Anatomy of a heart attack – going vegan with the Forks over Knives program

by Bruce A. Smith

Part 4 in a series.

I’m in the fourth month of my recovery from a heart attack, and I’m proud to announce that for the last half of that time I have been a vegan.  Not only am I a vegetarian, I don’t eat any animal products – no dairy, cheese or eggs – and no fish or chicken along with the prototypical prohibitions on beef.

 I also don’t know how to pronounce my new life style, apparently, as I call myself a vegan, as in “Vey-gahn,” but the know-it-alls of my life tell me that the correct pronunciation is “Vee-gahn.”

 Nevertheless, I am a vegan, and specifically I am following the dietary protocols of the Forks over Knives program, the noted vegan regimen that has grown out of the documentary film by the same title.

 The film is a thoughtful Hollywood venture with excellent production values, and it highlights the work of luminaries in cardiac care, most notably Dr. Caldwell Esselstyn, Jr., MD of the Cleveland Clinic, where by-pass surgery was developed; T. Colin Campbell, PhD, of the nutritional sciences department at Cornell; and Dr. John McDougall, a grunt doc in the trenches of primary care and practicing in Hawaii.

 The documentary also examines the “China Study,” the world’s largest investigation of the relationship between nutrition and disease, of which Dr. Campbell was a major participant.  The conclusions of the China Study fully support the theme of Forks over Knives – that a plant-based diet is the pathway to health.

 But Forks over Knives goes much further than any other nutritional video I have ever seen, and presents the scientific basis – and practical dietary methods – of eating your way back to health once you’ve already have a heart attack.

 In fact, Esselstyn’s work at the Cleveland Clinic, which forms the primary component of Forks, is focused on folks who are considered “cardiac lost causes,” and have already had tons of drugs, stents and by-pass surgeries.  They also have other medical complications such as diabetes.  For them, good food is their only hope.

 In essence, the Forks over Knives program is a strict über-vegetarian format that calls for a stringent reduction in fat, oils, and sugar consumption, along with an avoidance of processed foods.  This is all to the goal of helping guys like me clean out the residual amounts of gunk still left in our arteries and restoring our vascular system to optimal condition.

 During my heart surgery at Good Samaritan Hospital in Puyallup, Washington, I learned that my circumflex coronary artery had a 95% blockage, and I received a stent to get the blood flowing. 

 But my left descending coronal artery was 30% blocked, and Gawd-only-knows how much plaque is left in the rest of my blood system – including other organs, such as the kidneys or even in my brain.

 So, Forks over Knives is my way of cleansing myself, and reversing the potential for more heart attacks, strokes, diabetes or death.

 The numbers tell the story, and the math is appalling.  Here is what I was told in my educational classes at Good Sam’s cardiac rehab center in South Hill:

 The odds of dying of AIDS in the United States are one in a million; the odds of being shot to death are 1 in 10,000, and the odds of dying in a car accident are 1 in 5,000.

 But the odds of dying of heart disease are 1 in 2.

 The sad news is that most of the cardiac deaths don’t need to happen because virtually all heart disease is caused by nutrition.

 We eat too much fatty meat, too much sugar, and too many processed foods.  In a nutshell, too many tacos.  

 I had been steering myself away from all of that – I don’t remember the last time I bought hamburger meat – and I was trying to exercise more, but it wasn’t enough.  I was too fat, too sluggish, and my blood too thick with gunk.

 Yes, my cholesterol was high; the last time I had it checked was in the mid-1990s and it was over 300 then, but I don’t think that was a major problem.  In fact, I don’t think that cholesterol is bad per se, regardless of whether it is the so-called “good” HDL cholesterol or the “bad” LDL cholesterol.

 Here’s what I’ve come to learn through a combination of reading books, such as the exquisite “Bypassing Bypass Surgery” by Dr. Elmer Cranton, watching several DVDs in rehab by cardiac guru Joe Piscatella, or Forks over Knives:

 Cholesterol is vital to a healthy life, and our bodies self-produce most of what we have.  We need cholesterol, and we use it to produce hormones, cell tissue, and repair damaged arteries.  It is this latter dimension where heart disease enters and cholesterol gets the bad rap.

 Heart disease is at its fundamental level a nutritional disease, and is related to other systemic, chronic diseases such as diabetes, cancer and osteoporosis.  The dynamic that ties them all together is the action of free-radicals and the damage they cause in the body.

