Reversing Atherosclerosis and Preventing CVD Events with a Low-Fat Diet & Exercise ProgramJames J. Kenney, PhD, FACN(Nutrition Research Specialists, Pritikin Longevity Center)
Cholesterol from the blood gets into the artery wall and is primary cause of Atherosclerosis
30-Year Mortality & Serum Cholesterol for Men Aged 30-39yrs in Framingham Andersen KM, et al. Cholesterol and Mortality JAMA 1987;257:2176-80
Impact of Ketogenic Diet on Plasma Lipoprotein Levels in Epileptic Children
Nurses Health Study Data in Women with Type 2 DM Each 5% increase in Saturated Fatty Acids at the expense of carbohydrate raised CVD Risk by 29% Increasing dietary cholesterol by 200mg per 1000kcal increased CVD events by 37% This data suggests reducing SFA by 10% and dietary cholesterol by 400mg/day would cut the risk of CVD events by 95% Tanasescu M, et al. Am J Clin Nutr 2004;79:999-1005
Atherosclerosis starts and is promoted by anything that damages the Endothelium: Increased LDL-C and elevated blood fat levels Increased blood glucose Inflammatory substances [eg, CRP, TNF-a, IL-6] Toxins from tobacco smoke Excessive salt intake and elevated BP Turbulent blood flow Increased levels of pro-oxidants & free radicals Increased monocyte binding proteins and cell adhesion factors
Postprandial Lipemia Promotes Atherosclerosis * Oakley FR, et al. Am J Clin Nutr 1998;68:1202-7 ** Proctor S, et al. Arterioscler Thromb Vasc Biol 2004;24:1-6 ** * Oliveira MRM, et al. Int J Obesity 2004;28:1471-8 Fatty meals Clotting Factor VII activity* Chylomicron Remnants get into artery wall & are more likely to stay there than LDLs. ** Insulin Resistance is associated with slower clearance of Chylomicron Remnants and more atherogenic postprandial lipemia. *** Statin drugs do little to reduce postprandial lipemia and the increased thrombosis.
A Single High-Fat Meal Impairs Blood Flow Vogel RA, et.al. Am J Cardiol. 1997;79:350-354.
Impact of a Single High-Fat or Low-Fat Meal on Coronary Blood Flow & TG Levels in Healthy Young Men Hi Fat Meal Low Fat Meal Ann Intern Med. 2002:136:523-528
Impact of High-Fat, Moderate-Fat and Very-Low-Fat Diets Fed Either Isocaloricallyor Ad Libitum on Fasting Serum Triglyceride Levels Parks EJ. Am J Clin Nutr 2000;71:424
Impact of the Pritikin Program on other Promoters of Atherosclerosis: 1.Reduced Oxidative Stress & Free Radical formation 2. Reduced Expression of Cell Adhesion molecules 3. Reduced Monocyte binding to Endothelial Cells 4.Increased Nitric Oxide Production by Endothelium 5. Reduced of Inflammatory molecules (IL-6, TNF-a, CRP) Roberts, CK, et al. Circulation 2002;106:2530-2 Wegge, JK, et al. Metabolism. 2004;53:377-81 Roberts, CK et al. J Appl Physiol. 2006;100:1657-65
Most Heart Attacks and Strokes Result from the Sudden Rupture of an Inflamed Plaque
Effect of 12 Days on Pritikin Program on C-Reactive Protein Levels Postmenopausal Women Day 1 Day 14 5 4 CRP mg/L 3 2 1 0 Diabetic HRT Statin N=8 N=12 N=4 * P < 0.05 * * * Wegge JK, et. al. Metabolism, 2004;53:377-81
Does a Drop in HDL-C on a Low-Fat Diet Impair Reverse Cholesterol Transport? Shellness GS. Atheroscler Thromb Vasc Biol 2005;25:2016 Brinton EA. J Clin Invest 1990;85:144-51 Ornish D. JAMA 1998;280:2001-7 SR-B1 is a Liver Protein which removes cholesterol from circulating HDL particles Low-fat diets the production of SR-B1 SR-B1 speed up the removal of cholesterol from HDL particles thus lowering HDL-C levels Regression of Atherosclerosis shown in subjects on a very-low-fat diet despite HDL-C level
Relative Risk of Having a Stroke or Heart Attack Increase with Increasing Systolic BP Systolic BP Schuldt, D. Archives of Internal Medicine 1993;153:186-208
Blood Pressure and Customary Salt Intake in Various Populations MacGregor. Hypertension. 1985;7:628
Impact of Pritikin Program on Hypertensive Subjects 268 Subjects On Hypertension Medication with High Blood Pressure 3 Weeks at PritikinCenter on Low-Salt, Very-Low-Fat Diet & Exercise Program 83% left off all their High BP Medication but had BP as low or in most cases lower than when they came in on BP-meds Barnard JB, et al. J Cardiac Rehab, 1983;3: 839-46
