Surgery and its Alternatives

Integrative medical physician Sandra McLanahan, M.D., has for many years been the nation’s leading expert on the medical effects of yoga. Executive Medical Director of the Integral Health Center in rural Buckingham, Virginia, she also served for 20 years as Director of Stress Management Training for the Preventive Medicine Research Institute, where she was a crucial part of the research team led by Dean Ornish, M.D., which established, in studies published in The Lancet and The Journal of the American Medical Association, that heart disease can be reversed by a combination of a low-fat, high fiber vegetarian diet, yoga, meditation, and group support.

McLanahan is a 1968 magna cum laude graduate of Swarthmore College, received her M.D. from Wayne State University, and completed a residency in Family Practice at the University of Massachusetts. Aside from her work with the Integral Health Center and the Preventive Medicine Research Institute, Dr. McLanahan was among the founders of the pioneering Commonweal Cancer Help Program.

Her most recent book, Surgery and Its Alternatives, co-authored with her brother David McLanahan, M.D., a surgeon, is a unique and comprehensive guide for people facing the possible need for surgery, and is a must for their caregivers as well. The doctors McLanahan cover 200 different diseases for which surgery is sometimes necessary, describing the causes of each disease (including dietary and stress factors) and presenting alternatives to surgery as well as complementary medicine approaches that can be utilized along with surgery.

In this interview with Dr. Daniel Redwood, McLanahan, a 5th generation doctor, describes how her father inspired her ethic of service, how the incompleteness of her medical education led her to search for deeper answers, her work with Dean Ornish and the late Swami Satchidananda, the value of yoga, the best ways to deal with heart disease, and her vision of a truly integrated approach to health and healing.

For further information:
Sandra McLanahan, M.D.
Route 1 Box 1680
Buckingham, VA 23921
434-969-4680
Daniel Redwood: When did you first consider going into medicine?

Sandra McLanahan: I had an amazing father who just passed away at age 91, who was very oriented toward service. (My mother died when I was four.) He came from a very wealthy family, but he gave it all up because he saw people starving during the Great Depression. He went all around the Midwest founding co-ops and credit unions, so people could pool their resources and come together in community. He had six children; three of them are doctors and one is married to a doctor. So we all wanted to be of service.

I got interested in biology and science because of its beauty. It’s really been that which has brought me forward, the joy of life that I was given by my dad and his great dedication to service.

Redwood: What were the earliest influences leading you toward unconventional forms of medicine?

McLanahan: I got interested in that while I was in medical school. I began to see that so much of disease had a preventable aspect. I began to see that what medical school was oriented toward was simply drugs and surgery, and that it wasn’t getting at the root cause of disease. Then I read a transcript of a talk by Swami Satchidananda in which he said we have a natural state of ease, and when we lose it we get dis-ease. And so the aim should be to maintain the ease, and thereby maintain the health. Nobody had said anything like that in medical school. So I went on a retreat with him my senior year in medical school, and started learning about natural approaches to health, because he had been trained as a naturopath and a homeopath in India, as well as in the science of yoga. Since then, which was 35 years ago, I have been studying these approaches. I went to India with him and visited the yoga hospitals, looked at the naturopathic tradition over there as well as the naturopathic tradition in this country.

Redwood: How has yoga changed your life?

McLanahan: The basic questions of life that we all face are: Who are we? And what are we doing here? I was raised as a Methodist and I was taught about God as being the Supreme Being. So I kind of envisioned this Merlin-like presence. Then, as I began to study yoga and reflected on my spiritual understanding, I began to go deeper. I realized that if God is omnipresent, then it can’t be a supreme being, but more like a supreme state of being. So I began to understand who we are more deeply from the inside, who we are and what we are doing here. Yoga provides tools that help people stay healthy, physically, mentally, and then deepen their own spiritual understanding and experience.

Redwood: How did you become involved in Dean Ornish’s research on heart disease and how would you characterize its importance?

McLanahan: I wrote an article about the medical benefits of yoga, which I had been studying by going to India and also studying here in this country with Swami Satchidananda. He has Integral Yoga centers around the country. It is a very gentle, ecumenical, and open approach to yoga which I appreciate. Dean read my article after he had met Swami Satchidananda in Texas. His sister had heard him speak and invited him to their home. After Dean read my article, he invited me to speak at his medical school, so I came down there with my slide show about the medical benefits of yoga. And after I gave the talk, he came up to me and said, “Let’s do research together.”

