
'Healthiest hearts in the world' found - known
https://www.bbc.co.uk/news/health-39292389
======
Scaevolus
> At the age of 45, almost no Tsimane had CAC in their arteries while 25% of
> Americans do.

> By the time they reach age 75, two-thirds of Tsimane are CAC-free compared
> with the overwhelming majority of Americans (80%) having signs of CAC.

The article doesn't mention obesity _at all_. 40% of Americans over 40 are
obese[1]. Tsimane obesity rates of adults (>20 years) are 5.6% for women and
1.6% for men[2].

Journalists love writing about dietary composition as if increasing your fish
(or whatever) consumption is a magic bullet, but merely changing composition
without losing weight is only a moderate improvement (maybe 30% fewer heart
attacks, based on that retracted NEJM dietary study[3]).

[1]:
[https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)
[2]:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392307/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392307/)
[3]:
[https://www.nejm.org/doi/full/10.1056/NEJMoa1200303](https://www.nejm.org/doi/full/10.1056/NEJMoa1200303)

~~~
4ntonius8lock
It's almost as if human experiences don't fit into the carefully curated
categories we have in modern society where individual aspects are considered
in isolation and not handled in a holistic way.

It's as if: the need for meaning, relationships, sleep, body, teeth, eating,
professional development, daily routine, sitting, walking, how we walk, our
individual body constructs, personality archetypes, mental health, etc... were
more than the sum of their parts and being overly dissecting such things leads
to a lessening, not increase in understanding of the whole.

A great book on psychology like thinking fast and slow will do a great job at
dissecting reality from that narrow point of view, just as other books will do
the same in other fields. But I don't really know of any field that is
respected that combines many elements to study how to maximize human
potential/study the human experience as a whole.

I offer no solutions, just an observation in terms of how we deal with the
human experience in modernity.

~~~
Swizec
This is because I can change a thing but I can't change my whole life. Well, I
can, but that's hard and single things are easy.

~~~
4ntonius8lock
You are right, it is necessary to dissect. But I feel it's taken on a life of
it's own.

Just as work to live in some places has been distorted to live to work.

We should create categories to understand, not understand to create
categories.

I've seen it everywhere. My doctor trying to shove pills down my throat when I
had developed some bad habits and he didn't ask me ONE question about diet or
night routine. I've seen it in universities where professors attack each
others field instead of finding the common thread. In the boss that says
"that's not your job, thats marketing/QA/dev/business dev/growth team/etc".
It's a lack of understand that a team should provide value to the overall and
the categories should only be there to aid in overall progress.

------
AimForTheBushes
"The Tsimane get 72% of their energy from carbohydrates.

The fact that they have the best indicators of cardiovascular health ever
reported is the exact opposite to many recent suggestions that carbohydrates
are unhealthy."

Refined carbs ARE unhealthy and it's a bit disheartening that they didn't make
that distinction in the article.

~~~
will_brown
To add to your point Okinawans once had the greatest life expectancy on Earth
and the majority of their diet was carbs too.

Since the introduction of “western diet” post WW2 the majority of their diet
is still carbs and yet they now show significant increase of Chronic disease
(obesity, heart disease, type 2 diabetes, fatty liver disease and kidney
disease) and lowered life expectancy.

~~~
mikekchar
It turns out, though, that Okinawan long life expectancy was actually due to
rampant pension fraud rather than long life. I can't remember the exact date,
but it would have been around 2008, a reporter went to visit the oldest people
in Japan (most of whom were living in Okinawa). They started at the oldest and
found that the person wasn't home ("visiting relatives"). So they went to the
next oldest. Similar story. They went through the top 20 and couldn't find any
of them.

The government clued in and investigated and it turns out that Okinawan
doctors were making a tidy profit by agreeing not to file death certificates.
This enabled families to continue to claim pension benefits on behalf of their
supposedly aged relatives.

After the the smoke died down the went back and looked at Okinawan life
expectancy taking pension fraud into consideration and discovered that it was
pretty much exactly the same as the rest of Japan. The original life
expectancy/diet studies had relied on government information rather than
actually interviewing people. I'm sorry I don't have a citation for you as I
saw this in a documentary in Japan on TV.

