Doctor's Note

Wait a second, though. The Ornish program involves a number of other healthy lifestyle interventions such as exercise. How do we know it was the diet? That’s precisely the topic of my next video, Plant-Based Treatment for Angina.

What would happen if instead of going on a plant-based diet, you went on a low carb diet? You don’t want to know. But if you do, here you go: Low Carb Diets and Coronary Blood Flow.

In my last video I covered the green tea angle. If you missed it, check out Tea and Artery Function.

What effects might other foods have? See:

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  • Adrien

    Why Dr Dean Ornish still recommend Fish Oil supplement since the data don’t show any benefice ?
    Actually it look more like a nutrient with other benefice than just the improvement of endothelial function.
    Something like the same reason why Dr Greger recommend supplementing with Plant-based EPA/DHA ?

    I don’t know for now but at some point Dr Ornish recommended Fish Oil for cardiac patient.
    Dr Greger look more serious on this subject.

    • Daniel K. Morris- NF moderator

      Hi Adrien, I am not sure what Dr Ornish currently suggests in terms of supplements in his very successful program, but there is a great videos by Dr Greger on fish oil supplements that is a really up to date review of the scientific literature, all the references are listed under sources cited where you can check out the abstracts on PubMed. I included the link below

      fish oil

  • Don

    But the Okinawa centinarian diet involves fish several times a week. This seems to conflict with some of the studies.

    • mbglife

      Dr McDougall has addressed this a few times. His conclusion is that the big part of the Okinawan’s diet is purple sweet potatoes and that of that it’s not the color of the potato but that their on a predominately starch based diet. So he believes Okinawans as a group are long lived not because of their fish consumption, but in spite of it.

    • Thea

      Don: The traditional Okinawan diet is 1% fish. That’s a very, very small amount and thus in my opinion, is no conflict.

      Here is the study if you want to check the numbers or you can see the full breakdown of the diet in the table shown in Dr. Greger’s video on Okinawa.
      The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span. Ann. N.Y. Acad. Sci. 1114: 434–455 (2007)

      • Yes, there is more to understand about longevity, in American studies we forgot always that the oldest documented life was Jeanne Calment who passed at 122. I worked with centenarians in France , I have older than 90 people in my family too. For the Okinawa diet it looks to be related to sweet potatoes . “Food historians claim that this is not because of the astounding purple color, but rather because these tubers are flavorful, creamy, and high in fiber, vitamin C, and antioxidants. ” When I worked on the subject , on world wide longevity , the key was antioxydants and their usage.

        • Thea

          Claude: Thanks for sharing.

          Here’s a part I find interesting from your quote: “Food historians claim that this is not because of the astounding purple
          color, but rather because of the … antioxidants.” Dr. Greger says that the color *IS* the antioxidants. So, that astounding color is part of the reason the diet was so healthy. :-)

          • I worked decades ago on anthocyanin from blueberries. antioxydants found in the purple color. From this work I was an expert for ginkgo and work especially on aging , my expertise was in brain , so I have learn from the expert work( not to be published but to direct the choice to make the medicine) how antioxydants are working , the scavenger effect is efficient with the fibers and other nutriments delivered with the food rich in antioxidant . I am explaining that in a book I am writing. All sweet potatoes have antioxydants, vit B6 and Beta carotene . You have to eat them with the skin to get the fibers and few minerals helping the antioxidants to work. For my knowledge you may have more anthocyanin with purple sweet potatoes , but any organic sweet potatoes steamed with rice ( chinese used) will give you the scavenger effect you are looking for.

    • Dr Dave

      In the most recent Blue Zone studies (so-called long-lived cultures), the long-lived Okinawans came in second, behind the vegans of Loma Linda, Ca. The LLVs are Christians who are encouraged to follow the Genesis 1:29 diet, which is a pure vegan, whole food diet centered around fruits and vegetable foods bearing seeds, including whole grains, which are grass seeds. Their health statistics are excellent as well. Did the 1% fish make the difference, on average? I think so. See for today – there’s an article there from Jeff Nelson on his father’s experiences with heart disease. My conclusion is that moderation kills, and we can do better than the Okinawans. Cheers.

      • John

        But the LLV’s are not pure vegans. Less than half are actually vegans. A fairly high percentage are vegetarians, though. In addition, their spirituality connects them and their sense of community helps them as well. Blue Zones is a great book. It can help us achieve healthy longevity in many ways.

        • Dr Dave

          ? LLVs are Loma Linda Vegans. Vegans are vegans. The veg population in Loma Linda is big enough so that it can be divided into a vegan sub-group big enough to be statistically significant and compared to other eating styles. That’s what I was talking about. Of course the spiritual content is important, but the Okinawans have that as well in a culture that supports aging. In the end, the LLVs live longer on average and are healthier to boot. Best wishes.

          • John

            Thanks for clarifying that. I misunderstood your initials.

    • Eating fish for its heart healthy benefits, such as omega 3 and 6 fatty acids or even EHA/DHA in the skins, is far outweighed by the negatives of heart health such as: trans fats, saturated fats and cholesterol. Add to that list, a very high acid load on the kidneys, toxins, mercury, environmental contamination, disease, etc, etc….I think I’ll stick to flaxseed.

      • Stewart E.

        Good summation Trevor! Though a few more things could be added you already have a mouthful.

  • rob

    I wish Hypertension would have been covered here since there is a connection to the subject. My wife, 80, has been on a mostly plant food diet, is on Pradaxa blood thinner and started having high blood pressure several years ago. She is moderately active but is now on a 4th blood pressure medication Valsartan since just last week waiting to see since other had side affects.

    • Denise

      She should be assessed for sleep apnea or another secondary cause of high blood pressure such as renal artery stenosis, as it is unusual to have that degree of new onset hypertension at that age. Additionally, a highly processed plant-based diet can still be problematic, if it contains a lot of salt, high fructose corn syrup, and highly refined grains. The less processed, the better.

      • rob

        no way is that an issue

    • guest

      Rob: if your wife is suffering from a nutrient deficiency that causes or contributes to her blood pressure, drugs wouldn’t help. If she eats mostly a plant-based diet, the nutrients to pay attention to are vitamin B12, vitamin D, and iodine.

