The Plant Rx

Your resource for a plant-based diet

Interview: Dr. Caldwell Esselstyn on Heart Health

Posted by Jenn on December 21, 2010

Green Heart (And the Green Grass Grows All Aro...

Image by CarbonNYC via Flickr

(Source: By- Maryl Celiz on 11.04.10:  Original URL:

As an internationally known surgeon, researcher and clinician at the Cleveland Clinic, Dr. Caldwell Esselstyn, M.D., made the case for a plant-based as a cure to cardiac trouble, a feat he explains in his book Prevent and Reverse Heart Disease. Yes, you read right – prevent AND reverse. But you don’t have heart disease (yet), you say? Read on. In this revealing interview, Dr. Esselstyn, who will soon be talking plant-based heart health on the big screen in the groundbreaking film Forks Over Knives, speaks about the surprising young age we start to develop heart disease, how grave the situation is, and how we can completely avoid it.

Maryl Celiz: What in your practice prompted you to think of a plant-based diet as a treatment for heart disease?
Caldwell Esselstyn: It was sort of an evolution for me. I started out as a surgeon, and it was halfway through my surgical career when I was chairman of our breast cancer task force that it was apparent that no matter how many patients for whom I was doing breast surgery, I wasn’t doing one single thing for the next unsuspecting victim. In other words, why were people developing breast cancer, was the question. And I began sort of a global research pattern and it was striking to me that in the late 70s early 80s, even in Kenya and Africa, for instance, breast cancer was something like 20-30 times less frequently seen than in the United States. In Japan, in the early 1950s, it was very infrequently seen. But as soon as the Japanese would migrate to the United States, the second and third generation of Japanese-Americans began to have the same rate of breast cancer as their Caucasian counterpart. Perhaps even more compelling was cancer of the prostate, which, in the entire nation of Japan, in 1958 how many autopsy common deaths were there from cancer of the prostate? Eighteen – in the entire nation. Very striking public health figure. By 1978 they were up to about 137, which still pales in comparison to the over 28,000 that will die this year from prostate cancer in this country. About that time I began to feel that my bones would long be dust before I really had the answers to nutrition and cancer, although in hind sight I’m not sure that’s true. But the decision was made at that time to get at cancer through heart disease, because it was quite striking that in this global review, there were a number of cultures that were plant-based, where cardiac disease was virtually unknown. I mean, even today, if you want to look at rural China, the Papuan islands and New Guinea, central Africa, the Tarahumara indians in northern Mexico, heart disease is virtually non-existent. So, it was really very powerful epidemiological evidence, and there was some experimental evidence with animals to suggest that, if they did have a diet that was plant-based, they would be absolutely free of heart disease, and perhaps if we employed this on patients who are ravaged with heart disease, we could actually not only halt it but reverse it.

MC: How and why does a plant-based diet work to reverse heart disease?
CE: Well, to answer that question, all experts I think would agree that the initiation of heart disease, and the build up of plaque in the arteries is caused by injury to the inner lining of the artery. It’s the inner lining of the artery that has the amazing capacity to make a molecule called nitric oxide, which protects us. As long as we have absolutely lots and lots of nitric oxide being made by the lining of our artery, we’re fine. But, sadly, the typical Western diet we’ve now learned over the last 15-18 years that, every time these certain foods pass our lips, they impair, they compromise, and they injure the lining of our artery, so that it’s making less and less and less of this wonderful protective nitric oxide.  So much so that by, let’s say, age 20, the average age at which our GIs were autopsied in Korea and Vietnam, and even without a microscope, 80% of those GIs autopsies had evidence of coronary artery heart disease. That’s a pretty darn young age to have this. Now, they weren’t far enough advanced in the disease yet to have the heart attacks or the clinical events, which were probably still several decades away. But there it is, already established in people who are that young. And we thought for some time that it might be due to the stress of the military. So, another study was done 40 years later, where they looked at thousands of adults between the ages of 17 and 38, who were dying of accidents, homicides, and suicides. And low and behold, they found that the disease is now ubiquitous: everybody had it. This is pretty powerful evidence that it is the Western foods that are doing it.

