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The Last Heart Attack

Aired August 28, 2011 - 21:00   ET



DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Everywhere you look, it seems a heart attack is just waiting to happen. More than a million heart attacks a year. That's one, just about, every 30 seconds. Just in the United States.

If you haven't had a heart attack yourself, you likely know someone who has.

I've got a secret to share -- with what we know right now? We could see the last heart attack in America. I've been investigating this for over a year. I've got lessons to share, things you need to know, things your doctor may not tell you.

CHYRON: "The Last Heart Attack: Dr. Sanjay Gupta Reports."

WILLIAM JEFFERSON CLINTON, 42ND PRESIDENT OF THE UNITED STATES: I was lucky I didn't die of a heart attack.

GUTPA (voice-over): Former President Clinton, like too many people, was busy.

And for years, he ignored warning signs from his heart. But in 2004, during an exhausting book tour, there was something different.

CLINTON: I had a real tightness in my chest when I was getting off the airplane and the only time I'd had it unrelated to exercise.

GUPTA (on camera): We're here outside New York Presbyterian Hospital. In just a couple of hours, President Bill Clinton, former president, is scheduled to undergo surgery.

CLINTON: So I immediately went down to our local hospital and they did a test, they said you got real problems. They hustled me down to Columbia Presbyterian and they confirmed the determination that I had serious blockage and need the surgery.

GUPTA (voice-over): Doctors immediately knew -- options were limited. The 58-year-old Clinton needed to have his chest opened, his heart stopped, and surgery performed.

DR. CRAIG SMITH, NEW YORK PRESBYTERIAN HOSPITAL: There's no medical treatment for reversing the obstructions that had already formed in his blood vessels. CLINTON: I got Hillary and Chelsea there. All I remember is it happening fast and everybody who cared about me was scared and I felt rather serene, I thought the guy (INAUDIBLE) and have a heart attack.

GUTPA: On Labor Day, in 2004, Mr. Clinton had four blood vessels bypassed.

UNIDENTIFIED MALE: Starting this morning around 8:00 he had a relatively routine quadruple bypass operation. We left the operating room around noon and he is recovering normally at this point. So I think right now everything looks straightforward.

CLINTON: There was that period when you're just not sure you can come back. That bothered me -- that and the pain.

GUPTA: If it happened to him, could it happen to you? What about me?

I'm a pretty typical guy in his early 40s with a family history of heart disease. So I decided to go on a mission to never have a heart attack. But how?

(on camera): When people talk about trying to end heart attacks in the world or in America at least, one of the ways to do that is to take a look inside the heart, see what's happening before someone ever has a problem.

And that's what we're going to do here today. You're actually going to look for what? My heart?

DR. ARTHUR AGATSTON, UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE: Yes. For calcium which is part of the atherosclerotic process, the plaques in the heart. And if you're --

GUPTA: I've never had a problem, but you are looking for it anyways.

AGATSTON: Yes, if you are heading for a heart attack in 5, 10, 20 years, you're already have plaque. It's a lifelong process.

GUPTA (voice-over): That's Dr. Arthur Agatston. You may recognize him as the author of the South Beach diet books. But he's also the invented the coronary calcium scan. That's the test I'm having done.

In case you're wondering, he doesn't make any money from it.

We all know plaque is bad. It blocks your blood vessels. Plaque is formed by LDL cholesterol in the blood, the bad cholesterol. Think of it as L for "lousy," building up on the walls of your arteries forming plaque. It can accumulate slowly, over time, narrowing the blood vessels like something building up inside a pipe.

This narrowing in the blood vessels leading to your heart can cause chest pain, called angina. It can also cause a heart attack.

Did you ever wonder how seemingly healthy people can have a heart attack? This may surprise you. Most heart attacks happen in people with no symptoms. In people whose arteries are less than 15 percent blocked.

Here's how: cholesterol can cause unstable bubbles or blisters of plaque to form in your arteries. These can be incredibly dangerous. Most are covered by a cap, but inflammation and stress can cause the cap to thin and rupture resulting in a clot that blocks the flow of blood to the heart.

Robbed of oxygen, the heart muscle can't function properly -- heart attack.

And therein lies the key, Agatston says. We can now find clues before heart trouble gets dangerous, even before the first symptoms -- well before you get to the stage President Clinton was.

(on camera): Bill Clinton, former president, arguably had at least eight years of some of the best health care in the world. It was after he left office. He had significant heart problems. That surprised a lot of people. How could it be he could get this level of health care and still have heart problems?

