Fat Free/Vegetarian Theory of Heart Disease

[123xyz]

My comments in red.

The idea of avoiding fat and animal products is flawed and will lead to malnourishment. This has not been proven for Esselstyn protocol, which features the plant diet with no added oils. On the other hand, those patients using Esselstyn's protocol were not reported as presenting malnourishment symptoms anytime during the 12 year study.

Most now agree that man evolved for a few million years on a diet consisting of meat (and fat), fish and some plants. No bread, no rice, no pasta, no cereals. This is believed by some practitioners of the Religion of Evolution. Practitioners of other religions believe that man was a created being and that he was a created thousands (not millions) of years ago and that he was first created as a plant eater and the consumption of animal flesh came later. Different strokes for different folks. In any event, the particulars of one's belief system are irrelevant to a scientific critique of Esselstyn's study.

Read the Frammingham study, it's massive and has been running for years and shows the correlations between dietary fat (including sat) are low with heart disease. This therefore shows that Esselstyn's idea of removing animal products and reducing fat intake to 10% is totally unnecessary. Given the risks of undernourishment it's not wise to do so. That is the bulk of his protocol and its wrong, his model of heart disease is flawed. His model may be flawed but not his clinical results. His patients probably cared little about the model but cared greatly about the results. Esselstyn's protocol may be unnecessary but it certainly was sufficient. The Framingham study also showed that nobody had heart attacks when their total cholesterol was 150 or less.

Here's another study. In this one women were asked to decrease total fat intake, increase fruit and veg intake, and increase grains. The womens health initiative 2006 trial, involving 48 835 people. Method was: Intensive behavior modification in group and individual sessions designed to reduce total fat intake to 20% of calories and increase intakes of vegetables/fruits to 5 servings/d and grains to at least 6 servings/d. The comparison group received diet-related education materials. Conclusion: Over a mean of 8.1 years, a dietary intervention thatreduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk. This was the WHI of NIH study reported in 2006 in JAMA. The devil is in the details, as some of the Vitamin C studies have revealed. In the WHI study, those on the "low fat" diet actually ended up getting 29% of daily calories from fats/oils (according to Esselstyn) while the others got a little more. Not really much distinction. The main conclusion is thus not surprising. However, in any case, to extrapolate the WHI conclusion to an Esselstyn protocol wherein 10% of calories are derived from fat is not legitimate. Extrapolations can be done over ranges of a couple percent but not over ranges of a factor of 2 or 3. The secondary WHI conclusion that "more focused diet interventions...........may be needed" has some legitimacy as Esselstyn has proved.

I'd love to hear what Esselstyn's theory is on why he gets the handful positive results. My theory is that his patients will have lowered BG levels, lower adipose tissue, lower insulin requirements leading the more C being available as well as other factors such as increase magnesium intake. They probably have lowered LP(A) and lower risk of clots. What's his theory? That fat causes heart disease? How? By "clogging" the arteries? The point is that his protocol does have some benefits. But there are far too many drawbacks. All because of Esselstyn's misguided idea that dietary fat is causing or is linked to heart disease due to some outdated 1950's schoolboy theory on cholesterol. The diet could be far better. From what I can tell, Esselstyn asserts that his protocol simply restores the health & integrity of the endothelium as a whole and that when total cholesterol, driven by diet, is below 150, people don't have heart attacks. Perhaps not exactly theory but certainly defendable observation. His cardiac PET scans, which demonstrated remarkable blood flow restoration after just a few weeks on his protocol, are not ignorable. I'll leave it to the theoreticians to explain why. It certainly is possible/probable that his protocol could be improved but it was sufficient (if not necessary) to get some good results. And the "drawbacks" did not seem to present any reported issues in his patients over the duration of the 12 years.

It seems to me you've just gone and bought the low fat T-shirt and don't want to have to buy some butter when you next go shopping. Irrelevant comment that does nothing to buttress your claims.

