Reversing Heart Disease
Reversing heart disease is a holy grail of cardiology. It’s scary when you are told that you have a blockage in your arteries causing symptoms and are at increased risk of a heart attack. It’s even scarier when you are told you may need open-heart surgery or other procedures such as stents to tackle these blockages. That fear of a heart attack remains even after treatment and you ask yourself, what if it progresses and gets worse? Of course we would rather it simply disappear.
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What if we could reverse heart disease and make the blockages disappear. Wouldn’t it be great if we could just take a tablet, or follow a drastic diet and the plaques in the arteries would dissolve away, reversing all the years of damage done beforehand? Why even bother on preventing heart disease if we can simply reverse heart disease?
Multiple diets and programs claim to reverse heart disease. Every one claims it works and that it is the best. Below we examine some of these claims and the actual evidence underlying the claims from the Ornish Diet, Esselstyn Diet, Pritkin Diet, Chelation therapy and others.
Heart disease affects everyone, either directly or through someone they know. It’s scary and people are of course interested in whether heart disease can be reversed. Unfortunately, some people, often healthcare related professionals pray on that fear and claim that they have found the cure and that following their special recommendations or program will reverse heart disease. Patients naturally want that claim to be true, and driven by fear will adopt these recommendations in the hope that their heart disease will go away.
Miracle Cures That Can Reverse Heart Disease
The reality is that miracle cures are typically backed with low quality often-laughable research. When asked why the medical community as a whole is dismissive, they blame the medical community for being ignorant, obsessed with big pharma and too arrogant to open their eyes. The reality is that while a minority of healthcare providers lack compassion and the ability to listen to their patients fears and concerns, most healthcare professionals care, and care a lot. They want their patients to benefit from available therapies, and it’s not the case that they are ignorant of alternative methods; rather they are understandably reluctant to recommend therapies that make ludicrous claims on the basis of poor science to back them. I certainly don’t want my patients to be conned and taken advantage of.
Patients looking for miracle cures that reverse heart disease are not stupid, they are simply scared and looking for a glimmer of hope. Of course when they are told that their heart disease can be reversed, they take notice and are attentive. Its particularly distressing therefore that those making the claims do so in an evangelical manner, praying on hope, with the main motive being to be in the limelight, make themselves celebrities, and fuel their profit driven machines. Of course they claim that patients are their priority. Rather than invest in high quality research programs that could give them credibility, they invest massive amounts in direct to patient marketing with wild claims of totally reversing heart disease.
The reality is that there is a lot of hope for patients with heart disease. While heart disease is at an all time high, the deaths from heart disease have not followed that trend. Treatments can act to stabilize the disease even if they can’t necessarily reverse it. It’s actually an amazing era in which to be a heart patient from a treatment perspective.
Reversing Heart Disease – The Obvious
Before even thinking about reversing something we need to understand why it occurs. In the case of heart disease it’s pretty obvious. And a close look at the miracle cure programs show that in general they simply state the obvious. The fact is most of us take very little care of ourselves until an emergency forces us to. Our diets are typically poor and full of refined and processed foods, we don’t make time to exercise, we deal with a lot of stress, smokers keep smoking, we forget to pay attention to blood pressure and cholesterol profile.
Making this worse is the confused advice that the authorities have come out with regarding nutrition. First we should avoid all fats, then we are told that actually fat is ok but carbs are bad. Some say high protein, some say low. Some say calorie count, some say don’t ever count calories. The dietary recommendations are really where the confusion has set in. The reality is however that hardly anyone is capable of following a strict diet plan when most of us struggle to do anything in moderation.
If you look closely at these often highly priced books and programs, in addition to claiming they are the secret to heart disease being reversed, they all have one thing in common. They encourage a holistic integrated approach, which basically means a combination of diet, lifestyle and exercise. It is obvious that we need to be more physically active and make time to exercise regularly several times a week. No one will argue physical activity is bad. Smokers need to stop. Blood pressure and cholesterol goals should ideally be achieved. Stress reduction might be a good idea. Avoid processed foods and sugar. Have moderation in diet, whether it is a plant based diet, a Mediterranean diet, a no carb diet or other. While each one claims to be the best, the reality is that each is likely better than what we do on a normal day to day basis. The reality of a drastic approach such as that outlined by many diets is that it is often destined to failure because hardly anyone can maintain it over the long term. Lifestyle change means true sustainable lifestyle change.
Reversing Heart Disease – What I Tell My Patients
As we discussed above, there are some things that are just obvious and hardly anyone would dispute that they are key in the development of heart disease. We can’t alter our genetics, however there are many risk factors that are modifiable.
Take Responsibility for Doing the Obvious – These things are obvious factors when it comes to stabilizing heart disease and preventing events. If you smoke then obviously stop. Pay attention to your blood pressure and cholesterol levels (it’s not only your doctor’s responsibility but yours), know your treatment targets, keep a diary, and keep up with your medicines. If you don’t exercise then start, make it routine, at least 30 minutes at a good heart rate and at least 3-4 times a week. If you are worried about what you are able to tolerate, then start as part of a cardiac rehabilitation program. If you have a stress filled life that you feel was in part too much then take measures to reduce that. If you have diabetes, obsess about diabetes control. If you need to pay a wellness program or resort to a ton of money to state the obvious then feel free.
There is no miracle cure yet – I am sure to tell patients there is no miracle cure that will reverse heart disease. The key is to stabilize heart disease and if we are fortunate we may see a regression over time although large regressions in blockages are not the goal, as there is no good evidence that can occur. Stabilization of disease is the key and can be achieved through a combination of lifestyle change and currently available treatments.
Don’t be dismissive of medicines – Many of those who make claims regarding miracle cures also like to talk about the evils of the medicines prescribed by doctors. Ironically most of the studies that their claims are based on involve full use of available medical therapies. Unfortunately, despite that, part of the sales pitch of those claiming that heart disease can be reversed with their programs is that patients can completely come off their medicines. Of course medicines should be discussed with the prescribing doctors and side effects discussed and once targets have been met, potential reduction of these can be discussed. This is a responsible approach, unlike the approach suggested by the entirely self-promoting, conspiracy theorist, miracle cure evangelists.
Don’t Look for an Easy Way Out – The bottom line is that it takes hard work and a lot of it to adopt a so-called healthy lifestyle. Anyone looking for a quick fix plan will end up spending a lot of money adopting a drastic change that isn’t backed by any decent level of evidence, and likely will fail in the long term due to the drastic nature of a change that is not sustainable. It takes hard work, dedication and serious long-term goals and plans to succeed. If you want to get serious then get serious, and if you don’t, be realistic about your expectations and outcomes.
When It Comes to Diet, Don’t be Brainwashed or Naïve – Educate Yourself – The reality of all the miracle cures out there is that each one promotes a drastic dietary change in addition to lifestyle changes. Each one thinks it is the best and each one offers a relatively low level of evidence to back it up. Every diet has the following in common – cut out refined and processed foods, eat natural with fruit/vegetables, and cut out sugar. It’s a simple as that. Some are plant based and some are Mediterranean type. Information is widely available on the Internet and my recommendation would be to look at these various diets and learn which ones you feel that you could actually have a chance at doing long term. The bottom line is whether it’s Mediterranean, low carb, plant based or other, it’s clearly better than the high sugar, processed diet that most people eat. No matter what claims they make, none of these miracle diets are going to unblock all of the critical blockages in the heart arteries and totally reverse heart disease. At best we could hope for stabilization and if lucky some mild regression when diet is combined with lifestyle modification and medical treatments.
Be Hopeful – Patients with coronary artery disease have a good outlook in this day and age. Although procedures are not always the answer, they have advanced to where critical blockages can be treated effectively and safely. Modern day medicines have improved outcomes for heart disease patients. Knowledge about diet, particularly avoidance of processed foods and sugar, has allowed more sensible recommendations to be made. Availability of home blood pressure and glucose monitors have allowed patients to have a much higher level of participation in monitoring and controlling important chronic health conditions. Of course any strategy regarding heart disease should focus on prevention since the number of people with heart disease is rising. One good statistic however, is that the deaths from cardiovascular disease is actually falling. Patients with heart disease actually have a hopeful outlook.
