Gary Null and Amy McDonald
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 I've had a number of patients who have been rushed, almost on a monthly basis, to the emergency room to be worked up by cardiologists because their heart was pounding over 200 beats a minute. cardiologists would do EKGs and echocardiograms and tell them to go see a psychiatrist who would work them up, not find anything, and then put them on an antidepressant or a tranquilizer, and actually make the condition worse. |
Connie Bennett, C.H.H.C. with Stephen T. Sinatra, M.D.
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 Now, a growing group of cardiologists, including Dr. Sinatra, are working hard to spread the word about this convincing theory: Too much sugar and refined carbs can harm your heart.
For instance, Dr. Patrick Fratellone, who runs a cardiology, infectious-diseases, and internal medicine practice in New York City, also insists that "stabilizing blood glucose is essential to help heart patients heal."
Like many cardiologists, Dr. |
| In the last 25 years, many cardiologists have come to believe that high ("bad") LDL cholesterol (greater than 160) causes heart disease. I, however, see cholesterol as only a small part of the disease process. It's a minor player, but it's been built up to be the major player. Thankfully, a number of open-minded, nutrition-oriented physicians and cardiologists have now arrived at my point of view.
Actually, you may be surprised to learn that cholesterol is very important to our bodies. It lubricates our skin. It forms the basis for our sex hormones—testosterone, estrogen, and progesterone. |
Anne Harrington
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 The reason had to do with a skewing of the epidemiological data; while heart disease was on the rise in general, its incidence was particularly high among males who self-identified as white-collar managerial types—so much so that some cardiologists had taken to calling coronary heart disease the executive disease.
Why might white-collar executives be more at risk than others? In the mid-1950s, San Francisco cardiologists Meyer Friedman and Ray Rosen-man began to make the link to stress. |
Gary Null and Amy McDonald
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| I've had a number of patients who have been rushed, almost on a monthly basis, to the emergency room to be worked up by cardiologists because their heart was pounding over 200 beats a minute. cardiologists would do EKGs and echocardiograms and tell them to go see a psychiatrist who would work them up, not find anything, and then put them on an antidepressant or a tranquilizer, and actually make the condition worse. |
Benjamin H. Natelson, M.D.
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 In the 1980s, when women with these reactive hearts also reported having symptoms of fatigue, chest discomfort, and feeling worse after exertion or after standing, they were usually referred to cardiologists to be sure they didn't have heart disease. Such women received the diagnosis of mitral valve prolapse, a condition where blood sometimes backs up in the heart due to a malfunctioning heart valve. However, advances in cardiac imaging made it clear that these women did not have any heart abnormalities. |
John J. Ratey, MD
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 Over time, regular exercise also increases the efficiency of the cardiovascular system, lowering blood pressure. cardiologists have recently discovered that a hormone called atrial natriuretic peptide (ANP), which is produced by muscle tissue in the heart, directly tempers the body's stress response by putting the brakes on the HPA axis and quelling noise in the brain. What's so interesting about ANP is that it increases as the heart rate increases during exercise, thus illustrating another pathway by which physical activity relieves both the feeling of stress and the body's response to it. |
| Interestingly, it was the cardiologists who spoke up. The NEJM published a letter from doctors Carl Lavie and Richard Milani of the Ochsner Clinic Foundation in New Orleans. It read, in part, that the author "discusses generalized anxiety disorder and its treatment with pharmacologic agents and psychotherapy. We are surprised, however, that there is no mention of exercise as an additional means of treating anxiety. |
| The letter noted that cardiologists are interested in anxiety as a risk factor for heart problems, and then pointed out, "Exercise training has been shown to lead to reductions of more than 50 percent in the prevalence of the symptoms of anxiety. This supports exercise training as an additional method to reduce chronic anxiety."
The letter was a polite way of saying that the original article missed the boat. Lavie has written more than seventy papers on exercise and the heart, eleven of which focus on anxiety. |
| The importance of this exchange is that it's a case of cardiologists ("real" doctors) taking psychiatrists to task about how to treat the whole patient. If we go all the way back to Hippocrates, the wisdom of the day was that emotions come from the heart and that that's where treatment should start for maladies of mood. Modern medicine has separated mind and body, but it turns out that, in a very concrete way, Hippocrates had it right from the start. Just in the past ten years scientists have begun to understand how a molecule that originates in the heart plays on our emotions. |
Ray D. Strand
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 Wayne went direcdy to the hospital, where one of our local cardiologists examined him. An x-ray revealed that Wayne's heart was significandy enlarged, so the doctor immediately ordered an echocardiogram (a sound-wave study of the heart). The results were shocking: Wayne's ejection fraction (a measure of how strong the heart is beating) was only 17 percent. A normal ejection fraction is between 50 to 70 percent. When an ejection fraction drops below 30 percent, the patient is a possible candidate for a heart transplant. |
Benjamin H. Natelson, M.D.
