Transcript: Plant-Based Treatment for Angina
The Dean Ornish program that led to the improvement in artery function and the dramatic drop in angina attacks is not just about putting people on a plant-based diet. It also involves recommendations for moderate exercise and stress management, and we know exercise alone can improve endothelial function. So, how do we know diet had anything to do with it?
If you go back to Ornish’s first publication, he put cardiac patients on a quasi-vegan diet, with no added exercise—just diet and stress management— and got a 90% reduction in angina attacks within just 24 days. And Dr. Esselstyn was able to improve angina using a plant-based diet as the only lifestyle intervention. We have published case series going back to the 1970’s documenting this. Angina and Vegan Diet: like Mr. F.W. here. Chest pain so severe he had to stop every nine or ten steps. He started on a vegan diet and months later, he climbed mountains with no pain.
We know plant-based diets can reverse heart disease, dissolving plaque away, opening up arteries, in some cases without drugs, without surgery, but that doesn’t happen in 24 days. The improvements in anginal symptoms are too rapid and too great to be explained by the gradual regression of the atherosclerotic plaque. So, maybe it’s this improvement in endothelial function that’s doing it.
What is it about plant-based diets that improves our arteries' ability to dilate? Is it macronutrient differences, simply the lack of the deleterious effect of meat? Maybe it’s the drop in cholesterol? Endothelial function improves if we lower our cholesterol low enough, by any means necessary. This study took PET scans measuring blood flow to the heart before and after three radically different ways to lower cholesterol. The first method used drugs, the second a low-fat diet - a really low-fat diet, and the third, no diet at all. 90 days without food. They had a central line placed to basically drip enriched sugar water straight into their blood stream for three months. These researchers were not messing around. And no exercise or stress management treatments; they wanted to isolate out the effect of cholesterol lowering on cardiac blood flow.
They started out with miserable cholesterol levels, and the diminished blood flow to their hearts to prove it. The dark blue areas represent so-called perfusion deficits, areas of the heart muscle that aren’t getting adequate blood flow. After cholesterol-lowering, the cholesterol was still terrible, but with the improvement, there was an improvement in blood flow, and their angina attacks were cut in half. And when they stopped, and their cholesterol went back up, the blood flow to their heart muscle went back down. So, cholesterol lowering itself appears to improve blood flow to the heart, and they think it’s because when cholesterol goes down, endothelial function improves.
There’s a new category of anti-angina drugs, but before committing billions of dollars of public and private monies to dishing them out, maybe we should take a more serious and respectful look at dietary strategies that are demonstrably highly effective for treating angina, and that have also been shown to reduce subsequent cardiac disease. To date, these strategies have been marginalized by the ‘drug pusher’ mentality of orthodox medical practice; presumably, doctors feel that most patients will be unwilling or unable to make the substantial dietary changes required. While this may be true for many patients, it certainly is not true for all. And, in any case, angina patients deserve to be offered the Ornish or Esselstyn diet alternative before being shunted to expensive surgery or to drug therapies that can have a range of side effects and never really get to the root of the problem.
In response, a drug company executive wrote in to the medical journal, “Although diet and lifestyle modifications should be a part of disease management, many patients may not be able to comply with the substantial dietary changes required to achieve a vegan diet.” So, of course, everyone should go on their fancy new drug, Ranolazine. Costs thousands of dollars a year to take it, but the side effects aren’t horrible, and it works. Collectively, the studies show that at the highest dose, Ranolazine, sold as Ranexa, may prolong exercise duration as long as 33-and-a-half seconds. It does not look like those choosing the drug route will be climbing mountains anytime soon.
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 Katie Schloer.
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