Eggs Increase Risk for Heart Disease


Egg consumption may increase the risk for heart disease, according to a study published in Atherosclerosis. Researchers monitored the diets of 23,417 South Korean participants through the Kangbuk Samsung Health Study and found that heart disease risk increased incrementally with increased egg intake. Those who ate the most eggs, compared with those who ate the least, had 80 percent higher coronary artery calcium scores, a measure of heart disease risk.

Eggs also appeared to increase the risk for obesity, diabetes, and hypertension.

Choi Y, Chang , Lee JE, et al. Egg consumption and coronary artery calcification in asymptomatic men and women. Atherosclerosis. 2015;241:305-312.


Why Do Heart Doctors Favor Surgery and Drugs Over Diet?

on June 2nd, 2015

Fully Consensual Heart Disease Treatment

When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Esselstyn Jr. published a controversial paper in the American Journal of Cardiology, highlighted in my video, Fully Consensual Heart Disease Treatment, noting that heart bypass operations carry significant risks including the potential to cause further heart damage, stroke, and brain dysfunction. Angioplasty isn’t much better, also carrying significant mortality and morbidity, and often doesn’t work (in terms of decreasing the risk of subsequent heart attack or death). “So,” he writes, “it seems we have an enormous paradox. The disease that is the leading killer of men and women in Western civilization is largely untreated.” The benefits of bypass surgery and angioplasty “are at best temporary and erode over time, with most patients eventually succumbing to their disease.” In cancer management, we call that palliative care, where we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease.

Why does this juggernaut of invasive procedures persist? Well one reason he suggests is that performing surgical interventions has the potential for enormous financial reward. Conversely, lack of adequate return is considered one of the barriers to the practice of preventive cardiology. Diet and lifestyle interventions lose money for the physician.

Another barrier is that doctors don’t think patients want it. Physician surveys show that doctors often don’t even bring up diet and lifestyle options because they assume that patients would prefer to be on cholesterol-lowering drugs every day for the rest of their lives rather than change their eating habits. That may be true for some, but it’s up to the patient, not the doctor, to decide.

According to the official AMA Code of Medical Ethics, physicians are supposed to disclose all relevant medical information to patients. “The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The physician’s obligation is to present the medical facts accurately to the patient.” For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like:

“You should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from a cardiovascular event such as a heart attack or stroke is generally between 60 and 100, which means that if I treated 60 people in your situation, 1 would benefit and 59 would not. As these numbers show, it is important for you to know that most of the people who take a statin will not benefit from doing so and, moreover, that statins can have side effects, such as muscle pain, liver damage, and upset stomach, even in people who do not benefit from the medication. I am giving you this information so that you can weigh the risks and benefits of drugs versus diet and then make an informed decision.”

Yet, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors—that kind of paternalism is supposed to be a thing of the past. Today’s physicians are supposed to honor informed consent under all but a very specific set of conditions (such as the patient is in a coma or it’s an emergency). However, too many physicians continue to treat their patients as if they were unconscious.

At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiologyreminded us of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, so if we all existed on a plant-based diet, we would not have even needed this discussion.

The lack of nutrition training in medical school is another barrier. See, for example, my videos Doctors’ Nutritional Ignorance andDoctors Know Less Than They Think About Nutrition.

Shockingly, mainstream medical associations actively oppose attempts to educate physicians about clinical nutrition. See my 4-part video series:

  1. Nutrition Education Mandate Introduced for Doctors
  2. Medical Associations Oppose Bill to Mandate Nutrition Training
  3. California Medical Association Tries to Kill Nutrition Bill
  4. Nutrition Bill Doctored in the California Senate

For more on why doctors don’t make more dietary prescriptions, see my video The Tomato Effect, Lifestyle Medicine: Treating the Cause of Disease, and Convincing Doctors to Embrace Lifestyle Medicine.

Heart disease may be a choice. See Cavities and Coronaries: Our Choice and One in a Thousand: Ending the Heart Disease Epidemic.

-Michael Greger, M.D.

Why don’t authorities advocate a sufficient reduction in cholesterol down to safe levels?

