Unfortunately, the standard medical practice for dealing with angina has been a dash to dish out the drugs1 . This may well relieve the symptoms, but it does not deal with the underlying causes. And what’s the main cause? You guessed it, diet. This blog deals with a case study 2 of a 60-year old male who, having been diagnosed with angina, refused both drug therapy and invasive testing in favour of making a dietary change to a WFPB diet. But did it work?
The study subject reported a 12 month history of progressive severe mid-sternal chest discomfort after either walking only half a block, experiencing emotional stress or being out in cold weather. His family history included a mother who had coronary artery bypass surgery and a brother who had an acute myocardial infarction, both while they were in their early sixties.
With medical advice and counselling, he chose to adopt a wholefood plant-based diet (WFPB), which consisted primarily of the following:
- whole grains
Subject’s previous diet
He described his diet as having been a “healthy” diet of the following:
- skinless chicken
- low-fat dairy
- some vegetables, fruits, and nuts
Within just a few weeks of dietary change, his symptoms improved.
After four months, the following biometrics were recorded:
- BMI fell from 26 kg/m2 to 22 kg/m2
- blood pressure normalised
- LDL (low-density lipoprotein) cholesterol decreased from 158 mg/dL to 69 mg/dL
- ability to walk one mile without angina symptoms
Two years after starting the WFPB diet, he was able to jog more than 4 miles without incident and remained asymptomatic, off drug therapy for coronary artery disease, and has not required cardiac catheterisation 3 .
The study subject’s angina symptoms improved rapidly, as did his weight, blood pressure, and cholesterol levels. And this case study is supported by plenty of evidence that WFPB diets are strongly associated with:
- improved plasma lipids 4
- improved glycaemic control in patients with type 2 diabetes mellitus 5 6
- weight reduction 7
- blood pressure reduction 8 9 10
- improved vascular function 11
- profoundly improved coronary artery disease risk/symptoms 12 13 14 15
- reduced overall mortality 16 17 18 19
The more the merrier
Studies 20 have shown a dose-response-like effect – that is, the greater the adherence to a healthy lifestyle (including a WFPB diet), the greater the apparent benefit.
When less is more
Coronary artery disease in plant-eating populations
This case reinforces research showing that great improvements in our “modern” Western NCDs (non-communicable diseases) can be achieved without the need for medications or medical procedures. Previous epidemiological studies24 have documented the near-absence of coronary artery disease in indigenous populations that eat largely or exclusively plant-based diets, including:
- rural parts of China 25
- a highland population of New Guinea 26
- the Tarahumara Indians of Mexico 27
- rural parts of South Africa 28
- Norway during World War II 29
“A whole-food plant-based diet helped reverse angina without medical or invasive therapy. It appears prudent that this type of lifestyle be among the first recommendations for patients with atherosclerosis.”
Whilst some people might think it’s too difficult to live a “normal” life while eating a WFPB diet, it’s actually quite achievable within a real-world setting 30 and, with proper education and support, anyone can make the transition 31 . Additionally, a WFPB diet is not associated with markedly increased food costs 32 ; and, in any case, what price can you put on a healthier and longer life?
Whilst the above research only covers one case study, its findings are completely in line with copious research data showing impressive results on the prevention and treatment of cardiovascular diseases through eating a WFPB diet, ideally – and optimally – without any added salt, oils or sugar. Take a look at some of the research links to find out more.
Finally, an excellent explanation of how simple dietary changes can effect such radical health improvements is presented in the following video, where Dr Caldwell B Esselstyn explains how you can make yourself “heart-attack proof”.
References & Notes
- Typical angina drugs: Clot-preventing drugs -clopidogrel (Plavix), prasugrel (Effient) ticagrelor (Brilinta); beta blockers – these work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure, they also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina; statins – these are drugs used to lower blood cholesterol, and work by blocking a substance the body needs to make cholesterol; calcium channel blockers – also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. thereby increasing blood flow in the heart, reducing or preventing angina; blood pressure-lowering drugs – if you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, doctors tend to prescribe a drug to bring the blood pressure down. The two main classes of blood pressure drugs are angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs); finally, a drug called Ranolazine (Ranexa) may be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
- Case Rep Cardiol. 2015;2015:978906. doi: 10.1155/2015/978906. Epub 2015 Feb 10. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures. Massera D, Zaman T, Farren GE, Ostfeld RJ.
- Cardiac catheterisation is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.
- Ferdowsian H. R., Barnard N. D. Effects of plant-based diets on plasma lipids. The American Journal of Cardiology. 2009;104(7):947–956. doi: 10.1016/j.amjcard.2009.05.032.
- Barnard N. D., Cohen J., Jenkins D. J. A., et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006;29(8):1777–1783. doi: 10.2337/dc06-0606.
