Can Lifestyle Changes Remove Plaques in Your Arteries?

May 18, 2018 · 56 comments
Tim T (SF)
Debate is fun and all, but If you want to know the truth, do an experiment on yourself. I went plant based and my cholesterol went from 220 to 170 in 3 months. I exercised enthusiastically before and after.
Garrett Clay (San Carlos, CA)
I was in line at the supermarket not long after heart surgery and the young person in front of me had a cart full of what I’d call widow makers, stuff from the center of the store. I got his attention, pointed at his cart, slightly unbuttoned my shirt, pointed at the scar, then pointed at him, and raised my eyebrows. I didn’t say a thing. I suspect he will remember the interaction. There is nothing like having the surgeon slowly pull the two one inch tubes out of your chest a couple of days after that surgery to say “hey, maybe this is serious”.
Luk Brown (Vancouver)
This is riddled with confirmation bias. He starts by demonizing fats and then finds examples that confirms the bias. I could demonize sugar and then cite the exact same examples to demonstrate that sugar is the culprit. Personally I’m more persuaded by my bias vs his.
Barry Smith (Canada)
Vitamin K2 Look it up and read the many scientific papers.
Elizabeth McMillan MD (California)
In France during WWII there was no white flour or sugar as well as limited meats and fats. When I was studying in Tours France in 1961, the family I stayed with described their excitement at finding in1943 an old dried out loaf of white bread. They wrapped it in a moist towel to gradually rehydrate it before devouring it. All they had was whole wheat flour to eat. Why are we still talking high carb vs. low carb. Whole wheat and sugar are both carbs, but the body knows the difference.
Martha (NYC)
"Adhering to the required lifestyle changes, however, was challenging. The diet was a whole food, vegetarian diet that restricted fat to no more than 10 percent of total calories. In addition, the subjects had to quit smoking, perform regular aerobic exercise and participate in group therapy stress reduction sessions." I am living proof that even just eating a whole food plant based, very low oil (totally vegan) diet without aerobic exercise reduces plaque. No way is it 10% or less fat! But it is plant fat. Results: I had mild plaque in my lower extremities and 30% blockage in the carotid arteries 2 years ago. Now, last month vascular tests show zero plaque in the lower extremities and significant reduction of plaque in the carotid arteries, all without statins ever, even though my total cholesterol is 241. Down from 290 two years ago. (I have trouble with getting to a pool and cannot do fast walking due to knee arthritis but I am trying to do something else to get more exercise.) Cardiologist is impressed. I did it on my own, no group support. Learned how to follow instructions on-line, that's all it took. Plus fear of surgery if I didn't do this!.
The Pooch (Wendell, MA)
@Martha: Good work, but I guarantee that you also reduced sugar, refined starches, and other highly processed foods at the same time that you reduced fat and went vegan.
EFM (Brooklyn, NY)
Why would going vegan reduce sugars or starches? There are plenty of natural foods with both. As for fats that's more likely, but not necessarily the case as there are vegan acceptable fats like vegetable oils, nuts and even saturated fats like coconut oil products.
GiGi (Montana)
Diet theories recycle, so I guess it’s time to rediscover Pritikin.
jake d. (los angeles)
It seems everyone commenting on this article missed "malnourished" part in findings on Norweigans. More and more studies are coming out confirming that fasting is the best way to remain healthy and prolong your life. Not to mention that ketogenic diet kills cancer by starving it of its only food - sugar. I combine these two and am told that I look (God knows I feel) ten years younger than my age. But I doubt this "fad" will ever take off. If people think gorging on vegetables, brown rice and fruits is difficult, how can they ever forego ANY food (or drink besides water or tea) for 12-18 hours a day.
curt hill (el sobrante, ca)
this past January, i started fasting weekly - 24 hours with no food (lunch Wednesday to lunch Thursday). Just water and a small amount of caffeine. The thing i'm noticing is not the hunger pangs, which is totally manageable and almost non-existent. It's the DESIRE to eat. It's been a great discipline, i'm losing weight consistently, and I feel great.
