Diet and Spironolactone + Warferin

[KristyWalker]

I have been looking at what I should eat and should not eat on Spiro and already know what I need to avoid (or eat the exact same amount of the same vegetable cooked the exact same way everyday) on Warferin due to vitamin k. I have found my go to vegetables on Warferin are now on do not eat list because of my Spironolactone and the potassium they contain are there any vegetables or fruit left?

[Rachel]

Hi Kristy,

I have been on HRT for almost 3 years and have had a lot of blood tests. My potassium has been on the high side and sodium on the low side. I eat a lot of salt and avoid things high in potassium. I never get extreme, I just use moderation and variety. I never heard about cooking the same amount the same way.

Congratulations on starting HRT.

Make sure you discuss vitamin K, folic acid and iron with your doctor.

Rachel

[KristyWalker]

Cool

Sent from my SM-G920T1 using Tapatalk

[KayXo]

Clin Pharmacol Ther. 1980 Feb;27(2):198-201.

"It is concluded that the interaction of warfarin and spironolactone results primarily from the diuresis with consequent concentration of clotting factors and decreased anticoagulant effect."

Also, spironolactone induces (increases) the activity of CYP3A4 responsible for the metabolism of warfarin so it can potentially reduce its effects. Be sure to discuss this with doctor/pharmacist. As with anything you take while on warfarin, clotting times should be closely monitored. You shouldn't take medroxyprogesterone acetate (Provera) and non-oral bio-identical estradiol should preferably be advised. Doctors should be aware of this, hopefully.

On Spiro, as long as you avoid potatoes, bananas and anything very high in potassium and eat enough salt and drink enough water, you should be fine. Moderate intake of diuretics.

Best of luck.

[Soli]

On Spiro, as long as you avoid potatoes,

oh no  I didn't know... and soya too? 

[Soli]

this is shocking, look at this, what will I eat? haha

http://www.webmd.com/food-recipes/high-potassium-foods-topic-overview

well I had my blood tests 6 weeks ago, she would have told me if there was an increase I guess, so can I still eat potatoes? 

http://www.uptodate.com/contents/image?imageKey=PI%2F67156&topicKey=PI%2F4427&source=see_link&utdPopup=true 

[FrancisAnn]

I've been on HRT for almost 3 years with spiro. I also started the Atkins low carb way of eating a year or more back. Atkins is a great diet for life, good foods but no bad carb stuff like bread/potatoes, yuck. Maybe you should try it, I feel great & I've lost 20-25 pounds. Thousands of women & some men are Atkins people that now are much thinner, in much better shape physically.

[WendyA]

On Warferin as long as you are consistent and you work closely with your doctor you can eat whatever veggies you like.  Folks with heart disease are advised to eat a lot of greens every day, but the greens conflict with the blood thinner so the doctor would need to adjust the meds accordingly and you would need to be consistent with your intake.  Easier said than done I'm sure.

I'm on HRT w/spiro when I started I was getting about 5000mg of potassium in my diet every day.  The RDA is 4700mg. So far so good as long as you keep hydrated and you have good kidneys you should be fine.  My clinician wanted to make sure I wasn't getting any external sources of potassium like vitamins or in salt substitutes, but she said potassium from whole foods should be fine.  If interested in potassium food sources or any other nutrient this link is to the USDA database.  That said potassium is one of those things that needs to be checked regularly to see how your body processes things and your diet may have to be adjusted accordingly.

I've been on HRT for almost 3 years with spiro. I also started the Atkins low carb way of eating a year or more back. Atkins is a great diet for life, good foods but no bad carb stuff like bread/potatoes, yuck. Maybe you should try it, I feel great & I've lost 20-25 pounds. Thousands of women & some men are Atkins people that now are much thinner, in much better shape physically.

I guess there is more than one way to skin a cat.  I started eating a whole food plant based no oil diet about 24 months ago.  I eat all of those great carbs (about 400g a day) like potatoes, whole grains, beans, rice and corn, yum.  I feel great & I've lost 100 pounds.  I've been in the "normal" BMI range now for over 7 months.  Before this the last time I was below 180lbs was 1980.

