Cardiovascular disease (CVD) is a general term to describe dysfunction of the blood vessels in various parts of the body that lead to organ dysfunction. The heart, brain, kidneys, and extremities can all be affected by cardiovascular disease and cause major morbidity and mortality in the U.S. The strongest driving force behind the increase in CVD rates over the last century is the Standard American Diet coupled with a sedentary lifestyle. With dietary excellence CVD is entirely preventable.
An estimated 83.6 million Americans have some form of CVD (1 out of every 3 Americans). This is projected to increase to 43.9% in 2030. CVD accounted for 31.9% of deaths in the U.S. in 2010. More than 2150 Americans die each day of CVD with a death occurring every 40 seconds.1 These sobering statistics show the dangerous effect of eating a low nutrient, high caloric diet that consists primarily of processed foods and animal products.
Cardiovascular disease can manifest in various ways. When arteries are damaged and blocked in the heart, patients develop coronary artery disease that can result in chest pain and shortness of breath. When affecting the brain, patients can develop dementia with aging as well as suffer from a stroke, leading to a potential loss of speech, weakness of the body or complete paralysis. In the kidneys, CVD can cause elevated blood pressure, renal insufficiency, and eventually renal failure leading to the need for dialysis. Peripheral vascular disease affects the extremities and causes tingling, numbness or pain. In men, vascular disease of the penis can result in erectile dysfunction.
CVD is ultimately caused by oxidative stress and inflammation that leads to damaged arteries. With an intake of low nutrient, pro-inflammatory foods high in saturated and trans fat, as well as refined carbohydrates, cholesterol plaques begin to line the inner endothelial layer of the arteries. Other elements of excessive animal product intake also contribute, such as the iron and carnitine in meat and too much animal protein in general. These growing plaques can block the arteries and even rupture and promote a clot, causing rapid occlusion of the vessels. The same disease-promoting diet most Americans consume results in high blood pressure, high cholesterol, diabetes, insulin resistance, and obesity, all of which further contribute to an inflammatory environment that promotes atherosclerosis. Tobacco use, stress, sedentary lifestyle, poor sleep quality, and certain medications also increase risk of CVD. A Nutritarian diet, exercise, and tobacco cessation can remove plaque and reverse or eliminate the risk of CVD, as it has done in thousands of those following a Nutritarian diet worldwide.
In conjunction with a Nutritarian diet, exercise can lower the risk of CVD. Patients with diagnosed CVD need to have a personalized fitness program that allows them to gradually increase their exercise tolerance.
Tobacco use increases damage to arterial lining contributing to the deposition of cholesterol plaque and increasing the risk of CVD. Tobacco cessation is necessary for reversing CVD.
The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)
My cholesterol vastly improved since last year except for triglycerides.
I am 5'9'', 166 lb. I do pinch almost 2 inches at the belly and about 1 at the thigh, very skinny everywhere else. So, is the high triglyceride level anything to worry about? Is it due to being overweight? My target weight is 149 lb.
High triglycerides can be related to you not quite reaching your ideal weight yet but can also be related to you eating too many grains, fruits (>4 cups daily or so) or overeating at your meals or snacking, etc. But, the level isn’t concerning since it is at the upper side of normal and your other numbers are so good. You may want to check it again in the future once you have lost even a little more weight and modified your routine, just to notice more improvement.
In your book Eat to Live, you wrote that excess consumption of refined carbohydrates may lead to higher levels of triglycerides in the blood. Does a higher level of triglycerides contribute to clogging of the arteries? I’m just trying to understand how triglyceride levels can be a predictor of heart disease.
Having high triglyceride levels is almost always a marker for insulin resistance, which leads to endothelial dysfunction, inflammation, and vascular disease.
If one has had a stroke (after atrial fibrillation) and is advised by the cardiologist to take blood-thinners the rest of their life, is there still the possibility, in your opinion and experience, to get rid of the blood-thinner?