Betti (New York)
The best way to reduce or remove plaques from your arteries is to move overseas and eat better quality food. No matter what you eat (and that includes organic food) the food in the US is poisoned and will eventually make everyone sick.
curt hill (el sobrante, ca)
This is ridiculous. Not all US food is poisoned. I grow many of my own veggies, have my own chickens and am discriminating in my shopping. My veggies are clean and delicious. My chickens eat an organic veggie diet and scraps from the garden - the eggs are awesome. And, many smaller producers make amazing and clean food. Just stay away from factory farmed and produced foods....
SW (Los Angeles)
Ah, no. Sugar was also unavailable. The study's authors want to attribute the reduction in plaque to the change in fats in the diet. Did they consider the impact of sugar? No. Was a non-nutritious substance like white sugar included in the vegetarian Lifestyle Heart Trial? Probably not. (Someone on the other side of the paywall want to look?) This appears to be a classic example of confirmation bias. Additionally, there was no baseline on pre-war information, just a presumption that high fat=high plaque. They could just as easily presume high processed sugar=high plaque; however, they were unaware of the connection then. The sugar industry is trying to bury the connection today.
steve (uk)
They were certainly told to reduce simple sugars. High sat and trans fat do equal high plaque that's why we are told to reduce those fats. No moderate or high fat trial has ever shown plaque reversal so that is very telling.
JRM (CA)
It’s not difficult to understand. High fat and high sugar are BOTH unhealthy dietary choices. Just because eating lot of sugar is bad for you, doesn’t make eating a lot of fat good for you. The negative impacts of high fat diets are well-known, the answer isn’t ‘but sugar.’
The Pooch (Wendell, MA)
@steve: Conflating sat fat and trans fats is a desperate and unsuccessful attempt to justify your "fat is bad" ideology. Sat fat consumption has never been shown to cause CVD. The "low fat" diet only has benefits when paired with sugar reduction and calorie restriction.
Scott Cole (Des Moines, IA)
So if I decrease the plaque in my arteries, does that mean I'm now free from a heart attack or stroke to die a long agonizing death from cancer, Parkinsons, Alzheimers, or something even worse?
Mike (NY)
A whole foods plant based diet will reduce your risk of dying prematurely from the 15 of the top 16 causes of death. It will also increase your lifespan and more importantly your healthspan. See Dr. Greger's 2015 "Food as Medicine" talk on youtube where he reviews the research.
Lynn (NJ)
A low carb or ketogenic diet will lower your risk of heart attack AND cancer, Parkinson's, and Alzheimers. There is good information on dietdoctor.com and if you're concerned about cholesterol, take a look at Dave Feldman's research at cholesterolcode.com. Gary Taubes and Nina Teicholz have good info too (books, YouTube).
Brian (Los Angeles)
Um, actually, a ketogenic diet increases your risk for heart disease!!
Kevin (Denver)
Was it clear whether it was the low fat diet or the smoking cessation, or both, that contributed to the reduce plaque burden?
steve (uk)
No other intervention has been shown to reverse plaque burden, only food.
Joseph (SF, CA)
There have been some studies that supposedly show that aged garlic extract (Kyolic) supplement can reduce plaque. But how much is not clear form this article: ========= Breakthrough Shows Unique Garlic May Reverse Heart Disease Friday, April 25, 2014 A new study which shows a specific form of garlic that you can buy in any health food store; may control, maybe even reverse heart disease. Although previous studies have focused on garlic’s effect on cholesterol, this research done by Dr. Matthew Budoff, of LABiomed at Harbor General Hospital in Carson, is the first to look at its direct effect on the hearts arteries. ... https://labiomed.org/news/breakthrough-shows-unique-garlic-may-reverse-h...
F. St. Louis (NYC)
Oh no. Another fat-phobic doc. Better load up on the carbs, ditch the bottles of EVOO and toss out the nuts and seeds so the squirrels can get atherosclerosis.
Make America Sane (NYC)
What does "whole food" mean? No supplements added? No fish oil required? Vegetarian can mean eggs and cheese along with the spinach I understand. The 10% fat diet is the Dean Ornish diet -- why not say so?? Did Dr.Atkins at all disprove any of this? Questions galore. but I am going towards more veggies... to also stabilize blood sugar.