MC: What are the Western foods that are causing heart disease?
CE: Studies have shown that it’s these processed oils. Olive oil – yes, even sacred olive oil. Corn oil, soybean oil, safflower oil, sunflower oil – all these processed oils injure our endothelium – our lining of our artery. So do dairy products. So do meat, fish, and chicken. We found that when we took patients who were absolutely ravaged with heart disease and had them completely eliminate those foods that injured their arteries, not only did they begin to lose weight, lose their high blood pressure, and also lose their diabetes, but most importantly, their chest pain would go away – and it would go away often extremely promptly. And also, when we did the follow up angiograms, a number of these patients had shown striking reversal of disease. And I think the ultimate proof was, how so many of them lived well beyond 20 years.

MC: The body heals itself.
CE: It certainly does.

MC: Can a single meal have a negative effect?
CE: Yes. That’s how the evidence against the Western diet was discovered. There was a classic experiment that was done by Robert Vogel, who was a wonderful cardiologist at the University of Maryland. There’s a special test called the brachial artery tourniquet test, which can show how the artery can dilate in a normal situation. They put a tourniquet in the upper arm for about five minutes and measure the diameter of the artery after you put on the tourniquet and after it’s released, and you can see a striking dilatation – that is to say, the artery will widen greatly when the tourniquet is released after having been on for five minutes. That’s due to nitric oxide. However, when they took a group of healthy young people to a fast food restaurant, one half of the group got corn flakes, and they had a wonderful normal artery response. The other half had the hash browns and sausages, and within 120 minutes after that meal, they were unable to dilate the artery. It had so injured and so compromised the endothelium. Now, being young, a couple of hours later, that slowly began to recuperate somewhat. But you can just imagine the next morning for breakfast – scrambled eggs and bacon – and lunch, they might have white bread, mayonnaise and cold cuts, and at supper time, a baked potato with sour cream, lamb chops, vegetables soaked in butter, ranch dressing on a salad, and ice cream. In other words, we in Western civilization just hammer and hammer, injure and injure, repetitively, the lining of our blood vessel – and the vessel becomes diseased.

MC: So what is your recommendation – the rules of your program?
CE: What we want people to try to avoid, especially those ravaged by heart disease, are: Any of the processed oils, dairy, meat, fish, and chicken, and for the patient who has heart disease, I include nuts and avocados. What we want them to eat are all these wonderful whole grains, whether cereal, bread or pasta, and all the different types of legumes and beans, all the different vegetables – red, yellow and especially the green leafy vegetables. Can’t get enough green leafy vegetables, they are so power packed with the nutrients that help the lining of the blood vessel. And fruit. Not fruit juice – fruit. The other thing I ask people to think about is coffee with caffeine. There’s a significant study in the European Journal of Clinical Nutrition, that took a group of young adults and half got coffee with caffeine and the other half had coffee without caffeine. The group that drank the coffee with caffeine had injury and impairment to the lining of their arteries and their blood vessels. So, you can still have coffee, but we would prefer that it be without caffeine.

MC: Since chocolate and green tea also have caffeine, does that apply too?
CE: That will have to be independently studied to confirm, but my sense is that the other study was so clear cut in being positive as to whether or not there was caffeine, I think that if someone has a group of patients who are ill with heart disease, they would certainly be ill-advised at this point to have the caffeine even from other sources because when that evidence becomes available, if it confirms that the caffeine in tea has the same detrimental effect as does the caffeine in coffee, the you will have spared the patient further injury. On the other hand, if it doesn’t, you’ve certainly lost nothing.

MC: One of my favorite chapters in your book is the “moderation kills” chapter. Can you explain why moderation doesn’t work in this case?
CE: Let’s make it as simple as we can. Let’s suppose you’re someone who has heart disease and you have chest pain because you’ve got significant narrowing and blockage of the arteries to your heart. Why in the world would you want to, on Friday and Saturday night, continue to eat foods that are going to worsen your heart disease, and have another heart attack. How much food that is going to continue injuring me can I eat, and still get away without making my disease worse? It’s kind of a crazy thing when you think about it. It’s like saying, “I really love cigarettes, but I wonder if I just smoke half as much, whether my lung disease wouldn’t get worse at a slower rate.”

