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Healthy Living December Issue
BLOCKED ARTERIES: Clean Them Out Naturally

Drawbacks of Heart Surgery

Dialogues like this take place thousands of times each year in America. In spite of all of our advancements in technology, we still perform some 500,000 heart bypasses each year.1 The darling of heart specialists today, however, appears to be coronary angioplasty. Fully 404,000 angioplasties are performed each year in the U.S.2 Often referred to as the "balloon procedure" in lay circles, this technique opens up blocked heart arteries by forcibly opening a sturdy balloon inside the clogged vessels. The balloon flattens out the obstructing fatty deposits, and thus allows more blood to pass through the previously narrowed area. If the cardiologist believes there is a high likelihood of repeat closure of the artery, a stainless steel wire mesh circular tube, called a "stent," will be placed where the angioplasty was performed to decrease the possibility of short-term repeated clogging.

Many lay people today have become so familiar with both bypass surgery and angioplasty that they might think that Jim is a bit childish to fear such well-honed therapies. Yet, experts who recognize the results of these common procedures would likely share Jim’s sentiments. One of the greatest concerns with these methods is that they do not address the underlying disease process. That disease is atherosclerosis, a condition that silently affects blood vessels throughout the body. The disease causes a slow but steadily increasing blockage of major arteries. Bypass surgery and angioplasty do nothing to change this gradual accumulation of fatty deposits throughout the body. These high-tech procedures only "buy time" by addressing what are often the most life-threatening areas of blockage-the blood vessels nourishing the heart. If the process of atherosclerosis is not addressed, the arteries that have been bypassed will again clog up; the vessels that have been angioplastied or stented will again be obstructed with fatty material.

Furthermore, surgical methods are expensive and fraught with some very real risks. The average cost of a hospitalization for coronary artery bypass surgery is $35,000 to $62,000 (national average of $44,200) depending on the operating surgeons and in what hospitals they perform the surgery.3 Although the risk of operative death is now down to about three percent or less in some centers,4 most people are completely unaware of the potentially permanent side effects that can occur from this surgery. For instance, two percent of bypass patients have a stroke and up to 57 percent suffer some kind of neurological complication, often so subtle that the individual’s family may have simply written it off as "Dad is just getting older."5, 6, 7 MRI evaluations have shown that the brain swells within an hour of bypass surgery; the reason may be partly explained by microscopic blood clots that are common during heart surgery.8

On the other hand, coronary angioplasty costs about $22,000, depending on the physician who does the procedure and where it is performed.9 The failure rate of angioplasties done on a single heart blood vessel in the first six months is 35 to 45 percent, and for multi-vessel angioplasties is 50 to 60 percent within the same length of time. Such failures then require another angioplasty, stent placement, or even bypass surgery.10 Thus, performing surgery on a person with heart disease has three drawbacks, as summarized in Figure 1: Three Drawbacks of Heart Surgery.

Alternatives to Conventional Treatments for Heart Disease

Fortunately, there are alternatives to bypass surgery, angioplasty, and medications. However, many patients-and even physicians-are not aware of these options. Preventive medicine experts have now proven that blockages in heart blood vessels can be reversed by changing one’s lifestyle. Perhaps what is more important, when used properly, lifestyle agents such as stress control, smoking cessation, diet, and exercise have no harmful side effects. The only side effects are desirable ones-contributing to a better quality of life and a decreased risk of diseases of many types in addition to heart disease.

Those individuals with heart disease who become aware of the facts as outlined in this book are confronted with a vital question: "Am I willing to make the common sense lifestyle changes necessary to reverse my disease?" If the answer is "no" it is likely that either angioplasty or bypass surgery will be unavoidable at some point.

Failures of The Standard Heart Disease Diet

Let us see what The National Cholesterol Education Program Diet, by itself, has done for people. In a study called the Cholesterol Lowering Atherosclerosis Study (CLAS), individuals with coronary artery disease were treated with diet or diet plus medications. The diet used was one that the researchers apparently thought was strict: no more than 250 mg of dietary cholesterol per day, and less than 26 percent of calories from fat.16 Notice that the CLAS diet was actually quite similar to the National Cholesterol Education Program’s recommendations and was more fat-restrictive than the average American diet. After four years on this program, the participants’ heart arteries were re-evaluated by coronary angiograms. Those on the special diet without medication had a meager decrease in their total and LDL (bad) cholesterol levels. The results of the angiography (special x-ray pictures of the heart arteries) before and after the four year period, along with the cholesterol levels, are shown in Figure 2: Results of 26% Fat and 250mg Cholesterol Diet.