 Now, free-radicals are not bad per se, either, as they are critical molecules of energy transport and essential for life.  It’s the question of too many free-radicals in our blood and tissues, and that comes about because of our lousy eating habits.

 Our hamburgers and greasy fries, and overly sugared diets produce too many free-radicals and our blood becomes too “hot” electro-magnetically.  All of these free-radicals are “too free” in a sense, busy zapping tissue, in particular oxidizing the cells walls of our coronary arteries.  That causes inflammation to the individual cell, and as a result the vascular system sends out a distress call, emitting peptide molecules called coronary reactive proteins, also known as “c-reactive proteins.” 

 These molecules then signal the LDL cholesterol to get stickier, and when they reach  the inflammation point they stick to the damaged coronary walls, much like a quick slap of plaster on a busted sheet of drywall.

 Now, in a process I don’t fully understand, and I’m not sure anyone else does either, the patch-job doesn’t turn off too quickly, so we end up with more and more layers of sticky LDLs adhering to the inside of the arterial walls. 

 In time, they harden and form what is called plaque.  Then, with exertion or stress, or some other kind of increased demand on the heart, the plaque may break off a bit and start to flap in the slipstream of the blood cruising by.  If too big a piece flaps free it can block the artery and cause a heart attack.  I believe that is what happened to me.

 Now, I was one of the lucky ones.  I made it to the emergency room in time and got a stent put in to prop open the plugged artery.  But 40% of folks don’t make it, and many of them are women who are busy getting a sitter for the kids or dealing with some other social demand upon their time before they call 9-1-1 and get an ambulance ride to the hospital.

 As a result, more women die of their heart attacks than men.  Further, many fewer of those women who do survive get after-care, and for many of the same reasons – they just can’t afford the time.  Hence, their recoveries are more problematic and their incidences of a second heart attack are high.

 So, here is my current bio-chemical situation and why I’m a vegan.

 First, the pharmaceuticals I am taking for my heart do not remove any cholesterol or plaque.  My cardiac doctor, Peter Chen at the Cardiac Study Center in Puyallup, gave it to me straight.

 “There is no medication that I can prescribe, or program I can offer that will remove the plaque that remains in your body,” he told me in my post-op office visit.

 Specifically, the cholesterol drugs that I take, the so-called “statins,” only suppress my liver’s ability to produce my own cholesterol and simply don’t address the existing condition of plaque on my arterial walls or block the action of the cholesterol in the foods that I might eat.

 In my view, this is bad news for the 40% of all Americans over 45 years of age who take statins daily.  In fact, Lipitor, the most famous statin on the market, is the most widely consumed drug in the world, giving rise to plenty of fanatics who tout that the push for statins is just a gross marketing ploy designed to make fat cats, well, fatter.

 Since all animals produce cholesterol, then all animal food products contain cholesterol, including, eggs, salmon and yogurt.  In effect, Lipitor lets you eat steak or pizza by reducing the production of your personalized cholesterol and replacing it with cholesterol made by a bovine or some other creature.

 In fact, the salmon that everyone at Good Sam championed as my Number One Preferred Food has as much cholesterol as a T-bone steak.  Worse, some game meats, such as venison, have even more!  That is because, I believe, deer and elk have lots of stress in their lives and need lots of cholesterol to repair damaged tissues throughout their bodies.

 Fortunately, the nurses and physical therapists who attend to me and my mates in rehab are increasingly aware of the Forks over Knives program, and were instrumental in helping me get started.

 Make no mistake, Forks over Knives is radical; eating vegan is not easy.  Not only do you have to change what you eat, you have to change how you cook and how you shop, and most importantly you have to confront your cravings. 

Mine have been sharp, and it seems like a detoxification process is underway as I recover from chemicals in foods I have eaten for decades.  Or I have to adjust to the loss of familiar tastes, habits and preferences.  It takes time and a supporting hand.  Here’s my journey:

 I didn’t start right off with Forks over Knives.  Rather, I went first with what my cardiac doc and the cardiac team at Good Sam recommended, which is the famous “Mediterranean Diet.”

