A plant-based diet and coronary artery disease: a mandate for effective therapy

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466936/

By courtesy of Caldwell B. Esselstyn, Jr., M.D.

1. Background

A 1999 autopsy study of young adults in the US between the ages of 17 and 34 years of who died from accidents, suicides, and homicides confirmed that coronary artery disease (CAD) is ubiquitous in this age group. The disease process at this stage is too early to cause coronary events but heralds their onset in the decades to follow.[1] These data are similar to those reported in an earlier postmortem analysis of US combat casualties during the Korean conflict, which found early CAD in nearly 80% of soldiers at an average age of 20 years.[2] From these reports, which are 17 and 63 years old, respectively, it is clear that the foundation of CAD is established by the end of high school. Yet, medicine and public health leaders have not taken any steps to forestall or eliminate the early onset of this epidemic. Smoking cessation, a diet with lean meat and low-fat dairy, and exercise are generally advised, but cardiovascular disease (CVD) remains the number one killer of women and men in the US. The question is, why? Unfortunately, such dietary gestures do not treat the primary cause of CVD. The same can be said of commonly prescribed cardiovascular medications such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, anticoagulants, aspirin, and cholesterol lowering drugs and medical interventions such as bare metal stents, drug-eluting stents, and coronary artery bypass surgery.

It is increasingly a shameful national embarrassment for the United States to have constructed a billion-dollar cardiac healthcare industry surrounding an illness that does not even exist in more than half of the planet. If you, as a cardiologist or a cardiac surgeon, decided to hang your shingle in Okinawa,[3] the Papua Highlands of New Guinea,[4] rural China,[5]Central Africa,[6] or with the Tarahumara Indians of Northern Mexico,[7]you better plan on a different profession because these countries do not have cardiovascular disease. The common thread is that they all thrive on whole food, plant-based nutrition (WFPBN) with minimal intake of animal products.
By way of contrast, in the United States, we ignore CVD inception initiated by progressive endothelial injury, inflammatory oxidative stress, decreased nitric oxide production, foam cell formation, diminished endothelial progenitor cell production and development of plaque that may rupture and cause myocardial infarction or stroke.[8] This series of events is primarily set in motion, and worsened, by the Western diet, which consists of added oils, dairy, meat, fish, fowl, and sugary foods and drinks —all of which injure endothelial function after ingestion, making food a major, if not the major cause of CAD.[9]

In overlooking disease causation, we implement therapies that have high morbidity and mortality. The side effects of a plethora of cardiovascular drugs include the risk of diabetes, neuromuscular pain, brain fog, liver injury, chronic cough, fatigue, hemorrhage, and erectile dysfunction. Surgical interventions are fatal for tens of thousands of patients annually. Each year approximately 1.2 million stents are placed with a 1% mortality rate, causing 12,000 deaths, and 500,000 bypass surgeries are performed with a 3% mortality rate, resulting in another 15,000 deaths. In total, 27,000 patients die annually from these two procedures.[10] It is as though in ignoring this dairy, oil, and animal-based illness, we are wedded to providing futile attempts at temporary symptomatic relief with drugs and interventional therapy, which employs an unsuccessful mechanical approach to a biological illness with no hope for cure. Patients continue to consume the very foods that are destroying them. This disastrous illness and ineffective treatments need never happen if we follow the lessons of plant-based cultures where CVD is virtually nonexistent.

2. Treating the cause

In 1985, I initiated a small study utilizing WFPBN in 24 patients who were severely ill with CAD. The moment of truth came a year later for a patient in his 50 s with significant vascular disease in his heart and right leg. At study onset, while crossing a skyway into the Cleveland Clinic he experienced claudication that forced him to stop and rest five times. Results of a pulse volume study revealed a markedly diminished right ankle pulse. Following nine months of WFPBN, all claudication had resolved, and a repeat pulse volume was double that of his baseline.[11] As statin drugs were not yet available, this was proof of the concept that WFPBN alone can halt and reverse CVD.

After 12 years, we reviewed the CVD events of our 18 adherent patients. During the eight years prior to entering our study, while in the care of expert cardiologists, they had sustained 49 cardiac events, which was indicative of disease progression. In contrast, 17 of the 18 patients sustained no further events during the 12 years they spent in our study.