These are very discouraging results. Notice that the vast majority, almost four out of five, had worse blockages than they did before they went on the diet. Only six percent experienced an improvement. Clearly, these dietary changes and the resulting six percent drop in total cholesterol and LDL is not enough for the average person with coronary artery disease. The results are not unique. Similar studies have been performed in different settings and the results are always similar and equally disappointing.

Another study that illustrates this point was called the "Program on the Surgical Control of the Hyperlipidemias."17 This study examined the results of an intestinal surgery that interrupts the recycling of cholesterol through the digestive tract. They demonstrated that this surgery, called a "partial ileal bypass," could reduce cholesterol levels. This procedure came on the scene over 20 years ago; now, however, we recognize there are much better ways to deal with elevated blood fats. Consequently, my interest is not in the group that was surgically treated. It is rather in another group that was studied at the same time, those that served as the "controls." At the beginning of the program they randomly assigned enrollees to one of the two groups. The controls did not have the intestinal surgery but were placed on a special diet instead. Specifically, they were given a diet that was as restrictive, if not more restrictive, than the study shown in Figure 2: Results of 26% Fat and 250mg Cholesterol Diet. It contained 25 percent fat and 200 to 250 mg of dietary cholesterol.

The subjects were observed for a period of ten years. Those on the diet program lowered their total cholesterol and LDL. In one year their average LDL cholesterol went down slightly, from 178 to 174. By five years on the program that average was down even more, to 167, and by 7 years it was 159. Even at 10 years, participants still maintained a lower average cholesterol level than when they started, although the LDL value had risen back to 167. Despite the modest improvement in cholesterol numbers, blockages in their heart arteries became progressively worse, as shown in Figure 3: Results of 25% Fat and 200 - 250mg Cholesterol Diet.

Notice that they steadily became worse throughout the 10-year period. At the 10-year point, fully 85 percent showed disease progression.

Is it any wonder that so many bypass patients must undergo a repeat surgery 10 years later? Although a few individuals improve on a diet like that recommended by the National Cholesterol Education Program, most do not improve. Sporadic success stories are simply not good enough. Imagine your disappointment and frustration if you had heart disease and perfectly followed your doctor’s diet instructions for years only to find that your heart blood vessels became significantly worse. Your frustration would likely further increase if you then learned that almost everyone else who perfectly followed the same diet also became worse. Frustration would become complete when you learned that the diet had already been tested and found to be inadequate.

It is obvious that something better is needed.

A Proven Diet for Heart Disease Reversal

Dr. Dean Ornish and colleagues conducted a study called "The Lifestyle Heart Trial" in the San Francisco Bay area.18 Like the two previous examples, the focus was not on bypass surgery or angioplasty. In this trial, there was a remarkably different dietary approach: instead of allowing 200-250 mg of dietary cholesterol, as did the two previous studies, the Lifestyle Heart Trial allowed a mere 5 mg of cholesterol per day. Instead of 25 to 26 percent of calories from fat, this study allowed only a 10 percent fat diet. Total calories, however, were not restricted. Basically, the diet was nearly total vegetarian (fruits, vegetables, grains, and a small amount of nuts) with no animal products except egg whites and up to one cup per day of skim milk or non-fat yogurt. (The skim milk or non-fat yogurt contains 5 mg of cholesterol.) The results of the Lifestyle Heart Trial are tabulated in Figure 4: Results of 10% Fat and 5mg Cholesterol Diet in the Lifestyle Heart Trial. This diet is remarkably better on all counts. Notice the very large decrease in both total cholesterol and LDL "bad" cholesterol. These decreases are much greater than those that occurred in the previous two studies. Especially noteworthy is the fact that these individuals were already on a program very close to that advocated by the National Cholesterol Education Program before this study began. Before working with Dr. Ornish and his colleagues, the participants on the average were only consuming 31.5 percent of their calories from fat and 213 mg/day of cholesterol.

