In each issue Vegetarians in Paradise presents the 24 Carrot Award to an outstanding person or organization that endeavors to practice or promote education, natural health, wholesome nutrition, and ecology techniques for the mutual benefit of humans, animals, and the earth.
Vegetarians in Paradise proudly presents its 24 Carrot Award to Caldwell B. Esselstyn, Jr., M.D. , renowned physician and surgeon.
Dr. Esselstyn is an Olympic gold medal winner and was awarded the Bronze Star for his work as a surgeon in the Viet Nam War. He was honored in 1994 by being named one of the "Best Doctors in America" for his surgical expertise in endocrine and breast disease. Since 1985 Dr. Esselstyn has conducted the longest running study that proves heart disease can be arrested or reversed by a low fat, plant-based diet. Results of his study are described in his book Prevent and Reverse Heart Disease.
Through his work and his website he has been an inspiration and health resource to people around the world. Dr. Esselstyn clearly exemplifies the positive aspects of a compassionate lifestyle by devoting his life to helping others.
What follows are the questions asked by Vegetarians in Paradise (VIP) and the answers by Caldwell Esselstyn (CE).
VIP: What circumstances in your medical career led you to focus on diet and nutrition as a means for combating disease? What personal experiences led you to vegetarianism? How long have you been vegan?
CE: Approximately 14 years into my career as a surgeon, I found myself increasingly disenchanted with surgery as a means to control disease. As Chairman of the Cleveland Clinic's Breast Cancer Task Force, I was thoroughly frustrated as I was doing nothing for the next unsuspecting victim.
I began reviewing the epidemiology of breast cancer, prostate cancer, heart disease, and a host of other common Western ailments. I observed they were infrequently encountered in cultures consuming plant-based nutrition. This was especially provocative for my own family raised on an Aberdeen Angus cattle farm where my father had his first heart attack at age 43.
These were the major factors which led me to eating a plant-based diet and inspired me to perform research on the arrest and reversal of coronary artery disease. My last meal, which was not plant-based, was April 20, 1984.
VIP: You have a website at http://www.heartattackproof.com. What will people expect to find when they click on it?
CE: My website contains a short biography, my curriculum vitae, a number of my research papers on arresting and reversing coronary artery disease, as well as my recent presentation at the VegSource. Healthy Lifestyle Expo, " Resolving the Coronary Artery Disease Epidemic Through Plant Based Nutrition" plus the article summarizing my 12-year study.
VIP: We hear you have the nickname Dr. Sprouts. What's the story behind the name?
CE: I had to be a focused individual. As my passion and enthusiasm for plant-based nutrition grew exponentially because of my research success in reversing heart disease, I shared this information liberally. Not all the physicians were as enthusiastic as I was, especially if it meant taking away some of their business. Therefore, it seemed a name like Dr. Sprouts might not be too mean, but at the same time assuage their dissatisfaction being upstaged by someone not in their specialty. I consider it a compliment to have had enough of an impact that it brought out negative energy from those who couldn't refute my evidence-based research.
VIP: You currently are involved in a study to show the effect of a vegan diet on heart disease. Could you give us the details and progress of the study?
CE: The follow up on my original research is now in its 21st year and is summarized in my book for the public that is presently in the hands of the publisher.
The study was initiated in 1985 with the premise that patients who were seriously ill with triple vessel coronary artery disease could arrest and possibly reverse their disease through plant-based nutrition. The goal was to maintain total serum cholesterol below 150mg/dl and an LDL below 80mg/dl. Six of 24 patients who were noncompliant were released from the study during the first 6-12 months and returned to their expert cardiologists.
When reviewed at 12 years of follow up, 17 of our 18 patients had no further coronary events. One patient became noncompliant at 6 years (He was still eating plant based but was eating the NO-FAT sugar, white-flour-filled products) and developed recurrent disease necessitating by-pass surgery. It is of interest that those same 18 patients during the 8 years prior to study onset had experienced 49 coronary events while in the care of expert cardiologists. All compliant patients are doing well over 20 years later, including those who had been told by expert cardiologists at study onset that they had less than one year to live.
