How do high glycemic load diets influence coronary heart disease?
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RESEARCH
Open Access
How do high glycemic load diets influence coronary heart disease? Marc J Mathews*, Leon Liebenberg and Edward H Mathews
Abstract Background: Diet has a significant relationship with the risk of coronary heart disease (CHD). Traditionally the effect of diet on CHD was measured with the biomarker for low-density lipoprotein (LDL) cholesterol. However, LDL is not the only or even the most important biomarker for CHD risk. A suitably integrated view of the mechanism by which diet influences the detailed CHD pathogenetic pathways is therefore needed in order to better understand CHD risk factors and help with better holistic CHD prevention and treatment decisions. Methods: A systematic review of the existing literature was conducted. From this an integrated CHD pathogenetic pathway system was constructed. CHD biomarkers, which are found on these pathways, are the only measurable data to link diet with these CHD pathways. They were thus used to simplify the link between diet and the CHD mechanism. Data were systematically analysed from 294 cohort studies of CHD biomarkers constituting 1 187 350 patients. Results and discussion: The resulting integrated analysis provides insight into the higher-order interactions underlying CHD and high-glycemic load (HGL) diets. A novel “connection graph” illustrates the measurable relationship between HGL diets and the relative risks attributed to the important CHD serological biomarkers. The “connection graph” vividly shows that HGL diets not only influence the lipid and metabolic biomarkers, but also the inflammation, coagulation and vascular function biomarkers in an important way. Conclusion: A focus primarily on the low density lipoprotein cholesterol biomarker for CHD risk has led to the traditional guidelines of CHD dietary recommendations. This has however inadvertently led to HGL diets. The influence of HGL diets on the other CHD biomarkers is not always fully appreciated. Thus, new diets or other interventions which address the full integrated CHD impact, as shown in this paper, are required. Keywords: High glycemic load, Coronary heart disease, Biomarkers
Background Coronary heart disease (CHD) is the largest cause of death globally [1]. Cholesterol is commonly assumed to be a crucial element of CHD [2]. Therefore dietary recommendations have traditionally focused on the reduction of saturated fatty acids [3]. This has led to the adoption of low-fat, high carbohydrate diets [4]. However, such highglycemic load (HGL) diets have been shown to increase the relative risk for CHD [3,5]. Forty percent of CHD deaths occur in men and women who have cholesterol levels lower than the average for the
* Correspondence: [email protected] CRCED, North-West University, and consultants to TEMM International (Pty) Ltd, P.O. Box 11207, Silver Lakes 0054, South Africa
general population [6]. The focus on a single biomarker may thus be oversimplified. But how does a HGL diet influence all the CHD pathogenetic pathways? The authors could not find a study which integra
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