Cardiovascular Disease & Diet
Charles R. Attwood, M.D., F.A.A.P.
hen the chest pains started, Mary was on her regular flight from Miami to San Francisco. At age 46, she had worked as a flight attendant at American Airlines for over 20 years without missing a single day due to illness. She had always enjoyed excellent health--or so she thought. Now, within 3 hours she would find herself in a coronary care unit, where she was told that 3 coronary vessels were partically occluded, but one, the left anterior descending, was 95 percent blocked. The balloon angioplasty which followed gave her temporary relief, but after she returned home, within 12 weeks the vessel was closing again, and the chest pain returned. Another angioplasty was done, this time with a stint. Now, Mary was advised that she would almost certainly need bypass surgery.
That's when she came to me. She had already read my book, because with a strong family history of heart disease she'd wanted to learn more about protecting her family from a similar fate. Now, that she was the victim herself, she had expected her cardiologist to offer serious dietary counseling. The doctor's dietitian, however, only suggested that she eat less red meat, more poultry and fish. She was given the USDA's food pyramid, which was, they said, designed to keep her calories from fat around 30 percent. She came to me for a more vigorous plan to reduce her dietary fat. Furthermore, she had correctly assumed that her cholesterol level of 210 mg/dl was too high, even though the cardiologist and dietitian seemed comfortable with it. Both seemed virtually certain that she would need a bypass, because the chest pain was beginning to reappear during routine physical activity.
Mary, always slender, hadn't worried about her own heart until that fateful day on the transcontinental flight. Her concern until then was more for her family. She had eaten a typical American diet since childhood, and for 20 years most of her meals were in airports and hotels. Now, her own life was at stake, and she wondered why she wasn't given a more aggressive dietary approach. She had remembered reading in my book that at least six clinical studies had shown a progression of coronary lesions among victims of heart disease who consumed 30 percent of their calories as fat.
We talked at length about the proven regression of coronary lesions reported by Dr. Dean Ornish among his patients on a strict diet of vegetables, fruits, grains, and legumes. I wasn't sure that Mary would comply with this. She was a gourmet cook at home and on the road had always eaten a relatively high-fat diet. She proved me wrong. Highly motivated, and desiring not to "have my chest opened" she passionately took on my recommended "Four Stages to an Ideal Diet." Though it was designed for gradually reducing dietary fat and animal protein over a 3-4 month period, she reached Stage Four within a week. Mary was now on a plant-based diet and walked briskly for 30 minutes daily. "Can I do more," she asked.
My colleague, Dr. Caldwell Esselstyn of the Cleveland Clinic, had, for several years, kept me posted on a group of his patients with severe coronary artery disease, treated not only with an all plant-based diet, but also with a cholesterol lowering drug. On this regime, his patients had much more regression of their coronary artery lesions than that reported in the literature from a plant-based diet along. The key to this surprising degree of regression seemed to be the reduction of cholesterol levels to 150 mg./dl or below.
Mary had nothing to lose and a great deal to gain; so we convinced her cardiologist to add lovastatin, a cholesterol lowering drug which reduces the production of cholesterol in the liver, to her new program of diet and exercise. "It's my life." she said, "I can handle the dietary changes, but if the lovastatin will add to my chance of success, I want to do it." We were all delighted, when after 4 weeks, Mary's cholesterol level was 130. She felt wonderful and the chest pains did not return.
The cavalier attitude of the cardiologists and cardiac surgeons about alternative non-surgical approaches to her disease continues to dismay her. Now a strong advocate for plant-based diets for both children and adults, she has adapted many of the recipes from books by Ornish, Pritikin, Barnard, and McDougall to her own dishes.
"I'm lucky," she said to me several months later, "Women my age don't realize that we account for half of the 500,000 coronary disease deaths every year." She's right, it's the leading cause of disability and death among women Mary's age, while breast cancer, which gets all the media attention, is a distant second.
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