Heart Surgery or Plant-Based Diet?

In previous blogs, I shared two documentary films produced by the H.O.P.E. project 1 : “What You Eat Matters” 2 and “From Cancer Patient to Plant-Based Strong Man” 3 . H.O.P.E. have just released another short documentary film about Paul Chatlin, a man with heart disease who was saved from surgery by changing to a plant-based diet.

Paul Chatlin’s Story

Paul Chatlin

In 2013, after being diagnosed with heart disease, Paul’s doctor gave him a simple choice – change his diet or undergo major heart surgery.

At the time, Paul was eating a typical Western diet, with cheese and meat being his favourite foods. Having loved pretty much anything fried in oil, he was given a “nutrition prescription” which required him to give up all these foods and cut out the oil – replacing his habitual diet with a low fat, whole food, plant-based diet.

Having spent his whole life eating one way, he found it a struggle to know what he could now eat and how he could prepare it without using oil. Luckily, he came across and attended a seminar on plant-based nutrition by the world-renowned physician and researcher Dr. Caldwell B. Esselstyn 4, a major player in the famous WFPB documentary film, “Forks Over Knives” 5 and author of his must-read book, “Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure.” 6 .

As a result of the seminar, Paul was better equipped and motivated to strike out with his new diet and lifestyle. One month on, his heart pain went away completely. Within a year, his cholesterol levels had dropped from 309 to 122. He also lost over 40 lbs (18 kg).

Paul was so amazed with the health impacts of changing to a plant-based diet, that he started The Plant Based Nutrition Support Group (PBNSG) 7 to help others make the transition to the optimally health WFPB diet.

The film

In this second in the series of H.O.P.E. ‘Plant Power Stories’, Paul shares his journey back to health and encourages us all to give back to our communities.

Final thoughts

If you consider that plant-based eating is of value to the health and well-being of your friends and family, perhaps you could consider sharing this blog with them.

So many people are facing a lifetime on medications and/or having invasive surgery for conditions that could be avoided and treated with simple dietary changes. But, of course, they have to know that such an alternative exists in the first place!

Whilst anecdotal success stories such as Paul’s are likely to inspire hope, all nutritional claims made on this website are always backed up by peer-reviewed, scientific research.


References

  1. The H.O.P.E. Project. []
  2. I H.O.P.E. You Watch & Share This Film []
  3. The Healing Power of Plants []
  4. Dr Caldwell B Esselstyn’s website. []
  5. Forks Over Knives – The Film []
  6. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure []
  7. The Plant Based Nutrition Support Group []

1st Vegan President of the American College of Cardiology

“There are two kinds of cardiologists: vegans and those who haven’t read the data.” Dr Kim Allan Williams is a remarkable man. As the first vegan president of the American College of Cardiology, what he says about the value of plant-based diets and the harms of meat-based diets is well-informed and evidence-based. Additionally, his well-earned high status within his field means that other medical professionals are more likely to sit up and listen when he speaks about plant-based nutrition.

A great fan of Dr C B Esselstyn and Dr Dean Ornish, Dr Williams regularly sends his cardiac patients to one or the other of these luminary plant-based clinicians so that they can take part in their disease reversal programmes.

[su_quote]I don’t mind dying, but I don’t want it to be my fault.[/su_quote]

I have included a number of videos and a podcast where Dr Williams talks about his journey towards a plant-based diet. Whilst he doesn’t insist on a WFPB diet – suggesting that vegan cheese, vegan sausages, etc are better than any meat alternatives, even though they may not be optimal whole food nutrition – he is very clear that all animal products are harmful compared with plant products. These videos and his published research (some of which is outlined below) bear out his strong opinions on these matters.

(If you are viewing this on WP, the links to the videos are at the bottom of this page.)

Dr Kim Williams talks about being the first VEGAN President of the American College of Cardiology

Kim Allan Williams, MD, MACC, FAH: The Growing Acceptance of a PB Lifestyle by Cardiologists

Chef AJ Teleclass with Kim A. Williams, MD

Audio-only YT video. Well-worth listening to.

 

Meat Your Future – Interview with Kim A. Williams, Sr., MD (EXTENDED VERSION)

Dr Kim Williams talks about the Government’s Dietary Recommendations

Dr Williams quote.

Nutrition and Cardiovascular Mortality (Kim Allan Williams, Sr., MD) Jan 5, 2017

Is a Whole Food Plant-Based Diet an Answer to Chronic Disease? 2017 Documentary


A Sample from Dr Williams’ Full List of Published Research

“The real question about WFPB diet is ‘What doesn’t it cure?’ ” (Quote from Dr Williams)

1. Introduction to the “A plant-based diet and cardiovascular disease” special issue. 2017

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” (Arthur Schopenhauer, German Philosopher, 1788–1866).

