In The Whole Heart Solution, America’s Holistic Heart Doc Joel K. Kahn, MD, reveals more than 75 simple, low-cost things you can do right away—from drinking your veggies to opening your windows to walking barefoot—to make yourself heart attack proof.
Cardiovascular disease (CV) is the number one killer in the Western world. But it doesn’t need to be. The truth is that more than 75 percent of cases of heart attacks, strokes, and other cardiovascular disease events are preventable. In The Whole Heart Solution, America’s Holistic Heart Doc Joel K. Kahn, MD, reveals more than 75 simple, low-cost things you can do right away—from drinking your veggies to opening your windows to walking barefoot—to make yourself heart attack proof.Interactive transcript
When you get listed with the radical speakers of medicine because you think that food is important in health and it’s an interesting comment amongst my peers in medical schools and hospital administrators and practitioners. They’re all wonderful and good-hearted people, but it’s still a battle to talk about the fact that maybe, maybe our diet, our lifestyle, our fitness is linked to the development of disease and if you play the record forward, why can’t you play the record back? Why isn’t it possible to actually reverse disease once it’s identified by educating, setting up programs, immersing people, and leading them to understand the critical importance?
I’m going to talk predominantly about food and its link to cardiology and cardiac disease, but it certainly goes for active lifestyles, managing stress, optimal sleep, and we’ll talk about some that. But as I say, the saddest comment is that I’m here at all because it should be so ingrained. It’s interesting. I’m going to go off on a tangent for a minute, but I also have a lecture next week in Tucson where I have to debate a cardiologist who believes we need to add more butter and cheese to our diet. I don’t make that up. That’s what he said in the New York Times three weeks ago. That’s what he says in the new documentary. So I’ve had to dive deep into the literature.
And two things happened right after World War II and I’ll show you this. One was, it started to be recognized that there were a lot of heart attacks in the United States. It wasn’t really much of a medical problem before. I believe there were a few, but I believe it really did increase. And the second was that – I’ll show you the data in a minute – but during World War II, you might think that European countries would have a rise in heart attacks. It’s a pretty stressful thing to be living through the Nazi regime and stress is a component. Well, there actually was a drop in heart attacks during World War II and several smart observers noticed this in the late ‘40s and started to question why – and one question became could it be the change in diet during those four or five terrible years. But anyways, the reason I even bring that up because I will go over a little bit of that is we’ve certainly had an inkling for 65 years that there’s a critical role between what we eat and what diseases we do or don’t develop and yet, in 2016, at this wonderful gathering and conference, it’s still a cutting edge talk to present you the data that I’m going to present to you. So, I hope this talk is indeed in next year or the year after because there’s greater recognition, but I just don’t see that coming fast enough. Friends of mine in other institutions, Houston, California, and other places send me pictures all the time of horrible hospital food. And what do we do about it? I mean, some of them are employees of the system where they are at risk for speaking out and risk for activism because it’s such a slow system.
So 65 years later, I hope we’re nearing the age of enlightenment where some of this stuff doesn’t need to be gone over in such detail. But let’s dive in. Number one killer in America, men and women, projected that by now, heart disease wouldn’t be the number one killer in America. Projected by now that cancer would overcome it, but it’s like a race, a horse race, and heart disease keeps staying just ahead of cancer because it’s not dropping anymore. Heart disease was dropping in the last 25 years. It’s plateauing. It may even be creeping up a bit. And I think some of that is the negative confusion and information which is what I’m going to speak about more next week, but I’d be happy to take any questions on that that’s coming on confusing the public and we’re kind of going backwards in a consistent message about healthy eating and reducing saturated fat and reducing butter. We’ve got the public confused and I don’t know if that’s translating into why heart disease is still number one. I hate to believe that because we’d have to pin this message on 10 or 20 people. And they’re probably accounting for certain people’s deaths and all which is a rather awful burden to bear. But that’s speculation. I don’t know that.
So, heart disease. Many medical problems that can be presented, challenges whether personally, everybody in the room should be concerned. One in three people in the United States will develop such severe heart disease they may die of it. So either the person to your right, person to your left, or yourself, don’t look. If you’re at the end of the row, it’s a good place I guess. Maybe to me that makes odds worse. But it’s really a big deal. I mean, this is a huge cost both from economic standpoint, but from disrupting lives and families. I have so many connections now. I wrote a book called Dead Execs Don’t Get Bonuses. Crazy title because I had given a lecture to executives and they wanted to be provoked for a short lecture. But because of that, people e-mail me all the time. “I only wish my husband or my spouse or whatever had read your book and known about strategies to detect heart disease early,” which I’ll you show some of. So, I’m very acutely aware of the pain and suffering of young kids that no longer have a parent because of heart disease. And this is as I mentioned, the pointer doesn’t show up well on the screen, but you can get the point that somewhere around the ‘40s and ‘50s, people started commenting that we’re admitting people, we’re doing autopsies on people, we’re caring for people with heart attacks and other forms of clogged artery disease that we just didn’t see before. And then it appeared that it peaked and it’s come down a bit for a variety of reasons. Some are education to the public and health issues. Some are coronary care units and advances in medication and treatment, but this remains as you could see, deaths in the United States, hundreds and hundreds and hundreds of thousands throughout.
I live in Detroit. We have the University of Michigan stadium, the big house, the biggest in America. We put about 107,000 people in it every Saturday when there’s a game in Ann Arbor. And I think about the fact that you can fill that stadium 7 times and everybody is dead and that’s how many people die of a heart attack and heart disease in the United States every year. It’s such a phenomenal idea that you put your hands around because these are all real people with real issues and such. So, the enemy is a couple pathological pictures here, but we have this wonderful system, 50,000 miles of arteries through our body. Some are large like the aorta in our chest and abdomen. Some are smaller with many generations down to our fingertips and beyond until they become capillaries and then they change in the veins. They are dynamic. There’s a lining called your endothelium which you want to keep very healthy through healthy eating and lifestyle and avoiding smoking. And there’s clear data that high saturated fat diets damage your endothelium, processed foods damage your lining of your arteries called your endothelium. As endothelium, if you’re going to rip it all out – because nobody thinks about this – it would cover eight tennis courts. So you got 50,000 miles of arteries, but eight tennis courts of this special wallpaper lining that if it’s in good shape, it makes nitric oxide. I was also the group calling it nitrous oxide. I thought it would make you laugh, but it’s nitric oxide. It’s an incredible gas that your body will make when you take good care of it, avoid toxins, eat well, sleep well, don’t smoke, watch air quality.
But you can see here the consequence of pathology. It could be genetics. There are people that have genetically high cholesterol, maybe we used to say 1 in 500, looks like it’s more like 1 in 250 lately, but that means 249 out of 250 people don’t have a clear cut genetic cause for arteries to get progressively clogged. It was actually in 1913, a little history. A Russian researcher named Anichkov looked at this for the first time as coronary artery disease and clogged arteries becoming more frequent. And he looked in there and he said, “It’s cholesterol. It looks a lot like butter. It looks a lot like margarine, but it’s cholesterol,” and that observation in 1913 was followed by some experiments where he took rabbits, fed them high saturated fat diets like butter and the rabbits created these plaques. So we’ve known again for more than 100 years that diet some of you may accept that, some you may challenge it, but certain diets raise your cholesterol/high cholesterol in the blood. We know this for sure from the genetic diseases. If you are born with a genetic disorder where your cholesterol is 400, 500, or 600, you may have a heart attack at age 10 and I’ve cared for people like that who were just genetically disadvantaged, but most of us don’t have a cholesterol of 400, 500, or 600. But 300 is worse than 150 because Anichkov taught us in 1913 that the constituency of these arteries is cholesterol when they get clogged up and other components. There is no sugar in these arteries, and sugar excess in the United States is a problem. It clearly leads to diseases and augments obesity and all. But it is not the pathologic substance and that sometimes gets confused on the current controversy that might show up on the cover of Time Magazine and such aghast medical journals. Another one that actually looks predominantly like egg yolk or butter or cheese, but it’s a severely clogged artery looking a bit like a tree with rings of age as it progressively gets narrowed down and of course, at that point, somebody may feel bad and be at risk for that suddenly clotting off causing a heart attack or death. Well, the general feeling was until a few very brave souls questioned this that from birth, we have clean arteries, 50,000 wonderful miles of pathways to deliver oxygen and nutrients to tissues. But sadly, it is known particularly if you’re down in the Louisiana, Mississippi, Alabama areas, and you take children aged 10, 11, 12 and you run a little ultrasound on their neck as the typical way, you can actually start to see clear cut changes of atherosclerosis – hardening of the arteries even in young teenagers. We know by the time you’re about 20, if you’re a soldier in the Korean War, if you’re a soldier in the Vietnam War and you die of trauma and there’s an autopsy, you probably got what might be called fatty streaks or other forms of atherosclerosis clearly formed. And then by middle age, it progressively narrowed and then hopefully not, but the chance that an artery would be severely narrowed causing heart attack, stroke, loss of leg, and such.
