Drugs and Surgery

Cholesterol lowering drugs and heart surgery are quick fixes for a complex diet related disease. The drugs only target fasting cholesterol, which although important, is only one part of the cholesterol-diet problem. Stents and surgery are seldom life saving and carry considerable risks.

The “statin” class of cholesterol lowering drugs was released onto the market in the 1980’s. For the first time, doctors could prescribe a drug that not only lowered blood cholesterol levels, but actually reduced the risk of heart attacks and other cardiovascular events. Doctors were able to prescribe something that slowed or even reversed a disease for which previous treatments were little more than palliative. Some of us were concerned right from the start that because these drugs were so effective we might end up treating an essentially nutritional disorder with expensive drugs. We were assured by both the pharmaceutical industry and the medical experts that these drugs would remain an adjunct to a cholesterol lowering diet. Twenty five years later these concerns have proven to be justified: the statins are first line treatment for anyone at high risk of heart disease and dietary advice is minimal or non-existent. The standard cholesterol lowering diet remains rich in animal products and oils and is ineffective.

There have been many large well-funded studies showing that statins are effective at reducing cardiovascular risk in patients at very high risk. Risk reductions in the order of 30% are impressive but that still means that the majority of patients still got sicker or died. The subjects of these studies were heart attack survivors and other very high risk patients. We should not expect the same level risk reduction in apparently healthy people who take statins to counteract their diet-induced high cholesterol.

Statin drugs were thought to have minimal side effects other than rare instances of muscle “melt down” or severe liver reactions. But it is now recognised that these powerful drugs frequently cause side effects. These include muscle pain, skin disorders, abdominal symptoms, memory loss and other neurological disorders.

The pharmaceutical quick fix to a dietary problem is flawed and costs Australia over a billion dollars per year. It’s an overly simplistic approach to preventing the complex process of atherosclerosis by managing only one biological parameter – fasting cholesterol profile. It fails to address the inflammatory reaction that follows every high fat animal protein based meal (see The Leaky Gut Theory of Why Animal Products Cause Inflammation) or the beneficial effects of dietary fibre, antioxidants and other chemical found only in plants. This is discussed in more detail on the Endothelium and Atherosclerosis page. Given that the action of statins only deals with part of the problem, it is not surprising that the target cholesterol level for treating artery disease with pharmaceuticals keeps moving lower and lower (currently LDL<1.8mmol/l).

The clinical trials that used a no oil plant based diet got much better results than any drug based clinical trials. Dr Caldwell Esselstyn virtually cured heart disease in his series of cases, and he is about to publish the results of a larger series. Another study by Dr Dean Ornish also got spectacular results (see Intensive lifestyle changes for reversal of coronary heart disease). Arguably, these were small studies in comparison to the multimillion dollar drug trials that the pharmaceutical industry funded, and they were not “double blind” studies because both the researcher and the participants knew that they were eating a plant based diet and not a placebo diet. This sounds silly but the active drug Vs placebo is the gold standard for clinical trials in our reductionist view of health, and the inability to perform placebo controlled diet studies is one of the reasons why the evidence supporting dietary treatment of heart disease is not as highly regarded as pharmaceutical treatments.

Watch this video for more information about Dr Esselstyn’s research:
Caldwell B. Esselstyn, Jr. MD, Treating the Cause to Prevent and Reverse Heart Disease

Coronary artery stents and coronary artery bypasses are usually regarded as life saving procedures. In reality, most of these procedures just reduce symptoms and do not prolong life. These procedures should be reserved for emergencies such as an evolving heart attack and for those coronary artery blockages that carry a very high risk of death.

Coronary artery bypass surgery is major surgery that carries a substantial risk of death or serious complications. Recovery can be slow and painful and there may be cognitive decline associated with the procedure. Stents too carry a small risk of death and a substantial risk of heart attack as probes are passed along diseased arteries.

Doctors are expected to inform patients of the expected benefits and rissk of medical treatments as well as those of established alternatives. Given the evidence for the effectiveness and safety of a whole foods plant based diet it is unconscionable that most patients are not informed of this treatment option.


Dr Caldwell Esseltstyn has compared the current interventions for heart disease with radical mastectomy, a surgical treatment for breast cancer that was used for many years after it was known to be no better than more minor procedures. Follow this link for his editorial: Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century?