Prevent and Reverse Heart Disease with Caldwell B. Esselstyn, Jr., M.D.

we have the honor of hearing from dr. Caldwell Esselstyn was trained as a surgeon at the Cleveland Clinic he's a fellow of the American College of Cardiology will learn to any of you that have watched the movie Forks Over knives and in addition to his prestigious medical career in the great publications he's produced and the books he's produced for both medical and lay professionals he has served in Vietnam and was awarded the Bronze Star and in 1986 won a gold medal with the u.s. Olympic rowing team dr. Estes team please come join us [Applause] thank you so much for coming sir I want to really thank Naomi and her team for putting together this incredible conference and it's such a delight and it's such a such a delight for us as speakers who have felt the passion for this type of of research to see that there is of interest throughout the committee now we got a lot of ground to cover and I've been told I have to get you out of here by midnight so I thought we ought to really get cracking the the key here is that we in this country have to hang our heads in recognition of the fact that we have built a billion-dollar health industry around an illness that does not even exist and half the planet your cardiac surgeon and you decide you're going to hang out your shingle in Okinawa perhaps rural China Central Africa the Tarahumara the papal Highlands Trigg in it you better plan on selling pencils why they don't have cardiovascular disease why they all strive on whole food plant-based nutrition without oil now this slide is the oldest one of my presentation taken in 1968 when I was leaving Vietnam as a combat surgeon and it reminds me to share with the audience that if we do autopsies on our young GIS average age 20 80 % of those in Korea who were autopsy had gross evidence of coronary artery disease that you could see without a microscope not enough for their cardiac event yet but here the disease was already with a foothold that study was repeated than 45 years later this I'm now looking at those young women and then between the age of 17 and 34 who have died of access homicides and suicides now the disease is ubiquitous not enough for your cardiac events but here in this country you graduate from high school you get a diploma and you'll also get the foundation for cardiovascular disease now are there anybody here in the audience who's over the age of 17 always so much more exciting when you're talking with patients okay now we had a chance as a medical community to get it right in the world war two that's when the Axis powers of Germany over and the low countries of Holland and Belgium and and they occupied Denmark and Norway and in 1951 doctors strom and Janssen reporting and England's leading medical journal the lancet looked at the death rates from stroke and heart attacks in Norway during this period and it was interesting together if we look here in deaths from heart attack and stroke in Norway in 1927 going up 1938 going up 35 going up 39 and come the Germans 14141 who knew these Germans were these great public health educators but look what happened by 1945 with the death of Adolf Hitler the cessation of hostilities in the European theater immediately back comes the meat back comes the dairy back comes the strokes and back from the heart attacks but sadly we just didn't get it okay now here the plot thickens these next four or five slides would be the most important of my presentation if you look at the right obviously that's a terribly diseased artery and it has taken many many decades to get that and you're probably saying when that finally closes off that little opening in there in that right artery there'll be a heart attack but actually know only about ten percent of heart attacks come from something that is this chronic on this severe but I want you to notice on the left here we have a normal artery and even those of you in the back of the room can see that that delicate innermost lining of a normal artery that little tiny dark line the endothelium that all experts would agree that endothelium is the absolutely the life jacket and the guardian of our blood vessels why because it manufactures a truly magic molecule of gas nitric oxide which has some truly remarkable functions now on the left when you start eating the cheeseburger the hamburger the milkshake pizza everything suddenly begins to get sticky sticky sticky your platelets your white cells your LDL cholesterol everything gets sticky this is the interface blood is flowing up here in this blue area and you can notice the little tiny endothelial cells which separate the artery wall from the flowing blood now up here in the upper left these orange little molecules of LDL cholesterol are gotten so sticky from the pizza you've been eating and the endothelium is sticky and it's got some cracks and fissures so below and behold your LDL cholesterol migrates and finds its way into the sub endothelial space where it rapidly becomes oxidized by these free radicals from as this type of food you're eating so now the submental through those fellows space does not like these small hard dense LDL particles and calls for the swat team our white blood cells which Peter to be from Harvard here has painted blue in honor of Yale and we'd like that now here you see this macrophage gobbling up gobbling up all these small hard dense LDL particles till we get all the way over to here when we do what we do so often in medicine we change the name it's now called the foam cell and the foam cell is truly the Darth Vader of this sequence because it makes these nasty metalloproteinase proteinases and these nasty metalloproteinase enzymes tend to thin out the cap over the plaque right here in the left you can see how thin the upper part of this cap is and what happens is that gets so thin that the sheer force of blood charging over it tears it and now suddenly we have the rupture this is a seminal moment you have a rupture of a plaque there is no bigger than 10 20 30 40 or 50 percent and now there is the easing out of or the the extravasated into the flowing blood which activates our platelets our clotting factor and