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The Best Diet for Chest Pain

The Dean Ornish program that led to improved arterial function and the dramatic drop in angina attacks—a 91 percent reduction in reported frequency of angina—is not just about putting people on a plant-based diet. It also involves recommendations for moderate exercise and stress management. We know exercise alone can improve endothelial function, so how do we know diet had anything to do with it? This is the subject of my video Plant-Based Treatment for Angina.

Going back to Ornish’s first publication, he put cardiac patients on a plant-based diet, with no added exercise—just diet and stress management—and got the same 91 percent 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. There are published case series going back to the 1970s documenting this. One study participant, Mr. F.W., had chest pain so severe he had to stop every nine or ten steps. He couldn’t even make it to his mailbox. He started on a strictly plant-based diet, and, a few months later, he was climbing mountains with no pain.

We know plant-based diets can reverse heart disease, dissolving away plaque and opening up arteries—in some cases without drugs or surgery—but that doesn’t happen in 24 days. “[T]he improvements in anginal symptoms are too rapid in onset and [too great] in magnitude to be explained by the gradual regression” of the atherosclerotic plaque. So, maybe it’s this improvement in function as well as structure.

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. One 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, and the second used a low-fat diet—a really low-fat diet with less than 2 percent of calories from fat. And the third? No diet at all—that is, 90 days without food; the researchers had a central line placed to basically drip enriched sugar water straight into the subjects’ bloodstream for three months. These researchers were not messing around. The treatment protocol didn’t include any exercise or stress management, either. They wanted to isolate out the effect of cholesterol lowering on cardiac blood flow.

The study participants started out with miserable cholesterol levels and with diminished blood flow to their hearts, so-called perfusion deficits, areas of the heart muscle that aren’t getting adequate blood flow. After cholesterol lowering, their cholesterol levels were still terrible, but, with the improvement, there was an improvement in blood flow and their angina attacks were cut in half. When they stopped the treatment 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 the researchers 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 morbidity. 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 very-low-fat diet alternative”—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 for patients with cardiovascular disease and diabetes, 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. It costs thousands of dollars a year to take it, but it works. Collectively, the studies show that at the highest dose, Ranolazine may prolong exercise duration as long as… wait for it… 33.5 seconds!

It does not look like those choosing the drug route will be climbing mountains anytime soon.


See a comparison of the arterial function of vegetarians versus omnivores in my Plant-Based Diets and Artery Function video. How about comparing the Arteries of Vegans vs. Runners? If those on plant-based diets aren’t getting a regular, reliable source of vitamin B12, though, their artery health can suffer. See Vitamin B12 Necessary for Arterial Health.

Cholesterol may do more than just impair the function of our arteries. Check out the images in my video Cholesterol Crystals May Tear Through Our Artery Lining. For even more, watch How Do We Know that Cholesterol Causes Heart Disease?andOptimal Cholesterol Level.

Does Cholesterol Size Matter? Watch the video to find out.

Three things increase our cholesterol level: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. What about moderation? Well, how moderate do you want your disease? See Everything in Moderation? Even Heart Disease? to learn more. And, be sure to check out How Not to Die from Heart Disease.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


29 responses to “The Best Diet for Chest Pain

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  1. Vitamin B-12 is a non-issue for most. Seriously, who doesn’t take a multi? And even if one didn’t, nearly every cereal and bread out there (and tons of other products) are fortified with B vitamins.

    1. Anna,

      That isn’t true. People on this site have had B-12 insufficiency, even supplementing with Methyl B-12, maybe because it isn’t shelf-stable or because it doesn’t work for everybody. I ended up having charley horses in my legs and tiny lesions while supplementing with Methyl.

      I do eat Ezekiel bread, but not every day and I don’t eat cereal or use plant milk. I also haven’t been using Nutritional Yeast because I haven’t been eating at home (because my dog is fasting)

      Lots of people don’t take multi’s anymore because of studies where supplements increase mortality.

      People don’t want synthetic vitamins.

