Moderators: JeffN, f1jim, John McDougall, carolve, Heather McDougall
What You Need to Know About Vegetarian or Vegan Diets
Following a strict vegetarian diet is not as important as eating a diet rich in fruits and vegetables.
Although a low-saturated-fat vegan diet may markedly reduce risk for coronary heart disease, diabetes, and many common cancers, the real Achilles heel of the low-fat vegan diet is the increased risk of hemorrhagic (vessel rupture leading to bleeding) stroke. Apparently the atherosclerotic (plaque building) process that creates a local vascular environment favorable to coronary thrombosis (clot) and intravascular embolism (traveling clot) may be protecting the fragile blood vessels in the brain from rupture under years of stress from high blood pressure. Admittedly, hemorrhagic stroke is a very small percentage of the deaths in modern countries. It still is worth noting that if strict vegetarians are to have the potential to maximize their lifespan, it is even more important they avoid a high salt intake because salt intake increases blood pressure. Almost all of the soy based meat analogues and many other health food store (vegan) products are exceptionally high in sodium.
Infants whose mothers ate a high-fat and cholesterol-rich Western diet while pregnant have been shown to have foam cells and fatty streaks at birth. It is common for such fatty streaks to appear in children as young as eight months. The fatty streak will disappear and the artery will heal—even in adults—if the cholesterol level drops sufficiently. How- ever, if more and more cholesterol and fat are consumed, the process continues. The fatty streaks grow. Muscle cells that are part of the media section of the artery proliferate into the intima, and cause the fatty streak to become larger and thicker, thus becoming a full-blown atherosclerotic plaque. The body attempts to form a cap over the plaque with tough fi-• brous scar tissue, a process called fibrosis.
As the plaques grow larger, they cause the arteries to narrow, and thus reduce the blood supply to the heart, a condition called ischemia. Even- tually, the ischemia can progress to cause angina pectoris, literally a "strangling" pain in the center of the chest due to the diminished blood flow to the heart. If the ischemia becomes so advanced that one of the coronary arteries is entirely blocked, part of the heart muscle can die and one experiences a myocardial infarction, or a heart attack.
Exploring the Inner Landscape with the Mind's Eye
In order to visualize the conditions inside your arteries, let's imagine for a few moments that you could shrink yourself to the size of a cell, and that you could travel safely inside the walls of an artery. You would see an awe- inspiring world of living cells, proteins, nutrients, and bubbles of cholesterol and fat—all of which float in the living ocean that is your blood. You would see artery walls that were smooth and healthy, and others that were in various stages of atherosclerosis, caused by those very same balls of fat and cholesterol that you see floating through the bloodstream.
From your imaginary vantage inside the artery, you recognize this process as both destructive and disgusting. The courageous immune cells are literally killing themselves by consuming these bubbles of LDL. Not only that, but the beautiful artery wall—once a mosaic of per- fectly arranged tiles—has become contoured and bulbous, as if it were afflicted with horrible boils.
Atherosclerosis develops over a lifetime, beginning in early childhood. Dam- age from the foods we eat and products of cigarette smoke injure the inside linings of the artery. The resulting sores are known as plaques. The disease generally progresses because the healing processes cannot catch up with the daily injury. Unstable plaques often rupture, causing the formation of a blood clot which partially or completely occludes an artery. Eventually, scar tissue will replace the thrombus, resulting in a fibrous plaque, which may also completely occlude the artery.
Heart Attacks: The True Story
As I mentioned earlier, there are many misconceptions about heart dis- ease, but one of the most widespread is the notion that most heart attacks occur when a cholesterol plaque grows so large that it blocks off an artery entirely. It's true that sometimes a plaque can become large enough to block off a vessel, and thus cause a heart attack, but most heart attacks are not caused this way. Moreover, this belief is actually dangerous be- cause it lulls people into a false sense of security. Those who think that arteries are closed by a slow-growing plaque often comfort themselves by saying, `T ye got time to change my diet because my arteries must be at least partially open so that blood can get to my heart." What these people don't realize is that almost all heart attacks occur in people whose arteries are significantly open. The fact is that small plaques cause the most deadly heart attacks and strokes.
