Two Cardiologists & One Cardiac Surgeon Who Follow an Esselstyn-Style Plant-Based Diet. What's Their Story and What Health Benefits Have They Seen?

 

 

"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.

No seeds

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?

Absolutely!!

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?

 

 

Comments

[Lisa Austin]

Great post as usual. I am really shocked that the Dr says he doesn't share his experience with patients. It almost seems like with holding life-saving drug or procedure. You can communicate w/o "preaching". Also what about advocating diet with his hospital, the staff, his colleagues,etc.?

HLL agree with you that agressive approach is better than small steps. It's really not that hard.

Still I think something is happening. I have heard of friends of friends that have done the diet. At least plant-based although maybe not oil free.

I keep thinking how much energy ( of all kinds) we could save as a nation if more would adopt this way of eating.

[The Healthy Librarian]

Thanks, Lisa. I think you misunderstood--he meant he doesn't "preach"--as in pontificate to family or friends. That can be very off-putting. It's more lead by example. That was really my fault--I should have made that clearer, when I used his quote. I can see how that quote was ambiguous, & could be misinterpreted to mean patients.

[Gil Hanoch]

Great post. For the minority that follows a vegan diet but consumes olive oil and plenty of nuts and seeds, it would be useful to see any study that compares the health of vegans with vegans who avoid these fats.

You previously referenced a study that measures the blood flow after consuming these fats, showing a slower flow. I would be happy to see a step further testing the long-term effects. There is a chance that the restriction of the blood flow is temporary and does not have adverse long-term effects.

This is a very important question, since the switch to a healthy diet can be very difficult due to the craving of fat. If one can still eat olive oil and nuts & seeds, that would drop the craving for less healthy oils and most importantly: sugar.

I have a personal experience of dropping 28 pounds in about 3 months, unintentionally, mostly by cutting out sugar and the most unhealthy fats. This was while allowing myself to eat plenty of nuts & seeds and olive oil. Your posts make me worried that despite all the positive effects, I may be still subjecting myself to the risks of heart disease.

[Penny]

It is so encouraging to see more doctors getting on board. I just can't believe the disconnect between diet and heart disease-- especially among doctors. My aunt recently had a stroke and was served bacon in the rehab hospital!

I attended Colorado VegFest today. Great speakers. It does seem that there are fewer obese people in this state. Lots of bikers, hikers, runners, young people around everywhere.

[E26pt2]

I don't think I would be motivated one way or another if I learned that my doc followed a plant-based diet. I would tend to respect their advice more, but that would be the extent of it.

I'm in favor of the gradual approach, but to each his own. The Esselstyn plan has been very difficult for me. Despite having fruits and veggies available to me throughout my life and especially as a child, I do not like the taste and texture of most veggies, regardless of how they are prepared. I do love whole grains, so I have no problem adding more whole grains to my diet. The step-by-step approach has worked best for me, because I didn't want to throw away a cupboard full of food in the process of switching over. I haven't had any animal protein since 1995, so meat is a non-issue.

One of the things I'm finding is that many of the "safe foods" listed in the back of Dr. Esselstyn's book are not available in my area. I've cut back on a lot of oils, but I do have a tiny schmear of peanut butter on my whole-wheat toast each morning. I need the protein and the flavor and yes, the fat.

I have no health insurance, so I will be getting a full lipid panel done through the local community center in the next few weeks. It will be interesting to see if the changes I've made will be reflected in the bloodwork. I miss my old diet; I miss the fats...no animal fats, just MUFA's. I miss nuts most of all. Really hoping this diet does the trick for me, as I do not want heart disease. An EKG scare back in April was the impetus.

[Anonymous]

HI,
Great post! Thanks
I had a heart attack in November of 2009 and had four stents put in my heart. At the first visit after my surgery, I asked my cardiologist if I should be on a diet to help my condition. He told me that he was going to prescribe a pill that would allow me to eat anything I wanted. However, that is exactly what I didn't want.(To paraphrase Eisenhower - "Beware the Pharmaceutical- Industrial Complex) So I did my own research and in February of 2010 after reading several books by Dr. McDougal and Dr. Esseltsyn's book, "Prevent and Reverse Heart Disease", I went cold turkey and instantly changed my diet, overnight. I cut out ALL flesh and animal products, all oil and 95% of the processed sugar I used to eat. I am now a vegan and only occasionally at special times will indulge in the old ways.