Yes, if the person gets healthy with Nutritarian eating and gets rid of their stroke risk factors. That means they have to achieve a normal weight, blood pressure, and lipid profile without medications. At that point, the risk of the blood thinning agents can be greater than the supposed benefits.
Dr. Fuhrman has mentioned that those who follow a Nutritarian diet have to be particularly careful not to consume excess salt because we don’t have the "benefit" of atherosclerosis protecting us from that particular effect. What is the mechanism by which excess sodium causes bleeding strokes in people who don’t have atherosclerosis? Is high blood pressure always present? Is there a lowered risk when blood pressure is normal or low despite excess sodium?
Yes, there would be less risk with lower blood pressure, however, frequently, after years and years of salt intake, the sympathetic tone in the central nervous system flips and you suddenly have high blood pressure. Then, people say, "that’s strange, I always had low blood pressure my entire life and now suddenly it is running high all the time." Then, cutting back or cutting out the salt is too late. In other words, just because you have low blood pressure now, does not mean you have permission to use excess salt.
In fact, this is how most people operate. They are told by the media and health professionals they only have to watch salt intake if they have high blood pressure. Then, later in life when they develop high blood pressure, they cut back on salt, but the blood pressure does not come down from all those years of self-abuse. So, now you have a correlation between low salt intake and higher risk of cardiovascular disease from all those individuals that had a high salt intake in their past but are not using much salt once they developed serious cardiovascular pathologies.
I had a mild heart attack a few days ago. I am 48 years old, and I am more than 100 pounds overweight. What can I do now to make sure I never have another heart attack? I would appreciate any guidance you can provide.
The most important thing you can do to save your life is to lose at least eight pounds each month for the next year. That means follow the program consistently day after day, without faltering. Whether it is a holiday, a birthday or a stressful day, just do it; follow a Nutritarian eating style no matter what (you can find guidelines on following a Nutritarian diet in my books The End of Diabetes or The End of Dieting.
Eat G-BOMBS almost every day, and make it simple to stay on track: make a few salad dressings you like and use a variety of raw vegetables in your salads, including red cabbage, collards or kale, onion, arugula, and tomatoes. Top your salad with homemade dressing from my recipes and (no salt added) beans. Then, make plenty of lightly steamed string beans, artichokes, broccoli, and kale. Make fresh, no-salt tomato sauce with fresh tomato, garlic, onion, and basil. Let it simmer on a low flame for hours and use it as a topping for cooked vegetables and a base for dressings. Mix water, sautéed onion, mushrooms, and spinach, and use it cold all week on salads. Use frozen berries. Also, visit the Vitamin Advisor page on my website for guidelines on appropriate supplements to take.
Don’t forget about exercise: when you wake up in the morning, have a full glass of water and get out of the house and walk in the fresh air for at least 30 minutes every day. You can change your whole life, and never have heart disease again, starting now. Many people have found this is easy, delicious, and fun, especially when they have the camaraderie and communication with others doing it too. Consider joining the Member Center at DrFuhrman.com for more information, motivation, and support.
I have been diagnosed with congestive heart failure. My ejection fraction is 15%. Have you had any patients increase their EF following a Nutritarian diet? My cardiologist said that it would never increase.
Yes, I have seen some improvement in heart function in congestive heart failure patients, including dramatic improvement in ejection fraction over time. It depends on the degree of permanently dead heart muscle and if there is some "hibernating myocardium" or diseased tissue that is not totally destroyed. Let’s see if we can work together to do whatever possible to prolong your life. Since we are discussing such a serious condition, I would suggest you set up an appointment in my office.
Can congestive heart failure and arterial fibrillation be reversed?
It depends on the cause. If it’s caused by something such as hyperthyroidism, then reversal is possible, but, if it is related to coronary artery disease, hypertension or heart valve problems, the heart chambers enlarge and often scar, making complete reversal less likely. A Nutritarian diet with targeted supplementation reduces inflammation, lowers blood pressure, and reduces the propensity for arrhythmias and clot formation. All of this improves cardiac reserve and function over time.