Statin Medications
Although science has a large body of evidence to back up the use of statin medications in the use of cardiovascular disease, some controversy remains. The current overwhelming recommendation from most medical authorities is that they are a front line treatment for coronary artery disease and to prevent cardiovascular events. In this article some of the evidence for the role of statins in the stabilization and potential reversal of coronary heart disease is reviewed. Of course much of this is industry and profit driven although most drugs are now available generically.
Atherosclerotic Heart Disease
Atherosclerosis causes plaques responsible for blockages in arteries causing coronary heart disease. These plaques can increase in size over time to where they cause angina chest pains, or they can burst and lead to total blockage of the artery as happens in a heart attack. Often these plaques can be stabilized to reduce their progression over time by the use of medicines and lifestyle changes. Severe blockages can be treated with the use of stent procedures or bypass operations. But can coronary heart disease be reversed to prevent the need for emergency treatment or heart attacks?
When Does It Start?
Atherosclerosis begins at an early age with the earliest lesions appearing in late adolescence with advanced lesions typically developing at ages 30-40. With advancing age, the lesions become even more advanced, hard and calcified. Risk factors such as high cholesterol, smoking, diabetes and high blood pressure are associated with the development of lesions and control of these risk factors are associated with a lower likelihood of developing significant disease.
Studies In Animals
In the 1950’s a study was done in rabbits. The rabbits were fed extremely high levels of cholesterol and as a result developed very widespread atherosclerotic lesions. The rabbits were then injected with a substance that was known to break down fat in a process called lipolysis. As a result the lesions were much smaller and less widespread. The idea of shrinking plaques and reversing heart disease gained more traction with studies in monkeys in the 70’s. The animals were fed a high cholesterol diet for about 1½ years then a low fat diet for just over 3 years. After the high fat diet there were high levels of disease seen in the coronary arteries with blockages up to 60% narrowing, however after the subsequent low fat diet, the coronary blockages were noted to shrink significantly to about only 20% narrowing. Further similar studies in pigs and also in rabbits demonstrated that despite plaques containing complex features previously thought to be irreversible, they were still able to regress and show signs of stability. Further work over the years involving genetically modified animal models has helped to identify the mechanisms that underlie the regression of the plaques in these animal models and the potential to reverse heart disease to some degree.
Studies In Humans
Many large trials done in humans have demonstrated that the use of cholesterol medications such as statins has lowered the rate of clinical events such as heart attacks. The degree of plaque regression has been relatively mild however, and a potential explanation for this is that the medications are working to stabilize the plaques and therefore make them less vulnerable to burst and therefore less likely to cause heart attacks or progress to severe blockages. This plaque stabilization is important even if the lesion regression is minimal as shown in one study where there was only a 0.4% reduction in plaque size, but an almost 90% lower chance of having a heart event. Some studies have actually used ultrasound to look inside the arteries of the heart and assess the response to cholesterol lowering therapy with statins. In one study 24 months of high dose statin therapy was associated with a 7% reduction in plaque volume. Importantly, the lesions did not worsen over time, in of itself a major goal.
What To Make Of It
If modern day evidence based medicine is to be believed, then the cholesterol lowering medications (statins) are clearly associated with a decrease in cardiovascular events. Underlying this is likely a role in stabilization of plaques that cause coronary artery blockages that likely prevents rupture of the plaques that would cause heart attacks. There is some evidence that statins cause some mild reversal of the plaques also. Studies suggest that if started earlier in those at high-risk then statins can prevent the development of complex plaques. There is currently no magic bullet to go and clear out arteries and totally reverse plaques, however statins appear to be the most well researched medication available to stabilize plaques and prevent progression.
Is it worth trying?
I personally recommend and would be on these medications if I had significant heart disease. The body of evidence is remarkable. It would be better if patients would all adopt strict lifestyle changes and dietary measures, but most won’t and these medications have been credited with reduction in cardiac events despite the evolution of a terrible current day lifestyle. Its easy and often appropriate to be skeptical of industry and its motives, but in this case I think the sheer volume of trials and participants show a benefit in patients with clear coronary artery disease at risk of events.
Plant Based Diets – Esselstyn Type Plan
What is a plant-based diet?
A plant-based diet includes fruit, legumes, vegetables and whole grains. This diet is worth mentioning as it has some evidence underlying it regarding its effectiveness. We will discuss the limitations of this evidence later. In the studies the plant-based diet is defined as avoidance of dairy, meat, fish and added oil. Also its important to note that in these studies the plant based diet was advocated in combination with cholesterol medications. It is a profit driven program that centers around books and wellness institutes. It claims to reverse heart disease and avoid the need for heart procedures.
What did the studies show?
In the landmark study by Esselstyn and co-workers, 18 patients with severe coronary artery disease were followed. Most of the 18 patients had experienced failure of previous bypass surgeries or interventional procedures and were experiencing symptoms. The study is remarkable in that pictures of the heart arteries were repeated in most cases after 5 years. These patients were placed on a plant-based diet and attention was paid to cholesterol goals also. Reportedly, over the next 12 years, no patient experienced a further coronary event. In the 8 years before the study the same group of patients had almost 50 coronary events between them. In the repeat angiogram pictures, 70% of the patients had some regression of the degree of blockage and the remaining 30% had stable disease without progression. 90% of the patients were reported to adhere to the diet.
In the next study of a plant-based diet, the same author followed almost 200 people that were counseled on a plant-based diet in addition to usual cardiovascular care. They reported that the majority of patients were adherent to the plant based diet. Of the patients that followed (177/198) the diet strictly there was only 1 event, a stroke. That’s an event rate of only 0.6%. In the patients that were not adherent 13/21, (62%) had an event.
What to make of the studies?
Basically, this study claims to blow all other studies out the water. The findings are so incredible that one has to wonder if they are real. I’m an interventional cardiologist who sees such patients day in and day out and so one may wonder why if the results are so convincing, we aren’t all forced to put everyone on a plant based diet. It would be safer, more cost effective and beat almost any procedure for treating advanced severe coronary disease. This makes the findings hard to believe, although I think it would be arrogant to be entirely dismissive.
Of course there are many issues. Firstly there are only 18 patients. On the spectrum of trial evidence, this is weak, there is no randomization, no control, no multicenter, small sample etc.… For these reasons, the article itself is published in a journal that would typically never be read by cardiologists and is certainly not a high-ranking journal. The final issue is that the primary author of the study is author of several related books and therefore potential conflict issues arise on further discussions of the work by that team.
So does a plant based diet reverse heart disease? According to the findings of the initial study there can be some regression of blockages in patients on a plant-based diet and if there isn’t regression there will be stability. Importantly there is possibly a remarkable reduction in heart events. The findings would be much more believable if there was a larger study conducted, with randomized groups, and across different centers. I really cannot understand why this has not been done as if there is major belief in this approach this should have been done or at least attempted by the authors and their institutions.
Is it worth trying?
There is too much evangelical marketing that far overstates the true potential benefits of such a program and in reality somewhat discredits it in the eyes of the scientific community. It’s important that people understand that this is profit driven. I don’t think it’s harmful however. There is a potential benefit to this approach particularly in combination with standard therapy. The problem is the real life ability to stick to this diet would likely be dismal given the dietary habits of today! It would be much more compelling if the evidence was stronger. If I had significant blockages, I’d certainly want to hope it worked it although it would be hard. I think standard therapy should be continued alongside the diet. It’s certainly no miracle cure in isolation. Such diets also fail to take in to account potential beneficial effects of good fats such as olive and coconut oils championed by Mediterranean type diets that have shown to be associated with potentially favorable outcomes also.
Lifestyle Changes and Low Fat Vegetarian Diet – Ornish Type Plan
What is the Ornish Plan?
The definition often used in research studies of this plan is low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise. Its often neglected that this plan is not simply a diet, it is a comprehensive lifestyle change with all of the above that would be required to see the claimed results. It is a profit driven enterprise that centers on books and programs.
What did the studies show?
