LOOKING BACK, I WISH I COULD SAY my commitment to healthy eating was the result of native intelligence. But that wouldn’t be true. It was born purely out of need. For the first 32 years of my life, healthy eating had taken a backseat to other, seemingly more important issues. Besides, I’d always been in good health. Sure, there were things that could be improved. At around 250, my cholesterol was certainly high, but in the mid-1970s many doctors considered that level to be “average” and not a cause for alarm. And I could stand to lose a few pounds. There would be plenty of time, I thought, to improve my diet and my health in the future.
Then, in July 1977, I found out how wrong I had been. For the second time in a week, I was sitting in the office of Dr. John Nagle, a prominent cardiologist in Tacoma, Washington. I’d gone to see my family physician, Dr. James Early, five days earlier because I’d been experiencing shortness of breath and a low-grade but nagging chest pain as I warmed up to play tennis. The pain was dull, more like a feeling of fullness, and it would usually disappear by the end of the warm-up. But one day it stayed with me through two hours of play, so I called Dr. Early. “I’ve got a problem in my lungs, probably a touch
of bronchitis,” I told him. He asked me to come in right away. I had seen him just four months earlier for my annual physical, and the results were excellent, so I wasn’t expecting anything more than a quick visit and perhaps a prescription.
This time, however, my electrocardiogram indicated an obstruction of a coronary artery.
Dr. Early said there was no evidence of a heart attack, but he wanted me to see a cardiologist that same afternoon. Three hours later, I found myself undergoing a thorough cardiac examination with
Dr. Nagle. I was given an exercise stress test, which indicated that the cardiac muscle wasn’t getting enough blood, but it would take an X-ray to determine the extent of the problem. A thin plastic tube was inserted into an artery in my leg and threaded into my heart. Then a dye was injected into the tube, and Dr. Nagle traced its progress through my coronary arteries.
Now we were ready to review the results. Dr. Nagle began speaking. He told me that my chest pain was caused by three arterial blockages, ranging from 50% to 95%. “This is called coronary heart disease,” he said. “Buildups of fat and cholesterol are interfering with blood flow to your heart. The largest blockage is badly located. A blood clot could seal off the opening and trigger a fatal heart attack. I recommend immediate coronary bypass surgery . . .” There was more, but those words hit me like a hard slap in the face.
Just get up and leave, I told myself.
You’re not supposed to be here. Like most people, I knew something about the workings of the heart and the coronary arteries, but the information was chiefly of the Biology 101 variety. Some decent information was out there, but what
did it have to do with me, a young guy in the prime of his life? Unknowingly, I had succumbed to the “what I don’t know won’t hurt me” syndrome. In reality, however, what I didn’t know could not only
hurt me, it could kill me.
Facing Reality As the diagnosis sank in on that July afternoon, my own age of innocence and ignorance came to an end. My initial reaction was the typical “Why me?” response. Bernie and I had not yet celebrated our 10th wedding anniversary. Our daughter was six; our son was just four. I was in the midst of building a career and contributing to my community. Then I remembered reading a comment by President John F. Kennedy reflecting the fact that life was basically unfair—that unfairness was part of its nature. The randomness of death existed for everyone. All at once, I understood. Why
not me?
I was gripped by pure, stomach-churning fear. Old age was something I had always looked forward to sharing with Bernie and my kids. Now I had to face the fact that death not only could happen in the near
future, but probably would happen as a result of the time bomb inside my chest. As we talked that day, Dr. Nagle calmly and deliberately explained the many facets of my situation. Soon the late afternoon shadows began to turn into evening twilight, and I was suddenly aware of the importance of time.
Less than a week later, Dr. Kari Vitikainen, a gifted cardiac surgeon, performed a five-hour operation in which a piece of vein was taken from my left leg and used to create a new arterial channel. The new channel literally bypassed the blocked area, allowing blood to again flow freely to my heart.
Ten days after surgery, I went home to recover, happy to be alive but very concerned about my future. Bypass had not “cured” me. Dr. Early put it in perspective: “You had heart disease the day before
surgery, you had heart disease the day after surgery, and you have it today as well. The surgery took away the pain and the threat of an imminent heart attack. But it did not remove the disease. Only a change in your lifestyle can reduce your future heart attack risk.”
This knowledge was complicated by the prediction of another doctor, a well-known lipids specialist at a national university. I saw him after the surgery for advice on how to manage my cholesterol.
"Shouldn’t I change my diet?” I asked.
