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Dr. Joel Fuhrman, MD

If  you eat the standard Western diet that most people eat in the modern world, you will surely develop heart disease, and may die from it.  But there are other options. When it comes to treating heart disease, most doctors promote drugs, expensive, invasive testing, high-tech medical procedures and heart surgery as the standard options.  A significant number of research studies have documented that heart disease is easily and almost completely preventable through a diet rich in plant produce and lower in processed foods and animal products. Removing the foods that cause blood vessel damage and providing the body with copious phytonutrients can facilitate the body’s natural healing processes to reverse existing heart disease and restore quality of life.

Successful heart disease reversal with lifestyle changes have been reported in the scientific literature and the mass media. In the 1990s the low-fat, vegetarian diet devised by Dr. Dean Ornish provided the first hard evidence that heart disease could be reversed – that atherosclerotic plaques could regress – with diet and lifestyle changes alone.¹  Similar results were found by Dr. Caldwell Esselstyn. ²  More recently,  Bill Clinton began following the recommendations of Drs. Ornish and Essesltyn, which attracted the attention of the media, sending the message that heart disease is truly a disease caused by poor diet and inactivity – a disease with a diet and lifestyle cure.

Still, many Americans doubt the healing potential of the human body when given the correct fuel.  They are addicted to disease-causing foods and attracted to “high-tech” solutions.  They do not understand that cholesterol-lowering drugs, stents and bypass surgery do not cure heart disease.  Cholesterol-lowering drugs carry serious side effects, and there is no evidence that statin use reduces risk of death in individuals with elevated cholesterol when used for primary prevention.^3-5 Patients who undergo stent and bypass procedures have not removed the cause of their disease, and so they continue to experience progressive disability and most often die a premature death as a result of their heart disease. ⁶ Nevertheless, drugs and surgical procedures are still the standard care for treatment of elevated cholesterol and coronary artery disease.

Atherosclerotic plaque can be reversed, and cholesterol lowered without drugs or surgery. Making significant dietary and lifestyle changes allows people who suffer with coronary heart disease, high cholesterol, obesity and/or high blood pressure to reduce or even eliminate their dependence on medications, and avoid invasive surgical procedures.

What is the optimal diet for heart disease prevention and reversal?  Certainly not the small dietary changes recommended by government agencies and other organizations – these are only modest changes to the average American’s diet, and the average American starts developing heart disease during childhood.⁷ Unfortunately, these widely voiced recommendations have made many people think by eating reduced-fat processed foods and replacing red meat with egg whites, fish and chicken, they will be protected. They will not.  These changes are simply not rigorous enough to assure predictable reversal.

Low-fat vegetarian diets (like those recommended by Drs. Ornish and Esselstyn) are a vast improvement. However, I propose that a high-nutrient, vegetable-based diet can be even more effective.  Comparing the effects of 6-week dietary interventions on LDL cholesterol levels, a low-fat vegetarian diet reduces LDL by 16%, but a high-nutrient, vegetable-based diet including daily nuts and seeds reduces LDL cholesterol by 33%.^{8, 9} This result suggests that if we improve the low-fat, vegetarian diet by making it more nutrient-dense, and include more greens, beans, seeds and nuts we may reverse heart disease even faster, and reduce heart disease risk even more.

What is a high-nutrient, vegetable-based diet?  I call this a nutritarian diet, because it is guided by the ratio of micronutrients to calories in foods.  Ninety percent of calories come from nutrient-rich plant foods: vegetables, beans, fruits, seeds and nuts.

Not just vegan, nutritarian:  vegetable-based and nutrient-dense. We need to take vegetables out of the role of “side dish,” even in low-fat, vegetarian diets, whose calories are generally derived mainly from grains and other starches. To provide optimal levels of protective micronutrients, a diet must be vegetable-based, not grain-based.  Vegetables and beans are far superior to grains and white potatoes when it comes to nutrient density.  Furthermore, low-fat, high carbohydrate diets tend to increase triglyceride levels, a risk factor for heart disease.   In contrast, a high-nutrient, vegetable-based diet with beans as the preferred carbohydrate source decreased triglycerides, lower blood glucose and accelerate fat loss. ^{8, 10}