Dye studies of the heart blood vessels, called coronary angiograms, were made before the program started and then 12 months later. Special computerized assessments of these angiograms allowed very precise calculations of whether narrowing had worsened, stayed the same, or improved. To the amazement of many physicians, the computer comparisons revealed that 82 percent of the patients experienced a reversal of their atherosclerosis. Only 14 percent had no change, and just 4 percent worsened. This is the first study where any significant regression occurred by lifestyle changes alone, and it happened to 82 percent of participants within the short period of 12 months.

"Regression" was the term applied to the reversals in blockages that occurred in better than 8 in 10 of these participants. Overall, there was a 2.2 percent diameter regression of all lesions, which translates to a blood flow increase of 9 percent. Notice that those who began the study with the greatest stenosis or blockages, and thus had the greatest need for regression, reaped the greatest benefits. Of the coronaries that were more than 50 percent blocked there was a 5.3 percent improvement, translating to a 23 percent increase in blood flow. This is a significant amount of regression after only one year. Before this study was conducted, most physicians did not believe regression by lifestyle change was possible in any length of time-let alone within twelve months.

Note that a small percentage change in diameter stenosis provides a much greater percentage increase of blood flow. This is because the blood flow rate is mathematically proportional to the fourth power of the change in diameter (the diameter change multiplied by itself 3 times).19

Diet of Subjects in the Lifestyle Heart Trial

Even with medications, not a single study before the Lifestyle Heart Trial demonstrated regression in such a short period of time. This study not only showed that regression is possible in a short time, but it can occur without the use of medications, furnishing an example of what can happen with the acceptance of a simple lifestyle program that includes an excellent diet among other factors. Let us take a closer look at the diet; it is outlined in Figure 5: Diet Content in the Lifestlye Heart Trial.

Factors Other Than Diet in the Lifestyle Heart Trial

Along with changes in diet, the subjects made several other lifestyle changes. The complete list of changes is shown in Figure 6: Lifestyle Changes in the Lifestlye Heart Trial.

Recently, Ornish’s patients completed a five year follow-up evaluation. Measurement of heart blood flow continued to show significant improvements when compared to their evaluations before the five year program, and when compared with the control group who received the NCEP-type diet and other aspects of usual care.20

Alfred Whitehead, a philosopher, wrote a statement that applies to this problem of heart disease and the studies that show its reversal. The statement is quoted in Figure 7: Alfred Whitehead’s Philosophy.

Dr. Ornish’s work provides a good example of what an unusual mind can do with the obvious. Heart disease is the number one killer in America. Every U.S. physician is very familiar with it, yet it seems that most of us merely treat the disease’s symptoms rather than the root cause. Lifestyle is clearly the root cause in the vast majority of cases. Many medical professionals spend so much time and effort mopping up the floor that we do not notice that an overrunning faucet is the underlying cause of the problem, as illustrated in Figure 8: Treating the Symptoms.

Now that the obvious has been demonstrated, it is time for people with heart disease to take notice and begin to change their lifestyle accordingly-before it is too late.

Vegetarian Diet Reduces Cardiac Occurrences

Further support for the diet with reduced cholesterol and total lifestyle approach is provided by the St. Thomas’ Atherosclerosis Regression Study (STARS).27 This British study moved closer to the diet program that Ornish used and, as expected, produced results that were between those achieved on the NCEP diet and those on the Lifestyle Heart Trial regimen. The STARS researchers went beyond the NCEP Step II diet in a number of ways. They: (1) added a significant amount of plant fiber to the diet (up to 6 grams per 1000 calories); (2) further decreased cholesterol intake, amounting to only 100 to 120 mg per day for many of the participants; and (3) increased polyunsaturated fat in the diet. All of these changes made the diet closer to a vegetarian diet than the NCEP diet. They also counseled patients against smoking and "advised a suitable level of daily exercise." However, the description of these components in their report suggests that relatively little attention was given to these areas compared to Ornish’s structured focus on exercise. When angiograms done at the beginning of the STARS were compared with those done an average of about 3 years later, the results were as expected. That is, the results were between those achieved by Ornish and those seen with the NCEP diet. Specifically, regression occurred in 38 percent, while 15 percent progressed; about half did not show any significant change.

