Doctor’s Tip: Heart disease more than plumbing problem
October 17, 2016
The coronary arteries carry blood and oxygen to the heart muscle, called the myocardium. The term "heart disease" usually refers to cholesterol-laden plaque buildup in these arteries, called atherosclerosis or "hardening of the arteries." This can lead to:
• Heart attacks, caused by plaque rupture that results in a blood clot that blocks the blood flow to part of the myocardium.
• Chronic blockage of a coronary artery that prevents sufficient blood supply to part of the myocardium during exertion, manifested by chest pain called angina.
• Chronic damage to the myocardium, resulting in a weak heart called heart failure.
• Damage to the electrical conduction system of the heart, resulting in rhythm disturbances often requiring a pacemaker.
Over the past 40-plus years, a multibillion dollar industry has evolved, looking for blockages of the coronary arteries and fixing them with stents or bypassing them with surgery. The problems with this approach are:
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• Compared with lifestyle modification (healthy diet and regular exercise), stents and bypass surgery have not been shown to extend or improve quality of life. The one exception to this is the setting of an acute heart attack, when a stent can open up the blockage and save your myocardium and your life, and we are lucky to have this available at Valley View Hospital.
• These procedures are just stopgap measures because they do not treat the disease or the cause of the disease.
• Stents and bypass vessels can clog up with plaque.
• Stents often don't prevent heart attacks, because 99 percent of plaque is in the wall of the coronary arteries, not causing a blockage. Eighty-six percent of heart attacks occur when non-obstructive plaque, not detectable on stress tests or arteriograms (imaging of the coronary arteries), ruptures.
• Stents and bypasses are not only expensive, but can be associated with side effects including permanent brain damage (bypass) and death (stents and bypass).
It's important to know that:
• Heart attacks are the main cause of death in American men and women.
• In 20 percent of heart attacks the first symptom is the last: sudden death.
• People on a lifelong plant-based, whole (unprocessed), low fat and oil diet don't get atherosclerosis and therefore don't have heart attacks (or strokes, i.e. "brain attacks").
• Dean Ornish, M.D., showed over 25 years ago and Caldwell Esselstyn more recently that this diet can reverse heart disease. In the case of angina, symptoms can resolve in as little as three weeks.
• With appropriate counseling, many patients will adopt a plant-based lifestyle with regular exercise, and the food can be tasty.
• People complain about health care costs, and rightly so. If everyone in this country were to adopt a healthy lifestyle, 75 percent of the $2.8 trillion in annual health care costs in the U.S. could be saved (from Andrew Freeman, plant-based cardiologist at National Jewish in Denver).
For decades during the 20th century breast cancer was treated by radical mastectomy, with little evidence that this disfiguring, major surgery was the right thing to do. Eventually, doctors figured out this operation wasn't necessary and stopped performing it toward the end of the last century.
Caldwell Esselstyn, M.D., was a surgeon at the Cleveland Clinic and is famous for the "Forks Over Knives" documentary (available on Netflix and YouTube) and for his book "Prevent and Reverse Heart Disease." In 2010 he wrote an article for a medical journal with the title "Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?"
In referring to stents, bypass and pharmaceutical treatment of heart disease versus lifestyle modification, at the end of his article he has the following to say: "We can hardly be proud of a drug and interventional therapy that results in death, morbidity, inordinate expense and disease progression and can never halt this food-borne epidemic. Every patient with this disease should be made aware of this safe, simple, enduring option to cure himself or herself. Most coronary disease need never exist, and where it does exist, it need not progress. Present coronary artery disease therapy need not become the radical mastectomy of this century."
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.