I had been put on a statin at first but after research, I ask my primary care doctor to take me off the statin, indicating to him that I believed I could get my cholesterol levels down by my diet. And I have succeeded to get them down. The only medicine I take is a baby aspirin a day. My initial total cholesterol level in December of 2009 was 190. In February of 2010, while on simvastatin, the total cholesterol level was 107. In April of 2010, no longer on a statin, my total cholesterol level was 113. My latest blood pressure was 120/62 and resting heart rate was 64. By the way, I'm 65 as of June, 2012.

At home it is no problem maintaining the diet, although I'm the only one doing it. It is more difficult when I go out or am invited to a home but I have managed well to stay on track.

What made it possible to change overnight was
1) the wake up call of a heart attack,
2) the well thought out and documented education I received from the doctors I read, (it made sense)
3) The same diet that can cause a heart attack can cause a stroke (this was huge for me)
4) it fits my personality type. (The nurse who cared for me after the heart attack told me that he thought I was a Type A personality - I denied it)
I don't preach the diet but will share with anyone who wants to know about it. People do notice when you don't heap your plate with meat.
Keep up the good work.

[Anonymous]

Hi, Debby,

The post re the cardiologists was so interesting! It's exciting to see that physicians, especially cardiologists, are changing their diets.

To answer your question at the end, I made major changes each time - first to vegetarian in 1984, then vegan in 1997, then in 2003 Eat to Live, which is my current diet (no oil, 1 - 2 oz. nuts & seeds/day, tons of veggies, fruits, & beans, 2 - 3 servings whole grains/day but no wheat) .

Each time was a leap, but the leaps were spaced pretty far apart.

It seems that those who make the leap to low-fat, plant-based diets are more likely to make long lasting change while those who try the gradual approach go back to their old ways.

It is hard to keep the changes going unless you lose your taste for those unhealthy foods through a period of abstinence. That said it can often take a while for people to be ready to change, so even those who take the class but don't make a big leap at that point may later have an epiphany and then really do it.

I always recommend Dr. Esselstyn's book in my classes for those with heart disease or a family history as his evidence is so clear and compelling!

[Silvia]

Thanks a lot for this post! Very interesting!

I need to change completely otherwise I tend to slip at first slowly then completely.
But I was already eating vegan and grappling with vegan + gluten free (which was very difficult for me) when I decided to try the no added oil eating. I was inspired by your blog an the changes you experienced. I cannot thank you enough for sharing this valuable information.
As I write this I notice that I made a 100% change in my head but in practice I had a teaspoon of olive oil in the frying pan for quite a time. But I find that I cannot make the decision to only reduce - that does not work for me.
Going vegan but eating junk food lowered my total cholesterol to about 170 (my cholesterol a few years earlier was 260 / BMI about 21 which shocked me very much). Going oil free (with some walnuts, avocados, olives...)it went down to 153. But my HDL (80)was actually higer than the LDL (70) which was pretty astonishing. I use 2 tablespoons flaxmeal every morning. That and the walnuts must have tipped the balance. CRP was under the detection limit...
Following your blog and the info you post I think that it is not so much the cholesterol numbers but endothelial function and inflammation that are important factors. And I can influence them by the way I eat and not by using drugs.
At the beginning of 'no added oil' I craved (and ate)higher fat foods as olives quite a lot. But about a year into this kind of eating I only wanted smaller portions of high fat foods and find I feel unwell after for example eating a whole avocado.
I still find it very interesting that I now eat in a way I found completely unattainable when I first read the China Study even more impossible than eating vegan. And now it has become quite normal and the way of eating I feel good with.

[Anonymous]

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?

Interesting question, because each of my husband and my doctors ARE following a plant based diet themselves! In my case, it was AFTER I told my doctor why my LDL had come down a lot that she told me she had made the same choice after seeing the same DVD (Forks Over Knives)! So she didn't influence me or motivate me to change, but I was certainly happy to know that she and I were on the same page! In my husband's case, it was a year before he made the change that he realized his doctor was a believer in plant based eating because the doctor had given him a vegan food guide pyramid to ponder. (Also I had been a health conscious consumer serving a 'healthy' plate for years with increasingly less meat so in his view, we were 'already' moving in this direction. By the time he saw FOK with me, it was - his words - an easy and convincing choice to make.) Both of us feel incredibly lucky that our two doctors and we are on the same page, and it makes what they recommend have added believability for us.

We made an 'all at once' change last fall. (In my husband's view we had been eating a diet that was more healthy than the conventional western diet for years, so the change seemed gradual to him compared to some of the other examples we have heard about.

Also since we started last fall, we have made additional changes (eg. less oil and sugar). All that said, I think making gradual changes leaves one open to back sliding over time unless one has regular inspiration, support and encouragement (like the Esselstyns provided for his original study patients). Of course, that sale level of support helps anyone making an all-at-once change, too!

