Plant-based diet for treating heart disease

Coronary artery before and after plant-based diet (C. Esselstyn 2001)

Coronary artery before (left) and after (right) plant-based diet (Esselstyn CB Jr: Preventive Cardiology 2001;4: 171-177)

Few people realise that a plant-based diet not only prevents heart disease but can also reverse it. Choosing whole grains, fruits and vegetables and avoiding simple sugars, and saturated and trans fats, as in meat and dairy products, has been shown to result in regression of coronary atherosclerosis after 1 and 5 years in some studies (1) (2) and to continue for over 12 years in other studies (3).

In contrast, standard medical interventions for cardiac patients, such as coronary artery bypass, bypass grafts, atherectomy, angioplasty or stenting, treat only the symptoms, not the disease.  It is therefore not surprising that patients who receive these interventions alone often experience progressive disease, graft shutdown, restenosis, more procedures, progressive disability, and ultimately death from disease (4).

Caldwell Esselstyn MD persuaded 18 cardiac patients to continue with a plant-based diet for over 12 years. Adherent patients experienced no extension of clinical disease, no coronary events, and no interventions. This finding is all the more compelling when we consider that the original compliant 18 participants experienced 49 coronary events in the 8 years before the study (4).

Some patients believe that there is no need to change their diet if they have had heart surgery, stents inserted and/or are taking drugs like statins and aspirin.

A recently published international study (5) indicated that individuals (more than 31,000 men and women of an average age of 66 in this study) who chose whole grains, fruits, vegetables, nuts, and fish over meat, eggs and refined carbohydrates had a 35% reduction in cardiac death rates over 5 years. That’s a 35% reduction in addition to the decrease from surgery and optimal medical management. And these men and women were older, where you’d expect diet to be able to reverse less.

So it is never too late to make simple changes to your diet and lifestyle to improve your long-term health, whether you have medically-managed heart disease or not.

If you have heart disease, you can eat a wonderful variety of delicious, nutrient-dense foods:

  • All vegetables except avocado. Leafy green vegetables, root vegetables, vegetables that are red, green, purple, orange, and yellow – every colour of the rainbow
  • All legumes—beans, peas, and lentils of all varieties.
  • All whole grains and products, bread and pasta, that are made from them—as long as they do not contain added fats.
  • All fruits

You need to avoid:

  • Red meat, poultry and fish
  • Dairy products
  • Oils of all kinds (even olive oil)

 

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References

(1) Ornish, D. et al (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, Vol 280, No. 23, 2001-2007

(2) Ornish, D. et al (1990). Can lifestyle changes reverse coronary heart disease?  The Lancet, 21 July 1990, Vol 336, No. 8708, 129-133

(3) Esselstyn, C. (2001).  Resolving the coronary artery disease epidemic through plant-based nutrition.  Preventive Cardiology, 4, 171-177

(4) Esselstyn, C.  Updating a 12-Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology).  Article on Caldwell Esselstyn’s website.

(5) Dehghan, M. et al. Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention: A Prospective Cohort Study of 31 546 High-Risk Individuals From 40 Countries. Circulation, 4 December 2012, 126: 2705-2712

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Life expectancy continues to increase

Harry Patch lived to 111 years old

A recent paper by Professor David Leon, an epidemiologist at the London School of Hygiene and Tropical Medicine, in the International Journal of Epidemiology reports that Western Europeans are living longer than ever before despite concerns about obesity and health problems.  Average life expectancy in Western Europe is now six to eight years higher than in the 1970s.

The report used mortality data from the WHO Health for All Database and the Human Mortality Database, and its findings are likely to be reliable.

Data from 2007 indicate that average life expectancy for the UK was 80 years (for males 77.9 and women, 82), compared with 78 in the US.

The report also discusses life expectancy in Eastern Europe.  Between 1970 and the end of the 1980s, life expectancy in eastern European countries stagnated or declined, but after the fall of the Berlin Wall in 1989, life expectancy started to rapidly rise in the countries of the CEE (Czech Republic, Hungary, Poland and Slovakia).  This rise is still continuing but on a “parallel trajectory to Western Europe” that makes it difficult to close the gap between east and west.

Russia and the Baltic states have seen a decline in life expectancy that is only recently being reversed.  Russia in particular has had some dramatic fluctuations in recent years – its life expectancy in 2008 was just 68 years (men 61.8 and women 74.2) – the same age as 40 years previously.  Prior to this, Russia also saw a sharp decline in life expectancy between 1990 and 1994, when male life expectancy fell by six years to a low of 57 years.

The report discusses the possible causes of the trends in different countries.

The decline in cardiovascular disease is seen as an important contributor to the rise in life expectancy in Western Europe. According to the author,

Deaths from cardiovascular disease in the UK have seen some of the largest and most rapid falls of any Western European country, partly due to improvements in treatment as well as reductions in smoking and other risk factors.