However, this dietary approach decreased the number of cardiac events. When they looked at the total of all the strokes, heart attacks, deaths, coronary bypass surgeries, and angioplasties, they realized they made a remarkable impact. Whereas ten percent of control patients had one of these events, only three percent of the diet-treated patients had one. Beyond Diet - Physical Fitness

In this chapter we have seen that an excellent lifestyle is essential for anyone that wishes to reverse coronary artery disease. More than that, it is the basis for preventing heart disease from occurring in the first place. This lifestyle must include a diet that has negligible amounts of dietary cholesterol and is low in saturated fat. Besides being on a good diet, one needs to have a regular program of moderate exercise.

The importance of regular exercise in preventing and reversing heart disease needs to be emphasized. Regular exercise alone has been shown to help the heart in many studies. I will cite just one. A 19-year study of about 10,000 men addressed the impact of regular aerobic exercise on the risk of death due to cardiovascular disease.46 They were categorized into three groups as determined by each participant taking two fitness tests on a treadmill at an average of five years apart. Thus, physical fitness was assessed for each participant at the start and again after five years. Those who enjoyed sustained physical fitness (passed both tests) comprised the first group. Those who had short-lived fitness (passed only one of the two tests) made up the second group. The third group consisted of those who were unfit (failed both tests). The results are shown in Figure 19: Regular Exercise Reduces Risk of Coronary Heart Disease.

Note that those who were physically fit and maintained their fitness had the lowest risk. The risk was twice as much for those who failed to maintain a lasting fitness program, and was over four times as much for the non-exercisers. Another significant result is that in addition to the benefit for the heart, those that maintained their fitness also had the lowest risk of death from all causes.

It is sobering to recognize that non-exercisers increase their risk of death from heart disease by about the same amount as smokers. In other words, from the standpoint of heart disease, you probably have little right to pat yourself on the back for not smoking unless you exercise regularly. Exercise is clearly a major part of any program to prevent or reverse heart disease.

Healthier Lifestyle-Better Sense of Well-being

The Lifestyle Heart Trial also looked at the "before and after" results of how well participants fared as far as their general sense of well-being was concerned. Each participant was asked to fill out a questionnaire before and after the study regarding his or her psychological distresses. They were asked to rate their degree of anxiety, depression, insomnia, and their inability to experience pleasure (anhedonia). These four distresses were totaled to yield a distress index level for each participant. The average levels are shown in Figure 20: Changes in Psychological Distress in the Lifestlye Heart Trial.

It came as a surprise to many that after one year it was the vegetarian group that not only felt better physically, but mentally as well. They had a decrease in depression and anxiety, fewer problems with stress, and improved interpersonal relationships.47

Many mistakenly believe that their overall enjoyment of life will deteriorate if they change to a healthy lifestyle, especially if they become vegetarians. What will I tell my friends when I go out to eat? Will I have to sacrifice attending certain social events because of my new diet? What about my relatives coming home for the holidays? Will my taste buds suffer? Will my hunger be satisfied? Despite all of these new "problems," the vegetarian group enjoyed life more, and even had a better social life than before.

Sticking with the Program

Did it make a difference how closely the participants stuck to the program in the Lifestyle Heart Trial? Were there any adverse affects from "cheating"? This question was looked at very carefully in the initial report that featured 12 months of follow-up. The answer was a resounding yes, as illustrated in Figure 21: Adverse Effects of "Cheating" in the Lifestyle Heart Trial.

These results are not surprising. Within the vegetarian group, those that were the most adherent to the program had the greatest amount of regression; that is, they experienced the most reversal. Each diseased blood vessel improved over four percent on the average.48 Those that were moderately adherent to the program experienced a 2.5 percent regression of coronary artery disease. Those that were the least adherent had minimal improvement, measuring less than one percent.

The issue of adherence makes three points. First, the closer one gets to the optimal lifestyle, the better. Obviously, the closer we follow a vegetarian diet, a regular exercise program, and stress control measures-the better off our arteries are going to be. The second point is that lesser degrees of adherence can still produce some benefit, although the results are not as dramatic. The third is that the lifestyle changes in the Lifestyle Heart Trial were of greater benefit than the data shows because of weak adherence to the program by some participants.

Doctors’ Recommendations-Who Follows Them?

