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Heart Attacks and Cholesterol: Purely a Question of Diet

To achieve the cholesterol level necessary to prevent heart attacks, most must take cholesterol-lowering drugs or eat a plant-based diet.

December 21, 2011 |
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Supplementary Info

Heart Attacks and Cholesterol: Purely a Question of Diet, 5.0 out of 5 based on 4 ratings

Sources Cited

National Institutes of Health. 2004. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).

Roberts WC. Shifting from decreasing risk to actually preventing and arresting atherosclerosis. Am J Cardiol. 1999 Mar 1;83(5):816-7.

Roberts WC. It's the cholesterol, stupid! Am J Cardiol. 2010 Nov 1;106(9):1364-6.

Roberts WC. Preventing and arresting coronary atherosclerosis. Am Heart J. 1995 Sep;130(3 Pt 1):580-600.

Acknowledgements

Image thanks to zpeckler.

 

Transcript

Having a total cholesterol under 200 or an LDL under 130 reduces your risk, but, as the editor-in-chief of the American Journal of Cardiology wrote more than a decade ago, it’s time to shift from decreasing risk to actually preventing and arresting atherosclerosis.
In an editorial last year he advocates for an LDL under 60, a total cholesterol under 150. “Whether or not we are willing to alter our diet sufficiently and/or to spend the money necessary to obtain the lipid-lower- ing drugs, and then take them religiously to achieve this goal is up to us.”
“For the build-up of plaque in our arteries to cease, it appears that the serum total cholesterol needs to be lowered to the 150 area. In other words the serum total cholesterol must be lowered to that of the average pure vegetarian. Because relatively few persons are willing to abide by the vegetarian lifestyle, lipid-lowering drugs are required in most to reach the 150 level.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease and statins.

For more context, check out my associated blog posts: Generic Lipitor is not the answer to our heart disease epidemic, The Most Anti-Inflammatory Mushroom,Preventing and Treating Kidney Failure With Diet, Stool Size and Breast Cancer Risk, and Cholesterol Lowering in a Nut Shell.

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease and statins.

    And check out my associated blog post “Generic Lipitor is not the answer to our heart disease epidemic.”

  • http://nutritionfacts.org/members/MacSmiley/ MacSmiley

    Looks like it’s not just my old Palm. This video doesn’t appear on your YouTube profile page or my buddy’s Android phone either, Michael.

    Here’s the URL for anyone else with this issue:

    http://youtu.be/b6cA7dnEuPg

  • http://nutritionfacts.org/members/patmcneill/ patmcneill

    Dr. Greger,
    This study might also be of interest to you and your other readers. As always, your comments and insights would be most welcome: http://www.ama-med.org.ar/obesidad/Interheart-LANCET-2004.pdf

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Thank you Pat! The Lancet is one of my favorite journals. Sponsored by the World Health Organization, the INTERHEART study you point out was indeed a monumental undertaking, trying to tease out modifiable risk factors for heart attacks across populations in more than 50 countries on every inhabited continent. They concluded that more than 90% of the risk of our #1 killer is attributed to things we can do something about, like eating fruits and vegetables every day. The most important risk factor by far was cholesterol–twice as important as exercise–followed by smoking. The designated discussant at the European Society of Cardiology Congress, where the results were first reported, lamented “mankind is doing a good job of killing himself.” l Their follow-up study, called INTERSTROKE, published in 2010 concluded that 90% of strokes were preventable as well.

    • Dr. A Ta’eed

      Very enlightening study!

  • http://nutritionfacts.org/members/patmcneill/ patmcneill

    I am astonished by the heroic scale, scope, the rigor in these studies and especially the value of their conclusions to humanity (not to mention the environment and the welfare of our animal friends). BTW, your series of DVDs provided the spark of inspiration I needed to adopt a plant-based, whole-foods (B12 supplemented!) diet almost a year ago – the benefits are monumental. Why isn’t everyone doing this? Super thanks to you!!!

