The Broken Hearts Club

This is a more personal post than I normally like to share, but since February is national heart month, and I believe this post has an important and relevant message.

At the beginning of the month, I shared an amazing post from Dr. Ostfeld about how a heart disease patient changed his diet, and not only prolonged, but truly saved his life without any surgical interventions. Unfortunately, the story I’m about to share is it’s polar opposite, and happens far too often and to far too many families every single day in western countries.

While visiting Buenos Aires at the end of January, I received a message that a family friend had a second heart attack, and was in the hospital. I didn’t realize how serious it was at the time, however, I would arrive back in New York just in time for his wake and funeral. To say the least, it’s been a very sad and tiring time for my family.

Part of what makes this so incredibly sad, is because I believe his death was avoidable. Throughout my entire life, he ate an incredibly rich diet full of meats, dairy, and processed foods. He was always overweight and when I was young, he became the first person I knew to be diagnosed with Type 2 Diabetes. This didn’t change him in the least.

Than less than a year ago, he had his first heart attack, and an emergency triple bypass surgery. At the time, it seemed like he wasn’t going to make it. Yet, even to the astonishment of his doctors, he made what seemed like a full recovery. He was given a second chance; however, he didn’t seem to understand how serious his situation was. He refused to follow the doctor’s instructions to eat less saturated fat and cholesterol, and continued his sedentary way of life.

I even approached him and offered to talk with him and his wife about the impact that diet could have on his health. Unfortunately, he declined.

And now, he is gone. His wife, children, and grandchildren are now forced to cope with the results of his decisions.

While even Dr. Ostfeld writes that his story was one of the most remarkable transformations he’s ever heard of, there is a growing amount of evidence that shows that heart disease – America’s number one killer - is not only avoidable, but can also be reversed with a proper, plant-based diet.

Back in 1995, Dr. Caldwell B. Esselstyn, M.D. of the Cleveland Clinic published his bench mark long-term nutritional research on arresting and reversing coronary artery disease in severely ill patients. He then published a 12 year update in the Journal of American Cardiology, and then a 20 year update in his book, Prevent and Reverse Heart Disease. So what were these findings?

Starting in 1985, he took 24 severely ill heart disease patients and placed them on a very strict plant-based diet. He had a simple hypothesis; a low-fat plant-based diet could arrest heart disease (fat was kept to 10% of total calories). He came to this theory when he realized that coronary disease was essentially nonexistent in cultures whose nutrition assured a total cholesterol level of 150mg/dl or lower. Vegetables, berries and whole grains were able to be eaten without limit, fruits and juices were limited to a few severing’s per day. Fatty nuts and avocado were even more limited to a few times a week if at all. Oil, meat, and dairy of all kinds were completely off the menu. Two tablespoons of ground flax seeds daily was recommend for omega 3.

Between these 24 patients, they had 49 coronary events in the 8 years before the study. Out of those 24 patients who initially signed up for Dr. Esselstyn’s study, 6 were nonadherent and were returned to normal cardiac care. At a 10 year followup, those 6 patients who did not adhere to the diet had 13 new cardiac events.

The remaining 18 adhered to the diet. After 5 years, not a single patient had a repeat cardiac event and 11 of those 18 patients agreed to a second angiographic analysis which demonstrated that the heart disease was arrested in all 11 (100%). Further, in 8 of his 11 patients (or 73%), the disease had regressed. Angina initially reported in 9 patients was eliminated in 2 and improved in the remaining 7.

Evidence of reversing heart disease.

Similar results were reported in the 12 year follow up.

For comparison, in another study published in 2000, Richard M. Fleming, M.D. took 26 patients and placed them all on a healthy high carb vegetarian diet. Dr. Fleming planned on using a new technology known as a SPECT scan which enabled him to actually measure the blood flow within the coronary arteries.

His plan was to measure the before and after effects of diet. However after one year, Dr. Fleming discovered that ten of his patients decided against the vegetarian diet in favor for a high protein, low carb diet, which they believed would improve overall health. This gave Dr. Fleming the unique opportunity to compare the two diets on coronary health.

