Kim Williams, MD on Building an Evidence-based and Inclusive Cardiology Profession: PYP 218

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Kim Williams, MD, is past president of the American College of Cardiology (ACC).

Let's take a moment to appreciate how amazing that is.

First of all, he grew up poor and black on the South Side of Chicago. One winter he ended up in the hospital with pneumonia; his family couldn't afford to buy him a coat. His step-dad died of an intercranial hemorrhage when Kim was five years old.

Second, Dr Williams chose medical school over a promising career as a professional tennis player.

Third, he's the first and thus far only president of the ACC to “come out” as a vegan. The current chairman of cardiology at Rush University Medical Center in Chicago has been vegan himself since 2003, and now recommends a vegan diet to his patients as the first line of defense against heart disease.

I was thrilled when he agreed to be a guest on the podcast. What I didn't realize was the breadth and depth of the conversation we would have, ranging from tennis to his work in encouraging communities of color to produce cardiologists who can return to their communities to reverse and eventually prevent their epidemic of heart disease.

On the Internet, Dr Williams is best known for a meme quote: “There are two kinds of cardiologist: vegans and those who haven't read the data.” What's missing from that seeming dismissal of 99.9% of his profession is first part of his statement: “I like to joke…”

This is important because Dr Williams isn't trying to trash his colleagues. When I asked him about this, his reply was simple: “I don't want to stop until the leading cause of death among cardiologists is no longer cardiovascular disease.”

Wow. That's powerful.

And so is everything else about this brilliant, passionate, energetic, and graceful human being.

In our conversation, we covered:

  • growing up poor, black, and underserved by the medical profession
  • taking responsibility to do something about that – and starting by becoming a better student of science and math
  • becoming one of the best chess players in Illinois
  • trying out for the tennis team on a lark
  • getting into The Program in the University of Chicago (UC) for tennis, and getting admitted to UC
  • paying tuition by giving tennis lessons
  • the back injury that changed everything – possibly for the best
  • discovering the work of Ancel Keys
  • David Jenkins research on plant sterols and soluble fiber equaling statins in reducing cholesterol
  • what is nuclear medicine, and specifically nuclear cardiology
  • the crisis of underrepresented women and minorities in cardiology, and the lack of mentors and positive role models
  • the surprising “Grey's Anatomy” effect on a generation of female surgeons
  • how industry skews and misrepresents data on food and diet
  • the watering down of government-sponsored nutritional guidance
  • how to tell the difference between science and pseudo-science (hint: follow the money)
  • and much more…

Enjoy, add your voice to the conversation via the comment box below, and please share – that's how we spread our message and spread our roots.

Links

NY Times article: “Advice from a Vegan Cardiologist”

Dr Williams' professional page

Cardiology magazine profile of Dr Williams (includes amazing 1971 photo of him about to hit a backhand)

Transcript

Download the PDF transcript, or read it online

Read the full transcript here

HOWARD: This is the Plant Yourself Podcast, I'm Howard Jacobson of PlantYourself.com and the Big Change Program with Josh LaJaunie. This podcast is part of my mission to help you live a vivid and voluptuous life.

Two quick things before we get to today's interview which is amazing, you're going to love it. First I want to remind you that you can download the stop self-sabotage report at plantyourself.com/sabotage. I got some feedback back that I would like to share with you from someone who emailed me and said, "I loved this. I love how you began the report with your car story. There is just so much information to unpack and re-read. I feel very fortunate that you are so freely sharing your wealth of knowledge and excellent teaching skills with us."

I haven't gotten back to that person with permission to use their name but I feel okay just grabbing those couple of sentences because that's exactly what I was hoping people would say when they downloaded and read the Sabotage Report. Again, you can get yours at plantyourself.com/sabotage.

And the second thig is, I am so grateful to all of the people who became patrons this week. You'll hear their names at the end if you listen all the way through. And the one thing that concerns me is that I spent about four minutes at the beginning of last week's podcast talking about money and patronage, and I don't like that when other people do that on their podcast--talk about money all the time. I don't want to do it on my podcast either so I'm going to keep it really, really short. The money really does help me. Just looking at those numbers starting to increase to obtain a monthly figure that feels like I could sustain this thing over time without having to sacrifice my families' needs or sacrifice the lifestyle that I want. If you just want to help out just go to plantyourself.com and click the Patron button on the right. Everyone who subscribes gets access to the three times a month's Healthy Habit Huddles that so far have been only for the tribes of Well and for my coaching clients and students. That's all I want to say about that, because, like I said I wanted to keep it short. So let's get right to today's interview.