MC: In other words, if these animal foods and processed oils cause harm, why would you want to harm yourself – period.
CE: That’s right. Why would we want to have it in our school lunch programs? You can have ice cream and butter and cheese and milk, when we know that by age 12, when you carefully measure the carotid artery going to the brain of our young children, they are developing thickening of the artery. When you think about it, this is the age you really want to do it because all their doing right now is starting at a very young age to injure and impair their very delicate lining of their artery.

MC: I’m glad you brought that up because a lot of moms ask us – is it safe for children to eat a plant-based diet?
CE: Totally. Again, just go back to the cultures where heart disease is virtually absent. Personally, all of our children and our grandchildren eat plant-based and they are champion athletes as well as getting the job done elsewhere.

MC: Why do you recommend avoiding olive oil and avocados?
CE: They also have saturated fat, that’s why I’m particularly cautious, in the patients who already have heart disease. If somebody doesn’t have heart disease, and they’re eating avocados, they want to be sure that their cholesterol numbers are in a very acceptable, normal range. Under 150 total and maybe an LDL of 85. But otherwise in these products, especially for somebody who already has heart disease, you’re eating saturated fat and the various kinds of fats that are counterproductive to the disease. The olive oil, the studies are really quite clear. It has to do with the brachial artery tourniquet test – on a healthy individual, the artery should get 30% wider after they had the tourniquet on. Now, if you give somebody olive oil and administer that test, it will be compromised, meaning, there will be enough injury and impairment of the lining of the vessel so it can’t dilate sufficiently. The olive oil injures the lining of the blood vessel and its ability to make our protective nitric oxide. I’ve seen it in a patient where he was eating really well, but he was eating olive oil. And the only thing we changed was taking out the olive oil – and his chest pain disappeared.

MC: What about the brain – doesn’t the brain need good fats?
CE: I’m not sure that there’s any data that shows that there’s any deficiency of these good fats when you’re eating fully plant-based. I’m totally unaware that there’s any fat deficiency – most people want to know that you’re getting enough omega-3 and  omega-6, well, no question everybody gets enough omega-6. Omega-3 you get when you’re eating plant-based, and especially in the green leafy vegetables. And, interestingly enough, people who are plant-based, there is a recent study that suggests that  they are much more capable than meat eaters of naturally converting to omega-3 right within their own bodies. So, not only is there conversion, but you’re gonna get plenty of omega-3 through eating vegetables. I don’t know any study that suggests that your brain requires saturated, artery-killing fat to survive.

MC: What about flax seed?
CE: You certainly have that option – you can have a tablespoon or two of flax seed meal on your cereal to enhance the amount of omega-3.

MC: What would you like to say to people who still see a plant-based diet as an extreme option?
CE: Let’s suppose that we have a plant-based type of diet where you’re not going to be obese, not gonna be diabetic, you’re not gonna have high blood pressure, you have no risk of heart attack or the common stroke, and you markedly diminished your likelihood of the common Western cancers, and you’re obeying the kinds of suggestions that many of the societies like the American Cancer Society, the American Heart Association have suggested – more fruits and vegetables – but you’re just carrying it a step further. On the other hand, let’s suppose you somewhere else where they’re eating a Western type of diet. What have you got? Sixty million people who have heart disease, 22 million diabetics, millions and millions of hypertensive, people with high blood pressure. And 63% of the population is overweight, 33% of those are literally obese, and the nation is being taken to the cleaners by the health bill, which is now unsustainable. For instance, I don’t know how many are aware of the fact that Medicare is taking us to the poor house faster than anything else, due largely to a lot of unnecessary illness – 45% of the expenses of Medicare are cardiology. Heart disease is a toothless paper tiger that need never exist. And if it does exist, it need never ever progress. It’s a food borne illness. And about 75%-80% of these common chronic diseases are preventable if we were to eat plant-based.

