Is it possible to eat cod liver if you have high cholesterol?

Cod is a marine fish of the cod family. It has a greenish-brown color with brown spots and a white belly.

The size of cod depends on its age: the length reaches 1.8 - 2 meters, while the weight of the fish caught ranges from 4 - 12 kilograms. This fish has a barbel on the chin, three dorsal and two ventral fins without spiny rays, movable premaxillary and maxillary bones. Its scales are cycloid and its gills are comb-like.

In terms of the structure of the fins, representatives of the cod-like family are similar to the Cyprinidae, and in the position of the ventral fins, they are similar to the Perciformes.

Historical information

Content:

• Historical information
• Characteristic
• Beneficial features
• Cod liver
• Chemical composition
• Cod roe
• Using fish in cooking
• Cod for pancreatitis
• How to cook cod?
• Note to housewives
• Conclusion

Cod has played an important role in the history of Europe and America for more than a thousand years. The Vikings who lived on the Lofoten Islands ate dried fish. Immediately after the catch, it was hung in an open, well-ventilated area; after three months, the carcasses were beaten until the meat became soft and edible. Such nutritious food was stored for a long time, which was ideal for a wandering tribe.

Fish then gained popularity in Europe for religious reasons: unlike meat, it could be eaten during Lent.

Between 1958 and 1976, a diplomatic conflict arose over cod. The controversy stemmed from the first state's imposition of a 200-mile economic zone around the island, which prohibited fishing in Icelandic waters where British fishermen were casting their nets.

Interestingly, the maximum weight of the largest cod caught in history was 96 kilograms.

Bad and good cholesterol

These names are rather arbitrary, since low-density lipoproteins containing bad cholesterol have their own functions and beneficial properties. True, LDL benefits only when they are within normal limits (for example, they support the functioning of the immune system), but if there is too much “bad” cholesterol, then it poses a danger to the cardiovascular system. High-density lipoproteins, which contain “good” cholesterol, on the contrary, prevent heart and vascular diseases.

Threat to blood vessels. The dangers of high cholesterol Read more

Characteristic

The fish's habitat covers the Atlantic Ocean (Baltic, White Sea, Arctic cod). In the east of the Atlantic it is distributed from Spitsbergen and the Barents Sea to the Bay of Biscay, in the west - from Greenland to Cape Hatteras. In particular, it lives in the Norwegian Sea, the Pacific Ocean, and off the coast of Iceland. Interestingly, only two types of fish are most often found under the trade name cod - Pacific and Atlantic. Baltic, White Sea, and Greenlandic ones are in less demand.

Cod can withstand low temperatures (from minus 1 degree Celsius and below). Her life expectancy reaches 25 years.

The young individual feeds on mollusks, small crustaceans. At the same time, by the age of three she becomes a real predator and begins to eat other fish: capelin, pollock, herring, and her own young. To catch cod, they use fixed and purse seines, snurrevods, bottom and pelagic trawls, and longlines.

This is a prolific fish that begins to lay offspring in March-April, making long 1,500-kilometer migrations to spawning grounds. Cod spawn in the water column; their numbers can reach up to 2 million in a few weeks.

In 1992, the Canadian government imposed a moratorium on fishing due to a sharp decline in the number of individuals and the threat of complete extinction of the species. This is the most important commercial fish, which is a raw material for the production of canned food and a source of valuable fish oil.

Large exporters of cod: Canada, Denmark, Great Britain, Norway, Russia, Iceland.

The nutritional value

In terms of its popularity and demand, it hardly has worthy competitors.
Liver has won popular love for its beneficial properties, bright, rich taste, which is easily combined with other products. Canned food is used to prepare many dishes, including dietary health cuisine. The most daring chefs even use them as one of the ingredients in vegetable stews and pureed soups. Medicine has proven that systematic consumption of this cod by-product can strengthen bones, increase joint flexibility, improve vision and provide the necessary energy for the whole day. That is why cod and all its parts were the favorite food of the warlike and courageous Vikings. It was necessarily included in the diet of sick and wounded men and women in battles, as it promoted hematopoiesis and faster healing of wounds. In addition, Viking children were famous for their enviable health, strength and insight. Therefore, for the growth of modern children, especially those living in northern latitudes, cod by-product, or at least regular intake of fish oil, is recommended.

Beneficial features

Cod fish meat is very dietary: 100 grams of product contains 82 kilocalories, and the range of nutrients is extensive and impressive (see paragraph “Chemical composition”).

Effect on the human body:

1. Gives strength and accelerates the body's recovery after illness.
2. Increases immunity.
3. Strengthens teeth and bones.
4. Reduces cholesterol levels, normalizes heart function.
5. It has a beneficial effect on mental activity and improves oxygen supply to the brain.
6. Strengthens the structure of the hair fiber and gives strength to the nail plate.
7. Improves the condition of the skin and joints.
8. Stabilizes mood, calms the nervous system.

According to research by British scientists, cod oil inhibits the activity of enzymes that cause the destruction of cartilage tissue and blocks the transmission of painful impulses to the brain.

Fish should be on the menu at least 3-4 times a week for people who suffer from:

• arthrosis;
• vitamin deficiency;
• disorders of the musculoskeletal system;
• diseases of the brain, heart;
• hypertension;
• osteoporosis;
• rickets;
• alopecia;
• frequent colds;
• depression, emotional breakdowns, nervous disorders.

Due to the abundance of vitamins B12, D, carotene and unsaturated omega-3 acids, women are recommended to eat cod throughout the entire period of pregnancy and breastfeeding. At the same time, doctors recommend gradually introducing meat, liver and fish roe into the diet of children from the age of three.

Contraindications for use:

• individual intolerance;
• hypotension;
• hyperthyroidism;
• cholelithiasis or urolithiasis.

You should not combine fish with dairy products, as this can lead to indigestion and disruption of the digestive tract.