[Cobraman]

Just a thought I had while reading this thread. Current opinions on why edta chelation works is that by chelating out lead and other harmful heavy metals and toxins the endothelium of the vessels heal, become more resiliant and flexible, allowing greater circulation to occur. This theory would then maintain that arterial hard plaque is not removed, but just made to be less of an issue. This talk of Esselsten, of which I am not familiar, may have some value no matter which side of the fence you lie on. Plants in general do not have the calcium that animal protein does. Modern diets have plenty of calcium in them so that supplemention of calcium is at least a waste and may be detrimental w/o appropriate amounts of Mg, vit d, vitamin K. Now if the E diet is somewhat deficient in calcium the body will draw on its stores of calcium, including that which is w/in the arterial plaque. Perhaps this is where some of the positive results of this diet occur. Also this may be a way to increase the healing capabilities of Chelation and other modalities. Just thinking like a "mechanic" as one of our posters has talked about.

This may seem out there to some, but when I do gum surgery w/ a laser, if some of the tartar on the root surface has not been removed it is not an issue if it has been sterilized by the laser energy. The body will, in fact, use this calcium(from the tartar, aka calculus) as a graft for new bone creation. If the tartar were not sterile, no new attachment to the tooth would occur and therefore no new bone growth would occur.

[Donjman]

There is little meat to your argument. Still I will respond. My comments in red

This has not been proven for Esselstyn protocol, which features the plant diet with no added oils. On the other hand, those patients using Esselstyn's protocol were not reported as presenting malnourishment symptoms anytime during the 12 year study.

Esselstyn didn't test for nutrient deficiencies and other disease rates. As I've mentioned numerous times, people following his diet regime will most likely suffer from various vitamin/mineral deficiency simply because their diet doesn't contain the adequate amounts even by the RDA's standard eg Iron and B12. How on earth can you argue that a diet without iron/b12 won't leave someone deficient in iron or b12? People will have to supplement, the diet isn't optimal.

This is believed by some practitioners of the Religion of Evolution. Practitioners of other religions believe that man was a created being and that he was a created thousands (not millions) of years ago and that he was first created as a plant eater and the consumption of animal flesh came later. Different strokes for different folks. In any event, the particulars of one's belief system are irrelevant to a scientific critique of Esselstyn's study.

Evolution isn't a religion. Your point is irrelevant, you're confusing belief and faith (religion) with fact (evolution). Our ancestors consumed meat (and fat), fish and some plants. No bread, no rice, no pasta, no cereals.

His model may be flawed but not his clinical results. His patients probably cared little about the model but cared greatly about the results. Esselstyn's protocol may be unnecessary but it certainly was sufficient.

Correct his method is flawed, a small handful of people got better eating lots of vegetables and avoiding trans fat. The other parts to his diet are drawbacks and unnecessary.

The Framingham study also showed that nobody had heart attacks when their total cholesterol was 150 or less.

No it doesn't it shows that CVD events were lowered,probably due to the fact that people with such low cholesterol levels have received aggressive treatment from cardiologists that will reduce heart attack risk.

Statins do have some positive effects such as lowering inflammation, lowering CRP, slight anti clotting effects, some antioxidant effects, this is where any lowering of CVD risk has come form. They also have a huge amount of negative effects.

Back the Frammingham results'

It also shows that these "lucky" people in the sub 150 group have nearly DOUBLE the total mortality from all causes.

The exact stats are;

CVD risk for 140-199 is around 30-35 people per 10,000 men

CVD risk for sub 140 is around 25 people per 10,000 men

Total death for 140-199 is around 180-190 per 10,000 men

Total death for sub 140 is around 310 per 10,000 men

This was the WHI of NIH study reported in 2006 in JAMA. The devil is in the details, as some of the Vitamin C studies have revealed. In the WHI study, those on the "low fat" diet actually ended up getting 29% of daily calories from fats/oils (according to Esselstyn) while the others got a little more.

