The truth be told, coronary artery disease—the most common form of heart disease, which is responsible for heart attacks—need never exist. Existing, it need never progress.

How can one make that statement, given that coronary disease is the leading killer of women and men in Western civilization? Hardly a family in this country does not have an immediate or distant relative or friend who has experienced heart disease. And it starts young: Battle casualties from the Korean and Vietnam conflicts yielded a high incidence of coronary atherosclerosis at autopsy—as much as nearly 80 percent, from Korea—despite the very young average age of soldiers.^[1] A study of young civilian casualties (16–34 years old) caused by noncardiac trauma (e.g., accidents, homicides, suicides) revealed coronary atherosclerosis in the vast majority (again, nearly 80 percent).^[1]

Does this mean we are all destined to become ill from coronary heart disease? Not so fast. Epidemiological research indicates that populations consuming dietary patterns typical of many Western societies—where people can afford to regularly eat milk and dairy products, eggs, meat, chicken, white flour, and processed oils—have tended to show higher rates of coronary heart disease and cardiovascular disease than populations consuming more plant-rich or traditional diets.^[2][3]

World War II provided a graphic example of how the ravages of these diseases could be greatly reduced.^[4] Norway was one of several Western European nations occupied by Nazi Germany during the conflict between 1939 and 1945. The Germans reduced all livestock from these occupied countries, leaving the population to subsist primarily on whole grains, legumes, vegetables, and fruit. Almost immediately, deaths from heart attacks and strokes in Norway plummeted. With the cessation of hostilities in 1945, animal products became available once more, and immediately, the prewar levels of deaths from these illnesses returned. It is a powerful lesson in public health about the cause and cure of our most common killer—heart disease. But this message was not heeded by the medical profession or the public. In fact, the reverse has occurred. The popularity and success of Western culture have adversely influenced cultures worldwide, as they seek to emulate our toxic Western diet.

The people of rural China, the Papua Highlanders of New Guinea, and the Tarahumara Indians of northern Mexico are examples of how lifestyle, including adherence to plant-based nutrition, might spare us from this galloping epidemic.^[5–7]

American leadership in public health has failed to curtail this disease of affluence. Every five years, the United States Departments of Agriculture and Health and Human Services refashion nutrition guidelines for Americans, never relinquishing the foods that cause the epidemic. The USDA leadership is often made up of former power brokers of the beef, dairy, pork, and poultry industries.

The medical profession has an even poorer record, having taken the approach that every American must learn all the risk factors for heart disease, such as smoking, high blood pressure, diabetes, high cholesterol, and family history. This emphasis on risk factors is an unspoken concession that, as Americans eat such a toxic diet, we will all develop the disease sooner or later, and that the best we can do is to know our risk factors, to alert us and our physicians of how quickly we can expect it to catch us.

Modern medicine of the latter half of the twentieth and early twenty-first centuries must be condemned for its failure to share with the public the knowledge to eliminate the most common chronic killer diseases, such as heart disease, type 2 diabetes, obesity, hypertension, and dementia, all of which are a bitter harvest of the toxic Western animal-based nutrition.

Dementia prevalence increases sharply with age; among Americans older than 85, roughly one-third are estimated to have Alzheimer’s dementia, with overall dementia (including other types) even higher.^[8] Newer research reveals that Americans, beginning in middle age, sustain tiny silent strokes, which take an irreversible toll on the brain as they continue.^[9] Memory may become less astute by one’s sixties, and if these little strokes continue, dementia develops by the seventies or eighties. It is the end product of vascular injury to the brain, similar to what occurs with the heart.

The medical profession, never lacking for a new expensive imaging device or procedure, developed coronary artery bypass surgery, angioplasty, and stents for blocked arteries to the heart. One has to be in awe of the delicacy of these surgical feats. But are they the answer? A most emphatic, No! The epidemic has not changed course since the inception of these procedures, although, to be fair, they can be life-saving in emergency situations, such as when a heart attack occurs.

Academic scholars are increasingly critical of the overemphasis on these interventions, which provide enormous financial reward to the physician. The downside to these procedures is that many experience serious complications, sometimes even fatal complications. “Percutaneous coronary intervention . . . which includes both angioplasty and stenting, is one of the most common operations in the world,” but the risk of death—around 1–2 percent—is significant.^[10] Based on the lower end of this estimate, of one million stents performed this year, ten thousand lives would be expected to be lost. For comparison, that’s more than twice the American death toll from the war in Iraq.^[11]

The expense of these procedures consumes the lion’s share of the health budget. The CDC estimates that Americans collectively lose around $407 billion per year in healthcare costs, productivity losses, and premature death due to cardiovascular disease.^[12] Even when the procedures are successful, the benefits erode over time. Interventional cardiologists themselves concede that these procedures often do not extend life and do not prevent new heart attacks.

How is it possible that the medical profession cannot heed the striking lessons from Norway during World War II or the nonexistence of heart disease in the economically developing nations that, by culture, heritage, and tradition, subsist on plant-based nutrition?

Actually, some physicians have heard these lessons. These pioneers include Pritikin, McDougall, Klaper, Pinckney, Campbell, Ornish, Esselstyn, Barnard, and Diehl. During the 1980s, Dr. Dean Ornish and I, unbeknownst to each other and on opposite sides of the country, separately initiated studies within months of each other on plant-based nutrition as a treatment for patients severely ill with coronary artery disease.^[13][14] The goal for my study was to remove every last morsel of animal food, dairy, processed flour, and oils, which were causing the disease, and to have subjects eat a diet of vegetables, fruit, legumes, and whole grains.

