Public policy has mislead our doctors. Our doctors have failed to step up to the plate.

Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition

Caldwell B. Esselstyn, Jr., MD
From the Cleveland Clinic Foundation, Cleveland, Ohio
Caldwell B. Esselstyn, Jr., MD
The Cleveland Clinic Foundation
9500 Euclid Avenue, Desk A80
Cleveland, Ohio 44195
Preventive Cardiology
2001; 4: 171-177

Summary (Abstract)
The world’s advanced countries have easy access to plentiful high fat food; ironically, it is this rich diet that produces atherosclerosis. In the world’s poorer nations, many people subsist on a primarily plant-based diet, which is far healthier, especially in terms of heart disease. To treat coronary heart disease, a century of scientific investigation has produced a device-driven, risk factor-oriented strategy. Nevertheless, many patients treated with this approach experience progressive disability and death. This strategy is a rear-guard defensive. In contrast, compelling data from nutritional studies, population surveys, and interventional studies supports the effectiveness of a plant-based diet and aggressive lipid-lowering to arrest, prevent, and selectively reverse heart disease. In essence, this is an offensive strategy. The single biggest step toward adopting this strategy would be to have United States dietary guidelines support a plant-based diet. An expert committee purged of industrial and political influence is required to assure that science is the basis for dietary recommendations.

I have drawn two compelling observations from my service as the program director of 2 national cholesterol conferences and my participation in 3 others over the past decade. First, a great deal is known about what factors are responsible for causing coronary artery disease and what populations are vulnerable. Second, the present emphasis of identifying risk factors and those who are particularly vulnerable to atherosclerotic disease will not resolve the cardiovascular epidemic, which presently threatens 1 of 2 Americans and is predicted to become the number one global disease burden by the year 2020. 1

Autopsy data from the conflicts in Korea 2 and Vietnam 3 the Bogalusa study,4 and the PDAY5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that “normal” segments in patients with coronary artery disease also have diffuse symmetrical atherosclerosis, which is not yet disfiguring the intra-luminal diameter and thus is invisible to angiography.6 This work is further confirmation of the Roberts autopsy data, which demonstrates that essentially all patients with ischemic heart disease have triple vessel involvement.7

However, coronary artery disease is virtually absent in cultures that eat plant-based diets, such as the Tarahumara Indians of northern Mexico,8 the Papua highlanders of New Guinea,9 and the inhabitants of rural China10 and central Africa.11 Hundreds of thousands of rural Chinese go for years without a single documented myocardial infarction.10

Modern North America and Europe pride themselves on having the world’s most advanced medical care. What are these health-care systems doing about coronary artery disease?

Present Heart Disease Management Strategies

Figure 1 — Coronary angiograms of the distal left anterior descending artery before (left) and after (right) 32 months of a plant-based diet without cholesterol-lowering medication, showing profound improvement.

The present strategy focuses on interventional procedures and risk-factor modification. This approach is strictly a defensive strategy. It is pressing the limit of what society can afford. Our present cardiology budget exceeds one-quarter of a trillion dollars per year.1 Millions of symptomatic patients – generally those with arterial stenosis of more than 70% – have had interventions such as bypass, angioplasty, stenting, or atherectomy.13 Unfortunately, these interventions are accompanied by significant morbidity, mortality, and expense, provide only temporary benefit, and do nothing for patients at greatest risk for myocardial infarction, those with juvenile plaques of 30% to 50% stenosis, which are the ones most prone to rupture.14 As Forrester states, “angiography does not identify and interventional strategies don’t treat those lesions most likely to cause a heart attack.”15Therapies involving diet and lipid-lowering medication are not ignored by our health-care leaders, but sadly, their recommendations are clearly inadequate. The American Heart Association and the National Cholesterol Education Program (NCEP) recommend consumption of not more than 30% dietary fat and cholesterol levels below 200 mg/dL; numerous studies confirm that people who adhere to these recommendations experience not arrest and reversal of their heart disease, but rather continued disease progression.16 A question arises whether these recommendations expose millions to disease development and progression. However, because of the general respect commanded by these organizations, many doctors and patients perhaps are misled, trusting that following their recommendations will protect against heart disease.

Figure 2 — Coronary angiograms of the circumflex artery before (left) and showing 20% improvement (right) following approximately 60 months of a plant-based diet with cholesterol-lowering medication.

