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I've been diagnosed with coronary artery disease. My cardiologist and doctor are both pushing me to have a catheterization and if necessary a stent. I'm reluctant to go that route. I've changed my diet drastically and have begun a vigorous exercise program (3.5 hours/week of walking, hiking steep hills, and running). I'm looking for studies or evidence that will help persuade my cardiologist that vigorous exercise combined with my recent diet changes (I'm now eating a basically vegetarian diet plus fish) are worth trying.

My background: I am 67 years old, with reasonable weight (173lbs, 5"10"), and have been physically active all my life, though in recent years it's been mostly just vigorous walks 2-5 times a week.

I was a fairly committed amateur athlete until 25 years ago, when doctors began prescribing high blood pressure medication. I soon began feeling spells of weakness but didn't associate them with the medication, and I gradually began working out less as a result. Two years ago doctors changed my medication and I began getting dizzy spells in addition to weakness. Doctors told me it was normal.

In July I fainted twice. This got the attention of my doctor. He drastically reduced my blood pressure medication and gave me a series of cardiology tests. A stress EKG and CT scan revealed a possible serious arterial blockage. I'm scheduled for a stress echo cardiogram later this month. The dizziness, fainting, and weak spells all stopped when the medication was reduced, but my doctor keeps citing them as a major reason to have the catheterization & stent.

Since getting the diagnosis three months ago, I've been eating my new diet and exercising vigorously. Wearing a heart rate monitor has shown that I'm now working out harder and at a lower heart rate than before. I feel intuitively that this is a better route for me to follow than angioplasty and a stent.

I'd appreciate any thoughts and information about clinical studies or articles that might support using vigorous exercise and diet to reverse coronary artery disease. There are lots of articles about diet and most mention moderate exercise, but there's very little about the effect of vigorous or extreme exercise.

If you think I'm nuts, feel free to say so - my doctor already has!

Actually, you are making a great decision to investigate life style since it is the best treatment. Some things I would recommend:
1. Visit Dr. Caldwell Esselstyn's website, http://www.heartattackproof.com
Read EVERYTHING on the site and check out his lectures online at the Vegetarian Society of Hawaii. For SURE buy his book to learn a lot of things you need to know:

When I went through this with my cardiologist, he acknowledged many of the things you will learn from Dr. Esselstyn (and Dr. McDougall and Dr. Fuhrman, etc. etc.)
- The arteriogram is only necessary as a prelude to invasive treatment.
- The invasive treatment (stent or bypass) will not extend your life or protect you from future heart attack. This has been proven in many studies.
- The invasive treatment is purely for pain relief unless you are in a small minority of patients with special criteria for whom the bypass might slightly increase your odds.

My question to the cardiologist was why was this treatment urgent when I was not suffering unduly with the pain and I had not yet tried the lifestyle approach. He couldn't give me a good answer. You can look at my story in the link contained in my signature - it is a very typical story. When you do the lifestyle approach, you get better and have no problems.

Also, check out the CNN special that Sanjay Gupta, MD recently did on Bill Clinton and comparing lifestyle treatment with surgical intervention. I doubt that you will want intervention after seeing that. Dr. McDougall has written here on heart disease. Check that out.

To me, the fact that your cardiologist may be well trained and a nice guy with a family to support and bills to pay is no excuse for offering a surgical approach which is next to worthless for CAD and far inferior than the lifestyle approach with far more risks and complications immediately and down the road.

