clintonhealthcrisis reprint

8/2/2019 ClintonHealthCrisis Reprint

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BY VANCE LEHMKUHL

When President Bill Clinton suffered discomfort recently and had an operation to chear a blockage to his

heart, mainstream press outlets made it a teachable moment about heart disease. And the lesson they

taught was: Coronary heart disease is a death sentence. There’s nothing you can do to stop it.

After all, Clinton was a perfectexample of someone who had

“done all the right things” interms of diet and lifestyle and yet hisheart disease, after one intervention in2004, was still progressing. The head-line of one of the most widely readstories summed up the approach of themainstream media: “No cure for heartdisease, Clinton’s case shows.”

If “cure” is taken literally, this may be

true — there’s no miracle pill or proce-

dure that unblocks the coronary arteries.

But there are multiple studies showingthat heart disease can be reversed —

that its seemingly inevitable progression

can be stopped and turned back — by

changes in diet and lifestyle. For people

suffering from heart disease, that’s of

great importance, yet the notion is all

but invisible in the coverage of this case.

The article mentioned above quotesa parade of physicians conrming the

inevitably progressive nature of coro-nary heart disease: Clyde Yancy, MD,

president of the American Heart Asso-ciation (AHA), explains that “this kindof disease is progressive. It’s not a one-time event, so it really points out theneed for constant surveillance.”

Allan Schwartz, MD, at the New

York Presbyterian Hospital, stressed that

“heart disease is a chronic condition. We

don’t have a cure for this condition, but

we have excellent treatments.”

The “excellent treatments” include

the surgery Clinton underwent inFebruary, when doctors reopened the

clogged artery they had bypassed in

his 2004 quadruple bypass operation

and inserted, to keep the artery open,

two mesh props called stents. These

invasive surgical procedures are

shrugged off as a common, inevitable

part of the routine that patients should

expect to settle into.

“Essentially, it’s a tune-up,” Cam

Patterson, MD, cardiology chief at the

University of North Carolina at Cha-pel Hill, says in the piece. “We see

people who come in like this every

four to ve years.”

And Dr. Schwartz was quick to addthat “this was not a result of his life-style or his diet.”

Clinton himself subsequently madea statement blaming his poor diet whenhe was younger, but stayed mum onwhether he had indeed, as Schwartz

claimed, been “toeing the line” sincehis 2004 bypass.

What’s going on? Why is a well-documented option to reverse coronaryheart disease not mentioned by medicalspokespeople? Wasting no time, JohnMcDougall, MD, founder and medi-cal director of a well-known diet andlifestyle modication program (www.drmcdougall.com), weighed in with his

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explanation in an open letter to Clinton.McDougall deftly summarized the

situation: “With all

their good in-

tentions, and the

use of sophisti-

cated, expensive

technologies,your doctors are

allowing your

heart disease to

progress as if it

were a run-away

train destined for a wreck. Your cardiol-

ogist, Dr. Allan Schwartz, at New York

Presbyterian Hospital, is telling you that

further blockage is the normal course of

your disease, and your diet and lifestyle

are not involved. Medical experts ex-pressing their opinion in the news since

your surgery are misleading the public

into believing that the proper manage-

ment of this disease is through constant

surveillance and repeated surgical inter-

ventions. This is big business talking,

and in addition to mismanagement of

your personal care, one result will be

an increase in the already more than

one million angioplasties and 500,000

bypass surgeries performed annually inthe U.S.”

McDougall quickly got to the point:“You had two bare metal stents

placed in your heart following a fewdays of mild chest discomfort. Thishistory will continue to repeat itself until you seriously change your eatinghabits and get these meddling doctorsout of your life. You are missing an-other ‘teaching moment’ and bypassing

another chance to change health andhealth care in America.”Clinton is no heart expert, of course.

By and large, he was listening to hisphysicians — but he apparently wasn’tlistening to his friend Dean Ornish,MD, whose name inevitably comes upin discussions of heart disease and itsreversal.

Ornish, president and founder of the

nonprot Preventive Medicine Research

Institute (www.pmri.org), oversaw the

Lifestyle Heart Trial, a randomized

controlled study published in The Lan-

cet in 1990 and in The Journal of the

American Medical Association in 1983

and, again, in 1995 and 1998. Patients

who stuck to a low-fat vegetarian diet,

stopped smoking, exercised regularlyand also practiced yoga and meditation

not only stopped the progression of their

disease, but actually reversed it, in con-

trast to a control group who followed

standard medical advice. This was

the rst randomized controlled trial

proving that comprehensive lifestyle

changes can reverse the progression

of even severe coronary heart disease

without drugs or surgery.

