Make Yourself Heart Attack Proof - Caldwell Esselstyn MD

coronary artery disease really need never exist and if it does exist it need never progress Colin thank you for those kind remarks it's so exciting to be partnered with people like people like Dr Campbell who has such incredible uh credentials who are so generous with their time and have such belief in their convictions and integrity which is what we really are seeking today now what you see on this screen that's the uh building which is called the cowle building at the Cleveland Clinic and my office was on the eighth floor of this hospital and like all hospitals the Cleveland Clinic is a cathedral of sickness those hospitals shine when you crumble and we want to we want to change that right now coronary artery disease does not have the the top headline how many people in your community are going to die of West Nile virus us this year but how many are going to succumb to cardiovascular disease we learned from Framingham that one out of every two males in the course of their life will be affected by coronary artery disease one out of three females and more recently the data suggests that the females are catching up with the men this doesn't start out very well this is a young couch potato and if you look carefully you will see that even the relatives on the wall and the fish and the dog and the dog they're not a sleep yet it's always very exciting when you have to speak right after lunch you kind of uh are hoping now this is back in the days of soio at Cleveland soio is a great gas station which uh preceded BP and uh they just weren't really very public health conscious Dave Thomas who was the great founder of Wendy's and had many admirable personal qualities at what he did for Orphans but one of his his less admirable qualities was that I never heard in any of his advertisements which he participated in himself he never described in detail what preceded and what occurred during his quadruple bypass operation you may remember that when Burger in 1970s when Burger King wanted to outdo their competition with advertising they made a thing called the Whopper and the the saying went that it took took two hands to handle the Whopper whose two hands were handling the Whopper Wilt the stilt Chamberlain where is Wilt the stilt Chamberlain today he's died of heart disease now this is not a disease of the elderly we know from the data from the Korean battle casualties and the Vietnam casualties that when you look without a microscope at the coronary arteries of these young men an average age 20 years even without a microscope there is gross evidence of coronary disease in 80% so so this is not a disease of the young but what happens if you say well how about the civilian population recently there was a study entitled the paday study the pathobiologic determinance of atherosclerosis in the young these persons in this study had died from accidents homicides and suicides and their ages range from 16 to 34 the disease of coronary artery disease was ubiquitous it is tough isn't it right after the after a meal it's going to to get cranked up and listen to coronary disease so the disease is ubiquitous now it's frightening what's happening to some of the Puerto Rican population in New York where they're drinking so much Coca-Cola and having so much of this food food that we now know because of their excessive obesity they have type 2 diabetes in adolescence and the frightening thing is that they are the first generation that we expect that will not outlive their parents nature constantly tries to give us some information about a breakthrough and when did this great breakthrough in coronary disease begin to come a little bit in World War I but especially in World War II what we found was that when the Axis powers of Germany overran the low countries of Holland and Belgium and when they occupied Norway they took away all their sheep goats cattle and their livestock they lost their Dairy and what happened in Norway if you this is Norway and there you can see that how brisk the number of deaths from cardiovascular disease was right up until 1939 when the Axis powers occupied Norway and what happened was that with the loss of meat and dairy there was this absolute plummeting of death from cardiovascular disease only to resume again at with the cessation of hostilities ail peard is a Belgian pathologist who was telling his students in 1946 and 1947 at the autopsy table look at the plaques the plaques are back we didn't we didn't see these during the War years the plaques of return but there are another great lesson to be learned in the natural history of this disease is there are certain Nations by culture Heritage and tradition that seem to thrive largely on a plant-based diet and this this is where I learned about the importance of detail if you go to the Papa Highlanders they're absolutely fascinating because what we always think of as a major risk factor in heart disease is smoking cigarettes and it's absolutely horrible for many reasons but there was a remarkable study of the papa Highland ERS when they are actually autopsi beyond the age of 60 when they die the paple Highland handers most serious common source of morbidity is pulmonary their lungs why because they abolutely grow this hideously harsh tobacco and they smoke it not out in the back 40 they build these communal Hutches and you not only get a chance to rebreathe your own smoke but in case you're a little short you can get everybody else's smoke as well but the fascinating thing is when you autopsy these people over the age of 60 their arteries are absolutely clean why what do the papa Highlanders eat 19 different varieties of sweet potato no building blocks now bear with me for a minute this is a yellow arrow this is a blue [Laughter] arrow this is a coronary artery Branch this yellow arrow now is the point where a cardiologist