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With a heavy heart, we share the news of Dr. John McDougall’s passing. A visionary physician and author, beloved husband, father, grandfather, brother, mentor and friend, Dr. McDougall died peacefully at his home on Saturday, June 22nd, at the age of 77.

Jim Ettinger: Heart Disease, Cholesterol, Hypertension

The fundamentals of the McDougall Program are simple yet often difficult to implement. Star McDougallers have either adopted the Program themselves by learning from our website and books or joining one of our programs. For personalized help, learn more about the 12-Day McDougall Program. For questions on whether a change in diet can help your ailment, learn more about our consultations.
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Escapes Heart Surgeons

jimbeforeopti2-5619712I was born in 1940 in a suburb of Vancouver, Canada. I loved to be outdoors and active as I was growing up, and was generally a healthy kid. I topped out at 6 feet, and weighed a lean 187 lb. for many years. Mostly I worked in jobs that required much physical activity and chose active outdoor recreations, which helped me stay trim even though I was eating a standard North American diet and drinking quite a bit of alcohol.

I started to gain weight when I was about 30. At that time, my work in forestry took on more of an office quality. Also, my first marriage was getting stressful and I was drinking more in an attempt to make myself feel better.

In 1988, I had my first chest pains. My doctor initially thought it was indigestion, but after I went to the hospital, blood tests indicated that I was having a fairly major heart attack. Fortunately, an angiogram showed no serious heart damage – but a small branch artery was 95% blocked and this was of no serious concern. My doctor prescribed a medication for the chest pain, angina, which I took for about a year. This episode was a wake-up call to me! My response was that I more or less just stopped eating and my weight dropped off me like a rock. I was happy with my renewed trimness but unfortunately, it all came back on quickly when I went back to my old habits.

In 2001, at age 61, I consulted a blood lipid specialist. At that point, I weighed about 240 lb. (approximately 60 pounds overweight!) and my total cholesterol level was 8.83 I.U. (336 mg/dl). This was literally “off the chart,” as the ideal is under 3.8 I.U. (144 mg/dl)! My blood pressure ranged around 139/76 mmHg. The doctor wanted me to take blood pressure lowering medication which I refused. It just seemed to me to be an overly zealous treatment. He also recommended 20mg of Zocor daily to lower my cholesterol level, which I did take for awhile, but it made me feel really dizzy, so I stopped it.

When I asked the doctor if changing my diet might help, he scoffed, saying that the most I would be likely to improve it that way was about 1 point (38 mg/dl). We had a consultation with a dietician anyway. As might be expected, we were given the conventional eat “less red meat, and more fish and chicken” recommendations. My wife, Rosemarie, and I followed this advice, but by the spring of 2004, not only had I not lost any weight, I’d actually gained 5 more pounds.

By the summer of 2004, I knew something drastic had to change, because by now I was having some worrying chest pain and an irregular heart rhythm. So I stopped eating meat altogether, which was a big step for me! I’d been a hunter during my younger years; I loved to barbecue and eat smoked meat! For me, if it came down to a choice between continuing to live or eating meat, I chose life. My longtime friends were amazed that I would go almost vegetarian!

My wife and I also started taking an exercise class regularly at our local senior’s center. In September, my cholesterol had come down to 6.86 (260 mg/dl) and my weight to 225 lb. We felt very encouraged by these results, but my blood pressure and resting heart rate were still elevated, and the chest pain was still severely limiting my exertion during exercise class. Looking back on it now, while giving up red meat and starting to exercise had helped, I can see that all the high-fat foods I still had in my diet (fish, cheese, lots of nuts and oil in various foods) were holding me back.

On December 6th, 2004, I took a stress test and was diagnosed with angina (chest pains) from blocked coronary (heart) arteries. I was hoping they’d tell me that I was just under a lot of stress and to just relax more or something simple. Instead, my doctor instructed me to use a number of medications and go for an angiogram. She recommended a cardiologist who had a reputation for aggressive angioplasty and the use of stints – so I could see my future clearly. The doctor said absolutely nothing about diet.

