Terry Shintani, M.D., M.P.H., J.D. here discusses ways to prevent and reverse heart disease in this presentation. He is is the author of the Eat More, Weigh Less Diet, The Hawaii Diet, and The Good Carbohydrate Revolution.
Table of Contents
I want to thank you for coming this evening. It’s a very nice crowd this evening. The topic tonight is How to Prevent and Reverse Heart Disease. Well, it’s February, so because of Valentine’s Day I guess they call this heart month. And so all the health organizations try to deal with heart disease this month. And to me every month is heart month, because heart disease as you all know is the number one killer of all Americans. Today roughly 30% of us die of coronary heart disease.
If you look at other countries, some places heart disease is almost non-existent. For example, in parts of China – in rural China where their diet is nearly all plant based, heart disease rates are, believe it or not, 1%. In parts of Africa in the rural areas, heart disease rates are about 1%. And it should let people realize that coronary heart disease is well 90% preventable. I’m here to talk to you about ways that you can prevent and even reverse heart disease even if you’ve got it.
How many of you are interested in learning how to control cholesterol with your diet? Well, that’s about everybody. How many of you interested in controlling blood pressure with diet? How about dealing with blood sugar and diet? And why do I say blood sugar? Well, it’s because diabetes is actually a risk factor for heart disease as well. How many just want to learn how to eat twice as much food and still lose weight? Isn’t that funny? It’s funny. I say that at many of my lectures and I get the same reaction.
People are interested in their health but when it comes to losing weight and looking good, they’re even more interested in that. Everybody has the same interest. And you’ll see that in some of my statistics that in this way in terms of heart disease, people all around the world are actually more similar than they are different. The reason we talk about prevention of heart disease is that of all of the diseases that plague America today, the most common ones heart disease which is the number-one cause of death in America, some cancers, diabetes which is actually rising to epidemic levels, and strokes. These are actually very preventable diseases. And so it’s really important to deal with the now rather than later.
One of the great frustrations I have is that people often come to me when it’s too late. But actually with heart disease what’s really interesting is that it’s not necessarily too late. Much of what I do is through the Hawaii Health Foundation, which is a non-profit. I donate all my royalties from the books. How many of you tried Shintani Cuisine at Zippy’s? I donate all the royalties into the non-profit so we can promote health in Hawaii of that and off the proceeds from the book the Hawaii Diet and actually all of my other books. And we’ve conducted over 700 community programs and presentation of some sort over the many years. So we’ve really tried to reach every level of Hawaii society. I’ve done lectures from elementary school to senior housing to university. Of course, I’m a professor, I am associate chair of complementary medicine at the school of medicine. So I lecture at the medical school. I’ve lectured at conferences, [molly lifest] and all the way up to the NIH trying to get people to improve their diet and help to reverse heart disease. And this is one of the books the Hawaii Diet.
Prevalence of obesity in the U.S.
I’m going to start by talking about the prevalence of obesity in the U.S. and looking at it from an epidemiological perspective. Heart disease, of course, starts in the arteries in your heart. But I want everybody to take a holistic perspective looking at the whole country. Look at what’s happening in terms of obesity in this country, because obesity is one of the more important risk factors for coronary heart disease. And this is 1985 – this is from the Center for Disease Control, which means this is the best data in the world for this kind of information. That blue represents obesity rates and the darker the blue the more obesity.
Now this is about 20 years ago. Watch what happens in 20 years. There is an epidemic happening right before eyes. They ran out of blue you can see. And now they ran out of red. And today we have 6 million kids who are overweight. Now these are 6 million kids who are in the pipeline to get heart disease when they become adults. And if you look up here, it says July 2000. I just read the statistics for this year. It’s actually 9 million now. It’s increased 50% in five years; those are statistics for 2005.
