Program for Vascular Health Fruits and Vegetables

The Big Heart Disease Lie

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Numerous studies have shown that people whose diets consist of the greatest quantity of fruits and vegetables have the lowest incidence of heart attacks and strokes. In fact, many earlier studies reporting significant benefits from high intakes of vitamin C or beta-carotene concentrated on people who maintained diets high in a variety of fruits and vegetables. Researchers just assumed that because fruits and vegetables were high in beta-carotene or vitamin C, these particular vitamins were responsible for the beneficial health effects that study participants were enjoying. Now we know that these same fruits and vegetables contain over 10,000 complex chemicals, many of which are very powerful and versatile antioxidants against numerous types of free radicals.

There is growing evidence that it is the combined effects of these complex nutrients—not single nutrients—that provide us with such remarkable health benefits. Remember, there are dozens of types of free radicals, each operating in different areas of the body and cells. Some antioxidants act against a small number of these free radicals and not against others. For example, beta-carotene appears to have no affect on oxidation of DNA, but is an excellent antioxidant in preventing oxidation of cell membranes and neutralizing free radicals in the cytoplasm of cells. Many other flavonoids, on the other hand, are very powerful at protecting the DNA from oxidation.

One of the best studies ever done on the relationship between diet and cardiovascular-disease rates was the Seven Countries Study,350 which examined the diet and health outcomes of sixteen groups of people residing in seven countries of Northern Europe, Japan, and the Mediterranean countries over a thirty-eight-year period. It was found that people residing on the island of Crete had the lowest cardiovascular disease rate when compared to populations in the other seven countries. They also lived longer. Despite being heavy smokers, they had lung cancer rates lower than those of northern European countries.

So what accounts for this remarkable health affect on the island of Crete? Analysis of their diets demonstrated a very high intake of extra virgin olive oil, and of fruits and vegetables. In fact, they had the highest intake of antioxidants in their diet than any other group— including the Japanese. Despite the fact that Japanese consumed fewer saturated fats and more omega-3 fatty acids as fish, the people on Crete had lower coronary heart disease.

When intakes of vitamins C and E in various countries were analyzed, researchers found that the highest dietary amounts of both vitamins was in the Crete population. As we shall see later, extra virgin olive oil (which is actually a vegetable extract) contains numerous antioxidant flavonoids as well as health-promoting monounsaturated oils. By combining a high intake of fruits and vegetables with high intakes of extra virgin olive oil, the people living on the island of Crete have significantly lowered their risk of heart attacks and cancer, despite having the highest incidence of smoking in the world! They have even outdone the Japanese, the next-healthiest population in the world.

A recent study has also demonstrated that a diet rich in potassium, magnesium, calcium, and fiber was protective against stroke fatality among men.351 The greatest benefits were experienced by hypertensive men, but these nutrients also protected study participants who had normal blood pressure.

We can draw some conclusions from this study, based on what we already know about each of these nutrients. Potassium and magnesium can both lower blood pressure, and magnesium, as we have seen, can independently inhibit atherosclerosis. Magnesium also protects the brain and the heart from the effects of a lack of blood supply (ischemia).

Lowering blood pressure, the number one risk for a stroke, by just 9 mm systolic and 5 mm diastolic can reduce risk of coronary heart disease by 20 percent and stroke by 34 percent. When we are talking about such a widespread disease—one which affects over a million people a year—even small improvements in the percentage of the population affected translates into saving a lot of lives.

There appears to be a close association between vitamin C and high blood pressure, another risk factor. Some have hypothesized that as we age our vitamin C intake falls, resulting in the higher incidence of hypertension with aging. There is some evidence for this idea. In several studies, having a combined population of greater than ten thousand people, a strong correlation was found between low vitamin C intakes and high blood pressure.352 Several other studies have shown that giving 1,000 mg of vitamin C to mildly hypertensive women reduced both their systolic and diastolic blood pressure. Smokers are known to have drastically low vitamin C levels and a high incidence of hypertension.

