I first met Dr Esselstyn at the International Cardiovascular Nutrition Conference, which took place in Chicago in 2015. I already knew at the time, that Dr Esselstyn’s life work has focused on demonstrating the powerful connection between nutrition and cardiovascular health. He emphasizes the ability of diet to bring about regression or reversal of cholesterol plaque in the coronary arteries, and not just to delay or prevent worsening of atherosclerosis. This process involves the improvement of blood flow in the arteries of the heart, improvement in heart function and reduction of angina symptoms.
Before I met Dr Esselstyn I had already read his research papers, as well as his book “Prevent and Reverse Heart Disease” in which he summarizes his research findings and explains the scientific basis for the efficacy of the diet that he recommends. In my opinion, Dr Esselstyn’s book is one of the core books on the subject of nutrition and heart health and I recommend that my patients read it. I recommend it especially to anyone who has risk factors for atherosclerosis (or coronary artery disease). And since ischemic heart disease is a major cause of death in the West, I “especially” recommend his book to everyone. However, since Dr Esselstyn’s book has not yet come out in Hebrew, I will do my best to share some of the book’s message here, at least in a partial way.
But first, I want to address the context, which will help in understanding the importance of this work. In the developed world, or the West, ischemic heart disease is the reason for the heart attacks which cause death and disability. It is the reason that bypass operations and stents are needed. It is the cause of much suffering and premature death for so many people. Ischemic heart disease (or, coronary artery disease) is a kind of epidemic in the West, and it is not just a disease of old people. Autopsies of American soldiers who died in battle in the Korean and Vietnam wars showed that cholesterol deposits were commonly found in the arteries of these apparently fit young men in their 20’s. (This was not so in the case of Korean and Vietnamese soldiers who were autopsied). Ischemic heart disease is very rare in certain cultures. This phenomenon is explained in depth, in the book “The China Study”, which examines patterns of eating and patterns of disease in China and the US. The absence of ischemic heart disease in China is attributed to the extremely low levels of cholesterol in the Chinese population and to the traditional Chinese diet which contains only negligible quantities of animal protein and saturated fat.
In the West, we treat heart disease very aggressively, or rather, we treat the results of the atherosclerotic process. We treat with bypass operations and stents in order to open partially blocked vessels or create a new path for blood supply to areas of the heart, and these treatments do save lives in emergencies. We treat with medications, principally statins, in order to slow down the atherosclerotic process which leads to blocked vessels. And yet we still have an epidemic. So much for the context.
Dr Esselstyn’s research involved patients who already had ischemic heart disease, patients who had already had heart attacks, patients who had already undergone bypass operations and stents. The expectation for such patients, on the whole, would be for worsening of their condition over time. The research involved having these patients eat a diet composed of vegetables, pulses, grains and fruit. Meat, chicken, fish, eggs and dairy were not on the menu. Nor was oil, including olive oil. (An aim of the study was to keep the cholesterol levels below 150, and there were patients who also received medication for this reason).
So, what happened to the patients who ate according to this protocol?
The most important result is in fact not what happened, but what did not happen. These ill people, who had advanced ischemic heart disease, and for whom the general expectation was worsening of their condition over time, did not experience this expected worsening. Quite the opposite. They did not go on to have more heart attacks, bypasses and stents. After a year, imaging studies showed that that blockages in their heart arteries had not become worse, and in some there was a clear improvement. Simply put, the arteries had opened up more because cholesterol deposits in these arteries had decreased or even disappeared. This is what Dr Esselstyn calls ‘reversal’.
In this research, there was not an official control group, but there were patients who left the research project and returned to their former eating habits. Dr Esselstyn also followed up on these patients. And what happened to them? Sadly, these patients’ symptoms got worse, some developed heart failure, some developed cardiac arrhythmias, and some required emergency operations. In short, they had global worsening of their cardiac health.
In this trial Dr Esselstyn followed the patients for an initial 5 years, and then published a further follow up report after 12 years.
One of the interesting findings in this study was that angina symptoms were reduced in the initial months and even weeks of the diet. This phenomenon also occurred in the well-known research of Dr Dean Ornish. How can this be explained?
Dr Esselstyn emphasizes the importance of the endothelium, which is the layer of cells lining the inner walls of the blood vessels in our body. These cells have many functions, but the one which Dr Esselstyn emphasizes is the ability of healthy endothelial cells to produce a gas called nitric oxide. This gas causes relaxation of the artery walls which leads to their widening and therefore to an improvement in blood flow.
It turns out that eating fatty food reduces the endothelium’s ability to make the nitric oxide gas which normally dilates the arteries and improves blood flow. This is known due to the work of another researcher, Dr Vogel, who conducted studies on healthy young volunteers. He gave a fat free meal to one group, and a meal containing 50 g of fat to the other group, then measured levels of nitic oxide in the blood, and measured the ability of the main artery in the arm to dilate after being compressed. In the volunteers who ate the fatty meal, there was a reduction in nitric oxide and in the ability of the artery to dilate, and it took 6 hours for things to get back to normal. Dr Esselstyn makes the point that if we assault the endothelium by having a fatty meal every few hours, we ultimately damage the endothelium. When we stop assaulting these vital cells, they have a chance to recover, so that blood flow can improve. That is why it is possible to get an improvement in blood flow and a reduction in symptoms after a relatively short time on the very low fat diet of vegetables, pulses, grains and fruit. This diet also contains substances which help to repair the endothelial cells. Dr Esselstyn emphasizes the benefits of green leafy vegetables in this respect and in practice recommends that patients with heart disease consume as many as 6 portions of green leafy vegetables in a day, in order to accelerate the process of healing their blood vessels.
Once a month, Dr Esselsytn offers a patient education seminar at the Cleveland Clinic, and new patients come from all over the world. During the seminar, Dr Esselstyn gives an in depth lecture about meaning of his research findings, and goes into the actual diet in great detail, as well as answering questions which patients and their spouses may have. In the second part of the seminar, Dr Esselstyn’s wife, Ann Esselstyn, teaches the skills for making the new diet work, in one’s own kitchen and when eating out.
In May of 2016, I was a guest at one of these monthly seminars. I am convinced that the patients who attended received the best possible tools for rebuilding their health.
www.dresselstyn.com. This website contains Dr Esselstyn’s original research papers as well as additional writings.
Caldwell B. Esselstyn, Jr., MD Prevent and Reverse Heart Disease. The Revolutionary, Scientifically Proven, Nutrition Based Cure. Penguin 2008. This book has not yet been published in Hebrew.
www.ornish.com Dr Ornish’s website contains his research papers and additional writings.