by Dr. Joel Kahn
I had a transformative first day of undergraduate studies 40 years ago in Ann Arbor, Michigan when I decided to eat exclusively from the salad bar. I already was focused on a career in cardiology and had been accepted to combined undergrad-medical school program at age 18. However, I had no idea that first day in the dorm that the case for the role of plant-based diets to prevent and reverse disease would evolve to be the strongest for any diet to modify any chronic disease worldwide. Simply put, the litmus test for deciding if you will follow the latest Hollywood diet fad is to ask “Is there evidence that it can reverse years of heart artery damage, reduce heart symptoms, reduce events like hospital admissions, heart attacks, bypass surgery, and stents? If the answer is no or more likely “it has never been studied”, then politely say “thank you but I would rather stick with the only dietary plan ever shown to actually reverse the number one killer I may face or am facing now”. There is no evidence any diet other than a plant-based one can prevent and reverse this disease that has left people as young as their 30’s and on up weakened, limited or prematurely dead
The story of how we learned that plant-based diets are preventive and therapeutic in dealing with the #1 killer of men and women is so colorful and rich that I am going to take a deeper dive here than in other sections, but believe me, it will be worth interesting.
The incredible tale of Walter Kempner, MD and the Rice Diet
A remarkable nutrition experiment was launched in 1939 by a German-Jewish refugee of the Nazi regime, Walter Kempner, MD. He fed his patients rice, sugar, fruit and a few scraps of protein. What a popular diet that would be in today’s sugar-phobic world! Kempner immigrated from Germany to a relatively small and unknown Duke University Medical Center in Durham, North Carolina. He had a strong biochemistry background. At the time, high blood pressure was without therapy and was taking an enormous toll on many, including President Franklin Delano Roosevelt. From his science research, Kempner developed a diet that was extremely low in salt, protein and added fats and oils. It was also very low in taste and palatability. Kempner was known for being rather forceful with the patients that traveled to Duke while they worked on reversing their high blood pressure, kidney failure, and hypertensive eye and heart disease. Kempner was very careful in documenting and then publishing the outcomes of his patients. Amazing and never before seen reversal of these life threatening maladies sealed the fame of the Duke Rice Diet as it came to be known. The word was out and ultimately thousands of patients including many celebrities traveled to Duke for the therapy that was nearly or completely plant-based, low in oil and highly effective. Celebrities like Shelly Winters, Buddy Hackett and Lorne Greene were famous guests. In the process, Duke University Medical Center grew to become the world leader that it is. Although few prescribe the Duke Rice Diet anymore it still exists as the Rice House in Durham, N.C.
Lester Morrison, MD
The scene shifts to Los Angeles and the clinic of Lester Morrison, MD. This internal medicine specialist was caring for heart patients and survivors of heart attacks in the 1940s at a time that therapies were nearly non-existent. Morrison was aware of a unique report following the end of World War II from data reported from Norway. Despite expectations that the stress of WWII might lead to a spike in heart attacks in Nazi occupied countries like Norway, the data released after the war showed the opposite. The rate of heart attacks and cardiac deaths actually plummeted. Morrison and others hypothesized that the seizure of farm animals and dairy products in countries like Norway to provide food for Germany left the population relying on largely plant based sources. Morrison designed a dietary plan for his heart patients that emphasized omitting rich foods like cream, butter, full fat dairy, olives, nuts avocados, oils, glandular organs, and egg yolks. He tracked his patients followed this diet and compared them to patients that did not alter their diet. His results were published in a well-respected medical journal in 1951 and the follow up showed a more than 50% drop in deaths at 8 years and an even greater decrease in the low-fat diet group at 12 years. Although remember Morrison and his pioneering work, he set the stage for further pioneers that confirmed his observations.