In all compliant patients, results were prompt and enduring. Angina heart pain diminished or disappeared as cholesterol levels promptly lowered. In both studies, X-rays of the heart arteries confirmed that the disease could be reversed. Dr. Ornish proved this after one year of treatment. I showed the same at five years and reported results again at twelve, sixteen, and finally beyond twenty-one years in my book Prevent and Reverse Heart Disease. I am particularly pleased with a smaller subset of patients who were told by expert cardiologists in 1986 they had less than a year to live; all of them were alive twenty-one years later.

To be sure, it is not a walk in the park for patients to change to plant-based nutrition from a lifetime of eating rich, tasty animal foods and oil. They also face the challenges of eating in restaurants, traveling, and eating at friends’ houses. Patients need support and guidance as they surmount these hurdles, and their prompt improvement is their reward. While patients rejoice at finally discovering the answer to their disease, they are often furious that their physicians did not mention it.

These patients are empowered to reassert themselves at the locus of control, destroying the disease that was destroying them. They also recognize that, as opposed to the interventional approach, dietary lifestyle change does not come with the risk of mortality or sickness. Most importantly, the benefits do not erode but continue to improve with time. Patients are aware they have become heart attack proof and lose the fear that haunts heart patients and their families—that another heart attack might occur.

Why don’t more cardiologists employ this simple and successfully proven method? The stock answer is “My patients won’t follow such a diet.” But when entire cultures have lived without heart disease, and preferred this way of eating for centuries, and when thousands of heart patients have accepted this technique, is that answer acceptable? A more honest answer would be that there is much less financial reward for the caregiver. The hope is that insurance carriers will appreciate this less expensive and more reliable approach and reward lifestyle counseling, which would accelerate momentum and acceptance. I now treat invasive cardiologists who seek my counsel when they have the disease. Viewing a broader landscape for the health of America is imperative.

Everyone argues about the healthcare crisis and how it should be paid for. Where does one find the money? This is so serious that we see our great corporations, such as General Motors and Ford, brought to their knees because they cannot pay the healthcare costs of their employees or retirees.^[15] A far simpler approach is to eliminate all of these common chronic diseases of Western civilization, which do not exist in plant-based cultures.

Consider a slightly hypothetical example: a 250-pound mildly diabetic, hypertensive patient who has a heart attack. What would happen if they were fully compliant with plant-based nutrition treatment? The changes would be profound. By eight months, they might weigh 190 pounds. No longer would they be obese. Their diabetes and hypertension would disappear, as would any risk for a future heart attack. If they were a man, they would be protected from erectile dysfunction.

The alternative, a toxic Western diet consumed over decades, behaves as a malignant stew pushing us toward chronic illness. Perhaps one can best conclude by paraphrasing the words of John F. Kennedy: Ask not what your country can do for your health, ask what you can do for your health.

References

1. Joseph A, Ackerman D, Talley JD, Johnstone J, Kupersmith J. Manifestations of coronary atherosclerosis in young trauma victims–an autopsy study. J Am Coll Cardiol. 1993;22(2):459-467. doi:10.1016/0735-1097(93)90050-b
2. Fung TT, Willett WC, Stampfer MJ, Manson JE, Hu FB. Dietary Patterns and the Risk of Coronary Heart Disease in Women. Arch Intern Med. 2001;161(15):1857–1862. doi:10.1001/archinte.161.15.1857
3. Menotti A, Kromhout D, Blackburn H, Fidanza F, Buzina R, Nissinen A. Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol. 1999;15(6):507-515. doi:10.1023/a:1007529206050
4. Strom A, Jensen RA. Mortality from circulatory diseases in Norway 1940–1945. Lancet. 1951;257:126–129. doi:10.1016/S0140-6736(51)91210-X
5. Kende M. Superiority of traditional village diet and lifestyle in minimizing cardiovascular disease risk in Papua New Guineans. P N G Med J. 2001;44(3-4):135-150.
6. Navarro JC, Prado SM, Cárdenas PA, Santos RD, Caramelli B. Pre-historic eating patterns in Latin America and protective effects of plant-based diets on cardiovascular risk factors. Clinics (Sao Paulo). 2010;65(10):1049-1054. doi:10.1590/s1807-59322010001000022
7. Chen, J., Campbell, T.C., Li, J., Peto, R. Diet, Lifestyle and Mortality in China. A Study of the Characteristics of 65 Chinese Counties.
8. Alzheimer’s Association. 2025 Alzheimer’s Disease Fact and Figures. Alzheimers Dement. 2025;21(5). Online access: https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures
9. Center for Translational Research in Neurodegenerative Disease; College of Medecine (University of Florida). Stroke Background. Online access: https://ctrnd.med.ufl.edu/research/stroke/stroke-background/
10. Fromson N. Around 10% of deaths from coronary stenting, balloon angioplasty are preventable. April 3, 2024. University of Michigan Medicine. https://www.michiganmedicine.org/health-lab/around-10-deaths-coronary-stenting-balloon-angioplasty-are-preventable
11. Anastacio N and Murray M. The Iraq war—by the numbers. NBC News. March 20, 2023. https://www.nbcnews.com/meet-the-press/meetthepressblog/iraq-war-numbers-rcna75762
12. Centers for Disease Control and Prevention. Fast facts: health and economic costs of chronic conditions. August 8, 2025. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html
13. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336(8708):129-133. doi:10.1016/0140-6736(90)91656-u
14. Esselstyn CB Jr.. We Can Prevent and Even Reverse Coronary Artery Heart Disease. MedGenMed. 2007;9(3):46. Published 2007 Aug 31.
15. Johnson T. Healthcare costs and U.S. competitiveness. March 26, 2012. cfr.org. https://www.cfr.org/backgrounders/healthcare-costs-and-us-competitiveness