      • Karen McCormick

        Magnesium. Magnesium deficiency may be a cause. In fact, when people are hospitalized for high blood pressure, the treatment is often IV magnesium. I had issues with high blood pressure until I started taking magnesium, 250 mg twice a day. I’ve since switched to a plant based diet and having few blood pressure issues, unless I eat a lot of salt. Also, water can be very high in sodium, higher than the gov assumes it is, especially if you have a water softener.

      • rob

        We are very focused on nutrition and he blood tests are all good. I am having her get more magnesium and potassium, Eating more nuts & seeds. Also having healthy smoothies every morning. Also has alot of V-8 juice, salmon, DHA and D3.

        • I have been vegan for > 10 years & I have high blood pressure. My Doctor said it’s hereditary. I always had high blood pressure since I can remember.

          • rob

            Ray, I think you are right. May I ask what you take or how you treat it? I would like to have her take some things that appear to work for some like garlic (Kyolic) or celery seeds, but her blood thinner prevents it.

        • Louise

          V-8 juice has a lot salt and could be the cause of her blood pressure issues.

          • ron

            It is a low sodium version Louise.

        • Vicki

          V-8 is pretty high in sodium

  • Nancy Nowak

    I have been eating a plant based diet for a few years and still got angina pain and had to have a heart bypass operation. My LDA was blocked 95%. This was a year ago. I am doing well, but wonder what else I can do to avoid heart problems. I eat plant based, exercise every day and drink green tea. What more can I do? I do try to avoid stress too, with mindfulness meditation. Thanks for any suggestions.

    • Jim Felder

      If you haven’t already, I would try doing a very complete food diary including weighing each portion and then use to input a few days to maybe a few weeks worth of eating and see what it says. And don’t forget to include occasional snacks too. The little handful of nuts in the middle of the afternoon can be as significant dietarily as a meal. Cronometer allows you to put in recipes so that you can just input how many grams of a given recipe you ate and it will take care of summing the nutrients of all the ingredients. Percent of calories from fat, given the impact it has on the endothelium, would seem a place to focus attention. From the studies presented here, 10% of calories from fat would be a target to try to obtain. If you end up higher, then see what foods represent the highest amount of fat and try eliminating those. The most obvious would be any free oils in your diet. To see the impact of changes from changes in cooking techniques, like sauteing in vegetable broth rather than oil, just edit your recipes to make the switch and see how that changes the nutrient profile. Salad dressings can also be a huge source of fat, but there are a lot of no-added oil (but not necessarily fat-free) dressing recipes out on the net to try.

      Your vascular system sounds like it might in poor enough shape that it might require an even more focused effort to get a diet that can reverse heart disease rather than just halt any further progression. I hope this helps.

      • Nancy Nowak

        Thanks Jim and Thea! I do have Esselstyn’s book. One bit of confusion is that Dr. Greger emphasizes how good nuts and seeds are for our nutrition and Dr. Esselstyn says to eat almost no seeds and nuts, maybe just 5 walnut halves a day. Do you think our bodies are so senstivie that even this small difference could cause my arteries to clog up? One good thing was that only one of my arteries was clogged. The rest were perfect. Who knows, maybe I was born with a small artery. I am 75 years old. All of a sudden one day last year I had a pain in my neck when I walked and it lasted for a week and so I went to ER and the operation was done. I was never asked if I wanted to try to improve my diet. Actually there wasn’t much more I could do anyway.

        • mbglife

          In addition to Thea’s book recommendation, you might also check out some youtube videos by Dr McDougall on his starch solution diet. You can also order that book and find it at most libraries. Dr McDougall talks about no oils and almost no fats until your arteries are entirely cleaned out. In an older youtube video (Forty Year Old Vegan Dies) Dr Greger talks about getting enough B12, the minimum needed omega 3 to 6 ratios and niacin or folate…. I think (I am forgetting the last point exactly, but you’ll see it in the video). It’s a long video. The main info is near the end. If it was me, I’d be sticking to a more starch based diet with no added oil (which I do now) and almost no added fats. I wish you a full recovery.
          Mark G.

        • Kurt

          I know the plant-based gurus differ on nuts, but I think Dr. Ess would recommend strongly against 5 walnut halves per day. (Please correct me if he’s changed or modified his view on nuts.) According to Cron-o-meter, fat would comprise 83% of the 66 calories consumed. And most of the fat is omega-6, tipping the omega-3/omega-6 ratio in the opposite direction of most of us need to achieve the ideal.

        • Thea

          Nancy: I agree that the nuts/seeds issue is confusing for someone in your situation. If you are following Dr. Esselstyn’s diet, it does sound to me like you are probably doing all you can. In an ideal world, you would hold everything constant and play with adding and removing nuts/seeds from your diet to see if it helps or hurts or is neutral. But, you would need a good way to measure the effects. And I’m thinking you may not want to deal with such fine details and yourself a guinea pig after all you have been through. If you are anything like me, you just want to eat a healthy diet and enjoy life. So, I’m not really recommending you go that route.

          I’m not an expert, but if you made me give advice in this case, I would stick with: make sure you are really following all of Esselstyn’s advice. And then if it didn’t work, a reasonable approach would be to add some nuts because there is some good science to back up that idea (but maybe not as strong as Esselstyn’s experience, which is why I recommend following Esselstyn first). But I really don’t know if this is good advice or not…

          Keep us informed. If you find the magic diet that works for you, it may help others. Best of luck to you.

        • Jim Felder

          Like Thea, Kurt and mbglife say, I think Dr. Greger’s viewpoint on nuts is for otherwise healthy people. Dr. Esselstyn’s recommendations are for those like yourself who are suffering from active heart disease. In those with heart disease the need to baby your endothelium while it tries to heal itself is of more importance than the marginal improvement in an otherwise very healthy diet provided by nuts. So really Drs. Greger and Esselstyn are not in conflict with regards to nuts. Dr. Greger is addressing the average person and Dr. Esselstyn is addressing cardiac patients.

