LOOKING BACK, I WISH I COULD SAY my commitment to healthy eating was the result of native intelligence. But that wouldn’t be true. It was born purely out of need. For the first 32 years of my life, healthy eating had taken a backseat to other, seemingly more important issues. Besides, I’d always been in good health. Sure, there were things that could be improved. At around 250, my cholesterol was certainly high, but in the mid-1970s many doctors considered that level to be “average” and not a cause for alarm. And I could stand to lose a few pounds. There would be plenty of time, I thought, to improve my diet and my health in the future.

Then, in July 1977, I found out how wrong I had been. For the second time in a week, I was sitting in the office of Dr. John Nagle, a prominent cardiologist in Tacoma, Washington. I’d gone to see my family physician, Dr. James Early, five days earlier because I’d been experiencing shortness of breath and a low-grade but nagging chest pain as I warmed up to play tennis. The pain was dull, more like a feeling of fullness, and it would usually disappear by the end of the warm-up. But one day it stayed with me through two hours of play, so I called Dr. Early. “I’ve got a problem in my lungs, probably a touch
of bronchitis,” I told him. He asked me to come in right away. I had seen him just four months earlier for my annual physical, and the results were excellent, so I wasn’t expecting anything more than a quick visit and perhaps a prescription.

This time, however, my electrocardiogram indicated an obstruction of a coronary artery.

Dr. Early said there was no evidence of a heart attack, but he wanted me to see a cardiologist that same afternoon. Three hours later, I found myself undergoing a thorough cardiac examination with
Dr. Nagle. I was given an exercise stress test, which indicated that the cardiac muscle wasn’t getting enough blood, but it would take an X-ray to determine the extent of the problem. A thin plastic tube was inserted into an artery in my leg and threaded into my heart. Then a dye was injected into the tube, and Dr. Nagle traced its progress through my coronary arteries.

Now we were ready to review the results. Dr. Nagle began speaking. He told me that my chest pain was caused by three arterial blockages, ranging from 50% to 95%. “This is called coronary heart disease,” he said. “Buildups of fat and cholesterol are interfering with blood flow to your heart. The largest blockage is badly located. A blood clot could seal off the opening and trigger a fatal heart attack. I recommend immediate coronary bypass surgery . . .” There was more, but those words hit me like a hard slap in the face. Just get up and leave, I told myself. You’re not supposed to be here.

Like most people, I knew something about the workings of the heart and the coronary arteries, but the information was chiefly of the Biology 101 variety. Some decent information was out there, but what
did it have to do with me, a young guy in the prime of his life? Unknowingly, I had succumbed to the “what I don’t know won’t hurt me” syndrome. In reality, however, what I didn’t know could not only
hurt me, it could kill me.

Facing Reality

As the diagnosis sank in on that July afternoon, my own age of innocence and ignorance came to an end. My initial reaction was the typical “Why me?” response. Bernie and I had not yet celebrated our 10th wedding anniversary. Our daughter was six; our son was just four. I was in the midst of building a career and contributing to my community. Then I remembered reading a comment by President John F. Kennedy reflecting the fact that life was basically unfair—that unfairness was part of its nature. The randomness of death existed for everyone. All at once, I understood. Why not me?

I was gripped by pure, stomach-churning fear. Old age was something I had always looked forward to sharing with Bernie and my kids. Now I had to face the fact that death not only could happen in the near
future, but probably would happen as a result of the time bomb inside my chest. As we talked that day, Dr. Nagle calmly and deliberately explained the many facets of my situation. Soon the late afternoon shadows began to turn into evening twilight, and I was suddenly aware of the importance of time.

Less than a week later, Dr. Kari Vitikainen, a gifted cardiac surgeon, performed a five-hour operation in which a piece of vein was taken from my left leg and used to create a new arterial channel. The new channel literally bypassed the blocked area, allowing blood to again flow freely to my heart.