Ornish recently published a study inthe American Journal of Health Pro-

motion reporting the results of almost3,000 patients who went through hisreversing heart disease program in 24different hospital sites. They found sta-

tistically signicant improvements inall clinical metrics after 12 weeks thatwere still signicant after oneyear.

His most recent research (incollaboration with Dr. Eliza-beth Blackburn, who recentlyreceived the Nobel Prize inMedicine) proved, for therst time, that comprehensivelifestyle changes “turn on”

disease-preventing genes and“turn off” disease-promotinggenes, as well as increasingtelomerase by 30%. Telomerase is theenzyme that lengthens telomeres, theends of our chromosomes that controlaging.

So far, Ornish has not made manypublic statements about the lessonsto be learned from Clinton’s situation

since he is one of President Clinton’sconsulting physicians and considersphysician / patient condentiality tobe sacred. But he did appear on Larry

King Live along with Sanjay GuptaMD, and Wayne Isom, MD. Ornishchose his moment and his points care-fully and, as the segment was ending

got the facts out.

LARRY KING: “Dean, his doctorsaid that the bypass graft clogging upwas not due to lifestyle or diet. How dothey know?”

DR. ORNISH: “Well, you know, Ihave a different perspective. I can’ttalk about the President directly. ButI can say, in general, for them to say

that lifestyle, diet, exercise, stress re-ally don’t have anything to do with

whether a bypass clogs up is just notwhat the facts show. We’ve done stud-ies, and others have replicated themshowing that when you change your

lifestyle, you can stop and even reversethe progression of heart disease. But

if you just put a bypassin but you don’t changeyour lifestyle, it’s a lit-tle like mopping up theoor around a sink that’soverowing without alsoturning off the faucet, orputting a new oil lter inwithout changing the oil

It’s just going to clog upagain.“It doesn’t have to be

that way. And I say that not to blame,but to empower; because when wemake our lifestyle choices, when wechange our lifestyle more than mostdoctors recommend, we can stop andeven reverse the progression of heartdisease. And we can keep those by-

Dr. John McDougall

Dr. Dean Ornish

You are missing another ‘teaching moment’ and bypassing

another chance to change health and health care in America.



passes open without necessarily havingto have another stent.

“Randomized trials, like in The New

England Journal of Medicine two yearsago, the COURAGE study, showed

quite clearly that stents do not prolonglife. They don’t even prevent heart at-tacks, unless you’re in the middle of having one, which 95% of people whoreceive stents are not. And so the mainreason for getting them is to make theangina, or chest pain, better. But we’veshown, and others have shown, that if you change your lifestyle sufciently,you can reduce angina or chest pain by90 to 95% in just a few weeks — sim-

ply by changing diet and lifestyle.”At this point King turned to cardiac

surgeon Dr. Wayne Isom with a quick“Do you agree with that, Wayne?”

Before Isom answered (a quasi-dip-lomatic hedge), Ornish inserted, “And

it’s a lot cheaper and the only side ef-

fects are good ones.” And that’s pretty

much the sum total of the highest-pro-

le mention of this basic fact about

heart disease and its

treatment among all the

mountains of coverage

Clinton’s surgery gen-

erated.

Why so little report-ing on heart-diseasereversal? Is the main-

stream media showingextreme tunnel vision,or are they just reect-ing what’s comingout from the biggestnames in cardiology?Even the press releaseissued by the AHA inthe wake of Clinton’soperation is relativelysilent.

In the ofcial state-ment, AHA President

Clyde Yancy, MD

touts the usefulness of

stents in reducing pain

and says Clinton’s

angina “is not unex-

pected.” Heart trouble is a disease, he

stresses, and “diseases do progress and

must be managed and, where possible,

prevented.”

Yancy apparently means that coro-nary heart disease must be “managed”by surgical procedures, given that thisis the only management technique men-tioned in the release, which winds upwith statistics on coronary angioplastyand stenting. No notion of regressionor reversal makes any appearance inthe release.

I checked in with AHA headquartersto nd out why this might be and Rich-

ard Stein, MD, a cardiologist at NewYork University, spoke on behalf of theorganization.

“Does the AHA recognize the re-versal of coronary heart disease as areal achievable, reproducible treat-ment approach?” I asked. His answerwas careful: “There are certain patientsfor whom aggressive prevention tech-niques — including everything from

lowering LDL cholesterol, raisingHDL cholesterol and controlling dia-betes — with such techniques we canin certain patients see things that sug-gest regression.”