          Something else to think about is making a point to eat more nitrate containing plant foods. Plant nitrate is converted by bacteria and the body to ultimately nitrous oxide or NO, which is the vasodilator produced by the endothelial cells to relax the arteries. BTW, this is exactly what nitroglycerine does and why it relieves angina pain.

          So I would try going super low fat with no nuts and oily seeds and increasing nitrate rich foods and see what that does. I hope you find a way to beat back this heart disease dragon.

        • payoung NF moderator

          Hi Nancy, I think you’ve gotten a lot of good suggestions here and they all speak to the point i’d like to make so let me take a stab at this by adding my 2 cents. First of all I wouldn’t feel as though you were fine and “one day your artery clogged up”. A 95% LAD blockage takes decades to evolve so your artery was likely clogged long before you ever had a symptom. That said, in most cases it’s not the size of the blockage but the character (as in whether it’s stable or unstable) and the over all health of the endothelial wall that determines whether or not you’ll have a cardiac event. An endothelial wall that has inflammation or damage is more likely to become blocked than one that is healthy. Eating an anti-inflammatory diet like you do is always the best first step to eliminating or at least decreasing inflammation in the endothelial wall but may not be enough in some cases. It would have been good if someone had done an advanced lipoprotein analysis on you and had measured some specific inflammatory markers like IL-6, IL-17, TNF-a, and endothelin. My guess is that despite your healthy lifestyle some of these markers were likely abnormal and may have given a clue that you still had some underlying source of inflammation that wasn’t being addressed. There are other factors, unrelated to diet that can cause injury and inflammation in arteries like viruses, bacteria and heavy metals to name a few. In my practice I check the inflammatory markers to at least get a baseline because they are often abnormal well before someone has a cardiac event and can let me know that I need to look for other sources of inflammation that might not be so obvious. There can even be an imbalance in gut bacteria that leads to systemic inflammation in the absence of any gastrointestinal symptoms at all. So I guess what i’m trying to say is we shouldn’t fall into the conventional medicine trap of not recognizing that our body systems interact with each other. We have to examine and address abnormalities in the body as a whole. eating a WFPB diet, exercising and reducing stress is certainly the foundation but as I said in some cases may not be enough. I would seek the advice of a good Integrative Cardiologist or Functional Medicine doctor who can help you dig a little deeper. This may not be a do it yourself project.

        • Vege-tater

          Nancy, my issue was diabetes, but until I got my fats low enough, even whole healthy fats seemed to stall progress. Some of us may be more sensitive than others?

      • mbglife

        In addition to Thea’s book recommendation, you might also check out some youtube videos by Dr McDougall on his starch solution diet. You can also order that book and find it at most libraries.

    • Thea

      Nancy Nowak: To piggy back on what Jim Felder said: the idea of ‘plant based diet’ can mean a wide range of components. When dealing with your specific situation, the devil may be in the details. I think Jim gave some excellent advice. You might also look into the book, How To Prevent and Reverse Heart Disease by Esselstyn for more details that you can look for as well as recipes which will give you an idea of what a particularly heart-healthy diet looks like. (Best $9 you ever spent. Or check the library.)

      You might also search NutritionFacts for information specific to heart disease to get ideas of specific foods you could include in your diet that might help. Good luck.

    • bhrollin

      Nancy, read “The Starch Solution” by Dr. John McDougall. Then contact him and attend one of his ten day programs. It’s about five thousand dollars but a lot cheaper than bypass surgery. He is a very smart man and has helped many people.

    • Stewart E.

      Nancy, there have been some very good suggestions in response to your post. Jim Felder’s idea seemed to be a very good one to me and I totally agree with his emphasis.
      But to that, I must also add from my own experience the following example. I have no known heart problems but I do have T1 diabetes and therefore should be treated as though I have already had a heart attack. I did not know why until reading on glycotoxins I got the picture. So with this knowledge along with other things I continue on a wfpbd and as part of my control I get monthly lipid panels done. Generally my total cholesterol stays at 150 or lower.

      However there were times that it would shoot up over 200 and I was mystified to say the least. No I had not started sneaking breakfast tacos or cheeseburgers. Finally with a careful log I realized that I was still getting excess saturated fat in the form of coco butter. My favorited vegan dark chocolate bar turned out to be bad for me at the rate of about 1 oz per day. I eliminated that and my cholesterol returned to normal. Now for all I know the saturated fat in avocados might send it up as well in some people but just keep in mind we are all different and there are vegan sources of saturated fats you might look into. So I emphasize saturated fats but eliminating added oils is probably no less important as the oxidation of those oils, either with time and or heat, will produce a rancidity which I believe forms transfats.

      Good luck and I hope you will keep us informed as to what you find.

      • mike at the river

        Steward, I also have T1 diabetes (so says endocrinologist, I think its more like LADA, having developed it at age 45), What have you find on gyycotoxins? I follow WFPB diet, low fat, although some fat (beans, nut butter) raise my glucose level a lot less than rice or white potatos (but sweet potatos are a lot better, I live on them and oatmeal). Last cholesterol was an amazing 118. Do have stage 3 CKD. I find it frustrating when all the gurus talk about reversing Diabetes so quickly on plant based diet (I realise they’re talking abt T2). Still, WHPB is best.

        • Jim Felder

          True, Type I can’t be reversed, but I would think WFPB diet is critical to folks with absolute insulin dependence by keeping insulin sensitivity high so that you don’t have to take so much insulin and the sugars don’t hang out in the blood so long causing damage. Also it appears to be very effect in preventing as well as reversing fatty livers which causes the liver to not be able to sense the blood sugar level and so continue to dump sugar into the blood even though the level is completely adequate already.

          • mike at the river

            Jim, WOW, you made 2 points I never thought of. I knew abt keeping insulin sensititivy high (I suppose you could have T2 Diabetes in addition to T1), but I never pictured having low insulin resistance as helping clear out the sugar or glucose faster. Also, your point on fatty liver makes sense.
            What is your daily diet like? Do you watch protein (even plant-based) as well as salt to protect the kidneys? You’re probably aware of the research showing animal protein and fat is harmful to kidneys. And since Diabetes is a risk factor for heart disease, etc. a low-fat, WFPB diet is helpful for so many reasons.