  • http://nutritionfacts.org/members/euromixer/ euromixer

    Michael. Thank you for these videos, they are really useful and effective teaching tools. I eat a low fat, whole food, plant based diet with no added OIL. Daily green smoothie. Probably an A+ diet and I love it and have been eating this way for past 4 years.
    Heres my question. My TOTAL cholesterol is 150. Great! Buy my LDL year after year is about 85-97 over the past 4 years. No animal products. None of these soy isolate fake meats, beans, veg, fruits, grains.. What the heck could keep my LDL above 80? I have heard Dr Esselstyn say even if your Total and LDL Chol is higher than his recommendation of 150 and 80, if you are on plant based diet as he describes that I am still heart attack proof. But my question… why is it still above 80? Never been below 80 ever. My norm??

  • http://nutritionfacts.org/members/jolkapolka/ jzandecki

    Hello Dr. Greger,

    Similar to what some of the folks have expressed here, I have a comparable situation that I‘d like to share with you and get your input on. In the recent months my boyfriend and I have switched from a mostly meat-based diet to a mostly plant-based diet (we make some exceptions when we go out). We did this because of my interest in a healthier eating lifestyle and because of my boyfriend’s family history of coronary heart disease. Recently, my boyfriend has consulted a cardiologist and has had some tests done that indicated that he needs to lower his cholesterol and blood pressure or possibly take statins and other medications to do so. Neither of us likes the idea of him taking statins or any sort of medications to lower his numbers. So, we changed the way we eat. After 3 months of completely changing how we eat, my boyfriend went in to get his lab values retested. The results perplexed us. Instead of his lab values lowering after a 3 month plant-based dietary change, they increased (his blood lipids numbers: LDL from 125 to 134, triglycerides from 100 to 151, and his total cholesterol from 180 to 202)! Do you have any explanation as to why this might have happened? We have not given up on the plant-based eating, but given his most recent lab values his cardiologist recommended that he take the medication nonetheless. This is disheartening to us. Any advice and guidance would be greatly appreciated. Much thanks in advance!

    • Roger

      I know Im not Dr. Gregor but I can relate my experience. When I went vegan my HDL went down and my trigs went up. In order to get my numbers in the right direction I had to go whole foods vegan, low fat. This meant minimizing or eliminating white flour, sugar, and oil. I eat small amount of nuts but be careful some people go overboard with nuts and are not able to lose weight. Reducing white flour, sugar, and oil put my LDL at 82 and total at 148 and my trigs went down by 100.

    • WholeFoodChomper

      Thank you, Roger and Dr. Dons, for sharing your advice with me. Yes, I think my bf’s numbers could improve if he followed a more strict version of plant-based eating as well. While he is following our new way of eating MUCH better than I ever expected, he is not as into it as I am. Still your advice and results give me hope. I will try my best to influence him in positive ways mostly by example. Again, thank you for your suggestions; they are much appreciated.

  • http://nutritionfacts.org/members/drdons/ DrDons

    There are several considerations. The first is to make sure that there was not a lab error and that you were fasting with only water for 12 – 14 hours. I think avoiding statins is an excellent goal see http://nutritionfacts.org/videos/statin-muscle-toxicity/ I would do a 3-4 week trial of all whole food plant based diet avoiding oils and processed foods (i.e things with labels). Factors to consider: I would avoid all processed oils… olive oil and canola oil have saturated fat which gets converted to cholesterol; I would make sure that you are consuming adequate fiber see http://nutritionfacts.org/videos/beans-beans-good-for-your-heart/. The elevation in your triglycerides probably reflect increased consumption of sugars.. especially fructose/High Fructose Corn Syrup and possibly alcohol(I know it is plant based). Try and make all your own meals. Eating out will expose you to sugars and oils that are hard to control. After you do a good trial and repeat the blood panel see how you do. Over recommending drugs is common these days in medicine. You might enjoy reading Dr. Esselstyn’s book on reversing and preventing heart disease and some of Dr. McDougall’s newsletters go to his website click on Hot Topics and read more under Cholesterol and triglycerides or Heart Disease and Atherosclerosis… you might start with the Sept 2002 article on who should be treated. Given a new set of numbers plus information as above you will be able to work with your physicians. Don’t be discouraged keep working at it. Congratulations on working to stabilize your arterial disease and keep tuned to Nutritionfacts.org for the latest science.

