Can a Heart Attack be Prevented?
There are places around the world, some only recently discovered, that are inhabited by simple cultures who, throughout their existences, live a modest life, eat healthily, exercise through the natural exertion of their daily activities, experience minimal stress and place a high value on family and friends. These people generally eat a plant-based diet with meat consumed rarely, usually only on special occasions. They enjoy a long life with many of them living for over 100 years with little to no coronary heart disease or other chronic diseases. It is time for us to consider the example they set.
The Tarahumara Indians of northern Mexico consume a low-fat, high-fiber diet (10% fat, 13% protein, 75-80% carbohydrates) and have virtually no coronary risk factors. A study was performed that fed a group of Tarahumaras a diet typical of affluent societies for 5 weeks. The diet contained excessive calories and excessive fat, including saturated fat and cholesterol. The Tarahumaras saw their total cholesterol levels increase by 31%. The increase was primarily in the LDL cholesterol fraction which rose by 39%. Triglyceride levels (another type of fat found in the blood) also increased by 18% and all subjects gained weight (1).
The Papua highlanders of New Guinea eat a diet that is greater than 90% carbohydrate with a protein intake of only about 5 to 6%. In 1973 this population was examined and found to be lean and fit with no increases with age in their blood pressure, cholesterol level, fasting blood glucose or body fat. There was virtually no evidence of cardiovascular disease in these people (2).
Lipid levels of Kalahari bushmen who eat a diet very low in dietary fat and a lifestyle that is habitually high in physical activity have extremely low blood cholesterol levels (3).
In 1998 citizens of rural mainland China were studied. Their diet consisted of less than half the fat intake of Americans of the time and three times more fiber. Animal protein intake was very low, about 10% of the US intake. Blood cholesterol levels were also low. Coronary artery disease mortality was almost 17 times less than that of US men and 5 times less than that of US women. It was observed that the more plant-based the diet, the more health benefits were achieved (4).
It is critical to lower cholesterol levels in order to reduce coronary heart disease and heart attacks.
Human beings do require some cholesterol. It is necessary for production of the bile that helps digest food, especially fats, and to construct some hormones and vitamins. But we do not need to obtain cholesterol from our diets; our bodies can produce all that is required. Cholesterol is found in all animal-based foods including red meat, chicken, poultry, fish including shellfish, eggs and dairy products. There is no cholesterol in plant-based foods.
A wealth of scientific evidence substantiates the fact that LDL-cholesterol is the cause of the plaques in our arteries (atherosclerotic cardiovascular disease) that are the cause of many heart attacks. There exist more than 200 prospective cohort studies and randomized trials covering greater than 2 million participants and 20 million person-years of follow-up that demonstrate consistently and unequivocally that the higher the LDL blood level, the greater the risk of atherosclerotic cardiovascular disease (5).
LDL levels can be lowered in a variety of ways (6,7).
Taking medications such as statins or ezetimibe – These medications bring with them many possible negative side effects that make them a poor choice for lowering LDL.
Controlling type 2 diabetes and high blood pressure – These conditions increase the likelihood of plaque build-up.
Quitting smoking – Smoking damages the lining of arterial walls and lowers HDL levels.
Losing weight – Simply being overweight increases cholesterol blood levels.
Exercising more – Exercise can lower blood pressure, burn body fat, and lower blood sugar levels.
Losing weight combined with exercise can lower LDL levels.
Exercise can be mild to moderate such as brisk walking or gentle cycling or it can be intense such as jogging/running or fast cycling. The goal is to move the body enough to increase the breathing rate for at least 150 minutes every week.
Exercise can also raise HDL (high-density lipoprotein, the “good” type of cholesterol) that encourages removal of cholesterol from the body.
Limiting stress – Stress puts added strain on the whole body. It increases “fight or flight” hormones such as adrenaline that lead to increased blood pressure. Additionally stress may increase unhealthy behaviours such as smoking, physical inactivity, overeating and drinking too much alcohol, behaviours that can damage artery walls (9).
Eating a whole-food plant-based diet….
Most importantly – LDL-cholesterol can be very efficiently lowered by diet.
Many dietary factors contribute to high LDL and clogged arteries (6,7);
Saturated fats such as butter, milk fats including cheese, oils such as palm oil and coconut oil and meat fats
Trans-fats, found in margarines, vegetable shortenings, and partially hydrogenated oils.
Dietary cholesterol, which only comes from animal-based products. Cholesterol does not exist in plants.
Refined carbohydrates, processed foods and sugar-rich beverages that elevate another type of plaque-producing lipoprotein called apoB.
