"Most of my career I looked at coronary artery disease as a "terminal disease". You'd die from it. But, I began seeing more research showing that not only was it preventable, but it was reversible.
I heard Dr. Caldwell Esselstyn, Jr. speak at meeting three years ago--and it opened my eyes.
I started studying & doing my own research on others who were doing similar research. Esselstyn wasn't alone. There's a building body of evidence that coronary artery disease is preventable & reversible. That was eye-opening."
-Dr. Marc Katz, MD, PhD, cardiac surgeon, Medical Director of the Heart and Vascular Institute and Head of the Minimally Invasive Surgery Program at Bon Secours Richmond Health System-
Last week I asked for your help in deciding what to write about next.
Hands down, via Facebook, email, & blog comments--this was the post most of you wanted to read first:
Two cardiologists and one cardiovascular surgeon who decided to follow Esselstyn's plant-based no-oil diet.
What's their story, why did they decide to take this route for themselves, and how has it benefited their health?
Since starting Happy Healthy Long Life over four years ago I've heard from a number of physicians who have shared their personal success stories following an Esselstyn-style plant-based diet. They represent a wide range of specialties.
The stories all share similar elements. And the physicians are all surprised (some even shocked) & pleased by the non-pharmaceutical results:
- Effortless weight loss
- Significant improvements in cholesterol numbers, blood pressure, CRP, and other health markers or symptoms.
- Everyone's surprised at how much easier the diet is to follow than they expected.
- Their food tastes & preferences changed.
But, let's face it. A plant-based, no-added oil diet is far from mainstream, or standard medical practice. Many physicians aren't ready to "go public" about how well this is working for them, or for their patients who have hopped onboard.
To me it speaks volumes, when a cardiologist, in particular, chooses to adopt a plant-based diet. And, of course, I want to know why. I figured you would, too.
That's why I decided to share the experiences of two cardiologists & one cardiac surgeon.
Cardiologist Number One
When I was preparing my "Centenarian Strategies" presentation back in March, I asked a cardiologist who had written me, if he would be willing to share his "back story"--why he made the personal switch to a plant-based diet.
I thought it would be a compelling story to share. Everyone who has seen my presentation--and heard his story, thought so, too. I can't thank him enough for taking the time to put it into words.
Here's what he wrote:
Almost 3 years ago, as a 40-year-old cardiologist with a family history of heart disease, I looked at my body as a painful example of what happens when a person spends too much time working, eats badly, and never exercises. I was not very overweight, but I have high standards for myself and I felt that I was weak and quite flabby, and I knew that there was unseen damage on the inside of me.
Even more importantly, I just didn’t feel good.
Back in 1994 I had the good fortune to eat dinner with Dr. Esselstyn at a restaurant in Philadelphia and after the meal was over, he told me that by eating what I had ordered (fish) that I had subjected my body to “a hit from which it would never recover.” Those words stuck with me, and 15 years later, when I heard him lecture I found myself really wondering what it would be like to eat the way he does.
I read his amazing book, Prevent and Reverse Heart Disease, and suddenly on September 17, 2009, I began his plant-based, whole food, no oil diet.
My lipids fell by nearly half after only 3 weeks! My body fat percentage went from 19% to 15% within a year and I slowly lost 25 pounds over about 18 months before stabilizing at my current weight.
I was never hungry and I felt physically so much better, with so much more energy. I eventually quit caffeine too, which was not easy, but afterward felt great without it. Most importantly, I really felt in control of my health and my body, and this was the true cure for my mid-life crisis of a body going downhill.
All of this was without exercising. I later began exercising regularly, which added additional benefits, including further lowering of my body fat to 11% and gain of muscle and flexibility. I feel like I am more than 10 years younger now. My blood pressure has gone from 130/90 to 110/65 and my resting heart rate from 80 to 55.
Since I made these changes, I have made it a point not to preach to others about its benefits. I eat what I eat without compromising, but don’t make a big deal about it to others. I have never tried to convince anyone else to eat the way that I eat, but many people are interested and I have always answered every question asked of me carefully and completely.
In just a couple of years, almost 20 friends and family members have gone on to convert to the Esselstyn diet – it’s contagious! As a cardiologist, I know that, for people eating a typical American diet, the chance over a lifetime of severe illness or death due to food-related diseases is staggering. My greatest reward is knowing that my own choices have inspired others to make such wonderful changes in their own lives.
Cardiologist Number Two
I "met" this cardiologist about a year ago.
In his practice he had some patients who were unable to tolerate statins because of their side effects, and others who were just unwilling to take them.
They needed viable alternatives.
When he heard Dr. Caldwell Esselstyn's lecture he was impressed with both the research, and Dr. Esselstyn's results. Maybe this was the alternative he was looking for. But, before advising any of his patients to give a plant-based no-added-oil diet a try, he wanted to try it out for himself first.