I am a 53-year-old white male with congestive heart failure. I am still very overweight, although, to date, I have lost 53 pounds. I have had many years of alcohol and tobacco abuse but have not taken a drink for 4 years. I had a bi-ventricular pacemaker fitted two years ago and am taking large amounts of medication, especially to rid my body of excess fluid. I spent the last weekend in the hospital as I was feeling very poorly, and my cardiologist says that my heart now has an extra beat (which is apparently a progression of the disease and an enlarged heart).
In your opinion, is it possible at this stage to reverse congestive heart failure?
Yes, you may be able to see considerable progress in your condition, however, there is no room for compromise. Stick strictly to natural plants (mostly greens), avoid too much spinach (sodium), not a speck of salt in anything, and do not drink more than a few sips of water a day. That should allow you to reduce your diuretics and meds somewhat quickly. You should weigh yourself every day. If you are losing or staying the same day to day, fine. If you ever put on any weight you may need some more diuretic. The risk here is to follow my advice and be over-medicated which could cause dehydration and excessive blood pressure lowering, leading to kidney damage, so you need to work with a doctor to decrease your diuretics as you begin this program. You may need to set up an appointment in my office for more guidance. Careful adherence to the program should continue to unload fat weight and excess water weight pretty rapidly if you stay strictly on the program. Remember, this can be a delicious way to improve your health.
I work for a company where we have a significant financial incentive to score well on our BMI, cholesterol, and blood pressure. I have read several threads from those who are eating a Nutritarian diet, yet still scoring high on their blood tests, but you have stated that as long as they are eating predominantly high-nutrient foods and exercising, that high cholesterol number is not important. Then why do certain companies/doctors focus on these numbers?
I have followed a Nutritarian diet and practiced a very healthy lifestyle for years. I am at my optimal weight, (and have high cholesterol) so I will not be rewarded, however, my co-worker, who eats fast food but is on a statin, will!
I feel this encourages us to take the easy route (prescription drugs), rather than do what is best for our health (Nutritarian diet). Any comments? I have done everything you have suggested to bring my numbers down. My blood pressure is good, BMI great, triglycerides fine. Should I take a supplement?
I agree with you that a healthy diet with higher cholesterol is much healthier than a less healthy diet with lower cholesterol or medicated lower cholesterol. Plus, total cholesterol is not a good measurement of risk. One needs to consider the LDL particle number and size. The LDL particle size on a Nutritarian diet is much more favorable too, as are other markers demonstrating low inflammation. In conclusion, you are in phenomenal health, even if your LDL cholesterol does not drop below 100 as favored on those guidelines, whether it is recognized by your company’s standards or not.
After following a Nutritarian diet for several years now, I still struggle with less than ideal cholesterol. After the first year, my cholesterol went down below 200 (like 175). It has steadily crept up over the years. Last week, I had blood drawn for my annual physical and was shocked that the cholesterol number was 227. My LDL was 141. I’m 53, female, 5’7" and weigh 126 (this is my lowest weight in years).
My disappointment stems from me doubling my efforts to follow a Nutritarian diet. I have been making smoothies with spinach in the AM, salads for lunch, and salads and veggies for dinner. I have lost 5 pounds in the last 6 weeks alone!
One thing I have not done is keep up with my LDL protect supplements. I have not taken them for a few months. Could lack of the LDL Protect for a few months have caused such a difference when I am eating so well? Also, can stress cause a higher cholesterol level in the absence of bad eating? I recently lost my job.
Stopping the LDL and the increased stress can play a role, but most likely, this is caused by the recent weight loss and burning off more body fat (full of cholesterol). You must consider that you had plenty of stored saturated fats on your body that you autolysized, contributing to your continued utilization of those fats for cholesterol metabolism. In other words, you burned body fat for energy. Remember, you lost weight. The fat that was burned was animal fat (you are an animal). That fat was highly saturated and contributes to your high cholesterol production. Once that fat is off your body completely the picture will be different. In other words, once your weight has stabilized at this lower level, you will see an improvement in your cholesterol results, including a better LDL particle size and number.
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