before you know it we are over here to be in a matter of minutes now we are forming a clot and this clot is in and of itself self-propagating so in a matter of further minutes we're not only over the sea and the clot is completely blocking this artery so all the downstream blood flow here is stops this heart of heart muscle down here totally deprived of oxygen and nutrients and it starts to die and that's 90 percent of your heart attacks now if I do my job for you today correctly every one of you and your friends and relatives should be able to make yourselves heart attack proof we're not going to do this you're not going to make yourself heart attack proof with another drug or a pill or a procedure or an operation you're going to do it by changing your biochemistry how you going to change your biochemistry by totally changing the whole food plant-based nutrition when you do that you interrupt interrupt entirely this nasty cascade of events that I've just been describing things don't get sticky you don't have migration of the LDL into the sub endothelial space there is no SWAT team there is no foam cell as a matter of fact you will not be eroding or thinning out the cap over your plaque you will strengthen the cap over the plaque if you strengthen the cap over your plaque it cannot rupture if it cannot rupture you have made yourself heart attack proof we think it takes about three weeks to make that happen now you can forget the x-ray here but I want you to notice half of the opening is a plaque and half it is still opening and these are the endothelial cells now we used to think up until 1980 we used to think of the endothelial cell as one of those cute little red bricks that was simply lining one of our pipes that all changed in 1980 in 1980 doctor first got working in Brooklyn was taking the largest blood vessel in the rodent the aorta and he would do this sort of elliptical spiral staircase cut right through the endothelium immersed it at the bath of saline and it would constrict one day no cut the immerse the aorta it dilated did it again it dilated now suddenly the race was on globally what was the e d RF the doctor first God had discovered endothelial derived relaxation factor thank heavens that term was with us only eight years when doctor first got lube ignarro and dr. Murad discovered that the EDR F was a gas nitric oxide for which they got the Nobel Prize in 1998 now what is it about nitric oxide that makes it so special one nitric oxide keeps all the cellular elements in our bloodstream flowing smoothly like Teflon rather than filtro nitric oxide is the strongest blood vessel in the body when you climb stairs the arteries to your legs to your heart they widen it dilated nitric number three nitric oxide keeps the wall of your artery from becoming sick and stiff or inflamed protects you from getting high blood pressure or hypertension number four nitric oxide nitric oxide in a normal healthy amount will protect you from ever developing blockages or plaque so literally everybody on the planet whether they are from Chicago New York London Berlin or narf work if they have cardiovascular disease it's because by now over the previous decades they have so seriously trashed injured and turned their endothelial system into a train wreck they don't have enough nitric oxide protect themselves from making blockages in plaque but the good news is that this is not a malignancy once you get patients to understand that never again are they to have passed through their lips any food morsel that is going to further imperil danger and compromise the capacity of their endothelial cells to make nitric oxide then the endothelial cells recover your disease progression stops we often see significant elements of disease reversal now how do you measure nitric oxide you take an ultrasound probe place it over the brachial artery at the elbow and there on the screen is to read out then for five minutes you insert from the upper arm inflated above bust systolic blood pressure so that for five minutes there is zero blood flow to your forearm and hand in hand I've had that done it's not exactly habit-forming but nevertheless when you release the cuff immediately we measure the brachial artery diameter and the normal individual it'll be 30% greater now the next thing that happened was interesting was when dr. Robert Fogel chairman of cardiology at University of Maryland took a group of healthy young subjects to a certain fast food restaurant characterized by arches which are : half in him got the cornflakes brachial artery cat tourniquet chest those that had the hashbrowns and sausage within 120 minutes break your heart and tourniquet test they couldn't donate the artery that single meal of hashbrowns and sausage had so injured the capacity of their endothelial cells to make nitric oxide they didn't have enough to dilate your artery but being young following them into the late afternoon early evening they began to recover but you and I know that the next morning for breakfast it's going to be scrambled eggs and bacon lunchtime we'll have white bread with cold cuts and mayonnaise suppertime baked potato with sour cream lamb chops vegetables soaked in butter ranch dressing on the salad ice cream for dessert here in the good old USA we start in our childhood hammering and pounding and injuring our endothelial cell system all day long while I was emphasizing right now the endothelial cell these are three other highly important defense mechanisms that our bodies have we went to midnight we could discuss the other ones but let me just say this every single one of these optimal defense vac members become totally up when you eat plant-based nutrition when you're eating plant-based nutrition you're making all of these work the very best that they can let's get to some results this is the earliest study that I did it was small because I was still actively involved with surgery nothing against women it's just the way the patient's that were sent to me they all had severe triple vessel coronary artery disease and I wanted them to avoid the foods that injure the endothelial cells every time they passed your lips any drop of oil olive oil corn oil soybean oil safflower