In This ArticleView All
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In This Article
My Experiment with Veganism
Changes for the Better
The Outcomes of My Vegan Year
“Heart disease? Oh, c’mon, that’s so old school.” So went my thinking as I rode a conveyor belt into a CT scan in one of those dreary medical-imaging facilities I’d managed to avoid for the entirety of my 51 years. I was fairly certain this was just another test that didn’t really apply to me—one of the many my doctor had tacked on to the growing list of exams we Americans find ourselves subjected to as we move through the decades.
And why should it? I’d never smoked, I drank only in moderation—usually red wine. I exercised for a half-hour on most days, meditated not infrequently and did all the other things one is supposed to do tomanage stress. The EKG tracings of my heartbeats were suitable for framing.
True, I didn’texactlyfollow Michael Pollan’s dictum to “Eat food. Not too much.Mostly plants.” But I did mostly avoid processed junk. (Doritos while driving were, for some reason, allowed.) I’d managed to limit myself to what I thought was a tolerable dozen or so pounds of extra weight, and I ate red meat only a couple of times a month.
That my “bad” LDLcholesterol had been creeping upslowly since my early 40s didn’t concern me that much. My “good” HDL levels were, well,good,and my health care practitioner assured me that my ratio of good cholesterol to bad was, also, well, good.
Still, I continued to think of all this heart disease stuff as something that only applied to guys who carried around tackle boxes full of pills, listened to Sinatra on AM radio and instructed waitresses to “Go easy on the salt, will ya sweetheart? I gotta watch my presha.”
Paul GreenbergThe pharmacy left five messages confirming that my drugs were ready. But I didn’t pick them up. I just didn’t want to. I was convinced that I wasn’t a statin kind of a guy. Wasn’t there another way?
Paul Greenberg
The pharmacy left five messages confirming that my drugs were ready. But I didn’t pick them up. I just didn’t want to. I was convinced that I wasn’t a statin kind of a guy. Wasn’t there another way?
“I got this,” I thought to myself.
Two days later, my doctor called to say I scored a 90 out of 400—more calcification in my arteries than 60% of men my age. Without even asking, he phoned in a prescription for statins. If I followed doctor’s orders, I would be taking pills every day for the rest of my life. The pharmacy left five messages confirming that my drugs were ready. But I didn’t pick them up. I just didn’t want to. I was convinced that I wasn’t a statin kind of a guy. Wasn’t there another way?
During the next year I would find out that, yes, there was. Although it sure as hell wasn’t as easy as taking a pill.
Nathan Hacket
If there was one comfort in all this, it was the fact that I was hardly alone in the diagnosis I’d received. Heart disease remainsoverwhelminglythe top cause of death for Americans, picking off close to 700,000 of us every year, according to theCenters for Disease Control and Prevention.
And, according to theAmerican Heart Association, nearly 128 million U.S. adults were living with some form of cardiovascular disease between 2017 and 2020—which includes coronary heart disease, heart failure, stroke and hypertension.
Plaque is a combination of fats, calcium, cholesterol and other molecules that can chronically impede blood flow to the heart and brain. An acute situation can arise if a piece of unstable plaque cracks, exposing the blood vessel to clotting agents in the blood—causing a rapid blockage that leads to a heart attack. According to theNational Heart, Lung, and Blood Institute, clogged arteries are the leading cause of heart attack.
But statins do other interesting things. They can also lock the more dangerous, unstable plaque in place, preventing it from cracking. A review of the research about how statins work published in 2022 inPharmaceuticals (Basel)found that these drugs have ananti-inflammatory effecton the body and may relax veins and arteries, easing blood flow.
Yes, heart disease, on apopulationlevel, is as serious as it is common. And, “On a population scale statins are miracles,” according to renowned diet-centered physicianMichael Greger, M.D., author of the bestsellingHow Not to Die—which is why the default for my very mainstream cardiologist was to call in the medication cavalry.
Now,that’swhat I wanted to hear. I am an individual, damn it, not a population. And I am a pretty motivated one to boot. What if I adopted the most heart-healthy eating pattern possible, amped up myexercise regimeand dropped those pesky extra pounds? I decided to give myself a year to make it work. And if it didn’t, the drugstore was right around the corner.
Ever since writing a book about heart-healthyomega-3 fatty acids, I’d been interested in the differences in outcomes from diet to diet. I’d also been circling around the idea that the best diet for your body might also be the best one for the planet. So, when I began researching what to eat for my yearlong heart-improvement project, my attention eventually zeroed in on going vegan.
With health outcomes,plant-based dietshave shown promising results—although there’s conflicting evidence as to whether going vegan, vegetarian or eating mostly plants, but allowing for some meat, fish and dairy—is best.
