Download File - Caitlin Baker

Caitlin Baker
Does the consumption of a vegetarian, low-fat diet and implementation of lifestyle
changes serve as an alternative solution to reverse Coronary Artery Disease?
According to the Centers for Disease Control, heart disease is the number one cause of
death in the United States, killing 597,689 people annually (1). Coronary Artery Disease (CAD)
is the most prevalent type of heart disease, killing 385,000 people every year (2). CAD happens
as a result of plaque build up in the Coronary Arteries. Plaque build up is caused by many
lifestyle factors ranging from smoking to lack of exercise to the types of food that a person
consumes (3). The high prevalence of this disease has high economical impacts on the country
as well. From healthcare costs to medication/treatment to lost productivity, this CAD costs the
United States 108.9 billion dollars every year (2). Not only does CAD take a toll on American’s
wallets, but it affects people physically too. Specifically speaking, the medications and surgeries
that are given to cardiac patients can cause detrimental effects in the long run. Medications or
surgeries tend to have reverse side effects that cause a need for more medications. The question
is, when does the cycle of drugs and surgeries end? According to numerous researchers, it is
indicated that the horrific cycle of drugs and surgeries never has to begin in the first place.
Researchers are beginning to look at diet and lifestyle as a means of reversing heart disease.
These types of prevention are cheaper and don’t involve the drug/surgery cycle. This paper
focuses on the effects of reversing CAD with diet and lifestyle influences as the primary
treatment source. Evidence will be presented to reflect that diet and lifestyle changes, such as
switching to a plant based diet as well as including daily exercise, group support and stress
management, will serve as an effective and more cost effective way to reverse CAD.
The integration of CAD patients into a program that targets diet and lifestyle
Three studies developed a program in which CAD patients underwent intensive dietary
interventions as well as daily exercise, stress management training and group discussions/
Caitlin Baker
support. Koertge et al performed a study, named the Multicenter Lifestyle Demonstration
Project, with 440 CAD patients. This program was a year long program. This trial focused on
implementing a plant based/whole foods diet. Less than 10% of a patient’s calories were to come
from fat. The exercise element included getting 3 or more hours of exercise a week while the
stress management focused on including at least one hour of stress relief daily. Participants were
asked to join a support group that met two times a week as well. Patient measurement of a three
day diet analysis, a blood lipid profile, a treadmill stress test as well as behavioral questionnaires
were taken at month three of the study and at month twelve of the study. The results of this trial
indicate that the inclusion of many lifestyle factors help reverse CAD in both men and women.
In one year, total blood pressure dropped from about 133.5/ 79 to 131/76, weight was lost
(baseline average of about 82 kg to an average of about 77 kg) and total cholesterol decreased
from about 207 mg/dL to 191 mg/dL. LDL also decreased after the one year marker of the
program. LDL went from an averaged baseline of 126 mg/dL to 108 mg/dL. These results are
significant because all of the factors that were reduced are directly contribute to the intensity of
CAD. The more that the factors decreased, the less control that the CAD had over the patient.
Chainani-Wu et al performed a similar study. The group developed a program called the
Multisite Cardiac Lifestyle Intervention. This program focused, again, on changing diets to low
fat (less than 10% of total calories coming from fat), vegetarian/whole foods, incorporating
exercise, stress management and group support. In this trial, there were 56 participants with
CAD and 75 participants with Diabetes Mellitus (DM) and/or three or more risk factors of CAD.
After three months of intensive intervention, blood panels and bodily measurements were taken.
After three months into the program, the results showed a decrease in LDL, total body weight
and blood pressure. The average LDL decreased from an average of 89 mg/dL to 68 mg/dL in
Caitlin Baker
CAD participants and from 109 mg/dL to 104 mg/dL in high risk patients. The initial BMI in
CAD patients was 32.3 which dropped to 30.2 within three months while the average initial BMI
of high risk patients went from 34.2 to 32.9. The blood pressures went from an average of 127/76
to 115/70 in three months for CAD participants and from an average of 128/77 to 118/73 in
three months for high risk patients. What made this study unique was that it really focused on the
bio-markers of CAD. After the three months of the intervention, researchers saw that the number
of LDL particles in both CAD and high risk patients decreased from a combined average of 40.1
to 37.4 nmol/L while the medium sized LDL increased from 31.2 to 32.7 nmol/L . This is
significant because particle size plays a role in CAD development. The larger the LDL particles,
the less of a prevalence of CAD. Smaller particles increase the risk of CAD, so seeing that the
small LDL particles decreased and the larger LDL increased suggests that the LDL particles
were transforming. By the three month marker, the researchers also found averaged decreases in
fasting blood glucose- 118 to 104 in CAD and 118 to 102 in high risk patients as well as a
reduction in fasting hemoglobin A1c levels- 6.9 to 6.7 in CHD patients and 6.4 to 6.0 in high
risk patients. These are important findings too because these indicate whether or not a person has
DM. DM is a huge risk factor for CAD, so seeing signs that diet and lifestyle reduce this risk
factor is an amazing find. This study shows evidence that patients with CAD are able to control
or reverse the disease itself plus eliminate risk factors of CAD.
