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CAD AND TG/HDL RATIO
 

The Heart Attack Culprit: Cholesterol Isn't to Blame

Dr. Barry Sears,

Author of The Omega RX Zone: The Miracle of the New High-Dose Fish Oil by Dr. Barry Sears.
Zone Living

 
 
 
 Heart disease is the number-one killer of American men and women today.

"To live a longer and better life is to reduce the likelihood of developing heart disease and the average life expectancy of every American would increase by an estimated ten years."

"The underlying cause of heart disease – a decrease in blood flow to the heart and an increase in inflammation in the arteries. These both result from an increased production of “bad” eicosanoids."

"In fact, 50 percent of the people who are hospitalized with heart attacks have normal cholesterol levels, and 25 percent of people who develop premature heart disease have no traditional risk factors at all."

"...The likelihood of future heart attacks has everything to do with excess levels of “bad” eicosanoids – exactly the hormones that can be modified by my dietary recommendations.

A heart attack is simply the death of muscle cells in the heart from a lack of oxygen. This occurs when blood flow can’t reach the heart because of a blockage or clot in the arteries  

Causes of Heart Attacks

1. Clot formation: This occurs when a clot in the arteries caused by a clumping of blood platelets.

2. Plaque instability: Inflammation causes an unstable plaque to break off and block the blood flow in the artery.
3. Vasospasm: Sometimes a spasm in the artery blocks the flow to the heart.
4. Electrical chaos (sudden death):  The heart goes into electrical chaos and stops its synchronized beating on its own.

Recently has shown that elevated insulin puts one at a increased risk of heart disease. The reason is being that excess insulin causes body to overproduce “bad” eicosanoids altering the good eicosapentaenoic acid (EPA) vs bad arachidonic acid (AA) ratio of 1:6. It is noted that proper diet and or supplements (containing omega 3 and omega 6 in right balance) can restrict the excess formation of “bad” eicosanoids.

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"This unique test measures the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) in plasma. This ratio of the principle omega-3 and omega-6 fatty acids is a measure of the body's eicosanoid balance. Balancing the eicosanoids in the body is an excellent way for managing heart disease and other chronic and inflammatory processes.

Recently, a great deal of interest has been paid to the ratio of the fatty acids arachidonic acid (AA) to eicosapentaenoic acid (EPA). According to Dr. Barry Sears, author of Toxic Fat: When Good Fat Turns Bad, a lower AA/EPA ratio indicates a better balance of "good" and "bad" eicosanoids in your body. An AA/EPA ratio of less than 3 but not less than 1.5 is considered to be ideal. It is no longer considered "well" to have a ratio greater than 10. Anything exceeding 15 means a high level of inflammation in the blood (Toxic Fat Syndrome) and requires immediate dietary attention.

AA/EPA Ratio features:

  • True quantitative analysis of fatty acids
  • Included with the 0041 Fatty Acids - Plasma profile and 0241 Bloodspot Fatty Acid profile

Metametrix clinical laboratory

AA/EPA Ratio Profile - Plasma

A Measure of “Silent” Inflammation

http://www.metametrix.com/test-menu/profiles/fatty-acids/aaepa-ratio

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The Importance of TG/HDL Ratio

It indicates the type of LDL  particle and insulin level  in the body.

a) Ratio is less than 2 indicates  predominantly harmless large, fluffy LDL particles.

b) Ratio is greater than 4 indicates a lot of small, dense LDL particles that can accelerate the development of atherosclerotic plaques regardless of your total cholesterol levels.

c) A high TG/HDL ratio is a surrogate marker for elevated insulin.

How to Improve TG/HDL Ratio

Two ways:

 First: To decrease insulin levels. Excess insulin has been shown to increase triglyceride levels.

Second: To supplement diet with high-dose, ultra refined-grade fish oils.*

The fastest and most effective way is to do both simultaneously.

 

A study conducted by Gerald Reaven at Stanford:

Ppatients were put on diets consisting of the same number of calories but differing in their protein-to-carbohydrate ratio.

When the group consumed a high-carbohydrate diet, they had a much higher TG/HDL ratio than when they switched to a lower-carbohydrate diet. These changes occurred within four weeks of each dietary change.

Bruce Holub at the University of Guelph in Canada has shown that postmenopausal women can rapidly reduce TG/HDL ratio by diets with 3.5 grams of ultra refined-grade fish oil per day.

