Vegan Diet, Healthy Heart?

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.

14 thoughts on “Vegan Diet, Healthy Heart?

  1. When my son went off to College weighed 220. Lbs though 6 feet tall he was overweight. He changed to the vegan diet and lost over 40 lbs.
    He is now 35 with a weight of 170, an LDL of 60 and an HDL of 70!
    he continues a plant based diet and is betting on a heart healthy future
    Thanks for your article
    agree
    Frances NP
    Cardiology

  2. Bravo Dr Williams for going public about the benefits of a vegan diet. Better for our patients, better for our planet.

  3. Well intentioned commentary but mistaken nonetheless. Ornish’s work has been well critiqued elsewhere including my favorite site, sceincebasedmedicine.org (http://www.sciencebasedmedicine.org/bill-clintons-diet/ for example). Basically Ornish’s studies are small and involve multiple lifestyle changes- how do we know that the diet is responsible for his results? We don’t. Also, only a minority of patients are sensitive to dietary cholesterol’s influence on their serum cholesterol or lipoproteins. Most enlightened country’s put NO restrictions on dietary cholesterol intake. I’ll take eggs over vegan pancakes ANYDAY for a “healthy breakfast”!
    Atherosclerosis is a disease of abnormal LIPOPROTEIN trafficking- the LIPID values the author quotes correlate less accurately with outcomes than lipoprotein values (e.g. apoB and NMR LDL-P). In every population ever studied where there is discordance between the cvd risk predicted by lipids and lipoproteins, the lipoproteins more accurately predict risk. It the lipoprotein values we need to follow before and after dietary changes. Insulin sensitizing low simple carb/low sugar diets are the best at reducing atherogenic apoB lipoproteins. There are plenty of overweight vegans with high atherogenic particle counts NOT helped by their vegan diets rich in simple grains (see for example Lierre Keith’s “The Vegetarian Myth”)
    I like Polen’s advice of “eat FOOD, mostly plants, not much” these days. Our primary focus should be on Polen’s words and an insulin sensitizing diet, instead of demonizing animal proteins as vegans are wont to do. Campbell’s “China Diet” has been thoroughly discredited by multiple sources (for example rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ )

    Gregory S Pokrywka MD FACP FNLA NCMP

    Prevention of Cardiovascular Disease and Women’s Menopausal Health

    Assistant Professor of General Internal Medicine
    Johns Hopkins University School of Medicine
    Diplomate American Board Clinical Lipidology and Fellow, National Lipid Assn.
    Certified Menopause Practitioner: North American Menopause Society
    Director: Baltimore Lipid Center. Board Member, South East Lipid Assn.

    • Unfortunately, mentioning Lierre Keith’s “The Vegetarian Myth” lowers your credibility. Let us please focus on science and knowledge instead. A plant based diet has shown really great results in most scientific studies regarding heart health. Since I started to recommend a plant based diet to my patients, about two years ago, the patient health in general has improved immensely.

    • Wonderful response Dr Pokrywka! I am a cardiac nurse practitioner and battle daily with all of the conflicting evidence on lipids and CAD. I encourage all of my patients to eat a “clean”, whole foods diet that is free of processed foods, trans fats, grains and sugar. I encourage whole foods (even buttter-gasp!) and plently of fruits and vegetables. I have seen great results and reduction of triglycerides by prescribing a low carb, whole foods diet. Often the LDL and total cholesterol may increase but without advanced testing we cannot know if there has been an increase in atherogenic apoB lipoproteins . Thank you for your fantastic response.

    • The countless success stories of those who have switched to whole food plant based diets is truly inspiring. I’ve experienced amazing benefits my myself. Ethically, it’s also essential that we all let go of animal protein for the long term health of our planet.

    • Dr Pokrywka: as evidence as to why you are discrediting this article you reference two bloggers?? You also have a website selling your own cholesterol reduction services. A “high fat, low carb” – Atkins type diet seems to be what you advocate. Robert Atkins founder of the “high fat, low carb” trend had a history of heart attack, congestive heart failure and hypertension, and weighed 258 pounds at death (according to a medical report issued by the New York medical examiner’s office a year after his death). His widow refused to allow an autopsy (likely because official news that Atkins died of a massive heart attack – due to his “high fat, low carb” diet” – might cost the Atkins’ family a lot of money in future revenue).

      I will stick to my plant based diet AND to research by reputable cardiologists, thank you.