I too can recommend Dr. Esselstyns book and his diet which is essentially a McDougall diet at heart. I too, like SactoBob found myself scheduled for bypass when I discovered the medical research of Dr. Esselstyn as well as that of Dr. Dean Ornish in treating a low fat, plant food diet, for treating this condition. Against the wishes of my cardiologist I took up this program and the results were nothing short of striking. I urge you, before undergoing any medical procedure, to familiarize yourself with this data and seriously consider adopting this way of treating your condition. For me it brought a rather quick turnabout in my bloodwork and rather quick subsiding of my angina. SactoBob and I are not alone. I have met many with the same story or reversal of their heart disease. I hope you will seriously consider whether there is any medical benefit to this "alternative" treatment. It has certainly opened the door to a whole new life for me and my wife. I don't say this lightly but this program saved my life. In a reasonably short time you can actually feel the process of getting back your health begin. Our words may come across like pie in the sky hope but the reality is it's the only choice to getting control of your health back and stopping the endless march of heart disease. I do hope you join us as yet another example of turning your health and your life around. It is a simple process that isn't always easy. The changes you will make will seem extreme at first but I assure you they will become a natural part of your life and it won't be long before you are wondering why you didn't do this earlier.
Exercise can be an important component of health but make no mistake. Exercise alone will not reverse heart disease. It is firstly about the food as that is where the roots of heart disease lie. You are in Northern California and there are several of us here and if you ever wish to personally meet and talk there is much we can help answer. Feel free to ask. We have an active group here that would love the opportunity to help.
I am always excited to welcome someone that was where I was 5 years ago and meeting someone at the crossroads of their own health.
My friend, the next step is yours.
f1jim

It's the food.

In the book, Prevent and Reverse Heart Disease, Dr. Esselstyn describes his study where he took 25 people with serious heart ailments - some of whom were told that nothing more could be done for them medically - and worked with them to change their diet.

Those who adhered to his diet saw remarkable success, regained their heath and have lived healthy, full lives for more than two decades.

Dr. Esselstyn did not include an exercise program in his study - he wanted to show the change you can accomplish through diet modification alone.

While your emphasis on vigorous exercise may make you feel more in control of your health - if you couple exercise with only a moderate change in your diet you will not stop the progession of your coronary artery disease.

Not to say that other lifestyle modifications will not help. Dr. Dean Ornish, in his Program for Reversing Heart Disease book describes a broad approach to reversing heart disease including exercise and yoga. But, foremost, it is based on a plant-based, whole foods diet.

In addition to Dr. Esselstyn's book, I would suggest that you get a copy of The McDougall Program for a Healthy Heart. While it is 15 years old (this is nothing new), it includes information on how to change your diet and how to evaluate suggestions from doctors.

Before I learned about Dr. Esselstyn, I had a catherization where they were ready to put a stent in. My blockages were "only" 50% though, so the stent wasn't needed. But, if you look into it, you will come to learn that the stents do not help - unless needed to treat an emergency.

Stents do not address the cause of 80% to 90% of heart attacks. While stents can open a clogged artery, most heart attcks are caused by the rupture of soft plaques in a diseased artery. These ruptures then clot and slam shut the flow of blood to the heart. You protect yourself from the possibility of soft plaque rupture with a switch to a low fat, oil-free, plant-based diet.

The improvement that comes with a change to a plant-based diet as described by Dr. McDougall and Dr. Esselstyn is dramatic. I attended a lecture by Dr. Esselsyn two days ago. The science behind his advice is sound. The results from his patients are amazing.

- A 69 year old male developed chest pain. Within two weeks, he saw his family physician, who referred him to a cardiologist. He failed his stress test. An angiogram confirmed multiple sever blockages of his coronay arteries and a bypass was recommended. Instead, he chose a trial of Esseltyn plant-based nutrition. His angina disappeared within two weeks and he remains free of chest pain and other symptoms one year later.

- Following two heart attacks, failed angioplasty and bypass surgury, Evelyn was told she could not survive a year. Twenty-three years later, still on the Esselstyn program, she remains free of symptoms.

I could go on... Hopefully we have given you something to think about.

Be well,
-dog

Thanks to SactoBob, blondie, f1jim, and landog for your help.

I haven't gone quite as far as a totally vegetarian, oil-free diet, but I have gone to a mostly vegetarian diet, with fresh fruits & vegetables, whole grains & oats, extremely limited oil & fat, and fish such as salmon and trout. I've been doing this for almost three months.

I may take the next step to eliminate all oil, fat, and fish from my diet, but I feel I should adjust to my new diet first. A lot will depend on what my stress echo cardiogram later this month shows. If I am convinced that my cardiac condition is as serious as my doctor says, then I'll be more inclined to eliminate all oil, fat, and fish from my diet, but I'm coming to realize he's not very informed about cardiac issues.