In 1990 a study was published named “Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.” In this study 28 patients were assigned to the lifestyle intervention and 20 were assigned to standard care at the time. Study duration was a year. It was found that the intervention group had a decrease in blockage by a few percent and the standard care group had an increase in blockage by a few percent. It was concluded that comprehensive lifestyle changes might be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.
In 1998 the five-year follow up study was published. In similar findings to the 1-year study it was found that the intervention group had a decrease in blockage by a few percent and the standard care group had an increase in blockage by a few percent. The effect of the diet appeared to be even more pronounced over time. Importantly there were more than twice as many cardiac events in the control group.
What to make of these studies?
Again there is too much evangelical marketing that far overstates the true potential benefits of such a program and in reality somewhat discredits it in the eyes of the scientific community. It’s important that people understand that this is profit driven. I don’t think it’s harmful however. There may be a potential benefit to this approach particularly in combination with standard therapy. The studies demonstrate the potential for such a diet to have an effect on heart disease however the level of evidence is certainly not definitive and should not be marketed as a miracle cure. At least an attempt has been made to underpin the findings with research and evidence. A large multicenter controlled trial, with thousands of patients would provide a more compelling case. Regardless, the diet is an improvement on the diet that most people currently have and so it’s hard not to at least consider this as an improvement over current care. If there is a benefit then it would be due an approach is that it is holistic in nature and is not simply a diet, but a comprehensive lifestyle change. Such diets also fail to take in to accounts potential beneficial effects of good fats such as olive and coconut oils championed by Mediterranean type diets that have shown to be associated with potentially favorable outcomes also.
The Pritkin Program
What is the Pritkin Program?
It is a program for diet and exercise. The program champions unprocessed or minimally processed foods in addition to regular exercise and physical activity. It is more of a brand than a scientific method however. It centers on books and a resort that aim to improve cardiovascular health through the associated lifestyle.
What did the studies show?
When researching this I was a little disturbed by the overreaching scientific claims made. This program aims to distinguish itself from the others by saying it is the most scientifically studied and backed however the claims are overreaching. They claim that over 100 studies in prestigious journals have documented the efficiency of the program in helping thousands of patients worldwide. Lets look a little closer at these claims. The New England Journal of Medicine is considered amongst the most prestigious medical journals. The only article regarding the Pritkin Program in this journal is in fact a letter to the editor that is written by an author who is now central to the program. Furthermore the findings were that serum cholesterol could be reduced through lifestyle modification. The same article concludes “the long-term effects of the lower serum lipid levels on health and longevity are not addressed by these data. Whether severe restriction of dietary fat is a realistic public health approach to lowering serum cholesterol levels is uncertain.” Another article, which was really a “rapid communication”, was published in a good journal called “Circulation.” This study only looked at 11 people and demonstrated that low fat high fiber diet in combination with lifestyle modification and exercise can reduce blood pressure and some markers of inflammation. Importantly the findings of these studies whilst interesting and thought provoking do not meet a high level of evidence such a multicenter, randomized trial with high levels of participants. These studies do not show rigorously tested hard endpoints.
What to make of these studies?
Basically the Pritkin program states the obvious, but charges a high price to state it. If we exercise, stop smoking; stop eating processed foods and make healthy lifestyle modifications then we can potentially improve some health parameters. Whether this translates in to long term hard outcomes is not really known and it’s sad that these programs are driven by the need for instant gratification and profit as opposed to really showing they believe in their work by getting together and conducting high level scientific studies that would lessen the skepticism. Such diets also fail to take in to accounts potential beneficial effects of good fats such as olive and coconut oils championed by Mediterranean type diets that have shown to be associated with potentially favorable outcomes also.
Is it worth trying?
Would I try the obvious, lose weight, stop smoking, eat less processed food, exercise regularly and change my lifestyle to be healthy? Obviously less. Would I make drastic dietary changes that aren’t proven to change outcome and almost impossible to follow? No. Would I pay a lot of money to do the obvious? No.
Fruit, Vegetables and Risk of Heart Disease
The EPIC study is a study that is ongoing and had basically followed a large number of patients over many years in order to learn about factors associated with diseases from cancer to heart disease. One of the related studies looked at fruit and vegetable intake and its association to dying from heart disease.
What did the study show?
The study looked at over 300,000 participants followed over an 8-year period. The participants were from many European countries. The study placed emphasis in to into refining dietary methodology across centers, which is a great strength. Each portion of fruit/vegetable was defined as 80 g. The lowest fruit and vegetable group was seen as 3 portions or less and the highest 8 portions a day. It was found that when compared to the lowest group, those having 8 portions a day had a 22 percent reduction in death from heart disease. Further analysis showed that every unit increase in portion of fruit or vegetables resulted in a lowered risk. These findings held true regardless of intake of other food groups.
What to make of it?
Hardly anyone would argue against encouraging fruit and vegetable intake to prevent chronic diseases and improve their outcomes. This was one of the first studies to back that up with good evidence. Any study that uses complex statistics needs to be taken with caution however and will always be limited.
Is it worth trying?
Its like physical activity and lifestyle changes, it seems a no brainer to incorporate fruit and vegetables in to the diet. The interesting thing about this study is that it suggests that even those who had less than ideal dietary habits otherwise, fruit and vegetable can still reduce risk. Also don’t forget a reduction in cancers, blood pressure and stroke.
Traditional Risk Factors and Risk of Heart Attacks
What are Traditional Risk Factors?
Traditional risk factors are those such as smoking, exercise and blood pressure. These are the risk factors that doctors have targeted over years when giving advice to patients about reducing their cardiovascular risk. In the INTERHEART study, the investigators looked at the effect of 9 risk factors on the development of heart disease. These 9 risk factors were felt to be potentially changeable or “modifiable” risk factors. The risk factors were abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity.
What did the study show?
The study looked at 30,000 participants across every continent. It was found that abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of heart attack worldwide in both sexes and at all ages in all regions. Most of the risk was attributed to smoking, lipids, hypertension, diabetes, and obesity.
What to make of it?
This study tells us what we already knew, but backed that up with evidence. Moderating alcohol and weight, increasing fruit and vegetables, stopping smoking, increasing physical activity, reducing stress and waistline, controlling blood pressure and diabetes are all felt to be important. Importantly these risk factors are felt to be modifiable, which means we can do something about them.
Is it worth trying?
I don’t think anyone would argue against modifying the risk factors mentioned above. Its important to realize that not diet alone, but an integrated approach that incorporated lifestyle is likely to be the most effective in reversing and preventing heart disease.
Chelation Therapy for Heart Disease
What is Chelation Therapy?
Chelation therapy consists of intravenous infusion or sometimes-oral administration of a treatment containing disodium EDTA and various other substances. With regard to heart disease, it is thought these substances go through the bloodstream and can remove the calcium from plaques in the arteries therefore shrinking blockages. In the 80’s and early 90’s some proponents of chelation therapy were touting this as a miracle cure. The scientific community has remained very skeptical, as the evidence was poor and the therapy potentially harmful. A landmark trial called the TACT trial was performed and commissioned by the NIH to investigate the effects of chelation therapy on heart disease.
What did the study show?
The study looked at around 1700 patients who had a heart attack in the 6 weeks prior to the study. The study concluded that among stable patients with a history of MI, use of an intravenous chelation regimen with disodium EDTA, compared with placebo, modestly reduced the risk of adverse cardiovascular outcomes. Most of that was driven however by the need for repeat interventional procedures. They then said these results provide evidence to guide further research but are not sufficient to support the routine use of chelation therapy for treatment of patients who have had an MI. There is certainly no evidence that heart disease can be reversed by chelation therapy.
What to make of it?
To know what to make of this trial we don’t really need to look beyond the editorial articles that accompanied the article. In one editorial it reported “these findings do not support the routine use of chelation therapy as secondary prevention for patients with previous myocardial infarction and established coronary disease”. In another more scathing editorial it reported that “given the numerous concerns with this expensive, federally funded clinical trial, including missing data, potential investigator or patient unmasking, use of subjective end points, and intentional unblinding of the sponsor, the results cannot be accepted as reliable and do not demonstrate a benefit of chelation therapy. The findings of TACT should not be used as a justification for increased use of this controversial therapy.
