How Not to Die Read online

  What about for someone who had already had a heart attack and is trying to prevent another? Still no benefit was found.13

  Where did we even get this idea that the omega-3 fats in fish and fish oil supplements are good for you? There was a notion that Eskimos were protected from heart disease, but that appears to be a complete myth.14 Some early studies, however, looked promising. For example, the famous DART trial from the 1980s involving two thousand men found that those advised to eat fatty fish had a 29 percent reduction in mortality.15 That’s impressive, so it’s no wonder the study got a lot of attention. But people seem to have forgotten about the sequel, the DART-2 trial, which found the exact opposite. Run by the same group of researchers, the DART-2 trial was an even bigger study—three thousand men—but this time, participants advised to eat oily fish and particularly those who were supplied with fish oil capsules had a higher risk of cardiac death.16,17

  After putting all the studies together, researchers concluded that there was no longer justification for the use of omega-3s in everyday clinical practice.18 What should doctors do when their patients follow the American Heart Association’s advice and inquire about fish oil supplements? As the director of Lipids and Metabolism at Mount Sinai’s cardiovascular institute put it: “Given this and other negative meta-analyses, our job [as doctors] should be to stop highly marketed fish oil supplementation to all our patients . . .”19

  Heart Disease Starts in Childhood

  In 1953, a study published in the Journal of the American Medical Association radically changed our understanding of the development of heart disease. Researchers conducted a series of three hundred autopsies on American casualties of the Korean War, with an average age of around twenty-two. Shockingly, 77 percent of soldiers already had visible evidence of coronary atherosclerosis. Some even had arteries that were blocked off 90 percent or more.20 The study “dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease (CHD) becomes a clinically recognized problem.”21

  Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the first stage of atherosclerosis—were found in nearly all American children by age ten.22 By the time we reach our twenties and thirties, these fatty streaks can turn into full-blown plaques like those seen in the young American GIs of the Korean War. And by the time we’re forty or fifty, they can start killing us off.

  If there’s anyone reading this over the age of ten, the question isn’t whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have.

  Just how early do these fatty streaks start to appear? Atherosclerosis may start even before birth. Italian researchers looked inside arteries taken from miscarriages and premature newborns who died shortly after birth. It turns out that the arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions.23 This finding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy.

  It’s become commonplace for pregnant women to avoid smoking and drinking alcohol. It’s also never too early to start eating healthier for the next generation.

  According to William C. Roberts, the editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in your blood.24 Indeed, LDL is called “bad” cholesterol, because it’s the vehicle by which cholesterol is deposited into your arteries. Autopsies of thousands of young accident victims have shown that the level of cholesterol in the blood was closely correlated with the amount of atherosclerosis in their arteries.25 To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs.26

  Notice a pattern here? The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating animal products and processed junk. This likely explains why populations living on traditional diets revolving around whole plant foods have largely remained free from the epidemic of heart disease.

  It’s the Cholesterol, Stupid!

  Dr. Roberts hasn’t only been editor in chief of the American Journal of Cardiology for more than thirty years; he’s the executive director of the Baylor Heart and Vascular Institute and has authored more than a thousand scientific publications and written more than a dozen textbooks on cardiology. He knows his stuff.

  In his editorial “It’s the Cholesterol, Stupid!,” Dr. Roberts argued (as noted earlier) that there is only one true risk factor for coronary heart disease: cholesterol.27 You could be an obese, diabetic, smoking couch potato and still not develop atherosclerosis, he argues, as long as the cholesterol level in your blood is low enough.

  The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where you start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop in cholesterol-lowering trials.28 An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations-long project to identify risk factors for heart disease.29 The population target should therefore be a total cholesterol level under 150 mg/dL. “If such a goal was created,” Dr. Roberts wrote, “the great scourge of the Western world would be essentially eliminated.”30

  The average cholesterol for people living in the United States is much higher than 150 mg/dL; it hovers around 200 mg/dL. If your blood test results came back with a total cholesterol of 200 mg/dL, your physician might reassure you that your cholesterol is normal. But in a society where it’s normal to die of heart disease, having a “normal” cholesterol level is probably not a good thing.

  To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL. Dr. Roberts noted that there are only two ways to achieve this for our population: to put more than a hundred million Americans on a lifetime of medications or to recommend they all eat a diet centered around whole plant foods.31

  So: drugs or diet. All health plans cover cholesterol-lowering statin drugs, so why change your diet if you can simply pop a pill every day for the rest of your life? Unfortunately, as we’ll see in chapter 15, these drugs don’t work nearly as well as people think, and they may cause undesirable side effects to boot.

  Want Fries with That Lipitor?

