John Tanner suffered an unexpected, sudden cardiac arrest In October 2009. Against long odds, he survived, recovered, and began learning about the causes, prevention, and reversal of this nation's leading killer. He has incorporated what he has learned into his website www.nusci.org and is building a non-profit organization to propagate the knowledge of preventing heart attacks and other diseases. He has also started a healthy food delivery business under the name Little Green Forks to deliver healthy meals to people in the San Gabriel Valley.
Tanner is President and CEO of Tanner Research, Inc., a 100% employee-owned company that develops and markets Electronic Design Automation (EDA) software tools to designers of integrated circuits. Tanner Research is among a handful of companies to be named to the "LA Fast 50" five years in a row. John founded the company more than 25 years ago. Tanner Research currently employs about 50 people. The largest division creates and markets EDA software tools for the design of integrated circuits.
Tanner has also created a business unit dedicated to sharing calendars and contact information among multiple PC, Mac, and smartphone users. Tanner Research acquired base technology from Palm in 2004 and is advancing it under the name ClearSync. In addition, Tanner has licensed a new pogo stick design from Carnegie Melon University to Razor (the folding scooter company) and helped Razor get it into production. He is now developing an autonomous agriculture robot for intra-field produce transport.
Tanner earned his BA degree from Wartburg College in Waverly, Iowa, in 1979, his MS in Electrical Engineering from Caltech, in 1980, and his Ph.D. in Computer Science from Caltech, in 1986. He lives in Pasadena with his wife, Linda. Their three children are in college.
I had a great life, a wonderful wife of over 25 years, three great kids, two in high school and one in college. I loved my job running a high tech company. And then disaster struck.
But my story begins five years before, when my sister, three years older than I, was diagnosed with type 2 diabetes. My parents both had type 2 diabetes, at the time labeled adult diabetes or late onset diabetes. I was under the impression that diabetes was genetic in nature because it tended to run in families. It turns out to have very little to do with genetics, but I didn't know.
I had also heard that type 2 diabetes was heavily influenced by being overweight. It turns out there is a correlation, so I had a right to be concerned. At 6' 0" in height, as a young adult I weighed a healthy 150 pounds. As I approached my late 40s, my weight had crept up to 205 pounds. I decided to try to get off some of these extra pounds and did so by eliminating sodas and other sugary drinks, consuming more salads, and exercising.
Other than these changes though, I continued to eat a standard American diet, including cheeseburgers and pizza. But with this small change in diet and exercise, I was able to drop 30 pounds and reduce my glucose blood sugar readings from 111 to 104. I was tracking my glucose due to my concern about diabetes. Over 100 mg/dL is considered prediabetic, so I wasn't into the normal range yet, but at least headed in the right direction.
Checking My Cholesterol
I was not tracking my cholesterol. I was getting annual blood tests and receiving the results, but my doctor never discussed them with me. Later, I was able to go back and retrieve my blood test history and found that my total cholesterol had risen to a high of 238 mg/dL and my LDL hit a high of 147. I know now that these numbers were too high. But even so, with my own minor diet change and exercise, my total cholesterol dropped to 188 and my LDL to 113, so while I wasn't aware of the numbers at the time, they were heading in the right direction. So, with significant decreases in weight, glucose, and cholesterol, you might assume I was healthy. Wrong.
On October 11, 2009, I was running in my neighborhood, as I had done every morning for the previous five years. I was 52 years old and believed myself to be in good condition. My doctor had no concerns at my last checkup a few months earlier, and I had no history of heart disease in my family.
But this morning, I was running fine, then staggered a couple of steps and hit the ground unconscious, under full cardiac arrest. About half of all heart attacks are of this type and for cardiac arrest outside of a hospital, the survival rate is about 3%. You probably know friends or relatives who just suddenly keeled over and died.
My Life Savers
However, on this Sunday morning, there were 17 people involved intimately in saving my life: from my neighbors and their relatives to the firemen, from the paramedics to the ambulance crew, and from the ER staff to the specialists in the cardiac catheter lab. Due to the quick action and competence of these folks, not only did I survive, but I also did so with no detectable brain or heart damage, which is even more rare than surviving cardiac arrest.
