PreventandReverseHeartDisease

There will always be special situations in which patients with unstable coronary artery disease will require some type of urgent bypass or intervention, but I am convinced that with improved nutrition, we can spare a growing majority of patients from these procedures. And I am pleased to see that quite a number of scholarly cardiologists are beginning to question the wholesale rush toward mechanical intervention in heart disease.

One of them is Dr. John Cooke of Stanford University, who readily acknowledges that angioplasty—while it can help to relieve angina—hardly ever saves lives, and does nothing whatsoever to cure heart disease. He suggests, in fact, that about half of all angioplasties performed in the United States each year are simply unnecessary. Dr. Cooke writes: “In my opinion, it is far better, and well within your ability, to restore the health of your endothelium rather than have a cardiologist remove it with a balloon catheter. If your doctor recommends angioplasty, tell him or her that if at all possible, you prefer a medical and dietary approach. Angioplasty should be reserved for emergency situations (when someone is in the middle of a heart attack) or when medical and nutritional therapy have been attempted but failed to relieve the symptoms.”²

Similarly, Dr. James Forrester and Dr. Prediman Shah of Cedars-Sinai Medical Center in Los Angeles have criticized the fact that cardiologists are so quick to intervene with angioplasty or bypass procedures. In their own research, they wrote: “. . . we are led to the remarkable conclusion that angiography does not identify, and consequently revascularization therapies do not treat, the lesions that lead to myocardial infarctions.”³

In June 2005, researchers who conducted a meta-analysis of 2,950 cases of coronary artery disease reported in the journal Circulation that in patients with chronic, stable disease, intervention “does not offer any benefit in terms of death, myocardial infarction or the need for subsequent revascularization compared with conservative medical treatment.”⁴ And a year later, Dr. Richard Krasuski of the Cleveland Clinic’s top-rated cardiology department said flatly that aggressive treatment of patients with stable angina is generally unwarranted. “We don’t prevent heart attacks or death,” he declared. The reason: “Heart attacks can begin in any heart artery, not just those highly blocked vessels treated by angioplasty or stenting. So in general, the best prevention is control of risk factors that can protect every vessel in the body.”⁵

The thesis of my research has been absurdly simple: using a plant-based nutrition program to reduce cholesterol to the levels seen in cultures that never experience heart disease. My patients were willing in 1985 to put their cardiovascular health in the hands of a general surgeon who told them this was an illness that did not exist in three-fourths of the earth’s population. If it could be arrested and reversed in monkeys, I told them, it could also be arrested and reversed in humans. They decided to join in my experiment.

Our research data have clearly confirmed that we were right. My patients’ decision to enter the study not only put an end to the progression of their disease; the information we have gleaned from their experience has set a new gold standard in the therapy for coronary artery disease. We can arrest and reverse it. We can make ourselves heart-attack-proof. Coronary artery disease need not exist, and if it does, it need not progress.

The argument I still hear from physicians who do not embrace this truth is that they are certain their patients would not comply with such a strict nutrition program. I do not understand how they are so sure of this unless the patients are given a chance; in fact, after counseling patients with severe coronary artery disease for more than twenty years, I have found the opposite to be true.

If you explain to a cardiac patient that there is a program that will quickly relieve or eradicate his pain, that can eliminate any need for further intervention—no more bypass surgery, angioplasties, or stents—that can heal and replenish the vascular system, that has benefits that improve over time, the patient tends to pay attention. In my experience, in fact, like that distraught man on the cruise ship who heard me lecture—“I can’t believe no one told me there was another option!”—many thoroughly resent the fact that no one ever told them the truth.

Patients who undergo bypass surgery have, on average, a 2.4 percent chance of dying and another 5 percent chance of sustaining a stroke or heart attack during the procedure. Four percent of patients who get stents have heart attacks during the stenting, and 1 percent die. Let’s put flesh on that statistic: since there were more than 1 million stent operations last year in the United States, that means 40,000 patients had heart attacks during the procedure—and 10,000 died. If 10,000 American soldiers died in one year in Iraq, it would be called carnage. As the late Cleveland Clinic urologic surgeon William Engel said, “It is acceptable to lose an occasional patient, but best not to hasten them along.”

One of my recent patients had a terrifying experience with interventional cardiology. In September 2004, Jim Milligan, an insurance executive from Wooster, Ohio, was helping his wife can tomatoes. Suddenly he began to sweat and felt considerable chest pain. He sat up all night, the pain constant. The next day, at his wife’s insistence, he went to a local emergency room, where he was told he was having a heart attack.

Jim was rushed by ambulance to a hospital in Columbus for an urgent angiogram, which revealed significant blockages in his coronary arteries. A doctor inserted a catheter in order to put a stent in place. Suddenly, Jim couldn’t breathe. He had “a terrible taste” in his mouth. He started shaking. He was experiencing anaphylactic shock, a life-threatening reaction to the dye used for the angiogram. The procedure was immediately terminated, and Jim spent five days in intensive care.

Over the next four months, cardiac nuclear scans revealed that the blood supply to Jim’s heart was deteriorating. His left ventricular ejection fraction—the measurement of the heart’s capacity to pump blood, which is normally above 50 percent—was down to 40 percent.