[KayXo]

this is shocking, look at this, what will I eat? haha

Just eat in moderation, don't overdo it and as long as you stick to whole foods (avoiding certain other items), as Wendy mentioned, you should be fine. It's super important though to drink enough water and eat SALTY if you crave it. I apologize for making you panic, perhaps I shouldn't have said "stay away" but rather eat in moderation.

I guess there is more than one way to skin a cat.  I started eating a whole food plant based no oil diet about 24 months ago.  I eat all of those great carbs (about 400g a day) like potatoes, whole grains, beans, rice and corn, yum.  I feel great & I've lost 100 pounds.  I've been in the "normal" BMI range now for over 7 months.  Before this the last time I was below 180lbs was 1980.

What both you and Francis Ann have in common is the reduction in refined and processed carbs and this is why weight is lost. However, cutting down on fat may not be the healthiest thing to do long-term as it has NOT shown to be harmful for one's health and will actually raise HDL significantly (and important marker for cardiovascular health) while providing important vitamins that are not matched in the vegetable world like Vitamin A, D and K and also essential fats such as DHA and EPA which ALA weakly converts to. The overabundance of omega 6 in the vegetable world might cause inflammatory issues long-term. You might also suffer from intestinal issues long-term due to fiber scratching the lining of your intestines, causing a callous to form and also reduce absorption of nutrients. Some report anemia, low B12 while animal protein appears to be more complete and preferable for the human body. Over time, insulin and triglyceride levels might increase too much and cause health issues.

[WendyA]

What both you and Francis Ann have in common is the reduction in refined and processed carbs and this is why weight is lost.

True enough.  Thank you for your sincere response.  Also I appreciate the effort you have taken when speaking of carbs to place the emphasis on refined/processed carbs. 

However, cutting down on fat may not be the healthiest thing to do long-term as it has NOT shown to be harmful for one's health and will actually raise HDL significantly (and important marker for cardiovascular health)

After 3 decades of following hundreds of patients with heart disease eat a whole food plant based no oil diet it is safe to say that low HDL rates among these patients was not uncommon, yet recurrence of any heart disease symptoms was 0.6%. 

while providing important vitamins that are not matched in the vegetable world like Vitamin A, D and K

I get more vitamin A and K then I know what to do with and you're correct consuming with a little fat makes it more bio-available.  Vitamin D is is the sunshine vitamin.

also essential fats such as DHA and EPA which ALA weakly converts to.

You are correct ALA does weakly convert to EPA then the EPA converts to DHA.  It's lucky for me that we don't need much.

The overabundance of omega 6 in the vegetable world might cause inflammatory issues long-term.

Omega 6 is really only overabundant in processed oils.  My omega 6 intake is in no danger of being too high or inflammatory.

You might also suffer from intestinal issues long-term due to fiber scratching the lining of your intestines, causing a callous to form and also reduce absorption of nutrients.

I have not heard this ever mentioned in the literature.  While I don't wish to take this thread further off topic I wouldn't mind reading the studies behind this.

Some report anemia, low B12
B12

B12 is an issue for everyone my age.  The Institute of Medicine recommends everyone over 50 supplement with B12.

Over time, insulin and triglyceride levels might increase too much and cause health issues.

Since neither of these are a concern in the heart patients over decades and heart disease is my main concern I think I'll stick with my diet, but thanks for the concern. 

[Emileeeee]

I've been on them for about 7 months. I didn't really change my diet all that much and what I did was just because my BMI is apparently too high for surgery. All I really did is switch to only drinking water, which immediately made it difficult to hit the amount of calories I should have in a day. I don't like sweets, so that was never a problem for me. And I remove the rolls from hoagies and burgers. I get blood tested every 3 months and everything is consistently in the normal range. I should note that I supplement with D and B complex vitamins as well as taking a multivitamin.

[FrancisAnn]

Please look into the Atkins way of eating. It works for thousands of ppl all over the planet. LCHF, low car high fat. It's much smarter that stuff like Oprah wants to sell us!!! It's a better way to eat for the rest of your life, not some quick fix that does not work. I'm down about 25 pounds, feel & look great really.

[FrancisAnn]

Surgeons want our BMI lower so we are taking better care of ourselves. GRS is only one small part of being an attractive confident woman you know. Good luck all girl friends.

