Final Posting of the Summer: A Reflection of My Postings on Atherosclerosis

            Thank you for all those people who have read these posts about atherosclerosis. I hope you found them interesting and helpful.

            What started as an English blog assignment, has become a learning experience.  While making these posts as a new blogger, it helped me understand atherosclerosis even better than before I began this blog.

If this is your first time viewing my blog, here is the list of postings I have made in the past and a brief summary to reiterate what I have discussed about atherosclerosis.

1.      Introduction to Atherosclerosis and myself

Ø  A brief introduction of me and the description of atherosclerosis. Atherosclerosis is the buildup of plaque in the arterial walls. It can occur in any region of the body including the brain, heart, and legs.

2.      Update on Synthetic Blood Vessels

Ø  In this post, I mentioned the possibility of replacing blood vessels affected by atherosclerosis. Replacement vessels must be retrieved from another part of the patient's body. The potential of artificial blood vessels is also commented in this post.

3.      How atherosclerosis is affected by the brain and the nervous system.

Ø  Just as the title says, it contains a descriptive commentary of how the nervous system of the brain can affect atherosclerosis. Primarily, blood vessel dilation, or contraction, and blood pressure is affected by hormones from the brain.

4.      Atherosclerosis and Cholesterol

Ø  A major factor that plays a role in atherosclerosis is cholesterol. Knowing the difference between LDL and HDL cholesterol can be beneficial.

5.      Signs and Symptoms of Atherosclerosis

Ø  In this post, I briefly stated the signs and symptoms of atherosclerosis. Common causes of atherosclerosis include, old age, smoking, high blood pressure, and high cholesterol. Common symptoms includes, pain, shortness of breath, dizziness, and stroke. Obtaining regular check-ups at your nearest medical facility can help catch disease at an early stage.  

6.      Preventing Atherosclerosis with Basic Exercise

Ø  The importance of basic exercise is emphasized in this post. Basic exercise includes jogging, walking, yoga, swimming, jump rope, and etc. The promotion of nitric oxide from exercise helps maintain your blood vessels elasticity. Some exercise is always better than none.

7.      The Genetic Aspect of Atherosclerosis

Ø  In this post, I noted that atherosclerosis is not always developed from eating habits, but genetics may play a role as well. An Olympic athlete died from heart attack because of atherosclerosis. Even though he was a championship swimmer, he had a trace of atherosclerosis that may have been inherited from someone in his family.

8.      How Trans Fats Can Affect Atherosclerosis

Ø  This post is comprised of facts and the deception society should be aware of when it comes down to trans fats.  There is general consensus that trans fats are bad for health. Consumers need to read nutritional labels, even if they say 0 grams of trans fat. Avoid any processed food in packages and the term "partially hydrogenated" oil.  Trans fat allow food manufacturers to make products with longer shelf life.  

9.      Natural Remedies for Preventing Atherosclerosis

Ø  This informative post contains beneficial food products that can help against atherosclerosis. Eating fresh fruits and vegetables can always be beneficial.

            After developing these posts over the summer, I have come to realize that my own diet is filled with flaws and trans fats. I noticed myself continually progressing towards eating more fresh fruits and vegetables. Avoiding fast food places like McDonald's and Starbucks has been my first few steps. I find myself developing a new routing of oatmeal in the morning and salad for lunch.

            In addition, reading other articles about atherosclerosis and forums about health topics has become a favorite past time for me.  Some of my favorites belong to other science blogs and websites. A few sites I read about atherosclerosis include:

Ø  http://www.mayoclinic.com/health/arteriosclerosis-atherosclerosis/DS00525/

Ø  http://blogs.bmj.com/heart-journalscan/2011/02/13/hdl-function-and-atherosclerosis/

Ø  http://blogs.nejm.org/now/index.php/coronary-atherosclerosis/2011/01/21/

Ø  http://ehealthforum.com/blogs/atherosclerosis/#b

I hoped you enjoyed reading what I have to offer about atherosclerosis. If you have any comments or concerns, feel free to leave a comment, or email me.

Natural Remedies for Preventing Atherosclerosis

             Natural remedies can help prevent atherosclerosis. Although in severe cases of atherosclerosis natural remedies may not be of much effect, the best way to approach to any disease is prevention. Exercise and a healthy diet is a good way to start in the prevention of atherosclerosis. I previously discussed these topics in one of my previous posts about exercise and diets, so feel free to browse around the site.   In this particular post, I will focus on the natural remedies that help prevent atherosclerosis.