In January 2005, Jim called me. It was apparent in his counseling session that he entirely grasped our message. And over the next four months, his cholesterol plummeted—from 244 mg/dL to 140 mg/dL. His body weight fell from 254 pounds to 204. His longtime cardiologist wanted him to return to Columbus for an additional angiogram and, likely, more stents, but Jim was adamant about sticking to the arrest-and-reverse program. He found another cardiologist who did some research on me and was supportive of what Jim was trying. “If Dr. Esselstyn says do something,” he told Jim, “I’ll work with you.”

By April 2005, tests revealed that Jim’s left ventricular ejection fraction had returned to 62 percent—normal. He was given a clean bill of health, with no restrictions on his activity and, perhaps more important, given his anaphylactic scare, no further need for intervention.

It is difficult to imagine a patient with coronary artery disease, facing an elective intervention, who would not respond when told the truth about the dangers of the procedure. Reminded that the surgery will relieve only the symptoms of the illness, wouldn’t almost anyone choose, instead, to treat the underlying disease through arrest-and-reversal therapy?

Patients want to avoid the potential complications and mortality involved in intervention. Those who are sent home to die by their cardiologists, after failing bypass or stents, rejoice as they lose weight, lose their angina, lower their blood sugars, decrease their dose of insulin or come off it altogether, reduce the use of medication, see stress tests revert to normal, diminish the plaque plugging their arteries, and resume a fully active life. They are visibly empowered by the knowledge that they, not their physicians, now have control over the disease that was destroying them.

Even those who may be dubious at first are often won over. Several years ago, I encountered a doctor from Pittsburgh who had been advised at his own hospital to undergo bypass surgery but was reluctant to do so. He sought a second opinion from an eminent cardiologist at the Cleveland Clinic, who finally talked him into having a stent. The surgery was performed, but the stent was unsuccessful. The Pittsburgh doctor knew about my program, but declined to participate, fearing that it would cramp the active social life he and his wife enjoyed at home. He found that by reducing his activity, he could live within the limits of his angina.

Seven months later, I called to see how he was doing. Not surprisingly, he was still imprisoned by the chest pain. Frustrated on his behalf, I raised my voice over the phone: “Gordon, for God’s sake, just give me sixteen days and I will get you out of prison.” He agreed.

After sixteen days, his angina was almost gone—and it disappeared entirely over the following two weeks. That doctor is now a fierce advocate of my program, a complete believer in plant-based nutrition.

And here is something that gives me great pleasure—and a good deal of hope: these days, more patients are coming to me before they go through interventional procedures. And when they adopt the profound lifestyle changes I demand, they are finding that the interventions are no longer necessary.

John Oerhle is a case in point. John is a man who has never allowed a physical handicap to stand in his way. When he was sixteen, he was making a bomb in his basement and ended up blowing off his right hand and all but two of the fingers on his left. Nonetheless, he went to MIT and became a highly successful aeronautical engineer, as well as a croquet champion and top bridge player.

In 1993, after his brother had a heart attack, John started seeing a cardiologist who prescribed medication that he would have to take for the rest of his life. Ten years later, he experienced shortness of breath. He failed a stress test, then had an angiogram, which revealed 80 percent blockage of two major arteries and 100 percent blockage of a third. Not surprisingly, he was scheduled for open-heart bypass surgery.

Once onboard that train, it takes an unusual person to step off. But John is unusual. The scientist in him was too strong. He read widely on his disease, and ultimately canceled the surgery. Online, he Googled “atherosclerosis reversal therapy”—and found my website. He and his wife, Catheryn, came to see me and immediately grasped what I was recommending.

Within a month after he committed himself to plant-based nutrition, John Oerhle’s total cholesterol dropped to 96 mg/dL, and his LDL—bad cholesterol—to 34 mg/dL. One year later, after another stress test, John’s cardiologist commented: “I’d be hard-pressed to say there is anything wrong with this heart.”

Then there’s the case of Dick Dubois, a chronic marathoner and president of a container recycling facility in New York State. In the fall of 2004, Dick began to experience occasional tightness in his chest during his training runs. A stress test showed nothing abnormal, and he continued running. But the pain worsened, and by February 2005, an echo stress test suggested a partial blockage of the right coronary artery. His doctors prescribed cholesterol-reducing medication, aspirin, and a beta-blocker. But the pain persisted. He began walking, instead of running. Even so, through the summer of 2005, he continued to have chest pain.

In September of that year, an angiogram revealed multiple blockages in Dick’s coronary arteries. The worst was an 80 percent blockage at the origin of the left circumflex and left anterior descending artery. Dick’s cardiologists were concerned that any attempt at angioplasty or stenting could be fatal, and they scheduled an appointment for a bypass procedure with a leading cardiac surgeon at the Cleveland Clinic.