Not low-fat: include healthy fats from nuts and seeds.  Seeds and nuts are indispensable for cardiovascular health. The protective properties of nuts against coronary heart disease were first recognized in the early 1990s, and a strong body of literature has followed, confirming these original findings.¹¹  In spite of this wealth of data and all of the press on healthy fats, a “low-fat” diet is still viewed in a positive light.  Certainly adding fats in the form of oils is fattening and unhealthy, but naturally fat-rich foods like nuts and seeds have profound cardiovascular benefits.  Moderate use of nuts also encourages weight loss, not weight gain.12 Avoiding nuts and seeds means missing out on these benefits. A recent meta-analysis of 25 clinical studies that compared a nut-eating group to a control group solidified the LDL-lowering effects of nuts.¹³  Nut consumption reduces coronary heart disease risk far more than can be explained by cholesterol lowering alone – 35% reduction in risk for 5 or more servings of nuts per week.¹⁴  These additional effects are only beginning to be discovered – recent data has shed light on the protective properties of almonds  and walnuts on vascular health.^{15, 16}  The Physicians Health Study demonstrated that eating nuts and seeds regularly protects against sudden cardiac death caused by arrhythmia – this data suggests that following a low-fat diet for  a long period of time, though effective at reducing atherosclerotic plaque, could actually increase the risk of sudden cardiac death. ¹⁷

I have seen a nutritarian diet produce astounding results in my practice.  Hundreds of my patients, readers of my books and members of my website have dropped their cholesterol levels into the favorable range and reversed their existing heart disease – without drugs – using high-nutrient eating, which places vegetables – not meat, and not grains – at the base of our food pyramid.

Ronnie Valentine has a remarkable story of using a high-nutrient diet to reverse his heart disease and restore his health.  After having quadruple bypass surgery, and then three stents and an angioplasty, he went to the internet for answers and decided to try a nutritarian diet.   As you can see below, Ronnie has undergone a striking transformation.  The main point is not just the wonderful numbers he earned; it is that even after an angioplasty and with a medicine cabinet full of pills, he could not walk one block because of severe chest pain due to significant atherosclerosis and restenosis.  Yet, in less than a year on a high-nutrient diet, he became free of heart disease; he now runs, plays sports, and has a full, healthy, active life and needs no medications.

This is the goal of a high-nutrient diet – to flood the body’s cells and tissues with beneficial phytochemicals so that the body can heal itself.  When the body is in optimal health, we can enjoy an active and fulfilling life without the limitations of diseases or dependence on medications.

References

1. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.
2. Esselstyn CB, Jr., Ellis SG, Medendorp SV, et al. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J Fam Pract 1995;41:560-568.
3. Ray KK, Seshasai SR, Erqou S, et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010;170:1024-1031.
4. Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010;340:c2197.
5. Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010;375:735-742.
6. Esselstyn CB, Jr. Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Prev Cardiol 2001;4:171-177.
7. Berenson GS, Wattigney WA, Tracy RE, et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study). Am J Cardiol 1992;70:851-858.
8. Barnard ND, Scialli AR, Bertron P, et al. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol 2000;85:969-972.
9.  Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism 2001;50:494-503.
10. Sarter B, Campbell TC, Fuhrman J. Effect of a high nutrient density diet on long-term weight loss: a retrospective chart review. Altern Ther Health Med 2008;14:48-53.
11. Fraser GE, Sabate J, Beeson WL, et al. A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med 1992;152:1416-1424.
12. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr 2008;138:1741S-1745S.
13. Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med 2010;170:821-827.
14. Kris-Etherton PM, Hu FB, Ros E, et al. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr 2008;138:1746S-1751S.
15. Jenkins DJ, Kendall CW, Marchie A, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation 2002;106:1327-1332.
16. Ma Y, Njike VY, Millet J, et al. Effects of walnut consumption on endothelial function in type 2 diabetic subjects: a randomized controlled crossover trial. Diabetes Care 2010;33:227-232.
17.  Albert CM, Gaziano JM, Willett WC, et al. Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Arch Intern Med 2002;162:1382-1387.