What I found most impressive were the studies that cardiologist Dean Ornish, M.D., founder of thePreventive Medicine Research Institute, conducted in the 1990s, looking at what happened to cardiac patients when they were put on a plant-based (though not completely vegan) diet. In many cases, Ornish discovered that with people like me who had significant calcification, their arteries actually opened up. This phenomenon has been attributed in part to the high amounts ofanti-inflammatorymicronutrients that a plant-centered diet—full of vegetables, fruits, whole grains, pulses (legumes) and nuts—delivers.
I also couldn’t ignore a 2014American Journal of Clinical Nutritionstudy that reported that among a group of 96,000 Seventh-Day Adventists—who adhere to varying types of plant-based diets—those who were vegan had the lowest risk of hypertension, as well as the lowest BMIs, compared to participants eating a vegetarian diet or a plant-based diet that included small amounts of animal foods. Other research on this cohort has linked veganism to better cholesterol levels, reduced inflammation and lower rates of heart disease.
Is the Vegan Diet the Healthiest Diet?
So, plants it was. But which plants? Here again, I turned to Ornish, or rather Greger, Ornish’s colleague. In his hundreds of short nerdfest online videos, Greger has, over the years, tried to take all the studies of all the foods out there and wedge them into what amounts to a mega meta-analysis of everything from broccoli to beans to beets. Based on that distillation, Greger recommends a diet to his patients that meets nearly all of their nutritional needs and delivers the fiber, antioxidants and other micronutrients that are thought to be the key to tamping down inflammation, lowering LDL cholesterol and improving cardiovascular health. What most decidedly wasn’t on the list were animal products and highly processed foods of any kind.
The transition was choppy. Going out to eat was a nightmare. Restaurants had to be pre-vetted, and I became that irritating member of a social circle who didn’t partake in the shared appetizer platter. At home, though, things went much smoother. I’ve always loved to cook and swapping in mushrooms for pork in my Bolognese didn’t bother me much. In fact, I was impressed with all the many ways plant-based cooking had advanced since I last tried vegetarianism back in the ’80s.
In preparation for my experiment, I also switched to a more lifestyle-centered cardiologist,Suzanne Steinbaum, D.O., president of the SRSHeart Center for Women’s Prevention, Health and Wellness in New York City. She’s used to challenging establishment assumptions, having been a leader in drawing attention to the overlooked fact that for American women, too, cardiovascular disease is the No. 1 cause of death.
But even Steinbaum was cautious about the idea of holding off on drugs. In fact, like pretty much every doctor I interviewed for this article, Steinbaum saw many benefits in statins. “I know cardiologists who, after putting in so many stents on so many patients say, ‘They should just put statins in the water,'” she told me. Indeed, many of the cardiologists I talked to were themselves on statins.
But a week later, when the results of my first blood tests came back, Steinbaum was impressed. In just a few months, my LDL had dropped from 160 to 127 mg/dL. My blood pressure—which had been stubbornly stuck at 140/90 mm Hg—was trending downward to something like 135/85. Still, she said, we should really dive deeper to try to figure this out. In other words, more tests.
We have come a long way in the last 60 years in understanding theroot causes of heart disease. Way back in the Rat Pack days, when the physiologist Ancel Keys first started peering into arteries and finding fatty deposits in the vascular system of middle-aged males, the thought was that fat and cholesterol from food were somehow literally oozing into our blood vessels and clogging them up—a kind of plumbing problem. But as medical research has become more fine-tuned in its ability to identify nuanced pathways, we’ve come to understand that coronary artery disease is a multifactor issue, one that hinges on a complicated interlinking dynamic of diet, lifestyle and genes.
As I entered the second quarter of my vegan trial, Steinbaum and I started trying to tease out how I stood on those other factors. She ordered a battery of new tests that looked both at my liver’s natural ability to deal with cholesterol, as well as at my genetic proclivity to have faulty LDL-clearing enzymes in the first place.
If it turned out that apoB-driven LDL was at the root of my problem, it’s possible that my endeavors might hit a wall, regardless of how much broccoli and beets I shoved down my gullet. Nevertheless, I persisted.
This might have been as important a choice for me as changing diets. Exercise, it turns out, is about the most statistically effective form of intervention there is for reducing cardiac “events,” as doctors call heart attacks and strokes.
Besides shaving off pounds and reducing stress, exercise also lowers blood pressure, stabilizes the heart’s rhythm and even improves its overall structure. Particularly relevant to my dilemma, there is evidence, too, that exercise helps transform unstable plaque into the calcified stuff that won’t break off and cause…an event.