oil sunflower oil coconut oil palm oil oil and a cracker or only a piece of bread oil into salad dressing and with a mother or a face fish fowl chicken turkey eggs and no dairy milk cream butter cheese ice cream yogurt no sugar and I don't like caffeinated coffee now here's a peer-reviewed scientific article for those of you who are nervous about just said about oil Allah I love soybean and palm oil intake have a similar acute detrimental effect over the endothelial function in healthy young subjects this is the workers stamp from the Cleveland Clinic and this is how you argue those who are paleo all these foods contain the molecules of lecithin and carnitine and Stan Hazen found that when you ingest these molecules through these foods persons who are omnivores possess in their microbiome the bacteria in their gut will metabolize lecithin and Connaughton to TMA trimethylamine which is rapidly oxyde by your liver to trimethylamine oxide and trimethylamine oxide injures your blood vessel here's the schematic lecithin in the carnitine got bacteria trimethylamine oxide vascular disease however however stan found it if those persons were totally plant-based FINA by Lambchop check their blood no TM AO pretty exciting stuff however if you decide to have that lab chopped 4 or 5 days in a row you now convert your bacteria to the nasty one I'm going to switch gears for just a moment because in October of 2015 the w-h-o the World Health Organization did what nobody thought it ever could do all these different nations got together and agreed that red meat had the same level of carcinogenicity as smoking cigarettes so what are you gonna eat you're gonna eat all these marvelous whole grains for your cereal bread and pasta 101 different types of legumes and lentils all these marvelous red yellow and green leafy vegetables and some fruit now a comment here something that we've started in the last six and a half seven years it's not in my book but if I persuade a patient with heart disease to imagine shrinking their head so we could get inside their coronary artery they can see the plaque is an absolute a clone of oxidative inflammation now therefore we eat antioxidants but no do not go down to the health food store that buy a jug of pills that says antioxidant because it doesn't work it's going to be harmful antioxidants we want you to get from your food what food food that is high in what we call or AK value o our a/c oxygen radical absorbance blueberries strawberries and blackberries on your morning oat cereal that's a terrific start but nothing nothing can trump the antioxidant value of green leafy vegetables so I asked these patients to chew not smoothies not juicing to chew a green leafy vegetable roughly six times a day but with the size of their fist after it has first been boiled in water five and a half to six minutes so it's nice and tender and then you must anoint it with several drops of a delightful balsamic vinegar why because the acidic acid in the balsamic vinegar has been shown to restore the nitric oxide synthase enzyme which is contained within the endothelial cell responsible for making nitric oxide all right so you're going to chew this alongside your breakfast cereal again there's a mid-morning snack again with your lunch and sandwich that's three mid-afternoon for dinner time five god I adore it would you have that evening snack of kale what are you doing all day long you are bathing and basking that horrible oxidative cauldron of inflammation with nature's most powerful antioxidant now you're going to say what are the Greens that he's talking about they are bok choy Swiss chard kale collards collard green beet greens mustard greens turnip greens napa cabbage brussels sprouts broccoli cauliflower cilantro parsley spinach and arugula and asparagus and the top five are kale Swiss chard spinach arugula and beet greens [Applause] see it also helps your memory now in this early group I want to share with you several angiograms of disease reversal after you've seen these next three slides you will now know more than 90% of physicians in this country that this disease is reversible this is the left anterior descending coronary artery of a 67 year old retired pediatrician this is as small and improvement as the eye can see you look here from the left over to the right on this next till the leaves here to see this is the circumflex and a 58 year old factory worker and this was described as a 20% improvement from here to the right to here it even easier to see in this next the right coronary artery where this was described as a 30% improvement from here over to here now this next is the colleague of mine this is Joe crow and Joe replaced me as the chairman of the breast cancer task force in 1996 at age 44 he began to get chest pain not a smoker not diabetic not hypertension no family history regularly exercise but cardiology worked him up in October of 1996 could find nothing a month later he finished his surgical schedule he sat down to do post-op of the warders when suddenly there was the elephant sitting on his chest painted his jaw off jaw shoulder arm having a heart attack ripped down to the cath lab they start the catheterization cardiac arrest resuscitate finished the catheterization one more cardiac arrest then he stabilized in three days later discharged but very crest depressed because at the time of his angiogram what they had found was that the entire lower 1/3 of his left anterior descending the Widowmaker the entire lower 1/3 was all moth-eaten and diseased over a much 2 longest segment to just pound instant after stent and it was too far down to a bypass so they couldn't do these interventions and he was very depressed so an and I had Joe Aaron's wife out for supper two weeks after his heart attack Joe come on you've been eating this horrible horrible western diet you've got the typical disease why don't you think about going plant-based we've got ten years of data okay yes I'm gonna give it a shot they couldn't offer me anything else but I'm not gonna take any of those statin drugs I don't trust them fine that's your call not a problem he became the absolute personification of commitment to whole food plant-based