This post was authored by Kim A. Williams, MD, FACC, incoming president of the ACC, and originally appeared on MedPage Today.
Physicians want to influence their patients to make lifestyle changes that will improve their health, but sometimes the roles are reversed and we are inspired by patients. It was a patient’s success reversing an alarming condition that motivated me to investigate a vegan diet.
Just before the American College of Cardiology’s (ACC) annual meeting in 2003 I learned that my LDL cholesterol level was 170. It was clear that I needed to change something. Six months earlier, I had read a nuclear scan on a patient with very-high-risk findings – a severe three-vessel disease pattern of reversible ischemia.
The patient came back to the nuclear lab just before that 2003 ACC meeting. She had been following Dean Ornish, MD’s program for “Reversing Heart Disease,” which includes a plant-based diet, exercise, and meditation. She said that her chest pain had resolved in about 6 weeks, and her scan had become essentially normalized on this program.
When I got that LDL result, I looked up the details of the plant-based diet in Ornish’s publications – 1- and 5-year angiographic outcomes and marked improvement on PET perfusion scanning – small numbers of patients, but outcomes that reached statistical significance.
I thought I had a healthy diet – no red meat, no fried foods, little dairy, just chicken breast and fish. But a simple Web search informed me that my chicken-breast meals had more cholesterol content (84 mg/100 g) than pork (62 mg/100 g). So I changed that day to a cholesterol-free diet, using “meat substitutes” commonly available in stores and restaurants for protein. Within 6 weeks my LDL cholesterol level was down to 90.
I often discuss the benefits of adopting a plant-based diet with patients who have high cholesterol, diabetes, hypertension, or coronary artery disease. I encourage these patients to go to the grocery store and sample different plant-based versions of many of the basic foods they eat. For me, some of the items, such as chicken and egg substitutes, were actually better-tasting.
There are dozens of products to sample and there will obviously be some that you like and some that you don’t. One of my favorite sampling venues was the new Tiger Stadium (Comerica Park) in Detroit, where there are five vegan items, including an Italian sausage that is hard to distinguish from real meat until you check your blood pressure – vegan protein makes blood pressures fall.
In some parts of country and some parts of world, finding vegan restaurants can be a challenge. But in most places, it is pretty easy to find vegan-friendly options with a little local Web searching. Web searching can also help with the patients who are concerned about taste or missing their favorite foods. I typically search with the patient and quickly email suggestions.
Interestingly, our ACC/American Heart Association (AHA) prevention guidelines do not specifically recommend a vegan diet, as the studies are very large and observational or small and randomized, such as those on Ornish’s whole food, plant-based diet intervention reversing coronary artery stenosis. The data are very compelling, but larger randomized trials are needed to pass muster with our rigorous guideline methodology.
Wouldn’t it be a laudable goal of the American College of Cardiology to put ourselves out of business within a generation or two? We have come a long way in prevention of cardiovascular disease, but we still have a long way to go. Improving our lifestyles with improved diet and exercise will help us get there.
Also check out a version of this article on the New York Times’ Well Blog.