A Midlife Epiphany

Rajiv Misquitta

Rajiv Misquitta, MD, FACP

Nine years ago, life was going extremely well for me. I had just turned 40 and my boys were 1 and 3 years old. I was enjoying a robust medical practice and had also just been elected to the board of directors of the largest physician led group in the nation. Nutrition and lifestyle were not really on my radar. Suddenly, things took a turn for the worst. Driving to work on a cold November morning, I experienced chest pain and shortness of breath. Vivid memories of my father suffering from a heart attack at the age of 49 flashed through my mind. I stepped on the gas and somehow arrived at the parking lot of my hospital a few miles away. After steeling myself, I stumbled into the emergency room, which was two hundred yards from my car. After barely making it through the doors without fainting, I turned to my emergency medicine physician colleague and said the words you never want to hear “I think I’m having a heart attack.” I was quickly placed on a gurney and an EKG was taken. When the nurse showed me the EKG, it was clear to me that I was having a heart attack. The blood tests also confirmed my suspicion. I was rushed to the cath lab and had two stents placed in my coronaries. As I lay in the recovery room with a sandbag on my leg to stem any bleeding, I was struck with worry about what the future held for me. I had just shattered my youthful illusion of being indestructible.

On the road to recovery, I switched to the diet recommended by the American Heart Association (AHA), absent of most meat except fish and olive oil, and changed my lifestyle to include regular exercise. Four months later, I began to experience chest pain while running on a treadmill at the gym. This progressed to chest pain at rest which is also called unstable angina. I called 911 and the emergency rescue personnel rushed me to the nearest hospital. At the hospital a repeat cardiac catch revealed that my coronary disease had progressed and I would need bypass surgery. This was a horrifying thought as I had scrubbed on these procedures as a medical student. I had once again switched roles from being a physician to a patient, and I felt powerless in the wake of this terrifying disease.

After my bypass surgery, I once again embarked on the road to recovery and was determined to be even stronger than before and prevent this event from happening again. Modern medications (statins) and surgical procedures seemed at best to delay the advancement of heart disease. To me this was not acceptable. Fortunately, I stumbled upon the peer reviewed research, published by Drs. Dean Ornish and Caldwell Esselstyn, which showed intensive lifestyle changes can halt and even reverse heart disease. 1,2 I made a drastic change to my diet, following their recommendations, and gave up animal products and switched to a low fat whole-foods, plant-based diet. I also turned my attention towards finding ways of dealing with the increasing stressful demands of modern life. I found that reverting to the ancient teachings of yoga and taichi useful, and I became a yoga instructor and personal trainer. My grueling experience served as a doorway to total transformation. I lost 25 pounds following this lifestyle change and have never felt better. I also made it my mission to help others make positive changes in their lifestyle.

To help others make the transition to a healthier lifestyle, my wife and I published Healthy Heart, Healthy Planet. It provides a framework on how to switch to a low-fat, plant-based diet with simple recipes that are easy to follow. Heart disease is the leading cause of death in the United States, killing roughly 600,000 each year. The standard American diet (SAD) is composed of far too much animal protein and refined, nutrient-poor food. Furthermore, the inflated marketing budget of fast food pushes our population towards an unhealthy diet. We consume an average of 185 pounds of added sugar or sweeteners a year. That is about as much as a whole person. It is no surprise that 70% of Americans are overweight or obese. Rates of type 2 diabetes have also increased steadily, to the point where we now have 100 million Americans who are diabetic or pre-diabetic. We live in a world where calories are unavoidable and exercise is hard to come by, and this is contrary to our genetic programming.

I began to advocate a whole food plant-based diet to my patients. And for those who were able to follow it, the changes were dramatic. Their medicines were reduced and in some cases their chronic illness such as diabetes and sleep apnea were even reversed. I became a plant-based chef to better understand the infusion of taste in healthy food. I also quickly realized that just providing someone with information was not enough. Behavior change is far too complex. I introduced plant-based kickstarts to my colleagues at my medical Center and noticed tremendous results. However, to truly help my patients sustain behavior change over the long term, I realized that I would need to develop a structured pathway. I became consumed by this dilemma and teamed up with a psychologist and a program manager and began my adventure on developing a system to further study this issue. Our team has now expanded to include plant-based health educators and medical assistants. Our endeavor has evolved, and I am now a principal investigator of a clinical trial called H.A.L.T. or Health Achieved Through Lifestyle Transformation. It facilitates lifestyle transformation on patients with heart disease and diabetes. A whole foods plant-based diet is one of the interventions along with stress reduction and exercise. We are also studying food addiction, mood and outlook on life. Our preliminary results show a reduction in weight, HbA1c, cholesterol and systolic blood pressure. It is truly gratifying to witness the transformation on the lives of our patients. We have since developed a plant-based pre-diabetes program that is also beginning to show good results in its early phase. To house our fast growing collection of lifestyle programs, we developed the first department of Lifestyle Medicine at our South Sacramento Kaiser Permanente Medical Center. It straddles almost every field as the potential applications are enormous. I used the standards put out by the American College of Lifestyle Medicine as guideposts.

It has been 9 years since my cardiac event and I feel better than ever. I exercise 6 days a week and am far more engaged in life than ever before. The true epiphany for me was the realization that the foundational pillars of our health aren’t in high tech procedures or fancy drugs, but in what we eat, how much we exercise, how we deal with stress, our sleep habits, and our connection with others. As a nation, we cannot afford to continue building more hospitals, performing more surgeries and dispensing more medication. We will need to stop the rising tide of chronic illness that plagues our nation at the source, by influencing the lifestyle that is causing it with structured evidence based programs.

1 Ornish D., Scherwitz L.W., Billings J. et al., “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease.” Journal of the American Medical Association vol. 280, no. 23 (1998): 2001–2008.

2 Esselstyn C.B., Ellis S.G., Medendorp S.V. et al., “A Strategy to Arrest and Reverse Coronary Artery Disease: A 5-Year Longitudinal Study of a Single Physician’s Practice.” The Journal of Family Practice vol. 41, no. 6 (1995): 560–568.

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