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« What Does Katy Butler's "My Father's Broken Heart" Have to Do With Following a Heart Disease Prevention Diet, Meditation, Yoga, Osteoporosis & Movies? | Main | Can a Plant-Based No-Added-Fat Diet Survive "Real Life"? My Fourth of July Trial on the Esselstyn Diet - House Guests, Restaurants, Road Trips, and Dinner with Friends. Let the Numbers Speak for Themselves. »

July 02, 2010



I enjoy your blog for the information and insights you impart! Someone sent me a link to this blog:

What are your feelings about the caveman diet?

Thanks again....



I'm so glad this is working out well for you--sounds like you've found a way to make this change pleasurable for you and your family.

Linda Mandel

I am very concerned (and confused) because the Dr's no-fat diet means very little Omega 3s. Here is just some of the strong research that shows the need for this oil:
1. Harris, William S. (1997). "n−3 fatty acids and serum lipoproteins: human studies". Am J Clin Nutr 65 (5 Sup.): 1645S–1654S. PMID 9129504.
2. Sanders, T.A.B.; Oakley, F.R.; Miller, G.J.; Mitropoulos, K.A.; Crook, D.; Oliver, M.F. (1997). "Influence of n−6 versus n−3 polyunsaturated fatty acids in diets low in saturated fatty acids on plasma lipoproteins and hemostatic factors". Arteriosclerosis, Thrombosis, and Vascular Biology 17 (12): 3449–3460. PMID 9437192.
3. Roche, H.M.; Gibney, M.J. (1996). "Postprandial triacylglycerolaemia: the effect of low-fat dietary treatment with and without fish oil supplementation". Eur J Clin Nutr. 50 (9): 617–624. PMID 8880041.

The Healthy Librarian

Oops! I replied to Linda 2 days ago, and never got around to "publishing" my own reply! Hope this helps to explain.


I appreciate your concern, but it's unfounded. This diet makes certain that you get adequate omega-3s. N-3s are in tofu, beans, green leafy vegetables, flax meal, & chia seed, berries & English walnuts. If one were to eat a diet of 1750 calories, and 9-12 servings vegetables, beans, fruit, & flax they'd get more than enough of all their omega-3s. And since omega-3s have to compete with omega-6s for absorption into our cells, if the n-6s are too high (as in the typical American diet with a ratio of 17:1), the n-3s are just crowded out. Ideal ratio should be 1:1, or 2:1. N-6's are inflammatory, and too many are disease-causing.

All experts agree that it's better & easier to just lower one's intake of the n-6s (found in oils, margarine, meats, chicken, processed foods, peanuts, & most nuts), than try to fix the ratio by ingesting more n-3s.

You aren't going to increase your n-3s by ingesting oils. As for me, not only do I eat flax meal and chia--I also take pharmaceutical grade omega-3 fish oil & a DHA supplement (which isn't something Dr. Esselstyn would advise, however)

One important note: the diet isn't no-fat--it's no added fats. Fat exists naturally in most foods--especially in oats & soy.

Follow the link in the post to Bill Lands' NIH lecture--and watch the Jeff Novick video. Also, Dr. E has been using this diet successfully since the mid-80's. It's how he & his family eat. His patients are alive, healthy, thriving, and disease-free.


Double Rainbow is not a Trader Joe's Brand. But that may be the easiest place to find it outside the San Francisco Bay Area. Local health food stores may also carry it, as may small independent groceries.


Maire Reidy

Thanks for your post about Dr Caldwell Esselsty's heart health diet, and for all your posts, I love reading them and have picked up some great tips. I don't think I can kiss goodbye to avocados yet though.

The Healthy Librarian

Thanks for your positive feedback, Maire. Remember, Dr. E. advises no avocados for people with heart disease.

As far as I know, I don't have heart disease--but he suggested that I give it a 3 week trial without walnuts (also OK without heart disease) or avocados, (or oil of any kind, including when I eat out), and see how I feel, and how the numbers check out. Three weeks is flying by, and so far I'm shocked to miss any of it!


I love your blog! You write, "a microplane is a must for zesting citrus, or grating ginger. I wouldn't want to eat plant-based without my Kyocera ceramic utility knife." If I can ask, what model you have and how do you use it?

The Healthy Librarian

Chris, It's the Kyocera F110 utility knife with a 4.5" blade (really 5"). The microplane is the handheld grater zester: amazon link:


This sounds great and yet very challenging. I just have some questions on how things work and your overall experience with it:

1.Do you sometime have meat craving feeling? And what are your favorite plant based proteins?