 However, the Mediterranean Diet is great – but only if you live in the Mediterranean and have been eating your momma’s cookin’ all your life.  But for me, an American with USDA-certified gunk-filled arteries, I have a 25% statistical probability of getting a second heart attack after five years if I ate a diet heavy with fish, olive oil, salads, feta cheese and vino.  My doc didn’t tell me that dirty little secret, and maybe he doesn’t know, but that’s what I learned in my nutritional classes at Good Sam. 

 So, I needed a Plan B and that was Forks over Knives.

 In essence, Forks over Knives means eating lots of good food – fresh, organic and unprocessed.  Besides the ban on cholesterol-laden animal products, I don’t eat any “enriched” breads or pasta, and I need to stay away from oil, even olive oil, which has about 15 percent saturated fat.  For a guy like me, any saturated fat is a no-no, as it can enhance the free-radical load in my blood and add to my liver’s cholesterol production.

 In addition, I need to stay away from salt, or rather “sodium,” which attracts water molecules and tends to plump-up the body.  That increases the strain on my heart, which is slightly damaged due to its oxygen-deprivation during the blockages – and besides pumping blood, the heart also maintains the hydro-static pressure of the body.  Hence, less fluid means less pressure to maintain, and as a result the heart can get by with less oomph per beat.

 Here’s what I’m eating: rice and beans, lots of veggies, 100% whole wheat pasta and bread, and fruits.

 Breakfast is typically oatmeal and raisins, or granola and raisins.  Now that it’s June, though, the strawberries are emerging in the garden so I have a little variety.

 Lunch is generally a sandwich, made with two slices of “Dave’s” whole wheat bread lathered with hummus and topped with slices of cucumbers and tomatoes.  Often, I feel like I need some dessert afterwards and if so, I eat some more granola and raisins. 

Also, I’m not fully compliant with the Forks protocols regarding fats, as I eat commercial hummus that has Tahini in it, which is heavy with sesame seed oil.  But I find the pure, Tahini-free home-made version is not nearly as satisfying, so I figure I am weaning myself off fats.  It’s one more Forks goal to reach in the future once my conversion to veganism is more fully established.

 Dinner is the big challenge.  I have cooked and eaten a lot of mush, and my embrace of eating vegan has required me to also become a much better cook, which remains an elusive goal.  But here is what I can do after two-plus months of vegan cooking.

 I have two main dishes, or rather, pots.  One is a lentil-potato-veggie mix that is like a stew.  Every day I add a new veggie, such as asparagus or broccoli, so after a few days the stew has evolved through several stages of tastes.

 The second pot is a rotini pasta-portobello mushroom-salsa meal that also has a daily mix of zucchini and kale.  Beforehand I usually eat a salad, often supplemented by what is growing in my garden.

 Quick meals are organic soups from a box with something added, such as brown Basmati rice.  I keep adding beans, spouts and corn to the above with varying success.

 For munchies I love “low-fat” Triscuits, and baked corn chips.  Occasionally, I have a chocolate bar, which I crave, along with cake and cookies.  But as Joe Piscatella says, “chose the apple over the apple pie,” and I am endeavoring to reach for the fruit.

 As for eating out, I find Indian restaurants have excellent dishes, although I suspect they are heavy with cream sauces, which of course will have cholesterol.  Unfortunately, the cocoanut milk that they offer to substitute for the cream is heavy with calories and salt.

 The Forks people say that I never have to count calories, but that is not my experience.  I need to watch my portions in order to lose weight, and I’m losing about a pound a week.  I’m down about 20 pounds from the time of my heart attack and I have at least another 20 to go.

 I drink lots of coffee, black with sugar throughout the afternoon; evenings I have herbal teas or plain, hot water.  Occasionally, I will have a beer or a glass of wine, but I find alcohol is a rough mix with my cardiac meds.

 Speaking of which, I’d like to share my perspective on this important aspect of cardiac recovery.  I take four different heart medications: 

 Metoporol is known as a beta-blocker, and it relaxes the arterial walls, so they flex more easily and reduce blood pressure.  My usual BP is about 110/75, with a rate of 60 beats per minute, which puts a smile on my doc’s face.  I take a half-tab (12.5 mg) in the morning and evening, with food.

 I also take Lisinopril in the mid-point of my day, again a half-tab of 10 mg.  This drug suppresses the heart’s inclination to thicken and toughen in response to the oxygen starvation it experienced.  As a result, the Lisinopril helps the heart stay more supple and flexible, thus reducing strain.

