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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?

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

Cool

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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.

Quote from: KayXo on April 06, 2016, 06:53:27 PM

On Spiro, as long as you avoid potatoes,

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

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  :(

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.

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 (https://ndb.nal.usda.gov/ndb/nutrients/report/nutrientsfrm?max=25&offset=0&totCount=0&nutrient1=306&nutrient2=208&nutrient3=&subset=0&fg=&sort=c&measureby=m) 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.

Quote from: FrancisAnn on April 07, 2016, 02:14:35 AM
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.

Quote from: Soli on April 07, 2016, 01:26:22 AM
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. :)

Quote from: WendyA on April 07, 2016, 08:00:26 AM
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.

Quote from: KayXo on April 07, 2016, 09:49:17 AMWhat 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. 

Quote from: KayXo on April 07, 2016, 09:49:17 AMHowever, 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%. 

Quote from: KayXo on April 07, 2016, 09:49:17 AMwhile 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.

Quote from: KayXo on April 07, 2016, 09:49:17 AMalso 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.

Quote from: KayXo on April 07, 2016, 09:49:17 AMThe 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.

Quote from: KayXo on April 07, 2016, 09:49:17 AMYou 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.

Quote from: KayXo on April 07, 2016, 09:49:17 AMSome report anemia, low B12
B12

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

Quote from: KayXo on April 07, 2016, 09:49:17 AMOver 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. 

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.

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.

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.

Quote from: FrancisAnn on April 07, 2016, 03:26:25 PM
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.

Before spironolactone
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2FsHIrEPb.png&hash=2fb3c671d22e2c70add740afce6275c135db9cd3)

After spironolactone
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2Fo7COOzu.png&hash=b206ebcf7195e6e595a1fa19ed7aa02697111ee1)

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.

Quote from: WendyA on April 07, 2016, 11:34:35 AM
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?

QuoteI 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.

Quoteand 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.

QuoteVitamin 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.

QuoteYou 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?

QuoteOmega 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?

QuoteI 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."

QuoteB12 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.

QuoteSince 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."

Quote from: Emileeeee on April 07, 2016, 04:30:51 PM
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.

Kay,  Thank you for the concern and info.

Quote from: KayXo on April 07, 2016, 07:42:33 PMCould 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 (http://www.dresselstyn.com/site/study02/) 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 (http://dresselstyn.com/JFP_06307_Article1.pdf) 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 (https://youtu.be/nPeLgcyJ2Y8/) 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 (http://spectrum.diabetesjournals.org/content/25/1/38.full) 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 (https://www.sciencedaily.com/releases/2016/04/160406165248.htm).

Quote from: KayXo on April 07, 2016, 07:42:33 PMYou 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. 

Quote from: KayXo on April 07, 2016, 07:42:33 PMYou 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 (http://www.veganhealth.org/articles/omega3#fn39)" that covers the topic of ALA, DHA and EPA in detail with links to all of the cited studies.

Quote from: KayXo on April 07, 2016, 07:42:33 PMBut 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.

Quote from: KayXo on April 07, 2016, 07:42:33 PM
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.

Quote from: KayXo on April 07, 2016, 07:42:33 PMLancet. 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.

Quote from: KayXo on April 07, 2016, 07:42:33 PMGastroenterology. 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? (http://nutritionfacts.org/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 (http://www.nap.edu/read/11537/chapter/19#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."

Quote from: WendyA on April 08, 2016, 06:36:44 AM
Here is the 12 year followup (http://www.dresselstyn.com/site/study02/) 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.

QuoteHere is a paper (http://dresselstyn.com/JFP_06307_Article1.pdf) 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%.  (https://youtu.be/nPeLgcyJ2Y8/)

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.

QuoteJust because this diet is shown to be very effective for CAD, stroke and Type 2 Diabetes (http://spectrum.diabetesjournals.org/content/25/1/38.full) 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.

QuoteWho knows maybe one day they will be able to treat Coronary Artery Disease with a pill (https://www.sciencedaily.com/releases/2016/04/160406165248.htm).

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.

QuoteI 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

Quote from: KayXo on April 08, 2016, 10:00:32 AMFrom 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. 

Quote from: KayXo on April 08, 2016, 10:00:32 AMAnd 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. 

Quote from: KayXo on April 08, 2016, 10:00:32 AM"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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMIn 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMAgain, 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMThose 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMHe 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AM"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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMIn 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMthis 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMThey 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMYou 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMThe 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.

Quote from: KayXo on April 08, 2016, 10:00:32 AMI 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 (http://arstechnica.com/science/2016/04/sweet-drug-clears-cholesterol-reverses-heart-disease-and-was-found-by-parents/) and the substance is already approved for use.

Quote from: KayXo on April 08, 2016, 10:00:32 AMHad you copied and pasted the extract from the study into google, you would have found it. ;) Here is the link. :)

Thanks for the link.

Quote from: FrancisAnn on April 08, 2016, 04:28:58 AM
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.

FrancisAnn I came across an interesting study (http://www.ncbi.nlm.nih.gov/pubmed/20820038) by Dr. Walter Willett the chair of the department of nutrition at Harvard School of Public Health that shows certain low-carbohydrate diets are associated with higher all-cause mortality and certain low-carbohydrate diets are associated with lower all-cause mortality.  Thought you might be interested.

Thanks. There are so many diets. So many ppl saying my diet is better than your diet......It's almost funny. Oprah saying I eat bread every day & have lost ____pounds. One friend is on some new diet, we argue all the time about Atkins vs her diet. All I know is Atkins has worked for me, I'm down 20-25 pounds & would love to lose another 20 to look my best. It's tough with no foods like watermellons, carrots, apples, peaches.....bread....popcorn, they are all loaded with carbs. I'll look at this study to see what he has to say but everyone has a different opinion you know.

Wendy, I'm not suprised. Veggies have to be better for us that red meat....I sure miss lots of good veggies. What's a girl to do?? Eat bread to make Oprah more $????  Think I'll make a crustless low carb pumpkin pie soon, like I did last Thanksgiving.

Wendy, It's frustrating to know what is the best diet for weight loss & long life. I love atkins sometimes but hate it other times. However there is no doubt that carbs add on extra fat to our bodies, atkins diet tries to help burn off all the stored fat we already have stored on our bodies.....down to our idea BMI then eat more carbs & try to maintain our idea weight. It makes sense to me so I'll stick with it. Have a good day.

Quote from: WendyA on April 09, 2016, 02:17:55 AM
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.