The newer NCEP clinical guidelines, known as the Adult Treatment Panel 111, suggest broadening the identification of those at risk. This will mandate that millions of Americans take cholesterol-reducing drugs as well as make some dietary and physical activity adjustments. This is a rear-guard, after-the fact approach. It tacitly acknowledges that our food environment is so toxic that millions will become at risk and develop disease. As will be discussed, it is preferable to advise the public to avoid the categories of food that cause atherosclerotic disease.37The National Research Council, in its 1989 report “Diet and Health,” 17 recommended an upper limit of total cholesterol of 200 mg/dL and 30% dietary fat, even though “a number of the scientists felt that a greater reduction would confer additional health benefits.”17 However, the committee felt that setting the cut-off too low would merely frustrate the public. The council also surmised, incorrectly, that if the upper level were set at 200 mg/dL, most Americans would achieve a total cholesterol level of 150 mg/dL or less.17 That has not happened. Most Americans and their physicians feel “safe” with a cholesterol total of up to 200 mg/dL. They are not. In the Framingham study, 35% of ischemic heart disease occurred in patients with total cholesterol levels between 150 and 200 mg/dL.18 In the CARE study, the average total cholesterol level in patients with a history of heart attack was 209 mg/dL.19 In contrast, the American Cancer Society recommends no more than 20% dietary fat,20 while the World Health Organization prefers no more than 15%.21

Figure 3– Coronary angiograms of the proximal left anterior descending artery before (left) and showing 10% improvement (right) following approximately 60 months of a plant-based diet with cholesterol-lowering medication.

Dr. Scott Grundy, chairman of the NCEP, proclaimed approximately 14 years ago22 that 90% of heart attacks could be prevented if the population’s cholesterol was 150 mg/dL or less – a figure identical to that hoped for by the National Research Council in 1989. However, neither the NRC, the American Heart Association, or the NCEP is on record to show precisely what diet will achieve the goal of cholesterol of 150 mg/dL. The basic diet favored by these groups contains not only grains, legumes, vegetables, and fruit, but also oil, low-fat milk and milk products, butter, cheese, poultry, lean meat, and fish. I am unaware of any research proving that by eating such a diet one can achieve a cholesterol level of 150 mg/dL or avoid coronary artery disease.The Mediterranean diet and monounsaturated oils have become unjustifiably popular because of the Lyon Diet Heart Study.23 This approach is difficult to accept. No studies of monounsaturated oils have shown them to arrest and reverse coronary disease. The Lyon study did show a slower rate of progression, but this is hardly an acceptable goal. In a study of patients with coronary disease, Blankenhorn actually showed the reverse, that disease progressed as rapidly in patients on a monounsaturated diet as it did in those on a saturated fat diet.24 Rudel demonstrated a similar result in African green monkeys over a 5-year period.25 Particularly compelling was his finding that disease in the two groups was equivalent, even though the monounsaturated group had higher HDL, lower LDL, and more favorable LDL-to-HDL ratio. He recently replicated the results in rodents.26

The number of heart attacks continues to increase every year.27 Although the age-adjusted death rate for heart disease has declined, the decline may be artifactual.12 Stamler found deaths from cardiovascular disease approached 40% of those dying in a group of 80,000 young men with follow-up ranging from 16-34 years. The data confirmed a continuous graded relationship of serum cholesterol level to long term risk of coronary heart disease, cardiovascular disease, and all cause mortality. They also demonstrated substantial absolute risk and increased excess risk of coronary heart disease and cardiovascular disease death for younger men with elevated cholesterol levels and conversely a longer estimated life expectancy for younger men with favorable lipids.35 Our stop-gap, device-driven, risk factor-oriented approach is not working. Why? Because it fails to address our toxic food environment, which is responsible for the disease. It is focused only on those who are already ill or whose elevated lipids reflect an inability to detoxify their American diet. What are the other alternatives?

Taking the Offensive

Figure 4–Coronary angiograms of right coronary artery before (left) and showing 30% improvement (right) following approximately 60 months of a plant-based diet and cholesterol-lowering medication.

As I have reported earlier,28,29 a plant-based diet in conjunction with cholesterol-reducing medication eliminated progression of coronary artery disease over a 12-year period in patients with triple-vessel disease. Most of the 18 patients had experienced an earlier failed intervention of bypass surgery or angioplasty. All patients who maintained the diet achieved the cholesterol goal of less than 150 mg/dL and had no recurrent coronary events during the 12 years. At 5 years, angiography was repeated in most cases. By analysis of the stenosis percentage none had progression of disease, and 70% had selective regression.28 These data are compelling when one considers that the same group had experienced more than 49 coronary events during the 8 years before this study.28The recent case of a colleague is particularly telling. During September and October of 1996, a 44-year-old surgical colleague experienced occasional chest discomfort, yet neither electrocardiogram, stress echocardiography, or thallium scanning found evidence of disease. While eating the typical American diet, he had a total cholesterol of 156 mg/dL and an LDL of 97 mg/dL. He was lean, non-diabetic, and normotensive, did not smoke, and had no family history of coronary disease. His lipoprotein (a) and homocysteine levels were normal. On November 18, 1996, after his surgical duties, he became acutely ill with pain in the left arm, jaw, and chest. Immediate coronary catheterization found all vessels to be normal except for the left anterior descending artery, the distal third of which was diseased. Enzymes confirmed a myocardial infarction. However, no intervention was deemed appropriate.