AGATSTON: He had multi-vessel disease. So he had a lot of plaque -- that plaque certainly could have been identified with a heart scan years before.

GUPTA: I don't want to sound glib, but why wasn't it done? Again, you would assume the White House doctors, the president of the United States, they'd be doing that for him.

AGATSTON: Well, yes. It was not the standard of care then. We are past that.

GUPTA (voice-over): I decided to ask that Bill Clinton about that. It turns out he did have a coronary calcium scan just months after leaving office. But the technology was so new then doctors weren't quite sure what to do with the results.

CLINTON: They said I had some calcium build-up around my heart that put me basically in the top third of risk. But they said there was no evidence of blockage because I'd done so well on the stress test.

For a few months before this happened, I noticed whenever -- not every time, but often when I would do rather strenuous exercise, there are some really hilly areas in the town where I am. I'd climb those hills and have to stop and take a breath. I didn't take it seriously, because every time that happens, I just lowered the exercise level, got my breath back, and it was never painful. It was just tight.

If this isn't good for my heart, I don't know what is.

GUPTA: By the time he felt the first symptoms, that tightness in his chest, President Clinton's heart disease was well-advanced. It had been decades in the making.

STATSTON: You don't die with your first plaque. You develop atherosclerosis blockages really your whole life for many, many years before it causes a heart attack or stroke. GUPTA: And what Dr. Agatston told me next should ring a bell of hope for just about anyone who's ever worried about a heart attack -- it doesn't have to happen.

AGATSTON: One of the best kept secrets in the country in medicine is that doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It's doable.

GUPTA (on camera): And you're saying with what we know right now, we don't have to have any more heart attacks in this country.

AGATSTON: I'll never say any, but the great majority -- yes, absolutely.

GUPTA: It's the biggest killer of men and women, heart disease in this country.

AGATSTON: And it's completely preventable.

GUPTA (voice-over): Coming up, more tests to gauge my heart attack risk.

And can you really tell who is a heart attack waiting to happen?

Also, can the right diet make you heart attack-proof? We'll meet a woman who's betting her life on it.




GUPTA (voice-over): With a family history of heart disease and a lifetime of bad eating habits, President Clinton told me he was a heart attack waiting to happen. But what does someone really look like who is about to have heart attack?

You probably wouldn't think this guy -- Tom Bare, 53, thin, seemingly healthy, and one step short of a full-blown heart attack. In fact, he's checking into this hospital in Lincoln, Nebraska, for open heart surgery. It's an important lesson. What you see on the outside doesn't always match the inside.

DR. ED RAINES, SURGEON: On this instance obviously closed down quite a bit.

GUPTA: Surgeon Ed Raines shows us the striking images on the angiogram of Bare's heart.

RAINES: You can see this tight narrowing right there where that closes down so that limits the amount of blood that can get out. Then you've got a real tight narrowing right up here where that vessel on the side takes off, and then another narrowing here, then you've got a pretty tight narrowing there. GUPTA: All the major blood vessels supplying blood to the heart -- blocked. Yes, that is the very picture of a heart attack waiting to happen.

RAINES: He's at risk for heart attack just because of the amount of plaque that he has in there.

GUPTA: Like me, Bare has a family history of heart disease. That's why four years ago, he underwent the coronary calcium scan that we just learned about. His results were not good.

TOM BARE, HEART PATIENT: The score was 111.

GUPTA: Zero is the best. Over 100 means an increased risk of heart attack, even sudden death.

UNIDENTIFIED MALE: And you may breathe. Go ahead, rest your arms down if you'd like. It is going to take me a couple of minutes to check these images, make sure we have everything we need.

GUPTA: Bare went through the test again this year and the score was up to 243. The average score for someone his age? Five.

BARE: I was doing some exercise about three weeks ago, jogging routine that I do and made it about three-tenths of a mile and then had the classic symptoms, chest pain, and then pain down the left arm and shortness of breath.

UNIDENTIFIED MALE: What room is this?

UNIDENTIFIED FEMALE: This is room four.

GUPTA: As in the case of Bill Clinton, Bare was told he had no options by the time he saw Dr. Raines. Within days, he would need bypass surgery.

RAINES: In this instance, you know, this is sort of what I consider a medical failure. In other words, he got these narrowings and plaque despite our efforts to prevent it from progressing.

And my goal would be, even though I'm a surgeon and treat these things, is to not have them get to this point. From a public health standpoint, we have to do this, because this bypass operation is going to be very expensive.

GUPTA: He's not kidding. Average cost in the U.S. -- $112,000. And there are about 450,000 procedures performed every year. Total price tag: more than $50 billion.

