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From the Townsend Letter
May 2010

briefed by Jule Klotter

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Bert Hellinger's Family Constellation Work
Family Constellation work, developed by German psychologist Bert Hellinger, accesses a family's shared energy field, the depository of family trauma that passes from one generation to the next. When a family member takes on an improper role (such as a child acting as parent or the youngest child acting as the oldest) or is ignored, rejected, or exiled, the flow of love becomes blocked and the entire family system suffers. Likewise, hidden traumas, such as premature death, miscarriage, infidelity, or murder, disrupt the family system. Until these traumas are acknowledged, individuals may unconsciously carry the resulting wounds, and even recreate the experiences in order to heal them. "By making the unconscious conscious, by rendering the invisible visible," writes Louise Danielle Palmer, "by honoring the role and fate of every family member, we are reconnected with our own path and can reclaim our own destiny." Liberation from familial blockages can produce outer changes in the client's life and sometimes in the lives of other family members as well. Palmer's article reports shifts in life direction, addictions that end, even the healing of physical disorders after experiencing Family Constellation work.

Can one person separated by time and distance affect another? Can entanglement, defined by quantum physicist Erwin Schrödinger as connection between separated particles that persists regardless of distance, affect biological organisms? Dean Radin, senior scientist at the Institute of Noetic Sciences (Petaluma, California), says that it can. Several studies have documented correlations in brain activity (using EEG and fMRI) between partners or identical twins who were isolated in separate, soundproof, electromagnetically shielded chambers. For example, only one in a pair was exposed to a flashing light, but the other person also showed brain activity in the visual cortex. Such correlations do not occur with every set of twins or partners, but the effect has been repeatedly observed by independent researchers using "increasingly sophisticated experimental designs," says Radin.

How do family system constellations unveil ancestral entanglements? Constellation work occurs in a workshop setting. Participants, who have no previous connections with one another, are guided through the process by a trained facilitator. The client who seeks resolution of a long-standing problem supplies background information about past trauma and family. The client then chooses other participants to represent him/herself and the family members that the facilitator recommends including in the constellation. These representatives have no special knowledge or training. They simply respond to impulses activated by the intention to let the "entanglement," held in the client's energy field, be seen. A story begins to unfold through the representatives' body language and speech. Unexpected issues or events can arise. Sometimes, new characters need to be added to the constellation.

Bert Hellinger once said, "'I am not convinced the constellations always reveal an objective historical truth about the family, but they are reliable in pointing toward constructive resolutions.'" Typically, the constellation will reveal information that resonates with the client, information that encourages understanding, forgiveness, and love. The blockage releases. Jamy Faust writes: " … [Hellinger] shows that 'love is at work behind all human behavior,' that there is a great need for ‘balance in giving and taking and in gain and loss in the system,' and that ‘every member, living or dead, has an equal right to belong.' Hellinger's Constellation Method ultimately '…[tries] to find out what separates and what reunites.'"

Faust J. Historical foundations of Family System Constellations [web page]. Systemic Family Solutions. Accessed February 22, 2010.
Palmer LD. How to heal your family. Spirituality & Health. Nov/Dec 2006:50–55.
Radin D. The physics of our entanglements. Spirituality & Health. Nov/Dec 2006:56–59.

Flexibility and Arterial Stiffening
Exercise strengthens muscles, increases endurance, develops structural flexibility, and improves cardiorespiratory fitness – results that we can see. It turns out that some of these components of physical fitness are helpful in evaluating arterial health. For example, good cardiorespiratory fitness (i.e., not becoming short of breath during exercise) is associated with less arterial stiffening. Age-related arterial stiffening is an independent risk factor for cardiovascular illness and death. Recently, Kenta Yamamoto and colleagues documented a correlation between the inflexibility that keeps us from touching our toes and arterial stiffness.

