The very interesting finding by Maltese medical researchers (presented at a recent cardiology meeting in France) that Malta’s smoking ban (unlike any other country with similar ban) doesn’t appear to have reduced local heart disease rates, is perhaps too easily blamed on such factors as poor smoking ban enforcement in Paceville (as reported locally). A century of research into the cause of heart attacks and strokes has in fact identified several risk factors, apart from smoking and inheritance. These include high blood pressure, diabetes, lack of regular exercise, chronic stress, anger and depression, abdominal obesity, blood cholesterol levels and chronic inflammation in arterial walls.

Perhaps Malta’s higher prevalence rate of diabetes (compared to larger countries) is at least partly responsible for our cardiologists’ disappointment with our negative smoking ban results. Partly due to in-breeding and partly due to our bad non-Mediterranean staple diet (consisting mainly of foods made from refined white flour, rice, potato and commercial pastries rich in trans fats), combined with lack of exercise, we suffer from high diabetes type 2 rates with, almost certainly, a high proportion of the population in a pre-diabetic state – which also carries an increased heart disease risk. It is perhaps not widely appreciated that refined carbohydrates (white bread, white pasta and white rice) lower the blood’s good cholesterol, raise its bad triglycerides and increase inflammation in arterial walls, making them more susceptible to narrowing and blockage (thrombosis), the latter end-results being the basis of heart disease. This sequence of events is further accelerated by trans fats found in repeatedly-used vegetable oils for deep-frying, in margarines and in commercially manufactured foods like pastries, cakes and biscuits.

More than 20 years ago, a book written by two Sheffield University doctors, The Eskimo Diet – how to avoid a heart attack, highlighted the work of Dr Hugh Sinclair of Oxford University who, in the 1950s, investigated why Eskimos did not suffer from heart attacks (if they did not emigrate to Canada), and concluded that this was due to their diet rich in fish oil, which appeared to act as a blood-thinner.  The book strongly recommended a generous daily dose of fish oil to prevent heart disease. The Japanese, with their traditional vegetarian and fish diet, used to have only one fifth of North America’s heart disease rate, but in recent decades Japan’s heart disease rates have been rising in tandem with increasing popularity of Western foods rich in animal fats and trans fats. It had also been noted that Japanese who migrated to the US acquired similar heart disease rates as other Americans, and this observation was ascribed to dietary changes.

Polyunsaturated fats (omega-6) in vegetable oils, such as sunflower oil, are now suspected to be not as healthy as was once thought, because they are linked to risk of chronic inflammation in blood vessel walls and elsewhere. The healthiest oils are unrefined cold-pressed rapeseed (canola) oil and extra-virgin olive oil because they contain mainly monounsaturated fats. A special blood test called “high-sensitive C-reactive protein (CRP)” measures the amount of inflammation in blood vessel walls and is increasingly claimed to probably be a better indicator of heart disease risk than blood cholesterol levels – this needs to be introduced for heart disease screening by medical laboratories in Malta.

Malta’s cardiologists are right to emphasise the dangers of smoking and pollution and to insist on proper enforcement of smoking bans, but in our closely-knit community with a generally unhealthy staple diet and lifestyle with high obesity rates, other factors may well be responsible for the disappointing results of their very useful audit study.

Prof. Albert Cilia-Vincenti

Chairman

Academy of Nutritional Medicine (UK)

ATTARD