significant protection against heart disease and stroke.

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