A fruit-and-vegetable diet has been experimentally tested and found to achieve these very goals. The DASH (Dietary Approaches to Stop Hypertension) diet is based on findings from the National Institutes of Health clinical study, and is designed to be high in fruits and vegetables and low-fat dairy products. I disagree with the choice of dairy products, since consumption of even low-fat ones increased incidence of heart disease and prostate cancer in men in other studies.353 With this in mind, it is important to note that DASH may have been even more impressive if dairy products had been eliminated altogether.

Another study, in which British vegetarians were followed over a ten-year period, found a significantly lower incidence of coronary heart disease than among non-vegetarians.354 This finding conforms to the data on Seventh Day Adventists that demonstrated a positive relationship between eating meat and coronary heart disease. Vegetarians were also found to have lower cholesterol levels, and a lower incidence of hypertension than non-vegetarians. A more recent study, using the Framingham Study group, found a significant relationship between a high intake of fruits and vegetables and a lower incidence of strokes in men.355

In these various studies, the amount of fruits and vegetables in participants' diets made all the difference in the world. Eating two servings a day provided very little protection, if any. In fact, protection was not seen until five servings of fruits and vegetables a day. Ten servings were even better. It should also be appreciated that not all studies found this positive effect. The problem with the negative studies is that, in most, no consideration was given to the quality of the vegetables: not all vegetables are created equal in terms of nutrient density and quality.

Vegetables with the highest concentrations of nutrients include cruciferous vegetables, such as broccoli, brussels sprouts, cauliflower, cabbage, and kale. All these vegetables are high on the ORAC (oxygen radical absorbency capacity) scale, which measures a food's overall antioxidant capacity. Developed by Dr. Guohua Cao, a food scientist at the USDA, the system's greatest advantage is that for any food the synergistic effects of many antioxidants are taken into account—factors that would be easily overlooked in attempting to evaluate the effects of each antioxidant, and then merely adding the results together.

These nutrient-dense plants play the greatest role in preventing disease. In most of the reported studies, no effort is made to determine the number of high-quality vegetables that are being consumed. It's as if researchers simply assume a vegetable is a vegetable: in fact, some studies classify french fries as a vegetable, which they are—but only technically. I, for one, hardly think a high-carbohydrate vegetable saturated with unhealthy fats can be considered equivalent to a nutrient-dense vegetable such as broccoli.

One interesting study, in which 34,492 postmenopausal women were studied over a ten-year period, found that broccoli intake correlated strongly with a reduction in coronary heart disease death.356 The women with the highest broccoli intake had a 38 percent reduction in heart attack deaths.

How fruits and vegetables are prepared is also important. In the South, most vegetables are combined with fatback (chunks of animal fat), and broccoli is served smothered with cheese. Fruits are often dipped in sugary concoctions or covered in ice cream. Such combinations significantly blunt the beneficial effects of otherwise healthy food. In most studies, no consideration is made for such culinary practices.

A study of Finnish men and women found that coronary mortality and the incidence of coronary heart disease was significantly reduced in those with the highest intakes of flavonoid-containing foods such as fruits and vegetables.357 In this study, women who ate the most fruits and vegetables reduced their risk of coronary heart disease by 31 percent and the risk of dying from a heart attack by 46 percent. The men reduced coronary heart disease risk by 25 percent and the risk of dying from a heart attack by 33 percent. The study was adjusted for blood pressure, age, smoking, cholesterol levels, and body size to remove the effect of other factors that might influence the results.

These findings are consistent with a Japanese study, which found that the greatest influence in reducing coronary disease risk was a high intake of flavonoids, not soy products.358 This study is important because many are expounding the virtues of a diet high in soy products to reduce coronary disease risk. There are significant hazards to a high intake of soy products, including hormonal effects on babies and children, high glutamate levels, and thyroid suppression.