  • http://nutritionfacts.org/members/procyan/ Procyan

    I hope this helps another(s)… I spent 8 years sick to the gills on simvastatin. but i was terrified i need another bypass if i quit. My wife suggested i try some diet changes to help the drug along. Naturally i took her advice and went hard vegan, you know, Esselstyn vegan. Guess who is off statins and feeling like a million bucks. I simply decided to eat to live and i never looked back. Real men eat plants…a fireman said that! Do it for a year, then decide if it is too extreme. Just say yes…PLEASE

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Thank you so much for writing in and sharing your story (and being alive to tell it!)

  • http://nutritionfacts.org/members/jw/ jw

    Dr. Greger, my LDL was 123 and 6 months later, 117 (under a plant based diet). Two questions: 1) could it take years to get my LDL to under 70 if it’s even possible? and 2) can arteriosclerosis be reversed/cured under a plant based diet?

  • http://nutritionfacts.org/members/drdons/ DrDons

    Congratulations on your success. I have been impressed with how quickly cholesterol levels can be lowered by going on the correct diet (i.e no animal products, no processed oils, low saturated fat, high fiber, exercise). I have seen patients over time continue to lower and improve their markers. Whether this is a response to further changes in diet or exercise or the body adapting over time I’m not sure. I am not aware of any studies that would help sort all this out. There is good evidence that arterial disease can be stabilized and reversed by going on a good whole food plant based diet. The advantages that occur in the first weeks are do to the nitrous oxide system. Studies have shown that stable angina or chest pain do to poor blood flow in the heart can be reversed by a plant based diet. For more information see the video’s on nitrous oxide most recently http://nutritionfacts.org/videos/the-power-of-no/. Drs Ornish and Esselstyn in the 1990′s showed reversal of the blockages themselves at rechecks 1 and 5 years out. Dr. Esselstyn’s clinical work since has confirmed the ability to stabilize coronary artery disease. You have to remember that the markers are only feedback and are relative to each individual. In my opinion there have been too few studies on the outcomes of a plant based diet to fully understand whether those on a well designed plant based diet can have LDL’s over the recommendations and still be okay. Given the dangers of statins see: http://nutritionfacts.org/videos/statin-muscle-toxicity/ I would be cautious about prescribing them to patients on a well designed whole food plant based diet with Vit B12 supplementation. You can also read Dr. John McDougall’s May 2007 newsletter on who should take statins see:http://www.drmcdougall.com/misc/2007nl/may/statins.htm. Keep tuned to NutritionFacts.org for the latest science as the evidence continues to mount that you and the planet will be healthier if we follow a plant based diet.

    • Procyan

      Yes,  I wish someone could address this too…in the trenches so to speak, the crucial question is can those on a good WFPB diet have higher than recommended LDL’s and still be safe from plaque.   I see a lot of charts that show NO relationship between cholesterol and heart disease or even a negative relationship.  Are these true?                    e.g. http://healthcorrelator.blogspot.co.nz/2009/12/total-cholesterol-and-cardiovascular.html

  • Prof. F

    Hi Dr. Greger!I have started my journey to veganism about a year ago, and have gradually becomemore and more vegan. Now I am about 90% vegan. Previously I was a big meat-eater,and being a 52 year old smoker, my blood work was not good:Cholesterol: 203, HDL: 27 LDL: 125 VLDL: 50 and Haemoglobin a1c: 6.1Trygs: 251 Because of my prediabetic condition, I have also reduced a lot of my sugar intake andhave added omega-3, niacin and sterol/stanol supplements. I have dropped a few pounds. The doctors have suggested statins, but I’m willing to do a lot before starting a statin regimen.I have done a few blood tests over the year, and my cholesterol has gone as low as 160s. In my last lab work some numbers improved and others did not, whichpuzzled me. The new lab numbers areCholesterol: 174, HDL: 31 LDL: 113 VLDL: 30 andHaemoglobin a1c: 6.1Trygs: 145. Although I know that I can get further improvement by quitting smokingand adding more exercise, my questions are:1.- Should I have expected a significantly larger drop in totalcholesterol and LDL?2.- Apparently, the lower the VLDL and trigs are significant, but arethey mainly because of the lower sugar intake and the addition of omega-3, rather than avoiding animal products? 3.- What should I do to further lower the total chol., total LDL andHaemoglobin a1c ? More importantly: should I consider a more dramatic change in my dietor in supplements?
     
    Thank you!

