The five most powerful heart disease prevention strategies

You've seen such lists before: 5 steps to prevent heart disease or some such thing. These lists usually say things like "cut your saturated fat," eat a "balanced diet" (whatever the heck that means), exercise, and don't smoke.

I would offer a different list. You already know that smoking is a supremely idiotic habit, so I won't repeat that. Here are the 5 most important strategies I know of that help you prevent heart disease and heart attack:

1) Eliminate wheat from the diet--Provided you don't do something stupid, like allow M&M's, Coca Cola, and corn chips to dominate your diet, elimination of wheat is an enormously effective means to reduce small LDL particles, reduce triglycerides, increase HDL, reduce inflammatory measures like c-reactive protein, lose weight (inflammation-driving visceral fat), reduce blood sugar, and reduce blood pressure. I know of no other single dietary strategy that packs as much punch. This has become even more true over the past 20 years, ever since the dwarf variant of modern wheat has come to dominate.

2) Achieve a desirable 25-hydroxy vitamin D level--Contrary to the inane comments of the Institute of Medicine, vitamin D supplementation increases HDL, reduces small LDL, normalizes insulin and reduces blood sugar, reduces blood pressure, and exerts potent anti-inflammatory effects on c-reactive protein, matrix metalloproteinase, and other inflammmatory mediators. While we also have drugs that mimic some of these effects, vitamin D does so without side-effects.

3) Supplement omega-3 fatty acids from fish oil--Omega-3 fatty acids reduce triglycerides, accelerate postprandial (after-meal) clearance of lipoprotein byproducts like chylomicron remnants, and have a physical stabilizing effect on atherosclerotic plaque.

4) Normalize thyroid function--Start with obtaining sufficient iodine. Iodine is not optional; it is an essential trace mineral to maintain normal thyroid function, protect the thyroid from the hundreds of thyroid disrupters in our environment (e.g., perchlorates from fertilizer residues in produce), as well as other functions such as anti-bacterial effects. Thyroid dysfunction is epidemic; correction of subtle degrees of hypothyroidism reduces LDL, reduces triglycerides, reduces small LDL, facilitates weight loss, reduces blood pressure, normalizes endothelial responses, and reduces oxidized LDL particles.

5) Make exercise fun--Not just exercise for the sake of exercise, but physical activity or exercise for the sake of having a good time. It's the difference between resigning yourself to 30 minutes of torture and boredom on the treadmill versus engaging in an activity you enjoy and look forward to: go dancing, walk with a friend, organize a paintball tournament outdoors, Zumba class, plant a new garden, etc. It's a distinction that spells the difference between finding every excuse not to do it, compared to making time for it because you enjoy it.

Note what is not on the list: cut your fat, eat more "healthy whole grains," take a cholesterol drug, take aspirin. That's the list you'd follow if you feel your hospital needs your $100,000 contribution, otherwise known as coronary bypass surgery.

Comments (39) -

  • Ty

    1/23/2011 10:27:46 PM |

    It's too bad that there is not a randomized, controlled trial to show the superiority of this strategy.  

    Aside from assimilating scattered studies with surrogate endpoints, what would it take to definitively show that this strategy actually does improve cardiovascular morbidity and mortality?  

    If Dr. Davis can convince many in the "thinking" public, surely someone in the health care industry or NIH would be interested in pursuing this.

  • Andrew

    1/24/2011 2:13:50 AM |

    Magnesium and Chromium are also important minerals.  Neither are particular common in most diets.  Perhaps, they would fit into a top 10 list.

  • revelo

    1/24/2011 2:25:11 AM |

    I think regular testing is the most important strategy. If your tests come out okay, then there is no reason for anything else. If the test show problems, then address the problems in a methodical.

    Many people don't appear to have any problems with wheat. I'm 50 and spent perhaps 10 years in my 30's getting most of my calories from pasta, and another ten years in my 40's getting most of my calories from oats. I was never more than 10 lbs overweight and I haven't visited a doctor in 30 years, other than for an ear wax buildup about 20 years ago. My test scores recently were good and I have good glucose tolerance according to the glucose monitor I recently bought (reli-on from walmart).

