ó Dr. Kim Williams thought he followed a heart-healthy diet:
He avoided red meat and fried foods. He ate his chicken breast
without the skin.
2003, the Chicago cardiologist realized his level of LDL, the
so-called "bad" cholesterol, was too high. Inspired
by a patientís success with a plant-based diet, Williams
began using "meat substitutes" for protein. Within
six weeks, he says, his LDL level plummeted almost by half
into the healthy range.
firm believer in the vegan way of eating ó no meat, fish,
eggs or dairy ó Williams is about to step into a prominent
leadership role as president of the American College of
Cardiology. When he wrote an essay on the benefits of a
plant-based diet for cardiac patients, it kicked off yet
another rancorous debate over how people should eat to best
protect their hearts.
praised Williams, chief of the cardiology division at Rush
University Medical Center, for highlighting the widely
accepted health benefits of eating fruits and vegetables.
Critics grumbled about the "food police" and
questioned whether a physician with such an influential
position should be advocating for a diet that many view as
who recommend a vegan diet are experimenting on their
patients," said Dr. Jack Wolfson, an Arizona cardiologist
who encourages "Paleo" nutrition, or eating
unprocessed foods that can be hunted or gathered, including
says heís surprised by the polarized reaction and dismisses
the idea that veganism is "experimental" given the
considerable data gathered on people who eat that way. But heís
also eager for large-scale, randomized trials and acknowledges
there are many ways to eat more healthfully.
someone does to move away from the Standard American Diet will
make a huge difference in terms of diabetes, hypertension,
obesity and heart disease," said Williams, referring to
the nationís high consumption of sugar, saturated fat and
the health implications of diet, putting the issue in front of
people who live with an epidemic of heart disease is not a bad
thing," he added.
debate underscores the personal and complex nature of
nutrition science. Though fruits and vegetables are part of
any healthy diet, thereís no consensus on the best way to
eat, causing endless confusion and frustration for consumers.
statements in support of a plant-based diet ó an option
naturally low in saturated fat ó came not long after a study
published in March famously challenged the conventional wisdom
that people who consume more saturated fat are at higher risk
of heart disease.
products are easier than ever to find in stores and
restaurants, reflecting the dietís increasing popularity.
The trendy high-protein, high-fiber Paleo or
"caveman" diet includes grass-produced meats and
seafood and excludes grains, potatoes and legumes.
those who choose a plant-based diet, many cite health reasons,
but environmental and ethical concerns are more important for
eat no animal products ó including meat, fish, eggs, dairy
and, often, honey. But though Williams eats like a vegan, he
doesnít describe himself that way because of the termís
other connotations. Many vegans avoid all animal-based
products, including leather, fur, silk, wool and some soaps
and cosmetics, for ideological reasons.
just happens that my view on a plant-based diet agrees with
those groups," Williams said. "For me, itís a
health and diet statement."
generally abstain from eating animal flesh of any kind. Dairy
is usually OK, and some eat eggs. Pescetarians are vegetarians
who also eat fish and seafood. The term flexitarian refers to
people who primarily eat plant-based foods but might indulge
when they smell bacon.
vegetarian diets, including vegan ones, are nutritionally
adequate and appropriate for nearly everyone, including
pregnant women and elite athletes, according to the Academy of
Nutrition and Dietetics. The National Institutes of Health
says a varied vegetarian diet can reduce the risk of obesity,
heart disease and Type 2 diabetes, as well as lower blood
experts also say vegans and vegetarians who arenít careful
can wind up consuming a high-carbohydrate diet lacking in
can eat white bread and Oreos, a bunch of Boca Burgers, and a
gallon of sweetened soy milk and be Ďvegan,í" Dr.
Ashwani Garg wrote in response to Williamsí essay on MedPage
family medicine practitioner in suburban Hoffman Estates, said
in an interview that he commends Williams for raising the
issue of nutrition but would rather see him promoting
plant-based nonprocessed foods in general.
Neil Stone, medical director of the vascular disease center at
Northwestern Medicineís Bluhm Cardiovascular Institute, said
the vegan diet hasnít been conclusively shown to be better
than other healthful eating patterns, including the DASH diet
and the Mediterranean-style diet. Both emphasize fruits,
vegetables, nuts, beans and seeds, but they differ in the
amount of recommended fats.
are also the foundation of Paleo nutrition, "but everyone
should be eating some amount of meat and/or seafood on a
weekly basis," Wolfson said. "Iím talking about
free-range, grass-fed, healthy animals," he added.
"Iíd never tell anyone to eat a burger with a
who sells duck, pork and beef fat in his office to be used for
cooking, points to research that has challenged the
relationship between saturated fat and heart disease. But the
question is far from settled.
general, eating foods that contain saturated fats raises the
level of cholesterol in the blood, and high levels of LDL
cholesterol increase the risk of heart disease and stroke. But
the impact can vary by individual. For some people, the
cholesterol consumed in food has a greater impact on their
addition, researchers tend to study isolated nutrients, but
the foods we eat are more complex.
donít recommend focusing on any single nutrient ó
including fat," said Dr. Stephen Devries, executive
director of the Gaples Institute for Integrative Cardiology, a
nonprofit that advocates for a greater role of nutrition in
health care. "For example, cutting down on saturated fat
but replacing it with sugar, leaves you no further
March, the journal Annals of Internal Medicine published a
review of current literature that concluded the current
evidence does not support the idea that consuming less
saturated fat will prevent heart disease. Many experts quickly
responded that people shouldnít see the paper as a green
light to eat all the steak and butter theyíd like.
complicating factor is that when people cut down on fats they
tend to replace them with other foods that are bad for
cardiovascular health, such as processed carbohydrates.
not that saturated fats are good," Stone said. "Itís
what the saturated fat is replaced with thatís the problem.
Thatís what has confused America."
guidelines from the American Heart Association restrict the
consumption of saturated fats to about 6 percent of daily
calories and encourage people to eat polyunsaturated fats,
such as omega 3 and omega 6, to prevent heart disease. For
someone eating 2,000 calories a day, thatís about 13 grams
of saturated fat.
conversion to vegan eating began in 2003 after a nuclear scan
on a patient with severe heart disease showed startling
improvement after she had followed a plant-based diet for six
months while also exercising and meditating. He was surprised
but later discovered several published studies documenting
the same time, he discovered his own cholesterol was 170
milligrams per deciliter, well above the normal range of 70 to
searched the Internet and discovered that he was eating more
cholesterol than he realized. He changed to a cholesterol-free
diet, consuming protein in the form of vegetable-based meat
substitutes and nuts. "Within six weeks my LDL
cholesterol level was down to 90," he wrote.
Williams discusses the benefits of a plant-based diet with
patients who have high cholesterol, diabetes, hypertension or
heart disease. He may encourage those patients to seek out and
sample plant-based versions of basic foods such as chicken or
eggs, or heíll search for alternatives and email
same time, Williams recognizes that guidelines from the
American College of Cardiology and the American Heart
Association donít specifically recommend a vegan diet
because the studies on its effects arenít definitive.
colleagues, he hopes for large, well-designed randomized
trials rather than polls, opinions and analyses of
observational data. But until then heís sticking to
day that there is similar data on the dangers of processed soy
as there is on processed meat, I will drop it like a hot
potato, or perhaps just eat the potato," Williams wrote
in defense of his essay.