Defend against Britain's biggest killer

In a new book, cardiologist Dr Richard Fleming explains why simple diet and lifestyle changes can help prevent, treat and reverse heart disease - Britain's biggest killer. But unlike other experts, he doesn't think high cholesterol is the biggest, or only, risk factor. His research shows there is another major cause - inflammation of the arteries - and this unique seven-day diet plan aims to help reduce it.

As a cardiologist and founder of the Fleming Heart and Health Institute in the U.S., I have been treating people with heart disease for more than two decades. But several years ago, I realised that lowering cholesterol - the most common way of treating heart disease - was having very little effect. Coronary heart disease remains the world's biggest killer. It causes one in four deaths in men and one in six women, accounting for over 120,000 people a year.

But while we were able to slow down the disease with drugs and surgery, there didn't seem to be anything we could do to stop a fatal heart attack from occurring. This made me wonder whether we had identified all the lifestyle factors which were causing its incredible rise.

Heart disease has long been understood to be caused by high blood pressure, family heart history, diabetes, obesity, smoking and, above all, high cholesterol.

Cholesterol causes the development of harmful 'plaques' inside the coronary arteries, and these grow until they block blood flow to the heart, triggering a heart attack.

But I couldn't understand why half the people who suffer heart attacks each year still have what doctors describe as 'normal' cholesterol levels. And many men and women who die from a heart attack have only very small cholesterol plaques in their arteries.

I was telling patients to cut cholesterol levels by taking cholesterol-lowering drugs and eating less fatty foods, but still seeing no major change in their condition.

I came to the conclusion that the traditional risk factors explained less than half the cases of heart disease.

Pieces of the puzzle were missing. Not only did some of our basic beliefs appear to be inaccurate but treatment was not having the desired effect.

It was then I discovered that it was not simply cholesterol that was causing the problem but the immune system's reaction to cholesterol and other toxic substances in the blood.

When arteries become full of toxins, your immune system reacts by producing more immune cells to tackle them. Unfortunately, this build-up of immune cells creates swelling, heat, redness and, ultimately, boils in the arteries. When these boils burst, they form scabs, and if these are large enough they, too, will block the blood flow and trigger a heart attack.

So it is inflammation, not cholesterol, which is the root cause of heart attacks and strokes. And while cholesterol is still a major trigger for this inflammation, other factors such as the foods we eat, being overweight, lack of exercise, smoking and high levels of certain chemicals in the blood can cause it.

A lot of foods we think of as being bad for the heart because of their fat content, such as red meat, dairy products and fried foods, do trigger inflammation, but so do many other foods with little fat and cholesterol, including processed or sugary foods such as low-fat muffins, bagels, white bread and pastries.

These all cause an increase in the blood chemicals triglycerides and homocysteine. Triglycerides are globules of fat. When you eat too much fatty or processed food, the triglycerides increase and your blood turns thick and white, clogging your arteries.

Excess homocysteine acts like burning acid in your artery walls, creating wounds. So to tackle heart disease, you also have to reduce the amount of these foods which release these chemicals in your diet.

On the basis of my new findings, I designed a treatment programme for controlling inflammation - rather than just cholesterol - and by following it you can prevent and reverse the spread of heart disease.