Turning the Tide: Cardiovascular Disease – the number two killer in South Africa (3)

Dr David Glass - MBChB, FCOG (SA)

In the last two articles we have explored the causes of the rampant incidences of both ischaemic heart disease, as well as other vascular diseases like stroke and peripheral vascular disease.  It is obvious that all these diseases are strongly correlated with modern lifestyle and diets. Thus to reverse the trend, it is important to get back to the kind of diet and lifestyle we were designed to have.

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Before we get onto some rather practical issues, there is just one more factor that has been found to affect the risk of cardio-vascular disease, and that is oil.  Oil is a constituent of many plants and natural foods, and is essential for health.  However, in nature, oil is found in small quantities.  We humans have discovered a method to extract that oil and then present it in a pure form, stripped of all the other substances like fibre, minerals and phytochemicals that aid its usefulness in our bodies.

Some foods are particularly rich in oils – like seeds and nuts and animal products, and we are thus advised to eat these foods sparingly.  Unfortunately agriculture and production methods make these foods too easily available, and we tend to over-indulge in something that was originally intended to be used only occasionally.  For example,  how many of us would eat handfuls of macadamia nuts if we had to get the hammer out and laboriously crack open each shell?  We would soon tire, and move on to something easier to consume.  And yet we can sit down and eat a packet of roasted and salted macadamias with gay abandon.

Oil is the most refined food possible.  Pure oil has very little nutrient value apart from very high caloric value.  All oils have the same energy output – whether canola oil, or olive oil, or lard, or butter – or even diesel!  They all have 38 kilojoules per gram.  This is more than double the energy value of both proteins and carbohydrates.

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We have all heard that the Mediterranean diet is heart and health friendly – and an important part of that diet is perceived to be the liberal use of olive oil.  It is true that olives and their oil form a central part of the traditional Mediterranean diet, but there was also a lot more physical activity in times past.  The diet is also very plant rich, with traditionally minimal animal products.  Recent studies have shown that the incidence of heart disease in the modern Mediterranean areas is very similar to that in the West.  The incidence of stroke and other vascular disease is less than in other areas, and this fact has skewed the statistics relating to all heart and vascular disease, which makes some people believe heart disease is also reduced.  But evidently this is not the case.

Many clinicians and researchers who have been involved in reversal of heart disease have claimed that dietary oil should be drastically reduced, because of its inflammatory effect on the endothelial  lining of blood vessels.  All oils, even olive oil, can cause constriction of blood vessels, and inhibition of nitric oxide.

What is the practical significance of this?  Modern Western diets are very high in fats.  Just think of the amount of oil in fast foods, in most restaurant and fancy foods, and even in the recommendations of many clinicians involved in diabetes and chronic illness management.  It is also promoted in the Banting and ketogenic diets.

Some critics claim that a very low fat diet is impractical and extreme.  There is no doubt it takes commitment to go all out.  But think of the alternatives.  Dr Caldwell Esselstyn quips:  “some people think a plant-based, whole food diet is extreme.  Half a million people (in the USA) will have their chests opened and a vein from the leg sewn into their coronary artery.  Some people would say that was extreme.”  Symptomatic ischaemic heart disease is life-threatening, and requires drastic interventions.  The advantage of dietary interventions is that it has no harmful side effects, doesn’t involve any risks, and improves so many other aspects of health – lack of energy, arthritis, diabetes, renal disease, high blood pressure, allergic conditions, auto-immune conditions and cancer.

Of course many people have either stents, or bypass surgery.  These can be lifesaving if done at the time of a heart attack, but unfortunately do not solve the underlying disease process, which can progress unless the patient adopts significant lifestyle changes.

So how is all this information over the last three articles about cardio-vascular disease made practical? The following report comes from the Physician’s Committee for Responsible Medicine.  Back in July, 1990 Dr Dean Ornish published the results in the prestigious journal, The Lancet, of research that proved that ischaemic heart disease can actually be reversed without surgery or medicines.  Dr Ornish and his team studied 47 patients, all of whom had proven atherosclerotic disease, with narrowing of heart blood vessels clearly visible on angiograms.  Half the research subjects were assigned to the control group, who received standard care used by the medical profession at the time – a diet centred on “lean” meat, poultry, and fish, along with various medications and advice not to smoke.

The remaining patients were assigned to an experimental group that followed the following four steps:

  1. A low-fat, vegetarian diet
  2. Brisk walking for half an hour each day, or one hour three times per week
  3. Avoidance of tobacco
  4. Stress management interventions which involved meditation or yoga

The prescribed diet excluded red meat, poultry, and fish – virtually eliminating cholesterol and animal fat in the diet.  It also minimised vegetable oils.

One year later, all patients had a second angiogram to measure the blockages in their coronary arteries.  The results showed that the control group patients, who had been following the traditional medical route, had not improved.  In fact, the blockages in their coronary arteries were worse, on average, than at the beginning of the study.  They still had chest pain and still needed medications.

