Cardiovascular disease is no joke. When people hear this term, they hear heart attacks and stroke. When I hear it, I imagine all of the patients I’ve seen with all its manifestations, including erectile dysfunction, vascular claudication, angina, arterial thrombosis and embolism, as well as the classics, heart attacks and strokes. What many people fail to realize is that those who experience fatal heart attacks or strokes already had cardiovascular disease brewing inside of them for years, even decades. Autopsies done on young soldiers during World Wars already found signs of atherosclerosis. These are fatty deposits found in people’s arteries and can appear long before symptoms get more serious. We even have studies showing fatty streaks, atherosclerosis’ precursor, in young children. In some parts of the world, where they eat mostly whole plant foods, cardiovascular disease is unheard of. While in our modern and overfed societies, it’s one of our top killers.
Modern medical management is centered around symptom management. Some stabilize the atherosclerotic plaque, but don’t do a great job of reversing it. Other treatments are down-right invasive, with catheters, balloons and chests being sawed open so bypasses can be sown on. What if there was another way?
Firstly we can start by simply avoiding cardiovascular disease altogether. This isn’t some condition that is natural or that happens normally through aging. It is a food borne illness, caused by what we put into our mouths day in and day out. Some foods are highly inflammatory, and their impact on our blood vessels takes its toll over time. Anti-inflammatory diets, like a whole food plant-based diet, have been shown to not only reduce the risk of getting the disease, but in some cases, have even reversed it. This is no easy feat, since even our best medical treatments can’t accomplish this.
What Does The Science Say?
The scientific literature supporting claims that plant-based diets can reduce risks of having cardiovascular disease is growing exponentially. A few decades ago, we had case reports and expert opinions. Now, in 2022, we have prospective cohort studies spanning decades and systematic reviews and meta-analysis confirming what the anecdotes have been saying for years. Here’s a look at the body of evidence that has given the plant-based diet its claim to fame. The evidence is no longer « he said she said », but robust and well designed studies that have been reproduced over time and have made the plant-based diet’s powers almost irrefutable.
Specific Food Groups
Fruits and Veggies
In 2020, Zurban et al. published a systematic review and meta-analysis of 81 cohorts. This included over 4 million participants and looked specifically at consumption of fruits and veggies. The plant-based diet reduced the risk of developing cardiovascular disease by seven percent, coronary heart disease by 12 percent and stroke by 18 percent (Zurbau et al., 2020). They also showed a reduction in risk of death due to cardiovascular disease by 11 percent, coronary heart disease by 19 percent and stroke by 27 percent.
Legumes and Pulses
A systematic review and meta-analysis of cohort studies showed significant reductions of eight percent for cardiovascular disease risk, 10 percent for coronary heart disease risk, as well as nine percent reduction in risk of hypertension, and 13 percent reduced risk of obesity (Viguiliouk et al., 2019). Another meta-analysis of randomized controlled trials on the effects of pulses showed significant reductions in body weight (Kim et al., 2016), which may be due to improved satiety (feeling full longer), as demonstrated in another meta-analysis (Li et al., 2014).
Nuts and Seeds
There is substantial evidence to support effects on cholesterol reduction by regularly consuming nuts and seeds (Asbaghi et al., 2021). There is also evidence for cardiovascular risk reduction as demonstrated in a systematic review and meta-analysis of 19 cohort studies which showed a 15 percent reduced risk of cardiovascular disease and 18 percent reduced risk of coronary heart disease, as well as a 24 percent and 17 percent reduced risk of death due to coronary heart disease and stroke, respectively (Becerra-Tomas et al., 2019).
The science clearly shows that even in those not necessarily following a fully plant-based diet, there are still measurable benefits of simply increasing the amount of whole plants in your diet, whether it’s adding more fruits and veggies, beans, lentils and chickpeas, or nuts and seeds. Now, if you’re not already convinced that eating more plants is healthy, you drive a hard bargain, but I’ve got more studies. Not only do we have great studies on specific food groups, but also on plant-based diets as a whole.
