The Best Diet for Chest Pain

Written By Michael Greger M.D. FACLM on November 6th, 2018

The Dean Ornish program that led to improved arterial function and the dramatic drop in angina attacks—a 91 percent reduction in reported frequency of angina—is not just about putting people on a plant-based diet. It also involves recommendations for moderate exercise and stress management. We know exercise alone can improve endothelial function, so how do we know diet had anything to do with it? Going back to Ornish’s first publication, he put cardiac patients on a plant-based diet, with no added exercise—just diet and stress management—and got the same 91 percent reduction in angina attacks within just 24 days. And Dr. Esselstyn was able to improve angina using a plant-based diet as the only lifestyle intervention. There are published case series going back to the 1970s documenting this. One study participant, Mr. F.W., had chest pain so severe he had to stop every nine or ten steps. He couldn’t even make it to his mailbox. He started on a strictly plant-based diet, and, a few months later, he was climbing mountains with no pain. We know plant-based diets can reverse heart disease, dissolving away plaque and opening up arteries—in some cases without drugs or surgery—but that doesn’t happen in 24 days. “[T]he improvements in anginal symptoms are too rapid in onset and [too great] in magnitude to be explained by the gradual regression” of the atherosclerotic plaque.

So, maybe it’s this improvement in function as well as structure. What is it about plant-based diets that improves our arteries’ ability to dilate? Is it macronutrient differences? Simply the lack of the deleterious effect of meat? Maybe it’s the drop in cholesterol. Endothelial function improves if we lower our cholesterol low enough, by any means necessary.

One study took PET scans measuring blood flow to the heart before and after three radically different ways to lower cholesterol. The first method used drugs, and the second used a low-fat diet—a really low-fat diet with less than 2 percent of calories from fat. And the third? No diet at all—that is, 90 days without food; the researchers had a central line placed to basically drip enriched sugar water straight into the subjects’ bloodstream for three months. These researchers were not messing around. The treatment protocol didn’t include any exercise or stress management, either. They wanted to isolate out the effect of cholesterol lowering on cardiac blood flow. The study participants started out with miserable cholesterol levels and with diminished blood flow to their hearts, so-called perfusion deficits, areas of the heart muscle that aren’t getting adequate blood flow. After cholesterol lowering, their cholesterol levels were still terrible, but, with the improvement, there was an improvement in blood flow and their angina attacks were cut in half. When they stopped the treatment and their cholesterol went back up, the blood flow to their heart muscle went back down. So, cholesterol lowering itself appears to improve blood flow to the heart, and the researchers think it’s because when cholesterol goes down, endothelial function improves.

There’s a new category of anti-angina drugs, but before committing billions of dollars of public and private monies to dishing them out, maybe “we should take a more serious and respectful look at dietary strategies that are demonstrably highly effective for treating angina and that have also been shown to reduce subsequent cardiac morbidity. To date, these strategies have been marginalized by the ‘drug pusher’ mentality of orthodox medical practice; presumably, doctors feel that most patients will be unwilling or unable to make the substantial dietary changes required…While this may be true for many patients, it certainly is not true for all. And, in any case, angina patients deserve to be offered the very-low-fat diet alternative”—the Ornish or Esselstyn diet alternative— “before being shunted to expensive surgery or to drug therapies that can have a range of side effects and never really get to the root of the problem.” In response, a drug company executive wrote in to the medical journal, “Although diet and lifestyle modifications should be a part of disease management for patients with cardiovascular disease and diabetes, many patients may not be able to comply with the substantial dietary changes required to achieve a vegan diet…” So, of course, everyone should go on their fancy new drug, Ranolazine. It costs thousands of dollars a year to take it, but it works. Collectively, the studies show that at the highest dose, Ranolazine may prolong exercise duration as long as… wait for it… 33.5 seconds! It does not look like those choosing the drug route will be climbing mountains anytime soon.

In health, Michael Greger, M.D.