[Emileeeee]

Please look into the Atkins way of eating. It works for thousands of ppl all over the planet. LCHF, low car high fat. It's much smarter that stuff like Oprah wants to sell us!!! It's a better way to eat for the rest of your life, not some quick fix that does not work. I'm down about 25 pounds, feel & look great really.

I may inadvertently be doing part of that. I'm keeping carbs to a bare minimum. I wouldn't say I have high fat, but I haven't cut out fatty foods as much. I just take in smaller quantities of them at a time. Lost 15lbs doing that so far. No exercise.

[StillAnonymous]

Before spironolactone


After spironolactone


Our nutrition is not as linear as some may suggest or imply.  Our bodies have a vast amount of mechanisms to maintain certain balances and just because you are adding in more of something, such as potassium, doesn't necessarily mean that the surplus is going to stay in your body or have noticeable effects.  Maybe I'm just a lucky person.

[KayXo]

After 3 decades of following hundreds of patients with heart disease eat a whole food plant based no oil diet it is safe to say that low HDL rates among these patients was not uncommon, yet recurrence of any heart disease symptoms was 0.6%.

Could you provide the references, if possible? How is one certain that people strictly followed this diet for 3 decades?

I get more vitamin A and K then I know what to do with.

https://en.wikipedia.org/wiki/Vitamin_A#Equivalencies_of_retinoids_and_carotenoids_.28IU.29

"The conclusion that can be drawn from the newer research is that fruits and vegetables are not as useful for obtaining vitamin A as was thought; in other words, the IUs that these foods were reported to contain were worth much less than the same number of IUs of fat-dissolved oils and (to some extent) supplements. This is important for vegetarians, as night blindness is prevalent in countries where little meat or vitamin A-fortified foods are available."

"A sample vegan diet for one day that provides sufficient vitamin A has been published by the Food and Nutrition Board (page 120[12])."

A vegan diet may therefore provide enough vitamin A but sufficient consumption of fat is also required to help better absorb the carotenoids. You say this diet is an oil-free diet so this may indeed jeopardize how much you are able to absorb.

It has been suggested, based on some studies that Vitamin K2 (found in animal foods and dairy, especially abundant in fish eggs and organ meats) as opposed to K1 plays a role in prostate cancer (especially advanced), heart disease and skeletal metabolism. Vitamin K is better absorbed with some fat which your diet lacks.

and you're correct consuming with a little fat makes it more bio-available.

You said you don't consume any and this diet is fat-free.

Vitamin D is is the sunshine vitamin.

Some people aren't exposed to sunshine all year long and may suffer, as a result, from lack of bio-active Vitamin D, eating this way. Fortified beverages and a vitamin supplement may be required. Never a good sign of a healthy diet.

You are correct ALA does weakly convert to EPA then the EPA converts to DHA.  It's lucky for me that we don't need much.

Indeed but as ALA is only converted at a rate of 5 % or less, you may still not get enough.

https://en.wikipedia.org/wiki/Alpha-Linolenic_acid
"Eicosapentaenoic acid (EPA; 20:5, n−3) and docosahexaenoic acid (DHA; 22:6, n−3) are readily available from fish and algae oil and play a vital role in many metabolic processes. These can also be synthesized by humans from dietary α-linolenic acid, but with an efficiency of only a few percent.[14]"

You also stated your diet was oil-free so if you avoid those foods that contain oil, how are you supposed to get ALA in your body in the first place?

Omega 6 is really only overabundant in processed oils.  My omega 6 intake is in no danger of being too high or inflammatory.

Relative to omega-3, yes, especially considering how inefficiently ALA is converted to EPA and DHA. But now I wonder, since you mention oil-free, shouldn't you also be avoiding foods that contain omega-6, a fat?

I have not heard this ever mentioned in the literature.  While I don't wish to take this thread further off topic I wouldn't mind reading the studies behind this.

BMJ 2008; 337

"In 1994 we raised the possibility that, at least in the secondary
care setting, cereal fibre was actually more likely to do harm than good
in patients with IBS(1). Today, as a gastroenterologist who probably sees
more cases of severe IBS than the majority of my colleagues, I still find
that the total exclusion of all cereal fibre, such as bran and brown
bread, from the diet is one of the most rewarding treatment strategies I
can offer these patients."

Lancet. 1994 Jul 2;344(8914):39-40.