has inserted a catheter with an ultrasound on it and the ultrasound makes a picture and this is the yellow arrow here and this is that ultrasound device and this is the outline nice and smooth of the artery and now we advance the ultrasound from the yellow owl to the Blue Owl and we take another picture with the ultrasound and here is the ultrasound machine itself and here is the artery but lo and behold what is this this wedge here for years the gold standard was a coronary angiogram if you have a coronary angiogram and it's clear your arteries are okay right wrong one of the first things the artery does when it fills up with atherosclerosis is it tries to expand and it's quite remarkable how to a certain point it can still accommodate enough so that you think your vessel is completely healthy and normally normal by that anigram and it is not at all as we see here well what does that mean somebody comes to me and says Dron I only have one vessel in my coronary artery tree which is diseased uh-uh again when autopsy studies are done even those with single vessel disease if they happen to die as William Roberts who's presently the editor of the American Journal of Cardiology took all the arteries off the heart in a line and then made serial section through them everybody with coronary artery disease has triple vessel disease all vessels are enlarged now how does a heart attack occur we thought for years that this lovely normal artery here and you can see this little Fringe on the inside I'm going to be talking about this some more today this is called the endothelium this obviously is an artery that has had many many cheeseburgers and ice cream and chocolate and you might say Well when this little pinhole finally closes off the person's going to have a heart attack yeah maybe 12 or 15% there is newer thinking about this even though this person may ACC clude shut off this AR right there not going to be a necessarily it doesn't have to be a heart attack down because this plaque has occurred so long and so slow that little tiny collaterals have occurred along side it which will nourish or sustain the viability of that Downstream heart muscle so even if that shuts off the angina may get worse but you might not have a heart attack however 85% of heart attacks will occur not from those large plaques the dangerous plaques are the smaller ones that are occupying no more than 10 20 30 40 or 50% of the Lumen of the artery and as you see here it's a cross-section of an artery and here is a plaque occupying about 35% of the diameter of this vessel and most heart attacks occur in the following manner when you're so-called good bad when you're your good cholesterol and your bad cholesterol your bad chol cholesterol is your LDL but there are two forms of LDL cholesterol your fluffy puffy LDL which is not so bad but when you eat the American diet and you oxidize your fluffy puffy LDL into the small hard dense LDL it gets into this foam cell in the plaque and Peter Libby from Harvard has shown us that when your small hard dense LDL is now this is probably the most important slide I'm going to show today when I'm taking a few minutes on it this foam cell now begins to elaborate these nasty substances these enzymes which will begin to erode this little thin cap covering and it especially erodes it at where the shoulder of this plaque is meeting the arterial wall right up here the proximal end where it is now when it gets as thin let's say as a cobweb the sheer force of blood ripping and tearing and rolling over this weakened cap over the plaque it tears and when that has torn you will now have the loss or extravasation of this plaque content going out into the flowing blood where it activates platelets and now you begin to get the formation of a thrombus which in a few moments or minutes is is going to be completely uding wow this artery which has never had a chance to develop any collateral so that all the muscle Downstream is going to be immediately deprived of blood supply and that results either in a significant heart attack or perhaps a sudden death so when Dear Old Uncle Ned who was never sick a day in his life walks out slides in behind the steering wheel of the pickup truck and then collapses dies why because he was never sick with heart disease but this is the way it goes when the plaque ruptures so what we're going to have to learn today how to do what can you do so that within 3 weeks you can make it so that that cap will never rupture if you cannot rupture your cap of your plaque you have made yourself heart attack proof now I wrote a paper in 2000 that said in cholesterol lowering moderation kills I cannot stand the word moderation in this particular setting why because what happens is we have to look back in the 1990s when there were a whole slew of large scale randomized studies with the statin drugs and the statin drugs were really quite remarkable they lowered your cholesterol you didn't change your diet at all and it still lowered your cholesterol but what happened was they found in these large studies 30% fewer new heart attacks 30% fewer heart attack deaths 30% fewer interventions needed my question was what about the other 70% this is not cancer this is a benign disease why do you have to die from this because it wasn't simply treated it was moderation now presently the big push on coronary disease we get ever and ever more sophisticated in how we do the operation for bypass how we do the plasy and how we do the the stent now they got a stent coated with ceramus that is not supposed to shut down but what do we do if we look back over the last decade 250,000 people a quarter of a million people die immediately when they have these procedures I'm not talking about those that die later I'm talking about those that die with the procedure and there's a significant morbidity with infection heart attacks and strokes an expense