    The reason I started investigating diet issues is that I felt lousy during two months on the Appalachian Trail this past fall. My diet on the trail consisted of nothing but a pound per day of instant rice and another pound of dry-roasted peanuts plus a multivitamin, and then a gallon of ice cream and a package or two of cookies and maybe some candy bars and cheese whenever I stopped off at town. Like most of the other hikers, my problem was not gaining weight but rather losing too much. Those binges on ice cream made me feel very sick afterwards. I began to have cravings for oats, which I think helps to keep the blood vessels clear. Now that I've gotten back to civilization, I've been eating lots of vegetables and oats and my blood pressure is typically under 100/70 (I bought a sphygomanometer as soon as I got home from the trail and my initial BP was 120/70). I think people who exercise as much as a typical backpacker have no problems with complex carbs. A gallon of ice cream and a full package of iced oatmeal cookies at one sitting is another story.

  • Anonymous

    1/24/2011 5:31:31 AM |

    I found this blog after a search in April 2008 because my Fasting glucose had broken 100 (105) and I was worried I would end up a type 2 diabetic like my 90 year old dad. I began following the advice here: almost no wheat or grains, little sugar/fructose, added 8000 Vit D3, 12.5mg Iodoral, 2800mg omega-3 fish oil.  Now, my fasting glucose is 97, my Vit D went from 13(!) to 75.  I quit my statin and although my LDL went from 111 to 135, my HDL went from 60 to 74 and Trig from 108 to 62.  Lost 10 lbs without trying and now need to wear a beltSmile.  The only thing I can complain about is my BP seems to stay around 130/74. Otherwise I'm convinced. Thank you, Dr. Davis.
    Jay in CA.

  • Anonymous

    1/24/2011 6:23:10 AM |

    Hi Dr. Davis

    i've looked around your blog but did not find information on buckwheat flour, chickpeas flour and water chestnut flour.

    i understand they are safe for celiacs to consume but how far are they consistent with the heart-good diet i've picked up from your blog so far? e.g. consumption amount per day if they are fine? things to watch out.


  • Paul

    1/24/2011 6:26:47 AM |


    Have you had an NMR lipo test done? By your own description, being on such a high carb diet, your LDL particle numbers might shock you.

    And don't fall into the same trap that most prototypical thin men fall into.  Just because you are thin and active does not give you a pass on following these strategies.  Look at this blog post by Dr. Davis:

    Here's the prototypical male with lipoprotein(a)

    "Several features stand out in the majority of men with lipoprotein(a), Lp(a):

    Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

    Intelligent--Above average to way above average intelligence is the rule.

    Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

    Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

  • Anonymous

    1/24/2011 9:26:11 AM |

    I would recommend Nordic walking as an exercise.

  • Tony

    1/24/2011 11:33:05 AM |

    Do you have information about the interference of wheat (or other neolithic pathogens) on thyroid-function? I would guess that either phytates hinder the absorbtion of iodine (both in humans as well as in animals we eat), or that gluten/gliadins/etc directly interfere with thyroid function, or trigger an autoimmune reaction (or all of the above...).

    And from an similar area: You don't know by chance of any papers linking wheat with adrenal-gland problems?

  • Dr. William Davis

    1/24/2011 3:00:19 PM |

    Hi, Andrew--

    In fact, I contemplated a "six strategies" that included magnesium.

    I agree: magnesium is indeed near the top of the list for heart health.

  • Dr. William Davis

    1/24/2011 3:04:33 PM |

    Hi, Jay--

    Good news: With the favorable changes you've witnessed, the calculated (or what I call "fictional") LDL cholesterol increases, while the genuine measurement (e.g., NMR LDL particle number or apo B) drops.

    Of course, don't count on your friendly drug company to tell you this.

    Hi, Tony--

    The only connection I know of between wheat (gluten, in this case) and thyroid disease is that wheat exposure can activate (or at least be associated with) Hashimoto's thyroiditis, i.e., thyroid gland inflammation.

  • Anonymous

    1/24/2011 3:14:03 PM |

    dr davis,

    are you saying wheat mainly, that other carbs could be eaten and still some benefit could be had from just omitting wheat from diet?

  • Eric

    1/24/2011 5:16:37 PM |

    What kind of magnesium is best for those who have the old "Phillips Milk of Magnesia" effect with normal magnesium supplements?