Shrimps

Shrimp is a cholesterol-rich food. Moreover, they contain a lot of useful substances with low calorie and fat content. Shrimp contain very important vitamins, contain a record low amount of calories and fat, as well as unique acids B12 and PP, in addition, wild shrimp are rich in copper, zinc, and iron. But those who have high cholesterol levels should avoid shrimp as it is one of the seafoods that is very rich in cholesterol.

In addition to shrimp, cholesterol is found in crayfish, crabs, and octopus. Therefore, to prevent high cholesterol levels, it is recommended to exclude seafood from the diet.

Cod liver

This is an expensive northern delicacy, which owes its popularity to its bright individual taste, unique properties, high nutritional value, and compatibility with numerous dishes. It can be eaten on its own or combined with stews, creamy soups, salads and sandwiches.

The main distinguishing feature of cod liver is the lack of heat treatment during canning. Interestingly, to make most canned fish, fish is boiled, marinated or smoked. This leads to partial or complete loss of vitamins, macro- and microelements. Cod liver is placed in jars exclusively in its raw form and filled with its own fat. Thanks to this, the active substances of the by-product and the piquant taste are preserved throughout the entire shelf life of the product.

The energy value of canned cod liver reaches 613 calories, the amount of B: F: U equals 3%: 96%: 1% per 100 grams of product.

What are the benefits of offal?

1. Improves vision, sharpens the perception of light rays in the dark.
2. Protects the body from carcinogenesis.
3. Supports the coordinated functioning of the endocrine system and the normal condition of the joints.
4. Normalizes metabolic processes in cartilage and bone tissues.
5. Promotes the full functioning of the circulatory system, increases hemoglobin.
6. Strengthens the walls of blood vessels, prevents the development of anemia, atherosclerosis, cancer, rickets.
7. Improves skin condition, smoothes wrinkles

Who needs to eat cod liver?

This by-product is equally useful for children, adolescents, mature and elderly people. However, athletes and people suffering from:

• increased blood clotting;
• diseases of joints, bones;
• vitamin deficiency;
• inflammatory processes of internal organs;
• high content of “bad” cholesterol;
• heart problems.

Remember, 40 grams of canned cod liver per day covers the body’s daily need for healthy fatty acids, compensates for the lack of vitamins necessary to maintain normal functioning of the body, prevents the development of Alzheimer’s disease, arrhythmias and physical exhaustion.

The disadvantages of fish by-product include high calorie content, so overweight people should avoid eating it.

When buying canned food, pay attention to the inscription on the can. The “correct” product will have the “highest grade” label indicating GOST, confirming the preservation of cod liver according to technology regulated by the state. Pay attention to the composition of the product. Cod liver is preserved in its own juice and no other oil can be used in its preparation. The presence of “foreign” ingredients (flavors, dyes, stabilizers, flavor enhancers) in the composition indicates the introduction of harmful chemical additives into the product. Avoid purchasing such a product.

Where do we get cholesterol from?

We often talk about the fact that fatty foods are rich in cholesterol and can greatly increase its levels in the blood. But the bulk of cholesterol is produced by the liver - about 75-80 percent. The rest is absorbed from the intestines. Therefore, diet can only slightly reduce the amount of cholesterol. But this does not mean that you can neglect your diet if you have high cholesterol. You will have to abstain from some foods, and eat others on a limited basis.

Foods rich in saturated fat, mainly animal products, are sources of bad cholesterol. But natural plant products and sea fish supply us with good cholesterol.

People with high blood cholesterol levels are advised to avoid foods high in cholesterol.

Important! In any case, you need to contact a specialist who will prescribe a special diet and, if necessary, prescribe medications that suppress cholesterol synthesis in the liver.

Chemical composition

Cod is an ideal fish for people who are watching their figure and counting calories.
It contains a minimum of fat with a maximum amount of nutrients (vitamins, minerals, phospholipids). White dense fish meat contains 19% protein and 0.4% beneficial triglycerides. Table No. 1 “Nutritional value of cod meat and liver”

The energy value of cod depends on the method of cooking: salted - 98 kcal, stewed - 101 kcal, fried - 111 kcal, hot smoked - 115 kcal, grilled - 172 kcal.
Fresh fish can only be purchased at the places where it is caught, since its meat is not suitable for long-term transportation; in other cases, it is immediately frozen and salted. Table No. 2 “Chemical composition of cod meat and liver”

Remember, cod can accumulate arsenic and mercury, which cause poisoning in the body. Fish caught off the coast of Alaska is considered safe.

Cod roe

In terms of nutritional properties, cod caviar is not inferior to red and black. It is used for making sandwiches, salads, sauces, and snacks. Caviar is produced from mature cod eggs using vegetable oil and sodium benzoate. It goes on sale in ready-canned form.

Cod caviar is a valuable delicacy, a source of vitamins A, B, C, D, phosphorus, sodium, calcium, iodine, and potassium. In addition, the product contains omega-3 amino acids, which are essential for the human body. Interestingly, the degree of protein absorption in cod fish eggs is 2 times higher than in the livestock sector. It gives strength to people with low vitality (old people suffering from nervous disorders, stress), restores impaired metabolism, and supports the functioning of the thyroid gland.

It is believed that cod caviar has a beneficial effect on the body of a pregnant woman: it develops high intellectual abilities in the baby.

Despite its many benefits, it should not be eaten on a daily basis as it contains salt and can lead to the formation of kidney stones.

The nutritional value of cod caviar is 115 calories per 100 grams of product, the ratio B : F : Y is 42% : 55% : 2%.

Indications and contraindications for use

Regular consumption of cod liver is recommended for:

• children, teenagers;
• athletes;
• nursing mothers;
• people recovering from viral diseases;
• People on lipid-lowering diets;
• Patients with hypovitaminosis A, impaired absorption of Ca, P, insufficient production of estrogens, androgens, poor condition of the skin and mucous membranes;
• White collars.

Use the drug with caution in people suffering from hypotension, gastrointestinal disorders, kidney disease, gall bladder and hypothyroidism. Pregnant women, especially in the first trimester, should consult a doctor.