RAINES: Our money would be better spent years ahead of this to prevent him from getting to this point.

CHYRON: Tom Bare surgery begins.

GUPTA: Prevent ever getting to this point. That is precisely my goal -- for me, and for you, the last heart attack. Dr. Arthur Agatston has guaranteed he can see trouble coming, years in advance, well before I'd need surgery, if I do the right tests.

AGATSTON: So here is where the blood is flowing and this is lining.

GUPTA: Agatston is using an ultrasound to look for plaque in the carotid artery leading to the brain. A blockage here would cause a stroke and would be a sign I'm at increased risk for heart attack.

AGATSTON: Unless you do the imaging and advanced testing, you are really playing Russian roulette with your life.

GUPTA: Your body needs cholesterol. Actually makes it. It is in the lining of every cell in your body. The liver sends out LDL cholesterol and when everything works right the good, HDL, scavenges excess LDL and brings it back to the liver. You also get cholesterol in foods, things like meat, French fries, eggs, butter, desserts, ice cream.

Your cholesterol number is a good measure of what's in the blood. But here's the problem -- it doesn't tell if you it is building up in the walls of your blood vessels forming plaque. It's the plaque that causes heart attacks.

AGATSTON: If you look in the coronary care unit at people that have heart attacks, the cholesterol levels of those who have heart attacks versus those in the street who have it are essentially the same.

GUPTA (on camera): That is kind of surprising, right? Because you'll hear people exchanging their cholesterol numbers. And if it's low, they seem quite proud of it. If it's high, there's cause for concern. You say that that's -- you know what? You're not looking in the right place.

AGATSTON: That's essentially useless.

GUPTA: Here's what does matter -- Agatston says -- the size of your LDL, or bad cholesterol particles. Larger LDL particles don't pose much of a threat because they pass through the blood vessels without sticking. It's the smaller LDL particles that are more likely to lodge in the walls of blood vessels and cause a build-up of plaque.

AGATSTON: If they're small, you can have a lot of little particles that penetrate the vessel wall more and more easily. There are a lot of little old ladies in their 80s with very high cholesterols who have squeaky clean vessels. They have very large cholesterol particles and they don't get in to the vessel wall.

GUPTA: So you have to ask about the size of the particles as well when it comes to bad cholesterol.


GUPTA (voice-over): That's why the Dr. Agatston wants a blood sample.

(on camera): I don't think anyone likes getting their blood drawn. (voice-over): He wants to find out if I have a lot of small LDL particles -- a sign that I could be prone to building up plaque no matter what my overall cholesterol number is.

Coming up --

CLINTON: I was incredibly lucky that something more severe didn't happen.

GUPTA: Lessons from former President Clinton.

And pictures don't lie. I learn if my arteries are young or old.

(on camera): Time to find out what fate has to offer me.

(voice-over): And a controversial diet. This 66-year-old woman says she's eating her way to heart health.

UNIDENTIFIED MALE: We're never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness.




GUPTA (voice-over): Spend just a few minutes with Bill Clinton, and you'll see he's a changed man. For starters, he's a lot thinner than he was as president.

When his half-hearted exercise routine --

CLINTON: Really out of shape though.

GUPTPA: -- and his taste for fast food became the stuff of parody.

CLINTON: Your McNugget is relief from Great Britain, to Somalia, intercepted by war lords.

GUPTA: Dr. Dean Ornish has studied and written about diet and heart disease for decades.

DR. DEAN ORNISH, PREVENTIVE MEDICINE RESEARCH INSTITUTE: Mrs. Clinton asked me if I would work with the chefs who cook for the first family and then began working with President Clinton directly as one of his consulting physicians. The president did like unhealthy food and we were able to put soy burgers in the White House, for example, and have him get foods that were delicious and nutritious.

GUPTA: But even with Dr. Ornish's help, in 1999 after his annual physical, the White House doctor said the president had put on 18 pounds since a check-up just two years earlier.

While diet and exercise can go a long way, most doctors will tell you to get to the last heart attack in America, there is more.

ORNISH: There was public knowledge that he was going through some rather stressful times during that time. It just goes to show you that information alone is not sufficient. We need to work at a deeper level. We need to work with the underlying stresses that people are experiencing, the loneliness, the isolation in many cases that people are experiencing.

UNIDENTIFIED FEMALE: Try taking the weight towards the balls of the feet.

GUPTA: That's why Dr. Ornish prescription for heart patients includes yoga --

UNIDENTIFIED FEMALE: The mind will begin to quiet down.