Eugene bronald at the shat lecture in Harvard's mentioned that the present Cardiology budget for the United States is over a quarter of a trillion dollars and the sad thing is with all these interventions what's happening the benefits erode with the passage of time we got to do better than that so I ask my patients to look at coronary disease as a raging brush fire remember those endothelial cells that I mentioned a few minutes ago that line the inside of the artery there are 700 square m of endothelial cells in your body and that large think of it as a large large tennis court and your heart disease is that that tennis court is a blaze what does moderation do if you think of roast beef and ice cream and chocolate and if your cardiologist says eat lean roast beef or only have it once or twice a week let's go out and pour gasoline on the fire once or twice a week and you wonder and you wonder why patients the good old boy he fought hard he had his first bypass and then six or eight years later he had his second bypass and he couldn't have any more he hung on 12 years after his heart he never had a disease treated how do you treat the disease you don't talk about moderation CU if you say moderation to one person you'll say ah God I'm not going to have that birthday cake tonight but the other person will say yeah I heard Dr Elon he said it's not good to have that I'm only going to have half of it so moderation means different things to different people when I first started giving this presentation years ago this was a this was kind of a [Laughter] joke halfway through his hearty man breakfast Dwayne thought he heard some of his smaller AR is slamming shut Robert vogle did the classic study there have now been 10 we know that with a single meal you absolutely injure your endothelial cell how do we measure that if you put an ultrasound on your brachial artery in your arm and you measure you can get an idea of the diameter then you put a blood pressure cuff on your arm and you squeeze it off so there's no blood supply to your arm for five minutes then you release it and then you measure again the ultrasound and what do you find the diameter is markedly increased compensatory Vaso dilation flow mediate dilation vogle took these medical students and divided them in half one half at McDonald's got the Corn Flakes the other half got the McMuffin breakfast and what do you think happened to the braal artery T Test no change in those on the Corn Flakes and those getting the McMuffin breakfast after 120 Minutes you completely marketly reduced lost that compensatory vase of dilation and that has been shown many many times and it's profound and this is why I think as you'll see in our particular study and I think in in everybody who deals with this attention to detail is important these days before I counsel somebody I ask them I said be sure you read my website and be sure you're comfortable with the fact that two things that a if I'm going to counsel you you must be willing to Forever eliminate the phrase this little bit won't hurt and also if you're going to visit with me if you're going to have me counsel you I have no interest in counseling you if you want to just slow the disease if you want to absolutely annihilate this disease I'm delighted to try to help the Manel chemical sensus this goes back to what doug La was speaking about this morning Doug you guys aware of this study the Manel chemical sensus Center took three different groups of patients those at 34% fat typical American 20% fat and then down around 11 and 12% fat which is where our program is and they found that in only one of those three groups do you lose your craving for fat 12 weeks 90 days 3 months and that's in the group that is uh at 11 to 12% this is what should happen you put the fire out I want to share with you the study that I began in the early 80s I uh should share that I at the Cleveland Clinic I was chairman of our breast cancer task force and head of the section on thyroid and parathyroid surgery but my disillusionment with my surgery most profoundly occurred with breast cancer and no matter how much of this surgery we did the line wasn't getting any shorter and I was not ever doing anything for the next unsuspecting victim and it looked like a pretty nasty Epitaph to think this man did X thousands of mastectomies or partial mastectomies and and there had to be a better way so first I dug into the literature and found that in Kenya breast cancer was 20 times less frequent in Japan in the 1950s it was practically unheard of but when Japanese women would migrate to the United States by the second generation they now had breast cancer at the same rate as their Caucasian counterparts powerful prostate even more powerful in 1958 how many men in Japan died autopsy proven of cancer of the prostate 18 there'll be that many off of the staff at the Cleveland Clinic in the next two to three years well how can anything that that powerful we have an epidemic in this country I'm not talking about West Nile disease this is these are epidemics that are very real and very powerful so at uh after reviewing this I just didn't see any way with my resources that I could do a cancer related to nutrition and neoplastic disease or cancer and since card since coronary disease seem closely correlated with these population studies it seemed like a very appropriate thing to take the leading killer especially because it was a benign disease and there had been work to suggest that this could be changed and it could be possibly even uh reversed so I uh mentioned to you about the epidemiological data and I started with 24 uh patients all who had severe triple vessel disease the study was limited for several reasons one I still had to earn a living as a surgeon and secondly um I was allowed one half day a week for This research now also the rock upon which this study was most likely