One patient who was initially adherent developed angina and required bypass surgery six years after resuming a Western diet. These findings illustrate the need for close adherence with WFPBN.[12]
Twelve patients in our initial group had a follow-up angiogram. There was significant disease reversal in four of them, which suggests that WFPBN could not only eliminate future cardiac events but could also reverse angiographic disease. Even if significant angiographic reversal does not occur, patients can still benefit from more subtle improvements in the overall health of their endothelial cells and their capacity to produce nitric oxide, eliminating angina and future CVD events.[12] Additionally, the robust antioxidant value of WFPBN diminishes oxidative inflammation in plaques and foam cells, thus strengthening the cap over the plaques.

A strengthened cap is unlikely to rupture, and adherent participants have been empowered to make themselves “heart attack proof” without the additional expense or risk of ineffective drugs, stents, or bypass surgery. In 2014, we conducted a second larger study of 198 patients with significant CAD.[9] Of these patients, 119 had undergone a prior coronary intervention with stents or bypass surgery, and 44 had a previous heart attack. There were multiple comorbidities including hypercholesterolemia, hypertension, obesity, and diabetes. During four years of follow up, 99.4% of the participants who adhered to WFPBN avoided any major cardiac event including heart attack, stroke, and death, and angina improved or resolved in 93%. Of the 21 non-adherent participants, 13 (62%) experienced an adverse event. When comparing these results to the well- known COURAGE,[13] and Lyon Diet Heart Study,[14] which consisted of conventionally treated participants, there is beyond a 30-fold difference in major cardiovascular events favoring WFPBN.

In 1990, Ornish, et al.,[15],[16] utilized a low-fat vegetarian diet without added oil and stress management instruction to arrest CAD and reverse angiographic disease, which was confirmed in subsequent publications. Earlier, in 1951, Strom and Jensen reported a profound decrease in circulatory diseases in Norway during WWII when the Germans confiscated the country’s livestock, forcing the Norwegians to subsist mostly on plant food.[17] Results from both the On-Target Transcend trial investigators,[18] and the Epic Oxford Study[19] with more than 75,000 participants support the power of nutrition for primary and secondary CVD prevention.
In the early 1970s, Finland (and especially its eastern province of Karelia) was the heart disease capital of the world. Health authorities and local officials there became intent on educating the public on how to reduce cholesterol, blood pressure, and intake of animal foods and stop smoking. This group reduced their intake of dietary saturated fat, increased vegetable consumption, and decreased their smoking rate from 52% to 31%. During the next 30 years, Karelia’s CAD disease rate plummeted by 85%. For Finland as a whole, CAD decreased by 80%.[20]
Researchers at Cleveland Clinic under the direction of Stanley Hazen, which included Tang,[21] Koeth,[22] and Wang,[23] studied the metabolism of lecithin and carnitine found in eggs, meat, milk and diary products, liver, shellfish, and fish. The intestinal microbiota of omnivores metabolizes these substances producing trimethylamine oxide (TMAO), which causes vascular injury. This investigation was a powerful validation for WFPBN because ingestion of these animal foods by persons who strictly consume plants produces no TMAO. In fact, plant eaters do not have intestinal bacteria capable of producing TMAO.
The totality of converging lines of evidence, including epidemiology, wartime deprivation, large nutritional cohort population transitioning studies, and randomized and non-randomized investigations point to nutrition as the principle etiological factor in atherosclerotic CVD.

3. What is withholding the cure?

For years, I have resisted making the suggestion that compensation could be an issue in decision-making. However, multiple lawsuits have arisen in cases where unnecessary stenting or bypass surgery was performed for nonexistent or minimal lesions.[24],[25] Results of multiple investigations consisting of thousands of patients all show that stenting in an emergency situation is lifesaving while at the same time fails to prolong life or protect against future heart attacks in most patients undergoing elective stent placement when compared with optimal medical therapy. It is particularly disingenuous for physicians to tell patients that they are a walking time bomb—frightening them into accepting a procedure fraught with potential morbidity and possible mortality that is also non-curative—after an angiogram confirms a 90% blockage. Present day angiography does not identify, and angioplasty does not treat, the lesions that are most likely to cause a heart attack.[26]

Accepting the fact that most cardiovascular physicians are honest, caring, and compassionate, why do they resist WFPBN? Cardiovascular medicine practitioners receive essentially no nutrition education in medical school or postgraduate training. Therefore, they lack not only the skill set needed to help their patients modify their diets but also a basic awareness that plant- based nutrition can halt and reverse CVD. I recall a lawyer with CAD and angina who rapidly improved following WFPBN. He became quite angry after a follow-up visit to his cardiologist who said he knew WFPBN might be successful. The lawyer asked, “Why didn’t you offer it to me many months ago?” and the cardiologist replied, “In my experience patients won’t follow that program.” Where upon the lawyer stated, “That must be my decision, not yours.” It is not the message that is wrong but how and if the message is articulated that determines adherence and success.