The fact that US life expectancy lags behind the UK, he says, underlines that

GDP and health care expenditure per capita are not good predictors of population health within high income countries.

The rises in life expectancy seen in central Europe since the collapse of the Berlin Wall in 1989 reportedly illustrate that mortality can fluctuate rapidly in response to social, political and economic change.

The study’s author believes that the dramatic fluctuations in life expectancy in Russia are associated with the “stress and chaos” after the collapse of communism, as well as high rates of alcoholism. The recent upward trend in life expectancy in Russia and the Baltic states is probably due to recent reductions in alcohol-related deaths, rather than overall health improvements.

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Obesity in children

Overweight and obesity among children is widely regarded as being even more serious than it is among adults, with a very rapid rise in prevalence in the last two decades. Child obesity is likely to continue into adulthood, and many of the problems linked to obesity are more severe if the obesity has been present for a long period. Adults with the highest risk of diabetes, cardiovascular disorders, liver malfunction and orthopaedic dysfunction, are likely to have the most extreme levels of obesity and to have been obese since childhood[i].

fat_kid

Projections of child obesity based on trends from the 1980s and 1990s indicate that the annual increase in child obesity prevalence is itself increasing[ii]. By the year 2010, some 26 million school children in the EU are expected to be overweight, of which 6 million will be obese. The numbers of overweight children will rise by some 1.3 million per year, of which the numbers of obese children will rise by over 0.3 million per year.

At a conservative estimate, over a million obese children in the EU are likely to show a range of indicators for cardiovascular disease, including high blood pressure and raised blood cholesterol levels, and to have three or more indicators of the metabolic syndrome[iii]. Over 1.4 million children could have early stages of liver disorder.

The costs of childhood obesity have not been estimated but should include lost educational opportunity. A study of children’s quality of life found the psychological effects of severe obesity to be equivalent to a diagnosis of cancer[iv].

Behaviour, learning and mental health problems in children are rising as fast as rates of obesity and diabetes. Food affects brains as well as bodies, and early malnourishment can have devastating effects on both. Conversely, improving nutrition can help reduce antisocial behaviour as well as symptoms of ADHD, dyslexia, depression and related conditions[v].

The only pan-European estimates of children’s food consumption patterns are from self-reported surveys of health behaviours of children aged 11-15 years[vi]. The most recent (for 2001-2002) found:

  • In virtually all countries fewer than 50 per cent of children ate vegetables every day. On average, 30 per cent of children said they ate vegetables daily, but the children in countries once famous for their Mediterranean diets reported lower than average levels, especially Spain, where vegetables were typically eaten daily by only 12 per cent of children.
  • In virtually all countries fewer than 50 per cent of children ate fruit every day. On average, 30 per cent of boys and 37 per cent of girls reported eating fruit daily, but in sixteen countries only 25 per cent of children were eating fruit more than once a week. Lowest levels of consumption were reported among children in Northern European countries.
  • Soft drinks and confectionery were consumed daily by about 30 per cent of children (over 40 per cent in some countries).

According to the last National Diet and Nutrition Survey in the UK[vii]:

  • 92 per cent of children consume more saturated fat than is recommended
  • 86 per cent consume too much sugar
  • 72 per cent consume too much salt
  • 96 per cent do not consume enough fruit and vegetables

Governments are trying to improve children’s diets, but young people’s exposure to marketing pressures in our time-poor, anxiety-ridden, media-driven society is at an all-time high.

Widespread action is needed to reverse current trends – and we all need to take responsibility for what we are feeding young bodies and minds.

In a Cooking for Health class focused on Healthy Cooking for Your Children, we look at:

  • The best and the worst food for children
  • Easy steps to free your child from food traps
  • Simple, child-friendly recipes
  • Practical tips to help your child make the best food choices

The class involves 100% hands-on practical cooking in a small, supervised group, combined with teaching of up-to-date information and research findings on the effects of diet on health. Clear, easy-to-follow presentations and handouts are provided with plenty of opportunity for questions and discussion.

References

[i] Policy options for responding to obesity. Summary report of the EC-funded project to map the view of stakeholders involved in tackling obesity – the PorGrow project. Dr Tim Lobstein and Professor Erik Millstone. http://www.sussex.ac.uk/spru/porgrow

[ii] Jackson-Leach R, Lobstein T. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatric Obesit 2006;1:26-32.

[iii] Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatric Obesity 2006;1:33-41.

[iv] Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. J Am Med Ass 2003;289:1813-9.

[v] Richardson, A. They Are What You Feed Them. Harper Thorsons (5 Jun 2006)

[vi] HBSC. Young people’s health in context: Health Behaviour in School-aged Children 2001/2002. Health Policy for Children and Adolescents 4. C Currie et al (eds) Copenhagen: WHO Regional Office for Europe, 2004.

[vii] Gregory, J. et al. National Diet and Nutrition Survey: Young People Aged 4-18 years (The Stationery Office, 2000)