As it happened, shortly after the angiogram Dick had read The China Study, T. Colin Campbell’s brilliant work on nutrition and disease. He was interested in the chapters that described my work, and ultimately contacted me. On October 9, 2005, Dick and his wife, Rosalind, came to Cleveland for counseling. They decided to try my approach at least until the December appointment with the heart surgeon. When the surgeon called to say there was an unexpected opening in his schedule, and gave Dick an earlier appointment on October 26, Dick thought about it, but decided to stick with our program for at least two months. By the time the surgeon called, just eleven days after our counseling session, he was no longer experiencing any chest pain during his walking workouts. Eventually he canceled the surgery, even though the surgeon warned that left untreated, he had a 10 percent chance of dying within a year.

Three weeks after the initial counseling, Dick’s total cholesterol was just 101 mg/dL and his LDL (bad) cholesterol was 49 mg/dL. All his numbers looked terrific. I called him every seven to ten days to evaluate his progress. Each time, he reported new activities—cross-country skiing, then snowshoeing—which he pursued sensibly, reducing the intensity if it caused angina. In January 2006, eleven weeks after his counseling visit, Dick told me that a January thaw had made skiing and snowshoeing impossible, so he had gone to the high school track. He jogged for one mile and for the first time in more than a year he experienced no chest pain.

The stories of John Oerhle and Dick Dubois reveal how powerfully and promptly the body can heal itself from a devastating illness. And they underscore a point I have repeatedly stressed: patients with stable coronary artery disease should be cautious about the “quick fix” approach of bypass surgery and stents, which pose significant risks of complications and mortality. They should be offered intensive lifestyle change for twelve weeks in a reasonable trial. If they devote themselves to the program with unwavering commitment, many will avoid entirely the need for surgical intervention.

I still cherish the naive dream I had when I started this research. We have shown that the number one killer in Western civilization can be abolished, through consumption of a plant-based diet. But we can do much more. If the public adopted this approach to preventing disease, if, by the millions, Americans abandoned their toxic diets and learned a truly healthy approach to eating, we could largely limit all those diseases of nutritional extravagance—strokes, hypertension, obesity, osteoporosis, and adult-onset diabetes. Meanwhile, we would see a marked reduction in cancers of the breast, prostate, colon, rectum, uterus, and ovaries. Medicine could relinquish its primary focus on pills and procedures. Prevention, not desperate intervention, would become the order of the day.

Even I am not optimist enough to believe that this could happen overnight—that the entire population of the United States would switch to a plant-based diet the moment its benefits are widely known. But we can get there. The first step is to educate the public, teaching the truth about what we know about nutrition and the ravages of the traditional Western diet.

In my fantasies, for instance, I imagine a widespread use of the brachial artery tourniquet test (BART), which Dr. Robert Vogel used to such devastating effect to prove the vascular damage a single meal can cause. If public schools were forced to serve only meals that are BART-positive (i.e., maintaining normal artery dilation), if restaurants were required to inform us which menu items are BART-positive and which are BART-negative, if the labeling on all packaged foods carried information on their BART status, we would have gone a long way toward enlightening citizens and helping them make informed choices about enhancing or destroying their health. Although my BART fantasy may never come true, the basic point is that the place to start is definitely by enlightening the public.

Then, perhaps, we can slowly put in place some institutional changes. For instance, we can approach insurance companies, employers, and representatives of labor with a modest proposition: that heart patients targeted for the mechanical intervention of bypass surgery or stenting should first try twelve weeks of arrest-and-reverse therapy—plant-based nutrition plus, where necessary, cholesterol-reducing drug therapy. In fully compliant patients, we see angina disappear in just a few weeks, and stress tests may return to normal in eight to ten weeks, so the results would be clear to everyone involved: for the great majority of patients, the dangerous, costly mechanical intervention would be rendered unnecessary.

What I am proposing would require revolutionary changes in the world of medicine. My father used to observe that as long as medicine was practiced on a fee-for-service piecework basis, comprehensive preventive medicine would never become the driving force in a physician’s life. He was right. As I argued in Chapter 1, there are now no incentives built into the system to encourage the public to adopt healthier lifestyles. I once asked a young interventional cardiologist why he didn’t refer his patients for a nutrition program that could arrest and reverse their disease, and he replied with a frank question: “Did you know that my billed charges last year were over five million dollars?”

Those of us who practice medicine must engage in a new covenant with the public. We must never underestimate the layman’s ability to adopt healthier lifestyles. We must tell the truth. We must relinquish the procedural focus of medicine and take pride in prevention. We must rejoice in conveying knowledge that empowers individuals to take control of their own health.

The late Lewis Thomas, a highly respected physician and revered medical philosopher, lectured at the Cleveland Clinic in 1986. He referred to the mechanical wizardry available in vascular disease—the angioplasties and bypass procedures—as “halfway technology.” A mechanical approach to a metabolic, biochemical epidemic, he argued, was not the answer. Dr. Thomas further cautioned that there would be a moral and ethical challenge to physicians down the road: to relinquish this halfway technology in favor of simpler, safer metabolic and biochemical cures.

The time is now. The weight of scientific evidence and public opinion, once the truth is known, will prevail. And finally, we can start teaching people how to walk alongside the edge of the cliff, instead of desperately trying to save them after they fall off.