My guest today is Dr. Kim Williams. Recent past president of the American College of Cardiology and a vegan and a recommender of vegan diets for his patients and for the world. And when I invited Dr. Williams to be on the podcast that was kind of the limit of what I knew about him- just a real big deal in not just the plant based world but in the medical world at large and a guy that is promoting a plant based diet. Once I started researching and once we started having a conversation that was just the tip of the iceberg. This remarkable man, the things he has overcome the motivation he has brought with him and the breadth of spirit, knowledge, persistence, and passion is one of the most inspiring conversations that I've had. Dr. Williams welcome.

DR. WILLIAMS: Thank you for having me Howard.

HOWARD: You are kind of a big deal in the plant based world and in the wider world of cardiology. I would love for you to just start telling us about how you got into medicine. What was it that first peaked your interest and was able to sustain you through all of the grueling years.

DR. WILLIAMS: So it was really a compilation of things that I sort of do a lot of reflecting on the older I get that made me go into medicine. I think the first worry was when I was five and my stepdad died of an intracranial hemorrhage. I actually learned what that term meant as a five-year-old- hypertension- what that meant. I was always interested cardiovascular phenomenon.

Then, so the biggest problem with him passing away was not having a stepdad, but another part was that we were relatively impoverished which didn't stimulate me to go into any particular field. What it did mean was that I didn't always have the things I needed. One of them was a winter coat.

When I was eleven I ended up in the hospital with pneumonia. That was absolutely a real moment for me because I just got an up-close look at healthcare on the south side of Chicago. Given it was 1965, but still.

The way that I knew the medications were supposed to come at a specific time and they weren't - so I actually decided then that I was going to be a physician on the south side of Chicago and improve quality. Intestinally enough the first episode was more important than the second. I didn't end up in pediatrics but in cardiovascular with a very special interest in hypertension.

Proud to say that out American College of Cardiology Guidelines will be coming out in the next 10 weeks not the next 10 months- we have a lot to say about hypertension and hopefully we will have an impact on how that is managed from medications to lifestyle.

As it turns out that interest in hypertension would drive me to either cardiology or nephrology. I was interested in both, but you end up having to go with the kind of work that you feel like you could do no matter how tired you were. And that was cardiology. So that's how I got there, and I was very happy for the majority of my career to be on the south side of Chicago.

Now I'm on the west side. I was on the south side for over 30 years and left because of issues in terms of patient advocacy. They were making it challenging to take care of people in my neighborhood, so I had to find places where I could do that- I did that for a while in Detroit, taking care of inner city patients. A lot of pulmonary hypertension, a lot of stroke, a lot of kidney failure. You feel when you're doing that work that you're not just serving the community but the entire country.

What a lot of people don't know is the ravages of pulmonary hypertension, or the debilitation that comes with a stroke. Most people would actually prefer death to a stroke- it impacts everything their ability to work, their families. But then you've got this whole kidney failure thing which is a lot of times pre-programmed in African Americans. A lot of times it is genetic with the APOL1 gene making you much more likely to have kidney failure if you have the risk factors like diabetes and hypertension. It turns out that once you're on dialysis, everyone use to say that is kind of a death sentence after about 5 years- not true in African Americans they tolerate dialysis for a long time 15-20 years.

The interesting thing is that $86,571 per dialysis patient that's paid by Medicare because you automatically qualify for Medicare if you're on dialysis.

HOWARD: Wait, what's the number again?

DR. WILLIAMS: $86,571. Now that was three years ago last time I looked. It's probably higher now.

HOWARD: Is that an average for all time? Or per year?

DR. WILLIAMS: Per year. Per dialysis beneficiary. So just think of what good we could do if we managed hypertension better- particularly in African American patients who are going into kidney failure and going on dialysis. What a thing that would be. We would have more money for inner-city education, we'd have more money for building roads and bridges for goodness sakes. Anyway, why focus on that with plant based nutrition in mind?

As a cardiologist the majority of hypertension could be eliminated if patients paid attention to diet that have been shown to reduce or eliminate hypertension- pretty much a plant based diet. The DASH diet- DASH stands for- dietary approach to stop hypertension- has good data, it is not completely plant based but they do have randomized trials and those randomized trials show substantial improvement, decrease in the number of medications, better blood pressure control, but there is a lot of data out there that indicates that a person on completely plant based nutrition, particularly with a lot of grains and vegetable protein they could dramatically improve their blood pressure and people fall into about one of three groups, and in my practice it's about 1/3, 1/3, 1/3-mild improvement, moderate improvement, and complete elimination of the disease no more medications for high blood pressure. Now those patients are the ones who do the diet- exercise and lose the weight particularly the central weight. If you do those three things it has to make a difference.

HOWARD: There is so much that you just said in there that I would like to unpack. Now I want to go back to the beginning. It's really interesting, you experienced the loss of a stepfather to a serious medical condition, subsequent impoverishment, dealing with a medical community that wasn't serving your family, and your response was really sort of practical and like unemotional. There are so many other ways you could have response, like becoming a radical, becoming a community organizer like Barack Obama in Chicago. What were you thinking when you entered the system and had all these problems- and just had practically contribute-roll up my sleeves and contribute as oppose to what I could imagine myself in those situations just wanting to tear things down.