Green Tea

            Green tea is known to provide numerous health benefits. Among the health benefits green tea provide includes reducing the risk of cardiovascular diseases.  Green tea contain antioxidants that help fight against atherosclerosis by improving vascular health.

Omega-3 Fatty Acids

            Omega-3 fatty acids are known to reduce low-density lipoprotein (LDL) cholesterol and increased levels of high-density lipoprotein (HDL) cholesterol. Although omega-3 fatty acids are available as supplements containing docosahexaenoic acid, or DHA, they are easily acquired naturally from food. Among the top sources of omega-3 fatty acids include seeds (i.e. flaxseed) and fish (i.e. salmon).

The following link contains the Top 100 Sources of Omega-3 Fatty Acids.

Hawthorn

           Although hawthorn fruits is popular in the Asian community, researchers have found that hawthorn fruits may have potential medicinal purposes related to atherosclerosis. In the journal American Journal of Chinese Medicine, an article titled, "A study of the comparative effects of hawthorn fruit compound and simvastatin on lowering blood lipid levels", showed that there is potential benefits associated with the consumption of the hawthorn fruit. The hawthorn fruit helps reduce fat and cholesterol, the major components in plaque buildup in atherosclerosis. In other studies, the hawthorn fruit even helped with blood pressure and chronic heart failure. Some subjects even reported having an increases tolerance for exercise and higher threshold for fatigue.

 

Here is the picture of the Hawthorn fruit and its dried medicinal appearance:

Pomegranate Juice

            Pomegranate juice is both tasty and healthy. In the American Journal of Cardiology, Micheal Sumner and et. al. published an article on the "Effects of Pomegranate Juice Consumption on Myocardial Perfusion in Patients With Coronary Heart Disease". These researchers found that pomegranate juice helps reduce stress-induced myocardial ischemia in patients with coronary heart disease. Pomegranate also have one of the highest levels of antioxidants compare to any other fruit. Antioxidants help the body protect against free radicals that oxidize cells and molecules in the body, including the oxidation of LDL cholesterol that lead to plaque buildup.   

Flavonoids

            Flavonoids help reduce atherogenesis by helping with decreasing blood pressure, inhibiting LDL oxidation, and improving dyslipidemia. Flavonoids can be found throughout vegetables and fruits. But be aware that only natural fruits and vegetables contain these health benefits, not artificial oils made to smell, look, and taste like fruits and vegetables. Some of the most popular food containing flavonoids are soy, cocoa, grapes, and black or green tea.

Flavonoid

A picture containing some foods containing flavonoids:

Although these are just a list of some of the potential natural remedies of atherosclerosis, the general idea is to avoid animal products, with the exception to fish, and focus on vegetables or fruits.

References:

1.      http://www.comilac.com.tr/uploads/pdf/12PomGT.pdf

2.      http://www.ajconline.org/article/S0002-9149(05)01027-1/fulltext

3.      Wang QM, Gong QY, Yan JJ, Zhu J, Tang JJ, Wang MW, et al. Association between green tea intake and coronary artery disease in a Chinese population. Circ J 2010; 74: 294–300.

4.      Graham HN. Green tea composition, consumption, and polyphenol chemistry. Prev Med 1992; 21: 334–350.

5.      Hirano R, Momiyama Y, Takahashi R, Taniguchi H, Kondo K, Nakamura H, et al. Comparison of green tea intake in Japanese patients with and without angiographic coronary artery disease.

6.      _{Guillot N, Caillet E, Laville M, Calzada C, Lagarde M, Véricel E. "Increasing intakes of the long-chain omega-3 docosahexaenoic acid: effects on platelet functions and redox status in healthy men." FASEB J. 2009 23(9):2909-16.}

7.      http://nutritiondata.self.com/foods-000140000000000000000.html

8.      _{Xu H, Xu HE, Ryan D. "A study of the comparative effects of hawthorn fruit compound and simvastatin on lowering blood lipid levels." Am J Chin Med. 2009;37(5):903-8.}

How Trans Fats Can Affect Atherosclerosis

                Trans Fat, associated with unsaturated fats, can promote atherosclerosis.  However, do not mistake that all unsaturated fats are bad. Only saturated fats and trans fats are bad.