If you have heart disease, there is much you can do with simple lifestyle changes. But most people fail to grasp the full potential of lifestyle changes upon their overall health. Many with heart disease do not do much more than see their doctor and take medications. An American Heart Association study was made to determine how many individuals who have been diagnosed with heart disease complied with the corrective measures prescribed by their physicians. The astounding results are shown in Figure 22: Heart Disease Patients who Comply with Their Physician’s Advice.49

We see that about two-thirds of heart disease patients neglect to make the basic changes in habits prescribed by most doctors (lower salt, less red meat intake, daily walking, no tobacco, etc.). This is a surprisingly large number, since the disease will take the life of 80 percent of those patients. If they are unwilling to make the simple changes in lifestyle, how can we expect them to make major changes such as outlined in this chapter? Are these changes more restrictive than most people could tolerate?

Is Lifestyle Change for Everyone?

It is one thing to present overwhelming evidence that a vegetarian diet is of significant advantage in reversing heart disease, but is it a diet that the average person can follow for life? It may seem restrictive at first because most of us grew up eating whatever we liked-an abundance of meat, milk, eggs, cheese, ice cream, store-bought convenience foods, etc.-you name it, we ate it. But look how sick many have become on that lifestyle. Americans, instead of being an example of first class health, are among the world’s most obese, and continue to have high rates of heart disease. We have the largest and most advanced hospitals in the world-and we need them for people who are on the rich, refined, cholesterol, fat-laden diet.

If you begin to make the change to a vegetarian diet, you will be surprised that what may start off looking like a "sacrifice" does not have to end that way. This book is dedicated not only to inform you of a better way to live, but to also encourage you to make changes and experience the benefits. They say "Rome wasn’t built in a day," but when it comes to our eating habits, we fear the "building" process. Perhaps it would be more accurate to say we most fear the "remodeling" process, the cleaning out of freezers and cupboards of foods that are dangerous to our health. But on the positive side, joining a vegetarian or natural foods cooking class can help you get a jump-start into a new world of brand new dishes and foods that are both healthful and truly satisfying. If you do not have a cooking class available in your area, obtain several vegetarian cookbooks and set aside some quality time to experiment. A list of good vegetarian cookbooks is provided in Appendix II. Stick with it, and soon you will be surprised by how quickly you have a wide variety of new recipes that you can look forward to-and in addition, you will likely feel much better in a number of ways, both physically and mentally.

The Vegetarian Bandwagon Rolls

Vegetarianism is beginning to sweep the country. Millions of Americans have taken steps toward a more healthful lifestyle in varying degrees. Many have gone all the way to the total vegetarian diet and the other aspects of a healthful lifestyle. Vegetarian restaurants and health food stores are proliferating. All major airlines now offer total vegetarian meals on request. The number of brands of non-dairy foods such as milk and cheese made from wholesome grains is multiplying. Medical insurance companies are beginning to cover costs of vegetarian lifestyle instruction and counseling for heart patients. Community vegetarian cooking schools are increasing in popularity. Vegetarian periodicals and cookbooks are being published in increasing numbers. The vegetarian bandwagon is rolling and this is one you will not want to miss.

Medical insurance companies are recognizing that the vegetarian approach is much more cost-effective than the alternative of surgery. Mutual of Omaha’s expenses per heart patient is cut by over half by covering the cost of lifestyle instruction for heart patients. They report that their health care subscribers with chest pains that are on the program have a 65 percent decrease in the number experiencing chest pain. For the remainder who still have it, the frequency and severity decrease "often dramatically." They also report a significant drop in blood cholesterol with no medication; heart scans show that many patients experience cessation or reversal of heart disease progression, and exercise tolerance measured on a treadmill "improved 22 percent." This program is reducing Mutual’s health care costs while producing better health of its subscribers at the same time.

"Lifestyle Centers"

Some may feel that they would like formal instruction to help them in making the transition to the ideal lifestyle. There are institutions known as "Lifestyle Centers" that are dedicated to performing such a service. These centers accommodate guests with various aspects and severity of heart disease and other ailments who stay for a number of days or weeks. Each guest is put on a daily exercise routine tailored to the individual’s need, fed a vegetarian diet, given instruction in nutrition and other aspects of healthful living, and taught how to prepare healthful and tasty dishes to maintain the diet after returning home. A list of names and locations of such centers is found in the Appendix III.


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