SAFE ALTERNATIVES TO BYPASS SURGERY
by: Whitaker, Julian, M.D.
Julian Whitaker is a graduate of Emory University Medical School and a member of
the American Medical Association. In 1976 he began working with Nathan Pritikin
and this changed the direction of his professional career. In 1979 he opened the
Whitaker Wellness Institute in Newport Beach, California where he uses preventive
medicine with low-fat nutrition, exercise and lifestyle changes as the primary
treatment for patients with heart disease, high blood pressure, diabetes and
obesity. Along with Nobel Prize-winning Dr. Linus Pauling, Dr. Whitaker founded
the California Orthomolecular Medical Society. He is the author of Reversing Heart
Disease, Reversing Diabetes, The Heart Surgery Trap, and Dr. Whitaker's Guide to
Natural Healing. He is the publisher of Health and Healing, the nation's leading
health newsletter with a circulation of nearly 700,000.
HEART DISEASE I am of the very strong opinion that the whole premise of the invasive treatment of heart disease today is just plain wrong and has been disproven. The premise of doing catheterization to find blockages and the premise that you can't treat people unless you have an angiogram are wrong. We have this big debate that using chelation therapy and vitamins and minerals for heart problems is not backed up by scientific evidence. And all of that is just not true. I will present some studies to show you that the premise of the technical approach to cardiovascular disease of running in and trying to do replumbing, whether the replumbing is an operation or a catheter or a balloon simply doesn't get the job done and actually makes people worse. Most of these studies are listed in my two books on heart disease and my Guide to Natural Healing. Reversing Heart Disease, discusses diet and reducing risk factors, and the later book, The Heart Surgery Trap, discusses getting a second opinion when you are faced with a bypass operation or even catheterization.
SCIENTIFIC STUDIES ON BYPASS SURGERY If we believe that surgical alteration of the arteries is beneficial, then there should be some proof in the scientific literature. In the United States there have been only two truly controlled trials of the values of bypass surgery. Heart disease is a fatal disease - its primary effect is a fatal heart attack. Therefore if you have a therapy which improves that disease you should improve mortality rates. However, scientific studies of bypass surgery have demonstrated that people die at the same rate with or without the surgery. The first study, the Veteran's Administration Hospital Study, published in 1977, was a highly sophisticated five year study with about 600 patients, all of whom had blockages. Half of them had had heart attacks and were typical bypass candidates. They randomized the people into two groups of 300. Three hundred had the operation and 300 didn't. At three, four and five years later, they found no difference whatsoever in the death rates between the two groups. The three year death rate was about 4% per year for both groups.
They did another study. Usually if a surgical procedure is not validated by a scientifically controlled trial, they abandon the procedure. But this industry was already ongoing, so they decided to do another study with 800 patients, all of whom had blockages. This was the CASS study, published in 1984 in the New England Journal of Medicine. Again, the survival rates turned out to be identical between the surgical and non-surgical groups. The death rate in both groups was 1.6% per year which means the survival rate is 98.4% on a yearly basis. They also found that there was no difference in the death rate whether the patient had one, two or three blockages. If there is no difference, why are we operating on them? Subsequently they looked at the five and ten-year follow-up. At five and ten years there was no difference in death rates between the two groups or in any other statistics for that matter. At 16 years, they found that there was no difference at all, and in fact that those who had the surgery were doing worse because the operation actually alters the blood flow in such a way that it begins to weaken the heart, so that having a bypass makes the next heart attack more dangerous.
BYPASS SURGERY WEAKENS THE HEART The nationwide death rate from bypass surgery is 4%, but the nationwide death rate from the disease without the surgery is 1%, so the surgery is four times more deadly than the disease and actually increases it down the line because people have further problems. Once you get tied into the aggressive approach to heart disease, it is hard to get out because you are always having problems, and they always have to do another procedure, another angiogram or something else. Forty percent of the grafts are blocked up after five years, and 75% are blocked after 10 years. The side effects like memory loss and personality disorders are significant.
WALKING TIMB BOMBS Yet, when a person is confronted by a cardiologist or heart surgeon about whether or not they should have surgery, they are told they are a walking time bomb, that they can go any moment, "but if we operate on you we can save your life". Both statements are a lie. This is not just my opinion. It's not that I have an axe to grind. It has been proven to be untrue in the CASS study which showed that whether they were operated on or not, the death rate was the same. That means that time bomb doesn't go off 98.4% of the time.
