The improvement of arterial function on a whole food, plant-based diet appears so pronounced that cardiac patients can achieve a 90% reduction in angina attacks.
Plant-Based Diets and Artery Function
Endothelial dysfunction is the initial step in the development of peripheral artery disease, heart disease, and stroke. The remarkable finding that progressive endothelial dysfunction, the decline in the functioning of our arteries, is not an inevitable consequence of aging, that we can retain the arterial function we had in our 20’s into our 60’s, like the elderly Chinese, may, in part, be due to green tea, but other important dietary differences, including increased consumption of vegetables and fishes with lower consumption of other meat and dairy in the traditional Chinese diet, may be contributing to the protection observed in older Chinese arteries.
It’s probably not the fish. Pooling all the best double-blind, placebo-controlled studies found that fish oil supplementation has no significant effect on endothelial function. In, by far, the largest study done to date, comparing doses of fish oil equivalent to 1, 2, or 4 servings of fish per week, no effects of these long-chain omega 3 fats were found. This is consistent with studies that have looked at whole fish consumption as well.
Overall, there was no significant association between fish intake and endothelial function. In fact, in women, those eating the most fish had the worst arterial function. Women who ate fish more than twice a week had significantly impaired endothelial function compared to those who never or only rarely ate fish.
So, if it’s not the fish, maybe it’s the plants. Vegetarian diets appear to have a directly beneficial effect on endothelial function. Vegetarian arteries dilate four times better than omnivore arteries. Maybe it’s just because vegetarians tend to smoke less? Within five minutes of smoking a single cigarette, our endothelium is brought to its knees, completely clamped down, and this happens if you’re a smoker or simply breathing in second-hand smoke. But this study excluded smokers completely. The beneficial effects were independent of non-dietary risk factors. In fact, a healthy diet may even trump smoking. The preservation of endothelial function in older Chinese may help explain why they have such low heart attack rates, despite their high prevalence of cigarette smoking. And the improved arterial function was well correlated with the duration of eating vegetarian, the longer they ate healthy, the better their endothelial function appeared to be.
This was a cross-sectional study, though, a snapshot in time, so you can’t prove cause and effect. What we need is an interventional trial. Put people on a plant-based diet and see if their arterial function improves, which is exactly what Dr. Dean Ornish did, showing a significant boost in arterial function compared to control.
Is this just some intangible risk factor test result, though, or does it actually have real world implications? Are their arteries naturally dilating so much better that their chest pain actually improves?
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.
But this was back in the 90’s, when Ornish was only studying a few dozen patients at a time. How about a thousand patients put on a whole-food, plant-based diet. Within three months, 74% of angina patients becoming angina free.
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.
Please consider volunteering to help out on the site.
- P Rajendran, T Rengarajan, J Thangavel, Y Nishigaki, D Sakthisekaran, G Sethi, I Nishigaki. The vascular endothelium and human diseases. Int J Biol Sci. 2013 Nov 9;9(10):1057-69.
- K S Woo, J A McCrohon, P Chook, M R Adams, J T Robinson, R J McCredie, C W Lam, J Z Feng, D S Celermajer. Chinese adults are less susceptible than whites to age-related endothelial dysfunction. J Am Coll Cardiol. 1997 Jul;30(1):113-8.
- W Xin, W Wei, X Li. Effect of fish oil supplementation on fasting vascular endothelial function in humans: a meta-analysis of randomized controlled trials. PLoS One. 2012;7(9):e46028.
- T A B Sanders, W L Hall, Z Maniou, F Lewis, P T Seed, P J Chowienczyk. Effect of low doses of long-chain n-3 PUFAs on endothelial function and arterial stiffness: a randomized controlled trial. Am J Clin Nutr. 2011 Oct;94(4):973-80.
- J S Anderson, J A Nettleton, D M Herrington, W C Johnson, M Y Tsai, D Siscovick. Relation of omega-3 fatty acid and dietary fish intake with brachial artery flow-mediated vasodilation in the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2010 Nov;92(5):1204-13.
- D Ornish, L W Scherwitz, J H Billings, S E Brown, K L Gould, T A Merritt, S Sparler, W T Armstrong, T A Ports, R L Kirkeeide, C Hogeboom, R J Brand. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7.
- R A Vogel. Brachial artery ultrasound: a noninvasive tool in the assessment of triglyceride-rich lipoproteins. Clin Cardiol. 1999 Jun;22(6 Suppl):II34-9.
- J Frattaroli, G Weidner, T A Merritt-Worden, S Frenda, D Ornish. Angina pectoris and atherosclerotic risk factors in the multisite cardiac lifestyle intervention program. Am J Cardiol. 2008 Apr 1;101(7):911-8.
- H S Dod, R Bhardwaj, V Sajja V, Weidner G, Hobbs GR, Konat GW, Manivannan S, Gharib W, Warden BE, Nanda NC, Beto RJ, Ornish D, Jain AC. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am J Cardiol. 2010 Feb 1;105(3):362-7.
- C L Lin, T C Fang, M K Gueng. Vascular dilatory functions of ovo-lactovegetarians compared with omnivores. Atherosclerosis. 2001 Sep;158(1):247-51.
Images thanks to Ryan via Flickr.
Endothelial dysfunction is the initial step in the development of peripheral artery disease, heart disease, and stroke. The remarkable finding that progressive endothelial dysfunction, the decline in the functioning of our arteries, is not an inevitable consequence of aging, that we can retain the arterial function we had in our 20’s into our 60’s, like the elderly Chinese, may, in part, be due to green tea, but other important dietary differences, including increased consumption of vegetables and fishes with lower consumption of other meat and dairy in the traditional Chinese diet, may be contributing to the protection observed in older Chinese arteries.
