Can a Vegan diet REVERSE Heart Disease?!
Can a Vegan diet REVERSE Heart Disease?!
It´s often claimed a vegan diet reverses heart disease. A bold claim, but is it accurate? Did Drs. Ornish and Esselstyn prove a vegan diet reverses heart disease?
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References:
https://www.sciencedirect.com/science…
https://cdn.mdedge.com/files/s3fs-pub…
https://www.acpjournals.org/doi/10.73…
https://www.ahajournals.org/doi/10.11…
https://www.ahajournals.org/doi/full/…
https://www.sciencedirect.com/science…
Full 1h30min video: • Medical Doctor Debunks 10 Vegan Myths…
Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author’s knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
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0:00 Introduction
1:08 The Esselstyn report
3:21 The Ornish trial
7:29 Mediterranean diet \u0026 Plaque reversal
9:39 The bottom line
Content
0 -> "the vegan diet is the only one shown to reverse
heart disease", so right, the floor is yours. i've
7.92 -> heard also this in slightly different variations,
plant-based diet, or a healthy plant-based diet
13.68 -> is the only one shown to reverse heart disease,
different variations but people are essentially
17.92 -> referring to the same thing, and this stems from
the Ornish lifestyle heart trial and the Esselstyn
25.68 -> report, and basically there's a number of
caveats to these studies when you look at them
36.72 -> that don't really allow us to say that there is
a reversal of heart disease, or a regression,
44.24 -> in the cardiovascular literature it's usually
referred to as regression but it's essentially the
48.16 -> same idea, that the plaque is getting meaningfully
smaller, and the focus tends to be on clinically
55.44 -> meaningful, so that it actually makes a
difference clinically and in terms of risk,
60.4 -> so there's a number of concerns with these
studies as justification to make this claim,
65.84 -> one is the design of the studies, so Esselstyn
is not a trial per se, it's a case series,
72.16 -> so he's basically reporting his observations
and the outcomes of his patients that he advised
77.76 -> that they should do this diet. there's no
control group per se, there's a group that he
81.84 -> used as sort of a control that's essentially the
group of people that did not adhere to the diet,
86.64 -> that did not want to or could not stick to his
prescriptions, he's looking at them and saying,
92.64 -> look, these people had a higher rate of heart
attacks and strokes than the group who did stick
97.52 -> with my my diet. there's nothing wrong with
with him reporting those cases, it's great,
103.04 -> more doctors should do it, however, when we look
at this type of evidence we have to analyze it
107.36 -> objectively, and there's a lot of confounders
when something is structured this way, because
112.24 -> someone who can't stick with the diet, who
falls off the wagon or won't stick with the
116.56 -> diet is also less likely to follow other type
of health advice, also less likely to exercise,
122.64 -> more likely to smoke... at first glance,
the interpretation would be, okay, so people
127.68 -> had these outcomes, they did better because
they ate this diet. and that could be true,
133.36 -> we're not saying that that's ruled out, however
because there are all these potential confounders,
138.88 -> it could also have little or nothing
to do potentially with the diet,
143.52 -> right? these are all possibilities that
we have to consider. these confounders
147.2 -> are always potentially present, so what you do
is, depending on the design of the experiment,
152 -> you either adjust for them statistically, if
it's a cohort study you're going to assess all
157.44 -> of those, who smokes and how much, exercise, bmi,
education, socioeconomic status, all those things
163.92 -> are going to be recorded and then you're going to
adjust statistically with multi-variable analysis
168.56 -> and you're going to get a sense of whether
the effect of the diet still survives.
174.32 -> and here, because it's a case series, there's
no such process so the confounders are
178.48 -> essentially unadjusted for. the other good way
to address that is by doing a randomized trial,
185.12 -> you take your ideally homogeneous pool of
volunteers, you randomly assign them to
190.64 -> the diet and the control group, and that is a
more reassuring way of minimizing confounders.
197.68 -> so those are some of the concerns with
Esselstyn. now, on that note, Ornish,
202.64 -> the lifestyle heart trial has a more robust design
because it is a randomized controlled trial.
209.44 -> caveats are, pretty small number of participants,
212.56 -> not the end of the world, multi-pronged, so there
were multiple interventions, it was four or five
218.32 -> interventions, so it was a diet, an exercise
program, a relaxation/ meditation program,
222.8 -> reducing or stopping smoking, they lost weight,
quite a bit compared to the baseline and to the
228.88 -> control group... so again, we have a multitude of
things, if we wanted to say that this program had
235.84 -> a benefit in terms of the outcomes, i think that's
fair to say, but to conclude that it's the diet
241.44 -> specifically, very difficult to sell that.
so there's just too many things considered,
247.92 -> there's too many things used as an intervention
for them to single one out of the five.
252.96 -> right. it's a multi-pronged intervention. and
again, this is not to bash Ornish, this was the
259.36 -> experimental design, they didn't set out to prove
specifically that the diet did it, they set out to
266.56 -> get the result, to get the best odds of improving
outcomes and stopping growth of plaque or even
273.2 -> getting some reversal of plaque, right? so
they threw everything they had at these people.
277.76 -> this is very common, the misunderstandings and the
disagreements are often not on the data, it's the
281.84 -> interpretation of the data. so we should just
be careful not to overstate it. the other thing
287.36 -> that is sometimes forgotten is that the ornish,
the lifestyle heart trial wasn't a vegan diet,
293.12 -> it was a moderate vegetarian diet,
so it had some dairy in there,
296.96 -> sometimes people forget that and go as far as
saying it's the vegan diet, it has to be vegan,
301.6 -> if it's not a vegan diet you can't... that's
not supported by the ornish trial, right?