GUPTA: -- meditation and group sessions at his institute in Sausalito, California.

CLINTON: I came to Vermont determined to get my cholesterol down with low fat Ben and Jerry's Cherry Garcia.

GUPTA: We now know when President Clinton was president he passed his annual physicals but his heart disease was still progressing. Undetected.

I asked his cardiologist why.

DR. ALLAN SCHWARTZ, NEW YORK PRESBYTERIAN HOSPITAL: One lesson is that check-ups are not a substitute for lifestyle.

GUPTA: As president, Bill Clinton never got any of the advanced imaging, like the coronary calcium scan or the ultrasound of his carotid. Those are tests that are now more ready available to everyone.

And Clinton was also getting a false sense of assurance from the testing he did have. And it was the year he left office when he had the first symptoms of heart disease.

CLINTON: In 2001, when Chelsea was graduating from Stanford, I started running again. I wanted to get in good shape and I thought, this is crazy, I couldn't run more than three-quarters after mile without stopping and walking 100 yards and getting my breath back.

GUPTA: Three years later, the bypass operation with Dr. Craig Smith.

But President Clinton's heart troubles were not over. When the devastating earthquake struck Haiti in 2010, President Clinton flew to Port-au-Prince to support the relief efforts. I spent time with him and saw that he looked tired, not himself.

CLINTON: Got all pale and weak and then I got al these letters from the doctor crowd saying, yes, it's normal because fools like you won't do what you're supposed to do, because you don't eat like you should, you don't exercise like you should. GUPTA: The doctor said it was a mechanical failure of the bypass and he need stents to open the blocked artery.

CLINTON: I got so lucky they were able to put those two stents in, you know, and fix an artery that was pretty bent and ugly.

SCHWARTZ: The goal of the treatment and I think it will be achieved is for President Clinton to resume his very active lifestyle. This was not a result of either his lifestyle or his diet which have been excellent.

GUPTA: But Dr. Dean Ornish didn't see it that way.

ORNISH: So, I wrote him a letter. I said, you know, the friends that mean to most to me are friends that tell me what I need to hear, not necessarily what I want to hear. And you need to know that your genes are not your fate, that -- and I say this not to blame you but to empower you, and I'm happy to work with you in whatever extent you want to move forward in that way. And we met a few days later and he was ready to do it.

CLINTON: I essentially concluded that I just played Russian roulette because even though I had changed my diet some and cut down on the caloric total of my ingestion and cut back on how much high- cholesterol food I was eating, I still -- without any scientific basis to support what I did -- was taking in a lot of extra cholesterol without knowing whether my body would produce enough of the enzyme to dispose of it. And clearly, it didn't or I hadn't had that blockage. So, that's when I made a decision to really change. I should have done after the surgery.

GUPTA: Coming up -- President Clinton transforms his diet to save his heart.

And what is life like after heart surgery? Tom Bare's painful recovery and his complications.

BARE: Walked about three-tenths of a mile and it was just excruciating.

GUPTA: Also, she said no to surgery and yes to food as medicine. We'll tell you if it's working.



Here's a look at the headlines:

Long after Hurricane Irene slammed the shore on the outer banks of North Carolina and flowed up the Northeast corridor, we're seeing the worst devastation of the weekend in Vermont. Southern half of the state is essentially under water, hundreds of roads, entire communities. Authorities assume there are casualties but they have no idea how many or where. Montpelier, the capital, is bracing for major emergency ahead after of a river crest early Monday. Along the Eastern Seaboard, more than 4 million people are tonight without electricity. And at least 18 deaths are being blamed on Irene in seven states. Among the victims -- is an 11-year-old boy killed by a falling tree.

It is far too early for an accurate estimate of damages, but wind damage alone projected to top $1 billion. And as hurricanes go, Irene was not especially windy. A private risk assessment firm estimates storm related losses in the Carolinas alone could reach $400 million. By way of comparison, private insurance payouts from Hurricane Katrina totaled $45 billion and that's not including flood losses.

And where is Irene now? Well, speeding into southeast Canada with top sustained winds still clocked at 50 miles an hour.

Now back to the Sanjay Gupta special, "The Last Heart Attack."


GUPTA (voice-over): In Lincoln, Nebraska, 53-year-old teacher Tom Bare has emerged from 3 1/2-hour bypass surgery, an operation that required his heart to be stopped for more than an hour. He's in the intensive cardiac care unit -- it's the first stop on a slow, painful recovery.

BARE: Little sore. Little hoarse. Little tired. But other than that, pretty good.

