How Not to Die from Heart Disease

The most likely reason most of our loved ones will die is heart disease. It’s up to each of us to make our own decisions about what to eat and how to live, but we should make these choices consciously by educating ourselves about the predictable consequences of our actions.

Atherosclerosis, or hardening of the arteries, begins in childhood. The arteries of nearly all kids raised on the standard American diet already have fatty streaks marking the first stage of the disease—by the time they are ten years old. After that, the plaques start forming in our 20s, get worse in our 30s, and then can start killing us off. In our heart, it’s called a heart attack, and in our brain, it can manifest as a stroke. So for anyone  reading this who is older than ten years old, the choice isn’t whether or not to eat healthfully to prevent heart disease—it’s whether or not you want to reverse the heart disease you likely already have.

Is that even possible? When researchers took people with heart disease and put them on the kind of plant-based diet followed by populations who did not get epidemic heart disease, their hope was that it might slow down the disease process or maybe even stop it. Instead, something miraculous happened. The disease actually started to reverse. It started to get better. As I show in my video How Not to Die from Heart Disease, as soon as patients stopped eating artery-clogging diets, their bodies were able to start dissolving away some of the plaque, opening up arteries without drugs and without surgery, suggesting their bodies wanted to heal all along but just were never given the chance. That improvement in blood flow to the heart muscle itself was after only three weeks of eating healthfully.

Let me share with you what’s been called the best-kept secret in medicine: Sometimes, given the right conditions, the body can heal itself. Take, for instance, what happens when you accidentally whack your shin really hard on a coffee table. It gets red, hot, painful, swollen, and inflamed, but it’ll heal naturally if you just stand back and let your body work its magic. What would happen, though, if you kept whacking your shin in the same place, day after day, or three times a day (breakfast, lunch, and dinner)? It would never heal! You might turn to your doctor, complaining of shin pain, and would probably limp out of the office with a prescription for painkillers. You’d still be whacking your shin three times a day, but the pain would be a little duller, thanks to those pills you’d be popping.

It’s similar to people taking nitroglycerine for crushing chest pain. They may get tremendous relief, but they’re not doing anything to treat the underlying cause. Our body wants to come back to health if we let it, but if we keep re-damaging ourselves three times a day, we may never heal.

One of the most amazing things I learned in all my medical training was that within about 15 years after you stop smoking, your lung cancer risk approaches that of a lifelong nonsmoker. Isn’t that amazing? Your lungs can clear out all that tar, and, eventually, it’s almost as if you never smoked at all. Just think, every morning of your smoking life, your body started on that path to healing, until…wham!…you inhaled on that first cigarette of the day, reinjuring your lungs with every puff. In the same way, we can reinjure our arteries with every bite. But, all we have to do all along—the miracle cure—is just stand back, get out of the way, stop re-damaging ourselves, and let our body’s natural healing processes bring us back towards health. The human body is a self-healing machine.

Sure, you could choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? I don’t tell my smoking patients to cut down to half-a-pack a day. I tell them to quit. Sure, smoking a half pack is better than two packs, but we should try to put only healthy things into our mouths.

We’ve known about this for decades. Take the case of Mr. F.W., for example, as published in 1977 in the American Heart Journal. He had such bad heart disease he couldn’t even make it to the mailbox without crushing chest pain. But he started eating strictly plant-based and a few months later he was climbing mountains without pain.

There are fancy new anti-angina  drugs out now. They cost thousands of dollars a year, but at the highest dose, they may only be able to prolong exercise duration for as long as… 33.5 seconds. It doesn’t seem as though patients choosing the drug route will be climbing mountains anytime soon.

Plant-based diets aren’t just safer and cheaper. They can work better because they let us treat the actual cause of the disease.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created this series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

And don’t miss these other videos in this overview series:

Inspired to learn more about the role diet may play in preventing and treating heart disease? Check out these other popular videos on the topic:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

The Best Diet for Chest Pain

The Dean Ornish program that led to improved arterial function and the dramatic drop in angina attacks—a 91 percent reduction in reported frequency of angina—is not just about putting people on a plant-based diet. It also involves recommendations for moderate exercise and stress management. We know exercise alone can improve endothelial function, so how do we know diet had anything to do with it? This is the subject of my video Plant-Based Treatment for Angina.