This 2009 cross-sectional study involved 526 nonobese Japanese adults (body mass index <30) with no sign of chronic disease, according to medical history, physical examination, complete blood chemistry, and hematological evaluation of total cholesterol level and blood sugar. None of the participants were on medication, showed signs of peripheral arterial disease, or had smoked within the previous four years. Participants were divided into three age categories: young (20–39 years), middle-aged (40–59 years), older (60–83 years). Persons in each age group were subdivided into a poor- or a high-flexibility group, based on performance in a sit-and-reach test. Right and left brachial-ankle pulse wave velocity (baPWV) was used to assess stiffness in the central arteries. The researchers also measured the participants' leg extension power (to assess muscle strength) and peak oxygen uptake (to assess cardiorespiratory fitness).

The researchers found that better flexibility is associated with less arterial stiffening in middle-aged and older people. No correlations were observed in the young group of subjects. Upon further analysis, the researchers discovered that age, cardiorespiratory fitness, muscular strength, and flexibility correlate independently with baPWV, which reflects arterial stiffness. "The interaction among flexibility and other components of fitness or physical activity in determining the arterial stiffness awaits further studies."

The possibility that flexibility alone affects arterial stiffening is reflected in a study by M. Y. Cortez-Cooper et al. (Eur J Cardiovasc Prev Rehabil. 2008;15:149–155). The study was designed to test the effect of strength training on arterial flexibility in middle-aged and older adults. The study unexpectedly showed that stretching exercise, as well as strength training, "significantly increased carotid arterial compliance." K. Yamamoto and colleagues suggest that a program of stretching exercise, yoga, or Pilates may improve arterial flexibility as well. An intervention study is needed to show that an exercise program that improves structural flexibility will also lessen arterial stiffness.

Yamamoto K, Kawano H, Gando Y, Iemitsu M et al. Poor trunk flexibility is associated with arterial stiffening. Am J Physiol Heart Circ Physiol. October 2009;297;H1314–H1318. First published August 7, 2009. Available at Accessed February 17, 2010.

Gender Differences in Heart Disease
Heart disease is the leading cause of death in both men and women; but symptoms, diagnosis strategies, effective treatments, even risk factors can differ according to gender. High LDL levels (over 130 mg/dL), for example, correlate with a higher risk of heart attack in men. In contrast, low HDL levels (below 50 mg/dL) and high triglyceride levels (over 150 mg/dL) are more significant in women. Women are more likely to have conditions, such as lupus, that produce ongoing, low-grade inflammation. Chronic inflammation is believed to contribute to accumulation of atherosclerotic plaque. Having diabetes or any three of the five symptoms of metabolic syndrome (high triglycerides, low HDL, high blood pressure, abdominal obesity, and high blood sugar or insulin resistance) increases a woman's chance of a fatal heart attack more than a man's: "… diabetes more than doubles the risk of a cardiac death in women, while raising it 60% in men," according to Harvard Medical School's HEALTHbeat. Stress, a large waistline (35 inches or more in women and 40 inches or more in men), and cigarette smoking are equal-opportunity contributors to heart disease. (However, women who smoke and also use birth control pills are more likely to have a heart attack or stroke than women who simply smoke.)

Diagnosis of cardiovascular disease is more difficult in women than in men, partly because women tend to have less-obvious symptoms. Chest pain, along with nausea and sweating, is the classic sign of cardiovascular disease. While women with CVD do experience chest pain and angina, they also have "unconventional" symptoms like fatigue, malaise, shortness of breath, and depression more often than men. Nuclear stress tests that track blood flow to the heart (before and after treadmill exercise) are more reliable in women than an ECG stress test that records electrical conduction.

If a stress test is positive, the next step is an angiogram (an X-ray of the heart and blood vessels) to look for blockages. Conventional medicine treats blockages with angioplasty or bypass surgery. Women, however, are more likely to have microvascular disease, which is hard to detect with angiography. Coronary flow reserve studies and intravascular ultrasound of the coronary artery are used to assess blood flow in small vessels and to identify arteries that are uniformly narrowed by plaque. Unlike overt blockages, the conventional treatment for microvascular disease and uniformly narrowed coronary arteries consists of medication and lifestyle changes (e.g., diet, exercise, smoking cessation).

