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June 23, 2010


Ken Leebow

Thanks for the great overview of your visit with Dr. Esselstyn. He is one of my food and health heroes! While I am not on his plan, he was influential in changing my diet and lifestyle. He, not my doc, let me know that I could get my total cholesterol down to 150 with no meds. And, that is just what I did.

I recommend his book to everyone - even if you have no heart disease. At my site, I do list his hour-long presentation. It's excellent ...

Thanks again for the info. and good luck to you on your new lifestyle plan.

Ken Leebow

William Kruidenier

Thanks for this! Great summary -- I've benefitted greatly from your research and writing. I'm a long-time vegan and fan of Drs. Esselstyn, Campbell, et al, but watching your path and benefitting from your documentation has been very rewarding. I look forward to all your posts! And to the results of your next-three-weeks test!


what does dr E think about supplements - notably, calcium supplements for women over 50? and what about flaxseed oil capsules as a supplement - would that be considered an added oil?


I really like your blog--I read it regularly and I've learned a lot from you. And I'm blessed to be a normal-weight active middle-aged woman in good health with good numbers. So maybe I don't get it. I'm sure it's frustrating to have given up so many different foods and live such a healthy life, and still have your numbers be high. But this seems so extreme to me. Eating for health is, of course, important, but what about pleasure? What about moderation? None of us lives forever. Don't you think that sometimes you just have to have the cookie? Or the avocado, for heaven's sake?


Can we get the recipe for Arugula, Lentil, Corn & Vegetable Salad?


How do you reconcile this research with the data in Gary Taubes' Good Calories, Bad Calories? Taubes traces many health issues to grains and sugars, not fats. I realize that Esselstyn's research is particularly in the field of heart disease, but Taubes summarizes years of data that indicate that cholesterol numbers don't necessarily correlate to heart disease.

The Healthy Librarian

Sorry for the delay in responding to everyone's comments & questions. Work interfered.

Ken: Thanks for the kind words & the link to Dr. Esselstyn's video. Everyone--check out Ken's blog--he has got the personal experience to back up his advice.

William: Thanks for your kind words. Loved your blog--and the tip about squeezing lemon juice into your water--anti-oxidants and alkalinity! No, I didn't "dump the truck"--Dr. E's sessions are SO MUCH MORE than 1 post could convey--and his personal follow-up with his patients is the key that helps them make the whole lifestyle change. He and Ann are tireless dedicated advocates & role models for a plant-based lifestyle--and really care about their patients.

Spunky: Dr. E suggests 1000 mg of calcium daily for those over 50, & 1200 mg daily for those over 60. He also recommends D3, B12, & Omega 3 via 1 tablespoon of flaxseed meal a day on cereal or a salad. No to flaxseed oil capsules

Barbara: I did very occasionally have cookies & chocolate & a dessert--but I've really weaned myself off of sweets--and it was all my little occasional "cheats" that I was ignoring which was probably the reason my cholesterol numbers didn't drop as much as they should have. I'm going 100% for 3 weeks to see if this is the case--and if it makes a difference. I had 2 parents who had "slow death declines" from strokes--I have seen the tragic effects of cardiovascular disease. I'm willing to give up junk for health--and it's not as hard as I would have thought. My tastes have changed. PS Ann Esselstyn actually bakes delicious fat-free cookies & desserts. It's not deprivation at all!

Joann: Arugula, Lentil, Corn Salad. So simple. I filled a 6-cup container with arugula, red peppers, tomatoes, cucumber, about 1/2-1 cup of already cooked Steamed Ready-to-eat French Lentils from Trader Joe's refrigerated produce shelves (long-shelf life--delicious--saves time), Trader Joe's frozen roasted corn, and dressed it with 2 TBS of Trader Joe's Corn & Chile Salsa (great kick) & a few dashes of high quality balsamic vinegar. This was so filling!!

Rosemary: Dr. E says only eat whole unrefined grains-they are best in their flourless state. Most of these are low-glycemic. He also eliminates refined sugar & of course refined carbs which were the culprits in Taubes book. He only uses the smallest amounts of unrefined sugar (like maple syrup), and only on occasion-- for sweetening--and again it's to be used rarely. He warns (as Taubes speculates) that when you eliminate oil, you will probably crave sweets & refined carbs. Be mindful. Also watch out for dried fruits that are high in sugar, like dates, if triglycerides are a problem. No fruit juice except for occasional seasoning in recipes. His patients' excellent health basically disprove Taubes' generalization that carbs cause heart disease, not fat.