                 Geometric isomers exist as either cis (Z) or trans (E) isomers. The name "trans" is associated with the geometrical orientation of the two bulkiest carbon chains facing opposing sides. 

                A diagram here will help clarify what I mean:

*note: methyl = CH3

                Cis-isomers are naturally occurring most of the time, while trans-isomers are typically synthesized.  A trans fat occurs when food companies "partially hydrogenise" their oils so they can have a longer shelf life.  Nevertheless, if food companies meet the maximum allowed amount of trans fat per serving, or half a gram per serving, the United States Food and Drug Administration, or FDA,  allows food companies  to label their products as "Zero" trans fat. But this is simply not true. During the hydrogenation process both cis and trans isomers will form. So unless your ingredient label says fully hydrogenated, then you probably still have some trans fats in your food product. 

                Some examples of food containing trans fat, or partially hydrogenated ingredients:

Ø  Vegetable oils

Ø  Ice cream

Ø  Spreads (i.e. Margarine, shortening, butter, etc.)

Ø  Soups (i.e Cup noodle or ramen soup)

Ø  Fast food

Ø  Packaged food (i.e. cake mixes)

Ø  Frozen food

Ø  Candy

Ø  Baked goods (i.e. cookies)

Ø  Chips and crackers

Well the list goes on, but these are some of the top ranking food containing trans fat.

                Trans fat, or trans-fatty acids, has recently been identified to increase levels of low-density lipoprotein (LDL) cholesterol and decrease levels of high-density lipoprotein (HDL) cholesterol.  Trans fat can also be associated with the inflammation in the arteries, and cause cell membrane changes that make them leaky to calcium. The summation of high LDL cholesterol, inflammation, and calcification in the arteries increases the chances of heart diseases caused by atherosclerosis.

                 In an article published in the Journal of Nutritional Biochemistry, "A Mechanism By Which Dietary Trans Fats Cause Atherosclerosis", researchers have found a direct correlation between trans fat and a protein that influences the development of heart disease, diabetes, and cancer.   Researchers identify this protein as a "transforming growth factor", or TGF, that prevents atherosclerosis. By studying people with a high trans fat diet, the research study found that the TGF in these people were less responsive and their arteries had more significant blockage of blood flow than individuals with lower trans fats diet. 

                A hypothesis suggests that the body may recognize trans fats as saturated fats; therefore, the body treats these (saturated) fats as any other regular saturated fats.

                Henceforth, the take-home message is that trans fats are bad. Although in today's modern society groceries and supermarkets all carry something with trans fats, it is simply a matter of having the knowledge and ability to make the right choices. Personally, I like to read nutritional labels and I avoid all partially hydrogenate ingredients and stick to fresh fruits and vegetables.  

                Last, but not least, I leave you with some quick tips on trans fats:

Ø  Avoid the frozen aisle

Ø  Read the back of the label and not just the front

Ø  Look for and avoid the term "partially hydrogenated", even if it says trans fat free!  

References:

1.       http://www.foodnavigator.com/Science-Nutrition/Scientists-unlock-how-trans-fats-harm-arteries

2.       http://www.mayoclinic.com/health/trans-fat/CL00032

3.       http://news.illinois.edu/news/09/0616transfat.html

4.       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125015/pdf/nihms-224344.pdf

5.       http://www.webmd.com/diet/features/top-10-foods-with-trans-fats?page=2

The Genetic Aspect of Atherosclerosis

                Atherosclerosis is contributed to a healthy diet and adequate exercise, but family genetics can be the X factor.  The concern for this disease should not be secluded to only people that lack exercise or a healthy diet. A proper healthy diet low on fats and complimented with adequate exercise can reduce the probability of heart disease, but it does not eliminate the chances.

                Currently the London Olympics of 2012 is under the spotlight, but a great swimmer is not among them due to atherosclerosis. Certainly, everyone understands the strict diets and daily exercise routines that Olympic athletes undergo during training. The death of a Norwegian athlete swimmer, by the name of Alexander Dale Oen, came at almost a complete surprise.

                Alexander Dale Oen, born on May 21st 1985, was only age 26 on April 30th 2012 when he was found unconscious  in this hotel room in Arizona during his training camp in the USA.  After being brought to the hospital in Flagstaff Medical Center he was pronounced dead. A later autopsy found that he had suffered from a heart attack due to a chronic, coronary heart disease.  A more detailed autopsy reported that his left descending  artery was blocked by atherosclerotic plaque.  