The widely accepted belief by cardiologists is that "Eighty percent of the body’s cholesterol is made by the liver. That means, only 20 percent comes from our diet. That’s why it is so hard to lower cholesterol through diet alone. By banning nearly all cholesterol from your diet, you might be able to reduce your total cholesterol level by about 20 percent. Understanding this can often make the choice to take cholesterol-lowering drugs easier."
However, here's what cardiologist #2 experienced for himself on a plant-based diet:
He personally cut his total cholesterol from 209 to 136 and his LDL's from 144 to 72 with just nutritional changes. That's a 50% drop in LDL's. A lot better than the conventional wisdom would have you believe.
His interpretaton of the conventional cardiology wisdom that says "Diet can't cut cholesterol or inflammation significantly.":
I think it is fallacious to say that because 20% of your [cholesterol] intake is dietary, you cannot reduce [your cholesterol] by more than 20% by changing your diet.
This part is just plain wrong.
The statement that 80% of your cholesterol is made by the body and only 20% comes from diet is based on the average (as measured in the population eating the Western diet) cholesterol production of 1 gm per day and the recommended dietary intake of cholesterol of 200-300 mg.
For many Americans, the daily intake of cholesterol is much higher. For those eating a plant-based diet, the intake is near zero. So the 20% is not representive of a population, but rather an average of very different nutritional choices. Several other logistical fallacies occur to me:
- Population studies on humans who eat a plant-based diet with very low dietary cholesterol intake show some of the lowest intrinsic cholesterol levels. We have many studies on dietary modification showing that decreasing cholesterol intake can result in dramatic lowering of serum cholesterol levels.
- Relatively few (if any) studies of cholesterol regulation have been performed in vegans, so we don't have much information on the effect of this nutritional strategy on cholesterol synthesis. You can't extrapolate findings from studies of patients on a Western diet.
- The assertion that drug therapy of elevated cholesterol is more effective than nutritional changes focuses on a surrogate endpoint, that is, the cholesterol level, rather than clinically important endpoints like death, MI and stroke. Dependence on surrogate endpoints (cholesterol levels) is a one of the biggest criticisms of drug and device studies. Statins have been shown to result in improvement in early MI and death rates, but they are not above suspicion for longer term adverse outcomes and there is a growing concern about the downside of life long administration. Several drugs have been removed from the market because they lead to higher death rates despite their beneficial effect on surrogate endpoints. We need to look at the the MI, death and stroke rates of nutritional changes, not whether they can decrease cholesterol by 20%.
- That said, there is no question that statins have a role in the early treatment of unstable coronary disease, but it is likely not due to their cholesterol-lowering effect, but rather on their anti-inflammatory and pro-endothelial effect. There may be much less powerful effects long term on mortality and MI rates (as well as other longterm adverse effects). There is much less data on that."
Cardiologist #2 doesn't spend hours cooking or following elaborate recipes. He sticks to the basics, preparing simple meals with greens, plenty of vegetables, fruit, beans, legumes, & whole grains.
The Cardiac Surgeon
Dr. Marc Katz, MD, PhD is currently the Medical Director of the Heart and Vascular Institute and Head of the Minimally Invasive Surgery Program at Bon Secours Richmond Health System. He completed a general surgery residency at the Medical College of Virginia, & fellowships in cardiothoracic surgery & pediatric cardiac surgery at Boston Children's Hospital.
I recently learned about Dr. Marc Katz' plant-based conversion through Kirk Hamilton's June 16, 2012 Prescription 2000 Newsletter. You can listen to Hamilton's radio interview with Katz here, "Preventing and Reversing Heart Disease With A Vegan Diet - An Interview With Cardiac Surgeon Marc R. Katz, MD, MPH: ".
Katz' "plant-based awakening" occured after hearing Dr. Caldwell Esselstyn speak at a lecture three years ago. Learning about the "end-stage" coronary artery disease patients that Esselstyn treated by diet alone, and especially seeing the angiograms that showed disease reversal was the "game changer" for Katz. This was something that he previously thought was impossible.
Before that time, he considered heart disease to be a terminal illness--you could slow it down a bit, repair blockages, but you couldn't prevent or reverse it.
After hearing Dr. Esselstyn's lecture, and following up with his own research, Katz has since changed his mind about the major effect that diet can have on heart disease: specifically, a plant-based no-added oil diet. Beyond Esselstyn's work, he found a building body of evidence showing that heart disease can be prevented and often reversed.
And then he changed his own diet.
After hearing Dr. Esselstyn's lecture, Katz attended Esselstyn's day-long session at the Cleveland Clinic, and changed his own diet.
