While we appreciate that Mr. Bayan took the time to comment on our work, we are concerned that inaccurate statements he has made may discourage some people from making changes in diet and lifestyle that we have proven to be lifesaving.
For the past 24 years, the non-profit Preventive Medicine Research Institute and the University of California, San Francisco, School of Medicine have conducted research scientifically proving, for the first time, that the progression of even severe coronary heart disease can begin to reverse by making comprehensive changes in diet and lifestyle, without drugs or surgery. These studies have been published in leading peer-reviewed journals such as the Journal of the AMA, The Lancet, the American Journal of Cardiology, New England Journal of Medicine, Circulation, and others.
Mr. Bayan alleges that the diet we have proven to be so beneficial is "dangerous" for some patients because both HDL and LDL may decrease and triglycerides may increase. HDL and triglycerides are only potential risk factors for heart disease, they are not diseases. When we measured the actual severity of heart disease using state-of-the-art measures such as computer-analyzed coronary arteriography and cardiac PET scans, patients showed continued improvement over time, even in patients like Mr. Bayan whose HDL decreased or triglycerides increased. Also, cardiac events were 2.5 times lower in the group who followed the program compared to the control group who made more moderate changes in diet (30% fat, 200 mg cholesterol). [reference: JAMA. 1998;280:2001-2007.] Clearly, lowering HDL by changing diet did not harm these patients. LDL cholesterol decreased by an average of almost 40% during the first year, and none of the patients who adhered to the diet showed an increase in LDL.
As Dr. Connor wrote in the New England Journal of Medicine, "There are no data showing that the physiologic reduction of HDL cholesterol levels with a low-fat diet is detrimental. Diet-induced lowering of HDL cholesterol does not confer the same risk of atherosclerosis as do low HDL cholesterol levels in Americans consuming a high-fat diet." [ref: N Engl J Med. 1997;337(8).]
It is true that one can eat an unhealthful low-fat diet if it is high in simple carbohydrates such as sugar, white flour, alcohol, and many popular fat-free desserts. Such a diet may cause a shift to the more harmful pattern B LDL subclass that Mr. Bayan mentions.
But this is not the diet we recommend for reversing heart disease. Other studies have shown that a diet high in fruits, vegetables, grains, beans, and other complex carbohydrates (which is the diet we recommend) actually cause a shift AWAY from the pattern B LDL subclass to more beneficial patterns [ref: Kenney JJ, et al. Very-low-fat diets do not necessarily promote small, dense LDL particles. American Journal of Clinical Nutrition. 1999;70(3):423-5.]
Patients whose triglycerides increase are counseled to be even more mindful in reducing their intake of simple carbohydrates and increasing their exercise. Also, for many years we have recommended that patients take 3 grams/day of fish oil, which also helps to lower triglycerides. In the Multicenter Lifestyle Demonstration Project, we found that triglyceride levels, which initially increased slightly but not significantly, then fell significantly in years two and three. [ref: American Journal of Cardiology. 1998;82:72T-76T.] Almost 80% of people who were eligible for bypass surgery or angioplasty were able to safely avoid it by making these diet and lifestyle changes instead.
We respect the work of Dr. Robert Superko and often refer patients to his lipid laboratory for testing. Again, we have found that patients with small dense LDL also show reversal of heart disease on the program recommend.
The program that we recommend includes a reversal diet for those with heart disease and the prevention diet for others. The prevention diet may be higher in fat and cholesterol than the reversal diet and is tailored to the needs of the individual rather than offering one diet for everyone. The prevention diet may include some oils, fish and other animal products for some people.
Switching from saturated fats to monosaturated fats is better, but for reversing heart disease or lowering cholesterol it is better to avoid all oils other than fish oils. Olive oil is 100% total fat and 14% saturated fat. The more olive oil you consume, the more saturated fat you consume, the higher your plasma cholesterol. The studies showing that olive oil lowers cholesterol are only when substituted in equal amounts for butter or oils that are higher in saturated fat. Also, olive oil has almost none of the beneficial omega-3 fatty acids.
The bottom line is this: patients in our studies with severe heart disease reported a 91% reduction in angina (chest pain) within one month, and most became pain-free. They not only felt better, they were better. We measured improved blood flow within one month as measured by thallium scans and radionuclide ventriculograms, reversal of coronary artery blockages (atherosclerosis) within one year, even more reversal after five years, and 2.5 times fewer cardiac events (e.g., heart attacks). It works.
