Lifestyle changes can be lifechanging, with dedicated effort

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I ran across a recent article of yours about carotid artery stenosis. In this article you state that “there is no miracle food, drink or supplement that can clear out arteries.” This is actually not true. I’d like to point out Dr. Dean Ornish’s work as well as Dr. Caldwell Esselstyn’s work on heart disease. Both doctors showed regression in coronary plaques in their patients who followed a whole food plant-based diet. One young patient who suffered a heart attack even saw complete reversal in his coronary artery blockage on a whole food plant-based diet. I’d encourage you to check out their studies and books if you haven’t done so already. Their work is very encouraging and shows that we do not have to succumb to heart disease. — K.G. ANSWER: I appreciate your writing to give me a chance to make my point a little more clearly. I do want to emphasize that the patient was asking specifically about YouTube videos for “food, drinks and diet regimens that clear arteries.” I have seen some of these, which say, for example, all you need is a cup a day of lemon juice and turmeric to clear your arteries. There are health care professionals in the media who tout simple cures to reverse heart disease. These are what I refer to when I say there are no miracle cures. That is not what you are referring to in the work of Drs. Ornish and Esselstyn. Theirs was a significant lifestyle intervention, not a miracle supplement. Dr. Esselstyn did a small, uncontrolled observational study; Dr. Ornish did a small controlled study. In the Esselstyn study, the diet was quite restrictive: “Initially the intervention avoided all added oils and processed foods that contain oils, fish, meat, fowl, dairy products, avocado, nuts and excess salt. Patients were also asked to avoid sugary foods (sucrose, fructose and drinks containing them, refined carbohydrates, fruit juices, syrups, and molasses). Subsequently, we also excluded caffeine and fructose.” The Ornish study had a similar completely vegetarian diet, but 10% of calories from fat was allowed. In addition, there was (as there was not in Esselstyn) mandatory stress reduction time, and all smokers in the study quit. This study’s results, proven by angiography, showed reversal in coronary blockages by 3% in five years, compared with 12% worsening in the control group in the same time. Esselstyn analyzed the study by those judged adherent and nonadherent. For any subject who was judged nonadherent, 62% had coronary events. Less than 1% of adherent subjects experienced an adverse event. Together, these studies show that in a group of extraordinarily motivated study subjects, coronary lesions can undergo regression with a multi-interventional approach including profound diet changes and sometimes other lifestyle interventions. These aren’t miracle diets. It’s an entire dramatic change in lifestyle. Extreme lifestyle changes are not necessary to show benefit. In the PREDIMED study, a Mediterranean-style diet was recommended, with high amounts of fruits, vegetables, legumes, olive oil and nuts, with less red and processed meat, less commercial baked goods and spread fats, and less soft drinks. Those who were recommended this diet had fewer heart attacks, strokes and death than those who were in the control group and were recommended a low-fat diet.