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| They were no longer given unnecessary referrals to cardiologists, but unfortunately they were instead left to fend for themselves. They were among the many classes of patients who fell through the cracks of classical medicine.
In the late 1990s, this reactive heart problem was given a new name: postural orthostatic tachycardia syndrome, or POTS. I touched upon this issue in chapter 9. Translated into English, POTS is the syndrome of excessive heart rate acceleration after a person goes from the lying to the standing posture, and it is age-related. |
Connie Bennett, C.H.H.C. with Stephen T. Sinatra, M.D.
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| Like many cardiologists, Dr. Fratellone hears "horror stories" from patients flirting with disastrous dietary behavior—cereal, white bread, or bagel for breakfast, fast food for lunch, and maybe a few vegetables and protein for dinner.
"The higher the carbohydrate intake, the higher your triglycerides will be. When your triglycerides go up, your HDL or 'good' cholesterol goes down. Not enough people know that high triglycerides are an even bigger risk factor for a heart attack than high cholesterol," says Dr. |
Gerald E. Markle and Frances B. McCrea
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 Some 44% of all cardiologists routinely used antioxidants, principally vitamin E, fot primary prevention.4
Alas, it was too good to be true.
With the turn of the millennium, several clinical trials began to report no relationship between vitamin E, usually at a dose of 400 IU, and either cancer or heart disease. One of those with negative findings was the HOPE (Heart Outcomes Prevention Evaluation) study, a double-blind, placebo-controlled international trial of patients between ages 50 and 75 with vascular disease or diabetes, reported on patients that had been followed for five years. |
Connie Bennett, C.H.H.C. with Stephen T. Sinatra, M.D.
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| The reason more cardiologists haven't focused on the evils of sugars and simple carbs rather than cholesterol is because there is no patent on blood sugar. Basically, I'm saddened to admit, most doctors are indoctrinated or educated by the pharmaceutical industry. Drug representatives often come to doctors' offices with briefcases full of samples of cholesterol-lowering medications. These drug reps are there to talk about how the meds work, and they're armed with all kinds of literature—periodicals and copies of research studies—that "prove" the meds work. |
| Tragically, despite the studies showing the downside of cholesterol-lowering drugs, the medical community, including cardiologists nationwide, have concentrated on the alleged wonders of lowering cholesterol and continue to ignore the relationship between high blood sugar, insulin surges, and heart disease.
Excess Insulin Hurts Your Heart
Today, cardiovascular disease is the number one killer of both men and women in the United States. But did you know that 60 percent or more of those people with type 2 diabetes or insulin resistance develop some form of heart disease? |
Bottom Line Health
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| A SIGN OF TROUBLE
"For years, cardiologists have focused on chest pain as the primary symptom" of heart problems, Rozanski says. They consider a variety of other factors as well, including depression, lack of sleep and fatigue. This study increases interest in looking at other factors.
"We should think of shortness of breath not only in terms of lung disease," Rozanski adds. "We might need to screen a little more deeply for coronary artery disease. Someone with dyspnea might have a heightened need to undergo stress testing or other screening. |
| Many people who have heart disease are not taking their prescribed medications as often as they should, according to some cardiologists.
During a seven-year study at Duke University, almost half of the 31,750 people treated for major heart problems acknowledged that they were not taking beta blocker drugs, aspirin and cholesterol-lowering drugs exactly as their doctors had ordered.
In fact, the patients who would gain the greatest benefit from these drugs—the elderly and those who have heart failure or other diseases— were the least likely to be using the medications as directed. |
Ray D. Strand
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| Only 1 percent of the cardiologists in the U.S. recommend CoQlO to their patients with heart failure or cardiomyopathy.11 It is not as if they have a good alternative therapy in mind. The National Institute of Health has funded most of the studies involving CoQlO in the United States. But unlike the plethora of synthetic drugs, CoQlO is a natural product, and as such cannot be patented through the FDA.12 Pharmaceutical companies are not going to spend the $350 million needed to get a natural product like CoQlO approved by the FDA if there is no economic incentive. |
Andreas Moritz
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 The country/subcontinent of India, for example, which traditionally has been vegetarian for thousands of years, is rapidly adopting carnivorous eating habits, much to the benefit of that country's cardiologists and oncologists. (Ayurveda, the traditional medicine of India, was largely responsible for keeping the Indian population vegetarian.)