Imagine what tsunami of health problems we are in for as these kids become adults. Some people are saying that because of the high rate of obesity among the kids, they’re getting onset diabetes when they’re children. So they no longer really want to call it adult onset anymore. Not only that their diets are getting worse and worse and they’re saying that nowadays some of the parents are going to outlive the kids because of this wave of obesity that’s taking over this country. And the interesting thing is if you look down here you know what I found interesting since I mentioned tsunami, you know when I saw the tsunami refugees, they are all slim people. Did you ever notice refugees from hurricane Katrina? You know that’s this area down here, right? That’s where the rates of obesity are highest. And you know they didn’t look like refugees. They looked like they could survive quite a while without food and not have much problem. And I say that and it is funny but in the long run it’s not funny at all, because these are the people who are going to fill our hospitals with coronary heart disease, diabetes. I’m sure many of them already have diabetes and the early signs of heart disease.
But here you see that heart disease kills about a third of Americans. Cancer kills about a quarter of us. Stroke kills about 7%. Diabetes has actually risen; it’s about 3.5% now. And I mark the red bars to indicate those diseases that are diet related. And clearly heart disease and cancer and stroke and diabetes are certainly diet related diseases. And remember I said that heart disease in some parts of the world is only like 1%. So again most of these diseases are indeed preventable.
Why is America getting fat?
Well, I call this the Hawaiian paradox. In Hawaii, we have the healthiest state in the U.S. because people live the longest here. But native Hawaiians have the worst cell in the nation and as you know I spent most of my career working with native Hawaiians in YNI. And this is the national rate that I just showed you. Well this is the mortality rate for pure Hawaiians. It’s more than double for heart disease, more than double for cancer, more than double for stroke. And if you look at diabetes, the quintessential nutrition-related disease, it’s actually 588% higher in terms of mortality and this is a hard end point; it’s deaths, it’s not just incidents which may be reported or not. These are hard endpoints. And obesity among native Hawaiians is double that of the national average but these figures are rising as well. So how many of you think Hawaiians are naturally overweight? You would think so, right? I mean if you ever came out to see my patients with me in YNI, I have 300 pound patients by the dozens. I’ve had 400, 500, 600, 700, 800 pound patients. My biggest patient was 890 pounds. And you know I have a practice in town and in town I never see people that large. But out in [YNI] we have the largest concentration of native Hawaiians. It’s actually all too common.
I’ve heard people say well it’s all in the genes. How many of you have heard, well it’s all in the genes? So if it’s all in the genes, then 200 years ago when Captain Cook arrived the genes were pure. Most of the people aren’t pure Hawaiian these days. So then if it was all in the genes, then they should have been even more obese back then, right? Well let’s see if that’s true. This is Captain Cook’s artist. How many obese individuals do you see here? Well I don’t see any frankly and today the rate is here at actually 64% and this was measured on the homestead, so the people had to be half Hawaiian or more but these are all pure Hawaiians and you don’t see any. And the question is why? And the answer to that may be the answer as to how we can avoid obesity and heart disease because of course heart disease comes along with obesity. And if you don’t believe a drawing, well his photographs from a hundred years ago, this in the 1800s,you know you don’t see overweight Hawaiians. It’s really stunning.
In 1823, world traveler [Ian Stewart] said that the common people are thin, I’m talking about Hawaiian people. When’s the last time you heard of Hawaiians referred to as thin? Maybe 1823 or so I suppose, right? When I first showed this statement in YNI I would get this kind of reaction. Aren’t you shocked? I mean when I saw it myself I said “Is this for real?” I mean somebody who travel around the world, who have seen people from all countries referred to Hawaiians as thin. And I thought that everyone should realize that, because there is an important lesson. The lesson is that here’s a population who today we have so much trouble keeping them from becoming obese, when in the old days there was no trouble at all. So what’s changed? It certainly wasn’t the genes, and if anything the genes are less likely to do that.
So what changed? Well, they ate taro, which is 1% fat, which is mostly an unrefined complex carbohydrate food. It’s got lots of fiber and its calorie density is very low. And by the way Hawaiians never wasted anything. They would eat the tops too. So they actually eat lots of vegetables too. I don’t want anybody to forget that part of it because that’s actually as important. But grains were the world’s cheap foods throughout history. A starchy high-fiber low-fat staple, and of course in Europe there was some rye and wheat. In Asia, it was rice; in the Americas, it was maize or corn. This is mayan which is Central America.