THE EJECTION FACTOR The most important factor we consider is the ejection factor. This has nothing to do with blocked arteries; it is a measure of the efficiency of the pumping of the heart. The heart fills with blood; let's say it fills with 100 cc's, and then it pumps out 50 cc's. If the heart pumps out 50% that is called a 50% ejection fraction which means the heart is functioning well. This is the only measurement which will give you a prognostic indication about what is going to happen to that individual in the future. When the ejection fraction is 50% or greater, it doesn't matter how many blockages you have, even if it is the left main artery or triple vessel disease, the studies clearly show that surgery does not help you. It is when the ejection factor is low that you might have some benefit.
ESTIMATING THE EJECTION FACTOR You do not have to have an angiogram to get the ejection fraction. You can estimate the ejection fraction on the function of the heart over the telephone. I had a patient who was a lawyer in his mid-forties. He had been skiing out west and all of a sudden he had some chest pains, so he went to the cardiologist, and they did a stress test and an angiogram, and found a couple of blockages and scheduled him for surgery. He was lying in Johns Hopkins shaved and ready for surgery when someone gave him my book. He called me up and I asked him some questions to find out how his heart was functioning: "Do you get short of breath; do your feet swell; do you have to sleep on two pillows; do you wake up at night short of breath; do you get really short of breath going up stairs?" He answered no to all the questions, so I told him he better get out of the hospital. He came to see me, and he was so healthy I didn't even recommend chelation therapy. But he was about to undergo a $70,000 operation that was putting him in jeopardy. When you undergo bypass surgery, you are subjected to the pump, and that will cause brain damage. It causes brain damage to everyone. So all of his professional and social life was being put into jeopardy for an operation he obviously did not need, could not benefit from, and could only be hurt by. I have hundreds of patients who have been told they had to have bypass surgery when they just didn't need it.
ANGIOGRAPHY The only information you get from an angiogram is where the surgeon may or may not operate. It has nothing to do with treatment. Treatment depends on how much pain the individual has, the level of their blood pressure and cholesterol, the function of the heart and their exercise tolerance, whether they have cardiac arrhythmias. Eighty percent of angiograms go on to some kind of operation like a bypass or an angioplasty. So where you really stop it is with the angiogram. In 1987 and in 1992, Dr. T.D. Graboys and his group in Boston published studies in the Journal of the American Medical Association in which he gave his protocol for second opinions for patients who were told to have an angiogram. Most cardiologists tell you they can't treat you unless they have an angiogram to look at the blood vessels. I believe treatment of the patient with heart disease is usually best done without an angiogram. I am a nutritionally oriented physician. That is what you would expect me to say, and this is the way I treat my patients. But Thomas Graboys is a teaching cardiologist at Harvard. Of 168 patients referred to him who had been told by other board certified cardiologists to have an angiogram, he agreed with only six of them. If this Harvard board certified very conservative cardiologist feels comfortable in treating these 162 patients, why is it that they were told by other cardiologists they needed an angiogram or they couldn't be treated? Because it's a business. The increase in the numbers of bypass surgery reflects only one thing, and that is the number of surgeons in the community. Since that is what they have to do to survive in their profession, we are going to have more and more of this kind of thing. Get a second opinion. Dr. Graboys study concluded that bypass surgery could be reduced by 50% to 80%.
THE HEART INDUSTRY Eugene Brunwald published an article in the New England Journal of Medicine in 1977 which claimed that an industry was being built around an operation that had been disproven, and it was continuing to grow. It was a money machine. And that is still going on. In 1977, there were only about 70,000 bypass procedures per year. Now there are 500,000 bypass surgeries per year plus an additional 400,000 angioplasties, which also have never been validated scientifically.
ANGIOPLASTY Angioplasty will never be researched in a scientific study, and no one has ever mounted a scientific study on the benefits of angioplasty. The death rate of the procedure is roughly four times the expected death rate of the disease.