Harvard Medical School. His and hers heart disease. Part 1 [web page]. Harvard Health Publications. February 9, 2010. Available at Accessed February 12, 2010.

Harvard Medical School. His and hers heart disease. Part 2 [web page]. Harvard Health Publications. February 23, 2010. Available at Accessed February 23, 2010.

Hypertension and the Atlas Vertebra
Compression of arteries feeding the ventrolateral medulla (located in the brainstem near the atlas vertebra at the top of the spinal column) has been linked to hypertension. This relationship between circulatory abnormalities and hypertension in a subset of patients has been reported in studies for decades. In a 1994 Japanese study, for example, magnetic resonance imaging was used to evaluate the relationship between the upper ventrolateral medulla and vertebral arteries and arterial branches. Twenty-nine of the 32 people with essential hypertension (no known cause) showed arterial compression. One of the six people with secondary hypertension (due to renal, pulmonary, endocrine, or cardiovascular disease) also had arterial compression. Four of the 18 controls in this study showed compression. South Carolina researchers corroborated the findings of this study in 2005 when they observed a significant association between arterial compression of the ventrolateral medulla and essential hypertension.

Surgical intervention of compression has reduced blood pressure in hypertensive patients. A 1985 study, conducted by P. J. Jannetta et al., looked at blood pressure in patients who underwent surgery ("left retromastoid craniotomy and microvascular decompression") to treat cranial nerve dysfunctions. The surgeons found arterial compression of the left lateral medulla oblongata in 51 of 53 hypertensive patients but not in patients with normal blood pressure. After surgery, blood pressure was noticeably lower in 78% of the hypertensive patients.

A 2007 pilot study, conducted by George L. Bakris, MD, and colleagues, tested whether a nonsurgical procedure could also lower blood pressure in people with hypertension. The gentle National Upper Cervical Chiropractic (NUCCA) procedure is designed to correct malalignment of the atlas. The study hypothesis is based on the idea that compression of vertebral arteries occurs when the vertebra is malaligned. Correction of the atlas position would relieve compression and thereby reduce essential hypertension. The eight-week randomized study involved 50 people with stage I hypertension, none of whom were on antihypertensive medication. After randomly dividing the participants into two groups, the researchers assessed atlas alignment with X-rays and by checking the subjects' supine leg-length, posture, and paracervical skin temperature. According to chiropractic, a misaligned atlas results in leg-length disparities, apparent in comparisons of heel positions when the patient lies in a supine position. Disparities will change as the patient's head turns to the left or right if the atlas is misaligned. If no difference in leg-length exists or if no changes occur with head turning, the atlas is not out of alignment.

Half of the participants in this study received the NUCCA procedure consisting of light, precise nudges. The others underwent a sham procedure in which the clinician intentionally avoided the atlas's lateral-mass contact point. After the procedure, assessment of atlas alignment was repeated. About 85% of the treatment group maintained alignment after the first intervention for the entire eight weeks of the study. Blood pressure and pulse were taken during weekly visits. At the final visit, systolic blood pressure in the NUCCA group had decreased −17 ±9 mm Hg compared with a decrease of −3 ±11 mm Hg in the placebo group (P < 0.0001). Diastolic blood pressure decreased −10 ±11 mm Hg in the NUCCA compared with −2 ±7 mm Hg in the control (P = 0.002). "The improvement in BP following the correction of atlas misalignment is similar to that seen by giving two different antihypertensive agents simultaneously," the authors write in their article for the Journal of Human Hypertension (May 2007). Pulse rate did not change. The results need to be confirmed with a larger study that uses more than one practitioner, but this pilot study attests to the possibility that spinal manipulation can lower blood pressure in people with essential hypertension.