This patient was aware of my ongoing study and was curious for more information. He and his wife consulted me for an in-depth review of the plant-based diet and techniques of this arrest and reversal study. He became the personification of commitment to the plant-based diet. Over the next 32 months, without cholesterol-lowering drugs, he maintained a mean total cholesterol of 89 mg/dL and an LDL of 38 mg/dL. The repeat angiogram 32 months after his infarction showed that the disease was completely reversed. (Fig.1)

Even though many people might find a plant-based diet initially difficult to follow, every patient with the diagnosis of coronary artery disease should at the least be offered the option of this potentially curative arrest and reversal approach. As this young surgeon’s case illustrates, our plant-based diet approach can achieve total disease arrest and selective regression even in advanced cases. This approach is particularly compelling because patients can take control over the disease that was destroying them. If traditional interventional cardiology is a rear-guard action, our arrest and reversal therapy can be likened to a military offensive against atherosclerosis.

Limitations of this study are its modest number of participants and lack of comparable controls. Nevertheless, its size permitted the caregiver an opportunity for frequent patient encounters. These interactions enabled 75% of participants to achieve profound lipid reduction, dietary goals, and relief of symptoms which continued to improve throughout the study’s 12-year duration. Patients essentially served as their own controls often achieving profound angiographic reversal of disease as reviewed in the angiographic core laboratory. Fig. 1-4

New recommendations for a healthy diet

The expert faculty at the First National Conference on the Elimination and Prevention of Coronary Artery Disease have issued a new set of recommendations:30

1) Present nutritional guidelines of government and national health organizations do not provide a maximal opportunity either to arrest or to prevent coronary artery disease.

2) The optimal diet consists of grains, legumes, vegetables, and fruit, with <10%-15% of its calories coming from fat.

This diet minimizes the likelihood of stroke, obesity, hypertension, type II diabetes, and cancers of the breast, prostate, colon, rectum, uterus, and ovary. There are no known adverse effects of such a diet when mineral and vitamin contents are adequate.

3) Children and adolescents require major attention to develop early habits of optimal nutrition. Schools should assume a significant leadership role in achieving this goal.

4) Speculation about the degree of public compliance with a low-fat diet must not alter the accuracy of the recommendations.

At the 1999 national cholesterol summit meeting, Dr. William Castelli was asked what he would do to reverse the coronary artery disease epidemic if he were omnipotent. His answer: “Have the public eat the diet of the rural Chinese as described by Dr. T. Colin Campbell,” author of the Cornell China study (personal communication, William Castelli, Sept. 2-3, 1999). A recent prospective study of diet quality and mortality in more than 40,000 women confirms the benefits of consuming a diet high in fruits, vegetables, and grains.31

At a recent national meeting on hypertension, the original DASH study32 was updated.33 It was found that a diet emphasizing grains, vegetables, and fruit (and including low fat dairy and lean meat), with particular attention to reducing sodium intake, resulted in blood pressure reductions equivalent to those produced by hypertension drugs. 33

In addition, Dr. Dean Ornish has reported both 1- and 5-year data that support a plant-based approach to control coronary artery disease.16

Replace the “Food Pyramid”

An integral part of this offensive must be to eliminate the toxic food environment. Look at the so-called Food Guide Pyramid, the familiar geometric symbol used to promote the recommendations by the U.S. Department of Agriculture and the Department of Health and Human Services. It is laden with dairy products, animal products, and oils, which are the essential building blocks for coronary artery disease. In addition, from a design standpoint, the choice of a pyramid is potentially confusing and misleading. Some viewers may be led to believe that the foods at the top (meats, sweets, and fatty foods) are the most helpful, when in fact they are the most harmful. To avoid such sources of confusion, we should eliminate geometric figures and promote 3 simple food categories: safe, condiments, and unsafe.

Safe: grains, legumes, lentils, vegetables, and fruits
Condiments: nuts and seeds
Unsafe: oils, dairy foods, meat, poultry, and fish (not regulated by inspection, and frequently contain unacceptable levels of PCB’s, dioxin, and mercury

In addition, we should recommend dietary supplementation with a daily multivitamin, and, for those over 50 years old, an additional 1,000-1,200 mg calcium and 600 to 800 IU of Vitamin D. These recommendations are in concert with those of the expert faculty from the First National Conference on the Elimination of Coronary Artery Disease.30

Why are the current recommendations so weak?