Going back to Ornish’s first publication, he put cardiac patients on a plant-based diet, with no added exercise—just diet and stress management—and got the same 91 percent reduction in angina attacks within just 24 days. And Dr. Esselstyn was able to improve angina using a plant-based diet as the only lifestyle intervention. There are published case series going back to the 1970s documenting this. One study participant, Mr. F.W., had chest pain so severe he had to stop every nine or ten steps. He couldn’t even make it to his mailbox. He started on a strictly plant-based diet, and, a few months later, he was climbing mountains with no pain.

We know plant-based diets can reverse heart disease, dissolving away plaque and opening up arteries—in some cases without drugs or surgery—but that doesn’t happen in 24 days. “[T]he improvements in anginal symptoms are too rapid in onset and [too great] in magnitude to be explained by the gradual regression” of the atherosclerotic plaque. So, maybe it’s this improvement in function as well as structure.

What is it about plant-based diets that improves our arteries’ ability to dilate? Is it macronutrient differences? Simply the lack of the deleterious effect of meat? Maybe it’s the drop in cholesterol. Endothelial function improves if we lower our cholesterol low enough, by any means necessary. One study took PET scans measuring blood flow to the heart before and after three radically different ways to lower cholesterol. The first method used drugs, and the second used a low-fat diet—a really low-fat diet with less than 2 percent of calories from fat. And the third? No diet at all—that is, 90 days without food; the researchers had a central line placed to basically drip enriched sugar water straight into the subjects’ bloodstream for three months. These researchers were not messing around. The treatment protocol didn’t include any exercise or stress management, either. They wanted to isolate out the effect of cholesterol lowering on cardiac blood flow.

The study participants started out with miserable cholesterol levels and with diminished blood flow to their hearts, so-called perfusion deficits, areas of the heart muscle that aren’t getting adequate blood flow. After cholesterol lowering, their cholesterol levels were still terrible, but, with the improvement, there was an improvement in blood flow and their angina attacks were cut in half. When they stopped the treatment and their cholesterol went back up, the blood flow to their heart muscle went back down. So, cholesterol lowering itself appears to improve blood flow to the heart, and the researchers think it’s because when cholesterol goes down, endothelial function improves.

There’s a new category of anti-angina drugs, but before committing billions of dollars of public and private monies to dishing them out, maybe “we should take a more serious and respectful look at dietary strategies that are demonstrably highly effective for treating angina and that have also been shown to reduce subsequent cardiac morbidity. To date, these strategies have been marginalized by the ‘drug pusher’ mentality of orthodox medical practice; presumably, doctors feel that most patients will be unwilling or unable to make the substantial dietary changes required…While this may be true for many patients, it certainly is not true for all. And, in any case, angina patients deserve to be offered the very-low-fat diet alternative”—the Ornish or Esselstyn diet alternative— “before being shunted to expensive surgery or to drug therapies that can have a range of side effects and never really get to the root of the problem.”

In response, a drug company executive wrote in to the medical journal, “Although diet and lifestyle modifications should be a part of disease management for patients with cardiovascular disease and diabetes, many patients may not be able to comply with the substantial dietary changes required to achieve a vegan diet…” So, of course, everyone should go on their fancy new drug, Ranolazine. It costs thousands of dollars a year to take it, but it works. Collectively, the studies show that at the highest dose, Ranolazine may prolong exercise duration as long as… wait for it… 33.5 seconds!

It does not look like those choosing the drug route will be climbing mountains anytime soon.


See a comparison of the arterial function of vegetarians versus omnivores in my Plant-Based Diets and Artery Function video. How about comparing the Arteries of Vegans vs. Runners? If those on plant-based diets aren’t getting a regular, reliable source of vitamin B12, though, their artery health can suffer. See Vitamin B12 Necessary for Arterial Health.

