Welcome to my exercise room

Man was made for Joy and Woe;
And when this we rightly know,
Thro' the World we safely go,
Joy and Woe are woven fine,
A clothing for the soul divine.

William Blake

What is the most effective way to prevent or reverse cardiovascular disease?

Abstract: By mixing various combinations of diet, exercise, and cholesterol lowering drugs over a period of several years, I can show by means of laboratory data, that in my case, exercise and diet are more effective than medicine in altering parameters of my Lipid profile. I have been able to obtain my highest level of HDL and my lowest Total Cholesterol/HDL without drugs.

A diagnosis of moderate cardiovascular disease gave me the incentive to do whatever was necessary to attempt to reverse the process.

History: Moderate Coronary Artery Disease

I have never had symptoms associated with heart disease; however, I have had two relatives (my father and grandfather) die of heart attacks. I thought it might be a good idea at age 57 to have a serious heart check-up. I made an appointment with North Texas Preventive Imaging On October 13, 1996 for a serious predictive examination. The results led my HMO physician to send me to a Cardiologist. He performed an Angiogram and treadmill tests. The result: Moderate Coronary Artery Disease

In the above diagram of a heart, mention will be made only of the areas colored red. Area [0] represents the Aorta. It feeds the right coronary artery [4] and the left main coronary artery [1]. The left main divides into the left anterior descending [2] and the circumflex [3] which goes around to the back of the heart.

My blockages occur at 1 [30%] at 2 [70 - 75%] and at 3 [90%]

Treating The Disease

Legend for these graphs:

A cholesterol level of 200 or below is good. 200-239 is borderline high. 240-up is high. The USA average is 210-215. Individuals with coronary artery disease should reduce their LDL below 100 mg/dl.

For many years, I exercised irregularly, and ate a more or less regualar diet with some emphasis on chicken and fish for meats, and I avoided excess fat. I was also overweight at 220 pounds. Because of poor results on my blood profile of 10/31/96 shown below [Zone A] and because of indications in the imaging scan I was sent to a cardiologist. Within a few weeks, because of the diagnosis of moderate cardiovascular disease, I began Dr. Dean Ornish's program of moderate exercise and adopted his strict vegetarian diet. Simultaneously I began taking the prescription drugs: 30 mg Procardia, 10 mg Zocor, and over the counter 500 mg Ecotrin, all as daily doses.

[Procardia and Zocor were not the first choices of my cardiologist; his first choices were not then available on my HMO formulary. I guess bean counters take a lot of courses on the treatment of disease these days.]

My exercise component of the program consisted of: walking on a treadmill about 30 minutes three times per week at a pace at which talking would not be uncomfortable or a strain on breathing.

My blood profile taken 1/30/97 [Zone B] shows the results of well over a month of experience with these combined therapies. A few weks later I ceased taking all of these medications but continued the Ornish diet and exercise program. Results are indicated by my blood profile of 3/28/97 about three weeks after the medications were terminated. [Zone C]. I assumed that this profile reflected the results of diet & exercise alone devoid of any residual effect due to the medication. I was wrong as can be seen five months later by the profile of 8/23/97 [Zone D] which showed deterioration on all indices.

I resumed Zocor (at the 5 mg/day level). Another profile, about one month later, was taken on 9/20/97. [Zone E] Finally. nearly two years later a profile was taken after I had terminated all medication for over six months. [Zone F]

Also for those six months preceeding Zone F, I adopted a very vigorousl exercise program on a recumbent exercise bike of 45 minutes every day. I had also added monounsutarated fats to my diet in the form of peanuts and canola oil. And I added fish 3 to 4 times per week. I weighed about 160 pounds.

Relative Effects of Medicine and Diet/Exercise

The above pie chart shows how much reduction has been caused by exercise & diet and how much has been caused by medicine

Should have I used only medicine?
Should I have used diet and exercise only?
Should I have used both?
What kind of diet produces these effects?
Read on......

The Ornish Program

My primary aim was, if possible, to reverse my coronary blockages and reduce the risks associated with coronary artery disease.

The 1990 book entitled: Dr. Dean Ornish's Program for Reversing Heart Disease -- The only system scientifically proven to reverse heart disease without drugs or surgery, purports to do this. Dr Ornish's research findings show that over a four to five year period there was about an 8% relative improvement in his experimental group in terms of blockage (blood flow to the heart improved even more) whereas the comparison group suffered a 28% blockage worsening.

Dr. Ornish reported in his 1990 book that experiments with cholesterol lowering drugs showed that they could lower cholesterol substantially yet were not very effective if at all in reversing blockages. In addition, the side effects of these powerful drugs can cause other medical problems, as can be easily determined by reading the product literature.

I agree with Dr. Ornish that: "rather than using drugs to lower LDL or raise HDL...putting much less cholesterol and saturated fat into your body in the first place makes a lot more sense...than a lifetime of taking drugs which interfere with the metabolism and absorption of dietary cholesterol and saturated fat."