nutrition over the next two and a half years his total cholesterol plummeted his LDL cholesterol went from 98 to 38 then he had another angiogram and on the day at noon time that I knew that he had the earlier in the morning his follow-up angiogram I walked into his office and there it was sitting behind the desk I said Joe listen how'd the follow-up angiogram go you came around put his arms around me he said I think we're doing it okay so I said well that's great but how about any chance that I could see the angiogram and he said sure now this isn't gonna happen to everybody but when the plant is young and soft and made up of inflammation and cholesterol and fat the body has a remarkable capacity to rid this however it's gonna be my job today before the sub talk is over to show you how even those patients who have plaque which is old made up of fibrosis scar and calcification and unlikely to be changed or modified now even those patients get back to full activity of daily living without restriction despite my sparkling personality we had six of those original 24 patients I knew within the first 24 months well excuse me I knew was in the first two or three months that they just didn't get it I had no money for this study so with my blessing and their say-so we released the back full time to their expert cardiologists and we followed them as a sort of a quasi control group over the next 12 years and four of the six had to have another operation and to die on the other hand what about the 18 the state with the program we wanted to know in the eight years prior to coming into the program while they were in the hands of expert cardiologists how many events of disease progression were there in those eight years prior to coming into our study and there were these 49 events categorized as you see listed here on this slide however once those 18 patients got into our study over the next 12 years 17 those 18 had no further events we did have one little sheep who wandered from the flock after six years got into the lambchops french fries and glazed or nuts more pain and had a bypass but now he's back with the flock but proves the point that I'm trying to share with you today so he's exciting as that was for us we took a pretty good hit people said wait a minute this is a small study dr. Esselstyn this diet of yours is really pretty extreme strict severe draconian and how do you know you can do this again and with a larger group and will you get similar results and by the way let me just say it when anybody calls our diet severe strict extreme draconian that's the diet that half the planet Earth is eating that never has this disease but the diet that truly is extreme strict severe injury corneum is the one that ninety seven percent of Americans are eating every day that guarantees before they die they want perish along with some horrible chronic illness okay [Applause] so this is the second study this is 200 patients and the Journal of Family Practice July of 2014 - were lost to follow-up but what we're particularly proud about is that you can see how many were here at 89.3 almost 90% were adherent to our program how do you make that happen because most physicians who want to use this approach say dr. Esselstyn I just couldn't get my patients to do this and it's not that the message is wrong it is how the message is articulated the only way I think you're gonna have people make a lifestyle change is to show them respect the only way that I know to show a patient respect is to give them my time so several things right now once a month usually for no more than 12 or 16 patients always with their significant other or spouse you must have the spouse or significant other there we have a dower a six-hour program one day because they're coming from route Canada throughout the United States six-hour program they're going to learn all about how they have created this disease and precisely how we are going to empower them as the locus of control to halt and to reverse their disease and you gotta have a little bit of fun with them for instance when we have the group there and I'll say now remind me again how often do you use somebody how often do you eat out Oh dr. Esselstyn not very often let me try that again how often do you eat out well maybe it's three to three times a week okay so yeah that's a hundred and fifty six days out of 365 that you are taking and already train wreck endothelium and you're trying to train wreck it further that's that no sense look there are four there are four reasons to eat out one you don't do the cooking two you don't do the dishes three you don't do no it's three is the ambience four is the companionship go out to eat to further destroy more endothelial cells and I also should say that two weeks before we have our seminar I get my secretary will sent me a list of the patients names and phone number and then I personally insist upon calling every one of them because I want to get my arms around their story and I want them to have an opportunity to ask questions of me so that by the time they come to the seminar we have a strong platform from which we can all move forward now I'm pretty proud about the fact that look how do you know they were sick 119 and I was 177 already had had a stent or a bypass and here's what's growing colossal II we now are at the point where practically anybody who was being asked to have any elective stent or elective bypass but they're willing to go a whole food plant-based nutrition rarely rarely rarely will they ever have to have that intervention so here the results of those who are adherent we had one patient who had a small stroke the 21 who are not adherent 62% at disease progression now I I decided to compare our results with some of the better-known standard studies that are out there and this is on the left is the major cardiac event heart attack stroke and death so let's look it over in the far right that's the Mediterranean be on diet heart study at the end of four years 25 percent will have had a heart attack stroke or death next to it is the natural history of coronary disease from Columbia Hospital in New York City 20% heart attack stroke and death at four years and then