Akimura T, Furutani Y, Jimi Y et al. Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation. AJNR Am J Neuroradiol. February 1995;16(2):401–405. Available at: Accessed February 22, 2010.

Bakris G, Dickholtz M, Meyer PM, et al. Achievement of blood pressure goal with atlas realignment. J Clin Hypertens. March 2007(Suppl A);18(5).

Bakris G, Dickholtz M, Meyer PM, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens. May 2007;21(5):347–352. Available at: Accessed February 17, 2010.

Coffee RE, Nicholas JS, Egan BM, Rumboldt Z, et al. Arterial compression of the retro-olivary sulcus of the medulla in essential hypertension: a multivariate analysis [abstract]. J Hypertens. November 2005;23(11):2027–2031. Available at: Accessed March 4, 2010.

Stress Testing Before PCIs
Percutaneous coronary interventions (PCIs), such as angioplasty and stents, are designed to increase blood flow in plaque-occluded and weakened arteries. Recent studies indicate that PCIs are being performed in patients who are less likely to benefit from the procedures over the long run. When performed on people with nonemergency (stable) cardiovascular disease, such interventions relieve the pain of angina more quickly than medication and lifestyle interventions but do not result in fewer heart attacks or deaths. PCIs also have risks, such as thrombosis and decreased quality of life. The American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography do not recommend PCIs for people with stable angina unless noninvasive stress testing indicates moderate to severe blockage of arterial blood flow.

Unfortunately, most elective PCIs (not performed because of an emergency situation) are not preceded by stress testing, according to 2008study conducted by Grace A. Lin, MD, and colleagues. Stress testing involves evaluation of the heart's electrical system with ECG or blood flow with a SPECT or PET scan before and after exercise. When patients are preevaluated with stress tests, they avoid having an intervention that carries more risk than benefit. Also, they tend to have better outcomes. Cost is another reason to avoid unnecessary PCIs. These procedures cost Medicare $10,000 to $15,000 each, according to Lin and colleagues.

If a stress test indicates a blockage, the next step is angiography, a diagnostic X-ray of the heart vessels that uses a contrast medium. Preliminary evidence suggests that fractional flow reserve, a diagnostic test that can be performed in conjunction with angiography, may be a cost-effective strategy for identifying patients who are likely to benefit from PCIs. In a 2008 study, led by cardiologist Nico Pijls, people who underwent angiography and fractional flow reserve testing to evaluate blood flow in a blocked artery received stents one-third less often than those who were assessed with an angiogram only. In addition, outcomes in the year after PCI were better in the fractional flow reserve group: 13.2% of the group whose blood flow was assessed before angioplasty had a heart attack, or needed a bypass surgery or another stent procedure, compared with 18.4% of the angiogram group. At the two-year follow-up, only myocardial infarction was significantly reduced in the fractional flow reserve group. 
American Heart Association. Percutaneous coronary interventions (previously called angioplasty, percutaneous transluminal coronary [PTCA], balloon angioplasty) [web page]. Accessed February 18, 2010.

American Medical Association. Researchers say patients may benefit from having fewer stent implanted. AMA Morning Rounds. October 15, 2008.

Lin GA, Dudley RA, Lucas FL, Malenka DJ, et al. Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention. JAMA. October 15, 2008;300(15):1765–1773.Available at: Accessed February 18, 2010.

Peck P. TCT: fractional flow reserve guidance improves stenting outcomes [web page]. Medpage Today. September 24, 2009. Accessed March 10, 2010.

Vitamin D and Cardiometabolic Disorders
A March 2010 systematic review and meta-analysis of 28 studies finds an inverse relationship between natural vitamin D levels (measured as serum 25-hydroxy vitamin D [25OHD] and the risk of developing cardiometabolic disorders (cardiovascular disease, diabetes, metabolic syndrome). Metabolic syndrome consists of symptoms that are risk factors for both cardiovascular disease and diabetes: hypertension, abdominal obesity, abnormal lipid levels in the blood, and glucose dysregulation. In this British review, high levels of vitamin D are associated with a lower prevalence of cardiometabolic disorders in 85% of the study results (29 out of 33 outcomes). One study shows no effect, and the remaining three show a higher rate of cardiometabolic disorders in people with high vitamin D levels. One study in particular shows a statistically significant correlation between high vitamin D levels and diabetes among black participants.