· February 18th 2015 ·

Optimal Cholesterol Level

Doctor’s Note

It’s imperative for everyone to understand Dr. Rose’s sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study in Barriers to Heart Disease Prevention.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

Cure hypertension and reverse heart and kidney failure.

· December 8th 2014 ·

Kempner Rice Diet: Whipping Us Into Shape

Dr. Walter Kempner was a pioneer in the use of diet to treat life-threatening chronic disease, utilizing a diet of mostly rice and fruit to cure malignant hypertension and reverse heart and kidney failure.

View Transcript
Sources Cited

The Collapse of Cardiology

By Caldwell B. Esselstyn, Jr., M.D.

January 17, 20007 — Recent weeks have witnessed a collapse of the drugs and technology which form the present back bone of cardiology’s assault on the coronary artery disease epidemic. Is this a dark shadow over our cardiac health or could it be a time to rejoice?
Pfizer, in late December 2006 announced its long hoped for block- buster new drug Torcetrapib was killing more people in its test run than were dying in the control group. Pfizer had spent 800 million in developing this drug to raise HDL, “good” cholesterol and had openly forecast it would reap billions for the company once it came into production. But the research trial was clear and unequivocal with its results. Among 15,000 patients, 82 died taking Torcetrapib and 51 died taking a standard drug to lower cholesterol Additionally the Torcetrapib group experienced a greater number of cardiac events such as angina, heart failure, and a need for angioplasty. The independent monitoring group advised Pfizer to halt the trial and they complied. The unfathomable mysteries of human metabolism could not tolerate the assault of this drug. It was making vascular disease worse not better.

The double whammy for cardiology also developed in the second half of 2006. Reports from Europe in September 2006 indicated that patients utilizing the new drug eluting stents were suddenly having heart attacks and some were dying. While the number was small (0.5%), it was disturbing to cardiologists and remains frightening for patients.

When an artery to the heart is severely narrowed and causing symptoms cardiologists insert a balloon tipped catheter to the area of blockage and expand the balloon to widen the constriction. The benefit of this angioplasty is lost in 50% of patients because of recurrent constriction in 6 months. Placing a metal scaffold or stent improves the results to only 10% to 20% recurrent narrowing. Starting in 2003, stents were coated with a drug which diminished the rate of recurrent blockage after angioplasty. However, it is essential to maintain patients on an anti clotting drug for 6-12 months to prevent the stent from developing a clot or thrombosis. It now appears that after stopping the anti-clotting drug 1 in 200 or 0.5%or 5,000 nationwide and 10,000 persons worldwide will have a heart attack and 50% of these will die when the stent fails. These results have so upset cardiologists and the Federal Drug Administration that a national conference was called in December 2006 to review this disturbing news. Watching intently and participating were the stent manufacturers Johnson and Johnson and Boston Scientific. Billions of dollars are at stake.

Following testimony, experts contend that for patients with uncomplicated disease the benefits of the drug-coated stents outweighs the risks. For patients with more advanced or complicated disease patterns the outlook is less clear and more research data is required. What is clear is that everyone feels it may be necessary to prolong the period requiring the anti-clotting drug: Plavix from months to years or indefinitely. However Plavix is not without complications. It promotes bleeding, which may mean a gastrointestinal hemorrhage as well as easy bruising. The most desperate situations occur when a patient taking Plavix must stop it for dental work, hip or other major surgery and colonoscopy. Will they have a heart attack or die from a stent clot when Plavix is stopped? This scenario has occurred and is continuously encountered. It is as if a therapy for one disease now is painting patients into a corner from which they can not escape when other illnesses require surgical therapy.

This Gordian knot has lead leading cardiologists to question stent therapy.

Dr. Eric Topol, a member of the conference panel stated, “There’s a much more liberal use of angioplasty and stenting than there needs to be.”

The head cardiologist at Kaiser Permanente, Dr. Calvin L. Weisberger added, “A large pool of angioplasties and by pass surgery are being done with out scientific evidence.”

The hard science, which seems not to be prominent in all these discussions is that it is not the major blockages which are treated by angioplasty and stents which account for heart attacks. The small unstable juvenile arterial plaques are prone to rupture and cause over 85% of heart attacks, and they are not treated by angioplasty or by-pass surgery. Then why do cardiologists treat the blockages unlikely to cause the heart attacks? There is a lingering belief that somehow the patient will be improved by widening the opening, and there is the unspoken force of money – huge guaranteed money from doing these procedures.

