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March 22, 2013


Kim Hawkins

Thank you again, Debbie! Hope you experience a blessed Passover season.

Fred Pollack

The data in the Supplementary Appendix of the NEJM article ( is a must read to figure out what is actually going on in the Spanish study.

At the beginning of the study, the average intake of macronutrients in all participants, as a percent of calories were: 17% protein, 42% carbs, and 39% fat (Table S7 in Appendix).

The daily intake of fiber was 25 grams and was about the same at the end of the study in all groups (up 1g in the nut group and down 1g in the low-fat group). Cholesterol intake was about the same for all groups at both the beginning and end of the study - ~360g at the start, and ~330g at the end.

Control Group. This group was counselled to follow a low-fat diet. They received instruction at the beginning and thereafter once per year for the first 3 years, thereafter every 3 months until the study ended at 4.5 years.

The intervention groups received counseling every 3 months from the outset, and were provided the intervention food supplies (either extra virgin olive oil or nuts). If you look at table 1 in the article on the recommended foods for the low-fat group, they were not very good or even helpful. At the end of the trial, the low-fat group had reduced their fat intake from 39% all the way to 37%. Saturated fat went from 10.0% down to 9.1%. Dr. John McDougall, Dr. Caldwell Esselstyn, and Dr. T. Colin Campbell (and others) recommend a diet 4 tablespoons/day 93.6 79.5 58.9
Vegetables >= 2 servings/day 74.1 73.7 64.5
Fruits >= 3 servings/day 65.2 67.9 60.9
Wine glasses >= 7/week 29.9 32.3 25.1
Legumes >= 3/week 41.5 36.9 31.2
Nuts >= 3/wk 42.2 90.7 16.7
Sofrito sauce >= 2/wk 86.9 84.3 65.1

(Sofrito is a sauce made with tomato and onion, often including garlic and aromatic herbs, and slowly simmered with olive oil.)

People in the intervention groups did better with vegetables, fruits, and legumes (i.e. 3 of the 4 ingredients of eating a low-fat plant-based diet - a healthy diet). So, if all other things were equal, research suggests that they should do better.

EVOO is known to have more phytonutrients then regular olive oil. And, of course, nuts have more phytonutrients than animal sources. And, walnuts are the best nut source of ALA (short-chain omega-3 fatty acids). And, both the EVOO and Nuts group ate more nuts than the control group.

W.r.t. Wine consumption, from Mayo Clinic website, "drinking small to moderate amounts of alcohol may help prevent ischemic stroke and decrease your blood's clotting tendency." So, perhaps this helped the nuts/EVOO groups a little. The tomato, garlic and onion (in the Sofrito sauce) may have also been a small factor in helping the nuts/EVOO groups.

The Sad Truth

The 87 deaths from Cardio Vascular causes (across all 3 groups) could have been prevented by following the diet advocated by Esselstyn, McDougall, Campbell, Ornish, et al - the same diet that Bill Clinton has been on for 2 years, and that I have been on for 4 years. The published peer-reviewed research of Ornish and Esselstyn shows this to be the case. How sad!

And the average American that eats far less vegetables, fruits, and legumes than either of the Spanish groups (at baseline or at the end of the study) will now feel good about even eating more olive oil than they currently do.

Paul Myron, RPh

Thanks for putting this together and sending it out on e-mail. I am not a face booker because of the security issues that have turned up. I was taken with the disclosures of the investigators and their association with interests that would benefit from a favorable conclusion of the study.

The Healthy Librarian

@Kim: Thank you!

@Fred: Thanks for your terrific analysis--I tried to fix up all the garbled chart data--it looked perfect & when I "published it"--it garbled up exactly as it did for you. The comments here can't display tables, tabs, etc. Your personal experience with the Esselstyn Diet is motivating & inspiring--glad you shared it with me.

@Paul: Thank you! Beyond the industry/corporate interests of the researchers--no one mentions the obvious. Spain was more than happy to fund such a study--& their vested interest is their economy. Spanish olive oil--& wine are a tremendous part of the Spanish economy. They are continually funding studies to "prove" the benefits of Spanish (first-press) olive oil. And given these difficult economic times--the study couldn't have come out a better time for them.


Hi there! lovely website, and you have in fact turned me and my family on to Dr.Esselstyn's diet. It worked too - my husbands cholesterol decreased 80 points in 3 months (I think this is pretty amazing).

We don't follow it to a T anymore, but I still believe in it and it has changed the way I cook now (no oil, dairy and egg substitutes, etc).

However, it is the case that there have been no large, long-term studies to look at the the health outcomes of this diet (because decreased cholesterol may not completely equate with better health outcomes, especially for people who are not at risk for heart disease).

I was very excited to see the article about the results of the Mediterranean diet, and in my mind it was consistent with the Esselstyn hypothesis (eg: a lot of fat/animal products -> bad health, less fat/animal products -> better health). I was a little put off my Dr. Esselstyn's complete dismissal of it in the NYT article however. Maybe it's just the way he was quoted out of context, but I feel it's hard to make a concrete argument for his diet (and especially against others) with no large, long-term studies to back it up. Hopefully this is something he has in the works.

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