  • Flavia

    1/24/2011 6:26:14 PM |

    This is craaaaazy!!! Four days ago my BP was 150/100- I took your recommendations to hear, along with other supplements (whey, blueberries, coQ10, magnesium, olive leaf) + low carb + exercise and my blood pressure has dropped to 129/90. I cannot believe this.

    What is most incredible is that all docs said my BP was 100% genetic and there was nothing I could do (probably b/c i'm thin and young).

    I am blogging my progress. The goal is to get off that goddamn atenolol once and for all.

    Here's a rundown of what I am doing. Any advice from anyone would be super welcome.

  • Flavia

    1/24/2011 6:28:45 PM |

    BTW the one thing I am NOT doing is supplementing with iodine. Is this necessary? How does one know if thyroid function is wack? Any recommendations on what type of iodine to take?

  • David M Gordon

    1/24/2011 8:21:32 PM |

    You ever tire of your Sisyphean struggles, Dr D? Many people in the medical industrial complex simply do not give credence to your findings.

    For example, I shared your point #1 (re wheat) with a research pathologist friend -- yes, the same fellow whose knowledge you believe might be circa 1985 Smile -- and he said...
    "The statements that you list are at best applicable under select circumstances.  I doubt there is any scientific evidence (study in a peer reviewed journal) to support your claims. If you stop eating, your triglycerides, weight, and  LDL will go down, nothing to do with stopping wheat. Similarly, in >99% of individuals, CRP levels are not related to diet, especially wheat eating. The only time eating wheat would make a difference is if you cannot tolerate wheat for any reason."

    Which brings me back to my opening question. "Peer reviewed journal"...? I mean, c'mon, that is akin to waiting until everyone is bullish and owns a stock before you finally buy.

  • Tony

    1/24/2011 9:44:40 PM |

    I found this abstract (with relation to celiac disease patients - poor bastards):

    The American Journal of Gastroenterology (2001) 96, 751–757; doi:10.1111/j.1572-0241.2001.03617.x
    Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study

    Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function.

    A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies.

    Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later.

    The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.

  • Anonymous

    1/25/2011 8:14:25 AM |

    You want to know, how to make exercise fun: check this one out:

  • Gillian

    1/25/2011 10:36:27 AM |

    Dr Davies

    What do you think about consuming the Swedish innovation Oatly (trademark) that is a special  oatmilk with an elevated amount of betaglucans?
    Professor Rickard Öste has developed this type of oatmilk.

  • Tom T

    1/25/2011 11:08:00 AM |

    Thank you for your efforts and blog.

    RE Omega 3s, you recommend fish oil.  Is that preferable to getting Omega 3s from walnuts and ground flaxseed, both of which I understand to also provide Omega 3s?  Is there a benefit to fish oil vs. these other options?

    Thank you.


  • Dr. William Davis

    1/25/2011 12:50:15 PM |

    Hi, David--

    Great points.

    Perhaps your pathologist friend should consider spending some time with the living.


    Those are two different things. Walnuts and flax do NOT provide the same effects as the omega-3s from fish, just as the oil in your car's engine cannot be used to be put in the gas tank. Two different, though related, things.

  • Oatlover

    1/25/2011 1:07:50 PM |

    Ok, got'ca on the wheat, but what about oats? Same deal, or are they OK? I can cut out wheat without any problems, but I do like my oat porridge... ;)

  • Steve

    1/25/2011 2:08:24 PM |

    Niacin was near the top  of your protocol list earlier.  Has this fallen out of favour?  Or is it just the insurance abuse which keeps it off the list?

    I have recently been diagnosed with wheat & gluten IgE sensitivity.  So I will finally stop resisting the #1 rec.  After 4 days I am seeing some changes in eosinophilic esophaghitis, gingivitis, and rhinitis.

  • Dr. William Davis

    1/25/2011 10:49:43 PM |


    Oats are an entirely different issue. They cause blood sugar to skyrocket.


    The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably.

  • Anonymous

    1/26/2011 5:59:41 AM |

    I'd put a caution note for the fish oil, we now know some of us get very bad opposite effect.

  • Oatlover

    1/26/2011 8:41:08 AM |

    Okay, I'm not really that hung up on oats. Smile But oat porridge is a main staple of mine. I'll take your advise and cut out wheat and oat for at least a few weeks and see what it's like.
    I'm healthy and have no heart problems or blood sugar issues of any kind, but as I'm not getting any younger (about to turn 40), I'm hoping to prevent any future problems by finetuning my diet.