  • Nunu

    Hello,
     I am a 45 yr old fit, healthy female, who has been strictly vegan for over 2 years, and I feel great about it.
    I don’t smoke, exercise regularly, and eat very, very healthy: lots of greens and vegies, whole grains, etc. and few unnecessary fats or carbs, and I do everything I’ve learned that has to be done.

    Last week I wanted to check my cholesterol to compare it with a test I had 2 years ago, and was quite surprised: almost no change from 2 years ago:  my total chol. increased a bit to 196, as well as my LDL, to 99. This is far from the ideal of <150 tot. cho. and <70 LDL.

    The truth is that before becoming vegan I already ate quite healthy, but included animal proteins with lots of eggs, milk and several chicken or steak per week. After 2 years of 0 animal protein I thought my numbers will be great. Have you seen this happen in other patients? Assuming my diet and lifestyle are indeed as healthy as I think, how can this be explained? Genetics? I have no known family history of high chol.

    The good news: My HDL is very high, and it also increased a bit from 2 years ago to a total of 81, and my trigs are low: 81. I know these 2 factors mitigate the other numbers, and lower my risk factors considerably. But still I am puzzled:
    How can my tot chol and LDL not be lower? How (un)common is this with strict vegans that eat and live healthily with no known family histories? Any insights?
    Should my numbers require consulting a physician?

    Thx!

  • Kat

    I’ve been on a very low fat vegan McDougall-type diet for more that 6 years and my total cholesterol is 196. I did get it down to 167 by taking Niacin (the itchy one) about a year ago, but then quit since I had a massive nosebleed and had to call 911 and be transported to the emergency room. My platelets were 124, and I read Niacin can have a bad effect on clotting. Now the platelet count is 163.
    My present HDL is 59 and LDL is 119. I don’t want to take statins. What is the answer to this? I’m female, 73, and both parents died of cholesterol-related disease.

  • Jenni

    I have been searching for answers for the past 5 years with no luck, I have high cholesterol but live a healthy vegan life style. Is there any thing else that can cause high cholesterol? hdl = 2.07 mmol/L, ldl = 2.4 mmol/L, hdl ratio = 2.5 ratio, triglyceride 1.30 mmol/L

  • Caroline Graettinger

    Dr Greger, I’ve created a breakfast recipe based on your postings related to lowering cholesterol. What do you think? Can this be improved for more cholesterol-lowing impact?

    2/3 cup rolled oats (regular,
    not instant)
    1/4 cup dried apples
    2 Tbs dried currants or raisins
    1/2 tsp ground Ceylon cinnamon
    1/2 tsp amla powder (Indian gooseberry)
    2/3 cup water
    1/2 cup lowfat soy milk for topping

    • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

      Sounds delish! I make something very similar, as well. I like to use either hibiscus or green tea instead of water, and sometimes I add some cloves, dates, and flaxseed meal to “nutrify” it even more. I also love adding berries (frozen) to the mix. :)

      • Caroline Graettinger

        Ooh! I forgot the flaxseed meal and berries! Thanks for the input WholeFoodChomper. Your breakfast sound terrific!

  • http://www.facebook.com/liz.lugo1 Liz Pagán Lugo

    Dr. Greger, could you comment on this study: http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract

    I dont understand why there wasn’t correlation between saturated fat intake and CVD, CHD, or stroke risk. There are researchers saying vit K-2 is protective against cancer too. Why is it we use lack of Vit C production as evidence for eating plants but dont take the need for B- 12 as evidence for needing animal foods? Im trying to understand.

  • rick

    I have read, from several sources, that total cholesterol isn’t the real problem. Some are saying that the bad stuff is small particle cholesterol. Please comment.

  • Tris10

    I eat whole food, plant based (Esselstyn, McDougall…) but have familial hyper cholesterolemia (Total Chol 330 without drugs). I have been off and on drugs. I go off because I can’t handle the side effects- sever muscle pain and obvious memory problems. I’m in my early 40s. I’m wondering about studies for vegans with hypercholesterolemia and if we are protected by our diet alone despite our high cholesterol and LDL levels. I would love to be drug free AND have peace of mind I’m not short cutting my life. Seems my choices are I either kill my quality of life and live longer or enjoy my life and die early.

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