How to Keep David Letterman (and yourself) Off the Operating Table

by Caldwell B. Esselstyn, Jr., MD

March 1, 2011

Last Friday night Barbara Walters television special highlighted six celebrities and their thoughts and emotions surrounding their open heart surgery.  Barbara Walters, Robin Williams, and Charlie Rose had valve surgery, while President Clinton, Regis Philbin, and David Letterman had bypass surgery for coronary artery disease.  Few would challenge that the stage of illness of these celebrities did not require surgical intervention. The real eye-opener of the show was David Letterman’s remark that he fully expected a second bypass operation in the future.  The sober resignation to an inevitable recurrence is what we must challenge vigorously.

Let’s be clear: coronary artery disease is a food borne illness and need never exist.  If the gifted surgeons identified in the television special had opened their offices in rural China, the Papua Highlands of New Guinea, Central Africa or among the Tarahumara Indians of Northern Mexico, they would need to take on second jobs.  Why all the empty waiting rooms? These cultures have a plant based nutrition no coronary artery disease, and no need for bypass surgeons or stents.

The key to our vascular health is the innermost single layer of endothelial cells which line our blood vessels. Those cells produce nitric oxide molecules, which smooth blood flow, enlarge blood vessels on demand, inhibit inflammation in the blood vessel wall, and most importantly prevent the formation of blockages or plaque.

So how does nitric oxide fail?

Every time we eat a western diet of oils, dairy, meat, fish, poultry, and caffeine in coffee we injure our endothelial cells and deplete our protective level of nitric oxide.  Autopsies of 20 year olds dying of accidents, homicides, and suicides confirm coronary artery disease is now ubiquitous (albeit still in an early stage.)  Continued nutritional insult to endothelial cells leads to plaque blockages, chest pain, heart attacks, strokes, and the need for stents and bypass surgery. Cardiologists agree these procedures are a temporary patch job and have nothing to do with the cause of the disease.

What about cholesterol?  Cholesterol is an innocent bystander in plant based populations with healthy uninjured endothelium and copious amounts of nitric oxide.  Once nitric oxide levels fall with the introduction of the western diet, the endothelial tissues
become sticky allowing cholesterol to burrow into the vessel wall, creating plaque  buildup and blockages, and impeding blood flow.

Lowering cholesterol is helpful, but the key is to avoid eating foods that further injure the endothelium.  That has been the focus of our counseling goal with patients since 1985.  It is also why we have been able to successfully treat this disease through dietary intervention in hundreds of patients with the technique described in my book, Prevent and Reverse Heart Disease.   With this dietary approach the endothelium can rapidly recover its nitric oxide production, halt disease progression, and often achieve significant disease reversal.  As a result, patients rarely require stents or bypasses.

Note to David Letterman: Your fate is on your fork.

Why don’t physicians offer the plant based nutrition option to their patients?

1.    They are not taught nutrition and are unfamiliar with the efficacy of a plant based approach.
2.    They don’t have time for patient nutritional counseling.
3.    They often lack the skill set for behavioral modification.
4.    Insurance support for counseling is sparse.
5.    The status quo offers a handsome income stream.

The cure for the coronary artery disease epidemic is not a pill, a procedure, or an operation.  The cure is to empower the public with nutritional literacy and to make each individual the locus of control when it comes to protecting their health and vanquishing this food borne illness.

Since the time of Hippocrates there has been a covenant of trust between the physician and the patient. Informing patients of the causes of their disease is a crucial part of that trust. In the case of coronary artery disease, that conversation is not taking place. While stents and bypass surgery may be lifesaving in an emergency, all too often at the first sign of disease, these invasive procedures are employed, with all the associated morbidity and mortality.

We perform 1.2 million stents annually in the United States, with a mortality of 1% and procedural heart attack rate of 4%. This translates to 12,000 deaths  and 48,000 heart attacks every year.  We perform 500,000 bypass operations with a mortality rate of 3% and similar procedural stroke rate.  This totals 15,000 deaths and 15,000 strokes annually.  Over a decade these procedures result in 270,000 deaths, 480,000 heart attacks, and 150,000 strokes.

More than forty years ago brilliant pioneers set the interventional mode of cardiology treatment in motion.  Back then it was all we had.  However, today with an understanding of this disease causation we have the powerful option to halt and prevent this epidemic. This can never happen while symptomatic therapy reaps enormous financial rewards. Change would also be disruptive for powerful institutions.  The USDA (United States Department of Agriculture), which subsidizes the animal food industry, constructs a food pyramid for the public every five years laden with nutrition suggestions that further promote, rather than prevent, disease.  The $5 billion stent and $25 billion statin drug industry are hardly anxious to see this epidemic go away.  Few interventional cardiologists or cardiac surgeons are seeking fewer patients.

As heart-warming as Barbara Walters’ television special on celebrity heart surgery was, just imagine a one-hour primetime special devoted to educating the public that coronary artery disease—our number one killer—need never exist and that our fate is in our hands.  Maybe David Letterman could host.