Dr. Ornish's program is a comprehensive one, inclusive of moderate exercise (described above) lifestyle changes, and diet. The diet is exclusively vegetarian. Vegan is a better description: no animal or animal products. Dr. Ornish permits non-fat dry milk and egg whites (e.g. egg beaters) but restricts pastries, sugar laden foods, nuts, and avocados. The lifestyle changes include stress management and meditation. [Stress management training will lower LDL]

In my first two months on the diet I lost over 15 pounds; during the next six months I slowly lost 20 more pounds. I am never hungry and I actually like the diet and have found no problems with it.

With Dr. Ornish's diet and exercise program, I achieved remarkable results.

My blood pressure descended into an ideal range. My waist went from 42" to 36". A cholesterol level of 321 mg/dl fell 70 mg/dl. (28%). A triglyceride level of 377 mg/dl fell 20%. An LDL of 212 mg/dl fell 23%. I wanted to continue with this program.

Unfortunately, these gains seemed insufficient and pharmaceutical intervention was medically indicated.

Perhaps I could ADD medicine

While not claiming reversal, a study of 4,400 individuals using Zocor [simvastatin] showed a reduction in the risk of heart attack of 27%, and the risk of dying of a heart attack was 42% less. Lowering cholesterol levels also reduced deaths from all causes by 30% in men. Dr Ornish also admitted to utilizing cholesterol lowering drugs with his incorrigible cases.

I started taking a medication and in less than one month's time, 5 mg of Zocor per day has dropped my cholesterol, triglycerides, and LDL further by about 42 mg/dl each.

In 1995 Dr. K. Lance Gould, M.D.,after his small (35 people over 5 years) study of noninvasive coronary heart disease therapy, concluded: "Based on my clinical experience since the time the study began, I have seen that the combination of a very low-fat diet** and cholesterol-lowering drugs gives a patient about a 90 percent protection against a cardiac event."

"If a patient takes only lipid-lowering drugs and eats as he pleases, he lowers his risk of a cardiac event by around 40 percent. And if he eats a low-fat diet and does not take the medication, there's still a 30-40 percent decrease in events. But," said Gould, "if he combines them, he gets greater protection."

Perhaps I was finally on the right track? Not really. There was trouble ahead.

Medication discontinued

On October 22, 1997, I had a massive brainstem stroke which was, in my opinion, caused in part by my cholesterol medication. On recovery from the stroke I discontinued my anticholestrol medication, Zocor. [Soon thereafter I tried another statin drug, Liptor, and soon discontinued it also because of similiar albeit milder side effects.]

Since I was unable to take medication, I determined to compensate somewhat by increasing my aerobic exercise program to 45 minutes every day.

After returning home from my hospitalization and rehabilitation, I read that for every 3% of the lowering of total fat, ones chance for stroke goes up 15%. And I had lowered my total fat very low on my diet. Since it was also stated that one could increase monounsaturated fat without adverse cardiac risk, I added substantial amounts of peanuts and canola oil to my diet along with fish 3 to 4 times each week.

[Harvard Health Letter of 12/98 quotes a report from The American Heart Association: "..slashing fat to 15% or less daily calaries may raise triglycedides and lower beneficial ....HDL cholesterol changes that are belived to raise heart disease risk...the optimal level appears to be around 25%.]

After my stroke, extensive cardiac tests, including echo cardiogram, showed that I did not have any worsening of my coronary artery disease. [These tests were prompted to ensure that it was advisable for me to discontinue a precautionary medicine given me at the time of my stroke to be described next]

Analysis and Summary

Examining Profiles D and F, [in the above graph] periods during which I followed the Ornish program of vegan style diet and exercise, my total Cholesterol and HDL were identical. For Profile F, my triglycerides are much lower and my HDL much higher. (Just as the above statement from the American Heart Association suggested.)

In the above graph, the lower the bar the lower the risk.

Another index of risk is the Total Cholesterol/HDL ratio. A Total Cholesterol/HDL ratio greater than 5 in men represents increased risk. I am pleased that my ratio is now under 5! Long-term vegetarians have the lowest risk of any identifiable group with ratios of only 2.8

The reader will notice that Profile F has been the only combination of therapy which has produced these results. Drugs can be effective at lowering Total and LDL cholesterol but not so with HDL.

What did I Achieve Overall?

Eight months after the data shown above another lipid profile was taken. So those figures can be revised as follows:

Prompting the following comments on the lab report:

How were these Substantial Gains Achieved?

I would list the following factors as responsible for transforming profile A into profile F:

Exercise and diet have a profound effect on one's lipid profile!

I regret that I am unable to reduce my Total and LDL cholesterol more and increase HDL.

Medicines often have undesirable side effects and can be costly.

Medicines used to control colesterol prior to the discovery of the statins did not appear to have any effect on overall mortality. Statins appear to be effective drugs but I cannot take them.

John Morgan Suffers Stroke in 1997

Upon John's return from the rehabilitation hospital, Paul bolted an old pair of John's shoes to a recumbent exercise bike. The bike is low to the ground so that John will not fall off. Without the right shoe bolted to the pedal John's leg would fall off. Fortunately both of John's legs can push in the downward direction making aerobic exercise possible. He has been gradually increasing his workout routines till on March 8, 2000 he was up to 90 minutes per day. John reads mystery books while biking - he hates exercise but realizes it is essential for his health.

