"The first thing I do when people tell me that they can't reduce their cholesterol to 150 ml/dL or less is press them on precisely what they eat on Friday or Saturday nights, or what they might have consumed at that seemingly endless weekday meeting where there was "nothing else to eat."Often, under my questioning, they reveal tiny deviations from the nutrition program--lapses so small that they didn't even take them into account.
--Dr. Caldwell B. Esselstyn, Jr., Prevent and Reverse Heart Disease--
If you've received this via email, click here to get to the web version with all the links.
Let this be a cautionary tale!
I thought I was doing everything right with my diet. I'm eating loads of vegetables, fruits, beans, and whole grains. I feel wonderful. I've accrued countless benefits. But I didn't cut out oil or nuts or avocados.
- Two years ago I "mostly" cut out all dairy, eggs, and meat. And yes, that includes, cheese, yogurt, chicken, my beloved turkey sandwiches, and fish.
- About one year ago I "mostly" cut out sugar--ditching desserts that deliciously combine butter, oil, flour, and sugar. But, I didn't cut out super dark chocolate every once-in-awhile.
- I limited my cooking oils to just canola or olive oil, and cut down the amounts considerably.
- I still ate nuts, including almond butter, and my fave Larabars--and I ate them in moderation.
- I still ate avocados.
- Occasionally, I'd eat humus or baba ganoush that were store-bought or restaurant-ordered & of course they're made with fat-heavy tahini.
- I ordered vegan dishes whenever I ate out--but didn't think too much about the oil used back in the kitchen. Deep-fried falafel? Fried onions on top of the Mujadara? Indian vegetable curries? You get the picture. And I never asked the chef for "special orders" made without oil
- Maybe every other month I might eat fish at a friend's house, or at a restaurant.
I figured I was healthy. No diagnosed heart disease. I've exercised for over 35 years. My weight's fine, even though I'd love to drop a few pounds. I figured I could successfully follow the Esselstyn/Engine 2/McDougall/Fuhrman plant-based diet-thing "my way"--not exactly "their way"! Unknowingly, I chose to eat plant-based with moderate fat intake--which isn't exactly what they're prescribing. Oops on me!
Boy was I in for a surprise!
The Cholesterol Test - Did I Ace It?
My last cholesterol test was 2 1/2 years ago, taken five months before I started eating plant-based. And because I had squeaked in as "healthy" after my last cholesterol test--I still didn't need any statins--and my health plan wouldn't "authorize" a new cholesterol test for me for 2 1/2 years! I certainly was curious to see how eating plant-based was affecting my cholesterol--but I was going to have to wait 2 more years to find out.
But, when a new "Employee Wellness/Shape Up" initiative began this year at the medical center where I work--all that changed. Now--all of sudden I was required to retake the cholesterol test, and all the other tests needed to qualify for a health insurance discount.
Here's the deal: If you want to "Lock Into" 2009 health insurance rates for 2010 & 2011 you have to prove:
- Your weight is healthy--a BMI below 27 (which is actually overweight).
- Your blood pressure is normal at 120/80 or below
- You are diabetes-free
- Your cholesterol levels are in the normal range.
- If you flunk any of these tests--you have to "enroll" in a "special help" program to lose the weight, lower the cholesterol, control the diabetes, and lower the blood pressure--before you can get an insurance rebate.
I was sure I would Ace the cholesterol test that I took on May 6th. The blood pressure test was the one I was a bit worried about. I knew I'd pass the weight test.
So, imagine my disappointment when I got back my cholesterol test. I thought for sure the total would be between 150-170. Boy, was I mistaken. Yes, my tests were good enough to be in the so-called "normal range". I passed the test and I'll get my health insurance discount--but now I know I need to kick it up a notch if I want to beat the family "stroke and heart disease curse".
The results were good enough to still keep me "statin-free". But, now that I'm eating plant-based, ingesting nary a speck of dietary cholesterol I was expecting a STRAIGHT-A LIPID TEST. Nope, didn't happen.
Here are my 2007 & 2010 scores--the bad, and the better. According to my doctor, I'm one of those people whose cholesterol is affected to a large degree by what they eat.
The Cholesterol Report Card
9/28/07 11/08/07 5/6/10
Total CHO 269 198 209
LDL CHO 157 117 111
HDL CHO 96 72 77
Triglycerides 84 44 103
LDL:HDL Ratio 1:64 1:44
**Please note: Total Cholesterol = LDL + HDL + triglycerides divided by 5. That why a high HDL will falsely inflate the total.
Half-Measures Bring Half the Expected Results. Oops!
So I was good enough to get my discount, and stay off of statins--but I wanted to know why my scores hadn't dropped more. What was I doing wrong? What was I missing?
The next day I decided to email Dr. Caldwell Esselstyn to get his opinion. Sending this email felt totally presumptuous, an imposition, and nervy on my part--but I hit the send button before I could talk myself out of it.
- I told him I ate dark chocolate the night before the test
- I let him know I had eaten out the previous weekend
- I told him that I use spray oils, some canola & olive oil
- I let him know I ate nuts, and nut butters
- I asked him why he thought my triglycerides had increased so much. I was only eating whole grains & hardly any sugar.
The next day was Saturday and I headed out of the house early because I had to work. As I'm driving to the hospital my cellphone rings at 8:00 am. I figured it was either my husband trying to find something--or my sister, who was visiting from out-of-town.
Turns out it was Dr. Esselstyn, calling in reply to my email. As he says, a few people can get away with eating foods like avocados, nuts, and some oil and it won't affect their cholesterol at all. But, for most people, the least little addition of one of these offenders can keep the cholesterol up, and arteries inflamed. I'm one of those people.
Dr. E: I don't know what kind of restaurants you go to, or what you order. What did you order the last time you went out to eat?
Me: It was a Turkish restaurant. I had a salad, without cheese, topped with 4 fried falafels--a bit of salad dressing--and a couple pieces of pita bread with baba ganoush. White flour, tahini, salad oil, fried foods. Duh? What was I thinking? Funny how easy it is to ignore what is going into your mouth when you're eating out--and thinking, "This is vegan. It will be OK."
Me: And what about those triglycerides? Why would they be so much higher than before? I'm only eating whole grains (except when I'm not--like the restaurant pita bread)
Dr. E: For one thing, you can't keep eating chocolate, avocados, and nuts--and cooking with olive oil--and expect stellar cholesterol scores. And what about dried fruits. Are you eating those?
Me: Uh, yeah. My morning steel cut oats are loaded with dates, and raisins, and dried cherries. Dr. E informed me that these are the most concentrated sugars--I should avoid them--or eat smaller quantities.
I went on to express my concerns about eating too little oil, and asked him if a cholesterol under 150 could ever have negative effects. Not if you're doing it naturally, through your diet, he told me--like many disease-free native communities have done for years. And don't worry getting enough fat to absorb vitamins--there's fat in almost all vegetables, beans, and grains.
But, the best part... Dr. Esselstyn generously invited me to join his next small group 5 1/2 hour appointment that would be meeting in mid-June, where I would get a first-hand understanding of how I could kick up my "healthy eating" a notch, and learn why it's in my best interest to do so. Like ditching those added oils at home--and lurking in restaurant meals. And I'll get the chance to have all my questions answered.
I thought I would be able to skip the "no-added-oil-no-nuts-no-avocado" requirement of the Esselstyn diet But I guess My Way wasn't enough. Click here to read: I'm Going to Miss My Olive Oil. Who Knew It Wasn't So Healthy After All? Drs. Esselstyn, Ornish, Vogel, and Rudel Did.
Dr. Esselstyn's Heard This All Before
"The first thing I do when people tell me that they can't reduce their cholesterol to 150 mn/dL or less is press them on precisely what they eat on Friday or Saturday nights, or what they might have consumed at that seemingly endless weekday meeting where there was "nothing else to eat."
Often, under my questioning, they reveal tiny deviations from the nutrition program--lapses so small that they didn't even take them into account.
One example: by the time you hold down the nozzle on a popular cooking spray long enough to coat a wok or pan, you'll build up about a tablespoon of oil.