Unlike many of our cardiovascular prevention and treatment strategies, including antioxidants, vitamin E, folic acid and niacin to name a few, that have disintegrated over time, the “truth” (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction and mortality, as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions. Challenges with the science are, however, less daunting to overcome than inertia, culture, habit and widespread marketing of unhealthy foods. Our goal must be to get data out to the medical community and the public where it can actually change lives—creating healthier and longer ones.

In 2015, cardiovascular mortality went up in the US for the first time in over four decades. We apparently have reached the tipping point in cardiology. The effects of our guideline-driven management for treatment of heart disease and its risk factors, and the benefits of our ever-more-creative interventions on acute events seem to have plateaued. The rising epidemic of obesity and diabetes is now outstripping our preventive efforts, adding to the cost of healthcare and costing lives.

Starting with 2017 data, our Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) merit-based incentive payments and alternative payment models will be rewarding the absence of events more and more, and procedures less and less. So isn’t it time to move upstream, and place more emphasis on prevent-mode and less event-mode in our practices? Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes induced epidemic of morbidity and mortality.

2. A plant-based diet and hypertension. 2017.

There are a variety of mechanisms proposed by which plant-based nutrition leads to decrease in blood pressure. They include improved vasodilation,[10-13] greater antioxidant content and anti-inflammatory effects,[14-21] improved insulin sensitivity,[10, 22-25] decreased blood viscosity,[26, 27] altered baroreceptors,[10] modifications in both the renin-angiotensin,[13, 28-30] and sympathetic nervous systems,[10, 31] and modification of the gut microbiota.[30]

Long-term randomised controlled trials examining the impact of plant-based diets on various health outcomes, including hypertension, will further inform medical guideline creation and refine our understanding of the relationship between diet and disease. However, in lieu of such information and in the context of the data within this Special Issue, we believe that consuming a diet that is mostly or exclusively plant-based appears prudent for the prevention and treatment of hypertension.

3. A Deficiency of Nutrition Education and Practice in Cardiology. 2017

Results:

A total of 930 surveys were completed. Among cardiologists, 90% reported receiving no or minimal nutrition education during fellowship training, 59% reported no nutrition education during internal medicine training, and 31% reported receiving no nutrition education in medical school. Among cardiologists, 8% described themselves as having “expert” nutrition knowledge. Nevertheless, fully 95% of cardiologists believe that their role includes personally providing patients with at least basic nutrition information. The percentage of respondents who ate ≥5 servings of vegetables and fruits per day was: 20% (cardiologists), 21% (fellows-in-training), and 26% (cardiovascular team members).

Conclusions:

A large proportion of cardiovascular specialists have received minimal medical education and training in nutrition, and current trainees continue to experience significant education and training gaps.

4. The 2015 Dietary Guidelines Advisory Committee Report Concerning Dietary Cholesterol. 2015

Abstract:

The most recent 2015 Dietary Guidelines Advisory Committee report indicated that “cholesterol is not considered a nutrient of concern for overconsumption.” However, this statement may be too general as it does not acknowledge conflicting findings in literature regarding cardiovascular risk in certain populations. Current research suggests that dietary cholesterol may increase an subject’s risk of developing diabetes, increases a diabetic patient’s risk of cardiovascular disease, and may worsen coronary risk factors in subjects who are “hyper-responders” to dietary cholesterol. In conclusion, we suggest that a more cautious approach to dietary cholesterol intake is warranted, especially in high-risk populations.

Podcast with Dr Williams

Dr. Kim Williams And Jeremy Glogower Get Real About Going Plant-Based, Seven Rules We Can All Live By And More…


About Kim Allan Williams MD, MACC, FAHA, MASNC, FESC

Dr Williams was born in Chicago, and attended the College of The University of Chicago (1971 to 1975), followed by the University of Chicago’s Pritzker School of Medicine (1975 to 1979), internal medicine residency at Emory University (1979 to 1982), and overlapping fellowships in Cardiology at the University of Chicago (1982 to 1985), Clinical Pharmacology (1984 to 1985), and Nuclear Medicine (1984 to 1986). He is board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Medicine, Nuclear Cardiology and Cardiovascular Computed Tomography.

Dr. Williams joined the faculty of the University of Chicago in 1986, specialising in clinical cardiology, nuclear medicine and nuclear cardiology. He served as Professor of Medicine and Radiology and Director of Nuclear Cardiology at The University of Chicago School of Medicine until 2010. Among numerous awards and honours for his teaching in the medical school, residencies and fellowships, he was elected to Alpha Omega Alpha in 2008.

In 2010, he became the Dorothy Susan Timmis Endowed Professor of Medicine and Radiology and Chairman of the Division of Cardiology at Wayne State University School of Medicine in Detroit, MI. At Wayne State, he has started the Urban Cardiology Initiative – a program of education of physicians on disparities in healthcare, primary school education on cardiovascular health and community health screening in inner city Detroit. In November, 2013 he returned to Chicago as the James B. Herrick Endowed Professor of Medicine and Cardiology at Rush University Medical Center.

