Dietary/Nutritional education

Jamie Oliver gets it. Juvenile obesity and diabetes are on the rise. Most of the "diseases of affluence" start during youth. To make a real lifelong impact, nutritional education must start in school or before. Check out his talk at TED http://www.ted.com/talks/jamie_oliver.html

Forks over Knives

New film being made about Drs. Campbell and Esselstyn and their research. Trailer looks great, check out the website and view the trailer: http://forksoverknives.com/

Richmond Times Dispatch

Amazed at number of positive responses to newspaper article today. http://bit.ly/913XmP

Working on setting up seminars, support groups. Many have questions about the study, we have a grant proposal pending on; it will be for those with documented coronary artery disease to measure the impact of diet on the disease. For others, stay tuned working on more options.

The China Study

     Dr. T. Colin Campbell, Professor of Nutritional Biochemistry at Cornell University lead a study of 65 counties across 24 provinces in rural China.  It involved 6500 adults aged 35-64.  Dietary questionnaires, blood and urine samples were analyzed yielding over 347 data points for interpretation.

     Some key findings:

Fat intake:rural China 14% of total caloric intake vs US >35%

Protein intake: rural China 10% of calories from animal protein, US 70%

Total caloric intake of rural Chinese diet was 20-30% more that in US

     The diet consumed in rural China is plant based nutrition compared with the typical American diet based upon animal protein.

     The study analysis showed a tremendous difference in the incidence of "Diseases of Affluence", specifically cancer, heart disease and diabetes.  These diseases exist in very low rates in rural China compared to the US.  What's more, rural Chinese who emigrated to the US, adopting the local diet then developed these diseases at the same rate as native born Americans.  One finding I found to be particularly amazing involved a 3 county area in China with a population of over 400,000 in which, during the 3 years of the study, not a single person died from a heart attack.  In a comparable sized US region the rate of death from heart attacks is about 80 per year, so 240 over a 3 year period compared to zero.  I find that astounding.

     The effects of these dietary differences were also noted to impact other disease states i.e. kidney stones, osteoporosis, and autoimmune diseases.  The implications are broad.  Adopting a plant based diet can significantly impact the incidence and prevalence of the leading causes of death and disability in the U.S.  It will, however, take a tremendous change in our dietary habits.  

     Reading the China Study, as well as Dr. Esselstyn's Prevent and Reverse Heart Disease, has totally changed my perspective on diet and health.  I am now 2 months into my adoption of these dietary changes and feel great.  Join me, it's not as daunting a task as it first appears.   In fact it is quite simple.  Read the China Study, it is eye opening.

Cholesterol - It's not just bad for your heart

     It is widely publicized that high cholesterol levels are linked to coronary artery disease.  But.... did you know that the single biological factor associated with 'diseases of affluence' (diabetes, coronary artery disease and cancers of the brain, breast, colon, liver, stomach and leukemia) is..... you guessed it......Cholesterol.

     In the China Study,  Dr. T. Colin Campbell found that in rural China, where a plant based diet is followed the incidence of these diseases of affluence was extremely low.  In this region the average total cholesterol was 127! (The average in the US is ~200)

    More on this comprehensive study to come.

Prevent and Reverse Heart Disease

    I have recently finished reading 'Prevent and Reverse Heart Disease' by Dr. Caldwell Esselstyn.  It is more than interesting.  His general message is very powerful.  Western diets based on animal protein lead to significant vascular inflammation and development of plaque (blockages).  Additionally the inflamed lining of these vessels also makes "vulnerable" plaques at higher risk of rupture.  People with a total cholesterol of less than 150 and LDL of less than 80 are at extremely low risk for coronary events.  His study spanning more than 15 years showed solid evidence of stabilization and even reversal of coronary artery disease.  This is remarkable.

    To achieve these results the study patients followed a strict change in diet.  A no fat vegan dietary plan.  "Nothing with a face or a mother" is allowed to be eaten.  This includes no fish, dairy, nuts (except a few walnuts in low risk people), no avocados, no oils, and no soy milk (except non fat).  This may sound spartan at first blush but he goes on to describe many food ideas and the last half of the book contains many recipes and meal plans.  I have been following this diet for the last 2 weeks and have been very pleasantly surprised.  No hunger, no cravings and many options.  It does take more work, both mental and physical, as most prepared foods are off limits.

