Q&A with Dr. Esselstyn
Q&A with Caldwell B. Esselstyn, Jr., MD
Caldwell B. Esselstyn, Jr., MD, F.A.C.S.
Please note: If your question is about finding a doctor in your area who supports a plant-based diet, please see this link: How to Find a Plant-Based Doctor.
How is your approach to treating heart disease unique?
My program is a nutrition-based therapy that has been scientifically-proven to reverse heart disease. There is no other treatment plan backed by a study as long as the one I conducted, or a study that has produced such dramatic, visible results. Coronary angiograms (X-Rays) of the patients in my study show an actual reversal of the disease. To experience these benefits, my patients must stick to my plant-based diet program strictly, but the effects are more than worth the effort. For those that are very sick, it is the most effective treatment option--far less dangerous and more effective than invasive surgical procedures such as stents and bypass (except in acute emergencies), and much more effective than drugs alone. Traditional cardiology has relied on technology to ease the symptoms of heart disease, but has not addressed its causes. My approach is not another stop-gap solution, it prevents heart disease from occurring in those who don't yet have the disease, and it heals the body and reverses the disease when symptoms are present.
Best of all, over time the benefits endure and continue to improve. I am always excited when I see arrest and reversal in patient after patient and their joy and relief when they are free of the disease that was destroying them.
What would you say to someone considering a stent or other surgical procedure or drug therapy, to treat their heart disease?
All heart patients who are not absolute emergencies should first have an aggressive opportunity at non surgical medical therapy. This is not just my opinion but that of expert cardiolgists from Boston, Hartford, Houston, Stanford, San Diego, Seattle and Cleveland. The difference in my case is that I advocate an aggressive plant based nutrition program to arrest and reverse the disease and to avoid all surgery. Drugs alone do not prevent heart attacks and stop symptoms of heart disease.
How do you encourage your patients to stay on the diet?
There is no question it is hard at first. And it is hardest eating out at friends' houses. However, I am always impressed how well my patients do once they experience the relief of chest pain, weight loss, and the improved feeling of well being they have eating a plant-based diet. Then the motivation comes from within. It also helps that within 8-12 weeks of starting the program the fat receptor in the brain down regulates and they lose the craving for fat. And as they start feeling better and better, they know that they are the ones-- not their physician or their surgeon--that have control over the disease. It is a powerful feeling!
Why does the diet eliminate oil entirely?
NO OIL! Not even olive oil, which goes against a lot of other advice out there about so-called good fats. The reality is that oils are extremely low in terms of nutritive value. They contain no fiber, no minerals and are 100% fat calories. Both the mono unsaturated and saturated fat contained in oils is harmful to the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease. It doesn't matter whether it's olive oil, corn oil, coconut oil, canola oil, or any other kind. Avoid ALL oil.
Can you actually enjoy food on the program?
Everyone loves the food once they give it a try. It is all a matter of attitude--and you do need a positive attitude to get started and to understand that this new way of eating is the best thing you can do for your body. Then, the body will help you adjust. You actually begin to lose your physiologically based craving for fat and down load your fat and sugar receptors losing the craving. Once that occurs, you can fully appreciate the natural taste of plant foods--the colorful tastes and textures difficult to surpass..
Why should I change? My health is excellent.
No one escapes in the end--eventually the traditional western diet guarantees some form of disease in all of us. While it may not be heart disease at the moment, eventually it will be or hypertension, diabetes, stroke, obesity, gall stones, diverticulitis, rheumatoid arthritis, lupus, multiple sclerosis, or a greater likelihood of breast, prostate, colon, ovarian and uterine cancers. Even erectile dysfunction and dementia. The world famous Framingham Heart Study now approaching its 60th year looked at 1,000 people at age 50 who had normal blood pressure. They looked at the same group at age 70, and 90% now had high blood pressure. But there is something that you can do now to stop the cascading events that occur in the body and lead to disease. You can change your diet and begin safeguarding your health for the future.
More Commonly Asked Questions
Protein - Where do I get my protein / What protein drink is best?
The protein available in a diet of whole grains, legumes, fruit and beans, and red, yellow and green vegetables is adequate to nourish even professional champion athletes such as those who compete in the iron man races, professional football, mixed marshal arts, track and field. Avoid protein drinks. The extra protein is truly unnecessary and has the potential for harm if it contains animal protein.
Calcium - Where do I get calcium?
Calcium supplementation is unnecessary. There is more than adequate calcium in a plant- based diet of whole grains, legumes and grains and especially the green leafy vegetables.
Vitamins - What Vitamins should I take?
Take Vitamin B-12. If eating copious amounts of leafy green vegetables, a multi vitamin is unnecessary. Have blood tested for Vitamin D level and supplement as appropriate to maintain blood level in the low normal range.
Fish Oil - Should I take fish oil?
Fish oil is not essential. Fish get their omega 3 from plants. It is difficult to be deficient in Omega 3 if eating 1-2 tablespoons of flax seed meal or chia seeds and green leafy vegetables at several meals. There is also research that suggests that those on plant based nutrition become highly efficient in their own manufacture of omega 3. Patients on fish oil are also at increased risk for bleeding, and studies now indicate they are of no benefit for heart disease patients.
Flax Seed Oil/ Flax Seed Meal - What about flax seed oil?
Flax seed meal is well tolerated and supplies a bonus of omega 3 using 1 or 2 tablespoons on cereal daily. Avoid flax seed oil.
Olive oil, canola oil, coconut oil, Sunflower oil, soybean oil, peanut oil, any oil -
Which oil is best?
Avoid oils. They injure the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease. All oil is also empty calories.
Lotions with oil - Is it all right to use lotions with oil on my skin?
It is fine to use lotions with oil on your skin.
Omega 3 - How do I get my Omega 3's?
Omega 3's are essential fatty acids supplied in adequate amounts in people consuming plant based nutrition with plenty of green leafy vegetables. However 1-2 tablespoons of flax seed meal or chia seeds daily is perfectly acceptable. Avoid flax seed oil.
Family history - I have a bad family history? Does it matter?
Our data indicates even those with strong family history when eating plant based are protected from vascular disease. Family history loads the gun, but lifestyle pulls the trigger.
Nuts - What about nuts? I hear so many different opinions.
As nuts are a rich source of saturated fats, my preference is no nuts for heart disease patients. That also eliminates peanuts and peanut butter even though peanuts are officially a legume. For those with established heart disease to add more saturated fat that is in nuts is inappropriate. For people with no heart disease who want to eat nuts and avocado and are able to achieve a cholesterol of 150 and LDL of 80 or under without cholesterol lowering drugs, some nuts and avocado are acceptable. Chestnuts are the one nut, very low in fat, it is ok to eat.
Seeds (sunflower, pumpkin, sesame, etc.) Are seeds ok to eat?
1 -2 tablespoons of ground flax seeds or chia seeds daily for omega 3 are appropriate for everyone to eat including heart patients, if they wish. Some seeds baked in bread or crackers is acceptable. Just don't eat handfuls.
Coconut water - Is it all right to drink coconut water?
Coconut water is 8% saturated fat and about 50% sugar. So save your money and don't use it.
Prostate cancer- Does plant based eating help prostate cancer?
Prostate cancer is greatly lessoned by plant- based nutrition as best exemplified by the 1958 report confirming by autopsy 18 deaths in the entire nation of Japan.
Egg whites, fat free milk, yogurt - So What is wrong with egg whites, fat free yogurt, skim milk?
Egg whites, fat free milk and yogurt are ALL animal protein, and animal protein injures the lining of the arteries. Do not eat.
Cholesterol Number fluctuation - Why do my cholesterol numbers fluctuate?
Fluctuation of cholesterol is normal. It is nice to have it fluctuating in a range that would indicate you are unlikely to have cardio vascular problems.
Losing weight - What can I do to stop losing too much weight?
If you are losing too much weight, EAT MORE calories. Increase portion size. Eat snacks. Eat more whole grains and beans.