DR. WILLIAMS: That's interesting. I think you're right I have to admit that I wasn't much of a student back in primary school. It was that episode that made me a little more focused on academics then it took another year or so but once I grew up a little bit and realized that there is a relationship between my ability to help people and it wasn't just me- those were wars. I think mine was relatively private I think there were 4 kids in the room and I just felt bad for those kids. I think most people when they see people suffering just want to reach out and help.

To the extent that I had a talent with medicine and science and the language of science and math it was kind of like my responsibility to go in there and do something. But I hear what you're saying. Everyone has their own skill set- if they were a person of words they would probably want to write a newspaper article about it. I know what you mean but for me math and science were the ways in which I could communicate with the world.

HOWARD: And were you clear at that point, around age 11, that you wanted to go into medicine?

DR. WILLIAMS: Yeah- that was the one experience that really solidified it. Like I said, it might have taken another year and a half or so before I got the pieces. That's one of the problems were' facing now, I'm going to digress a little bit, that we still have a crisis in terms of workforce- we don't have enough women in cardiology yet, we don't have enough under-represented minorities.

One of the issues with underrepresented minorities, particularly African American men, is that they don't have a mentor that could say If I could have just, you know, a mentor that could say, "OK, I decided I want to go into medicine what should I do?" Than it wouldn't have taken me a year and a half to figure out that I need to get good grades to get into college and then get into medical school. That took a little while.

HOWARD: Did you meet and know doctors that sort of looked like you? Or were from your neighborhood?

DR. WILLIAMS: No. That's really my point - there were some. I just didn't see them. They didn't live in my neighborhoods. I say neighborhoods. We were poor enough that we moved every year. We use to laugh at the fact that I went to 8 different primary schools. I use to coach tennis for the Chicago park district - I know every neighborhood on the South side of Chicago. It's actually an advantage now but it didn't seem so much like it back then.

HOWARD: Did you get encouragement from other community members, teachers, your family, your mom, like, you know this is a path that we think you can succeed on? If there weren't other trail blazers.

DR. WILLIAMS: No- I think most of my family thought I would follow my grandfather into the ministry and be a southern Baptist preacher. In my high school there were a couple of teachers that were not encouraging- my own particular advisor said, "I don't know how you can do this, it's very difficult from inner-city schools." He didn't say it exactly in that way but, you know, he was saying don't apply to the University of Chicago, you'll never get in.

I just ignored him and applied anyway and did get in. You're pointing out a real deficit in some places that the guidance counselors and the lack for really good role models we're talking about having more representative physicians give back to their community and let people know that yeah they too can do this. It's interesting that having role models really does work. And this is my own personal theory, but I was talking about women in cardiology being underrepresented, about half of our internal residents are women, but only about 20% are in cardiology.

Part of it is lifestyle and part of it is role modeling, but they can't say that cardiology is just too busy because women want to have a family. First of all, that's not true you certainly can. But when you look at general surgery, that's a big change- that's a 50:50. That's my own personal theory- it's like Grey's Anatomy, season 12 or season 13, these young women that are applying to general surgery have grown up having role models on television having African American, Hispanic, and Caucasian women who were all living their lives as surgeons and having a great time. I think we need more buy in.

I'd love to say that the American College of Cardiology is working on this we have a task force specifically to try and improve the disparities in who does cardiology and also the American Medical Association has a specific program called Doctors Back to School where doctors will go back to the community and back to the schools and talk to physician minded kids. What I would like to see happen would be a bigger intervention aimed at African American Kids. One of the students at one of them, Hampton Institute, told me that no one comes by and talks about this type of thing but there are people who have already gone on to college and probably do have some competencies in the medical science let's just give them some direction. So we're just going to keep after it because we know that if we have more African Americans, Hispanic particularly, it will improve our healthcare system.

HOWARD: That's so interesting about Grey's Anatomy having that effect. One of my favorite books is called The Talent Code -it's sort of looking at hot beds of talent and there is this one Dominican Baseball star who makes it to the major leagues and a few years after that there was an explosion of Dominican talent. A similar think with Ana Kournikova in Russia and the ten years after she won a title. This Russian girl's academy like dominated tennis for a while.

DR. WILLIAMS: Absolutely, and the other great thing- since you mentioned tennis- is in the Czech Republic. In the Czech Republic it started out with Martina, although she's American now, but then it was Helena Sukova and then all of a sudden young girls in the Czech Republic had to train and saw this as a way that they could literally just work their behinds off- just work so hard that they could get out of poverty. So if you're playing Fed Cup- The Federations Cup, and it's the USA versus the Czech Republic, they could come in with their C Team and they have so many wonderful players- so you're absolutely right you get just a couple people that say, yes this can be done and this is the pathway to success, and it can impact an entire group.