To everyone who emailed me, this quick & dirty summary about why oil & nuts are on Esselstyn's NO list might help. If you really want to get the facts about why oil & nuts are not health foods get yourself a copy Jeff Novick's DVD "From Oil to Nuts". He puts it all together. Thank you, Jeff.

Sounds like you really do have great numbers. I couldn't advise whether it would be necessary to change what you are doing--but you'd probably see that extra weight just drop off by cutting down on the nuts, avocados, oil, cheeseburgers & fries. Maybe you didn't see this part of my post & the link to Dr. T. Colin Campbell's work. Animal protein, and dairy (cheese) in particular, are known to promote cancer (I know this sounds so wacko--but read the well-documented China Study & Dr. Campbell is a well-known respected researcher)--makes no difference if it's grass-fed or organic--it's not good stuff for us when it's more than 5% of our caloric intake.

It's not just cholesterol numbers that count--it's also about inflammation & protecting your blood vessels from injury. Omega-6 & saturated fat are inflammatory. Oil, meat, & nuts are all high in omega-6's & saturated fat--except for walnuts. Additionally, the name of the game is to get the most bang for your buck in terms of nutrients per calorie. It's better to eat the foods with the most nutrients per calorie--and meat, dairy, nuts, & oil aren't in that category.

Just wrote a lengthy reply to someone else, and maybe it will be helpful to you too.

I hear what you're saying and from the very first time I met Dr. Esselstyn I asked the exact same questions & wondered why he was still sticking with the no-added fat story of the 1980's. Well--I now understand why--because it really works--and it would take way too long to present the whole case but in a nutshell:

1. You can't compare the Loma Linda nut study to Esselstyn's work. He's followed his Core group of patients (the compliant & non-compliant) & hundreds since then--as individuals & can see how there is actual heart disease reversal when the plan is followed to the letter. (THose that didn't follow the program, or dropped out ended up with more heart disease &/or death) When he doesn't see improvements it's always because of slip-ups like a tiny bit of added oil or nuts. Sometimes it's from something as insignificant as using PAM too liberally.

2. Inflammation is probably even more important than cholesterol numbers in causing cardiovascular disease, and precipitating unstable plaque. Omega-6s are inflammatory. Omega-3s are anti-inflammatory. Most nuts (& all oils) are very high in omega-6s, especially cashews, almonds, pecans, & pine nuts. All nuts have from 5-21% saturated fat & we're supposed to limit daily sat fat to 5-7% of our daily calories. The BEST NUT to eat is the English walnut at 5% sat fat and an omega 6 to omega 3 ratio of 4:1. But, since nuts are so high in calories, it's best to limit walnuts to 1 oz a day. But only if you are already healthy & eating an already healthy diet--which I know you are. You can get all the nutrients that they provide from other foods that are more nutrient dense, and lower in calories.

3. The main point is to eat foods that are the most nutrient dense, and highest in anti-oxidants, getting the most bang for you buck. If you eat a great diet, a few nuts, avocado, or even a bit of oil won't be harmful. But, pouring olive oil & nuts on top of a typical Western diet is the last way to improve a diet.

4. The Loma Linda study was sponsored by the Nut Board (if memory serves me right) and the participants had to eat 2 1/2 oz. to get the results which is a huge caloric load (more than a meal) that would have been better spent on greens, beans, & berries, or other foods that are more nutrient dense.

5. Ornish backed off oil (sort of--for people who have no disease, & in very small amounts) not because it's beneficial--but because it won't be harmful in small amounts in healthy people. All oils have saturated fat, especially olive oil at 14%, even though it's primarily mono-saturated. And its omega-6 to omega-3 ratio is 11:1. Canola would be a better choice if you wanted to add oil, with an omega-6 to omega-3 ratio of just 2:1

6. The benefits of the Mediterranean & Lyon Diets according to Dr. Robert Vogel JACC 36:1455-60, 2000 are:

"The beneficial components...appear to be anti-oxidant rick foods, including vegetables, fruits, and their derivatives. Dietary fruits, vegetables and their products appear to provide some protection against the direct impairment of endothelial functions produced by high-fat foods, including olive oil." (Vogel study: a meal containing olive oil impair blood flow & vasodilation by 31%--and that was in healthy men)

So, it's not the oil or nuts that make the Med. Diet good--it's the fruits & veggies that are able to "overcome" the negative effects of the olive oil.