My doctor insists I'll be dead in 2-3 years if I don't do the catheterization, but from what I can tell, my condition is not as serious as many others. My cholesterol was borderline acceptable three months ago (and has probably improved since then). my weight is acceptable and dropping, and I've exercised regularly all my life. A resting EKG and a resting echo cardiogram both showed no problems at all (but a stress EKG and CT scan did show a possible problem). I've had no chest pains and no symptoms other than the weakness, dizziness, and fainting when my doctor was prescribing too much high blood pressure medicine. The only cardiac problem in my immediate family was my mother having a stroke at age 89.

I just don't think my doctor has grounds for asserting that I'll be dead in 2-3 years if I don't follow his advice.

Using a heart monitor while I walk, hike, and run, I've already noticed my heart rate dropping even though I'm exercising harder and longer, so I believe I'm on the right track. When I get the results late this month of the stress echo cardiogram and current cholesterol levels, I'll consider whether to take the next dietary step and go totally vegan.

In the meantime, I'm still looking for information about the role vigorous or extreme exercise can play in reversing coronary artery disease, coupled with a suitable diet.

Be open to the possibility of losing a lot more weight. I am 67, walk two hours daily, and do light exercises. I am six feet tall and weigh about 130 (down from 200 about 37 years ago). I have zero symptoms of heart disease now. I had heart disease 37 years ago at the age of 30 -- while exercising heavily.

Diet is the main solution: very low fat, high fiber, mostly or solely whole plant foods free of added, isolated fats (butter, olive oil, etc.).

SactoBob, yes, I did see the CNN special with Dr Sanjay Gupta and Bill Clinton. It was what first made me aware that there might be alternatives to what doctors were recommending. When I watched it, I had already modified my diet to be mostly plant-based. Watching it led me to modify my diet further.

For the first month, I began walking 6-7 days a week, rather than my erratic 2-5 days per week before. In the second month, I bought a heart monitor and I added hiking steep hills and running to my exercise routine.

Overall I'm now feeling great, the best I've felt in years.

Burgess, I agree about losing weight. My post was so long that I didn't want to make it longer by discussing weight.

I had allowed myself to become overweight. I was 186lbs 2.5 months ago. I've lost 13lbs since then and am still dropping.

Weight however is not my main consideration. I was extremely skinny growing up and when I began working out seriously after college, even though I was running and biking competitively as well as lifting weights, I actually gained 10-15lbs because of the muscle I gained.

So while I am watching my weight and am reducing it, I'm paying more attention to my waist size than to my weight. At a 33" waist, I am not terrible but it needs to come down. The vigorous hiking I'm doing in steep hills and the weight training I plan to resume will build up muscle that will to some extent counter the weight of fat I'm losing from my diet and exercise. Of course I'm aware that at age 67, I can't expect to build up as much muscle mass as I could decades ago.

You're welcome.


You really need to see Dr. Esselstyn's lectures, read his website, and buy and read his book. There is little if any benefit in reducing your intake off harmful foods. As Dr. E puts it, you are still throwing fuel on a fire. Reducing the amount is not going to put out the fire



Doctors are very accurate in diagnosing CAD. I would bet a lot of money that they are correct in your case. They are also very knowledgeable about the statistics of death and disability. I'm sure that they have a very good basis for both your diagnosis and prognosis. If you are in doubt, and do not want to start the program without more definite proof, then you may want to consider doing the further studies that the docs recommend. IMO, patient denial is the only really good reason for these tests.



Denial is a very common response. Again, I would urge you to look at Dr. Esselstyn's research. You are playing with fire IMO.




You can't exercise away CAD. Jim Fixx proved that conclusively. I myself avoided all exercise until I was reasonably confident that I was "heart attack proof" per Dr. Esselstyn.



There are many reasons why vigorous exercise is not the solution. Exercise plays no part in reversing the disease. What it can do is develop new peripheral circulation around the blockages, and that can relieve the physical discomfort - but it does nothing to stop or reverse the disease. The new peripheral circulation that you develop with exercise takes place in the older plaque that is stable and blocking the circulation. Generally, heart attacks take place in the newer and less stable plaque that is not going to be touched by the exercise program. This is all explained in Dr. Esselstyn's lectures and books.