"Whilst following up large numbers of patients with irritable bowel syndrome we got the impression that wholemeal wheat and bran products made people with the condition worse rather than better."

"All symptoms of irritable bowel syndrome were exacerbated by bran, with bowel disturbance most often adversely affected, followed by abdominal distension and pain. The results of this study suggest that the use of bran in irritable bowel syndrome should be reconsidered. The study also raises the possibility that excessive consumption of bran in the community may actually be creating patients with irritable bowel syndrome by exacerbating mild, non-complaining cases."

Gastroenterology. 2012 Feb;142(2):266-72

"A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered."

B12 is an issue for everyone my age.  The Institute of Medicine recommends everyone over 50 supplement with B12.

Not if you eat enough meat, eliminate anti-acids and other medications which can interfere with absorption of B12 and limit fiber consumption which may also impair digestion over time.

Am J Clin Nutr July 2003 vol. 78 no. 1 131-136

"The study cohort included 66 lactovegetarians or lactoovovegetarians (LV-LOV group), 29 vegans, and 79 omnivores. Total vitamin B-12, methylmalonic acid, holotranscobalamin II, and total homocysteine concentrations were assayed in serum."

Average age of omnivores was 51, 46-50 in LV-LOV group and 36-40 in vegans. Despite the fact omnivores were, on average, older and around 50...

"Vegan subjects and, to a lesser degree, subjects in the LV-LOV group had metabolic features indicating vitamin B-12 deficiency that led to a substantial increase in total homocysteine concentrations. Vitamin B-12 status should be monitored in vegetarians. Health aspects of vegetarianism should be considered in the light of possible damaging effects arising from vitamin B-12 deficiency and hyperhomocysteinemia."

Eur J Clin Nutr. 2010 Sep; 64(9): 933–939.

"Vegans have lower vitamin B12 concentrations, but higher folate concentrations, than vegetarians and omnivores. Half of the vegans were categorised as vitamin B12 deficient and would be expected to have a higher risk of developing clinical symptoms related to vitamin B12 deficiency."

"only two men (both omnivores) were categorised as folate deficient (defined as serum folate < 6.3 nmol/l)."

This may be because they eat unhealthy, all the while eating enough meat, as vegans typically eat more whole and healthy foods that contain more folic acid.

Since neither of these are a concern in the heart patients over decades and heart disease is my main concern I think I'll stick with my diet, but thanks for the concern.

Eur Heart J. 2015 Mar 1;36(9):539-50.

"This study confirmed the causal role of LDL-c in CHD risk, and provides support for a causal role of TGs in CHD. The existence of a causal link between HDL-c levels and CHD is less certain, although possible.
The findings may suggest that a treatment that lowers TGs as well as increases HDL-c levels may be beneficial in the prevention of CHD events, while only targeting TGs may not be effective. The role of HDL-c on CHD risk requires further investigation."

Nature Genetics 45, 1345–1352 (2013)

"These results suggest that triglyceride-rich lipoproteins causally influence risk for CAD."

[FrancisAnn]

I may inadvertently be doing part of that. I'm keeping carbs to a bare minimum. I wouldn't say I have high fat, but I haven't cut out fatty foods as much. I just take in smaller quantities of them at a time. Lost 15lbs doing that so far. No exercise.

Try to read a little about the Atkins diet please. Your body need fat but less carbs basically....Thousands of ppl worldwide use the Atkins way of eating....boo coo support sites where so many ppl help each other, recipes, suggestions.....It's safe & good for us ppl.   Take care & good luck Atkins sister.

[WendyA]

Kay,  Thank you for the concern and info.

Could you provide the references, if possible? How is one certain that people strictly followed this diet for 3 decades?

Here is the 12 year followup of the initial cohort of 24 folks with advanced CAD.  This group started in 1986. Essentially their doctors told them this trial was their last chance.  Adherence was self-reported, during the first 5 years Dr. Esselstyn actually met with them once a week. Then relaxed to once a month. By about the 18 month mark 6 of the patients were released back to their cardiologists because they couldn't remain adherent to this way of eating.