HOWARD: So at the same time as you're pursuing a career that was not traditionally available to African Americans from the inner-city you were also pursuing a sport-I think like Author Ashe and the Davis Cup team won for the first time in 1963 when you would have been like 8 years old.

DR. WILLIAMS: Right.

HOWARD: You chose tennis. I find that really interesting as well. You're like a double trail blazer.

DR. WILLIAMS: That was really a lot of interesting happen stance that formed my career in several ways. It's one thing to talk about stuff that happened a long time ago but if it gives hope to anybody to hear a funny crazy story I was actually a chess player. And I was one of the best chess players in the state at Chadian High School on the South side of Chicago that had not been known for quality chess. It was usually something reserved for the bigger schools. Usually Caucasian schools, not the inner city schools.

Turns out that we worked our way up to pretty much the top of the ladder in the Chicago public school system and qualified for State's, we were doing really well, and one day my whole chess team said that Chadian High School was starting a tennis team and they were all going to go out. So I just went out to be with the guys until the season was over. It had nothing to do with really wanting to be a tennis player.

But again like with the cardiology thing, the coach gave me a couple of things: here's how you hit a backhand, here's how you hit a forehand, you know, worked on it on my own and next thing you know I was playing number three singles and I had never played the sport before. So then it got interesting. The University of Chicago has actually had a long running program, called, believe it or not, The Program, where they seek out African American kid and try to help them both academically and athletically. They draw them in with the athletics and they put on a sports program in the morning and then in the afternoon you work on whatever academic issues you had: math, science. Absolutely a broad range.

And this is totally supported a little bit by NCAA a little bit by a few charities, but most of the bill is borne by the University of Chicago and it is serves by their facilitates. So if you ever go on campus in the summer and see the kids in the maroon t-shirts and they're African American and from the inner-city those are the kids that are served by The Program. It turns out that one of the kids from another inner city team that we played told us about The Program.

And I actually didn't have a plan other than playing chess that summer so I actually went over there to see if I could learn some tennis and there I was on the court with 60 other inner city kids and the guy that was giving this fantastically large group lesson, turns out he was an admissions officer for the University of Chicago and he was the varsity tennis coach. Unbelievable- he only taught it that one year and I had talked to him my first day about wanting to go to the University of Chicago and, undenounced to me, he had set up an interview, but he just told me to go to this building and talk to this guy. I didn't realize that that was my college interview and there I was in my tennis clothes.

And it turns out that I actually did get into the University of Chicago and he did become my tennis coach. He actually was such a good player that even at an older age we actually played pro events together. Doubles partners after I grew up in the sport. The next part of it that makes it sort of improbable is that I really was kind of poor, I didn't have a lot of resources and I didn't have a lot of help and getting good at tennis meant I could give lessons. I could pay my tuition, everyone was taking about how they came out of school with a lot of debt and I was almost debt free because of tennis. I owe tennis my medical career, pretty much and a lot to the University of Chicago and that program.

HOWARD: So do you have like ninja time management skills? My friends who are doctors - I remember when they were going through med school they barely had time to brush their teeth.

DR. WILLIAMS: It's interesting that you say that because, still, this is not a live interview so I can't strip for you, but I always wear tennis clothes under my clothes. A. Tennis might break out, and really I'm just use to it. I use to go from the Ward when there was a break for an hour and a half, schedule a tennis lesson, go the Lake Middleton Club in Chicago and teach the lesson, speed on back, finish work, study. I kept interdigitating tennis and medicine like that really for a very long time.

They did sort of unfortunately become at cross roads in the summer of 1976 at Loggerheads at the qualifier for the U.S. Open. I was beating the number one seed and I knew that if I won that tournament I was going to go to the U.S. Open and I was going to miss part of medical school which meant, you know, if you miss a week you're done for the quarter and if you miss a quarter you're done for the year. The really good thing is that up in the second set I hurt my back.

I finished the match but I really couldn't play and I got paired with a pretty brainy guy, he figured out that I couldn't move to my left, hit one to my right and the move to the left, and next thing you know I was back on my way to Chicago and went bac to medical school and never looked back. I still think about that, never had another back injury, and you know, would I have really given up one year of interacting with patients, teaching students, influencing medical care so that I could have played professional tennis and I think the answer is no pretty resoundingly.

I'm pretty glad I had that tweak, it took me six weeks to get over and then stop being a problem, but any thought to not go back to medical school and delaying it for tennis, which is what my coach was telling me to do, "you have to do it, you gotta do it, you have to try", that went away.

HOWARD: Some inner wisdom said let's tweak the back because we know this is the preferred path.

DR. WILLIAMS: I think so.