Like many of us, this 50-something surgeon had put on weight over the years, and his cholesterol was climbing, too. After switching to a plant-based no-added-oil diet, he lost 35 pounds over just a "very few months", and his cholesterol dropped by 1/3 without any drugs. In his opinon, "These were great results."
What's Katz eating now?
Breakfast: Chai tea with non-fat soymilk, a whole grain English muffin with homemade no-fat hummus; a piece of fruit like an apple or a banana
Lunch: a salad
Dinner: usually mixed grains, like quinoa and vegetables
Nuts are only an occasional treat for Katz--and he limits those to walnuts & chestnuts when he does indulge.
Absolutely no olive oil.
For omega-3's, he sticks to flax meal, on a daily basis.
He credits his wife for making the diet such an easy transition. Not only is she a terrific cook, but she's 100% onboard with following a plant-based diet.
Dr. Marc Katz' Interview Highlights
Why is there so much cardiovascular disease?
There's no question that it's diet related. We're getting fatter, and eating worse than ever before. Colorado is the only state in the nation where less than 20% of the population is obese. In 49 other states, the obesity rate exceeds 20%--and we're not talking about just being overweight. The dietary causes for heart disease & obesity are eating too much fat, too much refined food, not enough fiber, not enough plant protein, and not enough whole foods. 80% of cardiovascular is preventable by diet.
In your opinion, what causes coronary disease--cholesterol or inflammation?
The biggest issue is inflammation of the endothelium--the single layer of cells that line the blood vessels. Animal protein & fats have been shown to be very inflammatory to blood vessels. Both Drs. Caldwell Esselstyn & William Castelli, the lead researcher in the Framingham Study, cite the example of the Nazi occupation of Norway in World War II, when all the livestock in the country was consfiscated, meat & milk consumption dropped, and heart disease deaths plummeted. After the war, when the livestock returned, so did heart disease. On the other hand, those countries with the highest percentage of calories coming from unprocessed plant food also have the lowest incidence of heart disease & cancer.
You recommend "no-added fats" whatsoever for anyone trying to reverse heart disease. What about fish oil?
Yes, no oil whatsoever, including fish oil. Katz gets his omega-3's from ground flaxseed, daily. He seems unconcerned about the issue of conversion of the short-chain omega-3's (ALA) found in flax into the long-chain omega-3's (EPA/DHA) found in fish oil. [H.L. We'll save that discussion for another post.]
What's the breakdown of your cardiac surgery caseload? How much of it is for coronary artery disease?
It's about a 50-50 mix between structural repairs/general cardiovascular surgeries & coronary artery disease procedures.
How much nutrition education do you now give to your heart surgery patients?
I speak to all of them before & after the surgery--and give them the evidence that this disease can be halted &/or reversed if they're willing to make major diet changes. Before the surgery, if their coronary disease is stable, I explain that if they are willing to do this, it may be something they want to try first--before going ahead with surgery. Post-surgery, all heart surgery patients are put on a low-fat whole plant-based diet while they're in the hospital, and given diet recommendations to follow when they go home. However, Katz suspects that the number of patients who actually follow-through with all the recommendations when they go home is small.
If you had 20 patients who were 100% compliant with their diet--how many do you think could avoid surgery?
If someone has unstable symptoms--then they need to get out of trouble with surgery or a procedure, first. But, if they are stable, it's hard to say--I don't know of any randomized study on this. I can only give you a guesstimate. Perhaps, 40-50% could potentially reverse their disease. As for the others--by following this diet protocol--even halting the disease & not necessarily reversing it--that would still be a huge advantage & benefit for them.
Do you think cardiac surgeons would be looking for work if we did our jobs right--and everyone switched to a plant-based diet?
How can we motivate people to make major lifestyle changes?
I used to think that "splitting" the breast bone during cardiac surgery would be motivation enough to get someone to change their lifestyle into a hearty healthy one. Everyone's motivated when they're in the hospital, but they often lose that motivation & fall off the wagon when they leave the hospital & get immersed into the busyness of life. Katz thinks you have to start with small goals, and build on those--making small dietary changes--one at a time. Make goals attainable. Practice small changes. Turn those into habits--and then continue to add more. [H.L. Sorry, Dr. Katz--I think a more aggressive approach with more active hands-on education, nutritional counseling, cooking, shopping, label-reading instruction, group support & follow-up is necessary.]
If you were the "Health Czar" what would your top recommendations be?
1. A whole food plant-based diet
2. Daily exercise
3. A good preventive health care regimen--not just showing up in the ER for your health care.
If you learned that your doctor followed a plant-based diet--would that motivate you to change your diet?
What do you think works best? The step-by-step approach to making diet changes, or doing it all at once?
What has worked for you?