Here is a paper on the second group which of 198 patients.  Since this was a self selected (I don't want to die of a heart attack) group they had an adherence rate of 89-90%. Here is a lecture by Dr. Esselstyn that goes into a lot of the science, experiences and results of this and his original group. The lecture is 79 minutes so it isn't a short view, but it is interesting for anyone who is concerned with Coronary Artery Disease (CAD)

Just because this diet is shown to be very effective for CAD, stroke and Type 2 Diabetes doesn't mean there aren't other ways to get to the same point.  I'm not all about the idea that this is the only way, I'm smart enough but I'm not omnipresent.  Who knows maybe one day they will be able to treat Coronary Artery Disease with a pill.

You said you don't consume any and this diet is fat-free.

I said I don't use oil.  Everything contains fat. By calorie content Broccoli is 10% fat, Oatmeal 14% fat, Black Beans 3.5% fat, Spinach 14% fat, so you see this is not a fat free diet.  My fat intake typically runs about 9% of my daily caloric intake.  For the increased vitamin absorption, I do as you have pointed out and include fat with my salads by breaking up an ounce of walnuts and sprinkling them on my salad. 

You also stated your diet was oil-free so if you avoid those foods that contain oil, how are you supposed to get ALA in your body in the first place?

I avoid all processed oil and any processed foods that have oil added to them.  All foods have fat. As an example 1Tbsp of ground flax seeds has about 1.6g of omega 3 fatty acids. On average I get about 3.5g of omega 3 and about 4.3g of Omega 6 fatty acids a day.  If you are interested here is an interesting article, "Omega-3 Fatty Acid Recommendations for Vegetarians" that covers the topic of ALA, DHA and EPA in detail with links to all of the cited studies.

But now I wonder, since you mention oil-free, shouldn't you also be avoiding foods that contain omega-6, a fat?

No need to avoid, but for the most part you are accurate in that I do minimize my consumption of high fat fruits (avocados and olives) and rarely consume nuts or nut butters.  I do use flax seed or chia seed on a regular basis, but those are higher in omega 3 than omega 6 fatty acids.

BMJ 2008; 337

"In 1994 we raised the possibility that, at least in the secondary care setting, cereal fibre was actually more likely to do harm than good in patients with IBS(1). Today, as a gastroenterologist who probably sees more cases of severe IBS than the majority of my colleagues, I still find that the total exclusion of all cereal fibre, such as bran and brown bread, from the diet is one of the most rewarding treatment strategies I can offer these patients."

I tried to review this but you're missing the article cite number that should be after the 337 and I'm not going to look in every article from that volume.

Lancet. 1994 Jul 2;344(8914):39-40.

"Whilst following up large numbers of patients with irritable bowel syndrome we got the impression that wholemeal wheat and bran products made people with the condition worse rather than better."

"All symptoms of irritable bowel syndrome were exacerbated by bran, with bowel disturbance most often adversely affected, followed by abdominal distension and pain. The results of this study suggest that the use of bran in irritable bowel syndrome should be reconsidered. The study also raises the possibility that excessive consumption of bran in the community may actually be creating patients with irritable bowel syndrome by exacerbating mild, non-complaining cases."

I'll make sure not to eat bran sold in capsules.  Since bran by itself is a processed food that should be easy.  I couldn't read more than the summary so I have no idea how much further they broke things down.  One thing I'm sure of is this study was done on folks eating the typical western or standard American diet.  An unscientific case study of one here my intestinal issues have all resolved themselves since I changed my diet.

Gastroenterology. 2012 Feb;142(2):266-72

"A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered."

If you want the full story on this study take 5 minutes watch this video (Does Fiber Really Prevent Diverticulosis?) then click the "sources cited" button and review the cited studies.  Contrary to your previous assumptions about this site all of his info is cited from the same sources you cite and cover a wide array of study types.  For the record my intake of dietary fiber from whole foods is about 80g a day.

As far as B12 is concerned I agree with you, folks eating the way I do in the USA must supplement with B12.  In reference to the recommendation from the Institute of Medicine that all folks over 50 years old supplement with B12 You'll have to take it up with them.

Dietary Reference Intakes: The Essential Guide to Nutrient Requirements: Chapter 19 page 195

"Because 10-30 percent of older people may be unable to absorb naturally occurring vitamin B12 it is advisable for those older than 50 years to meet their needs mainly by consuming foods fortified with vitamin B12 or by taking a supplement that contains B12."