Refined carbohydrates and excess alcohol intake that elevate triglyceride levels and increase the risk of heart attack.
It is possible to remove LDL-cholesterol from already formed plaques
and reduce blockages in the arteries
A prospective, randomised, controlled trial looked at the outcome of comprehensive lifestyle changes (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise). After one year coronary artery lesions were analysed by coronary angiography. Coronary artery blockage decreased from 40% to 37% in the experimental group but increased from 42% to 46% in the control group. Overall, 82% of the subjects in the experimental group experienced reduction in their arterial plaques (8).
Eating plant-based has been shown to eliminate the need for coronary bypass surgery and to relieve the heart pain of angina. A five-year follow-up of 64 men with documented coronary artery disease is illuminating. These men had all been advised by their cardiologists to undergo bypass surgery. They instead chose to take part in a supervised residential program that used only diet and exercise as therapy. The program diet was a high-complex-carbohydrate, high-fiber, low-fat, low-cholesterol diet. Results of the study found that 80% of these men managed to turn around their coronary artery disease substantially enough to no longer require bypass surgery. Additionally, 62% of those taking drugs to relieve angina pain at the start of the study were able to discontinue their angina drugs altogether (10).
A review of published scientific research covering 27 randomized controlled and observational trials concluded that plant-based diets demonstrate the highest reduction of LDL lipoprotein levels. Dramatic reductions of 35% were observed. Eating even a small amount of lean meat diminished this reduction (27).
A 2005 review highlighted the positive effects of lifestyle modification for reducing and reversing chronic diseases such as coronary heart disease, hypertension, diabetes and metabolic syndrome (11).
Taking all these factors into consideration, the power of food choices in the prevention and reduction of arterial plaques becomes very clear. A completely plant-based diet keeps total fat intake low and almost eliminates saturated fat intake. It also supplies copious amounts of antioxidants and fiber, keeps inflammation to a minimum, helps maintain an ideal body weight and controls blood pressure and type-2 diabetes (8).
How long does it take to lower the risk of heart attack?
Surprisingly in just three to four weeks of healthy living the chance of a heart attack decreases dramatically. Plaques become more stable and less apt to rupture. Eating a plant-based diet of fiber-rich unrefined carbohydrates (fruits, vegetables, beans, whole grains) and exercising moderately lowers all the risk factors for a heart attack including LDL cholesterol, total cholesterol, triglyceride fats, blood pressure, type 2 diabetes, excess weight and inflammatory markers like C-reactive protein (7).
Being Heart Attack Proof
Although heart disease has been the most common cause of death in the Western world for decades, it seemed that no doctors were attempting to reverse it. The accepted treatment was to wait until the plaques became severe enough to warrant an angioplasty or a bypass. However, after observing evidence of the power of food in combating heart disease, two physicians began to put their ideas into action by studying their own patients.
Dr. Dean Ornish began his investigations during the 1970s. His numerous studies demonstrate beyond any doubt through the most rigorous and credible peer-reviewed evaluations that heart disease can be halted and reversed without medication (8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22). Dr. Ornish saw plaque regression in 82% of his patients. His program, “Dr. Ornish’s Program for Reversing Heart Disease” is an integrative lifestyle program available in the USA for the reversal of heart disease and other chronic conditions. His lifestyle changes include diet along with stress management and exercise (24). This program is now covered in the US by Medicare under “Intensive Cardiac Rehabilitation”. Numerous insurance companies are now joining in, covering this program for members who have risk factors for coronary heart disease and other conditions such as diabetes and early stage prostate cancer.
In Cleveland another physician was performing similar studies. Dr. Caldwell B. Esselstyn Jr’s research from the 1980s and 1990s showed astonishing results in heart patients who had been abandoned by physicians who believed they had run out of options. Dr.Esselstyn’s initial experiments showed enormous drops in total cholesterol and LDL and follow-up angiograms were stunning, showing not only halted progression of atherosclerosis but unheard of reversal of arterial plaques in 70% of these patients (25, 26, 27). Since 2009 the Cleveland Clinic has offered an innovative, evidence-based program aiming for lifelong heart health that was created by Dr.Esselstyn after decades of intensive research on the reversal of coronary artery disease through the means of diet.
Can we make ourselves heart attack proof? The observations and ensuing meticulous scientific evaluation that was started by these two men and continued by many other scientists assures us that it is possible. New research emerges almost daily further strengthening the use of intensive diet and lifestyle interventions to win the war against heart disease. Excellent health is indeed within the grasp of every one of us. It is all up to you.
