Diet vs. Drugs. Drugs are not the only viable option for reducing cholesterol levels. Making the case for a whole foods plant-based diet.
The current National Cholesterol Education Program (NCEP, 2002) guidelines are meant to help physicians inform patients about their risk of developing coronary artery disease. The current guidelines stipulate that patients with a total serum cholesterol level above 200 mg/dl and a serum LDL cholesterol of near optimal<100-129mg/dL should be provided with medication (p. 3198-3199). However, medication may not necessarily be the only option to lowering cholesterol levels. Lifestyle modifications should also be addressed with the patient. As demonstrated, the consumption of meat, fish, poultry, eggs, and dairy products raises cholesterol levels due to the consumption of cholesterol, saturated fats, and trans fats. It appears that the removal of these products can have a cholesterol lowering effect. According to Roberts (1999) “Meatless meals are inexpensive. If the money we use to purchase and eat the muscles of cows, pigs, chickens, turkeys, and fish were put into vegetables, fruits, and lipid-lowering drugs, our health would sky rocket” (p. 817). Our health would improve and our medical care costs would decrease as well.
Eating You Alive – Dr Robert Ostfeld
While medication is currently prescribed to cardiovascular disease patients, Chiuve, McCullough, Sacks & Rimm (2006) acknowledge that “a majority of Coronary Heart Disease events among US men may be preventable through adherence to health lifestyle practices, even among those taking medications for hypertension (high blood pressure) or hypocholesteremia (high cholesterol levels)” (p. 160). Severely restricting or eliminating the consumption of animal-based foods, that contain cholesterol, saturated fat, and trans fat can decrease LDL cholesterol levels within the blood to decrease the current should be addressed when dealing with a patient with desirable total cholesterol of (<200 mg/dL) (NCEP, 2001, p. 3167). According to Stone et al. (2013), the American College of Cardiology/American Heart Association Guidelines stipulate the importance of diet and lifestyle modification in the treatment and prevention of atherosclerotic cardiovascular disease events (p. 13).
According to Roberts (1999), “whether or not we are willing to alter our diet sufficiently and/or to spend the money necessary to obtain the lipid-lowering drugs, and then take them religiously to achieve this goal is up to us” (816). Encouraging people to limit the consumption of cholesterol, saturated fat, and trans fat does little to inform the public that even small amounts of animal-based foods increases their risk of heart disease.
Dr Kim Williams: Exposes the True Cause of Heart Disease https://www.drmcdougall.com/health/education/videos/advanced-study-weekend-experts/kim-williams-exposes-cause-heart-disease/
According to Esselstyn and Favaloro (1998), “one of the great stumbling blocks has been the government and national health organizations that support the target of 30% dietary fat and a cholesterol level of <200 mg/dL” (p. 8T). In fact, Esselstyn & Favaloro (1998) go on to state that “Greater health benefits would be derived from even less fat than the 30% recommendation (p. 8T). Currently the United States Department of Health and Human Services and the United States Department of Agriculture (DHH & USDA, 2015) recommend eating a low fat diet consisting of approximately 30% fat (p. 97).
According to Esselstyn (2001):
The basic diet favored by these groups contains not only grains, legumes, vegetables, and fruit, but also oil, low-fat milk and milk products, butter, cheese, poultry, lean meat and fish. I am unaware of any research proving that by eating such a diet one can achieve a cholesterol level of 150mg/dL or avoid CAD (Coronary Artery Disease) (p. 172).
According to the National Cholesterol Education Program (NCEP, 2002):
When carbohydrates are substituted for saturated fatty acids, the fall in LDL cholesterol levels equals that with monounsaturated fatty acids. When carbohydrate is consumed along with high-fiber diets, however, the rise in triglycerides or fall in HDL cholesterol has been reported to be reduced (p. 3264).
