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Larry King Live Weekend

How to Keep Your Heart Healthy

Aired March 17, 2001 - 9:00 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

LARRY KING, HOST: Tonight, Vice President Dick Cheney has heart disease. What about you? We're taking an in-depth look at the leading cause of death and disability among Americans.

And with us, legendary entertainer Sid Caesar. He's had a cardiac bypass and takes medication for arrhythmia.

Also in Los Angeles, Dr. Dean Ornish, heart specialist and best- selling author of "Eat More, Weigh Less." In Washington, Dr. George Beller, President of the American College of Cardiology. And in New York, Dr. Wayne Isom, Chairman of the Department of Cardiothoracic Surgery, the Weill Cornell Medical Center.

An hour that could save your life, next on LARRY KING LIVE.

Good evening. A very important program tonight. The subject is heart disease and a diversified panel, to say the least.

In Los Angeles, here with us is Sid Caesar, the legendary entertainer. He's had cardiac problems, including a triple bypass in the early '90's. He's, by the way, marking the 50th anniversary of the premier of "Your Show of Shows" with three installments of the Sid Caesar collection. We'll tell you more about that later.

Also in Los Angeles is Dr. Ornish, best-selling author. His books include "Dr. Dean Ornish's Program for Reversing Heart Disease" and "Eat More, Weigh Less." He's founder, president and director of Preventative Medicine Research Institute in Northern California.

In Washington is Dr. George Beller, President of the American College of Cardiology. They're holding their annual meeting this weekend and he's chief of the cardiovascular division of the University of Virginia Health System.

And, in New York, Dr. Wayne Isom. If I may add a personal note, Dr. Isom performed quintuple bypass surgery on yours truly in 1987. He's done the same with Ted Williams and Walter Cronkite and David Letterman and with Isaac Stern. He's chairman of the department of cardiothoracic surgery at Weill Cornell Medical Center.

Dr. Beller, we keep hearing much about how big this problem is. How big is it?

GEORGE BELLER, M.D., PRESIDENT, AMERICAN COLLEGE OF CARDIOLOGY: Well, it's the number one killer of Americans in the United States today. Coronary heart disease kills more men and women than any other disease that we know of. And patients who have a heart attack, a myocardial infarction today, though, have about a 90 percent chance of surviving that heart attack, compared to, say, 35 years ago, when I was in medical school, where approximately 40 percent of patients who came to an emergency room with a heart attack died during that hospitalization.

KING: Alright. So, Dr. Ornish, based on that, what Dr. Beller is saying is, more people have heart disease. More people live longer.

DEAN ORNISH, M.D., AUTHOR, "EAT MORE, WEIGH LESS": True.

KING: Is that a contradiction in terms?

ORNISH: No. They're living longer, but they're still dying of heart disease. We tend to think of it almost as a natural cause of death, but there's really nothing natural about it.

Even if your mother, your father, your sisters, your brothers, your aunts and uncles, all died from heart disease, it doesn't mean that you need to if you're willing to make bigger changes.

KING: But you'll still have it, right?

ORNISH: You may not. You may have early disease, but it may not be to a point where it actually causes you problems if you're willing to make big enough changes in your diet and lifestyle.

KING: Dr. Isom, would you agree that you can, that you can literally change nature?

WAYNE ISOM, M.D., CHAIRMAN, DEPARTMENT OF CARDIOTHORACIC SURGERY, WEILL CORNELL MEDICAL CENTER: Well, I don't know. It's as I've said before to you, Larry, I see patients after the horse is already out of the barn, so to speak. And they should have listened to Dr. Ornish and Dr. Beller before they ever got to me. By the time they get to me, they've got a major problem.

As I said, it's better to know me socially than professionally.

KING: How much surgery do you do a year?

ISOM: Well, at our institution, at Cornell, we do about 1,500 open heart procedures a year. Around 800 or 900 are coronary bypasses and that's what we're talking about here today.

KING: And Sid Caesar, were you one of those who fell of the track, that you had to meet the likes of the surgeon?

SID CAESAR, ENTERTAINER: Oh, yes. I, my doctor was Dr. David Cannom of Good Samaritan here in California. And what happened with me was, we found we had the arrhythmia in about 1985 -- '86, and he put me on Cardizem and Quinaglute and that took care of it for about five, six, almost eight years. And then in 1993 he said let's do the bypass.

He did a triple bypass and I have, what I've done is I've changed my entire lifestyle. No fat, the only fat I have is a little olive oil to mix up with food or to cook with, and no meat...

KING: You got scared?

CAESAR: Scared? You turn left at wow.

KING: Yeah, so did I. You get scared.

CAESAR: Oh, you get very scared.

KING: So, you changed everything. You exercise, you watch what you eat...

CAESAR: Well, I always exercised.

KING: You lost a lot of weight.

CAESAR: Yes. When you -- you see, carrying that extra load around with you, that's heavy, you know. That's like carrying five leases with you.

