Becoming vegetarian can help fight high cholesterol

I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a doctor, I believe in practicing what I preach, and my legs could no longer straddle the gap between action and rhetoric.

That, and I hit 192 lbs. on the gym scale.

I calculated my own BMI at 26, edging toward 27. I was officially overweight, just like two-thirds of Americans.

I have a sweet tooth. I’ve been known to polish off a whole plate of cookies, a la Ziggy, just so they won’t be there tempting me.

Another rude awakening was my cholesterol. Total 254, LDL 177 (!).

I was in disbelief. When I thought about how I would treat a patient with my numbers, I’d reach right for a prescription pad and start a statin drug (like simvastatin [Zocor] or atorvastatin [Lipitor]).

But like a lot of doctors, I’ve long felt impervious to the maladies that I treat.

No more.

Over the holidays I read a New Yorker profile of John Mackey, founder & CEO of Whole Foods, in which he mentioned a book called “The Engine 2 Diet,” by a Texas firefighter and former pro triathlete named Rip Esselstyn.

Since I grew up in the same Cleveland suburb as Esselstyn’s family, I was intrigued enough to buy the book.

For the last four weeks, I changed my eating habits accordingly:

1. No meat (surprising: no fish or poultry, either. Strictly vegetarian. ”Nothing with a face or a mother.” Eggs are out, too. Esselstyn does permit tapering down the meat habit, allowing small portions of chicken or fish the first couple of weeks to acclimate. I went cold tofu, though.).

2. No dairy (even yogurt, which I frequently tout to patients as a healthy food).

3. All the fruit and vegetables I want.

4. No oils (this surprised me, given all the attention to olive oil and things like flax seed oil that are high in unsaturated fats).

5. No refined grains (whole grain is ok, high in fiber!)

6. Sweets: only acceptables are fruits (“nature’s candy”), a little bit of sorbet, and a small amount of Dark (>70% cocoa) chocolate (avoid milk!).

The book promises much to those that follow its contents: more vigor, lower weight, lower cholesterol, and by inference (and looking at the exercise photographs near the middle) greater accomplishment and happiness.

Esselstyn is bursting with optimism that his diet can prevent (and even reverse) heart disease. He bases his ideas on the work of luminaries like Dean Ornish at UCSF, who has shown in the medical literature that extremely low fat diets (less than 12% of total calories from fat) improve symptoms, longevity (reducing heart attacks) and cause coronary plaques to actually regress. Esselstyn’s own father, a longtime Cleveland Clinic surgeon, published his own similarly themed book, “Prevent and Reverse Heart Disease.”

Esselstyn says that his data shows that total and LDL cholesterol can be significantly lowered, with a weight loss in the range of ten pounds in four weeks.

Staying on the diet requires planning. I needed to change the way I shop for groceries, and scour nutrition labels more carefully than I ever used to. By planning ahead, you have a small nutritious snack (e.g. a handful of healthy nuts) at the ready so that you don’t resort to junk food or quick, easy thought-free eating.

How’d I do?

After exactly four weeks of following the Engine 2 diet (with only a bit of cheating–a splash of non-fat milk in my coffee, occasional cheese on a whole wheat sandwich, a cupcake for my sister-in-law’s birthday), I was astonished:

I’ve dropped ten pounds. I feel remarkably different: More energetic. I sleep better. I have few dips in energy throughout the day. Aside from one day each of the first two weeks (where to satisfy my sweet tooth I overindulged in peanut butter or almond butter), I find I’m no longer craving any of the junkier things that I used to. I feel much more in control of my eating–both what I eat and the quantity. I’m reminded how as a culture we habitually overeat. We could all get by on so much less.

Here’s the stunner: Remember my total cholesterol of 254, LDL 177? After four weeks, the new numbers are total cholesterol 160, LDL 103. I think I’m going to keep this up.

John Schumann is an internal medicine physician at the University of Chicago who blogs at GlassHospital.

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  • Anonymous

    What was the previous diet like?

    Though the title is a bit misleading, as it is possible to eat a junk food vegetarian diet that would not be helpful. Vegetarian or not, one still has to choose healthy foods, like vegetables as described above.

  • Evinx

    Was it the diet, or was it the reduction in calories (as a result of the diet) that led to the weight loss, cholesterol, LDL, etc?

  • BD

    A great cookbook (though some recipes include dairy or eggs): World Vegetarian, by Madhur Jaffrey. Vegetarian food should taste good and be interesting… it’s not all slimy tofu and bland beans.

  • AnnR

    And what do you advise that women, who often need a source of iron and calcium do?