[KayXo]

Here is the 12 year followup of the initial cohort of 24 folks with advanced CAD.

12 yrs, not 3 decades as you asserted earlier. And not hundreds of individuals but 24, some of whom (6) stopped the diet. 

From actual study:

"I will present converging lines of evidence (many of them well-known and universally accepted) reiterating that when serum cholesterol levels are maintained <150 mg/dl, coronary artery disease is practically nonexistent.3 and 4"

He asserts this based on:

1) one one study where serum lipids were compared between different populations. The low prevalence of heart disease in a population being attributed to one marker, low levels of cholesterol (and the consumption of very little fat and saturated fat), is unscientific and wrong for the simple fact that there are so many other confounding variables that could account for low prevalence of heart disease (perhaps genetics, level of stress, smoking habits, sugar consumption, etc.). This is far from conclusive, as the author would like one to believe. 
2) and another study almost identical which compares lipids and dietary habits between populations from which we can make no absolute and certain conclusion that one factor or another is responsible for low prevalence of coronary heart disease.

And many such studies are later pointed to show that low cholesterol vs high cholesterol is better for heart disease when there could be potentially be so many other factors responsible. To determine cause and effect, we need to isolate one variable. The author is not objective and seeks confirmation of his theory, rather than seeking actual facts. This is a mistake often done by researchers and scientists.

"In contrast, a 5-year experience has shown excellent results in patients with severe coronary artery disease who followed a plant-based diet containing <10% fat and who took cholesterol-lowering medication.14"

The very first thing that comes to mind is the fact that not only diet was changed (in which many variables were modified) but a medication was ADDED too. Who's to say the excellent results aren't solely due to the medication? Changing many variables at one time prevents one from reaching definite conclusions. I'm surprised the author ignores this. This study was 5 years, not 3 decades.

In this study, 5 out of the 22 dropped out. 11 made it to 5.5 years, so only 50%. Not a good sign. What happened to them? Did they die? Have a hard time following the diet? The sample size in this study is also quite small.

Then it is stated

"Among the 11 remaining patients after 10 years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their prestudy diet reported 10 coronary events."

Again, this shows how hard it is for people to follow this diet, despite having "severe coronary heart disease". Only six of the original 22 continued this diet. Those dropouts may have had an increased incidence due to going back to eating more sugar and refined carbs rather than due to eating more fat...we don't know. Did they also stop their cholesterol-lowering medication? It has also been found that some of these medications don't halt or slow down recurrence of heart disease due to necessarily lowering cholesterol but rather through some other mechanism.

In the end, there are so many things involved that we really don't know which way to look to determine what really caused what.

Then, he goes on to say

"Today, after 12 years, I have followed the original patient cohort to determine adherence, safety, adverse effects, and long-term benefits. The original cohort contained 1 woman and 23 men, all nonsmoking, nondiabetic, and nonhypertensive patients with severe, angiographically demonstrated coronary artery disease."

He now states there were 24 individuals in this cohort, as opposed to the 22 mentioned in the original study.  Also, if you notice, there was only 1 woman! So these findings clearly could not be relevant to women.

"They agreed to follow a plant-based diet with <10% of calories derived from fat. They were asked to eliminate oil, dairy products (except skim milk and no-fat yogurt), fish, fowl, and meat."

Hence, this is not a fat-free diet.

"Six nonadherent patients were released within the first 12 to 18 months of the study, and they returned to standard care."

5 mentioned in the original study and now 6. It's strange how he says one thing and then another when the sample is so small that errors of this magnitude would be unlikely. He's constantly changing his story. Is he really keeping good track?

"The remaining 18 patients adhered to the study diet and medication for 5 years. At 5 years, 11 of these patients underwent angiographic analysis by the percent stenosis method, which demonstrated disease arrest in all 11 (100%) and regression in 8 (73%)."

What about the 7 others? What happened to them? Why didn't they go through the same analysis? 

"During the 7 years since the conclusion of the 5-year study, all but 1 patient have continued to adhere to the prescribed diet and medication."

Again, the numbers don't match with the other study.

In conclusion, it's messy and nothing certain can be concluded from this study.