The association between the level of cholesterol and incidence of heart attacks is just that, an ASSOCIATION. One cannot conclude from this that a cholesterol level of 150 and under will lead to no heart attacks but this is what he clearly thinks as his goal is to achieve this level in his patients and he tries to do this with the cholesterol lowering medication and diet.

QuoteThere has been no cause and effect asserted.

First he says:

"In a small group of my own patients, a 12-year follow-up shows prospective data confirming that a low-fat diet and lipid-lowering medication causes disease to halt or regress." When clearly, we can't isolate cause and effect from this study as too many factors were manipulated. Instead, he should have said "is associated with". This suggests he is indeed biased.

Then:

"For over a decade it has been known that sufficient reduction of lipids may arrest and, in some cases, reverse coronary artery disease.7 An analysis of 35 cholesterol-lowering studies confirms that the benefits are directly related to the degree of cholesterol reduction.8"

Bold statement, clearly implicating CAUSE, given that in these interventions, other factors are also at play like diet, or other effects of the medications/hormones involved that have nothing to do with cholesterol lowering which could have well played a role in lowering of CHD  (coronary heart disease) mortality.

Circulation. 1995 Apr 15;91( 8 ):2274-82.

"Certain types of intervention had specific effects independent of cholesterol lowering."

In this study, if you look at findings closely, you find that the risk ratio for CHD mortality is:

- 0.889, 1.011, in all trials, from which no significant finding can be extracted as it is over and under 1.
- 0.861, 1.004, in all unifactorial trials, from which no significant finding can be extracted as it is over and under 1.

Hence, no significant findings.

Same goes for total mortality, as risk ratios are 0.957, 1.057 and 0.948, 1.085.

So when they say "The results suggest that cholesterol lowering itself is beneficial", they forget, interestingly enough to say that none of these findings are indeed significant. This, to me, reflects gross bias. 

Uffe Ravnskov: High cholesterol does not cause atherosclerosis

"recent studies have shown that statins (...) may exert anti-atherosclerotic effects by other mechanisms. These 'pleiotropic' effects, probably related to inhibition of the production of other isoprenoids such as geranylgeraniol or ubiquinone, are well-established in vitro, and studies are beginning to show cholesterol-independent mechanisms, including anti-inflammatory effects, in vivo as well14, 15."

Also,

http://www.ravnskov.nu/2015/12/27/myth-2/

"If a high cholesterol really did promote atherosclerosis, then people with a high cholesterol should evidently be more atherosclerotic than people with a low. But it isn't so.

The pathologist Dr. Kurt Landé and the biochemist Dr. Warren Sperry at the Department of Forensic Medicine of New York University were the first to study that question. The year was 1936. To their surprise, they found absolutely no correlation between the amount of cholesterol in the blood and the degree of atherosclerosis in the arteries of a large number of individuals who had died violently. In age group after age group their diagrams looked like the starry sky. Drs. Landé and Sperry are never mentioned by the proponents of the diet-heart idea, or they misquote them and claim that they found a connection, or they ignore their results by arguing that cholesterol values in the dead are not identical with those in living people.

The latter problem was solved by Dr. J. C. Paterson from London, Canada and his team. For many years they followed about 800 war veterans. Over the years, Dr. Paterson and his coworkers regularly analyzed blood samples from these veterans. Because they restricted their study to veterans who had died between the ages of sixty and seventy, the scientists were informed about the cholesterol level over a large part of the time when atherosclerosis normally develops.Dr. Paterson and his colleagues did not find any connection either between the degree of atherosclerosis and the blood cholesterol level; those who had had a low cholesterol were just as atherosclerotic when they died as those who had had a high cholesterol. Similar studies have been performed in India, Poland, Guatemala, and in the USA, all with the same result: no correlation between the level of cholesterol in the blood stream and the amount of atherosclerosis in the vessels."

http://www.westonaprice.org/modern-diseases/the-benefits-of-high-cholesterol/

"most studies of old people have shown that high cholesterol is not a risk factor for coronary heart disease. This was the result of my search in the Medline database for studies addressing that question.2 Eleven studies of old people came up with that result, and a further seven studies found that high cholesterol did not predict all-cause mortality either.

Now consider that more than 90 % of all cardiovascular disease is seen in people above age 60 also and that almost all studies have found that high cholesterol is not a risk factor for women.2 This means that high cholesterol is only a risk factor for less than 5 % of those who die from a heart attack."

QuoteCholesterol is a marker, often cholesterol is a symptom of inflammation that causes the liver to produce more cholesterol.

http://www.westonaprice.org/modern-diseases/the-benefits-of-high-cholesterol/

"High cholesterol may therefore reflect mental stress, a well-known cause of high cholesterol and also a risk factor for heart disease. Again, high cholesterol is not necessarily the direct cause but may only be a marker. High cholesterol in young and middle-aged men could, for instance, reflect the body's need for more cholesterol because cholesterol is the building material of many stress hormones."

High cholesterol may be a symptom of many things and is sometimes actually associated with better outcome, although causality cannot be established.

"Consider the finding of Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University, who reported in 1994 that old people with low cholesterol died twice as often from a heart attack as did old people with a high cholesterol.1"

"six of the studies found that total mortality was inversely associated with either total or LDL-cholesterol, or both. This means that it is actually much better to have high than to have low cholesterol if you want to live to be very old."

"in 19 large studies of more than 68,000 deaths, reviewed by Professor David R. Jacobs and his co-workers from the Division of Epidemiology at the University of Minnesota, low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases.3

Most gastrointestinal and respiratory diseases have an infectious origin. Therefore, a relevant question is whether it is the infection that lowers cholesterol or the low cholesterol that predisposes to infection? To answer this question Professor Jacobs and his group, together with Dr. Carlos Iribarren, followed more than 100,000 healthy individuals in the San Francisco area for fifteen years. At the end of the study those who had low cholesterol at the start of the study had more often been admitted to the hospital because of an infectious disease.4,5 This finding cannot be explained away with the argument that the infection had caused cholesterol to go down, because how could low cholesterol, recorded when these people were without any evidence of infection, be caused by a disease they had not yet encountered? Isn"t it more likely that low cholesterol in some way made them more vulnerable to infection, or that high cholesterol protected those who did not become infected? Much evidence exists to support that interpretation."

"those who had low cholesterol at the beginning of the study were twice as likely to test postitive for HIV compared with those with the highest cholesterol.6

Similar results come from a study of the MRFIT screenees, including more than 300,000 young and middle-aged men, which found that 16 years after the first cholesterol analysis the number of men whose cholesterol was lower than 160 and who had died from AIDS was four times higher than the number of men who had died from AIDS with a cholesterol above 240."

