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Avoiding “bad” foods is not enough

November 10, 2016 by Joel Fuhrman, MD

To protect against heart attack and stroke, is it enough to avoid sweets, white flour, and fried foods?  Or do we need to place more focus on eating more vegetables, fruits, beans, nuts and seeds?  A large international study of nearly 16,000 people with coronary heart disease from 39 different countries suggests the latter.

The study scored participants on how closely their reported diets aligned with either “Mediterranean” or “Western” diet patterns.  For the Mediterranean score, participants received 0-4 points based on their daily servings of whole grains, vegetables, legumes, and fruits; weekly consumption of fish and moderate alcohol consumption added points too.  The Western diet score increased with more frequent consumption of refined grains, sweets and desserts, sugary drinks, and deep fried foods.

After a follow-up period of 3.7 years, major cardiovascular events (non-fatal heart attack, non-fatal stroke, or death from a cardiovascular cause) were assessed.  About 18 percent of participants had a Mediterranean diet score of 15 or higher, and this group had the lowest risk of major cardiovascular events.  Also, starting at a Mediterranean diet score of 12, there were dose-dependent risk reductions: for each 1 point increase in Mediterranean diet score, the risk of all major cardiovascular events was 5 percent lower, for heart attack 4 percent lower, and for stroke 9 percent lower.

There was no association between the Western diet score and cardiovascular events, which means that eating more or less unhealthy food did not make much difference either way. What made the real difference was when people ate more vegetables, beans, nuts and seeds.  The consumption of these beneficial foods had a more powerful effect than just avoiding unhealthy food.  The authors propose that dietary guidelines for prevention should focus on greater consumption of health-promoting foods.  Switching from white bread to whole wheat bread, giving up sugary drinks, and avoiding fried foods is a good start, but it’s not enough. It’s a modest change that will bring only modest results.  When you increase high-nutrient, cardioprotective foods, you’ll decrease the low-nutrient foods automatically, and over time lose your desire for them.  You may also save your life.

“Western” foods harm the cardiovascular system

The foods that contributed to the Western diet score have known hazardous effects on the cardiovascular system.  Refined grains, sweets, desserts, and sugary drinks are high-glycemic foods; a high-glycemic diet causes dangerously high glucose and insulin levels, dramatically increasing the risk of obesity, type 2 diabetes, and cardiovascular disease.2-5  These foods also lead to exposure to advanced glycation end products, which can cause damage to the vascular system.6  Foods fried in oil elevate circulating fats after a meal, drive inflammation, and impair endothelial function, promoting the development of atherosclerosis.7-10

High-nutrient plant foods benefit the cardiovascular system

The whole plant foods contributing to the Mediterranean diet score have been linked to lower cardiovascular risk in this and other large international studies. The INTERHEART study, for example, identified low vegetable and fruit intake as one of 9 mostly modifiable risk factors responsible for 90 percent of heart attacks across 52 countries.11  In the Global Burden of Disease Study, dietary risk factors (including low intake of vegetables, fruits, and nuts/seeds) were attributable for 11.3 million deaths worldwide in 2013.12  So remember, a Mediterranean diet is a step in the right direction, but it is not the same as a Nutritarian diet.  A Mediterranean diet may reduce risk of heart disease somewhat, but it still permits plenty of needless heart attacks, while a Nutritarian diet is designed to completely wipe out cardiovascular risk.

Unquestionably, green vegetables, berries, beans, nuts and seeds help to lower cholesterol and blood pressure, prevent weight gain, and mitigate the oxidative stress and inflammation that drive atherosclerosis.13-21  In my book The End of Heart Disease, I explain in detail how protective foods work to powerfully protect the heart and blood vessels.  The efficacy of a Nutritarian diet-style designed to offer maximal protection provides radical benefits, as demonstrated in a 2015 study in the American Journal of Lifestyle Medicine. It showed dramatic reductions in weight, cholesterol, and blood pressure, as well as case studies with advanced heart disease demontrating atherosclerosis reversal and resolution of heart disease.22  Everyone needs to know that drugs cannot offer the degree of protection that a Nutritarian diet can and that you do not have to have a heart attack.

  1. Stewart RA, Wallentin L, Benatar J, et al. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease. Eur Heart J 2016.
  2. Bhupathiraju SN, Tobias DK, Malik VS, et al. Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis. Am J Clin Nutr 2014, 100:218-232.
  3. Ma XY, Liu JP, Song ZY. Glycemic load, glycemic index and risk of cardiovascular diseases: meta-analyses of prospective studies. Atherosclerosis 2012, 223:491-496.
  4. Rossi M, Turati F, Lagiou P, et al. Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis. Eur J Nutr 2015, 54:215-222.
  5. Turati F, Dilis V, Rossi M, et al. Glycemic load and coronary heart disease in a Mediterranean population: the EPIC Greek cohort study. Nutr Metab Cardiovasc Dis 2015, 25:336-342.
  6. Stirban A, Tschope D. Vascular Effects of Dietary Advanced Glycation End Products. Int J Endocrinol 2015, 2015:836498.
  7. Hennig B, Toborek M, McClain CJ. High-energy diets, fatty acids and endothelial cell function: implications for atherosclerosis. J Am Coll Nutr 2001, 20:97-105.
  8. Botham KM, Wheeler-Jones CP. Postprandial lipoproteins and the molecular regulation of vascular homeostasis. Prog Lipid Res 2013, 52:446-464.
  9. Rueda-Clausen CF, Silva FA, Lindarte MA, et al. Olive, soybean and palm oils intake have a similar acute detrimental effect over the endothelial function in healthy young subjects. Nutr Metab Cardiovasc Dis 2007, 17:50-57.
  10. Higashi Y, Noma K, Yoshizumi M, Kihara Y. Endothelial function and oxidative stress in cardiovascular diseases. Circ J 2009, 73:411-418.
  11. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004, 364:937-952.
  12. Collaborators GBDRF, Forouzanfar MH, Alexander L, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015.
  13. Joshipura KJ, Hu FB, Manson JE, et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001, 134:1106-1114.
  14. Zakkar M, Van der Heiden K, Luong le A, et al. Activation of Nrf2 in endothelial cells protects arteries from exhibiting a proinflammatory state. Arterioscler Thromb Vasc Biol 2009, 29:1851-1857.
  15. Cassidy A, Mukamal KJ, Liu L, et al. High anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women. Circulation 2013, 127:188-196.
  16. Cassidy A, O'Reilly EJ, Kay C, et al. Habitual intake of flavonoid subclasses and incident hypertension in adults. The American journal of clinical nutrition 2011, 93:338-347.
  17. Bazzano LA, Thompson AM, Tees MT, et al. Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases: NMCD 2011, 21:94-103.
  18. Bazzano LA, He J, Ogden LG, et al. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med 2001, 161:2573-2578.
  19. van den Brandt PA, Schouten LJ. Relationship of tree nut, peanut and peanut butter intake with total and cause-specific mortality: a cohort study and meta-analysis. Int J Epidemiol 2015.
  20. Papanikolaou Y, Fulgoni VL, 3rd. Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008, 27:569-576.
  21. Streppel MT, Arends LR, van 't Veer P, et al. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005, 165:150-156.
  22. Fuhrman J, Singer M. Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.

Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
For over 25 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.