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Prevent and reverse heart disease
1. Preventing & Reversing
Heart Disease
Ashwani K. Garg, MD
Board certified family medicine, lifestyle medicine
Reversive Medicine
Certificate in plant-based nutrition
September 8, 2019
Chicago
2. Goals
• Discuss research on prevention and reversal of heart disease
• Mechanism of heart disease
• Discuss nutrition basics of plant-based diet
• Phytonutrients and antioxidants
• Putting it all together, analyzing diet
3. 34 seconds
• We are going to do a prayer/meditation for 34 seconds
• When you hear the chime, close your eyes and meditate or pray, or send
loving thoughts to your friends, your loved ones, and around the world
4.
5. Burden of Heart Disease
• Every 34 seconds, 1 American has a coronary event, and approximate every
1 minute 23 seconds, an American will die of one
• 1/6 deaths is related to heart disease (379,559 Americans)
• 620,200 will have a 1st heart attack
• 295,000 will have a recurrent heart attack
• 150,000 will have a SILENT heart attack
• CVD is the #1 cause of death globally (31% of ALL global death)
6. All males 65 years and older, and all females 70 years and older, who have been
exposed to the traditional western diet have cardiovascular disease and should
be treated as such.
-Lewis Kuller, M.D. Univ. of Pittsburgh April 2007
8. Dean Ornish, Early Pioneer
• Dean Ornish was the 1st to offer documented proof
that heart disease could be reversed by lifestyle
• Most patients, chest pain disappeared
• For 82%, artery clogging reversed
• This was REQUIRED READING during my
medical school years in the mid 1990s at
Northwestern Feinberg Medical School
9. What was the Ornish plan?
• Intensive lifestyle changes (10% low fat whole foods vegetarian diet, aerobic
exercise, stress management training, smoking cessation, group psychosocial
support) for 5 years.
• 1 year initial study extended to 5 years
• Decrease in stenosis in experimental group, increase in control group
• 2-1/2 times more events in the control group
13. Dr. Esselstyn study
• Diet only intervention: whole grains, lentils/beans, vegetables, fruits,
flaxseeds. Low fat / no oil (avoidance of nuts/olive/avocado)
• Initially 17 patients, then expanded to 177 (adherent) patients, 44 months
• 93% had resolution or improvement of symptoms
• 22% had disease reversal on radiology or stress testing
• 27 of patients were able to AVOID stent / bypass
• Avg. weight loss 18.7 lbs.
19. Heart Disease
• NO OTHER diet has been shown to reverse heart disease, not the
Mediterranean, not a low carb diet, not the standard diet or the AHA or
DASH diet.
• Whole food Plant-Based is the only one that has proven to reverse heart
disease.
22. Atherosclerosis
• Atherosclerosis is the disease
process that leads to heart attack
and heart disease
• Atherosclerosis starts in young age
• PRIMORDIAL prevention begings
in infancy and even before, in the
womb.
23. Thrombosis
• Thrombosis is a complicated
phenomenon that leads to
sudden heart attack and
stroke
• Thrombosis involves
inflammation, nitric oxide
deficiency, elasticity, and
inflammation
24.
25.
26. EPC
• Endothelial progenitor cells were
shown to be INCREASED by
Okinawan vegetables
Atherosclerosis. 2009; 204(2):544-8 (ISSN: 1879-1484)
29. The old nutrition paradigm (reductionism)
Food is thought of in terms of its components
Macronutrients (fat, protein, carb)
Micronutrients (vitamin A, B, C, D…)
Fiber
Leads to:
macro confusion
supplements
poor health outcomes (rearranging the deck chairs on a sinking ship)
30.
31.
32. The NEW paradigm (wholism)
• Defines nutrition as the synergistic and wholistic effects of FOODS on health
• Nutrients interact with other nutrients and don’t work in isolation
• Effect of the whole food is greater than any of its components.
• A fruit is not “sugar”
• Brown rice is not a “carb”
• An avocado is not “fat”
34. Nutrition… (according to
Campbell)
• The biologically “wholistic” process by which elements of
food and water are used by the body to optimize health
• The highly integrated reactions and events of countless food
chemicals working together, as in a symphony
35. Whole food plant-based diet
"One of the most fortunate findings from the mountain of nutritional
research I’ve encountered is that good food and good health is simple. The
biology of the relationship of food and health is exceptionally complex, but
the message is still simple. The recommendations coming from the
published literature are so simple that I can state them in one sentence: eat
a whole foods, plant-based diet, while minimizing the
consumption of refined foods, added salt and added fats.”
- T. Colin Campbell, PhD
37. Nutrient Composition
Plant and Animal-Based Foods (Per 500 Calories of Energy)
1. USDA Nutrient Database for
Standard Reference.
http://ndb.nal.usda.gov/ndb/.
2. Holden JM, Eldridge AL, Beecher
GR, et al. “Carotenoid content of
U.S. foods: an update of the
database.” J. Food Comp. Anal.
12 (1999): 169–196.
3. The exact food listings in the
database were: Ground Beef,
80% lean meat/20% fat, raw;
Pork,fresh, ground, raw; Chicken,
broilers or fryers, meat and skin,
raw; Milk, dry, whole;
Spinach,raw; Tomatoes, red,
ripe, raw, year-round average;
Lima Beans, large, mature
seeds, raw; Peas,green, raw;
Potatoes, russet
*B12 is from soil bacteria and is variable; can be obtained
from supplements or supplemented foods
39. Protein requirements
A balanced plant-based diet with adequate calories will always contain enough protein.