Then there is the harshest critic of all- scientific research. Study after study indicates for most patients undergoing angioplasties and stents, there is no increase in survival and no decrease in heart attacks.

Why might this be a time to rejoice? The morbidity, mortality, expense and transient benefits of a high technology approach toward the coronary disease epidemic, has failed. It is time to realize that the answer to a faulty lifestyle epidemic is not drugs and technology – it is lifestyle. The epidemiologic evidence that coronary artery disease does not exist in cultures consuming plant-based nutrition is robust and overwhelming. There is clear evidence that cultures which switch from a plant based culture to a western diet develop an epidemic of coronary heart disease. Lewis Kuller, Professor of Medicine at the University of Pittsburg School of Public Health, based on his 10 year cardiovascular health study states “all males 65 years of age or older who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.

This toxic diet with its burden of animal protein, dairy, processed oils, white flour, sugar, and excess saturated and trans fats and free radicals marinates in our bodies injuring our delicate cellular matrix with every bite at every meal. Science shows us how this occurs. We depend mightily on the capacity of our endothelial cells, which comprise the single cell layer lining our arteries, to manufacture nitric oxide. Nitric oxide is the strongest vasodilator in the body. It causes blood vessels to enlarge, prevents blood flow from being sticky or sluggish, and inhibits arterial plaque formation.

The brachial artery tourniquet test quantifies the endothelial responses. The test requires an ultrasound measure of the diameter of the brachial artery below the elbow before and after an upper arm tourniquet stops blood flow to the forearm for 5 minutes. Normally when the cuff is released and the brachial artery ultrasound measurement is repeated the artery dilates or widens. This occurs from a healthy out pouring of nitric oxide from the endothelium. When volunteers consume cornflakes their brachial artery tourniquet test is normal. If they consume sausage, olive oil, or saturated fat they fail the test. The ingested fat so injures the endothelium that it cannot produce nitric oxide. Regular consumption of the toxic western menu is a cardiovascular disaster. The time is long overdue to challenge the failure of drugs and technology to stop the coronary disease epidemic.

The natural next question is can patients who have severe coronary artery disease arrest and reverse this disease by consuming a totally plant based diet?

Dr. Dean Ornish and this author have investigated this question through scientific peer reviewed study. Dr. Ornish reported his results at one year and again at 5 years. This author reported results at 5 years, 12 years and most recently at 21 years in a book for the public, Prevent and Reverse Heart Disease, Avery /Penguin, February 2007. These studies indicate that fully compliant patients decrease the episodes of angina or eliminate them, decrease their cholesterol, decrease their weight, increase their exercise capacity, and arrest and selectively reverse their disease on follow up x-rays of the coronary arteries. Seeing these patients thrive beyond 20 years of initiating their plant-base therapy is the most powerful reason for wanting the cardiology community to embrace and utilize plant- based nutrition. There is no morbidity, mortality or added expense with plant-based nutrition and benefits endure and improve with the passage of time. Cardiologists say they doubt that patients will follow such a nutritional change. My experience in counseling hundreds of these patients indicates this concern is flatly not true. As a matter of fact, patients rejoice in the knowledge that they have become the locus of control over the disease that was destroying them and are distraught they were never told of this option by their cardiologist.

In summary, the dark shadow cast over cardiology, through failure of its miracle drug and the melt down of drug eluting stents with unforeseen clotting resulting in heart attacks and death should motivate us to look more closely at a proven therapy which is effective and endures and has the potential to eliminate the coronary heart disease epidemic, as well as other chronic western illness such as strokes, hypertension, adult onset diabetes, obesity, impotence and dementia.

Caldwell Esseltyn MD is a preventive cardiology consultant in the Department of General Surgery Cleveland Clinic Foundation, Cleveland, Ohio, and the author of the forthcoming, “Prevent and Reverse Heart Disease” due out February 1, 2007.

What Are Phytosterols?

What Are Phytosterols?

Phytosterols can help keep your heart and brain young. Find out which foods contain them and how much you need.