LOW FAT VEGETARIAN DIET When I worked with Pritikin I saw people on the Pritikin low fat diet get well. I saw diseases melt away. We were always able to take the patients off drugs. The Lifestyle Heart Trial conducted by Dean Ornish, published in the Lancet, 1990, demonstrated that atherosclerosis can be reversed by changing the diet. The control group received regular medical care and followed the standard American Heart Association diet. The experimental group was asked to eat a low-fat vegetarian diet for at least one year. The diet included fruits, vegetables, grains, legumes and soybean products, but no animal products were allowed except egg white and one cup per day of nonfat yogurt. Although margarine has been promoted by the American Heart Association, studies show that margarine and other hydrogenated foods are very damaging foods to heart patients and probably carcinogenic. They were also asked to perform stress-reduction techniques such as breathing exercises, stretching exercises, meditation, and other relaxation techniques for an hour each day and to exercise at least three hours a week. At the end of the year, the experimental group showed significant regression of atherosclerosis of the coronary blood vessels. In contrast, subjects in the control group showed progression of their disease.
VITAMINS AND MINERALS Research has shown that 300 mg. of vitamin C or more daily reduces heart attack rates by 50% and increases life span by about six years. Beta carotene, vitamin E and the other anti-oxidants have a similar effect. Doctors prescribe Mevacor to lower cholesterol presumably to lower heart attacks. The side effects of Mevacor are cataracts, liver failure, hepatitis or gall bladder disease. Why don't you just take some vitamin C which has no side effects whatsoever. Folic acid, vitamin B6 and B12 are essential for eliminating homocysteine build-up in the blood which reduces the conversion of LDL and the deposition of cholesterol in the arteries. This has been published in many journals including the New England Journal of Medicine and the Journal of the American Medical Association. You need to take B complex vitamins every day, at least 400 mg of folic acid, 50-100 mg of B6, and 400 or more mcg of B12. B vitamins alone can reduce heart disease dramatically. We use magnesium I.V.'s for heart disease, arrhythmias, high blood pressure, angina and asthma. It's a natural calcium channel blocker which works in a similar way to calcium channel blocker medications with none of the side effects.
ROGENIC AND HAWTHORNE I recommend Rogenic to my patients with angina, high blood pressure and other heart problems. Rogenic provides essential vitamins and minerals for the heart and vascular system along with special herbal extracts including hawthorne. Hawthorne extracts are widely used by physicians in Europe. Double-blind studies have shown it to be beneficial for angina, cardiac arrhythmia, and minor forms of congestive heart failure.
COENZYME Q10 AND CARNITINE If you have heart disease, you definitely need to be taking coenzyme Q10 and carnitine. I use coenzyme Q10 for every single heart patient, particularly when your ejection level is low. Take 30 to 100 mg three times daily. Carnitine also helps the ejection factor. Take 500 mg of carnitine two times daily.
AMINO ACIDS L-arginine at about 6 g per day will increase nitric oxide which relaxes the arteries, lowers the blood pressure and smooths out the blood flow. In a study done at Stanford, it was shown that L-lysine when given with vitamin C can actually carve out arterial blockages.
CHELATION THERAPY Most of you know about this. Dr. Cutler is now doing it at Stoneybrook. There is better research on chelation therapy than there is on bypass surgery, and it has to be better than bypass surgery because it doesn't hurt anyone. Chelation results in a 93% improvement. There are plenty of scientific studies on this subject. I don't think chelation therapy is a cure all, but I think used along with everything else, it is extremely powerful.
ENHANCED EXTERNAL CALIPULSATION This is a new very powerful therapy for heart disease. There has been a large study done on it in Stoneybrook in New York. People don't have to suffer with angina with this kind of therapy available. I have seen some excellent results. Of the patients I have treated, 16 out of 18 had complete relief of angina.
SUMMARY: The best that can be said about bypass surgery and balloon angioplasty is that they are irrelevant to the course of the disease in all but the most serious cases. Bypass does not increase blood flow to the heart in most cases and may even reduce blood flow. The cardiopulmonary pump used during bypass surgery can cause brain damage. This damage can lead to memory loss, paralysis and personality changes. The need for bypass surgery is determined mainly by how well the left ventricular pump is working, not the number of blood vessels blocked. Bypass surgery or angioplasty are not curative; they do not address the reasons why the plaque developed in the first place. The section upstream of the graft has accelerated plaque formation at a rate ten times higher than the ungrafted coronary artery. This is probably way patients do poorly over time. Up to 90% of bypass procedures are done when the ejection fraction is greater than 50% which indicates a healthy heart.
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