Is it worth trying?
I personally wouldn’t try or recommend it based on the evidence provided. There is no good evidence it reverses heart disease.
Outstandingly clear and comprehensive summary of areas that boggle the mind of those trying to keep up with the latest information. Thanks for sifting facts from fads and fantasy.
Would like something specifically about vitamin k2, pomegranate and dark chocolate.
Mainstream doctor for cold hands & feet, wore gloves around the house and socks to bed; I was told there was NOTHING that could be done, but, “Once it gets up here (as he dug his fingers into his chest) we can go in and dig it out.” Was told to just go ahead and keep wearing my gloves and socks as I mentioned. About a year & a half later – short story: Found out about CT (chelation therapy), examination by my naturopathic doctor showed I was headed for a heart attack or stroke by age 60-61, I did CT. Although I did a series of them – can’t remember how many, that was apx 27 years ago – and after the 3rd one no more socks or gloves as described. Had an annual hay fever and asthma problem at the time – never-ever again took a hay fever pill or used an inhaler. CT should be used as soon as any kind of circulation problem arises – but sad to say it’s pretty much slam-dunked by those that stand to lose money from profitable procedures if it comes into the arena openly. Also, when I did mine I brought my brother up from another state – had been declared legally blind. CT won’t bring back the damage that’s already been done – but he still has the same, usable, peripheral he had when he first did CT. And I heard one successful story after another, and the one story: man with parts of toes amputated (diabetic related), doctor wanted to amputate his foot, he found out about CT, did it. Color came back, new skin growth, no longer had to use crutches to walk – and amputation surgery CANCELLED. Yes, CT should be the first line of defense; but once again, it would cost ‘some’ in Mainstream Medical a lot in lost procedures that wouldn’t be needed, and throw in what Big Pharma would lost, wow! Two books written, early 90’s, “Bypassing Bypass” – Elmer Cranton & “Forty Something Forever” – Arlene Brecher. Here you’ll start to find out how long CT has been around but….slam dunked (even though it works for so many things.)
“…too much evangelical marketing that far overstates the true potential benefits of such a program and in reality somewhat discredits it in the eyes of the scientific community. It’s important that people understand that this is profit driven”
GIVE ME A BREAK
Do you guys REALLY expect people to keep believing that the “scientific community” is NOT profit-driven??? Nobody makes more profit than Big Medicine and Big Pharma. Nobody!
Thank you for taking time to read the article and your comments. I like to think we all have the same goal in mind, which is to help those with heart disease. Its important to realize the point of this article is simply to present the facts. The facts are that most of the claims made by these fad diets are unsubstantiated. This is disappointing because a lot of them have parts that deserve merit, but to claim that they are proven to reverse heart disease is simply misleading. I fully agree that the motives of ‘Big Pharma’ have been undesirable and i am not endorsing or attacking anything in particular. If they claimed they could reverse heart disease then I would have ensured they were presented also. I have been careful to leave out many things such as stents or procedures. The goal was simply to try and present an unbiased look at many of the programs that claim to reverse heart disease.
Dr, Thank you for taking the time to share your knowledge and opinions. Randy
Thank you. This was very helpful and also reassuring
Glad you found it useful.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Do you have any other ways to follow you? Intwrested in heart therapy. Im 49 with no medical insurance and need a plan.
Dr Thanks for the article presented so well . I am 53 yrs old Male and have been detected with blockage in my heart. I have been diabetic and hypertension for over 20 years. I want to know if there is any medication or Diet which can reduce the calcium in my heart. In 2018 I had calcium of 20mg and in 2022 my calcium reading was 119. Doctor says it may be due to Vaccination . request your hekp and guidance
Seems we all have the same goal to help AND make a profit as you do also. From my research dietary changes and stress reduction and proper sleep are more effective and less profitable than doctors, surgeons, and the medical community’s profit driven and lacking, biased knowledge of such. You fail to mention how many people have a heart attack that have normal cholesterol. Let food be our medicine is actually more effective than you care to admit.
The idea of the article was to stimulate discussion, not to falsely reassure people. Im simply providing a balanced viewpoint. If you are a heart patient and want to try a diet such as the ones above i would totally recommend it if you can but i’m not going to tell you it is guaranteed to reverse your heart disease because that it nonsense. Many people have a hear attack with normal cholesterol, however many smokers live a life without heart disease, it can go on and on, we still tell them to stop smoking.
I totally agree, let food be our medicine, its easier said than done though right!
The doctor is being very helpful, now please stop annoying all of us who are learning about heart disease! My husband had a heart attack 14 days ago.
Doctor, thank you very much for very clearly articulated guidelines which I found very helpful. As a heart patient with 3 stents after an event, I attended 12 weeks of rehab. The fundamental thrust was basically what you have stated.
Yet, my learning curve is slow …and periodically, needs reminding. I purchased the Mayo Clinic Diet and tried following without being paranoid about it. The general thrust of that Diet is very much all of what you have stated. My doctor has me on the typical meds and I know basically I have to follow a well established exercise plan…. not easy – ,eat a properly balanced diet …also easier said than done – take the meds which I do. I am 78 and am very aware that my heart is better than before, but still not perfect…. I am very grateful for the advances in the medical field and for my doctors who saved and extended my life. Thank you again, and I am sorry for the many negative commentaries of persons who can’t understand the limits of what science and man can do.
I agree Jeff! These guys are always touting the no proof and no evidence argument about anything that isn’t pharmaceutical driven. It is so unfortunate that we have so many people suffering and dying from these diseases because these Physicians can’t seem to get real accurate information that’s not paid for by big Pharma. That they assume we are all I can’t believe the stories that there is no cure all you can do is stay on medication for the rest of your life to sustain a disease and there’s nothing else you can do but just deal with it medication. I have personally seen countless is reversed disappear medical or pharmaceutical applications! totally natural and a whole stream of doctors that are getting these types of results seem to be mysteriously dying. Hmm….
I agree. He has said all diet plans are FOR PROFIT. Is not being a doctor and doling out Drugs that they get kickback from BIG PHARMA a For Profit motive?
I have 4 stents.
I have been following a whole food plant-based diet (90% compliance) for about 2 years. It has cost me nothing. In fact, beans are much cheaper than meat.
I have found NO studies that diets containing meat or dairy reverse heart disease.
I have seen NO serious studies that a well-planned whole food plant based diet is harmful.
So, while large-scale studies have not yet been done. If I am to bet my life (and I am) with every forkful of food I eat, for now, I will place my bet on more fruit, veggies and legumes and as little meat, eggs and cheese as I can forgo.
As soon as a study (of better quality than Esselstyn’s) tells me I can eat bacon and brie, I will switch. Until then I will follow a whole food plant based diet (as much as I can).
AND I will take my statins because it seems the evidence for THAT is solid. Even Esselstyn agrees.
And exercise, sleep (with cpap), (smoke and alcohol abstinence).
Doctor Ahmed, please do not assume it is difficult for your patients to change. You underestimate how motivated people can be. Of course, if you continue to tell then that diet is too hard so why bother, then they have no motivation.
The standard American diet is SO bad, (with FOR PROFIT garbage constantly pushed on us) I think attempting a diet like mine (and failing 50% of the time) Is still a step in the right direction.
We’re on the same page with much of this. There is no limit to the discussions i have with my patients regarding lifestyle, diet and such. The quotes regarding change are a direct reflection of hard statistics, it doesn’t mean that we shouldn’t keep trying, it also means that more research to provide real outcomes be done with regard to the plant based regimens, this is how they will be legitimized and the industries behind these absolutely have the means and resources to make this happen, rather they choose not to.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” – Upton Sinclair
Thanks for sharing your knowledge and experience – appreciated!
Dr. Mustafa Ahmed, Thank you for the article.
I thank you for the review of these three similar dietary and lifestyle programs.
There are a few others that are also along the same lines with only minor differences.
I have read all of the studies related to each of programs. Indeed I have read those studies many times over, line by line. I try to be skeptical of everything stated.
I am a CAD patient for the past 5 years with blockages in my LAD and 2nd diagonal.
I have had two stents placed in my LAD… with the second diagonal too small for a stent.