The data I have read for the study says 20% cals as fat. Where has the figure of 29th come from?

The main conclusion is thus not surprising. However, in any case, to extrapolate the WHI conclusion to an Esselstyn protocol wherein 10% of calories are derived from fat is not legitimat

You'd expect that such a large reduction in fat (from 39% to 20%) would bring about some positive changes though would you not? But nothing. I wonder what's so magical about the 10% figure

From what I can tell, Esselstyn asserts that his protocol simply restores the health & integrity of the endothelium as a whole and that when total cholesterol, driven by diet, is below 150, people don't have heart attacks. Perhaps not exactly theory but certainly defendable observation.

His idea is that a reduction in dietary fat (like the extreme measures in his diet plan) and a reduction in total cholesterol (with an added statin!) bring about the reduction in cardiovascular incidents.

Cholesterol is an antioxidant. It's logical to assume that people who have elevated chlolesterol levels suffer from significant oxidative stress, this would be due to poor diet, smoking etc. This is the reason that high cholesterol can correlate occasionally with CVD risk. Correlation does not equal causation. It's almost like saying someone is suffering from a cold, and they have an elevated white cell count, ergo white cells cause colds. It's faulty logic that has been proven wrong time and time again.

He's totally off the mark with a large amount of his diet advice, it will lead to undernourishment and increase disease risk.

Why is it the inuit tribes had no observable cardiovascular disease when their populations were studied in the past? Considering they ate a plant free carbohydrate free diet of fish and fat. It doesn't make sense and you know it.

Why is there a French paradox?

Why is it that the frammingham study proves him wrong? Researchers showed in 1987 after data analysis that for over 50's there is no releationship between total cholesterol levels and cardiovascular disease or total mortality/

What about the masai tribes studied and their low heart disease rates considering they eat up to 300 grams of animal fat per DAY?

What about pacific island populations (Pukapuka and tokelau islands)? Shown to eat very high sat fat diets (some 35% of daily calories) with average cholesterol levels of 240, next to no CVD observed in the populations.

Get your head of out of Esselstyn's book and do some thinking for yourself.

[Cobraman]

Donjman, well thought out, organized reply.

[Donjman]

Look at all of the things we know to deplete ascorbate;

Stress - Increase of ascorbate utilization, increase of blood sugar therefore a decrease of C uptake by cells
Being overweight - Increase of insulin levels due to insensitivity to insulin, increase in blood sugar levels therefore a decrease of C uptake by cells
Smoking - Direct decrease of C via oxidative stress
Diabetes - FAR greater risk of developing CVD, why? Higher BG levels leading to lowered vitamin C uptake and increase in urinary C.

Stress, overweight, smoking and diabetes, its classic risk factors for CVD

The things we know that lower CVD risk;

Exercise - More active, less adipose tissue, lower insulin requirements, lower blood glucose levels, more C uptake.
Eating fruits/veg - Directly contain ascorbate and other C sparing antioxidants
Lower weight and fat mass in general
Omega 3 supplements - Increase insulin sensitivity, lower adipose tissue, lower bg levels, increase C utilisation
Lower visceral fat - Visceral fat is has a direct correlation with insulin levels and thus BG levels. This is where the hip/waist ratio risk calculator fits in CVD risk, as it predicts insulin sensitivity (or lack of) and thus blood glucose levels levels and ascorbate utilisation.

Exercise, weight management, fruits/veg, don't smoke and low visceral fat, all of which increase asorbate utilisation and are guidelines to help with CVD.

Do you see how this fits generally into the theory? Rather than mindlessly perusing fat like Esselstyn when the evidence is the opposite to his theory.

Just some thoughts anyway


EDIT

One last point, the relationship with alcohol.

A small amount of alcohol in the diet does increase insulin sensitivity and thus lowers heart disease risk. A large amount does the opposite. This is where alcohol fits into the glucose/c antagonism theory and diet as a whole.