KING: We're going to investigate this from all aspects, the patient, the doctors, the treatment, in this hour ahead as we look at heart disease in the United States.

I'm Larry King. You're watching LARRY KING WEEKEND. We'll be right back.

(BEGIN VIDEO CLIP)

KING: Dick, how you feeling?

DICK CHENEY, VICE PRESIDENT OF THE UNITED STATES: Feeling good, Larry. Back at work full time with my doctor's full approval that the procedure, as you know, is a good one when it works, and it worked very well in my case.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

KING: Were you scared, Dick, this morning?

CHENEY: No. It's one of those things where I've learned, had drummed into me, properly so, over the years, that anytime you feel something that might be cardiac-related, you go check it out. And that's good advice for everybody, but especially anybody who has had a history of coronary artery disease, as I did.

(END VIDEO CLIP) KING: Let's get into something more immediate at hand, the case of the Vice President of the United States. Dr. Beller, from what you know and have read and can surmise, how much trouble is he in?

BELLER: Well, Vice President Cheney has had four heart attacks. He's had a coronary bypass operation. He's had an angioplasty where they put a stent inside his coronary artery. And then he had what was called restenosis of that stent, where scar tissue grew back into the artery itself, in the channel of the artery, and that was dilated with a balloon.

But he seemed to be doing very well and he's made a pledge, I understand, to exercise more regularly, to reduce his fat in his diet, to lose weight and to do all of the risk reduction measures that we advise these patients to do.

So, right now it looks like he's doing remarkably well. He's benefited from the major advances in the treatment of coronary heart disease over the last 30 to 40 years. And as long as he really works hard on continuing to take care of himself and reduce that risk, to stay on his medications, to exercise regularly, to eat a heart-healthy diet, I think he could do quite well. But he's going to have to be watched very closely by his cardiologist.

KING: Dr. Ornish, should he stay on the job?

ORNISH: Oh, I think so. I mean, a lot of people think that stress causes heart attacks, and stress certainly can play a role, but as you know it's not so much what you do, but how you react to what you do.

And for people like Vice President Cheney, who seem to thrive on stress, particularly if they practice some kind of stress management techniques, they can perform their job even better without getting sick in the process when they do that.

KING: Because we can't prove that stress causes an attack, can we?

ORNISH: Stress can cause a heart attack. It can cause your arteries to constrict. It can make your blood clot faster and lodge in the arteries. But it's not so much what's out there, it's how you react to what's out there.

You can put two people in the vice president's job, one like the vice president, who thrives on it, the stress isn't going to bother him. He's actually going to do well. Someone else might be overcome by it.

KING: Dr. Isom, will he be a candidate for more surgery?

ISOM: Well, I don't know all the details and I don't know what his previous grafts looked like or what his heart looks like, except what I've read, but certainly we do repeat heart surgery on patients all the time. In fact, about 15 percent of our practice is repeat heart surgery. It may be down 10, 15 years later, some even later than that, but they can certainly still undergo surgery and a re- revascularization.

KING: You want to jump in, Dean?

ORNISH: Yeah, I think Dr....

KING: By the way, anyone can jump in as long as you don't override.

ORNISH: Dr. Isom, I think, has made an important point, which is that bypass surgery and angioplasty can be lifesaving, but if you don't also treat what caused the problem, it's a little like mopping up the floor without turning off the faucet. The problem comes back again.

What we've been able to show in our studies is that when people make bigger changes, they can stop and often reverse the progression of disease, so even if they need a bypass, hopefully that'll be the last one they ever need. You're a good example of that.

KING: I am, I guess, yes. I had angioplasty ten years later. Do you fear recurrence, Sid?

CAESAR: Not really, because I haven't felt anything. I mean, I've had it since '93, I mean, that was when I had the operation. But I've felt sensational. To me, it was a miracle, because I was getting angina and I was afraid to do this and I was afraid to do that, and now all of the sudden, when I had the operation, it was like, my God, I mean, I could breath, I wasn't afraid anymore, I mean...

KING: Same thing.

CAESAR: ... after a couple of months, it was like, I was doing full push-ups, I was doing full pull-ups, I mean, I was really working out hard.

KING: We're hearing so much, Dr. Beller, about angina and that's what sent Vice President Cheney back to George Washington University Hospital. What is angina?

BELLER: Well, angina is a sensation of chest pain or chest pressure that's felt predominantly in the center of the chest and it's a squeezing sensation that often radiates up into the throat and to the jaw and down either the left arm or both arms.

It can be brought on by physical stress, by exercise, by walking rapidly up steps. And it can be brought on by emotional stress. And it is a warning sign. And to determine the extent of the underlying coronary blockages that are causing the angina, we usually perform a stress test or a stress test on a treadmill in conjunction with another procedure called an imaging procedure. And in our institution we use a nuclear stress test where we can assess noninvasively the blood flow going to the heart. And so...