The quality of a systematic review depends upon the search strategy and inclusion/exclusion criteria used to pick studies for review. The 28 studies in this review involve a total of 99,745 participants whose mean ages range between 40.5 and 74.5 years. Eighty-nine percent of the studies include men and women, and just over half of the studies have subjects from urban and rural areas. Part of the inclusion criteria for this review is that a study can be published in any language. As a result, this review consists of 14 studies from the US, eight from Europe, three from Australasia, two from Iran, and one from India. In addition to analyzing the correlation between serum vitamin D and cardiometabolic disorders as a group, the review authors also perform subgroup analyses for each outcome separately. Among the 16 reviewed studies that focus on cardiovascular disease, 13 "[show] that high levels of vitamin D are associated with a reduced prevalence of cardiovascular disease, pooled [Odds ratio] 0.67 (0.55-0.81)."

Vitamin D has at least three effects on the cardiovascular system. First, it promotes the production of a protein that inhibits cellular vascular calcification. Second, the presence of vitamin D encourages production of interleukin-10, an anti-inflammatory cytokine. Third, adequate levels of vitamin D curb activation of the rennin-angiotensin system, which raises blood pressure.

None of the studies in this review and meta-analysis look at the effect of vitamin D supplementation. The review authors state: "Further controlled trials are required to evaluate the causal association between vitamin D levels and cardiometabolic disorders as well as the benefit of vitamin D supplementation in the reduction of cardiometabolic disease."

Parker J et al. Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas. 2009. doi:10.1016/j.maturitas.2009.12.013.

Vitamin E in Atherosclerosis
For decades, a controversy has swirled around supplemental vitamin E and its effect on cardiovascular health. Does it have cardiovascular benefits? Is it useless? Is it toxic? Epidemiological studies show that people who eat more vitamin–E rich foods (wheat germ, brussels sprouts, leafy greens, eggs, vegetable oils) are less likely to develop coronary artery disease. Intervention studies during which participants take vitamin E supplements have had contradictory results. Some trials show benefits, some do not.

Alpha-tocopherol, the most studied form of natural vitamin E, has anticoagulant properties that reduce the risk of blood clots and thereby heart attacks. In a laboratory experiment, Jane E. Freedman and John F. Keaney Jr. "loaded" platelets with natural alpha-tocopherol (in the form of RRR-alpha-tocopherol or RRR-alpha-tocopherol acetate) or synthetic alpha-tocopherol (all rac-alpha-tocopherol). The platelets were then exposed to arachidonic acid, which causes platelet aggregation (the first stage of clot formation). "Aggregation was inhibited by 57 and 52 percent with RRR-a-tocopherol and RRR-a-tocopherol acetate, respectively, whereas [the synthetic version] produced no inhibition." The natural form RRR-alpha-tocopherol acetate has minimal antioxidant effects, so Freedman and Keaney conclude that inhibition of platelet aggregation is independent of antioxidant activity. Rather, their research indicates that the anticlotting effect may be due to alpha-tocopherol's inhibition of platelet protein kinase C-dependent protein phosphorylation. Inhibition of protein kinase C stimulation may also account for alpha-tocopherol's ability to improve endothelial function in the blood vessels, according to Freedman and Keaney.

Linda M. Grahma, MD, and colleagues report that alpha-tocopherol helps maintain endothelial cell migration (to an injury site as part of the healing process) in the presence of cell-oxidized low-density lipoprotein by inhibiting changes in cell membrane fluidity (Journal of Vascular Surgery. 2004;39:229–237). Like the anticlotting effect observed by Freedman and Keaney, this effect is also independent of the vitamin's antioxidant properties. Exactly how vitamin E (in the form of alpha-tocopherol) prevents clotting or promotes endothelial function is still being investigated.