Copenhagen Male Study: The effect of this ratio on the long-term development of heart disease. The researchers tracked healthy patients who had either a low TG/HDL ratio (less than 1.7) or a high TG/HDL ratio (greater than 6). 

The patients with the low TG/HDL ratio who smoked, didn’t exercise, had hypertension, and had elevated levels of LDL cholesterol had a much lower risk of developing heart disease than those who had a far better lifestyle but a higher TG/HDL ratio.

 This indicates that lower TG/HDL ratio should be goal to reduce heart disease.Life style modification helps to lower this ratio.

1970s: Russell Ross of the University of Washington pointed out that atherosclerosis was an inflammatory disease (like Alzheimer’s disease).

In 1995, statins were found to be far more effective at preventing heart attacks than previous cholesterol-lowering drugs.

Thee statins lower cholesterol levels and also powerful anti-inflammatory agents. The researchers at the Harvard Medical School found that pro-inflammatory C-reactive proteins were highly predictive markers for an increased risk of heart disease. 

They and other researchers found that statins lowered the C-reactive proteins level. The  greatest impact was noted in patients with highest levels of C-reactive protein. Aspirin also reduces inflammation and thus reduce heart attacks. Aspirin is cheaper and more effective.

Heart Disease and Inflammation

Reduction of  inflammation reduces our death rate from heart attacks.

1970s  epidemiological studies revealed that Eskimos in Greenland had virtually no heart disease even though they consumed a high-fat diet.

Additional studies suggested that more fish consumption lead to the lower risk of dying from heart disease.

The DART study showed that eating one serving of fish per week decreased heart attacks by 29 percent in patients who had had a previous heart attack. 

It was the fish oil in the fish that conferred these protective benefits,to lesser extent, people who eat fish have healthier lifestyles in general.

GISSI trial: Patients with heart disease who took about 1 gram per day of ultra refined-grade long-chain omega-3 fatty acids had a 45 percent reduction in their risk of having a sudden fatal heart attack, a 30 percent reduction in their total risk of cardiovascular mortality, and a 20 percent reduction in overall mortality. 

Vitamin E given by itself or in combination with fish oil had no benefits.

The Lyon Diet Heart Study: Survivors of heart attacks were split into two groups. "One group was put on a diet that followed the American Heart Association recommendations (basically the USDA Food Pyramid), and the second group was put on a Mediterranean-type diet (rich in fruits, vegetables, and fish; supplemented with short-chain omega-3 fatty acids; and very low in omega-6). 

At the end of four years, the two groups had the same cholesterol levels. There was, however, a more than 70 percent reduction in both fatal and nonfatal heart attacks in the group on the Mediterranean diet compared with the control group, who were allowed to eat hefty amounts of omega-6 fatty acids.

 This study was very damaging for the cholesterol theory of heart disease."

However, there are many other studies indicating definite relationship between cholesterol and coronary artery disease. CAD is multi-factorial disease.

The group on the Mediterranean diet experienced no sudden deaths (an electrical chaos in the heart, which makes it stop beating in rhythm and is the primary cause of cardiovascular mortality).

The primary difference between the two groups was the ratio of the arachidonic acid to eicosapentaenoic acid in the blood. The AA/EPA ratio of the individuals in the active group was 6.1, compared with 9.0 in the group following the American Heart Association diet.

 Thus, a 30 percent reduction in the AA/EPA ratio resulted in a greater than 70 percent reduction in fatal and nonfatal heart attacks, despite the fact that the TG/HDL ratio didn’t change for either group.

The AA/EPA ratio is by far the most powerful predictor of future heart disease.

The group on the Mediterranean diet never reached an AA/EPA ratio of 1.5, which is similar to that found in the Japanese, who have the lowest rates of heart disease in the world. 

Also, the TG/HDL ratio was still elevated in both groups in the study, and this indicates that insulin levels hadn’t been lowered and that both groups were still eating diets too rich in carbohydrates.

"My dietary program represents a considerable improvement over the intervention diets used in both the GISSI study and the Lyon Diet Heart. Where the GISSI study provided a little less than 1 gram of pharmaceutical-grade fish oil, I recommend five times as much. (You need at least 3 to 4 grams of ultra refined long-chain omega-3 fatty acids per day to lower triglycerides and thus lower the TG/HDL ratio.) While the Lyon Diet Heart Study recommended eating more fruits, I recommend 10 to 15 servings of fruits and vegetables per day.