Dening reversal as being chieyconcerned with stopping the build-upof atherosclerotic plaque. Stein seemed

to argue (1) that the benets in this areaare fuzzy and (2) that any advocacy orrecommendation risks convincing pa-tients that they’ll be 100% cured.

“In such cases, there’s good evi-dence that in some people we can lookat some indicators and show we’restopping plaque from forming,” heallowed, but added, “we are not con-sistently able to do it with everyone.”

“Using good Mediterranean diets

and many of the other techniques, wecan in some patients cause a regres-sion, stabilize the plaque. By doing so,these techniques reduce the likelihoodof having a heart attack. But they don’teliminate it.”

Stein added that “patients whofollow these measures, can reducetheir risk; but you can’t reduce therisk to zero. Clinton still had addi-tional plaque.” Well, yes, but Clinton

wasn’t following a regimen designedto reverse heart disease, so additionalplaque would simply have been seen aspar for the course.

And the implication that reversal or

regression techniques will inevitably

be presented as all or nothing, or that

they’ll give false hope to patients who

might not wind up seeing maximal

results, seems shaky. Why wouldn’t

doctors recommending this be as can-

did and rigorous about this prognosisas anything else?

Because risk cannot be eliminatedStein says, “people who follow thislifestyle might delay an event, lowertheir risk, but ultimately, it could stillhappen.”

Still, even if reversal did get “over-

sold” to some patients, the total harm

from this disappointment in falling

Dr. Hans Diehl notes that “bypass surgeries cost in the neighbor-

hood of $150,000 with a venous graft closure rate during the rst

year of 15 to 30%.”



short of the optimal benet (or this

potential delay in getting surgery)

would, it seems, pale in comparison to

all the lives lost by people who never

heard a word about a different way to

address their “progressive” disease.

As presented by Dr. Stein, the AHA

does recommend lifestyle changes, but

only as part of a suite of “techniques”that includes drugs and surgery. “Our

guidelines consistently call for these

steps,” he says. But then he added, “If

the idea is healthy longevity, then it’s

going to involve all of these different ap-

proaches. They all can help in different

ways. The best approach is combining

these — drugs, surgery and lifestyle.”

Hans Diehl, DrHSc, MPH, a clini-cal professor of preventive medicine

at Loma Linda University and thefounder of the successful CoronaryHealth Improvement Project (CHIP),commented, “The AHA has steadfastlyadhered to their concept that coronary

heart disease is incurable.They admit that coronaryrisk can be reduced, but theydon’t consider regressionthrough a lifestyle medicineapproach as a viable option.”

Dr. Diehl stressed that

focusing only on plaque re-

duction, whether in Clintonor in the patient community

at-large, is misleading since

the lifestyle approach pays

off in other ways as well. He pointed

out that it usually reduces the plaques

and enlarges the diameter of the arteries

within a year, and that it thins the blood,

getting more oxygenated blood to the

heart muscle, as well as diminishing or

completely relieving anginal pain.

In addition to these heart disease ben-ets, Diehl points out that the lifestyle

approach, unlike the pharmaceutical/

surgical emphasis, will generate other

clinical improvements. “Since heart dis-

ease keeps close company

with diabetes, hyperten-

sion, kidney disease

overweight, elevated cho-

lesterol, acid reux and

depression, when hear

disease is treated with

this lifestyle medicine ap-

proach, then these otherchronic conditions usu-

ally improve very quickly

as well.

Dr. Diehl draws a distinction between

the watered-down AHA diet recommen-

dations and those of researchers who

have documented heart disease reversal

In reference to Stein’s citation of “Medi-

terranean diets,” he responded that “The

Mediterranean Diet does not go far

enough to contribute to the reversal pro-cess in a consistent manner, if at all.”

Diehl also draws a key distinctionin the big picture: “When the right dietand lifestyle therapy is applied andencouraged, this process can be mostrewarding for all concerned. This ap-proach does not cause pain, it has noon-the-table mortality and it is verycost-effective. All these things cannotbe said for the more aggressive surgi-

cal and pharmaceutical approachs thatconsider coronary heart disease as ‘in-curable’ offering nostrums and pillsand stents and bypass surgeries, wherethe results erode often all too quicklywith time.”

It’s not that cholesterol-loweringdrugs have no role to play. Esselstynused statin drugs and diet therapy inhis eminently successful heart diseasereversal program. But Diehl points out

that they are at best a subordinate part-ner in the equation: “Cholesterol-low-ering drugs only do that — they lowercholesterol. Diet therapy, on the otherhand, comprehensively treats manyconditions simultaneously. All theirmarkers go down with such a diet andlifestyle approach.”