We started our first research in Texas, with a small group of heart disease patients, who we had in a hotel for a month. I taught the yoga, and Dean did the research aspects. We showed really spectacular results, but we wanted to get even more precise in our work. Some of the patients in the hotel were sneaking out for pepperoni pizza. So we took them to a resort for a month, where they couldn’t have access to such food, and the results were even more impressive. Then the third study where I worked with him in San Francisco was a controlled study, where we had an experimental group and a control group. I moved to San Francisco for a year and taught yoga to all the patients there. It was that research which was the most remarkable, showing a major difference between the experimental group and the control group in terms of being able to reverse heart disease.

Redwood: How did you show that heart disease was actually being reversed?

McLanahan: We did repeat angiograms, but we also did PET scans [positive emission tomography], which show the function of the heart. A PET scan is not invasive and does not carry a risk. So that’s how we’ve been following the patients since then.

Redwood: So this shows how much blockage is present in the vessels?

McLanahan: The angiogram shows the physical blockage, but the PET scan shows how much the physical blockage is actually blocking blood flow. It gives you a 3D picture of how much blood flow the heart is getting. So the PET scan is, in a way, a much better test, and it doesn’t carry a risk to the patient.

Redwood: I referred a patient to you about 10 years ago who had been told by a cardiologist that she probably would need a heart transplant. After following the dietary and other changes you recommended, over a period of a few months her cholesterol levels dropped from the 300s to the 100s, she stopped being short of breath, and she never needed the transplant. The question I want to ask is, how does this actually work? How can these dramatic results be possible?

McLanahan: She’s actually the patient with which I opened the book, Surgery and Its Alternatives. The story is in there.

Redwood: I didn’t recognize it. Some of the personal details were changed.

McLanahan: We’ve had many patients who have reversed their heart disease using the Ornish program, which is now available in 12 hospitals around the country, and Medicare is paying for it. There are four main components. They are a low-fat, high-fiber vegetarian diet, an hour of active exercise three to five times a week, one and one-half hours of yoga per day (which means half an hour of meditation and half an hour of yoga stretches in the morning, and half an hour of meditation at night), and then group support to stay on the program. The latest research project has been in Pittsburgh, with 500 patients. There has been a 90 percent success rate in reversing heart disease within one year. And some of them were very, very ill. That’s funded by Blue Cross – Blue Shield; it’s set up by them and run by them. It’s our demonstration Medicare project, and it’s been so successful that we feel that eventually this program will be available everywhere.

Redwood: That’s wonderful.

McLanahan: We feel that the reversal takes place from each of these components, but in looking very closely at compliance with the four components, the most powerful, I think, is the daily yoga practice. Because we are not just what we eat, we are what we circulate. And it allows circulation to improve to each part of the body, so that the body can do better repair work.
In the beginning, nobody believed heart disease was reversible. Ask any cardiac surgeon. You cut open the heart, and that plaque is calcified, which is why you can see it on a whole-body CAT-scan. That’s how Oprah [Winfrey] got her wake-up call; she had a whole-body CAT-scan which showed calcium in the arteries of her heart and it helped her to make her final transition to a healthy diet. Now, she is on a healthy diet and has maintained her weight loss for the last year. Before that, she was trying to do it by exercise alone. She was eating anything she wanted, and that didn’t work.
So we feel that heart disease is reversible, because the body can get rid of this plaque through the activity of the body’s white blood cells. White cells come in, remove the buildup of plaque and calcium, and do repair work. They’ve done some studies in dogs where they cut the lymph supply around the heart, and the dogs developed rampant coronary artery disease. It’s the lymph that allows the white cells to go in and remove any blood clot, remove any buildup of abnormality in the cells. If you think of it, the buildup of the plaque in the arteries of the heart has a number of components contributing to it. It’s not just how much fat you eat in your diet, although that is the main component because if you don’t have the rust it won’t build up in the pipes. The incidence of heart disease in people who have cholesterol levels under 150 is very, very low, so we aim to keep people’s cholesterol under 150. If you take chicken soup, for example, and a couple of hours later you hold it up against the light, what do you see?

Redwood: Globules of fat.