Dr. Williams has published numerous peer reviewed articles, monographs, book chapters, editorials, and review articles in the field of nuclear cardiology and minority health issues, with emphasis on education and innovations in perfusion imaging and quantitation of ventricular function. His research interests include selective adenosine receptor agonists, fluorinated perfusion PET imaging, cardiac computed tomography for plaque characterisation, health care disparities and payment policy, and appropriate use of cardiac imaging.

Dr. Williams has served on numerous committees and boards at the national level, including the American Society of Nuclear Cardiology (ASNC), the American Heart Association (AHA), the American Medical Association (AMA), the American College of Cardiology (ACC), the Certifying Board of Nuclear Cardiology, the Certifying Board of Cardiac Computed Tomography, the Society of Cardiovascular Computed Tomography and the Association of Black Cardiologists (ABC). He served as President of ASNC from 2004 to 2005. He served as Chairman of the Board of ABC from 2008 to 2010. He also served on the Cardiovascular Disease Examination Board of the American Board of Internal Medicine (ABIM-CV) until 2012. He served as the president of the ACC from 2015 to 2016.


References

  1. Video: Dr Kim Williams talks about being the first VEGAN President of the American College of Cardiology (https://www.youtube.com/watch?v=nyNy2mSnNRo). Published by Dr John McDougall.
  2. Video: Kim Allan Williams, MD, MACC, FAH: The Growing Acceptance of a PB Lifestyle by Cardiologists (https://www.youtube.com/watch?v=_KeGHwDRX6g). Published by PlantPure Nation/TV.
  3. Audio-only Video: Chef AJ Teleclass with Kim A. Williams, MD (https://www.youtube.com/watch?v=ebcX7N4yvEo&feature=youtu.be). Published by Charles Shrewsbury.
  4. Video: Meat Your Future – Interview with Kim A. Williams, Sr., MD (EXTENDED VERSION) (https://youtu.be/0SXqD6Y99PU). Published by Meat Your Future.
  5. Video: Dr Kim Williams talks about the Government’s Dietary Recommendations (https://www.youtube.com/watch?v=yW7ljppz5JQ&feature=youtu.be). Published by Dr John McDougall.
  6. Video: Nutrition and Cardiovascular Mortality (Kim Allan Williams, Sr., MD) Jan 5, 2017 (https://www.youtube.com/watch?v=ZLtvkuUZUvE&feature=youtu.be). Published by DeBakey Institute For Cardiovascular Education & Training.
  7. Video: Is a Whole Food Plant-Based Diet an Answer to Chronic Disease? 2017 Documentary (https://www.youtube.com/watch?v=xl8zNztsoGg&feature=youtu.be). Published by Plant Based News.
  8. Kim Allan Williams. Introduction to the “A plant-based diet and cardiovascular disease” special issue. J Geriatr Cardiol. 2017 May; 14(5): 316. doi: 10.11909/j.issn.1671-5411.2017.05.001. PMCID: PMC5466935.
  9. Sarah Alexander, Robert J Ostfeld, Kathleen Allen, Kim A Williams. A plant-based diet and hypertension. J Geriatr Cardiol. 2017 May; 14(5): 327–330. doi: 10.11909/j.issn.1671-5411.2017.05.014. PMCID: PMC5466938.
  10. Suter PM, Sierro C, Vetter W. Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care. 2002;5:9–19. [PubMed].
  11. Vogel RA, Corretti MC, Plotnick GD. Effect of a single high-fat meal on endothelial function in healthy subjects. Am J Cardiol. 1997;79:350–354. [PubMed].
  12. Hodgson JM. Effects of tea and tea flavonoids on endothelial function and blood pressure: a brief review. Clin Exp Pharmacol Physiol. 2006;33:838–841. [PubMed].
  13. Yokoyama Y, Nishimura K, Barnard ND, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014;174:577–587. [PubMed].
  14. Baradaran A, Nasri H, Rafieian-Kopaei M. Oxidative stress and hypertension: Possibility of hypertension therapy with antioxidants. J Res Med Sci. 2014;19:358–367. [PMC free article] [PubMed].
  15.  Manning RD, Jr, Tian N, Meng S. Oxidative stress and antioxidant treatment in hypertension and the associated renal damage. Am J Nephrol. 2005;25:311–317. [PubMed].
  16. Galleano M, Pechanova O, Fraga CG. Hypertension, nitric oxide, oxidants, and dietary plant polyphenols. Curr Pharm Biotechnol. 2010;11:837–848. [PubMed].
  17. Turner-McGrievy GM, Wirth MD, Shivappa N, et al. Randomization to plant-based dietary approaches leads to larger short-term improvements in dietary inflammatory index scores and macronutrient intake compared with diets that contain meat. Nutr Res. 2015;35:97–106. [PubMed].
  18. Watzl B. Anti-inflammatory effects of plant-based foods and of their constituents. Int J Vitam Nutr Res. 2008;78:293–298. [PubMed].
  19. Pauletto P, Rattazzi M. Inflammation and hypertension: the search for a link. Nephrol Dial Transplant. 2006;21:850–853. [PubMed].
  20. Asgary S, Afshani MR, Sahebkar A, et al. Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study. J Hum Hypertens. 2016;30:627–632. [PubMed].
  21. Upadhyay S, Dixit M. Role of polyphenols and other phytochemicals on molecular signaling. Oxid Med Cell Longev. 2015;2015:504253. [PMC free article] [PubMed].
  22.  Zhou MS, Wang A, Yu H. Link between insulin resistance and hypertension: What is the evidence from evolutionary biology? Diabetol Metab Syndr. 2014;6:12. [PMC free article] [PubMed].
  23. Viguiliouk E, Stewart SE, Jayalath VH, et al. Effect of replacing animal protein with plant protein on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2015;7:9804–9824. [PMC free article] [PubMed].
  24. Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32:2312–2321. [PubMed].
  25. Eddouks M, Bidi A, El Bouhali B, et al. Antidiabetic plants improving insulin sensitivity. J Pharm Pharmacol. 2014;66:1197–1214. [PubMed].
  26.  Ernst E, Pietsch L, Matrai A, Eisenberg J. Blood rheology in vegetarians. Br J Nutr. 1986;56:555–560.[PubMed].
  27. McCarty MF. Favorable impact of a vegan diet with exercise on hemorheology: implications for control of diabetic neuropathy. Med Hypotheses. 2002;58:476–486. [PubMed].
  28. Chen Q, Turban S, Miller ER, Appel LJ. The effects of dietary patterns on plasma renin activity: results from the dietary approaches to stop hypertension trial. J Hum Hypertens. 2012;26:664–669. [PubMed].
  29. Dizdarevic LL, Biswas D, Uddin MD, et al. Inhibitory effects of kiwifruit extract on human platelet aggregation and plasma angiotensin-converting enzyme activity. Platelets. 2014;25:567–575. [PubMed].
  30. Marques FZ, Nelson EM, Chu PY, et al. High fibre diet and acetate supplementation change the gut microbiota and prevent the development of hypertension and heart failure in DOCA-salt hypertensive mice. Circulation. Published Online First: December 7, 2016. DOI: 10.1161/CIRCULATIONAHA.116.024545. [PubMed].
  31. Park SK, Tucker KL, O’Neill MS, et al. Fruit, vegetable, and fish consumption and heart rate variability: the Veterans Administration Normative Aging Study. Am J Clin Nutr. 2009;89:778–786.[PMC free article] [PubMed].
  32. Full list of Dr Kim A Williams publications: (https://www.ncbi.nlm.nih.gov/pubmed/?term=kim+a+williams).
  33. Devries S, Agatston A, Aggarwal M, Aspry KE, Esselstyn CB, Kris-Etherton P, Miller M, O’Keefe JH, Ros E, Rzeszut AK, White BA, Williams KA, Freeman AM. A Deficiency of Nutrition Education and Practice in Cardiology. Am J Med. 2017 Nov;130(11):1298-1305. doi: 10.1016/j.amjmed.2017.04.043. Epub 2017 May 25. PMID: 28551044.
  34. Williams KA Sr, Krause AJ, Shearer S, Devries S. The 2015 Dietary Guidelines Advisory Committee Report Concerning Dietary Cholesterol. Am J Cardiol. 2015 Nov 1;116(9):1479-80. doi: 0.1016/j.amjcard.2015.07.077. Epub 2015 Aug 14. PMID: 26341187.