HOWARD: So you went to med school. You decided on cardiology, and I'm guessing for a certain number of years you were what we would call a traditional cardiologist.

DR. WILLIAMS: Uh-huh. Traditional in the way that my specialty was not--

HOWARD: Not a crazy plant-based guy I mean.

DR. WILLIAMS: Exactly, I was interested in diet for a long time. My mom, had-- even though we were fairly poor, the idea that the way to get out of being poor was to go to school. So, when I was in college she was in grad school. It must have been some time when I was 8th grade or 8th grade she was in the junior college and someone told her about some of the stuff that high cholesterol causes heart disease and red meat causes colon cancer. So she was actually, in late 60s, well that turned out to be true so she had tried to make us vegetarians and I went along with it until I was married. I was a vegetarian until I got married in 81.

In marital negotiations changed it to pesco-vegetarian and some chicken not knowing- because so few patients get nutrition counseling- not knowing that that was a low fat diet not a low cholesterol diet. Therefore, it was not healthy for someone who happens to have the genes to develop high cholesterol which I found out that I had.

Now whatever that had, as time went on I got older, I had an LDL cholesterol- the dangerous stuff, the bad cholesterol I had gotten it up to 170 back at a time when 110 would have been considered good and above 160 meant you needed to be on a statin drug. Once I found that out, before starting the drug, I just started fasting that day and repeated it and still the same, but then I happened to see a publication by David Jenkins on a vegan diet.

This was happening at a time when I had been primed to be interested in diet because a patient in my lab had had a marked improvement on her scan on the Ornish diet, so I was thinking about this diet stuff anyway, and then saw this article in the Journal of Medical Associations that they published David Jenkins study on, you know, plant sterols, almonds, soluble fiber, and vegetable fiber as a way to lower cholesterol and it did it very successfully. It did it equal to a statin.

So instead of grabbing a pill I grabbed a diet and six weeks later my cholesterol was almost normal- it had fallen in half. So I've been with it ever since- again, following the data and feeling like I really should have known that- like I should have been counseling my patients the whole time. It's not just about colon cancer it's not just about obesity. Cholesterol is going to plug up your arteries, it's the leading cause of death in the united states since 1980- continues to be, in fact it's growing again in terms of cost and mortality.

HOAWRD: When you say that you're talking about cardiovascular disease?

DR. WILLIAMS: Yes, and I'm not sure everybody heard that. I'm talking about the CDC, if they google it they can see that the CDC came out with the latest numbers- 2014, it's blanking in my brain- sorry, 215.1 per 100,000 die of cardiovascular disease. In 2015 that went up to 218.5. And what is so remarkable about it is that that was the first time in 40 years that there has been an increase in cardiovascular deaths in the United States.

HOWARD: And that number is age adjusted per 100,000?

DR. WILLIAMS: Yes, yes indeed. So why is it? Why is that? The CDC is blaming it on diabetes and obesity. If that really is true that diet. The diabetes epidemic, the obesity epidemic yeah it has a lot to do with the sedentary lifestyle we have but it is calorie overload. And the very principles that you here from these plant based physicians like, "the fat you eat is the fat you wear" and the one that I added, after a few key publications in 2016, was, "the sugar you eat is the fat you wear". We've got to do something about it, we have to continue preaching about it until people realize that they can control their own density- how long they live, and the enjoyment of their life is really dependent on their lifestyle and their habits.

HOWARD: So, I read the piece you published in Med Page Today on Cardio Buzz which II guess was, just before you became the president of the American College of Cardiology and the thing that really hit me was that you talked to this patient about her improvements on the Ornish plan.

DR. WILLIAMS: Yes.

HOWARD: And you took it seriously. And I have so many stories of clients of mine and just you know casual conversation about someone who had adopted a plant based diet, got better, reversed everything and their doctor basically said," oh wow, that's great" and the patient was sort of waiting for the doctor to say, "what did you do, what can I learn from this?" The doctor never said it so the patients would then say, "so do you want to know how I did it?" and the doctor would say "nah, not really". Like, what was it-- just that you yourself were worried about your cholesterol. What do you think made you take a different path and take an interest and say, "wow there is something here that I have to learn from?"

DR. WILLIAMS: Part of it is that my interest in nuclear cardiology and every detail of that- there was a great conversation with the lady because we were really good data collectors. I have a recording system that is unique and it has every detail that you could ever want. To see a scan dramatically improve like that, which I had seen before after multi-vessel angioplasty or four vessel bypass surgery- I had seen improvements but there was no such claim that any procedure had been done to this patient. So I had to call her and find out what happened. It really was diet and exercise. Yeah, that was going to stick in my brain-those pictures are instilled in my brain right now. Dramatically improving so much.

