Ka Wai Ola - Office of Hawaiian Affairs, Volume 3, Number 3, 1 March 1986 — He Mau Ninau Ola [ARTICLE]

He Mau Ninau Ola

■ : :■' . Some Healih Questior\s by Kekuni B(aisdell, M.D. <• * !. iii r - < . .... , ' - = - -

Ninau: E kauka, 1 am huikau (confused). Some doctors say eating fat causes heart trouble and cancer. Yet, I just heard another kauka say only some fats are bad, and others are even good! Whieh is right? Pane: Both statements are in some respects pololei (correct). They are not necessarily mutually exclusive or conflicting, although they may seem so. Please let me wehewehe (explain) eaeh separately. First about fat and ma'i pu'uwai (heart disease). Kukapaila (plenty) evidence supports the view shown in the following: Food fat, Blood fat, Arterial wall fat, Artery Closure, Infarction.

This means that increased mea'ai (food) fats or lipids lead to high koko (blood) lipids, that in turn ean lead to arterial occlusion, with death of tissue (infarction) from inadequate blood flow. Infarction in the heart is commonly called "heart attack," in the brain it is called "stroke" and in the foot it is called "gangrene," as wehewehe 'ia in this eolumn last year. Excess eating of certian mea'ai lipids, such as cholesterol, like butter and saturated fat, like bacon, raise koko cholesterol and definitely increase the risk of heart infarction, the most serious, eommon ma'i pu'uwai in us lahui Hawai'i today . Increase in total fat intake and too many calories with momona (obesity), ean increase koko triglyceride (another lipid), and also enhanee the likelihood of heart attack. This is why the high rate of coronary (heart) atherosclerosis (artery thickening) with infarction in us po'e Hawai'i today is believed to be mainly due to our generous ingestion of fatty foods, like spam and sausage, and iee cream, unlike our kupuna maka'ainana of pre-haole times, as wehewehe 'ia in last month's eolumn. In recent years, two kinds of lipids have been shown to be "good fats":

1. In 1975, increased levels of HDL (high-density lipoprotein) cholesterol in the koko were found by Dr. G. Miller in the United Kingdom to protect against heart attack. Low koko FIDL levels meant high probability of heart infarction. HDL seems to act by removing cholesteroI from the koko and blocking the entry of koko cholesterol into the arterial wall. Diet has little effect on koko HDL, but vigorous physical exertion increases HDL blood levelsand puhi paka (cigarettesmoking) decreases koko HDL concentrations. 2. In 1980, a high omega-3 fish-oil-diet was demonstrated by Dr. William Connor in Oregon to lower koko cholesterol and triglyceride without affecting koko HDL. [Omega-3 refers to a site of "unsaturation" in the carbon of the fatty acid].

■ t • -- - amnp «sbgt ss Thus, Connor provided an answer to the mystery as to why the Eskimos, who eat so mueh fish fat, have such a low rate of cardiac infarction: omega-3 fatty acids in their diet probably protect them from coronary atherosclerosis. More recently, Connor has reported that i'a i ke kai Hawai'i (fish in Hawaiian waters), such as ahi (tuna), mahimahi (dolphin), ono (mackeral), and 'opakapaka (snapper) also contain high amounts of omega-3 fatty acids. This new evidence supports the position stated in last month's eolumn, namely, that the high-fish diet of our kupuna maka'ainana of ancient times was sup>erior to ours of today, and perhaps like the Eskimos, they too may have had mueh less ma'i pu'uwai. Now about fat and cancer.

Current evidence is inconclusive and thus, is only suggestive of the following relationships: Fat diet. Cancer of eolon and breast. Diets high in total fat, saturated fat and cholesterol are strongly correlated with high occurence of eolon cancer in some populations elswhere, but it has not yet been clearly demonstrated in individual persons. Further, while we native Hawaiians consume large amounts of fatty foods and we have the highest index of obesity, we lahui Hawai'i puzzle the experts with our relatively low rate of bowel cancer, eompared to po'e haole, kepani and pake. Also, while high-fat diet and obesity seem correlated with high incidence of breast cancer elsewhere, the figures are not consistent, the specific types of lipid responsible are not evident, and high-fat diet alone does not readily explain why wahine Hawai'i have the highest rates of breast cancer in Hawai'i nei.

In summary, most food fats do increase the risk of heart attack. However, there are at least two "good fats": one blood fat, HDL cholesterol, protects against cardiac infarction; and one food fat, omega-3 fish fatty acid, lowers koko fats and thus, may protect against heart attack. Food fats may increase the risk of eolon and breast cancer, but we cannot as yet be certain of this. Meanwhile, it seems prudent to restrict all food fats, except omega-3 fish oils, whieh we should relish in the tradition of our ancestors, to keep our koko fat levels down and thus, hopefully, prevent heart infarction. Vigorous physical fitness and refraining from puhi-paka should maintain our koko HDL cholesterol levels high. Limitation of fatty foods may , or may not, reduce eolon and breast cancer, so we need to be seeking other preventive measures. Keia mahina a'e (next month), we will explore other ninau e piliana i ka mea 'ai.