Harvard research has shown that a vegetarian diet also reduces colds and allergies. Children especially benefit greatly from meat abstinence. |
Caldwell B. Esselstyn, Jr., M.D.
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 So by mutual agreement, I returned them to their cardiologists for standard care with the understanding that I would periodically check to see how they were doing. But the rest stuck with the program. They ranged in age from forty-three to sixty-seven years old. And they represented a spectrum of the community. They were factory workers, teachers, office employees, company executives.
Each approached the program in his or her own way. |
| Our local dietitians were skeptical about my theory, and several senior cardiologists at the Cleveland Clinic did not believe there was a connection between diet and coronary disease. Nonetheless, I pursued my studies.
Then, in April 1984, I had a personal epiphany—and in effect became the first subject of my own experiment. I was with my wife, Ann, at a meeting of the Eastern Surgical Society in New Haven, Connecticut. It was pouring rain. I was wet and uncomfortable— thoroughly disgusted with the day. And then a waitress served me a plate containing a huge, bloody slice of roast beef. |
| Interventional cardiologists earn hundreds of thousands of dollars annually, and particularly busy ones make millions. In addition, cardiology procedures generate huge revenues for hospitals. And the insurance industry supports the mechanical/procedural approach to vascular disease. It is far easier to document and quantify procedures for reimbursement than it is to document and quantify lifestyle changes that prevent the need for such procedures in the first place.
As a physician, I am embarrassed by my profession's lack of interest in healthier lifestyles. |
| Even interventional cardiologists are beginning to question the rationale of their procedures. In 1999, cardiologist David Waters of the University of California performed a study that compared the results of angioplasty—in which a balloon is inserted into a coronary artery to widen the vessel and improve blood flow—with the use of drugs to aggressively reduce serum cholesterol levels. There was no disputing the outcome. |
| His cardiologists, worried about the recurrence of angina, asked for more tests to see what was going on.
On the day of his follow-up angiogram, I went to Dr. Crowe's office after work. After we greeted each other, I thought I saw moisture in his eyes. "Is everything OK?" I asked.
"You saved my life," he declared. "It's gone! It's not there anymore! Something lethal is gone! My follow-up angiogram was normal."
Nearly ten years later, Mary Lind recalled that they had wondered, that first evening at our house, "how the Esselstyns did it"— how we had managed to completely change the way we eat. |
| This test measures the levels of a specific blood protein that increases with inflammation of the coronary arteries, and it is considered by many cardiologists to be even better than a standard cholesterol measurement at assessing your risk of heart attacks. All those patients who failed turned out to have elevated HSCRP levels.
There is a critical clue here to the overwhelming importance of nutrition. In my experience, fully compliant patients achieve normal levels of HSCRP within three to four weeks of adopting my plant-based nutrition program. The results are prompt, safe, and enduring. |
Gerald E. Markle and Frances B. McCrea
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| In one online self-report survey in 2002, cardiologists claimed the largest annual income of all surgeons, $475,000 (a nonsurgical specialty, radiology, was next at $415,000).3
Once again, Fran and I are reminded of who the real doctors are! and are not!
Estimating the numbers and types of surgical procedures is complex. Data for inpatient and outpatient (termed "ambulatory") surgeries are collected separately. The very definition of "surgery" is not always intuitive—especially the newer, less invasive techniques. |
Anne Harrington
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| In the late 1960s, Benson was one of the small but growing number of cardiologists who had come to believe that stress played an important part in heart disease. As he explained to a journalist in 1975, "many of the problems that heart doctors encounter [such as dangerously elevated blood pressure] have been created by daily stresses and tensions—the cost, so to speak, of living at an often hectic pace in a highly complex society."24
Could anything be done about this? Benson tried to find out. |
Bottom Line Health
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| Self-defense: People who have heart disease —or who are at high risk for it—and are depressed should consult their cardiologists about the most appropriate treatment, which might include antidepressants and psychotherapy.
Stephen J. Bunker, PhD, RN, manager, cardiac rehabilitation, National Heart Foundation, West Melbourne, Victoria, Australia.
Factors that Make Hospital Heart Care Great
Harlan J. Krumholz, MD, professor of medicine, Health Management Program, Yale University School of Medicine, New Haven, CT.
Elizabeth H. |
Andreas Moritz
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| This theory made so much sense to the surgeons, cardiologists and laypeople that for decades hardly anyone questioned it, except those few (including myself) who were more interested in discovering the true causes of heart disease. The newest scientific discoveries now finally expose this theory's major flaws, with little room for discussion.
Until recently30, it was believed that coronary disease evolved like sludge building up in a pipe. |
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