When someone “wins your heart,” they have captured your innermost being. Our hearts lend their shape to valentines, candy boxes, lockets, and so many other expressions of love, and when we are “heartsick,” we are devastated.
There is a good reason why the heart is central to so many expressions of emotion. At the center of your body, it transmits life to every part of you. It sends blood, rich in oxygen and nutrients, up to your brain, down to your toes, and everywhere in between, twenty-four hours a day, 365 days a year, never taking a vacation or even a little snooze.
Every time you take a step, your beating heart keeps you going. And when your step quickens, your heart does its best to keep up. If you’re good to your heart, you’ll have the energy to run, dance, and play with your children and grandchildren, and you’ll live longer, too.
Foods can do a lot more than trim our waistlines. If we let them work for us, they can have a dramatic effect on our health. In this chapter, we’ll focus on cardioprotection. This means more than taking care of your heart. It also means being good to the miles and miles of blood vessels that radiate out from it, carrying life and health deep into the tissues of your body.
Cardioprotection means defending yourself. If you’re in good shape now, I’ll show you how to stay that way. If you need a bit of help, let me show you the power of foods to restore health.
When I say “power,” I mean it. Let me share with you a message I received from a woman in Riverside, California. Her name is Ginny, and she approached me after a lecture. She was very worried. Her cholesterol hovered far above two hundred, and although she had already made some adjustments to her diet, she wasn’t getting very far. A future of heart disease was looming in front of her, and she was skeptical that a menu change would help enough to really matter. I suggested she give our approach a try. Shortly thereafter, she sent me this message:
I had tried for five years to lower my cholesterol with minimal success. I did not feel good on Lipitor and the oatmeal regimen was helping only moderately, moving my cholesterol down from mid 260s to high 240s. If you recall, I was moved to tears because I was so frustrated with my lack of success. You calmly suggested to try the low-fat vegan diet for 6 weeks and retest my lipids. After 2 and a half weeks, I retested with a 60 point drop to 183! Amazing! I am now a missionary for the powerful effects of the plant-based diet.
Each heartbeat propels blood into the aorta, the pipeline that rises from the top of the heart, giving off the arteries that go to the brain, then curves back downward to run along the front of your spine, eventually dividing to go down your right and left legs. Along the way, it sends arteries to your vertebrae, your internal organs, and most other parts of you.
If you could hop into a tiny submarine and cruise along from your heart through your blood vessels, you could see from the inside just how healthy they look. And you would notice something a bit odd. As the aorta descends and passes in front of the spine, yellowish streaks appear to be painted on the aorta wall. As your submarine driver, I can tell you that those streaks started appearing when you were a child in school. You cannot feel them, but they have been gradually growing.
You’ll also notice that in a few places, these yellowish streaks have thickened up into raised patches. Some have actually started to cover the points where the aorta gives off a branching artery. Checking the anatomical chart we’ve brought along, you ask, “Where’s the artery to my lumbar spine?”
“Covered over when you were nineteen years old,” I reply.
“What? How does my spine get blood?” you ask, wondering if this has anything to do with the backaches you’ve been getting lately.
“There are other branches,” I reply. “You’ve lost one or two, but some others are still open. They allow blood to detour around the blockage, at least to an extent.”
I notice that you do not look reassured. Some outflow points where arteries branch off are still visible; others are narrowed, and some have been completely paved over. Inspecting the side arteries, we see that many have the same streaks and thickened walls, narrowing the passage of blood.
“But I’m still young, more or less,” you protest. “These arteries look like I’ve got one foot in the grave!”
Surprising, isn’t it?
The year before I went to medical school, I had a job as an autopsy assistant at Fairview Hospital in Minneapolis, Minnesota. The hospital morgue was in the basement, and nobody ever visited the place unless they had to. The phone was a heavy black model that had not been replaced since the 1940s. The walls were the color of algae. But that drab and deadly quiet environment gave me an education. For most people, the idea of a stroke or colon cancer is just a vague theoretical notion. But if you are the person who runs the skull saw or who holds a colon tumor in your hand, these things become very graphic.
One day a man died in the hospital of a massive heart attack. Our job was to examine the body. The pathologist cut through the skin then, using what looked like a garden clipper, cut through each of the ribs. He removed a large pie-wedge-size section of the chest wall, setting it on the table next to the body. That exposed the heart. Knowing that I was headed for medical school, he made sure I saw everything.