And this study:

Lancet. 2001 Aug 4;358(9279):351-5.

"Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36)."

"We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) in elderly people."

4.65 mmol/L = 180 mg/dl

Cholesterol, in some cases, may also increase due to diet alone and may not be a bad thing.

Int J Clin Pract Suppl. 2009 Oct;(163):1-8, 28-36.

"The degree to which serum cholesterol is increased by dietary cholesterol depends upon whether the individual's cholesterol synthesis is stimulated or down-regulated by such increased intake, and the extent to which each of these phenomena occurs varies from person to person. Several recent studies have shed additional light on the specific interplay between dietary cholesterol and cardiovascular health risk. It is evident that the dynamics of cholesterol homeostasis, and of development of CHD, are extremely complex and multifactorial. In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated."

For instance, when I went ZERO carb and ate only protein and fat, my cholesterol went wayyyy up but so did my HDL and my Cholesterol:HDL ratio remained perfect, so did my LDL:HDL despite the fact that LDL also increased. Triglycerides having shown to be a causal agent in CHD, mine went wayyyyyyyyy down, under normal range. C-Reactive protein remained very low and there were no symptoms of inflammation whatsoever based on blood test results or how I felt and outward symptoms. Cholesterol was very high and yet everything indicated that my risk of CHD had actually gone down, my HDL being VERY high and triglycerides being very low.

QuoteYou 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.

Am J Cardiol. 1999 Aug 1;84(3):339-41, A8.

"The goal at study onset in 1985 had been to achieve a total serum cholesterol of <150 mg/dl, the level seen in cultures where coronary artery disease is virtually absent.3"

His focus seems to be heart disease, indeed. He believes that by just lowering cholesterol to under 150, heart disease will be halted, reversed and prevented when clearly, he does more than just lower cholesterol in his interventions (lowers refined carbs, for instance) which could account for results.

QuoteThe 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.

Can you please cite source from where you get these numbers?

QuoteCompare 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.

True but this was mostly in men (180 out of 198) and a bunch of factors were manipulated so that we cannot pinpoint what exactly led to these findings. Was it the low fat, exclusion of refined carbs or animal protein, the lack of caffeine or fructose but doesn't fruit contain fructose?? What's the point of a study like this if we cannot find out what exactly caused what? And why would I adhere to such a diet when any of these components could prove to have no relationship to the outcomes and be something that could enhance my quality of life and overall health perhaps?

QuoteThe 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.

"First, and quite compelling, is that 89% of patients were willing to make a substantial lifestyle transition to plant-based nutrition and sustain it for an average of 3.7 years (for some patients up to 13 years). "

In the previous study, after 5 years, 75% adhered and by 10 yrs, 50%. After that, it fell even more, to 6 out of 22 (27%). Who's to say that eventually some of them in the new study won't also stop eating this way?

QuoteOne 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.

In other words, you are saying dietary fat constricts blood vessels and clogs the arteries when...

Lipids. 2008 Jan;43(1):65-77

"Overweight men and women with atherogenic dyslipidemia consumed ad libitum diets very low in carbohydrate (VLCKD) (1504 kcal:%CHO:fat:protein = 12:59:28) or low in fat (LFD) (1478 kcal:%CHO:fat:protein = 56:24:20) for 12 weeks."

"Total saturated fatty acids and 16:1n-7 were consistently decreased following the VLCKD."

From full study...

"Two recent studies demonstrated that consumption of a diet higher in saturated fat resulted in lower circulating palmitic acid (16:0) in cholesteryl ester compared to a diet low in saturated fat [3, 4], a paradox likely explained by the level of carbohydrate [5] whose increase is known to be associated with de novo fatty acid synthesis [6] and decreased fatty acid oxidation."

"We have previously described a comparison between a very low carbohydrate diet (VLCKD) and a low fat diet (LFD) in subjects with features of metabolic syndrome. A notable finding was an inverse relationship between dietary and plasma saturated fatty acids (SFA). The VLCKD, with three-fold greater dietary SFA than the LFD, showed a consistently greater reduction in plasma SFA compared to the LFD [7]."

"Most striking, we reported that despite a three-fold higher intake of dietary saturated fat during the VLCKD compared to the LFD, circulating saturated fatty acids in TAG and CE were significantly decreased, as was 16:1n-7, an endogenous marker of lipogenesis. There were profound changes, as well, in other fatty acids in circulating TG, PL, and CE fractions (Tables 2–4)."

"In the context of hypocaloric diets, we showed that reducing dietary total and saturated fat only had a small effect on circulating inflammatory markers whereas reducing carbohydrate led to considerably greater reductions in a number of proinflammatory cytokines, chemokines, and adhesion molecules. These data implicate dietary carbohydrate rather than dietary fat as a more significant nutritional factor contributing to inflammatory processes"

"In this study, the VLCKD resulted in concurrent reductions in both 16:0 and 16:1n-7 in both TG and CE lipid fractions despite an increase in dietary saturated fat load. The significant reduction in dietary saturated fat in the LFD led to little decrease in total saturates and essentially no change in 16:1n-7, with one subject actually showing a drastic increase. The greater decrease in circulating SFA in response to carbohydrate restriction may have contributed to the larger decline in several inflammatory markers that are regulated by NF-κB [10, 11]. The decrease in circulating saturated fatty acids on the VLCKD is likely due to greater oxidation of the saturated fat from both diet and endogenous lipolysis, and a reduction in de novo lipogenesis."

BMJ. 2003 Oct 4;327(7418):777-82.

"These findings do not support associations between intake of total fat, cholesterol, or specific types of fat and risk of stroke in men."

Nutr Metab (Lond). 2006; 3: 24.

"carbohydrate restriction leads to an improvement in atherogenic lipid states in the absence of weight loss or in the presence of higher saturated fat."

Am J Clin Nutr. 2010 Mar;91(3):535-46.

"A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD."

Nutrition. 2012 Feb;28(2):118-23.

"Results and conclusions about saturated fat intake in relation to cardiovascular disease, from leading advisory committees, do not reflect the available scientific literature."

BMJ 2013;347:f6873

"An influential Swedish health organisation has recommended a diet that is low in carbohydrates but not low in fat for people who are overweight or obese or have diabetes.

The advice from the Swedish Council on Health and Technology Assessment is the result of a two year review of 16 000 scientific studies of diet. The recommendation contradicts the generally held belief that people should avoid foods that are rich in fat, especially those high in saturated fat."