Without a randomized controlled trial, can a physician feel secure recommending a plant-based option? Absolutely! Results from the COURAGE TRIAL[13] confirmed that stenting in stable patients was not superior to optimal medical therapy. The prompt, powerful, and enduring effects of WFPBN were recorded by Massera, et al.,[27] who reported dramatic reversal of crippling angina in a man who refused medication or surgical procedures but agreed to WFPBN. The man can now run four miles without symptoms.

In summary, current palliative cardiovascular medicine consisting of drugs, stents, and bypass surgery cannot cure or halt the vascular disease epidemic and is financially unsustainable. WFPB can restore the ability of endothelial cells to produce nitric oxide,[28] which can halt and reverse disease without morbidity, mortality, or added expense. As powerful as the data are, it is unconscionable not to inform the cardiovascular disease patient of this option for disease resolution. To begin to eliminate chronic illness, the public needs to be made aware that a pathway to this goal is through WFPBN.


This article is part of a Special Issue “A plant-based diet and cardiovascular disease”.
Guest Editors: Robert J Ostfeld & Kathleen E Allen


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Blueberry Oatmeal Pancakes


  1. Make the flax egg by mixing the ground flax with 6 tablespoons of water and letting it sit for 10 minutes. The consistency should resemble that of an egg.
  2. In a bowl, mix together the oats, milk, flax eggs, and oil. In a small separate bowl, mix the flour, baking soda, baking powder, sugar, and salt. Then combine both mixtures and stir, adding more milk if necessary for your desired consistency.
  3. Lightly grease a hot skillet or pan with additional oil. Pour ½-cup pancake rounds on the skillet and cook until bubbles form on the surface.
  4. Carefully drop 6–8 optional blueberries onto one side of each pancake, then flip and cook on the other side until golden brown.

Prep Time: approx. 30-40 minutes
Serving Size: 6 pancakes

by Daniel Velez

Source: https://lifeandhealth.org/food/blueberry-oatmeal-pancakes/171229.html

How to Lower Your Sodium Intake

Reduction of salt consumption by just 15 percent could save the lives of millions. If we cut our salt intake by half a teaspoon a day, which is achievable simply by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks—potentially helping more than if we were able to successfully treat people with blood pressure pills. As I discuss in my video Salt of the Earth: Sodium and Plant-Based Diets, an intervention in our kitchens may be more powerful than interventions in our pharmacies. One little dietary tweak could help more than billions of dollars worth of drugs.

What would that mean in the United States? Tens of thousands of lives saved every year. On a public-health scale, this simple step “could be as beneficial as interventions aimed at smoking cessation, weight reduction, and the use of drug therapy for people with hypertension or hypercholesterolemia,” that is, giving people medications to lower blood pressure and cholesterol. And, that’s not even getting people down to the target.

A study I profile in my video shows 3.8 grams per day as the recommended upper limit of salt intake for African-Americans, those with hypertension, and adults over 40. For all other adults the maximum is 5.8 daily grams, an upper limit that is exceeded by most Americans over the age of 3. Processed foods have so much added salt that even if we avoid the saltiest foods and don’t add our own salt, salt levels would go down yet still exceed the recommended upper limit. Even that change, however, might save up to nearly a hundred thousand American lives every year.

“Given that approximately 75% of dietary salt comes from processed foods, the individual approach is probably impractical.” So what is our best course of action? We need to get food companies to stop killing so many people. The good news is “several U.S. manufacturers are reducing the salt content of certain foods,” but the bad news is that “other manufacturers are increasing the salt levels in their products. For example, the addition of salt to poultry, meats, and fish appears to be occurring on a massive scale.”

The number-one source of sodium for kids and teens is pizza and, for adults over 51, bread. Between the ages of 20 and 50, however, the greatest contribution of sodium to the diet is not canned soups, pretzels, or potato chips, but chicken, due to all the salt and other additives that are injected into the meat.

