The bottom line is this: according to Drs. Caldwell B. Esselstyn Jr., Dean Ornish, and Robert Vogel, the absolute best way to keep your endothelial cells (and your heart) healthy is to consume a low-fat diet that is rich in whole, plant-based foods such as fresh vegetables (especially leafy green vegetables such as kale, spinach, collard greens!), fresh fruit, beans and legumes (rich in arginine, an amino acid required to produce nitric oxide), and whole grains. In this case, low-fat means to eliminate added fat, including all animal-based foods (saturated fat), all oils – yes, that includes olive oil too (14% saturated fat), and even most nuts and seeds, unless you have a prior history of heart disease, in which you are advised to eliminate all added fats, including nuts, seeds, and avocados.
The exception is to include a tablespoon a day of chia seeds or ground flaxseeds to get enough healthy omega-3 fatty acids in the optimal ratio with other fatty acids (omega-6 & omega 9) and limited walnuts or avocado if you already have a healthy heart. Interestingly, a study at Yale by David L. Katz and colleagues found using the brachial artery tourniquet test that subjects experienced improved blood flow after consuming about two ounces of walnuts daily for eight weeks.(1)
Dr. Esselstyn reached the conclusion that this is the best diet/lifestyle to prevent or treat heart disease by observing diets in cultures that are absent of coronary artery heart disease such as rural China, Papua Highlands of New Guinea, Central Africa, and the Tarahumara Indians of Northern Mexico.(2) The common thread among all these heart disease-free cultures is that they all consume plant-based nutrition without oil. Of the 17 patients with severe heart disease that strictly followed Dr. Esselstyn’s diet, none have experienced a single cardiac event after following the diet for over 25 years. That’s absolutely amazing considering this group had a combined total of 49 cardiac events prior to working with Dr. Esselstyn! According to Dr. Esselstyn, “coronary artery disease is a toothless paper tiger that need never exist, and if it does exist, it need never progress”.
Maybe this diet/lifestyle seems extreme. Yet, doesn't it seem extreme to cut into your body to have stents inserted or to have veins removed from your leg for heart bypass surgery? Especially because while stents or bypass surgery may be lifesaving in an emergency, when done electively, they won’t solve the problem. They are only temporary solutions that treat the symptoms, not the cause. They do not prevent future heart attacks or prolong life. And the same is true for statin drugs.
When you're eating an all plant-based diet that's high in antioxidants you literally change your internal biochemistry, and you strengthen the protective cap over your pre-existing plaque, which prevents future cardiovascular events. The good news is that when the endothelium recovers, it can produce nitric oxide that opens the arteries and makes them relax, and prevent plaques from even sticking to your arteries!
So unlike procedures and medications that only treat the symptoms, an all plant-based diet that's high in antioxidants treats the cause.