Again, I am very skeptical of any claims. Having said that I am troubled by your repeated emphasis on the idea that these programs are “profit driven”.. As though all of medicine is not profit driven. What was the cost to put two stents in my LAD? Though I am insured, I’ll be that the cost was easily over $20,000.
Compare that cost to the easy access to nearly everything these mentioned programs cost for anyone who has the time to go on the internet or buy a few inexpensive books.
I currently follow a mixture of Ornish, Pritikin, Esselstyn, and McDougall.
I have spent zero dollars and yet have been able to understand everything available about these 4 programs. Let me repeat that… I have spent zero dollars to gain a understanding of what they promote. I have accessed all of the studies they claim back up their programs and those journal article cost me zero dollars.
So while some patients feel the need to go through some formal program, it is easy for any motivated patient to gain all the knowledge they need without spending a dime.
Can one easily stay on the programs. If one understands the programs and cares very much about living, they can easily adhere 98% to the programs.. Perhaps gradually achieving that 98% adherence. You make it incredibly difficult, nearly impossible.
When the alternative is a future bypass or death, it really can motivate patients if their own doctor is not continually saying it is nearly impossible to follow.
Don’t knock these programs just because not everyone will follow them. Allow those who will the chance to benefit.
The real question for you is what else do you offer? I exercise 6 days a week. I take my Atorvastatin. I have already had two initial stents placed. I am willing to take any steps to give myself a better chance.
You don’t seem to be saying these programs are completely ineffective, yet you almost seem to be suggesting they are not of any value to follow.
Yet you offer nothing with any more hope.
Sure their studies are very limited in size and in having 500 experimental along with 500 controls for 5 years.. But you keep asking why these doctors have not done such studies.
Please…. you know full well the cost of doing such a trial of that size for years.
How many tens of millions of dollars would that cost? Sure, Lipitor has such studies for their drugs and guess how many billions were made off of Lipitor ( atorvastatin) ?
You have really done a disservice by repeatedly stressing the evil “profit” these programs are making, as though they could stay alive without charging anything.
Same with their lack of spending tens of millions to conduct a massive study.
BTW, one can go to the McDougall site and get absolutely everything for free.
No need to go to a weekend or week long program.
Some of us have spent zero dollars to understand these programs.
We have read and evaluated the shortcomings of the research.. some of which has been in reputable journals such as Lancet and JAMA.
We evaluate the limitations of those studies and weigh them with all the other information.
You seem to denigrate our efforts when at the same time you offer nothing more than the standard… olive oil and coconut oil ideas from the Med diet. A diet that really promises little in improvement compared to doing almost no changes.
We who have CAD are not fools and many of us are highly motivated to make every effort on improving our chances. Minor changes in lifestyle promise very little.
Major changes may or may not work for everyone, but it is wrong to keep suggesting they are of little value because 90% of people won’t follow them… or because some doctor dares to make a profit in promoting them.
I repeat, we are not fools out here. We’ve seen everything you have mentioned and know their are no guarantees, but on the other hand we are willing to follow a diet that has no known dangers but which may…. may… actually offer some significant benefit to avoid future events.
BTW, Medicare thinks enough of the Ornish plan that they pay for it.
I am glad you gave the overview, but you really go overboard on several points..
Profit being the major one. The next being the unwillingness of most patients to follow the plan. Please give those who can follow it some credit for taking control of their health.
Many of us out here with CAD want to give ourselves the best chance. I’ve seen nothing in your article to suggest that these plans offer a possibility of a great benefit.
We may never get that $25 million dollar study you want, precisely because their is minimal profit to ever be earned from these programs.
Lastly i do understand the excessive claims that some of these programs sometimes lead their followers to believe.
But many of us see those for what they are. Example.. “not a drop of oil”….
Not backed up by any study… It is more a psychological dictum than a necessity.
But BTW, many of the studies indicating liberal use of olive oil are also very flawed.
The most recent study from Spain was funded by the govt.. trying to promote olive oil.
Bottom line, I read and read and read studies. I have seen no dietary path that offers more hope for slowing or halting progression of CAD than that offered by Ornish, Pritikin, Esselstyn, and McDougall.
If you have a better dietary lifestyle plan I might look into, please offer it for your readers.
Of course I will also be very skeptical of it as well.
Give some of us credit for being highly motivated and also highly skeptical of every claim.
We are not dummies.
Thank you for the subject matter.
Your insight, time and comments are great. The article was not designed to remove credit from those taking initiative to improve their own health rather much the opposite. I fully agree that even the large medical studies on certain lifestyles are limited in effect and seem to change their conclusions on a yearly basis.
I did not harp on the fact that the Big-Pharma industry may the most guilty of all, simply because, (as you know), the people that take their time to research this stuff already feel that way. There is simply no point in yet another article reaffirming that, there are hundreds. The point of the article was to stimulate discussion but also provide a level of scrutiny to the ‘miracle’ plans that in their own way are guilty for not providing facts or respecting the intelligence of vulnerable patients.
The plans are to be encouraged for encouraging personal responsibility for ones health and to encourage aspects of lifestyle that we deep down know make sense. I like many believe a healthy sensible lifestyle with a hug emphasis on moderation and personal responsibility can play an important part in stabilizing disease.
They are to be discredited however for making ridiculous claims that people want to believe as they see it as their only source of hope. If these claims are not so ridiculous then why not take the time and spend the money to complete, raise the investment, and fund decent studies that prove the claims beyond doubt. It would pay off a million fold. The reason is that these plans don’t convincingly reverse anything in the way they claim. To think they aren’t profit driven is also naive, many have pushed and have been approved for reimbursement from CMS and are now huge profit centers. They also use outlandish and unproven claims pray on hope of patients with little other alternative and therefore should be subject to scrutiny.
The reality of modern day heart disease is that even those with advanced disease can have an excellent outlook. Medicines alone are not the answer and are of course highly limited in many ways. Healthy lifestyle, diet, exercise, activity, moderation and such are likely key. There is no magic reversal as things stand and people need to stop claiming as such, and maybe we would take them and their potentially useful plans more seriously. As you say, they need to not insult peoples intelligence.
It is funny because this poster complaining about the article – very articulate – but I look at that and the article I just read – and see Dax is saying the exact same thing as the doctor – another words – Dax taking issue on just a few things the doc is making sure to point out – Dax agreeing with that but thinks it should only have been pointed out once.
🙂 So – Pats on the back to both of you – and I am hearing the same thing from both of you with different focus points.
What I would like is information included about organic meats – I think any feedlot meat is what research is from – and shows it is bad – but the omega 3 and other trace minerals from grass fed and grass finished meats may actually be beneficial – as well as raw grass feed milk and butter …. I’d really like to see some more info on this – and to DAX point – while some will see this and cram steaks and butter down their throat – others will realize it means they can have some and still be going forward.
Dr. Ahmed, I was diagnosed w/CAD a year ago, had an angiogram which revealed 85% blockage (however accurate that is) of LAD + had less in other arteries. The interventional doc recommended bypass, which there was a good argument for, but I wasn’t having an event. I experienced shortness of breath when running after a mile. Working in a large healthcare system, I reached out to another highly regarded cardiologist same hospital that had me take a PET stress to determine flow. He said flow is THE main factor to determine surgery or not. PET revealed 8% deficiency of left ventricle. HE suggested diet, exercise and meds and he would be doing more harm sending me to surgery. That Dr also asked me to watch Forks Over Knives. I’m so thankful I reached out to this Dr! My BMI is nw 22.3, I walk about 1 hour everyday, adhere to diet and feel wonderful! I spent about $10 (used) on Esselstyn’s book Prevent and Reverse Heart Disease, read JAMA, keep up w/latest trials, trying to wrap my head around complex lipidology, etc. I take another PET Stress in 3 months. I think Ornish, Esselstyn, Caldwell, Gregor, etc should by commended, not ridiculed for their studies. The evidence is so overwhelming that diet, lifestyle and exercise are the major factors for combating chronic disease. I’m certainly not out of the woods and don’t expect to totally reverse the plaque, but being able to treat my CAD without getting my chest split open is a huge motivator! Thank God I reached out to an intelligent forward thinking cardiologist! I bet him $1000 my disease has not progressed. He saw my $1000 and raised me a $1000! I’ll let you know what my PET reveals in a few months. I don’t expect a “miracle reversal”. I just know how great I feel right now. About to go on a 25 mile bike ride. Take care!
