Got Heart Disease?
Is Heart Disease Preventable and even reversible based on dietary choices?
In 1900, the leading cause of death for Americans was infectious diseases such as pneumonia and tuberculosis. Back then, the average life expectancy for Americans was only 47 years. Medical advances in the early 20th century significantly reduced the threat of such diseases and Americans began living longer. By 1930, life expectancy had increased to age 60. As people began living longer, the leading cause of death for Americans shifted to heart disease, and so it remains. Today, heart disease is the leading cause of death for both men and women: about every 60 seconds, an American dies from a heart disease-related event. [1]
“Heart disease” is an umbrella term that designates various conditions which affect the heart’s structure and function. When most people inquire about “heart disease” they often mean “coronary heart disease” (clogged arteries), which is the most common type.
Our conventional understanding about the burgeoning epidemic of heart disease is that, as medical advances conquered infectious diseases in the early 20th century, people started living longer, which “opened the door” for heart disease. Indeed, the incidence of heart disease does increase exponentially with age: the risk of an 85-year-old man having a heart attack is 25 times that of a 45-year-old. But, a longer life, in and of itself, does not cause coronary heart disease: over 80% of coronary heart disease (CHD) cases, and 80% of sudden cardiac deaths (heart attacks), are related to diet [2], and therefore preventable.
In the last section of this article below, we will explore some of the leading independent research on diet and heart disease. For context on that research, and why this analysis focuses on independent (non-corporate funded) research, we’ll first explore the rising prevalence and increasing costs of heart disease in America.
Cardiovascular disease isn’t just the #1 killer in America– it’s also America’s costliest disease, with a 2016 price tag of $555 billion. A 2017 study [3] conducted by RTI International on behalf of the American Heart Association determined that over the next decade, the costs of cardiovascular disease (CVD) will exceed $1Trillion with nearly half of all Americans developing cardiovascular disease conditions, including:
High Blood Pressure………………………….123.1 million
Coronary Heart Disease ………………………24.0 million
Stroke……………………………………………..11.2 million
Congestive Heart Failure………………………..8.8 million
Atrial Fibrillation………………………………….7.2 million
In addition to the staggering toll on Americans’ health, the RTI report estimates the increasing direct and indirect financial costs of CVD: the direct costs are the medical expenses for treating heart disease, and the indirect costs are those incurred in lost productivity in the home and/or workplace.
The report estimates that on average, an employee with CVD costs their employer nearly 60 hours in lost productivity per year compared to an employee without CVD. Lost productivity is predicted to increase the most for individuals at age 45-64. And while white Americans will incur the highest overall losses in productivity, the report suggests that lost productivity will more than double among Black Americans and triple among Hispanics, as Blacks and Hispanics are disproportionately impacted by CVD.
As well, in terms of direct costs, medical expenses related to CVD are expected to triple over the next 20 years among Hispanics and more than double among Blacks compared to Whites. For elderly Americans, medical expenses related to CVD will more than double among those aged 65-79, and more than triple among those age 80 and over.
As mentioned above, the RTI report concludes that by 2030 about half of all Americans will have some form of CVD, with total medical expenses and indirect costs exceeding $1Trillion.
The medical expenses included in the staggering $1 Trillion in estimated costs for CVD are all related to medical treatment, including drug treatment. No estimated costs (or savings) are included for preventionprograms. A useful corollary of the RTI report, then, would be an equally rigorous, comparative analysis of the positive health impacts, lives saved, and ROI on improved productivity by investment in prevention versus treatment. Indeed, in their final report, the American Heart Association mentions “prevention” only once and in the very last section of their report, with no substantive elaboration.
In fact, there is substantive, independent (non-corporate funded) research which finds that over 80% of coronary heart disease (CHD) cases, and 80% of sudden cardiac deaths (heart attacks), are related to diet [4], and therefore preventable.
Before sampling the research on prevention of heart disease, it will be useful to clarify the term “prevention”. The Harvard School of Public Health distinguishes three categories of prevention [5] for heart disease: secondary, primary and primordial prevention.
starts after someone has a heart disease-related event such as a heart attack or stroke, to prevent a second event. It involves taking medications such as cholesterol-lowering statins and beta blockers to reduce blood pressure– and recommendations for lifestyle changes in diet and fitness.
aims to keep an individual who already exhibits markers of heart disease such as inflammation, atherosclerosis, and endothelial dysfunction from having a first heart disease-related event. As with secondary prevention, primary prevention involves taking medications such as cholesterol-lowering statin and beta blockers to reduce blood pressure– and recommendations for lifestyle changes in diet and fitness.
