6
Living, Breathing Proof
DON FELTON’S WIFE, MACKIE, used to get up each morning and fry bacon, then make gravy from the grease, and serve it to Don over toast or homemade bread. “I loved it,” Don says. “I ate it for years.” And it wasn’t just a matter of breakfast. “I remember side meat cooked in beans. Side meat was pure fat, a two-inch-thick piece of fat off the side of a pig, usually. The side meat is cured in salt, soaked overnight, rolled in cornmeal, and browned in a skillet with gravy made with the grease.” Don Felton makes no bones about it: he loved gravy. And he loved a lot of other fatty foods, as well.
He arrived at my office on January 15, 1986. He was fifty-four, and had been informed by his cardiologist that—after twenty-seven years of chronic heart trouble and treatment, including a double bypass that had begun to fail—there was nothing more conventional medicine could do for him. As he walked across the skyway that connected my office with the rest of the Cleveland Clinic, he had to stop three or four times because of acute pain in his leg. An angiogram showed that the main artery in the leg was entirely blocked.
Don and Mackie talked with me for two hours about the program he was about to undertake. When they left my office, they stopped at a little Italian restaurant not far away and had a bowl of soup. “I guess this is the last good soup we will have,” Don said to his wife. But he was, as he says, “at the end of the rope.” He did not want to take a chance on more surgery. He was committed to my nutrition program, and began to follow it that very day.
After three or four months, Don Felton’s chest pain eased. He no longer had to sleep propped up by pillows to ease the angina, which had been much worse when he lay down flat. And about seven months after he started the program, he mentioned that he had been so focused on his heart that he had forgotten to tell me about his leg: he now was able to walk across the skyway to my office without stopping—without a single stab of pain. I immediately sent him to the vascular laboratory for another pulse volume test, which showed that the flow of blood in the artery that had been blocked was back to normal (see Figure 12).
To me, Don is a test case in the power of the endothelial cells and how they respond to dramatically reduced cholesterol levels and lifestyle changes that eliminate all risk factors. And so, it turned out, were the rest of those who took part in my study. But anecdotal evidence of improved health is not sufficient to evaluate the results of this sort of research. I needed serious scientific information on just what was happening to participants in the study as they followed my program over the months and years.
Three separate measurements are necessary to evaluate results in this type of research:
  1. Analysis of cholesterol levels during the course of the study.
  2. Analysis of angiograms taken before, during, and after treatment.
  3. Analysis of the clinical results of the study.
 
Keep in mind the background of the eighteen patients who stuck with the program. All had severe, progressive coronary heart disease.
In the eight years before my study began, all had received state-of-the-art cardiac care at the Cleveland Clinic. Collectively, they had experienced forty-nine cardiovascular events, including:
 
Here is how they fared in my study.
Cholesterol. During the first five years of the study, the patients’ blood cholesterol was tested twice a month or more; for the next five years, it was tested once a month; and after that, every three months. The group began the study with an average blood cholesterol level of 246 mg/dL—a level all experts consider to be too high. By adhering to the nutrition program and using cholesterol-lowering drugs, they were able to reduce that group average to 137 mg/dL, cutting their cholesterol levels nearly in half. This is the most profound drop in cholesterol levels in such a study that I have been able to find in the medical literature, discounting recent studies using megadoses of statin.
Twelve years after joining the program, every one of the participants averaged total cholesterol below 150 mg/dL, the stated goal of the study. Their LDL—bad—cholesterol averaged 82 mg/dL, among the lowest ever reported in this type of study. Their good, HDL, cholesterol averaged 36.3 mg/dL, which is lower than the range generally accepted as normal. But it was sufficient to sustain the beneficial results. Our research strongly suggests, in fact, that lower than “normal” HDL levels are not worrisome as long as total cholesterol is well within the safe range—under 150 mg/dL—a finding that has been discussed by other researchers, as well.1
Angiograms. A coronary angiogram is a specialized X-ray of the coronary arteries. A flexible catheter is inserted into an artery, either at the elbow or the groin, and advanced toward the heart. At the entrance to the left ventricle, the heart’s main pumping chamber, the catheter can be alternately inserted into each of the coronary arteries. Dye is injected through the catheter into each coronary artery while a running film (cine-angiogram) captures a precise picture of the artery and its major branches.
When these angiogram pictures are taken over time, it is possible to compare them and thus to measure how diseased portions of the arteries are faring. Are they remaining the same? Are they getting worse—narrowing as they sustain further blockage? Or are they improving—growing wider, and thus allowing more oxygen and nutrients to reach the heart muscle? These analyses of the films must be scrupulously precise and objective. For my study, all were performed three times. In addition, to avoid any possibility of bias, the technicians who performed the angiogram analyses were “blinded”—that is, they did not know whether the film they were analyzing was the initial, baseline film taken before the patient joined the study, or the follow-up film taken upon its completion.