]So yes, the fact that I was a nuclear cardiologist and could actually see what was happening to blood flow in the heart was actually very helpful and in fact Dean Ornish had published it- this was not unique. He actually published it not with the rudimentary usual kind of cameras that we use in nuclear but the fancy ones, the PET scanners the one that are really expensive. He published- they're very accurate there is no question about the changes that you can actually quantify really carefully measure the percent change in blood flow. He actually has shown that in as little as three months' dramatic improvements before you have much for the artery to open up- so why does it work?

Probably because the small lining of the artery, the endothelial cells they are an alive active organism that Dr. Esselstyn always talks about you're just trashing them with oils. You go on an Esselstyn diet or an Ornish diet and you are going to improve the function the linings of those blood vessels and they're going to carry more flow. Soo it was really all circulating in my head when I found out that I had a high cholesterol, and yeah, changing the diet could fix that as well.

HOWARD: So for people who don't know what a nuclear cardiologist is. Possibly including myself Can you explain?

DR. WILLIAMS: Sure. Yeah, two words that don't go together- nuclear and medicine. Nuclear medicine really came about WWII after the bomb. If you have decay of uranium or polonium in any kind of nuclear reactor you get a lot of junk- and one of those pieces of junk was a compound technetium- another one that you can make is thallium. Things that relatively low amounts of radioactivity - radiation burden if you inject them into a patient and they have specific properties.

Thalium was the one, the first one that became very famous because thallium scanning could detect whether or not there was a problem with blood flow- you inject it in the vein and the coronary arteries will bring it to the heart, or not, based on how good the blood flow is and the heart takes it up the heart thinks that it is potassium, so it is supposed to be in high concentration in every cell .That that I just described with thallium and the heart is reproduced for a variety of nuclear tracers and nuclear compounds all over the body. So there is thyroid scans, brains scans sort of went away when CAT scans went out, bone scans are still done very heavily and there are scans for infection and scans for cancer. Nuclear medicine is actually mostly about diagnosis. There is a small portion of it still where you do nuclear medicine treatments to try and improve someone's like bone pain, for example. Or, look at their and try to improve their thyroid when it is overactive by giving them radioactive iodine.

But most of what you do with nuclear medicine is diagnosis. Nuclear cardiology got to be the very largest part of nuclear medicine, and probably still is -- and 50% of them are heart studies just because it became a really good way of telling what a patient's risk is. Almost everybody has it in the United States who eats animal products has some degree of coronary artery disease. Having a couple tiny plaques with perfectly normally flow you've got a good outcome. If your flow is limited, a little, not so good outcome. You can actually do sort of a stair step or increasing risk with increasing abnormality when you look at a scan of the heart done with stress and compare it to a resting heart. So that is basically it in a nutshell. We try to tell, you know, people who is it that needs an angioplasty or bypass surgery- you determine that by doing a nuclear stress test.

HOWARD: Gotha. And you're looking at the heart itself as opposed to Dr. Esselstyne's pictures of the coronary arteries. IS that a different type of diagnosis that he wrote about in Prevent and Reverse Heart Disease?

DR. WILLIAMS: Yes, very different. Dean Ornish wrote about both- angiogram and nuclear so called PET scans. So the one that we are doing is not invasive, the one that Dr. Esselstyn did you actually have to go in through the artery, into the artery from an artery that is a test to run a tube in there, shoot dye-that sort of thing. We actually can do a pretty good job of simulating that now a days with a CAT scanner. And if you do the dosages appropriately you can get very nice angiograms of the heart non-invasively.

But to make it sort of simple, the angiogram is a road map it is an anatomic road map- you know, 40% narrowing here-80% narrowing there. But the nuclear tells you what the flow is like. How good is that flow functioning? Sometimes there is like 40% blocking the flow, and sometimes it is an 80% narrowing with normal flow and you need to treat the ones that have the abnormalities- not the ones that just look like they are bad.

HOWARD: Gotcha. So, there is a meme that I see on my Facebook feed at least twice a week. It's got your picture and a quote that says "There are two kinds of cardiologists, Vegans and those who haven't read the data."

DR. WILLIAMS: Uh huh.

HOWARD: And, yet when you published your piece you got a lot of pushback from people who have read some data and it seems like over the last five years there has really been a pushback against the idea that cholesterol has anything to do with heart disease with health- that bacon diets and high fat diets are the way to go, or high protein low carb are the best thing and I know lots of people who are on them and who appear to be losing weight. What is your assessment of where the evidence is in terms of what can we say for sure- what have you seen in the last few years that is the most convincing? It is so confusing for lots of people

DR. WILLIAMS: Let me deal with that second, Howard. The first thing is I kind of wish people would stop spinning that around. I said it, and I actually said, "I like to joke that" and they took that off, okay?

HOWARD: Oh, oops!

