During hikes, lunch or dinner, some of my friends and companions wonder why I follow a plant based diet. This article contains pointers and pieces of information that I share with them.
How Dreadful Is Heart Disease?
The incidence of heart disease among South Asians (people from India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Nepal, Bhutan and Maldives) is 4 times the rate of people in Europe and USA.
About 25% of the heart attacks occur before the age of 40. (If you ask around, you're likely to hear stories of seemingly healthy Indian dads with little kids who had heart attacks between the ages of 35 and 40).
The incidence of death in the first heart attack is 2 times the rate in Europe and USA.
In 1990, Dr Dean Ornish surprised the medical community by demonstrating that heart disease could be cured! His interventions were fourfold: (a) eat vegetarian food, (b) no alcohol, (c) walk half an hour every day, and (d) pursue stress reduction activities like yoga and meditation. (Since Ornish's original paper in 1990, science has progressed further. For the latest guidelines, read recent books by Dean Ornish or Caldwell Esselstyn or watch their videos).
Before Ornish's work, nobody in the medical community believed that heart disease could be reversed. The prevalent belief was that after a heart attack, one had to be on medication for life. Soon after publication of his initial research in 1990, Dean Ornish convinced an insurance company to try his program on patients scheduled for bypass surgeries. The results were fantastic: patients didn't need surgery. As a result, the insurance company saved about $30K per patient.
Today, the medical community is convinced that heart disease can be cured. However, the general population, especially the Indian community, remains largely unaware of these studies.
Over the next 20 years, Dean Ornish continued his research. Finally, in 2010, The Ornish Reversal Program was ratified by Medicare. In 2013, Kaiser Permanenteendorsed plant based diets for the first time in its history. Both of these are landmark events.
The Ornish Reversal Program
In 2010, Medicare (US Government health care system) approved The Ornish Reversal Program for rehabilitation of heart patients. The program is now covered by several other medical health insurance providers. For participation, see list of providers.
TED Talk in 2004
The same talk is available at TED.com (17 mins, 2004). Dean Ornish's talk is not focused on heart disease alone. He talks about healing through diet in general.
The Struggle To Get The Message Out
(9 mins, Oct 2014).
Who Is Dean Ornish?
Some of my Indian friends refuse to believe that heart disease can be cured. They wonder, "Who is Dean Ornish? How come I have never heard of him?" To help them, I point them to the Wikipedia Page for Dean Ornish and remind them that he is not a 'quack' or a 'fringe doctor who claims to cure cancer'. Dean Ornish's original research paper was published in The Lancet ("Can lifestyle changes reverse coronary heart disease?", 1990) which is a top-notch medical journal.
Dean Ornish is also the family doctor for former US President Bill Clinton and his wife Hillary Clinton. He influenced Bill Clinton to change his diet after he had a heart attack in office.
'The Spectrum' stands out among books in the 'Plant Based Diets' genre because Dean Ornish provides a whole spectrum of choices. He divides people into 'healthy' (who do not have cardiovascular disease and whose goal is prevention) and 'sick' (who do have cardiovascular diease and whose goal is cure). For healthy individuals, small amounts of animal products and refined sugars are allowable. For sick individuals, there are sharp boundaries — cutting out animal products and refined sugars is necessary.
Dr Caldwell Esselstyn
Dr Caldwell Esselstyn is a former heart surgeon from Cleveland Clinic. He conducted a 20-year study over a small group of 18 patients. The text below has been copied from his website:
The patients in Dr. Esselstyn's initial study came to him with advanced coronary artery disease. Despite the aggressive treatment they received, among them bypasses and angioplasties, 5 of the original group were told by their cardiologists they had less than a year to live. Within months on Dr. Esselstyn's program, their cholesterol levels, angina symptoms, and blood flow improved dramatically. Twelve years later, 17 compliant patients had no further cardiac events. Adherent patients survived beyond twenty years free of symptoms.
Drop in cholesterol levels: After 5 years on Dr. Esselstyn’s plant-based diet, the average total cholesterol levels of his research group dropped from 246 milligrams per deciliter to 137 mg/dL (Above 240 mg/dL is considered “high risk,” below 150 mg/dL is the total cholesterol level seen in cultures where heart disease is essentially nonexistent.) This is the most profound drop in cholesterol ever documented in the medical literature in a study of this type.
Cardiac events: The 17 patients in the study had 49 cardiac events in the years leading up to the study, and had undergone aggressive treatment procedures. Several had multiple bypass operations. After beginning the eating plan, there were no more cardiac events in the group within a 12-year period.
Angiogram evidence: Angiograms taken of the participants in the study show a widening of the coronary arteries, and thus a reversal of the disease
Two differences between Dean Ornish's program and Esselstyn's guidelines relate to dairy and stress reduction. Esselstyn does not allow any dairy and he does not emphasize stress reduction, making it optional. According to him, simply changing food habits and ensuring daily exercise is sufficient for reversing heart disease. Both Ornish and Esselstyn emphasizes complete elimination of oils for heart patients.