Compared with the Lyon Diet Heart Study, my dietary program would have lowered the TG/HDL ratio through improved insulin control (which reduces the production of “bad” eicosanoids) and would have provided greater eicosanoid control with the increased intake of ultra refined-grade fish oil. These differences would have been reflected in the blood by the reduction of the TG/HDL and AA/EPA ratios. On the basis of all the available evidence we have from prospective studies, achieving the clinical goals that define the Omega Rx Zone would bring your risk of heart disease down to almost zero."


Excerpted from The Omega RX Zone: The Miracle of the New High-Dose Fish Oil by Dr. Barry Sears. Copyright by Dr. Barry Sears.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. As with any natural product, individual results will vary.

For more information about Dr. Barry Sears, his incredible fish oil supplements, or the popular Zone Diet, please visit www.zoneliving.com.


Dr. Barry SearsDr. Barry Sears is a leader in the field of dietary control of hormonal response. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his efforts over the past 25 years to the study of lipids and their inflammatory role in the development of chronic disease. He holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease.

Measuring Your Future Wellness

Measuring Your Future Wellness

We all desire to have a clinical marker of our future state of wellness. It is my opinion that the AA/EPA ratio in the blood is the best marker of that elusive goal because it measures the level of cellular inflammation in the body.

What is Cellular Inflammation?

Cellular inflammation is the type of inflammation that is below the perception of pain. What it does is to disrupt hormonal signaling at the cellular levels that leads to increased fat accumulation, acceleration of the development of chronic disease, and decreased physical performance. You can’t feel cellular inflammation, but you can measure it. The only way to measure cellular inflammation is by testing the ratio of two essential fatty acids (AA and EPA) in your blood.

What is the AA/EPA Ratio?

The AA/EPA ratio is an indication of the levels of cellular inflammation in your body. High levels of cellular inflammation do not mean you have a disease state, but it does indicate that you are not as well as you could be. Your future state of wellness can be determined by the levels of cellular inflammation in the blood as shown below.

AA/EPA Ranges Cellular Inflammation Future state of wellness
1.5 to 3 Low Excellent
3 to 6 Moderate Good
7 to 15 Elevated Moderate
> than 15 High Poor

The higher your levels of cellular inflammation, the more likely the future development of chronic disease will be accelerated. A recent study from Italy has demonstrated that the AA/EPA ratio is always greater than 15 in patients with chronic diseases (1).

Dietary Methods to Improve the AA/EPA Ratio

There are no drugs that can change the AA/EPA ratio. This is because AA/EPA ratio is a consequence of the diet. One method of lowering the AA/EPA ratio is to increase the intake of high-purity omega-3 fatty acid concentrates rich in EPA. This will increase the EPA content in the blood (2). This represents the fastest way to reduce the AA/EPA ratio. However, the best long-term method is to reduce the AA levels in the blood. This is best achieved by following a strict anti-inflammatory diet, such as the Zone diet (3-5). The Zone diet was designed to reduce elevated levels of both insulin and omega-6 fatty acids so that the production of AA is significantly reduced. The combination of an anti-inflammatory diet coupled with high-purity omega-3 concentrations represents the most powerful dietary approach to reach and maintain a low level of cellular inflammation for a lifetime.

How much EPA and DHA do I have to take to reduce the AA/EPA ratio?

A recent dose-response study in healthy women who had a high risk for potential breast cancer has provided supplementation guidelines for reduction of the AA/EPA ratio (5).

Grams of EPA and DHA supplemented per day AA/EPA Ratio
0 12.1
0.8 4.7
2.5 2.6
5.0 1.3
7.5 1.2

This data indicates that a daily dosage of EPA and DHA of 2.5 grams was sufficient to bring the AA/EPA ratio into the desired range for excellent wellness for these healthy individuals. This level of EPA and DHA recommendation correlates well with an Italian study that demonstrated in patients with various chronic diseases having an elevated AA/EPA ratio (>15) lowered their elevated AA/EPA ratio to approximately 5 with daily supplementation of 2.5 grams of EPA and DHA (1). This is also indicative that a person with an existing chronic disease may need greater amounts of EPA and DHA to get them into an excellent wellness range compared to a healthy individual.

However, these are only general guidelines for daily EPA and DHA supplementation. The best indication of the amount of the amount of EPA and DHA required to optimize the AA/EPA ratio for an individual is best determined with blood testing every six to twelve months.