 I also take a “blood-thinner” called clopidogrel, which is the newly developed generic for the cardiac war-horse Plavix, which is an anti-platelet medication designed to keep the blood from clotting around the stent.

 Lastly, I take lovastatin, which I aim to 86 over time with my Forks over Knives regimen.  My last cholesterol test in April, 2012, came in at 214, which I think is pretty good, but the Forks over Knives folks says I should aim for 150.  At that level, they claim my arteries should be producing plenty of nitrous oxide, which will clean out the plaque still clinging to my vascular walls and keep the arteries happy and healthy.

 I also take aspirin in the morning and evening to help keep the arteries pliant.  Along those lines I also take CoQ-10, as do many other cardiac patients.

 As for vitamins, I take a special mix called Catalyn, which comes from my step-daughter-the-doctor and has just about anything you’ve ever heard that grows in nature and is good for ya.

 With all this I often get dizzy and light-headed, so I have to make sure I eat something when I take my pills, and I often have to pause once I stand up.

 I also have to exercise daily.  I bought a bike and I go for an hour’s ride every day or go for a walk if it’s raining, or if I feel too woozy.

 Mentally, I’m up and down.  For the past month I’ve been dealing with low-grade migraine headaches that come on a daily basis, generally when I have to go out in public.  As a result, I travel with migraine meds, and some of my rehab sessions end up with me lying down or sitting in a chair until my vision clears and my strength returns.

 But I’m getting stronger, and now I’m also encountering a boredom more stunning than any other I have ever felt in my life.  I feel like I am at a crossroads.  I have to do something that is new and original.  Something grand and unlike anything that I have ever done before.  Being healed of a heart attack is much like getting a second life, of having a re-incarnation.  Hence, I am born anew.  What will I become?

 Not sure.  So, I’m taking deep breaths and opening myself to love and life.  I’ll keep ya posted.  But be assured that wherever I go I probably won’t need a knife.

 Have fork, will travel, (by bike.)

 ©  2012 Bruce A. Smith

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24 Responses to Anatomy of a heart attack – going vegan with the Forks over Knives program

  1. Hi, Bruce. It’s ‘VEEEE-gan’ all right. Reason: If you said you were a ‘VAY-Gan,’ that would mean you come from the Vega star system. 🙂 Good luck with your recovery!

  2. Peachy. says:

    What an excellent comprehensive piece you’ve shared. You don’t have to be a cardiac patient/survivor to benefit from the education. Tov ma’od

  3. Good article, Bruce. I haven’t been able to post for a while — it would block me. Don’t know what has changed…

  4. John Smith says:

    Great article, Bruce!! I know why you have to count calories!! You’re still eating a lot of calorie dense foods. We can talk about that sometime!! 🙂

  5. Paula Morris says:

    Excellent article Bruce. I like all the medical detail. You explained everything very clearly.

    I sympathize with you concerning your Vegan diet. That would be difficult to maintain for a long period of time. Giving up cheese, eggs and yogurt would be the hardest. Hopefully you are getting enough protein? I know there is protein in some vegetables, but still. Have you tried quinoa? It’s a grain like couscous or rice….but is a complete protein. It’s great with a vegetable stir-fry, with beans or lentils…but wash it well as it tends to be slightly bitter if you don’t. What about MUFA’s? Have you heard of them? They are monounsaturated fats that are good for you…like certain nuts, avocado, certain oils, dark chocolate, etc. What does Forks over Knives say about these? Have you tried investing in a vegan cookbook? Perhaps you could become a vegan chef? Haha.

    Lastly, those migraines sound a little like anxiety? I understand. Your body has had a serious shock. It is normal to feel unbalanced for awhile. I also understand about boredom. I was going thru that when I first moved here to WA state, and then living in a trailer for a year.

    You sound good tho. The healthier you get, the more likely you will be to relax and decide to have fun in your life again. The best to you.

  6. Karen Shearer says:

    Glad you are improving. I agree with Paula-quinoa might be something that you would want to try. I didn’t even know until a few months ago that there was a grain that is a complete protein. Also, just wondering if you have thought about juicing some of your vegetables. Just a couple suggestions in case you are interested. Keep inproving.