For the patients in the special intervention group, however, chest pain diminished within weeks.  Their cholesterol dropped dramatically without cholesterol-lowering drugs.  At the end of the year, 82 percent of the patients showed measurable reversal of their coronary artery blockages.  After 5 years, in many of the study patients, the heart blood vessels were back to normal diameter.


The recommendation is to keep to a vegetarian diet.  All animal products contain cholesterol, even fish and poultry.  Fish varies in amount of fat, but about 15-30 percent is saturated fat.  Plant foods have no cholesterol.  Animal products have around 20 – 25% fat.  In contrast, beans are only 4% fat, rice is between 1 and 5%, and potatoes are less than 1%.  Nearly all grains, beans, vegetables and fruits derive less than 10% of their kilojoules from fat.

Most plant foods are rich in soluble fibre (as found in oats, opposed to insoluble fibre which is in wheat bran).  Soluble fibre has special cholesterol-lowering properties.  Bile is a by-product of cholesterol metabolism and is excreted into the intestines.  Fibre absorbs the bile and reduces the  cholesterol synthesis.  Good sources of soluble fibre are beans, vegetables and fruits.  As little as 115 gm of beans daily has been shown to lower cholesterol and triglycreride levels more than 10 percent in just 3 weeks.  Other legumes (bean family) are chick-peas and lentils.  Apples and citrus are rich in pectins, a form of soluble fibre.  Barley, often used in soups, is also rich in soluble fibre.

Image: Pixabay


Exercise increases demand for oxygenation of blood vessels, increasing collateral blood supply to areas of muscle that don’t have enough.  This is mediated through nitric oxide, and possibly other mechanisms.  Exercise leads to substantial reduction of heart disease.  This includes activities such as walking, jogging, swimming, cycling and also gym cardio exercises.  Start gradually within the limits of heart symptoms, then gradually increase your distance and time.  The recommendation is 30 minutes daily, or 1 hour 3 times per week.

Exercise also has benefits in reducing stress and depression and general well-being by the release of endorphins – the happy chemicals.  Some people think that exercise gives license to eat fatty, refined foods.  Remember you have to do a lot of hard work to use up the energy in a single chocolate bar.  Your body is an efficient energy expender.  Before embarking on a rigorous exercise regime, first discuss this with your doctor.


Stress reduction involves first of all identifying the causes of stress.  This can include taking on too many responsibilities; burn out; trying to live beyond your means; family conflict or work conflicts; lack of meaning to one’s life; bearing grudges towards others or those who have wronged you.  Once you have identified the causes, try to identify how you can reduce the stress.  You may need the help of a counsellor.  Sometimes it means planning your day, and setting priorities and to-do lists.

I have found that spending regular time in early morning devotions and meditation about what I have read takes a lot of stress out of my life, because I am more aware of Divine leading in my life.  Some people find yoga, or hobbies like gardening or art can be helpful as well.  Another useful strategy is to become involved in social clubs or sports or church activities.  For those who are lonely or bored, offering your services as a volunteer in Meals on Wheels, or other service organisations can bring a sense of accomplishment and the blessing of service to others.

File photo

How to make the changes

There are a number of excellent websites that will provide information and on-going support.  ‘Forks over Knives’ has hundreds of articles as well as recipes at forksoverknives.com.  The Physician’s Committee for Responsible Medicine (prcm.org) has a wealth of educational material for both patients and clinicians.  Dr John McDougall has a very user-friendly website (drmcdougall.org) with many articles and dietary guidelines and recipes, as does Dr Dean Ornish (go to ornish.com).  Dr Caldwell Esselstyn’s website (dresselstyn.com) also includes guidelines and recipes, based on many years of research and practice.  A very helpful Youtube video to watch is “The Last Heart Attack” produced by CNN’s Dr Sanjay Gupta.

It is helpful to find a doctor who is interested in lifestyle interventions – not that common in South Africa yet.  Many dieticians are becoming acquainted with dietary advice that not only controls chronic diseases, but also helps to reverse these conditions.  This is different to the traditional teaching and practise.

You need the support of your family in these changes.  It is so hard to try to do it alone.  Often your partner will want to participate in your health-restoring journey, by becoming educated in the value of a plant-strong diet.  This diet and lifestyle will improve their health and well-being too.

In summary:

  • Cardio-vascular disease is the number 2 killer in South Africa
  • The most common cause is diet and lifestyle related – too much fat, especially saturated fats, too much animal products, and not enough unrefined foods.
  • Lack of exercise is a major contributor.
  • Stress in life, and lack of meaningful relationships are also major contributors.
  • The single most important intervention to reverse cardio-vascular disease is a whole-food,  plant-based, low oil diet.  The improvements are rapid and dramatic.
  • A life-threatening condition demands life-changing intervention – and if that results in many  other health benefits – all the more reason to go all out in adopting the changes.

To a heart-healthy life.

Dave Glass

Dr David Glass – MBChB, FCOG (SA)

Dr David Glass graduated from UCT in 1975.  He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital. 

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world.  He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work.  He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing.  He is active in community health outreach and deeply involved in church activities.  He enjoys teaching and sharing information.


Dr Dave Glass

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