to flounder was patient compliance and I'm I didn't have the the the skills that Doug ly has I kind of had to go by the seat of my pants when I went to uh the cardiologist uh to see if if I get some support they said oh you know forget it that cholesterol thing is a myth there's not really any relationship there so I went to our our senior dietician with a national reputation and she said nobody's ever going to eat that diet so I really knew I was on the right track and and so and I was to get compliance I borrowed a a friend from a Bert duny who was a surgeon I had great respect for from the West Coast who said this about treating cancer patients cancer patients are not afraid to suffer and they're not afraid to die but they are afraid of being abandoned by their family or their physician and I wanted to make it dugun sure that these patients knew that they were never going to be abandoned and then we had a few other compliance strategies so therefore the first five weeks I saw these patients myself every two weeks and went over every morsel they ate and we drew their um blood cholesterol we had to give them specific goals to I think this helps anytime that you're don't just say cut down on your red meat or take the skin off the chicken give them goals I wanted them to eat a totally plant-based diet like we see in those cultures where the disease is unheard of and I also wanted them to achieve the same blood cholesterol blood lipid levels that we see in those Nations like Colin Campbell rural Chinese for you range between 90 and 150 how many Americans have a cholesterol of 150 it's very hard to find naturally I mean not living on a Statin so keep the cholesterol under 150 the LDL under 80 and have a 11% plant-based diet I was so frightened moving out of my area of expertise into the Cardiology Arena that I used a belt and suspenders method although I I was totally committed to the Nutritional dietary program uh I wanted to give them a little nudge from a cholesterol Lo medication as well we did uh allow them any any unstructured exercise if they wanted to they could meditate I did not as meditation and relaxation and structured exercise was not a part of the program why because I hadn't found in any of my research that these nations that didn't have this disease didn't have it because of meditation or or exercise but it was because of culture Heritage and tradition they didn't eat any of the aosc building blocks and also my concern was if if you take people and ask them to do too many things that 20 minutes in the morning you have to meditate and then you got 40 minutes of structured exercise at night then 20 more minutes of Meditation Plus the most significant nutritional change you've ever known each of us has within us just so many behavioral modification units I wanted every one of those behavioral modification units to be focused on the nutrition you don't gain points by 15 more minutes on the exercise. bike on Tuesday does not entitle you to a hot fudge Sunday on uh Friday night because what we were trying to do was once these patients downregulated their fat receptor we have receptors for cocaine heroin nicotine but as soon as you can be off the fat for these 90 days you downregulate the receptor then you don't have a sense of denial you're not miserable your angina is improving your weight is low lost you're meeting the go goals of the study and it becomes terribly exciting what do we have to meet whole grains legumes lentils vegetables and fruit you've all famili and heard about this no oil fish foul meat or dairy no oil no oil let's just take a moment here because some people still are not clear about the fact no oil all right why because the data olive oil is terribly seductive Scott Gund Grundy did some studies that are very short term that showed that it increases your good cholesterol lowers your bad cholesterol improves your ratio it got a huge amount of press doctors heard about it and therefore it must be wonderful right wrong because you look at longer term studies blanken horn right in the California two groups of patients one saturated fat the other monounsaturated like olive oil the Baseline angiogram at the end of the year the angiogram disease of coronary disease had progressed just as much in each group Lawrence Rudell in the Research Triangle took the African green monkey similar liid metabolism to man saturated unsaturated 5 years in the monounsaturated olive oil group higher HDL lower LDL better ratio autopsy just as much coronary disease the oil companies didn't like that so Lawrence Rell repeated the study with rodents and the result the same Dr vogle has gone on and shown us indeed that olive oil activates clotting Factor 7 just as much as butter wow and Vogal in a separate study and on in a separate study have shown how it impairs flow mediated dilation that I just talked to you about the brauler tesque and last month in the journal uh the Journal of the of the of the National Cancer Institute olive oil along with meat and dairy is implicated in uh a risk factor for breast cancer well that wasn't quite enough because I do get the Harvard Heart letter and I have great respect for Thomas Lee who's the editor but one of those heart letters said for heart patients be sure you use the heart healthy oils canola oil olive oil so I wrote to Dr Lee I said dear dear Dr Lee I've have have always had the highest regard for your Harvard heart uh letter but I was puzzled and skeptical by your recommendation for oils for patients with heart disease and I enclose for your review uh these six articles and references that I'm aware of that suggest that this is not a good idea and I also enclose for you a copy of my study and 6 months later I got a letter back from Dr Lee dear Dr selon thank you for your reprints and your study I would agree with you that as we move forward in this most complex of diseases that