A second reason for our favorable results is the intensive, single-day, 5-hour counseling seminar that conveyed the message of nutritional intervention with depth, clarity, power, and completeness through a PowerPoint presentation, recipe handouts, books, video, strategies for plant food acquisition and preparation, and testimonials by prior participants. Thus informed, participants grasped in detail the importance of the endothelial cell and its product, nitric oxide. They were educated to fully comprehend which foods injure endothelial cells and how transitioning to a whole-food, plant-based diet empowers them as the locus of control to halt and potentially reverse their disease. The preseminar phone consultation, the seminar itself, and follow-up psychological support resulted in an adherence of 89% during this 3.7-year-long follow-up.
We believe food may be the most important lifestyle factor in establishing the presence or absence of disease.15,24-26 The adverse event rate among nonadherent participants was 62%. For adherent participants (119 experienced intervention prior to counseling: 75 had PCI with stent placement, and 44 suffered MI), the adverse event rate was at most 10% (“Worse” group in TABLE 2). An additional 27 counseled participants did not require previously recommended interventions. These data on required interventions and interventions recommended but found to be unnecessary (146/177; 82%), testify to the severity of illness in this cohort and illustrate the remarkable comparative lack of subsequent cardiovascular events in the 89% who complied with plant-based nutrition.
Less need for stenting? The prompt improvement (within 3 weeks) confirmed by PET scan documentation of myocardial reperfusion (FIGURE 1), resolution of angina, and angiographic evidence of disease reversal (FIGURE 2) demonstrated in our earlier studies involving plant-based nutritional intervention argue against elective deployment of stents for reperfusion. Successful nutritional treatment of CVD, coupled with standard medical therapy, may extinguish major cardiac event progression in the vast majority of patients.
Enabling the body to correct harmful processes. Future discoveries may help to explain why plant-based nutrition is so effective, yet we can postulate likely mechanisms. When foods that injure or cause endothelium dysfunction are avoided, the body readily restores the capacity of endothelial tissue to produce nitric oxide. Such change reduces production of vasoconstricting endothelin and thromboxane by injured endothelial cells.
Our insistence on daily ingestion of generous portions of green leafy vegetables favors an improved population of endothelial progenitor cells.33 Moreover, reductions in lipid, homocysteine, and triglyceride levels and insulin resistance enhance dimethylarginine dimethylaminohydrolase to enzymatically reduce asymmetric dimethylarginine and optimize nitric oxide synthase availability in nitric oxide production. The blood level of HDL-C may decrease with this antiinflammatory, plant-based nutrition. Nevertheless, the efflux capacity of HDL-C may be unrelated to blood concentration and could be significantly enhanced by the intervention to enable disease arrest or reversal.34,35 Consumers of plant-based nutrition do not harbor the intestinal flora unique to omnivores that enables production of proatherogenic TMAO. The standard nutritional, pharmaceutical, and surgical interventions of present cardiovascular medicine may not sufficiently address these protective mechanisms.
This study had several limitations. First, it included self-selected, very determined patients. Without a control group, it is challenging to establish causality and assess how much of the observed changes are specifically due to the diet. Only some of the observed beneficial outcomes may have been due to the diet. This study was not prospectively randomized. Nevertheless, this fact does not detract from proof of concept that major cardiovascular events occurred in probably <1% (and certainly <10%) of the entire adherent cohort, compared with 62% of the nonadherent cohort (TABLE 2). These data convey a strong message of patients accepting empowerment to be the locus of control to arrest their disease and confirm that patients will adopt a significant lifestyle transition to plant-based nutrition to halt and regress what we believe is a largely foodborne illness.
The past several decades have witnessed a substantial and sustained reduction in CAD. Nevertheless, CAD remains the number one killer of women and men in this country. Thousands of stable patients having stents experience no reduction in major cardiac events.6 While drugs have some effects on disease initiation and progression, these interventions do not address disease causation. Not surprisingly, most patients experience disease progression, more drugs, more imaging, repeat interventions, progressive disability, and, too often, death from a disease of western malnutrition, the cause of which has been largely left untreated. We have in press several patient experiences that exemplify the repeated failure of present-day cardiac drugs and procedural interventions, and that confirm the capacity of whole-food plant-based nutrition to restore health in “there is nothing further we can do” situations.36