  7. Jofannie Karla says:

    Thanks so much for your in depth report..much appreciated. We’ve recently invested in the Nutribullet as a terrific juice…small and powerful. For the first time in my life, I feel I’m getting the best nutrient balance for my system. Mark makes our drinks and puts in the following ingredients in various combinations: Kale, spinach, collards, broccoli, celery, carrots, beets and beet greens (not in my drink!). All of the above are organic. Then he adds blueberries, strawberries, raspberries, bananas, sunflower seeds, chia seeds, flax seeds, pumpkin seeds, sesame seeds (not all in one drink). In any given drink, he uses only two fruits, three or four veggie combinations (two thirds veggies to one third fruits), and as for the nuts and seeds he uses three tablespoons in combination as the spirit moves him! We feel fully satisfied and nutritionally complete. I will admit that I still want to crunch on something which is often Trader Joes herb popcorn.
    One other thing, Bruce. Not to further diminish your food choices, but we’ve found that all wheat is probably GMO and in addition has, over the centuries, been modified so that it actually causes inflammation in the body. Spelt is a better choice and spelt bread can be found in the Olympia Co-Op and in Trader Joe’s.
    One last note. We use a sugar substitute called Xylitol which is teaspoon for teaspoon just as sweet as regular sugar and has almost no glucose raising issues.
    We applaud you on your efforts in trying to make sense of the body-mind connection. We wish you continued understanding of self and awesome health.
    Jofannie and Mark

    • Paula Morris says:

      Dave’s Spelt bread is also at Fred Meyer in the healthy food section. It goes fast tho so you have to get there in time to get it. That’s what I eat. I agree with you about wheat.

  8. jofannie says:

    Bruce, Nutribullet is a juicer not a juice. Sorry for the typo.
    Also, remember to drink lots of water and flushes out toxins. Coffee is a diuretic.

  9. catalina says:

    When I went vegetarian (how you’re defining vegan is what I call vegetarian), I became sensitive to coffee and began getting migraines. Quitting coffee was worse withdrawal than cigarettes! But, the migraines went away (No coffee, sigh!) and rarely come back, except when I drink alcohol or eat too much chocolate.
    Watch out for GMOs, especially in corn and soy. Close to 100% of all corn and soy are now GMO. Wheat is another.
    I like Vay-gan – so exotic to come from a different star!

  10. Judi Flanders says:

    So glad you are doinf well. You have a lot to offer others and you are doing that.

  11. Josh Magill says:

    Great article. I can relate to the diet change being difficult because I have Celiac Disease, which limits your choices a lot in today’s greasy environment. Hard to eat out, but it can be done. Stay healthy Bruce!

  12. Bruce, I would like to ask you to help a friend off mine on face book who has a stent and wishes t learn more….let me know we can connect on face book as my friend is also available on face book and lives currently in Bangalore, India with his wife and kids and it would be a disaster if he had another heart attack…he is open to learning and I have helped him a lot but listening to someone like you who has been thru it will be a better wake up call for him. Namaste and lets connect on face book. 🙂

    Russell Monsurate
    Vancouver BC Canada

  13. Anita says:

    Hey would you mind letting me know which hosting company you’re using? I’ve loaded your blog in
    3 completely different browsers and I must say this blog
    loads a lot faster then most. Can you recommend a good internet
    hosting provider at a honest price? Many thanks, I appreciate it!

  14. Nice article. I can connect with the diet plan modify being challenging because I have Coeliac Illness, which boundaries your options a lot in the present oily atmosphere. Hard to eat out, but it can be done. Keep in good health Bruce.

  15. Mary Vezendy says:

    Wonderful! Just an FYI, the Catalyn supplement you are taking contains animal products (bovine)

    Here are the ingredients of the supplement: Proprietary Blend: 766 mg Defatted wheat (germ)†, calcium lactate, carrot (root)†, nutritional yeast†, bovine adrenal†, bovine liver†, magnesium citrate, bovine spleen†, ovine spleen†, bovine kidney†, dried pea (vine) juice†, dried alfalfa (whole plant) juice†, mushroom†, oat flour†, sunflower lecithin†, and rice (bran)†.

  16. Mike says:

    I enjoyed your story. I am just starting FOK and I am finding it’s a big change but I should have done it a few years ago. I just had my 6th heart surgery in Sept. My problem is the grafts from a by pass year ago, they keep clogging up. I hope this works and you have given me some hope. My dr thinks agent orange helped mine alone. Good luck to you.

  17. Great post, really a diet plan is the most important part of our daily life if there is an illness which can not be completely cure by the medications.

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