For a 150 lb. person, minimum is about 1/3 of the weight or 50 gm.
50 gm = 200 calories worth
Even a “low protein” diet of 10% will give enough if 2000 kCal/day
41. Plant proteins are the best fuel for the body
• Nutrient-dense
• Anti-inflammatory, anti-oxidative stress
• Increased energy
• Optimized athletic performance
• Reduction and treatment of cancer
• Prevention AND reversal of heart disease
42. Phytochemicals
• Phytochemicals are compounds only in plants that promote health
• There is no daily reference intake for phytochemicals
• New research shows they may very well be essential to life, and for
prevention of cardiovascular diseases and cancer
• ONLY about 1/5 of Americans meet the minimum intake
43. Flavonoids
• Pigments in foods found in pigmented foods such as leafy greens, citrus, tea,
berries, and chocolate
• Over 5000 natural occurring flavonoids have been isolated
• Antioxidant, anti-inflammatory, anticancer, antiplatelet, antibacterial
44. Carotenoids
• Alpha/beta carotene, lutein, lycopene, zeaxanthin
• Found in Carrots, fruits, vegetables, tomatoes
• Reduce muscle fatigue, neutralize free radicals, reduce risk of
prostate cancer
• Regulate cell growth, modulate gene expression
• Carotenoids also regulate body fat and modulate obesity
45. Nonstarchy polysaccharides
• fucoidan, beta glucan
• Mushrooms, barley, oats, brown seaweed, wheat bran
• Apoptosis of cancer cells, brain development,
antithrombotic, blood pressure, reduced risk of
breast/colon cancer, improved cholesterol and
reduced CVD
46. Lignans
• Outer coat of seeds, woody parts of plants, provide building blocks
• 100 times higher in flax than other foods
• Lowering of blood pressure
• Hormone regulation (phytoestrogen)
• Protective against heart disease and breast cancer
47. Glucosinolates
• Sulfur containing compounds found in brassica
(cruciferous vegetables)
• Indole-3-carbinol (I3C) formed from metabolism
• Denatured by high heat (boiling) and activated by
chewing
• Antibiotics will inactivate the absorption
• Anti-cancer, anti-CVD, immune regulation
48. Isoflavones (soy)
• Isoflavones (genistein and dadzein) act as agonist/antagonist for estrogen receptor
• Isoflavones were thought to be harmful based on ANIMAL studies
• HUMAN research supports benefit of soy foods
• Lower type 2 diabetes risk
• Lower menopause symptoms
• Lower breast and gynecologic cancers
• Lower prostate cancer
49. Omega-3 fatty acids
• ALA is an essential fatty acid, converted to DHA/EPA
• Omega-6 found in oils will “compete” with the conversion and interfere
• DHA can be obtained in algae form (for example Vegetology)
• Turmeric can increase absorption of DHA
• Role in heart health, brain health, anti-inflammatory
54. Every day, we make a choice what to eat and on
living beings’ lives.
It’s up to us to choose.
55. Is eating “plants only”
healthy?
Statement by the Academy of Nutrition and Dietetics:
It is the position of the Academy of Nutrition and Dietetics that appropriately planned
vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide
health benefits for the prevention and treatment of certain diseases. These diets are
appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood,
adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally
sustainable than diets rich in animal products because they use fewer natural resources and are
associated with much less environmental damage. Vegetarians and vegans are at reduced risk of
certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension,
certain types of cancer, and obesity… Vegans need reliable sources of vitamin B-12
https://jandonline.org/article/S2212-2672(16)31192-3/abstract
59. Mindful Eating
“Savor, Mindful Eating, Mindful Life”
• Lilian Cheung, Editorial Director, HSPH Nutrition Source
(written with Thich Nhat Hanh)
• (1) Honor the food (sometimes we forget where the food comes
from)
• (2) Engage ALL your senses (taste, sight, aroma, texture, beauty of the
food)
• (3) Be mindful of portion sizes (don’t take too much – modest
amount)
• (4) CHEW your food – enzymes digest food, taste is more powerful
60. Savor - continued
• (5) Eat slowly and mindfully – enjoy and taste food thoroughly
• (6) Don’t skip meals – you will overeat in this way
• (7) Eat a PLANT-based diet
(when I say PLANT-based, I really mean plants only)
(eating meat increases risk of cancer and other diseases)
• https://www.youtube.com/watch?v=Emd9q6_o6Z0
61. Other lifestyle factors
adapted from Dr. David Katz
• Feet (150-300 minutes of exercise weekly, with 2 days of resistance)
• Forks (plant-based diet)
• Fingers (avoid alcohol / tobacco)
• Sleep (7 to 8 hours per night of good quality sleep)
• Stress (mindfulness, regular practice of prayer/meditation, fellowship)
• Love (Love for one’s significant other, the Earth, the Animals, cultivation of
universal love)
62. Example analysis (plant-based)
Cronometer.COM
(1) breakfast smoothie, soy milk, spinach, banana, pineapple, kiwi, hemp
(2) lunch chickpeas, broccoli, bulgur
(3) apple/PB snack
(4) dinner bean/veg/kale curry with swt potato, tahini + 4 brazil nuts
(5) 10 almonds for a snack w/soymilk
75. Albert Einstein:
“Nothing will benefit human
health and increase the chances
for survival of life on Earth as
much as the evolution to a
vegetarian diet.