DR. WILLIAMS: But having, you know if you say something out loud sometimes you have to own it. What has happened over the years is that I have had a number of cardiologists initially sa, "Oh, how could anyone say something so-you know, trash all of his colleagues" but I have also had people who are in cardiology read the data and became vegan, and so I'm kind of glad I said it, and I do want to explain to you what I meant by that. But I have to admit that I am really, I don't want to stop what I'm doing until the leading cause of death in cardiologists is no longer heart disease.

HOWARD: Huh- so you said that very specifically, it almost slipped behind me-- that cardiologists die of heart disease, CVD disease more than any other cause.

DR. WILLIAMS: Absolutely! They're Americans on an American diet most of them. I want to save lives, I'm tired of my colleagues dying, one about six weeks ago in Indianapolis and then I won't say his name without asking his family for permission. We get a report that he drove off the highway off the road across the strip and landed into a house. It turns out he had a sudden cardiac arrest. You know? When are we going to stop?

We manage the disease so well in everyone else and the new succumb to it. So Anyway, back to the quote- what I was really talking about when I was joking about that I was talking about the fact that we keep publishing and switching hats to the vegan community, keep publishing studies in the American Journal of Clinical Nutrition.

Why not in the Journal of Cardiology or the American Journal of Cardiology where you have a vegan editor? Why not make sure that all of the data is getting in front of the cardiologists so that it goes against the researchers not the cardiologists. Now the fact of the matter is that since I said that some inroads, I did become president of ACC, we do have some ability to affect how the College gets things done. We were able to set up a nutrition subcommittee of prevention council- that nutrition subcommittee has Andy Friedman who is an amazing vegan cardiologist and a wide variety of folks Dean Ornish, Caldwell Esselstyn, wonderful, wonderful people who all have different points of view.

We have Mediterranean people we have Mediterranean diet people- we have a paleo person- we have a variety of folks with a variety of points of views but ultimately we can get together and write a review article that goes into JCC where the cardiologists will come out of that if they read it they are going to come out of it with more information about nutrition probably than they got in their entire career because it's the minimum for most of us. The pitch really is about education and research and doing it within cardiology where it can have the most impact.

HOWARD: So it goes. You had more to say?

Oh no, I just wanted to go back to your second point which is where are we? How much have we done? What and how do we deal with this TIME Magazine saying butter is in and all of these issues- well, the issue really is that we have to be very careful of separating science from pseudoscience and I am saying a very strong word again. The pseudoscience is a problem when there are conflicts of interest and particularly relationships with industry that influence the outcome.

Where do I even start?

I'll just give you two quick stories. Number one is we woke up to it back in February of 2015 to the recommendations from the dietary advisory group that were supposed to make the recommendations for reports that then become the dietary guidelines for the United States for the next five years- and it said some fantastic things. We had learned so much! Oh, did you know coffee isn't bad for you. Huge study, three cups of coffee lowers risk of heart attack and stroke. OKAY, I'll try to do coffee, I hate the taste of the stuff, but I'll try it anyway.

Whatever- you know. If there is really a good scientific basis behind it. They said that people should eliminate or minimize red meat. They said that sugar was a problem they said that Americans eat too much protein. This was going on and on and in such a positive way and then there was a little bit of a problem They said, "oh and by the way the previous 5-year guidelines said that we should limit cholesterol to 300 mg/day. We are now removing the 300mg limit because the American College of Cardiology says that cholesterol is no longer a nutrient of concern for consumption. I'm saying, wait a minute, I read our guidelines. I approved our guidelines! The vice president is on the board of trustees.

I don't remember this statement at all. So, they referenced us incorrectly and they referenced an analysis of compilation studies that looked at eggs and said that eggs were perfectly safe if you compared all of the data of 0-1 per week versus 7+ a week. That those two groups have the same cardiovascular outcome. Well, I had to see that. So I pulled that article and believe it or not, that's not what it said either! It actually said that there was no difference in cardiovascular outcome, but if you-over the short term, but you increase your rate of diabetes 42% short term. Short being 5-16 years by the way- we would hope that their patients live more than 5-16 years. If you were diabetic, you increase your cardiovascular mortality rate by 69%.

That is not a negative study! You don't use that as the basis for saying don't worry about how much cholesterol or how many eggs you're eating. So we galvanized our nutrition committee to start writing editorials about it, we published a couple from Rush University. We really went on all fronts, all available mechanisms, to try and influence this. We had already developed, because of our population health foray at the American College of Cardiology, we had relationships with the White House and the USDA, HHS, we rang all their phone numbers we got meetings together. It took a little research that there are members of that writing group who were paid by the Egg Board.