At the end of the year, those who stuck to the healthy vegetarian diet all showed a reversal of their partially clogged arteries – showing an average of 20% less atherosclerotic plaque in their arteries. Those who jumped ship to the low carb high protein diet significantly worsened, as the SPECT scans showed an increase of nearly 40% more artery clogging.

If you look at the provided scans, you can clearly see this. The yellow and red represent blood flow. On the top, you see the increased blood flow of a person following the vegetarian diet. On the bottom, you see the decreased blood flow of a person who switched to a high protein diet. While even Dr. Fleming admits more of this type of research is needed, it is suggestive, especially when taken in measure with Dr. Esselstyn.

If any drug had even come close to this type of result, it would be publicized everywhere. Instead, this life saving message has largely been ignored. One large criticism has resounded time and again, “Yes, these are excellent results, but the trial groups are far too small.”

So in 2014, Dr. Esselstyn responded with yet another new study. This time he followed 198 patients and 177 individuals were compliant with the diet (89%). Of this compliant group, only one individual suffered a cardiac event. That is a recurrence rate of .6% which represents the absolute lowest recurrence rate of any study on heart disease.

Out of the 21 individuals in the noncompliant group, 13 of them suffered adverse cardiac events. That is a rate of 62%. They were following standard cardiology care and medical interventions which included pills and various procedures. For those of you who like math that is a ratio of .6% to 62% meaning that Dr. Esselstyn’s work is 100 times more effective than that of the standard care given to most heart patients. 

These results are important because heart disease kills over 300,000 people annually and over 700,000 people suffer a heart attack every single year. Yet, as the results of these studies suggest, this needn’t be the case.

Please help me share this message. As Dr. Esselstyn says, “If the truth be known coronary artery disease is a toothless paper tiger that need never ever exist and if it does exist it need never ever progress.”

Dr. Esselstyne and Dr. Fleming aren't the only ones getting these results with diet and lifestyle changes. Dr. Ornish, Dr. McDougall and Dr. Ostfeld among others are all doctors who have created programs that have proven to arrest and reverse heart disease. In fact, just this week, Dr. Ostfeld and his colleagues at Montefiore Cardiac Wellness Program published a study that showed a patient completely reversed their angina simply by adopting a plant based diet.

For more on Dr. Esselstyn, watch the excellent documentary Forks Over Knives or get his book, Prevent and Reverse Heart Disease.

***

Esselstyn, Caldwell B. “Updating a 12 -Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology)” The American Journal of Cardiology, August 1999, 334-39.

            “A Strategy to Arrest and Reverse Cornonary Artery Disease: A 5- Year Longitudinal Study of a Single Physician’s Practice.” The Journal of Family Practice Vol. 41 No. 6 December 1995 560-68.

            “A Way to Prevent CAD?,” The Journal of Family Practice. Vol. 63, No. 7 July 2014 257.

            “The Nutritional Reversal of Cardiovascular Disease – Fact or Fiction?” Experimental and Clinical Cardiology. Vol. 20, No. 7, July 2014 1901.

            Prevent and Reverse Heart Disease: The Revolutionary Scientifically Proven, Nutrition-Based Cure. Avery Publishers, New York, 2008.

Fleming, R. M. “The Effect of High-Protein Diets on Coronary Blood Flow.” Angiology Vol. 51 2000 1075-1083.

Ostfeld, Robert et. al. “A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures,” Case Reports in Cardiology Vol. 2015, 2015.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Cumin-spiced Hummus and Gluten-free Lentil Flatbread

I've been told that in certain parts of Asia, every family has their own kimchi recipe. You can travel to a dozen different towns, and in each one, you’ll experience a dozen different varieties of the fermented dish. 

Hummus is like that in the United States… particularly among vegan bloggers. And today I’m going to share with you one of my oil-free hummus’.

Hummus is great as either a snack, appetizer, or as part of dinner. It can be used as a simple dip or used as a dressing. Literally, there is no limit to what you can do with this versatile spread. Typically made from cooked chickpeas, it has a nice blend of the macro-nutrients, and also offers several micro-nutrients as only plant-based foods can provide!

This recipe is for a simple and fast hummus and can be made with either canned or soaked and cooked chickpeas. Feel free to stray from the original recipe and start to create your very own variety!

