My First Prevent Heart Disease Lunch: Arugula, Lentil, Corn & Vegetable Salad
It All Starts in Adolescence according to the PDAY Study: Atherosclerosis begins in youth. Fatty streaks and clinically significant raised lesions increase from age 15 to age 34. 100% of the autopsies done on 15-34 year old accident victims showed fatty streaks in the aorta and 50-75% showed streaks in the coronary artery--all precursors to later coronary artery disease. Click here for study.
By 65-70 we all have it. All males 65 years & older, and all females 70 years & older who have been exposed to the typical Western diet have cardiovascular disease & should be treated as such. Without making any changes, you can expect to have a catastrophic event (a heart attack or stroke) in your 70's or 80's. -Dr. Lewis H. Kuller, The University of Pittsburgh-
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Friday was E-Day for me. Remember my "Oops! Take It From Me - Half Dietary Measures to Lower Your Cholesterol Will Result in Half Measure Improvements" post from May 19, 2010?
Thanks to the generosity of the Esselstyns, last Friday June 18th I participated in an intensive small group instructional session with Dr. Caldwell Esselstyn, Jr. and Ann Crile Esselstyn called "Prevent and Reverse Heart Disease" held at the Cleveland Clinic Wellness Institute. I only wish you could have all been there and learned everything I had the chance to learn.
Dr. Esselstyn was right--now I really get it! I'm not saying I like what he requires his patients to do, but I do get it. I now understand why he's so strict about the details of his diet (oops, not diet--I mean, lifestyle changes)--no oil, not even Pam, no nuts, no avocados, no chocolate--just vegetables, fruit, whole grains, beans, & legumes! Who would be thrilled to give up fat, sugar & salt? Wasn't it enough that I gave up meat, chicken, cheese, fish, & other dairy products two years ago? Apparently it wasn't, in my case. And I thought I was a savvy food shopper, but even I had a lot to learn from the Esselstyns. Now my eyes are wide-open.
So, who was there? There was a mix of health professionals, people with newly diagnosed heart disease, and people with Type-2 diabetes, heart disease, high cholesterol, elevated weight and/or hypertension who were ready to make major lifestyle changes to avoid surgical interventions & pharmaceuticals--and they came from all over the country.
Honestly, I've got over 25 pages of notes--so there's no way I can condense that all into one blog post, and no one would have the time to read it anyway, so I'll cut to the chase. Oops, turns out I didn't. Sorry!
Part One: Cardiovascular Disease, How We Get It & How Diet Prevents & Reverses It and Gets Rid of Many Other Diseases Along the Way.
Part Two: How to Make This Diet Work--Tips & Tricks on meal planning, shopping, & a "best products" guide.
Part Three: Success Stories of Real People
On-Going: Follow Along While I Follow the Esselstyn Diet for Three Weeks--I'm going to try to do this 100% & then get tested--there's no other way to see how it works.
1. Heart Disease can be symptom-less--Blockages of 10-70% have no symptoms & are the most unstable and dangerous. Your cholesterol numbers can be fine, you might even be an avid exerciser with a healthy weight, but your arteries may be telling a different story. Read Yes, You Can Prevent & Reverse Heart Disease - But Are You Up For The Challenge? Let Dr. Esselstyn Convince You and get a quick synopsis of how this works.
2. It's a given. Unless you're eating like the Papua Highlanders of New Guinea--which means a plant-based diet with no added fat, you've already got some degree of cardiovascular disease, and you're at risk for the vascular dementia (my genetic inheritance), breast or prostate cancer, osteoporosis, erectile dysfunction, hypertension, and type 2 diabetes--to name just a few of the diseases driven by the typical Western diet. Coronary artery disease & 80% of our other diseases are food-borne diseases.
3. Stents & bypasses are just temporary patch jobs. If you have blockages in one place assume you have them everywhere--and unless you radically change your diet, stents, bypasses, and statins are no guarantee that you won't have a future cardiovascular event.
"Multiple studies show that if you have one ruptured plaque you have many." -Dr. Steven Nissen, chairman of Cardiovascular Medicine at the Cleveland Clinic-
"We can't cure this disease until we address the fundamentals of lifestyle." -Dr. Eric Topol-
- 27,000 deaths occur annually from bypass surgeries & stents.
- 48,000 annually suffer complications from interventions.
- Over time the risk for failure increases for both stents & bypasses.
- 45% of our Medicare budget is spent on cardiovascular disease--according to Dr. Kenneth E. Thorpe of Emory University. Imagine.
- Although stents & bypasses are absolutely necessary if someone is in the middle of a heart attack--in the case of stable disease they do not protect from future heart attacks, they don't prolong life, they do not treat the illness, and they do not significantly alter the disease.
4. The Western Diet makes our blood sticky. Sticky LDLs, white blood cells, platelets, and endothelial cells cause the whole cascade of events that leads to inflammation, heart disease, plaque formation, and heart attacks. This is primarily diet-driven. What we eat is what makes our blood sticky.
5. It's All About Having Healthy Endothelial Cells--Eat Your Greens! You can put the brakes on heart disease in just 3-4 weeks if you rejuvenate the endothelial cells that line your blood vessels by eating as many healthy greens as you can. Greens heal the endothelial cells so they can produce life-giving nitric oxide--which prevents stickiness, keeps plaque from forming, and dilates blood vessels. Nitric oxide is the strongest vasodilator there is! Make kale your best friend.
When you're eating an all plant-based diet that's high in anti-oxidants you literally change your internal biochemistry--and you strengthen the protective cap over your pre-existing plaque--which prevents future cardiovascular events. Read more in A Delicious Heart Healthy Lunch at the Home of Dr. Caldwell B. & Ann Esselstyn - A Nitric Oxide Booster Shot
6. What damages endothelial cells? Fatty foods, fast food, all oils--including olive, palm, & soybean oils, and caffeinated coffee. Using the brachial artey tourniquet test to measure endothelial function it was possible for Dr. Robert Vogel and others to see which foods actually cause damage to our "life-saving" endothelial cells.
7. Exercise enhances nitric oxide synthase. But diet trumps exercise, hands-down, in preventing disease. Exercise is not an excuse to ignore what goes in your mouth. Keep in mind that Esselstyn has worked with serious athletes who still got heart disease.
8. Arginine is an enzyme that builds Nitric Oxide--but, it only works if you get it from food, not supplements. Getting arginine from supplements has been shown to cause more heart attacks. Get your arginine from legumes & beans.
9. Moderation Kills--Question: OK, if I follow this diet faithfully everyday, what's the harm of going out-to-eat on Saturday night? Answer: "It's Saturday night & I deserve to kill some of my endothelial cells!"
10. Why not just take a statin instead of following a strict diet?
- Most lipid-lowering studies show a slower progression of cardiovascular disease---slower PROGRESSION is still PROGRESSION
- Most lipid-lowering studies show 30% fewer new heart attacks. What about the other 70%?
- Most lipid-lowering studies show 30% fewer heart attack deaths. What about the other 70%?
- Most lipid-lowering studies show 30% fewer surgical interventions will be needed. What about the other 70%?
- And don't forget that statins increase the risk of developing diabetes by 9%.
- There are documented cognitive problems when statins are used in high-doses.
- As age & dose increases muscle pain & weakness increases in statin users. 70% of statins users who do not have muscle pain are shown to have microscopic inflammation in their muscle cells.
- Read more about the side effects in: What The Experts Say About The Side Effects Of Statins. What Are They? What Causes Them? Who Is Most At Risk? How Are They Treated?
- Statins inhibit the HMG-coA Reductase, the enzyme in our body that makes cholesterol in our liver. Our bodies need a certain amount of cholesterol to properly function--and to inhibit an enzyme can produce serious side effects. Why take a stain, when a plant-based diet can lower cholesterol & inflammation without needing to inhibit HMG-coA reductase?
11. How did I get another blocked artery when I'm doing everything right? Question posed to the Harvard Heart Letter physicians from someone who had a previous bypass and now has another blocked artery. Answer: The best we can hope for is that we can slow progression. You should congratulate yourself if you've dodged the bullet as long as you have! (Remember: unless you're eating a no-added fat 100% plant-based diet, you aren't really doing everything right. Moderation kills.)
12. Is it possible to reverse heart disease? Question posed to the Harvard Heart Letter physicians. Answer: Only 2 doctors, Dr. Caldwell Esselstyn & Dr. Dean Ornish have been able to consistently reverse heart disease--and they do it through strict diet changes. And only Dr. Esselstyn, who is a stickler for detail and patient follow-up, has been able to keep his patients disease-free since 1985.
13. Think of vascular disease as a low-grade brush fire. You need to remove all the gasoline to put this fire out--and keep it out. Even a tiny thimble-full of oil is like putting gasoline on the fire!
14. Esselstyn's goal is to maintain a total cholesterol of <150 & an LDL <80. He'll use the lowest dose of statins on rare occasions when absolutely necessary, but as statin dose increases cognitive problems have been documented & muscle pain, weakness, & muscle inflammation is widely reported. Expect lower HDLs when you eliminate added fat--lower HDLs are common in indigenous plant-eating populations without heart disease. HDLs don't need to by so high when LDLs are low. There can be variation in LDL's even when you really are "doing everything right". The Tarahumara Indians had a normal variation of LDLs from 80-115--before they started eating a more Western diet.
15. Why not just follow the Mediterranean Diet, which includes olive oil & fish? Yes, the Mediterranean Diet is better than the American Heart Association Diet & the Western diet, but it only slows the progression of heart disease--it doesn't prevent & reverse heart disease. And, sure who doesn't want to believe that it's healthy to eat fish & olive oil? I know I did. But followers of the Mediterranean Diet show reductions of only 19-25% in cardiovascular mortality compared to followers of more standard diets. Not a huge reduction in my book. Click here for a recent Circulation study.
16. Why can't I use olive oil? I've covered this at length in I'm Going to Miss My Olive Oil - Who Knew It Wasn't So Healthy After All? Drs. Esselstyn, Ornish, Vogel & Rudel Did but here's the short story: Dr. Lawrence Rudel fed African Green monkeys (who are close substitutes to humans for study purposes) olive oil for 5 years, and then compared their arteries to those of Green monkeys who were given saturated fat to eat. Rudel was shocked by the results--he expected the olive oil monkeys would be disease-free. Turns out even though the olive oil monkeys had high HDLs, they also had just as much coronary heart disease as the monkeys who ate saturated fat. Oops! Olive, soybean, palm, coconut, oils all contribute to heart disease--just avoid them.
17. Why can't I eat nuts? Recent studies say they increase HDL's, and lower LDLs? Esselstyn is skeptical about this research, based on the surprising results of Rudel's study. Just because the HDL's go up, & the LDLs go down, it's no guarantee that nuts are preventing or slowing down coronary heart disease. Little known fact: the nut industry has sponsored these cholesterol/nut studies & participants had to consume 2.3 ounces of nuts to accrue the lipid changes--that's 350-400 calories worth of nuts.
Then there's the omega-6 to omega-3 ratio thing--ideally we want to aim for a 2:1 or a 1:1 ratio of omega-3s to omega-6s, because a diet high in omega-6s is inflammatory. Most of us typically eat a diet that has a 17:1 ratio of omega-6s to omega-3s. Except for walnuts (and Esselstyn gives the OK for a few walnuts for folks without heart disease), most nuts are very high in omega-6s, and low in omega-3s. Cashews have a 117:1 omega-6 to omega-3 ratio. And all nuts are high in calories and saturated fat. Almonds, the nut super-star is 6% saturated fat.
17. Why can't I eat avocados? Like the nuts, its omega-6 to omega-3 ratio isn't so stellar. At 16:1, it's mostly fat, high in calories, and it also contains saturated fat. But, even Dr. Esselstyn allows some avocado into the diet for people who do not have heart disease. I can live with that.
18. Absolutely must eat foods every single day--oats & greens! Eat greens every day, with every meal--they are the most powerful antioxidants. Oats lower cholesterol, blood pressure, and slow the digestion of blood sugar. Also, include whole grains, legumes, beans, vegetables, & fruit (no fruit juices).
19. Where will I get my omega-3s if I don't eat fish? Flax meal is high in omega-3s, with a great ratio to omega-6s of 1:8. Greens are loaded with omega-3s, which is where fish get their supply--by eating plankton. Also consider chia seed, click here to read more. Are Chia Seeds (Salvia Hispanica) the New & Improved Flax Seeds?
20. How is it possible to lose angina pain in just 2-3 weeks on the Esselstyn diet? Yes, you still have blockages, but you've restored your nitric oxide production from your endothelial cells--which naturally dilates arteries. Even a tiny increase in artery diameter increases blood flow.
21. How will I ever get used to eating food without fat? It's absolutely possible, but you need to eliminate the added fat 100%--don't worry, there is still fat in all foods--this diet only eliminates the added fat, like oil & butter. According to the Monell Chemical Senses Study you will actually down regulate your fat receptors when you eliminate fat from your diet. You will stop craving it & wanting foods made with fat. The "fat craving" takes 90 days to go away. But watch out: When you down regulate fat receptors, your sugar receptors will be screaming out to you. Be especially careful to avoid refined sugar, foods that are naturally high in sugars, like dates, and any processed refined carbohydrates. And limit natural sugars like maple syrup. Sugar causes the body to produce more cholesterol.
22. Zero cardiovascular events have occurred in Dr. Esselstyn's group of 17 compliant patients over the past 25 years. No mortality, no morbidity, no expense from following a plant-based diet--if you eat in a way to makes the cap over your plaque super strong!
23. Dementia & Diet. Dr. Megan Cleary of California examined over 11,000 MRIs of the brains of 50 year olds & found many had tiny white spots that indicated that they had unknowingly experienced tiny, imperceptible strokes. These "brain attacks" have the same history and cause as heart attacks. Keep on eating the same way at age 60, 70, & 80 and there's a good chance that those tiny strokes will add up to increasing memory lapses, and progress on to dementia--depending upon what part of the brain has been affected. What's good for the blood vessels of the heart, is good for the blood vessels of the brain.
24. Leg pain caused by claudication is eliminated with this diet. It works its dilating/healing/dilation magic on diseased arteries everywhere in the body.
25. Erectile dysfunction--gone naturally. The penile arteries are much smaller than the coronary arteries, so they are like the canary in the coal mine--letting you know that you have atherosclerosis & cardiovascular disease. Most of Dr. Esselstyn's patients report that after 8-9 months on this diet, their erectile dysfunction is gone. To read more, click here
26. Cholesterol drops are seen as quickly at 10-14 days. Example of a 58 year old with a base cholesterol of 261 mg/dL, has a total cholesterol drop to 126 mg/dL with just 10-14 days on the diet.
27. How Brain Health Affects Walking. Now back to the tiny imperceptible strokes that show up as white spots on the brain--these tiny cognitive brain assaults affect our walking speed, our balance, our risk of falls, and ultimately are the cause of the downward slide into frailty. It all circles back to how eating a disease-preventing diet benefits both the brain & the heart. Click here for the article.
28. Bone Health & the Plant-Based Diet. Dr. David Shewmon, an endocrinologist at the Cleveland Clinic in Wooster, Ohio was able to show how urinary calcium excretion becomes normal within a week of eating a plant-based diet--a marker for decreased osteoporosis risk. With a usual diet urinary calcium is 400 mg/dL. After only one week on a plant-based diet the urinary calcium is less than 300 mg/dL.
29. Cancer Risk Decreases When Animal Protein Intake is 5% or less. Dr. T. Colin Campbell found in numerous replicated studies that the amount of animal protein eaten could turn on & off cancer cells. Tumors take off at 12% animal protein. Read the China Study. For a summary of the book read T. Colin Campbell of "The China Study" Pays a Visit - Does This Mean I Have to Become a Vegan" There is no limit to the amount of plant protein that can be eaten. Point of reference: Hamburger is 37% protein. Black Beans are 24% protein. Feast on beans!
Stay tuned for my adventures in eating the Esselstyn Way, and Ann Esselstyn's tips, tricks, & recipes that make this diet "easy" to follow. I'm now two days into it--and so far it's not as hard as I thought it would be.