Monica Reinagel, MS, LD/N, CNS,

November 19, 2013

Episode #260

The word “phytosterol” may be unfamiliar but you’ve probably been eating them your whole life.

At least I hope you have!

Because a diet rich in phytosterols is a great way to reduce your risk of heart disease. And now, researchers suspect that phytosterols also play a role in prevention of Alzheimer’s disease as well.

Read on to learn more.

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What Are Sterols?

The word “phyto” means plant, of course. But what does “sterol” mean? Sterols are a family of molecules with a specific shape and structure. Phytosterols are sterols found in plants. The sterols you find in animals are called zoosterols and the best-known of these is cholesterol. And here’s where the link between phytosterols and heart disease comes into play.

How Do Phytosterols Protect Your Heart and Brain?

Stimagsterol appears to inhibit the formation of the beta-amyloid protein that builds up in the brain of people with Alzheimer’s.

Phytosterols and cholesterol are similar enough in structure that they are absorbed through the same mechanisms—and only so many molecules are going to get through the gate. When your diet is high in phytosterols, you absorb less cholesterol. This can lead to lower LDL (or, “bad”) cholesterol levels and and a reduced risk of heart disease.

See also: Eat More of These Foods to Lower Your Cholesterol

Even better, new research suggests that phytosterols may also help reduce your risk of Alzheimer’s. One phytosterol in particular, called stimagsterol, appears to inhibit the formation of the beta-amyloid protein that builds up in the brain of people with Alzheimer’s. The research is still preliminary; we have to see if it works as well in people as it does in animals. But if stigmasterol can help protect our brains as well as our hearts, that will be a welcome bonus!

Where Do You Get Phytosterols?

Pistachios, peanuts, sunflower and sesame seeds, split peas, wheat germ, and canola oil are all particularly good sources, but virtually all nuts, seeds, and legumes contain decent amounts of phytosterols. Some fruits and vegetables, including berries, broccoli, Brusells sprouts, and avocado are also good sources. You can also buy foods, such as butter spreadspeanut butter, mayonnaise, and even orange juice, that have been fortified with extra phytosterols.

Vegetarians tend to have higher intake of phytosterols than meat-eaters, probably because they tend to eat more vegetables, nuts, seeds, and legumes.  That could be part of the reason that heart disease rates are lower in vegetarians.

See also: Should You Be a Vegetarian?


Of course, you could just go to the vitamin store and pick up a bottle of phytosterol supplements but I would much prefer that you get these nutrients from foods rather than pills. Why? Because foods that are high in phytosterols tend to be high in other nutrients that also protect your health, such as fiber and antioxidants. Eating nuts and legumes is also linked with a healthy body weight, which further protects you from disease. Finally, when you get your phytosterols from whole foods, it’s pretty hard to overdo it. Not so with supplements.

The Case Against Supplements

Extracting individual nutrients from foods and putting them into pills makes it easy to ensure consistently high intakes, no matter what you eat. But isolated nutrients don’t always have the same benefits as they do in a whole food context. Often, some critical co-nutrient is inadvertently left behind. Sometimes taking concentrated amounts of single nutrients leads to imbalances or overloads. Most importantly, when we rely on supplements to supply our nutrients, we rob ourselves of all the collateral benefits of a whole foods diet.

See also: Can You Get Too Many Vitamins?

A high intake of phytosterols can lower your cholesterol, for example, but it can also lower your beta-carotene levels. In the context of a diet that includes lots of fruits and vegetables, this is unlikely to cause a problem. But adding a phytosterol supplement to a diet that’s deficient in fruits and vegetables might. Very high levels of phytosterols have even been linked to an increased risk of heart disease. So let’s not assume that if a little is good, a whole lot more will be a whole lot better!

How Much Phytosterol Do You Need?

The cholesterol-lowering benefits of phytosterols appear to peak about about 2,000 mg per day. That’s probably more than you’ll be able to get from diet alone. (Typical intakes max out around 500mg per day.) I still recommend eating phytosterol-rich foods on a regular basis, but if you’re trying to maximize the cholesterol-lowering effect, you might want to add a phytosterol-fortified food to the mix. Check with your doctor to see what target range she recommends. And don’t forget to load up on the fruits and vegetables for extra beta-carotene.