     Now, as a cardiac surgeon, how is this new information to be integrated into my practice? First, I still believe that patients with tight lesions and unstable symptoms need urgent revascularization to relieve symptoms and ideally avoid muscle damage.  Next, I will be informing my patients about these findings, the potential impact on their long term health and encourage them to read this book and adopt the dietary changes. I am continuing my research in the exciting area.  

    Congratulations to Dr. Esselstyn for an amazing study over a long period, breaking with standard conventions and achieving stunning results.

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Minimally Invasive Heart Surgery

      Most heart surgery is performed via an incision known as a 'median sternotomy'.  This incision splits the breast bone (sternum) longitudinally.  The main advantage is exposure.  The heart is entirely visible and the surgeon can literally get both hands around it.  A disadvantage is that the resulting two long strips of bone must, at the end of the procedure, be wired back together.  Bone is slow to heal and significant upper body activity must be strictly curtailed during the healing time, about 3 months.  This means no heavy lifting, pushing, pulling or reaching.  Therefore, no golf, tennis or swimming.  More importantly no work if your job entails lifting, painting, digging or hauling.  Thus, a manual laborer is out of work for about 3 months.  Now, considering that heart surgery is only done for serious, frequently life threatening, conditions, it is a price that must often be paid for the multiple and significant benefits.  Most patients do very well with this incision and it remains the standard approach today.

      

      But.............what if we could achieve the same life saving, heart improving benefits via an approach that does not require the physical limitations post operatively?  This is the goal of minimally invasive approaches to heart repair.  The same work done on the inside, with, at least, equivalent results and safety, but with a mode of entry and exit that heals faster, with less pain and little to no physical activity restriction.

     

       A variety of approaches to heart surgery can be considered minimally invasive:

Mini sternotomy: this can entail an incision thru just the top or bottom of the breast bone, sometimes with a 'T' off to the right or left.  Advantage: smaller incision, half sternum remains intact.  Disadvantage: still requires bone healing, smaller field of vision.

Mini thoracotomy: an incision into the chest thru the space between two ribs. Advantage:much more rapid healing, minimal or no activity limitation, lower infection risk.  Disadvantage: smaller field of vision, limited access.

Endoscopic or thoracoscopic approach: utilizes small ports, usually 5-8mm incisions between the ribs, thru which a scope and a variety of instruments are passed. Advantage: scope increases field of view and magnification, very small incisions, rapid healing with minimally or no restriction, shorter hospital stay and recovery. Disadvantage: 2D vision, visual motor misalignment as surgeon is looking a scope away from operative field, instruments are long and not suited to very fine work.

Robotically assisted endoscopic approach: adds a powerful computer interface to enable introduction of wristed instruments, 3D vision magnified 10-15x, tremor elimination (tremor is exacerbated by long endoscopic instruments), motion scaling and hand eye alignment is restored compared to traditional endoscopic approach.  A variety of instruments and fine motion control make this amenable to fine reconstructive techniques.  Disadvantage: not available everywhere, longer procedure time.  Advantages: small port incisions, rapid healing, shorter hospital stay, rapid return to full activity, less infection risk.

      Each approach has advantages and disadvantages.  Some lend themselves to specific procedures more than others.  Aortic valve replacement surgery, for example, is not currently approachable via endoscopic or robotic approaches, but in many instances can be well suited for a small thoracotomy incision instead of the standard sternotomy.  Mitral valve repairs, atrial septal defect closure, maze procedures for atrial fibrillation and removal of left atrial myxomas can often be done via an endoscopic or robotic approach.  Some coronary bypass surgeries can be performed robotically or via a small thoracotomy.  The bottom line is, if you are in an elective situation and have the opportunity to do some research before a planned procedure, ask about all of your options.  A minimally invasive approach might be possible which could cut your hospital stay in half and allow you to return to full activity in as little as a week or two.