This was quite a bombshell. It meant that with this diagnosis of heart disease I would not be eligible for at least 6 months to purchase the medical insurance necessary to travel in the United States, so we had to cancel our yearly winter escape to the warmth and sun of Arizona. Now I was really under stress! I’m the kind of guy who needs to be able to do what I want, so once my physical condition was getting in my way, it was time to take action.

Six months ago a close friend told us about The McDougall Program. I talked it over with my wife Rosemarie. We read about the limited potential gain and high risk of angioplasty, compared to the zero-risk, overall health-promoting, life-enhancing potential of the McDougall Twelve Day Program. Wanting to choose the most efficient course of action with the best potential pay-off, we chose to give the low-fat, vegan lifestyle option a try. With our friend’s encouragement, we started learning about this new way of cooking and eating.

Within one week of starting the McDougall Program, my blood pressure had dropped to 104/63 mmHg. I took my own readings using the drug store machine every other day or so over the next month, and found they averaged about 107/64 mmHg, with a pulse of 69. When the doctor took it though, the systolic reading was always elevated. White Coat Syndrome! After approximately one month on the McDougall Program, I’d lost 8 more lb. to 217 lb. (My goal weight is about 185 lb.) I brought my total cholesterol down to 5.56 I.U. (211 mg/dl). We were delighted by the improvement, though I knew I still had two more points to get it under 3.8. I noticed a reduction in the chest pain during exercise class immediately after starting the diet. The improvement continued steadily over the first several months to the point of being able to exert myself 95% of my desired level without any chest pain. I was still having some mild chest pain though when walking up a steep hills without a warm-up; and I’ve also noticed that there is more discomfort when I’m under emotional stress.

Rosemarie was also losing weight — in the before picture she is 150 lb. and now she is 130 lb. She’s only 5’4″, so the 20 lb. loss makes quite a difference in her appearance. Since she’s lost the weight, people find it HARD to believe she’s 60! Her chronic IBS (Irritable Bowel Syndrome) was greatly relieved and her cholesterol level dropped to – into the safety zone (under 3.8), which was great! She bounces her way through the aerobic section of our exercise class now with all of her new energy, while most everyone else just walks.


Both Rosemarie and I noticed an improvement in the quality of my sleep and we were both generally feeling much better. So, I began weaning myself off the 20 mg of the anti-depressant, paroxetine, which I’d been taking for years. I went down very slowly at a rate of 5 mg reductions every 3 weeks, which was successful! I’m off the anti-depressants now and feeling happier than I have for years! I’ve since found out that the anti-depressants not only keep the lows of depression at bay, they also dampen the highs of happiness. If I’d known that, I doubt that I would have bothered trying them at all.

Because my cholesterol had still not reached an ideal level (below 150 mg/dl) I started taking 10mg Lipitor daily (the minimum dose) and the minimum dose of aspirin (81 mg).

Only one month later, as of May 2005, my weight is 210 lb. and still dropping gradually. The best news is that my total cholesterol is at 3.6 I.U. (140 mg/dl)! That’s comfortably into the safety zone identified by the Framingham Heart Study! My triglycerides, HDL and LDL have also dropped well into the safety zone! I feel as if a great weight has been lifted off my shoulders!

At this point, I’m almost looking forward to my next consultation with my new doctor. She’s young and seems to have some appreciation of the value of what they call “conservative” treatment: using diet and lifestyle change to reverse heart disease. (My former GP, as well as the doctor who gave me the stress test, both “washed their hands” of me!) I think it’s terribly annoying that mainstream medicine calls the proven benefits of diet and exercise “conservative” treatment, as if it is sub-standard, because it seems pretty radical to me!

We found the low-fat vegan meals a little plain initially, but started enjoying them more quickly than I’d expected possible. There have been many times over the past 6 months that I’ve been grateful my wife is willing to live this way too. If she weren’t, it would have been a whole lot tougher to get to where I am now. Eating meals with our friends who follow the Program too has been a good way to socialize without having to worry about “falling off the wagon”. When we’re invited to other people’s homes for meals, we generally bring our own low-fat vegan food with us and share with others. What we bring to these gatherings has been very popular!