See also: How to Get More Vegetables Into Your Diet

For those who aren’t worried about their cholesterol, enjoying nuts, seeds, legumes, wheat germ, and avocado is a great (and delicious) way to get the protective benefits of phytosterols, along with the many other benefits of these nutritious, whole foods.

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Olive Oil Shown To Promote Atherosclerosis

Olive OilThe following studies provide evidence for the atherosclerosis-promoting effect of olive oil, in monkeys, mice, and humans:1. Hepatic Origin of Cholesteryl Oleate in Coronary Artery Atherosclerosis In African Green Monkeys, Enrichment By Dietary Monounsaturated Fat, Journal of Clinical Investigation, 1997

“[We observed in monkeys] that the amount of coronary artery atherosclerosis was similar in the monounsaturated and saturated fat groups, in spite of the significantly improved LDL cholesterol concentration and LDL/HDL cholesterol ratio in the former.”

2. Dietary Monounsaturated Fatty Acids Promote Aortic Atherosclerosis In LDL Receptor–Null, Human ApoB100–Overexpressing Transgenic Mice, Arteriosclerosis, Thrombosis, and Vascular Biology, 1998

Mice were fed one of 6 diets with different fatty acid content: saturated, monounsaturated (cis and trans), polyunsaturated (n-3 and n-6), and a control diet.

“The reduction in aortic atherosclerosis was not found when either cis or trans monounsaturated fatty acids were fed. Rather, just as much atherosclerosis was seen when cis monounsaturated fat diets were fed as when saturated fat was fed, and significantly more atherosclerosis was seen when the trans monounsaturated fatty acids were fed.”

This is an important outcome when one considers that monounsaturated fats, often in the form of olive oil, are widely promoted as being healthful and effective for protection against heart disease.

3. Effect Of Fat And Carbohydrate Consumption On Endothelial Function, Lancet, December, 1999

“Consumption of a meal high in monounsaturated fat was associated with acute impairment of endothelial function when compared with a [low-fat] carbohydrate-rich meal.”

4. The Postprandial Effect Of Components Of The Mediterranean Diet On Endothelial Function, Journal of the American College of Cardiology, November 2000

“Contrary to part of our hypothesis, our study found that omega-9 (oleic acid)-rich olive oil impairs endothelial function postprandially.

The mechanism appears to be oxidative stress because the decrease in FMD was reduced (71%) by the concomitant administration of vitamins C and E. Balsamic vinegar (red wine product) and salad reduced the postprandial impairment in endothelial function to a similar extent (65%).

In a clinical study, olive oil was shown to activate coagulation factor VII to the same extent as does butter (44). Thus, olive oil does not have a clearly beneficial effect on vascular function.”

The major unsaturated fatty acids in olive oil are oleic acid (18:1n-9) and linoleic acid (18:2n-6) (42). A high-oleic and linoleic acid meal has recently been shown to impair FMD in comparison with a low-fat meal(28). (That’s the study above by Ong et al.)

In terms of their effects on postprandial endothelial function, the beneficial components of the Mediterranean and Lyon Diet Heart Study diets appear to be the antioxidant-rich foods—vegetables, fruits … not olive oil. Dietary fruits, vegetables, and their products appear to provide some protection against the direct impairment in endothelial function produced by high-fat foods, including olive oil.”

Clearly, olive oil is not the heart-healthy food it’s made out to be. It truly is a feat of marketing that a food which has been shown over and over to impair artery function exists in peoples’ minds as an elixir. The Mediterranean diet, with its generous portions of fruits, vegetables, and whole grains, improves health not because of olive oil, but in spite of it.

“If All You Ate Were Potatoes, You’d Get All Your Amino Acids”

The sentence above is haunting me.

Doug asked:

“I still don’t understand why more care isn’t necessary to avoid deficiencies of the essential amino acids. Is it the case that these amino acids are present in all fruits and vegetables? (I didn’t think this was so, but you mentioned on that other thread that thinking has changed in this regard.) Or is it simply that easy to avoid a deficiency of an essential amino acid by consuming any mixture of fruits and vegetables?”

