Featuring: Laurie Marbas, MD; Themis Yiaslas, PsyD & Saul Schaefer, MD

 

LM: We’d like to welcome Dr. Themis Yiaslas and Dr. Saul Schaefer from the Sacramento VA Medical Center.

Today, we’re going to talk to you about an article that you submitted to the International Journal of Disease Reversal and Prevention regarding a gentleman that you worked with. The title of your paper is Elimination of Angina, Comprehensive Cardiometabolic Risk Reduction, and 50-Pound Weight Loss in U.S. Navy Veteran with Myasthenia Gravis. Wow, that is a very complicated patient and some very interesting things that happened.

Can you tell us a little bit about the background? First of all, the program that the gentleman participated in and how you chose this particular case to submit to the journal?

TY: The program is called the Heart Disease Reversal program. Actually, at the very beginning, I had the idea and I reached out to Dr. Schaeffer at a time when I didn’t really recognize his background in this area, being one of a small number of people in the world who have actually shown regression of atherosclerotic plaques through a plant-based comprehensive lifestyle program. He was very supportive.

The program itself consists of three components, the whole foods, plant-based diet being the centerpiece, but also including safe, home-based, moderate intensity physical activity and stress management training. It’s an interdisciplinary crew. We’ve got myself, as a psychologist with behavioral medicine expertise; a registered dietitian; and a clinical pharmacist.

The program is available to anyone who has atherosclerotic heart disease here at our medical center. We actually did some outreach, sent some letters to folks who had the diagnosis and had care at our hospital. This patient actually reached out to me, directly, in response to a letter that said, hey, there’s this program that you can participate in. That’s how it began.

As the article states, he had just come off of two heart attacks within a two-month period and was quite down and out. He was pretty much ready to do what he could to improve his health. The results were pretty substantial.

We chose him in particular, too, because of how vocal he was. Within the first month, he really became someone that was very outspoken, helpful to other people in the program, sort of like an ambassador, of sorts, and has joined us at our seminars, giving his experience. You know, I learned a few things about him at those seminars and it struck me that he had that mixture of a remarkable story and almost the desire, maybe even the need to tell it to help others, so we asked him and he was all in.

LM: Wonderful. Can you give us a little bit of background on exactly how severe his illness was and what type of changes did you see? How long did it take? What was he eating? What did he do, exactly?

TY: He actually had quite a variety of different conditions, not all of them fully represented in our article, the key being atherosclerotic heart disease and type 2 diabetes. He had a significant amount of excess body weight, being obese, with this myasthenia gravis complicating things in the sense that any time he did any significant exercise, he’d have these neurological symptoms that would actually interfere and worsen. So, he was kind of stuck. He wasn’t really able to exercise or be as active as maybe he would have chosen to, based on his heart health.

The heart attacks gave him the message that I am a chip off the old block. He had a very significant family history, as he detailed in his story. This led him to conclude, “I’m going to die very soon.” He described even being afraid to leave his room and not really being able to feel the confidence to just be as active as he had been. He had begun making arrangements with his wife and really making plans with the expectation that he was probably going to have another heart attack and die pretty much any day.

One of the things we detailed in the article is this distinction between depression and demoralization. I think the key is that he didn’t present to me in a very depressed way. He didn’t score very highly on a screening measure that asks about depression symptoms, but when you got to ask him about it, there was this sense of lost purpose. It’s possible that you can be demoralized and have given up, in a way, about your fate, despite not being sad and down and those more obvious symptoms of depression.

How did he respond? He went all in. He was very aggressive in his approach and that’s what we ask people to do, do it all at once, in particular to have a rapid resolution of symptoms, but also so they can really feel the difference. What was I feeling before and how do I feel now? Within the first month, I think he essentially had almost total resolution of his angina pain. He described this chest pain as being so severe and affecting him every single day that he was afraid to move because of it. Without much exercise, just very simple calisthenics, really emphasizing the diet component, he was able to reduce that chest pain. That can be so frightening. In my experience, it’s those people who have that symptom resolve that it’s not really much more effort at that point. The benefit to quality of life is so obvious and so clear, it’s so rewarding to just keep doing it.

From there, he branched out, became more of a culinary expert, learning about different ways of cooking and trying to increase the variety. He was very aggressively managed in cardiology. His baseline LDL cholesterol was 38 and it definitely wasn’t down there just because of lifestyle beforehand, so to have his LDL cholesterol, for example, go down 42% in a month, it’s really just getting down to the basement. That was big for him.

The significant weight loss was big for him. The slow, steady improvement in blood pressure was huge. His fasting glucose, hemoglobin A1c was dropping and dropping, eventually prompting his physician to cut down his medicine. Pretty much everything we measured improved in terms of his cardiovascular risk factors. Combined with the angina and weight loss, he was just overjoyed. It’s very rewarding to work with someone like that, who puts everything into it and really gets rewarded.

