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.

Patient Googles His Way Out of Bypass Surgery*

By Robert Ostfeld, MD, MSc

One of the most common operations performed in the world today is coronary artery bypass graft surgery (CABG). I would like to share with you the remarkable story of a recent Cardiac Wellness Program patient here at Montefiore Medical Center (I’ll call him Mr. J), who changed his diet and averted the CABG knife.

Mr. J is a middle-aged man with high cholesterol and a family history of heart disease. Understandably, he desperately wanted to avoid the problems that many in his family had faced, so he ate a “healthy” diet of chicken, fish, and low-fat dairy, with a few fruits and vegetables mixed in. And he exercised. A lot. In fact, he loved exercising so much that he would do it for two to three hours a day — brisk walking, playing sports, etc.

Mr. J. first visited a cardiologist at age 55, after having experienced several weeks of tightness in his neck during physical activity. The condition had worsened to the point that only 30 to 45 seconds of exercise brought on significant discomfort. The doctor ordered a stress test, to see if heart disease could be contributing to this symptom. The test results were so wildly abnormal that he was sent immediately to the hospital for a cardiac catheterization, to look for cholesterol blockages in the vessels that supply his heart with blood. Such severe blockages were found that he was admitted directly to the hospital for coronary artery bypass graft surgery. In less than one day, his life had changed dramatically.

While lying nervously in his hospital bed, he began to think that maybe there was another way to approach this disease, so he went online. There, he read about the impact of a whole-food, plant-based diet on heart disease, and he decided that was the path for him. He called the nurse, gave back his hospital gown, and despite the pleas of his medical team, signed himself out of the hospital against medical advice. Mr. J’s nurse was so concerned that before he was able to leave, she called his wife to have her convince him to stay. He did not. Later, the nurse even called Mr. J at home to plead for his return. He politely declined.

Soon thereafter he found our Cardiac Wellness Program at Montefiore. He was already taking all the appropriate medications, and he chose to completely change his lifestyle as well. He fully embraced a whole-food, plant-based diet without oil and had perhaps the most remarkable turnaround I have ever seen. Within one week, he went from being able to walk only a block before feeling tightness in his neck to walking 25 blocks without incident! Fast-forward three months and he was back to exercising two to three hours each day without symptoms. That is what I call remarkable!

A few weeks later, Mr. J got another call from his nurse. She had just been diagnosed with cholesterol blockages in her heart, and her doctors were recommending cardiac procedures. With Mr. J in mind, she told her doctors no way and called him to learn how to do exactly what he did: embrace a whole-food, plant-based diet!

Mr. J never did get that bypass surgery, nor did he get a coronary stent. In fact, he did not need to have any procedures at all. He got healthier with appropriate medications and by wholeheartedly embracing a whole-food, plant-based diet.

The key to health, it seems, lies at the end of your fork.

* * *

*Postscript: While many heart patients may reverse their disease with lifestyle change alone, Mr. J also continued his prescribed medications, given the severity of his condition, and their doses were lowered as his health improved. Please note that I am not recommending lifestyle change over medical intervention for any particular person, as every case is of course different. Some cases are fraught with more risk than others, so please consult with both your physician and a physician trained in lifestyle medicine before making significant lifestyle changes.

This post was originally published on the Forks Over Knives blog, here.

* * *

Cardiologist Robert Ostfeld, MD, MSc is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City, where he encourages patients to embrace a whole-foods, plant-based diet. He earned his MD at Yale and his MSc in epidemiology at Harvard, and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.

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.

The Holistic Heart Book Review and Giveaway

Last month Dr. Joel Kahn offered a great guest post about where people can find reliable information about health and nutrition (I swear his very kind comment about my site was completely unsolicited!) However today I’m reviewing his new work and Dr. Kahn also agreed to send a copy of his book to a lucky winner so be sure to enter below!

Joel K. Kahn, M.D. The Holistic Heart Book: A Preventive Cardiologist’s Guide to Halt Heart Disease Now. A Reader’s Digest Book, 2013.

