128 THE CHINA STUDY CHART 5.4: CORONARY ARTERY BEFORE AND AFTER CONSUMING PLANT-BASED DIET adopting a whole foods, plant-based diet, that same artery opened up, reversing the ravages of heart disease and allowing a much more normal blood flow, as shown in the picture on the right (B) Is it possible that Dr Esselstyn just got a lucky group of patients? The answer is no Patients this sick with heart disease don't spontaneously heal themselves Another way to check the likelihood of this degree of success is to look at the five patients that dropped out of the dietary program and resumed their standard care As of 1995, these five people had fallen prey to ten new coronary eventsY Meanwhile, as of 2003 , seventeen years into the study, all but one patient following the diet are still alive, headed into their seventies and eighties 45 BROKEN HEARTS 129 Can any sane person dispute these findings? It seems impossible If you remember nothing else about this chapter, remember the forty-nine to zero score; forty-nine coronary events prior to a whole foods, plantbased diet, and zero events for those patients who adhered to a whole foods , plant-based diet Dr Esselstyn has done what "Big Science" has been trying to do, without success, for over fifty-five years: he defeated heart disease DR DEAN ORNISH In the past fifteen years another giant in this field, Dr Dean Omish, has been instrumental in bringing diet to the forefront of medical thought A graduate of Harvard Medical School, he has been featured prominently in popular media , succeeded in having his heart disease treatment plan covered by a number of insurance carriers and written several bestselling books If you have heard of the dietlheart disease connection, chances are that it may well be because of Dr Omish's work His best-known research is the Lifestyle Heart Trial, in which he treated twenty-eight heart disease patients with lifestyle changes alone.46 He put these patients on an experimental treatment plan and twenty additional patients on the standard treatment plan He followed both groups carefully and measured several health indicators, including artery blockages, cholesterol levels and weight Dr Omish's treatment plan was very different from the standards of high-tech modern medicine He put the twenty-eight patients in a hotel for the first week of treatment and told them what they had to to take control of their health He asked them to eat a low-fat, plant-based diet for at least a year Only about 10% of their calories were to come from fat They could eat as much food as they wanted, as long as it was on the acceptable food list, which included fruits, vegetables and grains As researchers noted, "No animal products were allowed except egg white and one cup per day of non-fat milk or yogurt "46 In addition to diet, the group was to practice various forms of stress management, including meditation, breathing exercises and relaxation exercises for at least one hour per day The patients were also asked to exercise three hours per week at levels customized to the severity of their disease To help the patients make these lifestyle changes, the group met twice a week for four hours at a time for mutual support Dr Omish and his research group did not use any drugs, surgery or technology to treat these patients.46 The experimental patients adhered to pretty much everything that 130 THE CHINA STUDY the researchers asked of them and were rewarded with improved health and vitality On average, their total cholesterol dropped from 227 mgldL to 172 mgldL, and their "bad" LDL cholesterol dropped from 152 mgl dL to 95 mgldL And after one year, the frequency, duration and severity of their chest pains plummeted Further, it was clear that the closer the patients adhered to the lifestyle recommendations, the more their hearts healed The patients who had the best adherence over the course of the year saw the blockages in their arteries diminish by over 4% Four percent may seem like a small number, but remember that heart disease builds up over a lifetime, so a 4% change in only a year is a fantastic result In all, 82% of the patients in the experimental group had regression in their heart disease over the course of a year The control group did not fare so well, despite the fact that they received the usual care Their chest pain became worse in terms of frequency, duration and severity For example, although the experimental group experienced a 91% reduction in the frequency of chest pain, the control group experienced a 165% rise in the frequency of chest pain Their cholesterollevels were significantly worse than those of the experimental patients, and the blockages in their arteries also became worse The patients in the group who were the least attentive to diet and lifestyle changes had blockages that increased in size by 8% over the course of the year.46 Between Dr amish, Dr Esselstyn and others before them, like Dr Morrison, I believe that we have found the strategic link in our heart disease battle plan Their dietary treatments not only relieve the symptoms of chest pain, but they also treat the cause of heart disease and can eliminate future coronary events There are no surgical or chemical heart disease treatments, at the Cleveland Clinic or anywhere else, that can compare to these impressive results THE FUTURE The future is filled with hope We now know enough to nearly eliminate heart disease We know not only how to prevent the disease, but how to successfully treat it We not need to crack open our breast plates to reroute our arteries, and we not need a lifetime of powerful drugs in our blood By eating the right food, we can keep our hearts healthy The next step is to implement this dietary approach on a large scale, which is exactly what Dr Dean Omish is currently working on His research group has begun the Multicenter Lifestyle Demonstration Project, which represents the future of heart disease health care Teams BROKEN HEARTS 131 of health professionals at eight diverse sites have been trained to treat heart disease patients with Dr Omish's lifestyle intervention program Patients eligible to participate are those who have documented heart disease severe enough to warrant surgery Instead of surgery, they may enroll in a one-year lifestyle program This program was started in 1993, and by 1998 there were forty insurance programs that covered the costs for selected patients 32 As of 1998, almost 200 people had taken part in the Lifestyle Project, and the results are phenomenal After one year of treatment, 65% of patients had eliminated their chest pain The effect was long lasting, as well After three years, over 60% of the patients continued reporting no chest pain 32 The health benefits are equaled by the economic benefits Over one million heart disease surgeries are undertaken every year.32 In 2002, physician services and hospital care for heart disease patients cost $78.1 billion (that does not include drug costs, home health care or nursing home care) The angioplasty procedure alone costs $31 ,000, and bypass surgery costs $46,000.32 In marked contrast, the year-long lifestyle intervention program only costs $7,000 By comparing the patients who underwent the lifestyle program with those patients who underwent the traditional route of surgery, Dr Omish and his colleagues demonstrated that the lifestyle intervention program cut costs by an average of $30,000 per patient 32 Much work remains to be done The health care establishment is structured to profit from chemical and surgical intervention Diet still takes the back seat to drugs and surgery One criticism that is constantly leveled at the dietary argument is that patients will not make such fundamental changes One doctor charges that Dr Esselstyn's patients change their eating habits simply because of Esselstyn's "zealous belief "47 This criticism is not only wrong and insulting to patients; it is also self-fulfilling If doctors not believe that patients will change their diets, they will neglect to talk about diet, or will it in an off-handed, disparaging way There is no greater disrespect a doctor can show patients than that of withholding potentially lifesaving information based on the assumption that patients not want to change their lifestyle Well-meaning institutions are not exempt from such closed-mindedness The American Heart Association recommends a diet for heart disease that favors moderation, rather than scientific truth The National Cholesterol Education Program does the same thing These organizations 132 THE CHINA STUDY pitch moderate diets with trivial changes as being healthy lifestyle "goals." If you are at high risk for heart disease, or if you already have the disease, they recommend that you adopt a diet containing 30% of total calories as fat (7% of total calories as saturated fat) and less than 200 mg/day of dietary cholesterol 48,49 According to them, we should also keep our total blood cholesterol level under the "desirable" level of 200 mg/dL,49 These venerable organizations are not giving the American public the most up-to-date scientific information While we are told that a total blood cholesterol level of 200 mg/dL is "desirable," we know that 35% of heart attacks strike Americans who have cholesterol levels between 150 and 200 mg/dPo (a truly safe cholesterol level is under 150 mg/dL) We also know that the most aggressive reversal of heart disease ever demonstrated occurred when fat was about lO% of total calorie intake Studies have clearly demonstrated that many patients who follow the more moderate government recommended diets see a progression of heart disease 51 The innocent victims are health-conscious Americans who follow these recommendations, keeping their total cholesterol around 180 or 190 mg/dL, only to be rewarded with a heart attack leading to a premature death To top it off, the National Cholesterol Education Program dangerously writes, "Lifestyle changes are the most cost-effective means to reduce risk for CHD[coronary heart disease] Even so, to achieve maximal benefit, many persons will require LDL [cholesteroll-Iowering drugs."49 No wonder America's health is failing The dietary recommendations for the most diseased hearts among us, given by supposedly reputable institutions, are severely watered down and followed by the caveat that we'll probably need a lifetime of drugs anyway Our leading organizations fear that if they advocate more than modest changes, no one will listen to them But the establishment-recommended diets are not nearly as healthy as the diets espoused by Drs Esselstyn and Omish The fact is that a blood cholesterol level of 200 mg/dL is not safe, a 30% fat diet is not "low-fat," and eating foods containing any cholesterol above mg is unhealthy Our health institutions are intentionally misleading the public about heart disease, all in the name of "moderation." Whether scientists, doctors and policy makers think the public will change or not, the layperson must be aware that a whole foods, plantbased diet is far and away the healthiest diet In the seminal paper regarding the landmark Lifestyle Heart Trial, the authors, Dr Omish and ... plummeted Further, it was clear that the closer the patients adhered to the lifestyle recommendations, the more their hearts healed The patients who had the best adherence over the course of the year... 82% of the patients in the experimental group had regression in their heart disease over the course of a year The control group did not fare so well, despite the fact that they received the usual... surgery or technology to treat these patients.46 The experimental patients adhered to pretty much everything that 130 THE CHINA STUDY the researchers asked of them and were rewarded with improved