we should remain flexible no oil no fish foul meat and dairy the key would be the initial meeting with the with the patient and the spouse you I cannot underestimate the importance of this uh you've got to give them the whole background of the disease like you're getting today and get into the the business of how the how they eat the recipes and how they could market and get their food see them as I mentioned twice a day excuse me twice a twice a month for the first 5 years once a month for the second 5 years and then once a year excuse me once quarterly and I think that made our study the the the longest uh arrest Universal study uh of that duration in addition those first 5 years we would have periodic group Gatherings about every three or four months either our house or one of the participants and the ticket of admission was one or two of your favorite legal recipes because recipes was what we were always looking back for back in the uh mid and early ' 80s and they they like the idea that both my wife and I were eating this way this is just a one of our Gatherings they started with cholesterol at 237 and then at 5 years they uh had I think the lowest total cholesterol in the literature for studies of this type L HDL held steady LDL was 76 we like it under 80 most cardiologists like get it down to 110 100 triglycerides 143 and again at 12 years they were still well under 150 the stable LDL and as a result they uh did very well now the angiograms I'm got to these angiograms that you about to see were the follow-up angiograms that they had at 5 years in a in a in a in 11 or 12 of these patients these angiograms were reviewed in triplicate in the angiography core laboratory at our physician at our facility by two senior technicians who have great skill and National trials in comparing these why am I going to take a moment to say this can't can't a cardiologist just flip this up on his screen and have the experience to say this is an 80 or 90% blockage or this is 70% no because when this was done routinely the cardiologist never recognized it what I'm showing you here is the smallest Improvement that your eye can see in a 67-year-old retired pediatrician and what happens where the arrow is here and here when that is reviewed in triplicate with a six-month Gap So to avoid bias of recall this is a I can say with accuracy that this is a 10% Improvement this vessel here happens to be a 20% uh Improvement and in a 58-year-old uh factory worker in a retired security guard this is in the right coronary artery this is a 30% Improvement and this was a gentleman by the name of Dr Joe Crow and and I use his name freely because I've had him at National meetings Joe at age 44 replaced me as the uh breast cancer for his chairman and at age 44 he had a cholesterol of 156 he had no family history he was not a smoker he was not overweight he did he was not diabetic and he began getting chest pains in October of 1996 and he saw Cardiology and they said he was fine and 4 weeks after he had seen the cardiologist he finished his surgical schedule and was writing post-operative orders in the operating room when suddenly the elephant began sitting on his chest crushing weight severe pain in his left shoulder and down his arm Joe Crow was having a heart attack now he was immediately taken down to the angiography suite and he had quote unquote a normal V normal coronary arteries except for the lower end of his left anterior descending which we call the Widowmaker the lower end of the left anterior descending had this sort of moth eaten look and it was far too long a segment to have an angioplasty or a stin and it was too far down in the artery to successfully have a bypass so Joe was feeling very disconsolate and depressed with three young kids and a wife and so we had him out to the house two weeks after his heart attack and an and I went over things and Joe I said look we've got 10 years of data now on this study I think you know you have been eating the horrible toxic American diet I think you've got to go plant-based and he said I'll do it but I'm not going to take the cholesterol lowing drug Joe Crow became the absolute personification of commitment to the plant-based diet his cholesterol went from 156 before his heart attack to 89 whoa just like a rural Chinese his bad cholesterol went from 98 to 38 and after not 5 years but after 2 and A2 years he had another anagram and as you can see look what nature did now you're not going to see that with all plaques plaques if you carefully look at them and analyze them are made up of calcium which you're probably not going to be able to budge a lot of scar tissue you can't change but that component which is made up of soft lipid GRL you can often get some significant reduction and that I think is exactly obviously what seemed to happen to uh to Dr Crow now pictures are fun but what about the patients how did they do I recognized within the first 12 to 15 months that there were six of these patients who simply were not compliant and they uh I was on an absolute barebones research budget and so with their understanding I said look I'm going to return you to your expert cardiologist for care you don't have to depend on this general surgeon for your care but I will insist upon from time to time I'll just want to see how you're doing and what's going on with you those patients over the next 12 years those six patients who dropped out four of the six had to have a excuse me a bypass operation one of them had an angioplasty and the other died of the of those remaining 18 patients who stayed with us we looked at what happened to them eight years prior to the study and they had had 49 coronary events while under the hands of expert cardiologists ranging from increasing angena disease progression by angiography bypasses Strokes heart attacks need for angioplasty or worsening stress test and in the 12 years on