In westernised South Africans, 40% of deaths in the economically active age group (25-64 years), is due to chronic diseases of lifestyle. Of all the lifestyle diseases such as cancer, hypertension (high blood pressure), diabetes, strokes and coronary heart disease (CHD), CHD causes the greatest number of deaths. In fact CHD is the number one killer in South Africa and many other countries of the world today. The development of CHD is a slow process and starts with fatty deposit build up on the inner walls of the arteries of the heart and brain. This may lead to narrowing of the arteries (arthrosclerosis) that supply the heart and the brain with oxygen. When the blood cannot get through anymore, the person suffers a heart attack or stroke. Often a part of the heart muscle dies or one section of the body is paralyzed (stroke), if the person is lucky enough to survive. The frightening thing is that, as excess cholesterol slowly constricts and clogs your arteries, you won’t necessarily suffer any discomfort or pain, except maybe for fatigue and shortness of breath. Some people experience chest pain (angina), but for many the first warning sign could be a heart attack or stroke.

Risk factors:

A number of risk factors contribute to an increased risk of CHD. These are high blood cholesterol, high blood pressure, being overweight, diabetes, smoking, stress, a lack of exercise and a family history of CHD. High cholesterol is a major cause of heart disease, which claims the lives of more South Africans than both cancer and car fatalities combined. An increasing number of people have also been found to suffer from high blood triglycerides, which is another type of fat in the blood that predisposes a person to diabetes. To decrease these higher triglyceride levels, a low fat, low GI diet is recommended. This differs from the treatment for high cholesterol levels, where a low fat high soluble fibre diet is recommended. High blood cholesterol, high triglycerides, high blood pressure, diabetes, being overweight, gout and cancer are all influenced by the amount of fat, especially saturated fat and "burnt" fat in our diet. Saturated fat causes the body to produce more LDL-cholesterol, which is the dangerous cholesterol, as it builds up in the arteries, causing the gradual narrowing of the blood vessels. Oxidised LDL-cholesterol is laid down in the arteries most easily and that is why it is important to prevent oxidation of LDL-cholesterol. The narrower the blood vessels are, the higher the blood pressure rises, eventually causing thickening of the walls of the heart muscle, which is sometimes irreversible. Saturated fat also causes the body to retain dietary cholesterol, which makes saturated fat the number one culprit in raising blood cholesterol, instead of dietary cholesterol, as was previously thought. It can also lower the good HDL-cholesterol, which is another reason it should rather be avoided as far as possible. Fat, especially saturated fat, is also believed to be the main dietary promoter of cancer, as well as the main cause of extra body fat or overweight. Most of the foods South Africans love to eat are high in saturated fats. To name but a few - fatty meat, dried sausage, fatty biltong, toasted sandwiches, pies and other confectionery such as cakes, tarts, biscuits, rusks, and croissants, fullcream ice cream, chocolate, rich sauces and desserts. Too much sodium, together with a high fat diet, can aggravate high blood pressure.

Treatment:

It is however possible to eat most of these foods, provided they are lower in fat, lower in their GI value and sodium. This book is full of delicious, normal recipes that are low in total fat, saturated fat, GI and sodium and will not cause fatty deposits to build up on the inner walls of the arteries. It was decided to rather recommend the use of Canola or Olive oil (which are high in mono-unsaturated fats) in the recipes, since it was found that large amounts of polyunsaturated fatty acids (PUFA’s), especially from plant origin eg. polyunsaturated margarine, sunflower oil, sunflower seeds, walnuts can have adverse health effects. This is due to the fact that the consumption of large amounts of these polyunsaturated fats can give rise to nasty reactive chemicals called free radicals, which are implicated in heart disease, cancer and ageing and can also decrease the more favourable HDL-cholesterol. Polyunsaturated fats which appear in fat fishes eg. pilchards, trout, tuna (in water/brine), sardines and salmon (without the oil), mackerel (in water), etc. seem to be much healthier, since they lower fibrinogen levels in the blood, which slows down the clogging of arteries. We would like to recommend that fatty fish be eaten 1-2 times per week. Mono-unsaturated fats, which are found in Olive oil, Canola oil, olives, avocado, peanut butter and raw unsalted nuts (except brazil nuts) decrease bad cholesterol and raise good HDL-cholesterol. HDL-cholesterol or "holy" cholesterol is the one that is responsible for the removal of the "bad" fats from the arteries, by transporting them to the liver to be excreted. HDL-cholesterol is increased by exercise and a low GI diet which also contains a small amount of the better fats mentioned above. This section will be incomplete if we fail to mention that, apart from the fact that an overall low fat diet should be followed to prevent and treat lifestyle diseases, and the majority of these fats should be mono-unsaturated and polyunsaturated coming from fat fishes, the diet should be high in soluble fibres. These were found to bind cholesterol in the alimentary canal, thereby reducing serum cholesterol, especially the bad LDL-cholesterol. You should also aim to be more active, stop smoking, decrease the intake of salt and lose weight/prevent becoming overweight.