"The council, which advises the Swedish healthcare system, concluded that the scientific evidence did not support a low fat diet. Instead people should focus on reducing their intake of carbohydrates."

QuoteHe also encourages the small use of flax or chia seeds for omega 3 intake.

Of which less than 10% or less actually makes it into EPA and/or DHA.

Proc Nutr Soc. 2006 Feb;65(1):42-50.

"However, alphaLNA-feeding studies and stable-isotope studies using alphaLNA, which have addressed the question of bioconversion of alphaLNA to EPA and DHA, have concluded that in adult men conversion to EPA is limited (approximately 8%) and conversion to DHA is extremely low (<0.1%). In women fractional conversion to DHA appears to be greater (9%)"

QuoteYou 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.

But, just based on these studies, you can't tell what exactly you need to do without having to compromise on other things which might have nothing to do with heart disease. The studies would have been more informative had one factor just been changed, say a decrease in all refined carbs ONLY, nothing else. Perhaps, the same results would have been found. I refuse to make so many changes, not knowing what exact change will be beneficial and what other changes either make no difference at all or can actually make me healthier and increase my quality of life and the pleasure I get out of eating. This study, as far as I'm concerned, is totally useless as it reveals nothing concrete and specific. It remains too vague.

QuoteMy 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.

All we have on paper (published) is those 198 patients and those other 22 or 24 patients of which 89% (176 people) and eventually 27% (6 people) adhered to the diet, respectively after an average of 3.5 yrs and after 10 yrs. Nothing else. Your original assertion of hundred(s) in 3 decades is not supported by these publications. Those 1000 folks you speak of, we first need to see actual results on paper to properly evaluate. Also, as I explained earlier, there are too many variables so one cannot establish specific cause and effect.

QuoteI simply stated what has been shown to work.

And what has been shown to work in MOSTLY men, in a small sample of individuals, is a host of things that were modified all at the same time. Far from conclusive.

QuoteBut 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.

Despite the fact that over time (decades), the lack of fats and animal protein could possibly lead to nutrient deficiencies. You could still perhaps have a much improved quality of life and health over what you have now if you had included some things that you avoid and which might have no incidence on heart disease outcome.

QuoteFor 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.

With those types of studies, we will NEVER have an answer. We need randomized controlled trials where only one variable is changed.

QuoteI agree, but did you read the article I linked to?  Quite a fascinating story (http://arstechnica.com/science/2016/04/sweet-drug-clears-cholesterol-reverses-heart-disease-and-was-found-by-parents/) and the substance is already approved for use.

The evidence for it working comes from studies on MICE and in-vitro studies. Until it has actually been tested in humans, we cannot conclude anything. The treatment in the twins did not cure the illness (Niemann-Pick type C disease (NPC) but improved it and the illness is quite different from the condition of heart disease which is not necessarily caused by cholesterol accumulating in arteries but rather to initial inflammation in that area triggering cholesterol to deposit in that area to try and improve situation. This drug would not address the source of the problem but rather the factor that actually tries and helps improve the situation. Not good!

http://www.cbn.com/cbnnews/healthscience/2013/february/forget-cholesterol-inflammations-the-real-enemy/?mobile=false

"Dr. Beverly Teter, a lipid biochemist at the University of Maryland, studies how the different kinds of fat in food affect our health.

Teter said scientists wrongly blamed cholesterol for heart disease when they saw high levels of it at a damaged blood vessel. Teter believes the body put the cholesterol there to fix the problem, which was actually caused by inflammation.

"It's the inflammation in the vessels that start the lesion," she explained. "The body then sends the cholesterol like a scab to cover over it to protect the blood system and the vessel wall from further damage."

Research also shows cholesterol can protect against respiratory and gastrointestinal problems, and helps create vitamin D. People with higher cholesterol live longer.

Teter said that's a scientific fact that she can vouch for personally.

"I come from a family that has, my mother's side, had naturally high cholesterol. Her cholesterol was between 380 and 420 when I started watching her medical records, and she died at 97," she said. "So I don't think that cholesterol was too bad for her."

http://www.sott.net/article/242516-Heart-surgeon-speaks-out-on-what-really-causes-heart-disease

"Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped."

Quote from: WendyA on April 09, 2016, 02:26:09 AM
FrancisAnn I came across an interesting study (http://www.ncbi.nlm.nih.gov/pubmed/20820038) by Dr. Walter Willett the chair of the department of nutrition at Harvard School of Public Health that shows certain low-carbohydrate diets are associated with higher all-cause mortality and certain low-carbohydrate diets are associated with lower all-cause mortality.  Thought you might be interested.

These prospective cohort studies where a host of confounding variables can account for difference in outcomes aren't reliable for concluding anything.

In this study, low carb is considered to be around 40% of the diet comprising of carbs. I wouldn't call this low carb. I consider 5-15% at most, a low carb diet.

There were more smokers among those eating the more predominant animal based diet (because vegetable based low carb diet still ate animal foods, up to 13% and 17% of animal protein and fat, respectively compared to 18.5% and 26% for animal based low carb), 32% vs 30% for women, 14% vs 9% in men. BMI was also slightly higher in that group, 25 vs 24 for women, 27 vs 26 for men which could suggest those with the higher BMI tended to be more genetically intolerant to carbs (and have a predisposition, it would have been interesting to compare family history of diabetes in both groups).

Also, those in the animal predominant diet tended to be less active, 3.0 to 3.1 in women and especially in men, 16 hours vs. 20 hours. There was more multivitamin use in the vegetarian based diet, in men, 44% vs 39%.

To resume,

some factors were not controlled for (history of diabetes/CHD/cancer in family) while men in this cohort which ate predominantly meat vs those who ate predominantly vegetables were less likely to take multivitamins, had a slightly higher BMI (suggesting a higher intolerance to carbs despite eating less carbs 35 vs 40%), were less active and more likely to be smokers.

35-40% is also NOT low carb, this is a joke!

I urge anyone, before jumping to conclusions, to read the entire study in detail. When one does that, one has a clearer and more precise idea of the relevance of findings.  In this study, the difference in mortality could have been due to factors other than animal foods, owing to less overall physical activity, more smoking, a genetic predisposition, higher vitamin and mineral concentrations, increased PROCESSED meat consumption (red meat was grouped together with processed meat although both are clearly different, this was higher in "animal" diet) etc. No definite conclusion can be made from this study. Again!