1 McMurray, M.P., Cerqueira, M.T., Connor, S.L., Connor, W.E. Changes in Lipid and Lipoprotein Levels and Body Weight in Tarahumara Indians after Consumption of an Affluent Diet. New England Journal of Medicine Dec. 1991; 32(24): 1704-1708.2
2 Sinnett, P.F., Whyte, H.M. Epidemiological studies in a total highland population, Tukisenta, New Guinea. Cardiovascular disease and relevant clinical, electrocardiographic, radiological and biochemical findings. J Chron Diseases 1973; 26:265.
3 Miller K. Lipid values in Kalahari Bushman. Arch Intern Med 1968; 121:414.
4 Campbell, T.C., Parpia, B., Chen, J. Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China Study. Am J Card 1998; 82(10B):18T-21T.
5 Ference, B.A., Ginsberg, H.N., Graham, I., Ray, K.K., Packard, C.J., Bruckert, E., Hegele, R.A., Krauss, R.M., Raal, F.J., Schunkert, H., Watts, G.F., Borén, J., Fazio, S. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017 Aug 21; 38(32):2459-2472.
8 20 Ornish, D., Brown, S.E., Scherwitz, L.W., Billings, J.H., Armstrong, W.T. et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990 Jul 21; 336(8708):129-33.
10 Barnard, R.J., Guzy, P.M., Rosenberg, J.M., and Trexler O’Brien, L. Effects of an intensive exercise and nutrition program on patients with coronary artery disease: five-year follow up. 1983; J Cardiopulm Rehabil 3:183-190.
11 Roberts, C.K., Barnard, R.J. Effects of exercise and diet on chronic disease. 2005. J Appl Physiol; 98: 3–30
12 Dean Ornish, M.D., Eat More, Weigh Less. New York: Harper Perennial, 1994.
13 Ornish, D., Gotto, A.M., Miller, R.R. et al. Effects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease. 1979. Clin Res 27: 720A.
14 Ornish, D., Scherwitz, L.W., Doody, R.S., Kesten, D., McLanahan, S.M., Brown, S.E., DePuey, E. et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA 1983; 240 (1): 540-59.
15 Gould, K.L., Ornish, D., Kirkeeide, R.L., Brown, S.E., Stuart, Y. et al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol 1992; 69(9): 845-853.
16 Gould, K.L., Ornish, D., Scherwitz, L., Brown, S., Edens, R.P. et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA 1995; 274(11): 894-901.
17 Ornish, D., Scherwitz, L.W., Billings, J.H., Gould, K.L. et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23): 2001-2007.
18 Koertge, J., Weider, G., Elliott-Eller, M., Scherwitz, L., Merritt-Worden, T.A., Marlin, R., Lipsenthal, L. et al. Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project. Am J Cardiol 2003; 91(11):1316-1322.
19 Pischke, C.R., Weidner, G., Elliott-Eller, M., Scherwitz, L., Merritt-Worden, T.A., Marlin, R., Lipsenthal, L. et al. Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus with out diabetes mellitus. Am J Cardiol 2006; 97(9): 1267-1273.
20 Pischke, C.R., Weidner, R.G., Elliott-Eller, M., Ornish, D. Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of less than or equal to 40 percent or greater than 40 percent in the Multicenter Lifestyle Demonstration Project. Eur J Heart Fail 2007; 9(9): 928-934.
21 Daubenmier, J.J., Weidner, G., Sumner, M.D., Mendell, M., Merritt-Worden, T., Studley, J., Ornish, D. The contribution of changes in diet, exercise and stress management to changes in coronary risk in women and men in the Multisite Cardiac Lifestyle Intervention Program. Ann Behav Med 2007; 33(1): 57-68.
22 Frattaroli, J., Weidner, G., Merritt-Worden, T., Frenda, S., Ornish, D. Effects of cardiac lifestyle intervention programs on angina pectoris and atherosclerotic risk factors. Am J Cardiol April 1 2008; 101(7): 911-918. 10.1016/j.amjcard.2007.11.039. Epub 2008 Jan 28.
24 Esselstyn, C.B.Jr, Ellis, S.G., Medendorp, S.V., Crowe, T.D. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J Fam Prac 1995; 41:560-568.
25 Esselstyn, C.B Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (An overdue requiem for palliative cardiology). Am J Card 1999; 84:339-341.
26 Esselstyn, C.B Jr. Foreword: Changing the treatment paradigm for coronary artery disease. Am J Card 1998; 82(10B):2T-4T.
27 Ferdowsian, H.R., Barnard, N.D. Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009 Oct 1; 104(7): 947-956.