        • Stewart E.

          Mike sorry about the delayed response. I got no alert about your message. Your point about LADA sounds spot on to me. Jim Felder made a good point about T2 in addition to T1. I use a pump and can therefore easily monitor my insulin intake. I ate very little in the way of fats before moving to a wfpbd so the effect was not so dramatic on my insulin usage as for some. Still, my daily intake went from about 46 units with a 5 unit standard deviation to about 37 units with the same standard deviation. So insulin sensitivity is a very important question for T1 and well as T2. And my experience suggests that it can be readily improved for T1 diabetics.

          Now the glycotoxins (aka advanced glycation end products) issue is something I am very concerned with, and your concerns at stage 3 CKD seem like it should be monumental. In addition to Greger’s videos on AGEs I started checking some of the sources. Seems diabetic nephropathy is directly associated with higher endogenous and exogenous AGEs. The external sources are mostly animal products so those being studied (T2 diabetics who have A1c >8) tended to have much higher diabetic nephropathy and probably also consume more animal products which means more fat and more animal protein.

          Now to me, another interesting thing is that these individuals have higher external as well as internal sources of glycotoxins. The higher diet from animal products will lower the insulin sensitivity. So reducing the animal products will reduce the AGE factors, the atherosclerotic factors such as excess cholesterol, transfats and saturated fatty acids will also be reduced. Then there is the excess protein load that could be eliminated and that too helps the kidneys. Turns out these same glycotoxins also reduce insulin sensitivity. So keeping them down for that reason will also help. So the wfpbd will then work to lower both the endogenous and exogenous AGEs and we gonna live longer. (some day I gotta do some graphics showing this relationship)

          Sounds like you are already doing most of what can be done. The only other things I haven’t asked about is your A1c. Looking at some of your well informed comments you seem to be the sort who would maintain good control. Glycosolated hemoglobin or HbA1c is a measure of one endogenous AGE as well as a marker for others. Because of the inflammatory nature of glycotoxins this is also extremely important. I keep hoping that with A1c at 7 or less and little external sources of AGEs I can continue to avoid diabetic side effects.

    • Julie

      I highly recommend reading “The Whole Heart Solution” written by a vegan preventive cardiologist. Lots of suggestions for all sorts of lifestyle changes in that book, plus it’s fun to read.

      • Thea

        Julie: I clicked on the link to take a peak. It looks interesting. But the first book on the page really caught my attention and tickled my funny bone: “Dead Execs Don’t Get Bonuses” :-)

  • thorn324

    (Sigh) How is one to reconcile the information presented in the video starting ca. 1:40 (regarding the article “Vascular dilatory functions of ovo-lactovegetarians compared with omnivores”) with the customary contra-dairy/contra-egg stance of Holy whole-foods/plant-based diet, Batman!!! errrr … I mean, Dr. Greger!

    Seriously, is this material simply a matter of saying that eschewing flesh foods is healthier than the SAD but … wait, the healthiest diet is eschewing the ova-lacto parts of the ovo-lactovegetarian diet, too? I feel that I should know better than to post this, but if I—at age 65—find it confusing, then maybe others do as well. Again, I (sigh).

    • Wade Patton

      I’ll eat meat before I eat any ovo or lacto. Less problems. Silly how we call folks who consume eggs and dairy “vegetarians”. Downright silly. And confusing yes!

      • Jim Felder

        Wate, I am with you 100%. Mammalian milk is a highly active and tailored food designed to stimulate growth rates appropriate for the infants of that species. It is completely inappropriate food for even the adults of the species, let alone the adults of a completely different species even if it tastes damn good melted all over a big cheese pizza!

        • Wade Patton

          Oh I’m a nut for pizza, but only a couple three times per month and preferred to be home-made-by-me.

    • Dr Miriam Maisel _NF Volunteer

      Hi thorn324. I found the full length article that you mention, for free on the internet. Going through it in detail, this study compared two groups of Taiwanese, an omnivore group and a group which was lacto-ovo vegetarian. The vegetarian patients were recruited from a group of Buddhists who avoid flesh eating on religious grounds. The full length article does not give any details as to what exactly anyone was eating, it just compares these two groups based on their overall declared eating pattern. Interestingly, the baseline characteristics of the two groups did not differ significantly as far as factors such as BMI, blood pressure, kidney function etc, and total cholesterol in both groups was between 160 and 170 (average age about 57). It leads me to believe that Taiwanese omnivores are probably not eating the amounts of meat that Westerners tend to eat, and that the vegetarians also were probably not eating the quantities of dairy and eggs that Westerners would either. The article relies on other studies that describe the nutritional composition of a vegetarian diet as containing “less protein” (12%) “less fat” (25-20%) and “more carbohydrate”(58-63%). there were 20 patients in each group in this study, so a small observational study. While the baseline vessel size was similar in both groups, the flow mediated dilatation of the brachial artery (measuring after occlusion of the artery for a few minutes with a blood pressure cuff) was about 3% in the omnivores and 13% in the vegetarians. This is where the number “4 times better” comes from in the video. This particular study did not look at refined or processed foods, salt, oils, etc and also, did not look at vegans. I would just take it as one small piece of the puzzle—the researchers themselves wonder about the mechanism of the beneficial effect of the Taiwanese lacto-ovo vegetarian diet as compared with the Taiwanese omnivore diet, and ask whether it is due to less protein, less fat, more arginine, etc. We have to look to other studies to get more answers.

      • dancer80

        Taiwanese do not eat the amount of dairy and meat that Americans eat, this is true. The public schools there have one vegetarian day per week and the society as a whole respects vegetarians and most of all vegans. Even meat-eating Taiwanese respect veganism as the kindest and healthiest of diets and lifestyles, it’s actually a vegan/ vegetarian’s paradise as far as food choices are concerned. When I was there last year, this was certainly my impression. Everyone from my meat-loving cousins to the street food vendor respected my choice of veganism, I never got the kinds of eye-roll or denigration that sometimes vegans experience from people here in U.S. who view veganism as extreme. Not in Taiwan, it’s quite the opposite, it’s like they look upon vegans as superior beings LOL.