~~~
will_brown
That’s a great story and I’ll look into it.

However, I do believe they legitimately have the most centurions and I have
read about autopsies on centurions which found they showed no signs of chronic
disease. Of course that is surviorship bias, but assuming the total number of
centurions is true, especially given the small population, I think there is
more there there.

------
tpush
"It means:

72% of calories come from carbohydrates compared with 52% in the US

14% from fat compared with 34% in the US, Tsimane also consume much less
saturated fat

Both Americans and Tsimane have 14% of calories from protein, but Tsimane have
more lean meat"

That really does seem counter to the low-carb diets that seem to be all the
rage among internet communities (also HN).

But, maybe it's just the constant exercise the Tsimane people are getting:
"They are also far more physically active with the men averaging 17,000 steps
a day and the women 16,000."

~~~
will_brown
>That really does seem counter to the low-carb diets that seem to be all the
rage among internet communities (also HN).

Generally people discussing “low carb diets” really mean managing blood
glucose/insulin spikes. So high glycemic carbs, refined sugars, refined carbs.

Not all carbs are created equal when we talk about impacts on blood glucose
and/or the liver.

~~~
52-6F-62
This is true.

It's likely that beside the rice and maize, most of their carbs come from
vegetables. It's one of the reasons why high-performance diets are usually
heavy on the broccoli!

~~~
munk-a
Another absolutely killer carb in western diets comes out of refined flour
which makes it into a ton of stuff. My wife is gluten-free currently for
health reasons and we've experimented with using more raw starch sources to
great success. Most of these flour based foods don't need to be super-refined
bleached flour.

~~~
mcbits
Most "whole wheat" flour is literally the same refined flour from the same
vat, but with some bran (fiber) and germ (nutrients) mixed back in. This could
happen at the refinery shortly after refining, or weeks to months later using
bran and germ sourced from a warehouse somewhere. Very unpredictable and not
indicated anywhere on the label.

What seems consistent is that both diets high in whole grains and high-fiber
diets in general have some heart health benefits. My guess is that
refined+enriched flour in a high-fiber meal is not much, if any, worse than
whole flour in a medium- or low-fiber meal. Those pastries and chips between
meals, on the other hand...

------
jonplackett
Doesn't even mention sugar. Seems like that would be a very large and
important difference.

Just says "72% of calories come from carbohydrates compared with 52% in the
US", which might encourage a westerner to eat more carbs, but if they're
eating whole rice and we're eating sugar that seems kinda important.

Comparison of gut bacteria would be interesting too, bet that's as important
as the diet itself.

~~~
chrischen
They're also exercising more than 100% of what Americans do.

------
ubertakter
So, what's their average total caloric intake? Hmm... 2400-2700/day[1] which
is not in the Lancet article[2], but I did find that in an American Journal of
Clinical Nutrition reference[3]. It appears they get lots of exercise, which
isn't surprising.

[1][https://coach.nine.com.au/2018/11/05/14/03/tsimane-diet-
card...](https://coach.nine.com.au/2018/11/05/14/03/tsimane-diet-
cardiovascular-health)

[2][https://www.researchgate.net/publication/315262221_Coronary_...](https://www.researchgate.net/publication/315262221_Coronary_atherosclerosis_in_indigenous_South_American_Tsimane_A_cross-
sectional_cohort_study)

[3][https://www.ncbi.nlm.nih.gov/pubmed/30383188](https://www.ncbi.nlm.nih.gov/pubmed/30383188)

~~~
rcombine
That is even more illuminating. They eat primarily unrefined carbs like rice,
corn, and plantains, 2400~2700 calories worth of it a day (more than I eat!),
and yet they are very healthy and fit. Considering the numbers, it really
looks like the difference is the amount of physical activity.

I think that sedentary humans are just not supposed to eat as much as we think
or want to do.

------
emptybits
Another fact about Bolivians ... they are, on average, the shortest people in
the world.