                Alexander is Norway's first Olympic medalist. He won silver during the 2008 Beijing Olympics by coming second in the 100 meter breaststroke finals. Alexander is also had some notable achievements over his swimming career including gold at the 2008 European Championships and setting  a new Nordic record for the 100 meter breaststroke. 

A picture of Alexander Dale Oen:

                Unfortunately, he will not be participating in this year's Olympics. This goes to show that atherosclerosis genuinely is not discriminatory towards healthy individuals with top physical fitness compared to individuals of less physical fitness. Although a healthy diet and adequate exercise may help reduce the risks of a heart disease, the genes passed down by past generations can play a major factor.

A tribute to Alexander by his admirers:

                Genetics help map out our bodies are constructed from within. Scientists have found that there is a major gene that contributes to how our body stores certain fats. A proposed mechanism of lipid peroxides being stored is thought to be related to how genes recognize, oxidize, and produce an inflammatory response to lipids.

                A recent study published online on July 3, 2012 in the journal Cell Metabolism commented that they have identified a signaling pathway that may control both atherosclerosis and obesity.  Scientist from the Singapore Bioimaging Consortium and institute of Molecular and Cell Biology determined that mice deficient in the Wip1 gene were resilient against weight gain and atherosclerosis. This gene can potentially affect how lipids are stored and recognized in the body and help prevent many disease, including heart disease. The mice in this study were found that through the regulation of the Ataxia telangiectasia mutated gene and the signaling molecule mTor, the mice was able to resistant to weight gain and atherosclerosis. Whether, or not, this gene is applicable to humans yet is still unclear, but nevertheless, this is a leap forward in finding a potential treatment in the genetic aspect of atherosclerosis.

References:

·         http://circ.ahajournals.org/content/91/9/2488.full

·         http://en.wikipedia.org/wiki/Alexander_Dale_Oen

·         http://in.news.yahoo.com/mechanism-controls-both-obesity-atherosclerosis-identified-121155576.html

·         http://www.nbcolympics.com/news-blogs/swimming/norwegian-swimmer-alexander-dale-oen-died-of-heart-disease.html

Preventing Atherosclerosis with Basic Exercise

            Atherosclerosis is the hardening of arteries. As plaque builds up, it begins blocking blood flow. Clogged arteries may lead to potentially lethal consequences.  Exercise can potentially prevent atherosclerosis and reduce the likelihood of clogged arteries.  Exercise promotes nitric oxide production in the blood, that promotes circulation.

            The problem is: individuals lack the motivation, or time to commit to a regular basis exercise routine.  However, a brief cardiovascular exercise a few times a week can make a world of difference compare to that of no exercise. 

            Nevertheless, I understand that not everyone can put aside 30 minutes to 1 hour exclusively for time to exercise daily. But it is better to put in 10 to 15 minutes at least 2 or 3 times a week, the more the better, than it is to not do any exercise.

            Moreover, I completely sympathize with those individuals that have not exercise since their P.E. (physical education) classes back in their middle school.  It is always hard to take that first step and start up a routine.

             As an individual who has always struggled with my own weight, I understand how the first few days, or even the first week, is hard on the body when you begin exercising.  The body has a set point, or the level of activity it is accustomed.  Once the body is out of this comfort zone, it will feel tired at first since you are not used to the increased level of activity. However, after continued exercise and increased level of activity, the body will raise that set point to a higher level. Which is also why when the same person working out the same routine over a prolonged period of time will not receive the same effect after continued use. Instead they are required to do an extra few repetitions or increase the weights to further increase their effectiveness when they exercise.

            On a personal level, I started a program called Insanity. By no means am I paid to advertise their product, but I became of fan of it due my progress. Before I began the program I was at the peak of my highest body weight at 175 pounds at 5 feet 3 inches. We all have those days where our weight goes up and down so the numbers are subjective. The program is marketed 60 days of the Insanity. It is actually about 54 days excluding the one day a week day off, or 63 days total if you count everything. I managed to lose about 15-20 pounds along with 2-3 inches off my waist.  It was hard at first, but now it has become fun and even addictive.