Ten days after surgery, I went home to recover, happy to be alive but very concerned about my future. Bypass had not “cured” me. Dr. Early put it in perspective: “You had heart disease the day before
surgery, you had heart disease the day after surgery, and you have it today as well. The surgery took away the pain and the threat of an imminent heart attack. But it did not remove the disease. Only a change in your lifestyle can reduce your future heart attack risk.”

This knowledge was complicated by the prediction of another doctor, a well-known lipids specialist at a national university. I saw him after the surgery for advice on how to manage my cholesterol.

“Shouldn’t I change my diet?” I asked.

“Don’t bother,” he said. “You have an aggressive form of coronary heart disease at a very early age. I’m not sure what you can do to help yourself. Frankly, I’d be surprised if you live to be forty.”

Now, for the first time, I was mad! He’s wrong, I thought. I’m going to find a way to beat this disease. My anger and determination became the twin foundations of a resolve to eat a better diet and live a healthier life. Finally, I had reached a point in time when I was ready to listen and learn. Once again, I turned to Dr. Nagle. “My advice is for you to focus on making healthy lifestyle changes,” he said. “You need to find a new diet pattern that meets your physical and emotional needs, fits your way of life and can be sustained for the long term. And you have to make it work in the real world. Only you and Bernie can do that.”

And so, in the midst of much confusion, we began.

The Mediterranean-Style Diet

When I started to collect information, to simply figure out what to do, the connection between diet and heart health was still controversial. One cardiologist who saw the importance of diet was Dr. John Farquhar of Stanford University Medical School.

I met Dr. Farquhar at a cardiac conference where he delivered a lecture called “The American Diet May Be Hazardous to Your Health.” I had listened to a number of speakers at this conference and had yet to learn anything that helped with daily living—that answered the basic question What can I eat today? That question was addressed in Dr. Farquhar’s discussion of the late Dr. Ancel Keys, a pioneer in cardiac research. In the early 1950s, Dr. Keys went to Italy to observe a curious dichotomy. Italians ate much more fat in their diet than Americans did, yet heart disease was virtually unheard of in their country. While Americans were feasting on steak and potatoes, white bread and butter, and whole milk, Italians ate very few animal foods and favored fruits, vegetables, whole grains, olive oil and wine. Could there be a link between diet and health?

Compelled to learn the answer, Dr. Keys instituted the Seven Countries Study, in which diet, blood cholesterol and frequency of heart attack were measured in communities in Finland, Greece, Italy, Japan, the Netherlands, the United States and Yugoslavia. In all, some 12,000 men in the 40-to-49 age range were tested and observed. The study illustrated that cultures in which saturated fat made up a significant
percentage of total caloric intake demonstrated elevated cholesterol levels and a higher incidence of coronary heart disease than cultures with a lower percentage. Thus the Finns, who ate 20% of their calories
as saturated fat, had cholesterol levels that averaged 265. The Japanese ate only 5% of their calories as saturated fat and had correspondingly lower cholesterol levels, averaging just 165. A most important point was that the heart attack rate for middle-aged Finnish men was six times greater than for Japanese men of the same age. American men in the study had a heart disease rate twice that of Italian men and four times that of Greek men. Dr. Keys’ conclusion: “Saturated fat in the diet leads to high blood cholesterol and then to heart attacks.”

As Dr. Farquhar clearly connected the dots between diet, cholesterol and heart disease, he provided a realistic vision of how to eat. His recommendation was the same as that of Dr. Keys: a Mediterranean diet emulating the traditional eating habits of southern Europe (Italy, Spain, Portugal and southern France), parts of North Africa (especially Morocco and Tunisia), parts of Turkey and parts of the Middle East (especially Lebanon and Syria). This diet emphasizes food from plant sources, such as whole grains, fruit, vegetables, nuts and olive oil. It also includes moderate amounts of poultry and fish while restricting meat, processed foods and refined grains.

The Mediterranean approach made…