Impact of a Single High- or Low-Salt Meal on Flow Mediated Dilatation [FMD] Dickinson KM, et al. Am J Clin Nutr 2011;93:500-5
Impact of Reducing Salt Intake on Flow Mediated Dilation (FMD) • Overweight Normotensive Subjects were fed either 1150 or 3450mg Na diets for 2 weeks • FMD was 45% greater after 2 Weeks on the Low Salt Diet than after 2 Weeks on the High Salt Diet • Improved blood flow despite n.s. change in BP • Authors conclude: “These findings suggests additional cardioprotective effects of salt reduction beyond BP reduction.” • Dickinson KM, et a. Am J ClinNutr 2009;89:485-90
Fasting Insulin Levels Increase with Increasing Body Weight Bagdade et al. J Clin Invest. 1967;46:1549-56
Relative Risk of Developing Type 2 DM with Increasing BMI Colditz et al Ann Intern Med 1995;122:481
Incidence of New Diagnoses of Diabetes in Participants of the DPPT 40 _ 30 _ 20 _ 10 _ 0 Placebo (n = 1082) Metformin (n = 1073, p<.001 vs. placebo Lifestyle (n=1079, P<.001 vs. metformin, P< .001 vs. placebo Risk Reduction 31% by Metformin 58% by lifestyle Cumulative Incidence (%) Adapted d from Knowler WC, et al. N Engl J Med 2002;346(6):394-403 0 1 2 3 4 Years from Randomization
Effect of % Dietary Fat on Ad LibitumEnergy Intake in Human Subjects Lissner L. et al. Am J Clin Nutr 1987;46:886
Ad Libitum Calorie Intake on High- & Low-Calorie Density Diets Stubbs et al. Ann NY Acad Sci 1997;819:44
5-Year Follow Data from Subjects who Elected the PritikinProgram over Bypass 64 Participants Chose To “Bypass the Bypass” 62% Left Medication Free in less than a month At 5 yr Follow Up: 81% had not opted to have Bypass Surgery Most reduced or got rid of their angina 4 died with 2 of those deaths due to CAD Barnard JB, et al. J Cardiac Rehab 1983;3:183-90
The Lifestyle Heart Trial Results after One Year Showed: 91% reduction in frequency of angina in the experimental group But 165% increase in angina in control group Significant regression of coronary atherosclerosis in the experimental group Progression of atherosclerosis in the control group Mean 40% reduction in LDL-cholesterol on the very-low-fat, near vegetarian diet group Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. The Lancet. 1990; 336:129-133.
Study Showed 10% Fat Diet Plus Statins Appeared Best For Preventing CVD Events (no lifestyle or drug) Sdringola S, et al. J Am Coll Cardiol. 2003;41:263-72.
Diet and Lifestyle or Elective Angioplasty for Treating Stable Coronary Artery Disease? Elective Angioplasty (PCI) may reduce angina but it does not treat atherosclerosis and is mostly ineffective for preventing future CVD events. “As an initial management in patients with stable coronary artery disease, PCI did not reduce the risk of myocardial infarct, death, or other major cardiovascular event when added to optimal medical therapy” * Diet & Exercise can be a safer and potentially more effective therapy for preventing and reversing atherosclerosis & CVD events than elective PCI. *Boden WE, et al. COURAGE Trial. N Engl J Med 2007;356:1503-16
According to Dr. Nissen (Head of Cardiology at the Cleveland Clinic): “So you can put a stent in a coronary artery, but unless … you change the metabolic milieu that caused this disease to develop, you will not change the outcome.”* “The risk of death from MI is exactly the same after the intervention as it was before intervention.” * * Nissen S. www.medscape.com/viewprogram.2590?mpid=18]
Results from Coronary Artery Surgical Study (CASS) 24,958 patients with ischemic CAD Randomized to CABG & medical therapy 16 year follow up Only 2.1% of bypasses yield improved mortality – only in those with left main and left main equivalent disease and poor left ventricular function benefited from bypass surgery Caracciolo EA, Davis KB, Sopko G, et al. Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience. Circulation. 1995;91:2325-34.
Optimal Diet for Reversing Atherosclerosis, HTN, Type 2 DM, and Preventing CVD: Low Sodium (<1500mg Na+/day) Low Calorie Density (minimal refined CHOs) Minimize Cholesterol and Fat (esp. SFA & TFA) Lots of Whole Grains, Fruits & Vegetables Modest Amounts of NF Dairy or Soy Milk Modest Amounts of Omega-3 rich Fish