Sunday, February 15, 2015

The Broken Hearts Club

This is a more personal post than I normally like to share, but since February is national heart month, and I believe this post has an important and relevant message.

At the beginning of the month, I shared an amazing post from Dr. Ostfeld about how a heart disease patient changed his diet, and not only prolonged, but truly saved his life without any surgical interventions. Unfortunately, the story I’m about to share is it’s polar opposite, and happens far too often and to far too many families every single day in western countries.

While visiting Buenos Aires at the end of January, I received a message that a family friend had a second heart attack, and was in the hospital. I didn’t realize how serious it was at the time, however, I would arrive back in New York just in time for his wake and funeral. To say the least, it’s been a very sad and tiring time for my family.

Part of what makes this so incredibly sad, is because I believe his death was avoidable. Throughout my entire life, he ate an incredibly rich diet full of meats, dairy, and processed foods. He was always overweight and when I was young, he became the first person I knew to be diagnosed with Type 2 Diabetes. This didn’t change him in the least.

Than less than a year ago, he had his first heart attack, and an emergency triple bypass surgery. At the time, it seemed like he wasn’t going to make it. Yet, even to the astonishment of his doctors, he made what seemed like a full recovery. He was given a second chance; however, he didn’t seem to understand how serious his situation was. He refused to follow the doctor’s instructions to eat less saturated fat and cholesterol, and continued his sedentary way of life.

I even approached him and offered to talk with him and his wife about the impact that diet could have on his health. Unfortunately, he declined.

And now, he is gone. His wife, children, and grandchildren are now forced to cope with the results of his decisions.

While even Dr. Ostfeld writes that his story was one of the most remarkable transformations he’s ever heard of, there is a growing amount of evidence that shows that heart disease – America’s number one killer - is not only avoidable, but can also be reversed with a proper, plant-based diet.

Back in 1995, Dr. Caldwell B. Esselstyn, M.D. of the Cleveland Clinic published his bench mark long-term nutritional research on arresting and reversing coronary artery disease in severely ill patients. He then published a 12 year update in the Journal of American Cardiology, and then a 20 year update in his book, Prevent and Reverse Heart Disease. So what were these findings?

Starting in 1985, he took 24 severely ill heart disease patients and placed them on a very strict plant-based diet. He had a simple hypothesis; a low-fat plant-based diet could arrest heart disease (fat was kept to 10% of total calories). He came to this theory when he realized that coronary disease was essentially nonexistent in cultures whose nutrition assured a total cholesterol level of 150mg/dl or lower. Vegetables, berries and whole grains were able to be eaten without limit, fruits and juices were limited to a few severing’s per day. Fatty nuts and avocado were even more limited to a few times a week if at all. Oil, meat, and dairy of all kinds were completely off the menu. Two tablespoons of ground flax seeds daily was recommend for omega 3.

Between these 24 patients, they had 49 coronary events in the 8 years before the study. Out of those 24 patients who initially signed up for Dr. Esselstyn’s study, 6 were nonadherent and were returned to normal cardiac care. At a 10 year followup, those 6 patients who did not adhere to the diet had 13 new cardiac events.

The remaining 18 adhered to the diet. After 5 years, not a single patient had a repeat cardiac event and 11 of those 18 patients agreed to a second angiographic analysis which demonstrated that the heart disease was arrested in all 11 (100%). Further, in 8 of his 11 patients (or 73%), the disease had regressed. Angina initially reported in 9 patients was eliminated in 2 and improved in the remaining 7.

Evidence of reversing heart disease.

Similar results were reported in the 12 year follow up.

For comparison, in another study published in 2000, Richard M. Fleming, M.D. took 26 patients and placed them all on a healthy high carb vegetarian diet. Dr. Fleming planned on using a new technology known as a SPECT scan which enabled him to actually measure the blood flow within the coronary arteries.

His plan was to measure the before and after effects of diet. However after one year, Dr. Fleming discovered that ten of his patients decided against the vegetarian diet in favor for a high protein, low carb diet, which they believed would improve overall health. This gave Dr. Fleming the unique opportunity to compare the two diets on coronary health.

At the end of the year, those who stuck to the healthy vegetarian diet all showed a reversal of their partially clogged arteries – showing an average of 20% less atherosclerotic plaque in their arteries. Those who jumped ship to the low carb high protein diet significantly worsened, as the SPECT scans showed an increase of nearly 40% more artery clogging.

If you look at the provided scans, you can clearly see this. The yellow and red represent blood flow. On the top, you see the increased blood flow of a person following the vegetarian diet. On the bottom, you see the decreased blood flow of a person who switched to a high protein diet. While even Dr. Fleming admits more of this type of research is needed, it is suggestive, especially when taken in measure with Dr. Esselstyn.

If any drug had even come close to this type of result, it would be publicized everywhere. Instead, this life saving message has largely been ignored. One large criticism has resounded time and again, “Yes, these are excellent results, but the trial groups are far too small.”

So in 2014, Dr. Esselstyn responded with yet another new study. This time he followed 198 patients and 177 individuals were compliant with the diet (89%). Of this compliant group, only one individual suffered a cardiac event. That is a recurrence rate of .6% which represents the absolute lowest recurrence rate of any study on heart disease.

Out of the 21 individuals in the noncompliant group, 13 of them suffered adverse cardiac events. That is a rate of 62%. They were following standard cardiology care and medical interventions which included pills and various procedures. For those of you who like math that is a ratio of .6% to 62% meaning that Dr. Esselstyn’s work is 100 times more effective than that of the standard care given to most heart patients. 

