AnUser
#42
Not reverse as defined in the literature.
Is plaque regression different than reversal, or is it just semantics? If the lumen of the artery gets wider and blood flows better (and plaques are more stable against rupture), it seems like semantics.
Beth
#44
Exactly.
It’s funny because I’m having this same conversation elsewhere today as spurred on by the new video you shared.
Most people (NOT ALL!!), even if not told they have to give up meat, and even if you say you can still be healthy while eating meat, get more defensive when one brings up that meat might not be the absolute healthiest choice than if you say ‘I’m coming for your guns’. It’s a fascinating dynamic to witness and happens almost all of the time. We are discussing that in my other chat, too
It’s typical that people care about his looks, even when he’s not saying, ‘eat plants and you’ll have big muscles like i do!’ IMO, an oncologist can be brilliant and say smoking is bad for your lungs, and this advice is no less valid even if there is a cigarette dangling out of his mouth while he says it… His looks are irrelevant but people judge by covers when it suits their purpose.
7 Likes
AnUser
#45
Yes, it’s different but those studies have not even shown regression of plaque.
No it’s not semantics, it’s different things.
I suppose if you assume by “reversal” that the person is claiming “complete reversal back to normal”, then it would be true that NO known interventions can do this to date. But Greger isn’t claiming that when he says “reversal”. The artery lumen widened (as measure by coronary CT scans) in the Ornish study, so the normal “progression” of plaques went in the opposite direction (regression/reversal). Greger/Ornish never claimed that the study showed “complete reversal” of plaques.
https://www.jacc.org/doi/epdf/10.1016/j.jacc.2021.10.035
“Ornish et al (1998) randomized 48 patients to intensive lifestyle changes (10% whole foods vegetarian diet, aerobic training, smoking cessation, group psychosocial support) and demonstrated reduced coronary atherosclerosis progression at 5 years (although this measured plaque regression by coronary angiography rather than direct plaque imaging)”
“Most dietary arms of patients undergoing statin treatments have shown that plaque volumes progressed, and therefore, the usefulness of a diet strategy alone for plaque regression in established coronary disease can be considered limited.”
Yes, limited because the Ornish diet study is the only dietary study to date demonstrating plaque regression. And that’s what Greger has said repeatedly.
1 Like
AnUser
#47
Yes he is, and otherwise he would say regression but even that is debatable.
If that is what you qualify as reversal, then you’d have to at the same time accept that pomegranate juice, vasodilation medication, reverses ASCAD, since it has the same effect.
This is all in the video.
Bicep
#49
Here are my known CAC values:
The LAD went steadily up. The LM went steadily down to zero. LCX went steadily up and RCA went steadily up. LM regressed, obviously it went to zero from 247. You could say I need to radically change course because my CAC is increasing and it’s obviously going to kill me. But these things were in the works probably 6 years ago. I think if I’m pretty good for a few more years my CAC will be lower and possibly zero.
Neo
#50
What are your Apo B levels nowadays?
Bicep
#51
Oh, it’s around 90 if I remember right.
AnUser
#52
No, talk about arguing semantics - cure implies that you do not have to do anything further, while reversal means that the disease can come back if you stop doing whatever changes you have done. It’s clearly obvious this is how it’s meant, as reversal to complete remission. The implication, both explicitly and implicitly is that people DO NOT have to use medications or surgery according to them, as in the case for reversal of disease.
Coronary angiography, or showing atery lumen widening does not mean plaque regression or reversal.
The study showing improvement via coronary angiography with pomegranate juice was not done in mice - it was in humans, and by Ornish himself.
If you accept that an improvement shown on coronary CT scans you’d have to accept that it reverses heart disease along with vasodilation meds, nitrates, beetroot juice, etc.
This is all in the video.
1 Like
AnUser
#53
CAC will not get clinically lower and you’re likely to have a stroke or heart attack before those years are up and it does not measure all the plaque especially the more dangerous, soft, plaque. You might not die from the stroke but it can be very impairing. Basically you are in the placebo arm of all of the drug lowering treatments and is expected to have the results as such, that compounds over time since the trials don’t run forever. I don’t think the calculators which assured you measured healthspan.
2 Likes
Neo
#54
@AnUser snd @Virilius what are your thoughts on this short thread
Karl is one of the most thoughtful people I’ve seen in the longevity community:
https://twitter.com/karlpfleger/status/1788629046408212597
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Under that definition, no “cures” exist for any diseases because the disease can always recur if the original stimulus is encountered (bacterial infection). Again, reversal doesn’t necessitate “complete reversal”. See my car analogy in previous post. That’s you jumping to that conclusion.
