According to the Centers for Disease Control and Prevention, coronary heart disease is the number one cause of death in the U.S., with 370,000 deaths annually, costing $108.9 billion per year. Someone in the U.S. has a heart attack every 43 seconds, and someone dies from a heart-related event every minute.1 And tell me this isn’t shocking: according to Michael Greger, MD, FACLM in his book “How Not to Die”, fatty streaks, which are the first sign of atherosclerosis (hardening of the arteries due to build-up of plaques of fatty material on the inner arterial walls), is found in nearly all American children by age 10!
Coronary heart disease, also called coronary artery disease, is a narrowing of the small blood vessels that supply blood and oxygen to the heart, and is caused by the buildup of plaque in the arteries to your heart (atherosclerosis).2 The plaque is an accumulating mess of cholesterol, cells, and debris that creates a bump on the inner artery wall that gets bigger over time, which reduces blood flow to the heart, limits the amount of oxygen-rich blood that reaches the heart, and causes chest pain (angina).3, 4
Eventually the growing plaque can completely block the coronary artery and deprive the heart of oxygen and nutrients, causing a heart attack.5 This type of blockage takes time to grow and comes with warnings such as shortness of breath and/or chest pain, which usually allows for treatment.
Of bigger concern is that the LDL (bad) cholesterol inside the plaque gets oxidized by free radicals from oils, dairy and meat. White cells fill up with the oxidized LDL cholesterol and become nasty chemical substances that erode the cap over the plaque until it becomes thin as a cobweb and then suddenly ruptures from the pressure of blood as it flows over the plaque.
The ruptured plaque leaks into the blood stream and triggers immediate clotting, which quickly blocks the artery (in a matter of minutes) and deprives the heart muscle of oxygen and nutrients, causing a heart attack.
This kind of heart attack comes without any warning and is most often fatal.5
Vascular endothelial cells make up a thin layer of cells that line the blood vessels throughout our entire circulatory system, from our heart, all the way down to our smallest capillaries.3, 6 These endothelial cells provide a smooth, protective surface that prevents toxic, blood-borne substances from penetrating into the smooth muscle of the blood vessel directly below.7
Caldwell Esselstyn, MD refers to endothelial cells as the “lifejacket of our blood vessels” because our endothelial cells produce nitric oxide, which he calls a “magical protective molecule of gas”.
Nitric oxide protects and dilates (opens) blood vessels, keeps our blood vessels flexible, keeps our blood flowing smoothly, inhibits inflammation, and keeps our blood vessels slick enough to prevent plaque (blockages) from forming!2
I like to think of the nitric oxide produced by healthy endothelial cells as a “teflon lining”, or non-stick surface inside my arteries that keeps the nasty mass of cholesterol, cells, and debris from ever sticking to the walls of my arteries so that plaques never get the opportunity to form, let alone grow into blockages.
To learn how to keep our endothelial cells healthy, let’s first look at how endothelial cells get damaged.
Our endothelial cells get damaged by foods that we eat, specifically, fatty foods (including animal foods, with saturated fat), fast foods, all oils, and caffeine. Dr. Robert A. Vogel demonstrated the direct and immediate impact of fatty food on our endothelial cells in 1999 using the Brachial Artery Tourniquet Test, a noninvasive technique that measures the diameter of the brachial artery.8
By measuring the diameter of the brachial artery before and after consuming various foods, Vogel was able to directly correlate the impact of consuming those foods on nitric oxide production by the endothelial cells. Foods that damage endothelial cells cause a drop in nitric oxide production, which reduces the diameter of the brachial artery.
Dr. Vogel used a group of students to show that even one fatty meal could damage the endothelial cells that line the brachial artery wall.9 Using the Brachial Artery Tourniquet Test, Vogel measured differences in diameter of the brachial artery before and after consuming a meal as well as how long it took the artery walls to spring back to their normal diameter. The students were divided into two groups: a “high fat” group that was fed a fast food breakfast with 900 calories and 50 grams of fat and a “no fat” group that was fed a breakfast of 900 calories and no fat.
Dr. Vogel found some impressive results. For those in the “no fat” group, the arteries remained normal, meaning no change in production of nitric oxide, so no damage to endothelial cells. For those in the “high fat” group, the diameters of the arteries were smaller after a couple of hours, meaning that they were not experiencing normal dilation of their arteries. In other words, their endothelial cells were damaged and producing less nitric oxide. After only one meal! So just imagine what happens to our endothelial cells and artery health after eating three high-fat meals a day, day in and day out, year after year, as so many Americans do!
This test produces similar results when we eat saturated fats from any source, including meat (beef, poultry, pork, etc.), dairy, fish, eggs, and oils.10 Yes, even oils, which are plant-based, all have some level of saturated fat, including olive oil. It’s the same saturated fat that damages our endothelial cells and clogs our arteries. Vogel found that olive oil restricts blood flow with a 31% reduction in diameter of the brachial artery.11
So now we know that fats and oils, even “healthy” olive oil, injure our endothelial cells, reducing the number of endothelial cells that can produce nitric oxide, which we need to protect our arteries from plaque. How do we keep our endothelial cells healthy to prevent or even reverse heart disease?
Low-fat meaning to eliminate fats in your diet from all animal-based foods (concentrated source of saturated fat), all oils (yes, olive oil too), and even most nuts and seeds. If you have a prior history of heart disease, 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, and if you have a healthy heart, limited amounts of walnuts or avocado. Interestingly, a study at Yale by David L. Katz and colleagues found with the brachial artery tourniquet test that subjects experienced improved blood flow after consuming about two ounces of walnuts daily for eight weeks.12
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.13 The common thread among all these heart disease-free cultures is that they all consume only plant-based foods without oil.
Of the 17 patients with severe heart disease in Dr. Esselstyn’s original study that strictly followed Dr. Esselstyn’s diet, none have experienced a single cardiac event after following the diet for over 25 years. That’s remarkable 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”.
To some giving up all animal-based foods, oils, and most nuts and seeds while eating only whole plant-based foods may seem extreme. However, does it not seem extreme to cut into your body to have stents inserted? Or even worse, to have your chest sawed open and a vein pulled out of your leg and inserted to bypass a blocked artery in heart bypass surgery? Especially since stents and bypass surgery, while lifesaving in an emergency, do nothing to prevent a heart 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 used to lower cholesterol.
When you eat only whole plant-based foods, which are naturally high in anti-oxidants, vitamins, minerals, phytonutrients, and fiber, you literally change your internal biochemistry, and you strengthen the protective cap over any pre-existing plaques, which prevents future cardiovascular events.
You also allow your endothelial cells to recover. And when your endothelial cells recover, they can produce nitric oxide to open and relax your arteries, make them slick, prevent inflammation, repair existing plaques, and prevent future plaques from sticking to your arteries!
In other words, you can prevent and reverse your own heart disease! I can’t think of a better gift of the heart that you can give to yourself and to your loved ones!