Doug, I would answer “Yes.” to your last question. I thought it summed up the facts well.

Plants are capable of manufacturing all 20 amino acids, which include the essential amino acids (EAAs), although amounts vary. I checked a number of foods (potatoes, broccoli, tomatoes, asparagus, corn, rice, oatmeal, beans, and others) and found all EAAs in each of these foods. Even an apple which is listed as having 0 grams of protein has all the EAAs, albeit it small amounts.

Since I said in an earlier comment, “No mixing of foods is necessary. If all you ate were potatoes, you’d get all your amino acids,” I felt obliged to back it up. Below is my back-up.

  • The first column lists all 8 EAAs for adults.
  • The second column lists the World Health Organization’s recommended intake per body weight.
  • The third column lists the specific RDI for a 120 lb adult.
  • The fourth column lists the amount of each AA in a medium potato, with skin.
  • The fifth column lists the amount of each AA in 5 medium potatoes.
  • The last column lists the % of recommended intake (for a 120 lb adult) for each AA when 5 potatoes are consumed.

Click for larger.- The WHO’s recommended intakes represent the minimum amount for an individual with the highest need, multiplied by a factor of 2 for safety.
– Methionine + Cysteine = Total Sulfur Amino Acids
– Phenylalanine + Tyrosine = Total Aromatic Amino Acids
– WHO: World Health Organization
– EAA: Essential Amino Acid

For a 120 pound adult, five potatoes (960 calories) supply over 100% of the recommended intake for all essential amino acids. They also supply 25 grams of total protein.
It’s pretty difficult for an adult to eat a plant-based, vegetarian diet that doesn’t provide all EAAs, as long as caloric needs are met.

Finally – The pool of AAs that our body uses to manufacture its own proteins isn’t limited by what we eat. Normal daily turnover of our cells provides a substantial pool from which to draw amino acids. Bacteria that line our colon also manufacture AAs, including EAAs, that we can utilize.

It is a misconception that plants provide “incomplete protein”, regardless of what Ms. Lappe advanced in her 1971 book, “Diet For A Small Planet.”

CardioBuzz: Vegan Diet, Healthy Heart?

Published: Jul 21, 2014 | Updated: Jul 21, 2014


In this guest blog, Kim A. Williams, MD, a cardiologist at Rush University in Chicago and the next president of the American College of Cardiology, explains why he went vegan and now recommends it to patients.

Physicians want to influence their patients to make lifestyle changes that will improve their health, but sometimes the roles are reversed and we are inspired by patients. It was a patient’s success reversing an alarming condition that motivated me to investigate a vegan diet.

Just before the American College of Cardiology’s (ACC) annual meeting in 2003 I learned that my LDL cholesterol level was 170. It was clear that I needed to change something. Six months earlier, I had read a nuclear scan on a patient with very-high-risk findings — a severe three-vessel disease pattern of reversible ischemia.

The patient came back to the nuclear lab just before that 2003 ACC meeting. She had been following Dean Ornish, MD’s program for “Reversing Heart Disease,” which includes a plant-based diet, exercise, and meditation. She said that her chest pain had resolved in about 6 weeks, and her scan had become essentially normalized on this program.

When I got that LDL result, I looked up the details of the plant-based diet in Ornish’s publications — 1- and 5-year angiographic outcomes and marked improvement on PET perfusion scanning — small numbers of patients, but outcomes that reached statistical significance.

I thought I had a healthy diet — no red meat, no fried foods, little dairy, just chicken breast and fish. But a simple Web search informed me that my chicken-breast meals had more cholesterol content (84 mg/100 g) than pork (62 mg/100 g). So I changed that day to a cholesterol-free diet, using “meat substitutes” commonly available in stores and restaurants for protein. Within 6 weeks my LDL cholesterol level was down to 90.

I often discuss the benefits of adopting a plant-based diet with patients who have high cholesterol, diabetes, hypertension, or coronary artery disease. I encourage these patients to go to the grocery store and sample different plant-based versions of many of the basic foods they eat. For me, some of the items, such as chicken and egg substitutes, were actually better-tasting.