      Anyway, I have been stumbling over people who are deficient or insufficient regularly now that I have been looking. Foods don’t always give enough. Mainly, people don’t eat the same foods every day, so you could get a lot of B-12 one day, which doesn’t help you, because you pee it out and suddenly you can go weeks without any of it and not know it.

      1. Cyano B-12 is the most shelf stable and the most effective, but the least popular right now and it is hard to find if you are a store shopper.

              1. I have fond memories of Woolworths from when I was a child. They had a little cafeteria and I think we got Grilled Cheese sandwiches and Chocolate milk before shopping.

                They might be reopening them in the UK. Wondering if it will come back anywhere in the US.

      2. I ended up watching the B-12 and arterial function video and that probably explains the Adventist Study right there. It was women Vegans who died earlier even than the fish eaters and Lacto-Ovo Vegetarians:

        The video said “One study of vegetarians whose B12 levels were really hurting even had thicker, more dysfunctional arteries than the omnivores. How do we know B12 was to blame? Well, when they were given B12 supplements, they got better. Their arterial lining started to shrink back, and the proper functioning of their arteries returned.”

        And

        “Postmenopausal Vegetarian Women have lower plasma Vitamin B-12, but higher Homocysteine levels and earlier menopause, which may attenuate the effects of a Vegetarian Diet on cardiovascular health.”

        That, plus, a higher intake of processed fake meat products with sodium.

        Plus, being less likely to have hormonal therapy.

        They were more likely to have wrist breaks.

        Just for ha ha’s I looked up to see if low B-12 could be related to bone breaks and there is a study on that:

        https://www.ncbi.nlm.nih.gov/pubmed/29239465

  2. Modern drug pushers come with a degree and a stethoscope. My doctors act shocked when I tell them my goal is get off all meds. There is no hope for health care for the masses when doctors buy the corporate Big Pharma line.

    1. Barbie,

      I agree with you.

      Though I suspect that eventually, the more people who get off meds, information will spread word of mouth.

    2. It’s horses for courses. For certain conditions like eg familial hypercholesterolaemia drugs can be a lifetsaver. Diet and lifestyle changes alone just won’t do it. But yes, in many cases diet and lifestyle changes are the best and most cost-effective option. This is even recognised in most of the current guidelines for eg cardiovascular disease, diabetes etc which state that diet and lifestyle changes should be the first line of treatment (and should continue to be promoted even when drug and other treatments are prescribed).

      However, we should also recognise that Esselstyn, McDougall and, I believe all, the plant-based docs (MDs) prescribe medications in appropriate circumstances.

  3. “These researchers were not messing around.” Haha! Indeed – on an IV without food for 90 days. That caused a double-take.

    It seems the evidence just keeps piling up regarding dietary changes and health. You mention that many doctors may feel a dietary change is too difficult for patients to maintain – and therefore recommend drugs. Do you think this mentality is shifting at all? I.e., are more doctors starting to recommend dietary changes as a first line therapy? Or is it getting worse? I’d be curious about your thoughts. Thanks for the article!

    1. The doctors/specialists I have encountered so far do not seem as enthusiastic as I am about diet and lifestyle being effective as a treatment plan in of itself. If I dared speak about ‘reversing’ any disease with diet, (CAD, diabetes, whatever) they would just gather up their files and walk out of the office. It isnt that they think the diet is too difficult.., they just dont believe that it does what some claim it does.
      Last thurs? a forum participant described what his cardiologist says is the perfect diet (basically mediterranean-ish) and that’s what I have heard as well.
      I would like to suggest a topic though, and that’s collateral blood vessels.. why do some people develop them faster than others? And does regular vigorous exercise stimulate the growth ie does the body respond in an ‘as needed’ way with collaterals when blood flow to the heart is compromised? TY

      1. Barb,

        You are right, they don’t believe that it does what it says.

        Neither do the people who go to those doctors.

        I am constantly amazed that people aren’t even curious after hearing it.