    • Anonymous

      In some parts of the world, people do not consume significant dairy products, and consume only a little meat due to poverty. But high intake of vegetables may help them with the calcium and iron, as many leafy green vegetables contain significant calcium, and some vegetables contain iron and vitamin C that helps absorb iron.

  • Ask A Doctor

    Proteins from meat are part of a balanced diet. White meat like that of fish is actually good for lowering cholesterol in a healthy way. So, I guess we don’t need to become vegetarians, do we?

  • Inquiring Mind

    @ Hospitalist:

    While I do agree with your commentary, and correct me if I’m wrong, but I learned in my nutrition class that spinach isn’t the greatest source of calcium since much of the calcium is not bio-available and locked up as calcium oxylate (?) which your digestive tract can’t break down to obtain the Ca++. Any thought for this food? Thanks.

    • Hospitalist

      You’re right about the spinach not having much available calcium – I was thinking of it in terms of iron. Most vegetables don’t actually – the big ones that do have good calcium bioavailability are broccoli, bok choy, soy beans and kale. It is important for a vegan to incorporate these into their diets or to take a supplement. There is also evidence to suggest that high intake of animal proteins actually causes a decrease in calcium absorption – so maybe a vegan doesn’t even need as much of the typical daily recommended allowance. From what I understand, the jury is still out on that.

      I am by no means an expert, just interested and have done a lot of reading – despite all those claims that doctors don’t care about nutrition or keeping people healthy. Most of the cookbooks I have even mention the concern for adequate nutrition in the beginning (protein, calcium, iron, B12 and zinc) and describe how one can obtain these in a vegetarian diet, so it helps give a practical side to all the science if one doesn’t want to sort through it.

  • chinocochino

    How about a vegetarian diet rich in fruits and vegetables that includes seafood? (pesco-vegetarian) I’m vegetarian and have discussions with my vegan friends about the benefits of seafood (tuna, salmon) and its omega 3 fatty acids and am curious as to whether “meat of the sea” has been proven to be better than land-based meat.

  • Hospitalist

    I actually had a similar significant decrease in my LDL from 139 to 97 after three months of a vegetarian diet. And I was not a strict vegan like the author is as I still had dairy products. I went back to eating meat for a few years (bacon, yum…) but finally became ovo-lacto vegetarian (still eat eggs and dairy) a few years ago. I have lost a little weight and even lowered my body fat percentage as well – I was surprised by that as I was consuming less protein and thought that I was losing weight because I was losing muscle, but it wasn’t the case.

    Vegetarian diets have been associated with lower rates of obesity, heart disease, diabetes and stroke. Unhealthy vegetarian diets are possible – potato chips and chocolate chip cookies are vegetarian, after all. But with some planning and research, it’s actually quite easy.

    With regards to getting enough nutrients – the biggest concerns are iron, calcium, B12 and protein. Leafy greens such as spinach, broccoli, kale, chard, etc. help with the iron and calcium. To get complete protein (all of the essential amino acids) one can either eat eggs and dairy or alternatively, make sure to have a combination of grains and legumes/nuts every day – such as red beans and rice. Also, some “grains” like quinoa are nearly complete proteins as well. B12 is a bigger issue, but most soy products are fortified with it. And you can always take a multivitamin.

    Whether it is the vegetarian diet or the decrease in calories is a really good question. I’ve wondered that myself. I know that I don’t really eat out much anymore and I pay much more attention to what I eat. You can’t eat any fast food besides the occasional nutritionally-devoid iceberg lettuce salad. I imagine that has played a large role as well.

    I know a vegetarian diet isn’t for everyone (or anyone in my family) but if someone is considering it, they shouldn’t be frightened away by claims of it being unhealthy. It can be very healthy if done the right way.

  • Mary Brighton, MS, RD

    I think your experiment is fantastic and a great inspiration for you to lead other patients on the same path. Would love to know how things continue in the next couple of weeks/months. The unfortunate “side effect” of severe dietary changes such as those you have undertaken is that the diet is difficult to follow long term.
    Saying that, a good compromise is a largely grain/vegetable diet with some nice fun carnivore foods fit in for the satiety.
    Keep us updated!
    Mary Brighton

  • Dr. Grumpy

    I try to follow vegetarian patterns, but after a lifetime of being a carnivore it ain’t easy. The book sounds interesting.

  • BobBapaso

    Now that you’re in good shape just add back a little “balanced” protein, and keep it up. You are eating the way men were intended to eat, from the beginning. Then the protein was bugs and things they could catch with their hands, but you can make up for that with a quarter pound of fish or chicken or egg white. You can also do it totally vegetarianally with a mixture of beans and something else. I forget what that is.

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