Martha (NYC)
Whole food refers to a plant only, vegan, way of eating that involves eating as close to the whole plant, not, say, the oils or juices, so that you benefit from the complex nutrition of the entire plant (vegetable, fruit, whole grain). It's not hard. In fact, it's easy peasy once you learn how. Go to this site: UC Davis Integrative Medicine to learn with chef designed whole food plant based no oil recipes from Latin, Mediterranean and Asian regions. I lost 30 lbs effortlessly eating this way, it's delicious and my plaque is gone or greatly reduced.
The Pooch (Wendell, MA)
@Martha: Meat, fish, and eggs are also whole, nutrient-dense foods that have nourished humans and human ancestors for literally millions of years.
steve (uk)
Yes when starving these are great foods. For a long healthy life in modern times they are not optimal.
Paul (Bay Area)
I feel like I need to have plaque first to get motivated to adopt a stricter lifestyle which will induce plaque regression.
steve (uk)
You do have plaque; studies show 100% of people on the western diet have some level from age of 4.
Denise Rose (Tucson)
Go to conferences on whole food, plant-based nutrition and you will find several doctors who use plant nutrition as a first line of defense for patients with blocked arteries. They can share countless stories of patient success: Check out Dr. Joel Fuhrman and Dr. Caldwell Esselstynn as well as Dr. Joel Kahn and Dr. Kim Williams. Let the naysayers who don't want to believe that processed foods, oils, trans and saturated fats are the culprits suffer from the heart disease they will be more vulnerable to by ignoring the whole food plant-based, low fat diet. Those of us who follow a healthy plant-based diet will outlive them no doubt with a much better quality of life.
Someone (Bay State)
The keyword in your answer is "stories", not data. Next.
DrVeggie (Rochester, NY)
Data are merely multiple stories.
Martha (NYC)
Someone, Please know that there "is" data: nutritionfacts.org, for starters. And "The China Study" by T. Colin Campbell.
Vanessa Bogenholm (Los Gatos CA)
So tired of this!! We all know that diet (stop eating processed foods, lower the sugar) and getting exercise is the key to good health all around, for your heart and to not get diabetes, lower joint pain, etc. BUT our American medical personnel still push PILLS and surgeries and say "it is too difficult for clients to change their lifestyles" No doctors, it is easier for you to be bought by big Pharma!! Help yourself, find a workout routine you enjoy and just avoid processed foods!!
Frank (Sydney Oz)
I've recently started daily 4mg candesartan to reduce my blood pressure on my enlarged aorta - but side effects I've noticed includes daily flashes of headaches probably due to reduced blood pressure/supply to the brain - so now I'm wondering about any association between dementia and insufficient blood supply to the brain ...
Jennie (WA)
I don't like any exercise. I wish there was an exercise pill.
SW (Los Angeles)
Don't wonder. Change your diet. Make the life style changes.
Charlierf (New York, NY)
Dr. Klasco’s presentation of the data is conventionally correct - and just plain wrong. Arterial plaque results from blood borne VLDLs, which you see in your lipid test results as triglycerides. VLDLs interact with a plasma protein, CETP, to generate small, dense LDL particles which pierce the arterial walls provoking immune responses which then form arterial plaque. VLDLs are increased by alcohol, fructose (half of sugar, etc.), and excess carbs. If you examine the evidence presented by Dr. Klasco, you will see that the low calorie situations he cites, even those he sees as low fat, also markedly reduced carbs (and often also fructose). If you read anecdotes from low carb dieters, you will be struck by how consistently they cite abnormally high triglyceride levels suddenly plunging to below normal (“normal” in conventional high carb diets is plaque-provokingly high). Not convinced by a commenter’s anti-triglyceride charges? Read the research of American Heart Associations bigwig Dr. Ronald Krauss.
alex (palisades)
VLDLs don't appear in lipid panel test results as triglycerides. There is a category for VLDLs and a category for triglycerides.