So Jax, I’d love to hear how it turned out… did you see any reversal?
Very well stated, Dax. Many expect doctors to provide a quick fix, typically in the form of pills. The medicines that perform well get shelved eventually as there is no big profits to be made. Quality of life takes a back burner to profits and expediency. Go to the doctor for excruciating back pain, leave with a cholesterol lowering medication and a scheduled mammogram. Nothing for back pain, because preventing addiction is in the best interest of the doctor and treatmenting facility – avoids government scrutiny. Same thing with high blood pressure. Here’s a prescription! Notice that no doctor ever will refuse to prescribe a BP medication and demand that the patient just suffer until it resolves itself. Nor will they take the time to insist the client change their diet first. Why? The government practicing medicine! Doctors risk law suit by not prescribing the BP meds. Funny they withhold antibiotics and valium, even though generally effective.
Bottom line is that patients get lost in the shuffle. Doctors do what the government allows. Government is paid by Big Pharma. Politicians and pharmaceutical companies profit from human misery; not to mention doctors. Don’t get me started about insurance companies!
There’s money to be made in “studying” and none in “cures”. Is that why nutrition isn’t taught at University? Ornish, McDougall, Fuhrman, et al, may not be flawless nor have the funds to defend their success rate with the same “science” as Lipitor (who pay for studies favorable to them), but these healthy eating advocates are helping people. If all they were selling was individual empowerment and self-accountability, that’s far more than my doctor or government has done to improve my health.
Hmmm. Funny, you don’t need an order from a doctor for a mammogram any longer. It’s common sense as a woman to get a mammogram. What an odd thing to complain about a doctor suggesting you do.
The fact is that the majority of people who have CAD are in the situation they are in because of poor life style choices. Most don’t want to change their lifestyle. Patients are not willing to help themselves. I have never known a doctor to not suggest a healthy diet and exercise as solution to many, many health issues. Those who follow this advice will find it changes their lives. Medications can be discontinued. Those who don’t change, spend a life time on meds looking to the doctor to be fully responsible for their poor health. Complain to family and friends that their doctor isn’t doing enough, when they do nothing to help themselves.
Last week I saw a heart surgeon for congenital heart disease, it’s surgery time again. I followed a very morbidly obese man in to the same office where i was seeing my surgeon, he insisted I was in the wrong office. I am young, healthy weight, intelligent, overall healthy appearance. This man was very upset, insisting I couldn’t possibly need to see a cardiologist. I had to get pissed off at him and tell him yes, my heart sucks, I was born this way and I need surgery. Is it ok with you if I go to my appointment? In his mind, only people who don’t take care of themselves need a cardiologist. I take care of myself and i am still sick. I have zero risk of CAD though.
Bottom line is it kills me to see folks who were born with healthy hearts abuse them.
It’s the American life style of overindulgance that clearly drives the big pharma companies. Drugs, alcohol, smoking, over eating. People are getting sick younger and younger in America.
For example a close friend had a major heart attack the day after he turned 5o. Had triple bypass. He complains constantly that can’t breathe, his blood pressure is high. He checks it 10 times a day. Goes to his doctor literally every day for 2 weeks because his BP is high. Hes been retested with every test known. His heart works fine, he is out of shape. All he wants is a medication that works. I ask him, did you tell the doctor you ate pizza and wings last night with enough sodium to give you another heart attack? He chuckles and says no. You ate a whole bag of chips and a package of cookies? You’ve gained 10lbs in the last month? And you just want a miracle pill????? WHAT THE HELL??? Help yourself !!
I promise you, every one of his doctors is very frustrated and encouraging him to eat a healthy diet, exercise…etc. yet they are obligated to give him the drugs he needs. I can see it coming, he may not, the drugs will never be enough to keep him going. He will die an untimely death. He’s the only person who can stop it.
I love your comments as they are so true. I am a health coach with a heavy emphasis on a plant based diet. I see people every day in poor health and overweight. When I tell them I could help them get better eating a plant based diet, they prefer to eat the junk and take pills. It amazes me every day that people have such inconsideration for their own health and value the taste of junk food over being able to walk across the room. I have seen amazing results for people that adhere to the diets recommended by Ornish, Esselstyn and others and am always amazed when someone obviously sick makes no effort to get well. They seem to gravitate to the diet fads like Paleo and Ketogenic who are just Atkins with a different label. I have finally figured out that a lot of people don’t want to believe that their own habits could be killing them that they are instead victims of genetics, etc. Like it or not, a plant based diet is known to cure many illnesses not just heart disease. Yes, there may not be as much research out there for plant based diets since most of the research done in the US is paid for by the cattle or dairy industry and slanted to make their products look healthy, thus the surge in eating saturated fat which has now been deemed as healthy by one of the studies funded by the dairy industry. It is a no brainer to me but I still run across people every day that would rather take a pill than take responsibility for their own health.
C’mon Dax, you just agreed with almost everything the doctor said. He said almost every time for every diet, it’s common sense to do what they say for free, not pay for the expensive program. Isn’t that EXACTLY what you did? He said they are all probably better than most peoples typical diet.
Just because you researched and collected the information from all four plans free, doesn’t mean that information was free to the industry – it is absolutely profit driven. It’s for sale and these guys make lot’s of money from these programs. You just didn’t pay. Good for you and you’re resourcefulness. *wink*
And very good info. in your post. But it’s kinda funny, you bolster the Dr. great points very well.
Very well explained. I appreciate it.
I too have CAD and my doctor advised me to rush for bypass surgery 5 months back. I choose dr ess plant bases diet plan and Since then I lost 12 kg in just 5 months and m feeling much better than ever. I believe this would not only halt my disease but it will reverse it. Despite several calls and emails to dr esselstyn he charged me 0 dollars for guidance.
Aamir,
Hope you are doing great. I’m also diagnosed with CAD in October this year. Doctor recommends bypass surgery.
I’ve been on Dr. Ornish diet for almost a month now. I’m feeling better. May I know what kind of tests you did to measure your progress?
It is really strange to say that the plans advocated by Dr Esselstyn and Dr Dean Ornish are motivated my profit. Both of these doctors performed scientific studies and published them in peer reviewed journals.
They did write books and get some royalty when you buy the books. But how else do you propose they get the word out? One is able to borrow these books from the library or buy it online for but a couple of dollars if you willing to buy them used or $10 if buying new. Is that profit?
Profit is really made when stents are placed in stable patients, earning the hospitals and the doctors tens of thousands of dollars. Or when a bypass is done when 100s of 1000s of dollars are made.
You do not mention anything about the uselessness of stents and bypass operations in stable patients. That these procedures don’t work any better than optimal medical therapy (that is, taking meds such as statins, beta blockers and aspirin).
Even statins give you a false sense of security. The only way to treat heart disease in the long run is to change the diet to a plant based diet with little added fat and regular exercise at a moderate pace.
Medicare should sponsor a large study to convince the skeptics like the writer and to save the country hundreds of billions of dollar every year.
In any case, taking advice from interventional cardiologists who make millions per year on the usefulness of procedures is foolhardy. Talk about a profit motive!
My history: I was having angina and was sent for a stress test which I failed. Before doing the angiography, the doctor told me I needed a stent. I declined. I did my own research and found that procedures in stable patients such as me do not work. That I needed to change my life style to address the systemic problem heart disease is. I came across Dr Esselstyn and Dr Dean Ornish in my research. I came across thousands of reviews and experiences of heart patients that followed the diet. That and talking to plant based doctors convinced me to start eating whole plants only with little added oil. I lost 30 lbs, got rid of my angina and am still here 5 years later. And I never got that stent!
If doctors start acknowledging the overwhelming evidence that a plant based diet works, our health system won’t be in such shambles.