This is one of the reasons that, in general, animal foods contain higher amounts of sodium than plant foods. Given the sources of sodium, complying with recommendations for salt reduction would in part “require large deviations from current eating behaviors.” More specifically, we’re talking about a sharp increase in vegetables, fruits, beans, and whole grains, and lower intakes of meats and refined grain products. Indeed, “[a]s might be expected, reducing the allowed amount of sodium led to a precipitous drop” in meat consumption for men and women of all ages. It’s no wonder why there’s so much industry pressure to confuse people about sodium.

The U.S. Dietary Guidelines recommend getting under 2,300 milligrams of sodium a day, while the American Heart Association recommends no more than 1,500 mg/day. How do vegetarians do compared with nonvegetarians? Well, nonvegetarians get nearly 3,500 mg/day, the equivalent of about a teaspoon and a half of table salt. Vegetarians did better, but, at around 3,000 mg/day, came in at double the American Heart Association limit.

In Europe, it looks like vegetarians do even better, slipping under the U.S. Dietary Guidelines’ 2,300 mg cut-off, but it appears the only dietary group that nails the American Heart Association recommendation are vegans—that is, those eating the most plant-based of diets.

Written By Michael Greger M.D. FACLM

Source: https://nutritionfacts.org/2019/11/19/how-to-lower-your-sodium-intake/

Omega-3 Breakfast Pudding


Quantity Unit Name
2 cups unsweetened soy or almond milk
1 ripe banana
¼ cup rolled oats
¼ cup chia seeds
cup fresh fruit, chopped
1 teaspoon alcohol-free vanilla
pinch of salt
Optional Add-ins: chopped nuts, unsweetened shredded coconut, and cinnamon


  1. Blend banana with milk using a blender, hand-mixer, or fork.
  2. Stir in the remaining ingredients.
  3. Ladle into jars, cover, and place in refrigerator overnight. It will be ready to grab and go in the morning!

Prep Time: 5 minutes
Serving Size: 6 servings

– Jonathan Ewald –

Source: https://lifeandhealth.org/undo-my-disease/diabetes/on-the-go-breakfast-pudding/094629.html

The 4 Best Ways To Avoid Heart Disease

Risks are everywhere. Every time you drive, you’re risking a car accident. Each time you have a conversation with someone, you risk a misunderstanding. In nearly everything we do, we taking a risk. Risks are unavoidable – they’re just a part of life – so the question boils down to what you do with those risks.

Let’s talk about health risks (we are Life & Health, after all). It might be easy to brush risks in this arena aside, given that everything seems to be a health risk. But really, more than anything else, is your health something you should be risking? Risk-taking health can lead to costly, lifelong issues, most commonly with your heart. That’s why we’re here to help guide you to lessen your risk for coronary heart disease (CHD).

You might be relieved to hear that the risk factors related to coronary heart disease are preventable.

The four major risk factors are:



High blood pressure

High cholesterol

It’s been shown that, if you have any of the above risk factors, the possibility of having CHD is extremely high. In fact, around 80-90% of CHD patients have one of the four above health problems. Out of patients who have had a fatal outcome from CHD, 95% of those patients had one of those four major risk factors.

Risk #1: Diabetes

Exactly how much does CHD risk go up when we have diabetes? A study of cardiovascular risk of patients with diabetes showed that diabetes can increase the risk of both CHD and ischemic stroke, a blood vessel blockage in the brain, by two to four times.

Risk #2: Smoking

The most preventable major risk factor for CHD is smoking. Just by not smoking, you can lower the risk of CHD, as well as lessen the risk of other diseases, especially lung diseases like chronic obstructive pulmonary disease (COPD) and cancer. Never smoking in the first place is a great way to avoid one of the “big four” risk factors of heart disease. If you already smoke, don’t sweat it. It’s never too late to quit and the benefits are literally immediate.

Risk #3: High blood pressure

High blood pressure, or what clinicians call hypertension, is usually a diet-caused disease. High sodium in the diet, lack of exercise, and stress, all combine and result in high blood pressure. High blood pressure is the most common risk factor in the U.S. for death among females and comes in as the second leading risk factor for death in males. In short, the risks associated with high blood pressure are far too high to ignore. Blood pressure is very manageable by maintaining a diet low in sodium, refined sugars, and fats. Also, regular exercise will keep the heart in good shape and lower the risk of high blood pressure.