When my wife caught up to me in the hospital, I woke up long enough to ask, "Where am I?" and "What happened?" My wife told me I was in the hospital and had had a heart attack. I nodded, drifted off, and a few minutes later woke again and asked,"Where am I?" and "What happened?" I was clearly suffering from oxygen deprivation, and it wasn't clear how much of me was going to come back. But after a couple days, my short-term memory returned, although I never regained a memory of what happened that day. Instead, I pieced together the sequence of events and the contributions of my lifesavers on that day.
Chest Compressions Were Important
Neighbors Dan and Jodie on my running route had son Mason who was born on his mother's birthday. Because of this dual birthday, Jodie's mom and dad, Christine and Alan were visiting from the East Coast. Christine was outside with her grandson, Mason, when I ran by that Sunday morning. Christine saw me transition from running normally to falling on the ground unconscious. Christine immediately called to her husband and daughter.
Alan came out and immediately started giving me chest compressions. As a former lifeguard, he had learned CPR, which starts with the airways. But he had recently seen on the Oprah Winfrey show that the best procedure is to start with chest compressions. After all, air in the lungs doesn't get to the brain if the blood isn't circulating. And we have about 10 minutes of oxygen in our blood which can sustain us if it is kept circulating. So Alan's actions and knowledge was a link in the chain that saved my life that day. I guess you can say that I also owe my life to Oprah.
911 to the Rescue
Jodie called 911 and then came outside to urge her father on. She said later that she was silently willing me not to die on her son's birthday. The first responders to the emergency call were the firefighters from L.A. County's Engine 66: fireman Adam, engineer David, and their Captain Joe. When they arrived, they noted that my wristwatch, in time mode, said 6 minutes. I started the timer when I began my run and was at the 2-minute location when I went down.
So in 4 minutes, Christine saw me go down, called to Jodie, Jodie called 911, the dispatch routed it to the fire station, and the firemen arrived. The fire station is right near my kid's grammar school where I drove my three kids for 16 years. Despite often being in a rush to get to school, we never once made it in only 4 minutes, so the fire crew must have been moving mighty fast. Thanks, guys!
Survival Odds Low for Cardiac Arrest
With the odds of surviving cardiac arrest so low, some firefighters go their whole career without ever getting a save. Yet knowing they will most likely just end up with a dead body, they still perform what they need to so that the few might live. Thanks again, guys.
In most cases of cardiac arrest, the firemen find the victim in a location or position difficult to treat. They may first have to carry the victim out of the bathroom and down the stairs before they can work on him/her. On this day, they were pleasantly surprised to find me conveniently lying on the grass near the sidewalk. They immediately took over chest compressions from Alan and deployed their AED, automatic electronic defibrillator. This device has sticky pads they attached to my chest. It determines automatically if a shock is warranted. If the heart is beating, it doesn't shock. And if there is no heart activity, it doesn't shock. But if the heart is fibrillating, that is quivering, but without a consistent heartbeat, it does shock. This machine determined that I needed a shock and delivered it. After that, my heart had a weak heartbeat. The original problem was still there, but at least my heart was beating.
Paramedics Arrive
Shortly after, two paramedics, Mark and Brian, arrived from an L.A. County facility a bit further away. They had a more sophisticated heart-monitoring device they used to determine my problem. The standard heartbeat trace is taught to have standard points designated by alphabet labels. If the segment of the heartbeat between S and T is higher than normal, this indicates an ST Elevated Myocardial Infarction (STEMI), which means a heart attack due to blockage of the Left Anterior Descending coronary artery. The LAD has the nickname "The Widow Maker" as it is often the cause of death.
With the field diagnosis, Mark called the nearest hospital equipped to handle STEMI cases. In this country, only about 25% of hospitals are so equipped. I had the good fortune of going down about midway between Arcadia Methodist Hospital and Huntington Hospital, both of which have STEMI centers. Just three or four blocks away was the former St. Luke's Hospital, which had closed just a few years before. Good thing, as often time is wasted by a STEMI patient being taken to a hospital not equipped to handle it. Then the patient has to be further transported to another hospital, wasting critical time. The survival rate is highly correlated to the time it takes to get the victim to a STEMI center.
Taking the Ambulance to Huntington Hospital
Shortly after the paramedics arrived came the Schaefer ambulance with crew Tadeh, Jordan, and Eric. Mark called on his cell phone to Huntington Hospital and informed them of an incoming STEMI patient. There was no crew on staff in the cardiac catheter lab that Sunday morning, but there were people on call. Because of the field diagnosis, the cardiac on-call staff was activated and headed for the hospital. They loaded me into the ambulance, with Mark monitoring me along with the ambulance crew, and Brian following in the paramedic truck. They hit the siren, and roared off. One of my regrets is that this was the only time in my life I've been in an ambulance with the siren going, and I don't remember anything.