When dietary recommendations are issued with the stamp of approval of the U.S. government, the public should be able to trust that these recommendations accurately guide them to foods that are unlikely to cause disease and away from those that are known to cause harm. Thus, any group promoting dietary guidelines for the public should make its decisions based on science. However, the USDA has been subjected to intensive industry lobbying, which compromises its capacity to be fair and objective.34 At the least, neither the experts who testify before the committee nor the committee members themselves should have relationships, financial or otherwise, to the food industry. These same rules regarding conflict of interest should apply to scientists who lead or are members of the National Cholesterol Education Program and the Food and Nutrition Section of the American Heart Association.

As recently as October, 2000, the Physicians Committee for Responsible Medicine successfully litigated the USDA to ascertain the compensation sources of the US Dietary Guidelines Committee. Six of the eleven committee members, including the chairman, had relationships to the meat, dairy, or egg industry. 36 Such conflict insures a perception that the American public and school children will not receive an unbiased recommendation of what constitutes the healthiest food choices. The USDA, by definition, a protector of the agriculture industry should disqualify itself from this responsibility, which more correctly may belong in the Centers for Disease Control.


The present device-driven, risk factor-identification, rear-guard strategy diagnoses disease after the fact and offers no promise of preventing disease or controlling its progression. We are fortunate to possess the knowledge of how to prevent, arrest, and selectively reverse this disease. However, we are not fortunate in the capacity of our institutions to share this information with the public. The collective conscience and will of our profession is being tested as never before. Ties to industry and politics result in conflict within our private and governmental health institutions, compromising the accuracy of their public message. This is in total violation of the moral imperative of our profession. The time is now for us to have the courage for legendary work. Science and not the messenger must dictate the recommendations.


Dietary Guidelines for Alzheimer’s Prevention

A special report from the Physicians Committee for Responsible Medicine 

Alzheimer’s disease affects nearly half of North Americans by age 85. The American Academy of Neurology forecasts that, unless preventive measures are developed, Alzheimer’s rates will nearly triple over the next four decades. Worldwide, Alzheimer’s rates will affect 100 million people by 2050.

While treatments for the disease remain unsatisfactory, scientific studies suggest that preventive strategies are now feasible. Evidence suggests that specific diet and exercise habits can reduce the risk by half or more. Although significant gaps in scientific knowledge remain, studies suggest that the same foods that are beneficial for the heart are also healthful for the brain and may reduce the risk of Alzheimer’s disease.

Dietary Guidelines

The seven dietary principles to reduce the risk of Alzheimer’s disease were prepared for presentation at the International Conference on Nutrition and the Brain in Washington on July 19 and 20, 2013.

The guidelines are as follows:

1. Minimize your intake of saturated fats and trans fats. Saturated fat is found primarily in dairy products, meats, and certain oils (coconut and palm oils). Trans fats are found in many snack pastries and fried foods and are listed on labels as “partially hydrogenated oils.”

2. Vegetables, legumes (beans, peas, and lentils), fruits, and whole grains should be the primary staples of the diet.

3. One ounce of nuts or seeds (one small handful) daily provides a healthful source of vitamin E.

4. A reliable source of vitamin B12, such as fortified foods or a supplement providing at least the recommended daily allowance (2.4 mcg per day for adults) should be part of your daily diet.

5. When selecting multiple vitamins, choose those without iron and copper, and consume iron supplements only when directed by your physician.

6. While aluminum’s role in Alzheimer’s disease remains a matter of investigation, it is prudent to avoid the use of cookware, antacids, baking powder, or other products that contribute dietary aluminum.

7. Include aerobic exercise in your routine, equivalent to 40 minutes of brisk walking three times per week.


As Alzheimer’s rates and medical costs continue to climb, simple changes to diet and lifestyle may help in preventing cognitive problems.

Saturated and Trans Fats

In addition to reducing the risk of heart problems and overweight, avoiding foods high in saturated and trans fats may also reduce the risk of Alzheimer’s disease. Saturated fat is found in dairy products and meats; trans fats are found in many snack foods.

Researchers with the Chicago Health and Aging Project followed study participants over a four-year period. Those who consumed the most saturated fat (around 25 grams each day) were two to three times more likely to develop Alzheimer’s disease, compared with participants who consumed only half that amount.1

Similar studies in New York and in Finland found similar results. Individuals consuming more “bad” fats were more likely to develop Alzheimer’s disease, compared with those who consumed less of these products.2,3 Not all studies are in agreement. A study in the Netherlands found no protective effect of avoiding “bad” fats,4although the study population was somewhat younger than those in the Chicago and New York studies.