        It is “too good to be true” and they get angry and defensive or make fun of it. They have a “won’t get fooled again” chip on their shoulder and do not want to hear even one syllable.

        Looking at my dog’s vet, he had originally told me that he probably wouldn’t survive the weekend and would be dead within a few weeks for sure. Then, weeks later, he said that he wouldn’t consider it anything at all unless my dog lived 3 months. At 3 months, he switched it as if my dog didn’t have the cancer in his organs and said that he wouldn’t consider it anything unless my dog lived 6 months. I am waiting to see if my dog makes it 6 months and if he changes it to he might be a little impressed if my dog lives a year, or something like that.

        1. I am predicting that the next thing he will say is that “Sometimes Cancer spontaneously regresses.”

          Which it does.

          But, the people who get that Spontaneous regression work very hard to have it happen.

          I do believe that some of it really is spontaneous, but that might just be a euphemism for “we don’t know the mechanism” because there are things like Water Fasting and it would actually be quite possible that someone gets sick and doesn’t eat for a week and suddenly their brand new immune system sees the Cancer. Or they only eat fruit and may not even know about Methionine at all, but accidentally kill Cancer cells left and right. Or suddenly they get sick on meat and suddenly there are enzymes that eat the cancer fibrin.

  4. I was hoping someone could clear up one matter for me. I understand that cholesterol builds up in our arteries and the good doctor also mentions fatty streaks as well. Are these the same thing?

    1. Well, I am not sure I can read Dr. Greger’s mind, but I did look up cholesterol and fatty streaks and got:

      “Cholesterol is a compound of the sterol type found in most body tissues. Cholesterol and its derivatives are important constituents of cell membranes and precursors of other steroid compounds, but a high proportion in the blood of low-density lipoprotein (which transports cholesterol to the tissues) is associated with an increased risk of coronary heart disease.”

      “Fatty streaks… consist of a large number of lipid-laden foam cells that contain cholesteryl esters and a variable amount of extracellular lipid [61–63]. These cells, found in the intima, are mainly macrophages derived from blood monocytes however some are SMCs. Modified LDL ingested through the scavenger receptor-mediated pathway is a common mechanism to promote foam cell formation. However, there is lesion transition characterized by deep intimal extracellular deposition of cholesterol-rich vesicular lipid deposits as very early plaques begin to form [64].”

      Does that help?

      1. Hi Deb,

        Thanks for that. Yes, it does help. I am guessing that cholesterol is a component of fatty streaks. I also found this.

        “For most Americans eating a conventional diet, plaque accumulates inside the coronary arteries that feed our heart muscle. This plaque buildup, known as atherosclerosis, is the hardening of the arteries by pockets of cholesterol-rich fatty material that builds up beneath the inner linings of the blood vessels. This process seems to occur over decades, slowly bulging into the space inside the arteries, narrowing the path for blood to flow.”

        The key part being “cholesterol-rich fatty material”.

        1. Hello Lawrence and Deb,
          I am a family doctor with a private practice in lifestyle medicine, and also a Health Support Volunteer for this website. It sounds like you both have a reasonable understanding of these issues. High blood levels of cholesterol, and in particular high levels of small LDL cholesterol particles, have been shown in numerous studies to be a major risk factor for developing atherosclerosis of arteries, including coronary arteries. “Fatty streaks” are an early manifestation of atherosclerosis.

          Having a high cholesterol level does not automatically mean you’re going to have a certain amount of atherosclerosis, and having atherosclerosis (cholesterol plaques) does not mean you are necessarily going to get a heart attack or stroke. It gets complicated: “plaque rupture”, which is usually due to “unstable plaque”, is what actually causes heart attacks; and oxidized cholesterol is worse, and HDL cholesterol has a protective effect, and so on.

          Well, I hope this helps. I might have just confused you more. If so, sorry.

          Dr.Jon
          PhysicianAssistedWellness.com
          Health Support Volunteer for NutritionFacts.org.

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