Cholesterol may do more than just impair the function of our arteries. Check out the images in my video Cholesterol Crystals May Tear Through Our Artery Lining. For even more, watch How Do We Know that Cholesterol Causes Heart Disease?andOptimal Cholesterol Level.

Does Cholesterol Size Matter? Watch the video to find out.

Three things increase our cholesterol level: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. What about moderation? Well, how moderate do you want your disease? See Everything in Moderation? Even Heart Disease? to learn more. And, be sure to check out How Not to Die from Heart Disease.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Improve Artery Function

Endothelial dysfunction is the initial step in the development of peripheral artery disease, heart disease, and stroke. As I discuss in my video Plant-Based Diets and Artery Function, the remarkable finding is that progressive endothelial dysfunction—the decline in the functioning of our arteries—is not an inevitable consequence of aging. We can retain the arterial function we had in our 20s into our 60s, like the elderly Chinese in my video Tea and Artery Function. This may be due in part to green tea intake, but “[o]ther important dietary differences relating to increased consumption of vegetables and fish, with lower consumption of [other meat and dairy] in the traditional Chinese diet, may be contributing to the protection observed in older Chinese arteries.”

It’s probably not the fish. Pooling all the best double-blind, placebo-controlled studies found that fish oil supplementation has no significant effect on endothelial function. In by far the largest study done to date, a comparison of doses of fish oil equivalent to one, two, or four servings of fish per week found no effects of these long-chain omega-3 fats. This is consistent with studies that have looked at whole fish consumption as well.

Overall, there was no significant association between fish intake and endothelial function. In fact, in women, those eating the most fish had the worst arterial function. Women who ate fish more than twice a week had significantly impaired endothelial function compared to those who never or only rarely ate fish.

So, if it’s not the fish, could it be the plants? Vegetarian diets appear to have a directly beneficial effect on endothelial function. Indeed, vegetarians’ arteries dilate four times better than omnivores’ arteries. But, could that simply be because vegetarians tend to smoke less? Within five minutes of smoking a single cigarette, our endothelium is brought to its knees, completely clamped down, and this happens if you’re a smoker or simply breathing in second-hand smoke. But the diet study excluded all smokers completely. The beneficial effects were independent of non-dietary risk factors. In fact, a healthy diet may even trump smoking. The preservation of endothelial function in older Chinese may help explain why they have such low heart attack rates despite their high prevalence of cigarette smoking. And, the improved arterial function was well correlated with the duration of eating vegetarian: The longer they ate healthy, the better their endothelial function appeared to be.

That was a cross-sectional study, though, a snapshot in time, so you can’t prove cause and effect. What we need is an interventional trial—put people on a plant-based diet and see if their arterial function improves—which is exactly what Dr. Dean Ornish did, showing a significant boost in arterial function compared to control.

Is this just some intangible risk factor test result, though, or does it actually have real world implications? Are their arteries naturally dilating so much better that their chest pain actually improves?

Ornish showed that on his plant-based diet and lifestyle program, cardiac patients had a 91 percent reduction in angina attacks. In contrast, control group patients, who instead were told to follow the advice of their personal physicians for diet and lifestyle advice, had a 186 percent increase in reported angina attacks. This “marked reduction in frequency, severity, and duration of angina [chest pain with the plant-based lifestyle intervention]…was sustained at similar levels after 5 years. This long-term reduction in angina is comparable with that achieved following coronary artery bypass surgery or angioplasty,” but without the knife.

But that was back in the 1990s, when Ornish was only studying a few dozen patients at a time. How about a thousand patients put on a healthy lifestyle track with a whole-food, plant-based diet? Within three months, nearly three-quarters of angina patients became angina-free.


Wait a second. The Ornish program involves a number of other healthy lifestyle interventions, such as exercise. How do we know it was the diet? That’s precisely the topic of my Plant-Based Treatment for Angina video.

What would happen if, instead of going on a plant-based diet, you went on a low-carb diet? You don’t want to know. But if you must, check out Low-Carb Diets and Coronary Blood Flow.

For more on green tea, see Tea and Artery Function.

What effects might other foods have? See:

And don’t miss my overview video: How Not to Die from Heart Disease.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: