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-
If you've received this post via email click here to go to the web version & all the links.
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.
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 ... http://www.feedyourheaddiet.com/must-view-videos.html
Thanks again for the info. and good luck to you on your new lifestyle plan.
Ken Leebow
http://www.feedyourheaddiet.com
Posted by: Ken Leebow | June 23, 2010 at 06:57 AM
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!
Posted by: William Kruidenier | June 23, 2010 at 11:25 AM
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?
Posted by: spunky | June 23, 2010 at 04:07 PM
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?
Posted by: Barbara | June 23, 2010 at 06:25 PM
Can we get the recipe for Arugula, Lentil, Corn & Vegetable Salad?
Thanks
Posted by: JoAnn | June 23, 2010 at 11:37 PM
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.
Posted by: Rosemary | June 24, 2010 at 06:02 AM
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!
Posted by: The Healthy Librarian | June 25, 2010 at 07:09 AM
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!
Posted by: Lance | June 25, 2010 at 11:07 AM
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.
Posted by: Chris G. | June 25, 2010 at 01:59 PM
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?
Posted by: raye lankford | June 25, 2010 at 04:03 PM
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
http://en.wikipedia.org/wiki/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.
also
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:
http://www.drpasswater.com/nutrition_library/Schurgers.html
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!
Carla
Posted by: Carla | June 29, 2010 at 09:04 AM
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)
http://www.drpasswater.com/
also there is a link to Dr Passwater's credentials.
Posted by: Carla | June 29, 2010 at 09:21 AM
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.
Posted by: The Healthy Librarian | June 29, 2010 at 10:44 AM
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!
Thanks!
Posted by: Roger Jones | October 24, 2010 at 05:40 PM
Roger,
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: http://www.thefrontburnerblog.com/2010/09/powdered-peanut-butter-a-review-taste-test.html
Bottom line: not all legumes are health foods
Hope this helps!
Posted by: Healthy Librarian | October 24, 2010 at 06:50 PM
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?
doug
Posted by: Doug Lerner | February 01, 2011 at 02:38 AM
Doug,
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!
Posted by: Healthy Librarian | February 01, 2011 at 04:34 AM
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.
Posted by: Anabel Hopkions | December 29, 2011 at 04:26 PM