The next player on stage is Nathan Pritikin. He is one of the most interesting pioneers in the field of plant-based therapy of heart disease and his legacy lives on internationally. He was in aerospace engineering and held many patents in that field for innovations with aviation. He had a manufacturing business in Santa Barbara. He had an inquisitive mind and had heard of the nutrition work being done by Lester Morrison, MD. Pritikin visited Dr. Morrison in the 1950’s when he was in his early 40s. He learned that his cholesterol was over 300 due to his diet rich in animal products and full fat dairy. He performed an exercise stress test and learned that he had failed it showing signs of advanced heart disease with a limited prognosis. Not one to be kept down, Pritikin dug into the books and designed a plant-based regimen rich in beans, low in fat, and combined it with walking. He was able to lower his cholesterol by nearly 200 points at a time when there were no drug therapies and slowly his stress test returned to normal. Convinced the diet would work for others, he began counseling those with heart disease, obesity, hypertension, and adult diabetes and observed stunning examples of reversal. Despite serious resistance from the medical community, Pritikin accumulated careful data and was able to present it at medical meetings. The mainstream academic world scoffed but the case examples were amazing. He wrote a book, The Pritikin Diet, that became an international best seller and earned him an invite to 60 Minutes. In one of the most popular segments of all time, Pritikin rocketed to superstar status and the calls for help were non-stop. He opened the Pritikin Center in Santa Monica and continue to record data on outcomes of guests who stayed 1-3 weeks. Prior to his death in the 1980s of leukemia he had specified that he wanted an autopsy after he passed. It demonstrated clean heart arteries. The autopsy report was published in the New England Journal of Medicine to prove his point on heart disease reversal. His legacy has remained strong after his death and his center has moved to Miami, Florida where it is known as the Pritikin Longevity Center and Spa. After the Pritikin program was approved by Medicare for reimbursement after a cardiac event, centers with Pritikin intensive cardiac rehab programs have flourished around the USA. The first of these in Michigan opened last year in Ann Arbor.
Dean Ornish, MD
Dean Ornish, MD is one of the most respected researchers in the field of preventive medicine. Raised in Dallas, Texas to a comfortable family with a father practicing orthodontics, Dr. Ornish was introduced early in life to Eastern philosophy when his parents invited Swami Satchidananda to their home. The Swami may not be a household name now but if you recall the Woodstock Festival in 1969, it was Satchidananda who offered the opening words. Ornish was impressed by his words and yogic practice and the two remained in contact while Ornish pursued medical training at Harvard and the University of California, San Francisco. Ornish took a year off from medical school to design and carry out a lifestyle trial with patients with very advanced and symptomatic heart disease. Originally the research was to have a focus on a yoga practice more than plant-based nutrition, but Ornish found the proposal was easier to sell to donors as a diet-heart program. The early results were astounding in that removing animal products and oil and replacing them with WFPB diets, stress management, social support and walking resulted in a 91% reduction in angina attacks in less than a month and improvements in stress test measurements of coronary blood flow. These exciting data were published in a premier medical that bias or a placebo affect from all of the personal attention were raised as criticisms. Ornish pursued additional funding and launched the Lifestyle Heart Trial with a randomization between lifestyle therapy and control along with advanced heart imaging using state of the art PET scans and heart catheterization analyzed by computer technology. Those results, which I read on July 21, 1990 stunned the world. Not only could angina attacks be reduced by over 90% eating a WFPB diet and the other lifestyle measures, but measures of blood flow and heart artery blockage severity improved substantially in only a year. The demonstration for the first time that years of heart artery plaque could be reversed by lifestyle measures emphasizing a WFPB diet was radical and paradigm changing then and remains a game changer today too. Any diet that proposes to be of health benefit must be judged against the Ornish Lifestyle Heart Program. Ornish pursued 5-year data on the study group including catheterization data showing even more dramatic reversal of plaque in the treatment group while the control group got worse and worse despite conventional cardiology care and follow-up. Not only did blood flow improve in the Lifestyle group with further reductions in heart blockages, but hospital admissions, heart attacks and need for heart procedures dropped by almost 50%. That translated to enormous savings in medical expenses. Many of us thought that the concept of nutritional cardiology and lifestyle medicine would be recognized for the breakthrough that it was and change practice dramatically. In reality, although Ornish was celebrated to some degree, to this day many cardiologists would not be able to identify his research or its implications for benefitting patients like Paul without surgery or stenting. Although it took additional years to gather adequate numbers of patients and their outcomes, ultimately CMS approved the Ornish program for intensive cardiac rehabilitation at the same time as the Pritikin program in 2010. There are dozens of these programs around the U.S. benefiting thousands of patients. More will be said about Dr. Ornish in future chapters but his work is finally being celebrated by current generations of physicians for the courage, vision and persistence to prove that heart disease is a food borne illness that can be tamed with low-cost lifestyle measures centering on WFPB diets, stress management, and abundant love.