The drug should not be used in case of acute thyroid dysfunction, hypervitaminosis D, excess calcium and allergic reactions.

Using fish in cooking

Cod meat is lean, tender in taste, and white in color. In salads, boiled or smoked fish fillet goes harmoniously with radishes, herbs, and apples. Cod is widely popular in cuisines around the world. It is used to prepare appetizers, puree soups, casseroles and pie fillings. They can also be grilled, dried, smoked, canned, fried, boiled and served as an independent dish.

To preserve vitamins, macro- and microelements, it is recommended to steam cod. When purchasing, pay attention to the condition of the carcass. Frozen fish will be watery and tasteless during cooking.

Sea fish has a characteristic strong smell, which intensifies during heat treatment, so you need to boil it in water with the addition of a large amount of spices, roots (onion, celery, parsley) or pre-sprinkle it with lemon juice.

Without loss of beneficial properties, chilled cod can be stored in the refrigerator for three days, and frozen cod can be stored in the freezer for up to six months. To prevent the fish from overcooking during cooking, boil it in water with cucumber brine at the rate of 1 liter of liquid per 80 milliliters of pickling.

Acceptable replacements for cod in dishes: hake, pollock, haddock.

In modern cooking, this type of fish is actively used in salads and casseroles. In India, it is marinated in vinegar with local spices, then fried over an open fire. In Russia, fish salad is prepared with the addition of radishes, herbs, green sour apples, seasoned with mayonnaise, in Scandinavia - with mustard, dill, onions, sour cream, in America - with peanut butter, cinnamon, white pepper, noodles, ginger, lettuce, soybean sauce, noodles. In Europe, cod is grilled in a honey mustard glaze.

Expert opinions - discussion of issues of diagnosis, treatment and prevention of hypercholesterolemia

Experts discuss the diagnosis, treatment and prevention of hypercholesterolemia:

A. V. Pogozheva Leading Researcher, Doctor of Medical Sciences, Professor of the Federal State Budgetary Institution “Federal Research Center for Nutrition and Biotechnology”, Moscow

Yu. V. Abakumova , Doctor of Medical Sciences, Professor, Chairman of the Saratov Regional Branch of the Academy of Medical and Technical Sciences of the Russian Federation.

Table of contents:

Diagnosis of lipid metabolism disorders

Table 1. Criteria for diagnosing lipid metabolism disorders

The role of cholesterol

Liver and cholesterol

Where is cholesterol spent in the body?

Why do doctors keep trying to link hyperlipidemia and atherosclerosis?

Should hyperlipidemia be treated?

Healthy fats

Principles of healthy eating

Expert A.V. Pogozheva, Doctor of Medical Sciences, Professor of the Federal State Budgetary Institution “Research Institute of Nutrition” of the Russian Academy of Medical Sciences, Moscow:

A progressive and continuous relationship between mortality from coronary heart disease and serum cholesterol concentrations is considered to be proven. According to WHO, an elevated level (more than 5.0 mmol/l) of cholesterol in the blood serum - hypercholesterolemia (HCS) - is a risk factor for premature mortality in 23% of cases and causes 12.4% of lost years of healthy life among Russian residents.

GCS is divided into primary and secondary. Primary HCS is associated with a genetic disorder of cholesterol synthesis in the liver and is inherited (homo- or heterozygous type). Secondary hypercholesterolemia is associated with diseases of other organs and systems (for example, diseases of the biliary system).

A positive correlation has been established between serum cholesterol levels and mortality from cardiovascular diseases (CVD), on the one hand, and excess (more than 40% of total calories) consumption of animal fat containing saturated and trans isomers of fatty acids and cholesterol, on the other hand. .

It is believed that an increase in cholesterol consumption in the amount of 100 mg per 1000 kcal/day helps to increase blood cholesterol by 12%. At the same time, a 1% decrease in total serum cholesterol is associated with a 2% decrease in the risk of coronary artery disease. According to the recommendations of the National Cholesterol Education Program, for moderate hypercholesterolemia, the amount of cholesterol in the diet should not exceed 300 mg/day, and for severe hypercholesterolemia, 200 mg/day. In this regard, the need for dietary and drug correction of HCS is obvious.

Diagnosis of lipid metabolism disorders

To diagnose lipid metabolism disorders and monitor the effectiveness of correction, the criteria of the All-Russian Scientific Society of Cardiologists are used and the content of total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL and LDL) in the blood serum is determined, on the basis of which the atherogenic coefficient is calculated (see Table. 1).

In patients with concomitant coronary heart disease, atherosclerosis of the peripheral and carotid arteries, abdominal aortic aneurysm, and type 2 diabetes mellitus, total cholesterol and LDL cholesterol levels should be below 4.5 mmol/l (175 mg/dl) and 2.6 mmol/l (100 mg/dl) respectively.

Along with this, in case of secondary hypercholesterolemia, the functional state of various organs and systems is assessed: ECG registration, ultrasound of the abdominal organs, chest X-ray, etc.

At the Federal State Budgetary Institution "Research Institute of Nutrition" of the Russian Academy of Medical Sciences, examination of patients with hypercholesterolemia using the algorithm is carried out within the framework of the system of providing high-tech nutritional and medical care to patients with impaired lipoprotein metabolism - hyperlipidemia (GLP-ICD 10 E 78, 78.0, 78.1) - in accordance with domestic and international standards medical care.