2.Could you post some links that have simple/delicious recipes especially salad, dressing,beans and legumes dishes?

3. Is it difficult when you eat out? I have to attend dinner party almost every week and this could mean I have to cheat for that meal or not going at all.

4. Do you have less energy when you work out during this course of diet? How would this affect your body when you do weight training and cardio exercise?

The diet is truly a great gift to your body. Keep up the good work!


Hank Roberts

Gack. must toss the peanut butter.
And even walnuts aren't good, they've got far more Omega-6 than Omega-3, according to the same video.

Could I balance about a tablespoonful of peanut butter and a glob of something full of omega-3s (fish oil capsules) to overwhelm the omega-6s?
Nope. Got to get the total fat down to half a percent of the diet, before the different mix of omega-3s and omega-6s is in the range at which they get metabolized in useful ways, if I understand this.

Heck, the oil in the vitamin-D and fish oil supplements is already more than that.

From the video, bits and pieces:

LINK FOR his spreadsheet, oh, good, my wife's an Excel spreadsheet guru:
(PC and Mac versions)

Quotes hand typed from the audio with reference to the caption scrolling text:

"the two types ... are metabolized by the same enzymes ... you can't make them on their own ... knowing what the proportion is ... will prove to be a valuable marker of tissue status....
... All you really need to know is what's the percent of omega-3 and omega-6 .... I like to talk about the problem in the tissue is the percent of omega-6 that's there, and when you don't have a lot of omega-6 there you don't have a lot of problems ....
... when you eat a little bit [of omega-3 or omega-6]... you get this tremendous linear increase .... but as you get up around 1 percent of daily calories it levels off .... and then the system's saturated and no more change. That is the beginning of enzyme kinetics for you guys ...."
AHA -- with dietary intake for the average person up above 10 percent, a small change in dietary intake isn't going to make a difference -- the kinetics say you have to cut the amount of this stuff down into the range below 1 percent before the kinetics curve starts changing

"whether it's omega-6 or omega-3, that's what supply does."
"what about in the context of omega-6 competition? .... and as you have more and more omega-6 the omega-3 is not very effective .... there are a lot of articles in the literature .... all done in the presence of substantial excesses of omega-6 ....the reality in the United States is you're way up here ... the rest of the world has another reality .... the paradoxes of a hyperbolic saturable system .... Sheila Innis showed us that if you lower the linolete .... in 2003 or 2006 she published .... everything is actually rational, predictable and real but you've got to deal with the numbers .... the midpoints for linoleic and linolinic .... we can tell what diet will do to tissue, I have it in a spreadsheet .... I want you to interact with that spreadsheet .... the midpoint for 50 percent removal of an excess of omega-6 .... is done with less than a half percent of daily calories. The median status .... in the United States is 100x the requirement or 10x the daily allowance...."

per the video...

I wish the images on the video were actually legible, but at least it's captioned with the text of what he's saying.

Taking bits of text out of the video and searching:
"Conclusions: With caveats inherent for ecologic, nutrient disappearance analyses, a healthy dietary allowance for nC3 LCFAs for current US diets was estimated at 3.5 g/d for a 2000-kcal diet. This allowance for nC3 LCFAs can likely be reduced to one-tenth of that amount by consuming fewer nC6 fats."

Then it gets confusing:
"There are several different types of omega-6 fatty acids, and not all promote inflammation. Most omega-6 fatty acids in the diet come from vegetable oils as linoleic acid (LA). Be careful not to confuse this with alpha-linolenic acid (ALA), an omega-3 fatty acid. Linoleic acid is converted to gamma-linolenic acid (GLA) in the body. It is then further broken down to arachidonic acid (AA). GLA can be gotten from several plant-based oils including evening primrose oil (EPO), borage oil, and black currant seed oil.

Gamma-linolenic acid (GLA) may actually reduce inflammation. Much of the GLA taken as a supplement is converted to a substance called DGLA that fights inflammation...."

Here's Lands:
"... A 25-year study showed cholesterol predicted death only to the degree that n-6 exceeded n-3 in HUFA. When tissue n-3 suppressed n-6-mediated inflammation and thrombosis, diet imbalances that elevate mevalonate and isoprenoid metabolites (and blood cholesterol) seemed no longer fatal. Interactive menu planning software, KIM-2, helps find personally palatable foods that balance tissue HUFA at any desired level. It manages details to prevent the two imbalances (see A good goal is 30% n-6 in tissue HUFA, near that from traditional Japanese foods. Many food combinations can reach this goal."

