Moderator: Howard Soule, Senior Fellow, Milken Instiute, Managing Director of Knowledge Universe Health and Wellness, LLC

Panelists:
Caldwell Esselstyn Jr., Preventive Cardiology Consultant, Department of General Surgery, Cleveland Clinic
Francine Kaufman, Professor of Pediatrics, Keck School of Medicine, University of Southern California; Head of the Center for Diabetes, Endocrinology and Metabolism, Childrens Hospital Los Angeles
Samuel Klein, William H. Danforth Professor of Medicine; Director, Center for Human Nutrition, Washington University School of Medicine
Dean Ornish, Founder and President, Preventive Medicine Research Institute; Clinical Professor of Medicine, University of California, San Francisco
Harold Schmitz, Chief Science Officer, Mars Inc.

If you read nothing else on this post, this is the one sentence takeaway: No matter what you think now, you are too fat and you already have heart disease, so you better start eating plants. And chocolate.

Francine Kaufman's thoughts: There is a need for a change starting with families and schools, particularly with respect to obesity. By the 21st century one in three children will suffer from diabetes. The real key will be in educating children about their own health, and in improving school nutrition.

My takeaway from Dr. Kaufman: Take the Wonder White away from kids.

Samuel Klein’s thoughts: In a study of rats and worms calorie restriction resulted in a 30% longer life.

Another study looked at thickness in the wall of the carotid artery in middle-aged adults. Those who were put on calorie-restricted diets showed marked improvement.

What does this all mean? That there are potential benefits to getting below the normal weight in the US, because there are beneficial effects in the reduction of overall body fat.

However, it is not as simple as reducing body fat.  Liposuction is the most prevalent cosmetic surgery in the United States with 440,000 procedures performed per year. 250,000 of them are in Los Angeles alone.

They took two samples of women, one group who were diabetic and the other group who had normal glucose metabolism, and removed 22 pounds of body fat. There was a dramatic effect on their appearance, but little to no effect on the risk factors for heart disease. If these women had reduced their body fat by changing their diets and maintaining a proper energy balance, they would have been healthier.

There is even concern that what is considered a “normal” weight is actually still too heavy, and that the “optimal weight” is ever lower.

My takeaway from Dr. Klein: Save your $10,000 for liposuction, read French Women Don't Get Fat, and eat healthier.

Caldwell Esselstyn’s thoughts: Large random trials have shown that a plant-based diet could reverse cardiovascular disease. In fact, coronary artery disease need not ever exist.

In Norway, deaths from heart attack and stroke plummeted between the years of 1940 and 1945. What caused this? When the Axis powers of Germany overran Holland and Belgium and occupied Norway, they took away the Norwegian lifestyle that included cows, goats, and chicken. Norwegians were forced, for that time, to subsist on whole grains and legumes. However, by 1945, dairy products and animal products were restored to Norway. It is not surprising that high levels of coronary disease were restored as well.

Dr. Esselstyn shows a slide of the bivalve artery on which there is a small bubble on the left side. This bubble of plaque is encroaching on 30% of the diameter of the artery. If this person, to whom the artery belongs, continues to eat the “toxic” American diet, the plaque bubble will rupture, leading to a lethal cascade of events. Platelets are activated, and a self-propagating thrombus ensues. The artery becomes completely blocked. That’s a heart attack, folks.

If you can make the bubble of plaque rupture-proof, then you make yourself heart attack proof.

Another example comes from a 44-year-old surgeon with a cholesterol of 156 and no family history of diabetes. In 1996, he felt chest pain. Cardiology couldn’t find anything wrong with him. Two weeks later, the surgeon had a heart attack.

The results from the catheter lab showed a tiny narrowed artery that was too long for a stent. The surgeon was insistent on “fixing” it and went on a plant-based diet. The surgeon’s cholesterol level from 156 to 89. His “bad” LDLs went from 98 to 38. Dr. Esselstyn’s slide showed the results of the angiogram and showed complete restoration.

Basically, anyone over the age of 20 who is currently enjoying a “toxic” American diet already has heart disease. The only answer to heart disease, obesity, hypertension, diabetes, and other common Western cancers is a plant-based diet.