the study 17 of those patients had no further events we had one little sheep who wandered from the flock at six years he got a little confident a little cocky started eating the wrong no no Dairy no milk what did he eat he began eating Foods in packages and bottles that said fat free by government the FDA in 1993 said to the food manufacturer you can say zero fat per serving if the serving has less than a half a gram myot tallics of artery clogging fat so what happened was when you have endon's morning breakfast pastry my granddaughter is going to have five slices but the He-man is going to have 10 now each of those 10 slices have a half a gram of artery clogging fat but the He-man doesn't have it alone he's going to have right zero fat preserving promise not one two swipes so he's now had two of the two swipes of the zero fat preserving promise Each of which has a half a gram of artery clogging fat but he was so good at breakfast come lunchtime he has a zero fat craft mayonnaise the zero fat salad dressing and the zero fat Alpine Lace cheese so now with your fat-free day going so fine you come home at night into the kitchen wrap your arms around your sweetie and look over her shoulder at the kitchen counter and then whisper into her ear sweetheart this little bit can't hurt is it any wonder that anybody can arrest their heart disease the flame is not going to go out you you can't put the fire out if you keep feeding it with these zero fat preserving products you've got to learn how to read ingredients not the white label that the government gives you read the ingredients are there mono triglycerides is there partially hydride hydrogenated is it hydrogenated is there glycerin you've got to know that is the absolute fundamental the important thing to detail now if we review what happens is compared to the intervention approach there's no mortality from the diet there's no morbidity from the diet and what happens with the passage of time it does nothing but continue to improve and the thing is so exciting not to the cardiologist or the cardiac surgeon the excitement here is that the Locust of control of this disease is in the hands of the patients and that's extremely empowering and it's so empowering also because how many people have a situation where Uncle Joe who is at a heart attack and Ne Uncle Joe or Mrs Uncle Joe or relatives don't know when he's going to have his next heart attack that is a huge burden for a family to constantly live in this absolute fear of when the other shoe is going to fall but if you make yourself heart attack proof then that fear goes out the window now quickly we want to go through a couple of other organ systems if you look at 500 swedes who are over the age of 85 onethird will have dementia well that's not a nice exciting thing to have you work all your life and then you get into retirement you get to be these senior years and then you have uh cerebral drift and they studied it carefully found out 1 half of that 13 was due to vascular disease and by now you know that doesn't have to happen but there was a fascinating studying done by Megan clear at the stroke meetings in February of 2001 in in Miami where what did she do she and her team looked at 11,000 MRIs of the brain and what did they find at age 50 many Americans begin noticing in their MRIs there's little unidentified white spots which we now know are small Strokes you keep walking you keep talking there's a lot of Reserve in your brain and you just have these little strokes but if they continue and you're now in your late 60s and into your 70s memory begins to go then cognition goes and then when Grandpa comes downstairs in his basement on Sunday morning in his bathing suit asking for waffles we got problems that is a normal MRI nice and dark throughout here except for these uh fissures but this I counted these the other day there are over 90 lesions severe suppose we start doing suppose we ought to start doing this on our Supreme Court Justices checking them out this is probably one of the most under recognized organs in the body the ascending aort when you're left heart squeezes all the blood goes into this enormous pipe we call the aorta it goes up for about 3 and 1 half to four cmers and just like you gather debris in your coronary artery you gather debris in your ascending aorta and if you've been in surgery and you open the aorta especially in the abdomen in these patients and you have just wipe your finger around the back of it it comes up like chees you're going through cheesecake very Loosely applied so aramco in France did a fascinating study where he took patients who had a a tendency to have high risk factors and he had them do what we call Trans esophageal echocardiog where they simply swallowed a tube with a little ultrasound probe and it anatomically is very very close to the aorta so you could get pictures of how much atherosclerotic debris was in that aort and he graded it between those who had 1 millimeter of debris to 1 point to one to 1 to 3.9 and those who had over 3.9 millimet of debris and they followed them for three years and which group had the highest rate of stroke yes the group with over 3.9 millim of debris but where it really shows up every day and this is very un undiscussed when you have a coronary artery bypass operation the surgeon has to place a clamp across the ascending aorta he doesn't go sideways he just needs to get a little cuff on the side so as he's in placing this we call it the satinsky clamp so he can get a little cuff of tissue to insert the gra the bypass graft into when he says when he says clamping if at the same same time you are monitoring the middle cerebral artery with an ultrasound you will hear this why all that debris has been loosened from that aorta and it goes up into your brain through the pth path of least resistance right up here and if you happen to have a quadruple bypass