Makes 2-3 servings

1 or 2 cans of chickpeas or 1 cup cooked chickpeas*

1 teaspoon of tahini

Juice of 1 lemon or 1 tablespoon of lemon juice

1 bayleaf

1 clove of garlic

Cumin seeds (or powder), salt, and black pepper to taste

Put all of the ingredients into a blender or food processor (a hand blender also works well) and blend until smooth and creamy. Slowly add water or veggie broth for desired texture. Taste the hummus and adjust spices and seasoning as needed or desired.

*Pro tip - save the water from the can to use for the hummus

Lentil Flatbread

Now hummus is amazingly healthy, especially when it’s served with veggies like carrots, bell peppers, or cabbage. However, if you are looking for something a little hardier, give this great BYOL-original Lentil and brown rice flatbread a try! Not only is the bread made from whole food ingredients rather than a refined flour, it only requires four essential ingredients, and can be made relatively quickly when in a bind! That being said, I suggest soaking the lentils and rice over night to help with digestibility.

While I’m suggesting pairing it with hummus here, the bread makes great toast with apple butter for breakfast, is perfect with all types of soups, Indian daals and curries, a nice snack with your afternoon mate, and can easily be brought to work or a picnic (It is literally the easiest way to BYOL!) You can also change the thickness by altering how long you let the bread rise and by how thick you make the batter.

Makes One Flatbread loaf

½ cup green or brown lentils (soaked)

½ cup brown rice (soaked)

½ teaspoon or half of an 8 gram packet of Active Dry Yeast

½ teaspoon baking powder*

¼ - ½ cup of veggie broth or water

Add optional spices and herbs such as a bayleaf, basil, or rosemary.

After soaking and rinsing the lentils and rice, put them either in a blender or food processor (again, a hand blender can work well for this). As you blend, slowly add a little bit of water or broth until you start to reach a dough-like consistency. It should be a little runny. Then add the baking powder and active yeast. Now let the mixture sit for 45 minutes to one hour. Pour the batter onto a parchment paper lined baking pan or pizza stone (I often use my cast iron pan) and place into the oven for 20 -25 minutes on 350. Once you’ve achieved the desired crispiness of the bread, remove from the oven and let cool. 

I hope two recipes help power your weekend! 

* If you are highly sensitive to gluten, or have celiac disease, make sure you get a certified gluten-free baking powder. 

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Welcoming 2014 with Open Arms, Eyes, and Hearts.

While I’m not one to set New Year’s Resolutions, I do like to plan for some short term goals as well as set the intention for the upcoming year. I also like to reflect and think back on the previous year. While I typically keep my yearly intentions and goals to myself  – and they are often just race goals – this year I've decided I’m going public with my 2014 year plans to as many people as possible. I’m hoping this will help hold me more responsible to them.

2013 was a year with a ton of ups and downs – like every year. And to expect 2014 to be much different seems naive. However, I am very excited to announce that I am planning on starting the course work necessary to complete a post-bacc so that I can begin moving forward with my long-term goal of becoming a Registered Dietitian.

Since beginning this blog, many people - friends and strangers alike - have written to me asking for help with their diets. I can sincerely say that it is one of the most gratifying experiences of my life.

Since I was trained as a historian, before I can start a master’s program in nutrition science, I first have to go back to the undergraduate level to fulfill some basic science and anatomy requirements that I have not done. I suspect that many of these courses will be difficult for me, but I also believe that I have the dedication, work ethic, and passion to help me get through the process. I also know that I can count on my incredible support network of friends and family. I consider myself very fortunate that my boss just agreed to support my request for class reimbursement, so hopefully most of my class work will be paid for by my job. 

As always, I am also recommitting myself to another year as a compassionate and healthy vegan. I encourage you all to join me, and try eating a healthy, plant-based vegan diet for the month of January. With the holidays over, now is a great time to commit yourself to healthy eating. Get a free 21-day vegan meal plan from Physicians Committee for Responsible Medicine.

I’m also hoping to launch a redesigned and enhanced BYOL site sometime this year. I’ve already started talking with a web designer, but now I just need to commit. I’ll be honest, this is a lower priority for me right now, but I’m hopeful that by 2015 BYOL will finally look like a respectable site!