GUPTA: Bare doesn't know it yet, but he's heading for a life- threatening complication. One that will soon have him back in the operating room.

BARE: It is nice to be home. You can -- they say you heal 10 times faster and you feel 100 percent be better.

I didn't have any idea of how uncomfortable I was going to be just doing little things. Like getting out of bed in the morning was the hardest thing to do.

GUPTA: Life after bypass surgery. For Tom Bare means it is three weeks before he takes his first walk outside and gets a painful warning of trouble ahead.

BARE: Little worried back there. My arm's starting to hurt. That's gone, now it's just hard to catch my breath.

GUPTA: I spoke to Tom Bare right before his operation.

(on camera): What happened?

BARE: None of the arteries worked.

GUPTA: Did they say that this was pretty unusual?

BARE: Never seen before.

GUPTA: Wow. That's not the kind of luck you want.

BARE: No, no, not at all. So the doctor's just going to use veins today.

GUPTA (voice-over): Complications are an unfortunate part of the process for 12 percent of the people who have bypass surgery. In fact, one in 300 patients need a second operation within two years and one in 20 receive stents during that time.

Bill Clinton needed to have one of his blood vessels re-opened six years after his operation. After getting the stents to open up that blocked artery in 2010, former President Clinton says he decided to make changes in his diet. This time around, he decided to get much more strict, radical even in his approach. No more meat. No more eggs. No more dairy. Almost no oil.

The mantra is: eat nothing that has a mother or a face.

(on camera): Talk about the fact that you loved to eat.

CLINTON: You know, I like the stuff I eat. I like the vegetables, fruits, the beans -- the stuff I eat now I like. I like It.

GUPTA: Do you call yourself a vegan now then?

CLINTON: Well, I suppose I am if I don't eat dairy or meat or fish, you know?

GUPTA: So you've cut all that out.

CLINTON: Once in a while, literally in well over a year now, at Thanksgiving, I had one bite of turkey.

GUPTA: You're doing this for your health.


GUPTA: Is that why you're doing it?

CLINTON: Absolutely.

GUPTA (voice-over): Clinton's dietary guides, Dean Ornish and this guy, Caldwell Esselstyn, at the Cleveland Clinic.

DR. CALDWELL ESSELSTYN, CLEVELAND CLINIC: Apparently, he read my book. I've never met the man.

GUPTA: Dr. Esselstyn has written him though.

CLINTON: He wrote me a letter saying I was even cheating online because he was afraid in my protein drink I had some dairy in there. It was hilarious. And I checked and on one of them, he was right. I only had done it once.

GUPTA: You check it out?

CLINTON: Yes, I did.

GUPTA: Every month, the 77-year-old Esselstyn holds a day-long seminar, attracting doctors and heart patients from across the country -- like Sharon Kintz, a retired private investigator from Canton, Ohio. Kintz had a heart attack six months earlier after a coronary artery became completely block.

SHARON KINTZ, HEART PATIENT: He said, for someone who had what you have, the only warning you usually get is death. And at that point, I really knew how lucky I was.

GUPTA: Like a lot of women, she did not experience the classic chest pain, but rather, fatigue and a pain in her jaw.

KINTZ: He said you're going to have to have open heart surgery. He says I can fix you today. I can just take you right down to O.R. and I can operate on you right now.

My son was in there and he was ready to wheel me down to the operating room because he was frantic. You know, it's terrifying.

GUPTA: What Kintz did next may surprise you. She turned the surgeon down cold -- said no to open heart surgery and decided to take a chance --

KINTZ: I bought some parsnips the other day. Always have sweet potatoes on hand.

GUPTA: Using food as medicine.

KINTZ: I love these.

GUPTA: Like President Clinton, Kintz has given up the foods she loves like butter and cheese. She's betting her life on Dr. Esselstyn's diet.

(on camera): She had a heart attack.


GUPTA: Doctors recommended she'd have an intervention. She's not doing it. Is there a downside? Could she be putting herself at risk?

ESSELSTYN: No. I think that's an excellent question. And hundreds of patients, data now going back over 20 years and this most recent study about a decade, once they start eating this way, you'll make yourself heart-attack proof.

GUPTA: Heart attack proof.

ESSELSTYN: We know that if people are eating this way, they are not going to have a heart attack.

GUPTA: Esselstyn thinks heart disease is completely preventable, no matter what sort of family history you have, simply by eating right. ESSELSTYN: It's a food-borne illness and we're never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness.

GUPTA: Esselstyn has won some allies, like Dr. Terry Mason.

