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.
1. 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.
2. 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.
3. 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
4. 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. And above all they contain
saturated fat which immediately injures the endothelial lining of
the arteries when eaten. It doesn't matter whether it's olive oil, corn oil, coconut il or any other kind , avoid ALL oil. This is so important I have detailed
oil in Chapter 10.
5. Can you actually enjoy food on the program?
We LOVE our food. Our children and grandchildren love our food
and the patients love the food. 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. Once that occurs, you can fully appreciate
the natural taste of plant foods--the colorful tastes and
textures are difficult to surpass.
6. Why should I change? My health is excellent.
No one escapes in the end--eventually the traditional western diet
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?
Extra protein powder and shakes are truly unnecessary and have the potential for harm if they contain animal protein. The protein available through plant-based nutrition is adequate to nourish professional champion athletes such as the iron man, professional football, mixed martial arts, track and field, etc.
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?
A multivitamin is a reasonable way to be sure of obtaining the full spectrum of vitamins, but my preference, especially if one is eating copious amounts of green leafy vegetables, is to limit supplements to Vitamin D as necessary to maintain blood level in the normal range and B -12.
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 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.
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.
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.
Family history –I have a bad family history? Does it matter?
Family history can shed light on whether one has an increased risk, but multiple autopsy studies of the young confirm that all who are consuming the standard western diet have established, albeit early, vascular disease. Family history loads the gun but lifestyle pulls the trigger.
Nuts – What about nuts? I hear so many different opinions.
For those with established heart disease to add more saturated fat 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. No nuts for heart disease patients, includes peanuts and peanut butter, even though peanuts are officially a legume. Chestnuts are the one nut, very low in fat, it is ok to eat. (For a clarification of misinformation about nuts and this diet, see here.)
Seeds (sunflower, pumpkin, sesame) Are seeds ok to eat?
Some seeds sprinkled on bread or crackers, etc., are acceptable. Just don’t eat handfuls.
Coconut water – Is it all right to drink coconut water?
Coconut water is 8% saturated fat (If the fat is less than .5 per serving it does not have to be listed on the label) 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 cholesterol falls. 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, 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 no 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 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! Merely 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. You lose all the fiber and its benefits.
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 that its helpful properties are destroyed. The sugar is stripped from the fruit, bypasses salivary digestion and results in a surge of glucose and the accompanying fructose contributes to inflammation and hypertension.
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 subset 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 get a big hit of radiation. If you have been eating the typical American diet, you have heart disease as autopsy studies have shown.
Erectile dysfunction- Will erectile dysfunction reverse with plant based nutrition?
We have seen erectile dysfunction reverse on multiple occasions. Those who follow the program most closely have the best results. How long it takes varies.
Do Cholesterol Numbers Matter?
What you eat matters most. LDL 85 or under is the ideal but it can vary if you eat plant based.
Sugar- How much sugar is safe?
Newer information suggests that excess sugar is harmful, especially fructose, one of the most commonly ingested sugars, which can contribute to inflammation and hyper tension as well as weight gain and exacerbating diabetes
Coffee – Can I drink coffee?
Avoid coffee with caffeine. Several studies indicate it may contribute injury to the lining of the artery.
Soy products – What about soy products?
Soy products are 40% fat and most of them are highly processed. An excess of soy protein may stimulate insulin growth factor, which is a tumor promoter. Eat soy products cautiously.
Does eating plant based help with congestive heart Failure?
There are multiple components in the treatment of congestive heart failure. It is our experience that when all the usual therapies have been instituted, there can be additional improvement with the introduction of whole food, plant based nutrition.
There are so many different diets out there…Paleo, blood type, how do I know which one to choose?
That is not as challenging as it may appear. You can separate hype from scientific reality by seeing if the author has done peer reviewed scientific research prior to bringing the ideas to the public.
What is the difference between plant protein and animal protein?
While the precise mechanisms need to be elucidated, animal and epidemiological studies as well as the brachial artery tourniquet test, confirm that animal protein accelerates both atherosclerosis and cancer, whereas plant protein does not.