Since the early 90s when Dean Ornish, M.D. and Caldwell Esselstyn, M.D. first published their respective works proving that heart disease is not only caused by, but can also be reversed through lifestyle changes and diet, there has been a fury of research on the topic. Despite this, heart disease continues to be America’s number one killer, taking nearly 600,000 lives every single year. Dr. Joel Kahn, a preventative cardiologist and Clinical Professor of Medicine at Wayne State University School of Medicine has recently published his own heart health manifesto, which neatly ties the best research on heart disease into one easy to read and very informative book. It is no exaggeration to say, this book can literally change your life.

In clear and precise language Dr. Kahn explains how complex the heart really is, comparing it to the brain, as the heart has its own neurons, hormones, and electrical field. Dr. Kahn’s work is broken down into two sections. The first section reviews the most current research on heart disease.

Unlike Dr. Esselstyn’s Prevent and Reverse Heart Disease which focuses exclusively on diet and heart health, Dr. Kahn’s book takes a different approach and demonstrates that it takes a healthy body to have a healthy heart. For instance, the thyroid gland, which sits about a foot above the heart, can have a profound impact on heart health. Roughly 2% of Americans have an overactive thyroid, and another 5% have an underactive thyroid (hyperthyroidism and hypothyroidism). The disturbance caused by these hormonal imbalances can both greatly affect the heart in negative ways. In this section, Dr. Kahn also demonstrates the importance of healthy arteries and further complicates our understanding of HDL – basically it’s not as simply as calling it “good cholesterol.”

In the second part of the book, Dr. Kahn offers over 70 “prescriptions” that he often writes for his patients. However, these prescriptions are a far cry from the one your doctor would typically write you. Instead, this is where the book truly becomes “holistic,” although I mean that in best possible light. Backing everything up with citations to peer-reviewed articles, (and admitting when the evidence on certain topics is still weak - such as grounding). These prescriptions range all over the place, from eating your greens, to changing your cleaning supplies and deodorant, to practicing yoga (vitamin Y, as Dr. Kahn puts it).  

Surprisingly, (and perhaps slightly controversial) Dr. Kahn highly recommends several different vitamins and supplements. While he is very careful about which ones he actually recommends, he suggests discussing these with your primary doctor before adding any supplements to your regimen. Besides claiming that the research on the benefits of supplements is strong, he has also seen many of his patients thrive when they start including some supplements and vitamins. One in particular is CoQ10 – Coenzyme Q 10, which is a powerful antioxidant made by the body, helps assist cells to produce energy. Around the age of 40, our body’s production of this antioxidant begins to slow, and Dr. Kahn recommends it to many of his patients. (note: there was not a citation on this supplement)

While all of this could be overwhelming, Dr. Kahn recommends that people start slow, picking just a few of his prescriptions out to try for a few weeks before adding more to the routine. He writes that the goal is to incorporate as many as possible without adding additional stress to our lives. In fact, reducing stress is one of his main goals!

It needs to be added that Dr. Kahn considers himself an ethical vegan. That said, while he promotes and encourages a complete plant-based lifestyle, he is far less dogmatic than some of the other authors on this topic. In fact, in his book, he includes some pointers for those simply looking to make wiser choices when it comes to animal products.

This book stands out when compared to the other works on this topic, both for its easy-to-follow writing style as well as for its holistic approach. If you are looking for practical and easy-to-incorporate advice to help protect your heart look no further. The added benefit is all of the advice will help improve your overall health, not just your heart. As Dr. Kahn says, it takes a healthy body to have a healthy heart. 

I got to meet Dr. Kahn and his wife Karen at the NYC Veg Fest!

GIVEAWAY

Here are the rules. First, the winner needs to live in the United States (sorry international readers, no disrespect). The contest will end on March 15th at midnight. To enter, you must be a subscribed reader to BYOL. To increase your chances of winning leave a comment on this post. You will also gain a point if you "like" Bring Your Own Lentils facebook page. 

Also be sure to find Dr. Kahn on facebook. He is always post interesting articles on health and fitness

a Rafflecopter 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.