My ER Experience
When I arrived at Huntington Hospital, I was rushed into the emergency room, where ER doctor Steve confirmed the field diagnosis and whisked me on upstairs to the cardiac catheter lab. There, staff members Stacey, Michael, and Norma and cardiologist Dr. Terry were arriving about the same time I was. Stacey, Michael, and Norma assisted as Terry fed a catheter in through an incision on my thigh in order to diagnose and address my blocked coronary artery. It was only about an hour from the time I collapsed to the time they were addressing the problem in the cardiac catheter lab. Undoubtedly, this speedy sequence of actions was instrumental in allowing me to survive, and to maintain essentially all of my heart and brain function. Now, though, when I forget our anniversary, I tell my wife, my forgetfulness was from the heart attack.
I was in the hospital for only five days. And after another week off, I went back to work. So in two weeks I went from heart stopped on the street to back to work. I was very lucky. In another week, I went back in for a perfusion test that measures the amount of damage to the heart muscle. The test results indicated that the damage was minimal, so my cardiologist said I could go back to my life the way it was.
What My Doctor Didn't Tell Me
At first I thought it was great that I could go back to my life the way it was. But the more I thought about it, the more I figured that my life the way it was probably caused my heart attack. So I began reading everything I could get my hands on about the causes of heart disease and how to prevent it. I quickly discovered a large body of scientific knowledge, thousands of studies published in peer-reviewed scientific journals. Here are some of the astonishing things that I found:
- Heart disease is completely preventable.
- Heart disease is reversible.
- You probably don't need medication.
- Within some communities, heart disease is unknown.
- Genetics have almost nothing to do with heart disease.
- Most doctors do not know or will not tell you how to prevent and reverse heart disease.
- Traditional treatments such as statin drugs, stents, and cardiac bypass surgeries just don't work.
Enough with the suspense, already. How can we prevent and reverse heart disease if drugs and surgeries don't work? In a single word: NUTRITION.
You've probably heard people say that fruits and vegetables are good for you. You've probably also heard that red meat can be harmful. I'd heard these things also but didn't pay much attention. So let me be really blunt:
I've spent the years since my heart attack reading professional journals, scouring the Internet, reading books, attending conferences and talking to experts. At first it was very confusing, with a lot of contradictory information. But as I tracked various claims back to carefully constructed scientific studies, it became clear to me that there is a core of solid, self-consistent science, but there are also a lot of people making statements with no solid science behind them that are intended to mislead the public into buying various food products, drugs, procedures, and services.
Falling Down the Rabbit Hole
As I learned more, it felt to me like Alice in Wonderland falling down the rabbit hole. In the body of science and my newfound understanding of the operation of the medical establishment, I discovered things that I have found astonishing. And I feel compelled to share my findings with anyone who will listen, because often it is a matter of life and death. I am trying to share what I wish someone would have shared with me before my cardiac arrest. And I feel that I must speak for the 97% of cardiac arrest victims that suddenly died and never had the chance to understand why and what they could have done to prevent it.
I started by talking with my family, friends, and co-workers. Then I moved on to schools, civic clubs, and churches. A year ago, I developed a 3-hour workshop where I share the most relevant nutrition science research results and include a meal that is both tasty and prepared using only the ingredients that research has shown to be most healthful. I've also created a non-profit organization, NuSci, The Nutrition Science Foundation, and its web site, www.nusci.org, where you can find book reviews, links to nutrition science research articles, recipes, and an archive of my electronic newsletter on nutrition science topics.
Medical Aftermath
On the day of my cardiac arrest, my blockage was cleared out with balloon angioplasty, and a stent was put in. A stent is a metal mesh tube that begins in a compressed form where it is inserted via catheter from the thigh to the coronary artery. In my case the clogged coronary artery was the left anterior descending (LAD) coronary artery. The compressed stent is moved into place off the end of the catheter, and then a thin cylindrical balloon inside the stent is inflated, expanding the stent and mashing it into the artery walls. The body responds to this damage by forming scar tissue that eventually covers the stent completely. If things don't go well, the scarring continues and in a process called restenosis begins to block the artery. Stents have a 20% to 40% failure rate, depending on who you ask. My stent failed.