7. Br J Nutr. 2004--when researchers went back to Crete to look at the health of islanders--the group with the highest olive oil intake had the highest heart disease, and those with the lowest olive oil intake had the the lowest heart disease.

8. The data on which the Mediterranean Diet is based came from the 1950's. At that time the people on the Isle of Crete had the lowest all cause mortality. It was post-WWII, they were poor, didn't have a lot to eat, ate mostly fresh fruits & veggies from their gardens, walked 9 miles a day, worked at hard physical labor and the highest consumption of oil was 3 TBS a day--and small amounts of fish. Big difference from how we live today.

Well this was longer than expected. Hope it helps!


Great post! The Esselstyn family, along with the McDougall's, are my inspiration, motivation, and method for changing my lifestyle. I'm jealous that you actually got to meet them in person!

Chris G.

Sounds like a very exciting endeavor and I’ll look forward to hear more about it. It is curious that that Dr E puts such an intense emphasis on total cholesterol, LDL cholesterol, omega 3s, and omega 6s, but does mind the decline in high density lipoproteins (HDL cholesterol) in his patients. Mimicking the goals of Dr E’s diet, HDLs inhibit plaque formation on arteries (atherogenesis) and removes LDL cholesterol from cells within artery walls. Given the large body of research on this and goals of his diet, is there a reason to focus on total cholesterol, LDL cholesterol, omega 3s, and omega 6s but not HDL? Also, what does Dr E think about soy. It raises HDL, and lowers LDL and triglycerides, but has a omega 6: omega 3 of around 8. Tricky. Complicated.

raye lankford

Hey, terrific post, and it's really got me thinking (brain spinning over here). I'm curious... for someone like me who tends to be on the underweight side (rather than overweight), I wonder how a diet like this might influence my bone health? On the plus side, it's definitely more alkaline and, as we know, alkaline diet + bone = happy skeletal system. But if you have low body fat to begin with, and maintaining a certain amount of body fat is necessary for maintaining skeletal health, if I cut out all fat from my diet (clearly I'm having trouble formulating this question!) -- cutting to the chase -- might it be detrimental for me? My last DEXA showed I had 13% fat on my spine and 17% on my hips. Still a little low. I think the ideal body fat/lean mass ratio for women is between 18 and 26%. (BTW, I'm not even sure those fat numbers on my DEXA are necessarily related to my total fat to lean mass ratio. If you have any ideas about that, I'm all ears!!)

I know skinny people can have fat-filled arteries (I'm probably one of them). I'm just trying to figure out how you achieve both desired goals: Keeping your arteries free of fat, but your bones padded with it?


As always, a great post that gets me thinking and studying more--Thank You!

Since reading this I have been pondering especially about 2 things:

1. Nathan Pritikin

who in the '50s dieted and exercised to reverse his heart disease, developed leukemia and finally committed suicide.

And wondered if I can take a lesson here.


2. Vitamin K2 is being studied regarding its function to direct calcium deposits to where they belong in the body (the bones) and away from where they DO NOT belong (the vasculature).

Here is an article that summarizes rather nicely all that I have been studying on this topic:

Just food for thought!

I am considering adding the Vitamin K2 Supplement to our careful diet, aerobic and weight training exercises (and plan to start yoga ASAP.)

Love your Blog!



In case you're interested, there is a link to part 2 under 'articles' on the left of the page:

(is just a bit down the page)

also there is a link to Dr Passwater's credentials.

The Healthy Librarian

Thanks for the links about k2 Carla. Interesting research. I do know that K1 which is found abundantly in greens can convert to K2 in the gut--in the presence of healthy gut bacteria. If one's gut bacteria isn't healthy it supposedly can't make the conversion from K1-K2.

No idea how you would know about your own gut bacteria wo some fancy analysis--but all I can say is that eating whole plant-based foods definitely puts your digestive system in tip-top shape. I've read it changes your intestinal bacteria.

Does that translate into good gut bacteria? I'll leave that for the experts.

Re Nathan Pritikin--his diet was slightly different from what I'm doing--more emphasis on low-fat (allowing small amounts of low fat milk, meat, poultry, & fish) and not as much emphasis on greens. It did emphasis unrefined whole foods, too!