Carbohydrate foods, or whole plant-based foods contain a variety of different fiber which can decrease the risk of cardiovascular disease. Individuals who increase the amount of fiber, viscous fiber, or soluble fiber in their diet, which are found in fruits and vegetables can reduce their levels of LDL cholesterol in the blood; an increase of 5 to 10 grams of fiber a day decreases LDL cholesterol levels by approximately 5 percent (NCEP, 2002, p. 3265). The consumption of soluble fiber found in fruits, oats, and other vegetables decreases both total serum cholesterol levels as well as LDL cholesterol levels (NCEP, 2002, P. 3265).
Eating You Alive – Dr Caldwell Esselstyn Jr – “95”
Short term studies of individuals following a whole foods plant-based diet higher in fiber and devoid of animal products have shown encouraging results. Shintani, Beckham, Brown, & O’Connor, (2001) placed individuals on an ad libitum low fat Hawaiian diet, ad libitum diet meaning they could eat as much as they wanted as long as calories from fat did not exceed 12%, those placed on the diet lost weight, had a drop in blood pressure, cholesterol, triglycerides, and had improved blood glucose levels (Para. 4). Another study conducted by Shintani, Hughes, Beckham, & O’Connor (1991) placed participants on the “Waianae diet program… which was a pre-western-contact Hawaiian diet” consisting of 7% fat; participants were encouraged to eat until they were full and in just 21 days the average drop in weight was 14 pounds, there was also a noticeable drop in cholesterol as well as blood pressure (p. 1647). Similar research conducted by McDougall et al., (2014) showed that following an ad libitum diet consisting of 7% of calories from fat for just 7 days resulted in an average weight loss of 3 pounds, while simultaneously dropping both cholesterol, blood pressure, and blood glucose levels in patients adhering to the diet. According to McDougall et al., (2014) their research found that a “Low-fat diet, starch based, vegan diet eaten ad libitum for 7 days results in significant favorable changes in commonly tested biomarkers that are used to predict future risks for cardiovascular disease and metabolic diseases” (p. 1).
Dr. Hans Diehl: The Importance of Changing Your Diet to Improve Your Health
Coronary heart disease; a whole foods plant-based diets impact on the progression of, and potential reversal of Coronary heart disease.
Many short term studies have shown the benefits of whole foods, plant-based diets, which contain relatively small or no consumption of animal products, cholesterol, and animal fats (particularly saturated fat and trans fat) while also being relatively free of refined oils. The populations consuming these diets rarely experience heart disease. According to the report “Diet, Nutrition, and the Prevention of Chronic Diseases,” published by the World Health Organization (2003):
Diet has been known for years to play a key role as a risk for chronic diseases. Traditional, largely, plant based diets have been swiftly replaced by high-fat, energy-dense diets with a substantial content of Animal-based foods. (P. 6).
Pre-industrialized countries that follow low fat plant-based diets, experience almost no adverse coronary events. In these countries, the percentage of calories consumed from fat, versus that of carbohydrate and protein, is typically under 15% fat. These diets, which are predominantly plant-based, are relatively low in fat and contain minimal amounts of meat, and almost no oil. For example, in the Okinawan diet, approximately 12% of calories within the diet consist of fat (Willcox et al., 2007). The Tarahumara Indians’ diet contains 12% of calories obtained from fat (Cerqueira, Fry, and Connor, 1979). In the traditional Thai diet, 9% of calories are obtained from fat (Kosulwat, 2002) and in the Pima Indians’ diet, 8-12% of calories are obtained from fat (Boyce and Swinburn, 1993). All of these diets are predominantly whole foods plant-based/vegetarian/vegan diets.
Roberts (1999), stated that he doubts that all Americans will become vegetarians, but does not believe “flesh is necessary for each of our 21 weekly meals. If we could decrease flesh consumption to 7 meals a week that would be a splendid start” (p. 817). Both Roberts (1995) and Thomas (2013) agree that to curb the progression of plaque within the arterial walls, total serum cholesterol needs to be lower than 150 mg/dL, thus a vegetarian diet needs to be followed, as even a small amount of animal meat can raise cholesterol levels, thus requiring the use of lipid-lowering drugs (p. 586; p. 1118).