It’s probably not the fish. Pooling all the best double-blind, placebo-controlled studies found that fish oil supplementation has no significant effect on endothelial function. In, by far, the largest study done to date, comparing doses of fish oil equivalent to 1, 2, or 4 servings of fish per week, no effects of these long-chain omega 3 fats were found. This is consistent with studies that have looked at whole fish consumption as well.
Overall, there was no significant association between fish intake and endothelial function. In fact, in women, those eating the most fish had the worst arterial function. Women who ate fish more than twice a week had significantly impaired endothelial function compared to those who never or only rarely ate fish.
So, if it’s not the fish, maybe it’s the plants. Vegetarian diets appear to have a directly beneficial effect on endothelial function. Vegetarian arteries dilate four times better than omnivore arteries. Maybe it’s just because vegetarians tend to smoke less? Within five minutes of smoking a single cigarette, our endothelium is brought to its knees, completely clamped down, and this happens if you’re a smoker or simply breathing in second-hand smoke. But this study excluded smokers completely. The beneficial effects were independent of non-dietary risk factors. In fact, a healthy diet may even trump smoking. The preservation of endothelial function in older Chinese may help explain why they have such low heart attack rates, despite their high prevalence of cigarette smoking. And the improved arterial function was well correlated with the duration of eating vegetarian, the longer they ate healthy, the better their endothelial function appeared to be.
This was a cross-sectional study, though, a snapshot in time, so you can’t prove cause and effect. What we need is an interventional trial. Put people on a plant-based diet and see if their arterial function improves, which is exactly what Dr. Dean Ornish did, showing a significant boost in arterial function compared to control.
Is this just some intangible risk factor test result, though, or does it actually have real world implications? Are their arteries naturally dilating so much better that their chest pain actually improves?
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.
But this was back in the 90’s, when Ornish was only studying a few dozen patients at a time. How about a thousand patients put on a whole-food, plant-based diet. Within three months, 74% of angina patients becoming angina free.
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.
Please consider volunteering to help out on the site.
- P Rajendran, T Rengarajan, J Thangavel, Y Nishigaki, D Sakthisekaran, G Sethi, I Nishigaki. The vascular endothelium and human diseases. Int J Biol Sci. 2013 Nov 9;9(10):1057-69.
- K S Woo, J A McCrohon, P Chook, M R Adams, J T Robinson, R J McCredie, C W Lam, J Z Feng, D S Celermajer. Chinese adults are less susceptible than whites to age-related endothelial dysfunction. J Am Coll Cardiol. 1997 Jul;30(1):113-8.
- W Xin, W Wei, X Li. Effect of fish oil supplementation on fasting vascular endothelial function in humans: a meta-analysis of randomized controlled trials. PLoS One. 2012;7(9):e46028.
- T A B Sanders, W L Hall, Z Maniou, F Lewis, P T Seed, P J Chowienczyk. Effect of low doses of long-chain n-3 PUFAs on endothelial function and arterial stiffness: a randomized controlled trial. Am J Clin Nutr. 2011 Oct;94(4):973-80.
- J S Anderson, J A Nettleton, D M Herrington, W C Johnson, M Y Tsai, D Siscovick. Relation of omega-3 fatty acid and dietary fish intake with brachial artery flow-mediated vasodilation in the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2010 Nov;92(5):1204-13.
- D Ornish, L W Scherwitz, J H Billings, S E Brown, K L Gould, T A Merritt, S Sparler, W T Armstrong, T A Ports, R L Kirkeeide, C Hogeboom, R J Brand. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7.
- R A Vogel. Brachial artery ultrasound: a noninvasive tool in the assessment of triglyceride-rich lipoproteins. Clin Cardiol. 1999 Jun;22(6 Suppl):II34-9.
- J Frattaroli, G Weidner, T A Merritt-Worden, S Frenda, D Ornish. Angina pectoris and atherosclerotic risk factors in the multisite cardiac lifestyle intervention program. Am J Cardiol. 2008 Apr 1;101(7):911-8.
- H S Dod, R Bhardwaj, V Sajja V, Weidner G, Hobbs GR, Konat GW, Manivannan S, Gharib W, Warden BE, Nanda NC, Beto RJ, Ornish D, Jain AC. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am J Cardiol. 2010 Feb 1;105(3):362-7.
- C L Lin, T C Fang, M K Gueng. Vascular dilatory functions of ovo-lactovegetarians compared with omnivores. Atherosclerosis. 2001 Sep;158(1):247-51.
Images thanks to Ryan via Flickr.
Republishing "Plant-Based Diets and Artery Function"
You may republish this material online or in print under our Creative Commons licence. You must attribute the article to NutritionFacts.org with a link back to our website in your republication.
If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video.
You may not use our material for commercial purposes.
You may not apply legal terms or technological measures that restrict others from doing anything permitted here.
If you have any questions, please Contact Us
Plant-Based Diets and Artery Function
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
Wait a second. 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 Plant-Based Treatment for Angina video.
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 must, check out Low-Carb Diets and Coronary Blood Flow.
What effects might other foods have? See:
- Eggs and Arterial Function
- Walnuts and Artery Function
- Dark Chocolate and Artery Function
- Coffee and Artery Function
- Fatty Meals May Impair Artery Function
- Olive Oil and Artery Function
- Sodium and Arterial Function: A-Salting Our Endothelium
- Vinegar and Artery Function
- Tea and Artery Function
And don’t miss my overview video: How Not to Die from Heart Disease.
In 2018, I published a series that starts with What Is the Optimal Diet? Check it out!
In 2024, I released How to Boost Your Endothelial Progenitor Cells (EPCs) for Heart Health.
If you haven't yet, you can subscribe to our free newsletter. With your subscription, you'll also get notifications for just-released blogs and videos. Check out our information page about our translated resources.