Medical Notes: Talk about aubergines instead of angina

HEART ATTACKS can be a tragedy like no other. Always terrifying and all-too-often fatal, they visit our homes and hospitals more frequently than any other cause of death.

As particles of cholesterol invade the walls of the arteries, blockages gradually build, choking off the blood supply to the heart. The same process occurs in the arteries to the brain, leading to strokes, and even in the arteries that nourish the lower back, starving the spine of the oxygen and nutrients it needs.

Caldwell Esselstyn, MD, a surgeon at the Cleveland Clinic, in Ohio, became frustrated with the high-tech and high-priced interventions at his disposal - surgery to bypass blocked coronary vessels, angioplasty to force them open again, and an ever-growing array of drugs. None offered anything more than palliation.

His patients were seriously ill, and even the most modern treatments had little to offer them. One, Mrs Oswick, had been told by a previous doctor that her condition was so hopeless all she could do was "go home and wait to die".

Esselstyn, like other doctors, had been impressed by the near-absence of heart disease is very poor countries. Their cholesterol levels were phenomenally low, and their arteries stayed open seemingly indefinitely.

He decided to set aside high-tech medicine long enough to test a different approach, focusing on getting his patients' cholesterol levels down to where they might be had his office been in China or rural South Africa. Mrs Oswick and 17 other patients had cholesterol levels hovering at 6.0, 6.5, 7.0 or higher. And despite the fact that no nutrition authority had ever suggested such a low goal, he aimed to get them all down below 3.9.

He began with diet, throwing out anything with even a trace of animal fat or cholesterol. Although most other doctors permitted white meats on the theory that they were somewhat lower in fat than beef, Esselstyn nixed poultry, fish, beef, and virtually all dairy products. If cholesterol levels stubbornly remained above 3.9 despite the diet, Esselstyn added cholesterol-lowering drugs.

He then added a third element, something few doctors would do in a modern medical practice: he invited his patients to dinner with his family. At the dining room table, the sterility of the office was gone. Instead of low-density lipoproteins, they talked about lasagne, and about aubergines instead of angina.

The initial results were encouraging. Chest pains diminished, then stopped. The patients lost weight and gained energy. After five years on the program, patients whose life expectancy had been measured in months were still alive.

Angiographic x-rays revealed that the blockages in their arteries were reversing, meaning that the accumulated plaque was actually dissolving without surgery. It seemed that his patients were becoming virtually heart- attack-proof. After 12 years, all but one were alive and well.

The findings were published in the August issue of the American Journal of Cardiology. Many doctors reacted with disbelief, not so much about the power of the regimen, but about the willingness of his patients to see it through. Few patients, they thought, would want to make such drastic changes in their diets. Esselstyn disagreed. "I wouldn't underestimate people," he said. "By tradition and culture, much of the rest of the planet eats this way. We can, too."

For Mrs Oswick, it has been 14 years since her doctor sent her home to die. She returned to teaching at a local university and often goes dancing with her husband. "I realised I wasn't ready to die," she said.

Neal D. Barnard is the author of `Foods That Fight Pain' (Bantam, pounds 7.99)