Here is a paper on the second group which of 198 patients.  Since this was a self selected (I don't want to die of a heart attack) group they had an adherence rate of 89-90%.

In this study:

Many things were modified. So, how do we know what caused what? B12 and a multivitamin was also added, caffeine, fructose were prohibited, all refined carbs, juices, etc. as well. Had they simply reduced refined carbs and all similarly very sweet foods, perhaps the same results would have been found. We don't know because so many factors were involved. Again, absolutely nothing certain can be concluded. Interestingly, again, 91% of the participants were men (180 of 198) AND this diet was sustained for an average of 3.7 years, not 3 decades...how did you come up with that figure?

They even state at the end of the study:

"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. Tis study was not prospectively randomized."

Far from convincing, Wendy. I would not adhere to such a diet based on this evidence which to me is no evidence at all because we don't know what caused what? You may be depriving yourself of foods that are nutritious and enjoyable that could actually improve your quality of life. The study is unable to pinpoint which factor exactly accounted for improvements. I suspect just reducing the refined carbs, juice and sugary foods could be sufficient without the need to cut fat.

Just because this diet is shown to be very effective for CAD, stroke and Type 2 Diabetes doesn't mean there aren't other ways to get to the same point.

A diet that involves changing so many things that we really don't know what exactly is beneficial and what may not make a difference at all.

Who knows maybe one day they will be able to treat Coronary Artery Disease with a pill.

I think it's simple. We don't need a pill with a host of side-effects. Just to stop eating so many refined carbs and sweet foods. Avoid smoking and keep stress to a minimum.

I tried to review this but you're missing the article cite number that should be after the 337 and I'm not going to look in every article from that volume.

Had you copied and pasted the extract from the study into google, you would have found it. Here is the link.
http://www.bmj.com/rapid-response/2011/11/02/problem-insoluble-fibre-irritable-bowel-syndrome

[WendyA]

From actual study:

"I will present converging lines of evidence (many of them well-known and universally accepted) reiterating that when serum cholesterol levels are maintained <150 mg/dl, coronary artery disease is practically nonexistent.3 and 4"

He asserts this based on:

1) one one study where serum lipids were compared between different populations. The low prevalence of heart disease in a population being attributed to one marker, low levels of cholesterol (and the consumption of very little fat and saturated fat), is unscientific and wrong for the simple fact that there are so many other confounding variables that could account for low prevalence of heart disease (perhaps genetics, level of stress, smoking habits, sugar consumption, etc.). This is far from conclusive, as the author would like one to believe.
2) and another study almost identical which compares lipids and dietary habits between populations from which we can make no absolute and certain conclusion that one factor or another is responsible for low prevalence of coronary heart disease.

The low prevalence of heart disease is not being attributed to low cholesterol.  The facts are in all populations as cholesterol approaches 150mg heart attacks virtually disappear.  This does not mean high cholesterol causes heart attacks. 

And many such studies are later pointed to show that low cholesterol vs high cholesterol is better for heart disease when there could be potentially be so many other factors responsible. To determine cause and effect, we need to isolate one variable. The author is not objective and seeks confirmation of his theory, rather than seeking actual facts. This is a mistake often done by researchers and scientists.

There has been no cause and effect asserted.  Cholesterol is a marker, often cholesterol is a symptom of inflammation that causes the liver to produce more cholesterol.  The underlying disease obviously has multiple causes.  You are wrong though he does focus on one variable, heart disease.  His goal was to get these patients under 150 mg of cholesterol by implementing a diet based on his best guess of what would lower cholesterol and inflammation. 

"In contrast, a 5-year experience has shown excellent results in patients with severe coronary artery disease who followed a plant-based diet containing <10% fat and who took cholesterol-lowering medication.14"

The very first thing that comes to mind is the fact that not only diet was changed (in which many variables were modified) but a medication was ADDED too. Who's to say the excellent results aren't solely due to the medication?

The benefits of cholesterol lowering drugs are well defined.  However in absolute numbers those who start taking them after they are diagnosed with heart disease after 5 years of daily statin therapy achieved a 1.2% lower chance of death, a 2.6% lower chance of heart attack, and a 0.8% lower chance of stroke.  To put this in real numbers the 5-year risk is about 19% for mortality and 8% for non-fatal heart attacks.  Compare this to the 5 year real world risk of Dr. Esselstyn's most recent group 0% deaths from coronary artery disease and 0.6% chance of non-fatal event.  In relative terms this is a 98.8% reduction of risk.