This article summarizes the experience of 198 participants seriously ill with cardiovascular disease. During 3.7 years of follow up of the 89% adherent to the program, 99.4% avoided further major cardiac events, which is pretty remarkable!
This article was written at the 12-year mark of the 20-year longitudinal study that tracked 18 patients who were initially very sick. The results at the end of 20 years were reported in Dr Esselstyn's book 'Heart Attack Proof (see above).
Making Heart Attacks History
This 14-minute TEDxCambridge talk from 2011 crisply explains the causes of heart disease and why heart disease is merely a 'paper tiger' because it is 100% preventible by proper diet and moderate exercise. A good video to watch!
Make Yourelf Heart-Attack Proof
This is a long video (62 mins) from Healthy Lifestyle Expo, 2003. Insightful talk.
CNN Documentaries by Dr Sanjay Gupta
Since 2013, Dr Sanjay Gupta has made a series of CNN documentaries centered around Bill Clinton, Dr Dean Ornish and Dr Caldwell Esselstyn:
When my friends wonder, "Who is Dr Sanjay Gupta?", I point them to his Wikipedia page. In 2009, Dr Sanjay Gupta was Barack Obama's favorite for appointment as US Surgeon General. However, he withdrew his nomination to continue working for CNN and pursuing his medical practice as a neurosurgeon instead.
What Exactly Causes Heart Disease?
Over years, thousands of research papers have been written about heart disease. Some of these papers attempt to identify high level causes. In this regard, The INTERHEART Study from 2004 is widely accepted. This study identified 9 factors that explain heart disease. For the South Asian population, Why Do South Asians Have High Risk for CAD? (Global Heart, Vol 7, Issue 4, Dec 2012, pages 307-314) provides a literature survey. Browsing through these papers and digging into details is an arduous task. However, no matter what paper you browse through, scientists generally agree that factors for heart disease can be grouped into four clusters:
Relaxation techniques ("stress management").
Unfortunately, South Asians have poorer genes when it comes to propensity for heart disease. However, scientists have discovered that "gene expression" of these genes can be switched off if the other three factors (food habits, exercise and relaxation techniques) are in good shape! :)
The above point has to be better understood by South Asians.
Kaiser Permanente is one of the biggest healthcare providers in USA. Since 2013, its physicians has been advocating plant based diets to patients.
Publication of this article was a landmark event. It enabled Kaiser physicians to start recommending plant based diets to patients. The article contains references to important studies and clinical trials that have demonstrated the efficacy of plant-based diets in combating heart disease, diabetes, obesity, and other diseases.
Kaiser is promoting plant-based diets to all healthy individuals for prevention. In contrast, The Ornish Reversal Program (covered by Medicare) is tailored for heart patients.
I sometimes tell my Indian friends that 97% of population in USA consumes meat. This includes researchers, doctors and policy makers. What made Kaiser and Medicare accept and promote plant based diets to the general population? It is because the evidence in scientific studies and clinical trials in favor of these diets is so strong.
South Asian Heart Center
South Asian Heart Center in Mountain View, California is colocated with El Camino Hospital. It is a non-profit that aims to spread awareness of work done by Dean Ornish and Caldwell Esselstyn among the South Asian community.
After doing a blood test, SAHC will put you in touch with three coaches: a health coach, an exercise coach anda meditation coach.
Whole Foods: Engine 2 Diet
Whole Foods advocates the Engine 2 Diet, which is also a plant based diet. The Engine 2 Diet was devised by Rip Esselstyn (former triathlete, Texas firefighter, book writer). He's Dr Caldwell Esselstyn's son.
Hyderabad Vegans is a thriving community of vegans in Hyderabad, Andhra Pradesh, India. They organize potlucks once in a while. The group was started by a couple who share their philosophy at this blog.
Dr Manthena Raju from Andhra Pradesh
Almost everybody from Andhra Pradesh in India has heard of Dr Manthena Raju. For two years, he appeared in a series of 750+ TV shows. Manthena Raju teaches yoga, pranayama and healthy food habits.
Two salient features of Dr Raju's guidelines are (a) drink lots of water throughout the day, and (b) eat MOSS-free food where MOSS stands for Masala, Oil, Salt and Sugar. Wow! Is it possible for food to be tasteful without these additives? Indeed yes. Over the years, Dr Manthena Raju has discovered and published a series of tasty, MOSS-free recipes.
YouTube Videos: If you understand Telugu, you may watch YouTube videos by user cleinfo123. There are 750+ videos. Playlists on various topics can be found in the Yahoo Group listed below.
Yahoo Group in English: natural_lifestyle_manthena has lots of material, including English translations of Dr Raju's works and an active English speaking community. There are telephone numbers and email addresses of people who follow him sincerely. Also, the 750 odd YouTube videos have been categorized into playlists by subject.
Dr Manthena Raju's food guidelines are not based on scientific research or clinical trials. However, they are in harmony with the Western concept of plant based diets in terms of what to eat and what to avoid. Dr Manthena Raju's system is actually a strict version of plant based diets because he provides additional guidelines, e.g., how to space meals apart, what food combinations to eat, and so on. Personally, I'm quite inspired by Manthena Raju's guidelines and hope to be able to follow them some day.