Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?

To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted in the late 19th century. The procedure was intended to remove all cancer cells of the breast, the overlying skin, the underlying muscle, and regional lymph nodes (Figure 1). It was mutilating, permanently disfiguring, and no more effective than less radical, less disfiguring procedures. Still, because of the prestige and respect Halsted commanded as a teacher of surgeons, his disciples defended and taught the radical mastectomy at the most revered medical colleges. His extreme surgery was perpetuated for almost a century, until challenges by courageous physicians in Europe and America, along with a prospective randomized study by Dr. Bernard Fisher, finally sounded the death knell of this standardized surgical error of the century. The 21st century analogue to this unfortunate chapter is the interventional and pharmaceutical treatment of coronary artery disease. This approach results in significant mortality, morbidity, and unsustainable expense. Neither the procedures nor the drugs that accompany them treat the cause. Standard care for coronary artery disease is nothing more than palliative. The purveyors of this treatment acknowledge that it is but a stopgap therapy. And as in the case of the radical mastectomy, there is a far more effective, cost-effective, and sustainable treatment. It’s simple: advocate a lifestyle of plantbased nutrition, make a bold leap toward a world free of heart disease, and lessen our use of scalpels and drugs. There is widespread agreement that the Western diet of processed oils, white flour, dairy, and meat progressively causes endothelial dysfunction and injury, diminution of nitric oxide, increased vascular adhesion molecules, endothelial permeability, low-density lipoprotein oxidation, foam cell formation, generation of reactive oxygen species, plaque cap thinning, and plaque rupture, which lead to clinical events. Contributing risk factors include a family history, hypertension, smoking, hypercholesterolemia, diabetes, metabolic syndrome, and obesity. Medications commonly used for this illness include ! blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, anticoagulants, and aspirin. The interventions include angioplasty with or without bare-metal or drug-coated stents, atherectomy, and coronary artery bypass surgery. Exercise may be prescribed and smoking cessation encouraged. Some patients may receive nutritional advice from a dietician or nutritional therapist, who often lacks knowledge or training in disease prevention and reversal. For the minority of heart patients, specifically those in the midst of heart attacks or acute coronary syndromes, stents or coronary artery bypass may be lifesaving. For the rest, none of the present therapies targets the cause: the Western diet. As a consequence, the disease marches on in all patients, which leads to more drugs, stents, and bypasses, increasing heart damage, heart failure, and, too often, death, from an essentially benign, food-borne illness. This food-borne illness has taken root in the hearts of even the “healthiest” followers of the Western diet, as proved by autopsy studies. There is ample evidence linking diet and disease: in plant-based cultures such as rural China, the Papua highlanders in New Guinea, central Africa, and the Tarahumara Indians of northern Mexico, coronary artery disease is virtually nonexistent. Conversely, plant-based cultures that adopt Western, animal-based nutrition promptly develop coronary artery disease. The reverse is also true. Deaths from heart disease and stroke plummeted from 1939 to 1945, during World War II, when the occupying German forces deprived Norwegians of their livestock, and rationing resulted in greatly diminished animal-derived foods. Within 2 years of the restoration of meat and dairy consumption after the cessation of hostilities in 1945, death rates from stroke and heart attack approached their pre-1939 levels. In 1985, I initiated a study that treated seriously ill patients with coronary artery disease with plant-based nutrition and succeeded in the arrest and reversal of their disease. This program has been published at 5, 12, 16, and most recently summarized at 20 years in my book Prevent and Reverse Heart Disease, making it 1 of the longest investigations of its type in medical research. The duration of the study is testimony that patients with coronary disease will adhere to these food changes for decades and beyond. Patients lose weight, blood pressure normalizes, and type 2 diabetes improves or resolves, as do angina, erectile dysfunction, and peripheral vascular and carotid disease. Angiographic reversal can be striking (Figure 2). Even more remarkable is the sense of control patients achieve when it comes to containing and reversing their disease. Despite widespread and growing awareness of this straightforward, painless, and inexpensive therapy, it is infrequently used. Physicians assert that their patients will not follow this approach. The hundreds of patients we have treated and our original study participants, who switched from a Western diet full of oil, processed foods, meat, and dairy to plant-based nutrition, are testimony to the contrary. Why have we succeeded where others have failed? Most physicians, who see 20 to 30 patients per day, have no time, background, or passion for nutritional counseling and lack training in behavioral modification. What is more, most insurance carriers do not reimburse for counseling. Time is at a premium in the physician-patient interaction. At the initial patient visit, a nurse, resident, staff physician, or assistant will perform a history and physical. The physiCleveland Clinic Wellness Institute, Lyndhurst, Ohio. Manuscript received April 5, 2010; revised manuscript received and accepted May 3, 2010. *Corresponding author: Tel: 216-297-8556; fax: 216-831-1925. E-mail address: aesselstyn@aol.com (C.B. Esselstyn).