- Barnard N. D., Cohen J., Jenkins D. J. A., et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. The American Journal of Clinical Nutrition. 2009;89(5):1588S–1596S. doi: 10.3945/ajcn.2009.26736h
- Mishra S., Xu J., Agarwal U., Gonzales J., Levin S., Barnard N. D. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. European Journal of Clinical Nutrition. 2013;67(7):718–724. doi: 10.1038/ejcn.2013.92.
- Jenkins D. J. A., Wong J. M. W., Kendall C. W. C., et al. The effect of a plant-based low-carbohydrate (‘Eco-Atkins’) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Archives of Internal Medicine. 2009;169(11):1046–1054. doi: 10.1001/archinternmed.2009.115.
- McDougall J., Thomas L. E., McDougall C., et al. Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort. Nutrition Journal. 2014;13(1, article 99) doi: 10.1186/1475-2891-13-99.
- Fraser G., Katuli S., Anousheh R., Knutsen S., Herring P., Fan J. Vegetarian diets and cardiovascular risk factors in black members of the adventist health study-2. Public Health Nutrition. 2015;18(3):537–545. doi: 10.1017/s1368980014000263.
- Dod H. S., Bhardwaj R., Sajja V., et al. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. The American Journal of Cardiology. 2010;105(3):362–367. doi: 10.1016/j.amjcard.2009.09.038.
- Ornish D., Brown S. E., Scherwitz L. W., et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. The Lancet. 1990;336(8708):129–133. doi: 10.1016/0140-6736(90)91656-u.
- Esselstyn C. B., Jr., Ellis S. G., Medendorp S. V., Crowe T. D. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. Journal of Family Practice. 1995;41(6):560–568.
- Esselstyn C. B., Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology) The American Journal of Cardiology. 1999;84(3):339–341. doi: 10.1016/s0002-9149(99)00290-8.
- Esselstyn C. B., Gendy G., Doyle J., Golubic M., Roizen M. F. A way to reverse CAD? The Journal of Family Practice. 2014;63(7):356–364.
- Orlich M. J., Singh P. N., Sabaté J., et al. Vegetarian dietary patterns and mortality in adventist health study 2. JAMA Internal Medicine. 2013;173(13):1230–1238. doi: 10.1001/jamainternmed.2013.6473.
- Bamia C., Trichopoulos D., Ferrari P., et al. Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition) Public Health Nutrition. 2007;10(6):590–598. doi: 10.1017/s1368980007382487.
- Wang X., Ouyang Y., Liu J., et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. The British Medical Journal. 2014;349 doi: 10.1136/bmj.g4490.g4490
- Bao Y., Han J., Hu F. B., et al. Association of nut consumption with total and cause-specific mortality. The New England Journal of Medicine. 2013;369(21):2001–2011. doi: 10.1056/nejmoa1307352.
- Gupta S. K., Sawhney R. C., Rai L., et al. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients—Mount Abu Open Heart Trial. Indian Heart Journal. 2011;63(5):461–469.
- Michaelsson K., Wolk A., Langenskiold S., et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. The British Medical Journal. 2014;349 doi: 10.1136/bmj.g6015.g6015
- Koeth R. A., Wang Z., Levison B. S., et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine. 2013;19(5):576–585. doi: 10.1038/nm.3145.
- Tang W. H. W., Wang Z., Levison B. S., et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. The New England Journal of Medicine. 2013;368(17):1575–1584. doi: 10.1056/nejmoa1109400.
- Epidemiological studies look at the distribution and determinants of health and disease conditions in defined populations. Such research often forms the cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare.
- Campbell T. C., Parpia B., Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. The American Journal of Cardiology. 1998;82(10):18T–21T.
- Sinnett P. F., Whyte H. M. Epidemiological studies in a total highland population, Tukisenta, New Guinea. Cardiovascular disease and relevant clinical, electrocardiographic, radiological and biochemical findings. Journal of Chronic Diseases. 1973;26(5):265–290. doi: 10.1016/0021-9681(73)90031-3.
- Connor W. E., Cerqueira M. T., Connor R. W., Wallace R. B., Malinow M. R., Casdorph H. R. The plasma lipids, lipoproteins, and diet of the Tarahumara Indians of Mexico. The American Journal of Clinical Nutrition. 1978;31(7):1131–1142.
- Trowell H., Painter N., Burkitt D. Aspects of the epidemiology of diverticular disease and ischemic heart disease. The American Journal of Digestive Diseases. 1974;19(9):864–873. doi: 10.1007/bf01071948.
- Strom A., Jensen R. A. Mortality from circulatory diseases in Norway 1940–1945. The Lancet. 1951;1(6647):126–129.
- Peters N. C., Contento I. R., Kronenberg F., Coleton M. Adherence in a 1-year whole foods eating pattern intervention with healthy postmenopausal women. Public Health Nutrition. 2014;17(12):2806–2815. doi: 10.1017/s1368980014000044.
- Hyder J. A., Thomson C. A., Natarajan L., et al. Adopting a plant-based diet minimally increased food costs in WHEL study. American Journal of Health Behavior. 2009;33(5):530–539.