This time, my heart problem was gradual. After my cardiac arrest and recovery, my cardiologist recommended high-heart-rate workouts of longer than just my 7 minute mile. So I had increased my running to two miles per day. After about three months, I found that before my run was done, I felt this very strong urge to stop running. It wasn't chest pain, and it didn't feel like fatigue in the usual running sense. I would just get to the point in my run where I knew I just had to stop running and slow down to a walk. In less than a week, it got to where this stopping point progressed from 11/2 miles to 1 mile, and then to a 1/2 mile.
The Stent Was Failing
At that point, I called my cardiologist. He listened to my story and immediately admitted me to the hospital. An angiogram of my heart showed that the LAD artery was closing off at the stent and just downstream from there. They proposed putting two more stents in those locations, although they said they would place the first new stent inside the original one and then see if that opened up my artery downstream, so I may or may not need the second new stent. Then they also said my right coronary artery was occluded more than it was on the day of my cardiac arrest three months earlier, and so I should have another stent there.
At this point, I called Dr. Caldwell Esselstyn, Jr., author of Prevent and Reverse Heart Disease, and to my surprise, he took my call. I said I had been on his diet for a couple months, and so how could I need another stent? He explained to me that I had fixed the original problem of my clogged arteries, but the new problem was caused by my body's reaction to the stent. No diet could prevent my artery walls scarring in response to metal mesh being mashed into them. So he confirmed that I needed another stent in my LAD artery. As for the RCA, he said he didn't believe it had gotten worse and he pointed out that it was difficult to compare two angiograms taken at different angles at different times and in my case by different people and different pieces of equipment in two different hospitals. So it was highly likely that I did not need a stent in my RCA.
Back to the Hospital
I was admitted to the hospital on Friday. My local cardiologist assured me that the most experienced heart specialist was on staff, and I would be well cared for. However, I was still on a blood thinner, and my blood was too thin for them to risk the catheterization and stent insertion just then. So they took me off the blood thinner and waited for my blood to thicken.
By the time I was ready to go, it was Sunday, and the experienced doctor was not there. Instead, they had a young doctor with only 30 stent emplacements to his record.
They wheeled me into the catheter room and began. During my initial catheterization three months before, I was unconscious, but this time they gave me the choice, and I elected to remain conscious throughout. The doctor proceeded to insert the catheter and the two of us could watch its progress on the monitors. Shortly, the doctor terminated the process, wheeled me out to where my family was waiting, and informed us that I had a big cholesterol deposit near where my left coronary artery branched off from my aorta and that this was in a location that could not be stented. My only recourse was open-heart surgery, and he would immediately schedule it.
The Doctors Disagree
Fortunately, it could not be scheduled for this Sunday, and when the more experienced staff came in on Monday morning, they did not share the younger doctor's interpretation of my angiograms. They explained their difference of opinion to me and said that they would perform another catheterization, this time with a tiny ultrasonic probe on the end of the catheter that could image the area of my arteries in question. They would determine if it were nonstentable plaque, and if so, pull me off the table and schedule me for open heart surgery.
On the other hand, if it were just a normal variant of branch from my aorta, then they would proceed with the stenting as planned. Needless to say, I was nervous as I watched them perform the exploratory catheterization. When they told me I would not need open-heart surgery, I was very relieved, and frankly didn't pay much attention to what followed. When I was done, they said I had three more stents. I still don't know if the downstream LAD stent was warranted. And I'm quite sure that the RCA stent was not needed. But it's too late now. Stents can never be removed.
Stents May Fail in Three Months
The most common failure time for bare metal stents is centered around three months after insertion. Mine failed right on schedule. My next batch of three stents were all drug eluting stents. I was told when I asked that they also have about the same failure rate--20% to 40%, but that the average failure time was closer to 9 months. They coat drug-eluting stents with a toxic anti-cancer drug that slows down the artery's tissue growth and thus slows the scarring process. It's now been several years since these stents were put in me, so while I am unhappy about the number of them, it seems like I may well have survived them. I'm certainly well past the most common failure period.
After my heart attack, I was put on the following medications: Plavix (Blood thinner). simvastatin (generic name of Zocor), Metoprolol (Beta blocker), Lisinopril (ACE inhibitor), and 320 mg/day of aspirin. I was on these medications for about a year. At that point I had done enough research to conclude that the risk of these medications was greater than their benefit, so I informed my cardiologist that I was going off these medications. He said he didn't recommend that course of action, but if I was committed to doing it, I should discontinue them one at a time so that if I had a problem, we would know which drug I needed to start taking again. I agreed.