CTA angiography isn’t perfect, but they didn’t have access to direct imaging of plaques when the study was done in the 1980s, so it’s the best they had. I really do hope they’ll repeat the study with updated direct plaque assessment.
I’m not sure why you seem to be taking this “drugs are absolutely necessary in all cases for plaque regression” stance. If dramatic reductions of ApoB are achieved via dietary means, you still don’t think you’d see equivalent regression of plaque as you would with the same ApoB reduction from statins and other drugs? If not more? Yes statins have pleiotropic effects, but so does a plant based diet (fiber, nitrate, anti-inflammatory compounds, antioxidant compounds, the vast majority of which come from greens/beans/fruits/whole grains rather than meat and other animal protein foods).
Personally, I reap the benefits of both. I guess you can be like Peter Attia and eat jerky all day while exercising and taking lipid lowering drugs, but IMO that’s foolish for high-risk patients.
3 Likes
I’d really like to know how this part happened and what’s going on at the level of the artery wall and lumen. Did the plaque fully reverse? Did it somehow transform from a calcified plaque to a soft plaque without any calcium? How and why? I thought this wasn’t supposed to happen.
AnUser
#57
It is not the same bacterial infection, that was eliminated. If the treatment didn’t work and some were left over, that’s different.
I can’t believe you don’t think that is what Greger means, but sure… you need to hear it explicitly. Here you go.
In 2012:
Then in 2019:
But, all we have to do all along—the miracle cure—is just stand back, get out of the way, stop re-damaging ourselves, and let our body’s natural healing processes bring us back towards health. The human body is a self-healing machine.
…
We’ve known about this for decades. Take the case of Mr. F.W., for example, as published in 1977 in the American Heart Journal. He had such bad heart disease he couldn’t even make it to the mailbox without crushing chest pain. But he started eating strictly plant-based and a few months later he was climbing mountains without pain.
…
There are fancy new anti-angina drugs out now. They cost thousands of dollars a year, but at the highest dose, they may only be able to prolong exercise duration for as long as… 33.5 seconds. It doesn’t seem as though patients choosing the drug route will be climbing mountains anytime soon.
Plant-based diets aren’t just safer and cheaper. They can work better because they let us treat the actual cause of the disease.
Here’s Greger in 2018:
You don’t know, until you put it to the test, and in doing so, discover the natural cure of coronary heart disease—discovered decades ago by Pritikin, a plant-based diet and lifestyle program; followed by Dr. Dean Ornish, and then Esselstyn at the Cleveland Clinic.
Here’s Greger again in 2021:
The question that haunted me during training was simple yet ominous: If the cure to our number-one killer could get lost down the rabbit hole, what else might be buried in the medical literature?
And here’s Esselstyn which Greger cites all the time, including in that video.
Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure
Amazon.com
So there you go.
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Ok, you’re clearly right that he means “cure” and he may be overselling it, although we don’t know for sure.
The Ornish study is still evidence of plaque regression/reversal, which also fits perfectly with the LDL/inflammation model of heart disease. I do hope we get some more detailed studies with direct plaque assessment after changing to a WFPBD.
2 Likes
Bicep
#59
Me too. My doc is about my age and is really good IMO. He says he’s seen it all, it does not surprise him. He says he’s seen it (plaque) move around a lot on his patients. He’s big on lipidology and uses statins and pcsk9i on himself to get his down to around zero. He took the jabs (though he didn’t believe in them) and the last one gave him myocarditis (or something similar) he’s certain it was the jab because it happened right away. He had lost the abdominal weight and has now gained it back. Too much stress in his job if you ask me. I’ll be surprised if I don’t outlive him.
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AnUser
#60
The definition of reversal or regression of plaque is defined as following in the literature:
Clinically relevant regression or progression was defined as a nominal change (from baseline to 2 years) of ≥10% for percent diameter stenosis11 and ≥0.2 mm (prespecified) for MLD.
https://www.ahajournals.org/doi/10.1161/circulationaha.108.773747
The Ornish study does not meet that criteria, therefore it is not regression or reversal of plaque (both can be said, but it is most commonly referred to as regression, and as I showed earlier Greger uses it as cure).
From Ornish study:
Average percent diameter stenosis regressed from 40.0% at baseline to 37.8% 1 year later, a change that was correlated with the degree of lifestyle change.
Even that 3% reduction is questionable.
I think you are arguing semantics here. Of course calcification can’t be reversed but soft plaque can be (completely) regressed with low enough LDL, inflammation, blood pressure and blood sugar levels.
1 Like
Neo
#62
@Virilius and @AnUser have 5 min to skim this tweet thread and share your thoughts: How Not to Age — Presentation - #54 by Neo
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