next to at the 19.4% bill bones karate but look here we are six tenths of a percent that's over a 30-fold difference what's going on here why is there such a difference between our results and theirs because ever since the days of Hippocrates there's been a basic covenant of trust that wherever possible the care giver will share with the patient what is the causation of the illness and sadly today in cardiovascular medicine that's not being done however along with several other other speakers today I'm proud to join with them we've been asked to become a member of the American College of Cardiology and nutrition committee and we are very aggressively trying to see if we can't educate cardiologists on the importance of the causation of the disease they've been designated to treat [Applause] [Music] now of all things the same month I wrote another paper on three patients what what right that I have writing about three patients well all three of these were an absolute story of the disaster of President Carter and by the way let me be sure you understand that I embrace his friends his friends I have great respect for the the caring and the compassion and the fund of knowledge of my cardiovascular colleagues but you know it's the openness can the best be even better so here is an interesting study three patients the first actually is from Newfoundland Canada and I've met my I'd not met Bob Mercer but I've been corresponding with him by phone and by mail when he was 44 years of age he had a stroke he had a partial occlusion of his right carotid actually a total collusion and a small stroke but he had such severe angina they found that dairy a daring a surgeon in Toronto would operate out I was the one totally blocked Gerardo Torrado he got through that operation had a wonderful result till he was now 69 years old he was in trouble diabetic severe angina erectile dysfunction and diabetes out of control and his one remaining carotid artery it was 90% of all things to have happen at that time his daughter age 37 at a heart attack during her convalescence she found a book called prevent and reverse heart disease and said pop we should do this together they did a year I got a letter from Bob mercy dr. Esselstyn thank you my angina disappeared I've lost 40 pounds my diabetes disappeared my wrecked-tile dysfunction disappeared and my one remaining carotid artery which was 90 block is now 67% block here is Bob mercy now these other two art art set arrows is at age 32 in Cleveland became diabetic age 42 in Cleveland got angina and at the Cleveland Clinic my alma mater he had his first of 14 since then he was told these aren't working you need to bypass that was great for a year and a half more in China and they said there was nothing further they could do from the standpoint of intervention that you have to have to deal it with drugs and he found his way through our program lost 40 pounds got rid of his diabetes got rid of all does angina and I think I have a picture of art here as well yeah and he appears every month at our seminar now the other is Jim McNamara who small stroke as he was pre-diabetic right carotid artery and then he began to get horrible sonication and they failed his first operation a nubbin leg failed first second operation on his leg failed third operation on his leg failed and he was miserable when he tried to put his leg up to go to sleep because of severe tingling and he came on board and lost 40 pounds lost all of his pre-diabetic State and now can walk non-stop with no problem with his circulation he was late so there's no mortality from the Diana there's no morbidity with the diet the benefits improve with time there's no extra expense because you got to eat and think of a patient who has had heart attack they're walking around with the sword of Damocles hanging over their head when do I get my next heart attack Dan says you never have to have your next heart attack you eat in a way that you make yourself are intact proof what in the world is the good of having a great part if your brain isn't there we got a lot of insight into this from the work of Megan Leary and her team from the West Coast who in 2001 at the stroke meetings in Miami looked at over 5500 M our eyes of the brains of Americans and they find that at age 50 she began to notice these little tiny white spots beginning in to appear in the American brand these are little strokes but come on your age 50 big brain tiny stroke not a problem I suddenly though you're now at 65 you're no longer 50 and more often too before you say sweetheart huh where'd I leave the car keys you get to that down bingo you're 75 years of age you look at her and her say a sweetheart where did I leave the car well you guess for that suddenly you're 85 and you look at her and you say are you my sweetheart I can't reverse that you don't suddenly get dementia on your 85th birthday you look hard in all those preceding decades to lay the foundation for dementia doesn't have to happen you know here is a normal MRI I counted 90 in these can you imagine a message trying to go through that scar now look carefully here on the left the brain is all the way out to the skull look carefully here on the right there's a big gap between the brain and the skull that is cerebral atrophy you don't want that as you get older you want your brain to grow roars you know how you do that exercise all right you're gonna do it in walking four or five times a week fast enough to almost break a sweat or you can bike your pants wimp but exercise is the key just as it is for this next situation you can see on the left the normal thigh muscle of a 40 year old triathlete on the upper right you see the thigh muscle in a 70 year old couch potato lower right thigh muscle of a 70 year old triathlete keep it moving now here on the left you're looking at the pulse volume and a patient who came to my office and crossing the Skyway he had to stop five times because of pain in his right calf claudication and if so I was so focused on his heart I forgot all about his leg 11 months later he said dr. Esselstyn you recall when I first thought seeing you or was stopping five times crossing the Skyway to your office yeah you said