Click here to go to my post about Gupta's documentary & view the entire program.
Here you go. If you're like me, you can't absorb everything when you watch a video on TV.
- What were the names of those diagnostic tests Dr. Arthur Agatston recommended?
- Why aren't cholesterol numbers the best indicators of heart disease?
- What kind of success can I expect on the Esselstyn diet?
- Oh--and what exactly is that diet anyway? What foods do I need to avoid?
It's all here in these transcripts and the supplementary articles--and there are links to the videos, too.
What Your Cholesterol Number Really Says
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(CNN) -- Learning your cholesterol numbers -- the good, the bad and the total -- is a well-established part of the annual physical exam.
A high cholesterol number results in angst and possible treatment. A low number brings relief. But are we putting too much stock in cholesterol as a sign of our heart attack risk?
"The cholesterol number is essentially worthless," says Dr. Arthur Agatston. The Miami cardiologist and South Beach diet books author says the cholesterol of people who have heart attacks and those who don't are almost identical.
"The overlap is troubling," Dr. Kwame Akosah at the University of Virginia agrees. "As an isolated predictor, it falls short."
As a sign of the weakness in cholesterol numbers alone, one large study found the average LDL cholesterol of people hospitalized for heart disease was 105, which is considered "near optimal."
The study, published in the American Heart Journal in 2009, found almost half of the hospital admissions had LDL cholesterol levels below 100, traditionally considered "low risk."
Another study found that only half of heart attacks occurred in people with high cholesterol (at or above 240), while a fifth of the heart attacks struck people whose cholesterol levels (below 200) deemed them safe based on long-held guidelines.
Agatston says the cholesterol numbers fall short because they measure cholesterol in your blood. They don't tell you the amount of LDL, or bad cholesterol, building up as plaque in the blood vessel walls. Plaque is what causes heart attacks.
As a result, studies show some people who think they're high risk based on cholesterol numbers are not, while others who think they are in the clear are developing dangerous plaques.
Your body needs cholesterol. The waxy substance is in the lining of every cell in your body. You also use cholesterol to make hormones, vitamin D and other substances.
Cholesterol circulates in the blood stream with the help of lipoproteins. The low-density lipoprotein, or LDL, carries cholesterol away from the liver. The high-density lipoprotein, or HDL, scavenges excess cholesterol and brings it back to the liver.
Your body produces cholesterol in the liver. You can also get cholesterol in fatty foods. When the LDL in the blood outstrips the HDL's ability to scavenge it, plaque can accumulate. The buildup of plaque is a lifelong process, beginning in childhood, but everyone is different.
Your genes play a role in whether you are prone to accumulating LDL as plaque. High blood pressure also makes you more prone to plaque buildup. If you are obese or diabetic or a smoker or suffer from a chronic inflammatory condition like lupus, you are also more likely to accumulate plaque than someone with the same LDL cholesterol number.
Akosah says he uses all these factors to determine a patient's "global risk" and tailors the treatment accordingly.
Also, there are different LDL particle sizes. Smaller particles tend to penetrate the vessel wall more easily than larger LDL particles.
Most heart attacks are not caused by the slow narrowing of blood vessels but by a rupture of a blister or bubble of plaque in an artery that is less than 50 percent blocked. Half of all heart attacks come with no warning at all, making diagnostic tests all the more important.
Younger women may be particularly jeopardized by a heavy reliance on cholesterol numbers. One study that looked at heart attacks in women under 65 found none had been deemed "high risk" for a heart attack using the traditional Framingham Risk Score, which looked at age, smoking, blood pressure, total cholesterol and HDL.
A class of drugs called statins lowers LDL cholesterol. Exercise and a low-fat diet rich in fruits, vegetables, whole grains and legumes can also lower LDL and raise HDL. Smokers who quit also improve their cholesterol numbers.
But the numbers themselves may be only the first step in learning your heart health.
"High cholesterol is not a diagnosis. It's a symptom. It's like a fever. The first step is to figure out what's going on," says Dr. James A. Underberg, a professor at New York University School of Medicine who specializes in preventive cardiovascular medicine.
Will you have a heart attack? These tests might tell
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(CNN) -- Most heart attacks strike with no warning, but doctors now have a clearer picture than ever before of who is most likely to have one, says Dr. Arthur Agatston, a Miami cardiologist and author of the best-selling South Beach diet books.
Agatston says relatively new imaging tests give real-time pictures showing whether plaque is building up in key blood vessels, alerting doctor and patient to an increased risk of a potentially deadly heart attack.
"Unless you do the imaging, you are really playing Russian roulette with your life," he said.
Agatston invented one of the imaging tests, the coronary calcium scan, which looks at plaque in the arteries leading to the heart. Plaque in these arteries is a red flag for a potential heart attack. (Agatston does not make any money from the coronary calcium scan.)
The other imaging test Agatston recommends is an ultrasound of the carotid artery, looking at plaque in the main blood vessel leading to the brain. Plaque in the carotid artery is a sign of increased risk for a heart attack and stroke.
Both tests are non-invasive and outpatient, although the calcium scan does expose the patient to the equivalent of several months of normal background radiation.
One large federally funded study found the coronary calcium score a better predictor of coronary events like a heart attack than the traditional Framingham Risk Score, which considers age, cigarette smoking, blood pressure, total cholesterol and HDL, the "good" cholesterol.
Agatston thinks the coronary calcium scan should be routinely scheduled at age 50, like a colonoscopy, or earlier for people with family histories of heart disease.
Most hospitals now offer the imaging tests, some at less than $100 for both, and they are often covered by insurance.
Cardiologists now generally use the calcium scan only for patients considered at intermediate risk for heart disease, determined by traditional measures such as cholesterol, blood pressure, lifestyle and family history.
High-risk patients already receive such aggressive treatment as cholesterol-lowering statin medication, but many doctors don't think low-risk patients need to incur the expense or small dose of radiation that comes with a coronary calcium scan.
"There is a large group in the middle called intermediate risk, which may be as much as 50% of the population," said Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University
A good candidate for a coronary calcium scan, she says, would be a 50-year-old man with slightly elevated cholesterol and a father who had a heart attack.
"Do you put this 50-year-old who has this family history on a statin medication with potential expense (and) side effects for the next four decades of his life, or do you further refine how far at risk he is?" she asked.
A calcium score would answer that question, she says.
There's a third test Agatston likes: a $65 blood test that looks at a patient's LDL, or bad cholesterol. LDL particles come in different sizes, and patients with a lot of small-particle LDL are more likely to build up plaque in their blood vessels, Agatston says. Alternately, patients with large LDL particles do not tend to accumulate plaque.
"There are a lot of little old ladies in their 80s with very high cholesterol who have squeaky clean vessels. They have very large particles, and they don't get into the vessel wall," Agatston says.
These new tests give patients a chance to make major changes in their diet and lifestyle, and give doctors an opportunity to treat them with medication.
"One of the best-kept secrets in the country in medicine is the doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It's doable," Agatston says.
Gupta: Becoming Heart Attack Proof
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Editor's note: Watch Dr. Sanjay Gupta Reports: The Last Heart Attack Sunday night at 9p and 12 midnight ET
While working on “The Last Heart Attack,” I had a chance to interview some extraordinary people around the country. Patients struggling with heart disease provided lessons that can sometimes be taught only after being smacked in the face with their own mortality. For example, I have never seen former President Clinton so candid. He was convinced he was going to die back in 2004, after feeling chest tightness during a flight back to New York on a small plane.
I interviewed cardiologists who believe we are so darn close to virtually eliminating heart disease. And, the truth is, it doesn’t involve spending any more money, investing in any more research or creating anymore tests. Rather, it will take a strict implementation of what we already know about diet and nutrition. It will also take brave champions to navigate through the clutter of confusing counsel, special interests and shoddy science.
One day, I had a chance to speak to a couple of those champions candidly while waiting for a shoot to begin - Dr. Caldwell Esselstyn and T. Colin Campbell, Ph.D. I had read Campbell’s book, "The China Study," years ago and remember how audacious he was in telling readers that most of what they believed about food and its relationship to health and disease was plain wrong. His findings changed the way people all over the world eat, including me.
And, I will admit, while I had trained my whole life to treat disease after it developed, I wasn’t medically trained in nutrition to be able to help prevent some of these diseases in the first place. Most of what I have learned has been on my own, since leaving medical school, and I think that is true for many doctors of my generation.
Simply put, Campbell’s research team found people who ate the most animal-based foods also had the most chronic disease. As important, people who ate the most plant-based foods were the healthiest. Campbell went on to describe the specific connections between nutrition and heart disease, diabetes and cancer. He also wrote of the ability to use nutrition to reverse these conditions – something that can start at almost any age.
Esselstyn took it a step further. “Sanjay, we want to make you heart attack proof.” Pretty audacious, I thought, but I couldn’t help but be engaged by this Cleveland Clinic surgeon, who was now devoting his life to preventing the diseases he made a living treating.“We are never going to end the epidemic of heart disease with stents, bypasses and medications,” he told me. That was music to my ears, because I didn’t want any of those things. Of course, it would involve essentially eliminating meat, dairy, eggs and oil – even olive oil. “Nothing with a mother, and nothing with a face,” the good doctor added.
Honestly, over the years, I have practiced the adage “eat to live,” not “live to eat.” Still, I knew it was going to be tough to carry out what he was asking. I started with a practical question for him. He was on the road traveling, and I was curious what he ate. “Thai food is always a good bet,” he told me. Sharon Kintz, who is a 66-year-old heart patient, joined me in Times Square to prove she could find a meal that satisfied her vegan requirements. Even former President Clinton says he is a vegan nowadays, and doesn’t at all miss the fast food for which he was once famous.
Virtually eliminating heart disease – it can be done, and truth is, we have known for a very long time how to do it. People have said to me as I was preparing this documentary – “Sanjay, you are advocating a radical change to the way we eat.” Perhaps, but if you really think about it, the way we eat now is in fact more radical. And when we look back on this time, a couple of hundred years from now, I guarantee you that our diet of today will be considered one of the most radical in history.
If we collectively ever want to get to the point where we have “The Last Heart Attack,” a good start would be to stop ignoring what we already know to be true.
The Heart Attack Proof Diet?
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(CNN) -- Dr. Caldwell Esselstyn Jr. didn't become a doctor to change the way America eats. He was a general surgeon.
But researching cancer, he stumbled on a fact that changed his career: Certain cultures around the world do not suffer from heart disease, the No. 1 killer in the Western world.
Esselstyn's practice took a dramatic turn -- from performing surgery to promoting nutrition. For more than 20 years, the Cleveland Clinic doctor has tried to get Americans to eat like the Papua New Guinea highlanders, rural Chinese, central Africans and the Tarahumara Indians of Mexico.
Follow his dietary prescription, the 77-year-old Esselstyn says, and you will be "heart attack proof" -- regardless of your family history.
"It's a foodborne illness, and we're never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness," Esselstyn says.
The Esselstyn diet is tough for most Americans to swallow: no meat, no eggs, no dairy, no added oils.
Esselstyn has written a book to spread the word, "Prevent and Reverse Heart Disease -- The Revolutionary, Scientifically Proven, Nutrition-Based Cure," and he has given talks around the world.
He is also a focus of the new documentary "Forks Over Knives." Esselstyn has won some high-profile allies -- such as Dr. T. Colin Campbell, co-author of "The China Study," and Dr. Terry Mason, chief medical officer at Cook County Hospitals in Chicago and the city's former health commissioner.
"We've eaten ourselves into a problem, and we can eat ourselves out of it," Mason says. But Esselstyn's prescription goes against conventional wisdom, which considers diet only one factor in preventing heart disease.
"Diet alone is not going to be the reason that heart attacks are eliminated," says Nancy Brown, CEO of the American Heart Association.
Other key factors include physical activity, cholesterol, blood pressure and weight, she says. The meat, dairy and egg industries defend the benefits of their protein-rich foods, all of which remain on the U.S. Department of Agriculture's MyPlate dietary guidelines for healthy eating.
Esselstyn's plant-based prescription also runs up against a culture where meat is served at most meals.
"Most doctors eat meat because most Americans eat meat, and if they don't really see for themselves or for their family why it might be a good idea to cut down or even cut meat out of their diet altogether, they might not be so inclined to recommend it to their patients," says Michele Simon, author of "Appetite for Profit."
Even doctors who see the benefits of Esselstyn's diet may not prescribe it for their patients.
"Anyone who is able to do that diet can have dramatic success. The problem is that many people are unable or unwilling to make these changes so in my practice, I try to take baby steps -- one step at a time," says Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University.
To help heart patients and others make the leap to his diet, Esselstyn holds a monthly, five-hour seminar at the Cleveland Clinic Wellness Institute to explain the science behind "plant-based" nutrition.
Esselstyn's wife, Ann, offers practical advice on how to prepare kale, bok choy, collard greens and other foods that may not be on the typical family's shopping list.
Esselstyn began recruiting patients in 1985 and says his diet has worked even on people deemed too sick for surgery. Esselstyn has published results from a small group of patients showing how his diet either halted the progression of heart disease or reduced the blockages in the blood vessels leading to the heart.
"We know if people are eating this way they are not going to have a heart attack," says Esselstyn, whose father had a heart attack at 43.
Anthony Yen, an entrepreneur who emigrated from China and came to love the fried foods, meat and desserts of the American diet, adopted the Esselstyn program in 1987 after undergoing bypass surgery.
"I'm still alive because of this diet," Yen says, now 78.
Esselstyn says people shouldn't hold off on starting his diet until after they develop symptoms of heart disease because most heart attacks strike with no warning.
"The reason you don't wait until you have heart disease to eat this way is often, sadly, the first symptom of your heart disease may be your sudden death," he says.
Esselstyn says his diet works because it keeps the lining of the blood vessels free of the dangerous blisters or bubbles or cholesterol-laden plaque that causes heart attacks.
Two decades after Esselstyn started trying to spread the gospel of his plant-based diet, the American Heart Association says 83 million Americans have some form of cardiovascular disease and many of the traditional risk factors for heart disease, such as obesity, are at all time highs. The association says the cost of treating heart disease tops $270 billion and is expected to more than double by 2025.
Esselstyn, a member of the U.S. gold medal rowing team at the 1956 Olympics, is not someone who gives up easily.
"We are on the cusp of what could be an absolute revolution in health -- not dependent on pills, procedures or operations, but on lifestyle," Esselstyn says.
The "Heart Attack Waiting to Happen" Isn't Always Obvious
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(CNN) -- If you're not overweight, eat pretty well and exercise now and then, you might think you're in good heart health. But doctors say you don't have to look like a heart attack waiting to happen to be one.
Tom Bare, 54, is a case in point. The high school science teacher was thin, active and ate well, but still needed open-heart surgery this spring to bypass blocked coronary arteries.
"I had taken care of myself, taken care of my body," Bare said.
Bare received a telltale warning sign this spring when he went for a jog outside his Lincoln, Nebraska, home.
"Made it about three tenths of a mile and then had the classic symptoms. Chest pain ... and then pain down the left arm and shortness of breath," Bare said. That's what prompted him to see his doctor. Within days, he was scheduled for surgery.
"He's at risk for heart attack just because of the amount of plaque that he has," said surgeon Ed Raines just before performing a quintuple bypass on Bare.
Bare has a strong family history of heart disease: His mother's parents both died of heart attacks, and his mother and brother both required heart surgery, he said.
Still, he was trying to do everything right. He was on a statin medicine, which he said had lowered his cholesterol from just under 300 to 125. Total cholesterol of 240 or above is considered a risk factor for heart disease.
Also, Bare's typical diet was better than most: oatmeal for breakfast, fruit for lunch, chicken or Mexican food for dinner.
He didn't smoke. He was not overweight or diabetic.
"Friends are saying if there's anybody in the group that shouldn't be going through this, it would be me, because of my lifestyle," Bare said. But, he added, "My brother has gone through this. My mom has gone through this. I knew it was coming."
Dr. Dean Ornish, who has researched the relationship between lifestyle and health, says even the most malignant family history can be overcome.
"I don't think anyone is doomed to have heart disease," said Ornish, founder and president of the Preventive Medicine Research Institute.
"You know, even if your mother and your father and your sister and your brother all die from heart disease it doesn't mean you need ever to die from it," he added. "It just means you need to make bigger changes in your life than someone else who doesn't have those kinds of genes."
For someone like Bare, that might mean adopting a plant-based diet, Ornish said.
Bare was worried enough about his heart health that he underwent a coronary calcium scan four years ago. The test showed plaque building up in his coronary arteries.
"My score was 111," Bare said. Zero is the best score. Five is the average score for someone his age. A score over 100 meant an elevated risk of heart attack. He had another coronary calcium scan this year. His score was up to 243.
A survey by the American Heart Association suggests many are misguided about their heart health. Some 39% of Americans think their heart health is ideal. The actual number is less than 1%, said Nancy Brown, CEO of the heart association.
"We're very concerned because we're seeing the risk factors associated with cardiovascular disease increasing," Brown said.
Bare has returned to school part-time until he regains his strength and he's hoping bypass surgery has given him a new lease on life. The science teacher says he'd like to travel, maybe see a volcano erupt.
"I'm told that I'm good for another 40 years or so, and I'm hoping that's the case, but with my history, I'm going to have to watch it," Bare said.
Even so, Bare said he has no plans to give up the food he loves.
From Omnivore to Vegan: The Dietary Education of Bill Clinton
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(CNN) -- By the time he reached the White House, Bill Clinton's appetite was legend. He loved hamburgers, steaks, chicken enchiladas, barbecue and french fries but wasn't too picky. At one campaign stop in New Hampshire, he reportedly bought a dozen doughnuts and was working his way through the box until an aide stopped him.
Former President Clinton now considers himself a vegan. He's dropped more than 20 pounds, and he says he's healthier than ever. His dramatic dietary transformation took almost two decades and came about only after a pair of heart procedures and some advice from a trusted doctor.
His dietary saga began in 1993, when first lady Hillary Clinton decided to inaugurate a new, healthier diet for her husband. In a meeting, she asked Dr. Dean Ornish to work with the White House chefs, who were accustomed to high fat, French cuisine.
"The president did like unhealthy foods, and we were able to put soy burgers in White House, for example, and get foods that were delicious and nutritious," said Ornish, director and president of the Preventive Medicine Research Institute in Sausalito, California. Other new menu items included such healthy fare as stir fry vegetables with tofu, and salmon with vegetables.
Even with the revamped White House menu, Clinton battled his weight throughout his two terms as president. At his annual physical in 1999, the White House physician noted the president had put on 18 pounds since a checkup two years earlier. The prescription: refocus on exercise and a low-calorie diet.
Clinton didn't know it, but weight was not his biggest health concern. The 42nd president has a family history of heart disease, and plaque was building up in the coronary arteries leading to his heart, undetected by White House doctors.
In 2004, less than four years after leaving office, the 58-year-old Clinton felt what he described as a tightness in his chest as he returned home from New Orleans, where he was promoting his memoir, "My Life." Days later, he underwent quadruple bypass surgery to restore blood flow to his heart.
"I was lucky I did not die of a heart attack," Clinton told CNN's Dr. Sanjay Gupta. After the surgery, the former president cut down on his calories and lowered the cholesterol in his diet, but his heart troubles were not over.
Last year, the former president went to Haiti to support the relief efforts but he felt weak. When he returned home, he learned he needed another heart procedure: two stents to open one of the veins from his bypass surgery, which had become, in Clinton's words, "pretty bent and ugly."
Ornish recalls meeting with Clinton a few days after his angioplasty. "I shared with him that because of his genetics, moderate changes in diet and lifestyle weren't enough to keep his disease from progressing. However, our research showed that more intensive changes change actually reverse progression of heart disease in most people."
"I told him, 'The friends that mean the most to me are the ones that tell me what I need to hear, not necessarily what I want to hear. And you need to know your genes are not your fate. And I say this not to blame you but to empower you. And I'm happy to work with you to whatever extent you want,'" Ornish recalled. They met a few days later, he said.
Clinton then decided to make profound changes in the way he eats.
"I essentially concluded that I had played Russian roulette," Clinton said, "because even though I had changed my diet some and cut down on the caloric total of my ingestion and cut back on much of the cholesterol in the food I was eating, I still -- without any scientific basis to support what I did -- was taking in a lot of extra cholesterol without knowing if my body would produce enough of the enzyme to support it, and clearly it didn't or I wouldn't have had that blockage. So that's when I made a decision to really change."
The former president now says he consumes no meat, no dairy, no eggs, almost no oil.
"I like the vegetables, the fruits, the beans, the stuff I eat now," Clinton told Gupta.
The former president's goal is to avoid any food that could damage his blood vessels. His dietary guides are Ornish and Dr. Caldwell Esselstyn Jr., who directs the cardiovascular prevention and reversal program at The Cleveland Clinic Wellness Institute. Both doctors have concluded that a plant-based diet can prevent and, in some cases, actually reverse heart disease.
"All my blood tests are good, and my vital signs are good, and I feel good, and I also have, believe it or not, more energy," Clinton said. His latest goal: getting his weight down to 185, what he weighed when he was 13 years old.
Clinton is trying to spread his newfound zeal for healthy eating to children. The Clinton Foundation has teamed up with the American Heart Association and is helping 12,000 schools promote exercise and offer better lunches so decades from now, today's children will not face the same heart troubles he has.
"It's turning a ship around before it hits the iceberg, but I think we're beginning to turn it around," Clinton said.
The Heart Attack Proof Diet Worked for Me
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I remember the day as if it were yesterday. I was lying in my hospital bed anxiously waiting for another unwanted heart catheterization. I was questioning how this could be happening to me again.
After all, I was only 41 years old. I was in pretty good shape. I didn’t smoke. I ate pretty well. Bad luck, bad genes, what was causing me to need a fifth heart procedure? It was easy to start feeling sorry for myself.
Then I thought about the book that I just finished reading for the second time since my last heart procedure that was sadly and inexplicably preformed just five months prior. It inspired me to pick up my iPad and search for the book’s author Dr. Esselstyn.
Within seconds I was watching a CNN video on YouTube with Wolf Blitzer interviewing President Bill Clinton, Dr. Esselstyn and Dr. Dean Ornish on how one might prevent and even reverse heart disease through diet and exercise. Motivated to go further, I then found Dr.Esselstyn’s office number on the internet and called without having any reasonable expectation that he could be reached.
To my surprise, his assistant Jackie answered the phone and told me that she would have Dr. Esselstyn return my call as soon as possible. As I hung up the phone, I had to scratch my head and question whether a famous doctor and author in Cleveland who I had just watched on CNN, who didn’t know me from Adam, would return my call as I lay there helplessly in my hospital bed.
To my surprise he did.
I had been rolled into the waiting/recovery room for the catheterization lab when my cell phone rang, that I am pretty sure I was not supposed to be using in the hospital, with Dr. Esselstyn calling. He caringly asked about my health history, blood work results and current symptoms that had led me back to the hospital again that day.
Sadly, he admitted that there was only so much he could do as I was literally minutes from being rolled into the next room to have the catheterization performed, but he did promise that he was convinced there was a way that I could prevent this hospital visit from ever happening again and that I would be hearing from him soon.
Moments later, my heart catheterization had begun and three hours later I was back in my hospital room in tears realizing that I just had three more stents placed around my heart.
In the nine years that preceded that day, I had progressively lost hope. After my first of eight stents were placed at the age of 31, a friend had given me a book called "Dr. Dean Ornish's Program for Reversing Heart Disease." After reading it I was inspired and confident that I could prevent this from ever happening again.
I then reached out to those that I thought I could trust - doctors, cardiologists, even a nutritionist to validate what I had read. It is safe to say that my confidence quickly turned to confusion. I remember stating, “If eating tree bark and water would keep me out of the hospital, then that is what I would do." Sadly, rather than confirmation, I instead was told that it was not necessary or even realistic that I commit to the lifestyle changes recommend by the book.
Nine years and eight stents later, I can’t help but think that the advice I received was well intentioned but nonetheless wrong.
After my fourth catheterization last June, I decided enough was enough and that there had to be a better way to go. I switched to a doctor that was part of the MDVIP program (focusing on preventive, personalized health care) that had a nutritionist on staff. During my visit with the nutritionist, she recommended strongly that I read Dr. Esselstyn’s book "Prevent and Reverse Heart Disease." After immediately reading the book cover to cover, I once again visited with my doctor and cardiologist who were clearly more supportive than my experience from years before, but there still was a suggestion that what I had read was too extreme, unrealistic, and even unnecessary.
Still confused, I did eat much better and exercised regularly. However, I did not follow what was recommended in the book to the letter. I found myself back in the hospital again that November.
Since that day in the hospital, I have not allowed any professional’s opinion or excuse to deter me from implementing what Dr. Esselstyn recommends. I attended his one day program at the Cleveland Clinic in December. My diet has consisted exclusively of fruits, vegetables, grains and beans with no added oils, nuts, seeds or avocado.
I have lost 48 pounds. My blood work has gone from total cholesterol of 208, LDL of 93, HDL of 41, and triglycerides of 368 last June to most recent results of total cholesterol of 89, LDL of 19, HDL of 53, and triglycerides of 83. That transformation is nothing short of amazing.
My next challenge is where to go next with my heart medications, which would seem to be unnecessary based on the miraculous change in my blood work.
I don’t blame my doctors, my cardiologists or nutritionists over the years. I believe they had my best interest at heart. I do believe, however, that the world deserves better advice on how to live a long and happy life, free of heart and other diseases.
I know there are no guarantees in life, but I am convinced beyond belief that I am on the right track. If I can do it, I know that anyone else can. They just need to be given a chance by being pointed in the right direction. Hopefully those hearing about my life experiences will help them avoid taking nine years to figure it out as it did with me.
Dr. Dean Ornish: Asking the Right Questions About Health Care
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Thomas Pynchon once said: “If they can get you to ask the wrong questions, then they don't have to worry about the answers.”
Here’s the wrong question: Should we cut back on or even dismantle Medicare, or should we just keep raising taxes and let the deficit continue to increase unabated? Since neither choice is optimal, the debate - some say debacle - in Washington these past few weeks about how to deal with our rising deficit, much of which is due to rising health care costs, has polarized and paralyzed our country.
There is a third alternative: When we address the underlying causes of most chronic diseases - our lifestyle choices - our bodies have a remarkable capacity to begin healing, and much faster than was once realized. When we address these lifestyle causes, then we can make better care available at lower cost to more people. And the only side effects are good ones.
When I lecture, I often begin by showing a slide of doctors busily mopping up the floor around an overflowing sink, but no one is turning off the faucet.
Many people tend to think of breakthroughs in medicine as a new drug, laser, or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle - what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our loving relationships and social support - can be as powerful as drugs and surgery, but they are. Often, even better.
Although cardiovascular diseases kill more people worldwide prematurely than just about all other causes of death combined, heart disease is almost completely preventable and even reversible today if we simply put into practice what we already know.
The same lifestyle changes that can prevent or even reverse heart disease also help prevent or reverse many other chronic diseases as well. For example, in the EPIC study, patients who never smoked, were not overweight, had at least 30 minutes/day of physical activity, and adhered to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption) had a 78% lower overall risk of developing a chronic disease. These included a 93% reduced risk of diabetes, an 81% lower risk of a heart attack, a 50% reduction in risk of stroke, and a 36% overall reduction in risk of cancer than participants without these healthy factors.
For the past 35 years, my colleagues and I have conducted a series of randomized controlled trials showing, for the first time, that heart disease is reversible simply by changing diet and lifestyle. Because of this, we appreciate that Medicare is now covering “Dr. Ornish’s Program for Reversing Heart Disease,” the first time that Medicare has covered an integrative medicine program. Since reimbursement is a primary determinant of both medical practice and medical education, this is a game-changer.
Our research also showed, for the first time, that these same lifestyle changes can slow, stop, or even reverse the progression of early-stage prostate cancer. We also found that these lifestyle changes beneficially altered the expression of over 500 genes in only three months, “turning on” protective genes that prevent disease and “turning off” oncogenes associated with breast cancer and prostate cancer as well as genes that cause heart disease, oxidative stress, and inflammation.
In collaboration with Dr. Elizabeth Blackburn, who received the Nobel Prize in Medicine two years ago, we published the first study showing that these lifestyle changes increased telomerase, the enzyme that lengthens telomeres, which are the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this. As your telomeres get longer, your life gets longer.
These findings are capturing the imaginations of many people. Many people believe, “Oh, it’s all in my genes, there’s not much I can do,” what I call “genetic nihilism.” Now, we understand how dynamic these mechanisms are, even on a genetic level, which are giving many people new hope and new choices.
Also, type 2 diabetes, high blood pressure, and elevated cholesterol levels may be reversed by making these same lifestyle changes. More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to health insurer UnitedHealth Group Inc. The ravages of diabetes - heart disease, blindness, amputations, impotence, kidney damage - are completely preventable for most people by changing diet and lifestyle.
In 2006, according to the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion.
Despite these costs, many people are surprised to learn that randomized controlled trials found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., the vast majority of those who receive them). Coronary bypass surgery also does not prolong life.
In other words, Americans spent more than $100 billion in 2006 for these two procedures that are dangerous, invasive, expensive and largely ineffective, most of which could be avoided by making comprehensive lifestyle changes instead. The major benefit of angioplasty and bypass surgery is to reduce angina (chest pain), but similar or greater reductions in angina occur in only a few weeks by making comprehensive lifestyle changes.
My colleagues and I conducted demonstration projects at hospitals throughout the country to determine if comprehensive lifestyle changes could be a safe and effective alternative to bypass surgery or angioplasty in those who were eligible to receive it.
After one year, almost 80% of people were able to safely avoid heart surgery or angioplasty, and Mutual of Omaha calculated saving almost $30,000 per patient in the first year. In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health care costs by 50% after only one year and by an additional 20-30% in year two and year three when compared to a matched control group.
The idea that changing lifestyle is difficult if not impossible, but taking a pill is easy, is not what the data show. Two-thirds of people prescribed cholesterol-lowering drugs are not taking them just a year later, whereas adherence to lifestyle changes was 85-90% after one year.
Why? Because cholesterol-lowering drugs don’t make you feel better, but lifestyle changes do. What is sustainable are joy, pleasure, and freedom, not risk factor reduction. Most people who have heart disease become free of chest pain after just a few weeks when they make comprehensive lifestyle changes.
When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. The latest studies have shown that your brain may grow so many new neurons that it may get measurably bigger in only a few months - this was thought to be impossible only a few years ago. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent - the same way that drugs like Viagra work.
For many people, these are choices worth making - not just to live longer, but also to live better.