      • dancer80

        Here are just a couple of blogs about the wonderful vegan/ vegetarian foods in Taiwan

  • Joe Caner

    Perhaps, that is why one starts feeling so good, so quickly when one switches over the a WFPB diet.

  • RalphRhineau

    With evidence like this, how do cardiologists (mine seemingly included) give short shrift to nutrition as part of cardiovascular therapy? Mind boggling.

    • Dr Miriam Maisel _NF Volunteer

      Hi Ralph. Most doctors are swamped and overwhelmed with the sheer number of studies and do not manage to take the time to evaluate the thousands of studies out there, but rather rely on guidelines which are based on consensus of experts, who are supposed to look at the current best evidence. These guidelines are probably out of date by the time they are printed (just as are medical textbooks….). As a doctor, though, I am still amazed when I try to discuss the work of Dr Ornish and Dr Esselstyn with colleagues, and they have simply never even heard of the work. However, there are some signs of hope. Last year the first International Cardiovascular Nutrition Summit took place in Chicago, where speakers included Dr Greger, Dr Ornish, Dr Esselstyn and the President of the American College of Cardiology, Dr Kim Williams MD, who recommends a plant based diet because he “knows it’s going to lower their blood pressure, improve their insulin sensitivity, and decrease their cholesterol” (NY Times, 6 August 2014). He himself follows a vegan diet. And since he is president of the College, this may really help influence cardiologists. There I also met Dr Columbus Batiste, another advocate of a plant based diet, and chief of Cardiology at Kaiser, in Loma Linda. So there are a few out there, and there will be more as time goes on. But because these recommendations are not yet mainstream, I do think it is wise for individuals who wish to take responsibility for their health, not to wait for the guidelines to catch up, but to look for the evidence of things that work, such as the approach of Dr Ornish, Dr Esselstyn, etc.

      • Stewart E.

        Miriam, I have been following this site for more than 4 years now and one of the things that I’ve noticed is the ever increasing number of MDs participating and moderating. This is the first time i’ve seen you post so I’ll thank you for doing so and for your participation.

        • Thea

          Stewart E.: All these fabulous doctors and RDs etc. are donating their time as part of a newish volunteer program at NutritionFacts. I agree that it’s been noticeable and really, really nice.

      • Paul

        Kaiser Permanente recommends a plant based diet for their members/patients. They also sell many plant based cookbooks and other PB books in their bookstores (at least in the San Francisco KP and I’ve also seen them for sale at the Oakland KP), including the Forks Over Knives cookbooks. My own PCP at Kaiser said I’m one of his few patients doing PBWF and he’s always pleased with my blood work. Since I’ve never been hospitalized overnight for any reason, I don’t know what they serve to inpatients, but you would hope they are at least following their own guidelines!

        • George

          And you can view/print Kaiser Permanente’s “Plant Based Diet, a healthier way to eat” booklet from their website. (18 double sided pages.

        • VegEater

          My Kaiser doctors in Southern California have not been enthusiastic about my PB diet. I’ve been wondering what kind of evidence Kaiser gave them, if any. It doesn’t seem to have been convincing.

          • Dr Dave

            The primary author and push behind the Kaiser WFPB approach has been Dr Craig McDougall. That’s right, Dr John McDougall’s son. And this apple fell very close to the tree. He is a fairly new MD practicing in Oregon, I think, under Kaiser. At the start, in addition to his father’s excellent work, he did several non-residential clinical studies. These data, both on health and business practice, and much more like it (like the China Study, Esselstyn, Ornish, etc) were apparently sufficient to convince his Kaiser management to get started in the WFPB area. After all, what’s the downside to better eating recommendations? A healthier insurance base population makes for higher profits, and Kaiser certainly knows this. But it will take time to penetrate the now-practicing MDs, Consumer patience, demand, and endless questions will move the cause along. Consumers like you and me must make this happen. We can do it. Kaiser has made a good choice, I’m considering joining them simply to use my money to encourage a better direction for healthcare (kind of like organics for both health AND sustainability). But I never go to the doctor anymore for anything other than tests that show how good I’m doing. I’m 70. This works. Best wishes.

      • RalphRhineau

        As a journeyman engineer and credentialed high school teacher, I understand the challenges of practicing and keeping current.

        My comment was to the point of how can evidence of such quality continue to be ignored? Sadly, I wish I could believe it was simply a matter of available time. The fact that the Calif Medical Association recently fought and killed an initiative to allow physicians to use 7 hrs of their continuing education credits to study nutrition shows the active hostility of the medical hierarchy to allowing low-tech medicine into the medical practices of its membership. John McDougall personally testified in support of the initiative. As Dr Greger has quipped, lifestyle medicine can be hazardous to profits.

        In my path following my recovery from a massive heart attack four+ years ago, I docilely took my meds and completed my cardio-rehab for the first two years and had two cautionary visits to the ER. Two years ago, my family physician, not my cardiologist, knowing I was already vegetarian suggested I go vegan to reverse my CVD. After I dropped another 35 lbs and lowered my cholesterol from 220+ to < 150, I've had to persistently push to be allowed to reduce/eliminate the medications that were giving me side effects of depression and muscle spasms which awoke me in the night. With each medicine withdrawn, my blood work has remained remarkably good. Although my blood pressure also dropped following my going vegan, he maintains it's necessary for me to stay on 5 mg of lisinopril. When I asked directly how much that low dose was contributing to my 112/68 BP, he deflected my question.

        The thing that started me looking to replace my current cardiologist was when he counseled me on how I could keep cheese in my diet by microplaning flavorful hard cheeses. Having literally *survived* the South Beach Diet which had me eating eggs, yoghurt and cheese in the years preceding my heart attack, I have no intention of allowing dairy into my life ever again, regardless of his well intentioned advice. Don't get me wrong, he's a good man but I don't think he believes in the power of plants to augment cardiohealth.