The mechanisms by which certain fats may influence the brain remains a matter of investigation. Studies suggest that high-fat foods and/or the increases in blood cholesterol concentrations they may cause can contribute to the production beta-amyloid plaques in the brain, a hallmark of Alzheimer’s disease. These same foods increase the risk of obesity and type 2 diabetes, common risk factors for Alzheimer’s disease.5-7

Cholesterol and APOEe4

High cholesterol levels have been linked to risk of Alzheimer’s disease. A large study of Kaiser Permanente patients showed that participants with total cholesterol levels above 250 mg/dl in midlife had a 50 percent higher risk of Alzheimer’s disease three decades later, compared with participants with cholesterol levels below 200 mg/dl.8 The APOEe4 allele, which is strongly linked to Alzheimer’s risk, produces a protein that plays a key role in cholesterol transport. Individuals with the APOEe4 allele may absorb cholesterol more easily from their digestive tracts compared with people without this allele.9

Nutrient-Rich Foods

Vegetables, legumes (beans, peas, and lentils), fruits, and whole grains have little or no saturated fat or trans fats and are rich in vitamins, such as folate and vitamin B6, that play protective roles for brain health. Dietary patterns that emphasize these foods are associated with low risk for developing weight problems and type 2 diabetes.10 They also appear to reduce risk for cognitive problems. Studies of Mediterranean-style diets11 and vegetable-rich diets have shown that reduced risk of cognitive problems, compared to other dietary patterns.12 The Chicago Health and Aging Project tracked study participants ages 65 and older, finding that a high intake of fruits and vegetables was associated with a reduced their risk of cognitive decline.13

Vitamin E

Vitamin E is an antioxidant found in many foods, particularly nuts and seeds, and is associated with reduced Alzheimer’s risk.14,15 A small handful of typical nuts or seeds contains about 5 mg of vitamin E. Other healthful food sources include mangoes, papayas, avocadoes, tomatoes, red bell peppers, spinach, and fortified breakfast cereals.

The Role of B-Vitamins in Reducing Homocysteine

Three B-vitamins—folate, B6, and B12—are essential for cognitive function. These vitamins work together to reduce levels of homocysteine, an amino acid linked to cognitive impairment. In an Oxford University study of older people with elevated homocysteine levels and memory problems, supplementation with these three vitamins improved memory and reduced brain atrophy.16,17

Healthful sources of folate include leafy greens, such as broccoli, kale, and spinach. Other sources include beans, peas, citrus fruits, and cantaloupe. The recommended dietary allowance (RDA) for folic acid in adults is 400 micrograms per day, or the equivalent of a bowl of fortified breakfast cereal or a large leafy green salad topped with beans, asparagus, avocadoes, sliced oranges, and sprinkled with peanuts.

Vitamin B6 is found in green vegetables in addition to beans, whole grains, bananas, nuts, and sweet potatoes. The RDA for adults up to 50 is 1.3 milligrams per day. For adults over 50, the RDA is 1.5 milligrams for women and 1.7 milligrams for men. A half cup of brown rice meets the recommended amount.

Vitamin B12 can be taken in supplement form or consumed from fortified foods, including plant milks or cereals. Adults need 2.4 mcg per day. Although vitamin B12 is also found meats and dairy products, absorption from these sources can be limited in older individuals, those with reduced stomach acid, and those taking certain medications (e.g., metformin and acid-blockers). For this reason, the U.S. government recommends that B12 supplements be consumed by all individuals over age 50. Individuals on plant-based diets or with absorption problems should take vitamin B12 supplements regardless of age.

Hidden Metals

Iron and copper are both necessary for health, but studies have linked excessive iron and copper intake to cognitive problems.18,19Most individuals meet the recommended intake of these minerals from everyday foods and do not require supplementation. When choosing a multiple vitamin, it is prudent to favor products that deliver vitamins only. Iron supplements should not be used unless specifically directed by one’s personal physician.

The RDA for iron for women older than 50 and for men at any age is 8 milligrams. For women ages 19 to 50 the RDA is 18 milligrams. The RDA for copper for men and women is 0.9 milligrams.


Aluminum’s role in Alzheimer’s disease remains controversial. Some researchers have called for caution, citing aluminum’s known neurotoxic potential when entering the body in more than modest amounts20 and the fact that aluminum has been demonstrated in the brains of individuals with Alzheimer’s disease.21, 22 Studies in the United Kingdom and France found increased Alzheimer’s prevalence in areas where tap water contained higher aluminum concentrations.23,24

Some experts hold that evidence is insufficient to indict aluminum as a contributor to Alzheimer’s disease risk. While this controversy remains unsettled, it is prudent to avoid aluminum to the extent possible. Aluminum is found in some brands of baking powder, antacids, certain food products, and antiperspirants.

