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Secrets of Cuban Health Care; Food as Medicine

Aired August 20, 2011 - 07:30   ET


DR. SANJAY GUPTA, HOST: Good morning, and welcome to a very special edition of SGMD. I'm Dr. Sanjay Gupta.

I'm reporting to you today from a place I have never visited before. I don't get to say that very often. But we are in Havana, Cuba. It's a spectacular place, and we've been working on this documentary about Diana Nyad for some time now.

For the few of you out there who may not know who she is, she's one of the most inspiring figures you're likely to meet, a 61-year-old long distance swimmer who set out to do the impossible, something that people told her simply could not be done.

She wanted to swim from here, from Havana, jump in the water right over here and swim all the way to Florida, more than 100 miles -- no rest, no shark cage, complete exposure to the elements. The swim was planned to take over two days, through day and night, more than 60 hours, was what the intent was going to be. And she had to do this, again, without any rest whatsoever.

What we now know is that Diana lasted about half that distance, about 50 miles, 29 hours in the water. The currents became so rough, the waves so big, her shoulders started to bother her. But it was no less inspiring to watch her near the end of that swim. Big question on a lot of people's minds now, including mine, Diana, is what is next for you? That's part of our story today.

Also, even though we're just about 100 miles away from Florida, we are a world away in terms of politics, in terms of the economy, in terms of the health care system here. People will tell you, if you talk about the Cuban health care system, prepare yourself for a fight. It is one of the more controversial issues you're likely to encounter.

What I can tell you this. Under Fidel Castro, everyone in Cuba has access to health care. That is very different, as you know, than a lot of other countries on the planet. What critics will say is that despite the fact that they have health care, oftentimes, that health care is not as good and patients do not fare as well. They'll tell you that the resources are limited for doctors and hospitals alike. They're often operating on a shoestring budget.

I came here to try and figure out what the real story in all this was and to get a real glimpse to try and show you.

(BEGIN VIDEOTAPE) (voice-over): Consider this. The life expectancy here in Cuba is about 77 years. That's comparable to the United States. Its infant mortality is among the lowest in the world. And the Cubans do all of this at one 14th of what we pay in the United States. How do they do it? Well, we came to find out.

You're looking at one of the better community hospitals in the capital city, Havana -- not a lot of flash, not a lot of dazzle, stuck in time circa 1960s.

(on camera): Technologies are available in certain place in the world, but you can't import them here.

DR. PEDRO ESTEVEZ, CUBAN DOCTOR: No, we can't get them even as donations sometimes. Half our scanners are from Phillips, for example, and they can't provide service.

GUPTA (voice-over): Dr. Pedro Estevez was born in Chicago. He did some of his training at NYU and now practices here in Cuba.

ESTEVEZ: I like the States personally, but my commitment is here. I have a job to do here. I mean, I think that the U.S. has plenty of doctors.

GUPTA: And there is a fear here that Cuba is losing its doctors.

(on camera): And Cuba's doctors aren't just practicing in Cuba, they're practicing all over the world. In fact, experts estimate that anywhere between a fifth to a third of all of Cuba's doctors actually practice overseas. Former president Fidel Castro believed in this "doctors for diplomacy" concept, sending doctors on humanitarian missions everywhere from Angola to Haiti.

But as we dug a little deeper, we find that there's another purpose, as well. For example, Cuba has sent 14,000 doctors to Venezuela over the last 10 years. And in exchange, Venezuela has sent millions of barrels of oil.

(voice-over): For all that we Americans spend on our medical bills, you would think that Americans would be much healthier, but we're not.

(on camera): One of the things that always comes up is that the cost per capita here in Cuba is much less than the United States. Yet life expectancy is about the same.


GUPTA: Childhood mortality rates are, in fact, lower here. How?

ESTEVEZ: I think it's the way the system is organized. It's the emphasis on prevention. It's the articulation of primary health care with the medical -- with the family doctor. It's the way we've been forced to use resources.

GUPTA (voice-over): And here is a key distinction. He is talking about prevention, not just catching problems early.

ESTEVEZ: For example, I was telling you about the screening for birth defects. That's 100 percent of Cuban mothers. The vaccination is 100 percent of kids. The hearing screening program for hearing loss -- that's all kids that are at risk.

GUPTA: So why invest so much in a hearing screening program? Because hearing loss has been associated with slower emotional and intellectual development.

Now, in order to have truly effective prevention programs, it helps to have a doctor and nurse right in your neighborhood.

(on camera): This is a neighborhood doctor's office, quite literally. The bottom floor here is the doctor's office. The doctor actually lives above the office, right here among the community.

There's a big focus on preventive care here, and that's why the doctor is here, to try and make sure that people are getting their vaccinations, they're getting their general care visits, but also to monitor to see if there's any potential outbreaks or threats to the community that are imminent. Doctors here will even make surprise visits, checking up on the general health of any given family.