DR. TERRY MASON, COOK COUNTY HOSPITALS: Is there anybody who doesn't know what it is?

GUPTA: Chief medical officer at Cook County Hospitals in Chicago and the city's former public health commissioner.

MASON: We've eaten ourselves into a problem and we can eat ourselves out of it.

GUPTA: But it also puts Esselstyn squarely against conventional wisdom which considers diet only a part of a heart-healthy lifestyle.

(on camera): If doctors said heart disease is a food-borne disease, if you follow this diet, pretty strict diet, very restrictive, but in exchange, you're not going to have a heart attack. What would you say to that? You agree with that?

SCHWARTZ: I would say that's an overstatement, an oversimplification and overstatement of really what we're able to do. Even though I know there are people who say it.

GUPTA (voice-over): Without a doubt, Esselstyn is one of those people. General surgeon by training, not a cardiologist, and he holds no special degree in nutrition. But during his research, he came upon a stunning fact.

Some cultures around the world like people living in Central Africa, Papua New Guinea highlanders, Tarahumara Indians in Mexico, have virtually no heart disease -- none. So, what can we learn from them?

Coming up -- taking a page from the heart-healthiest spots on the globe, the diet Dr. Esselstyn says can make you heart attack-proof.




GUPTA: Mr. President, how are you?


GUPTA (voice-over): Since leaving office, Bill Clinton has made his own health and the health of the country his top domestic priority. I saw him firsthand when he invited me to Little Rock.

(on camera): Last time we spoke a few weeks ago, you said you were going to be really strict on the diet. Were you doing pretty good job, you say. CLINTON: Yes, I'm doing it. I'm more strict now.

GUPTA: Are you?


GUPTA: So --

CLINTON: By the time I have my 65th birthday, I want to weigh what I did when I went home from law school in 1973.


CLINTON: That's what I'm working on.

GUPTA: That's a grand ambition. I like that. How much was that? Will you tell us?

CLINTON: I got down to 185. Now I got down -- when Chelsea was married, I weighed about 192, which is what I weighed when I graduated from high school. Anything under 195 was my optimum weight my whole life.

But in the summer of '73, we had a scorching hot summer and I ran three miles a day at the hottest hour of the day which I could do back then in order to make the pounds go off and it was the first time since I was 13 years old that I had weighed 185 pounds. I'm going to try one more time to make it.

GUPTA (voice-over): President Clinton's diet -- no meat, no dairy, almost no oil, got me thinking, how different what he's eating now as compared to what he used to eat and what most of us still eat. Make a habit of high-fat, high-cholesterol meals like this and you can physically see the beginnings of heart disease.

For starters, your blood actually looks different.

UNIDENTIFIED MALE: So let's start by looking at what healthy blood looks like after it has been centrifuged or spun. You can see there are two components. This bottom layer represents the blood cells and this top player represents the plasma. The plasma is a clear yellow layer that contains mostly water and electrolytes.

GUPTA: Here's what happens to your blood if you follow an unhealthy diet. The top layer is white and cloudy. It's just laden with heart clogging fat and cholesterol.

(on camera): You have some easy-to-remember adages about how people can decide what they should or should not eat.

ESSELSTYN: We know what they shouldn't eat. That is oil, dairy, meat, fish and chicken.

What do we want them to eat? We want them to eat all those whole grains for their cereal, bread and pasta, beans, vegetables -- yellow, red, green -- and fruit. Now what particular vegetables do we want them to have?

Bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, Napa cabbage, Brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula and asparagus. And I'm out of breath!


GUPTA (voice-over): Nothing with a mother, nothing with a face. You can imagine the meat, egg and dairy associations think that's a terrible idea.

SHALENE MCNEIL, NATIONAL CATTLEMEN'S BEEF ASSOCIATION: Incorporating lean beef into the healthy diet can actually help you stick to a healthy diet because it's a food that people enjoy.

MITCH KANTER, EGG NUTRITION CENTER: Eggs are a source of 13 vitamins and minerals. Eggs are the gold standard when it comes to protein.

GREG MILLER, NATIONAL DAIRY COUNCIL: Well, dairy foods are very nutrient-rich. You get a lot of nutrients for every calorie that you consume.

GUPTA: A plant-based diet like Dr. Esselstyn's runs up against our meat-loving culture.

MICHELE SIMON, AUTHOR, APPETITE FOR PROFIT: Us doctors eat meat because most Americans eat meat. And so, if they don't really see for themselves or their own families why it might be a good idea to cut back or even cut meat out of your diet all together, then they may not be so inclined to recommend it for their patients.