        I'm grateful for the name of Dr Batiste. I've been actively looking for a vegan-friendly cardiologist in southern California for a year and have had little success. Being part of Kaiser, I don't think my insurance will allow me to drive out to him, but perhaps he may know of a fellow traveler in metro-L.A.. Thanks to you for your efforts to change things from the inside. I wish you well.

        • Dr Miriam Maisel _NF Volunteer

          Good luck to you too! Even if your insurance doesn’t cover, it may be worth consulting with him as a sort of second opinion anyway, I mean, investing in a consultation if you have to pay. I had the impression that he is a very sincere guy and very caring and the impression that he is really there to help. So, worth a try.

  • mbglife

    Is there any truth to the belief that food should be separated into groups in order to digest them optimally and without problems. The three main examples I just heard for this are:
    1. Drinking water (or anything) will wash digestive juices into the intestines (aren’t they going to get there anyway with the digested food?
    2. fruit digests quickly and if eaten with heavy starches they will get kept in the stomach too long and begin to ferment and cause gas, bloating and acid reflux.
    3. eating an acid based fruit (citrus or tomato) will neutralize the enzymes needed to digest a sweet fruit (banana, dates, etc) and then neither will digest properly and we won’t get what we need from them and we’ll have digestive discomfort.
    There are other guidelines but these are the basics. So each food group should be eaten separately.

    The second point seems like it might make sense, but I’m not sure about it or the concept in general.

    Mark G.

    • Dr Miriam Maisel _NF Volunteer

      Hi Mark, There are many theories about food combining but as a doctor with a basic knowledge of biology and of human physiology, I find them all somewhat suspect. First of all, basically whole foods are already “combined”, for example, wheat grain, which we think of as a starch, provides about 10% of its calories form protein. Beans have starch, fiber and protein, and some legumes have protein, starch, fiber and more fat (such as soybeans and peanuts), vegetables such as broccoli provide a proportion of calories from protein, and most of the rest from carbohydrate. Fruit also is ‘combined’, containing sugars and fibers…. The only way you could really separate the elements would be to process them to death! On the digestion side, our digestive tract is fantastically engineered with different compartments and different acidity or pH levels in the different compartments where different enzymes act. Starch digestion start in the mouth (you might have done that experiment in grade school where you chew a U-Needa-Biscuit for a minute or two, and it starts to taste sweet because the starch is digested into sugar). The stomach has a highly acid environment where certain enzymes are able to cleave proteins, and after food is released form the stomach into the small intestine it is mixed with bile and alkaline secretions which come from the pancreas, for the breakdown of fats. (If your small intestine were subjected to the acid levels of the stomach it would be severely damaged.) Once food is broken down in this way to smaller components (protein to amino acids, starches to simple sugars and fats to fatty acids and glycerols) these are absorbed with the help of specific enzymes and transport proteins through the gut wall into the blood stream, and from there go to all the cells of the body. In fact I think there is potentially a benefit of combining foods, for example, if you eat something with a lot of sugar, and not much else, it will quickly enter the bloodstream and cause a certain rise in blood sugar, then insulin. If you have your sugar in a meal combined with other elements, it slows down the absorbtion of the sugar and so there is less of a spike in the blood sugar, it stays more even. Of course fat soluble vitamins such as A, E, D and K, are absorbed better when they are consumed with some fat. Vitamin A and K are mostly found in vegetables which do not contain fat– I think it would be good to have a look at the physiology of the digestive tract–it is really amazing and seems to know how to do the job. Having said that there are individual food sensitivities and also some people have difficulty digesting certain natural sugars (check out “FODMAP” if this topic interests you) and I think the food combining theories may have arisen as an attempted answer to these kinds of problems…..But in pretty much every cuisine that I know of, foods are not eaten one at a time, but in various combinations—seems that humans pretty much do this everywhere–So I think trying to separate things is first of all, not really possible, but also it makes life very complicated and it is, as far as I know, not been proven anywhere to be of benefit to health, long life, etc.

      • mbglife

        Hi Dr Maisal
        Hey thanks for that well considered reply. I thought of some of the same points you mentioned about why it likely isn’t true but the food combining theory point 2 about fruit seemed like it could have something to it. Maybe I’ll try eating an apple before a meal interested of after to see if it stops giving me reflux. Other than that experiment, I’m going to keep it simple and not worrying about it.


    • John

      1. According to both Ayurvedic and Chinese medicine, drinking a lot of water , especially cold water while eating can dilute your “digestive fire”. One is advised to drink water say, 30 minutes later.
      2. I have heard this from doctors who focus on digestion. I can’t explain the process.
      3. I have never heard of that.

    • guest

      mbglife:The third couldn’t be right. Conc. hydrochloric acid in stomach is much, much more acidic than any fruit, so no fruit can alter the pH of the stomach fluid significantly. And then the stomach content enters the small intestine, it’s neutralized by the bicarbonate ions in the small-intestinal fluid.

      • mbglife

        Got it. That makes sense. Looks like my chances of getting relief by eating sponges before a meal won’t help. :-( Too bad they’re so many well meaning people with bad ideas out there on YouTube videos. Lots of those bad ideas are why print think a vegan diet is dangerous to health and you “need” meat.

  • Sali88

    I’m leery of the figure of a 186% increase in angina in the control group. Are you sure you don’t mean 1.86 times as much? If the base occurrence is, say, an average of 15 attacks, then 1.86 times as much would mean an average 27.9 attacks. But if you’re saying a 186% increase, then that would be additive (2.86 times as much), and would mean an aveage 42.9 attacks – a significant difference. The higher figure seems less likely to me, so I just wanted to check.

    • EvidenceBasedNutrition

      Hi Sali — Thank you for the great question!

      I see you are referring to this part of the video — “Ornish showed that on his plant-based diet and lifestyle program, cardiac patients had a 91% reduction in angina attacks. In contrast, control group patients, who were instead told to follow the advice of their personal physicians for diet and lifestyle advice, had a 186% increase in reported angina attacks. This marked reduction in frequency, severity, and duration of angina chest pain was sustained five years later; a long-term reduction in angina is comparable to that of surgery, but without the knife.”

      Yes. I double checked and looked at the data from the study. It is a 186% increase in the control group. From the original study, “In contrast, control group patients had a 186% increase in reported frequency of angina”.

      Here is the study that Dr. Greger is referencing and here is a direct link to the full text of the study.

      This table shows the results directly. You may notice in this table that angina symptoms decrease in the control group at 5 years — that is because some participants in the study in the control group underwent surgery.

      • Sali88


  • Robert Haile

    I am an MD and in my 20’s my triglycerides were > 2,000( My urine was white as was my blood plasma.) at my lowest adult weight(154 pounds at 71 inches in height), greatest level of fitness( running over 100 miles/week as well as other sports) and high levels of plant intake. I not only risked death from heart disease but also pancreatic failure. The only combination that reduced my triglycerides was Zetia 10 mg/day and 4 grams of fish oil/day. My triglycerides now run 150-170. Statins did not work and caused myopathy and elevated CPK on repeated trials. I’m otherwise a vegan. The concern I have about large trials is that although they may directly relate to most people but there may be some exceptions with those who have specific genetic traits such as the 1% or so with gluten enteropathy. I wonder if you have encountered people such as myself with dramatically increased triglycerides

    • EvidenceBasedNutrition

      Hi Robert, you raise a great point that the results from studies like these can be great for the general population but that individuals may have subtle variations that must be taken into account.

      I believe Dr. Greger aims to provide people with broad coverage of the latest evidence based nutrition research in order to empower individuals to make the best decisions they can make for themselves with the help of their medical providers.

      I hope someone will comment on your question about others with increased triglycerides.

      Thanks for sharing how you are integrating lifestyle medicine with conventional approaches!

      • Robert Haile

        Thank you.

    • Jim Felder

      Every bell curve has its tail. I think it is very important that we have general clear and straightforward recommendations for the vast majority that live in the middle of the bell curve on these dietary topics while working to address the unique metabolic needs of those that don’t.

      On the topic of fish oil, had you thought to try algae oil? They contain the same preformed EPA and DHA, so they should have the same metabolic effect, but without strip-mining the oceans to get it. Plus the fact that since the algae are vat grown, they are never exposed to the environmental toxins that fish are. I know proponents of fish oil talk about hyper distillation to eliminate those toxins, but why risk this being just ad-speak when there is no need to risk the exposure. Also on a very practical level, I never get fish-burps with algal oil.

      • Robert Haile

        Thank you. I’m not sure I can get it here in Costa Rica as I live in a very small town with no motor vehicle, but I’ll keep it in mind.

    • payoung NF moderator

      Hi Robert, as an MD, you of course know this but when I start seeing trigs in the 2000 range in someone who is eating a healthy diet and is very active, I’m not thinking the usual suspects of diet and lifestyle. I’m thinking genetics or other more esoteric potential causes. I agree although most of the recommendations made in the large trials are sound they may not be completely applicable to someone like you. I’m happy to hear you found an answer. I might add, that despite much of what I’ve seen in the way of evidence here on NF I personally have seen significantly decreased triglycerides as well as normalized specific vascular inflammation markers with 4 grams of fish oil/day in a few patients. So for me the jury is still out on the fish oil question. I do by the way think the same result could probably be achieved with oil from algae although i don’t have experience with it.

      • Robert Haile

        Thank you for your interest.

    • Tom Goff

      There are certainly people with genetic polymorphisms that affect their TG levels.

      The details however are far beyond my comprehension. You may want to consider genetic testing and/or further research the literature on this topic eg

  • Green tea contains rutin which can act as a natural thrombolytic. SInce the number one cause of death for people in the U.S. over age 45 is a heart attack caused by a thrombus, consuming green tea makes good common sense. :-)

  • Jelena

    Can you please tell me your opinion on food combining…(not mixing carbohydrate-rich foods and protein-rich foods in the same meal,etc.)
    There is so many food combining charts to find on the net.
    Could you write a blog post about that topic or make a video,it would be wonderful.

    • EvidenceBasedNutrition

      Hi Jelena — Thanks for raising the question — this is a great topic for exploration.

      Eating balanced meals can be helpful — choosing from greens, beans, nuts, seeds, spices, grains, fruits and veggies. Ultimately, there are a lot of charts and information about this and I think at some point you have to trust yourself. Mainly because there are no clear cut answers on this topic. But this is a great question and there is *so* much for us to explore. I hope Dr. Greger can make a video summarizing the evidence on the topic. As of yet, he has not done so.

      On the other hand, Dr. Greger has spoken about having a few nuts with salads in order to absorb the fat soluble vitamins, combining pepper with turmeric to increase bioavailability, and other similar combinations based on the science. There are probably so many more things like this that we don’t know because we still need studies to discover these relationships.

      On a slightly tangential note, trying to maximize the nutrition of every meal is always a good rule of thumb. You can never go wrong adding greens or beans to meal. On that note, have you seen Dr. Greger’s Daily Dozen from his new book “How Not to Die”?

      In my view, a good start may be aiming to eat all these foods on a very regular basis. The science supporting these foods is stronger than the science of food combining.

      Take a look at Dr. Greger’s Daily Dozen for your
      android device or iphone. These apps are a good way to keep track of the healthy foods you can eat every day.

      I hope this helps as a start!
      And I am hoping to see more people share their own perspective so we can all keep learning together.

  • Dave

    I’m suffering from high blood pressure caused by gout which has affected my kidneys. Any thoughts on what you think I could do to help. There are not too many foods which I can eat, and my list is shrinking. Steamed vegetables cause me to swell around my mouth and nose. I eat salad, rice and beans, and not much else. I attempt to drink lots of water each day to flush my kidneys, typically between 5 to 7 – 12 ounces each. Right now, the water is also causing swelling. Can someone help me?

    • Cathleen_NF_Moderator

      Hi Dave- So sorry to hear about your struggles with gout and your kidneys. Have you checked out Dr. Greger’s videos on gout? Here they are in one place: Gout Videos Looks like cherries are high on Dr. G’s list. Are they something you can eat?

