Aspects of the epidemiology of diverticular disease and ischemic heart disease

A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures

A 60-year-old man presented with typical angina and had a positive stress test. He declined both drug therapy and invasive testing. Instead, he chose to adopt a whole-food plant-based diet, which consisted primarily of vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts. His symptoms improved rapidly, as well as his weight, blood pressure, and cholesterol levels. Plant-based diets have been associated with improved plasma lipids, diabetes control, coronary artery disease and with a reduction in mortality. Adoption of this form of lifestyle therapy should be among the first recommendations for patients with atherosclerosis.

Prevalence rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum

OBJECTIVE

To elucidate the prevalence rate of metabolic disorders among subjects with asymptomatic colonic diverticulum.

METHODS

We carried out a cross-sectional analysis of the association between colonic diverticulum and selected metabolic disorders among the male personnel of the Self-Defense Forces who underwent total colonoscopy as part of their retirement check-up (age range, 51-59 years).

RESULTS

The prevalence rate of colonic diverticulum was 10.2% among the population studied. The scores of lifestyle factors including those of cigarette smoking and alcohol consumption were similar between the subjects with colonic diverticulum and those without it. Type 2 diabetes (21.6% vs 14.0%, P=0.047) and hypertension (30.9% vs 19.8%, P=0.011) were more prevalent among the subjects with colonic diverticulum than those without it. The prevalence rates of obesity, dyslipidemia, hyperuricemia, and impaired glucose tolerance were similar between the two groups.

CONCLUSION

The prevalence rates of type 2 diabetes and hypertension are elevated among the middle-aged male subjects with asymptomatic colonic diverticulum. The results may partly explain the reported association between colonic diverticulum and cardiovascular disease.

Low-carbohydrate diets: a matter of love or hate

Low-carbohydrate diets (LChD) have become very popular among the general population. These diets have been used to lose body weight and to ameliorate various abnormalities like diabetes, nonalcoholic fatty liver disease, polycystic ovary syndrome, narcolepsy, epilepsy, and others. Reports suggest that body weight reduction and glycemic control could be attained while following LChD. However, these advantages are more notably found in short periods of time consuming an LChD. Indeed, the safety and efficacy of the latter diets in the long term have not been sufficiently explored. In contrast to what has been proposed, other mentioned pathologies are not improved or are even worsened by carbohydrate restriction. Therefore, the aim of this review is to define the concept of LChD and to explain their clinical effects in the short and long term, their influence on metabolism, and the opinion of nutrition or health authorities. Finally, evincing the research gaps of LChD that are here exposed will later allow us to reach a consensus with regard to their utilization.

Risk factors for gallbladder cancer: a Polish case-control study

A population-based case-control study of gallbladder cancer was conducted in the south-west of Poland, within the frame-work of the SEARCH Programme of the International Agency for Research on Cancer. A total of 73 cases and 186 controls were interviewed using a questionnaire including demographic and socio-economic factors, education, smoking, alcohol, tea and coffee consumption, and past medical history. A validated diet history was used to estimate the daily intake of calories, fats, carbohydrates, proteins, cholesterol, fibres and vitamins C and E. Gallbladder disease was the major determinant of subsequent gallbladder cancer: 41 cases (56%) vs. 15 (8%) controls had a past history of gallbladder disease, corresponding to an odds ratio (OR) of 12.5 (95% confidence interval, 5.8 to 26.6), and the OR was 12.1 for gallbladder problems dating back 20 years or more in the past. There was an inverse relationship with education, the OR being 0.3 (95% CI 0.1 to 1.2) for 13 years of education or more vs. less than 7. Gallbladder cancer risk was positively associated with total calorie intake, with ORs of 1.4, 1.5, 4.1 for the 3 upper quartiles compared with the lowest one (trend, p less than 0.01). Weaker direct associations were observed for proteins, carbohydrates and cholesterol. There was some suggestion of inverse associations with fibre intake, and a more consistent one with vitamins C and E. These results further quantify the role of gallstones, and suggest that total calorie intake and other dietary factors potentially linked with benign gallbladder conditions are involved in the aetiology of gallbladder cancer.

Ethnic immunity to coronary heart disease?

Dietary fat intake is often regarded as a major determinant of coronary heart disease (CHD) rate and it has been deemed unnecessary to invoke racial or other factors to explain the differences in CHD rates among different ethnic groups. Despite a high prevalence of CHD risk factors such as hypertension, obesity, and smoking, CHD remains a rarity in westernized black Africans. Cord blood total cholesterol (TC), low density lipoprotein cholesterol (LDLC) and apolipoprotein B (apo B) levels were measured and found to be respectively 12.1%, 18.3% and 22.4% lower in black neonates when compared to white neonates. These differences were again studied in a group of young black African males and a comparable group of age-matched whites who had been exposed to the same environment and western diet for at least 2 years. Although the body mass indices and serum albumin concentrations in the adult males were not significantly different, serum levels of TC, LDLC and apo B were 10.7%, 18.7% and 39.7% lower in the blacks, respectively. Furthermore, high density lipoprotein cholesterol (HDLC) and Apolipoprotein AI were 20.2% and 9.5% higher, homocysteine 45.6% lower and coagulation factor VII 26.6% lower in the adult black Africans. It is concluded that blacks are biochemically less responsive to an atherogenic diet than whites and these differences are already present at birth.