(on camera): You make house visits?

(voice-over): This doctor has worked here for 20 years. She has 784 patients in this neighborhood, and she knows everyone by name. Many of them she's known since they were babies. The Cuban health system demonstrates prevention isn't a passive thing. But in case you're curious, a doctor like her makes on average between $20 to $30 U.S. a month.

(on camera): I hear stories about Cuban doctors who also have to take jobs, side jobs, in order to make ends meet because they're not getting paid enough. True?

ESTEVEZ: Yes, it's true.

GUPTA: Does that -- does that make it hard to actually incentivize people to go into medicine?

ESTEVEZ: These are not stories. This is a public -- this a public acknowledge (ph). And we have economic difficulties.

GUPTA: -- to swim across that ocean all the way to Florida.

(voice-over): Later in the day, we were shooting on the beach and we were called over to help a young man who'd been hurt while swimming. I was asked to help in any way that I could.

(on camera): Let your leg relax. Wiggle your toes over here.

Is somebody coming (INAUDIBLE)

(voice-over): The young man turned out to be all right, but that ambulance never came. But even if it did, the question remains. In a system with scarce resources, could this man have gotten the treatment he needed? It's also part of the reality Cubans face every day.


GUPTA: Well, hopefully, that gives you a little bit of a glimpse into the Cuban health care system. We're going to follow health care systems around the world and show you comparisons to the United States in the months and years to come.

I do want to talk about something that's become a real American problem, though, the biggest killer of both men and women alike in the United States. It's heart disease. Many people believe that this is a lifestyle problem, it's decided by the choices that we make in our lives whether or not to have this heart disease.

I decided that I wanted to become heart attack-proof, to be convinced that I would never have a heart attack. And my doctors now say that I've achieved that. You're probably wondering how. That's next.


GUPTA: And we are back from Havana, Cuba, with a very special report for SGMD. You know, I've been taking a close look at heart disease for some time now, and I can tell you that the American culture, and especially the American diet, has been exported to just about every country in the world, and they're starting to pay the price.

Heart disease is the biggest killer in the United States of men and women alike. And now they say about one in three American adults has some version of it. What I think is so remarkable is that we know that with no new money spent on heart research, no new resources, no new breakthroughs, right now, we could have a shot at virtually eliminating heart attacks.

Sounds pretty remarkable, I know, but think about it for a second. For example, take a look at the food that you eat. Think about that. Now think about it again.


(voice-over): Sharon Kintz is 66 years old, a retired private investigator from Canton, Ohio. A year ago, she had a heart attack after one of her coronary arteries became completely blocked.

SHARON KINTZ, HEART ATTACK SURVIVOR: He said for someone who had what you have, the only warning you usually get is death. And at that point, I really knew how lucky I was.

GUPTA: Like a lot of women, Kintz did not experience the classic chest pain, but rather fatigue and a pain in her jaw.

KINTZ: He said, You're going to have to have open heart surgery. He says, I can fix you today. I can just take you right down to the OR and I can operate on you right now. My son was in there, and he was ready to wheel me down to the operating room because he was frantic. You know, it's terrifying.

GUPTA: What Kintz did next may surprise you. She turned the surgeon down cold, said no to open heart surgery and decided to take a chance --

KINTZ: I bought some parsnips the other day. Always have sweet potatoes on hand.

GUPTA: -- using food as medicine.

KINTZ: I love these. (INAUDIBLE) they're so wonderful. So I love these.

GUPTA: Kintz is betting her life on a controversial diet created by a Dr. Caldwell Esselstyn. He's a general surgeon by training.

(on camera): You have some easy to remember adages about how people can decide what they should or should not eat.

DR. CALDWELL ESSELSTYN, JR., CLEVELAND CLINIC WELLNESS INSTITUTE: We know what they shouldn't eat. That is oil, dairy, meat, fish and chicken. What do we want them to eat? We want them to eat all those whole grains for their cereal, bread and pasta, beans, vegetables yellow, red, green, and fruit. Now, what particular vegetables do we want them to have? Bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, Napa cabbage, Brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula and asparagus. And I'm out of breath!


GUPTA (voice-over): Nothing with a mother, nothing with a face. You can imagine the meat, egg and dairy associations think that's a terrible idea.

SHALENE MCNEIL, NATIONAL CATTLEMEN'S BEEF ASSOCIATION: Incorporating lean beef into the healthy diet can actually help you stick to a healthy diet because it's a food that people enjoy.

MITCH KANTER, EGG NUTRITION CENTER: Eggs are a source of 13 vitamins and minerals. Eggs are the gold standard when it comes to protein.