That's an unfortunate kind of reality. That reality came through very loud and clear- there was a lot of lobbying about that document a lot of the wonderful things that were in the initial document, not eating red meat- that sort of stuff got changed they ended up watering down a bit the recommendations about foods and they kind of stuck to the nutrients. Well, people don't eat nutrients they eat foods! So, then it became more of a problematic document- however, we did win after showing them the Institute of Medicine report from 2001 that, and they actually quoted it, "people should eat as little cholesterol as possible." So they are removing the 300mg limit, but for completely opposite reasons than they claim. It is because you shouldn't eat any!

If anybody knows their nutrition at all they know that there are only three animal products that don't have cholesterol that would be like egg whites, gelatin, and honey. That essentially means people are going to be vegetarian and preferably vegan in red to avoid eating cholesterol. So, anyway- we kind of won- but we didn't necessarily win because the first one about eliminating any concern about eating cholesterol hit the news and there was no retraction even though we got that changed completely. The other example that I would mention because I think it is so important was sort of the beginning of all of this- so we got to see that the red meat folks could do and what the egg board could do to influence the document to influence public policy we know that we know that this started really, really 5 decades ago.

This got published in the Journal of American Medical Association last summer it was an unfortunate discovery at an Ivy League University that the department of nutrition chair had systematically got on a campaign to remove sugar at the beheads of hand payments that were recorded from the newly founded Sugar Research Foundation to point the cardiovascular disease cause away from sugar and towards saturated fat. We all grew up even as vegans thinking, avoid saturated fat, you're going to get it from animals so that's bad- but sugar is okay because it comes from a plant.

But sugar, if you look at it very closely, I had actually seen a couple of publications that came out one in the Journal of American Medical Association, one in the American Journal of Clinical Nutrition talking about outcomes in sugar intake and the outcomes being bad, but no one knew that there had been 5 decades of suppression of this information and sort of twisting where the research would go and get published.

We do have a problem with what you're asking. Where is the data? Where are we? We are in, basically, sort of, dare I say a food fight? I mean this really is a major issue because what we are asking people to do goes against a lot of strong industries. Everyone says things like, if you were to eliminate all animal products that our greenhouse would go away. That we could solve world hunger by feeding US grain to all of the needy countries.

Well it would also eliminate a lot of jobs and upset a lot of people whose lifestyle has been that way- so I don't know that I have one of those global answers. It would be great if everyone on the plant would eat like me and we could take all of our cardiologists and turn them into infectious disease people or something like that because that is what would happen if everyone would be vegan we would have very little need in this country for cardiology.

So I can't answer all the questions but we can try to address them and we can certainly address them as individuals, and wouldn't it be nice if we could do it before we develop the heart attacks, strokes, instead of getting motivated after the fact.

HOWARD: Right. And I remember reading about some of that sugar stuff and it felt like I was disloyal to my team to kind of acknowledge and write about it. This was Mark Kegston.

DR. WILLIAMS: No, if you do a - I don't know the name I can google I really quick-it's in the Journal of American Medical Association. I think it came out in October so it should be pretty easy to find - I'm trying to think. Pretty close to-I have it on slides-but it is easier to find it on- I think.

HOWARD: I'm looking here at JAMA network, the Sugar Industry.

Yeah, Sugar- yup. Yes, this is September. I did it, at the end of September 12. So Kristin Kern- that's the name I was looking for. Kristin Kern. There was, and the company had an editorial, specifically about what I just mentioned that is food industry funding of nutrition research. I've used that graphic now. Go ahead.

HOWARD: When I first heard about this I read it in the New York Times, Mark Hegstead, became the head of nutrition at the USDA and he is quoted twice, or mentioned twice, in the China Study. I think he is mentioned in WHOLE, the book that I worked on with Colin Campbell, and it felt like I had this urge to suppress this. Like, no sugar- like it was set up like either sugar or saturated fat had to be the enemy and it is very refreshing to hear you say that sugar is also bad. Because it was like- you know- Esselstyn or Lustig. It is either Taubes or Campbell- like, we have to choose sides and we are no longer allowed to just look at evidence, even evidence that maybe contradicts what our team thinks. You know what I'm saying?

DR. WILLIAMS: Right-so, yes indeed. I'm glad that you at least, you know, that you're bringing attention to this it is really an important issue and I think it is something that we are all going to have to deal with. One of these days we are going to have a good dissociation between nutrition research and nutrition- and the relevant industries but it is not going to be easy to get there. That was just my administrative assessment- I'm now supposed to be in another place at 3:00pm.

HOWARD: Okay! Okay. Well, we better let you get there.

DR. WILLIAMS: I'm sorry it has been a great time talking to you. Hopefully people will be able to keep looking for more and more research- hopefully more cardiology publications and hopefully free up the shackles of industry.

HOWARD: Right on. Well thank you for your work and thank you for your time and get to your next appointment We will connect via email for closing. I really appreciate all that you're doing and you're an inspiration on so many levels. Thanks so much!

DR. WILLIAMS: Absolutely. All right, take care now.

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