Since I had already been doing 30 minutes a day, I upped my exercise “dose” to the upper part of Levine’s range and started running 45 minutes daily.
And my labs from Steinbaum cheered me. “The most compelling markers that we have are the cholesterol and blood pressure,” she wrote. “Your LDL cholesterol before you started your trial in February was 160, in May it decreased to 127 and now it is 118. Your ambulatory blood pressures in May were 120-145/80-95. Currently, your blood pressures are in the 120s/70-80s.”
Based on all that, it seemed I had beaten the rap. On the presumption that a continuation of my diet and exercise plan would further lower my numbers, Steinbaum was holding off on statins for the moment.
Other physicians I interviewed agreed that animal fat isn’t the biggest problem. Rather, it’s sugars and simple carbs thatdrive insulin spikesand inflammation and, in turn, heart disease. Indeed, it may be that certain sources of saturated fat have no impact on heart disease, but there isn’t consensus on the topic among experts who largely maintain that a diet low in all kinds ofsaturated fat, found primarily in fatty animal foods, helps reduce heart disease risk.
Although some think that a diet heavy in refined carbs—particularly added sugar—can result in higher heart disease risk, a 2022 study published inCochrane Database of Systematic Reviewsfound no evidence that a low-sugar diet was associated with less heart disease. Still, saturated fat and added sugars can add unnecessary calories, even on a vegan diet.
“But I bake my own bread and it’s 100% whole wheat!” I protested. Not enough, Hyman said. “My rule of thumb is the only bread you should eat is a loaf you can stand on that won’t squish.” As a precaution, I followed his advice and switched to a Danish health loaf that indeed bears a certain resemblance to a tasty brick.
In general, as I continued to modify my diet, I favored Greger’s advice to eat only whole, plant-based foods and eschewed the products coming out of the rapidly emerginghighly processed vegan foodsector.
If there is one thing I’ve learned after a year of being more in contact with the medical world than I’d normally care to be, it’s that tests beget tests. As I geared up to see Steinbaum for a final evaluation, we planned a repeat cardiopulmonary exercise test (CPET) to see if the impressive 112% VO2 score I’d gotten earlier was a fluke or a trend. We’d redo the apoB test and find out if I’d managed to tackle the “very bad” bad cholesterol issue. And, we’d test to see if I had any “endothelial dysfunction,” a way of charting whether the calcium picked up in my calcium score was inside or outside of my arteries.
But before I could get there, thecoronavirusswept across New York City. All nonessential services were shut down, including Steinbaum’s office. In mid-March 2020, I developed a dry cough, slight difficulty breathing, a fever and extreme fatigue. I knew people with impaired heart health were particularly vulnerable to COVID-19, and I was sure I had it. I worried.
And then, just as suddenly as they arrived, my symptoms vanished. My breathing returned to normal. I started running again. I felt great. Had my improved cardiovascular health contributed to my mild viral experience? Had all that diet and exercise paid off in actual life-saving in the face of a deadly pandemic? I wanted to think so. When I finally tested positive for COVID antibodies in May 2020, that very much seemed to be the case.
The Bottom Line
Here are a few takeaways from my year as a vegan.First, you are not me.Come up with a plan thatyourhealth care practitioner agrees with based on your numbers. For example, if you get a calcium score over 300 (as opposed to my 90), statins are probably in your future. And if you’ve already had a heart attack or stroke, don’t think about any of this until you’ve consulted your cardiologist.
Stick to dense,fiber-rich whole grains.Eat “bread that you can stand on without squishing it” as Dr. Hyman says.Go easy on the salt.Not all people are salt-sensitive, meaning their blood pressure ticks up in response to a high-sodium diet—but sodium is a major contributor to hypertension, which in turn is one of the major risk factors for heart attack and stroke.
If you’re going full-on vegan, you will likely have to supplement your diet with vitamin B12, omega-3 fatty acids and choline—nutrients that are primarily found in nonvegan foods like meat, fish and eggs. Women in their childbearing years should also take an iron supplement. Animal-free forms of dietary supplements are widely available.
Question your “healthy” diet.Log it and record what you’re really eating—even those Doritos in the car.Measure your exercise too.Are you getting 3 to 5 hours a week? If not, up it.
It’s OK to “cheat."(Full disclosure: I did several times.) A piece of meat here and there is not apt to blow out your arteries. Rather, as Dr. Greger notes, the goal is a significant overall decrease in saturated fat and an increase inanti-inflammatory plant-based foods.
I’ve seen the results of changes in lifestyle and diet and am committed to doing better with how I eat and exercise. Because, really, in these crazy times with all the stresses ahead, I know I’m going to need a whole lot of heart.
Originally appeared: EatingWell, September 2020
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