"THE breaking point for me was that I’d always been a thin, healthy, well-dressed, man. When I got obese, it came on slowly. I smoked. I drank a little alcohol.

Then, all of a sudden, I was obese. I had to start wearing custom clothes. I went out and bought so-called fat clothes, and when I saw myself in the mirror I started crying.

It just wasn’t me. At the time, I had two young daughters. I was too exhausted to play with them. I thought, ‘If I can’t get off of the couch, and I’m exhausted, and if someone came in to kidnap my daughters, I couldn’t do anything about it.’ I had to change."

With cases of diabetes and obesity reaching epidemic proportions across South Africa and other parts of the world, those words could be from any man who ignores his health and over time becomes tragically overweight.

In this case, the words come from Dr Frederic Vagnini, a US cardiovascular surgeon, bestselling author and the director of the Heart, Diabetes & Weight Loss Centers of New York.

Dr Vagnini’s personal experience with obesity and diabetes, and subsequently losing more than 45kg to improve his health, has left him with the unique perspective of having lived with a heart suffering from extreme weight gain as well as having operated on other people’s hearts under the same conditions.

Now, as director of a major heart centre in New York, he spends his time helping people avoid heart surgery in the first place with his innovative "V Protocol".

The basics of the protocol

According to Dr Vagnini, the V Protocol is a series of five "rungs" on a ladder of knowledge that you have to understand and climb to overcome the potentially mortal dual diagnosis connection of diabetes and heart disease, known as diabesity.

At the beginning of Dr Vagnini’s book, Beating the Cardio-Diabetes Connection – The V Protocol: The Expert’s Plan (FJV Enterprises), he says these steps include "understanding areas of personal health designed to overcome lack of motivation to change, and mitigate genetic disposition and poor nutrition, along with a failure to fully understand how specific medications and new, natural supplements can stop this catastrophe".

He did not come up with the protocol overnight; rather, it took decades of practise as a physician to develop his strategy.

"I went to medical school at St Louis School of Medicine," he says. "I did my internship for five years at the Downstate Medical Center in Brooklyn, then spent two years at Columbia-Presbyterian.

Then I went into the army in Augusta, Georgia, where I did general and vascular surgery. After that I got involved in non-invasive vascular studies and I wanted to learn everything."

The reason for Dr Vagnini’s excitement was because he was about to open a small practice in Long Island to treat vascular disease.

"I had to retrain myself," he says. "I didn’t know anything about drugs since I was a surgeon. I had to learn blood pressure medications and lipid disorders.

"And over the past 20 years, I saw more and more people with visceral obesity, high blood pressure, high cholesterol, metabolic syndrome, elevated uric acid, elevated homocysteine, low HDL and on and on. I knew this was becoming a real problem and I become obsessed with learning how to stop it."

Recognising a deadly connection

"Throughout the years of my practice, I started to notice that many people with heart problems had this glucose-heart disease connection," Dr Vagnini says.

"Oftentimes, when someone gets their heart checked, the doctor will check ECG, blood pressure, cholesterol etc. But they don’t check your blood glucose. Some people have elevated levels without being overweight, but most who have them are overweight."

Since Dr Vagnini was a heart surgeon and had trained himself in the use of blood-pressure medications, he knew that in many of his patients there was much more going on than just a heart issue, but in the beginning, people were not willing to listen.

"On top of being a heart surgeon, I knew the nutrients because I was interested in nutrition and supplements, because many of my patients were as well," he says. "But back then they called me a ‘fringe’ doctor because I incorporated vitamins and other supplements into my practice."

Dr Vagnini proved to be ahead of his time in recognising the importance of supplements to a healthy lifestyle.

Using everything in his arsenal

These days, when new patients walk into Dr Vagnini’s office, they can expect to leave with a fully individualised programme, not simply a prescription and a follow-up appointment. Diet advice, exercise plans, stress reduction techniques, meditation techniques, medical nutritionist advice and much more are now part of a standard heart health improvement plan.

"The V Protocol is doing all of what I just described, but that’s after our initial analysis," Dr Vagnini says.

"The first time I see a patient, I give the whole array of the protocol. I administer a variety of stress tests, including echo, echo stress and possible nuclear stress. We check for a culinary calcium score and endothelium dysfunction.

"Everyone who comes in gets a three-hour glucose intolerance test, a BMI test, total body water test, lean body mass test. I want to know everything about my patients, so I can use everything in my arsenal to help them lose weight and improve their health. I also include many general anti-ageing strategies as well."

With a lab on the premises, all the tests can be administered and the results can be revealed in a shorter time frame than at other facilities, making the time between a diagnostic work-up and the creation of a treatment programme as streamlined as possible. A big part of the programme involves supplements.

Using the supplementation key

With the growing body of knowledge about supplements and nutrients expanding every day, each patient gets a nutraceutical programme geared directly towards his or her own problems.

"Almost everyone gets vitamin D3," Dr Vagnini says. "Some start at 5,000 units, some higher. Many are very D deficient, which can increase the risk for cardiovascular disease. I’ve even prescribed 50,000 units of vitamin D a week for 12 weeks and seen excellent results."

In addition to vitamin D, Dr Vagnini often recommends other supplements.

"I often recommend resveratrol for a variety of reasons," he says. "It is a powerful antioxidant, it helps with insulin resistance and it helps you lose weight. I like to suggest pomegranate be taken with it as well. And of course, it has many anti-ageing benefits."

Omega-3s are also often involved in the V Protocol and Dr Vagnini refers to them as "miracle nutrients".

"Omega-3s may cut diabetes risk, but they also help regulate blood pressure and lower homocysteine," he says. "CoQ10 is another critical nutrient that helps with insulin resistance, cardiac performance and many more issues. If a patient is suffering from fatigue, I’ll tell them about the energy benefits of D-Ribose. There are so many supplements out there that are helpful."

He also recommends aged garlic extract to help with cholesterol levels, blood pressure and arterial wall support.

"Too many physicians see a problem and go right for the drugs," Dr Vagnini says. "I go natural as much as I can. I’ll use statin drugs if I have to, but I have no hesitation to try red yeast rice, green tea extract, rutin, carnitine, whatever I find my patients are having success with."

The V Protocol supplement list to improve heart and circulation

• Arginine

• Carnitine

• CoQ10

• Ethyl Pyruvate

• Ginkgo biloba

• Hawthorne

• Kyolic garlic

• Magnesium orotate

• Omega-3

• Orosine

• Resveratrol

• D-Ribose

• Taurine

• Vitamin D

• A full version of this article appears in the Life Extension Foundation magazine