Caldwell B. Esselstyn, Jr., M.D.
If the truth be known coronary artery disease is a toothless paper tiger that need never ever exist and if it does exist it need never ever progress.
Question: What is coronary heart disease?
Answer: Coronary heart disease is the leading killer of woman and men in western civilization. It is predicated to become the #1 global disease burden by 2020.
It consists of an inflammatory buildup of blockages in arteries to the heart muscle. These blockages are made of fat, cholesterol, calcium, and inflammatory cells. Blockages can become severe enough to cause symptoms such as shortness of breath or chest pain (angina). When blockages suddenly become complete, the portion of heart muscle fed by that blocked artery is now deprived of oxygen and nutrients, thus it is injured or now dies. This is a heart attack. The patient may survive or succumb if the event is accompanied by a fatal heart rhythm.
Question: Who develops heart disease?
Answer: Everyone eating the typical western diet. In autopsy studies of our GI’s who died in the Vietnam and Korean wars almost 80% at an average age of 20 years, had disease that could be seen without a microscope. Forty years later in 1999, a study of young persons between the ages of 16-34 years who have died of accidents, homicides and suicides, finds the disease is now ubiquitous.
Question: What is the cause of the disease?
Answer: It is the typical western diet of processed oils, dairy, and meat which destroys the lifejacket of our blood vessels known as our endothelial cells. This cell layer is a one cell thick lining of all of our blood vessels. Endothelial cells manufacture a magical protective molecule of gas called nitric oxide, which protects our blood vessels. It keeps our blood flowing smoothly, it is the strongest dilator (widener), of our blood vessels, it inhibits the formation of blockages (plaques), and t inhibits inflammation.
Question: With such natural protection why do we ever develop heart disease?
Answer: Every western meal of processed vegetable oils, dairy products, and meat (including chicken and fish) injures these endothelial cells. As individuals consume theses damaging products throughout their lives, they have fewer functioning endothelial cells remaining and thus less of the protective nitric oxide. Without enough nitric oxide the plaque blockages build up and grow creating eventually heart disease and strokes.
Question: Can it be stopped or even reversed?
Answer: Yes. First we must look at the lessons learned from cultures where there is a virtual absence of coronary artery heart disease such as rural China, the Papua Highlands of New Guinea, Central Africa, and the Tarahumara Indians of Northern Mexico. Their nutrition is plant based without oil.
Beginning in 1985 I initiated a study of seriously ill coronary artery disease patients. Their nutrition became plant based without oil. Their cholesterol levels plummeted. Their angina disappeared. Their weight dropped. I have reported this study at 5 years, 12 years, and 16 years, in the peer reviewed scientific literature and again beyond 20 years in my book Prevent and Reverse Heart Disease. In some of the patients we had follow up angiograms (x-rays) of previously blocked arteries demonstrating striking disease reversal, which is a testament to my often quoted statement “The truth be known coronary artery disease is a toothless paper tiger that need never exist and if it does exist
It need never progress.”
The greatest gift to these patients is the increasing recognition that they are the locus of control for their disease – not some pill or procedure. They have made themselves heart attack proof and lose the greatest fear of all heart patients and their families – when will the next heart attack occur?
Question: What about drugs, stents, and heart bypass surgery?
Answer: Admittedly in the midst of a heart attack a stent or bypass may be live saving, however, for the remaining 90% studies confirm that they do not prevent future heart attacks or prolong life. They are associated with significant complications such as hemorrhage, heart attack, stroke, cognitive decline, depression, and death. The benefits erode with the passage of time as the stents and bypasses may themselves develop blockage.
Some drugs may decrease blood pressure and the heart workload. Others interfere with clotting which helps a stent remain open. Statin drugs lower cholesterol. Noneof these drugs or interventions addresses the basic causation of disease and not surprisingly the disease progresses with the need for more drugs, stents, and repeat bypasses.
Question: Why aren’t physicians using nutrition therapy?
Answer: Most physicians have no training or understanding of the power of nutrition. In a busy practice they would not have the time for it. It is my belief that physicians must accord the plant based lifestyle transition its due. Every patient with cardiovascular disease should be referred to a physician or nurse practitioner with the knowledge and expertise in these counseling skills.
Question: But I understand physicians don’t feel patients will make this transition. How come?
Answer: Nutrition counseling is a skill which physicians don’t possess. Of all the encounters a patient with cardiovascular disease experiences, perhaps the least time and lowest priority is nutritional counseling. I see many patients with heart disease who recount that nutrition was never even mentioned. It is therefore unlikely that the patient feels that nutrition is important.
Question: What is that you do differently?
Answer: In an intensive 5 hour counseling session for a group of heart patients my first priority is to eliminate the mystery of what causes their disease. It has not been stress, or genes. It is their western diet of processed oil, dairy, and meat. Hypertension, diabetes, and smoking must be controlled but food trumps all. I spend at least an hour defining the protective role of endothelial cells and nitric oxide functioning as the ultimate guardians of our blood vessels. They quickly understand that their lifetime of ingesting these harmful products has totally overwhelmed and destroyed their endothelium to an extent where it is unable to protect them. They fully grasp that they must forever eliminate ingesting foods that will further destroy their already compromised endothelium. They understand heart disease is a food borne illness.
Question: Where is the good news?
Answer: They understand that they can halt their disease. They are presented with my scientific articles demonstrating reversal of disease. They learn that anginal chest pain may diminish or disappear within 10-14 days in some patients while others may take longer. We share our data confirming reversal of carotid artery disease to the brain, coronary artery disease of the heart, peripheral vascular disease in the extremities, and the reversal of erectile dysfunction. They are made to appreciate how rapidly and powerfully the endothelial function may be restored. The most significant message in our counseling is patient awareness that they are empowered to be the locus of control of their disease.
Question: What is your criticism of the present management of heart disease through drug stents and bypass surgery?
Answer: It is expensive, dangerous, and ineffective. None of these approaches addresses the factors that cause the disease. A doctor would never treat poison ivy without advising the patient to avoid exposure to poison ivy plants. Sadly the usual treatment of cardiovascular disease almost never includes hours of patient counseling so they may completely eliminate the foods which are injuring their endothelium. Stents may block, bypass veins shut down, drug doses increase, and blood vessel disease worsen. The present cost of this non-treatment of heart disease is unsustainable even in our wealthy nation.
Question: Dr. Esselstyn, are you a threat to the stenting and bypass industry?
Answer: Not really. Stents and bypass surgery in an emergency setting are absolutely lifesaving. However, for non-emergency situations an intensive lifestyle trial of 3-6 months would eliminate the need for most interventions. It is of interest that when physicians and some interventional cardiologist themselves develop the disease they come knocking at my door.
Question: What forces are lined against you?
Answer: The government, drug industry, and some of my own profession. The USDA every five years produces a food triangle which promotes the very foods which guarantee that millions of Americans will perish.
The drug industry has a $21 billion dollar income from statin drugs alone. The stent manufacturers make billions more. Neither of these companies would want this epidemic resolved.
Physicians who perform stents and bypass surgery earn millions and are hardly clamoring for fewer patients.
Question: Any final thoughts?
Answer: When people learn to eat plant based to eliminate heart disease it could inaugurate a seismic revolution in health. Other diseases that resolve include obesity, hypertension, stroke, heart attacks, gall stones, diverticulitis, asthma, osteoporosis, allergies, rheumatoid arthritis, multiple sclerosis, lupus, and a marked decrease in the common western cancers of breast, prostate, colon, endometrial, ovarian, and pancreatic.
To paraphrase John Kennedy “Ask not what your country can do for your health, ask what you can do for your health.”