The atherosclerotic lesions contain cholesterol and fat that collect in pools and make the plaque highly unstable. These unstable plaques can— and often do—burst open, or rupture, thus forming an open wound within the artery wall. Blood platelets and clotting proteins rush to the wound and form a blood clot—called a thrombus—over the open plaque. That clot can enlarge instantaneously, becoming so big that it causes blood flow to the heart or brain to be completely shut off The result . is a heart attack or a stroke. Ninety-five percent of heart attacks are caused by this process, called coronary thrombosis. Ironically, thrombosis .occurs most often in the smaller plaques, those that are not, by themselves, large enough to block the artery entirely or cause any symptoms.

Atherosclerotic plaques are filled with semiliquid, fatty, and necrotic mater- ial. An unstable plaque can develop a tear (fissure) in the surface, allowing the contents to rupture into the flowing blood. This rupture acts as a catalyst for the blood to clot, forming a thrombus that partially or completely oc- cludes the artery, causing a heart attack or a stroke. The highest risk of rup- ture is with tiny fat-filled plaques. Small, but lethal, plaques usually cause no symptoms, thus offering no warning of the impending disaster.
Thus, the key events that lead to a heart attack are:
• The presence of high total cholesterol and LDL cholesterol in the blood
• The initial injury to the lining of the artery wall
• The formation of unstable, cholesterol-filled, fat-filled plaques
• The rupture of the plaque
• The formation of a clot over the open plaque
• The clot closing off blood flow to the heart or brain, causing a heart attack or stroke
Developing Backup Circulation
Sometimes people have stable plaques that gradually grow large enough to close off an artery, but they do not damage the heart muscle because there has been adequate time for backup circulation to grow to that area of the heart muscle, thus taking over the circulation that was lost when the original vessel closed. Arteries can be 100 percent closed, yet the presence of these backup arteries—called collateral circulation, or simply collaterals—provides enough blood and oxygen to sustain the life of the muscle.
Whether or not a plaque forms in the first place, and creates a throm- bus in the second, depends to a great extent on a person's diet. The most important factors are what you eat, the level of cholesterol in your blood, whether or not you smoke, and whether or not you have indica- tions of heart disease such as angina pectoris (chest pain). As we will see in the next chapter, fat—especially saturated fat derived from animal. foods—accelerates the creation of these clots, or thrombi.
A Disease of All Ages
As I said in Chapter 1, this is not a disease of old people. Rather, it be- gins very early in life, usually in infancy. That's why the National Heart Lung and Blood Institute (NHLBI) now recommends that all children two years of age and older adopt a diet low in fat and cholesterol.
Anyone who suffers a heart attack or stroke and winds up in the hospital is urged to adopt the diet of the American Heart Association (AHA), which is lower in fat and cholesterol than the typical American diet. Unfor- tunately, as we will see later on, the AMA's diet is still too high in fat and cholesterol to protect you against the disease. If you have already suffered a heart attack or stroke, that diet may insure that you suffer another one.
As grotesque and lethal as atherosclerosis is, it is nevertheless re- versible. If followed properly, the McDougall Program for a Healthy Heart can cure heart and artery disease at its source.
Most of America’s health dollars are spent on the late stages of heart disease, strokes, hypertension, diabetes, and the common Western cancers of the breast, the prostate, and the colon. Like heart disease itself, these others are part of the bitter harvest of the toxic American diet. And like traditional treatments for heart disease, their treatment is not preventive. Having your breast cancer amputated, your malignant prostate gland radically removed, or your cancerous colon resected is painful, disfiguring, and costly—and too often does not resolve the underlying problem.
My own research has concentrated on coronary artery disease, and how plant-based nutrition can prevent and also arrest and reverse it. But with every year that passes, there is more proof that a plant-based diet has similar salutary effects on other chronic diseases, as well. Take stroke, for example—the third leading cause of death in the United States. The evidence is overwhelming that if you eat to save yourself from heart disease, you eat to save yourself from stroke.
There are two types of stroke. In hemorrhagic stroke, the less common of the two, a blood vessel in the brain ruptures because of high blood pressure or a genetic weakness of the vessel wall known as an aneurysm. A plant-based diet cannot do anything to cure a genetic aneurysm. But it will definitely help reduce blood pressure, an important step in the right direction.