Alpha-tocopherol's anticoagulant effect has also been observed in clinical settings. A recently published intervention study indicates that alpha-tocopherol can prevent venous thromboembolism in women with high risk of blood clots. The study involved 39,876 women, aged 45 years and over, in the Women's Health Study. The participants, who were randomized into two groups, took 600 IU of natural source alpha-tocopherol or a placebo on alternate days. "During a median follow-up period of 10.2 years, venous thromboembolism (VTE) occurred in 482 women: 213 in the vitamin E group and 269 in the placebo group, a significant 21 percent hazard reduction." In further analysis, researchers Robert J. Glynn and colleagues found that women who had experienced VTE before randomization had a 44% hazard reduction compared with a 18% hazard reduction found in women who did not have VTE previously. Moreover, women with genetic predisposition to VTE (factor V Leiden, or the prothrombin mutation) had a 49% hazard reduction. In comparison with 600 IU of alpha-tocopherol every other day, warfarin therapy is associated with a greater than 60% reduction in the risk of VTE. However, Glynn and colleagues point out that warfarin therapy requires laboratory monitoring because of its side effects (especially hemorrhage) and its interactions with numerous drugs and some foods. Although the researchers conclude that alpha-tocopherol's protective effect needs to be confirmed by other studies, Glynn and colleagues also state: " … a safer strategy [than warfarin] that (1) is useful for both primary and secondary prevention of VTE, (2) requires no laboratory monitoring, and (3) is associated with a substantial risk reduction would be of great value for high-risk patients."

Nearly all "vitamin E" studies use alpha-tocopherol, the common form of vitamin E found in body tissues. In reality, however, vitamin E found in food consists of four tocopherols: alpha, beta, gamma, and delta. Gamma-tocopherol, not alpha-tocopherol, is the primary form of vitamin E found in food, particularly plant seeds and nuts. "Gamma-tocopherol is well absorbed and accumulates to a significant degree in some human tissues," according to a 2001 American Journal of Clinical Nutrition review article. Unlike alpha-tocopherol, gamma-tocopherol has anti-inflammatory properties. Inflammation is believed to be a factor in cardiovascular disease. High doses of alpha-tocopherol actually deplete plasma and tissue concentrations of gamma-tocopherol. Alan R. Gaby, MD, says that it may be safer and more effective to use natural mixed tocopherols instead of relying solely on alpha-tocopherol supplements.

Challem J. Experiments find that vitamin E heals damage to artery walls. Nutrition Reporter. 2008. Sample issue 3.

Freedman JE, Keaney JF Jr. Vitamin E inhibition of platelet aggregation is independent of antioxidant activity. J Nutr. 2001;131:374S–377S. Available at: Accessed February 17, 2010.

Gaby AR. Study claims antioxidant danger – a repeat of flawed conclusions. Healthnotes Newswire. April 17, 2008. Available at: Accessed February 17, 2010.

Glynn RJ, Ridker PM, Goldhaber SZ, et al. Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism: report from the Women's Health study. Circulation. 2007;116:1497-1503. Available at: Accessed February 17, 2010.

Jiang Q, Christen S, Shigenaga MK, Ames BN. g-tocopherol, the major form of vitamin E in the US diet, deserves more attention [abstract]. Am J Clin Nutr. December 2001:74(6):714–722. Available at Accessed February 17, 2010.

Murray F. A natural deterrent to heart disease. HealthGems. 2008;10:4–6.

Walnuts, Fish Oil, and Coronary Heart Disease
Current dietary advice for preventing cardiovascular disease urges people to eat nuts. Walnuts, like other nuts, contain the amino acid L-arginine, a substrate for endothelium-derived NO (nitric oxide). In addition, the walnut has the highest content of vitamin E in the form gamma-tocopherol. Walnuts are also the richest nut source of plant omega-3 fatty acids. Does that mean that people can eat walnuts instead of fish to get omega-3 benefits?

