 Many of today's lifestyle medicine doctors, myself included, were greatly influenced by Nathan Pritikin, the nutrition pioneer who started reversing our disease with a plant-based diet and exercise, opening arteries without drugs and surgery, effectively curing our number one killer disease. But where did he come up with the idea? We tend to think of rural China as a place where with a fraction of our disease rates, forgetting about Africa. Pritikin was 43 when he was told by a cardiologist that he was a great risk of death from heart attacks, so he began to live on a diet patterned after the black population of Uganda. This was a population living off plants that was essentially free from death from heart attacks. After curing his own heart disease with a plant-based diet, he went on to save the lives of thousands of others. What was the data that so convinced him? Last year, the International Journal of Epidemiology reprinted this landmark article from the 50s that started out with a shocking statement. In the African population of Uganda, coronary heart disease is almost non-existent. Our number one cause of death, almost non-existent? What were they eating? Plantains and sweet potatoes, other vegetables, corn, millipumpkins, tomatoes, and green leafy vegetables are taken by all. And they're protein almost exclusively from plant sources. And they had the cholesterol levels to prove it, similar to modern-day plant-eaters. Apart from the effects of diet and the blood cholesterol levels, the researchers couldn't figure out any other reasons for their freedom from heart disease. 50-year-old findings just as relevant today. They showed that dietary intake to be a key, modifiable, established, and well-recognized risk factor for heart attacks, without needing to invoke novel, as yet undiscovered risk factors. This contrast with the rather desperate search in recent decades for even newer cardiovascular risk factors. We have the only risk factor we need, cholesterol. We've had it for 50 years, and we can do something about it. According to the editor-in-chief of the American Journal of Cardiology, this year the only risk factor required for these atherosclerotic plaques are number one killer is cholesterol, elevated LDL, or so-called bad cholesterol, in our blood. To drop our LDL cholesterol, we need to drop our intake of three things. Trans fat found in junk food and animal foods, saturated fat found mostly in animal foods, and dietary cholesterol found exclusively in animal foods. The journal actually went back and located Dr. Shaper, now 97 years old, and asked him to personally reflect on this groundbreaking study he performed more than a half century ago. He would be cheering to think that his article actually helped, and attitudes to diet have been changing in recent years. However, to his personal surprise and disappointment, we still lack a deep commitment to the diet-heart hypothesis, and it is likely that atherosclerosis and its complications will follow us throughout the next half century. What he discovered is that heart disease may be a choice, like cavities. If you look at the teeth of people who lived over 10,000 years before the invention of the toothbrush, they pretty much had no cavities. Didn't brush a day in their lives, never floss, no listerine, no water pick yet. No cavities. That's because candy bars hadn't been invented yet. Why do people continue to get cavities when we know they're preventable through diet? Simple, because the pleasure people derive from dessert may outweigh the cost and discomfort of the dentist. And that's fine. As long as people understand the consequences of their actions, as a physician, what more can I do? If you're an adult and decide the benefits outweigh the risks for you and your family, then go for it. I certainly enjoy the occasional indulgence. I've got a good dental plan. What if instead of the plaque on your teeth, we're talking about the plaque building up in your arteries? Another disease that can be prevented by changing our diet. Then what are the consequences for you and your family? No, we're not just talking about scraping tartar. We're talking life and death. The most likely reason most of our loved ones will die is heart disease. It's still up to each of us to make our own decisions, as to what to eat and how to live, but we should make our choices consciously, educating ourselves about the predictable consequences of our actions.