you know this last month it became four times three times two times once I don't stop anymore done back you go to the vascular lab now work on the right the pause file is double we now had within fifteen months of starting to study we had absolutely irrefutable scientific data that food and food alone could absolutely reverse cardiovascular disease and you're going to say wait a minute what about the statin drug well this is the second patient I've shared with you today dr. Crowe who refused and this patient Don 1986 we didn't have any statin drugs then so even the many patients that come to see us who simply are crippled by statins and can't take them are in no way precluded from enjoying these benefits here's another this is a 78 year old retired high school chemistry teacher in his retirement he and his wife love Sandra these square dance contest but during the fast square dance he was getting her bilateral calf pain so he saw these vascular surgeons and they got the images that you see up here showing how severely diseased he was but he didn't like that big operation they had planned for him he came to see us during counseling he said dr. Esselstyn if I happen to choose your method how long will it take me to get rid of this pain in my calves so I looked at him with great wisdom in my face and I said this will probably take about 10 or 11 months and three months later I got a phone call dr. Esselstyn you do not speak the truth the pain is gone okay now I don't know I'm assuming all of you are from this general Virginia area but I should share with you that in Ohio when you're watching a mystery or a sporting event just before the advertisement comes on you will hear the mellifluous tones of the announcers say something like when the moment is right will you be ready now we all know that the penile artery is really quite tiny compared to the size of the coronary artery so not infrequently before somebody comes down with heart disease they may find that they are no longer able to raise the flag however all is not lost not infrequently 10 or 11 months after I've counted somebody I'll get a phone call dr. Esselstyn yep they said mr. so-and-so sure enough couldn't hear from you yeah I said I really thought I ought to give you a call because recently something has come up and I wonder if I don't owe you another check now I promise you today before I wrap this up that I wanted to share with you how it is that those patients who have a plaque that is made up of fibrosis and scar and calcification can still get back to the activities of daily living without restriction what you're looking at here is a pet rubidium diaper animal scan of the heart and translation if it is orange or yellow that's good you're on the left but right down here where it's green that's bad that's poor blood supply we call that ischemia now at the time that he had that first PET scan I counseled him and 20 no and 10 days later his cholesterol from 248 to 137 and then three weeks after his first PET scan we repeated it now look on the right it's all back wait a minute we didn't wash out nobody got rid of a plaque in three weeks what's going on here now here's that here's what's the story if you look carefully you'll see this is a heart without a name without any muscle you're looking at the heart and you see those three large epicardial arteries the right corner are the left anterior descending and the circumflex which get all the publicity all the interventions of stan's and bypasses but look where every single one of those arteries is going it's going to get smaller and smaller as it dives into the heart muscle that's where all the oxygen and nutrients carried by this argument go into the muscle there are thousands of them there so I asked I asked Rodriguez who at the Cleveland Clinic is the director of the cardiovascular pathology lab and he died sexes 200 hearts a year from the deceased and I said how often do you ever see good old standard garden-variety after this chronic plaque in the artery once it has entered the muscle never never once in a very very great while in a severe diabetic otherwise never so here's what's going on when we first see these patients by now you know their endothelial system is trash as a matter of fact it is now your enemy it's not making hardly any nitric oxide your friend and it is now making two molecules that are against you endothelium and thromboxane which are basal blood vessel constrictors so this entire package of arteries when you first see them all those thousands our babies are constricted and as soon as you get those patients to stop not injuring at all again their endothelial system as it recovers it stops making the basal constrictor it starts making the nitric oxide vasodilator and that entire enormous enormous cascade of intramuscular vessels opens up and that's why you hear patients telling it where those with angina within days their disease is getting better pretty exciting but that's that seems to be what's going on here are the eight measures of disease reversal you can see it on an angiogram you can see it in the stress test I just talked to you about the PET scan we talked about the carotid we talked about pulse volume with the leg and the three symptoms of angina claudication and erectile dysfunction wrapping it up for those of you who don't get to Cleveland very often this is the building where I worked on the eighth floor for many years as a surgeon when I bring it to you because I want you to know what the trees look like in Cleveland in February [Music] however now that I've now that I've been retired from surgery I've moved into the wellness the Wellness Institute at the Cleveland Clinic and although the budget is more modest I can assure you that morale is quite high and I always I always like to finish up with my favorite this is a woman in Life Magazine trying to learn how to do the splits and although it's been 50 57 years since I left medical school I just say then while brains are important nothing is as important as persistence persistence persistence that best exemplified by this young damsel 1939 Life magazine trying to learn how to do the splits but it's tough she stuck with it and all