Hank Roberts
" Conjugated linoleic acid supplementation in humans have been shown to cause insulin resistance and fatty liver. Because of lack of any significant health benefit from CLA consumption and its associated risks on insulin resistance and fatty liver, this natural or synthetic group of fatty acids cannot be recommended as a supplement that can be used to improve human health."
(CLA sources are: meat, milk, and partially hydrogenated vegetable oils)

Years ago I started fish oil rather than flaxseed because I'd read that flax had more estrogenic effect; that finding seems to have held up. Besides tossing the 10-year-old bottle of flax for a fresh bottle and urging that on my wife, can you comment re males of various ages and flax? Examples, not pretending these are the best info:

(that's cited in a footnote to this large paywalled article you may have access to as a librarian:
Molecular Nutrition & Food Research
Volume 54 Issue 2, Pages 175 - 185
Special Issue: Special: Novel Approaches for Risk Assessment of Phytochemicals in Food, Published Online: 3 Dec 2009

Hank Roberts

Just one more post. Wow. From 1999 (free full text):

Journal of the American College of Nutrition, Vol. 18, No. 5, 487-489 (1999)
Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids

"First, the amount of plant oils rich in LA, the parent compound of the omega-6 class, which is converted to AA, needs to be reduced. Second, simultaneously the omega-3 PUFAs need to be increased in the diet. LA can be converted to arachidonic acid and the enzyme, {Delta}-6 desaturase, necessary to desaturate it, is the same one necessary to desaturate LNA, the parent compound of the omega-3 class; each competes with the other for this desaturase. The presence of LNA in the diet can inhibit the conversion of the large amounts of LA in the diets of Western industrialized countries which contain too much dietary plant oils rich in omega-6 PUFAs (e.g. corn, safflower, and soybean oils). The increase of LNA, together with EPA and DHA, and reduction of vegetable oils with high LA content, are necessary to achieve a healthier diet in these countries...."

Citing articles include an interesting one:
A Family of Bioactive Products of Omega-3 Fatty Acid Transformation Circuits Initiated by Aspirin Treatment that Counter Proinflammation Signals

The broader recommendation for using low-does aspirin has recently been limited to those who've already had heart attacks because of GI bleeding problems. I wonder how differently aspirin affects people with surplus omega-3; I'd guess all the studies done on US citizens are on average people with excess omega-6. Citing papers:

Hank Roberts

"here's the Bill Lands presentation in two parts, slightly edited for clarity.

Why Omega-6 Fats Matter for Your Health October 14, 2009 "

You do need the slides Dr. Land was showing. Anyone know if they're available in better form?

This is the full day's program in one video:
"Air date: Wednesday, October 14, 2009, 8:00:00 ... You can drag the timer button slightly to the right to the 12 minute mark where Dr. Lands begins speaking."

(The video quality is a little better though many of the slides are still illegible)

(hat tip to: )

He mentions two recent papers, mentioned in notes handed out at that meeting (can we get them??):

"A critique of paradoxes in current advice on dietary lipids." Progress in Lipids Research (2008) ("The editor ... let me have unlimited space and unlimited references, a luxury. So invite you to read this because it illustrates what are the primary causes that are readily modifiable and can be prevented ...")

Planning primary prevention of coronary disease

Hank Roberts

The slides are here (or so it claims, looks right):

Hank Roberts

Oy. Farmed fish are fed wild fish to get omega-3s!
Reviews in Aquaculture V1 Issue 1, Pages 10 - 57
Published Online: 10 Feb 2009
Fish oil replacement in finfish nutrition

"... dietary fish oil is required for the production of omega-3-rich farmed fish and this commodity, in a vicious circle, is at present derived solely from wild fisheries.... This review attempts to compile all principal information available regarding the effects of fish oil replacement for the diets of farmed finfish .... the production, availability and main nutritional characteristics of fish oil and the principal alternative lipid sources (such as vegetable oils and animal fats)."


Just wanted to let you know, HL, my 15yo saw the pic of your vegetable bin lunch while he was peeking over my shoulder and said, "That looks really good!" So now I really do have to get that red lentil recipe going on since there is no Trader Joe's in this state! Nor can I find seitan in the Kroger or the local health food store. Sigh. But blackberries we have a plenty, for free.