Interestingly, a high intake of fruits and vegetables not only can help protect us by preventing atherosclerosis in the first place, but in case of a heart attack or stroke, they can significantly reduce the damaging effects of the attack. This was dramatically demonstrated in a study involving over four hundred persons suffering from an acute heart attack.359 These patients were divided into two groups for comparison. One group was put on a diet high in nutrient-rich fruits and vegetables starting twenty-four to forty-eight hours after admission, and the other group received a routine hospital diet. At the end of the study, those on the high fruit and vegetable diet showed a significant decrease in mortality and a greater improvement in measures of heart function than those on the routine hospital diet.

Of special interest was the finding that when these patients were examined one year later they were found to have significantly improved LDL levels, lower total cholesterol levels, improved glucose utilization, and normal blood pressure: their risk of having another heart attack was significantly reduced. It should also be emphasized that the difference in mortality between the groups while they were in the hospital was dramatic. For example, in the hospital-diet group, twenty-five died whereas only six in the fruit-and-vegetable group died. Patients in the two groups were matched for severity of coronary disease and other variables.

There are multiple reasons why a high intake of fruits and vegetables protect us from heart disease. As we have seen, in addition to phytochemicals, fruits and vegetables are high in magnesium, potassium, calcium, and fiber—all of which have been associated with improvement of risk factors. In addition, plants are an excellent source of folate, which is necessary to prevent the accumulation of homocysteine in the blood and tissues. Homocysteine even in high normal concentrations is a significant independent risk factor for atherosclerosis.

As a good source of numerous nutrients, fruits and vegetables strengthen all of the tissues of the body, assure efficient energy production, improve the body's ability to detoxify, and protect us from free-radical damage. Fiber from plants helps control blood sugar levels, removes toxins from the digestive tract, may lower blood pressure, encourages a proper balance of colon bacteria, and improves elimination of colon contents. And if that is not enough, plant-based foods also contain complex carbohydrates and carbohydrate-protein complexes that stimulate the immune system for maximum efficiency.

Dietary Recommendations

Your diet should consist of seven to ten servings of fresh fruits and vegetables a day, with as many as possible in raw form. I have found that most people who say they eat a lot of fruits and vegetables actually eat only one or two types of vegetables—and then at most only one or two servings a day. Everyone should eat close to ten servings of fruits and vegetables every day: for densely packed fruits and vegetables, such as apples and broccoli, a serving is equal to one-half cup. One cup is considered a serving size for looser vegetables, such as lettuce and spinach. In general, your body needs at least five servings of fruits and vegetables a day to benefit from their disease-inhibiting effects. Most studies show that smaller quantities offer little, if any, protection against disease.

Unlike animal cells, plant cells contain a wall that we cannot digest, and therefore must be mechanically cracked open to get to the phytochemicals. We do this by chewing. Unfortunately, most of us do not chew our vegetables until they are a mush—which is the optimal state for nutrient absorption in our bodies—but you can blenderize them to achieve the same effect.

Cooking can destroy some vitamins, but it also releases vital flavonoids and other health-promoting phytochemicals from some fruits and vegetables, making them more available for absorption. If you do want to cook your vegetables, use distilled water for boiling or steaming. When you use fluoridated water for cooking, the fluoride becomes progressively more concentrated as the water evaporates. This is very dangerous, since fluoride cannot be washed off foods.

If you're unable to prepare ten servings of fruits and vegetables a day, I highly recommend using a blender to make up a liquid supply. If you eat whole vegetables, your body can absorb only about 30 percent of the available nutrients, whereas juicing or blenderizing allows up to 90 percent absorption.

Even if you are extremely busy, find one day a week that you can spend blenderizing foods. I have found that the high-powered Vita-Mix processor is excellent for breaking down the plant-cell wall and releasing nutrients from fruits and vegetables. Whatever method you use, make a large amount of the fruit and vegetable mix described below, reserve enough to last the week, and freeze the rest. That way you can carry some with you in a thermos bottle and have plenty in the freezer to thaw and use later.