Charlierf (New York, NY)
Alex, triglycerides do not mix with blood, that’s why the triglycerides stored in fat cells are sent into the plasma as free fatty acids. The triglycerides you see in your lipid panel are generated by de novo lipogenesis in your liver, which packages them as part of - VLDLs.
steve (uk)
Why not research Kim Williams the past president of the ACC who is 180 degrees from Krauss? It's very telling how Krauss's advice changed when he started working for the beef and dairy industries. Strange that.
Dan Green (Palm Beach)
We love our junk food. Well marketed, priced right, and developed over many years to satisfy taste buds. Same as soft drinks. My observation is, many folks are trying to watch their diet.As for exercise, look at all the gym rats who workout everyday. New stats by the medical profession latched on to another 40 million souls who should be taking B/P meds. The new guidelines really lowered the readings bar.
Dr. J (CT)
"Despite their proven benefits, diet and lifestyle modifications must be viewed as adjuncts to, rather than substitutes for, medication for many patients." To the contrary, I consider "diet and lifestyle modifications" to be the primary method of prevention or even regression of heart disease for most people, with medications prescribed for the low percentage of people for whom lifestyle modifications alone are not sufficient -- to prevent heart disease. And there are many other benefits from a healthy diet than just preventing cardiovascular disease. Otherwise, a prescription is simply a permission slip to continue an unhealthy diet; SAD. (Standard American Diet).
Pat (Somewhere)
"The diet was a whole food, vegetarian diet that restricted fat to no more than 10 percent of total calories." I'd be interested in a similar study based on more modern ideas that consider excessive carbohydrate consumption to be the problem, not dietary fat.
steve (uk)
You'll be happy to know that they have been done and they did not work. That's why the guidelines are there to reduce sat fat strangely enough.
The Pooch (Wendell, MA)
@steve: This is just false. Numerous randomized controlled trials, with human subjects, have found benefits to high(er) fat, low(er) carb diets, while no controlled trial has ever found harm from naturally fatty foods.
Mimi (Dubai)
There is zero evidence linking dietary fat and LDL cholesterol levels with heart disease. There is plenty linking consistently high insulin levels, which is related to consumption of sugars and refined carbohydrates. An observation based on a few people during WWII is not a sound basis for recommendation of any particular lifestyle changes.
steve (uk)
There are numerous studies showing this is the case, please research and stop quoting low carb journalists and book writers.
The Pooch (Wendell, MA)
@steve: There is no experimental or clinical trial demonstrating harm from dietary fats. The Women's Health Initiative, 40,000+ women, 7 years, found _no benefits_ to the low fat/low sat fat diet. No benefits for heart disease, obesity, diabetes, cancer, or overall mortality. Nothing. Zilch. There are numerous experimental trials demonstrating benefits to high(er) fat, low(er) carb diets for weight loss, blood sugar regulation, and improvement in CVD risk factors. All of the "fat is bad" studies were observational studies, based on self-reported food surveys, confounded with dozens of variables, and the claimed risk ratios were always tiny.
Mopar (Brooklyn)
In addition to animal products, flour, sugar, cereal, coffee, and tea were rationed, and alcohol and cigarettes were difficult to obtain. People ate whole grains, legumes, vegetables and fish, and not a lot of it. And they exercised more (gas rationing? mass transit reductions?). So the "lifestyle" changes were many. To attribute the health benefits only to decreases in animal products, when clearly people increased fiber intake and reduced blood sugar, not to mention smoked less and exercised more, among other things, seems unwarranted and misleading.
sumit (New Jersey)
On the other hand, I doubt if being under German occupation could have reduced stress.
nyc2char (New York, NY)
or slavery for that matter.....which in other forms are still going on today...so...the stress continues!
Sequel (Boston)
The studies reported here are too small, too focused on other topics, and too limited in positive results to be taken as an endorsement of either drugs or lifestyle changes. The most reasonable conclusion anyone should draw from this is the idea that lifestyle changes may have a positive impact on placques, and should be studied in a far more rigorous and large-scale manner.
CB (California)
Better yet, try lifestyle changes—gauge how you feel and get a lipid panel done after six months.