It really prompted this idea that this isn’t just a boosted mood. There’s something qualitatively different about him, which I thought needed further focus and attention. How do you feel when you go this way? Yeah, you feel better, you have more energy, you lose weight, but the shift from a dead man walking to someone who feels like they’re in command of life, who’s out living life to the fullest, that, to me, seemed like a mini-resurrection, of sorts, which is what I’m proposing in the article, that maybe we should call this something to differentiate it from just feeling better, what happens with plant-based nutrition.

SS: One of the things that struck me over the years – I’ve been involved for decades, actually, in the concept of using diet and things like meditation, stress reduction to improved cardiovascular health, starting at UCSF and then we have a coronary artery disease reversal program at UC Davis and we published the results. For the scientific literature, it was important that we showed that you could both reduce atherosclerotic plaque and, in a greater way, reduce cardiovascular events, which has been a common finding in these sorts of trials. That’s well accepted now, but I think the remarkable thing that’s really exemplified by this patient and by the reversal program here are the psychological benefits of being on a plant-based diet and being part of a group. I think being part of a group, having a sense of a common enemy and a common mission and a common way of dealing with these issues brings people together, brings a sense of community, and I think that has a significant, profound psychological effect on their well-being.

We have found previously in our studies that people that remain in the program really become proselytizers, enthusiasts. They become committed and they do really well, both on the medical side and the psychological side, the well-being side. People that, for whatever reason, don’t stay in the program don’t get these benefits. Even though they may initially get some of the chemical, biochemical benefits, they don’t get the psychological benefits and they wind up having more events and having more disease.

I think a couple of key points. One is the intensity of the program, the commitment of the people running the program, like Themis; and of the patients putting their heart, literally, and soul into the program; and then the benefits that they reap and the sense of community they gain from being there. So, I think people have become more accepting of this intervention. Where it was radical 30 years ago, it’s now, I think, accepted among many physicians, among nutritionists, biologists, and the public at large. I think one of the key issues is implementing this in people that are at risk or have severe heart disease.

LM: Wow. What time period are we talking about? How long is the program? How long was it before the gentleman entered the program and had this tremendous 50-pound weight loss, reversal of his metabolic disease, relief from his angina? How long are we talking here?

TY: As far as the timeline for that, January 2018, we met first. Within one month, I think there might have an instance or two of some angina, but it was more or less resolved between the one-month mark and before the program ended. As he went through it, the core group that met every week, that was 12 sessions, so we had a period of 3-3½ months where he had experienced these benefits. We do labs after one month, so we actually could see improvements in all his cholesterol numbers and body weight and all of that within the first month, which is pretty significant.

As far as the 50 pounds, which we are describing him accomplishing that, was all the way into, I think, October 2018. So, about a 10-month period to reach that 50-pound weight loss mark. The way he described it was that he was losing 1-2 pounds a week, just on the regular. We actually don’t talk about weight loss in the program, as a goal. We mention it happens, for example, but we don’t encourage the typical weight management behaviors, like calorie counting or watching how much you eat, other than encouraging people to eat until they’re full. It was a benefit that he enjoyed, but it wasn’t necessarily something that he was specifically striving for. He was just trying to follow a whole foods, plant-based diet.

SS: I think our diets in America and largely the Western world are so bad, when you compare it to what a good diet would be, that getting off that bad diet and getting onto a plant-based diet really reduces calories, provides satiety with fewer calories, and is a lot healthier. A lot lower saturated fat, sugar, salt, all the things that we encourage our patients not to eat.

The thing is it’s persistent because, in the conventional dietary plan, you buy in and you’re forced to eat smaller portions or whatever. This is really a much broader conversion in terms of a thought process and style of living, so I think it’s easier to maintain that over the long haul.

TY: I was thinking, too, you had asked about his background and other conditions. That was one of the things that stuck out to us, too, was that routinely we’re seeing folks that have more than just atherosclerotic heart disease, so what are you supposed to do? What often comes up are things like, “Well, I was told I needed to watch these carbohydrates, and I have to do this for my diabetes, and I have to watch my salt, and I have to…” There’s actually so many tailor-made nutritional approaches for different conditions, what do you do? One of the benefits for this particular patient, but also for other people that we work with, is that we really simplify things. There are some requirements, like if you have gout, we have to look for those high purine foods. If you have heart failure, we focus on, in some cases, fluid restriction. We have this core approach, with some modifications that we can do for the individual, but really it’s been described as easier. We’ve had folks finish a diabetes program, for example, a behavioral lifestyle program, and they come to us and say that it’s easier. It takes less work.

I think that’s an important factor. It’s one of the things that makes somebody feel less confident that they have any control over their health, when the chips are stacked so high. “What do I do? If I eat this way, it’s going to hurt this diagnosis.” For him, he could just do one way and it made it easier.