of all things to happen the other day in downtown Norfolk Nayomi spot her and she now had got it right I want to just summarize by a few comments one yeah remember we started late questions still I guess the reason that I find myself when I was thinking about my career as a surgeon why I thought when I retire from surgery I'm going to learn two things I'm going to learn how to play the piano and I'm going to learn how to win serve well neither of those things could have been hit but why because I really see in front of us in medicine what really I think could be an absolute seismic revolution and this seismic revolution in health that is before us is never going to come about with another pill or another drug the seismic revolution is never going to come about through another procedure or an operation but the seismic revolution will come about when we in the profession have the will the grit and the determination to share to share with the poet what is the lifestyle and most specifically what is the nutritional literacy that will empower them as the locus of control to absolutely annihilate chronic illness thank you [Applause] we're not letting you up quite yet another question [Applause] [Music] well we're gonna open up the floor for questions now he's looking for tough ways on tap water and alkaline water and the benefits tap water and alkaline water do you have any thoughts on those and potential benefits no whichever you like I mean do the what type of water did the Okinawans eat what type of water does they they were drinking Central Africa I think I have I have no problem either one I have a question for you you spoke earlier about how effective campus eating is on young soft plaque and I know you mentioned at the end you were talking about some of the more advanced disease states what I haven't heard and I was just curious about how that affects somebody with a high calcium score and how that works on reversing calcium or stop the progression and I have a quick second question to something I haven't heard about addressing was the effects of this on elevated lipoprotein a you know the calcium score is kind of interesting and important when you get a calcium score that tells the physician two things it tells us that you've got coronary artery disease but it also tells us that you have got a number of non calcified inflamed black it's the non calcified inflamed by the more dangerous ones because those are the ones that can rupture but and this is something that I think most physicians don't know but it was something that I was taught years ago by Bill Castelli dr. casselli was for many years the director of the world famous Framingham study and he said if you get somebody who had like a high counseling score and they absolutely get it right and over the next year they're eating whole food plant-based nutrition then they have another calcium score and if it was a hundred at baseline that may now be 175 or 200 but he said the patient is much better off because what has happened is during the time that they are eating whole food plant-based nutrition which is so powerful as an anti-inflammatory as that those previously non calcified inflamed plaque are losing their inflammation it is as though the body wants to get in on the act and hasten along the quelling of this inflammation by dumping in some calcium in those previously non-causal a pipe so if your physician says to you Mike I know that plant-based diet you're on is making you worse that's absolutely wrong okay now the other was about developing small a LP a yes sir what is it 20 percent of the roughly of the population will have LP small a what do you suppose they do about the LP small area in central Africa in Okinawa how many of you ever checked their healthy small a I think that is the consensus pretty well is this you have learned through that well hopefully what I've shared with you today we everybody in this audience and all friends and relatives to eat in a way that you make an absolute endothelial fortress your endothelium is strong and tough and therefore if you have a strong and even if you have an LP small a it's gonna be harmless you know something you have to think about when we get a little bit too carried away with cholesterol do you think that when the human body was formed hundreds of thousands of years ago we have come all this way with an understanding our body has this understanding that every single cell membrane in our body is made up of cholesterol now are we going to be only to say and that when we were somehow when we reformed we were blessed with an organ that made a cholesterol that would make us all vascular Rex I don't buy that for one minute I mean if you had let's say a thousand people who absolutely follow the program that I espouse to the tea they'll be some who have a cholesterol 110 or there's 140 160 180 200 220 but as long as they are eating in a way that they have an endothelial fortress I don't think that should be a concern the question is the last slide you showed was where all Americans will have some sort of atherosclerosis and was somewhat most patients that we see in clinic for example middle-aged patients Norris factors exercise well and not Restorick cardiovascular disease risk factors score maybe less than 7.5% but there India it's hard to for some of these patients hard to get it you know 105 in most cases stays in that range of 95 to 105 or do this to need a statin if even following a star yeah I think that's an excellent point but you remember this what are you gonna do with your patient who may know it'll make you feel better because you're their number will be lower but I'm not sure that they have to have that because as I mentioned we have many patients who have come to us who simply cannot take a set there are four side effects assess one is brain fog on a severe muscle pain the other is of course a liver liver problem and so really if the patient has a LDL of eleven five and they're eating in a way that they are maintaining an absolute endothelial fortress they should absolutely do fine because it's the injury to the endothelium that's where this disease has its inception that's for all experts that I'm a familiar