Dr. Caldwell Esselstyn
Have you met Dr. Caldwell Esselstyn? Or watched him on a video? I had the pleasure of meeting him nearly 20 years ago when we both spoke at a local Detroit plant based conference at that time in an elementary school with a crowd of a few hundred. That same conference now draws over 6,000 attendants in a large convention center www.vegmichigan.org). Dr. Esselstyn, or Essy as many call him out of affection, is a man of great integrity, passion, curiosity and accomplishment. He won a Gold Medal in the Olympics in the 1950s and went on to marry the energetic granddaughter of the founder of the Cleveland Clinic, Ann Crile. He served in Vietnam. He had a successful surgical career focusing on breast disease until renovations in the surgical locker room paired him up with Dr. Rene Favalaro. It was simply E goes with F. Favalaro was the first cardiac surgeon to perform bypass surgery, the detour operation. Esselstyn’s passion to learn led to a deep dive into reading about heart disease. He read about cultures that had no measurable problem with the number 1 killer in the Western world. He was aware of the data from Norway and the drop in heart attacks during WWII that also impressed Dr. Lester Morrison decades before.
Essy did not feel constrained by his training as a breast surgeon and approached the cardiology and cardiac surgery divisions at the Clinic in the early 1980’s, asking them to refer patients not suitable for bypass or angioplasty for a nutritional program. Along with his wife Ann, he began studying and documenting the course of advanced heart disease patients who were encouraged to eat a plant based diet without any added oils, nuts or avocados. The goal was a percentage of calories from fat of about 10%. The data he accumulated in improved symptoms, sexual function, stress test results, hospital visits, and ultimately examples of angiographic regression of coronary lesions were published in peer reviewed cardiology journals. Essy recently published an updated sample of nearly 200 patients and identified a high compliance rate with his program and a low cardiac event rate. In short, plant-based diets without added oils appeared to quickly heal the lining of arteries called the endothelium and promote plaque to for the Cleveland Clinic, the busiest heart surgery hospital in the world. As a side note, the Clinic is also on a mission to be the leading example of a healthy role model. Last year they booted out a McDonald’s in their lobby that was a blight on their otherwise fine reputation. They replaced it recently with a middle eastern café with many plant based options. The Clinic is also the first major medical system to heed the findings of the World Health Organization classifying processed red meats like bacon, pepperoni, and hot dogs as Class I carcinogens. The Clinic banned these foods this year against what must be considerable push back from staff, guests and sadly staff physicians too. Dr. Esselstyn and his wife Ann have published several successful books and cookbooks to make following their program easier. Although their program is considered “radical” or extreme by some, as Essy points out, sawing the chest open, taking veins out of legs, and rerouting them as temporary detours to the heart is extreme and radical. Eating large salads, casseroles, stews, soups and side dishes is hardly radical. Of final note, the Esselstyns’ have been assisted on their mission to heal by their children. Jane is a nurse who joins her parents in many cooking demonstrations. Their son Rip is a triathlete and served as a fireman in Austin, Texas. He tested his father’s diet on his fellow fireman in the engine house and identified in only 28-days major improvements in their blood pressure, blood cholesterol, and weight. This experiment prompted several books and a food line to support the lifestyle plan.
Dr. Joel Fuhrman
Recently, the science of cardiac disease reversal has been supplemented by published results from Dr. Joel Fuhrman. Dr. Fuhrman is a family physician in New Jersey who also was an Olympic athlete. He had a passion for nutrition early in his career and developed the concept of a nutrient dense plant rich program, encapsulated in his book Eat to Live. Dr. Fuhrman has had many successful public TV programs discussing the benefits of nutrient dense and plant-rich diet for weight management, diabetes, immune function and heart disease. In his recent peer reviewed publication Dr. Fuhrman reported sustained drops in body weight, cholesterol, and blood pressure in hundreds of patients following his program. He included case studies of cardiac patients realizing important gains in symptoms and other measured outcomes. The reports were quite convincing. Dr. Fuhrman differed in his approach from the early work of Pritikin, Ornish, and Esselstyn by including nuts, seeds and avocados. Therefore, his diets were higher in fat calories from whole foods than the programs taught by the other leaders. His program does shun added oils. With the growing recognition that a small handful of nuts daily are associated with important reductions in a variety of maladies including cardiovascular disease, nuts are now incorporated in small amounts in the programs of Drs. Ornish and Esselstyn. What about avocados? There still a split jury for patients working on the reversal of serious problems like heart disease, adult diabetes and excess weight due to the high fat content of avocados.
The colorful history of the the medical support for the prevention and reversal of heart disease, along with type 2 diabetes, prostate cancer, obesity, hypertension, high cholesterol and other life-robbing chronic disease is inspiring. No other body of science can compare in terms of choosing a dietary pattern to follow. Indeed, the U.S. News and World Report selected the Ornish diet as the #1 diet for heart disease for the 7th year in a row. What are you waiting for? Protect the miraculous 50,000 miles of arteries supplying every part of your body by bathing them in a whole food, plant-based diet rich in colors and diversity from the garden.