On October 22, 1997 I suffered a relatively rare brainstem stroke. I was rushed to Harris Hospital and given tPA within the three hour limit. Paralysis disappeared minutes later but returned. After several days I was transferred to Health South Rehabilitation Hospital on Lancaster Street in Fort Worth, Texas and apparently caught Pneumonia around that time.

Recovery was slow. My speech was and continues to be impaired. With an AFO (ankle-foot orthotic) on my right leg, I can walk with a hemi-walker for limited periods over relatively flat terrain -- this is precarious but I try to do it some each day for exercise of the leg muscles. Balance is precarious; if I slip, I have very limited recovery. If I hold on to a fixed object with my left hand mobility is enhanced; the hamstring, the muscle which moves the lower leg back, is quite weak. I cannot move the toes of the right foot; I have little control of the ankle. I have very limited use of my right arm and it is an effort to move it. With great effort I can close the fingers of my right hand; I can sometimes open my index finger. I cannot extend the other digits. My ability to learn new material of a scholarly nature is somewhat impaired. My ability to perform several tasks simultaneously has been hampered. I have a tendency to drool. I later discovered that I have an irrational fear of heights; the prospect of driving an auto seems dubious since I have a startle reaction. My right arm, hand, and leg spasm through the night and to a much lesser extent during my waking hours - more so in the mornings. Evenings are usually spasm free.

On the positive side my other mental powers and memory are intact. I have always retained complete sensation and for the most part have been pain free. I get around well in a wheelchair inside and an electric wheelchair outside. I count my blessings and consider myself a very fortunate fellow.

For chores in the kitchen, John has devised a long run of chain stretched across the kitchen and surrounded with PVP pipe. A dog leash hangs from it. The other end is attached to a safety belt around his mid section as shown in the photo below. He had a series of handles mounted near the windows in the morning room to transfer to and from the couch as well as to let him hobble around on foot while holding tight with his left hand.

What caused my stroke?

What do you think caused your stroke the physician in the emergency room asked me? I told him I thought it was my prescription medicine for reducing cholesterol. As I review the situation in my mind, I think that I have identified three Causative factors:

  1. As you are aware from my discussion, my body manufactures enormous amounts of Cholesterol, Triglycerides, and LDL. Even though diet, exercise and pharmaceuticals have, more recently, reduced this enormously, the same kind of plaque that my body has placed in my coronary arteries, over the years, must also have been clogging cranial arteries. My primary care physician thinks this is the reason.

  2. When I returned from the rehabilitation hospital I found that someone has apparently re-read the large and on-going framingham study, one of the major studies on which the recommendation that one should reduce his consumption of dietary fat was based. This new news appears to have found that for every 3% reduction in dietary fat your chance of stroke rises by 15%. [Curiosly, while saturated and monounsaturated fats appear to contribute to the statistic, polyunsaturated fats have no effect.] And wow, I had really exceeded in reducing ingested fat.

    Now understand, no one gives an apology. No nutritionist says gee were sorry for the bad advice. No explanation as to why researchers all of a sudden discovered this from the data. There is mostly silence. But you can see the back pedaling begin. Now the advice is: ‘Get rid of animal fat not total fat.’

  3. And finally, I think the precipitating event was Zocar, the prescription drug that I was using to reduce high levels of cholesterol. Don’t misunderstand me, the data I read suggests that this drug not only substantially reduces heart attacks but also stroke. Drugs often have serious side effects which are often different for different people. In my case, I became very dizzy with the whole world appearing to go around , within a couple of days after I increased the dosage of this drug. I was not extremely alarmed because I knew that dizziness was listed as a side effect for the drug. Nevertheless I stopped taking the drug .

    It was many months later that I tried this drug again, and, again within two days of increasing my dosage level, I again experienced a similar reaction, this time the extreme dizziness was accompanied by sudden vomiting. I was suddenly very sick. I could not walk to the bathroom and vomited in my bed. Sometime later, while still in bed, I noticed the symptoms of stroke and asked to be taken to the hospital. After returning from the rehabilitation hospital I started to use a similiar drug from the statin family of drugs. Again, on attempting to increase the dosage I suffered symptoms somewhat like those I experienced with Zocar albeit in a milder form. I discontinued ALL statin drugs immediately.

In summary, my experiences lead me to suspect that my stroke of October 22, 1997 was caused by an inherited predisposition to artery disease, a lifetime of poor eating habits & lack of exercise exacerbated by bad nutritional advice concerning total dietary fat consumption, and precipitated by a rare side effect of a prescription drug.

UPDATE: 5/11/2007 [age 67]

Total Cholesterol 169
HDL [good cholesterol] 48
LDL [Bad cholesterol] 94
Triglycerides 134

Maintenance Program:

  1. No statins or similiar drugs
  2. Exercise of three 15 minute sessions/day
  3. Proper diet

Above is John in his Jazzy (electric wheelchair) in the front yard: