Sanjay Gupta: The interesting thing is I've never had a heart attack, thank God, and before this particular heart attack, I had seen thousands of heart attacks and really never been phased.
But there was something very interesting and very particular about this heart attack, so I'll tell you the story, it's a true story. I have a friend who is a GP, he's about 50 years old and this was about five, six years ago and he was very fit, completely well, used to go to the gym, never smoked, did all the right things.
And one day he just finished at the gym and he was driving down this country road when he just felt a bit dizzy and a bit clammy and started noticing a little bit of heaviness. And because he was so astute, he immediately rang his wife up and said, "Look, I'm not going any further. I'm coming home, get an ambulance ready."
And he changed direction and went home and there was an ambulance waiting for him and he says, oh, he was in a lot of discomfort by that time and he said, "Then I remember just the voices fading away." And at that time, his heart unfortunately stopped beating because he was having a heart attack.
He was successfully resuscitated and he was taken to the local center where they found the heart attack and they put a stent in and opened up his blood vessels and thankfully, he survived. So that's great and he's still doing okay.
What was very interesting about this was that subsequently, so until this point, it felt like just a normal heart attack. Yes, he is my friend, but I'm a cardiologist, this is something that I'm used to.
There was nothing that phased me about this, but what then became interesting was that we shared common friends and all my common friends came to me and said, oh, Sanjay, you're a cardiologist, this is shocking. Can you do something? Can you test us out so that this doesn't happen to us, because we're the same age.
He had no warning, was completely fine. Can you do a test, can you do something? And I said, yeah, I'm a cardiologist, I can do it. And they said, what you going to do? And I said, well, I could do this thing called a CT scan, a cardiac CT, which is a test where you can go through a scanner and you can look at the state of the heart arteries. And they said, great, let's do it. So I said, okay, and I sent them all for this test.
And I wish I'd never done this because the results came back and when you look at the heart arteries in the population, so if you take the population, you can have these beautiful clean arteries, they're completely clean, great.
Or you could have arteries which are full of crud where there's tight narrowings and there you know that there's a problem and you do something about it. And then there are people who have a little bit of crud, not too much, but there's crud, it's not squeaky clean.
So my friend said, okay, so what do you do with these results? And I said, well, if you've got clean arteries, great, that's as good as it gets. If you've got the crud, the bad crud, then I think we need to fix it.
And they said what about if we've only got a little bit of crud, if we're in the middle? And they all turned out to have a little bit of crud, not so bad. And I said, well, then what do you do? And they said, well, what do you recommend?
And I said, well, I don't know what you do about this. You can't put stents in because there is nothing blocking anything. You can't do bypasses, because there's nothing actually ... So they said, well, is this dangerous, if it's not actually causing a blockage, is it dangerous?
And I went and did some reading and I found out that actually one of the things that happens is for the majority of people who have heart attacks, which proved to be very dangerous heart attacks, they have had no warning, it just comes out of the blue.
Those people who have very bad crud, which is actually obstructing flow will often get a warning, because they'll walk, the blood can't get through to the heart, they'll start getting discomfort and if they feel that then they'll go and say, I'll go see my GP, get checked out.
They go get checked out, someone does this, says, oh, you've got a 95% blockage, you need a bypass, and they have the bypass and then they turn around and say, the doctor saved my life. Actually, it wasn't the doctor that saved your life, it was the warning you got
Barry McDonagh: Yes.
Sanjay Gupta: You see? My friend, however, had no warning, so he can't possibly have had that situation where you would have this kind of bad narrowing. Because he had no warning, he'd been to the gym. So what did he have? And so it can't be cLean arteries, what about the bit in the middle?
Now that's a very interesting group because although there is no obstruction to blood, so you function normally, a bit can sometimes just break off. And when it breaks off the body thinks you've sustained a wound and a blood clot forms to try and cover that wound and that blood clot blocks this vessel off.
And within a minute or so, you have your heart attack. So then the question arose, so they said, okay, so you've told us this is terrible, we've got this, do something about it. What do I do about it? And I said, okay, well I'll go up and read up about it, what can you do?
The problem is there is no technology at this point in time which will tell us which bit of the crud is going to come off, so you could fix one area and it could be somewhere else. So whatever you have to do, you can't do a procedure, it has to be for the whole body, because you've got blood vessels everywhere, and even if the heart's okay, you could still have some crud in your brain, you could still have a stroke.
So I thought, okay, well, what can you do? Can you give them medication? What medications are there? Aspirin. I went and looked up aspirin and I said how effective is aspirin? Everyone takes asprin and I said, well, if you have heart disease or heart artery disease, which hasn't misbehaved, how effective is aspirin?
And I found out that you have to treat 1,667 people for a year to prevent one non-fatal heart attack. So I thought, what about statins? Statins are the other big thing, so I went up and read about that and I discovered that you would have to treat 60 people for five years to prevent one non-fatal heart attack. And over 200 people for five years to prevent one stroke.
What about a Mediterranean diet? I went and read up about that and whereas with statins you have side effects, with a Mediterranean diet you have none. You have to treat 61 people for five years on the Mediterranean diet to prevent one death, non-fatal, heart attack or stroke. So suddenly, I started realizing that actually, diet is probably far more effective than any of the medications out there. I then started looking up what are the other things that could actually cause bits to break off?
Because if you could address those things, then you could potentially prevent it, and it all comes down to this thing called inflammation, which is how disrupted the body's equilibrium is and the more disrupted the body's equilibrium is, the more inflamed you are. And the more inflamed you are, the more chance there is of things going wrong.
And what are the things that we do to cause inflammation?
Barry McDonagh: All the fun things.
Sanjay Gupta: Certainly, I think one of the biggest things is stress. Stress is hugely inflammatory and we put our bodies through so much stress and it's not surprising that when we go through that stress, things start going wrong.
Lack of sleep and we compromise on our sleep all the time and sleep is our natural remedy for inflammation, yet we compromise on our sleep. Lack of exercise. Again, exercise in moderation is a wonderful anti-inflammatory and then there's diet and in terms of diet, all the kind of stuff that is put in our food.
Our food is adulterated to that level where ... these allergies these days, where have they come from? When I was a boy, there was no such thing as allergy.
You almost wonder what is happening to the food? What is all this processing? The adulteration of food, could that be contributing in some way? And so then that made me start thinking completely differently because I started realizing that actually, those are the important things, the lifestyle is the important thing and that needs to be tackled and actually, when a person comes to me, all I would do is just give them some tablets, which have minimal benefit.
They are not really addressing this whole issue of lifestyle, the education, the connection, the talking, the empowering the patient to take charge of their health and not wait to develop a disease, but to take charge of their health before they develop a disease.
Because by far, prevention is far better than cure. Once you've developed heart disease, you don't get rid of it. So the better thing is to be educated and empowered before you develop the disease, so it never happens.
So I went back to my friends and I said, actually, the only thing I can recommend to you is live a life of moderation and try and eat healthy and get some exercise and don't compromise on your sleep and try and be happy and minimize your stress and that's the best you can do.
Barry McDonagh: Things we know but I suppose are the hard things to do, aren't they? It's not as sexy is taking the latest drug or a treatment is it?
Sanjay Gupta: Exactly. Because the problem with the latest treatment is, it is only there to mask symptoms, it doesn't sort the underlying problem out. And this is the inherent problem, so I thought, well, how do you do this, how do you get that message out there? And I thought well I don't get the time and I would be ... in some ways, people would look upon me as some kind of maverick if I started going against this. So I thought I'd reach out to people directly by doing the YouTube work and just talking to them about just feeling, the things that a doctor should give a patient, reassurance, education, empathy and that idea that you can control your quality of life, which is by far more important than anything else. And if you lead a good quality of life and a responsible quality of life, you're doing the best you can to lengthen your life as well.
Barry McDonagh: And we spoke just before about this, so you'll live better years at the end, so you've got quality years at the end, rather than just ...
Sanjay Gupta: Absolutely, because I think if I asked anyone and I see a lot of people who are in the latter stages of their life, everyone says the most important thing for me is my quality of life. It doesn't really matter how long I live, as long as they live well.
This is the sad thing, we are so worried about how long we're going to live that we forget to live well.
Barry McDonagh: That's a really important point.