It turns out that plant omega-3, found in walnuts, and marine omega-3, found in fish, produce different effects on blood lipids associated with cardiovascular disease, according to a small 2008 study conducted by researchers at Loma Linda University. In this randomized crossover feeding trial, 25 normal to mildly hyperlipidemic adults followed one of three isoenergetic diets (30% total fat and <10% saturated fat) for four weeks: a walnut diet (42.5 g walnuts/10.1 mJ), a fish diet (113 g salmon, twice/wk), or a control diet (no nuts or fish). Researchers analyzed fasting blood samples at baseline and at the end of each four-week diet period for serum lipids. The fish diet lowered serum triglyceride levels the most: 1.0 ± 0.11 mmol/L, compared with the walnut diet (1.11±0.11 mmol/L) and the control diet (1.12 ±0.11 mmol/L; P<0.05). Also, the fish diet increased beneficial HDL-cholesterol concentration: 1.23±0.05 mmol/L, compared with the control diet (1.19 ± 0.05 mmol/L) and the walnut diet (1.18±0.05 mmol/L P<0.001). In contrast, the walnut diet had a greater effect on total cholesterol than the fish or the control diets: 4.87 ± 0.18 mmol/L compared to control (5.14 ± 0.18 mmol/L) and fish (5.33 ± 0.18; P<0.0001). The walnut diet also lowered "bad" LDL cholesterol concentrations: 2.77 ± 0.15 mmol/L compared with the control (3.06 ± 0.15 mmol/L), and fish (3.2 ± 0.15 mmol/L; P<0.0001). "The ratios of total cholesterol:HDL cholesterol, LDL cholesterol:HDL cholesterol, and apolipoprotein B:apolipoprotein A-I were lower (P<0.05) in those who followed the walnut diet compared with those who followed the control and fish diets," say the authors. From this study, it looks as if both walnuts and fish have a place in the cardioprotective diet. This study does not, however, test for a combined effect of the two foods, nor does it look for difference in gender response to the foods.

Serum lipid values are not the only effect produced by walnut consumption. Researchers in Spain performed a randomized crossover study involving 21 hypercholesterolemic men and women that looked at the effect of walnuts on endothelial function. Coronary endothelial dysfunction is considered a predictor of heart attacks. In their article, the researchers state that "[v]ascular reactivity may be improved by dietary factors such as marine n-3 fatty acids, antioxidants, and L-arginine, but whole foods rich in these compounds have not been investigated." For four weeks, participants ate a cholesterol-lowering Mediterranean diet. For the next four weeks, they ate a diet of similar energy and fat content in which walnuts replaced about 32% of the energy from monounsaturated fat (8 to 13 walnuts per day). At the end of each four-week period, researchers took fasting blood samples and performed ultrasound measurements of brachial artery vasomotor function to assess endothelial function. (Only eighteen subjects completing the protocol had suitable ultrasound studies.) "Endothelium-independent vasodilation and levels of intercellular adhesion molecule-I, C-reactive protein, homocysteine, and oxidation biomarkers were similar after each diet." The walnut diet, however, produced "improved endothelium-dependent vasodilation and reduced levels of vascular cell adhesion molecule-1."   

Rajaram S, Haddad EH, Mejia A, and Sabaté. Walnuts and fatty fish influence different serum lipid fractions in normal to mildly hyperlipidemic individuals: a randomized controlled study [abstract].
Am J Clin Nutr. April 1, 2009;89:1657S–1663S. Available at: Accessed February 17, 2010.

Ros E, Núñez I, Pérez-Heras A, Serra M et al. A walnut diet improves endothelial function in hypercholesterolemic subjects: a randomized crossover trial.
Circulation. March 22, 2004;109:1609–1614. Available at: Accessed February 17, 2010.


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