McLanahan: When the globules of fat are in the bloodstream, the body in its wisdom tries to remove this fat, because it can’t get good circulation, especially through the small capillaries, when there are big fat globules in the way. So it puts them in the wall of the artery, to try to get them out of the stream of the artery itself. But slowly, there is so much fat built up that it actually impairs the blood flow itself. So the treatment is to remove the fat from the diet. There are also components of inflammation and bacteria, but both of these risk factors can be reversed by excellent lymph flow. If the lymph is flowing well, you have the ability of the white cells to remove any inflammation, any bacteria, as well as any buildup of blood clots or excess fat. We don’t have a pump behind our lymph [as is the case with the heart pumping blood]. We have more lymph in the body than blood, and it’s the [muscular action of the] deep breath that helps to pump the lymph. That’s part of yoga practice; the stretching and breathing of yoga practice also helps circulate the lymph.

Redwood: I’m interested in your views on two current controversies relating to heart disease. The first is whether people should drink alcohol on a regular basis to help their hearts, and the second is whether high-fat regimes like the Atkins or Zone diets are beneficial.

McLanahan: The nature of the research on alcohol is that, in a culture that is eating a lot of fat, the alcohol will at least allow people to relax enough to take a deep breath, lean back, and enhance the circulation of their lymph. There are factors in alcohol that help to prevent clotting, but they are also found in red grapes. So people can eat red grapes and other foods that have antioxidant activity and assist in helping prevent excessive coagulation, without the side effects of alcohol. Alcohol is responsible for more hospital admissions in the country than any other single agent. So to recommend that people use alcohol as a way of reducing their risk factor is like saying, “You can continue your risk factor, but take this poison to make up for it.” It doesn’t make sense to me. I would rather go to the root cause, which involves teaching people how to eat right so they don’t need an anticoagulation factor from a poison in order to relax. There’s another way to do it, and the evidence from studies on the Seventh Day Adventists is clear: you don’t need to drink alcohol to prevent heart disease. They have a very low risk factor for heart disease, and they don’t use alcohol.
Then there’s the next portion of your question, about the Atkins diet and the Zone diet. You can lose weight by a number of methods. You can lose weight by chemotherapy, but I don’t recommend it. And yes, you can lose weight by eating smaller portions, which is what happens in the Atkins and Zone diets. They’re eating less calories per day, but the nature of the calories is such that these particular substances, over a long period of time, damage the heart and kidneys. So what you’re doing, by following such a diet, is trading your excess weight for increased risk of heart and kidney disease. So it’s short term gain and long term risk.

Redwood: Tell us about your newest book, Surgery and Its Alternatives, which you co-authored with your brother David McLanahan, who is a surgeon.

McLanahan: It covers 200 different diseases that might in some cases cause a person to be recommended for surgery. We put the book together because surgery is one of the most promising ways to study alternative medicine. It’s a simple, well-circumscribed area in which you can have an outcome that will show whether these interventions can be helpful. We have over a thousand footnotes in the book. We introduce the entire spectrum of alternative medicine to people, explaining what we feel is useful in terms of what’s been researched, particularly in the surgical setting.
What we have is a description of each disease, and what we think is the root cause of the disease. In many cases it’s diet and a combination of other factors. We look at how diet and disease are related, and then how stress and disease are related. Then we present the alternatives that you can use to help change your diet and stress components, and lifestyle in general. We also include an alternative medicine program for those who end up having to have surgery, with things you can use to help you get through the surgery. There’s now quite a bit of evidence for these alternatives and how they do help people. So we include those studies, so that people can look at the research that’s been done so far. They can look at the research in the surgical setting and look at what they would like to incorporate into their own recovery program.

Redwood: Have you had ever patients who were dead set against having surgery, where you felt it important to make the case for going under the surgeon’s knife?

McLanahan: Oh yes. I practice integrative medicine, which I believe is the best choice for the future. This combines alternative approaches with the best of Western medicine. There are times when drugs and surgery can be life-saving. But we want to shift, and I am happy to say the President Bush has made a statement that he wants to shift our medical establishment toward prevention and make it the number one priority. We don’t have a health care system in the country right now, we have an illness care system. Once you’re sick, they try to fix things. But it makes more sense to keep Humpty Dumpty from falling off the wall in the first place. The kinds of information we included in this book are aimed at helping people act preventively. And yes, at a certain point surgery can be the very best choice. Appendicitis, for example, is a simple case where surgery is the best choice.

Redwood: What forms of complementary medicine have you found to be most helpful for people undergoing surgery, or preparing for it?

