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The disease

Coronary artery disease (CAD) is the most common form of heart disease. It occurs when the arteries that supply blood to the heart become narrowed or blocked. If this happens slowly over time then it is likely to cause angina or chest pains which are initially felt with activity, or at rest as the disease progresses. If this happens suddenly then it can cause a heart attack.

CAD is the leading cause of early death worldwide. In Australia, on average, one person is hospitalised due to a heart attack every nine minutes [1], and 1 in 20 Australians and New Zealanders are living with heart disease.

The cause

Eating habits and other lifestyle factors play a key role in determining the risk of heart disease. The standard Western diet promotes both the build-up of plaques in our arteries, and the conditions under which these plaques are most likely to rupture and cause immediate blockages. When this happens in the coronary arteries that supply the heart with oxygen and nutrients, symptoms will develop.

Build-up of plaque commonly begins in early childhood, setting the stage for CAD events in adulthood.

The nutrition prescription

A low-fat whole food plant-based diet, combined with regular exercise and a healthy overall lifestyle, can prevent, delay, and even reverse heart disease and other cardiovascular events. It is the only eating pattern that has been scientifically demonstrated to do so:

  • Patients in a randomised controlled trial with moderate to severe coronary heart disease who followed a low fat plant-based diet (in addition to other lifestyle changes) demonstrated regression of coronary atherosclerosis after 1 year that continued to regress further after 5 years, and had less than half as many cardiac events as patients receiving usual care.[1]
  • 198 consecutive patients with established coronary artery disease who transitioned to a low fat plant-based diet in addition to their usual cardiovascular care experienced just 1 major cardiac event amongst them after an average of 3.7 years of follow up, a recurrent event rate of only 0.6%.[2]

A plant-based diet can improve several risk factors for heart disease:

High blood pressure: A plant-based diet, rich in potassium, improves blood pressure.
High cholesterol: Aim for high-fiber foods, which can help lower cholesterol.
Atherosclerosis: Diets rich in saturated fat and cholesterol cause plaque buildup in the arteries, restricting blood flow.
Inflammation: Plant-based diets help reduce inflammation, which can lead to heart disease and other conditions.

Large research studies have consistently shown a reduced risk of heart disease in those following a vegetarian or vegan diet with an average risk reduction of around 25%.[3]

Medical supervision of diet change is essential

Shifting to a low fat plant-based diet can lead to rapid reductions in medication needs; people who are on medications for high blood pressure especially should seek medical supervision.

Video overview from

Further Resources

Plant Based Health Australia logo

Plant-based Health Australia: an up-to-date review of the evidence base on heart disease and diet, with detailed references and case studies.

PCRM logo

Physician’s Committee for Responsible Medicine: Heart Disease overview, news and resources.


Both Dr Ornish and Dr Esselstyn’s patients required a whole food plant-based eating pattern that was very low in fat. This is believed to be because fat, even from plant-based sources, can increase cholesterol levels and impair the function of the endothelial cells that line our blood vessels. Both doctors recommend people with established heart disease avoid high-fat plant-foods, especially oils, but also coconut, avocado, and nuts and seeds and products incorporating these ingredients.

For this reason it is essential that anyone with established heart disease or strong risk factors refer to either Dr Ornish or Dr Esselstyn’s books:

and/or consult a credentialed plant-based doctor, dietitian, or nutritionist to ensure the appropriate prescription.

Although Dr Ornish and Dr Esselstyn’s research has focussed on coronary artery disease, the vast majority of strokes are caused by a similar mechanism and can be thought of as ‘brain attacks’, involving disruption of the supply of blood from the arteries that supply the brain. For this reason it is certain that risk of stroke will be similarly reduced. High blood pressure is also a major risk factor for both types of stroke and is very effectively treated by the Ornish and Esselstyn regimens.

Once again the mechanism of peripheral vascular disease, and even erectile dysfunction is the same, involving narrowing and/or occlusion of the arteries that supply the relevant part of the body. Patients who have undertaken Dr Ornish and Dr Esselstyn’s regimens report rapid improvements and resolution in symptoms of both of these conditions also.

  1. Australian Institute of Health and Welfare 2020, National Hospital Morbidity Database (NHMD)
  2. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease JAMA. 1998; 280:2001–2007.
  3. Esselstyn CB Jr., Gendy G, Doyle J, et al. A way to reverse CAD? J Fam Prac 2014; 63: 356–64b
  4. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649. doi:10.1080/10408398.2016.1138447

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