Management of constipation. 1. High fibre diets work

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Management of constipation. 2. When fibre fails

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Effect of blackgram fibre on ethanol-induced hyperlipidemia in rats

Rats fed a diet low in fibre and provided with ethanol for 4 weeks showed a higher concentration of cholesterol in the serum, liver and heart, but not in the aorta when compared with control rats not provided with ethanol. Animals maintained on a diet of blackgram fibre (30%) and provided with ethanol had significantly lower concentration of cholesterol in these tissues and in the aorta. The concentration of triglyceride was also raised in the serum, liver and heart in rats fed a diet low in fibre + ethanol. A diet of blackgram fibre caused a significant decrease in serum and liver triglyceride. Fecal excretion of neutral sterols and bile acids decreased in rats fed a diet low in fibre + ethanol, whereas blackgram fibre caused an increase in such fecal excretion.

Dietary fiber and cholesterol metabolism in rats fed a high cholesterol diet

The effect of administering blackgram (Phaseolus mungo) fiber (isolated as neutral detergent residue) at the 30% dietary level has been studied with regard to lipid concentration in the tissues and that of biliary and fecal bile acids and sterols. Rats were fed a high fat-cholesterol diet and compared with those fed a cellulose diet. The results indicate that blackgram fiber significantly lowers cholesterol in both serum and aorta [11]. There was an increased concentration of biliary sterols and bile acids and increased fecal excretion of sterols and bile acids, each of these effects being significantly greater than those observed in the rats fed cellulose.

Ischaemic heart disease-an hypothesis to integrate the role of insulin, fibre and sucrose

The theory that a high dietary cholesterol and saturated fat intake has an aetiological role in coronary artery disease is inadequate. So are those theories based upon insulin, upon refined carbohydrate and upon dietary sucrose. An alternate hypothesis is presented. Central to it is prolonged hyperinsulin-aemia. This, acting synergistically with the changes in lipide metabolism secondary to the effects of dietary fibre and sucrose, is crucial to atherogenesis. There is abundant evidence for an association of insulin and vascular changes, both in vitro and in epidemiological studies. Laboratory and epidemiological evidence also exists for an effect of fibre and soluble carbohydrate on cholesterol synthesis and excretion, both as itself and as bile acid. A scheme is presented to demonstrate these complex inter-relationships and their role in vascular diseases.

Prevalence of diverticular disease of the colon in patients with ischaemic heart disease

In view of the similar patterns of incidence of diverticular disease of the colon (DD) and ischaemic heart disease (IHD) in different communities, the prevalence of diverticular disease was investigated in male patients after recovery from acute myocardial infarction. A significantly higher prevalence of DD was found among infarct patients (57%) than among male control subjects (25%) matched for age and social class.

Recent progress in dietary fiber (plantix) in human nutrition

Dietary fiber was extensively discussed in an article by G.A. Spiller and R.J. Amen in this journal in 1975 (Volume 7 Issue 1). The progress in this field has been tremendous in the past 2 years. What was an uncertain field in 1975 and what at that time to some investigators still appeared as a hypothesis or fad without much proof has turned into a much more respected part of nutritional sciences. The scientific quality of recent studies on dietary fiber in human nutrition shows a great deal of sophistication and care. Improved analytical methodologies are being used more extensively. Many nutritionists and clinicians have accepted the fact that a reasonable increase in the dietary fiber intake in the U.S. and U.K would be advisable. In this article, the possible beneficial effects of dietary fiber on health, the possible harmful side effects, and the food science aspects are carefully discussed after an update on chemistry, analytical procedures, and nomenclature. Undoubtedly, dietary fiber has found a new niche in the sciences of nutrition, medicine, epidemiology, and foods.

The effect of wheat fibre on plasma lipids and faecal steroid excretion in man

1. The effect of isoenergetic substitution of bran and wholemeal bread for white flour and white bread was investigated in six healthy volunteers in a metabolic unit. 2. A 21 d high-fibre experimental period was preceded and followed by a 14 d control period, so that each experiment lasted 7 weeks. Blood samples were taken on each of the last 3 d and faeces collected (using carmine markers) for the last 6 d of each diet period. 3. Plasma cholesterol, triglycerides and serum calcium concentrations were not altered by the addition of wheat fibre. 4. Wheat fibre caused a significant increase in faecal bulk and frequency. Faecal steroid excretion was the same in the last week of the first control and the high-fibre periods but increased in the subsequent control period.