    • Thank you Dr. Pokrywka for a well thought out rebuttal. I think putting ourselves in the position of endorsing a dietary regimen that has more or less been a basic diet of a large portion of the Indian sub-continent may be misguided. The coronary disease related outcomes of those populations is relatively abysmal as compared to those in animal protein heavy cultural diets (Scandinavian, Northern European). As for environmental friendliness, a largely plant based diet in a time of food scarcity and shrinking water supplies over much of the globe is a questionable solution. Much of the planet’s population struggles to find land on which to grow the plant based diets they have traditionally consumed. The use of agricultural chemicals, pesticides, hormone disrupting compounds is unregulated and rampant due to production pressures. Truly “organic” meat substitutes (such as soy) are difficult to find easily and are expensive when you do. A plant based diet is expensive for people to adhere to, is difficult to secure in large portions of this country, and does not make monetary:calorie sense for the majority of the population.

  4. I’m very happy to say that Dr. Ornish is not the only one out there trying to help people reverse heart disease. Yes, heart disease, diabetes and a myriad of other illness are actually caused by food-like products which is what we are currently eating.
    It was 3 days after my 43rd birthday when I had a heart attack. Doctors were saying it’s in my genes. Well, I was the first in my family with no previous ailments to justify blockages. I was eating “healthy” and exercising 6 days a week. After having a stent put in my left circumflex artery and having many more blockages left untouched I left the hospital with nothing more than “you need to change your diet” and 6 different pills to take. I was mad. I found Dr. Caldwell Esselstyn’s book Preventing and Reversing Heart disease and I embarked in the change of a lifetime. A change that would allow for all the plaque built up in my arteries to clear out. There is no place on this page for me to attach my ultrasound pictures of what my abdominal aorta looked like on July of 2012 vs. July of 2013. I can clearly testify that a Vegan diet can and will reverse heart disease if in addition to eating “whole plant based foods” people also abstain from consuming added oils (all types including olive oil), nuts, seeds, avocados and coconut or at least have them very sparingly.
    If anyone is willing to dispute my success as well as many other people’s i would suggest that before clinical trials randomized or otherwise be started or even before it is discarded as a possibility give it a try on yourselves for 30 days and see what difference it would make.
    Dr. Caldwell Esselsty Jr., Dr Dean Ornis, Dr. John McDougall, Dr. Neal Bernard, Colin Campbell PHD, Dr. Baxter Montgomery and many others have helped numerous thousands of people REVERSE their heart disease through a vegan plant based diet. Very different from the cosmetically improved standard american diet (SAD) that the ACC, AMA and ADA claim works.

  5. As a doctor and an influence to many patients, you need to be willing to see that any patient who changes to a whole food plant based diet is healthier than when eating the SAD. It might not be your preference-but it doesn’t “harm” someone compared to staying on SAD. I feel it is unfortunate that educated people as yourself get caught up in statistics. The reality is that vegans live longer and are healtier overall until their death. It’s your choice to eat eggs-I’ll eat oatmeal.

  6. Wonderful to see mainstream medicine joining the conversation about the benefits of eating an alkaline diet. Any change from our chemically laden processed and nutrient deficient Standard American Diet will result in a wonderful outcome for our patient populations. Getting the patients to explore and commit to the lifestyle changes will be a hurdle but the paradigm shift is happening. Especially when the patients realize a nutrient dense plan of eating will decrease the costs of their medications and need for costly medical interventions over the long term.

  7. Lost a sister one year younger than me at age 52 from heart disease and diabetes Shortly after her death I went to the doctor and was told I was going to have a heart attack soon. Went home turned on the TV an Dr. Neal Barnard was on PBS, Reverse Diabetes and Heart Disease, by following a low fat vegan diet.
    I decided then and there to try it out. Well four years later and 50 lbs. lighter I feel great. Doctor said I put 10 years on my life. My blood work is good now, blood pressure now normal, blood sugars great. I have more energy now, have not had a cold or flu since going plant based.

  8. Heart attack and quadruple bi-pass at 53–now age 57 and told I look 40. Suffered from diabetes 2 and did not want to go on insulin. Was walking 5 miles a day; eating low cals but for 2 years after bi-pass was not vegetarian or vegan. A1C would not come down and prognosis was not good. Was prescribed good stuff like Victoza which bloated my stomach and made me sick along with taking my energy. The quality of life was not there.

    Began my own form of nutritional medicine starting with vegan diet and my numbers were magically under control–something meds and doctors could not do! Two years on vegan diet and numbers from A1C to cholesterol and triglycerides are unbelievable.

    Work 7 days a week; have my stamina; libido is back; and quality of life is better. Why doctors would question results is beyond me but hints to another agenda. What happened to “first do no harm?” Thank you Kim for a great article and having an open mind unlike some of your peers as I am reading. . . .

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