There are dozens of products to sample and there will obviously be some that you like and some that you don’t. One of my favorite sampling venues was the new Tiger Stadium (Comerica Park) in Detroit, where there are five vegan items, including an Italian sausage that is hard to distinguish from real meat until you check your blood pressure — vegan protein makes blood pressures fall.

In some parts of country and some parts of world, finding vegan restaurants can be a challenge. But in most places, it is pretty easy to find vegan-friendly options with a little local Web searching. Web searching can also help with the patients who are concerned about taste or missing their favorite foods. I typically search with the patient and quickly email suggestions.

Interestingly, our ACC/American Heart Association (AHA) prevention guidelines do not specifically recommend a vegan diet, as the studies are very large and observational or small and randomized, such as those on Ornish’s whole food, plant-based diet intervention reversing coronary artery stenosis. The data are very compelling, but larger randomized trials are needed to pass muster with our rigorous guideline methodology.

Wouldn’t it be a laudable goal of the American College of Cardiology to put ourselves out of business within a generation or two? We have come a long way in prevention of cardiovascular disease, but we still have a long way to go. Improving our lifestyles with improved diet and exercise will help us get there.


What is Cholesterol? What Causes High Cholesterol?

Answer: In general, the main sources of saturated fat are from animal products: red meat and whole-milk dairy products, including cheese,sour cream, ice cream and butter.

Cholesterol is a lipid (fat) which is produced by the liver. Cholesterol is vital for normal body function. Every cell in our body has cholesterol in its outer layer.

Cholesterol is a waxy steroid and is transported in the blood plasma of all animals. It is the main sterol synthesized by animals – small amounts are also synthesized in plants and fungi. A sterol is a steroid sub-group.

Cholesterol levels among US adults today are generally higher than in all other industrial nations. During the 1990s there was some concern about cholesterol levels in American children. According to the CDC (Centers for Disease Control and Prevention), nearly 1 in every 10 children/adolescents in the USA has elevated total cholesterol levels; and this was after concentrations had dropped over a 20-year period.

The word “cholesterol” comes from the Greek word chole, meaning “bile”, and the Greek word stereos, meaning “solid, stiff”.
What are the functions of cholesterol?

It builds and maintains cell membranes (outer layer), it prevents crystallization of hydrocarbons in the membrane
It is essential for determining which molecules can pass into the cell and which cannot (cell membrane permeability)
It is involved in the production of sex hormones (androgens and estrogens)
It is essential for the production of hormones released by the adrenal glands (cortisol, corticosterone, aldosterone, and others)
It aids in the production of bile
It converts sunshine to vitamin D. Scientists from the Rockefeller University were surprised to find that taking vitamin D supplements do not seem to reduce the risk of cholesterol-related cardiovascular disease.
It is important for the metabolism of fat soluble vitamins, including vitamins A, D, E, and K
It insulates nerve fibers
There are three main types of lipoproteins

Cholesterol is carried in the blood by molecules called lipoproteins. A lipoprotein is any complex or compound containing both lipid (fat) and protein. The three main types are:
LDL (low density lipoprotein) – people often refer to it as bad cholesterol. LDL carries cholesterol from the liver to cells. If too much is carried, too much for the cells to use, there can be a harmful buildup of LDL. This lipoprotein can increase the risk of arterial disease if levels rise too high. Most human blood contains approximately 70% LDL – this may vary, depending on the person.

HDL (high density lipoprotein) – people often refer to it as good cholesterol. Experts say HDL prevents arterial disease. HDL does the opposite of LDL – HDL takes the cholesterol away from the cells and back to the liver. In the liver it is either broken down or expelled from the body as waste.

Triglycerides – these are the chemical forms in which most fat exists in the body, as well as in food. They are present in blood plasma. Triglycerides, in association with cholesterol, form the plasma lipids (blood fat). Triglycerides in plasma originate either from fats in our food, or are made in the body from other energy sources, such as carbohydrates. Calories we consume but are not used immediately by our tissues are converted into triglycerides and stored in fat cells. When your body needs energy and there is no food as an energy source, triglycerides will be released from fat cells and used as energy – hormones control this process.
What are normal cholesterol levels?