with agree that this disease had MS onset and but by it but yeah but to do this and do it right you know it really makes you have to think twice any time to eat out and for instance I just had a patient last week nobody that I've seen but some of the guy have a phone call said that they've been following our program and although four years earlier they had had a couple of stents then after he finished a 5k run this past Sunday he was hospitalized with a heart attack and he had told his wife that he was saying following our program 100% but 100% does not include at every lunch at his workplace he was eating the beyond beyond burger beyond me and so forth which are loaded with coconut and all the oils that are just carrier yourselves asunder thank you so much for being here and I would like to ask you specifically said the importance of green leafy vegetables kale Swiss chard spinach beet greens what if you are on a med like whorfin because of a genetic disorder and you're not able to take these green leafy vegetables how can you gain the benefit without actually eating them the the problem often comes up with patients who have atrial fibrillation and they are on coumadin and their question of all to buy them Cavey you're eating with these four greens makes it hard and what pretty much is the consensus of those who understand this and do it right is it you talk with the physician who is doing the anticoagulation have you taken coumadin and you Excel with them look I am consistently going to be eating this amount of green leafy vegetables and then they will appropriately adjust the level of coumadin so you've achieved the level of anticoagulation that is appropriate and on the other hand what you've presented is a little bit more challenging you have some congenital condition I don't know what what is that condition you have you would likely have some clotting disorder that requires you to be on blood thinners that maybe increases the risk of blood clots in the legs or the lungs yeah then I would again if you're oncoming you were talk talk with your physician and say listen I I don't really think I ought to be precluded from enjoying the healthiest foods on the planet and maybe they would agree to allow you to increase your greens and they will appropriately adjust the coumadin dose so that they still can achieve the level of anticoagulation that they propria thank you so much I feel so grateful and thankful to be here and that you're here today my question is about homocysteine levels how do you feel about that and why a homocysteine yeah I think most people will find it when they're eating a whole food plant-based nutrition that they're homeless esteem will not be elevated you know a test we need to ask for and be proactive or does the doctor even if you don't have heart disease do you think you need to have hours checked you know one of the things that is taking us to debtors prison as a country faster than anything you can imagine is healthcare and one of the things that we do with healthcare is we have all this this testing and it's amazing how much testing costs just to get a CT scan it's a thousands of dollars and even when you're go in and get a metabolic panel for blood tests this is all these things cost so I find myself increasingly bending toward the following the society to try to keep the test to an absolute minimum we can consistent with a safety for the patient but I think that if somebody is eating totally without exception both food plant-based nutrition they're gonna they're gonna make all their numbers they're going to be somewhere where they ought to be now we and we should mention about a word about omega-3 there's gonna be a lot of talk about right because right now the American Heart Association is having its annual meeting and there's a paper that now for the first time contradicts what we have learned earlier that's supposed to be beneficial which fish oil tablets now that paper was sponsored by the maker of fish oil tablets and that always raises a flag however look they're looking at if you want to get omega-3 I don't want you to have to get it with oil which may have PCBs dioxin and so forth and mercury if you want to get omega-3 ice there should be able to get it to flaxseed meal chia seeds and plenty of green leafy vegetables however if you check your omega-3 and get the Omega check it'll need to be optimal on a minimal or moderate or too low and if it's too low then I would say take omega-3 tablets not an oil but they're made with algae that's just that's the thought and this way and also be a little conservative about about these these tests are just got it got to the point insurance carriers are still paying for them but god they're so expensive and all the money that we as a country have that should be going into education restoring the grid and the infrastructure is going into health which is crazy because of people who eat right this would not be an issue just it's just interesting that there are two authors function University of University of Chicago 1999 till Pell and Murphy writing in the Chicago University Press estimated that this country could eliminate heart disease we would save 40 trillion dollars I'll probably get a reprimand from what I'm gonna say but this was my personal decision I'm 66 years old nearly two years ago I had a stent placed at 90 percent block 30 the doctor prescribed makes four or five drugs which I only talked for two weeks because how are they made and because I was extremely concerned about the long-term effects side effects of that I've been on a whole I will say that in making that decision not to take the drugs was extremely stressful because itit let's make a great decision or not and so now I have been to a doctor in two years I feel like I need to go to one and I'm not sure what tests I should take we're we're asking because my doctor said if I want to pull myself like go away from my prescription drugs but I'm feeling a great I'm strong I just started going p90x nice work [Applause]

Channel: Sentara Healthcare

Views: 373,328

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Id: ZC3wRx4vV7g

Length: 68min 12sec (4092 seconds)

Published: Fri Dec 21 2018