  The cholesterol-lowering statin drug Lipitor has become the bestselling drug of all time, generating more than $140 billion in global sales.32 This class of drugs garnered so much enthusiasm in the medical community that some U.S. health authorities reportedly advocated they be added to the public water supply like fluoride is.33 One cardiology journal even offered the tongue-in-cheek suggestion for fast-food restaurants to offer “McStatin” condiments along with ketchup packets to help neutralize the effects of unhealthy dietary choices.34

  For those at high risk of heart disease who are unwilling or unable to bring down their cholesterol levels naturally with dietary changes, the benefits of statins generally outweigh the risks. These drugs do have side effects, though, such as the potential for liver or muscle damage. The reason some doctors routinely order regular blood tests for patients on these drugs is to monitor for liver toxicity. We can also test the blood for the presence of muscle breakdown products, but biopsies reveal that people on statins can show evidence of muscle damage even if their blood work is normal and they exhibit no symptoms of muscle soreness or weakness.35 The decline in muscular strength and perfo
rmance sometimes associated with these drugs may not be such a big deal for younger individuals, but they can place our senior citizens at increased risk for falls and injury.36

  More recently, other concerns have been raised. In 2012, the U.S. Food and Drug Administration announced newly mandated safety labeling on statin drugs to warn doctors and patients about their potential for brain-related side effects, such as memory loss and confusion. Statin drugs also appeared to increase the risk of developing diabetes.37 In 2013, a study of several thousand breast cancer patients reported that long-term use of statins may as much as double a woman’s risk of invasive breast cancer.38 The primary killer of women is heart disease, not cancer, so the benefits of statins may still outweigh the risks, but why accept any risk at all if you can lower your cholesterol naturally?

  Plant-based diets have been shown to lower cholesterol just as effectively as first-line statin drugs, but without the risks.39 In fact, the “side effects” of healthy eating tend to be good—less cancer and diabetes risk and protection of the liver and brain, as we’ll explore throughout the rest of this book.

  Heart Disease Is Reversible

  It’s never too early to start eating healthfully, but is it ever too late? Such lifestyle medicine pioneers as Nathan Pritikin, Dean Ornish, and Caldwell Esselstyn Jr. took patients with advanced heart disease and put them on the kind of plant-based diet followed by Asian and African populations who didn’t suffer from heart disease. Their hope was that a healthy enough diet would stop the disease process and keep it from progressing further.

  But instead, something miraculous happened.

  Their patients’ heart disease started to reverse. These patients were getting better. As soon as they stopped eating an artery-clogging diet, their bodies were able to start dissolving away some of the plaque that had built up. Arteries opened up without drugs or surgery, even in some cases of patients with severe triple-vessel heart disease. This suggests their bodies wanted to heal all along but were just never given the chance.40

  Let me share with you what has been called the “best kept secret in medicine”:41 Given the right conditions, the body heals itself. If you whack your shin really hard on a coffee table, it can get red, swollen, and painful. But your shin will heal naturally if you just stand back and let your body work its magic. But what if you kept whacking it in the same place three times a day—say, at breakfast, lunch, and dinner? It would never heal.

  You could go to your doctor and complain that your shin hurts. “No problem,” he or she might say, whipping out a pad to write you a prescription for painkillers. You’d go back home, still whacking your shin three times a day, but the pain pills would make it feel so much better. Thank heavens for modern medicine! That’s what happens when people take nitroglycerin for chest pain. Medicine can offer tremendous relief, but it’s not doing anything to treat the underlying cause.

  Your body wants to regain its health if you let it. But if you keep reinjuring yourself three times a day, you interrupt the healing process. Consider smoking and lung cancer risk: One of the most amazing things I learned in medical school was that within about fifteen years of stopping smoking, your lung-cancer risk approaches that of a lifelong nonsmoker.42 Your lungs can clear out all that tar buildup and, eventually, it’s almost as if you never smoked at all.

  Your body wants to be healthy. And every night of your smoking life, as you fall asleep, that healing process is restarted until . . . bam!—you light up your first cigarette the next morning. Just as you can reinjure your lungs with every puff, you can reinjure your arteries with every bite. You can choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? You can choose to stop damaging yourself, get out of your own way, and let your body’s natural healing process bring you back toward health.

  Endotoxins Crippling Your Arteries

  Unhealthy diets don’t just affect the structure of your arteries; an unhealthy diet can also affect their functioning. Your arteries are not merely inert pipes through which blood flows. They are dynamic, living organs. We’ve known for nearly two decades that a single fast-food meal—Sausage and Egg McMuffins were used in the original study—can stiffen your arteries within hours, cutting in half their ability to relax normally.43 And just as this inflammatory state starts to calm down five or six hours later—lunchtime! You may once again whack your arteries with another load of harmful food, leaving many Americans stuck in a danger zone of chronic, low-grade inflammation. Unhealthy meals don’t just cause internal damage decades down the road but right here and now, within hours of going into your mouth.