GREG MILLER, NATIONAL DAIRY COUNCIL: Well, dairy foods are very nutrient-rich. You get a lot of nutrients for every calorie that you consume.

GUPTA: Dr. Esselstyn is not a cardiologist. He has no special degree in nutrition. But when it comes to food as medicine, he's a true believer.

(on camera): She had a heart attack.

ESSELSTYN: Oh, yes. I know. GUPTA: You know Sharon. Doctors recommended she have an intervention. She's not doing it. Is there a down side? Could she be putting herself at risk?

ESSELSTYN: No. I think that's an excellent question. In hundreds of patients, data now going back over 20 years, and this most recent study about a decade, once they start eating this way, you'll make yourself heart attack-proof.

GUPTA: Heart attack-proof?

ESSELSTYN: We know that if people are eating this way, they are not going to have a heart attack. It's a foodborne illness, and we're never going to end the epidemic with stents, with bypasses, with the drugs because none of it is treating causation of the illness.

GUPTA (voice-over): Esselstyn's food-based prescription puts him squarely against conventional wisdom which says diet is only part of a heart-healthy lifestyle.

(on camera): If a doctor were to say to me, Look, heart disease is a foodborne disease, if you follow this diet, pretty strict diet, very restrictive, but in exchange, you're not going to have a heart attack, what would you say that? You agree with that?

DR. ALLAN SCHWARTZ, NEW YORK PRESBYTERIAN/COLUMBIA HOSPITAL: I would say that's an overstatement, an oversimplification and an overstatement of really what we're able to do, even though I know there are people who say it.

GUPTA: I was curious about the science behind Dr. Esselstyn's claims, so I dug up some of these peer-reviewed journals. They're small, just a handful of patients, but the results are pretty impressive. In one study here, patients on the Esselstyn diet and cholesterol-lowering medication had no heart attacks, had no coronary events of any sort after five years. And three quarters of these patients actually saw their blockages get smaller.

(voice-over): A year after her heart attack, Sharon Kintz says she feels great. Check out those moves. A year ago, simply walking was enough to wear her out. With the diet, there's one question you have to ask. Can she keep it up?

(on camera): I asked Sharon Kintz to meet me here in New York City. You know, cooking at home is one thing, but eating on the road, eating on the run -- well, that's quite another. As the old saying goes, if her diet can make it here, it can make it anywhere.

46th and Broadway, please.

Sharon, how are you?

When you cook at home, it's a lot more in your control. What's the most difficult thing when you're on the road?

KINTZ: What I see here is I see pizza, which is not because I'm sure there's oil in it, and cheese. And that looks like pepperoni.

When I look up here, I see pasta.

GUPTA: Right.

KINTZ: So my question would be, when I go in, Do you have whole wheat pasta? And then my second question is, Can you prepare it without oil? That's not --

GUPTA: That -- no.

KINTZ: That's a not. That's a not.

GUPTA: That's not.

KINTZ: But they have pasta and they have salad.

GUPTA: Here's another restaurant. I'm going to take some advice from you. You look at a menu like this, tell me what comes to your mind.

KINTZ: The majority on there I'm not going to eat.

GUPTA: So you just focus in on the salads?

KINTZ: No, not really. I could have the baby spinach leaves minus the chicken. I could have the peaches, the strawberries. Forget the walnuts. And --

GUPTA: Is this a restaurant that you would --

KINTZ: Oh, yes.

GUPTA: You could come in and --

KINTZ: If I was hungry, you bet.

GUPTA: You can get a meal here.

KINTZ: You bet I can.

GUPTA: Sharon, you think this diet's going to make you live longer?

KINTZ: Oh, I hope so. I hope I get to see you retire.


GUPTA: I have a feeling you're going to -- that's a very long time.


GUPTA: But I hope you do.

KINTZ: I hope I do, too. (END VIDEOTAPE)

GUPTA: Nothing with a mother, nothing with a face, no dairy, no oil. It's not easy to do, I can tell you from personal experience. But one person who's giving it a go, former president Bill Clinton. He went through his presidency never knowing he was on the verge of having a heart attack. But he was.

It took quadruple bypass surgery to really open his eyes, and nowadays, he is changing his diet. Perhaps kicking and screaming a bit, but he's starting to do lots of different things to try and reduce his risk, including bringing his weight down to almost what it was when he was a teenager.

How's he doing it? I sat down with him one on one. That's next.


GUPTA: And we are back with a special SGMD. You know, according to the American Heart Association, 40 percent of Americans believe they're in ideal heart health. The real number, though, fewer than 1 percent. Those numbers starting to ring true in places like Havana, Cuba, where we are now, as well.

Former president Clinton thought he was in ideal heart health, but it took a quadruple bypass surgery to save his life. I sat down with him, as he is a changed man now, even a vegan. That's right, a vegan. He told me how he did it.


BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: I was lucky I didn't die of a heart attack.

GUPTA (voice-over): Former president Clinton, like too many people, was busy. And for years, he ignored warning signs of his heart. But in 2004, during an exhausting book tour, there was something different.

CLINTON: I had a real tightness in my chest when I was getting off the airplane. And it was the -- no pain, but it was tight. And it was the only time I've had it unrelated to exercise. So I immediately went down to our local hospital, and they did a test. They said, You got real problems. They hustled me down to Columbia- Presbyterian, and they confirmed the determination that I had serious blockage and needed the surgery.

GUPTA: The doctors immediately knew options were limited. The 58-year-old Clinton needed to have his chest opened, his heart stopped, and surgery performed.

UNIDENTIFIED MALE: There's no medical treatment for reversing the obstructions that have already formed in his blood vessels.

CLINTON: So I got Hillary and Chelsea there. And all I remember is, it was happening fast and everybody who cared about me was scared, and I felt rather serene.

GUPTA: On Labor Day in 2004, Mr. Clinton had four blood vessels bypassed.

UNIDENTIFIED MALE: Starting this morning around 8:00 o'clock, he had a relatively routine quadruple bypass operation. We left the operating room around noon, and he is recovering normally.

CLINTON: Well, it hurt like the devil for about three weeks. And it hurt so much that I had a hard time even watching movies, much less reading. And then when I started again to exercise -- and I forced myself out -- I mean, like, the first day, you know, tried to just walk a half a block one way or the other. I was trying to push myself into doing the therapy. There was that period when you're just not sure you can come back.

GUPTA (on camera): How do you know that you're healthy now? I mean, did -- first of all, would you call yourself healthy now?

CLINTON: Well, I think I'm healthier than I was. You know, I'm -- I lost 20-something pounds. And I feel good. And I actually have, believe it or not, more energy. I seem to need -- when I do sleep, I sleep better, but I seem to need less sleep to function at a reasonably high level than I did on the other diet.

GUPTA: I mean, you've talked about the fact that you love to eat. This is --

CLINTON: You know, I like the stuff I eat. I like the vegetables, the fruits, the beans. The stuff I eat now, I like. I like it.

GUPTA: Do you call yourself a vegan now, then?

CLINTON: Well, I suppose I am if I don't eat dairy or meat or fish, you know?

GUPTA: So you've cut all that out? I mean, do you --

CLINTON: The only thing -- once in a while, literally in well over a year now -- at Thanksgiving, I had one bite of turkey.

GUPTA: I mean, you're doing this for your health.


GUPTA: Is that why you're doing it?

CLINTON: Absolutely.

GUPTA: Mr. President. How are you?


GUPTA: The last time we spoke, a few weeks ago, you said you were going to be really strict on the diet. You were doing a pretty good job, you said?

CLINTON: Yes, I'm doing -- I'm being more strict now.

GUPTA: Are you?

CLINTON: Yes, by the time I have my 65th birthday, I want to weigh what I did when I went home from law school in 1973.

GUPTA: Wow! That's --

CLINTON: That's what I'm working on.

GUPTA: That's a grand ambition. I like that. So how much was that? Will you tell us?

CLINTON: I weighed -- I got down to 185.

GUPTA: All right!

CLINTON: Now, I got down when I -- when Chelsea was married, I weighed about 192, which is what I weighed when I graduate from high school. Anything under 195 was my optimum weight my whole life. But in the summer of '73 -- we had a scorching hot summer and I ran three miles a day at the hottest hour of the day, which I could do back then, in order to make the pounds go off. And it was the first time since I was 13 years old that I'd weighed 185 pounds. I'm going to try one more time to make it.


GUPTA: We'll have much more with former president Clinton. Also, all the studies out there that can potentially make you heart attack-proof. That's what doctors have told me that I now am, and I want to share it with you. And watch our special. It's called "The Last Heart Attack." It's this Sunday, 8:00 PM and 11:00 PM Eastern.

I'm Dr. Sanjay Gupta reporting to you from Havana, Cuba. We'll be right back.


GUPTA: Well, we are winding our time down here in Havana, Cuba, and I can tell you it's been a -- it's been a really fascinating trip to a place I had never been before. We came here to see an icon, Diana Nyad, trying to do something no human being has ever done before, swim from Cuba to Florida without any sort of protection. We know how her story ends, but we walked away in some ways even more inspired than we believed possible.

We also took a look at this place of Havana, Cuba, looked at the buildings, the throwback sort of feeling that you get when you're here, the cars from the 1960s, 1970s. In some ways, this seems like a place that's really stuck in time. We looked at their health care system to try and figure out what works and what we could learn, also what still needs to be done.

Hope you've enjoyed it, as I've enjoyed my time here in Havana. Time now to get you to the CNN "NEWSROOM."