At the five-year mark, seven of the eighteen participants were unable to have a follow-up angiogram. The results I report here are for the eleven participants who did have follow-up angiograms after five years. The analyses were stunning. In sustaining cholesterol readings below 150 mg/dL, these patients eliminated any clinical progression of their disease. Every single one arrested progression of the heart disease, and eight participants actually selectively reversed it. Some of the reversals were striking, as you can see in the photographs that accompany this text. Figure 13 (see here) shows a 10 percent reversal of disease over five years in the left anterior descending coronary artery of a sixty-seven-year-old pediatrician. Figure 14 shows a 20 percent improvement in the circumflex coronary artery of a fifty-eight-year-old factory worker. Figure 15 shows a 30 percent improvement in the right coronary artery of a fifty-four-year-old security guard. Again, see the angiogram of Dr. Joe Crowe, revealing total disease reversal after thirty-two months (Figure 1).
Having angiographic proof of disease reversal was an occasion of enormous joy for study participants and cause for family gatherings and champagne toasts. It was also enormously gratifying for me. It showed, beyond argument, that the hypothesis and foundation of the research was solid. We now had irrefutable scientific evidence that heart disease could be arrested and reversed. And if it can be reversed it can also be prevented.
Clinical results. Before discussing the clinical results, it is important to review the one death that occurred during the study. The patient was a man in his sixties who had severe coronary artery disease. He had been accepted into the study two weeks after sustaining a massive heart attack during an unsuccessful angioplasty. His unstable condition persisted and seven months later he underwent bypass surgery. His left heart chamber was so badly damaged and scarred that it was able to pump blood at less than 20 percent of its normal capacity.
Such patients have a very poor outlook. Nevertheless, this man survived. And after he had spent nearly five years on the program, a follow-up angiogram compared four of the areas where his arteries had narrowed. Two were unchanged. Two had improved.
Ten months later, he died of a cardiac arrhythmia. Postmortem study showed no new blockages or heart attacks. Despite the improving coronary artery blood supply and decrease in angina, his heart, which was so scarred, had literally electrocuted itself into arrest.
As for the rest of the group, all improved. Nine of the patients had come to the study with angina—pain in the heart muscle caused by inadequate blood supply. It was completely eliminated in two and much improved in the remaining seven, including the patient who died. Exercise capacity improved. Sexual activity was enhanced. One patient confided that the impotence that had long bothered him had been cured in the course of the study.
The results have lasted over the years. Don Felton, who could barely manage the walk to my office when he first came to see me, is now in his seventies—fit and active. “When I first started, I was down,” he says. “Now, I’ve been eating this way for so long I don’t think about it anymore.” Mackie still makes him gravy, but she makes it with fat-free broth, and he pours it over mashed potatoes. And Don still goes deer-hunting every year. But there are a few differences from the old days. For one, he takes oatmeal on the trips so he doesn’t miss his healthy breakfasts. For another, he doesn’t eat venison anymore.
Emil Huffgard, once such a prisoner of nitroglycerin, unable even to sleep unless he was in a sitting position, improved quickly after starting to eat right and to reduce his cholesterol. He had worked for the telephone company as an engineer, but had been forced to retire early because of his health. About six months after he joined the study, he came to my office and, with tears in his eyes, said, “If I continue to improve this much, I’ll have to go back to work!” And despite his wife’s worry that he might not make it to their daughter’s wedding, he was able to walk her down the aisle after all. Eleven years after Emil joined the program, an angiogram confirmed that he had achieved some reversal of his disease.
(Don and Emil, both of whom had undergone bypass surgery before joining the study, teach an important lesson in the downside of that procedure: the vessels used for bypassing blocked arteries simply cannot last forever. Eventually, they scar shut. In Don’s case, a vein had been used to bypass his clogged coronary artery. It lasted for twenty years—about twice as long as most vein bypasses—but eventually had to be replaced. In Emil’s case, an artery had been used for the bypass, and it lasted for fully thirty years. At the end of that time, it suddenly blocked, causing a mild heart attack and requiring a corrective bypass. In both men, the reversal of disease in their native coronary arteries, due to their compliance during the course of our study, enabled them to tolerate the required surgery safely. Today, both are well, free of angina or any restriction on their activity.)
Jerry Murphy, the company executive whose male family members had all died young as far back as anyone could remember, is, as I write, in his mid-eighties. During fourteen years on our program, he maintained a total cholesterol level below 120 mg/dL. The patient who was once called “a heart attack about to happen” by his cardiologist jogged every day until he was seventy-eight. Today, he is beginning to experience a bit of arthritis—something no other male members of his family ever had. None lived long enough to acquire it.
Evelyn Oswick, whose doctor had told her to go home, find a rocker, and wait to die, is now in her late seventies. Despite her initial skepticism, once she made up her mind about my nutrition program, she never turned back. And her heart disease, as a result, is completely under control. In fact today, when Evelyn sees a new doctor, she tells him she no longer has heart disease. With characteristic self-confidence, she declares that anyone who has a heart attack these days is simply foolish, since there’s such solid information on how to arrest the disease.
