Why eating plants strengthens your musculoskeletal system

Falsely believing I was a prisoner of my genes, I knew with certainty that I was destined to get heart disease.


My father, who is 82 years old, has had countless cardiac procedures over the past 25 years including cardiac bypass, numerous cardiac stents and angioplasties, and blockages removed from his carotid arteries–the vessels that carry oxygen to the brain–as well as Femoral artery bypass and stents. Both of my Grandfathers died of heart attacks as well as numerous uncles. My paternal grandmother died of complications from a stroke. At best, I could prolong the inevitable by eating “right” and trying to maintain my weight.


I had no idea what eating “right” really meant. I thought eating lean meat was healthy when in reality the cholesterol is in the lean portion of the meat. I thought if a little olive oil was healthy then a whole lot would be healthier. This is also known as the “bigger hammer theory” in orthopedics; if a little hammer is good then a bigger hammer is better–and if a little hammer doesn’t work, use a bigger hammer! The reality was I did not have any education on nutrition in medical school. Being a busy orthopedic surgeon, I did not see the need to educate myself. The old saying “when the pupil is ready, the teacher will appear” is very true in my case.

At the age of 53, I needed cardiac bypass surgery. I had an 85% blockage of my Left Anterior Descending coronary artery, an 80% blockage further downstream, and a 70% blockage of my Right Main coronary artery. My cardiologist thought the blockage was too significant to stent and recommended bypass surgery, which would entail cracking my chest open.


As fate would have it, prior to my arteriogram, the test that determined my blockage, a partner of mine recommended I read the book “The China Study” by T. Colin Campbell, PhD. I had never heard or read anything like it. In the book Dr. Campbell referenced another book, “Prevent and Reverse Heart Disease” by Caldwell Esselstyn, M.D., which I also promptly read. In addition, I did some research on the statistics related to coronary bypass surgery. In a 2005 study in the American Journal of Cardiology there was close to a 45% failure rate after 12-18 months.


Armed with the information contained in these two books along with the statistical information I found, I decided to cancel my bypass surgery. Instead, my wife and I adopted a whole food, plant based diet. Within six months I had a normal stress test, my total cholesterol was down from 494 to 115 (HDL 64 and LDL 15), and my triglycerides fell from over 3,200 to 175.


What were your previous numbers?


It's great for the readers to see the numerical changes. And I felt better than I had in years. At this point I knew this “diet” was working to improve my health but I wanted more information. I committed myself to studying nutrition. The more I learned, the more I saw the connection between food and its effects on the body, in particular the musculoskeletal system.


As an orthopedic surgeon, I primarily treat patients who develop shoulder-related issues. The orthopedic community has known for years that rotator cuff tears start in the area of the rotator cuff that has the poorest blood supply. In addition, most tendinopathies, where the tendon which attaches to the bone begins to deteriorate, occur in areas of the tendon which have the poorest blood supply.


Studies show that children who eat the Standard American Diet (the SAD diet) have fatty streaks in their arteries by age 15. This is the beginning of atherosclerosis, or arterial plaque. Arterial plaque has been described as a pimple on the arterial wall. These do not just occur in coronary arteries but throughout the body and can significantly affect the muscles and tendons of the body. This in turn hinders our body’s ability to heal even minor injuries to tendons and muscles. Food can significantly alter our body’s response to injury and aging.


The average age of a person with an asymptomatic rotator cuff tear is 58.7 years of age. The average age of a male that has a Myocardial Infarction, otherwise known as a heart attack, for the first time is also 56.5 years of age. Is this close age range just a coincidence or might the same underlying pathology be the cause?


We do not know the exact cause of rotator cuff tears. What we do know is they start in the area with the poorest blood flow. Just as erectile dysfunction is now being called the canary in the coal mine regarding vascular disease, I think tendinopathies are also the canary of vascular disease and are ultimately due to our poor nutrition. I think most of the degenerative conditions I treat as an orthopedic surgeon are diet related and can significantly be reversed by adopting a whole foods, no-added oil, plant based diet.


I see the effects of our poor American diet every day whether it is in the office or in surgery. Most patients seek orthopedic treatment for degenerative or inflammatory problems that primarily result from lifestyle choices either by inactivity, diet, or overuse. I have done thousands of surgeries and I see what our diet does to tendons, muscles, bones and bursas. I have seen bone so weak it would not hold an anchor or screw. I have seen tendons so degenerated it would not hold suture or a stitch. I have seen the inside of the shoulder joint so inflamed that the normal white capsule is brilliant red. I think most of these conditions could be significantly improved if not prevented by a whole food, no-added oil, plant based diet.


The Effing F’s of Nutrition


There are foods that FIGHT inflammation or foods that FEED inflammation. We are either feeding or fighting the inflammation in our bodies with our fingers, our feet, and our forks. With our fingers–by the way we snack. With our feet–by how much we exercise. With our forks–by what we eat. Our snacks need to be whole foods, we need 30 minutes of moderate exercise a day, and with our forks we need to eat more whole plant foods with little to no processed food.


The best way to illustrate these effects is to describe two fictitious athletes–Tiger Tim and Plant based Pete. While these athletes are fiction, the science behind what I will describe is very real. Tiger Tim is a typical American soccer player who eats the SAD diet. Plant based Pete is also a typical American soccer player but he eats a whole food, no-added oil, plant based diet.


Both athletes heard they can improve their performance with beet juice. Beet juice and other high nitrate containing foods increase nitric oxide production which is essential to increasing blood flow in exercise. Beet juice makes the production of ATP, our body’s energy molecule, 16% more efficient. It also decreases oxygen requirements by 19%.


Nitric Oxide production is critically important for the body to heal itself. When our arteries are more relaxed, blood flow increases. One thing that has been shown to affect our blood vessel’s ability to relax is dietary fat, both plant and animal. The SAD diet gets at least 30% or more of its calories from fat. This amount of fat impedes our body’s ability to heal by affecting nitric oxide production. Nitric Oxide production in our arteries occurs in the inner lining of the artery otherwise known as the endothelium. Fat blocks this production. It takes 4-6 hours after a high fat meal for the endothelial nitric oxide production to return to baseline.


What does this have to do with our two athletes? If Tiger Tim is eating a SAD diet, his arteries are not going to respond to the addition of the dietary nitrates the same as Plant based Pete’s will. Nor will Tiger Tim’s muscles respond the same to training. When exercising, the burn felt in the muscle is due to lactic acid production. However, delayed onset muscle soreness is an inflammatory condition. Food contributes significantly to inflammation, either by feeding inflammation or fighting it.


Inflammation also occurs in response to arachidonic acid production. Arachidonic acid is a product from linoleic acid, the essential omega-6 fatty acid. The SAD diet contains entirely too much Omega-6 fatty acids as well as saturated and trans fats all of which promote inflammation. Tiger Tim’s muscles will have significantly more delayed onset muscle soreness and inflammation compared to Plant based Pete’s muscles with the same amount of any given training program.


Whole food, no-added oil, plant based diets are anti-inflammatory. The inflammation in Tiger Tim’s muscles is not just due to the Omega-6 fatty acids either but also related to the animal flesh he eats. The meat, whether it is chicken, beef or pork, etc. has bacterial endotoxins which cause an intense inflammatory response. By not eating meat, Plant based Pete is not exposed to the endotoxemia that Tiger Tim experiences each time he eats meat, meaning Plant based Pete can train harder and more intensely.


Tiger Tim’s arterial walls would also be stiffer than Plant based Pete’s because of the effects of a chemical that is produced by acinetobacter bacteria during fermentation in his gut. Acinetobacter bacteria inhabit the gut of meat eaters but are not prevalent in the gut of a plant based eater. This bacterium produces a gas called TMA, trimethylamine. Tiger Tim’s liver converts this TMA into TMAO, trimethylamine-N-oxide, which stiffens arterial walls, impeding blood flow among other health problems. This stiffness would also hamper the effects of dietary nitrates.


If Tiger Tim drinks dairy, his bones would also be weaker than Plant based Pete’s because of the acidity of the protein in dairy. Contrary to what has been advertised, milk does NOT build strong bones but in fact weakens bones. It has been shown that people with back pain have more clogged lumbar arteries than people with no history of back pain; the greater the blockage, the worse the degeneration in the disc. If we can reverse heart disease, which numerous doctors have now proven, back pain might be reversed by the same whole food, no-added oil, plant based diet. Dairy is also a significant contributor to saturated fat, which, as stated earlier, increases inflammation among other things.


We either feed the inflammation and degeneration or fight it. I have chosen to fight it. My wife and I give free monthly seminars teaching the science of plant based nutrition, how to begin making changes, and hopefully establishing a community of like-minded people. And we do this in the heart of a very meat centric state with some of the worst health in the entire world. We want to inspire our readers to make the same changes. Is it hard? Yes, but with a committed community, it is entirely doable. Find your tribe!


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