These results are important because heart disease kills over 300,000 people annually and over 700,000 people suffer a heart attack every single year. Yet, as the results of these studies suggest, this needn’t be the case.

Please help me share this message. As Dr. Esselstyn says, “If the truth be known coronary artery disease is a toothless paper tiger that need never ever exist and if it does exist it need never ever progress.

Dr. Esselstyne and Dr. Fleming aren't the only ones getting these results with diet and lifestyle changes. Dr. Ornish, Dr. McDougall and Dr. Ostfeld among others are all doctors who have created programs that have proven to arrest and reverse heart disease. In fact, just this week, Dr. Ostfeld and his colleagues at Montefiore Cardiac Wellness Program published a study that showed a patient completely reversed their angina simply by adopting a plant based diet.

For more on Dr. Esselstyn, watch the excellent documentary Forks Over Knives or get his book, Prevent and Reverse Heart Disease.

Esselstyn, Caldwell B. “Updating a 12 -Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology)” The American Journal of Cardiology, August 1999, 334-39.

            “A Strategy to Arrest and Reverse Cornonary Artery Disease: A 5- Year Longitudinal Study of a Single Physician’s Practice.” The Journal of Family Practice Vol. 41 No. 6 December 1995 560-68.

            “A Way to Prevent CAD?,” The Journal of Family Practice. Vol. 63, No. 7 July 2014 257.

            “The Nutritional Reversal of Cardiovascular Disease – Fact or Fiction?” Experimental and Clinical Cardiology. Vol. 20, No. 7, July 2014 1901.

            Prevent and Reverse Heart Disease: The Revolutionary Scientifically Proven, Nutrition-Based Cure. Avery Publishers, New York, 2008.

Fleming, R. M. “The Effect of High-Protein Diets on Coronary Blood Flow.”
Angiology Vol. 51 2000 1075-1083.

Ostfeld, Robert et. al. “A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures,” Case Reports in Cardiology Vol. 2015, 2015.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Monday, February 2, 2015

Patient Googles His Way Out of Bypass Surgery*

By Robert Ostfeld, MD, MSc

One of the most common operations performed in the world today is coronary artery bypass graft surgery (CABG). I would like to share with you the remarkable story of a recent Cardiac Wellness Program patient here at Montefiore Medical Center (I’ll call him Mr. J), who changed his diet and averted the CABG knife.

Mr. J is a middle-aged man with high cholesterol and a family history of heart disease. Understandably, he desperately wanted to avoid the problems that many in his family had faced, so he ate a “healthy” diet of chicken, fish, and low-fat dairy, with a few fruits and vegetables mixed in. And he exercised. A lot. In fact, he loved exercising so much that he would do it for two to three hours a day — brisk walking, playing sports, etc.

Mr. J. first visited a cardiologist at age 55, after having experienced several weeks of tightness in his neck during physical activity. The condition had worsened to the point that only 30 to 45 seconds of exercise brought on significant discomfort. The doctor ordered a stress test, to see if heart disease could be contributing to this symptom. The test results were so wildly abnormal that he was sent immediately to the hospital for a cardiac catheterization, to look for cholesterol blockages in the vessels that supply his heart with blood. Such severe blockages were found that he was admitted directly to the hospital for coronary artery bypass graft surgery. In less than one day, his life had changed dramatically.

While lying nervously in his hospital bed, he began to think that maybe there was another way to approach this disease, so he went online. There, he read about the impact of a whole-food, plant-based diet on heart disease, and he decided that was the path for him. He called the nurse, gave back his hospital gown, and despite the pleas of his medical team, signed himself out of the hospital against medical advice. Mr. J’s nurse was so concerned that before he was able to leave, she called his wife to have her convince him to stay. He did not. Later, the nurse even called Mr. J at home to plead for his return. He politely declined.

Soon thereafter he found our Cardiac Wellness Program at Montefiore. He was already taking all the appropriate medications, and he chose to completely change his lifestyle as well. He fully embraced a whole-food, plant-based diet without oil and had perhaps the most remarkable turnaround I have ever seen. Within one week, he went from being able to walk only a block before feeling tightness in his neck to walking 25 blocks without incident! Fast-forward three months and he was back to exercising two to three hours each day without symptoms. That is what I call remarkable!

A few weeks later, Mr. J got another call from his nurse. She had just been diagnosed with cholesterol blockages in her heart, and her doctors were recommending cardiac procedures. With Mr. J in mind, she told her doctors no way and called him to learn how to do exactly what he did: embrace a whole-food, plant-based diet!

Mr. J never did get that bypass surgery, nor did he get a coronary stent. In fact, he did not need to have any procedures at all. He got healthier with appropriate medications and by wholeheartedly embracing a whole-food, plant-based diet.

The key to health, it seems, lies at the end of your fork.

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*Postscript: While many heart patients may reverse their disease with lifestyle change alone, Mr. J also continued his prescribed medications, given the severity of his condition, and their doses were lowered as his health improved. Please note that I am not recommending lifestyle change over medical intervention for any particular person, as every case is of course different. Some cases are fraught with more risk than others, so please consult with both your physician and a physician trained in lifestyle medicine before making significant lifestyle changes.

This post was originally published on the Forks Over Knives blog, here.

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Cardiologist Robert Ostfeld, MD, MSc is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City, where he encourages patients to embrace a whole-foods, plant-based diet. He earned his MD at Yale and his MSc in epidemiology at Harvard, and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.