I also want to announce that I have an upcoming surgery - it's just 9 days away. After several repeated injuries in my lower right leg over the past 3 years, my sports doctor finally linked the muscle damage to a bone growth in the back of my knee. I will be having the bone growth removed on January 9th in the hopes that after I heal, I will be able to avoid these injuries. I already have two Half Ironman events scheduled -Eagleman in Maryland, and the inaugural Princeton 70.3 - so hopefully I will recovery quickly and will be able to get back to my current fitness level relatively quickly.   

I hope you all had an enjoyable New Year and that the closing of 2013 was a pleasant one. And as always, I want to thank all of you for continuing to follow my musings about the power of plants, proper nutrition, and sport. I promise you all that BYOL will continue to offer the latest research on nutrition, as well as many new and delicious plant-based, low fat, high carb recipes. (Yesterday I learned of a new report from the World Health Organization was released stating that meat is more dangerous than cigarette smoking! Exciting times, indeed!) 

Wishing all of you a happy 2014! 

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Green Mac 'N "Cheese"

As a way of building a little excitement for the final week of the “Keep it Simple” giveaway, here is just one of the delicious recipes from the book!

This simple meal takes less than 20 minutes to throw together and I promise after you taste this nutritious dish, it’ll become one of your regulars. Don’t believe me? Even my persnickety sister, who is something of a connoisseur of mac and cheese loved the dish… Just more evidence that home-style comfort food doesn’t have to destroy your health!

To create that cheese-y goodness, this dish calls on an old school vegan staple, nutritional yeast. While many promote the yeast for being a good source of B-12, most studies show that it is not an active source, and hence should not be depended on for this essential vitamin. However, the yeast is still worlds healthier than any of the heavily processed faux-cheeses that have recently saturated the market. For some, this may be a new ingredient but it is relatively inexpensive and available at most health food stores and many local grocers as well. Make sure what you get is actually nutritional yeast and not brewers yeast, and if possible look for a non-fortified version, as fortified vitamins and minerals are really just isolates added to foods.

Makes 2-3 servings

1 box of quinoa, rice, or whole-wheat pasta (elbows are traditionally used)

1 cup raw cashews

1 small-medium red onion

¼ cup Nutritional Yeast

2-3 cups spinach

1 tsp onion powder

water or veggie broth as needed

Cook the pasta or grain of your choice according to the package.

While the pasta is cooking, add the cashews into a blender or food processor.

Process until the cashews are like a flour. Then add 1 cup water, nutritional yeast, and onion powder and blend again until creamy.

Now roughly chop the onion and place on a skillet with just a little bit of water to sauté the onions.

Once the onions start to caramelize, add the spinach and cook for another minute or until the spinach is wilted and begins to cook down.

Add the onion and spinach to the blended mixture and blend/process again until bright green and creamy. Add more water if the sauce becomes too thick.

Once the pasta is al dente, pour the Green “Cheese” over the hot noodles and serve.

This is just one of the great recipes. Trust me, you don't want to miss out on this book, so make sure you go sign up for the giveaway!


As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice. 

Meat, Dairy, and Mortality: TMAO

Recently two articles in the New York Times shocked many of its readers. In review, the Times reported on the findings of two different studies conducted at the Cleveland Clinic and found a new and startling connection between diet and heart disease. 

Specifically, and unsurprisingly, the link was established between the consumption of animal products and the increased risk in mortality from heart disease. While the results of the work by researchers such as Dr. Caldwell Esselstyn has shown for years that those following a plant-based diet have a significantly reduced risk of heart disease (America’s number one killer), until these studies, it was not known exactly why that was. 

Basically it goes like this: within 24 hours after the consumption of carnitine, a chemical found naturally in meats, certain gut bacteria metabolize it into a more toxic chemical known as trimethylamine. Trimethylamine gets oxidized in our livers and converted into Trimethylamine-Oxide (TMAO) which circulates throughout our blood stream. 

The problem with TMAO is that it increases the buildup of cholesterol and plaque in our arteries. This, of course, greatly increases the risk of having a heart attack, stroke, aneurism, and a few other un-pleasantries.

Now, our bodies naturally produce carnitine, however that doesn’t get turned into TMAO. It is only when we ingest outside sources that the carnitine ends up in our guts and gets oxidized. Carnitine is found in very limited amounts in plants, but animal products are human's major source of the chemical. So obviously we should stay away from the greatest sources of canitine which is red meat- so think about avoiding all forms of cow.

