According to the history books, Elvis Presley’s death on August 16, 1977 was the result of a self destructive rock ’n’ roll lifestyle fueled by an addiction to prescription drugs.
And the years following his death haven’t been much kinder.
Today, pop culture views Elvis more of how he died, rather than his incredible impact on American culture.
But according to a new book, “Elvis: Destined to Die Young” by author Sally Hoedel, forget all of what you have heard about Elvis in the decades since he died. The reality is that Elvis was a very sick man who did not take prescription drugs to get high. He took them so he could function and continue to be Elvis Presley.
Hoedel instead argues convincingly that the real reason Elvis died at a young age is because of faulty genes, not from abusing prescription drugs.
“Elvis’s drug use has been blown into huge proportions and sensationalized,” Hoedel said. “His story is always seen as one of self destruction. It’s sex, drugs, and rock ’n’ roll that sells and that people find interesting. But it really does hide this other layer of truth, which is that he was a very sick man. Elvis’s biological makeup was running out of steam the same as his mother years before. So I see it as a futile struggle to survive. I do believe he was not destined to live a long life.”
Hoedel, a lifelong Elvis fan, said that the more books that she read about Elvis, the more questions she had than answers about why he died so young.
She noticed that the one thing historians overlooked, was that none of them ever looked at his family’s health history. Had they done so, Hoedel said they would have found clues about what was really wrong with Elvis and been able to piece things together from that medical history to see that many of his ailments were with him from an early age.
“We have evidence and plenty of records of what Elvis and his mother suffered from,” Hoedel said. “It’s just never been talked about. So I had these questions and decided to do some research and see what I could find. Maybe Elvis had this. Or maybe had that. It was really amazing to me.”
Looking at the family tree, Hoedel said Elvis’s grandparents on his mother Gladys’s side - Bob and Doll Smith - were first cousins. That doubling of the gene pool led to heart and liver problems, damaged organs, and impaired bodily functions that were passed down the line to Gladys and other relatives, and then on to Elvis that cut their lives short.
Gladys Presley died at age 46 of liver trouble. Elvis’s Uncle Tracy died of a stroke at age 49. His Uncle Travis suffered from heart and liver problems and died at 58. And his Uncle Johnny died at 46 from kidney problems.
“That’s a lot of young deaths from liver and heart related issues,” Hoedel said. “Just common sense tells you there is something going on there.”
Hoedel discovered that Elvis was a carrier of Alpha-1 Antitrypsin Deficiency, a genetic disease that affects the liver. A-1 is a protein that protects the lungs and is produced in the liver.
Hoedel said little was known about genetic diseases or damaged genes at the time though, and no one understood or studied the family history to identify or rule out genetic disease as the cause of Elvis’s death. However, based on the evidence, Hoedel believes genetic disease was the culprit.
“It turns out it is one genetic disease that even as a carrier can be very difficult to live with,” Hoedel said. “If you are deficient in it, your lungs don’t get enough protection. It tends to look like COPD. When you inherit two bad genes, it can’t leave your liver and it kills your liver and looks like cirrhosis, which I propose is why Gladys died of liver disease.”
Underlying health issues
Hoedel said Elvis had serious health issues long before it was obvious on the outside. Although Elvis appeared perfectly healthy in the movies and on stage, the Elvis of 1956 had the same underlying health problems as the Elvis of 1977.
They just weren’t visible yet, Hoedel concludes.
Other organs were already showing signs of damage early on, most noticeable in his colon. In fact, Hoedel said Elvis suffered from disease or disorder in nine of 11 bodily systems, and that of those, five were present from birth prior to his fame.
Even as a toddler, Hoedel said family members noted that Elvis struggled to have a bowel movement. Friends who knew him in Lauderdale Courts in Memphis described Elvis as being constipated all the time. Hoedel believes that may be the result of Hirschsprung disease, a condition of the large intestine that causes difficulty passing stool.
“That is a genetic issue where the end of the colon is not fully wired out with nerves as it should be, so it can never clear itself out,” Hoedel said. “So there is evidence it was a lifelong problem and it would have been very painful.”
Hoedel said that the biggest reason Elvis’s health issues have been buried for 40 years is that he never wanted to appear weak.