      • Dave

        Hi Cathleen – Thank you for your prompt reply. You’re so kind to care. I will look at those videos. I have tried tart cherry juice in the past, however, it did very little. I believe most of what I read recommends tart cherries. Is that correct? I think they are currently out of season, however, plan to buy some once they are back in. Do you know if they are kidney safe?

        Once again, your help is greatly appreciated. Dave

    • Thea

      Dave: You already got a nice reply from someone who knows more than I. That’s going to be worth more than I have to say. I just wanted to add (for what it’s worth) that I feel for you and hope you can find some relief soon.
      Also, everyone once in a while, I read a post like yours and get a scared feeling inside. I’m not an expert, but your situation seems really serious to me. While the community is normally here to answer questions, I do think that sometimes it is OK to suggest to someone to work with a doctor. I’m not saying you haven’t already tried. I’m sure you have. But if someone you feel comfortable with has not already been working with you, I hope you are able to keep looking until you find someone who can help. I don’t know how much help it would be since you are already eating about the cleanest diet a person can possibly eat, but if you can’t find anyone local, perhaps you could use Dr. Klaper’s phone consultation service.
      One more thought: If sour cherries are out of season, you might be able to find them frozen. After seeing one of Dr. Greger’s videos about eye sight, a friend of mine wanted to start eating black currents (I think it was black currents anyway). She couldn’t find any fresh, but she found a company on line who would ship frozen ones using dried ice. Maybe you could find something similar for sour cherries.
      Best of luck to you.

    • guest

      Dave: I’m like Thea, no expert. But if my interpretation of what you’ve written is correct, I’m concerned. Presumably, you’re under the care of a doctor but don’t seem to be getting anywhere. As Thea has suggested, I’d look elsewhere. Here’e the Life Extension Foundation’s entry on gout, at the end of which there’re some suggestions:
      Also, I have some interest in ayurveda; the South Asian herb known as bibitaki is used to treat gout. Amla is also known to be helpful. If you can’t find tart cherries or high-quality juice, there’re supplements; wouldn’t hurt to try.

  • lgking

    I am a Californian who has been living and working in Asia for the past 25 years, and particularly amongst Chinese communities. And I have to say that I find the Chinese to be some of the most unhealthy people on the planet. Their lifestyle and dietary habits can border on appalling. Even wikipedia survey of life expectancy of Chinese vs. (big-butt) Americans is 75 years vs. 79 years (must be all that ‘healthy fat’).

    The myth of the ‘wisdom of Asia’ is just that…a myth. The only thing more appalling in my observation is the disease, public defecation, death, and dying in the streets of India.

    I will however grant the existence of isolated pockets of a remote village here and there that is so cut off from civilization that they have to consume the local bark off trees, etc.

    • John

      Most of the research is on the traditional lifestyles of small town Asians, not the millions of Chinese who moved to astonishingly polluted cities to get rich in the last few years.

  • Massimo

    What I always find disturbing in studies about the Chinese is the high proportion of fried foods in their traditional diet. This should significantly reduce the benefits observed in an otherwise healthy diet. China is huge and different counties have certainly sufficiently different habits, but when we say “Chinese” these differences are hidden in the average results we get. I wish there were some systematic analysis of the effects of the frying habits in Chinese subgroups.

  • Dave

    I’m humbled and appreciate all of your help and concern regarding my serious health conditions. I will be seeing an ND next month for more in depth help. The MD’s time is limited, which means only quick help with referrals, and, understandably, little personalized care. I haven’t been able to find a primary care/nephrologist who specializes in what I need.The ayurvedic solutions are encouraging and worth exploring further. Tart or sour cherries, either frozen or fresh also make great sense. Also, I’ll look into Dr. Klaper’s phone consulting service Thank you again.

  • dancer80
    • Dr.Jon_NF Volunteer

      I just looked at at the article (from The Telegraph, 3/30/2016), and at the full text of the article referenced (from Molecular Biology and Evolution, published 3/29/2016). Yes, the headline is atrocious (“Long term vegetarian diet changes human DNA, raising risk of cancer and heart disease”). The scientific article is looking at the prevalence in an Indian population of a certain gene allele; this is NOT about vegetarian diet mutating human DNA, which is what the title implies. Furthermore, the crux of the article is here:

      individuals with I/I genotype having higher metabolic capacity to convert precursors to longer

      chain PUFA may be at increased risk for proinflammatory disease states as they efficiently

      convert LA to ARA. Put another way, individuals with the I/I genotype may be vulnerable to illhealth

      when adopting a diet rich in n-6 LA which severely reduce synthesis of anti-inflammatory

      n-3 LCPUFA because n-6 competes with n-3 to access the Δ-6 desaturase enzyme.

      So, all this is saying is that this “l/l genotype” — which MAY be more common among vegetarians (there is no evidence presented to support this), should avoid diets rich in n-6 LA (linoleic acid). This is what is present in corn and cottonseed and other common vegetable oils, whereas the beneficial n-3 fatty acids are present in nuts, seeds, and fish.

      • Great job Dr. Jon! Here’s the actual paper:

        As you can see it says nothing of the sort. They compared a genetic marker in a population in India (most of which ate meat) to a U.S. population and found higher rates of a gene variant that facilitates the elongation of omega 6 fatty acids. They found higher rates in India, which they speculated may have come from natural selection of generations of a population which historically has been about 40% vegetarian. Says nothing about the health of U.S. vegetarians (or Indian vegetarians for that matter). Even if you have this gene variant, you’d just avoid omega 6 rich oils like sunflower, safflower, and cottonseed oil, which is a good idea anyway. Classic man bites dog story media nonsense sadly.

        • Dr.Jon_NF Volunteer

          Thank you Dr. G! Your comments will hopefully put this to rest for many of your readers who might have been a little concerned to read this. I don’t want to name names, or cast aspersions, but it makes me wonder where publications like The Telegraph find their “Science Editor”s!

  • Juliette Goddard


  • Bob

    Okay, I love these videos, but is there any way you could stop swallowing massive amounts of spit and making that disgusting gulping sound in EVERY VIDEO???