The third module (“Nutritest-IP 3”) includes a complex of clinical, physiological, instrumental, biochemical, immunochemical and genetic studies, including:

• study of basal metabolism and calculation of the oxidation rates of macronutrients (proteins, fats, carbohydrates) using intermediate indicators of non-protein energy expenditure and non-protein respiratory coefficient, as well as assessment of energy expenditure during physical and nutritional exercise Eact.;
• assessment of the component composition of the body (x-ray densitometry, computed tomography, MRI) with determination of the content of fat and lean mass, visceral fat, as well as bone mineral density;
• assessment of lipid metabolism with determination of the content of apolipoproteins A, B, lipoprotein (a), the spectrum of fatty acids, phospholipid composition of erythrocytes, etc.;
• assessment of carbohydrate metabolism disorders with determination of insulin resistance markers (Caro index, Homa-IR criterion, β-cell functional activity index, etc.);
• assessment of protein metabolism with determination of the content of homocysteine, albumin, prealbumin, transferrin, C-reactive protein;
• study of hormonal (insulin, C-peptide, glucagon, leptin, adiponectin, resistin, ghrelin, cortisol, aldosterone, ACTH, prolactin, thyroid hormones) status;
• determination of the body’s supply of vitamins (B1, B2, B6, B12, A, C, E, folic acid, etc.), macro- and microelements (magnesium, iron, potassium, iodine, selenium, zinc, chromium, etc.);
• study of immune status (immunoglobulins, TNF-α, IL-1, 2, 4, 6);
• study of antioxidant status with determination of the content of malondialdehyde and diene conjugates in plasma and erythrocytes, as well as the activity of superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase. In recent years, F2-isoprostane and 8-oxo-7,8-dihydroguanine have been used as markers of oxidative stress associated with stimulation of smooth muscle cells and DNA damage;
• study of the functional state of the cardiovascular system (Holter ECG monitoring, bicycle ergometry, treadmill test, stress echocardiography, coronary angiography, ventriculography, myocardial scintigraphy with 201 T1, radionuclide ventriculography, myocardial scintigraphy with 99m Tc-pyrophosphate), kidneys, nervous and endocrine systems , digestive system;
• genotyping with assessment of the expression of genes for apoproteins APO-E, APO-B, APO-C3, lipoprotein lipase, prothrombin (FII), plasminogen activator inhibitor (PAI-1), methylenetetrohydrofolate reductase (MTHFR), NO synthase (NOS), beta-adrenergic receptors and etc.

Table 1. Criteria for diagnosing lipid metabolism disorders

You can find an example of a consultation of a patient with hypercholesterolemia conducted by A. V. Pogozheva, MD, professor of the Federal State Budgetary Institution “Research Institute of Nutrition” of the Russian Academy of Medical Sciences (Moscow), in the article “Clinical observation”, heading “Situation”.

Expert Yu. V. Abakumova, MD, professor, general practitioner of the highest category, chairman of the Saratov regional branch of the Academy of Medical and Technical Sciences of the Russian Federation:

Without a doubt, the most famous compound is cholesterol. Probably no other molecule has made a greater contribution to medicine (cardiology, nutrition, general pathology, biochemistry, etc.). Cholesterol can rightfully be called a molecule of the 20th century. Throughout the 20th century, researchers studied him, either accusing him of almost all sins, or completely justifying him. To date, the case has ended in an acquittal: high cholesterol intake does not cause atherosclerosis and coronary heart disease. The occurrence of these diseases depends on other factors.

Data obtained by scientists from the Saratov regional branch of the Academy of Medical and Technical Sciences of the Russian Federation in one of the studies also confirm the “innocence” of cholesterol. We compared the amount of dietary cholesterol in the diet of patients with active atherosclerosis (group 1) and healthy individuals (group 2). It turned out that both sick and healthy people received almost the same amount of cholesterol from food, namely about 0.4 g/day. Also, their levels of total cholesterol in the blood did not differ, which was confirmed by other researchers. Thus, neither patients with active atherosclerosis nor healthy individuals (i.e., before the disease develops) have excess dietary cholesterol.

A person receives about 400 mg of cholesterol per day from food. The body itself synthesizes about 1200 mg/day. The average total amount is about 1600 mg/day. It has now been proven that dietary cholesterol does not affect the development of hyperlipidemia and atherosclerosis!

There is no clause limiting cholesterol intake in current WHO recommendations for proper nutrition! This is absolutely true, since hyperlipidemia is formed as a result of increased formation (synthesis) of lipids in various tissues, primarily in the liver. Almost all cells and tissues of the body have cholesterol synthesis systems. Why? Because cholesterol is a vital substance, without which the cell dies. Each cell has its own cholesterol synthesis system. This property is a kind of insurance in case there is suddenly a deficiency in the supply of this substance with food or for some reason its hepatic synthesis stops.

The role of cholesterol

There are three ways the body uses cholesterol:

1. Synthesis of steroid hormones (about 10% of the total cholesterol pool).
2. Synthesis of bile acids, without which digestion is impossible, and synthesis of vitamin-like substances.
3. Construction of the cell wall and all intracellular membranes. Without this (structural) cholesterol, the cell dies.

Cholesterol plays the role of a structural stabilizer of membranes. The membrane is a fairly “fluid”, unstable formation in which pores, ruptures, and so-called breakdown phenomena easily form. Through them there is an uncontrolled flow of various substances into the cell, and the contents of the cytoplasm can leak out. The incorporation of cholesterol molecules into the membrane strengthens it, imparts rigidity to the entire structure, stopping breakdown phenomena, ensuring controlled operation of pores and receptors.

With a deficiency of cholesterol, the risk of cancerous cell degeneration increases. Therefore, when treating a patient, you should not reduce the level of cholesterol in the blood below normal limits.

Animal products are rich in cholesterol: meat, lard, whole milk, butter, seafood (mussels, oysters, etc.). However, as follows from the above, there is no particular need for strict dietary regulation in relation to cholesterol.

Thus, the cause of hyperlipidemia is either increased cholesterol synthesis in the body (primarily in the liver) or a decrease in its use. A decrease in consumption for hormone synthesis naturally occurs in old age, which is also associated with the progression of atherosclerosis at this age.

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Liver and cholesterol

First of all, it is necessary to pay attention to the functional state of the liver - the organ that produces cholesterol “for export”, i.e. for the whole body. Why does it suddenly produce more of this substance than it needs?

In general, cholesterol synthesis is a regulated process. This means that the liver synthetic systems form it as much as the body needs. When there is an excess of dietary intake, cholesterol synthetic systems reduce the volume of production. And vice versa. This has been proven by experiments with a radioactive label.

However, with the development of atherosclerosis, the amount of cholesterol in the body increases. That is why the term “cholesterolosis” appeared (Yu. M. Lopukhin).

For a very long time there was no answer to the question about the causes of impaired liver function. Various versions have been proposed, but all are insufficiently proven. However, in the 1970s. American researcher Catherine Fabrikant accidentally discovered that certain viruses can disrupt the cholesterol and lipid synthetic systems of the liver. These results were later confirmed by the results of extensive experiments conducted by Belarusian researchers.

The ability to disrupt the above liver systems has been noted in some viruses: respiratory (for example, influenza), enteroviruses, hepadnaviruses. But the damage they caused turned out to be more or less temporary. After a certain time, the cell restores its enzyme systems. And only damage caused by the herpes virus cannot be repaired. It is persistent and remains forever. As a result of the attack of the herpes virus, the liver cell “does not hear” inhibitory signals to stop the synthesis of cholesterol and continues to form this substance, as well as the corresponding apoproteins in large quantities.

Where is cholesterol spent in the body?

Cholesterol comes from the liver into the blood as part of lipoproteins. Lipids are not present in free form in the blood, because they are water insoluble. To impart hydrophilicity and for transport through the bloodstream, they bind to special carrier proteins (apoproteins) and become lipoproteins. In addition to the transport function, apoproteins isolate the active centers of certain fat molecules, for example, fatty acids, which are active saponifiers (without the insulating effect of apoproteins, they would quickly saponify all blood vessels from the inside).

The fixation of cholesterol in blood vessels depends on the ratio of saturated and polyene fatty acids in lipoproteins, since cholesterol ester with a saturated fatty acid is difficult to remove by high-density lipoprotein. When studying the characteristics of fatty acids in lipoproteins, it was found that in LDL and in the cells of patients with atherosclerosis (A), the level of polyenoic acids is reduced.

But the consumption of fatty acids is a food factor! Depending on the nature of the foods and fats, the body receives fatty acids with different properties. With some (unsaturated) cholesterol esters it is easy to remove from tissues, but with others (saturated) it is very difficult. Consequently, the choice is up to the quality (and quantity) of dietary fats - triglycerides (TG), which contain fatty acids.

Triglycerides, or true fats, contain fatty acids. These are long, most often single-chain compounds containing up to 22 carbon atoms. Their chemical formula is approximately this:

H3C - CH2 - CH2 - CH2 - CH2 - - CH2 - CH2 - CH2 - COOH

It is they that “burn” in the body, releasing the energy of the chemical bond “CH2 - CH2”. The body uses them as fuel, like “gasoline,” and practically does not use them as plastic material. The chemical bond energy in fatty acids is very high. Oxidation (“combustion”) of 1 g of fatty acids provides 9 kcal of energy, i.e. almost the same as gasoline - 10.5 kcal / g (for comparison: carbohydrates - 4 kcal). Triglycerides are found in many foods: meat, lard, vegetable fats. Actually, vegetable oils are triglycerides.

Recently, special attention has been paid to myristic acid. This fatty acid is part of milk fats. The special chemical properties of this acid lead to the growth of LDL in the blood, which is deposited in tissues and is difficult to remove from the body.

European experience

According to a number of researchers, in European countries there is a clear connection between the consumption of dairy fats and the prevalence of cardiovascular diseases. These data served as the basis for a national program of measures to change the nutrition of the population in Finland. The experience of this country, which has achieved a significant reduction in the incidence of CVD, is very important both for similar programs in other countries, and for every family, every person shaping their diet.

In Finland, as in other Nordic countries, a unique diet has historically developed with a high consumption of meat, whole milk, dairy fats and a low consumption of vegetables, fruits, fish, and vegetable oils. Morbidity and mortality from CVD were very high.

Since 1972, a nationwide program for the prevention of these diseases began to operate in Finland. Among the measures carried out within the framework of this program was a fundamental change in diet. As a result of the implementation of the national program, the consumption of vegetables increased 3 times, fish - 2 times. Two facts deserve special attention: firstly, a sharp reduction in the use of whole non-skimmed milk and the transition to skimmed milk and, secondly, the transition to the use of vegetable rapeseed oil instead of butter. While before 1972, about 80% of the population consumed skim milk and butter and only 5% consumed skim milk and vegetable oil, by 1997 only 20% of the population continued to consume high-fat dairy products. It is clear that the implementation of the Finnish national project has led to a sharp reduction in the consumption of myristic acid. Quantity turned into quality: mortality from CVD fell by 60%. Such a vivid experience of Finland can serve as an example both for large social groups and for an individual family or individual.

Be careful with medications!

Fixation of cholesterol in the vascular wall depends on various changes: liver dysfunction, hypothyroidism, diabetes mellitus, nephrotic syndrome, iatrogenic factors.

When looking for the causes of hyperlipidemia in a patient, special attention should be paid to taking medications. Thus, the use of progestins and oral contraceptives, which have sharply increased recently and are often prescribed by gynecologists without good reason, leads to pronounced changes in lipid metabolism and hypercholesterolemia. After their abolition, normalization of lipidemia does not occur immediately, but over a long period of time. The use of diuretics (except indapamide) and beta-blockers, i.e., drugs most often prescribed to patients with coronary artery disease and atherosclerosis, is also one of the factors of hypercholesterolemia.

Medical misconceptions

To assess lipidemia, the patient undergoes a comprehensive study - a lipid profile, total cholesterol (2.2–5.3), HDL, triglycerides, and LDL are determined. Both the absolute values ​​of these indicators and their relationships with each other are important. Thus, with total cholesterol greater than 6.22 mmol/l and an LDL:HDL ratio greater than 5:1, the risk of developing atherosclerosis is considered high. In contrast, the level of triglycerides is not directly related to the development of atherosclerosis and the progression of hypercholesterolemia, but rather reflects dietary fat intake and pancreatic dysfunction, which must be taken into account when prescribing treatment.

A lipidogram carries very limited information: more or less lipids of a certain type in the blood. The attention of practitioners to lipid profiles and hyperlipidemia is often unreasonably great. They are trying to associate the development of atherosclerosis with changes in the lipid profile and hyperlipidemia, and to judge from it the degree of atherosclerotic vascular damage. However, such conclusions cannot be drawn! In practice, combinations often occur:

• the patient has hyperlipidemia, but without atherosclerotic vascular lesions;
• severe atherosclerotic vascular damage without hyperlipidemia.

As a result of scientific research conducted by scientists from the Saratov regional branch of the Academy of Medical and Technical Sciences of the Russian Federation, it was found that the average levels of cholesterol in the plasma of patients and healthy people differ little (5.04 ± 0.9 and 4.9 ± 0.6, respectively, with p > 0.05). Undoubtedly, there is a certain relationship between cholesterol levels and the development of atherosclerosis. However, as Professor E. Sh. Halfen, who spent his entire life working on this very issue, once said at a scientific conference: “I don’t know what connection this is.”

Why do doctors keep trying to link hyperlipidemia and atherosclerosis?

Because until recently, the lipid concept of the development of atherosclerosis was generally accepted; more precisely, until now it has not been possible to replace it with any more compelling theory. At first, its essence was expressed by the phrase “without cholesterol there is no atherosclerosis”, and then - “without lipoproteins there is no atherosclerosis”.

How are atherosclerosis and hyperlipidemia related (if related)?

Atherosclerosis is a disease, a characteristic feature of which is the formation of atherosclerotic plaques in the walls of arteries - pathological formations, unique in their structure and cellular composition, the development of disturbances in the blood supply to internal organs, damage to their structure and function. In the pathogenesis of this disease, disturbances in thrombus formation, energy production, and disturbances in lipid and carbohydrate metabolism are important. Internal organs are characterized by the development of heart attacks, as well as ischemic and diffuse sclerotic changes. As can be seen from this (incomplete) definition, hyperlipidemia is one of the factors in the pathogenesis of atherosclerosis, and is not at all determining. It (hyperlipidemia) may or may not be present in a patient with atherosclerosis or coronary heart disease, ischemic brain disease, etc. Atherosclerosis develops regardless of its presence or absence. With some caution, hyperlipidemia can be considered as a marker of the development of atherosclerosis, but even then it is not very sensitive.

Should hyperlipidemia be treated?

Rather, it is necessary to treat atherosclerosis. However, recently the number of patients in whom hyperlipidemia is combined with hepatic steatosis in the absence of atherosclerotic changes has increased. Most likely, we are talking about a kind of debut of atherosclerosis, when there are metabolic changes, but not (yet) structural ones. Although there may be other pathological processes. In this case, the use of appropriate diets gives good results and hyperlipidemia is a convenient marker for monitoring the dynamics of the process.

How to treat?

Firstly, do not use statin drugs until the last possible opportunity due to their hepatotoxicity and serious side effects.

Secondly, apply diets, primarily individual ones, taking into account the characteristics of a particular patient. The first step in creating a diet is to provide the body with quantitatively adequate protein that is complete in amino acid composition. After this, issues of quantity and quality of fats are resolved.

Dangerous products

What other nutritional components, nutrients, foods, dishes have the greatest impact on human health, promote or prevent the development of cardiovascular pathology?

Trans fatty acids are fatty acids with an unusual structure. The main amount of trans fats is produced in the food industry using the technology of hydrogenation of vegetable and fish oils to produce margarine and a number of oils. Food products prepared with trans fats have a long shelf life and do not go rancid (chips and other crunchy foods, for example). Trans fats significantly change the fat and carbohydrate metabolism of the human body and significantly potentiate the development of cardiovascular diseases and cancer.

According to WHO experts, the epidemic of cardiovascular diseases can be explained by high consumption of saturated fatty acids and trans fats. Thus, it is not the total fat intake that is important, but the nature of the fat in a person's diet. WHO recommends significantly limiting the consumption of foods that contain trans fats and saturated fats, especially myristic acid.

Healthy fats

Among the fats, which are very diverse in their chemical structure, role in the body and effect in relation to various diseases, there are also those that prevent the development of cardiovascular diseases.

There are some types of fatty acids that are not used for energy supply, but are involved in the synthesis of a number of important compounds. These are the so-called polyunsaturated fatty acids (linoleic, linolenic, etc.) and branched-chain fatty acids.

Their structure contains double bonds:

H3C - CH2 - CH2 = CH2 - CH2 - CH2 = CH2 - CH2 - COOH

They are found in vegetable oils (especially flaxseed, soybean), nuts, seeds, and fish oil. Introducing them into the diet in sufficient quantities is mandatory to maintain health and prevent disease. The so-called polyunsaturated fatty acids of the omega-3 class also prevent the development of CVD. These fats are found in the greatest quantities in nuts and in the fat of northern sea fish (tuna, herring, salmon, etc.). Today it has been proven that omega-3 polyunsaturated fatty acids have a multifaceted effect on the human body at different age periods.

Firstly, they are necessary for the proper development of the brain of children (of different ages).

Secondly, they are necessary for the normal functioning of the immune system throughout a person’s life.

Third, eating these fats reduces triglyceride levels in the blood and prevents the development of CVD.

Fourthly, omega-3 polyunsaturated fats reduce the tendency to form clots in the blood, minimizing the process of thrombosis. This is very important, because increased thrombus formation is an independent risk factor for the development of myocardial infarction and stroke.

Fifthly, omega-3 polyunsaturated fats stabilize the heart rate, and this is considered their most remarkable property. In fact, studies have shown a significant - 45-70% - reduction in the likelihood of sudden death from cardiac arrest. However, low intake of omega-3 fats is associated with a high incidence of sudden death from cardiac arrest.