Greens: Chewing vs Juicing

study in Okinawa, Japan demonstrated that eating lots of leafy green vegetables is really effective at preventing damage to the endothelial cells which line our blood vessels. But is it better to chew or juice our vegetables?

Oxidative inflammation

The specific process we want to avoid is oxidative inflammation. To do this this, we want to eat loads of anti-oxidants.

Food or supplements?

But can’t we just get these from swallowing a jugful of anti-oxidant potions sold by the local health store? Apparently not. This supplement approach not only does not work, but it’s probably going to be harmful.

The anti-oxidants we want will only come from food that has a high ORAC (oxygen radical absorbance capacity) – raspberries, blueberries and strawberries are excellent, but the absolute champions appear to be the green leafy vegetables, at least according to Dr Caldwell B. Esselstyn.

Cardiovascular disease and greens

Dr Esselstyn has successfully reversed heart disease in his patients merely by making radical changes in their dietary intake. He says:

“If I’ve got somebody who is significant in cardiovascular disease, whether it’s their legs, their carotid, their heart, we really wanna hasten this along…I want them to have a green leafy vegetable, six times a day. And how do we do that? I want it to be the size of your fist after it has been boiled in boiling water for five and a half to six minutes, until it’s nice and tender. Then anoint it with some delightful balsamic vinegar, so you’ve got something that is tender and delicious. And I want this alongside your breakfast cereal, I want it mid-morning snack. I want it with your lunch and sandwich. Again, mid-afternoon. Obviously at dinnertime.”

