Where There's a Will There's a Way

Last time, we talked about the evolution of treatment for heart disease that led to coronary artery bypass surgery, PCI (percutaneous coronary intervention) with angioplasty, and the latest iteration of angioplasty with both bare metal and drug-eluting stents. 

Heart disease continues to be the number one cause of death in the US, making up about 13% of deaths in this country in 2018. The statistics are quite impressive, but in a bad way. Between 2015 and 2018, more than 126 million American adults had some form of cardiovascular disease (CVD), and the direct and indirect costs of treatment was north of $363 million. The American Heart Association At-a-Glance data sheet cites the staggering statistics of heart disease, associated co-morbidities, and contributing factors for this head-shaking reality brought on by our first-world lifestyles. We Westerners do our part to prolong this with our propensity for the things we should avoid—smoking, consuming diets high in fats, and lack of adequate physical activity, which in turn leads to obesity and increased blood lipids, specifically total cholesterol, an accurate marker for increased risk for life-threatening illness.

Because heart disease is so prevalent in our population, it’s understandable that many of the pilots we work with here in the Pilot Information Center medical group are being treated for it and dealing with the FAA to acquire a special issuance medical authorization. Equally not surprising, the FAA does more special issuances for CVD than any other medical pathology. About 13,000 cardiac special issuances are granted annually for all three classes of medical certification. That’s over one-third of the total SIs for all the other medical conditions that require discretionary issuance. Included in the category are diagnoses of coronary heart disease, a clinical history of heart attack, coronary artery bypass (CABG), PTCA (angioplasty) and angioplasty with stent placement, but doesn’t include hypertension, pacemakers, heart valve conditions such as aortic insufficiency, or valve repairs and replacement, all of which could be considered a form of “heart disease,” but not necessarily related to coronary artery disease.

I mentioned last month that I am reading a fascinating book that has been around since about 2007, Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD, a former cardiovascular surgeon at the famed Cleveland Clinic. I was referred to the book by a member whom we helped with a special issuance for heart disease some time ago. Dr. Esselstyn’s book outlines his treatment for preventing and, in many cases, reversing heart disease through a rigid change in that western diet I mentioned at the outset. His 300-page book, a very interesting and easy read, describes how he has helped his heart patients avoid conventional western “treatments” for heart disease and actually prevent the disease from taking them to the brink of a surgical procedure that only treats the symptoms rather than implementing a “cure.”

His plan is quite simple, but I’ll tell you up front that it requires a dramatic lifestyle change in how we eat. In short, he describes the rules for his program this way:

  • You may not eat anything “with a mother or a face.” (no meat, poultry, or fish!).
  • No dairy products!
  • No oil of any kind, not canola oil, peanut oil, not even olive oil!
  • No nuts; no avocados!

Okay, I’m with you, that is DRAMATIC, and excludes just about everything that most of us consider dietary staples. However, if you love fruits and vegetables, the news is good; you can eat just about anything in the fruit and vegetables part of the food pyramid (except avocados!). Also, you can chow down on whole grains and legumes (beans). In fact, the food pyramid that has been around for years lists the proper dietary percentages: 40% of our diets should contain bread, pasta, cereals, and 35% fruits and vegetables, with only 20% the forbidden meat and poultry and 5% fats, oils, and sugars.

Dr. Esselstyn also strongly advocates for a total cholesterol of less than 150. That’s considerably less than the “desirable” level of under 200 that is considered a “healthy” level. But he is adamant that lower cholesterol levels will result when the diet recommendations are followed.

At a time when inflation is really starting to affect our grocery shopping habits, cutting back on meat, fish, and poultry might be a little easier to do. I try to pay attention to diet, and I’ll be the first to admit as a native Texan that giving up red meat, along with fish and poultry, will be a challenge. Not to mention how much I love milk and cheese, and buttermilk! Although I don’t have a family or personal history of heart disease, I’m going to give this diet a go, albeit with maybe a cheat meal on occasion just to keep the gas grill operating during the upcoming winter.

One final comment on the book; over half the pages feature more than 150 heart-healthy recipes and I have already cranked out a couple of them, including pea guacamole (yes, I love avocados, but there’s not any in the recipe) and black bean soup. With the cooler weather coming, many of the meals will be easy to pull together even though the fruits and vegetables won’t be “farm fresh” from our local markets.

The book is available, and I picked up a used copy for about $8, so it’s been a worthwhile read.

I hope you all have a great fall and enjoy the holidays fast approaching!

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification, Pilot Health and Medical Certification

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