Our results: I've lost 5 lbs and my LDL went from a high of 191 to 119. DH has lost lost 14 lbs, his LDL went from 149 to 114 and he feels more energetic. Both of us have normal blood pressure, glucose levels, weight and BMI.

Thanks HEAPS for your wonderful blog! I mentally salivate when I see it pop up!

[Dawn]

Thanks D!--That was informative. Interesting thoughts from all three. I was particularly interested in the cholesterol --diet/liver discussion. I have always thought this would be hard to measure in people that eat typical diet.
I am renewing my zeal to stick with my no-oil whole foods style of eating and very much appreciate your blog. Thanks again!

[Ramona]

About a year ago I saw Forks over Knives. I immediately read both Dr Esselstyn's and Dr Colin Campbel's books and both made complete sense to me. I made a total change in my diet, no moderation.

I've lost 65 lbs in the last year. I feel like myself again.. not like the old woman I was becoming before I made the change...

I haven't had any blood tests in the last year. I'm sure my numbers are much improved... how could they not be? But, in a way, the numbers matter less than the fact that I feel so much better; no more arthritis, painful knees, feet, constant low-grade weariness. The benefits are so dramatic that I don't need numbers to convince me.. I'm already there. Good numbers would simply be, can I say "icing on the cake"?

My doctor recently retired and so I am looking for a new one. I will be interviewing him/her about their belief in the effects of nutrition on health. I have new standards now regarding the confidence I place in my doctor.

I so appreciate your blog and particularly each bit of evidence you find that the medical community is realizing the benefits of good nutrition. I expect a tipping point will arrive when the general public reaches the same conclusion.

[Silvia]

After listening to the interview with Dr. Katz I think I understand what he considers small steps best for change and motivation.
I would actually recommend to friends something like 'eat one - two cups of vegetables for each meal' etc. I think this might work for people who consider this kind of 'radical' change simply impossible. This would be something like changing habits in small steps which works really well for me in other fields.

And I was eating vegan and gluten free when I decided to skip the oil and this can be considered a change in smaller steps. Still I consider myself a person who cannot do things by half. I have to commit completely but I also have to consider the change possible.

But for people with manifest heart disease I think the Esselstyn way is the best. It takes far less self discipline to simply eliminate whole food groups than to take in small portions of them and live with cravings and poor results. And you have to take full measures to get really good results.

Thinking back I do not know how or why I managed this type of change when I never before even managed to stay completely vegetarian or vegan for more than about a month...

[Charles McCool]

Really interesting topic. I am surprised about the no-oil but certainly there is no dispute about a plant based diet being beneficial. The cholesterol finding is fascinating, also. Best wishes!

[mistah charley, ph.d.]

I am sorry that the cardiologists wish to conceal their identities, but it is understandable given what the leading figures in their field think. Specifically, here's something from Gordon F. Tomaselli, MD, Chief, Division of Cardiology, Johns Hopkins Hospital, President of the American Heart Association 2011-2012, speaking at JHH on "Prevention of Heart Disease: What Should I Be Doing?"

3/22/2012 9:49 AM EDT Length: 01:23:22

At 44 minutes, in response to a question from the audience:

"I'm sorry - whole foods based diet?"

"I've heard anecdotal reports of people who've gone to complete vegan diets, for example. Not many of my patients really can do that. But I think the message here should NOT be that I need to go to a complete vegan diet to consider this a successful intervention. What you need to do, is just make sure those things that aren't optimal, you do a little better job at. Lower the caloric intake. Lower the amount of salt in your diet. Increase exercise a little bit more. And that can be progressive over time. For people who have the worst coronary heart disease, diet alone usually doesn't fix the problem."

Although we can't hear the questioner, it is likely that they are better informed than the President of the American Heart Association, who has "heard anecdotal reports" when he could have read papers published in peer-reviewed journals. His view that "not many of my patients can do that" is a common prejudice, not one based on evidence. His impression about the lack of efficacy of diet in the most serious cases is contradicted by the same papers he has only heard anecdotes about, rather than read.

[Jill Princehouse]

I think it's best to go 100%. You get fast results that encourage you to keep with it.

I did it without my doctor's support. I wish my diet and health results would encourage my doctor to try it. I have a genetically atrocious lipid picture and yet my vessels are clear. Follow Essy's ANTIINFLAMMATORY plant-based diet to the letter and anyone's vessels will clear despite a bad genetically-induced lipid profile. It's different food than an animal-based, but it's delicious food.