LM: I see the benefit for him. I think that’s a very important point, that the mechanisms that are in play here with the whole foods, plant-based diet will see benefit across many chronic diseases – diabetes, heart disease, hypertension, high cholesterol, all of those different things. Absolutely.

When you have such a wonderful story, people are going, “Oh, that’s just that patient,” but we all know, because we work with these patients, this is routine. This is a very common occurrence. What can someone who resists, maybe a physician who a patient brought this story to them or a person who is reading this and identifies himself as someone similar to this gentleman, what is the takeaway? What should be their first steps? What should they do? What would you encourage someone like that to actually do? Is there anything that they need to be monitored for, like if they’re on insulin for diabetes, hypertension meds, all those things can improve very rapidly. What do you guys typically recommend?

TY: You just brought up a couple of keys. One big takeaway is to go all in for a short period. If you’re a patient, sometimes just putting a toe in the water, trying one plant-based meal, you think, “What does this taste like?” It’s difficult to dabble. You can dabble if you want. That’s definitely one way, but our way is to go all in, dive in 100%, do so over a three-week period or a week period and get all the support that you can. There are people that are going to be allies in your circle. Who can help you? Is it a spouse, a friend, someone else who can maybe do it with you or be a helpful supporter?

There are lots of great online resources. The Plantrician Project has great materials. There’s also a great many out there, these so-called quick start guides. They’re totally free. You can explore them at your leisure and say, “Hey, could I do this? What’s the right time to start?”

If you have a lot of these conditions, like you were mentioning diabetes and high blood pressure, we’re actually really aggressive about that. We have people that are either getting dose reductions or discontinuing meds within the first few weeks, so it’s actually kind of really important, hey, you know that blood pressure cuff in your closet? You might want to pull that out and use it every morning, just to monitor things. Those are the keys, and blood sugar, monitoring those regularly.

I think that’s a big takeaway, that it may be quite surprising how quickly this works. Don’t sleep on it. Don’t think it’s going to be a two-, three-, six-month endeavor. You will see results rapidly.

SS: It’s interesting because there’s a parallel to gastric bypass where, with just getting the bypass, your weight doesn’t change immediately, but your diabetes does and your glucose control does, so there’s something about changing the microbiome or metabolism that can affect, especially, diabetic control very rapidly, without weight loss.

LM: I would have to say, as a physician that works with these patients daily, absolutely. Insulin is oftentimes cut in half within the first week. That is not an uncommon experience with me. The blood pressure will depend on the patient, but that is wonderful.

Are there any final suggestions? Let’s say someone comes across this video or article and they’re thinking about this. What would you like to say, the one- or two-sentence summary that you would like to highlight about your entire article that you submitted?

TY: If you’re looking for something that’s going to give you a chance to dramatically change the status quo, if you’re ready to challenge your own assumptions about what you’re capable of, and you want to be more in control of your health and not have it delegated to healthcare providers or other people, if you want to take that control back, if you have oppressive symptoms, like angina, and you want some relief, make the decision to go all in for a period and let your experience help you decide whether this is right for you.

You might be surprised. It might be the beginning of the rest of your life, one that’s imbued with a sense of gratitude and joy and health, and you might never look back, so give it a try.

SS: I’ll summarize it. Lifestyle is much better and more important than pills. Even though I prescribe them all the time and they have a role, really, lifestyle is key.

LM: Absolutely. Plants over pills and pills when needed.

I think what you’re describing here is a gentleman who found hope when he had no hope and was written off as medical management only, and he probably saw the demise of his life coming rapidly and said even the best medical care can’t help me, but literally what was on the end of his fork was his salvation. I think that is a resurrection of a new individual, so I think you’re right on when you say that.

Thank you both so much for this information. It’s such an inspiring case and I’m sure it will inspire others to take some changes into their own hands and their own plates and do well. Thank you again. I so appreciate your time.

 

 
Themis Yiaslas, Psy.D.

Themis Yiaslas, PsyD is a Behavioral Medicine Psychologist at the Sacramenta VA Medical Center. He also works as a trainer and consultant for the National VA Motivational Interviewing Training Program, and is an Assistant Clinical Professor, at UC Davis School of Medicine. He received his Psy.D., Clinical Psychology from PGSP–Stanford Psy.D. Consortium, at Palo Alto University.   

 

 
Saul Schaefer, MD

Saul Schaefer, MD is Chief of Cardiology Section at the VA Northern California Health Care System, and Director of Medical Student Research and Physician Scientist Training Program at the UC, Davis, School Of Medicine. Dr. Schaefer focuses his clinical research on the utilization of non-invasive cardiac testing to diagnosis ischemic heart disease and pulmonary embolism. He received his medical degree from the UC, Davis, School Of Medicine in 1981.