I’m about to kick off a new series of posts about nutrition, I’ve learned a lot in the two years since my previous series in this area. I’ll give the same caveat I gave the last time: I’m an amateur in the subject of nutrition, though I like to think I’m well read on this subject.

I thought I’d start things off by explaining what I personally eat and my reasoning. I recounted my eating history up till early 2019 here.

I now eat a diet that is close to whole food plant-based (WFPB), at least as I interpret it. I’ll explain that in more detail in the next post, but here it is in a nutshell: I eat a lot of unprocessed plant foods, like fruits, veggies, legumes, whole grains, and a minimal amount of animal products, processed foods like cooking oils, and overly processed packaged foods. As I’ve discussed previously, I don’t interpret “processed” vs, whole foods as strictly as some do. Processed foods for me brings up images of things like donuts, cookies, potato chips, not canned beans or frozen vegetables, which to me are whole foods. There is concern expressed about sodium content of some canned foods, but you can always choose lower sodium versions.

Finally, I eat, but in moderation, healthy unprocessed foods like avocados and nuts that are higher in fat (these Chef AJ’s “purple foods). Most WFPB authors, like Dr. Michael Greger and Joel Fuhrman, emphasize that these are highly nutritious foods, but for those with some health conditions (which includes me), it is better to choose foods with a lower fat content. Dr. Greger discussed in detail how the WPFB diet addresses all the top chronic diseases plaguing modern civilization, including heart disease, diabetes, and cancer in his book How Not to Die.

I choose to be stricter about fat content, including oil, and animal products, because I have two “pre-existing conditions” (to use insurance parlance): heart-valve disease and coronary artery disease. I’ll get to these and how diet affects them below.

A Note On Strictness vs. Moderation

I found that the stricter I am at following WFPB, the healthier I am (for example blood test results. I am also able to eat as much as I want without being physically hungry. I am also less subjected to psychological food cravings. For me it is absolutely critical to hold the line about overly processed foods, what I’ve referred to in the past as my “no junk rules“. The little gremlin that whispers sweet nothings in my ear, like “what could it hurt just this once, if you had one little piece of…”? It never does that for oatmeal or kale. It’s for cookies, candy, and other junky food. These are all foods to the right of Chef AJ’s red line, discussed previously. I can get away with moderation on “purple foods” (nutritious foods to the right of the line like avocados and nuts). But junk is much more dangerous.

About the only time I allow it is at special occasions, like a birthday party where I’ll have a small piece of cake. But I have to be on my guard and not be tempted into seconds. And say “no thank you” when someone says “Richie, there’s one piece left, it’s got your name on it”.

I’ve been at this WFPB approach for a bit over four years now, and I’ve found stricter works better for me. When I first tried it, in early 2017, in my newfound enthusiasm I was pretty strict, and it worked great. I had the classic “last ten pounds” to lose, and I had just gotten high triglycerides and mediocre cholesterol numbers from my Doc. I recounted that story here. Over the ensuing few months, I effortlessly lost the weight, during a time when my aortic stenois was severe and I was having exercise-induced AFIB, so I couldn’t exercise much. This also led to vastly improved bloodwork and a very pleased Doc. Best of all, the little gremlin voice was gone. No psychological cravings.

But after recovering from my heart valve surgery, I loosened up a bit, thinking it was ok to follow the 80/20 rule, where you eat “on plan” 80% of the time and stray from it, in moderation, the other 20%. This worked out OK but not great for me. I gained some weight back and the little gremlin came back, not as strong in the past but still a nuisance. My weight did not get too bad because I could now exercise all I wanted and I enjoy exercise. Every once in awhile I’d think “why not just go back to what worked in early 2017?” I finally got back to that point this spring, and the psychological cravings are gone again, and my weight is where I want it.

So I’d have to say that for me, stricter is better. Being too strict about diet raises the alarm bell of “orthorexia” (being obsessed about healthy eating), but for me that is not a problem. The rules are quite simple. Stick to a wide variety of delicious and nutritious foods, and eat till full. Avoid junk.

Medical Conditions and Diet

I tend to read the literature quite a bit about my heart valve and CAD conditions, because with my technical background it interests me, But I don’t worry about it, I just think it prudent to do what is under my control to deal with them. What I eat is one of those things.

I have a replacement heart valve which I’d like to last as long as possible. These valves can last from as little as 8 to 20+ years, and obviously I’d prefer the higher end. They do not usually fail by “wearing out”, they tend to calcify. Not enough is known about how diet affects that, but it appears that a “heart healthy” diet is also a “heart valve healthy” diet. Specifically, it appears that low ldl-cholesterol helps [1]. Interestingly, driving ldl lower with statins does not help with heart-valve health [2], so diet becomes more important. I do also take a vitamin K2 supplement because there is evidence that it makes calcium go the right places, like your bones, and stay away from where it shouldn’t be, like your heart valves.

Secondly, I am formally diagnosed with coronary artery disease. I flunked the calcium score test badly, which indicates calcification in my coronary arteries, which is usually associated with plaque. A score of less than 100 means small amounts of plaque, while greater than 400 means large amounts. My score was 1800! This was the highest my cardiologist had ever seen in his practice. This test is very reliable with few false positives. The only mitigating factor is that there is some evidence that flunking the test may be less harmful for endurance athletes. Still, this was a major alarm bell. I had further testing which indicates it’s not too severe yet, but I also had an angiogram which indicated mild to moderate plaque. My cardiologist feels I’m borderline at this point, my current ldl of 101 is ok but he’d prefer to see it lower since I’ve already shown at least signs of CAD (the ideal amount for CAD patients is considered 70).

The only way I’ve been able to get my ldl in the range below 100 is by being stricter about low fat, We could also do it by increasing my currently low dose of statin, but as we saw above, that does not help with my heart valve. Also, ideally, I’d like to reverse what coronary plaque build up is already there. While much is made about the heart-healthy aspects of the Mediterranean diet, that diet has been shown to slow the progress of CAD, but not reverse it [3]. The only diet which has been clinically shown to reverse CAD is a low fat version of WFPB [4,5]. I’ve mentioned in the past that I went through cardiac rehab after my valve surgery. The nutritionist at the hospital also recommended WFPB.

Finally, I’m 68, and interested in healthy aging in general. The populations around the world that have less incidence of our modern chronic diseases and live longer and healthier all eat a diet is closer to WFPB [6,7]. Only one is completely vegan, but while the others eat some animal products, it is much less than typically eaten in modern diets.

That is why I eat a WFPB diet, In the next post I’ll go into more details about WFPB, and show that there is nothing extreme about it. It is similar to mainstream guidelines (such as those from the Harvard School of Nutrition), but lower in fat and animal products.

References

1. Nalini R,, “Low-density lipoprotein and aortic stenosis”, Heart. 2008 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951852/)
2. Rosebo, A, et all, “Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis”, N Engl J Med, 2008 (https://www.nejm.org/doi/full/10.1056/NEJMoa0804602).
3. Kris-Etherton, P, et al, “Benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease”, Circulation. 2001 (https://www.ahajournals.org/doi/full/10.1161/01.CIR.103.13.1823)
4. Ornish, D, “Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial”, The Lancet,, 1990.
5. Esselstyn C, “A way to reverse CAD?”, J Fam Pract., 2014.
6. Buettner, D, “The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest”, National Geographic, 2012.
7. Day, J, Day, A, and LaPlante, M, The Longevity Plan: Seven Life-Transforming Lessons from Ancient China, Harper, 2017.