KING: Having angina doesn't mean you're going to die, does it?

BELLER: No, it does not, but it is a warning sign that you do have a significant obstruction in at least one coronary artery where more than 50 percent of the diameter of that artery is probably clogged up.

KING: It's been 14 years, and I still carry this. This is called Nitrostat, I think it's about $1.30 for the whole bottle. It's been around for years. And whenever I remember my angina, and I haven't taken one of these in 13 years, it stops the pain.

ORNISH: It does, because it dilates the vessels.

KING: It's a mini-explosion.

ORNISH: That's right. But, you know, one of the things that we learned in our studies was that when people make really big changes in their diet and lifestyle, we found a 91 percent reduction in angina within a few weeks. So, you don't have to wait years for the benefit.

KING: Sid's an example of that, right?

ORNISH: Sid's an example of that.

KING: I'm an example. I don't get pain.

ORNISH: That's right. So, listen to the pain. The problem is, 30 percent of people don't listen to the pain and by the time they get to the hospital it's too late.

Now they're clot-busting drugs that can really be lifesaving. So if you think you're having any kind of symptoms, don't, you know, just to be on the safe side, go straight to the emergency room. It's better to be safe than sorry.

KING: And how much of this is inherited?

ORNISH: Well, there's a genetic predisposition to heart disease. If your father and your mother had it at an early age, you're more likely to get it. But what that means is that you probably just need to make bigger changes in diet and lifestyle than someone who lived to be 90.

KING: Because when I had a heart attack, it was the first question they asked me.

ORNISH: Is what happened to your parents?

KING: Is your father alive and what happened to him. How did he die.

ORNISH: And what happened?

KING: He died of a heart attack at age 43.

ORNISH: That's why.

KING: We'll be right back with Sid Caesar, Dean Ornish, George Beller and Dr. Wayne Isom. Dr. Beller -- Beller is a doctor and so to is Ornish. Doctors like to be called doctor, it's part of the heritage.

CAESAR: Dr. Caesar.

KING: Dr. Caesar. You got any honorary doctorate once.

CAESAR: I'm a doctor...

KING: And I got one. Five doctors are on the show tonight.

CAESAR: Let's make it six.

KING: That's it. We'll be right back, don't go away.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

KING: We have the same heart surgeon, Dr. Wayne Isom, who has gotten famous now with all the people he's done.

UNIDENTIFIED MALE: He's an incredible man, isn't he?

KING: Yeah. Unbelievable. You feel OK? The ticker's fine?

UNIDENTIFIED MALE: Well, I felt OK immediately. I never had any repercussions from that quadruple bypass at all. As far as I know.

KING: And I know you got...

UNIDENTIFIED MALE: If I keel over tonight, it wasn't Isom's fault.

(END VIDEO CLIP)

KING: Let's go back now to Dr. Wayne Isom. Could you explain, for the layman, and a lot of people watching, indeed, a lot of people watching may be facing this in the next few days, what happens during bypass surgery? Explaining it simply.

ISOM: Well, actually you're rerouting the blood in the vessel around the blocked vessel. For example, if you try to stop up the Long Island Expressway and put five or six cars with a car wreck, you're going around that car wreck through a side road and putting a new area to drive around the Long Island Expressway.

KING: And where do you get the new road from?

ISOM: Well, there's a number of places. One, like yours, you have the artery on the backside of the breastbone called the internal mammary artery, which is probably the best because it stays open the best, and we use that to go around the blocked vessel, usually the left anterior descending, which is a very important vessel.

And then we can take veins, the saphenous veins, from the thigh, which are about the right size, and you can do without those. There's two sets of veins in the leg, lower leg, too, and we can take the superficial set out and the deep set will take over. They're about the right size.

You can also use the radial artery, one of the arteries in the arm, and you can also use some of the vessels in the arm. So, there are a number of places. We can always find, we call it a conduit. We can always find some vessel to get around the obstruction.

KING: And the blood goes in those new, in the new place, around.

ISOM: Yes.

KING: And the place that's discarded just flows out, right?

ISOM: Yeah, well, the area, the area in the heart that's obstructed can go ahead and close off. For example, in yours, your native circulation is completely closed. You have no native circulation in -- your left main is obstructed. Your right main is obstructed. I know it because I've seen them. And you're living off of all the new vessels that we've put in.

KING: I don't know if that's good or bad, to know that I'm totally obstructed.

Dr. Beller, they keep telling you it doesn't extend life, it just makes life better. Is that true?

BELLER: Well, I don't think that's -- it does extend life. We know that.

KING: It does extend life?

BELLER: Yes.

KING: They used to say it doesn't. It just makes life better.

BELLER: We know -- particularly, life is extended in people who already have had some damage to their heart muscle. So, if they have a decreased function of their heart muscle and they have, let's say, three blockages in the main three arteries, and they get successfully bypassed, it definitely prolongs their life and improves the quality of life and gets rid of the angina, like it did for you.

