Sticking with Cholesterol....

The subject of cholesterol and the whole fats question is something of a vexed issue of late. If you were to search online you would find a huge amount of information, much of it completely contradictory. Some will tell you it is wise to keep your cholesterol levels as low as possible whilst others will insist that having a high level of cholesterol in your bloodstream will have no bearing on your future health. To be as honest and straightforward with my readers as possible, I will admit to being a member of the first group and believe firmly, especially if a person has had any heart problems, that they would be well advised to control their cholesterol levels.

Firstly, we need to establish exactly what cholesterol is. If you were to hold some cholesterol in your hand you would find yourself looking at a waxy substance that might remind you of the scrapings from a whitish-yellow candle. Cholesterol is a lipid fat that is made in the cells of your body. There are many different types of cells that create cholesterol but the most productive are those in your liver that make approximately 25% of the total. You do need some cholesterol to keep healthy but your body creates all the cholesterol you need. You do not need to add cholesterol from outside sources (ie your diet!).

Cholesterol itself is performs three main functions in the body: it is used as part of the coating of cells; it makes up the bile acids that help in the digestion process; it allows the body to create Vitamin D and certain key hormones such as testosterone for men and oestrogen for women. Cholesterol is not bad, indeed it is vital to healthy bodily functions, but an excess of the wrong type is.

Cholesterol comes in two main types:

HDL (High Density Lipids) often referred to a good cholesterol.

LDL (Low Density Lipids) sometimes referred to a bad cholesterol but, the really bad ones are VLDL (Very Low Density Lipids) these are the ones that clog up your bloodstream and result in the problem of atheroma and the resulting cardiac issues.

Atheroma is the process of the degeneration of the walls of the arteries. This is generally caused by the build up of fatty deposits and scar tissue. Over time this will result in the restriction of blood flow and lead to cardiac events of all sorts. This formation is what we hope to prevent and reverse using these dietary and lifestyle methods.

A general reduction in cholesterol levels will offer a patient increasing levels of protection from the risk of heart attack but it needs to be stressed that it is not just the levels that are important but the ratio of LDLs to HDLs. Many in the field recommend going for a ration of 3:1 but some go even further and say that ideally one would achieve a ratio of 1:1. Commonly, in countries suffering high levels of heart problems such as the UK or the US, levels of 7:1 or 8:1 are commonly seen although the average is roughly 4.5:1.

Dr. Esselstyn sets a very clear goal in relation to the desired levels and ratios of cholesterol. He aims for a total blood cholesterol figure lower than 150mg/dl (milligrams per decilitre) and levels of LDL lower than 80mg/dl. By following the plant-based diet he recommends (as given in the previous blog) these levels are readily achievable. According to the doctor, at this kind of level you not only protect yourself from the possibility of a future cardiac event but even make possible the reversal of damage to the coronary arteries.

One of the good pieces of news about a plant-based diet is that plants themselves are very, very low in cholesterol. Many websites will tell you there is none at all, but this is not entirely accurate. The levels are so low though that they hardly register. Also, it should be noted, that the sort of cholesterol they do have is of a type that your body can use in a protective manner. To give some idea of the scale, the yoke of an egg (not recommended on the Esselstyn diet!) has 15000 mg/kg of cholesterol; the most concentrated form in the plant world is the European False Flax that contains as much as 200 mg of cholesterol per kg of plant oil. That is a ratio of 75:1. Note that this is in the oil form, again something that Esselstyn warns against, so even these very low levels would be avoided following his diet.

For interest, and to complete the picture, meat contains up to 5000 mg/kg and butter 2500 mg/kg. Without going into the issue of saturated versus unsaturated fats (a subject for a future blog), suffice it to say that the saturated fats are the ones to avoid. Dairy products and meat are high in saturated fats. One can readily see how the avoidance of meat and dairy products logically forms the foundation of Esselstyn's heart-friendly diet.

Finally, after quite enough technical information for one week, a little inspiration. Doctor Ellsworth Wareham was a cardio-thoracic surgeon for most of his long career. A few years ago, at the age of 95, he decided it was time to retire although there was no deterioration in his competence levels and the hospital he worked at tried everything they could to persuade him to continue. He is now 98 years of age and, as you can readily see from the video, remains remarkably healthy physically and sharp mentally. Doctor Ellsworth has been on a plant-based diet since his mid forties...