“These are called coronary arteries,” he said, “because they crown the heart.” Slicing one open, he pointed out atherosclerotic plaques. “Feel them,” he said. I did, and it was frightening. The plaques looked like bits of chewing gum stuck inside the artery, except that they were hard as concrete. And they weren’t just in the heart. They were in the carotid arteries to the brain, the arteries to the kidneys, and all up and down the aorta, the body’s main pipeline.
“That’s your morning bacon, Neal,” the pathologist said. “And this is your roast beef.” He wasn’t kidding. In America, heart disease starts in childhood, thanks to our meaty diets, and eventually kills half of us. It lurks in three-quarters of men by age twenty-three, the pathologist said—which happened to be exactly my age at the time.
After the examination, I carefully picked up the section of ribs from the table and put it back into the chest, sewed up the skin, and cleaned the table. Washing my hands, I went upstairs to the cafeteria. As I lifted the lid from the plate, what did I see but ribs staring back at me. It was an inverted chicken breast, whose exposed ribs looked and smelled very much like the body I had been working on. I stared at the meal, then put the lid back on. I simply couldn’t eat it.
As the pathologist told me, “heart disease” is really artery disease. It attacks many parts of your circulatory system simultaneously. And in countries where meat and dairy products are staples, it starts early.
The process begins as cholesterol particles enter the artery wall, causing the gradual buildup of fatty streaks, then plaques—small bumps that narrow the passageway for blood. If one of these plaques bursts open, it can trigger the clotting of blood, which ends up plugging the artery passage. In the coronary arteries, that loss of blood flow can mean the death of a whole section of heart muscle. This is myocardial infarction, or heart attack.
But the artery narrowing itself can cause serious problems, even if the plaques do not burst open and form clots. In the coronary arteries, narrowing leads to chest pain. Narrowed arteries to the legs cause leg pains, called claudication. Narrowed arteries to the genitals cause sexual dysfunction.
That’s right—in most cases, erectile dysfunction is a sign of clogged arteries. Diabetes, high blood pressure, and the medications used to treat them also contribute to impotence. Happily, a plant-based diet is good for all these conditions.
And here’s another surprise: The common back pain that comes from pinched nerves appears to start out as blocked arteries to the lower back. As the back loses its blood supply, the disks that act as cushions between the vertebrae become more and more fragile, and can eventually break. Like a broken pillow whose stuffing is exploding out, a herniating disk ends up pinching a nearby nerve, causing back pain.
Here’s how to protect your heart and your arteries.
When you eat animal fat, it causes your body to make more cholesterol. When I was a child, my mother cooked up bacon for her five children. She lifted the bacon strips out of the hot grease with a fork and set them on a paper towel to dry. Then she carefully lifted the pan and poured the hot grease into a jar to save it. But she did not bother to put the jar in the refrigerator. She simply put it on the shelf in the kitchen cupboard. She knew that, as bacon grease cools, it becomes a waxy solid. And the fact that bacon grease is a solid fat—as opposed to a liquid oil—is a sign that it is loaded with saturated fat—the kind of fat that causes your body to make more cholesterol.
Chicken fat, turkey fat, beef fat, pork fat—they are all waxy solids and are high in saturated fat. Dairy fat, too. You can’t pour cheese like an oil; you have to cut it with a knife. It is loaded with saturated fat.
Fish fats are not so different. While some fish are lower in fat and others (such as chinook salmon) are very high, they all contribute their load of fat and cholesterol. In other words, they are more like beef or chicken than they are like broccoli.
Of course, some people eat fish specifically because it has “good fats.” What they are thinking of are omega-3 fats, which are reputed to fight inflammation and prevent blood clots. Unfortunately, there are two problems with that thinking:
First, most of the fat in fish is actually not omega-3. All fats—including fish fats—are mixtures. From 15 to 30 percent of the fat in fish is plain old saturated fat, and most of the rest consists of various other types of fat with no health benefits at all. Their main effect is to pad your waistline, which is why salmon enthusiasts often have trouble with their weight.
Second, studies show that omega-3s may not have the health benefits people had hoped for. A detailed analysis in the British Medical Journal found that neither fish nor fish oils protect against cardiovascular disease, cancer, or death.1
In research studies, a switch from a beefy diet to a chicken-and-fish diet lowers LDL (“bad”) cholesterol only about 5 percent.2 For comparison, an entirely plant-based diet can cut LDL by 20 to 30 percent, or even more.3–4
So it is important to avoid animal fat. You will also want to steer clear of cholesterol. It may surprise you to learn that cholesterol is actually not the same as fat. Fat is the yellow layer under a chicken skin or the white stripes in marbled beef. But cholesterol is not visible. Cholesterol molecules hide in the membranes that surround each cell in an animal’s body, and most of it is in the lean portion. So if you take a bite of chicken, for example, there is fat under the skin and in between the muscle cells; the cholesterol lurks in the muscle cells themselves, packed into the cell membranes that surround each cell.
All animal products contain cholesterol. So it is in meats and dairy products, and you’ll find a mother lode of cholesterol in eggs and in shellfish, such as shrimp and lobster. Plants are different. When you look at the cholesterol content of vegetables, fruits, and other foods from plants, their labels indicate a big zero. If you set aside animal products, you are getting no animal fat and essentially no cholesterol. That simple change can mean a dramatic effect on your blood cholesterol test, and can help most people avoid the need for cholesterol-lowering medications.
Snack-food manufacturers sometimes use liquid oils, such as peanut or soybean oil, to cook potato chips and other snack foods. But these oils have a short shelf life; they turn rancid rather quickly. So to extend shelf life, some manufacturers use partially hydrogenated oils, sometimes called trans fats. By adding hydrogen atoms to oil molecules, the liquid oil turns into a waxy solid that has a buttery mouth-feel and a much longer shelf life. Unfortunately, partially hydrogenated oils won’t help your shelf life at all. They are similar to animal fats in their cholesterol-raising actions.
Because hydrogenated oils have come under fire in recent years, some manufacturers have switched to tropical oils, such as coconut or palm oil. They, too, are loaded with saturated fat, and are no better than animal fats.
It pays to keep all fats and oils to a minimum. Yes, olive oil is better for you than bacon grease. But remember, all fats are mixtures. Olive oil is mostly made of a kind of fat called monounsaturated fat. The name is not important; all that matters is that this sort of fat is in no way essential for the body. It is about 75 percent of the fat in olive oil, and it’s basically a source of concentrated calories. Another 11 percent is polyunsaturated fat, similar to the fat found in typical cooking oils (such as corn or soybean oil). This is mostly just concentrated calories, too.
So by now, you are no doubt on the edge of your seat wondering, What is the other 14 percent? Well, it turns out to be plain old saturated fat—the same cholesterol-raising, artery-clogging fat found in chicken fat, pork fat, and other less-than-healthful products.
So are there any “good” fats in olive oil? If you send a bottle to a laboratory to be analyzed, they will tell you that less than 1 percent of it is in the omega-3 form that can actually be called “good” fat. All the rest—well, it’s just there to fatten you up.
As I pointed out in chapter 2, this is not a “no-fat” program. Typical vegetables, fruits, and beans contain small amounts of natural fats—usually between about 5 and 10 percent of their calories. It is odd to think that there is a tiny bit of oil in a bean or a broccoli floret. But there is, and the body needs the traces of natural oils in plant foods.
Some people seek out additional fats in the form of walnuts or other nuts, seeds, or soy products, for example. So even without pouring any oils onto your salad or into your frying pan, you will get traces of natural oils in the foods you eat. And that is good. Skip the fatty foods and added oils, and the natural oils in vegetables, fruits, and beans will take care of themselves and you.
As you check food labels on commercial products, favor those with no more than two or three grams of fat per serving.
I often hear from people who have tried the simple methods we have suggested and who are amazed, not only at their results, but by how easy it all turns out to be. I received this e-mail message from Ronald, whose cholesterol had been well into the danger zone, at 210 mg/dL:
Four weeks from beginning this diet I had my cholesterol measured again. It was 153, a drop of about 25% in a month. Amazing! AND I have broken through a static position and have begun steadily losing weight again. It is EASY to lose weight this way. I can’t believe this; I would have done this sooner had I known.
So many people have gotten used to the idea that menu changes produce only weak results, because they haven’t tried a program that really works. And once they do, the results are often spectacular.
By now you know that a plant-based diet has a profound effect on cholesterol. And certain foods deserve special mention:
David Jenkins, MD, PhD, at the University of Toronto showed that foods alone could lower cholesterol levels nearly as well as cholesterol-lowering drugs.4 The trick was to start by omitting animal products, and then emphasize foods with known cholesterol-lowering ability: oats, barley, and soy products, for example. His patients cut their LDL (“bad”) cholesterol by nearly 30 percent in just four weeks.
When I was in medical school, the George Washington University Hospital sold cigarettes in its gift shop. I know this because I bought them. Lining up at the cash register for Merit Menthols, I often ran into my surgery attending physician, who was there to buy Marlboros.
We were not idiots; we knew we had to quit. But we naively figured we could get away with it for a while, and then quit when our lives were less stressful.
Happily, the hospital eventually stopped selling cigarettes and banned smoking altogether. The doctors’ lounge eventually aired out, and our lungs breathed a sigh of relief. But smoking affects more than your lungs. It accelerates atherosclerosis and all the problems that come with narrowed arteries—yes, that includes backaches and erectile dysfunction—and makes it much more likely that you could have a heart attack.
If you smoke, it does not really matter how you quit. What counts is that you do quit. Most people find that it is much more challenging to quit smoking than it is to change their diets. That was certainly my experience. I found it really tough to quit smoking, while changing my diet was really quite easy. But millions of people have succeeded, and you can, too.
Exercise doesn’t do much to lower your total cholesterol, but it can give a nice boost to HDL (“good”) cholesterol, which helps your body rid itself of cholesterol particles. Exercise also helps control blood pressure.
Dr. Atkins and other low-carbohydrate advocates suggested that rice and potatoes were dangerous, while steak and heavy cream were healthy foods. Many people took that advice to heart, only to pay a heavy price.
Jody Gorran, a Florida businessman, started a low-carbohydrate diet hoping to lose a few pounds. By coincidence, he happened to have a heart scan just before beginning the diet; it turned out to be totally clear, and his cholesterol was enviably low at 146 mg/dL. He began the meaty low-carb diet, secure in the belief that it could not hurt him.
But two months into the diet, his cholesterol shot up to 230. Even so, he stuck with the regimen, believing that, so long as he avoided carbohydrates, as Dr. Atkins advised people to do, he would be all right. Unfortunately, his cholesterol did not return to normal.
One day, out of the blue, crushing chest pain stopped him in his tracks. Arriving at the hospital, a cardiologist found a 99 percent blockage in a coronary artery. Although he had had a clean heart scan before starting the diet, he had developed a life-threatening artery blockage. Jody needed emergency heart surgery to save his life.
Happily, he got help in time, and stopped the unhealthful diet. He then switched to a plant-based diet, which was not only good for his waistline; it also returned his cholesterol to normal. Jody’s remarkable story was published as a case report in the Journal of the American Dietetic Association.7
It was once thought that heart disease was a one-way street. Once you had it, you had it for good. The idea was that heart disease was eventually going to kill you, in all likelihood. But with prescriptions and various surgical procedures, doctors could postpone the inevitable and keep you as comfortable as possible.
In 1990, that dismal scenario gave way to a dramatically different understanding. In chapter 1, I mentioned Dr. Dean Ornish, a visionary pioneer if ever there was one. When Dr. Ornish was a medical student, heart disease was the number one killer of Americans, just as it is today. Not content with conventional approaches that often required heroic and expensive surgery, chronic medication use, and a gradual surrender to disease, he began to study a lifestyle approach that directly addressed its causes.
Dr. Ornish’s program was simple. He used four steps: Starting with a vegetarian diet, he added mild exercise (a half-hour walk each day) and taught simple stress management techniques. Patients who smoked were encouraged to quit. And that was it. No drugs, no angioplasty, no stents—none of the invasive methods that are routine in cardiology today.
The program was simple, but his patients flourished. They lost weight quickly and, for the most part, permanently. Their chest pain was abolished. And when their arteries were examined by angiogram (a special X-ray of the heart), the results made medical history. Arteries that had been narrowed by advancing atherosclerosis finally began to reopen, so much so that the changes were clearly evident in 82 percent of patients in the first year. And as the years went by, their risk of any sort of heart complication was cut dramatically.3,8
Cardioprotection means more than just controlling your cholesterol. It is also essential to keep your blood pressure in a healthy range. Normal blood pressure is less than 120/80 mmHg.
High blood pressure isn’t just rough on your heart. It also contributes to strokes and is one of the biggest threats to your kidneys—something people tend not to think about until their doctors start talking about what it means to lose them.
So how do you control your blood pressure? Well, you already know that it helps to keep your sodium (salt) intake low. If you were to add up all the sodium in the foods you eat (which you can do by reading labels), you will want to aim for a sodium limit of about two thousand milligrams per day.
But let’s go a step further. It turns out that the diet changes that bring down your cholesterol do exactly the same thing for blood pressure. Here’s why:
First of all, as you lose weight your blood pressure drops, too. And the diet changes you are about to make are the perfect way to lose weight.