307.6 -> so bottom line, it's possible that the diet is
having that effect but we just can't say based on
312.48 -> the evidence, it's possible that five or ten years
from now more results will nail that a vegan diet
319.2 -> or a plant-predominant diet is sufficient to get
these results, so right now i think we should be
323.6 -> agnostic with regards to the granularity, not the
general idea of a plant-rich diet. to be clear,
330.96 -> you're not making the claim that the diet
didn't cause the heart disease reversal,
335.68 -> you're saying that we don't have enough reason
to believe that it did. yeah, exactly. it's not
341.76 -> convincing. i'm not convinced that the diet alone
did it. it's possible. it's certainly possible,
348.56 -> we just don't have the evidence to say that, and
certainly to say that it was a vegan diet that
352.08 -> did it and that only a vegan diet could do it,
that is really a stretch. a couple more things:
357.84 -> the technique, without getting too into the weeds,
the technique that was used, the imaging technique
363.52 -> is angiography. basically you're getting an image
of the outline of the lumen of the artery and not
371.52 -> a measurement or a visualization of the plaque per
se, and so there's some uncertainty there as well,
377.92 -> angiography gives you sort of a surrogate
and sort of a guesstimate of plaque,
384.72 -> but it's not a reliable measurement of plaque,
so if you see the, it's called the stenosis,
390.16 -> right? the narrowing of the artery where the
plaque presumably is, and you can see that
396.8 -> widen a bit over time with a treatment, but
there's more than one way that that can happen.
402.24 -> yes, the plaque could be shrinking, the artery
could be dilating, there's even technical reasons,
407.92 -> the angle at which you're visualizing the artery
could influence that as well, so there's just some
414.08 -> uncertainty there with the technique. there are
more recent techniques that are used now in statin
419.44 -> trials and things like that that specifically
look at the plaque and can measure the plaque more
424.32 -> accurately. there is also some specific criteria
in the literature that are thresholds for where
430.96 -> it's considered clinically meaningful regression
of plaque, and it's pretty hard to cross those,
435.76 -> even the the statin trials, most of them don't
reach that bar, and these diet trials don't
442.08 -> even get close to that bar of really compellingly
showing a reduction in plaque that is clinically
447.84 -> meaningful. another thing that's interesting
to note, when people say the vegan diet is the
452.64 -> only one that has this effect, there have been
other interventions, there's one actually that
456.96 -> was published last year, this large trial called
CORDIOPREV, and they use the mediterranean diet,
463.12 -> classical mediterranean, right? not what people
are eating nowadays in the mediterranean region,
466.72 -> right? not the mcdonald's and everything, but
what's normally referred to as the mediterranean
469.84 -> diet in the literature and the classical
mediterranean, with whole foods, lots of fruits
473.36 -> and vegetables, some dairy, olive oil, low in red
meat, low in processed foods, etc. this was a very
479.44 -> large trial, a thousand volunteers over seven
years, massive trial, and they used ultrasound
486 -> in the carotid arteries in the neck and there
was a suggestion of a reduction in plaque size.
490.8 -> i would not claim that the mediterranean diet
reversed heart disease, i think that would be
495.28 -> a bit of a stretch as well, but you see what I'm
saying, if we're gonna claim that the suggestion
500.88 -> of reduction of plaque in the ornish trial proves
reversal we have to admit these things as well,
508.32 -> we can't kind of gerrymander. let me see if i
also understand this correctly, you said that
512.48 -> the ornish trial wasn't even a vegan diet, it was
a vegetarian. yeah, the lifestyle heart trial,
519.36 -> i'm pretty sure was a moderate vegetarian
diet, so it was largely plant-based, plant
526 -> predominant and it had some dairy in there. okay,
so not only was it not even a vegan diet but to
532.16 -> use this trial is to also indirectly accept this
mediterranean trial which also wasn't even a vegan
539.04 -> diet, because they included some amounts of...
right. yeah, both both diets are plant-rich,
547.12 -> plant-predominant, maybe that's even fair to say,
550.48 -> the ornish diet almost certainly is getting more
calories from plants than the mediterranean diet
557.68 -> but otherwise in terms of this suggestion of
regression of plaque i think they're about
564.56 -> the same, someone who's a specialist in imaging
might disagree, might think one technique is more
570.72 -> compelling than the other, to me it's not clear
that one is super convincing and the other is not.
577.92 -> really important, a lot of this discussion on
plaque size kind of misses the big picture, which
584.48 -> is the actual outcomes, right? at the end of the
day, and this is very common in nutrition debates
589.36 -> and nutrition controversies and disagreements, is
people harp on things that aren't necessarily the
596 -> biggest question that we have to answer. so plaque
progression and speed of plaque progression,
602 -> that's absolutely relevant but at the end
of the day what you care about is outcomes,
605.92 -> the risk of having a heart attack, a stroke,
revascularization, of dying of coronary heart
610.8 -> disease. that's the million dollar question, and
so, both the ornish trial and for example this
615.84 -> CORDIOPREV trial showed an improvement in
symptoms and improvement in outcomes for these
622.4 -> plant-predominant diets, there's no reasonable
doubt that healthy lifestyle including a diet
628.48 -> rich in unprocessed plant foods is a pillar of
prevention and management of cardiovascular risk,
633.68 -> there's no real doubt about that, and
the potential that these things have,
636.96 -> it's just that extra stretch of saying that it has
to be 100% vegan otherwise you're killing yourself
643.12 -> and that only the vegan diet has shown this and
not that, that's a little bit of an overstatement
Source: https://www.youtube.com/watch?v=Ypilw1KCq9Y