Q: What originally inspired you to focus your career on the prevention of heart attacks and strokes?
A: It was inspired after 20 years (1994) of doing family practice and having many of my patients suffer from a heart attack or stroke. These devastating events occurred despite my best efforts and despite referring my patients to cardiologists before a heart attack. Around 1994, I attended a talk delivered by a cardiologist, Dr. Paul Shields. He had purchased an electron beam tomography scanner, which could detect calcium in coronary arteries. He taught me that the presence of such calcium meant the patient had coronary artery atherosclerosis, which places them at risk for a heart attack. He also taught me that arterial disease was an inflammatory condition and the test hsCRP could indicate if inflammation was occurring. After learning this, I encouraged my patients to have these tests. Since insurance did not cover them, some patients opted to undergo the tests, while others did not. The patients who had calcium and elevated hsCRP were informed they had an increased risk of a heart attack. They were then offered preventative treatment, which always included lifestyle advice, aspirin, statins, and ACEI. Within a few years, it was very apparent that prevention worked, as none of the patients who did the testing had heart attacks or strokes. Some of the patients who did not undergo testing still experienced events. After doing this for about three years, a tragic event occurred, which solidified my decision to focus my practice on heart attack and stroke prevention solely. One of my family practice patients who was in her late fifties had symptoms suggestive of angina. I sent her to a cardiologist who performed an angiogram. The angiogram was normal. I told her that heart attacks can happen in people with a ‘normal’ angiogram, and I encouraged her to do the other tests. She had coronary calcification and an elevated hsCRP. I put her on aspirin, statin, and ACEI. Her symptoms stopped, and her hsCRP returned to normal. I saw her every few months for about six months, and she continued to do well, so I told her to come back in six months. At the end of a busy family practice day, about six months later, my nurse asked me if I had heard about the above patient. I said I had not heard about her, but she should be about due to come in. My nurse then told me that an autopsy had just been completed, and the patient died of a massive heart attack. I was stunned and went to the bathroom, crying, and threw up. I felt horrible for failing this patient, and I wanted to apologize to her husband. I got him on the phone, and he started crying. He told me that their insurance had changed about three months ago. They had to change doctors and were embarrassed to tell me. They went to the new doctor, who told the patient that I was a quack. He told her that since her angiogram was normal, she had no risk of a heart attack. He took her off all the medications. Two months later, she died of a massive heart attack! At that moment, I knew what I was doing was saving lives and that prevention should be my total focus. After that, no one could “shake my tree”.
Q: When you and Amy launched the BaleDoneen Method, what principles were most important to you from day one?
A: One principle was that insurance companies would not influence what tests we ordered or what treatments we delivered. Those decisions would be determined by peer-reviewed science. We understood that it generally takes about twenty-five years from the time good science is published before the establishment and insurance companies accept it. We also decided that our financial gain would come from our knowledge and not from tests or treatments. We recognized that we are human and might subconsciously order an unneeded test or therapy if it increased our income. We were also committed to treating each patient as a unique individual. Therefore, although we pay attention to guidelines, because guidelines are designed to manage populations, they frequently did not apply to our patients. From a medical standpoint, our method was anchored in assessing each patient for the presence or absence of arterial disease as the means to determine proper prevention management as opposed to the standard of care (SOC), which makes such decisions based on risk factors. The SOC method was known to fail frequently, which allowed heart attacks to remain the number one cause of death since 1900. The other principle was recognizing that arterial disease is an inflammatory condition, and the degree of inflammation determines the risk for a heart attack or stroke.
Q: What sets the BaleDoneen Method apart from traditional cardiovascular care models?
A: We base management on the presence or absence of arterial disease and on inflammation.
Q: How has your thinking evolved over the past 20 years as more science has emerged around inflammation and arterial disease?
A: The evolving evidence continues to support our founding principles. We now recognize that oxidative stress (OS) is the common denominator triggering inflammation and arterial disease. Our list of conditions causing OS continue to grow and reaches way beyond the standard cardiovascular risk factors. Therefore, our management opportunities to stop arterial disease continues to grow. Some good examples are air pollution, noise pollution, and nanoplastics. The science that explains how arterial disease starts with the transformation of contractile smooth muscle cells in the media layer of the arterial wall into migratory secretory smooth muscle cells was instrumental in refining our method. We now have a rational explanation for how our method shuts down arterial disease.
Q: What does “personalized prevention” mean to you in real clinical practice?
A: Every patient is unique. We tailor their management based on that uniqueness. We utilize genetic testing to assess their individual prevention needs, taking into account their distinctive spiritual, family, community, and socioeconomic situation.
