American Diets

Doctors Should Start Advocating Dietary Options to Treat Heart Disease

It’s time to start advocating diet changes for heart patients—not just medication, says Dr. Daniela Drake.

Tetra Images/Corbis

“I dropped dead three years ago,” John Tanner told me recently. “I just collapsed when I was taking my daily jog.” Luckily for Tanner—who’s now very much alive—his fall was witnessed and resuscitation efforts began immediately.

Sudden cardiac death, which Tanner suffered, strikes 350,000 people a year, killing nine of 10 victims. This year, 2013, marks the two-year anniversary of Medicare’s coverage of intensive cardiac rehabilitation, a diet and lifestyle program for people already diagnosed with heart disease. But many of those affected don’t know they have the disease, leaving some physicians wondering if we shouldn’t extend these preventive programs to the general public.

Our current preventive routine focuses on treating such cardiac risk factors as hypertension and cholesterol. While that may have some positive health effects, aggressive medical therapy is also a boondoggle for drug companies. Indeed, blood pressure and cholesterol meds account for nearly a quarter of the four billion prescriptions written annually (PDF). Cholesterol-lowering statin drugs routinely reach blockbuster status, selling more than $1 billion a year. In one year alone, Lipitor drove $12.9 billion in sales, a blockbuster 13 times over.

Yet sudden cardiac death still kills 1,000 people a day. “We’ve been treating dietary disease with medicines. That can stabilize disease but doesn’t reverse it,” says Dr. Baxter Montgomery, a cardiologist from Houston, Texas. After years as a heart doctor, Dr. Montgomery now focuses on reversing cardiac disease with diet. Using his approach, he has shown a complete regression of atherosclerotic plaques in as little as 5 1/2 months. He’s such a strong believer, he built a restaurant in his office that serves heart-healthy food.

Montgomery is part of a small but growing group of conventionally trained physicians disillusioned with traditional medical care. These doctors, who focus on a patient’s lifestyle, tend to prescribe food and exercise over drugs. Citing our epidemics of heart disease, diabetes, and obesity, many “lifestyle” physicians contend that drug-centered standard-of-care doesn’t work particularly well.

After all, it’s common to hear about a patient getting a clean bill of health, only to drop dead in the doctor’s parking lot minutes later. That’s not unlike what happened to Tanner, a Ph.D. now dedicated to getting the word out about this preventable illness. “My doctor told me I was OK,” he says. Tanner was 52 when he collapsed, exercised regularly, and ate what he considered to be a healthy diet.

As Tanner’s case shows, it’s imprudent to wait until heart disease is diagnosed before taking action: our cardiac tests fail to detect a lot of existing disease. Autopsy data show us that more than half of Americans have heart disease by our 50s, says Dr. Montgomery. That number is 85 percent by the time we’re in our 70s. In other words, if you’re an American eating a standard American diet you’re going to get heart disease, pretty much guaranteed.

If the typical American diet is the problem, then it’s obvious that improving the diet should improve our outcomes. Starting with the groundbreaking work of Dr. Dean Ornish in the 1990s, small-scale studies have shown that aggressive dietary intervention reverses heart disease. At the Cleveland Clinic, Dr. Caldwell Esselstyn—who is credited with influencing President Clinton’s dramatic weight loss—demonstrated even more impressive results through a more aggressive diet.

Dr. Esselstyn showed that patients who follow a low fat, unprocessed vegetarian diet can open their clogged arteries—and remain symptom-free for years. Admittedly, the Esselstyn diet is a radical departure from the way most Americans eat, and some people find it difficult to comply. But for those who think his diet is extreme, Dr. Esselstyn tells me, “There’s no more extreme diet than the standard American diet. It’s causing our epidemics of heart disease, cancer, dementia, diabetes, obesity…”

It’s true that 67 percent of Americans are overweight and 33 percent are obese (PDF). Obesity is one of the risk factors for cardiovascular disease that we can’t medicate. So even though cardiovascular death rate has decreased in the last decade, our disease burden remains unacceptably high (PDF). After all, someone dies of the disease every 39 seconds, and every 40 seconds someone else is having a stroke.

If otherwise robust people with access to health care are dropping dead in their 50s from a preventable illness, then something’s gone terribly wrong. As Tanner laments, “I wish I’d known, four years ago, that it was possible to prevent heart disease through diet—and that I was at such high risk.” Indeed, all of us eating a typical American diet remain at significant risk for premature cardiovascular death, no matter how many heart medicines we’re taking.

But as far as the professionals go, diet advice falls in the contentious twilight zone between freedom of choice, public health, and medical care. Just look at the animus Michelle Obama’s stirred up by asking people to eat more greens. And everybody knows that most doctors don’t even discuss diet.

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For good reason, physician guidelines tell us not to bother. The U.S. Preventive Services Task Force, an organization that sets practice guidelines, says that while a dietary approach works to control blood pressure, the evidence is weak for recommending it. In other words, physician time is better spent prescribing medicines.

To be sure, writing prescriptions is more straightforward and far less time consuming. Doctors also are confused about which diet to recommend. The ascendency of the Paleo diet, which is a meat-based, low-carbohydrate, relatively high-fat diet, has reopened the diet debate that many had hoped was settled. Although the Paleo diets have been shown to have many salubrious effects, as Esselstyn explains to me, “Where’s the Paleo diet data showing reversal of heart disease? There isn’t any.”

Mostly, critics complain that Ornish’s and Esselstyn’s results are either not reproducible or that the diets are so strict as to be doomed to failure. Of course, prejudices about the dietary benefits are not helped by the media characterization of the Ornish diet as the “no fun diet.” But what’s really “no fun” is to drop dead in the middle of your life from a preventable illness—or be crippled by chest pain while chained to a regimen of ’round-the-clock drugs that are not only expensive but also occasionally toxic.

At a time when we’re set to expand medical coverage, Americans need to take a sober look at what conventional medical care really offers—a lot of pharmaceutical treatment for a lot of dietary diseases. We should all be aware that taking these medicines may do more to enrich the pharmaceutical companies than to eradicate disease.

If history is any guide, the smart money is on continued expansion of the role of pharmaceuticals and costly invasive cardiac treatments. But what if the answer to preventing and reversing heart disease were truly just eating better? It can’t be that the medical community is in such thrall to pharmaceutical companies that we won’t seriously advocate dietary options. It can’t be that we physicians have so little faith in our patients that we don’t even offer them the choice.