            Conversely, I am not trying to advertise that you should run out there and grab an exercise program, it may not be right for you.  Everyone has their own level of fitness and should go on their own pace. If a long-term exercise program is not right for you, simply pick up a routine and stick to it.

Some basic exercise include:

Ø  Jogging

Ø  Swimming

Ø  Yoga

Ø  Walking

Ø  Jump Rope

Ø  Weight training

            In a study from the journal of "Experimental and Clinical Cardiology", researchers study on the effects of exercise on the development of atherosclerosis. Researchers have found that "mild to moderate exercise training protects against experimental atherosclerosis" in mice. Mice with exercise had a significant reduced risk of heart-relate disease than compared to mice with no exercise. Therefore, it is crucial to squeeze in any little bit or exercise you can before it is too late. Personally, I attempt to do a few push-ups before bed or when I wake up in case I have a busy day and forget to do a longer exercise during the day. Some exercise is always better than no exercise.

References:

1.      Froelicher VF. Animal studies of effect of chronic exercise on the heart and atherosclerosis: A review.Am Heart J. 1972;84:496–506. 

2.      Kramsch DM, Aspen AJ, Abramowitz BM, Kreimendahl T, Hood WB., Jr Reduction of coronary atherosclerosis by moderate conditioning exercise in monkeys on an atherogenic diet. N Engl J Med.1981;305:1483–9.

3.      Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation. 1999;99:963–72. 

4.      Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med. 1989;320:915–24. 

Signs and Symptoms of Atherosclerosis

                Cardiovascular disease continues to be the number one killing disease in America over tobacco or cancer. Many cases of cardiovascular disease, but not all, typically results from the hardening of arteries and the buildup of plaque, or atherosclerosis.  

                The hardening of arteries and the buildup of plaque is the result of constant wear and tear within the endothelial lining in blood vessels.

Arteries can experience wear and tear from:

Ø  Old age

Ø  Smoking

Ø  High blood pressure

Ø  High cholesterol

                These are typically the most common risk factors, but are not excluded to only these factors.  There can even be hereditary factors that are passed down from generation to generations from close relatives.

                Unfortunately, nearly every individual has some form of atherosclerosis, but the level of severity of plaque buildup may vary.

                In early stages, the inner layer of cells along the blood vessel are torn as a result of the risk factors mentioned above.  The body then uses cholesterol  along with other material to repair the walls. White blood cells that are responsible for digesting excess cholesterol  and other debris in the blood stream become trapped along the wall and becomes plaque. However, signs and symptoms do not appear until the buildup of plaque has become a significant hindrance to blood flow.

Signs and Symptoms include:

Ø  Pain or dizziness during exertion

Ø  Shortness of breath

Ø  Poor wound healing

Ø  Stroke, in severe cases

                These symptoms are caused by insufficient blood flow to regions of the body created by the blockage in the blood vessel from plaque buildup. Consider a toll booth on a bridge, regardless of how many cars there are on the road the speed of traffic is restricted at the toll booth. Similarly, the opening gap within the plaque buildup in the artery limits the speed of the blood flow. Platelets in the blood that are used to promote blood clog will be unable to reach an open wound as quickly and can even be caught up within the plaque.

                Since atherosclerosis can occur in just about any region of the body, it is often categorized by the region it is found.  

Regions where atherosclerosis is found are classified as:

Ø  Coronary artery disease - Located in the chest region.

Ø  Cerebrovascular disease - Located in the brain.

Ø  Peripheral artery disease - Located in the limbs, typically the legs.

However, how can an individual physically determine that atherosclerosis is occurring in their body?

                Although some techniques can be more riskier and have potential complications, other methods are more practical.

Methods used for testing for atherosclerosis:

Ø  Angiography - inserting a tube into the blood vessel and physically checking for regions of plaque buildup. This procedure is considered to be risky and is frequently reserved for serious cases of atherosclerosis.

Ø  Carotid Artery Ultrasound - an ultrasound test along the carotid arteries. This procedure is considered as risk free.

Ø  Electron beam computed tomography (EBCT) - A specialized CT scan that photographs the heart and uses a computer to measure the level of calcium presence.

                

Regardless of what level in severity of plaque buildup, it is always wise to be conscious of eating and exercise habits while being aware of any signs or symptoms of atherosclerosis. My personal opinion and advice is to get regular check-ups and minimize recreational drug consumption, or quit them altogether if you are not medically required to consume. 

