- Heart Disease Basics
- What about the American Heart Association Diet?
- Whole Food Plant-Based Diet vs. Mediterranean-Style Diet
- Why Don’t We Hear About the WFPB Diet from Most Doctors?
- Why Are Stents and Bypass Surgery Not Enough To Prevent A Heart Attack?
- Basic Principles of Whole Food Plant Based Diet
- Cookbooks for a Heart Healthy Diet
Heart Disease Basics
- Coronary artery disease (heart disease) begins in most Americans by age 20. It is the most common type of heart disease in the United States (US). , 
- Despite medical advice on lifestyle changes relating to sleep, diet, and exercise, heart disease has remained the leading cause of death in the US for over a hundred years., 
- Across the world, people who eat a whole food plant-based (WFPB) diet with only a tiny amount of animal products do not have heart disease. 
- Heart disease begins when the blood vessels are injured and form plaque, leading to heart attack, stroke, and death. 
- The Standard American Diet (SAD) of animal-based foods – meat, poultry, seafood, dairy, and eggs – with added oils and added sugars injures the blood vessels and is the root cause of heart disease. 
- Common dietary and lifestyle advice, heart medications, coronary artery bypass surgery, and heart stents do not treat the main cause of heart disease. 
Limitations of Traditional Treatment Methods for Heart Disease
Traditional cardiology continues to relieve symptoms with medications, stents, and bypass surgery. Stents and bypass surgery can save lives in an emergency, and medications can slow the progression of heart disease. However, none of these measures cure or reverse heart disease.
Research suggests that patients with chest pain can be offered treatment with medication and lifestyle changes first and then offered stents and bypass surgery later if symptoms persist. While beneficial, surgical and medical treatments for heart disease are not without risks. We should make all efforts to prevent the injury that would necessitate the need for these interventions in the first place., 
We can avoid heart disease by adopting a whole food plant-based diet. Cultures whose diets are whole food plant-based see minimal heart disease. In addition, switching to a whole food plant-based diet can help relieve heart disease symptoms. You may see the benefit within weeks of adopting this diet.
While beneficial, surgical and medical treatments for heart disease are not without risks. We should make all efforts to prevent the injury that would necessitate the need for these interventions in the first place. 
Treating the Root Cause of Heart Disease
In 1985, before statin (common cholesterol medicine) medications were available to treat heart disease, Dr. Caldwell B. Esselstyn, Jr. conducted a study for 12 years that showed a whole food plant-based diet stopped and reversed severe heart disease in the study participants. Study participants had healthier blood vessels and relief of their chest pain. They severely reduced their stroke and heart attack risks by adopting this diet. 
In 1990, Dr. Dean Ornish showed that a low-fat vegetarian diet without added oil, smoking cessation, moderate exercise, and stress management stopped and reversed heart disease. 
Why is Animal Protein So Damaging?
Research shows how animal-based foods promote heart disease. Our gut or Intestinal bacteria feed on animal-based foods and produce a chemical called trimethylamine oxide or TMAO. TMAO can cause injury to our blood vessels, leading to plaque formation, heart attack, stroke, and death. Those who eat only plants do not have the type of intestinal bacteria that make TMAO. This further supports the heart benefit of a whole food plant-based diet. , , 
What about the American Heart Association Diet?
The American Heart Association (AHA) recommends eating the standard American diet (SAD) of meat, poultry, seafood, dairy, eggs, added oils and added sugars. Foods such as these injure the blood vessels and cause heart disease. Although eggs do not appear in the list below, the Association’s “How to Cook Eggs Video” says an egg a day is okay. The American Heart Association advises to:
“Eat an overall healthy dietary pattern that emphasizes:
- a wide variety of fruits and vegetables
- whole grains and products made up mostly of whole grains
- healthy sources of protein (mostly plants such as legumes and nuts; fish and seafood; low-fat or nonfat dairy; and, if you eat meat and poultry, ensuring it is lean and unprocessed)
- liquid non-tropical vegetable oils
- minimally processed foods
- minimized intake of added sugars
- foods prepared with little or no salt
- limited or preferably no alcohol intake” 
The AHA diet is more consistent with the standard American diet than the whole foods plant-based diet.
Whole Food Plant-Based Diet vs. Mediterranean-Style Diet
Because sixteen countries border the Mediterranean Sea, and each country has unique farming and eating practices, the phrase “Mediterranean Diet” is a misnomer. However, there is an
eating pattern that is typical of Mediterranean-style diets. This Mediterranean-style eating pattern is high in fruits, vegetables, bread, cereals (grains), potatoes, beans, nuts, and seeds. It is low to moderate in dairy products, fish, poultry, and wine. It includes eggs 0-4 times each week and little red meat. Oils, such as olive and rapeseed (canola), are used in salads and food preparation. Olive oil is not the only oil used. , 
Studies show that a Mediterranean-style diet lowers your risk of heart disease by 50%-70%. Dr. Esselstyn’s studies showed that the whole food plant-based (WFPB) diet was 30 times better for heart health than the Mediterranean-style diet. For those who find the whole food plant-based diet too restrictive and difficult to follow, the Mediterranean-style diet may be a way to slow the progression of heart disease. , 
Why Don’t We Hear About the WFPB Diet from Most Doctors?
Realizing that most cardiologists are honest and caring physicians who have their patient’s best interests in mind, why don’t they recommend the WFPB diet to all their patients? Physicians receive almost no nutrition education in medical school or residency training. They may be unaware that the WFPB diet can stop and reverse heart disease and are not taught the skill set needed to help their patients change their diets.