GUPTA: Even doctors who do see the benefits of the Esselstyn's diet may not recommend it to patients.

DR. ERIN MICHOS, JOHNS HOPKINS HOSPITAL: Anybody who's able to do that diet can have dramatic success. The problem is, is that many people are unable or unwilling to make these changes. And so, in my practice, I try to take baby steps, one step at a time.

GUPTA: And Dean Ornish says, when it comes to diet, it's not all or nothing.

ORNISH: One of the interesting findings in all of our studies, the more people changed their diet and lifestyle, the more they improved, in direct proportion.

GUPTA: I was curious about the science between Dr. Esselstyn's claims. So, I dug up some of these peer review journals. They are small, just a handful of patients, but the results are pretty impressive. In one study here, patients on the Esselstyn's diet and cholesterol lowering medication had no heart attacks, had no coronary events of any sort after five years. And three-quarters of these patients actually saw their blockages get smaller.

You're not talking about just reducing your chance of heart disease. You're talking about potentially reversing heart disease.

ESSELSTYN: Oh, absolutely.

GUPTA: The lay wisdom is that once you develop these plaques, they're there, you're stuck with them. Try not to let them get worse. Is that faulty thinking?

ESSELSTYN: I think it's absolutely faulty thinking.

GUPTA (voice-over): Here's a picture Esselstyn likes to show of a heart patient with a blocked coronary artery, and here's that same patient after going on a plant-based diet.

You see the way the blockage has almost disappeared?

Sharon Kintz survived a heart attack a year ago after a coronary artery became completely block. Now she's counting on the Esselstyn diet to keep her from having another.

UNIDENTIFIED MALE: Thankfully, your heart muscle function is normal.

GUPTA: Kim's cardiologist, Dr. Adnan Zaidi, says -- so far, so good -- with the diet.

DR. ADNAN ZAIDI, CARDIOLOGIST: It is a difficult sell, but those who get on to it have benefited from it, without question.

(on camera): I asked Sharon Kintz to meet me here in New York City. You know, cooking at home is one thing, but eating on the road, eating on the run -- well, that's quite another. As the old saying goes, if her diet can make it here, it can make it anywhere.

Forty-sixth and Broadway, please.

Sharon, how are you?

When you cook at home, it's a lot more in your control. What's the most difficult thing when you're on the road?

KINTZ: What I see here is I see pizza, which is not because I'm sure there's oil in it, and cheese. And that looks like pepperoni.

When I look up here, I see pasta.

GUPTA: Right.

KINTZ: So my question would be, when I go in, Do you have whole wheat pasta? And then my second question is: can you prepare it without oil? That's not --

GUPTA: That -- no.

KINTZ: That's a not. That's a not.

GUPTA: That's not.

KINTZ: But they have pasta and they have salad.

GUPTA: All right. So, here's another restaurant. I'm going to take some advice from you. You look at a menu like this, tell me what comes to your mind.

KINTZ: The majority on there I'm not going to eat.

GUPTA: So you just focus in on the salads?

KINTZ: No, not really. I could have the baby spinach leaves minus the chicken. I could have the peaches, the strawberries. Forget the walnuts. And --

GUPTA: Is this a restaurant that you would --

KINTZ: Oh, yes.

GUPTA: You could come in and --

KINTZ: If I was hungry, you bet.

GUPTA: You can get a meal here.

KINTZ: You bet I could.

GUPTA (voice-over): Kintz is a true believer. So is former President Bill Clinton. And nowadays, they have a lot of high-powered company. All of these CEOs and former CEOs are either vegetarians or vegans.

Coming up -- plaque starts in childhood. What some schools are doing now so kids don't get heart disease later. And Dr. Agatston tells me if I should be worried.




GUPTA (voice-over): The former president once told me he likes to see results. He's helped with relief efforts after the tsunami in Asia and the earthquake in Haiti. He's worked on getting affordable AIDS drugs to Africa. He and his foundation are seeing results closer to home -- like at the Northeast Elementary Magnet School in Danville, Illinois.

UNIDENTIFIED FEMALE: On your mark, get set, go!

GUPTA: At Northeast Magnet, students have phys ed every day. More than one in five schools in the United States don't require P.E. at all. Fresh fruits and vegetables are on the menu every day. No more fried foods. No more French fries.

(on camera): Fruits and vegetables at every school lunch. Again, that seems like it should be the way it is. CLINTON: It shows you how far afield we have gotten. There were so many people, schools, that were serving lunches that didn't have fruits and vegetables because they contracted with firms to provide them and they were trying to save money. And the kids were happy with pizza and French fries or whatever.