KING: Do you feel, Sid, had you lived better, you wouldn't have needed this?

CAESAR: Oh, sure. Because I used to eat everything. I would, you know, oh, look at that, I'll eat that. I'll eat this and I'll eat that and then I'll eat this. Look at that, I'll drink that, and I'll have this and I'll...

KING: You drank a little, did you not?

CAESAR: Oh, I drank, I ate, you know, I mean, I did whatever I wanted, but it was -- I'd go overboard right away, you know. I'll have a, yeah, I'll have one steak. No, I'll tell you what, I'll have a piece of roast beef before that, then I'll have that steak. No, let's have a lobster first, then we'll go with the roast beef, and then we'll windup with the steak and then when you bring the baked potato, because it's got to be baked, with a lot of butter and plenty of sour cream and I want the chives because they're very healthy.

KING: And we'll have a cigarette before the dessert.

CAESAR: Yeah, and then we'll smoke a nice cigar after that.

KING: That's great.

CAESAR: Oh, boy, I feel good.

ORNISH: And you put the cheeseburger on a whole wheat bun.

KING: By the way, laughter can help, and Sid Caesar's videos, the Sid Caesar Collection, are available on DVD and in the standard video form and you can get more information on it www.sidvid.com. That's www.sidvid.com. It's the Sid Caesar Collection and it's hysterical.

And we'll be back with more. Don't go away.

(COMMERCIAL BREAK)

KING: Dr. Beller, there were stories in the paper this week, I was over there last week, at George Washington University, where the doctors decided not to do a new procedure approved in November by the FDA. A radiation procedure after an angioplasty to insure that the stent stays and it doesn't clog again. What do you think of this concept? I understand there is debate in the medical paternity.

BELLER: Well, Larry, first of all, the biggest problem with the angioplasty procedure, which has really been a quite successful one, is that there is what is called restenosis, where the artery slowly closes off again with scar tissue. And studies have shown that when you put a stent in and the scar tissue grows back in the stent and then you have to have another procedure, if you put a source of radiation, like radiation therapy, right adjacent to that blood vessel, this is at the end of a tube, that you can significantly reduce that rate of what we call restenosis, from perhaps 40 to 50 percent inside that stent down to 10 to 15 percent. So, it's...

KING: What's the argument against it?

BELLER: Well, they're still early in experience using this radiation procedure. And there is some evidence that at the edges of the stent there could be some tissue growing back. But from what I've seen of the clinical trials, they're very promising and I do think this is going to be one of the ways in which the restenosis problem will be solved.

Down the road, though, there is another new technology coming forth and that is stents that are coated with certain kinds of medication. And these coated stents, when put in, can also inhibit this restenosis process. In other words, the medication on the stent diffuses into the coronary artery and inhibits the growth of that scar tissue growing back. And that's still in experimental trial right now.

KING: Dr. Isom, what do you make of the radiation idea?

ISOM: Well, I still think, you know, the experience is short there. They have not been doing it that long and Dr. Beller can correct me, but I think there's just a few five-year studies. And one of the things that worries me about that is, we operate on patients who have had significant irradiation, for example, if they've had marked irradiation for their breast cancer or for their thymoma or a lymphoma in the chest, over a period of about 15 years we'll see those patients come back and we have to operate on them because the radiation caused obstruction.

So, I think before we do this to everybody, we ought to wait and look and see how long it's going to work. For example, if you look back historically, they used to radiate young people because of their thymus enlargement and, lo and behold, 15 years later, 20 years later, those same children developed cancer of their thyroid. So, radiation is not a benign procedure.

I'm probably biased because I see the failures, I see all of those that come back. I don't see the ones that still are doing OK after the angioplasty and the stent.

KING: Let me get a break and we'll come back. By the way, Dr. Ornish always has a Website. You can go through WebMD, which is part of the CNN family, right here, and DrDeanOrnish.com as well, right Dean?

ORNISH: Yeah. Lots of free stuff.

KING: We'll be right back with more. We're only halfway through. This is LARRY KING LIVE. Don't go away.

(COMMERCIAL BREAK)

KING: We're back on this special tonight on LARRY KING WEEKEND devoted to looking at heart disease. Our guests are the legendary entertainer, a giant. He's in every entertainment Hall of Fame there is, the brilliant Sid Caesar and the Sid Caesar collection is released now on VHS and DVD and they're some of the funniest shows ever. It marks the 50th anniversary of "Your Show of Shows".

Dr. Dean Ornish is the best-selling author. His books include "Dr. Dean Ornish's Program for Reversing Heart Disease" and "Eat More, Weigh Less" and he's the founder, president and director of Preventive Medicine at Research Institute in California.

Dr. George Beller is president of the American College of Cardiology. He's in Washington. They're holding their annual meeting this weekend. He's Chief of Cardiovascular Surgery, the division, at the University of Virginia Health System.

And Dr. Wayne Isom, of the New York Hospital, now the Weill Cornell Medical Center. He's Chairman of the Department of Cardiothoracic Surgery. By the way, Wayne, on a personal note, is it more pressure when you're doing a Ted Williams?

ISOM: No, I don't think so. As I've told you before, you know, once you get in there, everybody looks the same. There's no difference what they look like on the inside.

KING: They're bringing Sid Caesar in to you, you don't say to yourself, "Sid Caesar!"

ISOM: You might beforehand, but once your open, you look the same on the inside, no matter what. You could be Russian or Japanese, you look the same.

KING: It's all the same. When you were going, the night before, isn't that the scariest?

CAESAR: Yes. I made more deals with God. I made, I will never, I will do, I will do this, I will -- and you get scared, you know, because tomorrow you may not be here.

KING: Norman Cousin said laughter helps.

CAESAR: Yes. And boy it does. I'm telling you.

KING: He used to get tapes, to look at tapes of Groucho.

CAESAR: Yes, he had...

KING: And "Your Show of Shows" he used to watch.

CAESAR: Right. That's right. And he had a disease where his joints were separating and the doctors gave up on him. And he laughed. He brought in Laurel and Hardy. He brought in Chaplin. He brought in W.C. Fields, he brought in, he brought anything. And he laughed himself well, and that's the truth.

KING: Yeah. Medically, you can't explain why attitude helps, can you? You can't explain it through medical school.

ORNISH: It's true. We don't know why it works, but we know that it works. One study came out in "The Journal of the American Medical Association" in 1993 and it looked at people who'd had a heart attack. Six months after a heart attack, those that were depressed, 18 percent were dead. Those that weren't depressed, 3 percent were dead. That's a sixfold difference in mortality.

So, we're not just talking about quality of life, we're talking about quantity of life. And depression is treatable. So these are things that we really need to pay attention to. It's not as easy to measure as cholesterol, but it's just as important.

KING: And Dr. Isom, are there new methods of the surgery? I understand that in some places some people are doing it arthroscopically, they don't have to go on the heart-lung machine. Is that true? ISOM: Yeah, what -- there's two types. There's the minimally invasive, where you do it through a small incision. And then there's the second one, the off-bypass surgery, where you don't go on the heart-lung machine.

That's not really new. Actually, Kolesov in Russia did that in the late '60's, did the first coronary bypass, off-bypass.

KING: And why wouldn't everybody do it minimally?

ISOM: Well, for one reason, you can just get to one vessel easily, possibly two, and your vision, the visualization, is not as good. The thing that you want -- I'm a little bit concerned about it, because I see a number of patients coming to me with complications. I saw three yesterday who had had the off-bypass surgery and their vessels were stenotic or they'd narrowed down. One of them had closed off. And this was a 50-year-old man who had huge vessels and should have been able to be doing all the things that you're doing. And only less than a year later, his vessels had narrowed down.

So, I don't think it's for everybody. And before I jumped on the bandwagon there, I would want a second opinion, especially if somebody told me they were going to do it off-bypass.

KING: Dr. Dean, do you believe that your methods can -- are you against bypass surgery, angioplasty? Are you an anti-person?

ORNISH: Or an uncle person.

KING: Because you are an M.D.

ORNISH: Yes, I am. And I have great respect for Dr. Isom and Dr. Beller and if I ever needed a bypass, I'd go to Dr. Isom, or an angioplasty, to Dr. Beller. They can be lifesaving in a crisis. But even when someone has that, they also need to change their lifestyle or they're going to, you know, if you're literally bypassing the problem, you're not treating the cause.

But we also found that, you know, it doesn't have to be a new drug or a new laser or something really high tech to be powerful. The simple choices that people make in their lives everyday, what they eat, how they respond to stress, whether or not they smoke, whether or not -- the quality of their relationships, these can play as powerful a role as sometimes bypass and angioplasty, at a fraction of the cost. We've found most people can avoid surgery if they're willing to make these changes.

So, if a patient of mine says, "You know, there's no way I'd be willing to make changes to that degree," I'd refer them to Dr. Isom or to Dr. Beller. But if they are, many can safely avoid it. In fact, Medicare is now paying for a demonstration project, where they're going to pay for 1,800 patients to go through the hospitals that we've trained to see if they can safely avoid surgery as well.

KING: We'll be back with more of our outstanding panel on this edition of LARRY KING WEEKEND right after this. (BEGIN VIDEO CLIP)

REGIS PHILBIN, HOST, "LIVE WITH REGIS AND KELLY": They rolled me into the emergency room, I guess the same thing happened to you.

KING: Yep.

