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Blocked Arteries: Clean Them Out Naturally

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Triglycerides Increased in the Lifestyle Heart Trial

For average Americans, the higher their triglycerides, the worse they fare as far as coronary artery disease is concerned.28 It was therefore surprising that the individuals who reversed their heart disease on the Lifestyle Heart Trial experienced a rise in their triglycerides, as seen in Figure 15: Triglyceride Changes in the Lifestyle Heart Trial.

The vegetarian group had a 46-point increase in triglycerides. On the other hand, the control group lowered their triglycerides over the same time period by 17 points. This rise in triglycerides is not typical for vegetarians in other studies. Some studies have identified groups of vegetarians with lower triglyceride levels than average.29, 30 What, then, was happening in the Lifestyle Heart Trial? Individuals on a fat-restricted vegetarian diet may tend to run a higher triglyceride level because they are consuming higher amounts of complex carbohydrates. Carbohydrates made up fully 70 to 75 percent of the Lifestyle Heart Trial diet. However, these carbohydrate-rich foods usually look like good guys regarding heart disease risk as well as cancer risk. It seems difficult to comprehend that they were getting "too much of a good thing."

One concern focuses on research findings that suggest that higher triglyceride levels are associated with lower HDL levels, which agrees with what we see in this study. In fact, a little-known detail about Ornish's program is that participants showed a tendency to lower their average HDLs while following the prescribed lifestyle. This tendency was slight after the first year, but became more marked by the end of five years. Average HDL's in Ornish's low fat vegetarian group started out at 39 as previously stated. Five years later they were 35. In as much as we know that HDL protects the heart, raising triglyceride levels (even the "good" triglycerides) may still turn out to have some harmful effects.

Although the rise in triglycerides did not appear to interfere with the overall success of the Lifestyle Heart Trial, it leaves a nagging question: could the results have been still better if fat consumption had not been so rigorously reduced? Could Ornish's severe fat restrictions come back to haunt the participants in the long run? The question is more than academic. As we have already seen, vegetarians who have not made pains to drop their fat intake, do tend to consume less fat than average but nowhere near as little as Ornish and his colleagues required. Interestingly, in Resnicow's own research, as well as in nine other studies that he analyzed, total vegetarians generally had lower cholesterol, lower LDL levels, and lower triglyceride levels--all with equally good HDL levels.31 This evidence casts suspicion on the extremely low fat intake and the corresponding high carbohydrate intake of the Ornish diet being the cause of the rise in triglycerides.

Another report documenting vegetarians' lower triglyceride levels provides further insights. Specifically, vegetarians who decrease their fat consumption within more moderate ranges (down to 23 percent of their calories) have been found to lower their triglycerides.32 Other research has shown that a vegetarian diet that does not excessively restrict fat consumption can lower cholesterol levels, yet maintain HDL values.33 These studies cast further suspicion on the very low-fat diet. The concern is that lowering fat consumption to the profound levels of the Ornish diet will result in a rise of triglycerides and a depression of HDL, as we have seen in the Lifestyle Heart Trial.

The very low fat vegetarian diet may be depressing HDL levels for reasons other than its effects on triglycerides. McDougall used an even lower fat diet, 5 percent of total calories (compared to Ornish's 10 percent), and was able to lower cholesterol 11 percent in a 12 day live-in program, while HDL levels plummeted 19 percent. Triglyceride levels did rise but only in some subgroups of women over 50. It seemed clear in McDougall's study that a tendency for triglyceride levels to rise did not explain the whole HDL depressant effect of the very low fat vegetarian diet.

A last bit of information may help to put the percent fat issue into still better context. When Dr. Ornish analyzed his data to find the most important part of his diet in reversing heart disease, he found it was its low cholesterol content rather than its low fat content.34 Although Ornish's work was not designed to be statistically valid in making such comparisons, the result is nonetheless intriguing. It implies that the absence of animal products in the diet (which ensures that a diet will have no cholesterol) is more important than dramatic reductions in fat content. This line of thinking is in harmony with the latest studies that demonstrate the preventive benefits of some high fat, no-cholesterol foods like nuts. Studies on the beneficial effects of nuts are presented in the previous chapter.

Still further support to this perspective comes from Stanford University. Researchers there also demonstrated that lifestyle changes could be used to significantly impact the progression of coronary artery disease.35 Based on their research and other published studies, they concluded: "In general, it appears that better angiographic outcomes are achieved with greater reductions [in LDL cholesterol] because studies reporting regression of disease in their treatment groups also produced reductions in LDL of 35 percent or more." As we have seen in the previous chapter, a very low fat diet is not necessary to achieve a reduction of either total or LDL cholesterol.

Considering all of the evidence regarding the best level for fat in the diet, we conclude that five to ten percent is too low, and 30 percent is probably too high. About 25 percent fat seems to be optimum.

28 Austin MA. Plasma triglyceride and coronary heart disease. Arterioscler Thromb 1991 Jan-Feb;11(1):2-14.

29 Resnicow K, Barone J, et al. Diet and serum lipids in vegan vegetarians: a model for risk reduction. J Am Diet Assoc 1991 Apr;91(4):447-453.

30 Liebman M, Bazzarre TL. Plasma lipids of vegetarian and nonvegetarian males: effects of egg consumption. Am J Clin Nutr 1983 Oct;38(4):612-619.

31 Resnicow K, Barone J, et al. Diet and serum lipids in vegan vegetarians: a model for risk reduction. J Am Diet Assoc 1991 Apr;91(4):447-453.

32 Liebman M, Bazzarre TL. Plasma lipids of vegetarian and nonvegetarian males: effects of egg consumption. Am J Clin Nutr 1983 Oct;38(4):612-619.

33 Otani H, Kita T, et al. Long-term effects of a cholesterol-free diet on serum cholesterol levels in Zen monks. N Engl J Med 1992 Feb 6;326(6):416.

34 Ornish D. Reversing heart disease through diet, exercise, and stress management: an interview with Dean Ornish [interview by Elaine R Monsen]. J Am Diet Assoc 1991 Feb;91(2):162-165.

35 Haskell WL , Alderman EL , et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994 Mar;89(3):975-990.

Notice of Credit
The article above is compliments of the Uchee Pines Institute, Seale, Alabama, a teaching and treatment facility devoted to natural remedies. For mor information, call 334-855-4781,e-mail:, or visit their Website:

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