  • Onschedule

    1/26/2011 11:33:01 PM |


    I had been eating oats as part of what I thought was a "healthy diet," but stopped when I started tracking my blood glucose and watched it consistently soar afterwards. I found oat bran had the same effect on my blood glucose. Since giving them up, I no longer get the light-headed tired hunger that used to force me to take lunch early. Since giving up wheat as well, I've never felt better.

    Well wishes for your trial!

  • Anonymous

    1/27/2011 1:36:26 PM |

    Dr Davis,

    What you mean by: The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably?
    What is the relationship between wheat/corn starch and sugar and niacin dosage?
    Is a lower dose of niacin efficient when wheat/corn and sugar are eliminated?


  • Steve

    1/27/2011 7:13:16 PM |

    Here is the conventional wisdom of max 1,000 IU Vitamin D via the NYT: LINK

  • Anonymous

    1/29/2011 2:23:44 PM |


    Some time ago, I decided to try to understand the origin of the phrase "Balanced Diet". After a lot of Google searching, I landed on a page that sketched out the use of the term, and have since lost the link.

    The term became popular, evidently, in about the 1920's and it was associated with the rapid discovery of many vitamins in foods. At that time, vitamin discoveries would seemingly pop up out of the blue.

    One writer, the first in a chain, remerked that "under the circumstances (unknown vitamins lurking in the food supply), we should therefore eat as broadly as possible so as to take in as many potential vitamins as possible."

    "Balanced Diet", under this interpretation, arose out of dietary ignorance, not dietary fact.

  • Kevin Kleinfelter

    2/2/2011 8:01:31 PM |

    I understand that you don't like wheat and other grains.  Are beans good or bad?  

    Yes, they are carbohydrate, but they're low glycemic index.  Are they a food which both anti-grain and USDA pyramid can agree are good, or do they have a down-side (other than gas)?

  • Ari

    2/2/2011 9:49:57 PM |

    Could you replace wheat with oats or other grains?

  • Ari

    2/2/2011 11:49:35 PM |

    For that matter, how about quinoa or polenta?


  • Dr. William Davis

    2/3/2011 3:06:30 PM |

    Hi, Ari--

    No, no, no, and no.

    These grains increase blood sugar to high levels in the majority of adults.

    I will be discussing such grains in an upcoming post.

  • Rob

    4/30/2011 8:29:37 PM |

    Hello DR WD.

    Today I have for the first time read  "The Heart-Scan Blog" and was interested to read of your recommendations as to the five most powerful heart disease prevention strategies.  In my case "prevention" is a little late in the day since I was diagnosed with severe Congestive Heart Failure  in the autumn of 2008. My EF at that time was just 15% to 20% and a considerable area of the heart muscle was  a-kinetic.   Although the usual heart drugs were prescribed,   after a few months of feeling lack-lustre and devoid of energy, I decided to stop taking them and instead changed my diet and supplemented,  primarily with Ubiquinol. From barely being able to shuffle 20 metres or so I now readily walk about 4 miles a day. The diet  has seen one or two changes along the way but has  for the best part of the last two years been grain free. Lean and fatty meats and eggs by the dozen  are consumed  each and every week  as are lots of vegetables  and  oily fish.  Coconut oil, natural sea salt,  apple cider vinegar,  turmeric, cayenne pepper and Italian tinned tomatoes  all go into delicious home-made salsas that spice up the blandest of vegetables.   Processed oils are avoided but raw butter enjoyed without any restriction whilst  British, French and Swiss unpasteurised cheeses   figure strongly on my menu. All I can add is that on that diet I feel wonderfully reinvigorated.

  • Zeal

    7/10/2011 9:08:00 AM |

    Now we know who the sesinlbe one is here. Great post!

  • Fleta

    7/10/2011 9:11:03 AM |

    I had no idea how to approach this before—now I’m locked and leoadd.

  • Darrance

    7/11/2011 5:21:05 PM |

    I found just what I was needed, and it was entertianing!

  • Margaretta

    7/11/2011 9:12:42 PM |

    Alaakzaam—information found, problem solved, thanks!