that's times four and if you have another bypass two four years later it's four more times and it's not surprising some of these people have as significant incopy they can't hold their job and as John McDougall and I were talking at lunch up to 52% lose up to 20% of their cognitive capacity as as me measured by neuros pychological testing this was in the New England Journal about a year and a half ago but not many bypass surgeons look you in the eye and say I'm going to take away your some of your cognition one of my patients in coming to the SC through the block long Skyway to my office had to stop five times because of severe pain in his calf we call it claudication because of poor circulation we got so focused on his heart that we sort of forgot about his leg but when he first came in I did have him go to the vascular lab and this was his pulse volume then at the on the time of his first visit eight months later he said to me Dr selon we've been so focused on my heart I forgot to tell you that I don't stop five times coming to your office two and a half months ago I found that I didn't stop 4 3 2 I don't stop at all okay Don back to the Vas your lab and I think you can see the amplitude of the pulse is significantly increased there was no mechanical intervention of the artery in his leg he simply did this or allowed his body to do this with profound cholesterol reduction now this is a study that's I'm going to try to finish up this year I got uh very in interested in the fact that many patients when I first would start counseling them would come back and say within 10 days or 2 weeks my chest pain was getting better well how can that be have they washed out all that plaque no that hasn't happened that rapidly but something else has and I thought we ought to try to get some science into this this is a pet rubidium diol scan where the isotope being carried by the blood will show up in the heart muscle and if it if it shows up uniformly and completely you're as yellow or orange you're okay but but this green patch in this 58-year-old school bus driver from Youngstown who came in with a cholesterol at 261 at Baseline I saw him that afternoon we went at him with a hammer and tongs and he got his cholesterol down to 126 in 10 days and then 6 weeks later we repeated the scan and he is completely reperfused here now what seems to be going on as we see also in this 75y old retired tul and die maker cholesterol 248 and you can see this whole wall is really bad now this isn't as Dean showed us the other night somebody who had this repeated after a year or 18 months this is at 6 weeks this is actually one at 12 weeks where he had restored his flow this one is particularly fascinating because you can see a progression in this view it's you're supposed to look kind of like a donut and here he is at rest this individual had a cholesterol of 290 the only thing that was higher was his weight he was a retired Barber from sanduski and he was lying in the Intensive Care Unit at the clinic with anina at rest lying flat had failed to bypass operations and he was wonderfully compliant though but you can see he really had a very very poorly profused heart muscle here and we did this not at only at Baseline but look in 10 days he knocked his cholesterol down from 290 to 130 he's my champ for that and and in 3 weeks he was beginning to get a little bit better profusion here and by 6 weeks he had really gotten it all together he had the unmitigated tarity to call me from the 18th hole of the golf course complaining that he still occasionally had a little chest discomfort which went eventually went away when his weight went down to 250 and there he is again now this is the most exciting one and this is what got me very inspired about the next PATH that my research will take this was a stock broker with a cholesterol of 248 and here he was not profusing right here and he came back they got his cholesterol down to 137 he came back and we did this at 3 weeks and he was reperfusing the green is gone now let's get smarter I think I can be a lot what is what is happening here is that when you lower cholesterol you immediately begin to re restore the capacity the of the coronary artery endothelium the inner lining of the coronary artery endothelium those cells make the nitric oxide once they have been restored to make nitric oxide now that is the most powerful vasod dilator the body makes so that this whole coronary vascular tree despite these lumps and bumps and plaques Upstream the whole coronary vascular tree under stress now it doesn't basil constrict it widens and according to P's law of throw through the how tube is related to the fourth power of the radius we get an enormous increase in flow with a small increase in diameter now why is it exciting it's exciting because if we can do it in three weeks maybe we can do it in one week and if we can do it in one week who's going to want to have a bypass an and plasty or a stent and if we can somehow get into the head of the insurance companies that is that brussel sprouts and broccoli are cheaper than the stance uh we may make some progress these again are those endothelial cells right in here 700 square m of endothelial cells the largest endocrine system in your body we want to have you heal your endothel cells in three weeks thicken the cap shrink the plaque and now you've made yourself heart attack proof homosysteine is a rascal that like coronary disease is a risk factor and by being sure that you have plenty of folate b6 and b12 in your diet and don't eating and you're eating a a sensible plant-based diet this should not have to be an issue if you want to know what your coronary arteries are like without getting a catherization through your groin with a with a wire and a catheter shoved up into your coronary arteries as we see here on the left on the right this is a cardiac CT the software is so