Thomas (2013) recognizes that while heart disease reversal programs have existed prior to both Dean Ornish and Caldwell Esselstyn, their programs showed both the effectiveness a physician has on persuading individuals to make lifestyle changes as well as show casing not only the speed but the resiliency the human body has in its ability to heal through dietary intervention (p. 1118). Dietary modification is powerful in reversing even extensive, chronic disease. As highlighted by Ornish and Esselstyn, Thomas (2013) believes that “because the evidence of the role of diet causing atherosclerosis (buildup of fatty tissue and cholesterol within the arterial wall which clogs the artery [American Heart Association, 2017, para. 1]) is already so overwhelming, assigning a patient to a control group would be major violation of research ethics” (p. 1118). In other words, a few, researchers and doctors believe it is unethical to assign patients to a diet containing animal-based foods due to the evidence linking these foods to an increased risk heart disease risk.
Walter Kempner, creator and founder of the rice diet at Duke University in the 1940s, treated patients with hypertension and kidney failure and was criticized for his lack of control. According to Klemmer, Grim, and Loft (2014), “Kempner argued that the prior state was the comparator rather than a randomized control group. Of course the control group in Kempner’s day had a survival expectancy estimated at 6 months” (P. 686-687). Nevertheless, according to Klemmer, Grim, and Loft (2014) Kempner’s studies were “subsequently extended to patients with nephrotic syndrome, hypocholesteremia, diabetes mellitus, atherosclerosis, and subsequently obesity. And it worked, not in all patients but in many, for whom no other therapeutic options were open” (2014, p. 686). According to Klemmer, Grim, and Loft (2014) the rice diet consisted of a 2,000 calorie diet, which consisted of 2% to 3% fat, 4% to 5% protein, and the remainder of the diet was complex carbohydrates 92% to 94% (p. 684).
According to Thomas (2013), “evidence of the value of a low-fat plant-based diet for managing obesity, cardiovascular disease, and diabetes has been available in the medical literature for decades” (p. 1118). The diets shown to drastically improve health and reverse coronary artery disease contain 10% or less of calories from fat. Those programs include: Walter Kempner’s Rice diet, The Nathan Pritikin Research Foundation, John McDougall, and the physician’s committee for Responsible medicine, as well as Dean Ornish and Caldwell Esselstyn’s programs for heart disease reversal. That is in stark comparison to the American Heart Association’s diet of 25 to 35% fat (Thomas, 2013, p. 1118). The United States Department of Health and Human Services and United States Department of Agriculture (HHS and USDA, 2015) 2015 – 2020 United States Dietary guidelines for Americans recommends a diet of 20 to 35% fat, however, the lower minimum of fat intake of 20% is not promoted within the guidelines, and can only be found within the recommended daily intakes graph listed near the back of the guidelines (p. 97).
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These government recommendations for higher levels of fat within the diet tend to frustrate researchers. According to Esselstyn and Favalora (1998):
We cannot continue to have public and private organizations on the forefront of health leadership recommend to the public a dietary plan that guarantees that millions will perish from the very disease the guidelines were supposed to prevent (p. 8T).
While change within HHS and USDA guidelines has been slow, in regards to lowering the overall fat consumption for Americans, the Centers for Medicare and Medicaid Services are listening.
In august 2010, after years of peer reviewed published scientific literature, two programs proven to have beneficial effects on stopping the progression and even reversing the progression of heart disease, both the Pritikin program and Ornish diets, consisting of 10-15% of calories from fat or less, are now covered by the Centers for Medicare and Medicaid Services (Horrigan, 2010, p. 346).
Channel 13 Houston: Woman Reverses Heart Disease Using
Below is a brief video on the benefits of a whole foods plant based diet and plant-based diets actually help improve the functioning of our arteries, veins, and heart. This video is part of the plantrician project https://vimeo.com/105982061
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