McLanahan: Dr. Mehmet Oz is a surgeon at Columbia who is using a variety of techniques before and after heart transplants, and has been studying them. He has discovered from his research that the most powerful is yoga, because these are tools that patients can use for the rest of their lives. Basically, yoga consists of five components: stretching, deep relaxation, breathing, meditation, and visualization. These various components can be used before your surgery, during surgery through use of a tape cassette played while you’re having the surgery, and then afterwards to help you recover. Then, they can also be used for the rest of your life to help prevent the disease that got you in trouble in the first place. Because even though we know what may be helpful in terms of diet, cigarettes, alcohol, and exercise, we may not do these things if we’re under stress. So we need to address the stress component in all of our lives.

Redwood: In his foreword to your book, Dr. Bernie Siegel points out that patients who receive risk information from their doctors in the hospital hallway immediately before surgery (rather than the night before) have higher rates of cardiac arrest. What does this tell us, and what are some of the other things that patients should ask for if they are facing surgery?

McLanahan: In our book, we give a list of questions to ask your surgeon. Then we give a list of things to request from your surgeon. You need to ask a certain number of questions at first to understand and have a good relationship with your surgeon. Surgeons want a good outcome from their patients, so many are willing to do whatever the patient would like in order to achieve that outcome. For example, one patient had a music cassette that he wanted to play, and the surgeon said, “Okay, I’ll just play it to the entire operating room.” This patient did so well under his surgery that all the doctors and nurses came to him afterward and requested copies of the tape, because they enjoyed it so much. We’ve found that surgeons who operate with music do better. So that’s one thing you can discuss with your surgeon.

It’s a good idea to get the risk information ahead of time rather than right before the surgery. It’s also important to have a good connection with your anesthesiologist, because that’s the person who’s going to put you to sleep and wake you up again. Then, there are cassette tapes that you can use for deep relaxation. You can make your own tape of music that you like, and suggestions such as “I’m going to wake up feeling well,” “The surgery will go well,” “I will feel happy and good,” or “My body will assist the surgeon by moving the blood away from the surgery site.” We have already prepared tapes or you can make your own with the music that you like.

Redwood: Is there anything you’d like to add?

McLanahan: I think a lot of surgery can be avoided, and you are not required to accept a surgeon’s suggestion. You can educate yourself. Ninety percent of hysterectomies are avoidable; in general, hysterectomies are only needed for cancer. This is a surgery that used to be routine; between a third and a half of American women end up with a hysterectomy. Now that we understand that it creates a much more difficult menopause and an increased risk for heart disease, we can act preventively by using a combination of dietary change, acupuncture, relaxation training, and yoga to help people through menopause without choosing to treat it in a way that harms the body, avoiding hormone replacement therapy and using natural approaches instead.

Redwood: Sounds good to me.

McLanahan: I want to tell you, Daniel, that I learned a lot in working on this book. It was a great process to do it with my brother, because he’s at the opposite end of the medical spectrum. He’s a very classical surgeon. But he’s eating more salads now, and I’m appreciating more the kind of work that he does, that it does have a place, and that somehow we can all come together and work together in an integrated spirit.

The other aspect of the book I want to mention is that eventually we are all going to face our own mortality and the mortality of our parents and friends and relatives. We need to understand that, as Edgar Cayce taught, spirit is essence, mind is the builder, and the body is the result. This is the opposite of what science has taught us, which is that consciousness somehow springs from the machine of the body. When we have a spiritual framework and spiritual perspective on our lives, it helps us to deal with the questions and difficulties of mortality. We can get a sense that death is safe. We don’t have a sense in this country that death is safe. About 70 percent of Americans die alone in hospitals, and that is a big tragedy. That’s why I work with Dannion Brinkley, who wrote the book Saved by the Light. He has an organization called Compassion in Action (www.dannion.com), the aim of which is to provide alternative medicine in the scene of death and dying. And that is terribly important, that we can ease the transition. We can also use that as an opportunity to feel the reality of our spiritual self. I’ve had so many patients tell me (and I had my own experience of my father going in and out of the light) about the nature of reality. Various patients have seen angels and heard music. So the reality of the spiritual world is very accessible when we include this as part of life. It can actually enrich our lives to have less fear of death.

Dr. Daniel Redwood, the interviewer, practices chiropractic and acupuncture in Virginia Beach, Virginia. He is the author of A Time to Heal: How to Reap the Benefits of Holistic Health, Contemporary Chiropractic, and the forthcoming Fundamentals of Chiropractic, and is Associate Editor of The Journal of Alternative and Complementary Medicine. A collection of his writing is available at http://www.drredwood.com. He can be reached by e-mail at danredwood@aol.com