Jim Trusso, who had so much trouble with the program when he joined the group, stayed with it. His wife, Sue, says that even today, he “is not a fruit-and-vegetable person.” But he knew that changing his eating habits was the only way he could save himself. And little by little, he learned to live with the diet, how to season healthy foods so that he grew to enjoy them. Shortly after I wrote the twelve-year follow-up report on my patients, Jim joined a charity event, bicycling from Cleveland to Toledo and back—a round-trip of approximately 225 miles. He was definitely overdoing the exercise, and sustained a cardiac arrest during the exertion. (This was not a heart attack, but rather a case of building up epinephrine through exercise and then stopping suddenly; with his muscles no longer consuming the epinephrine, it caused arrhythmia and Jim’s heart stopped beating.) He was resuscitated, and an angiogram suggested that he needed a third bypass to more fully protect him in his active lifestyle. His strong constitution withstood the surgery.
Now in his sixties, Jim has retired from the education system—he ultimately became superintendent of schools—but he is hardly sitting still. He bikes on the beach every day, between eight and ten miles. He kayaks, lectures at the local arboretum, and travels the world with Sue. And to this day, he maintains his cholesterol level at 121 mg/dL. He won the bet with the doctor who wagered a steak dinner than he would never get his cholesterol level below 305. But he has never collected—for obvious reasons!
Jack Robinson also made a bet with his cardiologist. Two years after he refused bypass surgery and started my nutrition plan, his doctor in Akron was still deeply concerned about Jack’s choice. He suggested the following wager: Jack would have another angiogram, and if it showed further progression of disease, he would agree to have the bypass. The angiogram did not show disease progression. Quite the contrary, it showed that Jack was reversing the effects of his disease.
Ultimately, Jack moved to Piqua, Ohio, where he signed on with a new cardiologist. Like Jack’s old doctor, the new one was skeptical of Jack’s nutrition-based approach, and in 1998, Jack reluctantly agreed to have yet another angiogram. This one revealed even further improvement—so much, in fact, that to Jack’s dismay, the cardiologist began boasting that it was his drug regime that had made all the difference.
What has occurred with all these people is very basic: the blood supply through their coronary arteries to their heart muscle has improved. In the majority of patients, the arteries themselves are measurably wider. Profound reduction of cholesterol has increased the capacity of the endothelium, the arteries’ inner lining, to produce nitric oxide, which in turn dilates the arteries themselves—even diseased arteries. And that’s not the only improvement. Recent research indicates that reducing blood cholesterol levels decreases the thickness of the membrane surrounding red blood cells, thus enhancing its permeability. This allows the red cells to pick up oxygen more readily as they pass through the lungs, and enables them to release the oxygen more efficiently as they circulate through the heart muscle. Finally, the patients’ plant-based diet, eliminating the ingestion of foods that injure vascular tissues, has restored strength and integrity to the endothelium as a whole. Any plaques in these patients were protectively capped and could not rupture or initiate the cascade of clotting that defines a heart attack (see Figure 16).
These patients are now heart-attack-proof.
Three of the original members of the study have died since it ended. One died of pulmonary fibrosis. The second vomited violently, collapsed, and died amid copious bleeding about thirteen years after he entered the program. No autopsy was ever performed, but because of the vomiting and bleeding, which are not associated with heart disease, I suspect he died of Mallory-Weiss syndrome, in which a gastric artery is eroded by acid and retching. The third was a retired truck driver, who fell into a terrible depression. At the time of his death, he was living in a facility where he couldn’t eat safely, and little by little, his health deteriorated.
 
 
In 1998, I reviewed the status of the six patients who were released from the study in the first twelve to fifteen months, and returned to their cardiologists and prestudy diet. In every one of them, the heart disease had grown worse. All told, since leaving the study, they had suffered:
 
What a contrast! As I have reported, the patients who stayed with the program collectively had sustained no fewer than forty-nine cardiac events in the years leading up to the study. One man, six years into the program, went back to his old eating habits during an eighteen-month period of hectic business activity, and his angina, which had disappeared, returned, requiring bypass surgery. That was the only case of a new cardiac event among participants in the study during the first twelve years. There was another case of bypass surgery that I learned about while writing this book, but I do not count it as a true coronary event. The patient in question left the Cleveland area two years after joining the study, and I lost contact with him. He continued to follow the nutrition program—and does even now, twenty years later—but he told me that he insisted upon the bypass surgery in order to hasten relief from symptoms that kept him from improving his tennis.
Among the fully compliant patients, during the twelve-year study, there was not one further clinical episode of worsening coronary artery disease after they committed themselves to keeping cholesterol within the safe range.
All of these patients have continued, on their own, to follow the nutritional program and cholesterol-lowering medication I recommended, even though the study has ended. As they reflect upon nearly two decades of freedom from disease, these patients are empowered by the knowledge that they have taken control of their own health, and have taken into their own hands the treatment of the disease that was destroying their lives.
Anthony Yen, whose New Year’s weekend in 1987 nearly turned into a deadly debacle, puts it perfectly. One of his five bypasses had failed just before he joined the study, and he was determined to keep the disease from growing worse. He remembers how tough it was to follow the program at first, having to keep the detailed diary of what he consumed, and facing blood tests every two weeks.
But suddenly, one day a month or so into the program, Anthony realized he felt dramatically better. “I walked in the wind, and had no angina,” he says. He turned to his wife, Joseanne, and spoke triumphant words any one of the study participants would endorse: “We won the battle!”