“Don’t bother,” he said. “You have an aggressive form of coronary heart disease at a very early age. I’m not sure what you can do to help yourself. Frankly, I’d be surprised if you live to be forty.”
Now, for the first time, I was mad! He’s
wrong, I thought.
I’m going to find a way to beat this disease. My anger and determination became the twin foundations of a resolve to eat a better diet and live a healthier life. Finally, I had reached a point in time when I was ready to listen and learn. Once again, I turned to Dr. Nagle. “My advice is for you to focus on making healthy lifestyle changes,” he said. “You need to find a new diet pattern that meets your physical and emotional needs, fits your way of life and can be sustained for the long term. And you have to make it work in the real world. Only you and Bernie can do that.”
And so, in the midst of much confusion, we began.
The Mediterranean-Style Diet When I started to collect information, to simply figure out what to do, the connection between diet and heart health was still controversial. One cardiologist who saw the importance of diet was Dr. John Farquhar of Stanford University Medical School.
I met Dr. Farquhar at a cardiac conference where he delivered a lecture called “The American Diet May Be Hazardous to Your Health.” I had listened to a number of speakers at this conference and had yet to learn anything that helped with daily living—that answered the basic question
What can I eat today? That question was addressed in Dr. Farquhar’s discussion of the late Dr. Ancel Keys, a pioneer in cardiac research. In the early 1950s, Dr. Keys went to Italy to observe a curious dichotomy. Italians ate much more fat in their diet than Americans did, yet heart disease was virtually unheard of in their country. While Americans were feasting on steak and potatoes, white bread and butter, and whole milk, Italians ate very few animal foods and favored fruits, vegetables, whole grains, olive oil and wine. Could there be a link between diet and health?
Compelled to learn the answer, Dr. Keys instituted the Seven Countries Study, in which diet, blood cholesterol and frequency of heart attack were measured in communities in Finland, Greece, Italy, Japan, the Netherlands, the United States and Yugoslavia. In all, some 12,000 men in the 40-to-49 age range were tested and observed. The study illustrated that cultures in which saturated fat made up a significant
percentage of total caloric intake demonstrated elevated cholesterol levels and a higher incidence of coronary heart disease than cultures with a lower percentage. Thus the Finns, who ate 20% of their calories
as saturated fat, had cholesterol levels that averaged 265. The Japanese ate only 5% of their calories as saturated fat and had correspondingly lower cholesterol levels, averaging just 165. A most important point was that the heart attack rate for middle-aged Finnish men was six times greater than for Japanese men of the same age. American men in the study had a heart disease rate twice that of Italian men and four times that of Greek men. Dr. Keys’ conclusion: “Saturated fat in the diet leads to high blood cholesterol and then to heart attacks.”
As Dr. Farquhar clearly connected the dots between diet, cholesterol and heart disease, he provided a realistic vision of how to eat. His recommendation was the same as that of Dr. Keys:
a Mediterranean diet emulating the traditional eating habits of southern Europe (Italy, Spain, Portugal and southern France), parts of North Africa (especially Morocco and Tunisia), parts of Turkey and parts of the Middle East (especially Lebanon and Syria). This diet emphasizes food from plant sources, such as whole grains, fruit, vegetables, nuts and olive oil. It also includes moderate amounts of poultry and fish while restricting meat, processed foods and refined grains.
The Mediterranean approach made great sense to me on a scientific level, since heart health is not based on either eating or eliminating a single food group. Instead, the Mediterranean diet looked to a combination of healthy factors. It wasn’t just about what you
didn’t eat; it was also about what you
did eat. But while the Mediterranean diet appealed to both my brain and my taste buds, significant obstacles were in the way of its implementation. For one thing, I didn’t live in a country that would support this dietary lifestyle. Consider the contrast between a hypothetical “Mediterranean man” and an
“ American man”:
- The Mediterranean man eats whole-grain bread for breakfast, then walks to work in the fresh air. The American man grabs a doughnut (rich in added sugar, trans fat and calories) to fortify a stressful freeway commute.
- The Mediterranean man eats his main meal at midday and centers it on vegetables, whole-grain bread, cheese, yogurt, fruit and perhaps a glass of wine. After a sedentary morning in front of a computer screen, the American man makes quick work of a cheeseburger or a deli sandwich and washes it down with a soft drink.
- Both men work until six o’clock. The Mediterranean man comes home to a light meal of salad, a small bowl of pasta and fruit. Dinner with family and friends lasts 90 minutes, followed by a stroll in the piazza. The American man brings home Chinese takeout for dinner. The kids have soccer practice and his wife is working late, so he eats his dinner in 15 minutes of solitude in front of the TV set.