Physical Exercise and the Brain

In addition to following a healthful diet and avoiding excess amounts of toxic metals, it is advisable to get at least 120 minutes of aerobic exercise each week. Studies have shown that aerobic exercise—such as running, brisk walking, or step-aerobics—reduces brain atrophy and improves memory and other cognitive functions.25

A recent study published in Annals of Internal Medicine found that adults who exercised in midlife, around age 40, were less likely to develop dementia after age 65 compared with their sedentary peers.26 A similar study in New York found that adults who exercised and followed a healthy diet reduced their risk for Alzheimer’s by as much as 60 percent.27


Satisfactory treatments for Alzheimer’s disease are not yet available. However, evidence suggests that, with a healthful diet and regular exercise, many cases could be prevented.


1. Morris MC, Evans EA, Bienias JL, et al. Dietary fats and the risk of incident Alzheimer’s disease. Arch Neurol. 2003;60:194-200.
2. Luchsinger JA, Tang MX, Shea S, Mayeux R. Caloric intake and the risk of Alzheimer’s disease. Arch Neurol. 2002;59:1258-1263.
3. Laitinen MH, Ngandu T, Rovio S, et al. Fat intake at midlife and risk of dementia and Alzheimer’s disease: a population-based study.Dement Geriatr Cogn Disord. 2006;22:99-107.
4. Engelhart MJ, Geerlings MI, Ruitenberg A. Diet and risk of dementia: Does fat matter? The Rotterdam Study. Neurology. 2002a;59:1915-1921.
5. Hanson AJ, Bayer-Carter JL, Green PS, et al. Effect of apolipoprotein E genotype and diet on apolipoprotein E lipidation and amyloid peptides. JAMA Neurol. Published ahead of print June 17, 2013.
6. Puglielli L, Tanzi RE, Kovacs DM. Alzheimer’s disease: The cholesterol connection. Nature Neurosci. 2003;6:345-351.
7. Ohara T, Doi Y, Ninomiya T, et al. Glucose tolerance status and risk of dementia in the community: The Hisayama Study. Neurology. 2011;77:1126-1134.
8. Solomon A, Kivipelto M, Wolozin B, Zhou J, Whitmer RA. Midlife serum cholesterol and increased risk of Alzheimer’s and vascular dementia three decades later. Dement Geriatr Cogn Disord. 2009;28:75-80.
9. Anoop S, Anoop M, Meena K, Luthra K. Apolipoprotein E polymorphism in cerebrovascular & coronary heart diseases. Indian J Med Res. 2010;132:363-378.
10. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care. 2009;32:791-796.
11. Georgios Tsivgoulis, M.D., University of Alabama at Birmingham, and University of Athens, Greece; Sam Gandy, M.D., associate director, Mount Sinai Alzheimer’s Disease Research Center, New York City; April 30, 2013, Neurology.
12. The 9th International Conference on Alzheimer’s Disease and Related Disorders in Philadelphia, July 17-22, 2004. Jae Kang P2-283. Fruit and Vegetable Consumption and Cognitive Decline in Women (Mon., 7/19, 12:30 p.m.)
13. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006b;67:1370-1376.
14. Devore EE, Goldstein F, van Rooij FJ, et al. Dietary antioxidants and long-term risk of dementia. Arch Neurol. 2010;67:819-825.
15. Morris MC, Evans DA, Tangney CC, et al. Relation of the tocopherol forms to incident Alzheimer disease and cognitive change.Am J Clin Nutr. 2005;81:508-514.
16. de Jager CA, Oulhaj A, Jacoby R, Refsum H, Smith AD. Cognitive and clinical outcomes of lowering homocysteine-lowering B-vitamin treatment in mild cognitive impairment: A randomized controlled trial.Int J Geriatr Psychiatry. 2012;27:592-600.
17. Douaud G, Refsum H, de Jager CA, et al. Preventing Alzheimer’s disease-related gray matter atrophy by B-vitamin treatment. PNAS. 2013;110:9523-9528.
18. Brewer GJ. The risks of copper toxicity contributing to cognitive decline in the aging population and Alzheimer’s disease. J Am Coll Nutr. 2009;28:238-242.
19. Stankiewicz JM, Brass SD. Role of iron in neurotoxicity: a cause for concern in the elderly? Curr Opin Clin Nutr Metab Care. 2009;12:22-29.
20. Kawahara M, Kato-Negishi M. Link between aluminum and the pathogenesis of Alzheimer’s disease: The integration of aluminum and amyloid cascade hypotheses. Int. J Alzheimer’s Dis. 2011;276393.
21. Crapper DR, Kishnan SS, Dalton AJ. Brain aluminum distribution in Alzheimer’s disease and experimental neurofibrillary degeneration.Science. 1973;180:511-513.
22. Crapper DR, Krishnan SS, Quittkat S. Aluminum, neurofibrillary degeneration and Alzheimer’s disease. Brain. 1976;99:67-80.
23. Martyn CN, Osmond C, Edwardson JA, Barker DJP, Harris EC, Lacey RF. Geographical relation between Alzheimer’s disease and aluminum in drinking water. Lancet. 1989;333:61-62.
24. Rondeau V, Jacqmin-Gadda H, Commenges D, Helmer C, Dartigues J-F. Aluminum and silica in drinking water and the risk of Alzheimer’s disease or cognitive decline: Findings from 15-year follow up of the PAQUID cohort. Am J Epidemiol. 2009;169:489-496.
25. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci USA. 2004;101:3316-3321.
26. DeFina LF, Willis BL, Radford NB, et al. The Association Between Midlife Cardiorespiratory Fitness Levels and Later-Life Dementia: A Cohort Study. Ann Intern Med. 2013;158:213-214.
27. Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer’s disease. JAMA. 2009;302:627-637.

Is Your Body Burning Up With Hidden Inflammation?

Could something as simple as a quick and easy blood test save your life?


It is called a C-reactive protein test, and it measures the degree of HIDDEN inflammationin your body.

Finding out whether or not you are suffering from hidden inflammation is critical, because almost every modern disease is caused or affected by it.

If your immune system and its ability to quell inflammation in your body are impaired, watch out. You are headed toward illness and premature aging.

Fortunately, addressing the causes of inflammation and learning how to live an anti-inflammatory lifestyle can dramatically improve your health.

Today, I am going to review what the primary causes of inflammation are and give you a simple, 7-step approach that will help you cool the fires raging out of control in your body.

Cooling off Inflammation is Key #3 to UltraWellness and in this blog — the third in this 7-part series on the 7 keys to UltraWellness — I am going to teach you how to do just that.

The first step is to understand what inflammation is and why it can become so dangerous.

Inflammation: The Good, the Bad, and the Ugly

Everyone who has had a sore throat, rash, hives, or a sprained ankle knows about inflammation. These are normal and appropriate responses of the immune — your body’s defense system — to infection and trauma.

This kind of inflammation is good. We need it to survive — to help us determine friend from foe.

The trouble occurs when that defense system runs out of control, like a rebel army bent on destroying its own country.

Many of us are familiar with an overactive immune response and too much inflammation. It results in common conditions like allergies, rheumatoid arthritis, autoimmune disease, and asthma. This is bad inflammation, and if it is left unchecked it can become downright ugly.

What few people understand is that hidden inflammation run amok is at the root of all chronic illness we experience — conditions like heart diseaseobesitydiabetesdementia,depressioncancer, and even autism.

study of a generally “healthy” elderly population found that those with the highest levels of C-reactive protein and interleukin 6 (two markers of systemic inflammation) were 260 percent more likely to die during the next 4 years. The increase in deaths was due to cardiovascular and other causes.

We may feel healthy, but if this inflammation is raging inside of us, then we are in trouble.

The real concern is not our response to immediate injury, infection, or insult. It is the chronic, smoldering inflammation that slowly destroys our organs and our ability to function optimally and leads to rapid aging.

Common treatments such as anti-inflammatory drugs (ibuprofen or aspirin) and steroids like prednisone — though often useful for acute problems — interfere with the body’s own immune response and can lead to serious and deadly side effects.

In fact, as many people die from taking anti-inflammatory drugs like ibuprofen every year as die from asthma or leukemia. Stopping these drugs would be equivalent to finding the cure for asthma or leukemia — that’s a bold statement, but the data is there to back it up.

Meanwhile, the real effects of statin drugs like Lipitor in reducing heart disease may have nothing to do with lowering cholesterol, but with their unintended side effect of reducing inflammation.

But is taking medication the right approach to addressing the problem of inflammation?

No. It is DOWNSTREAM medicine.

Here’s how UPSTREAM medicine thinks about inflammation …

How to Locate the Causes of Hidden Inflammation

So if inflammation and immune imbalances are at the root of most of modern disease, how do we find the causes and get the body back in balance?

First, we need to identify the triggers and causes of inflammation. Then we need to help reset the body’s natural immune balance by providing the right conditions for it to thrive.