Even if physicians know the benefits of the WFPB diet, many believe patients will not follow such a strict diet. No matter how many (or how few) patients are willing to try the WFPB diet, every patient should have the opportunity to decide for themselves. According to Dr. Caldwell B. Esselstyn, Jr., who wrote the book Prevent and Reverse Heart Disease,  it is not the message is wrong but how and if it is stated that determines whether patients will follow the WFPB diet and succeed. 
In 2017, the cost of inserting a heart stent at a hospital in the US was reported to range from $11,000 to $41,000.  In 2016, the average cost for bypass surgery was reported to be $151,271, ranging from $44,824 to $448,038.  Inserting stents and performing bypass surgery is profitable for doctors and hospitals. The public is seeking a magic bullet. Some heart patients may like the “quick fix” of a heart procedure to treat their chest pain. , 
Why Are Stents and Bypass Surgery Not Enough To Prevent A Heart Attack?
Severely narrowed coronary arteries can cause chest pain. However, the larger, older plaques are not prone to rupture and cause a heart attack.  In fact, arteries with larger, older plaques may have time to grow extra arterial branches to allow blood to flow around the narrowed arteries, thereby performing their own bypass. 
Most heart attacks occur when the outer lining of a younger, smaller plaque breaks, and clot-promoting factors ooze into the artery and clog it. The smaller plaques, narrowed by only 30% – 50%, are more prone to rupture and cause most heart attacks. ,  These smaller plaques may go undiagnosed because they are not seen on X-ray.
Because bypass surgery and stents treat the more severely blocked coronary arteries that are narrowed by more than 70%, the smaller plaques remain untreated by these procedures. So, you may have stents and bypass surgery but still be at risk for heart attack or stroke from the smaller, younger plaques.
Lowering your blood cholesterol level will reduce your heart attack risk by about 30% over five years. Thus, it appears that lowering blood cholesterol, which occurs with the WFPB diet, is the more effective treatment for heart attack prevention and long-term survival. 
Dr. Daniele Massera reported on the powerful benefits of the WFPB diet for a man with heart disease who had severe chest pain and refused heart medications and stents. His prior “healthy” diet included skinless chicken, fish, and low-fat dairy with some vegetables, fruits, and nuts. With physician counseling, he agreed to the WFPB diet of mainly vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts. His symptoms improved within a few weeks of eating the WFPB diet. Two years later, he had no chest pain and no need for heart medications or stents. Dr. Massera concluded that the WFPB diet should be among the first recommendations for patients with heart disease. 
Basic Principles of Whole Food Plant-Based Diet
Simple Steps (chapter 8 of Prevent and Reverse Heart Disease) explains the WFPB diet rules in detail and lists more specific foods to eat and avoid.  Note that oil is not a whole food. The olive is a whole food. To make a bottle of olive oil, many olives must be pressed and processed.
The basic dietary rules from Prevent and Reverse Heart Disease, by Caldwell B. Esselstyn, MD (pages 5-6)
|Do Eat||Do Not Eat|
|All vegetables (leafy greens, root vegetables, red, green, purple, orange, yellow vegetables).||Anything with a mother or a face (no meat, poultry, eggs, fish).|
|All legumes (beans, peas, lentils).||Dairy products (butter, cheese, cream, ice cream, yogurt, milk, including skim milk).|
|All whole grains and whole grain products (bread and pasta without added fats or oils).||Oil of any kind (including no olive oil).|
|All fruits except avocado.||Nuts (generally no nuts or avocados).|
Heart disease is the leading cause of hospitalization and death in the US.  The WFPB diet heals the blood vessels and enables them to stop and reverse heart disease without chronic illness, death, or added cost. A study from Oxford University compared the cost of diets like vegan and vegetarian to the current typical diet of 150 countries. Results showed that in high-income countries like the US, vegan and vegetarian diets could reduce food bill costs by one-third. 
If you are diagnosed with heart disease, ask your physician about the benefits of the whole food plant-based diet. We hope to get to the day when physicians recommend this diet among the first options to treat heart disease. Increased awareness by the American public of the benefits of the WFPB diet could greatly reduce heart disease.
Cookbooks for a Heart-Healthy Diet
- Plant-based Wellness Cookbook: Three Generations of Cooking with the Doctor, the Dietitian, and the Diva, by Dulaney J, Majnaric A, Dulaney A.
- Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure With More Than 150 Great-Tasting Recipes, by Esselstyn CB, Jr.
- The Prevent and Reverse Heart Disease Cookbook: Over 125 Delicious, Life-Changing, Plant-Based Recipes, by Esselstyn AC.
- Be A Plant-Based Woman Warrior: Live Fierce, Stay Bold, Eat Delicious, by Esselstyn
- The McDougall Program for Maximum Weight Loss, by McDougall J, McDougall M.
- The New McDougall Cookbook: 300 Delicious Low-Fat, Plant-Based Recipes, by McDougall J. McDougall M.
- The McDougall Quick and Easy Cookbook: Over 300 Delicious Low-Fat Recipes You Can Prepare in Fifteen Minutes or Less, by McDougall J. McDougall M.
- The Healthiest Diet on the Planet: Why the Foods You Love – Pizza, Pancakes, Potatoes, and More – Are the Solution to Preventing Disease and Looking and Feeling Your Best, by McDougall J, McDougall M.
- Straight Up Food: Delicious and Easy Plant-Based Cooking without Salt, Oil or Sugar, by Fisher C
Written by Marilyn Radke, MD | Edited by Dayna Smith, MD and Guest Editor Jaimela Dulaney, MD | Reviewed January 28, 2023 | Copyright myObMD Inc, 2023
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