Dropping Drugs One at a Time
First off the list was Plavix. Research indicates that there is a beneficial effect for a few months following stent emplacement--3 months for a bare metal stent and 9 months for a drug eluting stent. During that time, the metal of the stent is in contact with the blood flowing through it, and the blood can clot if you aren't taking a blood thinner. After that time, the stent is completely covered by scar tissue forming from the artery walls around the stent. When there is no longer any stent-blood contact, then studies show that an 81 mg enteric coated aspirin daily is just as good as Plavix plus aspirin, so the Plavix really doesn't add any benefit.
I was looking forward to getting off my blood thinner. I was told that I should not participate in any sport where I could get a head or internal injury, as the blood thinner could cause me to die of internal bleeding. I like to ski and ski fast, but I had put this on hold while on blood thinners. I did notice that when taking Plavix, I would bruise easily, and if I got a little cut, it took a long time to stop bleeding. When I discontinued the Plavix, I no longer bruised easily, cuts stop bleeding quickly, and I'm skiing again. Yay!
Cutting Back on Simvastatin
Next to stop was the simvastatin, but I did so in stages, cutting it in half from 80 mg/day to 40, then to 20, and then finally stopping. When I was on full dose, and had been on the healthy diet for more than a year, my measured blood cholesterol was under 100 mg/dL. In some meters, this was too low to give a number. When I went from 20 mg/day to none, my cholesterol popped back up to 160. My cardiologist immediately recommended that I go back on statins - an interesting position given that my GP didn't seem to think that my cholesterol of 238 before my heart attack was a problem.
But I told my cardiologist that I would not go back on the statins and I just stuck with my diet. At my next checkup, my cholesterol was under 150, where it has remained to this day. My doctor called and left me a message saying congratulations and keep up the good work with the diet. At this time, my LDL was also right at 80, and has gradually dropped to about 70 more recently.
Next to Go Were Blood Pressure Drugs
While on my meds, I noticed that I would sometimes feel faint when I would stand up. When I asked my doctor why, he looked at my blood pressure and found that it was on the low side. Usually people with heart disease also have high blood pressure, so it's not surprising they prescribed Metoprolol and Lisinopril to reduce my blood pressure. However, by switching to a whole-food plant-based diet, I had removed the root cause of high blood pressure, and by also taking the meds, my blood pressure was going too low. I asked my doctor why he was prescribing the two drugs to lower my blood pressure when my blood pressure was too low. He said there were other benefits to the drugs. When I asked what they were, he couldn't answer, but just said that all five drugs were the Standard of Care for treating heart disease.
As I researched these drugs, I found that many experts would never prescribe either of them, as their benefits are doubtful. One of the drugs was thought to be somewhat beneficial in the case where the heart muscle was damaged and was in the process of rebuilding itself. This situation didn't apply to me, so I discontinued both Metoprolol and Lisinopril. The result: I can now stand up without feeling faint, and my blood pressure is well within the normal range.
Just One Small Negative Reaction
Curiously enough, the only negative reaction I got from discontinuing any of my medications was when I dropped from 320 mg/day of aspirin to 81 mg/day. For a couple days I had a sore lower back. I had heard of aspirin backlash and so wasn't surprised, but it was annoying. After two days, the pain went away.
For three years, I took the baby aspirin daily. Then I read about a study indicating long-term exposure to aspirin could result in damage to the digestive system. I tried but was unable to quantify the risks of taking the aspirin vs. not taking the aspirin, but all indicators were that the mortality rates were low for either case. So I decided to drop even the baby aspirin. This time I tapered off slowly to avoid the backlash. Now I am completely drug free and loving it.
Please Join Me
I've been on a whole-food plant-based diet for several years now, gradually improving my diet as I learn more. I invite you to join me in this adventure of discovery. Browse my website (www.nusci.org), and if you are in the Los Angeles area, sign up for one of our free workshops - details on our web site. And if you would like to help expand our ability to get the word out, you can support us with your tax deductible donation here: www.nusci.org/donation
If you know a group of people that would like to hear a presentation about extending life and health, please call me at (626) 872-4050.
John Tanner, PhD
CEO, Tanner Research, Inc.
Director, NuSci, The Nutrition Science Foundation