Diehl’s CHIP program does not to-tally eschew drugs, but recommends

5

Dr. Hans Diehl

Improved Cholesterol Levels with Patients in Dr. Diehl’s CHIP Program

For every 1 percent drop in LDL cholesterol, the coronary risk drops by three times that

much. This graph shows how a shift toward a more optimal, cholesterol-free diet can lower

the LDL cholesterol regardless of the initial risk category. For instance, 121 male CHIP par-

ticipants — with an initial reading between 150 and 190 mg/dl — dropped their average

LDL cholesterol from 162 to 125 mg/dl within four weeks. That’s a drop of 23%, and this

translates into a coronary risk reduction bewtween 50 and 75%.



them “only if diet alonedoes not succeed inbringing down choles-terol below 170 or 160.”And he points out that of his 50,000 CHIP partici-pants, “86% respond ef-fectively to diet therapy

within four weeks.” (Seewww.chiphealth.com/ chipvideo.)

So while Stein isn’t off

base suggesting there’s a

place for all three — drugs,

surgery and lifestyle — in heart disease

treatment, two of those are very dispro-

portionately represented. And for all the

talk about diet not having the same suc-

cess for everybody, neither do drugs and

surgery. Diehl notes that “bypass surger-

ies cost in the neighborhood of $150,000

with a venous graft closure rate during

the rst year of 15 to 30% and stenting

runs easily into $35,000 with a non-

functionality rate of 35 to 45% for the

procedure within the rst six months.”As might be expected, Dr. Esselstyn

himself takes issue with the priorities,or lack thereof, in the AHA’s guide-lines. One of his best-known successstories is a 12-year study publishedin The American Journal of Cardiol-

ogy in 1999. Angiograms there clearlyshow the regression of atheroscleroticplaques brought about by his recom-mendations — a carefully designed,

very low-fat, vegan diet, with choles-terol-lowering medication used only ina few cases.

“They (the AHA) think our diet isextreme,” he observes wryly. “The ex-treme diet is actually the one that is cre-ating this epidemic of a ‘food-borne’illness called coronary artery disease.”

Esselstyn emphasized that the tech-niques he’s been using are of a wholly

different order than recom-mending a Mediterraneandiet. “We have studieswhere we started with thewalking dead, those ‘toosick’ for intervention,” hesays. “We had striking ex-amples of heart attack rever-

sals.” (See heartattackproof.com.)

As indicated by the suc-cesses of Ornish, Diehl andEsselstyn with thousands of people, the idea that patients

are unwilling to make comprehensivelifestyle changes is not true for every-one. (In contrast, according to Dr. DeanOrnish, two-thirds of people who areprescribed statin drugs are not taking

them after just three months.)

This is echoed by John H. Kelly,

MD, MPH, a board-certied expert in

preventive medicine (see http://life-

stylehealthdoc.com) who has overseen

lifestyle intervention studies at the

Carilion Clinic in Roanoke, Virginiaand elsewhere. Informed of the AHA’s

“can’t get it to work for everybody” ra-

tionale, Kelly says, “The fact is, there is

evidence indicating the majority of in-

dividuals with atherosclerotic heart dis-

ease can open up their narrowed arteries

rather than continuing to close them.

This is a disease that we can arrest in its

progression, and often show regression.

But we need to treat its causes and not

merely its symptoms.”He continues with an example: “Wehave a documented case of a patient,a 60-year-old white male, who camewith a stress echo (a stress test plus anechocardiogram) from his cardiolo-gist showing S-T-segment depression,reduced blood ow and blood-vesselblockage.” His cardiologist had recom-mended an angiogram.

“But the patient didn’t want to dothe angiogram. Though it’s only diag-nostic, it’s an invasive procedure thatcan’t be done unless an operating roomis available — 1 in 500 being fatal.So instead, he chose to make lifestylechanges. He went vegetarian, and hischolesterol dropped.

“We showed him how to substan-tially reduce the fat, oil, salt and sugarin his diet and to eat more whole foodsHe also moved progressively towardwalking four to ve miles a day, andhis cholesterol came down wonder-fully,” Kelly says. “After a ve-weekCHIP lifestyle intervention programhe wanted to get a second stress echotest because he wanted to know thepossible clinical outcome.