Purists will scream heresy because they think vegetables or their juices must be consumed fresh to take full advantage of their nutritious enzymes, but blending is certainly preferable to the alternative: a junk-food diet, completely devoid of any form of fruits and vegetables.

The vegan diet—which disallows all animal products, including eggs and milk—is one of the healthier diets you can follow. In particular, the Hallelujah Diet, developed by George Malkmus, contains an excellent blend of fruits and vegetables that has been shown to significantly reduce disease rates, and in some cases, produce dramatic improvements in some very serious diseases.

The only problem with the vegan diet is the potential for vitamin B12 deficiency. A recent study found that the overall healthiest diet is vegan-vegetarian, which is mostly fruits and vegetables with a little fish thrown in for additional nutrients. Since we've already seen that seafood contains mercury and pesticides, that leaves us with a vegetarian diet plus nutrient supplements. If meat is included in the diet, it should always be from a trusted organic source (e.g., grass-fed cows and free-range poultry that have not been pumped full of antibiotics and other drugs).

One mistake people often make, especially those who juice, is to eat only their favorite fruits or vegetables, often overlooking nutrient-dense vegetables, such as kale, cabbage, celery, or broccoli. In general, you should use more vegetables than fruits, and if you have cancer, diabetes or Candida yeast infection, it is wise to avoid fruits altogether.

Following is a list of highly nutritious fruits and vegetables that you should include in your diet—whether or not you are making a blended mix. For blenderizing, pick at least four fruits and four vegetables from the following lists (a "+" means nutrients are destroyed by heat).

Drink at least twelve ounces twice a day of your blend. At first, this may provide too much fiber, and may cause diarrhea. In that case, dilute the blend by half with distilled water. Once you adjust to that, gradually increase the amount of blend and reduce the amount of water. It may take a couple weeks to accomplish this.

Some of you will ask: is that one glass each of fruit blend and vegetable blend? I prefer to mix the two together. This adds a little sweetness to the vegetable blend. I suggest mixing

Fruits currants (black or red) oranges and tangerines Macintosh apples+ blueberries blackberries raspberries strawberries cranberries grapes (only if fluoride-free) prunes sweet-and-sour cherries pineapple+

cilantro parsley beets+

rhubarb spinach

Vegetables kale broccoli brussels sprouts tomatoes cauliflower+

cabbage (purple or red)+

four ounces of fruit mix to eight ounces of vegetable mix. Drink this twice a day. If you prefer to drink them separately, I suggest six ounces of fruit mix and one full twelve-ounce serving of vegetable mix.

As we have seen, the modern diet is full of omega-6 fatty acids—such as those found in corn, safflower, sunflower, peanut, and canola oils—but very low in omega-3 fatty acids. We have also seen that increasing omega-3 intake can improve blood flow, reduce the risk of heart attack and stroke, improve brain function, reduce inflammation, improve the immune system, and inhibit the formation of cancer.

While most studies have shown that eating fish even once a week reduces heart attack and stroke risk, there are serious drawbacks to eating fish containing large amounts of omega-3 fatty acids. The main danger is that fish with the highest omega-3 fatty acid content also have the highest methylmercury levels. Serious accumulations of mercury can occur from eating these types of fish regularly.

Another concern is pesticide and herbicide residue in seafood. We know that fish tend to accumulate and retain these poisons for long periods of time, and that bottom-feeding animals (shrimp, oysters, crabs, and lobsters) present the greatest risk. In the case of seafood from the Gulf coast, the problem is that all of the giant industries, refineries, aluminum plants, and fertilizer plants dump their waste into the Mississippi River, which empties out into the Gulf. All of these bottom-feeding creatures contain significant levels of mercury, lead, and other heavy metals as well.

As I mentioned in the discussion on omega-3 fatty acids, I recommend taking a high-DHA and low EPA supplement instead of high EPA oils, since DHA is responsible for most of the benefits attributed to omega-3 oils. Many of the fish-oil capsules you find in health food stores contain only 30 percent omega-3 oils,360 which would require you to take twenty to

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