Gupt Ji said:
“In any case, taking advice from interventional cardiologists who make millions per year on the usefulness of procedures is foolhardy.” –
I say taking advice from a person with no formal education in the medical or nutrition field is more than foolhardy. I’ll take the educated Dr. in this case. I heard the unsubstantiated claim from fanatics, even some educated one’s.
And what was this doctor’s advice?
No miracles, get exercise, quit smoking, lose weight, and recommends many of the plant based dietary practices in these diets. Do you guys actually read carefully the article? Seriously.
The only reason I came to read this article btw, was for ONE REASON ONLY. Does a vegan diet REVERSE arterial buildup? Not stop it, REVERSE it. Are there well researched, peer reviewed and professionally published studies with diverse evidence to support REVERSAL?
All the other stuff was a bonus.
I have to wonder how much genetics plays in. I have to admit, I don’t eat the healthiest. I love steak and other not so healthy items. My cholesterol is 131, triglycerides 78. Chol/hdl ratio 2.9. My husband who eats salads every day for lunch, doesn’t drink, smoke, doesnt put anything bad into his body, doesn’t even drink a soda, has sky high cholesterol. He is physically active all day, every day, slender. I find it crazy.
Nice to read this blog really amazing article, and thanks for posting re-engineering.
16 years ago my husband had a heart attack and stents. since then he has been 99% vegan. Now at 64, we just learned he has some blockage in a different area than the stents, “not life threatening” at this time. Cholesterol numbers are good, not a problem. Family history – cardiac problems and overweight. He exercises some, (knee been hurting last few weeks & not so much during teaching school days.) Suggestions about diet? Eliminate oil and salt? We will get membership to swim so stress off joints for exercise.
Sounds like he is doing well and that you have taken care to alter lifestyle. In terms of diet, it seems he has chosen a diet that would be considered by many to be a good choice in this setting. The reality is there is no 100% way to prevent disease progression however that in combination with risk factor modification (blood pressure, diabetes, etc) leads to better outcomes. Exercise if possible is definitely encouraged. Some recommend oil and salt restriction however others would recommend moderation and good oil consumption. Very confusing isnt it! I think adherence to some form of ‘healthy’ diet as discussed above is the best advice. In terms of the blockage, symptom surveillance and regular follow up is key.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
My mother is having 30-40% blockage.She is also having high blood pressure.She is being adviced to take medicines and have low fat diet.She is 42 years old.She is having many tensions and worries in her life.Can this blockage be fully cured?How should she carry her lifestyles so that she could be saved from heart disease?
The blockages are not critical at this stage and they can be stabilized with good attention to risk factors, lifestyle etc.
No smoking. Meticulous control of diabetes. Lifestyle changes. Healthy diet. BP control. Cholesterol evaluation. Exercise. and so on.
you can follow my twitter at @MustafaAhmedMD
“Healthy Diet”? That’s the crux of it. In your article you state, “Have moderation in diet, whether it is a plant based diet, a Mediterranean diet, a no carb diet or other. While each one claims to be the best, the reality is that each is likely better than what we do on a normal day to day basis.”
So are you claiming “No Carb” is better? Really. These nearly always promote high fat (including saturated fat), loads of dietary cholesterol and no whole grains and fruit.
Do you really chuck that in the same category as a plant-based diet? I think that is a disservice to people to say that. Are you saying that the evidence on saturated fat and heart disease is irrelevant?
Hi Doctor, I’m a 48 yo male, I’m 75 pounds overweight, with family history of heart disease. For about 15 years I have felt moderate chest pain, shortness of breath, pressure, and heart palpitations, which have been almost completely relieved by taking baking soda, later changed to Omeprazole.
For 1 month I have been jogging on a treadmill, 3 time per week for 5 minutes each session. And with antacids, there are no issues, except legs and feet feeling tight and tired.
My doctor however wasn’t so convinced that I was “OK”, and scheduled me to see a cardiologist. Well my insurance ran out before I could see him/her. So now I am left with prescriptions of Valsartan, Omeprazole, and and anti inflammatory med.
I’m about to run out of meds as well…
I also suffer from ADHD, self esteem and low energy issues, and depression. So as you can probably imagine, I had to skim through some of your thoughtful blog.
Do you have any advice? Should I try to reach my (ex)primary doctor? And ask him, “what should I do in the meantime”?
Honestly, at the news that the calcification is fairly permanent, and that I have to eat, exercise and medicate properly, I feel even more tired, unmotivated, and defeated.
The outlook for you can actually be very good and its key you stay positive. Please reach out and seek medical evaluation asap to see if a plan can be made to ensure you get the medicine you need.
First, let me start by noting your statement regarding Dr. Esselstyn having a conflict of interest is incorrect. He has only published a single book and the website Vegsource released a video of one of his lectures. Esselstyn’s son, Rip, has published several books. However, Esselstyn has published additional papers with further patient studies.
Second, my father had a triple bypass and in less than two years later was scheduled for stints. I insisted he get a second opinon from Dr. Esselstyn and after agreeing to follow the Esselstyn program, he was off 50% of his medications in 10 days and all meds in ~14 – 16 days. Subsequent follow ups reversed the recommendation for a stint.
I would suggest failing to objectively consider a program like Esselstyn’s while promoting drugs is doing a disservice to your patients and readers.
Its not by any means a personal viewpoint rather it is a objective viewpoint. I don’t have any problem with any of these diets, i don’t think they are bad and they are certainly better than conventional lifestyles. I am very much against unnecessary procedures and would be delighted to see advancements in reversal. Its important that it is explicitly pointed out that the superlatives and claims by many of these diets are not backed up by anywhere near the level of evidence expected. I don’t promote drugs and i don’t want to deter anyone from trying any of these diets. To the same tune, while i wish there was one, I don’t want my patients being told there are magic cures simply because some books say so with class C evidence. By all means, try the diets though.
Eccelstyn and Ornish are backed up by very comprehensive studies such as framington and china study. The evidence is overwhelming when comparing the occurance of CAD in plant eating populations verses western populations where it remains No 1 killer. Get your cholestoral under 150, eat plants and be encouraged that you are taking control and making excellent progress to achieving better health. Don’t muck around with this, go hard and be committed “moderation kills” as eccelstyn says. If you have CAD it is a no brainer the more committed you are to lifestyle change the more you will nail your disease (go 100%). I totally agree with DAX and others advocating plant base and find it jaw dropping that cardiologists are not being hardline enough and encouraging people to adapt radical change (e.g these plant based regimes). It will not only save them but give them control of their condition rather than waiting for the next event or drug.
Comments appreciated for sure. Firstly, the whole point is that they are not in any way backed up by comprehensive studies. Its too easy to adopt the traditional resorting to Framingham second degree associations. That doesn’t mean they don’t work, i like to think they may even be beneficial. However the idea that there is convincing proof that they will take established calcified blockages and magically restore normal health is misleading. Do you really not think that most cardiologists and patients share the same common goal? I personally would like nothing better to prescribe a diet and see astonishing changes. Radical change as a concept is not easy, particularly in the absence of concrete proof, most will not adopt it and as a strategy it is unfortunately destined to fail. On a side note i commend those that try ‘healthy’ diets, as they at least try, i tell them i don’t know at all what effect it will have on established blockages, but i like to think it may be beneficial.
Jesus Christ!
Dear Cardiologists that are opposed to the obvious that lower cholesterol and healthy lifestyle changes “will” understandably/common-sensibly result in the reduction (Read: Reversal!) of fat deposits in the arteries,
Please just stop! You just reaffirm my firm belief that you want my money, and a lot of it, in the name of angiography, angioplasty and by-pass surgeries by talking against the common sense, while angioplasties and by-passes are known to fail.
Listen to yourself – “Following a healthy, plant-based diet is unrealistic,” “Healthy diet plan advocates are charging a lot of money (compared to you, they are charging peanuts actually)”, “they cannot reverse blockage (while statins that reduce cholesterol can, as you say yourself).”
Your opposition has just confirmed it to me that I did the right thing to refuse angiography and angioplasty, the procedures I, now that I have read this article, will never ever go for. I’m right here and you are right here too. I can assure you I will be a healthy beast in a few years without the stupid angioplasties and angiographies (I have 70%+ mid-LAD and 70%+ D1 blockages).