MC: What is it about animals that is not healthy?
CE: It’s the animal protein as well as the animal fat that contributes to the plaque and blockages in the arteries – it injures the endothelium. In chapter three of The China Study, Dr. Campbell explains how lethal animal protein is in the production of cancer. It is really quite striking. But there is also clear cut experimental evidence that the animal protein and the animal fat is what seems to be injuring the lining of the blood vessel.

MC: Is there a specific amount of fats that you would recommend for healthy people?
CE: Eating is supposed to be an absolute joyous and pleasurable time. I don’t want people to have to sit down and calculate how many calories they’re eating, or how much protein, fats or carbohydrates they’re eating. What I want them to do is to recognize what are the foods that are going to injure them, and what are the foods that are going to protect them and enhance their health. And when you eat from a spectrum of the healthy foods – the whole grains for your cereal, bread, pasta, rolls or bagels, the different types of beans, the many different vegetables, and fruit, you’ve got a marvelous variety of healthy foods, and the idea of having to get mathematical about that suddenly takes away from it and makes it a burden, and it doesn’t have to be that at all. If you think about all of these wonderful varied plant-based cultures throughout the world – I mean, obviously the people in rural China are eating differently that those in the Papuan islands, or eating differently than those in central Africa, and yet the common denominator of these populations is that they just don’t have the common Western diseases and that’s so powerful, and yet none of them ever calculates beyond portion control and common sense.

MC: What’s your sample daily menu?
CE: I love breakfast – I have a huge bowl of oats, and not as oat meal as most people have it. Oats are wonderful because they have a natural compound within them that helps lower cholesterol, and another compound that decreases inflammation in the body. So, I really like to have oats on a regular basis. Now, what do I put in them? Either oat milk or hazelnut milk or even almond milk – unsweetened. In addition, I’ll have some strawberries, blueberries and banana, and often I’ll top it off with some grape nuts or some non-sugar cereal – it’s really reprehensible that they even manufacture sugary cereal. So, that will last me for six to seven hours. Then for lunch, usually we have a hummus sandwich with Ezekiel or Nestennacher, which is a wonderful bread lightly toasted with almonds. Now hummus is garbanzo beans, which I like to have without tahini – so no olive oil. On top of the hummus, some kale or spinach, chopped up scallions, a little lemon – eaten as an open sandwich – and then fruit for dessert. For dinner, a favorite meal might be beans and rice, covered with either peas, carrots, chopped up peppers, tomatoes, water chestnuts, chopped up scallions, corn. And a treat might be a little salsa on top of that or a light sprinkling of low-sodium tamari.

MC: That sounds delicious. Any final thoughts?
CE: Would just like to say that this country is going to have to have a seismic revolution in health. And it’s never gonna come from another pill, or another procedure or operation. It’s really gonna come when perhaps we, in public health, or in medicine, have the determination to share with the public what is the healthiest type of lifestyle that they can follow, and let them know that although exercise and social interchanges are terribly important, nothing can trump food in terms of health. It’s either going to devastate you or it’s going to enhance your health and well-being.


7 Responses to “Interview: Dr. Caldwell Esselstyn on Heart Health”

  1. Hi Jenn, I’m a vegan cardiologist based in West Hills. We should definitely talk! I am in the BYOB Potluck Group, so perhaps we can catch up at the next potluck!

  2. fynespirit said

    Your blog is a great resource; a kind of ‘one stop shop’ for vegans. Thanks.

    • Jenn said

      Thank you for your kind comment! That is my goal. I’m working hard on it. It you have any thoughts or suggestions as to how to make it more valuable or useful please so not hesitate! Happy Holidays, Jenna

  3. […] Interview: Dr. Caldwell Esselstyn on Heart Health ( […]

  4. […] Interview: Dr. Caldwell Esselstyn on Heart Health ( […]

  5. LoisAnn Dixon said

    Great article interview!!!

    I am anxious for all ideas for this healthy eating lifestyle!!!

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