The Most Powerful Anti-Oxidant

When we eat vegetables “…[w]hat you are doing is you are bathing that cauldron of oxidation inflammation all day long with nature’s most powerful anti-oxidant” – nitric oxide, produced by the endothelial cells within our blood vessels. And it is the green leafy vegetables that he considers to be our best source of nitric oxide-producing foods.

Which vegetables are best?

Cabbage, kale, brassicas, spring greens, bok choy, Swiss chard, beet greens, mustard greens, turnip greens, Brussels sprouts, broccoli, cauliflower, coriander, parsley, spinach, rocket, asparagus. That’s just a few, but enough to get you started.

Nitric acid as we age

By the age of 50, nitric oxide production from the endothelial cells of the healthiest person will tend to drop to approximately 50% of what it was at age 25. Does that mean that your anti-oxidant protection will run dry no matter what you do? Apparently not. Another route for making nitric oxide is through the gastrointestinal (GI) tract.

Nitrates to nitrites

When we consume green leafy vegetables, the nitrates contained within them get converted into nitrites when they get inside our GI tract. But not as much nitrate is absorbed as nitrites when the food passes through the body. However, there is an additional method that we can use to get the maximum “bang for our buck” from these nitrates.

Chewing or juicing – the answer

  • If we chew nitrates (i.e. our green leafy vegetables) rather than juicing them, then the nitrates are going to mix in the mouth with the facultative anaerobic bacteria that reside in the grooves and crevices of the tongue.
  • These bacteria will reduce the nitrates in the mouth to nitrites, so that when these additional nitrites are swallowed, they are further reduced by gastric acid into nitric oxide, and this will join with the body’s nitric oxide pool.
  • The nitrites in the stomach that are not converted into nitric acid will be reabsorbed into the circulation further downstream.
  • In turn, they will circulate back to the salivary glands where they will now be concentrated ten to twenty fold.

So chewing rather than juicing allows the saliva to release more nitrites and these, in turn, get further reduced by gastric acid into nitric oxide. This nitric oxide is then available to the endothelial cells to keep your blood vessels healthy and, hopefully, your body free of cardiovascular disease.

Quick Quiz - Greens: Juicing vs Chewing

(All answers are contained in the article.)

1. What is one of the major roles of nitric oxide in our blood vessels?
2. Which of these foods are the best anti-oxidants?
3. By the age of 50, by how much may nitric acid production from endothelial cells have reduced?
4. When we consume nitrates, the body converts them into ns.
5. So, which releases more nitrites for nitric acid production?

 


References

Mano R, Ishida A, Ohya Y, Todoriki H, Takishita S. Dietary intervention with Okinawan vegetables increased circulating endothelial progenitor cells in healthy young women. Atherosclerosis. 2009; 204(2):544–548.

Heinonen OP, Huttunen JK, Albanes D, et al. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994;330(15):1029-1035.

Esselstyn CB Jr., Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014 July; 63(7): 356-364.

Esselstyn C. Resolving the coronary artery disease epidemic through plant-based nutrition. Prevent Card. 2001; 4: 171–177.

Esselstyn C, Ellis S, Medendorp S, Crowe T. 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(6):560–568.

 

Olive Oil Injures Endothelial Cells

I know it’s not popular amongst advocates of the so-called Mediterranean diet, but there is a fact about olive oil that has been established in peer-reviewed literature for some time now: Olive oil is NOT as good for you as you might have thought.

So why is it that those eating the Mediterranean diet have had such a reputation for longevity and good health? The answer lies in what other foods are eaten and, equally importantly, which other foods are not eaten (processed junk food).

The traditional Mediterranean diet is fading away as the Western diet – also known as the Standard American Diet (SAD) – spreads its influence across the continent.

But before the golden arches threatened to overshadow the Acropolis, the traditional Mediterranean diet was largely plant-based, consisting of vegetables, fruits, nuts, beans, whole grains, pasta, olive oil, wine, and very small amounts of fish, eggs, dairy, and meats. And while heart disease mortality was lower when compared to the UK and USA, for instance, the benefits seem to have been conferred primarily by a high percentage of plant content, the regular consumption of nuts and an avoidance of sugary/fatty desserts, with fruit being the common after-dinner treat.

And, while compared to the modern Western diet, the Mediterranean diet has been shown to be better at cutting heart attack risk, it has not demonstrated the health-promoting power of a purely whole food plant-based diet – whether the latter is with or without SOS (added sugar, oil and salt). As you will know by now, the WFPB diet is the only known diet that has been clinically proven to reverse heart disease.

A major problem with the Mediterranean diet is that it includes three elements that are associated with inflammation and its many harmful consequences in the body:

  • refined grains (pasta and breads),
  • animal products, and
  • olive oil,

and it is the olive oil that concerns us here.

A  publication in the Nutrition, Metabolism & Cardiovascular Diseases journal pretty much sums up its findings in the title of the study:

“Olive, soybean and palm oils intake have a similar acute detrimental effect over the endothelial function in healthy young subjects.”