But avoiding red meat is not enough. The problem is that a second chemical known as choline can also be oxidized into TMAO when ingested due to the similarity in structure between carnitine and choline. According to the research, “eggs, milk, liver, red meat, poultry, shell fish, and fish are all major dietary sources for choline, and hence TMAO production.” 

Now for the really interesting part: the researchers discovered the oxidation process doesn’t occur until these chemicals reached the microbial-gut bacteria. They discovered this by introducing a potent antibacterial to the gut, wiping out all of the microbial-gut bacteria and then measuring the production of TMAO after consuming animal products. The result was that no TMAO was produced when animal products were consumed. However, those same people were fed a steak a second time a few weeks later (after the gut was able to restore some of its habitat) and the production of TMAO skyrocketed after the meal was consumed. 

However, when the researchers got a “vegan” (or perhaps more accurately someone who avoids all animal products but apparently has no moral objection to consuming them in the name of science) to eat an 8oz sirloin steak, there was no increase in TMAO production- even without the antibiotics. This was explained by the differences in microbial communities between vegans and omnivores. Basically, when you eat certain foods, certain bacteria will grow in your gut. When you change your diet and start eating completely different foods, the make up of your floral gut will also change. Since the vegan hadn't been regularly consuming animal products, they did not have the bacteria that oxidizes into TMAO. This suggest, among other things, that those eating a plant-based diet will have a healthier floral gut.

Even if you were to eat a completely plant-based diet, you’re not 100% safe. Most energy drinks contain large amounts of carnitine in them. The weight-loss supplement lecithin contains choline and the regular consumption of these products could result in the development of certain bacteria in the gut that will oxidize TMAO, and thus, consuming these products regularly can increase the risk of heart disease.

As is so often the case with linking diet to disease and mortality, the consumption of these foods impacts more than just our hearts. The regular consumption of eggs was also found to increase the risk of prostate cancer in men. In a study looking at the diet of men who were already diagnosed with cancer, those who consumed more eggs had a rate of progression of prostate cancer by more than 2 to 1. According to researchers from Harvard University, the “plausible mechanism that may explain our observed association between eggs and prostate cancer progression is high dietary choline.” 

So not only did consuming eggs increase their risk, and potentially helped cause them to get prostate cancer in the first place, continuing to eat the eggs actually helped to spread the cancer from its isolated area in the prostate to the rest of the body. Once this happens, survival rates plummet down to 1 in 3. According to one study, those who ate 1 egg every few days had “an 81% increased risk of lethal prostate cancer compared to men who consumed less than .5 eggs per week.”

While the New York Times articles attempted to put their readers at ease by stating that a new drug is being worked on to target and wipe out the bacteria that oxides these chemicals, it seems to be far more simple, and reasonable to limit- or better yet- completely eliminate the consumption of animal foods.  

Further reading:

Kolata, Gina, “Culprit in Heart Disease Goes Beyond Meat’s Fat.” NYT April 7, 2013.

Z. Wang, E. Klipfell, B. J. Bennett, R. Koeth, B. S. Levison, B. Dugar, A. E. Feldstein, E. B. Britt, X. Fu, Y.-M. Chung, Y. Wu, P. Schauer, J. D. Smith, H. Allayee, W. H. W. Tang, J. A. DiDonato, A. J. Lusis, S. L. Hazen. “Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease”. Nature 2011 472(7341):57 – 63.

J. E. Lee, E. Giovannucci, C. S. Fuchs, W. C. Willett, S. H. Zeisel, E. Cho. “Choline and betaine intake and the risk of colorectal cancer in men. Cancer Epidemiol.” Biomarkers Prev. 2010 19(3):884 – 887.

Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, et al.. “Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis.” Nat Med. 2013 Apr 7. 

E. L. Richman, S. A. Kenfield, M. J. Stampfer, E. L. Giovannucci, J. M. Chan. “Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: Incidence and survival.” Cancer Prev Res (Phila) 2011 4(12):2110 - 2121

Dr. Greger also has an excellent video summarizing much of this research and many other studies on this top.