The China Study (20 page)

124                          THE CHINA STUDY
patients who undergo bypass operation do not have fewer heart attacks than
those who do not have surgery. 12
Remember which plaque buildups cause heart attacks? The deadly
buildups are the smaller, less stable plaques that tend to rupture. The by-
pass operation, however, is targeted to the largest, most visible plaques,
which may be responsible for chest pain, but not for heart attacks.
Angioplasty is a similar story. The procedure is expensive and carries
significant risks. After identifying blockages in a coronary artery, a bal-
l o o n is inserted into the artery and inflated. It pushes the plaque back
against the vessel, thereby allowing more blood to flow. Roughly one
out of sixteen patients will experience an "abrupt vessel closure" during
the procedure, which can lead to death, heart attack or an emergency
bypass operation. 3 ? Assuming that doesn't happen, there is still a good
chance that the procedure will fail. Within four months after the proce-
dure, 40% of the arteries that were "squished" open will close up again,
effectively nullifying the procedure. 38 Nonetheless, barring these unfa-
vorable outcomes, angioplasty does a good job of providing temporary
relief of chest pain. Of course, angioplasty does little to treat the small
blockages that are most likely to lead to heart attacks.
So, upon closer examination, our seemingly beneficent mechanical
advances in the field of heart disease are severely disappointing. Bypass
surgery and angioplasty do not address the cause of heart disease, prevent
heart attacks or extend the lives of any but the sickest heart disease pa-
tients.
What's going on here? Despite the positive public relations surround-
ing the past fifty years of heart disease research, we must ask ourselves:
are we winning this war? Maybe we should ask ourselves what we might
do differently. For example, whatever happened to the dietary lessons
learned fifty years ago? Whatever happened to the dietary treatments
discovered by Dr. Lester Morrison, as discussed earlier?
Those discoveries largely faded away. I only learned about this
1940s and 1950s research in recent years. I am bewildered because
the profeSSionals I heard during my graduate student days in the late
1950s and early 1960s vigorously denied that any such work was be-
i n g done or even being contemplated. In the meanwhile, America's
eating habits have only gotten worse. According to the u.S. Depart-
m e n t of Agriculture, we consume Significantly more meat and added
fat than we did thirty years ago. 39 Clearly we are not moving in the
right direction.

BROKEN HEARTS                             125
As this information has resurfaced in the past two decades, the fight
against the status quo has been heating up again. A few rare doctors are
proving that there is a better way to defeat heart disease. They are dem-
onstrating revolutionary success, using the most simple of all treatments:
food.
DR. CALDWELL B. ESSELSTYN, JR.
If you were to guess the location of the best cardiac care center in the
country, maybe the world, what city would you name? New York? Los
Angeles? Chicago? A city in Florida, perhaps, near elderly people? As
it turns out, the best medical center for cardiac care is located in Cleve-
land, Ohio, according to US News and World Report. Patients fly in to the
Cleveland Clinic from all over the world for the most advanced heart
treatment available, administered by prestigious doctors.
One of the doctors at the Clinic, Dr. Caldwell B. Esselstyn, Jr. has
quite a resume. As a student at Yale University, Dr. Esselstyn rowed in
the 1956 Olympics, winning a gold medal. After being trained at the
Cleveland Clinic, he went on to earn the Bronze Star as an army surgeon
in the Vietnam War. He then became a highly successful doctor at one
of the top medical institutions in the world, the Cleveland Clinic, where
he was preSident of the staff, member of the Board of Governors, chair-
m a n of the Breast Cancer Task Force and head of the Section of Thyroid
and Parathyroid Surgery. Having published over 100 scientific papers,
Dr. Esselstyn was named one of the best doctors in America in 1994-
1995. 40 From knowing this man personally, I get the feeling that he has
excelled at virtually everything he has done in his life. He reached the
pinnacle of success in his professional and personal life, and did it with
grace and humility.
The quality I find most appealing about Dr. Esselstyn, however, is not
his resume or awards; it is his principled search for the truth. Dr. Essel-
s t y n has had the courage to take on the establishment. For the Second
National Conference on Lipids in the Elimination and Prevention of
Coronary Artery Disease (which he organized and in which he kindly
asked me to participate) Dr. Esselstyn wrote:
Eleven years into my career as a surgeon, I became disillusioned
with the treatment paradigm of U.S. medicine in cancer and heart
disease. Little had changed in 100 years in the management of
cancer, and in neither heart disease nor cancer was there a serious

126                          THE CHINA STUDY
effort at prevention. I found the epidemiology of these diseases
provocative, however: Three-quarters of the humans on this plan-
e t had no heart disease, a fact strongly associated with dietY
Dr. Esselstyn started to reexamine the standard medical practice.
"Aware that medical, angiographic and surgical interventions were
treating only the symptoms of heart disease and believing that a funda-
mentally different approach to treatment was necessary," Dr. Esselstyn
decided to test the effects of a whole foods, plant-based diet on people
with established coronary disease. 42 By using a minimal amount of cho-
lesterol-lowering medication and a very low-fat, plant-based diet, he
has gotten the most spectacular results ever recorded in the treatment
of heart disease. 42, 43
In 1985, Dr. Esselstyn began his study with the primary goal of re-
d u c i n g his patients' blood cholesterol to below 150 mgldL. He asked
each patient to record everything he or she ate in a food diary. Every
two weeks, for the next five years, Dr. Esselstyn met with his patients
to discuss the process, administer blood tests and record blood pres-
s u r e and weight. He followed up this daytime meeting with an evening
telephone call to report the results of the blood tests and further discuss
how the diet was working. In addition, all of his patients met together
a few times a year to talk about the program, socialize and exchange
helpful information. In other words, Dr. Esselstyn was diligent, in-
volved, supportive and compassionately stern on a personal level with
his patients.
The diet they, including Dr. Esselstyn and his wife Ann, followed was
free of all added fat and almost all animal products. Dr. Esselstyn and
his colleagues report, "[Participants 1were to avoid oils, meat, fish, fowl
and dairy products, except for skim milk and nonfat yogurt."42 About
five years into the program, Dr. Esselstyn recommended to his patients
that they stop consuming any skim milk and yogurt, as well.
Five of his patients dropped out of the study within the first two
years; that left eighteen. These eighteen patients originally had come
to Dr. Esselstyn with severe disease. Within the eight years leading up to
the study, these eighteen people had suffered through forty-nine coronary
events, including angina, bypass surgery, heart attacks, strokes and an-
gioplasty. These were not healthy hearts. One might imagine that they
were motivated to join the study by the panic created when premature
death is near. 42,43

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BROKEN HEARTS
These eighteen patients achieved remarkable success. At the start of
the study, the patients' average cholesterol level was 246 mgldL. During
the course of the study, the average cholesterol was 132 mg/dL, well below
the 150 mg/dL target/ 43 Their levels of "bad" LDL cholesterol dropped
just as dramatically.42 In the end, though, the most impressive result
was not the blood cholesterol levels, but how many coronary events oc-
c u r r e d since the start of the study.
In the following eleven years, there was exactly ONE coronary event
among the eighteen patients who followed the diet. That one event was
from a patient who strayed from the diet for two years. After straying,
the patient consequently experienced clinical chest pain (angina) and
then resumed a healthy plant-based diet. The patient eliminated his an-
gina, and has not experienced any further eventsY
Not only has the disease in these patients been stopped, it has even
been reversed. Seventy percent of his patients have seen an opening of their
clogged arteries.43 Eleven of his patients had agreed to angiography, a
procedure in which specific arteries in the heart can be "x-rayed." Of
these eleven, the blockages in the arteries were, on average, reduced in
size by 7% over the first five years of his study. This may sound like a
small change but it should be noted that the volume of blood delivered
is at least 30% greater when the diameter is increased by 7%.44 More
importantly, this is the difference between the presence of pain (from
angina) and absence of pain, indeed between life and death. Authors of
the five-year report note, "This is the longest study of minimal fat nutri-
t i o n used in combination with cholesterol-lowering drugs conducted to
date, and our finding of a mean decrease of arterial stenosis [blockage)
of 7.0% is greater than any reports in previous research."42
One physician took special note of Dr. Esselstyn's study. He was only
forty-four years of age and seemingly healthy when he found himself
with a heart problem, culminating in a heart attack. Because of the na-
ture of his heart disease, there was nothing that conventional medicine
could safely offer him. He visited Dr. Esselstyn, decided to commit to
the dietary program, and after thirty-two months, without any choles-
terol-lowering medication, he reversed his heart disease and lowered his
blood cholesterol to 89 mg/dL. What follows is the dramatic image of this
patient's diseased artery before and after Dr. Esselstyn's dietary advice
(Chart 5.4).8 The light part of the picture is blood flowing through an
artery. The picture on the left (A) has a section marked by a parenthesis
where severe coronary disease reduced the amount of blood flow. After

THE CHINA STUDY
128
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 pro-
gram 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

129
BROKEN HEARTS
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, plant-
based 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 prominent-
ly in popular media , succeeded in having his heart disease treatment
plan covered by a number of insurance carriers and written several best-
selling 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 do 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 pa-
tients 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 sever-
ity 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 re-
ceived the usual care. Their chest pain became worse in terms of frequen-
cy, 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 cho-
l e s t e r o l l e v e l s were significantly worse than those of the experimental pa-
tients, 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 symp-
t o m s 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 do not need to crack open our breast plates to
reroute our arteries, and we do 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