His death occurred after complications from experimental treatment for terminal leukemia--I wouldn't assume any direct relationship to his diet--or the diet as a cause of his disease or suicide. His autopsy was described at "absolutely remarkable", with no calcifications or fatty streaks in his coronary arteries--and his blood vessels were described as like a teenager's!

On the contrary, the amount of omega-3s we get from what we eat can have a very profound positive effective on the brain, mood, and depression. A diet too high in omega-6s from oils, even nuts, and other animal products prevents proper absorption of the omega-3s, and also prevents adequate conversion of plant-based omega-3s, like the ALA found in flax. Most Americans have an omega 6 to omega 3 ratio of 17:1, when ideally it should be 2:1. Read Evelyn Tribole & Dr. Bill Lands for omega-6 research.

I specifically asked Dr. Esselstyn about research from the 1970s about the association of low cholesterol to depression, suicide, and cancer. He said it never panned out when the specifics were looked into. Don't quote me on this one, but for instance, cholesterol often drops in the presence of illness, and in many cases there was prior mental illness, or depression, and this wasn't a population that had lower cholesterol as a result of nutrient dense healthy eating.

Lowering cholesterol with drugs to a very low level, , not naturally through diet,however can sometimes cause depression or cognitive issues.

Last point, re taking K2 supplements--Dr. E. made sense when he gives the example of the risks of taking supplements over food. Arginine, is the enzyme that builds nitric oxide--but you have to get it naturally from plants for it to work properly. A study on arginine supplementation was stopped when heart attacks actually increased by taking arginine pills.

Just some food for thought--based on my own speculation & interpretations!

Interesting that K2 is highest in eggs & meat.

Roger Jones

I have read two of Ornish's books and one of Esselstyn's. Peanuts are Legumes but it is as though these doctors avoid talking about peanuts. Are peanuts okay? Is peanut butter with no additives okay? I've googled myself silly to get these answers from these two doctors!

Healthy Librarian


Peanuts & peanut butter are highly caloric, very high in fat, have some saturated fat, and have one of the highest amounts of omega-6s of any food, which makes them highly inflammatory. For example: 2 tbs of peanut butter has 188 calories, 16 grams of fat, 3 grams of saturated fat, 3610 mg of omega-6, and only 16.3 grams of omega-3. The ideal ratio of omega-3s to omega-6 should be 1:1, with up to 4:1 still being considered good.

If you love peanut butter, you can get a defatted peanut butter product called PB2 that's made by Bell Plantation, or defatted peanut flour made by Trader Joe's. Mix 2 tbs of the powder with 1 TBS of water for a great tasting low fat low calorie peanut butter. It's really good!

Read more about it here:

Bottom line: not all legumes are health foods

Hope this helps!

Doug Lerner

You write:

"For example: 2 tbs of peanut butter has 188 calories, 16 grams of fat, 3 grams of saturated fat, 3610 mg of omega-6, and only 16.3 grams of omega-3."

That means there are 16,300 mg of omega-3 vs 3,610 mg of omega-6. In other words there is much more of the beneficial omega-3, right?


Healthy Librarian


Glad you're such a careful reader & you caught this awful typo. I meant to write:

For example: 2 tbs of peanut butter has 188 calories, 16 grams of fat, 3 grams of saturated fat, 16.3 grams of omega-6 (which is 16,300 mg) and only 3610 mg of omega-3. Peanut butter is one of the HIGHEST SOURCES OF OMEGA-6s & MANY OF US PRACTICALLY LIVE ON IT--ESPECIALLY KIDS!

Anabel Hopkions

My husband and I started the program 2 1/2 weeks ago. How much protein do we need? I feel a little light-headed in the evening and night. I see Clinton takes protein powder. is there one we can use? Does anyone know what we should eat (portions, etc) to lose weight on the diet? I have lost a little based on my clothes but my husband thinks he is gaining, alto he is not eating more than I am. How much wine is allowable? I will have a re-test on blood work in 2 weeks. Had a stress echo last week - haven't seen radiology results but doc who was there said I was "superior." I am 70, 5 foot 2, somewhere around 130 lbs. I walk 3 miles nearly every day. My husband, also 70, had a quad bypass 25 years ago, doc says his bypasses are wearing out. He will be getting a cartoid surgery soon (80% blockage). We have been on weight watchers for the most part for over 5 years but my husband hasn't kept up with the exercise and we both drink too much wine I fear.

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