But there is more to it. When you avoid animal fat, your blood becomes less viscous—that is, it’s less “thick.” So it is more like water and less like grease, and that means that it flows more easily through your arteries.9
If we were to hop back into our microscopic submarine and go scooting around in your blood vessels, we would notice that your bloodstream seems much cleaner. If it was a bit like an oil slick before, much of that grease is now gone. Your blood flows more readily through the arteries and veins, and it’s not surprising that your heart does not have to push so hard to keep your blood moving.
The credit, of course, goes to the vegetables, fruits, and other plant foods you’re eating now, because they don’t carry the load of fat you were previously eating in meat, cheese, and so on. And for extra credit, vegetables and fruits are rich in potassium, which also helps lower blood pressure.
Researchers have found that plant-based diets reduce blood pressure quite quickly.10 Your blood pressure will likely start dropping within the first week of the Kickstart, and you should see significant results within six weeks or so, if not sooner.
Even so, remember that high blood pressure is dangerous. It is important to have your blood pressure checked, and if you are being treated with medications, do not stop them on your own. As your diet improves and your blood pressure comes under better control, you can work with your health care provider to reduce or discontinue your medications if and when the time is right.
Diabetes increases the risk of damage to the heart, and threatens the blood vessels to the eyes, the kidneys, and the extremities. People with diabetes lose about a decade of life, on average, compared with people without the disease. Most ultimately succumb to heart disease.
It does not have to be that way. Our research has shown that diabetes can be turned around.
When I was a child, my father specialized in diabetes treatment at the local clinic in Fargo, North Dakota. And I never once heard him say that a patient was cured. He and his patients were fighting a war of attrition, surrendering ever so slowly.
When I was a hospital intern, I shared my father’s pessimism about diabetes. Patients needed endless monitoring and medications, and most seemed to wind up with serious complications—heart disease, vision loss, kidney failure, and intractable neuropathic pain in their feet.
However, in recent years, my research team has developed and tested the new approach to diabetes that I mentioned earlier. Using a low-fat, entirely plant-based diet, many of our research participants improve dramatically. In some cases, you would never know they’d ever had the disease. We have presented our findings at many medical conferences and have published them in peer-reviewed journals.11,12,13,14,15 You will find the details in Dr. Neal Barnard’s Program for Reversing Diabetes. In the meantime, let me give you the short version:
Diabetes is a condition in which there is too much sugar in the blood. This sugar—glucose—is the main fuel for the body, as you know. The problem in diabetes is that glucose cannot get into the cells of the body where it belongs. Instead, it circulates in the blood at abnormally high levels, causing all sorts of problems.
In the most common form of diabetes—type 2 diabetes—the problem appears to start with the buildup of tiny fat particles inside the muscle cells—the intramyocellular lipid that interferes with insulin’s efforts to bring glucose into the cells, as we saw in chapter 3. A similar fat buildup occurs in the liver.
The three keys to choosing foods for diabetes are (1) avoiding animal products, (2) minimizing fats and oils, and (3) avoiding high-glycemic-index foods (as we saw in chapter 2). When people with type 2 diabetes improve their diets, their condition often improves dramatically, presumably because their cells are cleaning out some of that fat so insulin can work again.
This approach has gotten a great deal of attention in recent years, and many people have gotten in touch with our research team to let us know how it has worked for them. While more typical “diabetes diets” tend to produce weaker results, the combination of a vegan diet, minimizing fats, and going low-GI can be very powerful.
A healthy diet does not mean we will live forever. But we certainly can add years to our lives. And more important, we can really live during the time we have. Rather than being hobbled by extra weight and endless health problems, we can enjoy life.
Other researchers have identified so-called blue zones—places where people live extraordinarily long lives—a concept popularized by Dan Buettner in a National Geographic magazine cover story in 2005. Among these are Loma Linda, California; Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; and Nicoya Peninsula, Costa Rica. One of the traits common among residents of all of these places is a diet focusing on foods from plant sources, particularly legumes, rather than animal sources. They also avoid tobacco, exercise frequently, and maintain strong familial or social supports, which probably help them maintain these healthful choices.
So how many years can we add to our lives? Researcher Gary Fraser, MD, PhD, estimated that an overall healthy lifestyle, including a vegetarian diet, regular exercise, and avoiding tobacco, among other sensible choices, can extend life about ten years.16 And during those extra years and the decades preceding them, you can aim to have a much healthier life than many people have come to expect.
As we have seen, the same dietary changes that help us slim down are also good for our hearts and the rest of our bodies, too. I hope that, if you take good care of yourself and inspire your loved ones to do the same, you’ll be able to send one another valentines for many years to come.