Objective 

Their objective was to evaluate the acute effect of the ingestion of large amounts of olive, soybean and palm oils, fresh and at two different deep-fry levels, on the glucose and lipid profiles and endothelial function.

Method

Subjects were randomly given a potato soup meal containing one of three different vegetable oils (olive, soybean and palm). Flow-mediated vasodilation (FMD) was performed and blood samples taken to establish the lipid profiles and plasma glucose levels.

Results

All types of oil tested (including olive oil) resulted in a similar acute endothelial impairment.

Conclusions of the Study

“No difference was found in the acute adverse effect of the ingestion of different vegetable oils on the endothelial function. All the vegetable oils, fresh and deep-fried, produced an increase in the triglyceride plasma levels in healthy subjects.”

What are Endothelial Cells and Why are they so Important?

The endothelial cell layer is a one-cell thick layer within the inner surface of our blood vessels. These cells are of vital importance for vascular health and their damage is what leads to the development of CVD (cardiovascular disease).

When you eat the typical Western diet you develop intracellular adhesion molecules – causing blood to flow like Velcro. This results in the LDL particles in the bloodstream burrowing into the subendothelial compartment. The so-called “bad” LDL cholesterol gets oxidised by free radicals in our diet into small hard dense LDL molecules, so our body sends out messengers called chemokines that recruit white blood cells (monocytes) to sort them out.

These monocytes follow the LDL into the subendothelial compartment in order to scavenge for the LDL particles. Once inside the subendothelial compartment, these monocytes are referred to as macrophages as they try to mop up and clear away all the LDL particles.

The macrophages get bigger and bigger as they absorb the LDL particles and they then change their name again and become known as foam cells.

These foam cells are the really dangerous particles because they release some unpleasant enzymes called metalloproteinases which then gradually erode the plaque on the endothelial cell.

The cap over the plaque is very thin and once it ruptures, the plaque content then oozes out and causes a plaque clot.

The plaque clot then grows and spreads out over the inner diameter (lumen) of the blood vessel and this results in something you really don’t want to happen: the downstream heart muscle loses its blood supply.

The result is that the heart muscle dies. This whole nasty process is thought to account for around 90% of all heart attacks.

 

 

Is it Too Late for Sufferers of Heart Disease?

Fortunately, it is not too late, even if plaques have formed. The cap over the plaque can be strengthened and, if it is sufficiently strong, you become “heart attack proof” as Dr Esselstyn says, but only if you change to a whole food plant based diet.

How is Nitric Oxide Involved?

Initially it was called EDRF, but had its name changed because it was then discovered that EDRF was in fact a gas – nitric oxide (chemical symbol NO), discovered by Furchgott et al in 1998, for which they received the Nobel Prize.

The Functions of NO

  • It prevents intracellular contents from getting sticky – makes the blood flow like Teflon instead of Velcro.
  • NO is the strongest vasodilator in the body. When you run for a bus or climb the stairs, it’s the NO produced by your endothelial cells that dilates the blood vessels and allows you to increase activity level without passing out.
  • It prevents the vessel walls from getting stiff, thickened or inflamed – hence preventing hypertension.
  • Sufficient NO will prevent blockages or plaques building up on the surface of the endothelium.
  • NO will prevent the artery wall from “migrating” into the plaque.
  • NO can destroy the foam cells (referred to by Dr Esselstyn as “Darth Vaders”).

What is the Flow-Mediated Dilation Test?

If you take an ultrasound probe, place it over the brachial artery at the elbow, you can get a readout of the diameter of the artery.

You then put a blood pressure cuff on the upper arm, inflate it above systolic blood pressure and leave it there for 5 mins.

During this time, there is zero blood flow to the forearm and hand (a weird sensation to say the least).

You then release the cuff and once again measure the new diameter of the brachial artery.

In a normal artery it should immediately increase by 30%.

Enter Dr Robert Vogel…

Dr Vogel did a brilliant study by taking a number of healthy young people to McDonald’s and splitting them into two groups.

He gave one group cornflakes and measured their dilation response. It was normal.

He gave the other group hash browns and sausages. Their brachial arteries could not dilate normally – even after two hours. The endothelial cells’ ability to make nitric oxide was so damaged that they could not dilate the artery. They were tested on an off into the evening, by which time they started to recover full function as the evening progressed.

A One-Off or Chronic Problem?

It is not a good idea to repeat this test, but people do – millions of them, day in day out, week in week out, for years and decades. The next day it’s egg and bacon or cappuccino and brioche for breakfast, ham and cheese sandwich or chicken salad for lunch, take-away Chinese for dinner. What was an acute reaction becomes a regular, chronic health threat.

This is why, in the 21st century, by the time our children are leaving school, they already have the foundation for cardiovascular disease.

Best Advice

If you really want to protect yourself as much as possible against these cardiovascular events, do all you can to optimise the health of your endothelial cells.

