Congratulations on starting a heart disease reversal diet!

• Don’t stop your medications! Not yet. Medications should only be deprescribed under medical supervision when they are no longer needed.
• Emergency coronary artery stents for heart attacks can be life-saving. But did you know that most non-urgent (elective) procedures do not prolong life and may not even provide long-term symptom relief? Your heart specialist can advise you whether it’s safe to defer planned procedures.
• If you want rapid and transformative improvements, you will need to adhere closely to the nutrition program and pay attention to other lifestyle factors, particularly physical activity.
• You may wish to consider enrolling in our next 5-part webinar series or attending our 7-day Immersion retreat.
• For personalised support, if you are in Australia, you can make an appointment with Dr Malcolm Mackay or another healthcare practitioner from our directory of doctors, dietitians and other health professionals.

Our take on the heart disease reversal diet is broadly consistent with Dr Caldwell Esselstyn (Prevent and Reverse Heart Disease) and Dr Dean Ornish (The Ornish Program).

Key nutrition points:

• Whole grains, legumes and starchy vegetables provide most of our calories.
• Nuts, seeds, avocados and other high-fat items are limited or excluded.
• Non-starchy vegetables (and mushrooms) fill half the plate.
• Green leafy vegetables are part of every meal (at least three times per day).
• Fresh fruit is unrestricted.
• Vegetable oils are excluded.
• Animal products – red meat, chicken, fish, eggs and dairy products – are excluded.
• Sodium is limited.
• Sugar and sugar syrups are excluded.

For more details, see below: Dietary Guidelines for Treating Heart Disease

Physical activity:

Regular walking at a comfortable pace is safer than remaining sedentary. If you have advanced heart disease or are coming from a low base activity level, you may need to start with short periods of slow walking and gradually increase over subsequent weeks.

Medical clearance is advisable before commencing more vigorous fitness training or recreational activities. If necessary, your GP can refer you to an exercise physiologist, who can assess your physical limitations and prescribe an exercise program.

 

The Heart Disease Reversal Diet

The heart disease reversal diet is essentially the WFPB dietary pattern we would recommend for everyone, with a few minor tweaks for heart and metabolic health. Most people with heart disease have weight to lose, many have insulin resistance, and some have chronic kidney disease. The heart disease reversal diet supports the management of these other health conditions.

Dietary Guidelines for Treating Heart Disease:

Whole grain, legumes and starchy vegetables:

At the core of our diet are the whole grains, legumes and tubers, the ‘starches’ that provide the bulk of our calories. Whole grains and legumes provide ample protein and most of our dietary fibre. They are low in calories in their wet, cooked form, so you’ll need a lot of them on your plate. (See our Energy DensityEnergy Density page and our FAQ on Whole Grains)

Fruits and vegetables:

Fill up to half your plate with a variety of vegetables. Mushrooms, a fungus rather than a plant, are included here. Include plenty of cruciferous vegetables and other leafy green vegetables.

Enjoy fruit with meals and as snacks. Fresh fruit has only ever been associated with better health outcomes, even for people with diabetes. Berries are particularly rich in protective phytonutrients. If you have high triglycerides, you may need to temporarily restrict fruit to 2-3 servings per day.

Green leafy vegetables:

As a key part of the Esselstyn heart disease reversal diet, we recommend including nitrate-rich vegetables with every meal. Examples are kale, spinach, silverbeet, broccoli, rocket, beetroot and cos lettuce. The suggested quantity is at least half a cup of cooked greens or a whole cup of raw greens. Aside from nitrates, green leafy vegetables are nutrient-rich, high in antioxidants, and improve metabolic health.

Spices and flavourings:

Many of the spices are extremely high in protective phytonutrients. Turmeric, for example. Use them to flavour your meals rather than taking them in excessive amounts or as supplements. Use vinegar or lemon juice as dressings for vegetables.

Limit high-fat, whole plant foods:

The disease-reversal diets of Esselstyn, Ornish, Barnard, McDougall, and Pritikin are all at the low-fat end of the whole-plant food spectrum. Nuts, seeds, avocados, and whole soybean products are limited to very small quantities. One to two servings of soy per day and a tablespoon of ground flaxseed are suggested. Use nuts and avocado sparingly – limit avocado to a maximum of one quarter per day. Most nuts have a less-than-ideal fat composition. Walnuts are probably the best choice.

See our FAQ What are ‘good fats’? and Omega 3 Essential Fatty Acids

Limit bread and flour products:

Whole grain products are healthy. However, there are several problems with bread. The milling of grains results in more rapid starch absorption, which can excessively raise blood glucose in those with insulin resistance and reduce the amount of resistant starch delivered to the colonic microbiome. Store-bought bread is high in salt. Bread is often eaten with high-fat toppings such as nut butter or oily hummus. A small amount of 100% wholemeal bread is ok. See FAQ whole grains

Dried fruit:

Dried fruit and dates are about six times as high in natural sugars and calories as fresh fruit. They may contribute to weight gain and elevated triglyceride levels. They are yellow traffic-light foods for most patients with heart disease.

No animal products:

Meat, chicken, fish, eggs, and dairy products increase cardiovascular risk through multiple mechanisms. For most people, blood cholesterol will only fall to heart-healthy levels when most, if not all, animal products are removed from the diet. Regular fish consumption does not protect against cardiovascular disease.

Low sodium:

Salt raises blood pressure and damages endothelial cells. Most chefs and food manufacturers use a lot of salt to make their food delicious, which makes it difficult to limit sodium intake. Nearly all bread products are high in sodium. Avoid salty condiments at home, and your taste buds will reset, so you’ll better appreciate the natural flavour of whole plant foods.
See our FAQ on salt.

No coffee:

Coffee may increase heart rate and blood pressure. Unfiltered coffee (including decaf) contains cafestol, which raises blood cholesterol. Filtered and instant coffee contain much less cafestol.  Observational studies of coffee intake and cardiovascular disease are mixed. Tea is probably a better choice.

Smoothies and juices:

It’s preferable to chew your food. Juices have lost much of their fibre and are not recommended as an everyday food. Smoothies disrupt the fibrous structure, resulting in more rapid absorption of fruit sugars and reduced delivery of carbohydrates to the colon microbiota. But taking your green leafy vegetables as a breakfast smoothie is better than not eating them.

Minimise refined sugars:

Incidental intake of a teaspoon or two of sugar or sugar syrups in a day is probably insignificant. But in general, sugar (white, brown, etc.) and sugar syrups (honey, maple, date, agave, etc.) are best avoided. You can sweeten desserts with whole foods such as fruit or dates. Artificial sweeteners are not recommended.

No alcohol:

Alcohol, even red wine, is not heart-protective and has toxic effects throughout the body.
See FAQ alcohol

No oil:

Vegetable oils are processed foods that promote weight gain and may directly damage arteries. Avoid oil and margarine at home and go out of your way to minimise intake when eating out.
See No Oil! page.

Supplements:

We recommend a food-based approach to nutrition with minimal supplements.

• A vitamin B12 supplement is required for all vegans and older adults.
• Vitamin D3 may be required if sun exposure is inadequate.
• DHA (long-chain omega-3) supplements do not reduce heart risk and increase the risk of atrial fibrillation. [See our discussion on Omega 3 for more information]
• Research evidence does not show significant benefits from other nutrient supplements such as CoQ10 or vitamin K2.

See Vitamins and minerals section.

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