[https://www.worldatlas.com/articles/countries-with-the-
short...](https://www.worldatlas.com/articles/countries-with-the-shortest-
average-heights.html)

~~~
JoeAltmaier
Oh! Short stature, mountainous country near the equator - means the least
gravity affecting their circulation! Natural heart-healthy situation!

~~~
copperx
You might be joking, but higher altitude also means less oxygen, which
translates to reduced oxidation and less risk of cancer.

I'm on my cellphone so I don't have the paper on hand, but there was a big
study where they compared lung cancer rates in different geographic areas and
found that the highest cancer incidence was at sea level, whereas the lowest
was at higher elevations. They tried controlling for other obvious variables
but elevation was unquestionably the best explanation.

Oxidation may explain plaque in arteries.

------
apo
> One idea is that intestinal worms - which dampen immune reactions - could be
> more common and this may help protect the heart.

That worm infects most of the population:

> And about 70% of the population has a parasitic worm infection [Ascaris
> lumbricoides, a type of roundworm]. ... Up to a third of the world's
> population also lives with such infections.

[https://www.bbc.com/news/health-34857022](https://www.bbc.com/news/health-34857022)

Before latching onto exercise or diet as the primary factors, it's worth
considering the effect of this worm infection. It could influence the heart
indirectly through nutrient flow, immune suppression as suggested for the
original article or the one on pregnancy, or directly via for example
larvae/segments, etc.

BTW, the lifecycle of this thing is the stuff of nightmares:

> Ascaris lumbricoides, a roundworm, infects humans via the fecal-oral route.
> Eggs released by adult females are shed in feces. Unfertilized eggs are
> often observed in fecal samples but never become infective. Fertilized eggs
> embryonate and become infective after 18 days to several weeks in soil,
> depending on the environmental conditions (optimum: moist, warm, shaded
> soil).[5]. When an embryonated egg is ingested, a Rhabditiform larva hatches
> then penetrates the wall of the duodenum and enters the blood stream. From
> there, it is carried to the liver and heart, and enters pulmonary
> circulation to break free in the alveoli, where it grows and molts. In three
> weeks, the larva passes from the respiratory system to be coughed up,
> swallowed, and thus returned to the small intestine, where it matures to an
> adult male or female worm. Fertilization can now occur and the female
> produces as many as 200,000 eggs per day for 12–18 months. These fertilized
> eggs become infectious after two weeks in soil; they can persist in soil for
> 10 years or more.[6]

[https://en.wikipedia.org/wiki/Ascaris_lumbricoides](https://en.wikipedia.org/wiki/Ascaris_lumbricoides)

Clearly, the juvenile state spends some time in the circulatory system, where
it should have some opportunities to influence coronary artery calcium.

I looked for studies that examined the incidence of heart disease/CAC buildup
among other infected populations but didn't immediately find anything.

------
lordnacho
One thing I didn't get a clear answer from the doctor about last time I saw
one was this.

Can you unclog your arteries by changing your lifestyle, ie diet and exercise,
or is the clogging permanent?

~~~
cogman10
[https://www.webmd.com/cholesterol-management/cholesterol-
and...](https://www.webmd.com/cholesterol-management/cholesterol-and-artery-
plaque-buildup)

> Once a cholesterol plaque is there, it's generally there to stay. With
> effective treatment, though, plaque buildup may slow down or stop.

> Some evidence shows that, with aggressive treatment, cholesterol plaques can
> even shrink slightly. In one major study, cholesterol plaques shrank 10% in
> size after a 50% reduction in blood cholesterol levels.

> The best way to treat cholesterol plaques is to prevent them from forming or
> progressing. That can be done with lifestyle changes and, if needed,
> medication.

~~~
hackits
[https://youtu.be/c5ELzL7DGpw?t=2426](https://youtu.be/c5ELzL7DGpw?t=2426)

Vitamin K - Mk7, Vitamin V, and Magnesium seem to help with the removal of
calcifications of the artillery. Though I couldn't really find referees other
than reports on `Vitamin K intake and calcifications in breast arteries
Angela`

------
scythe
But is their health abnormal after accounting for the usual RRs associated
with their BMI, exercise, fiber and trans fat intake? They don't drink or
smoke, I presume?

