Each issue the VIP birds endeavor to soar to the highest literary peak to peck out the most unique, informative, and accomplished book that contributes to vegetarian enlightenment.

This month we feature a landmark book that shows that proper nutrition can prevent and reverse heart disease.

Visualize a revolutionary new television show called Extreme Health Makeover. The participants are obese people with high cholesterol and/or diabetes who are likely candidates for a heart attack or stroke. Possibly, these people may have angina or have already had a heart incident or a minor stroke. To heighten the suspense, each contestant would select one of two doctors who would present him/her with two radically different treatment choices.

The first doctor might say, "You need a triple bypass. We'll crack open your chest, take a few sections of vein out of your leg, stitch you back together, and you'll be fine for a few years."

The second doctor might recommend a totally different approach that would not include surgery, but, instead, better health through nutrition. This doctor would present each patient with a stringent diet regimen that avoids animal products, fish, dairy, eggs, oils, nuts, and avocados. Compliance would be strict with no deviation from the program because the doctor says, "Moderation kills."

Given this choice, a significant number of people might opt for the dietary approach, as stringent as it is, in order to avoid drastic surgical intervention. As Caldwell Esselstyn points out in Prevent and Reverse Heart Disease, many doctors are not interested in giving their patients this choice. The common view of physicians is that this type of nutritional approach won't work because most people will find it too hard to comply. Esselstyn says they are wrong. He also emphasizes, "Coronary artery disease need not exist, and if it does, it need not progress."

In the book Esselstyn details a 20-year study he began in 1985 with 24 patients who needed an Extreme Health Makeover. He described them as suffering from advanced coronary disease with many plagued by angina. A majority had one or two bypasses, stents, or angioplasties. They had been told there was no further treatment that could help them. None of them smoked or suffered from hypertension.

He placed the group on a low-fat (9 to 11% calories from fat) plant-based diet with these simple rules:

• You may not eat anything with a mother or a face (no meat, poultry, or fish).
• You cannot eat dairy products.
• You must not consume oil of any kind--not a drop. (Yes, you devotees of the Mediterranean Diet, that includes oive oil.
• Generally, you cannot eat nuts or avocados.

"You can eat a wonderful variety of delicious, nutrient-dense foods:"

• All vegetables except avocado. Leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellow and everything in between.
• All whole grains and products, such as bread and pasta that are made from them--as long as they do not contain added fats.
• All fruits.

Each patient kept a daily food diary and was asked to take a daily multivitamin and limit consumption of alcohol and caffeine. Each received a prescription for a cholesterol-lowering statin drug. Unique to the study was that Dr. Esselstyn personally counseled each participant at regular intervals and arranged for group support meetings at his home. Each participant was regularly monitored for blood pressure, weight, and cholesterol. Exercise and meditation were not prescribed in the study.

Six patients were released from the study during the first 12 to 15 months and returned to their cardiologists and their previous diets. Examining their status 13 years later, Esselstyn found that four cases of increased angina, two with potentially lethal arrhythmia, four with bypass surgery, one angioplasty, one congestive heart failure, one death from arrhythmia complications.

By contrast those who stayed with the program achieved remarkable results. As Esselstyn reports, "Among the fully compliant patients, during the twelve-year study, there was not one further clinical episode of worsening coronary artery disease after they committed themselves to keeping cholesterol within the safe range." The safe range is cholesterol below 150 mg/dL with a LDL (bad cholesterol) lower than 80 mg/dL.

"If you follow a plant-base nutrition program to reduce your total cholesterol level to below 150 mg/dL and the LDL level to less than 80 mg/dl, you cannot deposit fat and cholesterol into your coronary arteries," Esselstyn says.

After the 12-year study ended, the compliant patients continued to adhere to the nutritional program and have enjoyed two decades of freedom from heart disease.

Throughout the book the author relates the stories of participants who were able to reverse the effects of the heart disease and resume their normal lives. Most significant is the section of photographs showing PET scans and and angiograms of before and after their entering the program.

Not wanting to give his patients a program he had not experienced himself, Esselstyn and his family embarked on a dietary regimen a year before he began the study. By eliminating meat from his diet for three months, he experienced a cholesterol drop from 185 mg/dL to 155. By shunning oil and dairy, he saw the number plunge to 119 mg/dL. He reports that his father who had his first heart attack at 43 had cholesterol of 300 mg/dL.

More than half of the book is devoted to over 150 recipes developed by Dr. Esselstyn's wife Ann Crile Esselstyn that the family and patients have used for the last 22 years. Those who complain the diet is too hard should taste The BEST Banana Bread, Marakesh Express Red Lentil Soup, Chocolate Mousse, and Magic Banana "Ice Cream" and know that all of these delicious items are part of this program.

Ann also provides tips on meal preparation and explains that none of the recipes contain salt because they don't use it in their personal diet and because it would create problems for their patients with hypertension. She recommends substitutes and low sodium alternatives.

She also extols the health benefits of exercise and says that she does yoga, running, cross country skiing, and weight lifting while her husband swims a mile a day, lifts weights, and bikes three times a week.

The Appendix includes notes supporting the extensive research behind the information in the book as well as Safe Food, items they recommend that fall within the diet guidelines. In the Resources readers will find cookbooks, helpful websites, and contact information for manufacturers of food products. Also included is a bibliography of Dr. Esselstyn's publications on heart disease.

Dr. Esselstyn is a remarkable man who has written a remarkable book that dares to challenge his professional colleagues. In an era where so many people are eating themselves into chronic illnesses like heart disease, Prevent and Reverse Heart Disease presents a simple nutritional solution to a problem that has evolved into a national health crisis. His recommendations empower each individual to take charge of his/her health instead of turning to the medical profession for surgical intervention.

He says, "I have an ambitious goal: to annihilate heart disease--to abolish it once and for all." His goal will be realized only if his message is widely disseminated and people to turn their backs on unhealthful eating patterns to embrace a lifestyle that encourages their wellbeing.

Hopefully, doctors, instead of mocking and marginalizing practitioners like him, will change their focus to prevention instead of surgical procedures that cost thousands of dollars and offer no cure. He points out that surgery is far more lucrative for doctors than providing nutritional guidance to make that surgery unnecesary. As Esselstyn concludes, "We can start teaching people how to walk alongside the edge of the cliff instead of trying to save them after they fall off."

To read the Vegetarians in Paradise interview with Dr. Esselstyn, click on 24 Carrot Award.

Reviewed March 2007