In this study, 5 out of the 22 dropped out. 11 made it to 5.5 years, so only 50%. Not a good sign. What happened to them? Did they die? Have a hard time following the diet? The sample size in this study is also quite small.

Good questions.  True the initial sample size was small because it was never done before and because Dr. Esselstyn was still in a full time surgical rotation.

Again, this shows how hard it is for people to follow this diet, despite having "severe coronary heart disease". Only six of the original 22 continued this diet.

The recently published 5 year paper has a 89.6% adherence rate after 5 years.  Possibly times are changing.  There are certainly many more resources available for folks these days and support groups are just a click away, both online and local via meetup.com.

Those dropouts may have had an increased incidence due to going back to eating more sugar and refined carbs rather than due to eating more fat...we don't know.

Without a doubt you are correct.  One of the many reasons he chose such a low fat diet for his patients is because literally dietary fat quickly finds its way into the blood and takes about 6 hours to be processed.  During this time the dilation of blood vessels is severely restricted.  When one already has clogged arteries and is suffering from angina this is not a good thing.

He now states there were 24 individuals in this cohort, as opposed to the 22 mentioned in the original study.  Also, if you notice, there was only 1 woman! So these findings clearly could not be relevant to women.

Those were the patients who expressed an interest.

"They agreed to follow a plant-based diet with <10% of calories derived from fat. They were asked to eliminate oil, dairy products (except skim milk and no-fat yogurt), fish, fowl, and meat."

Hence, this is not a fat-free diet.

What is your point here?  As I explained previously there is no such thing as a fat-free diet.  So of course it has fat in it. He never allowed any nuts, nut butters or high fat plant foods (avocado, olives, coconut etc...)  He also encourages the small use of flax or chia seeds for omega 3 intake.  It was also an evolving diet because somewhere about 1991 was when he eliminated all dairy.

In this study:

Many things were modified. So, how do we know what caused what? B12 and a multivitamin was also added, caffeine, fructose were prohibited, all refined carbs, juices, etc. as well. Had they simply reduced refined carbs and all similarly very sweet foods, perhaps the same results would have been found. We don't know because so many factors were involved. Again, absolutely nothing certain can be concluded.

You are correct that there may be less restrictive ways to get to the same point.  You are wrong about the fact that nothing can be concluded.  One conclusion is obvious, if your Dad, Uncle, Mom, Grandfather etc... died of heart disease and you have anxiety over it now there is something you can do to prevent yourself from falling victim to it.

Just an update of no particular importance at some point multi-vitamins were removed from his protocol.

this diet was sustained for an average of 3.7 years, not 3 decades...how did you come up with that figure?

My mistake, the on going program has been in existence for 3 decades. The first cohort started 3 decades ago the next paper is a snapshot of 198 consecutive patients but is not inclusive of the 1000s of folks that Dr. Esselstyn has counseled and trained in this way of halting and reversing heart disease.

They even state at the end of the study:

"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. Tis study was not prospectively randomized."

This is obvious, I even said there may be more than one way to skin a cat.  That is why I haven't argued against anything I simply stated what has been shown to work.

You may be depriving yourself of foods that are nutritious and enjoyable that could actually improve your quality of life.

Possibly.  But the foods I eat now are nutritious and enjoyable and my quality of life has improved dramatically.  Add to that the preponderance of evidence of the benefits of eating plants and I'll stick to it.

The study is unable to pinpoint which factor exactly accounted for improvements. I suspect just reducing the refined carbs, juice and sugary foods could be sufficient without the need to cut fat.

For all I know this study may be going on as we speak.  Whether or not it would be sufficient for folks with advanced disease is hard to tell, but for all others it may be all that is needed.  I certainly don't have the answers.

I think it's simple. We don't need a pill with a host of side-effects. Just to stop eating so many refined carbs and sweet foods. Avoid smoking and keep stress to a minimum.

I agree, but did you read the article I linked to?  Quite a fascinating story and the substance is already approved for use.

Had you copied and pasted the extract from the study into google, you would have found it. Here is the link.

Thanks for the link.