The final study conducted by Ornish et all, called the Lifestyle Heart Trial, is yet another
trial that focuses on diet, exercise, stress management, group support. This program focuses on
the restriction of smoking as well. The twenty experimental participants in this trial were to be
on a whole foods, vegetarian, low fat (less that 10% of daily calories coming from fat) diet.
Weekly exercise limits were set for each patient and recommendations for stress management as
Caitlin Baker
well as for group support were given. This trial contained a control group of 15 participants who
used the “typical” methods to treat CAD- the methods that are generally prescribed in hospitals.
This study was originally only supposed to go for a year, but after seeing such positive results
after year one, the researchers decided to extend the program for four more years to see if the
CAD would continue to regress over time. The researchers measured the participant’s baseline
coronary artery percent stenosis, or how wide the opening is between the plaque build up in the
coronary artery (4), as well how many cardiac events a participant went through throughout the
trial period. After the five years, the coronary artery percent stenosis widened by 7.9 %
improvement in experimental participants and in the control group, the stenosis worsened by
27.7%. The results also showed that the amount of cardiac events was significantly different
among people in the experimental versus control group. Those in the experimental group only
experienced 15 total cardiac events among everyone whereas the control group experienced 45
total cardiac events. Overall, this study showed that with diet and lifestyle influences, CAD has
the potential to be reversed over time.
These three studies showed similar results and conclusions. Each program’s results
indicated that implementing strict diet guidelines as well as stress management, exercise and
group support systems was an effective way to lower LDL cholesterol, decrease BMI as well as
cholesterol and blood pressure. The lowering of these four components serves as a way to
reverse CAD. There were no conflicting results among these three trials.
Although the trials in the three articles showed promising and similar results, the amount
of people in each trial is something to consider. Each trial did not have many participants. The
lack of participants could have influenced the values of the results to make the results appear
greater than they really are. One strength of the article was that the trials lasted a pretty long
Caitlin Baker
duration of time. Two of the programs lasted a year, while the other lasted 5 years. The long time
span of the trials shows that the results of the trials will keep getting better with time, if the
participants continue to keep up the program demands.
Conclusion
In conclusion, all three articles (5-7) supported the theory that CAD can be reversed with
diet and lifestyle as the primary source of treatment if the implemented program lasts for at least
one year. The implementation of this type of program is cheaper than medications because food
is being used as the source of medicine. Diet and lifestyle changes lower LDL counts, blood
pressure, BMI and cholesterol (5-7). Fasting Hemoglobin A1c and blood glucose, which
contribute to the formation of CAD, are also lowered with a lifestyle program (6). These types of
programs are also seem to decrease coronary artery stenosis as well as decrease the chance that
future cardiac events will happen to a CAD patient (7). Although theses studies yielded positive
results, diet and lifestyle changes alone may be risky to treat a CAD patient because not enough
research has been done on the topic. The trials that were completed didn’t have many
participants in them. The lack of participants fails to yield strong evidence although, the evidence
that is available is a good way to set up future programs. The three programs were highly
successful, so it would be easy to set up similar, large scale programs in the future. To current
medical experts, it would be advisable that diet and lifestyle changes be implemented with
cardiac medications until more research is done on the subject.
References
1. Centers for Disease Control and Prevention. Leading Causes of Death. CDC web site. http://
www.cdc.gov/nchs/fastats/lcod.htm. Last updated January 11, 2013. Accessed
2013.
May 4,
Caitlin Baker
2. Centers for Disease Control and Prevention. Heart Disease Facts. CDC web site. http://
www.cdc.gov/heartdisease/facts.htm. Last updated March 19, 2013. Accessed May 4,
2013.
3. Centers for Disease Control and Prevention. Coronary Artery Disease. CDC web site. http://
www.cdc.gov/heartdisease/coronary_ad.htm. Last updated December 7, 2009.
Accessed May, 4 2013.
4. Miller-Keane. Encyclopedia Dictionary of Medicine, Nursing & Applied Health. 7th ed.
Pennsylvania, United States: Elsevier; 2003: 1670-1671.
5. Koertge, J, Weidner G, Elliott-Eller M, et al. Improvement in medical risk factors and quality
of life in women and men with coronary artery disease in the multicenter lifestyle
demonstration project. Am J Cardiol. 2003; 91: 1316-1322. doi: 10.1016/ S00029149(03)00320-5.
6. Chainani-Wu N, Weidner G, Purnell M, et al. Changes in emerging cardiac biomarkers after
an
intensive lifestyle intervention. Am J Cardiol. 2011; 108: 498-507. doi:10.1016/
j.amjcard.2011.03.077.
7. Ornish D, Scherwitz L, Billings J, et al. Intensive lifestyle changes for reversal of coronary
heart disease. JAMA. 1998; 208:2001-2007. doi: 10.1001/jama.280.23.2001.