The benefits of reduction of the AA/EPA ratio.

The JELIS study was one of the largest cardiovascular studies ever done using more than 18,000 subjects with elevated cholesterol levels. When these subjects were given high doses of EPA (1.8 grams of EPA per day), their average AA/EPA ratio decreased from 1.6 to 0.8. This reduction in the AA/EPA ratio was associated with an additional 19% reduction in cardiovascular events during the next four and half years (7).

Until there is more data, I do not believe it prudent to reduce the AA/EPA ratio to less than 1.5 even through significant cardiovascular benefits do occur at lower AA/EPA ratios in patients with elevated cholesterol levels as demonstrated in the JELIS study.

References

  1. Rizzo AM, Montorfano G, Negroni M, Adorni L, Berselli P, Corsetto P, Wahle K, and Berra B. “A rapid method for determining arachidonic:eicosapentaenoic acid ratios in whole blood lipids: correlation with erythrocyte membrane ratios and validation in a large Italian population of various ages and pathologies.” Lipids in Health and Disease 9:7 (2010)
  2. Sears B. The OmegaRx Zone. Regan Books. New York, NY (2002)
  3. Sears B. The Zone. Regan Books. New York, NY (1995)
  4. Sears B. The Anti-Inflammation Zone. Regan Books. New York, NY (2005)
  5. Sears B. Toxic Fat. Thomas Nelson. Nashville, TN (2008)
  6. Yee LD, Lester JL, Cole RM, Richardson JR, Hsu JC, Li Y, Lehman A, Belury MA, and Clinton SK. “Omega-3 fatty acid supplements in women at high risk of breast cancer have dose-dependent effects on breast adipose tissue fatty acid composition.” Am J Clin Nutr 91: 1185-1194 (2010)
  7. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, and Shirato K. “Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis.” Lancet 369: 1090-1098 (2007)
  8. ========================
  9. http://www.yourfuturehealth.com/services_aaepa2.htm

Omega 3 Profile +

Test Specifics  (room 2 of 6)

Overview

The Omega 3 Profile+ is a complete essential fatty acid panel.  While analyzing 35 unique essential fatty acids (EFAs), the Omega 3 Profile+ centers on seven simple, but critical omega-3 measures:

  1. Omega 3 Score (heart disease risk assessment)

  2. Serum AA/EPA Ratio (inflammation marker)

  3. GLA (immune system)

  4. ALA (cardiovascular health)

  5. Arachidonic Acid or AA (inflammation)

  6. EPA (circulation)

  7. DHA Score (brain function)

Omega 3 Score  (heart disease risk assessment)

The Omega 3 Score identifies your risk for heart disease.  Studies published in the American Journal of Clinical Nutrition and the American Journal of Epidemiology used this test in their research on heart disease.  These studies showed that you are 70% less likely to die of a heart attack and 32% less likely to develop heart disease if you have an Omega 3 Score of 7.6 or greater.

Serum AA/EPA Ratio  (inflammation indicator)

The serum phospholipid AA/EPA ratio, on the other hand, is an excellent marker for silent inflammation.  Some people are not as familiar with inflammation as they are the specific diseases that can result from having inflammation.  Some of the most common inflammatory diseases include:  arthritis, diabetes, ADD, Alzheimer’s, and heart disease.

The serum AA/EPA test measures the ratio of arachidonic acid or “AA” (omega 6’s) to eicosa pentaenoic acid or “EPA” (omega 3’s).  The higher the ratio, the more inflammation is present in your body.  Silent inflammation can go undetected for years and it affects the brain, heart, and immune function.

Research has shown the American average serum AA/EPA ratio to be 11 while people with chronic illness and disease typically have scores above 15.  Optimum ratios are usually around 1 to 1.5. 

Improving your scores, Reducing your risk

The most exciting thing about the Omega 3 Score and serum AA/EPA ratio is that both can be improved through nutrition and both are improved in the same way.  The easiest way to improve these scores and reduce your risk of developing inflammation and heart disease is to increase your level of omega 3’s.

Omega 3’s are not produced by the body so your only options are to supplement your diet with omega 3’s or to change your diet to include more fish rich in omega 3’s (like salmon).  At YFH, we do not sell nutritional supplements or recommend specific brands—there is no conflict of interest.

 

 

Omega 3 Score

Serum AA/EPA Ratio

Tests for

Heart disease

Inflammation

Goal

> 7.6

1.0 to 1.5

Improved by

Increasing level of omega 3’s (via fish oil or DHA)

Increasing level of omega 3’s (via fish oil or DHA)

Summary

Since YFH began offering this test, our clients have shown dramatic improvements.  In addition to reducing their risk for heart disease, our clients have noted significant improvements in degenerative diseases like Cancer, Arthritis, Diabetes, Multiple Sclerosis, and Attention Deficit Disorder (ADD) and also a myriad of other frustrating conditions like psoriasis, fertility issues, weight control and hormone imbalance.

Lastly, the Omega 3 Profile +’s requirements are unique and therefore, it is separate from all of our other services.

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EICOSANOIDS- "super-hormones"

Eicosanoids are the most potent biological agents known. They control all hormonal systems and every physiological function:  the cardiovascular and reproductive systems; the central nervous system and the immune system.
They are chemical messengers, and produced in a very low concentrations by each cell in bodies. They last only a few seconds and do not enter the blood stream.

HISTORY

The eicosanoids are the first kind of hormonal control in living organisms and in existence over 500 million years.

They were isolated in the prostate gland in 1936, and named prostaglandins. The examples are Leukotrienes, thromboxanes, prostacyclins, lipoxins, the hydroxylated fatty acids, etc play fundamental roles in bronchoconstriction, allergies, cardiopathies, inflammation, etc.

In 1982 the Nobel prize for medicine was conferred upon the investigators who explained the mechanism of drug action, such as aspirin acts by modification of the body's eicosanoid levels. 

The eicosanoids are involved in all bodily functions and decisive for health and those diseases that might be manifestation of eicosanoid balance or imbalance. 

Two types of eicosanoids:

Good eicosanoids: Those brings about great benefits to health.

Bad eicosanoids: Those causing great damage if produced in excess.

Both are necessary in correct balances in order to achieve good health.

THE PHYSIOLOGICAL ACTIONS OF "GOOD" AND "BAD" EICOSANOIDS
 "Good" eicosanoids  "Bad" eicosanoids
 they inhibit platelet aggregation  they promote platelet aggregation
 they promote vasodilation of blood vesserls  they promote vasoconstriction of blood vessels
 they reduce pain  they increase pain
 they diminish cellular proliferation  they stimulate cellular proliferation
 they improve immune system efficiency  they depress the immune systen
 they improve cerebral function  they degrade cerebral function
 they combat inflammation  they promote inflammation
Obviously, in nature there are no entirely good or entirely bad substances.  In the same way, the opposing action of eicosanoids is important.  For example, in blood platelet aggregation, the "bad" eicosanoids promote aggregation, while the "good" eicosanoids inhibit it.  Should platelets become aggregated at the wrong time, a blood clot is formed which could lead to a heart attack, but if no platelet aggregation should take place following wounding, then there is a risk of excess bleeding.  It is the same for blood pressure:  too much of the "bad" eicosanoids causes increased pressure due to excess vasoconstriction, but too much of the "good" eicosanoids can lead to collapse due to exaggerated vasodilation.  Hence this is an important equilibrium that, surprisingly, may be controlled by food. 

Dietary fats are the sole source of essential fatty acids, which are the building blocks of eicosanoids; and the balance between protein and carbohydrates controls another important hormonal axis, that between insulin and glucagon, which in turn determines whether "good" or "bad" eicosanoids are produced.  Hence, through diet, we must try to introduce the correct quantities of essential fatty acids and control insulin production that, if excessive, can have negative effects on health.

All the "bad" eicosanoids are derived from arachidonic acid (AA), a long-chain omega 6 fatty acid.  For the production of more "good" eicosanoids there must be an abundance of omega 3, eicosapentaenoic acid (EPA), which is found in fish oil and inhibits the production of AA. Furthermore, high insulin levels, which can have an influence on the enzyme delta 5 desaturase, leading to the production of AA, should be avoided.

Unfortunately, current day-to-day diets include both too few long-chain omega 3 and excessive carbohydrates, leading to excessive insulin production.  In order to re-establish the balance, it is necessary to bridge the omega 3 nutritional gap through a diet of fish that are rich in it (salmon, herring, mackerel, sardines, etc.) or through fish oil, and control the stimulation of insulin by choosing the correct carbohydrates and a balanced association among carbohydrates, protein and fats.


WHAT ARE EICOSANOIDS

http://www.en.enerzona.com/_vti_g4_eico.aspx?rpstry=53_

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