The amount of cholesterol in human blood can vary from 3.6 mmol/liter to 7.8 mmol/liter. The National Health Service (NHS), UK, says that any reading over 6 mmol/liter is high, and will significantly raise the risk of arterial disease. The UK Department of Health recommends a target cholesterol level of under 5 mmo/liter. Unfortunately, two-thirds of all UK adults have a total cholesterol level of at least five (average men 5.5, average women 5.6).

Below is a list of cholesterol levels and how most doctors would categorize them in mg/dl (milligrams/deciliter) and 5mmol/liter (millimoles/liter).
Desirable – Less than 200 mg/dL
Bordeline high – 200 to 239 mg/dL
High – 240 mg/dL and above

Optimum level: less than 5mmol/liter
Mildly high cholesterol level: between 5 to 6.4mmol/liter
Moderately high cholesterol level: between 6.5 to 7.8mmol/liter
Very high cholesterol level: above 7.8mmol/liter
Dangers of high cholesterol levels

High cholesterol levels can cause:
Atherosclerosis – narrowing of the arteries.

Higher coronary heart disease risk – an abnormality of the arteries that supply blood and oxygen to the heart.

Heart attack – occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. This causes your heart muscle to die.

Angina – chest pain or discomfort that occurs when your heart muscle does not get enough blood.

Other cardiovascular conditions – diseases of the heart and blood vessels.

Stroke and mini-stroke – occurs when a blood clot blocks an artery or vein, interrupting the flow to an area of the brain. Can also occur when a blood vessel breaks. Brain cells begin to die.
If both blood cholesterol and triglyceride levels are high, the risk of developing coronary heart disease rises significantly.

Symptoms of high cholesterol (hypercholesterolaemia)

Symptoms of high cholesterol do not exist alone in a way a patient or doctor can identify by touch or sight. Symptoms of high cholesterol are revealed if you have the symptoms of atherosclerosis, a common consequence of having high cholesterol levels. These can include:
Narrowed coronary arteries in the heart (angina)

Leg pain when exercising – this is because the arteries that supply the legs have narrowed.

Blood clots and ruptured blood vessels – these can cause a stroke or TIA (mini-stroke).

Ruptured plaques – this can lead to coronary thrombosis (a clot forming in one of the arteries that delivers blood to the heart). If this causes significant damage to heart muscle it could cause heart failure.

Xanthomas – thick yellow patches on the skin, especially around the eyes. They are, in fact, deposits of cholesterol. This is commonly seen among people who have inherited high cholesterol susceptibility (familial or inherited hypercholesterolaemia).
What causes high cholesterol?

Lifestyle causes
Nutrition – although some foods contain cholesterol, such as eggs, kidneys, eggs and some seafoods, dietary cholesterol does not have much of an impact in human blood cholesterol levels. However, saturated fats do! Foods high in saturated fats include red meat, some pies, sausages, hard cheese, lard, pastry, cakes, most biscuits, and cream (there are many more).

Sedentary lifestyle – people who do not exercise and spend most of their time sitting/lying down have significantly higher levels of LDL (bad cholesterol) and lower levels of HDL (good cholesterol).

Bodyweight – people who are overweight/obese are much more likely to have higher LDL levels and lower HDL levels, compared to people who are of normal weight.

Smoking – this can have quite a considerable effect on LDL levels.

Alcohol – people who consume too much alcohol regularly, generally have much higher levels of LDL and much lower levels of HDL, compared to people who abstain or those who drink in moderation.
Treatable medical conditions

These medical conditions are known to cause LDL levels to rise. They are all conditions which can be controlled medically (with the help of your doctor, they do not need to be contributory factors):
High blood pressure (hypertension)
High levels of triglycerides
Kidney diseases
Liver diseases
Under-active thyroid gland
Risk factors which cannot be treated

These are known as fixed risk factors:
Your genes 1 – people with close family members who have had either a coronary heart disease or a stroke, have a greater risk of high blood cholesterol levels. The link has been identified if your father/brother was under 55, and/or your mother/sister was under 65 when they had coronary heart disease or a stroke.

Your genes 2 – if you have/had a brother, sister, or parent with hypercholesterolemia (high cholesterol) or hyperlipidemia (high blood lipids), your chances of having high cholesterol levels are greater.