My takeaway from Dr. Esselstyn: My heart is already screwed.

Dr. Dean Ornish, Harold Schmitz

Dr. Dean Ornish’s thoughts: Dr. Ornish has done 30 years of research. A series of studies initially focused on cardiovascular disease shows that over time, the disease can get better, and more quickly than people originally thought. Even things like the progression of prostate cancer can be reversed.

There is a lot of talk about “evidence-based care,” but the reality is that we live in an era of “reimbursement-based care. In essence, healthcare is all about the Benjamins.

Take cardiology as an example of what’s going on in healthcare. We spend $100 billion for bypass surgeries, angio, and stents, but a meta-analysis has shown that these procedures do not, in the end, prolong life.

And yet, why are insurance companies, Medicare, etc. paying for healthcare that is not effective?

Virtually all heart disease can be prevented by putting into practice things we already know: changing lifestyle.

To prove hi point, Dr. Ornish called upon a Mutual of Omaha demo in which the company saved $30,000 per patient in the first year by simply helping people change their diets.

The country needs to change the way people view healthcare. Starbucks spends more for its employees’ healthcare  than it does on coffee beans. Change reimbursements, medical practice, and education so that the focus is on eating healthier. Motivate people to make and maintain diet and lifestyle changes. Medicare will pay for programs that do this because it’s right and will make difference.

We need to work with food companies like Pespico, McDonalds, ConAgra, DelMonte, and Safeway into becoming behavioral modification businesses.

For example, Dr. Ornish helped to introduce an edamame salad in a fast food chain that has 16 types of lettuce, mandarin oranges and almonds. The McDonald’s apple and walnut salad was a huge success and now makes McDonald’s the biggest purchaser of apples. Half of profit growth for Pepsico was from healthier foods. So the changes are taking place.

People may ask, “Will eating healthfully really make me live long? or will my life just seem long because I’m eating healthy.” There is freedom to choose from a spectrum of choices.

My takeaway from Dr. Ornish: My insurance company should pay for all of my groceries and restaurant checks.

Harold Schmitz’s thoughts: Nutrition presents a confusing situation for consumers. A slide shows 2004 AHA data on the costs of cardiovascular disease. The US spends almost as much on cardiovascular disease as it does on Defense. As Dr. Esselstyn stated, most people already have some form of cardiovascular disease. However, it is difficult to underestimate the importance of bloodflow.

One of the things that Mars is focusing on is chocolate (obviously). A slide of data from Harvard Medical School shows the range of components that can be present in chocolate. Because chocolate is made from cocoa, and cocoa is a tree fruit, it contains phytochemicals and flavonols, which are what make plant-based diets so important in health.

One way to show the effect of chocolate on cardiovascular health is to look at its effect on blood flow in the extremities (fingers). This is relevant to diabetics because diabetes is a vascular disease and people can die from failures of bloodflow. The slide shows that 60 minutes after cocoa consumption, there is increased  bloodflow in finger.

A Type 2 diabetic has extremely poor bloodflow, but five days after consumption of cocoa, essentially bloodflow in the extremities is normal.

Chocolate has positive effects not only on cardiovascular health, but on cognitive impairment.

Not only is controlling calories important, but we also have to think about the quality of calories we ingest, i.e. making the calories that we do ingest extremely valuable.

These data pose an important question: Can there be such a thing as prescription strength chocolate?

The answer is “yes,” but we also need to address a few issues before answering the question. Good research has to be done to find out what beneficial compounds are in cocoa. Additionally,  what are the mechanisms of these compounds’ bioactivity? Getting the science right is the key point.

Harold ended the panel with two provocative statements:
Science: Nutrition science does not fully embrace the fundamentals of pharmaceutical industry. They could benefit from embracing the chemistry of foods to know how to construct foods and how to effectively deliver them

Economics: Part of the problem is that we ought to ask why isn’t this scientific study done? Because the business sector does not reward nutrition science the way it rewards the pipeline in the biomedical industry.

My takeaway from Harold: Chocolate might save my life.