“Now in 99% of patients, ordinar-ily a second stress test is going to showfurther deterioration. What we foundin this fellow was so remarkable thatwhen his cardiologist looked at thissecond test, he said ‘maybe the rsttest was artifactual’ — i.e. maybe thepatient didn’t have heart trouble at all,but it was justan artifact of the imaging

process.”What he

found was “a

change in the

S T - s e g m e n t

from 3 mm of

depression to

less than 1 mm,

which is a nega-

tive or normal exam, indicating better

oxygen delivery throughout his heart

muscle. His cardiologist gave him aclean bill of health and sent him home

with some baby aspirin.”

Although this is just one dramaticcase, it resonates with the peer-re-viewed studies of Esselstyn and Ornishthat show that such clinical outcomesare achievable by patients. Given thatthis result is a far cry from the occa-sional surgical “tune-up” presented as

Dr. Caldwell, B.

Esselstyn, Jr.

Dr. John H. Kelly, Jr.

Physicians are simply not as familiar with the science behind heart

disease regression through dietary lifestyle changes.



the norm (and indeed the only possi-bility) by AHA spokespeople, one hasto wonder what is behind the apparentdisregard for such programs amongmainstream cardiologists.

Could the low-fat vegetarian diet

as a central component of all of these

reversal methods be seen as a threat

to entrenched industries whose rep-resentatives at the top of the medical

pyramid discourage their adoption by

the doctors “on the ground?”

Esselstyn implied as much in our

conversation: “Of course, there’s a

huge amount of money behind con-

tinuing the status quo,” he noted. And

quickly he added: “Organizations

against lifestyle change include the

USDA, which is stacked with former

members of agribusiness, ex-cattle-men, pork producers and so forth.”

Dr. Kelly is a bit more diplomatic in

his assessment. “Lifestyle treatment is

still in its infancy,” he explains, “large-

ly because there’s not much money to

fund into research into. After all, who

will benet nancially from it?”

But Kelly pointed to another expla-

nation: Physicians are simply not as

familiar with the science behind heart

disease regression through dietarylifestyle changes. And until there is

an institutional push for it, they are

unlikely to immerse themselves in

learning how to prescribe a process

that’s utterly foreign to the approaches

they’ve been exposed to in their years

of medical training.

“One study looked at the frequency

of lifestyle change recommendations

for chronic conditions offered by phy-

sicians. Fewer than 20% of the pa-tients had doctors recommending life-

style changes. When asked why they

had not done so, doctors responded

that they felt they didn’t have enough

knowledge or experience in that area,

that it was outside of their expertise.

Doctors are reluctant to prescribe

treatments they don’t understand well

or know how to use.”

Speaking as a physician, Kelly

says, “We’re not that good at ‘voli-tional’ treatment. There’s a need for

us to learn how to educate, empower

and motivate our patients.’

Good luck with that. As Dr. Hans

Diehl puts it, “Therapeutic nutrition

in medicine is a wasteland.” Even af-

ter decades of criticism from all sides,

there’s little argument with the fact

that doctors’ education is still lacking

in this area. A recent study found that

the average amount of nutrition train-ing that medical students receive falls

“short of the 1985 minimum recom-

mendations of the National Academy

of Sciences (NAS), and far short of the

1989 recommendations of the Ameri-

can Society for Clinical Nutrition

(ASCN).”

Kelly is optimistic that physicianscan acquire the knowledge needed tobecome champions of dietary and life-

style treatments. “I do think that doc-tors and health professionals who havepersonal experience with the power of lifestyle change do become passionateabout it. And the effectiveness of a rec-ommendation is largely tied to a physi-cian’s conviction or belief in it.

“It’s like smoking-cessation stud-

ies,” he offered. “Doctors who were

smokers were terrible at getting their

patients to quit. The most success-

ful were ex-smokers. Physicians whomake changes themselves will be

more likely to talk about them.”

For now, in the absence of much

institutional support, doctors such as

McDougall, Ornish, Diehl and Essel-

styn are at the forefront of educating

their colleagues. Esselstyn sees hope

in the reception he’s gotten from Kai-

ser Permanente, an integrated man-

aged care organization in California

that serves nearly nine million people“Kaiser called and wanted to know

if I would speak and educate their

doctors about this. I went out there

and gave two lectures, a demonstra-

tion of the counseling involved. They

mobilized, got together, and they’re

running their rst group through now

If they pull it off, this will be big be-

cause they keep such good records.”

Even though the teachable momen

Clinton’s case presented did not panout, such doctors as John Kelly willcontinue their work with the satisfac-tion of making a difference for the bet-ter, knowing that the truth will be borneout over time. The notion that heartdisease is treatable by diet and lifestylechange is “a minority opinion,” hesays. “But, it’s a scientic one. And it’sgrowing.”



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This article was used with permission from The

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