sophisticated now at the Cleveland Clinic that you can get beautiful pictures of your coronary arteries just by doing this cardiac CT here they are at the base of the aorta this is a lovely picture of the coronary artery this is another view from above and I think that that is really elegant especially if patients who are reluctant to want to change and don't don't think they have any coronary disease this can be quite convincing and here is another view of the same just in case a few of you thought the oil thing wasn't serious this i' really I borrowed from Colin Campbell just to hammer that oil thing one more time because look at the difference here was Colin in 1997 at the Second National Conference on the elimination of coronary disease and they were asking him while Dr Campbell why is it there is such a difference in coronary disease as we see here from this Mediterranean area and Dr Campbell said well I since they're both eating the same kinds of vegetables grains and fruit it's due to uh in my opinion to olive oil now we do have a struggle and what we're struggling against are Physicians the media the government and our national health organizations and that's what makes this business exciting if every everybody was doing this and there was no challenge who would want to do it so we've got some work to do the American Heart Association and the national cholesterol education program recommend 30% less calories from fat and up to 200 milligrams of cholesterol remember 35% of the people in the Framingham study who develop heart disease had cholesterols between 150 and 200 you follow these recommendations it's a guarantee that millions of Americans will perish this is the national re research Council in 1989 in their classic compendium nutrition uh diet and health and in the conclusion they say that there is evidence that further reductions in fat May confer even greater health benefits however the recommended levels are more likely to be adopted by the public because they can be achieved without drastic changes in dietary patterns why not just tell the public the truth let them decide to what degree they want to be compliant why not why give them evidence that is incorrect and here's this Framingham now my own institution I have to take a little crack at this is now up to I believe it's over eight years we're considered number one in the role this is for uh bypass angioplasty and stance not prevention because this goes on on the second floor on the first floor we actually build a disease this is uh our Hospital that was uh that was McDonald's this is Pizza Hut at the clinic and these are all my friends and the staff over the last 35 years who have crumbled from either strokes and heart attacks to some degree and but we didn't get it right just a few weeks ago we had another now this though may be a crack in the wall Eric toppel is the acknowledged one of the great leaders in cardiology in this country and he has been acknowledged for all of his interest and mostly it's been all these intervention procedures but he was the author of a study of some 600,000 patients where they looked at whether or not there were risk factors that caused heart disease a lot of doctors say that half of my patients don't have risk factors they looked and they found indeed in truth over 95% of patients indeed had at least one risk factor and his conclusion was these studies certainly blow away the myth of bad genes we cannot cure this disease until we address the fundamentals of lifestyle and we hope that that may be a really a very powerful thing so those of us H who look at this U profession the 20th century was really the century of of great breakthroughs and now what we've got to do is we've got to take it beyond that we can't just PE keep trying to mend people when they've Fallen apart we have got to have the 21st century be the the century of prevention and we've got to be careful this is the elephant and this is the baby chick some Nations don't need this kind of instruction but these guys are in great trouble and what you want to do with your clean arteries your arteries at 90 ought to look like they did at age nine and I'm always fascinated by the idea that Dr uh uh oh the fellow who run who runs the tire company who spoke yesterday yes uh he talked about the importance of persistent and passion and this happens to be a young lady who was trying to learn to do the splits in My Life Magazine back in the 19 late 19 1930s and with great passion and persistence somebody came across her the other day in Seattle and indeed uh she had got it [Applause] right and I think that uh on that particular note I want to say one final thing to this audience recently I spoke at the U North American vegetarian conference and I heard Michael Gregor's tape and he talked about how vegans are dying of heart disease and they have cholesterols well under their and 230 that really is unacceptable and I when I think that you've got to understand the importance of detail I don't have time in a talk like this to get into it but you have to know your numbers I'm not addressing now some Phantom people out there who are not vegans and that all of you are automatically protected here you're not protected if you go out to your best friend's house for a meal and belly up to the trough you're not protected what do you do with when you eat out do you know what is going on in that kitchen do you know that your cholesterol without a cholesterol oing drug is always under 150 and your LDL is under 80 know your numbers get the feedback we don't want to have you get those little white spots you're too precious to all of us thank you [Music] [Applause]

Channel: VegSource - Jeff Nelson

Views: 916,993

Keywords: heart, attack, disease, caldwell, esselstyn, reverse, cure, vegan, plant-based, diet

Id: AYTf0z_zVs0

Length: 62min 21sec (3741 seconds)

Published: Thu Dec 03 2009