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Stethescope and CardiographCaldwell Esselstyn, Jr. is a retired surgeon who has become a nutritional cardiologist.  His book is called Prevent and Reverse Heart Disease, and his program is featured in the new documentary Forks over Knives.

His food philosophy is similar to that of Nathan Pritikin and Dean Ornish, who also demonstrated reversal of heart disease, though even more strict.  Unlike Ornish, he does not focus on exercise and stress reduction as essential components, but asserts that proper diet alone is necessary.

Twenty years ago he began treating 23 men and women with intractable symptoms of heart disease, who were failing despite optimal drug and surgical therapies.  Those who complied with the program achieved “total arrest of clinical progression and significant selective reversal of coronary artery disease.”  Angina disappeared in a few weeks and abnormal stress tests became normal.

He and his wife, who created the recipes in the book, and their children, all follow the same diet, which is plant-based and then some.  The idea is to reduce fat intake of all kinds to less than 10% of caloric intake.  The average American diet contains 40% fat.

Here are the rules:

  1. No meat, poultry, fish or eggs.
  2. No dairy products
  3. No oil of any kind, including no olive oil
  4. No nuts or avocadoes, because they contain too much fat.
  5. All vegetables are acceptable except avocado, including root vegetables like potatoes.
  6. All legumes, including beans, peas, and lentils
  7. All whole grains and grain products, including bread and pasta, as long as they have no added fats.
  8. All fruits.

It is a rigidly vegan diet, but in Esselstyn’s experience virtually 100% effective.  The average cholesterol level on the program falls below 150.  If it does not, he recommends statin drugs to get it there.  The book presents angiograms and perfusion studies that have normalized.  He believes blood vessels can be as clean at 90 years of age as they are at nine.

He also believes that the program eliminates other vascular diseases such as stroke and peripheral vascular disease, as well as high blood pressure, obesity, osteoporosis and possibly dementia.  He states that it offers protection from several common cancers: breast, prostate, colon, rectum, uterus and ovaries.

For most individuals it is not an easy program to get into, and requires commitment.  On the other hand, having heart surgery is not easy either, and stents have been shown to reduce symptoms but not to prolong life.

What remains unanswered is whether people who have no evidence of heart disease can do well on a moderately low-fat diet, such as the Mediterranean Diet, which Esselstyn states has greatly inferior results compared with his program.  It would allow for eating olive oil, fish, nuts, small amounts of dairy products, poultry and a little meat.

The evidence cited in Esselstyn’s book is strong, and I recommend that anyone with heart disease, or strongly predisposing risk factors, buy the book and follow his advice.  Even those who are unable to fully comply with the program are likely to improve.  It beats the alternatives.

Allan Sosin MD

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