Ultra-low-fat diet/drug combo can arrest heart disease, suggests small study
"Eating an ultra-low-fat diet and taking lipid-lowering drugs to maintain a cholesterol level below 150 mg/dl stops - and can even reverse - heart disease," says Caldwell B. Esselstyn Jr., MD. "Every patient with coronary artery disease should be offered this option of therapy," he says.
In the longest study of its kind reported to date, Esselstyn followed 22 patients with severe heart disease for 10 years. During this time they ate a "vegan" diet of fruits, grains, and vegetables and avoided oils, meat, fish, fowl, and dairy products, except for skim milk and nonfat yogurt. In addition, all patients took cholesterol-lowering drugs. The goal was to keep cholesterol levels below 150 mg/dl.
Unlike other studies, patients were not required to participate in any structured exercise or meditation program. Esselstyn promoted adherence to the diet by seeing participants every 2 weeks for 5 years, and every month thereafter for another 5 years.
Of the 16 patients who stuck to the diet, 15 had no further cardiac events (the other patient died after 5 years from an earlier cardiac injury). In contrast, all 5 patients who returned to their previous diet experienced a total of 10 additional cardiac events, including angina, heart attack, and congestive heart failure.
After 5 years, angiograms were taken of 11 patients who had had 37 coronary events during the 8 years before the study. The progression of heart disease had been stopped in all 11; in 8 of these patients, disease was partially reversed. The reductions in the size of the blockages - ranging to 30% - are some of the largest ever reported. No compliant patients have experienced any further coronary events during the 10 years of follow-up.
Esselstyn says that the purpose of his study was not to reverse heart disease. "The goal was to lower cholesterol to the levels found in cultures that are not plagued with heart disease," he says. "From an average pre-study level of 246 mg/dl, patients quickly achieved and continue to maintain an average level of 132 mg/dl. No other study has achieved such reductions."
Esselstyn believes that low cholesterol is the key to preventing and treating heart disease. "Most of the people in the world do not get heart disease because they are getting less than 10% of their calories from fat," he says. The federal government recommends that no more than 30% of calories come from fat, but Esselstyn thinks this is too high.
"Twenty-five percent of heart attacks occur in people whose cholesterol levels are between 180 and 210 mg/dl, which is the currently the recommended range," he says. "The secret is to keep your cholesterol level below 150 mg/dl."
"The first 3 months of the diet are the hardest," Esselstyn explains. "After that, the craving for fat is lost."
Although some call the vegan diet extreme, Esselstyn believes that the real extreme is the need to undergo heart surgery that treats only symptoms, not causes.
Modern Medicine, Volume 64, February 1996