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Antonin Scalia: Bad Health Decisions
In 1986, President Ronald Reagan appointed Antonin Scalia to the United States Supreme Court.  He was the first Italian-American justice and spent the next 30 years as perhaps the most conservative member of the court.  
On the morning of February 13, 2016, the 79-year-old justice was found dead in his bed.  His doctor-prescribed breathing apparatus, called a CPAP (Continuous Positive Airway Pressure)  machine was next to his bed but it was not plugged in and the breathing tube was not over his mouth and nose where it belonged.  We will never know the definitive cause of his death because no autopsy was performed, but the most likely diagnosis is that he died of a heart attack.  He had multiple risk factors for heart attacks: heart disease, diabetes, high blood pressure, sleep apnea, degenerative joint disease and chronic obstructive pulmonary disease.  He was nearly 100 pounds overweight and a lifelong smoker. His lifestyle had set him up for a heart attack.  


Early Life and Education
Scalia was born in Trenton, New Jersey in 1936, the only child of an Italian immigrant father who became a professor of Romance languages at Brooklyn College, and a first-generation American-Italian mother who was an elementary school teacher. At age three, he moved with his family to Queens, New York.  He was graduated first in his class at Xavier High School and went to Georgetown University where in 1957, he was graduated first in his class and summa cum laude.  He went to Harvard Law School where he was on the Harvard Law Review and was graduated magna cum laude.  In 1960, he married Maureen McCarthy, an English student at Radcliffe.  They had nine children. 
Legal Career
Scalia spent six years in a Cleveland law firm and then became a professor at the University of Virginia Law School.  He served in the Republican administrations of Nixon and Ford, and became an Assistant Attorney General.  He had to leave his federal government position when Democrat Jimmy Carter came into office.  He became a professor at Georgetown University Law Center, the University of Chicago School of Law and Stanford.  In 1982, President Ronald Reagan appointed him to the US Court of Appeals and in 1986, to the Supreme Court where he stayed until his death 30 years later.   
Cause of Death
Various conspiracy theories appeared in the news immediately following Scalia's death because it occurred in a remote location with no officials available to examine his body.  However, there was no evidence of foul play and no reason to pursue these theories because there was just about every possible reason to predict that Scalia would have a heart attack. His medical history shows multiple risk factors for a heart attack, including: 
Diabetes. All diabetics are at high risk for heart attacks since high blood sugar levels specifically damage the heart muscle and the arteries leading to them (J Clin Invest, March 2012;122(3):1109–1118)
Sleep apnea. Sleep apnea means that you stop breathing for several seconds multiple times while you are asleep.  Stopping breathing when you sleep lowers oxygen concentration in your blood that can deprive the heart muscle of oxygen and cause irregular heartbeats.  Symptoms of sleep apnea include: loud and chronic snoring, choking, snorting, gasping during sleep, and pauses in breathing. Other symptoms include waking up at night feeling short of breath, daytime sleepiness and fatigue, waking up with a dry mouth or sore throat, insomnia, frequent night-time urination, forgetfulness, difficulty concentrating, moodiness, irritability, depression, morning headaches, restless sleep and impotence. Sleep apnea can often be cured just by losing excess weight.
High blood pressure. High blood pressure damages the arteries to form plaques and cause heart attacks.
Degenerative joint disease. Most cases of joint damage are called osteoarthritis. Recent research shows that most cases of osteoarthritis are caused by an overactive immunity called inflammation and that people with a diagnosis of arthritis are at increased risk for heart attacks (Arthritis Care & Research, December 2013).  Heart attacks are increased significantly after joint replacement surgery (Arthritis & Rheumatology, published online August 31, 2015). His doctors had recently refused to do shoulder surgery on him because of his serious heart disease.  Obesity is a major risk factor for osteoarthritis as it causes the inflammation that damages joints (Med J Aust 2016;204(2):47).  Osteoarthritis should be treated with a lifestyle that reduces inflammation: eating a plant-based diet, losing excess weight, exercising, keeping hydroxy vitamin D levels above 50 nmol/L, avoiding infections and treating any chronic infections 
(Osteoarthritis and Cartilage, January, 2013;21(1):16–21).
Chronic obstructive pulmonary disease (COPD). This means that the bronchial tubes that carry air to and from the lungs are blocked so that a person cannot empty his lungs and suffers from low blood oxygen.  COPD is most commonly caused by smoking and is a major risk factor for heart attacks. 
Pills, devices such as the CPAP machine and even surgery do not cure any of these conditions; they only treat the symptoms and sometimes give you time to change the lifestyle habits that led to the problems. On the other hand, we do have plenty of evidence that lifestyle changes can reverse diabetes, plaques in arteries, high blood pressure, sleep apnea and so forth.  


Lifestyle Factors That Predicted His Death
Obesity. The most common cause of diabetes is a liver full of fat.  When you are overweight, your liver fills up with fat.  This prevents your liver from doing its job of removing sugar from your bloodstream when blood sugar levels start to rise.  A high blood sugar level damages every cell in your body including the inner lining of your arteries. It causes plaques to form there and set you up for a heart attack.  I have no record of his diet, but people who are this far overweight usually have a lifelong unhealthful diet, low in vegetables and fruit and high in sugar-added foods and drinks, fried foods, red meat, processed meats and other processed foods. 
Smoking: He was a life-long smoker. Smoking damages lungs and hearts, and kills by causing heart attacks and cancers. 
Lack of exercise: On the day he died, the sheriff found a "blue stretch band exercise device on the kitchen counter." That is the only evidence I could find that he had ever exercised. 
The Moral of This Story
How could a man with the power to make decisions that affect every person in the United States have made such horrible decisions about his own health?  Here was a brilliant man who died because he was not motivated enough to correct an unhealthy lifestyle that caused his diseases.
• Pre-diabetes and diabetes affects half of all North Americans
• Heart disease causes more than 40 percent of U.S. deaths
• COPD (chronic obstructive pulmonary disease) affects more than 24 million North Americans
• Sleep apnea affects more than 22 million North Americans and increases risk for diabetes and heart attacks
If you have any of his heart attack risk factors, please take Judge Scalia's death as a wake-up call to make the lifestyle changes that can prevent a premature and unnecessary death.


March 11, 1936 – February 12 or13, 2016 

March 6th, 2016
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About the Author: Gabe Mirkin, MD

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