A Change of Life Style Can Mend a Heart, Doctors Find
A strict vegetarian diet combined with moderate exercise and relaxation techniques like yoga and meditation can reduce cholesterol and begin clearing clogged arteries without the use of heart-disease drugs, a new study by California researchers has found.
The study, presented Monday by Dr. Dean Ornish of UC San Francisco, at the American Heart Assn.’s annual scientific meeting, is said by researchers to represent the largest reduction in blood cholesterol ever reported as a result of changes in life style rather than drug use.
Ornish’s admittedly radical regimen may benefit not only heart patients like the 50 men and women in his ongoing study: If changes in diet and life style can reverse disease in sick people, they may also help prevent heart disease, he and others said.
“We’re using very expensive, high-tech, state-of-the-art measures to evaluate a very low-tech, low-cost, ancient intervention,” Ornish said. “There’s really nothing new about the intervention per se. It’s the fact that we’re studying it and trying to see does it work, and to what degree and for whom.”
Atherosclerosis, a form of arteriosclerosis that involves thickening and hardening of the arteries, is a major contributor to nearly 700,000 deaths from heart attack and stroke in the United States each year. Cholesterol, fats and other substances build up on artery walls, narrowing the vessel and cutting off blood flow to the heart.
Research into preventing and reversing atherosclerosis has focused on controlling cholesterol and fats in the blood. Many scientists have doubted, however, whether changes in diet and life style can significantly help people with serious heart disease.
“To the best of my knowledge, these are the largest reductions (in cholesterol and plaque build-up) reported without using drugs or surgery in a reasonably free-living population,” said Ornish, an assistant clinical professor of medicine at UC San Francisco and director of the Preventive Medicine Research Institute in Sausalito.
Also reported at the meeting, which has drawn 26,400 heart specialists, were significant declines in fat consumption by Americans in last 20 years and the results of the first studies of a new generation of tools for scraping, grinding and melting fatty deposits off the insides of arteries. The miniature tools, threaded into arteries on catheters, are being tested on small numbers of patients nationwide and abroad.
Alison M. Stephen of the University of Saskatchewan in Canada reported that an analysis of 170 diet studies done since 1920 showed that the average American’s fat intake dropped from 40% to 42% of total food energy in the early 1960s to 36% to 37% in 1984. Consumption of saturated fats, a prime culprit in elevated cholesterol, fell from as high as 20% in the 1940s to 12% to 13%.
Stephen’s findings contradict national food supply figures, which show fat consumption continuing to increase into the 1980s. Those figures fail to take into account fat trimmed from meats or removed from milk during processing and food diverted from human to animal consumption, Stephen said.
Stephen believes that reductions in fat intake are contributing to the recent decline in the rate of deaths from coronary heart disease in the United States. Although the death rate is dropping, diseases of the heart and blood vessels are still the nation’s top killer, claiming nearly 1 million lives a year.
In Ornish’s diet and life style study, patients were randomly assigned to two groups. One group received traditional care, including advice for moderate life style changes including lowering cholesterol intake, controlling blood pressure and stopping smoking. The other group was placed on a rigorous regimen including total vegetarianism. Their diets include pasta, cereal, vegetables and fruit but no nuts and seeds, avocados, butter or coconut or palm oil. Fat consumption is held to less than 10% of the diet. Cholesterol intake averages 4 milligrams a day, compared to the typical American’s 400 or 500 milligrams.
The group on the strict regimen meets two evenings a week for an hour of exercise and yoga or other stress management techniques. Once a week, Ornish’s team caters the dinner; on the other night, dinner is pot luck.
In that group, total blood cholesterol levels dropped during the first year of the study from a median of 227 to 136 milligrams per 100 cubic centimeters of blood. The average extent of coronary artery narrowing decreased from 38.8% to 34.9%, Ornish reported.
In the control group, the researchers found no significant drop in cholesterol levels and a continued narrowing of the patients’ coronary arteries. The narrowing increased from 44.8% to 50.6% of the arteries clogged.
The changes were measured using state-of-the-art techniques capable of showing the condition of the arteries and the degree of blood flow and fat content in the blood. For objectivity’s sake, the measurements were done not by Ornish but by the chairman of the division of cardiology at the University of Texas Health Science Center in Houston.
Texas researcher Dr. K. Lance Gould said in an interview Monday that he was initially skeptical that Ornish’s approach could cause a reversal of atherosclerosis. He said he is seeing data, however, that shows that reversal is occurring, although the patterns of reversal need further study.