According to WHO analytical reports, it has been established that “consumption of omega-3 fatty acids is a key determinant of the prevalence of coronary heart disease, reducing the likelihood of sudden death from cardiac arrhythmia.”

Sources of polyunsaturated fatty acids of the omega-3 class are fish oil, fatty sea fish, and nuts. To achieve an adequate intake of omega-3 fats, it is recommended to either adopt a Mediterranean-type diet rich in nuts and fish, or consume fish oil, or use special omega-3 fatty acid supplements.

In 2002, experts from the WHO European Bureau set targets for nutrients that are necessary to achieve a good level of public health. Some of them are given in table. 2.

Based on the targets, the WHO Regional Office for Europe has developed 12 principles of healthy eating (see “Principles of healthy eating”).

Historical fact

In conclusion, I would like to turn to history, with which it is worth starting the study of any issue.

We will not be mistaken if we say that the development of medicine throughout the 20th century took place under the banner of cholesterol and this same substance was the basis of many scientific myths.

Isolated in its pure form at the end of the 19th century, cholesterol, after experiments on animals, was suspected of being the cause of the development of atherosclerosis. The experiments of N. N. Anichkov and S. S. Khalatov (1912) are best known to society. It is generally accepted that these scientists managed to obtain experimental atherosclerosis. However, this is not quite true.

At a meeting of the Society of Russian Doctors in St. Petersburg, N. N. Anichkov reported that after feeding with cholesterol, rabbits exhibit severe fatty degeneration of the liver and bone marrow (which does not happen with atherosclerosis). At the same time, foci of cholesterol deposition were identified in the intima of the aorta, but without changes in the condition of other vessels. In areas of cholesterol infiltration, smooth muscle infiltrates and other elements of the atherosclerotic plaque, sclerosis and vascular deformations characteristic of spontaneous human atherosclerosis were not found. It is noteworthy that rabbits with experimental atherosclerosis do not develop myocardial infarction. These differences in experimental atherosclerosis can be associated with the peculiarities of the endothelial structure and cholesterol metabolism of the rabbit. Thus, it is clear that atherosclerosis was not obtained. Since the rabbit is a herbivore in its metabolism, does not receive cholesterol from food and cholesterol is a foreign substance for it, then after the experiments with rabbits, experiments were carried out with carnivorous and omnivorous animals: dogs, pigs, rats, i.e. with animals similar to humans in their exchange. They showed that dietary intake of cholesterol, even in very large quantities, does not lead to atherosclerosis or any deposition of cholesterol in blood vessels, and the changes obtained in herbivores are a storage disease. By the end of the 1920s. The inconsistency of the theory of food origin of atherosclerosis was absolutely clear. However, in the absence of another, I had to accept this theory as at least a working concept.

Principles of healthy eating

1. Eat a nutritious diet based on a variety of foods, mostly plant-based rather than animal-based.
2. Eat bread, grain products, pasta, rice, potatoes several times a day.
3. Eat a variety of vegetables and fruits several times a day, preferably fresh and locally sourced (at least 400 g/day).
4. Maintain your body weight within the recommended range (BMI 20–25) through moderate exercise, preferably daily.
5. Control your fat intake (no more than 30% of daily energy) and replace most saturated fats with unsaturated vegetable oils.
6. Replace fatty meats and meat products with beans, legumes, lentils, fish, poultry or lean meats.
7. Consume milk and dairy products (kefir, curdled milk, yogurt, cheese) that are low in fat and salt.
8. Choose foods that are low in sugar and eat less refined sugar by limiting how often you consume sugary drinks and sweets.
9. Choose foods low in salt. Total salt consumption should be no more than 1 tsp. (6 g) per day, including salt found in other foods.
10. If alcohol consumption is allowed, it should be limited to two drinks (10 g of alcohol each) per day.
11. Prepare food in a safe and hygienic manner. Steaming, baking, boiling or microwaving foods can help reduce the amount of added fat.
12. Promote exclusive breastfeeding and the introduction of safe and adequate complementary foods from 6 months, with breastfeeding continuing throughout the first years of life.

Source: CINDI Nutrition Program Guide (EUR/00/5018028, E70041R).

Table 2. Some target indicators for developing a healthy lifestyle

Cod for pancreatitis

Cod fish meat is dietary and is recommended for consumption by patients with pancreatitis. Unlike pork, lamb, veal, and poultry, it lacks coarse fascia and tendons, it is tender and easily digestible. With minimal culinary effort, cod can be made into a dish with a puree-like consistency, which is especially important for a diet for pancreatitis, which involves grinding all food products in order to spare the digestive organs.

Fish is allowed to be consumed during the period of remission and exacerbation of the disease from the second week of the attack. It is boiled, steamed, served in the form of meatballs, cutlets, soufflés, quenelles, and meatballs. In addition to dishes prepared from minced cod, during the period of remission it is allowed to eat whole fish (baked, stewed, steamed). It makes nutritious casseroles and pies that will help diversify the patient’s diet.

Fish dumplings are recommended to be served with vegetable and cereal side dishes and vegetarian soups. In case of chronic pancreatitis, animal meat is replaced with cod, which is allowed to be consumed no more than 3 times a week. At the same time, the following fish dishes are prohibited: canned food, liver, aspic and broths that stimulate gastric and pancreatic secretion. In addition, avoid taking dried, smoked, or salted cod.

Remember, the healthiest fish is fresh. It should have a strong, elastic surface, be moderately shiny, and have a marine scent. The presence of yellowish stains on the carcass, damage, and a foul odor indicate long-term storage of the product on store shelves, which has been re-frozen. Avoid eating such fish.

The maximum daily portion of cod for a patient with pancreatitis is 200 grams.