To do this, start by always avoiding the following:

  • Oils – no matter whether it’s olive oil, corn oil, soybean oil, safflower oil, sunflower oil, canola oil, palm oil, oil in a crisp/chip, oil in a cracker, oil in bread, oil in a salad dressing.
  • Anything with a face or that had a mother – no matter whether it’s fish or fowl, beef or pork, turkey or chicken, cream or milk, cheese or butter, yogurt or ice cream.
  • Anything with added sugar – no matter whether it’s organic muscovado sugar, molasses, honey, juices* (orange, apple etc), maple syrup or agave syrup.

All of these injure endothelial cells to some extent; and you don’t need a history of cardiovascular disease to already have it developed within your body – in one study, 57% of men who experienced sudden cardiac death had zero history of coronary heart disease.

* Eating an apple or an orange is not the same thing as drinking fruit juices. The fructose is bound with the fibre. But when you make orange juice or apple juice, the sugar is free, goes into your gut and is immediately absorbed, injuring your liver, promoting protein glycation, and injuring those precious and delicate endothelial cells.

I know it is difficult to consider such dramatic changes, but remember that we live in a nutritionally toxic environment in the 21st century, where the all-pervasive “normal” diet is something that has never existed on Earth before. Nowadays, a person who insists on eating a truly healthy diet will feel and probably be treated like an alien from a distant galaxy.


Quick Quiz - Olive Oil Injures Endothelial Cells

(All answers are contained in the article.)

1. What items were identified as being a problem in the Mediterranean diet?
2. What are some of the functions of NO (nitric oxide) in our blood vessels?
3. Where are endothelial cells found?
4. When macrophages digest small LDL particles, what do they become?

 


References:

Rueda-Clausen CF, Silva FA, Lindarte MA, Villa-Roel C, Gomez E, Gutierrez R, Cure-Cure C, López-Jaramillo P. Nutr Metab Cardiovasc Dis. 2007 Jan;17(1):50-7. Epub 2006 Mar 20. Olive, soybean and palm oils intake have a similar acute detrimental effect over the endothelial function in healthy young subjects.

Esselstyn C. Prevent Card. 2001; 4: 171–177. Resolving the coronary artery disease epidemic through plant-based nutrition. 

Esselstyn C, Ellis S, Medendorp S, Crowe T. J Fam Pract. 1995; 41(6):560–568. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. 

Go A, Mozaffarian D, Roger V, Benjamin E, et al. Circulation 2013; 127: 6–245. doi: 10.1161. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. 

van Dam RM, Willett WC. Nutr, Metab Cardiov Dis. 2007; 17(1): 50–57.  Unmet potential for cardiovascular disease prevention in the United States. 

Ryan A. Harris, Steven K. Nishiyama, D. Walter Wray, and Russell S. Richardson. Hypertension. 2010 May; 55(5): 1075–1085. Published online 2010 Mar 29. doi: 10.1161/HYPERTENSIONAHA.110.150821. Ultrasound Assessment of Flow-Mediated Dilation: A Tutorial.

Vogel RA, Corretti MC, Plotnick GD. Am J Cardiol. 1997 Feb 1;79(3):350-4. Effect of a single high-fat meal on endothelial function in healthy subjects.

Kannel WB, Doyle JT, McNamara PM, Quickenton P, Gordon T. Circulation. 1975;51:606–13. Precursors of sudden coronary death: Factors related to the incidence of sudden death. 

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Hard to Find a Healthier Bread…

 

 

This is one the healthiest bread recipes I have come up with. It may not have the oily and salty attraction of some other breads – because, well… it has NO OIL OR SALT!

We can all get rather addicted to the convenience, texture and taste of commercially-prepared breads. The tastier and more “spongy” they make the bread, the more they will sell.

But I wanted a bread that provides most of the convenience, texture and taste that we expect from bread, but without the fragmented food elements and chemicals that may be added, including: salt (1.), sugar, (my recipe contains a small amount but commercial bread can contain lots), trans fats (“partially hydrogenated oils” – linked to serious health risks (2., 3.)), potassium bromate (oxidising agent), azodicarbonamide (dough conditioner/bleacher), monoglycerides & diglycerides (emulsifiers E471), butylated hydrocyanisole (BHA preservative linked to cancer (4., 5.)), caramel colouring (linked to cancer (6., 7.)), high fructose corn syrup (HFCS linked to heart disease and diabetes (8.)), Undeclared GMO Soy oil (9.), vegetable oils (10,. 11,. 12,). And this is not a definitive list..

And if you still think that adding vegetable oils (even really expensive extra virgin olive oil) is a healthy option, you may want to check out some of my future blogs. In the meantime, a brief word from Dr Caldwell Esselstyn.

So, after all that waffle, here’s the recipe:

Whole Wheat Seeded Health Bread.

This basic recipe forms the canvas on which the rest of the health bread recipes I use are formed. This recipe is incredibly versatile, and makes a delicious, moist health bread that can be enjoyed with any kind of meal. It is also delicious served with natural fruit preserves and organic, natural nut butters. These health breads don’t require kneading, as the ingredients form more of a batter than a dough once mixed together.

