The ENDOTHELIUM Association
All heart attacks and most strokes are caused by a sick endothelium

Heart Attack: No Warning

A heart attack is by definition a blockage of the flow of blood to the heart (ischemia is the medical term)  -
which starves the heart of oxygen; Without oxygen, heart cells die and the heart, as a whole, dies. There are
two types of heart attacks:(in layman’s terms) the blow out and the build up. The blow out type, which
happens in about 60% of heart attacks, is the more dangerous because it comes without warning, any time,
in any place. In the blow out, an accumulation of debris, including blood clotting platelets, is suddenly
released into the blood stream. A blood clot is suddenly formed. The clot dams up the blood flow. If this
happens in the chest, it is a heart attack and in the head, it is a stroke.  Alternatively, there is another way for
this to occur.  Particularly if you have narrowed arteries, a sudden emotional shock:, such as anger, a car
accident or bad news can have the same affect. Arteries close and blood flow stops. There is a high
probability of death in either situation..
Cooke   Esselstyn  Ornish   

Dietary Origin

We have to face the fact that we are part of the primate family.  All
of our close relatives are primarily vegetarian.  We all came out of
central Africa.  About 2.6 million years ago, in our evolutionary
history, humans started to develop more of a taste for meat and fat.
This change, in what we  would and could eat, enabled our
ancestors to evolve greatly and  to migrate to every corner of the
globe.  In evolutionary terms, this was a great success.  We may die
sooner as omnivores than as vegetarians but we were able to live
on land we could never have been able to occupy had we not
diversified our diet. Deaths, while they may have occurred earlier,
were still well after reproduction and child raising had happened.  

Today we are living far far longer than our primitive ancestors.  
Most of us want to live longer still. We are now paying a price in
heart attacks and strokes for our omnivore eating behavior. Our
tongue changed but our endothelium did not change.  It is a
vegetarian. That is our problem.
  Lieberman    Wikipedia
A bonobo, another close relative

The Endothelium

The endothelium is an organ, composed of endothelial cells, is truly extraordinary.  We have endothelial
cells from the top of our head to the tip of our toe. Endothelial cells vary greatly in their function from one
location or another. In general, they support and maintain the function of the organ with which they are
associated.  Endothelial tissue lines our cornea (eye ball) covers our internal organs, inside and out as well
as our body cavity and elsewhere. The endothelial cells are specific, not only to a particular organ but to the
particular functional needs at a particular location on the organ. For example, the arterial endothelium lines
the arteries, where it provides a Teflon like shield between the blood and the artery walls so that nothing
carried by the blood stream stick to the walls. The endothelium also communicates with the artery walls
where it receives requests for various substances, principally nitric oxide (NO), which it makes and delivers
to the appropriate artery walls, thus keeping arteries flexible. As blood moves down the arteries to the cells,
the arteries become progressively smaller, withe the arterial walls becoming thinner and thinner until only
the endothelium is left to deliver blood to the capillaries. The endothelium at this point is perforated to
deliver the blood to the cells. The endothelium is also there to return the blood to the lymph system   There
are about 100,000 miles of arteries. and the total area of the endothelium, if spread out would cover about
3/4 of a football field and in total size rivals the liver. The endothelium also has a repair function.  It is this
function that leads ultimately to arteriosclerosis.

The endothelium is a irritated by an animal product diet. We are primates. All of us are plant
eating animals.
Smoking, diabetes and various other conditions also are deleterious. However,an animal
product diet gradually, but inevitably, causes irritation to the endothelium. Eventually this causes
inflammation. When this happens, the repair function occurs and the endothelium turns off its Teflon quality
to let the white cells in to fight the infection.  That is the start to the whole process that ends up as
arteriosclerosis which leads to heart attacks and strokes.

Aird   Cooke   Esselstyn   Ignarro  Ornish  Sinatra   Whitaker


NO is a gas and as such it has no difficulty passing through the walls of cells. This makes it an ideal
signaling molecule. In addition, NO is a very busy molecule, not only in the arteries but throughout the body.
Our healthy bodily functions are a continuing balancing and rebalancing act.  NO carries our four key
functions:  keeping arteries flexible, preventing blood clots from forming, preventing the arterial inflammation
that leads to arteriosclerosis and minimizing the effect of the destructive
free radicals The artery wall also
needs the NO to tell that particular section of the arteries to relax.

NO is produced not only by the endothelium but by white blood cells, neural cells and by exercise.  The
more exercise you do, the more
NO you generate.
Ignarro   Cooke   Esselstyn  Sinatra  


To make NO, the endothelium uses an amino acid, L-arginine, as the raw materiel for nitric oxide.  Amino
acids are the building block for proteins of all kinds.  The word "protein" comes from Greek.  It means "of
prime importance" and indeed they  are.  There are twenty two standard amino acids of which L-arginine is
one.  Eight of the amino acids that the body does not make itself and must be acquired by the food we eat
are called "essential" amino acids.  Five others, and L-arginine is one of  them, are called "semi-essential"
amino acids because during childhood and at other times they may or may not be produced.  Some recent
research suggests that in African Americans the production of L-arginine may be a problem.  

L-arginine is found in may foods such as soy, nuts, beans, legumes, fish, chicken, etc.
 Cooke   Esselstyn   Ignarro  Sinatra   
Artherosclerotic plaque from a
carotid artery
The Sick Endothelium/Arteriosclerosis

A "normal American" diet irritates the endothelium. Very gradually
and over a long time, it becomes inflamed. The walls attract more and more
debris, For most, there is finally a crisis, however, the age range is
enormous. For some it is your 30's, more in the '40s and '50s, more still as
you age. A lucky few never have a problem. Genetics makes a huge
Source  Cooke  
 Esselstyn   Ignarro  Ornish  Sinatra   Whitaker

Irritation of the endothelium leads to an inflamed endothelium. It
seeks help
from the white blood cells.  White blood cells are the
policemen of the body.  They gobble up invaders; germs, bacteria, etc.  
The endothelium opens up its formerly impervious walls to let the white
cells in. The artery walls then start to becomes like Velcro. They attracts
debris that it once repelled. The walls thicken and sicken.

In addition to white cells entering the endothelium, the infamous low
lipoproteins LDL cholesterol, also get into and under the
endothelium where it is trapped. The LDL oxidizes. The white cells attack
and consume the invading LDL. All those steaks, those double cheese
burgers, and fries with shakes add to the LDL going into your system.  The
white cells keep gobbling up more and more LDL. In time, the white cells
become very very fat, so fat that they look like foam.  In fact, they are
called "
foam cells".  These white "foam" cells think they are about to loose
the battle and look for more help.  They make a
free radical called
superoxide anion" to assist them in destroying the LDL - which causes
more oxidation.  The LDL invasion also causes fat appearing streaks to
form between the endothelium and the artery wall.  This blocks both the
signaling and the formation of NO.  

Some foam cells will rupture through the endothelium causing
damage to the endothelium.  Platelets, the scab making material in the
blood, repairs the damage.  Additional
platelets are attracted to take up
residence in the artery wall. Damaged endothelium cells, foam cells and
platelets, together, make a factor that attracts
fiberoblasts, a cell that forms
connective tissue, and
smooth muscle cells.  As a defensive measure,
these cells make scar tissue over the damaged area.  In time, as this
process continues, the plaque becomes larger.  You are building
arteriosclerosis.  You are also developing pockets that collect all this stuff.
These pockets are somewhat analogous to a boil The "boil" sticks out the
side of the artery wall.   You are very likely to  have a number of these
scattered about your body. The cap over these "boils" is very unstable.
The sick endothelium also makes substances that erode the cap!  You are
increasingly at risk.
It is very dangerous.
Source  Cooke  Sinatra   
To repeat, the caps on the "boils" are unstable because the inflamed endothelium makes
substances that erode the caps causing them to break (plaque rupture).  The material within the
"boil", that include platelets, gushes into the artery.  Platelets coagulate the blood forming a
blood clot. Suddenly you have an instantaneous dam. Depending upon where in the body it
occurs, you have a stroke, a heart attack or a severe pain in the leg or wherever else in your body
it occurs.  Some 60% of heart attacks happen this way - with no prior warning at all.
Source  Cooke   Esselstyn   Ornish  


If you get a pain in the chest or somewhere else, you are in luck. You can check it out and you should
- immediately. Arteriosclerosis may have closed an artery to the point where you feel a pain in the chest when
you exert yourself. This is angina.  
Angina is a condition that is caused by an insufficient blood supply which
causes pain.  This is a wake up call.  You really need to do something. You have a little time. This is a time to
get a very careful evaluation as to whether you are in a crisis situation of immanent death that precludes
anything but immediate surgery. Very probably it does not. Surgery can save your life but it is not a cure. If
surgery is recommended, Dr. Cooke writes that it is a good time to get a second opinion, preferably by a
cardiologist that does not do surgery.  Most people will have the time to address the problem. Fortunately you
have a very forgiving endothelium.  If you take care of your endothelium, it will take care of you. Many people,
who have radically change the way they eat, have eliminated their pain in just two to three weeks. This is a
clear sign that their endothelium has started the process of healing itself and stabilizing the cap on the "boils".
Cooke   Esselstyn  Ornish  Sinatra   Whitaker

Erectile Dysfunction     ED

Men in their forties often get an advance warning. We have all seen the TV add about ED, erectile
dysfunction. Unfortunately few doctors do more that write a prescription but this should be a time for a serious
discussion of the arterial system and the endothelium. Just as angina is a warning, so too is erectile
dysfunction. You are in trouble.

 Ignarro  Ornish  Sinatra

Transient Ischemic Attack   TIA

This is a temporary blockage of the blood flow in the brain which can happen as a result of a variety of
arterial problems.  It is often called a :"mini-stroke". All of the causes indicate that the arterial endothelial
system is not healthy. It is a wake up call  There are a variety of treatments doctors can offer The cure is to
feed your endothelium a diet it likes.  Do that and the endothelium will start taking care of you.

 Esselstyn   Sinatra   Wikipedia

Heart Attack Symptoms:   Men and Women -

Sudden chest pain (typically radiating to the left arm or left side of the neck or left side of the jaw),
 shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a
sense of impending doom).

Also chest discomfort including pressure, squeezing, fullness, indigestion, burning,
light-headedness, nausea or choking, or a feeling of tightness in the throat, fainting, sweating,
shortness of breath may also be symptomatic.  

Other symptoms could include discomfort in the left arm, either shoulder, between the shoulder
blades, in the left jaw.

Symptoms that last more than a few minutes.

Women may experience fewer typical symptoms than men .

Most commonly shortness of breath, weakness, fatigue, a feeling of indigestion or stomach ache.

When in doubt, check it out. This is a crisis situation. A lot can be done early in an attack.

Approximately one quarter of all heart attacks are silent, without chest pain or other symptoms.

Stroke Symptoms:

One one side of the body a sudden numbness or weakness in an arm, leg or face.

Speech loss or communication loss or comprehension loss.

Sudden fall for no reason, or dizziness, or unsteadiness.

Suddenly one eye is being shaded or a shade is being pulled down, loss of vision or dimness for
halfof the visual field.

This is a crisis situation where treatment is needed as soon as possible.

Peripheral Artery Disease (PAD) Symptoms

Hair does not grow on your legs.

Pain, cramping, aching, fatigue, heaviness in your lower half: legs, buttocks, calves, feet while
walking or at rest.  

Pain in the legs when going up hill, exercising, carrying a heavy load.

Discoloration of feet or legs.

Slow healing of cuts or bruises of the legs or feet.

These require immediate medical attention and are serious but are not a crisis.



There is no operation for a sick endothelium.  There are operations that focus on the arteries such the
angioplasty to widen narrow arteries, stents to keep them open and open heart surgery that bypasses sick
arteries.  The operations are very good at relieving you of pain but good as new you are not. You may be
free of pain but these are not cures. All are a  temporary fix. They do nothing to change the underlying on
going disease process.  The disease proses continues if you do not change what you are doing
 Cooke   Esselstyn   Ignarro  Ornish  Sinatra   Whitaker

Dr. John P. Cooke, a professor at Stanford Medical School, authored the book, The Cardiovascular Cure, in
which he wrote the following, "
If your doctor recommends angioplasty, tell him or her that if at all possible, you
prefer a medical and dietary approach. Angioplasty should be reserved for emergency situations (when
someone is in the middle of a heart attack) or when the medical and nutritional therapy have been attempted
but failed to relieve symptoms.

If your doctor still insists that you need an angioplasty or surgery for your heart and vessel disease, get a
second opinion, preferably from a cardiologist who does not perform invasive procedures."

Endothelium recovery?

Your probability is very good.  Even people with a very severe disability have been able to become pain free
and have had their lives restored.  Your diet has to change and you need professional attention as to the
changes you require. Change your diet, change your life.  Take a good look at the angiogram on the Home
page.    Source  
Cooke   Esselstyn   Ornish

This website does not provide medical advice.  The website is for information purposes only.
For medical advice, consult your healthcare provider.
Foam Cell