References:

http://heart-disease.emedtv.com/atherosclerosis/atherosclerosis-p3.html

http://www.webmd.com/heart-disease/silent-symptoms-diagnosing-atherosclerosis?page=2

http://www.webmd.com/heart-disease/what-is-atherosclerosis?page=2

Atherosclerosis and Cholesterol

                Atherosclerosis is the buildup of plaque. Plaque may consists of cholesterol, platelets, and macrophages being trapped in a lesion along the epithelium of the arterial walls.

            Today's post we will focus on cholesterol. Not all cholesterol is bad. In fact, in all your cells in your body has cholesterol built within its lipid bilayer cell membrane.

            It is practically impossible to render your body free of cholesterol. So how do we counteract atherosclerosis with the topic of cholesterol?

            Cholesterol can be categorized as either low-density lipoprotein (LDL) or high-density lipoprotein (HDL). The cholesterol that is associated with plaque buildup is the LDL cholesterol. So you might be wondering, how can a common person understand the difference and how do we avoid it?

            There is a common phrase saying, "you are what you eat".  There is probably a book with this title, but by no means am I referencing that piece of text in this post. In short, your body is comprised of what you feed it.

            The best way to differentiate between food with LDL or HDL cholesterol can be fairly simple. Typically in meat, LDL is associated with red meat and HDL is associated with white meat. Red meat can be classified as beef, lamb, veal, and pork. While white meat can be classified as chicken or fish.

            However, this is not always the case. Pork for example, is red when raw, but white when cooked. Meanwhile, tuna is red when raw, but white when cooked. This can be confusing, but by nutritionist standards, any meat from a mammal is consider red meat.

            Nevertheless, regardless of what color the meat is when raw or cooked, the best way to distinguish meat with LDL or HDL cholesterol is to simply look at how much saturated fat is on the meat before its cooked. You know the juicy and flavorful white bits on the meat, yeah that stuff. The leaner the meat is, the less fat on the meat, the lower the level of LDL cholesterol in it.

Food to avoid that contains LDL cholesterol:

·         Eggs

·         Dairy

·         Meat

·         Animal products

·         Trans fats (typically in processed food)

·         Hydrogenated Oil

            Conversely, meats that are high in HDL cholesterol, such as fish, are filled with the good fats. The omega-3 fatty acids in salmon has now been referred to as the good cholesterol. 

Food that helps lower LDL cholesterol, while promoting HDL cholesterol:

·         Oatmeal

o   Soluble fiber that helps reduce cholesterol, also found in fruits and vegetables

·         Fish

o   Omega-3 fatty acids that help reduce blood pressure

·         Walnuts, almonds, and other nuts

o   Reduce blood cholesterol, while maintaining healthy blood vessels with polyunsaturated fatty acids

·         Olive oil

o   Antioxidants that lower LDL cholesterol

·         Food with added sterols or stanols

o   Orange juice or yogurt that has added sterol or stanols

Here is a clip that contains good tasting food that help lower cholesterol:

            Generally, it would be ideal to avoid all animal products and meat altogether, but that is not only unreasonable to certain individuals, but also potentially bad for individuals which rely on meat as a staple for nutrition. The best way to counteract atherosclerosis is to simply reduce fat consumption, but not necessarily avoid it altogether while maintaining a balanced diet through fruits and vegetables. 

References:

1.       Krauss R. M., Eckel R. H., Howard B., Appel L. J., Daniels S. R., Deckelbaum R. J., Erdman J. W., Jr, Kris-Etherton P., Goldberg I. J., et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Stroke. 2000;31:2751-2766.

2.       Hu F. B. Plant-based foods and prevention of cardiovascular disease: an overview. Am. J. Clin. Nutr. 2003;78:544S-551S.

3.       Hoffmann I., Groeneveld M. J., Boeing H., Koebnick C., Golf S., Katz N., Leitzmann C. Giessen Wholesome Nutrition Study: relation between a health-conscious diet and blood lipids. Eur. J. Clin. Nutr. 2001;55:887-895.

4.       Key T. J., Fraser G. E., Thorogood M., Appleby P. N., Beral V., Reeves G., Burr M. L., Chang-Claude J., Frentzel-Beyme R, et al. Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutr. 1998;1:33-41.

5.       http://www.mayoclinic.com/health/cholesterol/CL00002