You have a blockage, its scary, i understand. Its that fear that makes people want to think there is a quick fix and a reversal. The future with the correct treatment (which may well not require procedures at all) in this day and age with medical treatment is good. The fact is there is no good evidence that these diets reverse disease to 0%, its nonsense to suggest so. i would still recommend you at least try one of them though. I like to think most cardiologists are not about what you have stated. Im an interventional cardiologist, and i certainly agree procedures should only be performed when strongly indicated. Read my article here https://myheart.net/articles/stent-save-life/. I understand its scary, but the outlook can be good, and alienating medical professionals or making pointless comments is not the answer.
Thank you for the thoughtful analysis.
I can say from personal experience that blockage in the heart is not reversible. My dad had significant blockage 20 years ago. Since then he’d had the most amazing lifestyle (food, exercise, yoga, weight etc). And yet, 20 years later he had two minor heart attacks, and the angiogram revealed that his prior blockage was as bad as ever, and that he had a new blockage as well requiring a bypasss surgery of 5 arteries.
I hope this information is useful to anyone who’s in this boat and trying to reverse heart disease.
The big benefit of lifestyle changes though is that the rest of his health is in great condition.
Allow my two cents. I woke up one morning feeling what I thought was indigestion. Four hours later I was in the cath lab having a stent placed in my LAD. 8 months later, another stent placed in the OM 1. I will admit living a somewhat unhealthy lifestyle (diet, smoking, drinking, over weight). In other words, a perfect candidate for a MI. I had been working on losing weight but smoked a little and drank too much. I was living what I’d call “the good life”. I am now on a diet that I can live with and it is based on the info that is provided from the diets mentioned, which I will add, is only common sense. I exercise (always did that anyway) lost 45 pounds with more to go, each as little saturated fat as possible, watch the cholesterol intake and calories. I consume very little sugar. I do enjoy a couple of beers. My BP is under control. My problem is with atorvastatin. It is giving me real problems. I stopped taking it for a few days and I feel completely different. I forgot how good I could feel. I am letting my doctor know. Hopefully we can find another option or lower dose. Something. But I am here to tell you, a good diet will help you lose weight and feel better about yourself. It needn’t be extreme but not wishy washy. I give thanks for each that I feel good and alive. There are no guarantees. Only effort and caring. Good luck to all.
I am 64. After my Congestive Heart Failure diagnosis in 2009 my first symptom were feet swelling, energy loss and chest pains. Suddenly I got weak and dizzy and had severe shortness of breath. My blood pressure was 200/100, respiration was 28 with oxygen saturation of 88 percent. I was extremely short of breath. My doctor started me on blood pressure medications, Lasix and nitroglycerin, the medications helped but not much. In January this year my PCP referred me to Herbs, i immediately started on their natural organic. I had a total decline in all symptoms including the leg and feet swellings, shortness of breath, fatigue, weight problems, excess urination, chest pains and others.
May I know what kind of Herbs did you take?
great article – well balanced – and informative – thanks !
Doc:
I’ve been an avid exerciser all my life (31 years in the Marines!), don’t smoke, drink only red wine, aren’t overweight the least and am careful on what I eat and have been on statins for 25 years (family genetics). I just got the results of a calcium coronary heart scan of 108–moderate heart disease! I’ve patterned my life for 53 years so I wouldn’t get these results. Everything I read says, exercise (I do), quit smoking (I don’t smoke), eat healthier (always room for improvement) lower your blood pressure (mine is very low)….not sure where to go or what to do now. Seems I’ve done what you’re suppose to do all for naught! Suggestions?
I would look at it differently. Your lifestyle likely has you in a much much stronger position than you would be in without it.
As a relatively young woman with chronic CAD and so far, a chest with 7 stents metal jacket style on 2 arteries, I really appreciated the honesty of analysis and comment in your article.
It’s possible to take full responsibility for lifestyle changes in exercise, weight, stress and diet ….and also be informed on promoted diets offering hope but still be majorly frustrated, confused and angered by the plethora of contradictory dietary advice seen daily. Much of it promoted by members of the medical profession.
It can add great worry to those really doing their best to support their ongoing good health/health prevention.
I found this article helpful, balanced and objective.
I’d be delighted to see a body similar to FDA tasked with reviewing and approving (or not) dietary recommendations/advice before they can be marketed in any way to the public. I feel this would enable people to make choices with confidence and reduce the “snake oil salemen” elements out to profit without proper research etc.
i think we are in agreement! and yes i can imagine the frustration and how it leads people to think certain things are guarantees of success that have been proven for decades despite the fact that isnt the case, although in reality most of us are on the same page in that we would love to see one of these things proven and working.
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Dr. Ahmed:
Thank you for your article. I appreciate the explanations provided regarding heart disease and the experiments regarding reversal of heart disease in the 50’s and 70’s. Also, your review of the diets I found informative and objective. Pointing out the pros and cons of each, including the fact that they are profit driven, was entirely appropriate in my opinion. A statement of fact is not a condemnation of the program or it’s merits. Changing our lifestyle as Americans is incredibly difficult as our society is built upon processed and packaged foods and maximizing our time to be productive for profit. The comment of a friend of mine, “Americans live to work, others work to live” rings very true in my mind. This has been the most helpful article i have read discussing the various programs and options for diet and lifestyle regarding our health. Critical pieces of information that were left out of the Eddylsyn and Ornish presentation that gave me pause (and I hope everybody that read the article and has seen the Netflix docudramas) is that the people were ALSO taking medication to assist with their cardiac issues. That is a very important fact that was not discussed (to my knowledge) in those programs and should be disclosed.
Respectfully,
Russ
While this article is helpful, I feel that the good doctor casts unnecessary doubt on the Esselstyn and Ornish plans. I have been on Dr. E’s vegan, no oil diet for over four years. I feel much better. However, I have not had any tests to see if my stenosis has been reduced. Hopefully it has at least stop progressing.
Neither Ornish nor Esselstyn claim that their diets are “miracle cures” and both admit that it takes a lot of dedication and work. It is certainly not an “easy way out.” The easy way out is taking high doses of statins while eating meat and fatty oils and somehow believing that you will not have any more problems.
Regarding proof: They have angiograms and others test results that clearly show much more blood flow in the previously-clogged arteries after some time on the diet. They don’t claim that the artery will end up totally clear, just that the disease will stop progressing and start to reverse the blockage. One patient had a 7% reduction of stenosis after a year on the diet, for example.
I agree with you, more studies should be done. However, the meat, dairy and drug industries are against that, not Esselstyn and Ornish. Also, Esselstyn was head cardiac surgeon for the Cleveland Clinic, so he is not some snake oil salesman.
Profit: You can get 99% of the info you need for free from both Dr. E and Dr. O’s websites. Selling a few books and giving a few speeches likely adds up to a tiny fraction of what they made as physicians. The makers of statins and other drugs are the profit-hungry villains. They do make a product that helps people yet it also harms people and they cover that part up. They also over hype their products’ abilities and hide its dangers.
Why do doctors want to believe that a statin can reverse arterial plaque yet not believe that eliminating foods that damage the endothelial cells can benefit the patient? I know that you avoided such a firm stance. However, you raised unnecessary suspicion about some possibly life-saving diets that not only beat drugs, they have zero side effects. There is no downside to eating an oil-free, vegan diet. There is a big downside to taking high doses of statins and having surgery, unless it is absolutely necessary. Thanks so much for the article.
You did not mention the large China study that was done on a plant based diet nor mention when other culture adopt a Western diet what happens. It seems apparent a plant based low sugar and oil diet does prolong life and there is regression in blockages. The question is how much and how long does it prolong life and its quality over traditional medicine? Maybe, nutrition should be a first line of defense or at least a choice. I know with 3 blockages and being a runner 5 days a week I have noticed with the statins I still get tired and need to walk some. Even during a 5k I may take 8 short walk breaks which slows my times down to 23 minutes. On long marathon run I tire after 15-18 miles and doing good to just finish missing qualifying for Boston by 9 minutes in December. I do feel if I could get more oxygen flow I could last longer and perform better.