Gosh, such research. I'm impressed. I worry more over my nails more than worrying over food but I eat well & never any junk food at all. I've been on the Atkins way of eating for a year & one half & feel very good. If you guys ever want some delicious pancakes try this: 2 eggs, 2 oz of cream cheese, a splash of baking powder, mix well, wait 5 minutes for the batter to thicken, bake like any pancakes, DELISH & only 2 carbs. Have fun.

I have to admit I can't keep up with your brand of OCD and your ability to continue to argue points I thought I had already agreed to or ceded.  :)

Quote from: KayXo on April 09, 2016, 10:39:49 AM
High cholesterol may be a symptom of many things and is sometimes actually associated with better outcome, although causality cannot be established.

Agreed.

Quote from: KayXo on April 09, 2016, 10:39:49 AM"Consider the finding of Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University, who reported in 1994 that old people with low cholesterol died twice as often from a heart attack as did old people with a high cholesterol.1"

Maybe this stat is buried in their study (represented by the 1), but the results and conclusion published for this study didn't come close to saying one group died twice as often as another group. 

Quote from: KayXo on April 09, 2016, 10:39:49 AM
Lancet. 2001 Aug 4;358(9279):351-5.

"We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) in elderly people."

This is the exact type of study you find repulsive because of the confounding factors and lack of details.  Since in modern medicine a doctor trying to lower your cholesterol almost always equates to giving the patients drugs or high dose supplements I think their conclusion might be spot on.

Quote from: KayXo on April 09, 2016, 10:39:49 AM
Int J Clin Pract Suppl. 2009 Oct;(163):1-8, 28-36.

"The degree to which serum cholesterol is increased by dietary cholesterol depends upon whether the individual's cholesterol synthesis is stimulated or down-regulated by such increased intake, and the extent to which each of these phenomena occurs varies from person to person. Several recent studies have shed additional light on the specific interplay between dietary cholesterol and cardiovascular health risk. It is evident that the dynamics of cholesterol homeostasis, and of development of CHD, are extremely complex and multifactorial. In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated."

I didn't think you were a big fan of quoting Opinion pieces.

Quote from: KayXo on April 09, 2016, 10:39:49 AM
For instance, when I went ZERO carb and ate only protein and fat, my cholesterol went wayyyy up but so did my HDL and my Cholesterol:HDL ratio remained perfect, so did my LDL:HDL despite the fact that LDL also increased. Triglycerides having shown to be a causal agent in CHD, mine went wayyyyyyyyy down, under normal range. C-Reactive protein remained very low and there were no symptoms of inflammation whatsoever based on blood test results or how I felt and outward symptoms. Cholesterol was very high and yet everything indicated that my risk of CHD had actually gone down, my HDL being VERY high and triglycerides being very low.

The numbers look positive and I wish you well.  But unless you misspoke above about ZERO carbs which equates to zero plants then depriving yourself of all of those phytonutrients doesn't seem to be a beneficial long term plan.
 

Quote from: KayXo on April 09, 2016, 10:39:49 AM
Am J Cardiol. 1999 Aug 1;84(3):339-41, A8.

"The goal at study onset in 1985 had been to achieve a total serum cholesterol of <150 mg/dl, the level seen in cultures where coronary artery disease is virtually absent.3"

His focus seems to be heart disease, indeed. He believes that by just lowering cholesterol to under 150, heart disease will be halted, reversed and prevented when clearly, he does more than just lower cholesterol in his interventions (lowers refined carbs, for instance) which could account for results.

If he just believed getting cholesterol to <150 mg/dl alone would do the trick he would be like most every other doc and push high dose statins heavy from the beginning. True, all his interventions may be the key.  He may (I have no idea) argue that his interventions are all geared to reducing cholesterol naturally by reducing inflammation. 

For informational purposes. His current focus for his heart patients is diet intervention first with an emphasis on eating exclusively plants, no processed crap including all oils, minimize or eliminate added sugars. no high fat plant foods including all nuts, he does allow flax and chia seeds and he has a special push for these heart patients to eat 6 servings a day of plants that will aid in the production of nitric oxide the body's main vasodilator.  Even though the blockages aren't elminated, by increasing nitric oxide his heart patients are able be free of their anigina due to increased blood flow. The specific list of plants he recommends to increase nitric oxide is asparagus, bok choy, swiss chard, kale, collards, collard greens, beets, beet greens, mustard greens, turnip greens, napa cabbage, brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula. If you top these with vinegar that will also aid in the creation of nitric oxide. One other current caveat is no smoothies. Part of the biological process for creating nitric oxide in your body is actually chewing the food. Then if required he does use some low dose drugs.

Quote from: KayXo on April 09, 2016, 10:39:49 AMCan you please cite source from where you get these numbers?

The statin info on absolute benefits came from TheNNT (http://www.thennt.com/) and the risk assessment for those with coronary artery disease came from here (http://eurheartj.oxfordjournals.org/content/ehj/early/2013/12/17/eurheartj.eht533.full.pdf?maxtoshow=&hits=20&RESULTFORMAT=1&andorexacttitle=and&fulltext=electronic&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT).

Quote from: KayXo on April 09, 2016, 10:39:49 AM
True but this was mostly in men (180 out of 198) and a bunch of factors were manipulated so that we cannot pinpoint what exactly led to these findings. Was it the low fat, exclusion of refined carbs or animal protein, the lack of caffeine or fructose but doesn't fruit contain fructose?? What's the point of a study like this if we cannot find out what exactly caused what?

I see how this is frustrating to you.  At the time he was a full time surgeon and the patients he that were referred to him from cardiologists at the Cleveland Clinic were essentially the walking dead.  He was about 55 and was convinced by the science at the time that a plant based diet was the way to go so he took a big swing and the results for those that stuck with it were amazing.

"Was it the low fat, exclusion of refined carbs or animal protein, the lack of caffeine or fructose but doesn't fruit contain fructose??"  I don't know, one thing or all of them in synergy? I think I should point out here that maybe I should call this a very low fat diet since 99.9% or more of the studies out there think 30% of calories from fat is "low fat" and the participants in those studies rarely get below 35%.  Also in reference to fruit / fructose he takes his cue from the Dr. Lustig from the University of California, San Francisco School of Medicine who did the primary research into sugar and its effects on the body.  Dr. Lustig says that the fructose in whole fruit is bound with the fiber and causes no harm.  Besides increasing nitric oxide by chewing another reason he doesn't want smoothies is because with today's high speed blenders the fiber gets quickly processed and the fructose ends up in more of a free state.

Quote from: KayXo on April 09, 2016, 10:39:49 AM
And why would I adhere to such a diet when any of these components could prove to have no relationship to the outcomes and be something that could enhance my quality of life and overall health perhaps?