Canned seafood delicacy

Cod liver is one of the most valuable fish products. It saturates the human body with trace elements, vitamins and fatty acids. It is a healthy dish for both women and men.
Today, cod liver is offered mainly in canned form. Only in some countries it is sold fresh, in close proximity to the fishing grounds. The thing is that raw liver is a tender and delicate product. When it is removed from cod, it begins to spoil very quickly. There are 2 options for cod liver preparations:

1. Canned food is prepared directly on ships, at sea, in floating factories.
2. The raw materials are frozen, and then thawed and canned on shore.

Cod liver is harvested in Norway, Japan, Denmark, Sweden, Ireland, and Iceland. The finished product most often comes to Belarus from Russia, namely from Murmansk, Kamchatka, the Arkhangelsk region and their environs. The delicacy is valued for its high fat concentration: from 65% to 72%. Interestingly, in some countries, for example, the USA and Canada, cod liver is not consumed in its pure form at all.

. It is used only in the production of fish oil for medicine and cosmetology.

How to cook cod?

Before cooking, cut off the head, tail, and fins of the fish, gut it and wash it. If necessary, cut into pieces and rinse again under water. When purchasing frozen cod, be sure to defrost the carcass naturally before cooking in the refrigerator. When using a microwave oven or hot water, the fish will lose its taste and consistency.

You can cook the cod whole or in pieces (in portions). However, the finer the fish is cut, the less nutrients it will retain after heat treatment. Cod is cooked in a regular saucepan, double boiler, slow cooker, or pressure cooker.

Recommendations for preparing sea fish:

1. You can put cod in both cold and hot water. In the first case, there is a guarantee that the tough fish meat will be cooked evenly.
2. When placing cod in a regular pan, the water should completely cover its surface.
3. Once defrosted, meat cannot be re-frozen.
4. You can cook fish under a closed or open lid.
5. To enhance the taste of cod, add cucumber pickle, tomato paste, citric acid, salt, carrots, onions, peppers or spices to the water.
6. The fish is cooked exclusively in gutted form.
7. Throughout the entire period of cooking cod, constantly control the heat: at first it should be high, when the water boils, reduce it to medium level, at the final stage reduce it so that it is weak.
8. To preserve the structure of the fish, add 15 milliliters of vegetable oil to boiling water.
9. If you do not have suitable kitchen equipment, you can cook the cod in a deep frying pan, adding water periodically. In this case, the process of preparing sea fish will be no different from the traditional method.

The duration of cooking cod depends on the size of the carcass (cut) and averages 15 minutes. Small pieces will be ready in 5 minutes. The fastest way to cook fish is in a pressure cooker. And the cooking time in a double boiler or multicooker will not differ in any way from heat treatment in a regular saucepan. The readiness of cod can be checked based on two factors: the ease of separating the fillet from the skin and bones, and the degree of meatiness of the meat.

Remember, regardless of the serving size, fish boiled for a baby is cooked for at least 20 minutes, then crushed until creamy and carefully checked for the presence of cartilage and bones.

What harm is there from fish?

As such, fish is not harmful if it is fresh and has undergone proper heat treatment. The freshness and quality of the fish is also affected by the aquatic environment in which it lived.

Chemical waste is often thrown into waters, which can negatively affect the product, making it poisonous, which will certainly affect health in the future:

1. The stable functioning of the kidneys and liver may be disrupted, and in women, the ovaries.
2. Diseases and dysfunctions of the gastrointestinal tract (especially problems with the pancreas) may develop.
3. Old and sick fish cause metabolic and circulatory problems.
4. Hormonal metabolism and the functioning of the genital organs in men may be disrupted (leading to infertility and other dangerous diseases, including oncology).

Spoiled fish or fish caught in dirty waters can harm everyone, especially children and pregnant women. If a pregnant woman has high cholesterol, or the product is stale, this can lead to miscarriage or diseases of the digestive system. Therefore, before eating fish, you should make sure that it is fresh and does not pose a threat to health.

The spoiled product should not be eaten under any circumstances.

Note to housewives

Classic recipe for cod with vegetables

Ingredients:

• cod – 1 carcass;
• carrots – 1 piece;
• lemon – 0.5 pieces;
• potatoes - 8 pieces;
• onion – 1 piece;
• rosemary – 2.5 grams (0.5 teaspoon)
• olive oil – 45 milliliters (3 tablespoons);
• black allspice, salt - to taste.

Cooking principle:

1. Clean the carcass from scales, remove the entrails, cut off the head, and wash.
2. Cut the back diagonally with a sharp knife.
3. Grind pepper and salt in a mortar. Coat the cod with the mixture inside and out.
4. Insert lemon slices into the slits.
5. Cover a baking sheet with foil and place the fish on it.
6. Peel potatoes, onions, carrots and cut into strips or rings.
7. Drizzle the vegetables with olive oil, add salt and place on both sides of the cod, sprinkle with rosemary.
8. Cover the top of the dish with foil, place in a preheated oven for 40 minutes, set the temperature to 180 degrees. Cook until potatoes are soft.
9. When serving, decorate with herbs.

Cod casserole with rice

Ingredients:

• cod fillet – 400 grams;
• cream – 100 grams;
• rice – 250 grams;
• tomato sauce – 250 grams;
• hard cheese – 150 grams;
• egg - 2 pieces.

Cooking sequence:

1. Cut the cod fillet into portions.
2. Boil the rice until half cooked, grate 100 grams of cheese, and combine these ingredients.
3. Place half of the resulting mass in a baking dish, then spread the fish over the surface, cover the cod with the remaining mass on top.
4. Grate 50 grams of cheese on a coarse grater.
5. Boil the eggs hard and chop. Combine with grated cheese and sprinkle on top.
6. Mix cream and tomato sauce and pour over casserole. If desired, the dish can be sprinkled with breadcrumbs, and onions and cabbage can be added to the rice-cheese mixture.
7. Preheat the oven, bake for 15 minutes at 180 degrees. Serve hot.

Dishes based on cod are tasty, light and satisfying. They can be eaten for dinner along with fresh vegetables and herbs.