PHILBIN: They put the camera up my groin muscle, right inside my heart, showed me where the blockage was. I saw it. He said, "Do you want to do it now or do you want to wait?" I said, "Do it now" and he did it.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: Dr. Beller, we don't want to bore people with statistics, but this part is true. In an aging population, the number of Americans 65 or older are going to double from 40 million now to 80 million in 48 years. Young people are more overweight, sedentary than ever. Epidemic of type II diabetes due to obesity and lack of physical activity. Are we going to have a lot more to worry about? Are things going to worse before they get better?

BELLER: I definitely think so. In fact, it's been estimated that there'll be a 60 percent increase in the prevalence of coronary heart disease over the next 50 years. And I really am worried, as many are, that this epidemic of obesity in this country, which is predominantly due to poor nutritious and physical inactivity. And this obesity is markedly increasing the number of cases of type II diabetes. And we're seeing diabetes now in very young people in this country.

There was a 30 percent increase in diabetes in eight years, from 1990 to '98, a 6 percent increase in diabetes just last year. And we know that 2/3 of these patients are going to die of cardiovascular disease.

So, we really have to do something to reverse this trend. We have to get people on heart-healthy diets. We have to start getting young people to have exercise as a lifelong activity that is incorporated in their daily living.

And with the elderly, as we increase the number of elderly people in the United States as the baby boomers enter their seniors, they're going to have more chronic disease and we're going to see an increase in the number of cases of heart disease in that age group, particularly congestive heart failure, hypertension and, again, coronary heart disease. So, we definitely are going to see more people with heart disease.

KING: You're battling, aren't you, the advertising industry of America which tells you enjoy those french fries?

ORNISH: That's true. You know, it's...

KING: And they do enjoy them.

ORNISH: Well, you know the old joke is, am I going to live longer or is it just going to seem longer, if I change my lifestyle and my diet. But you can eat tasty food that's delicious and beautifully presented. There's a lot of misinformation about diet. I'm actually debating Dr. Atkins next week at Dr. Beller's American College of Cardiology meeting next Tuesday. And there's so much misinformation out there, from advertising, from...

KING: Atkins says you can eat anything.

ORNISH: He says -- I mean, I'd love to be able to tell people that pork rinds and bacon and sausage are good for your heart, but they're not. You know, you can lose weight by eating fewer calories but burning more calories. Burn more calories by exercise. Eat fewer calories by either eating less food, which is hard to maintain, or eating less fat, because fat has more calories per gram. So, when you eat less fat, you're eating fewer calories without having to eat less food.

KING: Was it hard to change, Sid?

CAESAR: No. Not at all.

ORNISH: You've got some great recipes, by the way, you were telling me.

CAESAR: I told him about, you know, when I went on a diet, I said that's it, I mean, really, because when they say it's either or, I mean, you really -- I cut out all the fat. The only thing I use is olive oil...

KING: But is it boring?

CAESAR: No. You know what I do? I make the best food. I make, you know what I make for breakfast? I can make a nice tuna fish. A tuna fish, you know, drain off the oil and then just put a little olive oil and a little vinegar and just chop that up with a little bit of stuff, and put a littler garlic, a little onions, and chop it up and nice, then you got a beautiful meal. And you got no fat, except the olive oil, which is good for you.

And then, when you get used to that kind of a taste, because you have to change your taste. You have to change your taste because those nice steak fries and those steaks...

KING: You can't duplicate them.

CAESAR: You can't duplicate. Don't even try.

ORNISH: But your pallet shifts, don't you think?

CAESAR: I beg your pardon?

ORNISH: When you eat low fat, you begin to prefer low fat foods.

CAESAR: Well, it's...

KING: I can't eat whole milk. I can't drink whole milk.

ORNISH: See, that's why.

CAESAR: Just like when you're driving a car...

KING: Skim milk.

ORNISH: But at first the skim milk didn't taste good. After awhile, it taste fine.

KING: Then you get used to it.

CAESAR: When you're driving a car, I used to go, if somebody cut me off, it was like, "I'll get him. I'm going to drive over him. And then I'm going to land on him."

Now, if a guy cuts me off, I go hum, then I go, "Wait. I'm never going to see that person ever again in my life. Never. Why risk my life because of two seconds. To hell with it."

KING: Don't you think education is going to pay off, Dr. Isom?

ISOM: Yes. Sure. I think so. And I think we're seeing that to some degree. They can already recall, Dr. Beller can recall, 30 years ago, and he and I are about the same age, it think, in fact, exactly the same age. When we went to the American Heart meeting or American College of Cardiology meeting, every other seat would have a place to put a cigarette, an ashtray, and it was hard to see the slides because the smoke was coming up.

Now, then, there's no ashtrays. It evolved into smoking outside, and now then, you don't see anybody smoking outside. So, it's changed and I think you're seeing that more in society, hopefully. Otherwise, we're going to be real busy.

KING: We'll take a break and we'll be right back. Don't go away.

(COMMERCIAL BREAK)

KING: Dr. Beller, we haven't discussed pharmaceuticals. How big a part do they play in this field?

BELLER: Larry, a major part. If someone comes in with a heart attack today, they're going to be discharged, probably, on aspirin. They're going to be discharged on a beta blocker, which reduces their chance of dying from that heart attack. They're going to probably be put on a class of drugs called an ASE inhibitor, and most likely they're going to be put on a statin drug, or a drug that lowers cholesterol, but has recently been found to have other beneficial effects on the heart.

So, medications are really important, I think, in the management of patients with coronary heart disease. They've been able to show a prolonging of life when used appropriately.

KING: Many people in the, if we called it the health field, are kind of anti-taking drugs. Are you?

ORNISH: No. Drugs can be lifesaving. But many people can avoid medications if they're willing to make bigger changes in their diet and lifestyle, of course, under their doctor's supervision.

KING: But if there's no side effects from the medication, what's wrong?

ORNISH: Well, all medications have side effects, both known and unknown. What usually happens, someone goes to their doctor, they've got high cholesterol. They say try diet. They get put on a moderately fat restricted diet, 30 percent fat. They come back a month or two later, their cholesterol hasn't come down very much, and what are they told? You failed the diet, diet didn't work, now you have to take Lipitor or Zocor or other drugs for the rest of your life.

What I tell people is, OK, now you have a choice. You can either make bigger changes in your diet, and we've found a 40 percent reduction in cholesterol, just by diet alone and lifestyle, or you can go on those drugs. And many people don't even know they have that choice.

KING: You're proving that right, Sid.

CAESAR: Yeah.

KING: Do you take a lot of -- you don't take a lot of medication.

CAESAR: No, I take Coumadin and I take Cardizem. Coumadin thins your blood and Cardizem helps your heart.

KING: It's a beta blocker, right?

ORNISH: That's right. Cardizem is a calcium channel blocker, actually.

CAESAR: Yes.

ORNISH: But, again, those medications can be lifesaving. I'm not antidrug. But I think we also need to treat the cause, that's all.

KING: Dr. Isom, I've heard of some cases, I've read, some people who have had elective bypass surgery before the fact. In other words, there's very slight blockage and they want to take a preventative move, prophylactic heart surgery. Have you heard of that and would you do it?

ISOM: No, I -- it depends on how bad the blockage is. If the blockage is less than 50 percent and you put a graft in, it's got a good chance of closing. You may do more harm than good. KING: Really?

ISOM: Oh, yeah. For example, if somebody has three vessels involved, two are 90 percent and one is 40 percent, someone might say, well, go ahead and do the third one, the 40 percent one. If you do that, your graft may close and it clots off and, as I said, you do more harm than good.

Now, what you may be referring to is somewhere around 10 to 15 percent of the population have so-called silent myocardial ischemia. They don't know that they've got a heart problem. They don't have any pain. Dr. Beller has, I'm sure, has seen patients in his studies that have no symptoms at all, but when he does the radionuclide studies, the heart gets no blood supply or very little blood supply at all.

To me, those patients are probably in a little more jeopardy than the patient who has, who walks across the street and gets angina, it stops. Walks another block and gets angina and stops. They have a warning sign. But not everybody has warning signs.

KING: Yeah. Dr. Ornish?

ORNISH: Well, one of the interesting findings is that people generally think the more clogged the artery is, the greater the risk of the heart attack. But it actually may not be true.

Some people, like Dr. Valentine Fuster, and others at Mt. Sinai, think that the 40 percent blockages might actually be more dangerous than the 90 percent ones. The more severe blockage is more likely to cause angina or chest pain. But the more moderate blockages are actually more likely to cause a heart attack. Why? Because by the time you've got a 90 percent blockage, it's pretty calcified, it's stable, you've had new blood vessels, the built-in bypasses called collaterals, they grow around it.

But a 40 percent blockage is inherently unstable. And that's one of the reasons why diet and lifestyle or even cholesterol-lowering drugs, work so well to prevent heart attacks, Dr. Beller alluded to this earlier, because they stabilize the lining of the artery in those 40 percent blockages.

And when you think about it, those aren't the ones getting bypass, and yet those are the ones that it may be the most important.

KING: As we head to our final segment, when we come back I'm going to do a little bit with -- you know, they say laughter helps? I'm going to -- we did this on radio, years ago. We will ask Sid Caesar his philosophy of life and this philosophy of life, combined with all you've learned the rest of this program, may save your life. It is the philosophy of living in the now. Don't go away, we'll be right back.

(BEGIN VIDEO CLIP)

CAESAR(?): If I accept the fact that I have a bad heart, I mean, I won't sculpt, I won't paint, I won't act, I won't write, I won't do anything. I'll just sit down and be frightened. And I refuse to be frightened.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

KING: We've been talking about them. These are the new tapes you can get on DVD or video, available, the Sid Caesar Collection. And if you want to inquire about it, you can check into his Web site, www.sidvid.com.

Sid has a great philosophy of living, and I think it's important that we all pay attention to it. And you're philosophy is...

CAESAR: First, you have to ask yourself a question. What is a now?

KING: What is a now?

CAESAR: What is a now?

KING: Well, this is a now.

CAESAR: But how important is a now? How, how wonderful is a now? You know, a now goes by at the speed of light. 186,000 miles per second. Einstein said if you wanted to put the special theory of relativity into one sentence, it would be "One mans now is another mans was."

KING: You know, that's brilliant. In other words, this now...

CAESAR: This now...

KING: ... is gone.

CAESAR: ... you're never going to see again.

KING: And we'll never get it back?

CAESAR: Never get it back.

KING: So, but how can you live in it if it's gone before it comes?

CAESAR: Because you think about the going-to-be.

KING: Oh, the going-to-be philosophy.

CAESAR: Now, there is a was. The next thing that comes up after a was is your going-to-be. Otherwise, if there's going-to-be, you're was.

KING: So, what you're saying is, your living your life in the going-to-be.

CAESAR: No, I'm living my life in the now. I'm looking forward to the going-to-be. The was, was. KING: This is a now?

CAESAR: This is a now, which is gone.

KING: It just left?

CAESAR: It just left, it left immediately. As you say it, it leaves.

KING: So the now...

CAESAR: The now...

KING: ... is history.

CAESAR: But you have to live in it. You have to enjoy that now. Enjoy that now, and then if you have a bad now, you're going to have a bad was.

KING: That's right. I never thought of that.

CAESAR: You have a bad now...

KING: Then you can have a bad going-to-be.

CAESAR: No. Because if you clear it up in the was, then you can look forward to a new going-to-be.

KING: We hope we've helped you folks.

I'm sure, Dr. Beller, that has changed, maybe, your philosophy of how you might approach patients.

BELLER: I'm listening to Sid.

KING: In the now, Dr. Isom, what do you think of the idea, to live right in the now, and not when there was a was, but it's going to be a going-to-be?

ISOM: I think it's a great idea. One advantage we have in medicine is we're surrounded daily by people who are was and there's not going to be a going-to-be for them. So, it makes you appreciate every day. Every morning, you get up and appreciate it.

KING: Wait a minute. You're saying you agree with this.

ISOM: Sure.

KING: That means you understand it.

ISOM: Yeah.

KING: OK.

ISOM: Sounds logical to me.

KING: Dr. Ornish, can you bring this to your patients.

ORNISH: Absolutely. The whole...

KING: In the now.

ORNISH: The whole point of meditation is to bring you into the present moment, which is the now. Your life is a living meditation.

KING: So, in other words, what he don't know what he's talking about and I don't understand him, you men of the medical profession, this is genius to you.

ORNISH: That's genius.

KING: Live in the now.

CAESAR: Live in the now, which is gone.

ORNISH: Which is all we have.

KING: Are you optimistic in this whole field, Dr. Beller? Are we going -- are we ever going to cure heart disease?

BELLER: I'm very optimistic. I think that we're going to continue to make new discoveries. The unraveling of the human genome is going to allow us very early in life to identify people who are at risk for subsequent heart disease. They're going to be coming up with new technologies, new medications, gene therapy. And most of all, we're going to try to be very effective in preventing this disease. We're going to start with young children in schools. We're going to teach them heart-healthy diets. We're going to get them on exercise programs. We're going to stop them from smoking and we're going to do everything we can to prevent the development of this disease, but we're going to be able to detect it earlier and intervene earlier in those people that are prone to the disease.

KING: Dr. Isom, are you optimistic?

ISOM: Yeah, I agree. I give a lecture to the medical students at Cornell and in one of them I mention that I think they will be telling their grandchildren, or their grandchildren will be asking them, were they really doing surgery for this back 40 years ago? My God, I can't believe that you were, oh, resorting to cutting somebody's chest open and operating on the heart when all you had to do was X, Y and Z.

I also agree with Dr. Beller, that I think somewhere along the line, when we bring your children in to get their DPT shots, they'll get a blood sample and a look at the human genome, and maybe they should, one of them should stay away from fats completely...

KING: And you'll know that early?

ISOM: ... make a difference. Certainly.

KING: Alright. And Dr. Ornish, quickly, are you optimistic too? ORNISH: I'm very optimistic. I agree with everything that Dr. Beller and Dr. Isom just said, but I want to emphasize again...

KING: Quickly.

ORNISH: ... if you change your lifestyle sufficiently, heart disease now can be as rare as malaria.

KING: And he just said now.

CAESAR: That's now a was.

KING: And your -- that was a was.

CAESAR: It's now a was.

KING: So, remember the was, and you'll have a better going-to- be.

CAESAR: Because if you have a good was, you had a good now.

KING: Thank you very much for joining us on this edition of LARRY KING WEEKEND. Have a good heart. Good night.

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