Primordial prevention works to prevent the development of related conditions as inflammation, atherosclerosis, and endothelial dysfunction through proper diet and other lifestyle factors.
Whether the goal is to avoid escalation of existing risk factors for heart disease, as in Primary and Secondary Prevention– or to avoid development of such risk factors altogether as in Primordial Prevention– in cases related to lifestyle choices, diet is the causal agency in all categories of prevention. I.e., in cases related to lifestyle choices, medicines such as statins and beta blockers work to manage the symptoms of CVD, whereas diet works to reduce and/or reverse, or obviate the risk factors. [6]
In a peer-reviewed paper [7] published in the Journal Family Practice, researchers followed a cohort of 198 consecutive patients with established cardiovascular disease (CVD). The patient group was interested in transitioning to whole-food plant-based nutrition as an adjunct to usual cardiovascular treatment. Participants were adherent if they eliminated dairy, fish, and meat, and added oil.
After 3.7 yrs, the researchers found that 99.4% of adherent patients had avoided major cardiac events. 93% experienced improvement or resolution of symptoms during the follow-up period, including 22% who were available to document disease reversal with radiographic or stress testing results.
Given that cardiovascular disease is the number one killer of Americans, these are significant and quite compelling results. In their closing remarks the researchers conclude that:
If “cardiovascular disease is a disease of western malnutrition”, what does the independent (non-corporate-funded) research reveal about the role of dairy in western malnutrition?
The research has well established that saturated fat intake is associated with increased concentration of serum cholesterol, and that serum cholesterol concentrations are associated with CHD and CVD [8]. And that dairy-based foods are the leading source of saturated fat in the standard Amercian diet [9]. Saturated fat makes up about 60% of the fat in cow’s milk, and about half the calories in milk are derived from fat– and it goes up from there:
Fat’s Share of Calories in Dairy Products
*Note: the 2% milk label is misleading; it is a calculation by the weight of the products.
Milk labeled “2%” still gets 34 percent of its calories from fat.
[Source: Whitewash: Keon, J. (2010) Book. BC, Canada: New Society Publishers.]
Researchers at Harvard University published a recent study [10] in The American Journal of Clinical Nutrition which investigated the relationship between dairy fat intake and onset of cardiovascular diseases, such as heart disease and stroke. The researchers analyzed detailed information about the dietary and lifestyle activities of more than 220,000 health professionals (from the Health Professionals Follow-Up Study, the Nurses’ Health Study, and the Nurses’ Health Study II) over several decades.
The study revealed that regular consumers of dairy-based foods such as whole milk, yogurt, butter, cheeses, and cream have about the same risk of heart disease as consumers of so-called “junk foods” that contain high amounts of refined carbohydrates and sugars. However, researchers found that when dairy fat was replaced with the same number of calories from vegetable fat or polyunsaturated fat, the risk of cardiovascular disease dropped by up to 24%. And replacing the same number of calories from dairy fat with healthful carbohydrates from whole grains was associated with a 28% lower risk of cardiovascular disease.
“Clean” (plant-based) Fats and Proteins lower the risk of CVD.
In addition to saturated fat, cow’s milk and other dairy-based foods also contain trans fatty acids (trans fats). Trans fats are a form of unsaturated fat that occur naturally in dairy-based foods, and are also artificially produced in foods such as hydrogenated fish oils and other hydrogenated oils. Multiple studies have linked consumption of trans fats to heart disease, inflammation, higher “bad” LDL cholesterol and lower “good” HDL cholesterol levels [11]
A study [12] of trans fats published in the American Journal of Clinical Nutrition assessed the cardiovascular health effects of replacing trans fats with dietary stearic acid (non-hydrogenated soybean oil). The study found that intake of trans fats should be reduced as much as possible because of its adverse effects on lipids and lipoproteins. And that the replacement of trans fats with soybean oil in foods that require solid fats reduces LDL (bad) cholesterol, which is the primary target for CVD risk reduction.
The studies cited above show that the adverse impacts of saturated dairy fat and trans fats to coronary heart disease is well established in the independent (non-corporate-funded) research.
Recent independent research has also investigated the impacts of animal-based proteins such as the proteins in dairy-based foods on cardiovascular disease as well.
For example, a 2016 study [13] published in JAMA Internal Medicine examined the risks of all-cause and cause-specific mortality for a variety of food sources of animal-based protein, including dairy-based foods. As well, the study contrasted mortality rates for animal-based proteins vs plant-based proteins. The researchers analyzed 32 years of dietary data from 2 large US cohort studies (including over 130,000 participants from the Health Professionals Follow-up Study and the Nurses’ Health Study).