I can tell you that it not that hard to change your lifestyle to one that is recommended by Drs. McDougall, Esselstyn, Novice etc., and that the quality of your life will be dramatically improved by doing so. You will notice the difference easily within the first month. While I hope that is your choice, I wish you well in any event.

"Of 1 million stents performed this year 1% or 10,000 will die from the procedure."

DigitalDragon, you have cardiovascular disease - but, you are not alone:

"Dr. Lewis Kuller, a professor of public health from the University of Pittsburg from his 10 years cardiovascular health study made the following statement in April 2006: 'All males who are 65 years of age and older who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.'"

These quotes are from T. Colin Campbell's website . <--click there!

SactoBob, you raise valid points. Here are my observations regarding them. Feel free to refute them. I'll listen.

1) I recognize that denial is a factor and I'm trying to deal with it. But I also want confirmation. On my first visit with the cardiologist in August, she said she wouldn't be convinced I had CAD without either catheterization or the stress echo cardiogram. I've now requested the stress echo cardiogram and it will be performed later this month. I'll decide after that how to proceed.

2) I have valid reason to be skeptical about doctors, and about my doctor (not the cardiologist). During the time I was being prescribed too much high blood pressure medication, my doctor and others ignored my complaints. They treated my spells of weakness as hypochondria and they told me that my dizziness and feeling like I was going to faint were normal. After I finally did faint in July, my doctor changed his tune and now is saying that it's proof that I will die without treatment. Just like he was earlier ignoring my complaints about side effects of the medication, now he's ignoring me when I point out that the problems stopped completely when he drastically reduced my medication.

I've been monitoring my blood pressure daily for nearly three months. When I showed my accumulated readings to my doctor recently, he wasn't interested, and told me just to show them to my cardiologist. All he's done is tell me I'll die without medical intervention, but has shown no indication that he understands cardiac problems or has any interest in them. I do however respect my cardiologist and find that unlike my doctor, she actually listens to me.

3) Regarding Jim Fixx: Given what we know today and Fixx's background (His father had a heart attack in his 30s and died of a heart attack in his early 40s, Fixx himself had very high cholesterol and almost totally clogged arteries), he probably should not have been running like he was without first tackling underlying problems, but those problems weren't easily diagnosed or treated in the 1980s. He was an unusually high risk individual who was pushing himself to an unusual extreme and was refusing to consult a doctor.

DigitalDragon,

At this point, you have the information you need. If you have any further questions, I am sure that you will get answers. You could email Dr. McDougall directly if you wish. He usually responds. Good luck.

You have been given excellent advice and Bob is correct that you dont need any more but I thought I would throw in a few more points anyway:

-Exercise does not prevent fat and cholesterol from forming plaque on the linings of the arteries nor does it remove plaque. (It does have secondary beneficial effects like raising HDL, helps to keep a healthy weight, regulates appetite and sleep, enlarges the blood vessels etc.)

-Dr Ess said that one of his patients reversed his heart disease while sitting on the couch for 5 years.

-As for your Dr saying you will die if you do not do the catheterization that is simply not true! Dr Ess explains how when your arteries start to clog up overtime your body develops collateral, small vascular threads that go around the blocked arteries to feed blood and oxygen to your heart. Our bodies are smart! This is why people rarely have heart attacks even with completely blocked arteries.

DigitalDragon,

If there is any doubt; I'd fully commit to the plan and ask questions later.

My personal experience: I was familiar with the work of both McDougall and Esselstyn. I even liked the idea of making this lifestyle change my goal. The sticking point was the no oil. I couldn't come to terms with the idea of eating out being difficult, cooking difficult, etc. So I decided to come back to the idea of this lifestyle change when I was older.

I mean I am young. I am active. I vigorously exercise. I run. I lift. I play soccer. Every nurse who has ever taken my pulse or blood pressure has given me a nice compliment on my "runner's heart".

I thought I was set for years to come. Nope. A year and a half later, after a soccer game, I had a heart attack. No warning. No symptoms. No family history. Not overweight. Not a smoker. Vigorously exercising regularly.

My point being that all my vigorous exercise and lack of risk factors did not stop an artery from occluding. I found that no oil is a very small price to pay. I wish you the best of outcomes.

-J