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In the longest ongoing study of its kind, Cleveland Clinic general surgeon and researcher Caldwell B. Esselstyn, Jr., M.D., has shown that a low-fat diet, coupled with cholesterol- lowering medication, is the single most effective way to stop progression of coronary artery disease. As detailed in an article in the August 1, 1999 issue of The American Journal of Cardiology, the heart patients in Dr. Esselstyn’s trial fared significantly better and over a longer period of time than patients in similar studies.

Dr. Esselstyn attributes the success of his 12-year trial to substantially lower mean levels of both total cholesterol (145 mg/dl) and LDL (82 mg/dl), low-density lipoproteins or so-called “bad cholesterol.” To achieve these levels, the 18 patients in Dr. Esselstyn’s study consumed less than 10 percent of their daily calories from fat–a percentage common in countries where heart disease is virtually nonexistent–and took cholesterol-lowering medications.

“In this study, patients become virtually heart-attack proof,” says Caldwell B. Esselstyn, Jr., M.D., which is remarkable since these same patients had experienced 48 cardiac events among them in the eight years prior to joining the study. Over more than a decade of Dr. Esselstyn’s ongoing trial, only one patient, who was noncompliant, experienced a cardiac event.

Many of the patients who joined Dr. Esselstyn’s trial did so as a last hope of staving off heart disease which had recurred despite their having had numerous angioplasties and bypass surgery. Dr. Esselstyn believes his patients benefited from having only one lifestyle goal on which to focus–a plant-based diet that eliminated meat, fish, fowl, oils and all dairy products in favor of grains, legumes, vegetables and fruit. “We achieved these excellent results without structured exercise, meditation, stress management, and other added lifestyle changes that were considered essential in other studies,” the Cleveland Clinic researcher explains.

Dr. Esselstyn’s findings also demonstrate that national dietary guidelines do not go far enough in recommending reductions in fat intake to Americans hoping to prevent heart disease. The American Heart Association and The National Cholesterol Education Program, for example, recommend a fat intake of 30 percent of one’s daily calories. “If 30 percent of your diet consistently comes from fat, you’re still at considerable risk for a heart attack,” the researcher says. In the American Journal of Cardiology article, Dr. Esselstyn says modern cardiology has “given up on a cure,” and is instead fixated on stopgap measures such as bypass surgery and variations of angioplasty that “treat the symptoms, not the disease.” For example, one of his patients, Evelyn Oswick, was told 21 years ago to “go home and wait to die” after a triple bypass operation and an angioplasty failed to keep her heart disease at bay. After 21 years on the plant-based diet and cholesterol-lowering drugs, Mrs. Oswick says she has never felt healthier. It’s challenging at first for patients to adapt to a plant-based diet. But, Dr. Esselstyn explains, “these same people cherish the idea of a guarantee against recurrence of heart disease. They are empowered when they can take control of a disease that once threatened to end their lives.”

A general surgeon, Dr. Esselstyn embarked on his cardiology research, worried that medicine’s reliance on pills and procedures, failed to “keep the next unsuspecting victim from succumbing to disease.” Although he grew up on an Angus cattle farm, Dr. Esselstyn had his last steak 23 years ago when he and his wife adopted a plant-based diet. “I knew that in order to ask patients to adhere to it, we had to adhere to it first.” A former Olympic gold medalist in rowing, Dr. Esselstyn nevertheless welcomed protection against heart disease himself, since his father had suffered a heart attack in his early forties.

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