Risk #4: High cholesterol

When we screen for cholesterol, too often we get numbers above where the levels should be. There are many ways we can address high cholesterol, with diet playing a significant role. When we shop for groceries, we can lower our cholesterol levels by cutting out meats, dairy, and processed foods that contain unhealthy fats. Instead of those high-fat foods, choose heart-healthy foods such as fresh fruit, seeds, and tree nuts. These contain vitamins, essential minerals and the healthy fats that our hearts and various cells need.

The American Journal of Cardiology estimated that if just 5% of diabetes was prevented by lifestyle and diet changes, close to 30,000 incidents of heart failure could be avoided yearly. These smaller steps to lower risk can pay off when it matters. So what’s the consensus? Take less risks with your life and health so you can enjoy taking risks in other ways, like going on adventures, traveling to unknown places, and forming new relationships.



Source: https://lifeandhealth.org/lifestyle/how-to-reduce-your-4-risks-for-heart-disease/1612257.html

Endurance-training but not resistance-training is keeping our cells young

As the days are getting longer and warmer, more and more people feel attracted to go out and enjoy nature. You can also see more people out there bicycling or jogging and it seems that together with nature our drive to sports is awakening. The positive effects of sport are widely known. Activity is strengthening our cardiovascular system and it is able to prevent us from many kinds of various diseases. People who are doing sport are healthier, more balanced and live longer than people who are not active.

Just recently I was reading an article about the effects of sport on our cells that was very interesting to me. Professor Laufs from the University of Leipzig in Germany was examining the effects of different types of sport on the cells of our body and he found out, that it makes a great difference, what kind of sport we are doing! If you want to do sport, you have principally two choices: Either you can do endurance-training like swimming, running or cycling, or you can do resistance-training, and strengthen your muscles. You would typically do this with dumbbells or other fitness-devices in a gym. It was astonishing to me, that Professor Laufs found out, that endurance-training had a much greater benefit on the health of our cells, than resistance-training!  

Professor Laufs and his team were examining 266 inactive young people and putting them basically into 3 different groups. The first group was starting with endurance-training (running) 3 times a week, the second group was doing resistance-training (pumping iron) 3 times a week and the third group was continuing their inactive lifestyle from before. After six months blood-examinations were taken from the participants and their Leukocytes were examined for length of telomeres in the cell nucleus. Now Professor Laufs found out, that the length of telomeres in the “running-group” was increased, while resistance-training did not show these effects! But what does this mean?

The DNA contains our genetic information in the cell nucleus. It is packed in 46 Chromosomes. Now each Chromosome is “protected and sealed” by a special cap on each end, which is called “telomere”. The problem is, that this cap is shortening with each replication of the cell and that this shortening of telomeres is viewed to be an important mechanism of cellular aging. But there is one enzyme in our body, called “Telomerase” that can reverse this shortening of Telomeres. Now Professor Laufs found out, that the length of Telomeres and the activity of Telomerase was increased in the “running-group” compared to the “inactivity-group”, but that resistance-training (pumping) did not show the same effects! That means, that endurance-training like running, cycling or swimming has an outstanding potential of keeping our cells young!

To my knowledge this was for the first time, that it could have been scientifically shown, that sport can keep our cells young on a molecular level! The reason for the increased activity of telomerase in the running-group may be due to an increased level of nitric-oxide in the blood-vessels during endurance-training, which is acting like a hormone and providing different cellular changes. You can say, that we are made for moving outside and that by doing so, we can do our part for “healthy aging”. It was very interesting to me also, that sport is not all the same, but that endurance-training seems to be more healthie for our body than resistance-training! Resistance-training can be an addition or complement to endurance-training, but it can never replace it.  Another advantage of endurance-training is, that you can easily do it outside and get an additional extra-portion of fresh air and sunlight! And you can practice it in a group together with other people! So why don’t use the warmer and brighter days of springtime to go out and do some exercise? Your cells will love it!    

Source: “Endurance but not resistance training has anti-aging effects”, European Society of Cardiology, 27.11.2018 (ESC Press Office)

Link: https://www.escardio.org/The-ESC/Press-Office/Press-releases/endurance-but-not-resistance-training-has-anti-aging-effects