You are what you eat....

Following the heart attack I spent some time wandering around in the wilderness, feeling a little depressed and dis-empowered. It felt as if I could at best delay the inevitable but no better than that. After seeing various videos featuring ex-president Bill Clinton discussing the changes he had made to his diet under the influence of Doctors Dean Ornish and Caldwell Esselstyn I began to realise that there might be a better way. I did a little research the internet and found several sites relating to these issues, in particular, Esselsytn's own site was most informative and easily understood. He has the happy knack of explaining sometimes quite complex ideas in simple terms.

Having the possibility, through adherence to Esselstyn's dietary and lifestyle suggestions, of not only slowing the progress of the disease but actually reversing its effects felt tremendously encouraging and empowering to me. I could once more be the master of my own destiny.

Esselstyn himself has been a vegan of long standing but often the term 'vegan' is noticeable by its absence in his writings. Perhaps because some people have a very dismissive attitude to vegetarianism and veganism in general Esselstyn tends to adopt the term 'plant-based'. From my personal point of view, I have no problem with whatever they call the diet as long as it is efficacious in relation to the underlying problem. As old Bill Shakespeare once wrote (in Romeo and Juliet): “A rose by any other name smells just as sweet!”

The diet itself is as much about what it omits as what it includes. In very simple terms, all animal based foods are not allowed. This includes the more direct examples such as meat, fish and poultry but also foods derived from animals such as eggs, butter, cheese and any other dairy products. There are no exceptions. In that way the dietary advice is very clear on this point. An interesting way of thinking about this is why would you want to consume your nutrients second-hand only after they have been consumed by an animal when you can get the nutrients directly? Most of the common animals we eat get their nutrients via eating plants. We then eat them. Surely it is better to cut out the middle man (or middle animal in this case!), and get to the source of the nutrients directly?

Esselstyn is also very strong on the avoidance of all oils, even those that are oft touted as 'good oils'. According to the Doctor, for human beings there are no such things as good oils, in the long run they all damage our arteries. Even those often touted as healthy such as olive oil and canola oil are banned. Doctor Ornish is not quite so binary on this issue but I prefer the simplicity and clarity of Esselstyn's approach.

Refined grains are also to be avoided in favour of whole grains. White bread, white rice, even so-called enriched flour such as that to be found in bagels and most generally available baked goods are deemed to be off the menu. You are allowed grains but only in their whole variety rather than after they have been processed in some way.

Nuts are also banned because of the amounts of fats involved. This may seem drastic but having a heart attack is also pretty drastic in itself. I suppose it depends on how motivated you are to avoiding succumbing to further cardiac events. The one exception he makes is walnuts because of their high omega-3 content. Even this exception is directed at those who are trying to avoid a heart attack rather than those who already have suffered one. In the latter case he suggests that nuts of all sorts are best avoided altogether.

Finally, although these last two are so obvious that they hardly needs stating, avoid sugars and sugar based confections and do not smoke. Concentrated sugars are simply awful for the body but I think by now this is common knowledge. Not smoking goes without saying. If someone still believes that they can improve their health against a background of smoking one would wonder what planet he/she has been of for the last thirty years. To make an unequivocal statement: smoking is terrible for your heart and terrible for your lungs (amongst other unpleasant physiological effects).

After that rather long and wide ranging summation of what you cannot eat you are probably wondering what exactly you are allowed to consume! This is clearly not a diet for those who wish to compromise. The idea is reduce cholesterol down to levels scarcely seen in America and the Western world. This is not simply an attack on cholesterol though as it role in heart disease is far more subtle than was first realised. It is part of an overall and comprehensive strategy that will, if successful, allow your arteries the chance to repair themselves and for normal life to return.

You are allowed to eat just about any type of vegetable and, contrary to our normal idea of a diet, in whatever quantity you desire. You definitely need never go hungry on this diet although there may be a few problems whilst you adjust your mindset away from the unhealthy and disease causing foods towards the more healthy alternatives. After quite a short period it becomes second nature. At this stage the thought of consuming the greasy, fatty, processed fayre that is often served up in the name of food may even begin to become a little unappetising, to say the least. Even the sight of the stuff can become quite off-putting once you have adapted to a healthier, plant-based diet.

Legumes of all sorts are also highly recommended on this diet. Any type of bean or pea and lentils of all kinis are allowed. This gives a huge range of choice. Once you start to look into these things you begin to realise just what a huge variety of healthy food stuffs there are out there for you to choose from. Oddly, once you get into the swing of things, you may even find that your daily diet becomes far richer and more varied than it ever was before.

All whole grain products are allowed. This means that the grain has not been processed in any way (which often reduces it nutritional value). It is not at all uncommon these days for manufacturers even to add oil in the process of producing a loaf of bread. Clearly this is a big no-no on this diet!

Fruits of all sorts are definitely allowed and even encouraged but just be careful not to overdo it. When it is consumed it should be as close to its natural state as possible rather than in any desserts or sweetened forms. There is a type of sugar called fructose in fruits and over consumption of this bears the same dangers as many other forms of sugar consumption. Fruit juices, for this reason, are to be avoided.

You can drink a wide range of beverages such as tea, coffee, water, oat milk and no-fat soy milk. Personally, I can have a few problems with coffee as a strong cup can send the pulse racing so I tend to keep it down to one every now and then. Most of the time when I am in a situation where I previously drank coffee I tend to pick from a pretty comprehensive and wide range of teas that are available in this day and age. In my own case, and particularly when writing, I especially enjoy a pot of fresh green tea.

Even alcohol is allowed on this diet though keep it to sensible levels. Getting drunk on a regular basis is not good on any diet!

To cover for the possibility of any deficiencies, Dr. Esselstyn recommends taking a multivitamin tablet each day, vitamin C and D and a supplement of B12 (1000 mcg daily). People over 50, should look after their levels of vitamin D, therefore Esselstyn advocates supplementing with a tablet each day although getting sufficient exposure to sunshine would also help in its production. Finally, as regards supplements, Esselstyn recommends taking a tablespoon of flaxseed meal every day. This can be taken directly or added to your cereal.

Statins can be a controversial area but the cholesterol lowering effects are clear. Some claim many other benefits and feel that most people would be wise to use them once they approach middle age. Others point out possible negative side effects. If you are able to reduce your cholesterol levels to below 150 milligrams per decilitre then you can probably avoid the need to take statins. If above that, Doctor Esselstyn himself generally comes down on the side of using statins, particularly if you have already had a heart attack.

Ideally, as with many other such interventions, when one goes on this diet one should consult with a doctor before beginning. Have some blood tests done that inform both you and him/her of your cholesterol profile. Then, every three months afterwards have these levels re-checked to ascertain what progress you have made. Medication such as statins may become unnecessary if your levels have reduced below the 150 mg/dl mark.

In next weeks post we will address the problem of cholesterol and its relationship to a healthy heart. There is much misunderstanding in these areas and much controversy too. Again I would urge, in this day of huge amounts of free information (not always accurate though – be careful!) via the internet, to do some of your own research and familiarise yourself with the concepts involved. It is your heart, your health and, to some extent at least, your responsibility!

 For many years there was an attitude afoot wherein the person suffering health problems went to their doctor and hoped to get some kind of medication to make the problem go away. Essentially, the role of the patient was almost entirely passive whilst the doctor and the medical profession were cast in an almost omnipotent role. Increasingly in recent years, this is no longer the case. Your health is your own responsibility. So many of the ailments we suffer in these times are as the result of unhealthy lifestyles and attitudes, and poor diets. Merely allowing doctors to intervene when you suffer the effects is not good enough! It is your life, your health and your choice.  

The Aftermath. What to do?

The events referred to in my previous blogs transpired some two and a half years ago now. Happily, for me at least, I have survived this initial stage and even find myself in reasonably good health at the time of writing. Unfortunately, a fair percentage of heart attack victims never make it this far, particularly those who choose to continue the lifestyle that was, to a certain extent at least, responsible for them suffering a heart attack in the first place. Factors such as smoking, drinking to excess, lack of exercise and stressful lifestyles are obvious enough but perhaps the biggest single change that people such as I need to consider is their diet.

My own personal history in this matter seemed, at the surface level at least, to be relatively good. I had been a vegetarian for 27 years, had only smoked during my distant youth and I barely drank alcohol, only indulging in the odd glass of wine or beer once or twice a month. Unfortunately, all was not as it seemed though. My diet, although lacking meat and many of the problems related to the ingestion of it, was still not good. I had an ongoing weakness for cakes, biscuits and many other mass-produced, high in sugar, confections. Added to this, I had also spent many years in a high stress occupation that necessitated working long hours on shifts, often having to work with some degree of intensity late at night. During that period of my life I faced several health challenges and although that was long in my past now the ongoing effects were not so easily eradicated.

So it was that I found myself in middle age having to deal with the reality of suffering a heart attack and the somewhat disconcerting feeling that it could all so easily happen again. I had thought that the current, relatively low stress lifestyle that I adopted at the time would protect me. My exercise options were somewhat more limited than most due to the impact of a long-term back injury but I still managed to swim three times a week. The heart attack had proved me wrong though. Whatever it was that I was doing it was clearly not working. At this stage I have to admit to a certain feeling of helplessness, of being a passive victim of circumstances. This was not a good feeling...

The after-care advice that I received from my health provider basically told me to do all the things I had previously been doing anyway: exercise, avoid fast food, de-stress, don't smoke. There seemed also to be an unwritten and unspoken assumption in all this too, a sense that all a patient could do was forestall the inevitable, to put the dreaded event back in time but not to heal, not to actually get permanently better.

So it was that I found myself feeling like a ship without a rudder, sailing to who knows where but with the certainty that eventually it would not be a good place. I recalled from my earlier studies in psychology a group of experiments conducted by Martin Seligman into learned helplessness. Basically the results of these were that when you put an animal into a no-win situation it acquired a habit of not looking for other options even when these were in fact open to it. The animal 'learned' to be helpless. This now felt much like the situation I found myself in.

This continued for some months after the initial heart attack. There was a certain wariness to everything I was doing, as if I was at some level expecting another 'event' at some stage. When and how it would happen I had no idea, but there was a persistent feeling of inevitability that tended to take much of the fun out of life. The feeling of no longer being in control, of no longer having choice, is not a good one in this situation.

During this time of drift, through sheer serendipity, and through a mutual interest in psyhology, I had met a certain Russell Monsurate on Facebook. His posts interested me and he seemed to have a very positive attitude to life in general, which I greatly appreciated at this stage. In particular, he often seemed to post articles relating to cardiac health. It was one of these that was to change both my psychological and, if my current well-being is anything to go by, my physiological state. 

The article itself referred to the changes in former president of the US Bill Clinton. This piece originally caught my attention as I had long been an admirer, although not an entirely uncritical one. Despite his shortcomings, one always had a feeling that his heart was in the right place, even when that heart appeared to be ailing as he reached his fifties.

At the age of fifty eight Bill Clinton had undergone a bypass procedure. Such drastic occurrences in one's life do tend to focus one's attention. In Bill Clinton's case, despite making some changes, he did not fundamentally address the problem of his famously indulgent diet. The former president had always been known for his appetite and, despite the warning, his excesses in this area still remained relatively uncurbed. Three years later he suffered another 'event', this time calling for the insertion of a couple of stents.

At this stage his former medical adviser, Dean Ornish, wrote a letter to Clinton pointing out the inevitable result of continuing down the path he was taking and a way that he could, with patience and persistence, avoid this apparent inevitability. What Ornish suggested was a drastic change of diet. He advised the avoidance of meat, fish, dairy products and any processed so-called 'fast foods'. He also advised a minimal reliance on oils.

Ornish's view was further supported by Dr. Caldwell Esselstyn. Clinton reviewed the evidence and his own parlous state of being and decided that he needed to take the plunge. What followed was an immediate improvement in the state of his health. He began to lose weight, going down some 20 lbs in the first year alone. Blood tests started to show, and continued to show, a great improvement in all the classic markers related to coronary health. The former president, on seeing the obvious success of the diet in his own case, became not only a follower but a keen advocate of this vegan, plant-based diet.

From my personal point of view, if Dr. Esselstyn's book was to be believed, the really good news in all this was that cardiac problems of this sort could not only be slowed down but the process can actually be reversed. It seems that the body's remarkable ability to heal itself applies to this area too. Not that surprising really, but having subconsciously assimilated the assumptions of many in this area, I had believed that all that was left to me was delaying the inevitable. Now, for the first time, I realised that one has a lot more choice, a lot more control than that. One can not only slow down the progress of heart disease but, if one remains disciplined, one can actually reverse the process.

 This was good news indeed.