The Third Annual Montefiore-Einstein Preventive Cardiology Conference.

You can easily get your own report on the conference by searching #MEPCC19 on Twitter.

  There was once again a stellar group of presenters there, starting with Dr. Ostfeld himself, who opened the conference, followed by

• Dr. Caldwell Esselstyn, Jr. on his favorite topic: why Heart disease is a paper tiger that need not exist, and if it does can be reversed with diet. I never get tired of hearing him and I had a chance to speak with him briefly.
• Dr. Philip Gordts, on a fascinating (relatively) new evolutionary theory on why red meat is such a trigger for heart disease in humans. Understanding the "why" is always helpful. See also this newspaper article Red meat triggers toxic immune reaction which causes cancer, scientists find. Bottom line: we always knew from the research of Dr. Colin Campbell that animal proteins tend to stimulate tumor growth and now this mechanism that Dr. Gordts discussed may be the evolutionary reason why our bodies reject meat - it contains a sugar which occurs in many mammals, but not humans, called Neu5Gc and the body rejects it and treats it as a foreign invader.
• Dr. Walter Willett, on achieving an optimal diet.
• Dr. Wilson Tang, on Diet, Intestinal Biota and Cardio-renal Disease Risk. This area is ever so important. The first shocker always is that it takes only three days on a #WFPB diet for your gut to stop making TMAO, which is a leading cause of CVD.
• Dr. Andrew Freeman on why 2019 is the year of the Plant-based diets.
• Dr. Michelle McMacken, who runs the Lifestyle Medicine program at Bellevue gave the Daniel and Michael Ostfeld Memorial Lecture
• Dr. Ostfeld himself presenting on the practical issues in implementing the diet in your clinical practice (Answer: leverage outsourced support mechanisms as much as possible).
• Then a series of presentations by interns who are active in the Lifestyle Medicine field, which was brilliant. Speakers were Drs. Danielle Belardo, on a Cardiac case, Sasha deJesus, again on Cardiac issues, Clark Yarber, on an outlier case of Cardiac Syndrome X, and Timothy A. Zaki on Type 2 Diabetes.

All followed by a panel discussion of questions from the public.

There's too much information that comes out of an event like this, but here are a few highlights that stood out for me:

• Esselstyn: Focusing on the green leafies for the nitrates that convert to nitric oxide in the body, which keeps your arteries limber, combined with the high ORAC value of various fruits, particularly berries, for that is what repairs cell damage. Those are just two simple concepts that makes the whole logic of the whole foods, plant-based diet understandable.
  Complete reversals, even without statins, are typically possible in three to four weeks, but certainly within 3 months. Angina usually is much reduced within 1-2 weeks. His conclusion was that he "... felt more excited about medicine today, 20 years after retiring as a surgeon," because of the increasing uptake of these new ideas in the medical field. A comment from Dr. Joel Kahn emphasized again that stents or bypass surgery only correct for the effects of heart disease, but do not heal the disease itself - only diet will.
• Dr. Walter Willett commented on the general fact that 5-10 years life extension is a reasonable expectation from changing to a whole foods, plant-based diet. He focused on the big picture of planetary health and the EAT/Lancet study. He cautioned against becoming overly simplistic about lowering medical costs, as people will live longer. So they might spend less on medical services per year, but live more years. Time will tell.
• Dr. Wilson Tang took us through the whole TMAO issue and how choline is converted to TMA by the enzymes in the intestinal tract and subsequently oxidized in the liver to result in TMAO. It is a big cause of inflammation and implicated in heart disease (CVD/CAD), type 2 diabetes (T2D), and chronic kidney disease (CKD). Evidently, the point is that a plant-based diet will stop this immediately.
• Dr. Walter Willett's take away points were that even the Economist labeled 2019 the year of the vegan and the fact that Medicare and most major insurers now cover either the Dean Ornish program or the Pritikin protocol for reversing heart disease. Equally obvious, it is still cheaper to change to a #WFPB diet now, rather than wait until you have heart disease.
• Dr. Michelle McMacken injected a dose of reality with a beautiful case history of a 42-year-old with undiagnosed T2D and an A1C at 12.7%, who was no longer a diabetic after 4 months (A1C below 6) after throwing out his metformin at 2 months in. She also cautioned that "unhealthy vegan" is as bad or worse as the SAD.

Here is a summary on YouTube by Dr. Joel Kahn.

The whole thing was brilliant as always and an enormous asset of our community in the Bronx. Meanwhile, once again no one from the Bronx officialdom was present, but Eric Adams' office was represented, even if he could not make it. Otherwise, people came from all over. At lunch, I talked with a lovely doctor from Montgomery, Al.