The Most Effective Way to Prevent Cardiovascular Disease

Dr. Frank Shallenberger, MD

April 26, 2021


Judy and I went to Israel several years ago. We went to visit the holy sites. We both found Israel to be a light in a troubled world – an amazing place where Christians, Jews, and Muslims get along peacefully.

But one of the things that we enjoyed the most had nothing to do with peace. It had to do with juice. Virtually everywhere we went we were able to find a street vendor who would press us a fresh glass of juice for $3.

And it turns out that not only is the juice they served us refreshing in that hot climate, it’s also one of the best ways to prevent heart disease.

The reason this juice is so good at protecting your heart has to do with oxidized LDL cholesterol.

I’ve told you before about oxidized LDL. It’s important for two reasons. First, although many doctors still persist on saying that LDL cholesterol causes atherosclerosis, that is wrong.

We have known for 20 years that LDL cholesterol causes atherosclerosis only when the LDL is oxidized. LDL that is not oxidized is harmless.

In fact, non-oxidized LDL is a fundamental nutrient for your cells, especially the brain and nerve cells. Lower your non-oxidized LDL cholesterol levels and you are making it harder for your cells to function. And that leads to the second reason for knowing about oxidized LDL.

Simply measuring the amount of LDL in your blood does not give you any idea of how much of it is oxidized. If your total LDL levels are high, but your oxidized levels are low, you have no problem.

On the other hand, if your total LDL levels are low, but your oxidized levels are high, watch out. In that case you are on the road to cardiovascular disease even though your LDL is low.

It’s All About Your Oxidized LDL Levels, Not Your Total LDL

I think that this is one of the more important health-related concepts you can know about. Here’s why:

An LDL cholesterol molecule becomes oxidized when electrons are removed from it. Several of the various cells in the walls of our arteries can oxidize LDL. This includes endothelial cells, smooth muscle cells, mast cells, and macrophages.

The oxidation process is especially likely when your body is already pressed with too many free radicals and not enough antioxidant enzymes to protect you from them. The oxidized LDL is then taken up by the macrophages.

As the macrophages become laden with oxidized LDL they turn into “foam cells.” They are called foam cells because of the foamy way they look in a microscope. It is these foam cells that go on to form the plaque on our arteries. Stop the foam cells from forming and you will stop the plaque.

And the secret to keeping foam cells at bay is keeping the levels of oxidized LDL low. And that’s where the Israeli juice comes in. The juice we enjoyed so much was pomegranate juice.

Why Pomegranate Juice Is So Effective

Pomegranate juice protects us from heart disease by going straight to the very core of heart disease – atherosclerosis. Atherosclerosis refers to the buildup of plaque in the arteries. Atherosclerosis is what causes coronary artery obstruction, strokes, and all of the other cardiovascular diseases.

And here’s the thing. There are several studies that show that pomegranate juice may be the best single way we have to prevent atherosclerosis.

In one study, researchers looked at the effect of pomegranate juice on 13 healthy men between 20-35 years old. They produced the pomegranate juice by crushing the pomegranates the same way the street vendors did. They then pasteurized it and froze it (i.e., it wasn't fresh).

The researchers gave each man 50 milliliters of the juice each day for two weeks. This amounts to a little more than 1½ ounces of juice a day. Even at that ridiculously low amount of juice, a remarkable thing happened.

Before and after each week of the two weeks they measured the tendency in these men to oxidize LDL. After only one week of this small amount of pomegranate juice, they were oxidizing LDL 29% less.

At the end of two weeks, their bodies were oxidizing LDL an amazing 43% less! I have not heard of anything else nearly as effective.

Then, in order to find out how pomegranate juice reduces the tendency to form oxidized LDL, the researchers looked at the effect of pomegranate juice on mice. They found out that it decreased the ability for macrophage cells to oxidize LDL by 82%.

They also found that even when the LDL was oxidized, the pomegranate juice decreased the ability for the macrophages to take up the oxidized LDL and form foam cells by 22%.

It Works in 2 Ways

In other words, pomegranate juice works in two ways. Not only does it decrease the levels of oxidized LDL, it also prevents oxidized LDL from forming foam cells.

It’s very clear to me from my research that drinking pomegranate juice is not only enjoyable, but it may be the most effective way to prevent cardiovascular disease in all of its forms.

Cardiovascular disease is the number one killer in the U.S. And that’s true even if you don’t have a strong family history. That said, drinking pomegranate juice may be the most important single thing you can do for your overall health. So where do we get this pomegranate juice?

You can buy pomegranate juice made from concentrate in stores and online. The problem is that it may not work as well as the freshly made or frozen version. So how can you find out if it is working?

One good way would be to check your oxidized LDL level before and after drinking it for a few weeks. If the level goes down, then that’s proof that it works.

Of course, the best way to take your juice would be by making it fresh every day. That’s what I do. I bought a pomegranate press for $120 online. Costco sells fresh pomegranates for about $3 apiece. Each one makes about 6 ounces of juice. I take it three-to-four times per week.

There aren’t many laboratories that are measuring oxidized LDL in the US. But here are two. One is Dunwoody Labs ( The other is Doctor’s Data ( All your doctor has to do is to contact one of these labs and they will send him a specimen kit. The test is a simple blood draw.

Remember, measuring your total LDL level is a waste of time. It’s your oxidized LDL level that is important. So make sure that everyone in your family does it. And make sure they do it before they have a problem. Lowering your oxidized LDL level works well to prevent atherosclerosis, but there is no evidence yet that it will get rid of the atherosclerosis you already have.


Aviram, M., L. Dornfeld, M. Kaplan, et al. “Pomegranate juice flavonoids inhibit low-density lipoprotein oxidation and cardiovascular diseases: studies in atherosclerotic mice and in humans.” Drugs Exp Clin Res. 2002;28(2-3):49-62.

Fuhrman, B., N. Volkova, and M. Aviram. “Pomegranate juice inhibits oxidized LDL uptake and cholesterol biosynthesis in macrophages.” J Nutr Biochem. 2005 September;16(9):570-6.

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