Sunday, November 14, 2010

Saturated Fat & Stroke, Lab Values! and Chasing Capacity

Green is good brain.  Red?  Not so good.

Am J Clin Nutr. 2010 Oct;92(4):759-65. Epub 2010 Aug 4.

Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study.

Department of Public Health Medicine, Graduate School of Comprehensive Human Sciences, and Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan.


BACKGROUND: Prospective epidemiologic studies have generated mixed results regarding the association between saturated fatty acid (SFA) intake and risk of ischemic heart disease (IHD) and stroke. These associations have not been extensively studied in Asians.
OBJECTIVE: The aim of this study was to test the hypothesis that SFA intake is associated with the risk of cardiovascular disease mortality in Japanese whose average SFA intake is low.
DESIGN: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) comprised 58,453 Japanese men and women who completed a food-frequency questionnaire. Participants were aged 40-79 y at baseline (1988-1990) and were followed up for 14.1 y. Associations of energy-adjusted SFA intake with mortality from stroke (intraparenchymal and subarachnoid hemorrhages and ischemic stroke) and heart diseases (IHD, cardiac arrest, and heart failure) were examined after adjustment for age, sex, and cardiovascular disease risk and dietary factors.
RESULTS: We observed inverse associations of SFA intake with mortality from total stroke [n = 976; multivariable hazard ratio (95% CI) for highest compared with lowest quintiles: 0.69 (0.53, 0.89); P for trend = 0.004], intraparenchymal hemorrhage [n = 224; 0.48 (0.27, 0.85); P for trend = 0.03], and ischemic stroke [n = 321; 0.58 (0.37, 0.90); P for trend = 0.01]. No multivariable-adjusted associations were observed between SFA and mortality from subarachnoid hemorrhage [n = 153; 0.91 (0.46, 1.80); P for trend = 0.47] and heart disease [n = 836; 0.89 (0.68, 1.15); P for trend = 0.59].
CONCLUSION: SFA intake was inversely associated with mortality from total stroke, including intraparenchymal hemorrhage and ischemic stroke subtypes, in this Japanese cohort.
PMID: 20685950 [PubMed - indexed for MEDLINE]

My Thoughts: Stroke, aka "Brain Attack", or more accurately cerebrovascular accident, is the damage of brain tissue secondary to either ischemia (blockage) or hemorrhage (bleeding); it's a debilitating condition that I've seen countless times over the course of my career, and has personally affected my family, as there is a strong genetic disposition on my father's side for CVA (Grandfather, Great-Aunt, and Grandmother secondary to IDDM).  But to the pertinent point:  Saturated Fat, once again, has been incorrectly labeled over the years as a negative and potentially dangerous fatty acid---yet, as this study shows, a LOW intake is associated with a greater increase in a very serious disease.

As I'm just a few days away from re-certifying my Advanced Cardiac Life Support, unfortunately, one of the elements I may have to sit through is the brutal diatribe of nutrition related to cardiac events.  It boggles my mind that the association that is supposed to lead us on cardiac and vascular health, is in fact, doing more damage than good.  I've seen a ton of changes (on a professional level as a paramedic) in the acute care setting over the past 15 years, yet I still haven't seen anything on the preventative side, nutritionally related.  

Yup, just keep on endorsing those Cheerios, American Heart Association.  

 Yay Lab Values!  Wow, I'm a geek!

So I got pretty excited a few days back---a buddy of mine wanted me to look at some labs he had just had done, and I had also just gotten some long-awaited values of my own back.  Before I get into mine, lets take a look at Mr. White's labs (He drives a white truck.  He's not Mr. White.):
Background:  34 y/o male, 5'10", 170lbs, approx 12-13% BF (rough estimate).  Crossfits x 3/week, Shiftworker, occasional adventure racer, and has been moving to a Paleo diet over the past year.

Labs, 2009
    Total Cholesterol:   4.63mmol/L (179.04mg/dL)
    HDL:                     1.32 (51.04)
    LDL:                      2.80 (108.28)
    Triglycerides:         1.15 (101.86)
    C-reactive Protein: 1.3mg/L
    Trig/HDL ratio:      1.98
    American Values(mg/dL) in orange
Labs, 2010
   Total Cholesterol:   5.17mmol/L (199.9mg/dL)
   HDL                      1.53 (59.06)
   LDL                       3.40 (134.48)
   Triglycerides           0.59 (52.27)
   C-reactive Protein <0.2mg/L
   Trig/HDL ratio        0.88

As you can see, Mr White has made some phenomenal changes in just the course of a year; his HDL has gone up (a good thing), his LDL has gone up (a good thing.  No, I'm not kidding.  And yes, I'm right), his CRP, which is a marker for systemic inflammation, has dropped to seriously awesome low values, Trigs have slashed in HALF, and his Trig/HDL ratio is now well below 1.0 (not a value his, or my, physician does.  I've added that in.