Preheat the oven to 390 degrees (200 degrees Celsius gas mark 6). This recipe yields three loaves, so you will need three silicon medium-sized loaf tins – silicon so that they do not stick, being that no grease or oils are used.

Ingredients:

4 cups (1kg) organic wholewheat flour. I vary this from time to time by adding differing amounts of wholemeal ancient flours – usually rye and spelt, but also sometimes Khorasan also called kamut (adds sweetness) or einkorn.

35-75ml organic raw brown sugar (I use as little as possible and let it rise for longer).

2 tablespoons (30ml) instant dried yeast.

0.5-1.5 cups (75-200g) mixed seeds (can include pumpkin, poppy, sunflower, sesame, flax, chia).

4 cups (1 litre) lukewarm water.

Instructions:

Dissolve the sugar in the lukewarm water and sprinkle the yeast over the top. Cover tightly with cling film and a dish towel, and set aside for the yeast to activate, it will start to bubble when it has activated.

In a large mixing bowl, mix together the flour and seeds. Add the water, sugar and yeast mixture and mix very well to form a slightly runny batter. Divide the batter equally amongst the loaf tins which should be on a firm metal baking tray. Place the bread tins somewhere warm and draught-free until the batter has risen and the loaves have doubled in size. Bake for 45-50 minutes, until a dark crust has formed and the bread sounds hollow when tapped. You can also check that they are completely baked by using a skewer or knife. If there is any batter sticking to the latter, put them back in the oven for another 10 mins or so. Allow the loaves to cool in the tins for ten minutes before turning out onto a cooling rack.

Try it. Vary it. Improve on it. And let me know how you get on.

The following is Yuri’s “Flower Bread” – basically the same recipe with added red pepper and garlic, but made in a wonderful flower-shaped silicone bread/cake tin that he found in Italy.

Fantastico!

 


References

  1. https://nutritionfacts.org/topics/salt/ “Dozens of similar studies demonstrate that if you reduce your salt intake, you may reduce your blood pressure. And the greater the reduction, the greater the benefit may be. But if you don’t cut down, chronic high salt intake can lead to a gradual increase in blood pressure throughout life.”
  2. Vandana Dhaka, Neelam Gulia, Kulveer Singh Ahlawat, and Bhupender Singh Khatkarcorresponding. J Food Sci Technol. 2011 Oct; 48(5): 534–541. Published online 2011 Jan 28. doi: 10.1007/s13197-010-0225-8. Trans fats—sources, health risks and alternative approach – A review
  3. Trattner S, Becker W, Wretling S, Öhrvik V, Mattisson I. Food Chem. 2015 May 15;175:423-30. doi: 10.1016/j.foodchem.2014.11.145. Epub 2014 Dec 3. Fatty acid composition of Swedish bakery products, with emphasis on trans-fatty acids.
  4. Otterweck AA, Verhagen H, Goldbohm RA, Kleinjans J, van den Brandt PA. Food Chem Toxicol. 2000 Jul;38(7):599-605. Intake of butylated hydroxyanisole and butylated hydroxytoluene and stomach cancer risk: results from analyses in the Netherlands Cohort Study.
  5. https://ntp.niehs.nih.gov/ntp/roc/content/profiles/butylatedhydroxyanisole.pdf.
  6. https://www.fda.gov/downloads/Food/GuidanceRegulation/FSMA/UCM517402.pdf.
  7. Garima Sengarcorresponding author and Harish Kumar Sharma. J Food Sci Technol. 2014 Sep; 51(9): 1686–1696.
    Published online 2012 Feb 9. doi: 10.1007/s13197-012-0633-z. Food caramels: a review.
  8. James M. Rippe Theodore J. Angelopoulos. Advances in Nutrition, Volume 4, Issue 2, 1 March 2013, Pages 236–245, https://doi.org/10.3945/an.112.002824. Sucrose, High-Fructose Corn Syrup, and Fructose, Their Metabolism and Potential Health Effects: What Do We Really Know? N.B. The symposium was supported in part by an educational grant from the Corn Refiners Association (I ALWAYS SUSPECT BIAS WHEN THUS FUNDED). 
  9. https://nutritionfacts.org/video/gmo-soy-and-breast-cancer/. “The bottomline is that there is no direct human data suggesting harm from eating GMOs, though in fairness such studies haven’t been done, which is exactly the point, critics counter. That’s why we need mandatory labeling on GMO products so that public health researchers can track whether GMOs are having any adverse effects.”
  10. https://nutritionfacts.org/topics/vegetable-oil/. “Research confirms that ingestion of oil, no matter which type of oil or whether it was fresh or deep fried, showed a significant and constant decrease in arterial function.”
  11. https://www.drmcdougall.com/misc/2007nl/aug/oils.htm.
  12. http://nutritionstudies.org/plant-oils-are-not-a-healthy-alternative-to-saturated-fat/