If you don't have the anxiety over a family history of heart disease or actually have current active symptoms of heart disease no reason you would.  Especially when you consider the Blue Zones, those places on earth that have the longest living populations.  For a time the Okinawans of Japan had the most folks living to 100.  Their diet was primarily plant based, 60% of calories from purple and orange sweet potatoes, but they had less than 10% of their calories from animal products.  The Adventists in Loma Linda, California currently the longest lived group, vegetarians but for their members that partake of meat is as a side dish or condiment, less than 10% of their calories from animal products.  Sardinia, Italy Plant based, meat is usually reserved for Sunday or special occasions, but they drink Goat's milk and eat pecorino cheese made from grass-fed sheep.

So all three groups are plant based with occasional meat in their diet.  Beyond a predominately plant based diet they all seem to a have the following shared attributes - strong family, don't smoke, physically active, socially engaged.  When you find out exactly which part of their culture is responsible for their long lives let me know.

Quote from: KayXo on April 09, 2016, 10:39:49 AM

QuoteOne 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.

In other words, you are saying dietary fat constricts blood vessels and clogs the arteries when...

No. I wasn't talking about clogging arteries. I was talking about fat in the blood stream restricting the ability of blood vessels to dilate (http://www.sciencedirect.com/science/article/pii/S0021915000004159).  When a heart patient is already suffering from angina caused by already clogged arteries anything that restricts the blood flow further increases discomfort.

Quote from: KayXo on April 09, 2016, 10:39:49 AMDespite the fact that over time (decades), the lack of fats and animal protein could possibly lead to nutrient deficiencies.

It is humorous how many folks use the guise of concern for nutrient deficiencies to try and make some sort of point.  I know you have been paying attention and know that I get plenty of fat and we have already discussed that B12 needs to be supplemented.  The folks you should be concerned with are the masses in this country that eat the standard American diet. They are already suffering from a lack of many nutrients that you can't get in a french fry or a pizza sauce.  Additionally many are suffering from an excess of fat.  Regardless of what caused it that should concern us all.

Quote from: KayXo on April 09, 2016, 10:39:49 AMYou could still perhaps have a much improved quality of life and health over what you have now if you had included some things that you avoid and which might have no incidence on heart disease outcome.

There is no way I could have a much improved quality of life and health over what I have now,  but I understand your point.

Quote from: KayXo on April 09, 2016, 10:39:49 AMThe evidence for it working comes from studies on MICE and in-vitro studies. Until it has actually been tested in humans, we cannot conclude anything.

I never said you could conclude anything. I said it was a fascinating article.  Sometimes you are quite myopic.

Quote from: KayXo on April 09, 2016, 10:39:49 AMThis drug would not address the source of the problem but rather the factor that actually tries and helps improve the situation.

I agree.  How would you suggest we address the source of the problem?

Quote from: KayXo on April 09, 2016, 10:39:49 AM
"Dr. Beverly Teter, a lipid biochemist at the University of Maryland, studies how the different kinds of fat in food affect our health.

Teter said scientists wrongly blamed cholesterol for heart disease when they saw high levels of it at a damaged blood vessel. Teter believes the body put the cholesterol there to fix the problem, which was actually caused by inflammation.

"It's the inflammation in the vessels that start the lesion," she explained. "The body then sends the cholesterol like a scab to cover over it to protect the blood system and the vessel wall from further damage."

I agree and have implied such twice now. 

Quote from: KayXo on April 09, 2016, 10:39:49 AM"I come from a family that has, my mother's side, had naturally high cholesterol. Her cholesterol was between 380 and 420 when I started watching her medical records, and she died at 97," she said. "So I don't think that cholesterol was too bad for her."

Seems like an acceptable case study of one.

Quote from: KayXo on April 09, 2016, 10:39:49 AM"Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped."

Yup!

Quote from: WendyA on April 10, 2016, 07:45:07 AM
I have to admit I can't keep up with your brand of OCD

Not very nice, especially considering you are doing just the same as me and indeed "keeping up". You are taking this to a personal level. I am simply arguing with you on matters relating to nutrition and health. Nothing more. Let's keep this civil. Thanks.

QuoteMaybe this stat is buried in their study (represented by the 1), but the results and conclusion published for this study didn't come close to saying one group died twice as often as another group.

In table 3 on page 4 of the article, men and women with the highest cholesterol levels, above 240 mg/dl (in the highest tertile) died twice as less (2.4% vs. 5.1-5.2 % in men, 2.1% vs. 4.5-5.0 % in women) from coronary heart disease.

QuoteThis is the exact type of study you find repulsive because of the confounding factors and lack of details.

Indeed, it is of the associative type from which we can draw no conclusions but which warrants further studies of the randomized controlled type. They are useful insomuch as they are followed by more stringent, controlled studies. If not, if we continue doing the same type of study over and over again, then there is really no point and it seems much of what you base yourself upon is of these types of studies and not "more" controlled.

QuoteSince in modern medicine a doctor trying to lower your cholesterol almost always equates to giving the patients drugs or high dose supplements I think their conclusion might be spot on.

There is no point in lowering your cholesterol in any which way, in my opinion based on everything I read so far. Unless one suffers from familial hypercholesterolemia, perhaps, which is something else entirely.

QuoteI didn't think you were a big fan of quoting Opinion pieces.

Opinions with supporting evidence.

QuoteThe numbers look positive and I wish you well.  But unless you misspoke above about ZERO carbs which equates to zero plants then depriving yourself of all of those phytonutrients doesn't seem to be a beneficial long term plan.

The Inuits barely, if at all, ate any plants and despite this, survived living in the Arctic (no easy task) for tens of thousands of years. To survive, you had to hunt, manufacture tools, think of ways to trap and kill animals, go through extended periods of famine, endure the harsh weather. A unhealthy, malnutritioned, fatigued individual, could not have withstand such conditions and survived for so long. Their population should have gone extinct long ago but their survival shows plants are not needed. I read many books, from beginning to end, written by explorers who lived with them for years and reported their eating habits. I can provide you the references of one in particular, if you want. Plant matter in their diet is practically non-existent as you'll see.
 

QuoteIf he just believed getting cholesterol to <150 mg/dl alone would do the trick he would be like most every other doc and push high dose statins heavy from the beginning.

Perhaps, he believed statins alone could not do this and that lowering intake of dietary cholesterol would also be needed.