Such transgressions can easily be enough to injure the endothelium's capacity for producing nitric oxide, which in borderline cases can mean the difference between success and failure. It is the kind of attention to tiny details that makes my program work.
It is true that there are some people without heart disease who strictly adhere to a plant-based diet--no lapses at all--and even so, cannot reduce their cholesterol below 165-170 mg/dL. (Some researchers have suggested that years of eating fat and cholesterol may compromise the body's natural capacity to reduce cholesterol levels.)
For these people, a modest dose of a cholesterol-lowering medication under physician supervision should take care of the problem. It is worth noting, however, that anyone who achieves a cholesterol level of 165-170 mg/dL by eating a strictly no-fat, plant-based diet is already doing wonders for his or her health, even without reaching the optimal level.
That person is, by definition consuming large quantities of natural antioxidants, which prevents the body from oxidizing LDL cholesterol into its most dangerous, artery-clogging form."
--from Esselstyn, Dr. Caldwell B. Prevent and Reverse Heart Disease. New York: Penguin Group, 2007--
Reconsidering the So-Called Healthy Oils
Drs. Matt Lederman and Alona Pulde appear in the upcoming documentary, Forks Over Knives--they're the physicians who were responsible for turning around the health of writer/director Lee Fulkerson and Joey A. of Tampa. On their web site they provide an excellent explanation of why oils need to go:
Question: Do you prohibit the use of vegetable oils? Does this include Olive Oil?
Answer: Thank you for your question and your interest. Our feeling about oils is that they are processed forms of foods high in calories and low in nutrients. The more a food is processed the less healthy it is!
Furthermore, vegetable oils including olive oil are NOT health foods! These oils suppress the immune system (increasing risks of infections and cancer), promote atherosclerosis (clogging of the arteries), increase bleeding, cause insulin resistance, and lead to obesity.
With regards to olive oil, we have been misinformed of its “benefit” from observations that people on the Mediterranean diet are healthier than people on the American diet. This is so because their diet consists largely of fruits, vegetables, and grains with little animal products...not because of the olive oil. In fact, they are healthier DESPITE the olive oil in their diet and not because of it!
That being said, although we highly recommend against the use of vegetable oils, we don’t like to use the word prohibited. So if you feel you have to use a little bit of olive oil or else you will go back to cheeseburgers, milkshakes, and fries...then by all means, use that bit of olive oil.
However, it might be helpful to know that there are many healthier forms of fat to use out there. Ground up, unsalted olives are much healthier than the extracted olive oil and still add the wanted olive flavor.
When you are frying something you can use a fat substitute like juice or vegetable broth to cook with rather than oil. Then you can add a healthier unprocessed form of fat if you want that particular flavor...such as ground up cashews, seeds, or avocado.
The benefit of using a ground up whole food is that you then also get things like fiber, vitamins, and minerals that are discarded when you extract the oil from the whole food. These nutrients are not only important for your health but also help shut off your hunger signals, ultimately preventing you from overeating.
Finally, we don’t like to use the term “okay” like you are doing something wrong if you don’t follow these rules. Certain oils/fats (olive, canola, peanut, avocado) are less saturated and better for your heart than others (palm kernel, coconut, butter) but we would never say olive oil is a health food.
Also, remember that the most important thing is that we do our best. Meaning, if you are out and wind up eating some oil because there is no alternative and you didn't prepare for the situation...it's not the end of the world or your health. Rather, just be better prepared for next time. Any move closer towards a low fat plant based diet is not only healthier for you, but will prevent more disease and give you more energy. So in the end, please don't be too hard on yourself as you do the best that you can!
Cleaning up my kitchen act: I've already started sauteing with vegetable broth, or other flavored liquids instead of with oil or oil sprays. It wasn't such a big deal. I'm using parchment paper or a Silpat to roast vegetables, or for "stick-free" baking. Just yesterday I found a delicious tahini & oil-free red pepper humus. I've also discovered a fat-free whole grain pizza crust made by Kabuli. I can do this!
I'd really appreciate any tips, advice, or experiences that you can offer to help me with this new adventure in going oil-free--or almost-oil-free.