Hank Roberts

the transcript I found is at
this Amazon page

Last bit, summarizing, by Dr. Land:
"... this puts together everything I've told you. And I want you to see.... to get you to where you really would like to be. Let's lower the omega-6. You're eating like 17,000 milligrams a day. What would happen if you just made it 4,000? ([video timestamp] 47:21) Now you're at a level ... where you now have the protection that you want. You can prevent it. It's as simple as that. You can get this from the website"

Chris O'Keefe

I come from a long line of heart disease, just turned 61, have had HIGH LDL for 25 years... and want to change.

I wonder about the elimination of fish and all oils - I've read so much about how the brain NEEDS these to be healthy. Does anyone know any research on long-term effects of removal of all oils and fish on brain health? Also, being totally new to all this - should I continue to take low-dose aspirin? Vitamins? B-complex? And can anyone recommend a good protein powder - I'm assuming you need some source of protein and I'm not a fan of eggs...

Sorry for all the questions but it's hard to read every blog and website just to find these specific answers. You guys seem to be a great source of information on vegan diet and heart health!
Thanks so much! Christin

Healthy Librarian

Wow, Chris, quite a a lot of questions! I personally take a high quality molecularly distilled fish oil, and I also take a vegetarian form of DHA. Dr. Esselstyn would not recommend one eat fish or take a fish oil supplement, for many excellent reasons.

"What about fish or fish oil capsules? Don't we need our omega 3's?

Fish oil isn't a panacea and it can raise total and LDL cholesterol levels, increase your chance for hemorrhagic stroke, and suppress your immune system. If the fish oil is rancid it releases disease-causing free radicals. Better to rely on ground flaxseed meal, walnuts, soybeans, and green leafy vegetables. There are vegetarian forms of omega 3's, like the all important DHA (a must for pregnant women, babies & brains)--click here for more info. And bottom line: Where do the fish get their omega 3's? From feeding off of plankton--microscopic plants."

Research is inconclusive right now about whether short-chain omega-3s (ALAs) can convert to provide sufficient omega-3s--necessary for brain health. I'm hedging my bets. Fish oil, in the long run isn't sustainable--and eventually, omega-3s should be more widely available in algal-format.

Read these posts to better understand what I'm talking about:

Can't answer about low-dose aspirin. As for B vitamins (my opinion only) it's better to get them from whole food sources, and they're plentiful in beans, greens, & citrus. If you're eating vegetarian you will definitely need a B12 supplements, and Dr. Esselstyn advises 1000 mcg a day--that seems like a lot, but as we age we absorb less & less. You don't want to short-change yourself on B12. Best to take it sub-lingually, to bypass the digestive system.

As for protein powder, most of us get more than we need--not a good thing. If you exercise a lot, and feel you need more, avoid isolated soy protein or whey protein. Neither are recommended--and have cancer-causing implications.

My husband uses a rice protein that works quite well--but he is a high level exerciser. Others use hemp protein. Eat lots of beans--high in protein, too. Hope this helps!

jerome barry

If the only oils I can consume are plant based
such as flaxseed why is olive oil unacceptable?

Ann Duffy

I've been following Esselstyn's whole plant diet for 7 months with great results. Cholesterol below 150 and lost 10 lbs in the first 2 weeks. They recommend eating greens at every meal. I often make "stews" with some type of whole grain and a myriad of veggies, but making a salad to boot...too much work!! All I do is shop, schlep and cook. I found that I really like to get my Kale in with a smoothie, but have heard that Esselstyn doesn't approve because h e believes that one is better sated when eating the greens and also the greens turn into glucose too quickly??? Could you shed some light on this.

I'm not worried about weight as I weigh less now than I did when I was 12 years old. I'm 5'9" tall and weigh 118. I've been trying to find some definitive info on drinking your greens as smoothies to no avail.
Thanks in advance.

Vicki C.

Thank you so much for your wonderful blog! I just saw "Forks Over Knives" and it really impacted me...

I was hoping to ask a quick question: You mentioned in this post that Ann Esselstyn had an extensive food list -- could you tell me how I can find it? Or is it contained in the book "Prevent and Reverse Heart Disease"?


Hahahaha. I just read your About info.

I was exactly the same growing up - telling my parents that I needed chores, that we had to switch from full-fat milk to skim milk, and asked for Wheatabix instead of Fruit Loops, etc, etc.

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