  Originally, researchers blamed the animal fat or animal protein, but attention has recently shifted to bacterial toxins known as “endotoxins.” Certain foods, such as meats, appear to harbor bacteria that can trigger inflammation dead or alive, even when the food is fully cooked. Endotoxins are not destroyed by cooking temperatures, stomach acid, or digestive enzymes, so after a meal of animal products, these endotoxins may end up in your intestines. They are then thought to be ferried by saturated fat across the gut wall into your bloodstream, where they can trigger the inflammatory reaction in your arteries.44

  This may help explain the remarkable speed at which cardiac patients can experience relief when placed on a diet composed primarily of plant foods, including fruits, vegetables, whole grains, and beans. Dr. Ornish reported a 91 percent reduction in angina attacks within just a few weeks in patients placed on a plant-based diet both with45 or without46 exercise. This rapid resolution in chest pain occurred well before their bodies could have cleared the plaque from their arteries, suggesting plant-based diets don’t just help clean out arteries but also improve their day-to-day function. In contrast, control-group patients who were instead told to follow the advice of their doctors had a 186 percent increase in angina attacks.47 It’s no surprise their conditions worsened, given that they continued to eat the same diet that crippled their arteries in the first place.

  We’ve known about the dramatic power of dietary changes for decades. For example, there was a paper entitled “Angina and Vegan Diet” published in the American Heart Journal back in 1977. Vegan diets are exclusively plant based, avoiding meat, dairy, and eggs. Doctors described cases like that of Mr. F. W. (initials are often used to protect patient confidentiality), a sixty-five-year-old man with angina so severe he had to stop every nine or ten steps. He couldn’t even make it to the postbox. He was started on a vegan diet, and his pain improved within days. Within months, he was reportedly climbing mountains with no pain at all.48

  Not ready to start eating healthier? Well, there is a new class of antiangina drugs, such as ranolazine (sold as Ranexa). A drug company executive suggested its product be used for people not “able to comply with the substantial dietary changes required to achieve a vegan diet.”49 The medication costs more than $2,000 a year, but the side effects are relatively minor, and it does work . . . technically speaking. At the highest dose, Ranexa was able to prolong exercise duration by 33.5 seconds.50 More than half a minute! It doesn’t look like those choosing the drug route will be climbing mountains anytime soon.

  Brazil Nuts for Cholesterol Control?

  Can a single serving of Brazil nuts bring down your cholesterol levels faster than statin drugs and keep them down even a month after that single meal?

  It was one of the craziest findings I’d ever seen. Researchers from—where else?—Brazil gave ten men and women a single meal containing between one and eight Brazil nuts. Amazingly, compared to the control group who ate no nuts at all, just a single serving of four Brazil nuts almost immediately improved cholesterol levels. LDL—the “bad”—cholesterol levels were a staggering twenty points lower just nine hours after eating the Brazil nuts.51 Even drugs don’t work nearly that fast.52

  Here’s the truly insane part: The researchers went back and measured the study participants’ cholesterol thirty days later. Even a month after ingesting a single serving of Brazil nuts
, their cholesterol levels stayed down.

  Normally, when a study comes out in the medical literature showing some too-good-to-be-true result like this, doctors wait to see the results replicated before they change their clinical practice and begin recommending something new to their patients, particularly when the study is done on only ten subjects, and especially when the findings seem too incredible to believe. But when the intervention is cheap, easy, harmless, and healthy—we’re talking just four Brazil nuts per month—then in my opinion, the burden of proof is somewhat reversed. I think the reasonable default position is to do it until proven otherwise.

  More is not better, however. Brazil nuts are so high in the mineral selenium that eating four every day may actually bump you up against the tolerable daily limit for selenium. Nevertheless, this is not something you have to worry about if you’re only eating four Brazil nuts a month.

  Follow the Money

  Research showing that coronary heart disease can be reversed with a plant-based diet—with or without other healthy lifestyle changes—has been published for decades in some of the most prestigious medical journals in the world. Why hasn’t this news translated into public policy yet?

  In 1977, the U.S. Senate Committee on Nutrition and Human Needs tried to do just that. Known as the McGovern Committee, they released Dietary Goals for the United States, a report advising Americans to cut down on animal-based foods and increase their consumption of plant-based foods. As a founding member of Harvard University’s nutrition department recalls, “The meat, milk and egg producers were very upset.”53 That’s an understatement. Under industry pressure, not only was the goal to “decrease meat consumption” removed from the report but the entire Senate nutrition committee was disbanded. Several prominent senators reputedly lost their election bids as a result of supporting the report.54