VIP: How does your heart reversal program differ from those of Doctors Ornish and McDougall?
CE: Dr. Ornish and Dr. McDougall are men I greatly admire. We all believe in plant-based nutrition. I am adamant about avoiding all oils and traces of oil and seek targets of total cholesterol less than 150mg/dl and LDL cholesterol less than 80mg/dl. If necessary, I will add a low dose statin to assist in attaining these goals. I have always wanted a program that can reach those with modest means. Today my counseling involves one hotel overnight if the patient is not local, an intensive 4 hours of one-on-one (two including spouse, who I always insist attends) counseling concluding with lunch, and a 40-page handout. My wife, Ann, works with me counseling on the foods to eat, on shopping, and on preparing meals.
The patients keep diet diaries 10 to 14 days before the visit and for two three-week post-visit periods with a full lipid profile following each 3-week post visit period. Patients must call with each lipid profile, and this should occur 6 times yearly, especially in those with heart disease. Knowing their lipid numbers is their lifeline.
While I recognize there are benefits to meditating, relaxation, and exercise in my original group, I left it optional. My concern has been that each of us has just so many behavioral modification units within us. I wanted all my patients' focus to be on nutrition modification. Most exercise on their own to the degree that worked for them.
None of my original patients chose meditation or relaxation. I believe it was this flexible approach and follow up that has allowed us to report the longest arrest and reversal study to date. Simplifying the counseling to a single half-day with intense prompt follow up offers a strong likelihood for success. It avoids long out-of-town hotel and meal expenses enabling a broader spectrum of patients with fewer financial resources.
I feel exercise is a very important component of a healthy lifestyle and urge my patients do as much as they can.
VIP: How have your colleagues responded to your efforts to reverse heart disease through diet?
CE: While I initially took a heavy beating from colleagues who never believed that nutrition modification could prevent or reverse heart disease, that has all changed via the success of our evidence-based research.
I have now treated multiple physicians and senior trustees within our institution with gratifying results. While some individual cardiologists are enthusiastic, as a group they begrudgingly accept the science but hide behind self-serving and patronizing remarks such as "I don't believe my patients would follow such a nutrition change." That is utter nonsense. We, on the contrary, find that patients rejoice when they recognize an opportunity to safely defeat their disease where they become the locus of control.
CE: Moderation kills is a phrase I use to emphasize to patients the importance of total nutritional adherence. I cannot stress this point enough. The only reason we succeed where others may fail is attention to detail. The data are now so powerful that even a single meal of added fat will injure the delicate endothelial cells' capacity to manufacture nitric oxide. This function is critical in the restoration of cardiovascular health. You wake up every day and make a simple decision: either I am going to enhance or injure my cardiovascular system today.
VIP: You seem to have an extensive speaking schedule. What types of audiences have you attracted? Are you often speaking to the choir?
CE: My speaking engagements are quite varied. Yes, I often seem to be speaking to the choir but often not. Just imagine speaking to 200 Akron, Ohio firemen, definitely not the choir.
VIP: If a person resolves to improve his/her health and lose weight at the same time, what initial dietary measures would you recommend?
CE: To improve health and lose weight I'd encourage fully plant based nutrition without any animal products or oils. Avoid processed white flour. To aggressively lose weight, it is helpful to decrease or eliminate the grains (cereals, bread, pasta) and white potatoes. This allows total focus on nutrient rich green leafy vegetables, green vegetables, all other colorful vegetables, legumes and 2-3 servings of fruit daily. Avoid fruit juices but drink plenty of water and exercise regularly.
VIP: You have the distinction of winning an Olympic gold medal. Would you describe your participation?
CE: I delayed my medical career a year to participate in the 1956 Olympic games. Rowing in the Yale eight-oar shell required total focus. We had to win the Olympic Trials in Syracuse, and we had to recoup our initial loss at the Olympic Games and come in through the back door -- the recoup race is technically called the repechage, meaning to fish again-- in order to regain entry into the semi-final and the final which we won convincingly by a deck length.
