CAD? Tough current medical and surgical treatments manage coronary artery disease, they do little to prevent or stop it. Nutritional intervention, as shown in our study and others, has halted and even reversed CAD.

By Caldwell B. Esselstyn Jr, MD; Gina Gendy, MD; Jonathan Doyle, MCS; Mladen Golubic, MD, PhD; Michael F. Roizen, MD The Wellness Institute of the Cleveland Clinic. Dr. Esselstyn is author Prevent and Reverse Heart Disease and has been on the Board of Governors Cleveland Clinic.

ABSTRACT Purpose X Plant-based nutrition achieved coronary artery disease (CAD) arrest and reversal in a small study. However, there was skepticism that this approach could succeed in a larger group of patients. The purpose of our follow-up study was to define the degree of adherence and outcomes of 198 consecutive patient volunteers who received counseling to convert from a usual diet to plant-based nutrition. Methods X We followed 198 consecutive patients counseled in plant-based nutrition.

These patients with established cardiovascular disease (CVD) were interested in transitioning to plant-based nutrition as an adjunct to usual cardiovascular care. We considered participants adherent if they eliminated dairy, fish, and meat, and added oil.

Results X Of the 198 patients with CVD, 177 (89%) were adherent. Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%, significantly less than reported by other studies of plant-based nutrition therapy. Thirteen of 21 (62%) nonadherent participants experienced adverse events. Conclusion X Most of the volunteer patients with CVD responded to intensive counseling, and those who sustained plant-based nutrition for a mean of 3.7 years experienced a low rate of subsequent cardiac events.

This dietary approach to treatment deserves a wider test to see if adherence can be sustained in broader populations. Plant-based nutrition has the potential for a large effect on the CVD epidemic.

The core diet. Whole grains, legumes, lentils, other vegetables, and fruit comprised the major portion of the diet. We reassured patients that balanced and varied plant based nutrition would cover their needs for amino acids, and we encouraged them to take a multivitamin and vitamin B12 supplement. We also advised the use of fax seed meal, which served as an additional source of omega-6 and omega-3 essential fatty acids.

Foods prohibited. 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.

Enabling the body to correct harmful processes. Future discoveries may help to explain why plant-based nutrition is so effective, yet we can postulate likely mechanisms. When foods that injure or cause endothelium dysfunction are avoided, the body readily restores the capacity of endothelial tissue to produce nitric oxide. Such change reduces production of vasoconstricting endothelin and thromboxane by injured endothelial cells. Our insistence on daily ingestion of generous portions of green leafy vegetables favors an improved population of endothelial progenitor cells.33

33. Mano R, Ishida A, Ohya Y, et al. Dietary intervention with Okinawan vegetables increased circulating endothelial progenitor cells in healthy young women. Atherosclerosis. 2009;204:544-548

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