Bernie and I were well aware of these differences. We had lived as students in Italy, where lunch was the main meal, supper was light, fresh fruits and vegetables were in abundance, people walked everywhere and the lifestyle was neither hurried nor harried. But now we lived in the United States, where, like everyone else, we were pressed for time. On more days than not, lunch was a quick sandwich and themain meal was steak and potatoes.
Another obstacle. The Mediterranean diet included meat aboutonce a month, fish and chicken once a week or so, and milk virtuallynever. But I
liked meat and milk! If I had to restrict meat to once a month and give up milk altogether, the diet was doomed to fail. So, instead of adopting the Mediterranean diet as it was traditionally eaten, we adapted it to our way of life and food preferences. It became a
Mediterranean-style diet that took the principles of healthy Mediterranean eating and applied them to the American lifestyle. For example, I ate meat, fish and poultry more often than Mediterranean people do, but a lot less frequently than the typical American. Fatfree milk was included in my new diet, as were soy foods.
The Mediterranean-style diet was a great compromise in favor of balance, familiarity, taste and practicality. Bernie cooked meal after meal, trying new recipes and adapting old ones. She took our family
favorites and began to make them healthier without sacrificing taste.
This was neither an easy nor a quick effort. Progress was slow and measured in small increments. Trial-and-error ruled. Some meals were disasters; others were great. Some new cooking techniques worked well; others did not and had to be abandoned. But Bernie’s focus never strayed. From each bit of experience, she gleaned new information, insight and techniques. We were building the proverbial bicycle as it was being ridden, but we kept at it, knowing that the alternative—returning to our old diet—was not the answer.
Finally, progress started to take root, and a new, healthier way of eating began to take shape. Bernie’s techniques and recipes had made it possible.
The Road Back After six months, my biometric measurements—weight, cholesterol, triglycerides, blood pressure—had improved dramatically. Dr. Nagle remarked that all his cardiac patients and their families should follow what we were doing. He asked if we would put our dietary experience into a book, and that’s how the
Don’t Eat Your Heart Out Cookbook came to be.
I never planned to write books on diet and heart health. That first book and the books that followed were the product of our work to beat the odds and keep me alive. But for more than 20 years, they’ve been dietary bibles for other heart patients and for people interested in preventing heart disease. Endorsed by health professionals and used by thousands of hospitals in cardiac rehabilitation programs, they offer a blend of current science, commonsense advice, meal plans and delicious recipes that have helped millions of people eat better, lose weight, lower cholesterol and improve heart health. Two of the books, the
Don’t Eat Your Heart Out Cookbook and
Take a Load off Your Heart, have been presented by PBS as television specials.
So, why this new book? First, we know far more today about what constitutes a heart-healthy diet than we knew in the past. This is reflected in the current USDA Dietary Guidelines, which call for more
fiber-rich fruit, colorful vegetables and whole grains every day, while limiting foods with saturated fat, trans fat, salt (sodium) and added sweeteners. In addition, a number of foods have now been identified as providing health benefits beyond basic nutrition, such as playing a role in reducing the risk of heart disease. These “functional foods” are central to the balanced dietary program presented here.
Next, the American dietary lifestyle has changed over the last decade—and not necessarily for the better. Home cooking and eating together as a family have virtually disappeared. Instead, we take out, order in, open cans and microwave prepackaged meals, or just head for a restaurant to gobble down supersized servings. Life may be more stressful and move at a faster pace than in the past, but the plain fact is that we have to get back to whole foods, unprocessed and easily prepared. This book has information, tips, menus, a realistic “pick-and-choose” meal plan and over 300 recipes to help you do this efficiently
and effectively.
And finally, I’m still here, almost 30 years after bypass surgery, which should say something about the effectiveness of my balanced eating program. I haven’t been seduced by fad diets that ban entire food groups, and I don’t subscribe to one-dimensional eating: one week spareribs, the next week grapefruit. Unlike those diets, which are strong on theory but fail to produce long-term results, my program has staying power. And it works in the real world. I recently celebrated the 28th anniversary of my bypass surgery by hiking on Mount Rainier with Bernie. I’ve experienced the joy of seeing our daughter and son graduate from high school, college and graduate school; of walking our daughter down the aisle and making a toast at our son’s wedding; of celebrating 38 years of marriage; and of holding our first grandchild. None of this would have happened without the principles of healthy eating set forth in this book.
Joe Piscatella
