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Thursday, November 7, 2013

Can You Reverse Heart Disease? 11-08


Is Heart Disease Reversible?


Can You Reverse Heart Disease?



What may be possible if you have coronary artery disease.

Imagine that you’ve just left your cardiologist’s office. He’s told you that you have to make some changes. Your blood pressure is way over the limit at 170 over 100 and your LDL cholesterol (that’s the “bad” kind) is hovering right around 200. He conducted an exercise cardiac stress test, putting you on the treadmill and increasing the speed and elevation periodically while monitoring your heart -- and he didn’t like the results.

The diagnosis: coronary artery disease (CAD).

Besides surgery or medication, is there anything you can do to modify the course of CAD? The answer to that is, clearly, yes -- as long as your doctor is on board. Making some simple but significant changes in what you eat, how often you exercise, how much you weigh, and how you manage stress can help to put the brakes on heart disease.

But can you actually reverse heart disease, not just slow it down? The answer to that question is much more controversial. Here are two expert's views.

Yes, You Can!


Dean Ornish, MD, founder and president of the Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco, says that you absolutely can reverse at least some of the damage of even severe heart disease. Indeed, one of his six best-selling books is titledDr. Dean Ornish's Program for Reversing Heart Disease.

In his 2007 book The Spectrum, Ornish describes patients waiting to undergo a heart transplant -- those with the worst possible damage -- who enrolled in his program while on the transplant list. Some of them, he says, improved so much that they no longer needed a transplant.

“Our studies show that, with significant lifestyle changes, blood flow to the heart and its ability to pump normally improve in less than a month, and the frequency of chest pains fell by 90% in that time,” Ornish says. “Within a year on our program, even severely blocked arteries in the heart became less blocked, and there was even more reversal after five years. That’s compared with the natural history in other patients in our study, in which the heart just got worse and worse.”

Those lifestyle measures include exercise -- Ornish calls for people to walk at least half an hour a day, or an hour three times a week. Your cupboards, refrigerator, and dinner table will also need a total transformation if you expect to have a chance of actually reversing heart disease, not just preventing it or stopping its progression.

“Just making moderate changes in your diet may be enough to prevent heart disease, but it won’t be enough to reverse it,” Ornish says.

Ornish's plan categorizes foods from 1-5, ranging from most to least healthful. To actually reverse heart disease, you have to stay in Category 1.

In essence, that means becoming a vegetarian, filling your plate with fruits and vegetables, whole grains, legumes, soy products, nonfat dairy, and egg whites, and keeping away from fats, refined sugar, and carbohydrates. “You want to eat foods in their natural form as much as possible," Ornish says.

Ornish’s program also calls for regular yoga, meditation, and stress reduction.

If you have serious heart disease and are extremely motivated, you may be able to make such major changes, but they are difficult to sustain, says Lori Mosca, MD, MPH, PhD, professor of medicine and director of preventive cardiology at Columbia University Medical Center and the author of Heart to Heart: a Personal Plan for Creating a Heart Healthy Family.

“You have to live a very strict lifestyle, way beyond even the normal heart-healthy life,” she says. “And even then, I wouldn’t say you can ‘reverse’ heart disease, because that implies you had something and now you don’t. With very strict changes you can regress heart lesions, but they shrink -- they don’t go away. You can’t cure heart disease, but you can slow its progression.”
Mosca instead emphasizes slowing heart disease, and preventing it in the first place, through lifelong efforts to eat heart healthy, get regular physical activity, avoid smoking, and maintain a healthy weight.
On the diet side, that means embracing variety. “I don’t think that dietary approaches that are highly restrictive are sustainable,” she says. To keep heart disease in check, she advises:
Embrace the USDA’s new “MyPlate” program (similar to a visual she’s had on her Web site for years), in which half your plate is loaded with fruits and vegetables, and the other half is evenly divided between lean proteins and high-quality carbs such as brown rice.
  • Limit the saturated fat in your diet to less than 7% of calories.
  • Choose heart-healthy sources of fat, such as salmon and other fish rich in omega-3 fatty acids, nuts, and olives.
Ornish agrees that for most people who are just looking to either prevent heart disease or slow it down, going entirely “Category 1” isn’t needed. “If you need to reverse a life-threatening illness, you’re well advised to live as much as you can on the healthiest end of the spectrum,” he says. “But if you’re just trying to stay healthy, it’s unsustainable to say, ‘Never eat certain foods.’ It’s much more sustainable to just move in a healthier direction.”
And if you slip up and eat something that’s really not heart-healthy (a bacon cheeseburger, say, or a gooey doughnut) -- don’t beat yourself up. “If you indulge one day, then eat healthy the next. If you don’t exercise one day, do more the next,” says Ornish. “Guilt, shame, and anger are toxic to the heart, so forgive yourself and move on.”
Once you start making those changes, you might find that the rewards spur you to make more.
“We found that the more people changed their diet and lifestyle, the more they felt better, no matter how old or sick they felt,” Ornish says. “The better you feel, the more you want to keep doing it. The myth is that a pill is easy and diet and lifestyle changes are hard, but the data show that less than half the people prescribed Lipitor still take it after a year. Taking a pill to prevent something bad happening is fear-based, and it can be boring. But making healthy changes to your life makes you feel good, so you’re not just living longer, but better.”