GUPTA: Right.

CLINTON: I told you years ago when we started this I didn't know how much of a dent we could make in this because changing a culture is hard. It's turning a ship around before it hits the iceberg. But I think we are beginning to turn around.

UNIDENTIFIED FEMALE: Does anybody know what a cardiologist is?

GUPTA: Dr. Arthur Agatston is focused on young people.

UNIDENTIFIED MALE: I really think you guys should open a restaurant.

GUPTA: The South Beach diet author started a foundation working with students in Philadelphia on healthy eating.


GUPTA: Efforts like this these come at a time when obesity and diabetes, both risk factors for heart disease, are at all-time highs.

In the next 20 years, the American Heart Association predicts 33 million more Americans will have heart disease, unless we change.

NANCY BROWN, AMERICAN HEART ASSOCIATION: We are very concerned because we are seeing the risk factors associated with cardiovascular disease increasing.

GUPTA (on camera): Would you call yourself healthy now?

CLINTON: Well, I think I'm healthier than I was. You know, I lost 20-something pounds. All my blood tests are good. All my vital signs are good and I feel good. I actually believe it or not have more energy. I seem to need less sleep.

ORNISH: Once you begin making changes most people find they feel so much better so quickly it refrains the reason for making these changes from fear of dying to joy of living. And joy is what's sustainable.

UNIDENTIFIED FEMALE: Reach back with your right hand.

GUPTA (voice-over): A year into her diet, a year after her heart attack, Kintz feels great. Simply walking tired her out 12 months ago.

Sharon, do you think this can make you live longer?

KINTZ: I hope so. I hope I get to see you retire.

GUPTA: I have a feeling you have to live a very long time, which I hope you do.

KINTZ: I hope I do, too. Yes. Well, you know what? If I don't live longer, I know I'm going to live more of a quality life.

GUPTA: And Sharon Kintz is doing it using food as medicine.

For Tom Bare, it was a tougher road. He required surgery.

BARE: I was told I was going to feel like a million dollars. That hasn't happened yet. I'm still waiting for that, that payoff. I'm told that I'm good for another 40 years or so. I'm hoping that's the case. But with my history, I'm going to have to watch it.

GUPTA: So what about me? I have a family history. Am I heart attack-proof?

(on camera): So, a couple weeks ago, I met with Dr. Arthur Agatston to get a full workout, to gauge my likelihood of actually having a heart attack.

AGATSTON: Sanjay, good to see you.

GUPTA: Time to find out, time to see what fate has for me.

AGATSTON: We had good news when we did the imaging.

GUPTA: Right.

AGATSTON: You had no plaque on your coronary arteries on the calcium score.

GUPTA: Right.

AGATSTON: Your carotids were really like a spring chicken, very young.

GUPTA: I like that. Yes.

AGATSTON: Someone who's on his 20s.

GUPTA: Someone made a comment to me that this is sort of a four-year guarantee that I don't have a heart attack. Would you agree?

AGATSTON: Yes. I would extend it to five to seven years.

GUPTA: Based on what you've already seen before we go over there, five to seven years if I'm feeling chest pains probably not a heart attack.


GUPTA (voice-over): More good news. Looking at LDL, the bad cholesterol, Dr. Agatston tells me they are mostly large particles, the kind that don't build up as plaque in the blood vessels.

(on camera): Putting it my whole picture together now, the imaging, all my laboratory test, what can you tell me?

AGATSTON: You are at low risk for future heart attack even though there is a family history. And, clearly, the lifestyle that you maintain your weight, that you do an exercise has helped to decrease your risk.

GUPTA (voice-over): If diet and exercise can make someone like me low risk for a heart attack, even with a strong family history, that's encouraging.

AGATSTON: I don't think there's any question that not only could we be past our last heart attack, but the vast majority of people, even my age, if they are prepared to change their diet, exercise more could actually reverse a lot of their blockage.

ORNISH: Heart disease could be as rare as malaria today if we simply put into practice what we already know.

ESSELSTYN: It's possible to keep everybody from having a heart attack with education, with knowledge, with information. Now, the question becomes, are people going to do this?

GUPTA (on camera): I hope I have given you food for thought today? And if all this makes you want to overhaul your diet, especially if you are a heart patient, you should talk to your doctor.

Look, we got a long way to go in this country. I hope you will join me. Together we can work for "The Last Heart Attack."

I'm Dr. Sanjay Gupta. Thanks for watching.