Tired, no energy - Why am I tired and have no energy since eating plant-based?
If you feel tired and lacking in energy, be sure you are eating enough calories. Also exercise because you need to use energy to make energy. Depression also contributes to lack of energy. But first of all eat more.
Not losing weight - Why haven't I lost weight/ Why have I stopped losing weight?
If not losing enough weight, eliminate flour products like bread, pasta and bagels. Instead, eat whole grains like rice, quinoa, barley and farro, etc. Reduce portion size, Increase leafy green vegetables and exercise.
Triglycerides- Why did my triglycerides go up?
If your triglycerides are high, cut back on simple carbohydrates, which would include alcohol, wine, beer, white flour products, sugars including dried fruit, honey maple syrup, molasses, rich desserts, fruit juice or an excess of fruit.
HDL- My doctor is so concerned because my HDL has gone down
It is not uncommon for HDL to fall when consuming plant based nutrition. Do not be alarmed. The capacity of HDL to do its job has been shown recently by scientific research that there is no relationship between the capacity of the HDL molecule to function optimally and its blood level. Recent research has confirmed that the HDL molecule can be injured and weakened when one is ingesting a pro inflammatory western diet and conversely it appears despite a lower than normal level to be optimized by anti inflammatory plant based-nutrition.
LDL - Where should my LDL be?
LDL is the bad cholesterol. The closer it can be to 80-85 or lower, the better. However, if one is unable to take statin drugs and eating plant-based nutrition, and the LDL won't go lower than 95-105, it would appear that they will still be fine. The lesson we learned from the Tarahumara Indians, who never have cardiovascular disease, is that the most key protective element is not so much the pure LDL number as is knowing that nothing ever is eaten which is a building block of vascular disease or can injure endothelium.
Statins - Should I take statins or not?
Statins are not the reason that cultures such as the Tarhumara and the Papua Highlanders do not have cardiovascular disease. Statins appear to have modest benefit in primary prevention but are of some help in slowing disease progression for those who already have an established diagnosis of cardiovascular disease. Clearly though, some of our most profound successes in arresting and reversing disease were with patients who either refused or were incapable of taking statins. Nothing is as powerful for the prevention of cardiovascular disease as plant based nutrition.
Coumadin - Can I eat leafy greens when I am on Coumadin?
Coumadin (Warfarin) is an anti clotting drug shown to have significant benefit in protecting people with atrial fibrillation from having a stroke. Can patients on Coumadin eat all the green leafy vegetables with vitamin K, which may shorten their clotting time? The answer most emphatically is YES! Inform the physician who is monitoring the Coumadin and clotting time that you are regularly going to be eating copious amounts of healthy green leafy vegetables. He/she will appropriately adjust the Coumadin dose.
Juicing- Is it all right to juice?
Do not juice. Fructose separated from fiber is too rapidly absorbed and injurious. You lose the benefits of fiber best obtained eating the fruit. Chew your food.
Fruit juice - What about fruit juice?
Drinking fruit juice is like pouring the sugar bowl down your throat. It is fine to eat the whole fruit. Do not drink the juice.
Smoothies - How about smoothies? I love them!
Avoid smoothies. The fiber is so finely pureed and rapidly swallowed without the benefits of mixing with helpful bacteria in the mouth. The sugar is separated from the fiber of the fruit, bypasses salivary digestion and results in a surge of glucose. The fructose enhances inflammation, hypertension and endothelial injury. Chew your food.
A Fib- Will plant nutrition work for A Fib?
While A Fib is largely independent of nutrition, and is a heart rhythm abnormality, there are some subsets of cases which are presumably related to less than optimal heart circulation. While it would be totally inappropriate for me to suggest plant - based nutrition would cure atrial fibrillation, the many ancillary benefits would indicate plant based nutrition would be of value.
Calcium score- Is a calcium score helpful?
With cardiac CT you are exposed to significant radiation. A high calcium score is a surrogate indicating you have many more dangerous non-calcified plaques. This information can be powerful motivation for a lifestyle change to whole food plant based nutrition.