My plan of action, based on current information, is to continue on the McDougall Program with the few medications I’m on now for the next two years. Then, if my condition has continued to improve, as I have every confidence it will, I’ll see if I can maybe get off the medications. In any case, even if I have to take the Lipitor for the rest of my life, I’m feeling better than I ever have. To be turning 65 this month and able to say that, is all right by me! It’s great to be at the official beginning of my senior years with optimism about being around to enjoy them!


Dr. McDougall’s Comments:

One of the most difficult challenges for patients these days is to escape from the controlling heart disease businesses. Cardiologists (heart doctors) are some of the most intelligent and self-assured (that is a nice way of saying arrogant) people you will ever have to bargain with. Their glowing assets can be turned to good or evil for the patient. Unfortunately, in too many cases the patients are harmed more than helped by enthusiastic treatments that are found by scientific research to be lacking. If the truth about the limitations of heart surgery and the benefits of a healthy diet (with judicious use of cholesterol-lowering medications and aspirin) were enthusiastically applied in medical care, then I believe over 90% of heart surgery could be safely avoided, and the patients would be much better off.

If you or a family member falls into the heart disease treatment business then you need to sit face to face with your doctors and ask some serious questions, like:

Q: Does a low-fat diet reverse the underlying atherosclerosis?
A: Yes. Within a year, reversal can be seen in over 80% of people.

Q: Does a low-fat diet reduce my risk of a heart attack?
A: Yes. And within hours, by stabilizing the small, dangerous, volatile plaques.

Q: Will medications work fast to stop a heart attack?
A: Yes. Aspirin (81 mg) reduces the risk of heart attacks immediately.

Q: Will medications help reverse the atherosclerosis?
A: Yes. Cholesterol-lowering medications (statins, niacin and Colestid, etc.) are of some benefit.

Q: Will a low-fat, plant-based diet stop my chest pains?
A: Yes. Within 3 weeks there is a 90% reduction in chest pains with this diet.

Q: What are the indications for heart surgery?
A: There are two: Incapacitating chest pains and to save your life.

Q: Rather than surgery, can I take medication for chest pains?
A: Yes. Medications, like beta blockers and nitrates, are very effective.

Q: Does an angiogram test to look at my heart arteries lead to heart surgery?
A: Yes. Two-thirds of people who have this test have heart surgery.

Q: Does heart surgery treat the plaques (the dangerous part of my disease) that threaten my life?
A: No. Heart surgery treats large, old, stable plaques that are of very little risk to you. But, they are sometimes big enough to impair blood flow and cause chest pains.

Q: How does a heart attack happen?
A: A very small, young, fat-filled, volatile plaque (sore) bursts, causing a blood clot to form in a heart artery.

Q: Does angioplasty (a form of heart surgery) stop chest pains?
A: In many cases yes. But, it also causes treated arteries to close down in 20% to 50% of cases.

Q: Does angioplasty save lives?
A: No. It only treats big and old blockages that are rarely life threatening.

Q: Does bypass surgery relieve chest pains?
A: In many cases it does, but at a big price.

Q: Does bypass surgery save lives?
A: Rarely. It only treats the big and old plaques. But, in a small subset of patients – those with damaged heart muscles – there is a small survival advantage. A simple echocardiogram test for your heart function (ejection fraction) determines if you have heart muscle damage.

Q: Do patients undergoing bypass surgery suffer brain damage?
A: Always – and in about half the cases it is significant and permanent.

Q: Does a diet change have side effects?
A: No – only major benefits happen with a return of health, like with Jim, in most cases.

Q; Can you guarantee any proposed surgery will be successful with no side effects?
A: No. But, if your doctors are going to insist that surgery is your only option then you should expect this guarantee.

Q: If you disagree with Dr. McDougall, will you provide me with scientific studies to support your opinion?
A: Hopefully they will. After all, you are making a major purchase that will affect your future.

If you would like to learn much more about heart disease, then please read the following free articles from my newsletter archives:

June 2003: Cleaning Out Your Arteries

September 2004: What Next, Bill Clinton?

September 2002: Cholesterol – When and How to Treat

February 2003: Niacin – A Time Honored Treatment for Cholesterol and Triglycerides

January 2003: Taming Elevated Triglycerides, Insulin Resistance, and Syndrome X

April 2004: HDL “Good” Cholesterol is Not Worth Your Attention