On the more common variety of stroke—ischemic or embolic stroke—there is even better news. These have the same origin as coronary artery disease. An ischemic stroke occurs when fat and cholesterol block blood vessels that carry oxygen and nutrients to the brain, just as they may block the coronary arteries that nourish the heart. An embolic stroke also deprives the brain of nutrients and oxygen, but in a slightly different way. When an artery sheds part of its diseased inner lining, that debris—called an embolus—is carried through the bloodstream until it gets wedged into a blood vessel that is too small for it to traverse. Now it blocks the flow of blood through that vessel. This may happen almost anywhere in the body, blocking blood flow to a kidney, an intestine, a leg, or some other organ. When it occurs in vessels that nourish the brain, it is a stroke.
In the 1990s, Pierre Aramenco, a physician from Paris, studied this process in Frenchmen who were at risk for vascular disease.2 Using ultrasound probes inserted through the esophagus, Dr. Aramenco measured the thickness of atherosclerotic debris growing on the inside of each patient’s ascending aorta, the giant artery that climbs directly from the heart and sends branches to the brain. He divided the men into three groups. One group showed 1 millimeter of debris on the lining of the aortic wall. The second had debris measuring between 1 and 3.9 millimeters thick. The third had more than 3.9 millimeters of debris. Dr. Aramenco followed the patients for three years. Not surprisingly, the group with the greatest amount of plaque growth shed the greatest number of emboli, and had the most strokes (see Figure 17 in insert).

Figure 17Large arching vessel, or aorta, from the heart may fill with plaque debris, which in flaking off may travel, or embolize, to the brain, causing large or small strokes.
The buildup of fatty plaques in blood vessels can cause damage in many different ways. For example, when an aorta that contains plaque is clamped during coronary bypass surgery, plaque debris is loosened and enters the bloodstream as an embolus. Using ultrasound to monitor the middle cerebral artery in the brain, technicians can distinctly hear the embolizing plaque as it enters the brain. If the patient dies during surgery, the plaque debris may be found in the brain at autopsy.
This tragic sequence helps explain the fearful loss of cognition in coronary artery bypass patients.3 But neuroradiologists also report that using magnetic resonance imaging, they can detect little white spots in the brains of Americans starting at about age fifty. These spots represent small, asymptomatic strokes (see Figures 8 and 19 in insert). The brain has so much reserve capacity that at first these tiny strokes cause no trouble. But, if they continue, they begin to cause memory loss and, ultimately, crippling dementia. In fact, one recently reported study found that the presence of these “silent brain infarcts” more than doubles the risk of dementia.4
We now believe, in fact, that at least half of all senile mental impairment is caused by vascular injury to the brain. Not long ago, a Swedish study of five hundred eighty-five-year-olds found that fully one-third of them showed some form of dementia. A careful analysis revealed that in half of those with dementia, their mental impairment was due to a diseased arterial blood supply to the brain.5 Similarly, a study in the Netherlands focused on five thousand people between the ages of fifty-five and ninety-four.6 The researchers studied the circulation in the brains of all their subjects, then asked them to perform various written tests of mental acuity. The results were quite clear: those suffering from artery disease and thus impaired circulation in the brain performed less well on the tests than did those whose arteries were clean. Age made no difference. Arterial health was the variable that counted.
This should come as no surprise. Clogged arteries serving the brain and clogged arteries serving the heart are part and parcel of the same disease. The cause is the same: a buildup of fat and cholesterol and lethal damage to the delicate endothelial lining of the blood vessels. And the cure is the same, as well: adopting a healthful new way of eating that includes not a single ingredient known to damage vascular health.
Just as you are not doomed to heart disease as you grow older, you also are not doomed to mental deterioration. Most cases of stroke and dementia, like heart disease, need never occur. Your aorta, along with all your other arteries, can be as clean at ninety years of age as they were when you were nine.
Esselstyn Jr. M.D., Caldwell B. (2008-01-31). Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure (p. 98). Penguin Group. Kindle Edition.
Users browsing this forum: No registered users and 10 guests