And the idea was if you look at the arrows is that it only went in one direction that it was inevitable, that it was to some degree aging. After we learn that it wasn’t just aging and that was in the ‘50s and the ‘60s with things called risk factors. We realized it wasn’t just aging. Did you smoke or not smoke was a factor. That wasn’t clearly understood for heart disease until the ‘50s and ‘60s. The way you ate which is still the controversy going on was a risk factor whether you had a diagnosis of diabetes, high blood pressure and plenty of relatives at a very young age. So the arrow always went towards worse and worse, and that was the accepted convention except for a few people, a few brave souls that are usually not discussed in their standard medical world, but need to be celebrated and need to be taught because of the huge potential that we can go up the scale, not just down the scale with this very serious condition that can rob us of our energy, rob us of our sexual ability, rob us of our ability to enjoy life and actually take our very life. So this was one of the pieces of information I mentioned in the introduction, but this is from the country in Norway and if you see the years on the bottom, on the X axis that there was a consistent rate of dying from circulatory diseases. largely heart attacks through the ‘20s and the ‘30s until about 1940. And that was very carefully documented. One of the problems with studying countries is, are their death records accurate? Is there even a death record system? The country of Mexico didn’t have much of a system like that until the 1970s, but Norway did and there was this tremendous drop in deaths due to cardiovascular disease – sort of the opposite, the oxymoron, of what might be expected due to the stress. And then it rose and returned to normal and as certain bright observers looked at this, they said people who were smoking, people who were living in about the same area, but one of the first things that the Nazi regime did is they took animals out of the communities, took them back to Germany for the soldiers and left people to forage in the forest and eat off of whatever they had in their garden or in their backyard. And it was well documented that animal food consumption went down significantly in countries like Norway. The northern European countries Finland, Norway, Sweden, tend to eat more animal products and higher saturated fat diet than southern Europe, Italy, and such and it may be the growing season, maybe just tradition and culture. So when you take animals out of Norway, you’re left with a whole new diet plan which subsists on roots and vegetables and seeds and legumes and such. So, people looked at this when it became available and started to question whether this could be a therapy. There’s this kind of a funny slide from 1939, you’ll see there’s clearly the wrong, Morrison. And I didn’t make the slide. I thought it was kind of fun that they put that in there. Somebody has a sense of humor. But, I’m going to go through it just real quickly because these are the radicals that challenged the system to say what should be so obvious – that the way we eat can contribute to disease and controlling the way we eat might be a pathway to resolving disease and we’re going to go deep on a couple of these. But Walter Kempner, if you ever have the time and you’re interested and you want to read some of the most bizarre medical stuff in your career, you want to read about Walter Kempner who was a German Jew that escaped Germany just before World War II, was taken in. He was already quite a renowned researcher. He was taken in to Duke and established a lab doing research. And during that research, identified the hypothesis. He didn’t know about this Norway graph yet because he started this actually during the time period of World War II.
“I eliminate.” I’m speaking as Walter Kempner. I guess it would be if I eliminate. He has a very heavy accent when you watch anything from him. If I eliminate fat from the diet of patients – at the time there was no medical treatment of high blood pressure. There was no medical treatment of kidney failure. There was essentially no medical treatment of diabetes except for insulin when it was available. If I eliminate fat from the diet, I believe I can reverse some of these diseases. He set up a clinic at Duke called the Rice Diet Clinic. Some of you may have heard of it - celebrities, Elizabeth Taylor, Buddy Hackett - because it went on for decades. But he was a very careful researcher and he documented and he published in peer reviewed medical journals. So this was not some guy that didn’t have a system of recording. These dramatic cases of children swollen with edema from kidney failure that three months, six months, nine months later were essentially brand new. People with diabetic eye disease. It was robbing them with their eyesight. That by eliminating fat from their diet, documented by photographs. Even people with very abnormal electrocardiograms at the time that cardiology was early and crude in its conception, but that you could see improvements in electrocardiogram. What he fed them was crazy. He fed them white rice, sugar, and fruit, very little vegetable. And he believed that that radical diet was a very difficult diet to keep them on. The original program was pretty much a locked building at Duke, ultimately became a little bit more resort-like. It was very famous for being very stern and very difficult with his patients. Occasionally said to beat his patients if he ever saw them eating anything outside the norm. He’d threw a few scraps of chicken on once in a while, but the day that came out of his work and it caught people’s attention for whatever his personality quirks. And this went on for decades. And there’s many books written about him. He has sort of dropped off the map as one of the fathers of diet, you can say diet heart hypothesis, diet diabetes hypothesis. But his work was known and then his work about Norway was known and then a physician in Los Angeles, again, somebody who sort of dropped off the map, Lester, Morrison, an internist, had a large practice of heart disease patients. Again, in the 1940s, heart attacks started coming on. Executives. It was largely a male disease. You know, the big meal, the stress, the smoking which was prevalent. I’m sure there were women having heart attacks in the 1940s, but probably at a young age, it was largely men. And he designed a diet – I’m going to show you a little more data in a minute, it wasn’t Jim Morrison – and asked the question, “If I modify the diet of my patients with severe heart disease, could I improve their outcome?” At the time, essentially no clinician in the country was doing that.
I’ll move just quickly to mention Roy Swank. if you’ve ever heard of a Swank Diet, but he was the Chief of Neurology in Portland, Oregon. An academic neurologist who studying a variety of sources, again, asked the question, “If I drop animal fat…” It’s well known again that multiple sclerosis is more common in northern countries. Some people think it’s the diet, the sun, the vitamin D. He hypothesized a comment I made a few minutes ago. There’s a lot more animal products in animal fat, saturated fat, typically eaten in northern countries, in Europe and even true on North American continent. And he designed a diet. And he followed people for 50 years with multiple sclerosis, carefully documenting and publishing improvements and stabilization of multiple sclerosis. There is still much to be read if you have friends, colleagues, or know of anybody with multiple with multiple sclerosis. They should clearly read about the Swank diet. The main criticism of his work is he was studying multiple sclerosis before there were MRIs of the brain and that is now the gold standard of assessing improvement or not or worsening. Very recently, Dr. John McDougall in California published a small study where he showed stabilization of MRI. He couldn’t show improvement. Clinically, they did improve. So it’s still up in the air. 1960, they have Ancel Keys there. Some of you know that name, some don’t. I could talk to you about him for 10 hours. I’m a big fan. But he was born in 1904 in California, I end up getting a PhD at Scripts in Marine Biology. Went to Cambridge, got a second Ph.D. in Human Physiology. Quite an accomplished researcher. In the late ‘30s, he was recruited to Harvard Medical School, not a bad place. He was actually at age 18. They just introduced IQ test in the state of California. He ranked #1 in all 18-year-olds in the IQ, not a bad accomplishment. But he quickly returned to his hometown in Minneapolis and started studying a variety of human conditions. First, actually starvation because World War II was just embarking and the US government used his data for re-feeding populations when they liberated countries in Europe. Ended up publishing like a 1300-page book on starvation that is still considered the database for almost all knowledge. If you’ve heard of K-rations during World War II. He developed that little packet, I think was 3500 calories. I’m fine, but if somebody wants to bring me water, that would be great. And then Dr. Keys noticed the same phenomenon on what happened in Norway. And he got very interested in this idea that diet in heart disease–
He was a Ph.D. twice. And he designed a study in Minneapolis of executives and showed that the higher your cholesterol in Minneapolis, the more likely you are to have a heart attack and then he hypothesized to the world that he thought there was this connection and he took a lot of heat. And then he designed what they’re saying call the “7 Country Studies”. It was a phenomenal first time in the world study of very different populations – Italy, Finland, Crete, Japan. Does what you eat make a difference in your risk of heart disease? Actually, those studies are still ongoing. They just published last year, a 50-year follow-up of the 7-Country Studies. Almost everybody is dead.
Let me just move on, Nathan Pritikin. You may know the name. Another just radical thinker because that is what the theme of this conference is. Think outside the box. Nathan Pritikin never graduated college, living in L.A., multiple patents. He was working for the government on radar and other things and he heard about Lester Morrison or Jim Morrison whichever you like a few shots over. And he heard that he was using diet to treat heart disease. He was curious about it. There was heart disease in his family. He was about 40 years old and he went to Dr. Morrison, and he said, “Can you check my cholesterol?” At the time, cholesterol was just starting to be checked and his cholesterol was over 300. Nathan Pritikin. He was famous for eating hotdogs, ice cream, butter, good American diet of the 1950s. And then he went on a treadmill test and realized by the report of Dr. Morrison, “you just flunked your stress test. You’re in your early 40s. You must have very bad heart disease from your very bad diet,” and he dived into the literature which was his style, reading everything he could and came up with a program of eating essentially plant-based vegetarian, low-oil, walking every day. And very quickly, he was able to demonstrate that he had reversed his abnormal stress test. His cholesterol fell down. This is years before we had drugs and managed cholesterol. And he ended up in 1976 opening a center in Santa Monica to reverse disease. Wrote a book that sold millions of copies and became quite a well-known hero that many people relied on. I won’t go into George McGovern, but he tried to get the American government in 1977 to say that meat was bad for you, but the meat and dairy lobbies beat him down and he never got elected to another public position again after that. So you have to be careful where you speak and who’s listening and where the money is.
So, early stuff. This is Lester Morrison. He’s a little busy, but it’s so interesting because the cardiology world is totally unaware of this early pioneer. Reduction in the rate of death in coronary disease by a low cholesterol, low fat diet: 100 cases of people who had a heart attack either were put on a low fat, low cholesterol diet or told just do whatever you want to do. After three years, their weight went down more if they were on this low cholesterol, low fat diet. Their cholesterol fell from 300 to 220 on this low fat, low cholesterol diet. Again, people will say dietary cholesterol doesn’t matter. You’ll hear that all day long in the blogger world. Well, I don’t think Dr. Brian Clement would agree with that on the panel we’ll have later today, and Dr. Morrison disproved that 65 years ago. And patients felt good and their clinical status improved. What did he tell them not to eat? Creamy soups, liver, brain, kidney, pork, fatty meat, fatty fish, fatty roe, whole milk, whole cream, whole cheddar, egg yolk, kind of the sweets of the baked goods, waffles, cakes, muffins. He was so ahead of his time. Egg yolks, pies, frozen creams, concentrated fats. He wasn’t much of a fan of olive oil. But it was the whole gamut. You can’t pick out the one thing here that may have helped these patients one or the other. Interestingly, if you look at the last line – olive, nuts, and avocados – and some people ask why does some of the future researchers – I’ll tell you about in a minute – avoid olive, nuts, and avocados. It pretty much goes back to Dr. Morrison. He just wanted to get as much animal and to some degree, plant-based, tropical oil-based saturated fat out of the diet. These are the stunning results he published. Again, he basically lost. We are always excited about the new data, we forget about the old data, but if you look at 12-year survival, the low fat group in red and the control group in blue. I mean 50% were still alive in the low fat group. It’s for a disease at the time that basically had no treatment. It’s pretty remarkable. So, Lester Morrison forgotten, he lived until the ‘60s. He has written a few books. I’ve got one of them in my bag. I like to read because he is kind of new on my radar map, but we’ll give him a shout-out.
Then just a little bit on what might happen in the Pritikin program and I’ll tell you why I bring it up. But he would typically invite people with obesity, blood pressure, blood sugar, cholesterol, or heart disease problems to eat a nearly plant-based diet. Actually, there still is a Pritikin program in South Beach Florida as well as now around the United States. I’ll mention that in a minute. It was a very low-fat diet. Very big numbers over the years. He opened this in 1976. He was very careful in accumulating the data. In just three weeks, cholesterol would fall by 25%, triglycerides would fall, and body weight would fall, blood sugar, blood pressure. He ended up accumulating enough data, just to bring it up the date so you’re aware of this – that in 2010, the Pritikin program had so much data on heart patients who’d been through the Pritikin program and then were tracked in terms of outcome. And it was demonstrated that if a person with heart disease went through this Pritikin three-week program, the cost of their future heart care, hospitalization, maybe bypass, maybe heart attack, maybe stent, medications was far less than the control group that didn’t attend the Pritikin program, that Medicare approved the Pritikin program as one of the two programs in the United States for heart disease management and reversal that exists. I’ll tell you about the other one in a minute.
But to this day, there are dozens of programs. You don’t have to go to just South Beach Florida. We just got our first program of this type opened in Michigan in Ann Arbor, a Pritikin Cardiac Rehab Program. It takes a dedicated team and physician and dietitian, maybe psychologists to really educate a group of people on this. Even though it was in the ‘50s when Nathan Pritikin started this journey, 60 years later, it’s a very viable and alive program. It’s not completely plant-based. They allow a few meals a week. There may be skinless chicken and fish. A new book came out recently. It is veganish and it’s very close. So, back to the fact that these are pressing matters because we still are dealing with so many and these are some ancient figures I showed you, but what can we do with all these people? It isn’t just another medicine, another procedure, or another fatality. So we learned an important lesson even though we have these clues from the ‘40s, ‘50s, and ‘60s that lifestyle matters. But in 1993 and again in 2000, a group of researchers asked the question, although the United States government lists heart disease as the number cause of death in America. That’s just kind of a cubbyhole to put people in what really causes heart disease.
And as you can see on the left, you’re right, is that if you go to actual kind of lifestyle changes, three things account for almost all cases of death in the United States and certainly death from heart disease. Smoking, poor diet usually defined as a lower absent amount of fruits, vegetables, and whole grains and a sedentary, physically inactive lifestyle. That these are all remediable and modifiable and programs can be developed and education can be made to get people to work on those three activities and potentially have a huge impact on the rates of death from both heart disease, cancer, diabetes, and all.
So, a fundamental work about how important lifestyle is generally in heart disease, the feeling is as of now maybe 20% is genetic that we can attribute to genetically inherited cholesterol disorders, clotting disorders, predisposition for blood pressure and such, but 80% is whether you smoke or not, whether you use your fork wisely or not, or whether you are physically active, we now include standing and fidgeting amongst physical activity because it’s an amazing day that British women, they fidget while they sit and I encourage many people watching to fidget right now. Fidget politely. Don’t fidget and annoy the person next to you, but fidgeting actually reduce mortality in British women that answered a poll 20 years ago, that “I fidget a lot”. So pretty amazing that that idea of moving your leg or getting up or having ants in your pants might actually keep your life significantly longer.
So this theme to keep going is that indeed we’ve got this major problem and we have the opportunity to combine the advances in medical technology and it has been a wonderful run. I’m a guy that’s put many, many stents in patients’ arteries, but to not educate those patients about the power of food and lifestyle and certainly for the rest of the public hopefully, so that they don’t need to end up on somebody’s emergency room or cath lab table. Critically important.
So I just like to point out as it served a wake-up call and I know we’re probably preaching to the choir of very educated, health conscious people. But just how bad processed food can be, not 20 years from now, but how bad processed food. This 70-year-development we’ve had of eating in bags, eating in boxes, eating in vending machines, eating in restaurants where you have really no control over food quality in general. And so there’s a classic study done by a cardiologist, Dr. Robert Vogel. I had the pleasure training with him long ago when he was in Ann Arbor, but he did this study when he was at the University of Maryland. And it’s so interesting and classic. It’s always worth pointing out. So these were healthy volunteers that came to the University of Maryland two times. One time, they came and they were fed a low-fat breakfast. It was oatmeal made without full fat milk and they were watched for seven hours and the measurement which is what it says in small letters, “endothelial function” - that amazing 18 tennis court wallpaper that’s inside your arteries which basically are your arteries acting normally and healthy or not.
That when you eat a low fat meal for breakfast in healthy volunteers and you measure every hour for seven hours how your artery function is, there is no deterioration or impact of a low fat meal. Now, you might ask why low fat? It’s already been determined that sugar doesn’t affect this. You can drink a big glass. I’m not advocating the people to go out there and start drinking big glasses of orange juice or eating lots of sugar, but sugar was tested and it didn’t drop those functions. So they looked at the impact of fat. But the red line was the same volunteers coming back another day and they were handed a McDonald’s Egg McMuffin just out of the yellow bag right out of the drive-in window down the road from the University of Maryland and really within less than an hour, you could determine that endothelial function, artery function, the ability of an artery to dilate and do what arteries should do which is provide an easy access of blood throughout the whole body started to drop and then by four hours, had dropped seriously below baseline and took a full six hours to come back to normal. So processed food isn’t just a slow and a concern for health a few years down the road. I got to get the kids to soccer so I eat fast food and that’s all we can do and a few years from now, when they’re in college, I’ll clean out my lifestyle. It’s affecting you right away, right now, every meal. Recently, I’ve learned from a dietitian a little thought process once you see this is, think about what your body is going through two hours after the meal you are about to eat. Be a little mindful about that and when you look at a meal like this and you’re aware that within two hours, it’s going to have a very negative impact on your health, it might motivate you to make better choices. So, very impactful data. It’s been repeated many times. If you add in hash browns, it’s just a longer, deeper drop in artery function. And it’s not just the University of Maryland, it has been shown over and over. It probably represents because they have looked at how this happens that the sausage patty, the burger at most fast food places, they hopefully don’t have living bacteria in them, but they’re such poor quality meat sources, there are many, many dead bacteria. And the walls of dead bacteria have a chemical or molecule called lipopolysaccharide or endotoxin. So very soon after chewing, swallowing and the entry of these food parts into your small intestine, this molecule can get into your bloodstream and start affecting your arteries. So quality, quality, quality. You’re eating a dead bacteria when you’re supporting these fast food places.Rather scary.
On the other end of the spectrum as what’s the award for the healthiest heart diet year after year after year and although US news and world report isn’t necessarily the be all and end all, they get a lot of attention and they do have panel experts to look at this. And we’ll talk now about Dr. Ornish and the Ornish diet. A real radical thinker in the 1970s who’s still just a young man of 63, but it says dieters are sure to do their heart a favor on the Ornish diet according to experts and if they use a rigorous version of the plan, that could actually reverse heart disease. So, pretty crazy statement most would say. If you took a poll of most cardiologists, they would not be aware of the possibility to reverse heart disease. It’s ironic they gave it a number one ranking year after year, but the picture doesn’t really match the diet if you take a look at it for a minute. So they almost got it, right? So Dr. Ornish’s story was he is from Dallas and was an undergrad in Houston and his parents, for reasons I don’t know, started inviting a world famous yogi into the house when he was travelling to the United States, Sachidananda. Some of you may know that name. He has passed on but wrote many books and was quite world famous. And young Dean Ornish got the idea that mind, body, spirit – your body treating you well had something to do with health.
The Ornish Food Pyramid: A Food Pyramid That Was Vegetables, Fruits, Beans, Legumes, Whole Grains, Non-Fat Products Like Cereals, Pretty Much A Mediterranean Diet Without The Olive Oil And Without The Salmon
And he went on to Harvard Medical School and other training and would periodically take a year off and do some interesting studies. And based on his experience with Sachidananda, he created a food pyramid that was vegetables, fruits, beans, legumes, whole grains, non-fat products like cereals, pretty much a Mediterranean diet without the olive oil and without the salmon. you might say. And went to test that if you look at what was excluded, it was a lot like Lester Morrison’s study and to answer critics that those crazy people never focused on sugar, they only focused on fat and they missed the boat. All these diets were naturally low in sugar and were encouraged not to have any added syrups and added sugars. You are allowed to eat a piece of fruit for God sakes.
So, in the 1970s when he was a medical student, took a year off and studied some patients with very severe CADs (coronary artery disease), he locked them in a nice hotel. He got some funding from a local resident and showed that by feeding them this diet and that was really the only intervention, that they were able to walk much further within just 30 days on a treadmill. These were serious heart patients. The number of chest pain episodes they were having dropped significantly and even was able to arrange pre and post stress tests on these people and their ability to perform and demonstrate better blood flow. This is radical, crazy, insane stuff in the 1970s. This is actually just at the time that balloon angioplasty was coming on board. Very, very few people were aware of the data, but he was already publishing with good people. Dr. Ornish was unknown, but Anthony Gatto, the second author is a very, very well-known researcher worldwide. And then due to some criticisms of that experience which maybe this was all placebo. You lock people in hotel, you’re giving them food. You’re giving them attention. You’re drawing their blood. They must be loving all this research experience, maybe this is placebo. What about a control group? He had to step up the game a bit and had to get significantly more funding out of some financers. The Enron Corporation was one of the biggest donors. So although they are not always loved for everything that they did of course, they were able to be charitable towards this research project and he designed a studywhere he looked at this in a randomized way. Some patients who got his program and by this point, he had extended it to include a mind-body component where there was stress management. Patients were taught meditation. Patients were asked to walk. Of course, they were all asked to not smoke. I know the names on this list don’t mean much to you but again, Dr. Ornish was able to gather some of the most prominent researchers in the country as his co-authors, so this was accepted into the finest of journals and should have been a real tidal wave through the world in terms of its impact. So, he looked at this first one year and then 5-year randomized control trial of very, very severely diseased heart patients who were asked either go through his Ornish intensive lifestyle program of largely plant-based, no added oil, whole food, no added sugar diets. Or allowed to just follow along with whatever their cardiologists recommended. In terms of the numbers, LDL cholesterol in the control group in one year was 157, but had fallen again. It’s very common nowadays amongst naysayers that diet does not impact your blood cholesterol, but in this group, blood cholesterol fell 60 points in one year by changing your diet. More radical were words that say progression or regression because what Dr. Ornish built into the study was all these people had a heart catheterization, analyze very sophisticated measures via computer and they agreed to have that done again at one year and five years even if they didn’t need it. That was part of the study. So regression means in the experimental group, if you eat, if you manage stress, if you walk, and you meet with Dr. Ornish for a year, 82% of the time, your artery showed less blockage. First time that arrow started to go the opposite direction. We knew from Lester Morrison, it seemed to have an impact in terms of death and that’s a pretty good marker. Dr. Morrison didn’t have the catheterization data. From Walter Kempner, we had some experience with people’s electrocardiograms and other things improving. But this was by far the first time that what cardiologists consider the gold standard. Are your arteries getting more blocked with time which almost always happened? Your arteries gained less block with time. It was demonstrated 82% showed improvement. That triangle is a change in narrowing, change in stenosis. On average, at the end of the year, arteries were two percent less blocked on the Ornish program and three percent more blocked. And all those don’t sound like stunning numbers, my 60% blockage is now 58%. But arteries are 4r2 pipes, so just a small change in the radius can be a big change in the amount of area that blood can go through and it instantly translated it into a major improvement in the way these people were feeling. Dr. Ornish went on to publish the five-year followup data. Everybody had this repeat catheterization and assessment. And this remains again, one of the most stunning figures in cardiology history and treatment, but it’s largely ignored. So let me go through it. It says in the bottom, baseline one year and five years. That’s when these catheterizations, measured via computer, totally objective, wasn’t somebody who might have some bias might say the numbers were better or worse. And on the Y axis is the amount of narrowing. At the beginning of the study, both these groups were 41% blocked than average. So, there’s all these measurements they are making that was average. The group in black circles were the group that was told just follow with your own cardiologist. So what happens, at least in the 1980s when you’re seeing a cardiologist getting very good care in San Francisco area and other areas, you get worse. And I would truly offer you the chance and it’s almost certainly the same thing today that standard cardiology care, arteries tend to get worse with time.
So it went from 41% to 42% to 52% block. And the remarkable and amazing finding was it got better with the Ornish Heart Disease Reversal Program using both food and stress management and love and group support and walking, so that the arteries were less blocked at the end of five years. A more impressive nature perhaps to insurance and regulators was the fact, I just want you to look at the last line that says, “Any events 25 and 45.” This was at the end of five years. Forty-five of the people in the control group, 45%, had gone on to have death, a heart attack, a bypass, a balloon angioplasty. Twenty-five in the Ornish experimental group. That’s dropping it by about 40% to 50%. That caught the eye of insurance people who said, “If this is a therapy that drops the need for...” Death is not expensive. Death is a non-event for an insurance company, but hospitalization, bypass, and angioplasty are expensive events that perhaps this is a kind of therapy that should be reimbursed. It actually took from 1998 until 2010, but this was the announcement by our government, Medicare, CMS (the M is for Medicare) that both the Ornish program and the Pritikin program had showed you would now be covered for Medicare patients with heart disease who are looking to stabilize and reverse their heart disease. These are the only two programs. And I’m not really knocking anything. There is no Paleo approved program. There’s no Mediterranean diet approved program. Both these programs are either 98% to 99% plant-based, no added oil, 10% of calories from fat. They’re kind of counter-cultural to the covers of Time Magazine and the rest that we see nowadays, but they are the only programs because the data was so large that the things we care about – not ending up in an emergency room, not having expensive and maybe disfiguring procedures. And certainly an inkling that actual survival was improved. So usually, these are programs that are at hospitals that have had an interest. There’s about 50 Pritikin programs and about 50 Ornish programs around the country, could be at a hospital in your community. Usually it’s called intensive cardiac rehab and they’re really a wonderful way for people with heart disease to add to their standard therapy and get an opportunity to learn and then implement actual strategies in a sort of I called low-tech high fiber because it’s not very glitzy and fancy compared to a laser or a proton accelerator, but this is the real deal of learning the importance of lifestyle. It’s really the importance of food. We could have learned it in 1913 from Anichkov, could have learned it in 1940s from Morrison, but it took until 2010 and it’s largely ignored. I mean we all know that it’s not sexy. It’s not as profitable as putting in a stent, but it is the real deal. Now, I could go on and on and on about a few of these people, but it’s critically important that we have every opportunity to educate when we can.
Dr. Ornish did continue to do these studies and follow up and has a research institute in Sausalito, California that’s still very active. He is still a young man and very engaged in all this, but he got very interested in prostate cancer with the question, “If I can reverse heart disease with a lifestyle program that emphasizes whole food, plant-based, low-added oil, no added sugar kind of diets with a stress management, can I actually impact cancer?” So he was able to get 93 men who the urologist had said, “You really don’t need radiation or prostatectomy right now.” There are many men that are advised, “We’ll just watch your prostate cancer.” Half of them entered his program like they were heart patients. They were not heart patients. They were prostate cancer patients and half were told, “Just follow up with your urologist.” This stuff was done with, again, he gathered some of the best cancer scientists in the world to be his co-authors. At the end of the year, this blood measurement called the PSA went down if you stop eating dairy and meat and eggs and start eating more fruits, vegetables, grains without added oil. The PSA went up in the group that was being watched which usually is what happened. One of the phenomenal findings was that you can actually make your blood like chemotherapy without chemotherapy. That if you take the blood of somebody eating Dr. Ornish’s lifestyle program, drip it on prostate cancer cells, it is eight times the power of killing prostate cancer cells compared to the control group. That took only three months so you could radically change the ability of your immune system to actually kill prostate cancer cells. And then in a field that we now call epigenetics, one of the most interesting fields in the last dozen years is that if you measure the activity of genes that are involved in controlling cancer, there are certain genes that promote cancer, genes that fight cancer, that within three months of adopting the Ornish diet, there were 48 genes that fight cancer that were shown to turn on simply by changing diet, lifestyle, stress management. And over 450 genes are involved in promoting cancer that turned off that some people call nutrigenomics (the food you eat affecting the activity of your genes) or epigenetics that there’s things even more important than your genetic structure, that your lifestyle can dictate your genes. Your genes load the gun, your lifestyle pulls the trigger is a common statement. And this was done with a woman named Elizabeth Blackburn, Ph.D. at UCSF. She went on to win the Nobel Prize in medicine. So, you just don’t see. There’s no other dietary plan other than this plan where this kind of impact on genetic activity has been shown. So again, I’m open to the idea that there are any healthy-eating styles that may promote good health and I’m aware that in Crete, they eat a high fat, polyunsaturated fat diet and they seem to be healthy. And in Japan, they eat a non-fat diet and they are healthy. But if you want to follow the pattern of science, this is only dietary style that has been shown to affect genetic activity in a positive way certainly for prostate cancer. And for those of us that don’t want to get old too quick, don’t want to get too wrinkled, don’t want to suffer some chronic debilitating diseases, Dr. Ornish went on again with Elizabeth Blackburn, now Nobel Laureate, to look at activities of your telomere, length of your telomere, the tips of your chromosome that may dictate the rate at which your cells are aging. If you have long telomeres, you’re probably doing better than short telomeres. And if you look at the blue bar, patients that were engaged in the Ornish lifestyle program, healthy diet, physical activity, stress management, social support, at the end of five years, they actually have longer telomeres than the baseline. And then in a control group, they were just followed for five years, the natural progression is your telomere, the tips of your chromosomes get shorter. So there’s at least an inkling that one of the best anti-aging programs may not be a $500 vial of cream, may not be some new age therapy. It maybe cucumbers and peppers and radishes, and walking and socialization, and laughter and kind of the essential connectivity that’s part of Dean Ornish’s program. It’s really radical because again, there is not another dietary style that we have this kind of data from such quality people. So that’s why it went on. Let me move forward only out of both respect and fairness, but what if Dr. Ornish was the only one who had ever documented that coronary artery disease is the number one killer in America, number one threat to people in this room right now. I’ll get to that in a minute that people listening, people in the room might assume they don’t have heart disease. I would not assume that, not to be Debbie Downer. Talk to you in a minute about how you know.
But if it was only Dr. Ornish that showed this, there might be some skepticism. It’s California. Everything in California is odd. It’s not translatable to Dakota and Ohio and other places. So in a very interesting story, I’ll just tell us because it is interesting. Dr. Esselstyn is now 83 years old. He is a professor of surgery at the Cleveland Clinic. He is married to a wonderful woman named Ann Crile Esselstyn. Her grandfather started the Cleveland Clinic. So, Esselstyn was a legacy there. He was a surgeon of breast and thyroid disease. And for one year, they were redoing, this is in the early 80s. They were redoing the surgical locker room at the Cleveland Clinic and he got thrown together with another surgeon. He had to put his gym shoes next to another surgeon’s gym shoes and that was Dr. Rene Favaloro because Dr. Esselstyn was an E, Dr. Favaloro was FA and they just did it alphabetically. Well, Dr. Favaloro was the first surgeon in the world to perform bypass surgery in the heart. And they would chat and they would talk and come at the end of the day and compare notes. And they both realized that they really hadn’t done anything to prevent disease. Dr. Favaloro kept doing a great job of operating and moved back to Argentina and kept operating. But Dr. Esselstyn, God bless him, started finding this data about Morrison and Kempner and Pritikin and he was just fascinated. He is a very bright man. And he designed a study at the Cleveland Clinic in the mid-80s unaware of Dr. Ornish. He would just go to a cardiologist. “If you got the worst patients, you can’t bypass them, you can’t stent them. Let my wife and I cook for them. Let us meet with them. Let us try and teach them. We’ll do it with our own money and our own time. We’re just passionate about it.” But, he started to collect data. He didn’t have the Enron Corporation or whatever to fund fancy aspects of the study, but it was real. So again, he paid close attention to this kind of data. And he concluded after studying natural populations that are reported to have very little or no heart disease including Japan and others that they would emphasize whole food, plant-based diets and Dr. Esselstyn is probably the biggest proponent on the scene of avoiding all animal products including all added oils, very low fat diet. The standard American diet is somewhere in the range of 40% calories from fat. Some people eat more than that. Some people advocate more than that. This is more characteristic of what may be called an Okinawan diet which in the ‘40s was the center of probably the longest lived, healthiest people in the world. That’s all changed now. Thanks to KFC and Arby’s and McDonald’s and such. But anyways, the diet that more mimicked natural populations that had essentially no heart disease, there wasn’t meditation. There wasn’t anything else. It was mainly a dietary program. A lot of social support. They would actually go over to Dr. Esselstyn’s house and they would do little cooking sessions. So before patients engaged in this program, they had had 49 events meaning they had gone to emergency room or had a heart attack or had a stent or had a bypass and those that were willing to follow his program with his wife Ann, they actually very quickly stopped having those events. In fact, had none of them. Small study. There wasn’t a control group. There was just this historical fact that they were sick people. I’ve met some of them. There were people that couldn’t walk to the mailbox because of blocked arteries in their legs and leg pain. They are in terrible heart trouble and sexual dysfunction, and they are about as honest as people are about what kind of improvement they had. One of the powerhouses of Dr. Esselstyn’s program is some of these people needed to have heart angiograms before and after and even though it wasn’t built in the program like Dr. Ornish. This is an angiogram in 1996 and an angiogram repeated two and a half, three years later on a segment of heart arteries called the LAD or left anterior descending artery and a previously badly narrowed long segment that really couldn’t be treated with a balloon at the time because of its long nature had completely reversed. Happened to be a general surgeon who was very incapacitated by chest pain and the post image, he had completely resolved, was back to work and very productive. A little less obvious maybe to the untrained eye, but 1987 on a bended artery on your right,, excuse me on your left with an arrow was a narrowed artery called the right coronary artery and five years later, at least from my trained eye, that looks on your right to be essentially normal. We never see this in cardiology. I mean, these pictures had been shown now thousands of times because they are so unusual, so dramatic and it’s not coincidence. When you repeat somebody’s catheterization, it’s either the same or it’s worse. It’s never better like this unless you do something rather radical like recognize the power of food. So again, all that data leads to the idea that this is really not a one-way street. This is a two-way street, thank goodness, that we can go from fatty streaks on to clinically serious lesions, but we can go from clinically serious lesions back up the pathway at least to a point where there’s one documented case of complete reversal disease. I will tell you about that in a second. Otherwise, we don’t really anticipate. We are completely resolving decades of atherosclerosis in five years or one year. But even small changes in narrowings lead to a major improvement of blood flow. People feel better and I mentioned now a few times this magical wallpaper lining of your artery called your endothelium. And you stop bombarding your arteries certainly by smoking with toxins, by animal saturated fat like you’re going to find in cheese, eggs, and butter and meat products and living as clean a life as you can now that we have chemicals everywhere probably add to the conundrum. But if you can keep your endothelium healthy, you can also develop a very resistant artery, 50,000 miles of arteries resistant to strokes and heart attacks even if they have plaque. So you may have some disease left in your arteries but if that wallpaper is like Teflon, if nothing will stick to it. Whoever brought me water, that was amazing water because I have not coughed once since. No, I’m good. I’m good. I’m good. I appreciate it. It’s like miracle water. You should bottle that. Orlando miracle water. We can make some money. I don’t know what the pH is, but it certainly stopped my cough. Thank you very much. Every time I speak, I cough. I did my bar mitzvah at age 13, I cough. I’m not nervous. Don’t know what it is. Somebody help me with that.
Alright. Always fun to have little fun. We have to have a few new heroes and I’m going to tell you we’re going to get off the food topic, but we got this entire compendium, the biggest criticism of everything that is truly a miracle, that you can give a patient a copy of a DVD called Forks Over Knives and they have everything they need to correct their heart disease if they’ll just listen to it and enact it, maybe get a few skills, get themselves a new NutriBullet and a crackpot and a few things. But you know, that is all you need to potentially reverse decades of heart disease, many cases of adult diabetes.
And again, that documentary Unplugged, I have no financial ties. I didn’t make it. Although I do have an article in their website this week about one of my patients who, 30 days, watched that video and we repeated his blood work before and after watching that video and the changes he made, dramatic, amazing improvements in advanced panels of his inflammation, cholesterol and such. Very powerful and great example. But this whole compendium of the ability to take America’s number one killer, the world’s number one killer and tame it and potentially prevent it, and for those that are suffering from it reverse it with very low cost, very accessible lifestyle therapy largely based on food. Food that is now very available – rice and beans, inexpensive. We still don’t have that many heroes. We don’t have that much data. So anytime I get more data, we got to throw it in the mix.
So, many people have heard of Dr. Joel Fuhrman, Eat to Live, and many other books. He has been advocating this sort of food plate – vegetables, beans, fruits, whole grains. But the purple section is where he might be a little different than with Dr. Ornish, Dr. Morrison, Dr. Esselstyn set up their studies long ago, decades ago, in that he felt that seeds and nuts were whole foods, were rich in minerals and polyphenols and forms of fat that were not animal-based and not saturated fat and was advocating that we not shy away from seeds and nuts and if we had him on a panel, he’d have to sit over here and Dr. Ornish. And I don’t think there’s ever been a panel where all of them have sat together. But he put together a program and it all kind of was there. I was aware of it. You may be aware of it. It’s a wonderful program that many people benefited from by watching his PBS shows and reading his books and all. But he published data. And when he publish data, you get accolades because we can now present it in a meeting. So this is late 2015, American Journal of Lifestyle Medicine. If you look at blood pressure, systolic before and after 443 examples, blood pressure dropped by more than 25 points. That is as good as any prescription drug, maybe two prescription drugs, and diastolic blood pressure dropped on average by 15 points, but that wasn’t with drug, but with converting to what Dr. Fuhrman would call a nutritarian approach – heath equals nutrients over calories – looking for foods that are nutrient-dense. It’s a nice way of also describing fruits and vegetables and legumes and whole grains and nuts and seeds. A program that’s largely plant-based. There’s a little room in Dr. Fuhrman’s pyramid for some occasional animal products, a very small percentage of calories. When weight loss was looked at, if you look at, over 30 would be technically a BMI over 30 are called obese that at the end of three years was a 55-pound weight loss in those who were beginning the program at the highest weights. And those that would fit a definition being overweight, BMI of 25 to 30, 310 patients, they lost on average and sustained an average of weight loss to about 14 pounds. As we all know, it’s easy to construct any program to lose weight for 10 days and do the Jello diet. You can do the Slurpee diet, whatever you want. Ten days doesn’t cut it in the world of true health, but three years is a pretty good measure and pretty impressive data. And then again, LDL and cholesterol, triglycerides before and after, no medication, falling from 171 to 128 and triglycerides falling from 205 to 126 and such. He did in his paper publish about 10 case studies of cardiac patients. That seemed very similar, that kind of patients Dr. Ornish and Dr. Esselstyn were studied. People with previous bypass. A lot of disease. Not a lot of options in treatment and documented major improvements in their status. So I think we can add to the world of cardiac disease and cardiac reversal, Dr. Fuhrman’s slight variant on this whole theme of whole food, plant-based, low-added oil, and now recognizing it. He seems to have swayed down – this is really a minutia for anybody who follows it – but Dr. Ornish has added a small amount of nuts to his program as of this year and it’s even rumored Dr. Esselstyn has too. So the whole world is coming together in joy over all this.
Just a quick case study, not of heart disease, but Marc Ramirez is a friend of mine back in Michigan. He is an executive with a phone company, big job, flies all over the country. He was at University of Michigan on Rose Bowl team, Big 10 champ, 1986 in his freshman year with Jim Harbaugh, now our coach at Ann Arbor. Stayed there for years and within about 10 years after that and I think I have a picture, I see, yep. He had a family. He had kids and he had about 80 extra pounds that he didn’t because he wasn’t training five hours a day like he had during his undergraduate years. His big fear came true which was he was a Latino family that was rich in diabetes, adult diabetes. There’s a very high incidence of adult diabetes in Latino populations, very high incidence in all populations. But his mother had acquired the need for dialysis due to diabetes. He had a brother that had a heart attack. His sister lost eyesight due to diabetes and about at age 35 he was diagnosed and was frightened, but when you don’t know anything else, you take your pills and you poke your finger and ultimately, he took his insulin. But it turned out, about five years ago, he was handed by a friend a copy of Forks Over Knives.Again, just happened to be the story and he looked at it with his wife Kim and said, “You know, this is crazy,” and then he found about other programs that are science-based and published, but are available to the public like Dr. Neal Barnard’s Reversing Diabetes program available in books and DVDs and online and they embraced it, and within three months, was off of all medicine and within about 6 to 12 months, had dropped a significant amount of weight. That was just approaching five years ago. I was with him Thursday night on a TV show. And he’s fired up and motivated. He teaches many people as possible. For some, adult diabetes is modifiable; for some it’s reversible. There are ex-diabetics that will no longer suffer from neuropathy and retinopathy and kidney disease, nephropathy and be at risk of premature coronary artery disease and stroke and all the rest. Phenomenal, phenomenal. Realized the power. But is it taught in hospitals? Is it taught in clinics? Is it part of the program? Almost everybody I know in patient examples that have done this have done this on their own and had to bring their internist or their endocrinologist a copy of a book or a DVD or some other information that they got through the alternative health world if you want to speak about this. Although it’s in the peer reviewed literature, it’s just there is not going to be a pharmaceutical rep coming in and presenting the idea that diet and lifestyle will be incredible. If we could develop lifestyle reps that had some financial support to come to offices and bring doctors healthy lunches and educate them about the benefit of the patients. Never thought of that before, but I think that actually could solve the gap, but if there was just some way to tie it in with insurers or hospitals that could actually fund it.
So, in coming to a close of this idea about cardiology and diet and all, some of you may know this or not, but another good friend of mine, Dr. Kim Williams, a cardiologist who was in Detroit for years, now he is in Chicago. He is the head of Department of Medicine in Northwestern. But as you have read, just last year, he was president of the American College of Cardiology, kind of the central group that overlooks many policies and although he couldn’t convert them in a year to acknowledge that plant-based nutrition should be up there with aspirin, statins, and other therapies, he certainly made inroads. He did a ton of interviews and led to this quote, “There’s either vegan cardiologists or those who haven’t read the data.”
I will say, I’m going to change gears in a minute. I didn’t introduce myself formally, but my story in a nutshell, I grew up in a Kosher home in Detroit. It was not plant-based. We made goulash and whatever. But I didn’t eat ham and cheese and cheeseburgers. There always was that one second pause that what I’m about to eat, does it meet what I’ve been taught and raised to eat or does it not. And it was a bit of a mindfulness about it. Went up to Ann Arbor in 1977 as an undergrad, walked in the cafeteria, and it literally took two minutes to become a vegetarian. I looked around and half of me was saying what’s Kosher, what’s Kosher; and the other half was saying this stuff looks horrible and the salad bar at least has a few colors that I can recognize. It’s not great.
And since 1977, I’ve been either partially or 100% plant-based. It’s been 30 years now that I can say vegan. I give kudos to a book by John Robbins called the Diet for a New America I read in the 1980s. I was now a cardiology fellow, 10 years into my cardiology training or medicine training, never heard a word of nutrition like everybody knows. There is still to this day, you can become a board certified cardiologist, there’s not one hour of nutritional training required to become a board certified cardiologist. And that in 1990 which is when I had my first practice out of training, three weeks after I started is when Dr. Dean Ornish published that first paper of prominence. And it hit me like a lightning bolt and I just figured when I have people on the cath lab table, when they’re having a heart attack and I got a needle on their groin, that will be a really good time to talk to them about nutrition because if they started giving me any grief… so it’s been really looking for resources and there’s many more resources now. But they are still largely unknown to the medical community. Meetings of plant-based physicians which is way too few in this country, but it’s getting better. It’s just that the pace is very slow. It was on my introductory slide. I didn’t make a big deal about it, but I got so fired up about all this that about a year ago, my son and I opened the largest plant-based restaurant between New York and L.A. in Detroit called GreenSpace Café. It’s non-GMO. It’s 140-seat. We got a bar. It really looks like a hip warehouse loft in Soho or something and the Detroit community has responded very positively to it. It’s an insane thing to do. I work during the day and I come home from the bar about midnight, but people are so happy and so grateful. The food is very high quality. So, I’m fully committed to this as a path that you see little lights everywhere nowadays, but we need to call a lesson more and more. So I actually put a controversial name on a slide, “What you find at the end of your fork is more powerful is more powerful than anything you’ll find at the bottom of a pill bottle” by the author of Eat Fat, Get Thin, but Dr. Hyman is a friend of mine and has many bright ideas. So I think what I have is about 10 minutes, but I want to go over this because anytime I have an opportunity to talk about some new ideas, maybe new to you, I want to put them in front of you because I think somebody listening today or as this gets replayed, hopefully we can spare them a heart attack by what I’m going to present to you.
So in the 1600s, an English physician known as the English Hippocrates, Thomas Sydenham, very well-known doctor said, a man, “a person is as old as his arteries”. Or I like to be positive. A person is as young as their arteries, but the ability to identify the age of your arteries, which can be tough because they’re internal and none of us sitting here right now probably, unless you’re very mindful, can be aware of what your arteries are doing and what your age is, is a key marker more than ever, more than we ever knew of your overall health. If your arteries are aging prematurely, your whole body is aging. That’s new science in the last year. Old arteries are more likely making kidney disease, dementia, cancer, as well as heart disease. And we lose people. The bottom right is Blake Krikorian. Blake Krikorian made about half a billion dollars in I.T. companies out in L.A. before he hit 50, but about six weeks ago, walking back from surfing in the ocean, he was walking to his car and dropped dead of a massive heart attack. It was in the news. He was well known and his companies are very well known. Obviously, Garry Shandling in the lower left and the man with a nice smile in the right here in the middle left was CEO of McDonald’s, James Cantalupo, and Tim Russert. I mean these are real people that have access to the best medical care yet they drop dead of heart disease. How can that happen? And it’s just more likely to happen for those that maybe don’t have such access. This is Oscar Munoz. Oscar Munoz took over in July as the new CEO of United Airlines last year and within six weeks of starting the job, he suffered a massive heart attack at age 55. The question is, how can somebody in that prominent position? When we talk about Bill Clinton. How did Bill Clinton not know he had four arteries severely blocked? He is the former president in the United States and all the care he got. Munoz’s heart attack was so bad that he ended up having a heart transplant in January.
As you can see, I wrote a blog about it - can we have plants, not transplants? I was hoping that maybe I could reach him and get United Airlines to grab on to some serious lifestyle measures and maybe it will. He’s actually back to work. He is a modern miracle, but what if a 55-year-old man didn’t have to suffer heart attack or knew years before that the problem was brewing. So, we’ve talked about heart disease, diabetes, cancer. I haven’t said these exact statistics, but the current science says they are largely preventable with lifestyle changes. P is preventable. This is what I call my PDR (preventable, detectable, and reversible). How do you prevent heart disease science, if you look at very small print, this studies in about 40,000 in Europe who were asked 25 years ago, “Do you have heart disease and what are your lifestyle habits?” And the answer was, “I don’t have heart disease,” and they filled out what their lifestyle habits where they were followed up 20, 25 years later. Those that remained free of heart attacks answered, “I don’t smoke. I walk. I eat all these fruits and vegetables every day. I sleep many hours at night peacefully and I enjoy a few alcoholic beverages a week.” That one actually consistently goes on the list of preventing a heart attack and extending life whether you want to incorporate that in your life or not, but that’s a guilt-free little part of a heart attack proof lifestyle. Eighty-five percent reduction in heart attacks than those that say, “I do five of five.” Now typically, the number of people that do five of five is like three percent because it’s the fruit and vegetable one that is the least. The United States, there’s like two percent of Americans or less eat more than five servings of fruit and vegetables a day. So, we got a long way to go. But this is what I want to focus on. That was prevention, lifestyle prevention. Detection. How can it be that Winston Churchill overweight, cigar in his hand lives until 90 something, 91? And Jim Fixx, if anybody remembers the Book of Running in the 70s, thin guy, well known, runner, drops dead at age 53 and on autopsy, he had horrible advanced heart disease without symptoms. Now he was known to be a terrible eater. He was famous for saying, “I can eat whatever I want because I run 10-15 miles a day.” But how can these people, how can we do better than just wait for the day. And indeed, there are tools that allow us right now, in fact for for at least the last five years, but certainly in 2016, to be a heart attack prevention specialist. But what I want you to know about whether you’re watching live in the audience or in replay is a CAT scan of a heart called a coronary artery calcium scan.
Coronary artery calcium scan. There is calcium in your bones. There’s never calcium in the heart detectable on an x-ray. The heart is made of blood, fat, and muscle. Calcium is a hard white material on x-ray. It is never in the heart. So you have a panel A on the left, B in the middle, and C on the right. There is now a test that takes less than a minute. You lie down. You roll in a CAT scan. You have no IV. Nothing is injected. You hold your breath and you go home. Whatever your heart rate is, whatever your medicines are, it doesn’t matter. And then in those 20 seconds, you get an image of the heart arteries without having to inject dye. You don’t want to see any white dots over your arteries and you can be (A) a calcium score of zero which predicts and incredibly low risk situation for 5-10 years or more. You can be the middle panel with a few white dots, meaning the arteries have plaque. You didn’t know it, but now you learned it. And you can be the horrible situation on the right where you’re walking around with literally arteries that are 10, 20, 30 years older and be playing tennis and be travelling the world and have no clue, but you’re at an extremely high risk of events happening. Now, the good news is, you can also work on it if you find it because these tests have been around for more than 15 years. They used to be very expensive. In my community, it’s about $100 to have this CAT scan. It’s not insurance covered in Michigan. It is in Texas and a couple other states. Coronary artery calcium scan. How important is it? If you look at the yellow line, that’s 10 to 12 years followup of people who had a coronary artery calcium score of zero. The good news, the panel that was on your left, panel A, they’re almost completely free of suffering a cardiac event like a heart attack or death. If you’re the red line, your calcium score, because there’s a number that can be calculated, if you’ve got heavy calcium and that score is over 400, you can see there’s about a 25% chance over the next 10 to 12 years you’re going to have a heart attack or possibly die. Would you like to know that? My argument is, if you read about what happened to Garry Shandling, he wasn’t feeling good for 12 or 18 hours, called his friend who was a doctor and he was told to stay home. If you knew your calcium score was 600 or 700 and you weren’t feeling good, would you hightail into the emergency room maybe save a life, let alone the idea that it might help get motivated and learn how to reverse the process. So I’m a big advocate. If you know you have heart disease, if you’ve had a stent or bypass, you definitely had a real heart attack, you don’t need this test. This is for the other 95% that assume they’re okay because they’ve seen their doctor, maybe even had a stress test because you can pass the stress test and still have quite significant coronary artery calcification. And you probably need to do at once for $100 when you’re 45 or 50, you can do it a little younger if you have diabetes or a bad cholesterol or smoking. You can do it when you’re older too.
So what do you do about it? Well, that’s the last part of PDR. R is reversible. Prevent, detect, and reverse.
We’ve talked about Morrison and Ornish and Esselstyn and Pritikin and they’re all incredibly powerful lifestyle-based, but I will tell you, just tease you with it and I’ll show you. These are examples of people that had very high coronary artery calcium scores. There’s a coronary artery calcium score of 2032 that within six months had dropped in half using certain nutritional and vitamin and supplement-based treatments. There are ways even beyond diet to really push the envelope and these are the kind of things I do on my clinic in Detroit, is I use plant-based diets based on all the teaching of all these heroes, but go beyond that.
Infrared sauna can be part of that program. Something that’s used at Hippocrates Health very aggressively. There’s a vitamin out there called Vitamin K2 that’s involved in calcification of arteries.
In a large study that’s shown here in the graph, the higher your blood level of vitamin K2, the lower was the amount of calcium in your aorta and the lower was the risk of cardiac death during follow-up in the study. This just happened to be a blood test and followup. There’s an ongoing study that’s randomized vitamin K2 or placebo to really prove the point, but I’m just putting it out there. This is called the Rotterdam Study that there are therapies if you have one of those coronary artery calcium CT scans. They can reverse it.
This is another therapy called Nanobac that 58% of patients take in a certain vitamin, had a drop in their calcium score within four months. Some of them dropped all the way back to zero which is a great place to be.
And finally, there’s a word that’s still in traditional cardiology, is illegal to say it a conference, chelation therapy. Chelation is a kind of therapy where it was usually intravenous where there were chemicals that were believed to removed plaque from arteries, remove what are called heavy metals like mercury and lead from arteries. Largely, abandoned by the standard medical community due to a lack of data and probably should have been abandoned due to lack of data until 2012 when this large government-funded study called the TACT trial was published. If you look at the lower green line, that’s a combination of chelation and high dose vitamins given to almost 18,000 heart patients followed for five years compared to if you go to the very top, one of those blue lines that was looking at the outcome of developing problems. There was a huge difference. If you are a diabetic who had had a heart disease and you got chelation and vitamins, you’re at a huge advantage over getting placebo.
So when the TACT trial was announced by the University of Miami and they said chelation seems to have a power to stabilize the cardiac status of diabetics with heart disease. There was no angiograms performed so we can’t actually say reversed their disease. It just improved the chance their going to have a heart attack, end up in the hospital or die. It should have had a ripple effect throughout the country. We should have had chelation centers developing or at least a lot of discussion. But standard medicine doesn’t accept new ideas that aren’t reimbursable, that aren’t understood. This whole thing disappeared from public eye in about two or three weeks until about 6 weeks ago when the University of Miami announced they got another 30 million dollars from the government and they are embarking on what’s called TACT 2 which will be a second phase of the study. I think it’s going nail it that this is a very powerful alternative therapy of heart disease that can be incorporated with other therapies. Very noble and very exciting actually. So, I think I have just a couple last slides. How do we go from 1984 thinking cholesterol was bad to 30 years later, celebrating butter? I just want to again go back to show you that diet matters. This was 302 men and women that had had a heart attack and had blocked arteries. They took their butter away and you might say this is crazy. They took their saturated fat away. They put them on canola oil margarine which was much lower in saturated fat and we all cringe when we hear about vegetable oils and canola oil. But it actually dropped the risk of a heart event and death by 65% within just a very short time. The Lyon Heart Study is a very famous study. And this is my own personal pet peeve, is this whole butter stuff. This is what happened in the country of Finland. In the late ‘60s, Finland had the highest heat attack rate in the world and young people, 40-year-old strapping farmers in Finland, loggers in Finland were dying like flies left and right literally. They had a heart attack rate higher than the United States by far and the government got behind a project called the North Karelia project to say, “We’ve got to educate the public. Don’t smoke of course. Eat up fruit and vegetable, but give up butter. Do anything but eat butter. You can eat margarine or don’t eat anything.” Heart attack rates fell by 80% in five years in Finland with an education program that said decrease animal saturated fat. Either substitute it with vegetable, polyunsaturated oils, or nothing. Eighty-five percent reduction of heart rate. So I make that point that if you’re confused nowadays by all this stuff, you need to ask about what about the Lyon Heart trial, what about Finland.
This is my last point. If I can’t you for heart disease, there are circles there, the penile artery is 1 mm, the heart arteries are 3 mm and if you don’t eat for your heart arteries, then eat at least for the guy– should be eating for their 1 to 2 mm penile artery. Meaning if you feel lucky enough and to want to eat all those crap and buy into Time Magazine that butter is back, just make sure you’re feeling lucky because I don’t think it’s going to work out very well for you in the long run.
Thank you for recommending the whole food, plant-based diet on reversing heart disease. I have Forks Over Knives and The China Study as references. “I’ve read all the books. It’s been two weeks. I’ve never felt better. I lost 15 pounds, more energy. Although, it’s not my focus, I’m going to get off all my medications.” These are kind of notes that patients will send you when you just opened the door and let them begin studying on their own what’s available, what the data is, and they start to experience the benefits. I thank you very much. I think I’m right on time and I appreciate your attention. Have a wonderful day.