As a doctor, my job is to find those inflammatory factors unique to each person and to see how various lifestyle, environmental, or infectious factors spin the immune system out of control, leading to a host of chronic illnesses.

Thankfully, the list of things that cause inflammation is relatively short:

• Poor diet–mostly sugar, refined flours, processed foods, and inflammatory fats such as trans and saturated fats

• Lack of exercise

• Stress

• Hidden or chronic infections with viruses, bacteria, yeasts, or parasites

• Hidden allergens from food or the environment

• Toxins such as mercury and pesticides

• Mold toxins and allergens

By listening carefully to a person’s story and performing a few specific tests , I can discover the causes of inflammation most people.

It’s important to understand that this concept of inflammation is not specific to any one organ or medical specialty. In fact, if you read a medical journal from any field of medicine, you will find endless articles about how inflammation is at the root of problems with the particular organ or area they focus on.

So what’s the problem?

There is almost no communication between specialties. Everyone is treating the downstream effects of inflammation, but addressing the causes of inflammation that are upstream could help people who have multiple problems that are really linked together by this common root cause.

Take, for example, a man who came to see me recently. He wanted to climb a mountain and asked for my help to get healthy. He was 57 years old and took about 15 medications for six different inflammatory conditions: high blood pressure, pre-diabetes, colitis, reflux,asthma, and an autoimmune disease of his hair follicles called alopecia.

Yet when I asked him how he felt, he said “great”. I told him I was surprised because he was on so many medications.

Yes, he said, but everything was very well controlled with the latest medications prescribed by the top specialists he saw in every field–the lung doctor for his asthma, the gastroenterologist for his colitis and reflux, the cardiologist for his high blood pressure, the endocrinologist for his pre-diabetes, the dermatologist for his hair loss.

But did any of those specialists ask him why he had six different inflammatory diseases and why his immune system was so pissed off? Was it just bad luck that he “got” all these diseases — or was there something connecting all these problems?

He looked puzzled and said “no”.

I then searched for and uncovered the cause of his problems: gluten. He had celiac disease, an autoimmune disease related to eating gluten, the protein found in wheat, barley, rye, spelt, and oats.

Six months later he came back to see me. He had lost 25 pounds, had no more high blood pressure, asthma, reflux, or colitis, and said he had normal bowel movements for the first time in his life. His hair was even growing back. And he was off nearly all his medications.

7 Steps to Living an Anti-inflammatory Life

So once you have figured out the causes of inflammation in your life, gotten rid of them, the next step is to keep living an anti-inflammatory lifestyle. But how do you do that?

Here is what I recommend. It’s a disarmingly simple but extraordinarily effective way to achieve UltraWellness:

1. Whole Foods — Eat a whole foods, high-fiber, plant-based diet, which is inherently anti-inflammatory. That means choosing unprocessed, unrefined, whole, fresh, real foods, not those full of sugar and trans fats and low in powerful anti-inflammatory plant chemicals called phytonutrients.

2. Healthy Fats — Give yourself an oil change by eating healthy monounsaturated fats in olive oil, nuts and avocadoes, and getting more omega-3 fats from small fish like sardines, herring, sable, and wild salmon.

3. Regular Exercise — Mounting evidence tells us that regular exercise reduces inflammation. It also improves immune function, strengthens your cardiovascular systems, corrects and prevents insulin resistance, and is key for improving your mood and erasing the effects of stress. In fact, regular exercise is one among a small handful of lifestyle changes that correlates with improved health in virtually ALL of the scientific literature. So get moving already!

4. Relax — Learn how to engage your vagus nerve by actively relaxing. This powerful nerve relaxes your whole body and lowers inflammation when you practice yoga or meditation, breathe deeply, or even take a hot bath.

5. Avoid Allergens — If you have food allergies, find out what you’re allergic to and get stop eating those foods–gluten and dairy are two common culprits.

6. Heal Your Gut — Take probiotics to help your digestion and improve the balance of healthy bacteria in your gut, which reduces inflammation.

7. Supplement — Take a multivitamin/multimineral supplement, fish oil, and vitamin D, all of which help reduce inflammation.

Taking this comprehensive approach to inflammation and balancing your immune system addresses one of the most important core systems of the body.

In the future, medicine may no longer have specialties like cardiology or neurology or gastroenterology, but new specialists like “inflammologists”.

But by understanding these concepts and core systems that are the basis of healthy livingnow, you don’t have to wait.

Now I’d like to hear from you …

Have you had your C-reactive protein tested?

Do you think inflammation may be at the core of your health condition?

Why do you think so many doctors practice downstream medicine instead of catching problems early with upstream medicine?

Please let me know your thoughts by posting a comment below.

To your good health,

Mark Hyman, MD