The joy is inexplicable. It was especially meaningful, as we had been written off after our initial failure. The bonding with fellow oarsmen is beautiful and enduring. Three of our crew have died: one from a brain tumor, one from liver cancer, and one from heart disease.
The take-home lesson for me was that you must never give up; especially when in your heart you know you are right -- no matter the odds. The other bonus was the sense of self-confidence that came with the experience. I know I can do this. It is an attitude. Needless to say, this has been of immeasurable importance in helping me stay the course through the travails of my research, acceptance, and delivering the message of plant-based nutrition.
Finally, there was always an unspoken obligation of an Olympic Gold Medal winner. You cannot escape being a role model. It is so discouraging for me to see former Olympians physically deteriorate into obesity and poor health habits.
In summary, the Olympic experience has been a wonderful, cherished gift and rare opportunity with rich, poignant memories that will endure forever.
VIP: Other than your Olympic gold medal, what other honors have been bestowed upon you?
CE: This information is on my website, http://www.heartattackproof.com/
VIP: Of all of your personal accomplishments, which ones give you the most pride and satisfaction?
CE: Without a doubt my number one accomplishment was my marriage to Ann Crile and the close-knit loving daughter and three sons we created. And now we have 6 grandchildren. Nothing can top the love of a close-knit family.
VIP: How do your friends and relatives react to your emphasis on a plant-based diet?
CE: Initially friends and relatives were highly skeptical and outwardly critical of our plant-based nutrition, but as the research progressed and was published with striking evidence of disease reversal, they are now increasingly supportive. Today as they or their friends get into trouble with heart disease, they come to me for advice.
VIP: What role does your family play in your career activities?
CE: As I mentioned, my family is the central focus of my life. My wife, Ann, is an integral part of our counseling effort and has authored the advice and recipe section of our book just submitted to the publisher.
VIP: What personal goals have you set for yourself in the coming years?
CE: The immediate goals are to publish my book for the public and aggressively assist in marketing it. We want the public to be aware that heart disease need never exist, and if it does exist, it need never progress.
There is some fascinating research that I would like to complete regarding the capacity of the plant-based diet to rapidly restore the quantity of endothelial progenitor cells. There is also the challenge to establish what is truly good food or bad food, to show clearly food that is NOT injurious to endothelial cells. This would have the power to entirely reclassify all foods and would totally change all cafeterias in schools, businesses, culinary institutes, restaurants, and hotels as well as eating at home. People would know up front if the food they were eating would injure them.
VIP: What leisure activities and hobbies do you enjoy?
CE: I love my daily exercise periods. I try to swim a mile daily and lift weights three times a week. Weather permitting, I ride a mountain bike to enjoy the outdoors.
I grew up operating farm machinery and still enjoy the satisfaction of baling and clearing a field of hay. When I am not in the fields in the summer, we counsel patients from the farm in upstate New York where I grew up. All summer we have family and friends coming and going, and I maintain challenging biking and hiking trails.
VIP: Can you give our readers the main features of your personal diet regimen?
CE: My diet is plant-based. I love my breakfast of rolled oats (not oatmeal), Grape Nuts, raisins, banana, blueberries, and oat milk with a sprinkling of flaxseed meal.
Lunch is lentil or pea or a vegetable soup, maybe a veggie heaped sandwich, occasionally brown rice nori rolls or something reheated from the night before. The evening meal always has a heaping salad and a vegetable like green beans, Brussels sprouts, broccoli, etc. Often we have brown rice and beans topped with a variety of vegetables. See my book for 120 pages of delicious options.
VIP: What person or persons have had the most influence on your life?
CE: Persons who have most influenced my life are persons of conviction and integrity--my wife, my father, my father-in-law, John McDougall, and T. Colin Campbell.
VIP: We may have omitted areas that are important to you. Please feel free to add anything you would like to share with our readers.
CE: The present health care crisis, the uninsured, companies going bankrupt, Medicare drug benefits, and sky rocketing health care costs have one common need. We have the knowledge to eliminate chronic illness without dependency on drugs and procedures. Lifestyle is the way out of this quagmire of unnecessary diseases. We are challenged as never before to convey this message to purveyors of health care and to the public.