The difficulty with "non-mathematical" sciences is that they tend to treat
math as a tool for validation rather than expression. This is partially a
failure of communication on the part of mathematicians.

------
jvanderbot
You know what else? They dont have air pollution like pm2.5, which is known to
cause heart and lung disease.

[https://laqm.defra.gov.uk/public-
health/pm25.html](https://laqm.defra.gov.uk/public-health/pm25.html)

------
devm0de
What about what protective or healthy heart genetic markers their population
might have?

------
caublestone
Does anyone know if the Tsimane drink alcohol?

------
discreteevent
It would be interesting to know if they observed how much sleep they take.

------
negamax
Small anecdote: I did travels through Europe a while back and did lots of
walking. That's fairly normal in many European towns and cities. Really felt
great and decided to do 20k steps a day after return. Which tapered off slowly
and unconsciously. Need to get back to that level. Your body respond quickly
in positive direction, I can recall that much.

------
netwanderer3
This is a perfect example of how everything in life is always a trade off. Do
you want a healthier heart to live a few extra years or do you want to sit on
your couch and browse HN while enjoying your BigMac? Pick one because only a
fool would believe they could have both.

------
PerfectElement
> 72% of calories come from carbohydrates

Not much different from the Blue Zones:
[https://en.wikipedia.org/wiki/Blue_Zone](https://en.wikipedia.org/wiki/Blue_Zone)

------
throwaway55554
Tsimane diet fad coming soon.

~~~
rcombine
Tsimane _exercise_ regimen, really.

~~~
52-6F-62
Don't forget the intestinal worms

------
deevolution
"One idea is that intestinal worms - which dampen immune reactions - could be
more common and this may help protect the heart"

Let me get some of those worms!

------
sharph
How much vegetable oil did they consume?

~~~
BoneVays
Judging from other "natives" I met, probably as much as they can(with Walmart
being 1000 miles away, that would be little). I don't know if you were
thinking in terms of "incriminating" veg oil in favor of butter etc, which is
the trend in Atkins etc, but the takeaway message of such studies is exercise
and the stress-free life, you become what you do and what you think! Eating is
a part of thinking and doing, but only up to a point.

~~~
sharph
I was indeed thinking in terms of "incriminating" veg oil, but more in favor
of omega 3 fatty acids (as is also the trend in Atkins etc,) not necessarily
saturated fats in butter. (edit: Also silently implying here that n-3 to n-6
ratio matters. Omega-6 fats are essential, but in nature n-3:n-6 is found in
more desirable ratios.)

I get what you're saying re: exercise and stress, but I have to believe that
for some percent of the population, diet rules over the ability to have
enthusiasm for exercise and the ability to deal with stress. Everybody's got
stress. Some people feel it more than others.

~~~
BoneVays
Just to clarify, I am talking about natural exercise and natural non-stress :)
In their small communities you get stress and excrete it, while in the average
larger community you accumulate it. It is the background "stress radiation",
low intensity nagging stress, that does all kinds of nasty things to us - more
accurately, we do it to ourselves and each other. Similarly, I would not
equate time in the gym or jogging in Manhattan to their exercise.

I don't know if by some fluke they have the perfect 3-6 ratio in their diets,
but if you get your fresh food and exercise (and those beneficial worms ;) ),
it does not matter.

------
rich-tea
This one was quick. It took decades before anyone questioned the war on fat.
Looks like the war on carbs is already at that stage.

Give it a few years and we'll start to see the bad affects of too much
protein. Mark my words.

People who live a long time don't care about diets. Show me one who did.

~~~
DoingIsLearning
> People who live a long time don't care about diets. Show me one who did.

Jack LaLanne?

He was one of the first modern evangelists of fitness and diet and lived to be
96, according to wikipedia.

Purely anecdotal but you did ask for a single example.