Studying Plant-Based Diets
Quek et al. pooled together all cohort studies conducted (seven total, including a total of over 300,000 participants) that assessed associations between some measure of plant-based dietary pattern (including both vegetarian status, plant-based diet indices) and risk of cardiovascular disease (Quek et al., 2021). Not surprisingly, they found that greater adherence to an overall plant-based dietary pattern was associated with a 10 percent lower risk of cardiovascular disease, as well as an eight percent lower risk of death due to cardiovascular disease. There were only three cohorts which looked at healthy plant-based diets, and pooling together the data from those three showed a 13 percent reduced risk of cardiovascular disease, whereas the two cohorts which reported on unhealthy plant-based diets showed an 11 percent increased risk, although this was not statistically significant. What does this all mean? It means that vegan junk food, although theoretically plant-based, doesn’t reduce the risk of cardiovascular. Choose whole plants, not French fries and soda.
As an experiment, I wanted to explore PUBMED and see if I could find other studies that show benefits of plant-based diets on cardiovascular disease, other than the ones mentioned above. I stumbled upon this one which peaked my interest. This trial utilized a prospective, randomized, open‐label, blinded end point study design. It was a study that looked at cardiovascular disease in patients on a vegan diet and compared them to the American Heart Association diet. The 100 patients, who all had angiographically defined coronary artery disease, underwent 1:1 randomization to either a vegan diet or the American Heart Association (AHA) recommended diet. What I found most interesting about this study is not that it showed no difference in cholesterol levels, BMI or blood sugar control. The headline easily could’ve read « Vegan diet not better than American Heart Association Diet ». Instead it looked another valuable yet less talked about marker for cardiovascular disease, hsCRP. This protein is a marker of systemic inflammation, the kind that causes chronic inflammation that just so happens to be a risk for cardiovascular disease and a marker commonly used in medical practice to detect auto-immune conditions. This diet looked at 100 people, randomly divided between two groups, and measured weight, glycemic control, cholesterol and hsCRP. Now, since this was a study on secondary prevention, meaning that the participants already had cardiovascular disease, they were most likely already on medical treatment. If so, this explains that their metabolic parameters, like weight, cholesterol and glycemic control didn’t budge too much and remained similar even with different diets. Also, the study only had 100 patients, and maybe it wasn’t sufficiently powered to show small differences. Which is the exact reason that it’s impressive that even in these small groups, already on medical treatment, the researchers still found significant reductions in hsCRP, a potent marker of inflammation, in those on the vegan diet. Chronic inflammation is a risk factor for cardiovascular disease, auto-immunity, depression, pain and cancer. Significantly reducing inflammatory markers in 8 short weeks with a vegan diet is pretty damn impressive and shouldn’t be taken lightly. Although this study was a small interventional trial, with 100 participants over a 2 month period, it did make significant findings that reinforce the notion that well planned healthy vegan diets can play important roles in disease prevention and that this reduction in risk could possibly happen much sooner than we first thought. Although studies of this type are limited by their small numbers in comparison to observational cohort trials, as well as their short durations, the fact that they managed to show significance in a marker as important as hsCRP is still impressive.
Plant-Predominance Hides Behind Many Names
Many people hear plant-based diets and think vegan diet. In terms of health outcomes, when I hear plant-based, I really think plant-predominant, or even plant-focused. If you’re currently transitioning towards more plants, then consider yourself on a plant-forward diet. Many dietary patterns, like the Mediterranean Diet, the Portfolio Diet and even the DASH Diet, are all plant-focused diets. Although they make space for some animal products and processed foods, they do promote a mostly plant-based diet. Even the Canadian Food Guide was updated in 2019 to recommend a plant-predominant dietary pattern, where meat and dairy are no longer official food groups. Water is now the recommended beverage of choice and the meat group is replaced by a « protein » food group, where recommendations are to obtain most of your protein through plant foods. Newly published studies can really flip old recommendations on their heads, but the general public often lags behind before adopting these new lifestyle recommendations. So whatever you want to call it, a dietary pattern that reduces animal products, dairy and processed foods is the evidence based way to not only add years to your life, but life to your years.
Check out my website plantbaseddrjules.com and look for the “How To” section in the menu. There, you’ll find tips and tricks that helped me on my journey towards a plant-predominant diet. Everything there is completely free, no catches! If you're looking for quick, easy and healthy plant-based recipes, check out plantbaseddrjules.com and download my free recipe eBook!
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