Clinical Research and The Science of Arterial Disease
Q: You’ve published landmark studies on halting and reversing arterial disease. What clinical discovery stands out as most game-changing?
A: Understanding the first step in forming arterial disease. This is the transformation of contractile smooth muscle cells in the media layer of the arterial wall into migratory secretory smooth muscle cells. These transformed cells move into the intima and produce proteins that electrostatically trap cholesterol, which triggers the ‘inflammatory’ response. By stopping the transformation, you stop arterial disease. Therefore, knowing what triggers the transformation is critical. OS is the most frequent trigger. There are also other triggers our method manages, such as gingipains produced by some high-risk periodontal pathogens.
Q: Inflammation and oxidative stress are major focuses of your lectures. How do these processes quietly drive heart disease?
A: OS results in cholesterol being trapped in the arterial wall. This triggers an immune response designed to ‘clean up’ the cholesterol in the artery. The immune response is inflammatory. If you mitigate OS, the trapping halts and the immune response ends.
Q: What’s your response to critics who still see arterial plaque as inevitable or irreversible?
A: Science does not support either one of those contentions.
Q: In your opinion, what is the most overlooked early sign of cardiovascular risk?
A: Great question with numerous possible responses. If forced to pick, I would answer erectile dysfunction (ED). The vast majority of ED is caused by the presence of arterial disease. ED is very common being present in about 15% of men 25-44 and around half of men 65 and older. Having ED doubles the risk of having a heart attack or stroke in the next four years.
Brain Health, Cognitive Function, and Heart Connections
Q: Your latest book, Healthy Heart, Healthy Brain, ties artery health to brain health. What’s one connection most people don’t realize?
A: Both are anchored in OS as a primary cause.
Q: What have you seen clinically that links early arterial disease with cognitive decline?
A: Clinically I’ve seen a paucity of cognitive decline. This includes one of my patients who is 93 and type two diabetic who sits on a bank board. In my opinion, this is due to shutting down his arterial disease during the last 18 years.
Q: What kind of prevention strategies support both heart and brain longevity?
A: Minimizing OS which involves numerous conditions including, exercise, diet, sleep, weight, oral health, psychosocial health, avoiding nicotine & excessive alcohol, avoiding air and noise pollution, avoiding insulin resistance, maintaining a normal blood pressure, management of autoimmune diseases, maintaining a normal vitamin D, maintaining a healthy gut microbiome, avoiding radiation, avoiding nanoplastics, avoiding cadmium, arsenic and lead.
Teaching, Mentorship, and Impact
Q: You’ve spoken to thousands of providers around the world. What common questions do you hear from medical professionals?
A: Why didn’t they teach what you talk about in medical school?
Q: How do you approach teaching such a complex subject in a way that sticks?
A: Emphasize the big principles we discussed above. Encourage the ‘student’ to apply the information to themselves.
Q: What keeps you motivated to continue researching, practicing, and teaching prevention?
A: The SOC is still terribly sub-optimal. It is exciting to know that the most common devastating human condition, namely, arterial disease, can be halted and regressed. The consequence is terrific, with not just the prevention of heart attacks and strokes, but the avoidance of all the chronic conditions anchored in microvascular disease, such as dementia, heart failure, kidney failure, erectile dysfunction, peripheral arterial disease, and macular degeneration. In addition, by decreasing OS, cancer risk is reduced and longevity is enhanced. It is a blessing to know how to shut down arterial disease. It would be remiss to stop utilizing and sharing that wisdom.
Universal Questions
Q: Can you share a story about a patient transformation that still sticks with you today?
A: There are many, but ‘Joe’ is remarkable. At the age of 58 after suffering from terrible obstructing coronary artery disease, he was told all they could offer him was a heart transplant. Instead, Joe plugged into our method. He still has his own heart. He is 77 now and leads a beautiful life enjoying his family, girlfriend and outdoor activities.
Q: What do you wish more people understood about preventing heart attacks and strokes?
A: Everyone has the opportunity to live out their life without suffering the consequences of those events and with minimal chance of developing numerous chronic diseases of aging.
Q: What motivated you to focus your career on prevention rather than treatment?
A: After experiencing firsthand as a family practitioner for 20 years, the failure of the SOC to maintain wellness.
Q: What’s one common misconception patients have about cardiovascular risk?
A: That cardiologist know how to stop it.
Q: What’s one simple change patients can make today to improve their heart health?
A: Do some form of physical activity daily.
Q: What do you love most about working with patients using the BaleDoneen Method?
A: Our partnership in establishing and maintaining their wellness.