“In the 70s especially, men didn’t talk about their health like they do now,” Hoedel said. “Back then, people were private about this. So of course he wouldn’t want to appear weak or talk about his health issues in front of the Memphis Mafia guys. They weren’t just his friends, he was their boss.”
Instead, Hoedel said Elvis hid his bowel problem because it was embarrassing to him and did his best to deal with his long-standing health issues.
Elvis turns to prescription drugs
Elvis also suffered from insomnia, which was the first ailment he turned to medication for. But contrary to the popular perception which has distorted the truth, Hoedel said Elvis was not a drug abuser. He turned to prescription drugs because he was trying to find a solution and cover his health ailments - which caused him intense and uncomfortable pain - so that he could continue to be Elvis Presley.
“He has insomnia and he starts with sleeping medication, and it works,” Hoedel said. “He then moved on to other things, and they worked as well.”
Hoedel said the people around Elvis knew that he took a lot of medications - Elvis would receive a packet of pills to help him sleep and for pain relief - but were unaware of the full extent of his pain due to constipation, insomnia, and other health ailments.
“They saw him take the pills,” Hoedel said. “But they didn’t know what was really going on. They saw him take these pills and then they wrote these books saying he was a drug addict. But they don’t even know why he was taking the.”
Hoedel does not dismiss the amount of drugs that Elvis was taking, and acknowledges that what started off helping Elvis absolutely did hurt him as he developed high tolerance levels and addiction issues.
Elvis’s physician, Dr. George Nichopoulos, wrote 199 prescriptions for Elvis totaling more than 10,000 doses of sedatives, amphetamines, laxatives, hormones and narcotics in 1977 alone.
But what is clear from her research though, is that Elvis did not take the drugs to get high and did not die as the result of prescription drug abuse.
“Even today, people will say, well, he was taking Dilaudid. That’s for cancer patients. Why would he need that?” Hoedel said. “So I ask people, if you had been constipated for two days, how uncomfortable is that? Now imagine having that issue your whole life. It does explain some of that stronger medication because he was in a lot of pain.”
Dr. Nichopoulos was charged with overprescribing medication, but was found not guilty after it was determined he acted in the best interest of his client. One expert witness at trial said without those drugs Elvis would have died ten years earlier.
The real cause of death
Hoedel said Elvis had ten drugs in his system when he died, but all were in the range consistent with the condition they were being used to treat.
“Even Dr. Nic knew he was sick but couldn’t really quite figure out what was wrong with him,” Hoedel said. “Elvis had things that would not have been recognized back then. It is difficult to diagnose those things now. It would have been difficult to diagnose those things then.”
Hoedel concludes that based on her research, in the end it was not prescriptions drugs that killed Elvis. The King of Rock ’n’ Roll died from a sudden, violent, heart attack, likely caused while he was straining to have a bowel movement, something called the Valsalva maneuver.
The Valsalva maneuver presses the bowels together and increases the pressure in the abdomen and chest, which reduces blood flow to the heart.
“Someone who overdoses slips into unconsciousness,” Hoedel said. “But Elvis stood up and was aware of the sudden pain and was going toward the door for help, which suggests a cardiac event. Dr. Nic said it was very common for Elvis to strain extra hard to empty his bowels. So when he was in the bathroom that night and he is trying so hard to empty his bowels, it leads to the Valsalva maneuver. And that is what ultimately led to his cardiac arrhythmia.”
A “walking time bomb”
But like every aspect of Elvis’ life, Hoedel said there are so many contradictions as to the cause of death.
“When you look at the toxicology reports from two different labs, they come up with two different outcomes,” Hoedel said. “One says lethal amounts killed him. The other says there was nothing in there that would have killed him. And then you have the medical examiner saying it is a heart event.”
In 1994, Tennessee hired Dr. Joseph Davis to investigate the circumstances surrounding Elvis’s death to look into whether there was a coverup. Davis, who also examined the Kennedy assassination, concluded that it was not drugs that killed Elvis, but rather that it was heart-related. Dr. Richard Shefford, who has conducted over 23,000 post mortem exams including one that looked into Princess Diana’s death, also concluded that Elvis died from a heart attack.
An autopsy revealed that Elvis’s heart showed signs of hypertension and congestive heart failure, and liver damage. Hoedel said the biggest shock though, was his colon. Elvis’s colon was five inches in diameter in some places and eight to nine feet long. A typical colon is two inches in diameter and four to five feet in length. That enlarged colon would have served as a reservoir where contamination can occur and produce bacteria producing toxins that could lead to organ failure.
Hoedel said medical experts that she consulted told her that Elvis would have been in extreme pain as a result of the constipation.
“I spoke with doctors and laid it all out,” Hoedel said. “ I asked them - and they weren’t Elvis fans - what do you think about my theory? They came back with ‘my gosh, he was a walking time bomb. He could have died at any moment. So that was helpful to know that I was on the right track.”
Hoedel doesn’t downplay the fact that Elvis took a lot of prescription medications, but said history and medical professionals missed the key question which is, why did Elvis turn to drugs in the first place?
Had they done so, Hoedel said a much different story would have emerged.
“I can’t say that drugs weren’t a problem, because they absolutely were a problem,” Hoedel said. “But they did not kill him. He had all these other things going on. If they would have seen the list of ailments that he suffered from, and thought about where they came from in his family tree, you would see a bigger picture. What my book does is show that he had diseases and disorders in nine of the eleven systems of the body by the time he died. And five of those I have proven were present prior to fame. And that is absolutely certain about the bowel problem and constipation.”
Instead, Hoedel said decades of books ignored the question of why he turned to prescription medication in the first place and instead attributed his death to sex, drugs, and rock ’n’ roll.
“It’s an easy go-to,” Hoedel said. “And I don’t know why Elvis is subjected to that. I think there is an element of romanticism going on and an elements of sensationalism. And that keeps the truth buried.”
Restoring Elvis’s humanity
Hoedel said sadly, Elvis’s drug use has been blown out of proportion ands his humanity overshadowed by legend and myth. Elvis has been reduced to a rock ’n’ roll icon who died in his bathroom after taking too many prescription pills, which is very unfair and does his real legacy a great injustice.
“He is such an icon. He is so big. Everybody knows who he is,” Hoedel said. “He’s not even thought of as human any more. But Elvis was real and was human.”
Hoedel said most books rarely offer him that humanity because they are so busy trying to find the next sensationalized aspect of his life that will sell books as opposed to looking for the truth about Elvis.
“And the other problem is, Elvis is seen as this rock ’n’ roll star, and if we look at him as a historical figure, we might look at him a little more honestly,” Hoedel said. ‘He’s a historical figure like Henry Ford and Thomas Edison. He culturally shifted our universe in a big way. And I think he needs to be looked at that way. I really do believe this book uncovered a layer of truth. I know it’s not sexy and it’s not the prevailing sex, drug, and rock ’n’ roll. But Elvis has been robbed of his humanity for a long time and by looking at his health flaws, we find a way to restore it.”
Book makes you look at Elvis differently
Hoedel said the response to her book has been overwhelmingly positive. Her biggest critics have been Elvis fans who haven’t read the book and refuse to read it. Most people though, have thanked her because the book has given then something else to think about as a fan.
“Elvis fans tend to pick their lane and the like to stay in there a lot of the time,” Hoedel said. “I’ve had people say to me ‘it was clearly the drugs. You’re making excuses.’ I believe drugs were a problem. I’m not making excuses. But what I know for sure is that if you bring an open mind to the table, you’re going to think about Elvis in a different way - whether you agree with everything in there or not.”
Hoedel said Elvis deserves to have his integrity and dignity and humanity just like any other historical figure and not just an image of this bloated guy who became a character in our culture.
“I knew I wrote a book with integrity from start to finish,” Hoedel said. ‘And I wanted to give it back to Elvis because Elvis has rarely been given that integrity. So I was confident in that whether people like it or not, I knew I did it the right way.”
Liberating Elvis from an unwanted image
Hoedel said she doesn’t think Elvis would be embarrassed by the book and what she found. Instead, she believes Elvis would feel liberated by being released from the chains of an image he didn’t want, but mistakenly created - his problem with prescription drugs.
“I believe Elvis would hate to be remembered for that,” Hoedel said. “When we learn about all of the personal struggles that he went through, it is a story of survival and not self destruction. When we only focus on that sex, drugs, and rock ’n’ roll angle of Elvis, so much is lost. He overcame serious poverty to become the world’s greatest entertainer and provided for so many of his family members. And for him to be remembered just for taking lot of pills and dying in the bathroom is a great disservice to him.”