Cardiovascular Disease | Part 4

Food as Medicine: Preventing Heart Disease with Diet

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Dr. Aaron Hartman

May 31, 2022


Food as Medicine: Preventing Heart Disease with Diet Alone

Where’s the proof?
For those who have been following me for more than a few days, the statistic that 50% of all chronic disease can be attributed to processed food is not news. What I’d like to do today is take a deep dive into some of the research on food and its effects on cardiovascular disease.
As you know, cardiovascular disease is the number one killer in our country for both men and women, and is on the rise. Could diet alone have a truly significant impact on this epidemic? And if so, what would such a diet look like? That’s what we’re going to discuss today.



The Framingham Heart Study: Why Don’t We Hear about the Effects of Diet?

We’ll start with one of the biggest studies to date that people talk about, which is the Framingham Heart Study. This study, based in the UK, evaluated over 10,000 patients for medications and other heart disease treatments, but the dietary aspect of this study is often overlooked. The Framingham Study showed that nondescript “CV-lowering or lipid-lowering diets” decreased total cholesterol, triglycerides, and increased HDL. Unfortunately, in this pivotal trial, detailed specifics on diet weren’t studied, hence more research was needed.

The Seven Countries Study: Overlooking the Quality of Dietary Fat

The Seven Countries Study was an international study that looked at lifestyle and diet. A high-fat diet was shown to increase the prevalence of heart disease. This is where we get the idea that fat in the diet causes heart disease. But the study didn’t specify what kind of fat was a healthy fat or an unhealthy fat, which would have been a great question. We now know that healthy fats can actually contribute to heart health, which we’ll discuss further below.

The Pritikin Diet: Did Diet or Exercise Improve Cholesterol?

Then the Pritikin Diet showed the ability to improve cholesterol. This diet is a low-fat diet, consisting of only 10% of calories from fat, and includes primarily vegetables, grains, and fruits, and is also combined with exercise. So now we’re starting to see some conflicting data based on how these trials were designed.

The Ornish Diet: Is it the Diet, Exercise, Stress-Reduction, or Smoking Cessation That Causes the Benefits?

Dean Ornish has been well-known for his vegetarian-style, low-fat diet (again 10% of total calories). The Ornish diet includes lots of complex carbs, low refined (processed) carbs, and low dietary cholesterol and is combined with exercise, stress reduction, and smoking cessation. This diet showed a reduction in all-cause mortality, total cholesterol, and showed many other benefits. At year five, there was a reduction in calcium build-up in the heart, heart attacks, strokes, and overall deaths. Because of these findings, the focus on vegan-style diets became super popular, while his lifestyle change and stress reduction aspects have been largely overlooked.
These are some of the reasons I like to read the actual research to find out what was really studied, not what secondary sources say about them.

The Portfolio Diet: Studying the Numbers Instead of Actual Health Outcomes

The Portfolio diet study was another big trial that included a vegetarian-type diet with soluble fiber, nuts, soy protein, and plant sterols to see how they affected cholesterol numbers. The interesting part about this is that actual outcomes like death and heart attacks weren’t the focus, but they did show that total LDL cholesterol fell 29.6% and triglycerides fell almost 10%. In comparison, the group that received cholesterol-lowering medication had a 33% reduction in total cholesterol. The difference between the dietary intervention and the medication intervention was not statistically different.
So what does that mean? This means food really is medicine, especially for your heart. What matters most in evaluating these studies is a heart attack, stroke, and death. Ultimately we should be focusing on outcomes, not numbers like cholesterol. That’s the most important aspect of evaluating research, trials, and treatment.
Ultimately, we don’t treat statistics, we treat patients; the most important thing to a patient is the outcome.

The Lyon Diet Heart Study: A Study Using Healthy Fats

Enter the Lyon Diet Heart Study. This was the first single-blind prevention trial of its kind. Over four years it looked at the endpoints of heart attack and cardiovascular disease. The primary outcome evaluated was whether heart attack victims lived or died after the attack. These are important outcome data points. The Lyon diet included 30% of calories from fat. You heard me right 1/3 of the diet was fat, but it was healthy fat – about 12% were monounsaturated fatty acids like olive oil and it was enriched with alpha-linolenic acid (ALA), which is the primary omega-3 from seeds. Flax seeds are actually the most abundant source of alpha-linolenic acid. In this study, they found cardiovascular disease prevention in 20 to 30% of all major events.



The PREDIMED Study: Lowering Inflammation and Heart Disease with Olive Oil

Again, another study, the PREDIMED Study, which was a three-month randomized trial based in Spain, showed that consuming about a liter of extra virgin olive oil per week lowered all the inflammatory markers for heart disease. You read that correctly; healthy fat lowered cardiovascular inflammation. In this study, hsCRP, interleukin 6 (IL-6), ICAM-1 (Intercellular Adhesion Molecule 1), VCAM-1 ( vascular cell adhesion molecule one) all were reduced. All these were lowered with a simple intervention of extra virgin olive oil. When you dive into the deep science, the inflammation (measured by these markers) is what actually causes heart disease, not the cholesterol itself.
So what’s the point of all this? When you look at this data from these diet studies and combine them with the nutraceuticals we discussed last week, we can induce an LDL reduction of up to 50% in patients with significantly elevated LDL. This is superior to any drug on the market. We actually see plaque regression, fewer fatty streaks, decreased calcium buildup in the heart, as well as improvement in some of the small markers of arterial function.


A diet designed to achieve these kinds of incredible cardiovascular effects would include omega-3 fatty acids, especially those from nuts and seeds, extra virgin olive oil, and nutritionals like red rice yeast, niacin, green tea, or EGCG, and plant sterols. These are simple things that most people can do in the comfort of their own homes to achieve better health outcomes, at least based on the research we have right now. These outcomes are far superior to medication-alone treatment regimens.
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Take care and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.


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