The study revealed that after adjusting for other dietary and lifestyle factors, animal protein intake was clearly associated with a higher risk for cardiovascular disease (CVD) mortality. Conversely, higher plant protein intake was associated with lower all-cause and CVD mortality. Further, the researchers observed that the substitution of plant protein for animal protein was associated with a lower risk for mortality.
In summary, the independent (non-corporate-funded) research proves that the saturated fats [14], trans fats [15] and proteins [16] in dairy-based foods are all linked to increased risk of cardiovascular disease. That, as Mike Rayner, Professor of Population Health at Oxford University observed, “saturated dairy fat is at the very top of the danger hierarchy for cardiovascular disease and strokes.” Thus, given dairy-based foods is the leading source of saturated fat in Amercians’ diets, and that cardiovascular disease is the number one killer of Americans, Doctors Against Dairy conclude that the consumption of dairy-based foods is the leading cause of mortality in Americans.
And further, given the exponential increases in deaths and healthcare costs projected for cardiovascular disease [17] in America, the replacement of dairy-based fats and proteins with plant-based fats and proteins would positively impact those trends [18] and should become a matter of urgent public policy for the USDA and Depts of HHS and be appropriately reflected in the US Dietary Guidelines for Americans.
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Melonie Heron, PhD, “Deaths: Leading Causes for 2014,” National Vital Statistics Reports, US Dept of Health & Human Services, Centers for Disease Control & Prevention, June 30, 2016, https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_05.pdf
Disease Prevention, “Preventing Heart Disease,” The Nutrition Source, Harvard TH Chan, School of Public Health, https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/
RTI International, “Cardiovascular disease costs will exceed $1 Trillion by 2035,” RTI International, February 14, 2017, https://www.rti.org/news/cardiovascular-disease-costs-will-exceed-1-trillion-2035
Disease Prevention, The Nutrition Source
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Caldwell B. Esselstyn, Jr., MD, “Updating a 12-Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology),” The Cleveland Clinic Foundation, Cardiohub.org, March 23, 1999, http://cardiohub.org/wp-content/uploads/2015/04/updatingA12Year1.pdf
CB. Esselstyn, Jr; G Gendy; J Doyle; M Golubic; MF Roizen, “A Way to Reverse CAD?,” US National Library of Medicine National Institutes of Health, July 2014, https://www.ncbi.nlm.nih.gov/pubmed/25198208?report=abstract
Y Yokoyama; SM Levin; ND Barnard, “Association between plant-based diets and plasma lipids: a systematic review and meta-analysis,” PubMed.gov, US National Library of Medicine, National Institutes of Health, September 1, 2017, https://www.ncbi.nlm.nih.gov/pubmed/28938794
Epidemiology and Genomics Research Program, “Top Food Sources of Saturated Fat Among U.S. Population, 2005-2006,” National Cancer Institute, Division of Cancer Control & Population Sciences, April 20, 2018, https://epi.grants.cancer.gov/diet/foodsources/sat_fat/sf.html
Mu Chen;, Yanping Li; Qi Sun; An Pan; JoAnn E Manson; Kathryn M Rexrode; Walter C Willett; Eric B Rimm; Frank B Hu, “Dairy fat and risk of cardiovascular disease in 3 cohorts of US adults,” American Journal of Clinical Nutrition, American Society for Nutrition, November 2016, https://academic.oup.com/ajcn/article/104/5/1209/4564387
CM Oomen; MC Ocké; EJ Feskens; MA van Erp-Baart; FJ Kok; D Kromhout,“Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population based study,” US National Library of Medicine National Institutes of Health, March 10, 2001, https://www.ncbi.nlm.nih.gov/pubmed/11253967
J Edward Hunter; Jun Zhang; Penny M Kris-Etherton, “Cardiovascular disease risk of dietary stearic acid compared with trans, other saturated, and unsaturated fatty acids: a systematic review,” American Journal of Clinical Nutrition, Oxford Academic, January 2010, https://academic.oup.com/ajcn/article/91/1/46/4597175
Mingyang Song, MD, ScD; Teresa T. Fung, ScD; Frank B. Hu, MD, PhD; et al, “Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality,” JAMA Internal Medicine, JAMA Network, October 2016, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2540540
Y Yokoyama; SM Levin; ND Barnard, PubMed.gov
J Edward Hunter; Jun Zhang; Penny M Kris-Etherton, American Journal of Clinical Nutrition
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RTI International, RTI International
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