The Importance of Your TG/HDL Ratio

How can you tell which type of LDL you have? All you have to do is determine your ratio of triglycerides to HDL cholesterol, which would be found as part of the results of your last cholesterol screening. If your ratio is less than 2, you have predominantly large, fluffy LDL particles that are not going to do you much harm. If your ratio is greater than 4, you have a lot of small, dense LDL particles that can accelerate the development of atherosclerotic plaques – regardless of your total cholesterol levels.

These are the type of changes that we WANT to see on a Paleo diet; some, though are completely at odds with what your physician will want to see. Why? Lack of proper education on the nutritional front, and the perpetration of misinformation stemming from over 50 years ago. I won't even get into the pharmaceutical companies.

HDL and LDL are both elevated because it is being shuttled about for hormone synthesis and cell repair; this is why using a standard lab value and ranges is inaccurate for athletes, the healthy, the sedentary, and the sick.

My Labs:  Back in March I had convinced my physician I needed a coagulation profile due to my high intake of fish oil (true) and my desire to return to full contact martial arts (not so true.  Ha!).  I had asked for an INR and a PTT test;
   INR:  1.1s, norm range 0.9-1.2s
   PTT:  26.0s, norm range 18-45s

Apparently, at an intake ranging from 6-9g of EPA/DHA per day, I'm not about to bleed out through my eyeballs should I sneeze.  I knew this, but it's something I wanted to see for myself; consider it a n=1 Mythbuster episode.

Home of Andy Deas

If you've listened to even ONE episode of The Paleo Solution, you'll know that Andy Deas is the dude that keeps Robb Wolf focused like a laser beam...ok, well, tries to.  He's also a trainer at NorCal Strength & Conditioning, and he happens to have himself a shiny new(ish) blog.  If it's anything like Robb's (opinionated, full of info, well written), it'll be worth checking out.  Word on the street is he's going to continue his series on the the love/hate with all things Crossfit.  Sounds familiar?  You bet.

Check out his blog here:  Chasing Capacity

Various Random Training Sessions

Oct 21st, CFLA, 12PM
Overhead Press, 65#x10, 95#x5, 115#x3, 125#x3, 135#x1, 140#x1 (previous PR from 2008)
Yeah, 2 years later and I'm only back matching my PR, but a PR nonetheless.  It's been a long-assed road, but thankfully, very minimal pain/popping/discomfort lately.

Oct 22nd, CFLA, 1PM
Deadlift 135#x10, 225#x5, 315#x1, 365#x1, 405#x1, 425#x0.  Got greedy and tried to jump 20lbs; 405# felt damn good, but the PR Gods were not shining down upon me.  Got 425# halfway up, but no lockout = no dice, brother.
As Many Rounds As Possible(AMRAP) in 12 Minutes:
10-40#DB snatch, right
10-40#DB snatch, left
10-Abmat situps, unanchored
10-Goblet squats, 40#

8 Rounds.

Nov 1st, CFLA, 1PM
AMRAP in 25 minutes:
250m row
12 Wall Ball Shots (squat-thrust-throw 20# ball to 10' mark)
12 Kettlebell swings(53#)
10 rounds; this was a longer burner that never got easier.  Sean'O and I hit this one together, and it was damn nice having someone racing along side of me!

Nov 2nd, U of L
Rock Climb x2 hrs.  I'm currently working on a 5.11a; I feel like I'm technically getting better, but more importantly, I'm more relaxed AND able to push fatigue limits, if that makes any sense at all.  My climbing mentor, MD, just got back from what was probably a stellar trip to Red Rock Canyon, Nevada.  Hopefully, we can hit Skaha Bluffs next summer.

Nov 3rd, Lethbridge Coulees
Mountain Bike x1 hr
Just a quick rip through the coulees; it's been a killer fall, dry, warm, and I haven't been on my bike much since the summer.  Legs seemed a bit heavy, but the home-climb wasn't too bad.

Nov 8th, CFLA, 1PM
High bar Back Squat, 10's and 5's, up to 225#.
Left knee is still aching all around the patella; this is worrisome, and I'm hoping it's just some stubborn tendinitis.  I'm thinking this goes back to my last snatch session at the beginning of Oct, but who knows.  Time for this old man to invest in some knee sleeves
AMRAP in 8 minutes:
5 Deadlifts (185#)
10 Lateral Bar Jump-Overs (there & back = 1) 
12 Rounds

Yoga x1.5hr.  I may have unintentionally P.O.'d a few yoga-goers, as I was asked "are you guys ready for a good workout tonight?!"  I responded by saying that I had already worked out, and was looking forward to some relaxing active recovery.  There was a bit of awkward silence.  I honestly wasn't trying to be snide---I thoroughly enjoy yoga, and I find it complements HIIT nicely.  For some folks it's their primary form of exercise, albeit low-intensity (for the record, the class was an Ashtanga style; I'm sure a Vinyasa/Bikram combo would be much more intense.)  There is a place in town that offers Bikram, and I'd love to check it out.