Quotehe has a special push for these heart patients to eat 6 servings a day of plants that will aid in the production of nitric oxide the body's main vasodilator

QuoteThe specific list of plants he recommends to increase nitric oxide is asparagus, bok choy, swiss chard, kale, collards, collard greens, beets, beet greens, mustard greens, turnip greens, napa cabbage, brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula. If you top these with vinegar that will also aid in the creation of nitric oxide.

Is there even direct, causal evidence for this in human beings? Have you looked at the evidence yourself?

QuoteThen if required he does use some low dose drugs.

In the first study he reported, cholesterol lowering medications were prescribed to everyone.

Quote"Was it the low fat, exclusion of refined carbs or animal protein, the lack of caffeine or fructose but doesn't fruit contain fructose??"  I don't know, one thing or all of them in synergy?

Hence, we've learned absolutely nothing from his studies.

QuoteI think I should point out here that maybe I should call this a very low fat diet since 99.9% or more of the studies out there think 30% of calories from fat is "low fat" and the participants in those studies rarely get below 35%.

I never understood cutting fat. It has not been shown to cause health problems and even associations are lacking. Makes no sense to me. Sugars do seem to be much more the culprit.

QuoteAlso in reference to fruit / fructose he takes his cue from the Dr. Lustig from the University of California, San Francisco School of Medicine who did the primary research into sugar and its effects on the body.  Dr. Lustig says that the fructose in whole fruit is bound with the fiber and causes no harm.

Today's fruits are not those fruits we were exposed to thousands of hundreds of years ago, which were much less sweet, more fibre-dense and especially more nutritious. They have been genetically modified, made to be sweeter and less nutrient dense. Let's not forget that.

QuoteIf you don't have the anxiety over a family history of heart disease or actually have current active symptoms of heart disease no reason you would.

High animal fat intake has not been shown to cause heart disease. To cut it out of one's diet for this reason makes no sense at all. I watch my carb intake as I believe the science in favor of this is much more solid. I also stay away as much as possible from junk food and trans-fats.

QuoteEspecially when you consider the Blue Zones, those places on earth that have the longest living populations.  For a time the Okinawans of Japan had the most folks living to 100.  Their diet was primarily plant based, 60% of calories from purple and orange sweet potatoes, but they had less than 10% of their calories from animal products.  The Adventists in Loma Linda, California currently the longest lived group, vegetarians but for their members that partake of meat is as a side dish or condiment, less than 10% of their calories from animal products.  Sardinia, Italy Plant based, meat is usually reserved for Sunday or special occasions, but they drink Goat's milk and eat pecorino cheese made from grass-fed sheep.

Associations. It couldn't be perhaps genetics or the environment they lived in or the fact that they ate very little sugar, etc. No...it MUST be the plants. These reports don't reveal anything interesting to us, we remain in the dark about what caused these people to live so long and simply speculate. Not scientific at all. The Masai people in Africa also are very healthy despite eating mostly their animal's blood, milk and meat. What about the French, and the Swiss eating plenty of animal foods, rich in fat and suffering much less of heart disease. In old age Inuits, in the past, no heart disease or western civilization diseases were noted despite them living on nothing but animal food. Same with several African populations eating a high fat animal diet. There are plenty of instances where we can find opposing evidence so that eventually what we notice is the one thing they all have in common is how little sugars they consumed over their entire lives and how there was no processed foods.

QuoteNo. I wasn't talking about clogging arteries. I was talking about fat in the blood stream restricting the ability of blood vessels to dilate (http://www.sciencedirect.com/science/article/pii/S0021915000004159).  When a heart patient is already suffering from angina caused by already clogged arteries anything that restricts the blood flow further increases discomfort.

"The standardized high-fat meal consisted of whipping cream, liquid chocolate and non-fat dry milk"

Are you serious? This is your high fat meal? Very natural indeed. I'm curious why they didn't instead feed them eggs with butter or a fatty chunk of meat? Would results have been different?

QuoteIt is humorous how many folks use the guise of concern for nutrient deficiencies to try and make some sort of point.  I know you have been paying attention and know that I get plenty of fat and we have already discussed that B12 needs to be supplemented.  The folks you should be concerned with are the masses in this country that eat the standard American diet. They are already suffering from a lack of many nutrients that you can't get in a french fry or a pizza sauce.  Additionally many are suffering from an excess of fat.  Regardless of what caused it that should concern us all.

I am discussing with you about your diet and expressed concerns. We aren't discussing the typical diet and situation of American people.

QuoteThere is no way I could have a much improved quality of life and health over what I have now

You could be surprised.

QuoteSometimes you are quite myopic.

Let's keep this civil, Wendy. Thank you. :)

QuoteSeems like an acceptable case study of one.

My point is: there are mixed findings where sometimes high cholesterol is associated with no problems, sometimes with, sometimes low cholesterol is associated with problems, sometimes, not. It's all over the place.

Quote from: KayXo on April 10, 2016, 03:15:55 PMThere is no point in lowering your cholesterol in any which way, in my opinion based on everything I read so far. Unless one suffers from familial hypercholesterolemia, perhaps, which is something else entirely.

If as you have stated or implied high inflammation causes higher cholesterol production so the body can deal with the inflammation.  Then a goal of lowering cholesterol, by way of eating foods that combat inflammation seems to be something you might agree with.

Quote from: KayXo on April 10, 2016, 03:15:55 PMIs there even direct, causal evidence for this in human beings? Have you looked at the evidence yourself?

I have.  Nitric Oxide wasn't even discovered until 1992 and won the discoverer the Nobel prize in 1998.

Here are some studies covering this.
Chemical synthesis of nitric oxide in the stomach from dietary nitrate in humans. (http://gut.bmj.com/content/40/2/211.abstract)
Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial. (http://www.ncbi.nlm.nih.gov/pubmed/22019438)
Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers. (http://www.ncbi.nlm.nih.gov/pubmed/24120618)
Whole beetroot consumption acutely improves running performance. (http://www.ncbi.nlm.nih.gov/pubmed/22709704)

Quote from: KayXo on April 10, 2016, 03:15:55 PMIn the first study he reported, cholesterol lowering medications were prescribed to everyone.

This makes little difference since cholesterol lowering medications have such a small real percentage of effect on future cardiac events.  Still I'm not sure we know how many patients in the first study took drugs, it could well be all of them. 

"The original cohort contained 1 woman and 23 men, all nonsmoking, nondiabetic, and nonhypertensive patients with severe, angiographically demonstrated coronary artery disease.
...
Cholesterol-lowering medication was individualized. The only goal was to achieve and maintain a total serum cholesterol of 150 mg/dl."