Blood Test Results: Blood pressure, Cholesterol, and HDL

Yesterday I went to the Doctor’s for the results of the blood work I had drawn last week. After first telling me I had Chlamydia, the Doctor pulled up the correct chart (Thankfully, I don’t have Chlamydia, unfortunately there is an Anthony in Harlem who does.) the Doc began going over my numbers.

After being vegan for 6 years, my B-12 levels were perfect. The healthy range is between 200-900 pg/mL. I scored a 695. I did this by consuming a few fortified foods once in a while such as soy and almond milk but I also take a B-12 supplement every few days. It is the only supplement I take and I don’t take it every day.

In America, heart disease is currently our number one killer, but as Dr. Esselstyne boldly states in the documentary, Forks Over Knives, “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.” Now if you’ve read Dr. Esselstyne’s book How to Prevent and Reverse Heart Disease (BYOL review pending), or Rip’s Engine 2 Diet, you’ll remember that there are a few magic numbers when it comes to blood pressure and cholesterol that nearly guarantee you’ll stand apart of the majority of Americans who currently suffer from the disease (many of whom won’t know they even have the disease until after they have died of a serious heart attack!).

First, blood pressure. Unfortunately, according to the CDC, one in three Americans have high blood pressure, many of whom are told to take medicine for the rest of their lives to artificially lower it. We consider high blood pressure, or hypertension, to be a natural part of the aging process, but this is not true. Rather it is a natural part of the Standard American Diet. Adults who consume a mostly plant-based diet typically have blood pressure levels similar to their children. I’m happy to use my Mom as a shinning example of this. She has had high blood pressure my entire life and for the last several years was on medication to control it. Last August I convinced her to switch to a plant-based vegan diet. Since the beginning of April, she has been completely off her medications!

Blood pressure is expressed in two numbers. The first number is called the systolic blood pressure and this represents the force your heart exerts on your arteries when your heart squeezes. You want your systolic pressure to be 120 or below. Mine was 106.

Next is the diastolic blood pressure, and this represents the force the blood exerts on your arteries when your heart relaxes. This number should be below 80. Mine was 60.

Cholesterol is, perhaps, America’s real greatest killer! And to think most people willing put extra cholesterol into their bodies whenever they chose to eat an animal based food! The average American’s cholesterol, again according to the CDC is around 200 mg/dL. This, by their standards is borderline risky, however the research shows that even this number is too high. Heck, just common sense can tell you that! Currently ¼ of the population will die from heart disease… something is clearly off with our numbers. Rather, Dr. Esselstyne argues from his research that to be “heart attack proof,” our total cholesterol levels should be below 150. Among others, Dr. Campbell’s The China Study concurs with this number. Mine was 88 mg/dL.

Now besides the total number, cholesterol is also made up of a few numbers. The two most commonly discussed are LDL, or low-density lipoprotein, and HDL, or high-density lipoprotein. We traditionally refer to LDL as bad, and HDL as good because LDL sticks to our arties, while HDL tends to clear them. 

If LDL is bad, we obviously want our LDL reading to be low. Most people’s LDL is around 100, but according to Dr. Esselstyne that number is still too high, and can put one at risk of heart disease, and several other chronic degenerative diseases. Instead, he recommends we should aim for 80 or below. Mine was 34.

Now HDL is a bit more tricky. Because it is the “good” cholesterol, we assume we want that number to be high; however, according to several research studies, what is far more important is to have your total cholesterol and LDL levels in check.

My HDL level was 27 mg/dL. My Doctor told me that it was way too low and it could potentially put me at risk for heart disease; however, I believe - and the science supports me - that there is an error in his thinking. Yes, 27 mg/dL is very low, however, my total cholesterol is over 100 points below average. So obviously my other levels will also be low. According to Dr. John McDougall, “When total cholesterol is lowered, all fractions of cholesterol are reduced, including HDL-cholesterol. This is not bad, but expected, and actually of no harm.”

In a study done on the Indian population, Tarahumara, a population that thrives off of a nearly complete plant-based diet and has almost zero accounts of heart disease help prove this. The researchers subbed the Tarahumara plant-based diet with an “affluent” diet high in fat, animal protein, and cholesterol, the natives total cholesterol raised 31% from an average of 121 to 159 in just five weeks. At the start of the study their HDL levels were around 32 mg/dL. Over the five weeks, those levels, on average, also jumped by 31% to 42. The study concluded they were at significantly higher risks for contracting heart disease at the end of the study then they were at the beginning even though their “good” cholesterol level rose. Essentially, labeling one form of cholesterol as “good” and one as “bad” is a classic example of the reductionist thinking that is too common when it comes to health and nutrition. A certain amount of both forms of cholesterol are needed for the body to function properly- and our bodies make both so there is no reason to increase our consumption of it with animal foods.

Worldwide (comparing people who eat different diets) those who have the lowest HDL levels (like people in rural Japan, China, and Africa) have the lowest rate of heart disease – and also the lowest total cholesterol. Those with the highest HDL levels (like people in the USA and Western Europe) have the highest rates of heart disease. 

As Dr. McDougall notes, when total cholesterol drops so too will HDL. In fact, in a study of over 500 of his patients, he found that, on average, people reduce their overall HDL levels by 19 percent (8 mg/dl – from 41 mg/dl to 33 mg/dl) in 11 days.

The Doctor told me that I should try and raise my HDL by consuming more Omega-3 fatty acids. At first he suggested fish, but then remembering that I was vegan he then offered I consume nuts and some seeds. He never specifically said walnuts, chia or flax, but those were the foods he was groping for. (As a side note, studies on cows and fish have both shown these animals get their Omega-3s from eating greens- It is not implausible to suggests humans do the same.)

Now, you might think, well, that doesn’t seem unreasonable, and until just a few days ago, I might have agreed. But we have to remember there are two essentially fatty acids that our bodies need to get through food. The first is Alpha-linolenic acid or Omega-3, which the doctor said would help raise my HDL- the second is Linoleic acid or Omega-6. According to recent studies, the ideal ratio between these two EFAs is a 1:1. A whole food, plant-based diet typically provides exactly that, a 1:1 to 3:1 (still within the safe realm) Omega 6 to Omega-3 ratio (for comparison, SAD is a 20:1 – 50:1 ratio). For someone eating the Standard American Diet, increasing their consumption of Omega-3 foods is a good idea, however for someone eating a plant-based diet it may not be. By increasing the Omega-3 intake, you could disrupt the ratio between Omega-6 to Omega-3, and this can lead to increase risk of heart disease as well as type-2 diabetes among other aliments. Both of these outcomes would be very rare with the numbers that I am dealing with, but why take the chance?

Finally, one cannot die of low HDL just as you cannot die from having a high HDL number. That said, far more people go to their graves from heart attacks believing their high cholesterol is safe because they have a lot of “good” cholesterol. We need to stop thinking about these matters in such reductionist ways. 

I hope you all have a great weekend filled with healthy foods!

As always, I am not a medically trained Doctor and this blog should not be taken as medical advice. Consult your doctor about any changes you make to your diet and all of your health concerns.

References:

Brinton EA.  “A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates.”  Journal of Clinical Investigation. 1990 Jan;85(1):144-51.

Kausik, et al. “Long- Chain Omega-3 Fats, Fish and Type 2 Diabetes,” American Journal of Clinical Nutrition 90, 613, 2009.

Esselstyn, C. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure, New York, Penguin Group, 2007.

Esselstyn, R. The Engine 2 Diet: The Texas Firefighter's 28-Day Saver-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds, New York, Wellness Central, 2009. 

Knuiman JT.  HDL cholesterol in men from thirteen countries.  Lancet. 1981 Aug 15;2(8242):367-8.

McDougall J.  “Rapid reduction of serum cholesterol and blood pressure by a twelve-day, very low fat, strictly vegetarian diet.”  Journal American College Nutrition. 1995 Oct;14(5):491-6.

McDougall J. “Good Cholesterol “Worstens” with McDougall?” McDougall News Letter September 2003.

McMurry MP.  “Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet.”  New England Journal of Medicine. 1991 Dec 12; 325 (24):1704-8.

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.