Quote from: KayXo on April 10, 2016, 03:15:55 PMHence, we've learned absolutely nothing from his studies.

We have learned if you have heart disease and follow his protocol you have the best chance compared to any other currently tested protocol of not experiencing another cardiac event.

Quote from: KayXo on April 10, 2016, 03:15:55 PMI also stay away as much as possible from junk food and trans-fats.

A wise move.  Are you aware of how much trans-fat (https://ndb.nal.usda.gov/ndb/nutrients/report?nutrient1=605&nutrient2=&nutrient3=&fg=13&fg=1&fg=4&fg=15&fg=17&fg=10&fg=5&fg=7&max=25&subset=0&offset=0&sort=c&totCount=1361&measureby=m) you may actually be consuming?

Quote from: WendyA on April 12, 2016, 04:30:35 AM
If as you have stated or implied high inflammation causes higher cholesterol production so the body can deal with the inflammation.  Then a goal of lowering cholesterol, by way of eating foods that combat inflammation seems to be something you might agree with.

Lowering inflammation rather than lowering cholesterol would be the goal, yes. From what I read so far, too much sugar in the diet leading to overstimulation of insulin can lead to inflammation. 

QuoteChemical synthesis of nitric oxide in the stomach from dietary nitrate in humans. (http://gut.bmj.com/content/40/2/211.abstract)

This shows that after ingestion of potassium nitrate, nitric oxide concentration in the stomach significantly increased. I see no mention of its increase in the plasma. So what? This actually was and is sometimes used as food preservatives for meats. Yay for meats?! Nitrates are used abundantly in processed meats. I eat mine with celery extract.

QuoteFlavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial. (http://www.ncbi.nlm.nih.gov/pubmed/22019438)

Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers. (http://www.ncbi.nlm.nih.gov/pubmed/24120618)

Good studies. :) Thank you. BUT, while it may improve endothelial function and blood pressure, foods may come with some drawbacks (high fructose, pesticides, oxalates, etc.) so whether the end result is favorable or not, who knows? Just thinking of all possible factors.

QuoteWhole beetroot consumption acutely improves running performance. (http://www.ncbi.nlm.nih.gov/pubmed/22709704)

In this study, it is noted the potential harm of nitrates but perhaps those studies done in animals or those in humans where the process of intoxication was topical may not apply. It's still a controversial subject, I haven't really explored this subject much. So while something can be good, it must be weighed against its bad, both the good and bad be measured accurately and well enough so that we are certain of its benefits and risks in human beings.

The findings are not that impressive, in my opinion but still show a slight advantage, indeed. Beets like spinach contain oxalate and this may not be so good (i.e. gout, kidney stones).

QuoteThis makes little difference since cholesterol lowering medications have such a small real percentage of effect on future cardiac events.  Still I'm not sure we know how many patients in the first study took drugs, it could well be all of them. 

"The original cohort contained 1 woman and 23 men, all nonsmoking, nondiabetic, and nonhypertensive patients with severe, angiographically demonstrated coronary artery disease.
...
Cholesterol-lowering medication was individualized. The only goal was to achieve and maintain a total serum cholesterol of 150 mg/dl."

"Six nonadherent patients were released within the first 12 to 18 months of the study, and they returned to standard care. By 1998, these patients, who initially had levels of angiographic and clinical disease equivalent to those of the adherent patients, had sustained 13 new cardiac events. The remaining 18 patients adhered to the study diet and medication for 5 years."

Also

"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%).14 One patient admitted to the study with <20% left ventricular output died from a ventricular arrhythmia just weeks after the 5-year follow-up angiogram had confirmed disease regression."

Again, I wonder. If 18 patients adhered for up to 5 years, why were only 11 going through the angiographic analysis? What happened to the remaining 7? Also, despite treatment, one died.

QuoteWe have learned if you have heart disease and follow his protocol you have the best chance compared to any other currently tested protocol of not experiencing another cardiac event.

So far, low carb studies are showing great potential in reversing and arresting heart disease. His protocol is full of different variables that were changed and manipulated. I would not follow it not knowing what exactly helped and what didn't and could be included in a healthy diet. Why would I eliminate certain things like fats if this study is unable to show exact cause and effect? It makes no sense. This study only showed that when you modified several factors, in MOSTLY men, that things improved over the 5-12 yr span. Nothing else. It would especially be useful to know what lowered risk exactly. Like I said, his studies are absolutely useless. I would never cut all this out of my diet not knowing why exactly risk lowered. It could well be that the reduction in refined carbs and juices alone was responsible so why do all the rest of the stuff? Say only A out of A, B, C, D, E, F, G lowered risk but that all the other factors which were also changed in the diet had no effect and actually improved my quality of life and pleasure. I would be depriving myself of those unnecessarily because of a poorly made study. This is why I say it's useless.

QuoteA wise move.  Are you aware of how much trans-fat (https://ndb.nal.usda.gov/ndb/nutrients/report?nutrient1=605&nutrient2=&nutrient3=&fg=13&fg=1&fg=4&fg=15&fg=17&fg=10&fg=5&fg=7&max=25&subset=0&offset=0&sort=c&totCount=1361&measureby=m) you may actually be consuming?

http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Trans-Fats_UCM_301120_Article.jsp#.Vw050jDhA2w

"Small amounts of trans fats occur naturally in some meat and dairy products, including beef, lamb and butterfat. There have not been sufficient studies to determine whether these naturally occurring trans fats have the same bad effects on cholesterol levels as trans fats that have been industrially manufactured."

As I pointed out before, high or low cholesterol on its own is not the problem.

Adv Nutr July 2011 Adv Nutr vol. 2: 332-354, 2011

"There are 2 predominant sources of dietary trans fatty acids (TFA) in the food supply, those formed during the industrial partial hydrogenation of vegetable oils (iTFA) and those formed by biohydrogenation in ruminants (rTFA), including vaccenic acid (VA) and the naturally occurring isomer of conjugated linoleic acid, cis-9, trans-11 CLA (c9,t11-CLA)."

"Some epidemiological studies suggest that a positive association with coronary heart disease risk exists between only iTFA isomers and not rTFA isomers. Small clinical studies have been conducted to establish cause-and-effect relationships between these different sources of TFA and biomarkers or risk factors of CVD with inconclusive results. The lack of detection of treatment effects reported in some studies may be due to insufficient statistical power. Many studies have used doses of rTFA that are not realistically attainable via diet; thus, further clinical studies are warranted."

"Further research is needed to determine the health effects of VA and c9,t11-CLA in humans."

It's important to differentiate between the different forms of trans-fats.