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“My approach is not another stop-gap solution, it prevents heart disease from occurring in those who don’t yet have the disease, and it heals the body and reverses the disease when symptoms are present.” Caldwell B. Esselstyn, Jr., MD, author of Prevent and Reverse Heart Disease (Avery, 2007)

“We must never underestimate the layman’s ability to adopt healthier lifestyles. We must tell the truth.” Caldwell B. Esselstyn, Jr., MD

Preventing and Reversing Heart Disease

Real People, Real Results

If you were told that a strict plant-based diet would prevent and even reverse heart disease, would you adopt the diet? What if you had advanced heart disease and were facing open-heart surgery or balloon angiography? Based on clinical experience, conventional medicine says you are not likely to radically change your diet in either case. Caldwell B. Esselstyn, Jr., MD, formerly a surgeon, researcher and clinician at the Cleveland Clinic, says the odds are high that you would chose the diet—if your doctor took the time to fully and completely explain the benefits. Both are probably correct. Most people are not willing to change. Nevertheless, we should be given full information and every opportunity to help ourselves.

You should know about the success Dr. Esselstyn has had with diet and, if necessary, minimal use of cholesterol-lowering drugs.

His diet rules are simple—and strict: All vegetables, fruit, whole grains, beans and lentils are allowed; but no meat, chicken, fish, eggs, refined grains, dairy products (even skim milk), oil, nuts or avocados. In short, eliminate all fats except those found in plant-based foods; no animal foods or concentrated fats (oil, nuts). His aim is to avoid any food known to cause or promote vascular disease. If you are free of heart disease, walnuts in moderation are permitted. Esselstyn acknowledges that the omega-3 fatty acids found in fish are essential to artery health and other bodily functions, but prefers to use plant sources, such as flaxseed.

Although his diet sounds—and is—Spartan, Dr. Esselstyn’s meal suggestions are more satisfying—rabbit food it’s not—than you might think. (Example below) And, the choices begin to have more appeal when you learn the results of his 20-year nutritional study.

Study Results

The patients in the study had advanced heart disease. They were literally at death’s door. Despite aggressive treatment—think bypass and stents—most were told they had less than a year to live. They were referred to Dr. Esselstyn as a last resort. He sat down with each patient for up to an hour (as long as necessary) and explained the benefits of plant-based nutrition. He also explained that surgical repairs do not stop the progression of the underlying disease; that lifestyle change is the only way to stop or reverse their disease. He gave them reason for hope.

Within months on Dr. Esselstyn’s program, their cholesterol levels, angina symptoms, and blood flow improved dramatically. Twenty years later, most of them are still alive. Sounds almost too good to be true, doesn’t it? Here are the details.

Six patients opted out; they did not grasp what Dr. Esselstyn was trying to do and were not willing to follow the diet. (What eventually happened to these six is in Dr. Esselstyn’s book.) Seventeen patients signed on to the program. Each was put on a plant-based diet and given a prescription for a cholesterol-lowering drug. Every two weeks for five years—this is very important—Esselstyn contacted each patient to go over what they were eating, cholesterol readings, problems, etc., and make necessary changes in their nutrition or medication. This level of contact is, of course, almost unprecedented. It really paid off. It was the key to keeping them on the diet. The continuous encouragement and guidance—and the symptom relief they were experiencing.

Dr. Esselstyn goes over the history of each patient in his book, but here is an overview of what happened.

One patient, who was accepted into the program after sustaining massive heart damage (function reduced to 20%), died after surviving five years on the program. Despite showing improved blood supply and decrease in angina, he died of cardiac arrhythmia. “Postmortem study showed no new blockages or heart attacks,” Dr. Esselstyn relates. The other patients improved and survived.

As a group, the patients began the study with average total blood cholesterol of 246; desirable is 200 or less. By adhering to the diet and using cholesterol-lowering drugs, their average cholesterol dropped to 137; less than 150 is ideal and considered protective. Their cholesterol went from “high risk” to “safe” on the program. “Below 150 is the total cholesterol level seen in cultures where heart disease is essentially nonexistent,” Dr. Esselstyn tells us. Every participant achieved a total cholesterol level below 150.

Almost half of the participants showed a widening of their coronary arteries—an actual reversal of their disease. This is not opinion; it is documented fact. Angiogram X-ray pictures were taken at the beginning of the program, and after five years. “At the five-year mark, seven of the eighteen participants were unable to have a follow-up angiogram,” Dr. Esselstyn writes. “The results I report here are for the eleven participants who did have follow-up angiograms after five years. The analyses were stunning. In sustaining cholesterol readings below 150, these patients eliminated any clinical progression of their disease. Every single one arrested progression of the heart disease, and eight participants actually selectively reversed it.” A color insert in the book shows the angiogram pictures. You can see the improved blood flow, in some cases after only 3 weeks. The results are indeed stunning.

Finally, and most importantly, for all participants, symptoms improved. “Nine of the patients had come to the study with angina—pain in the heart muscle caused by inadequate blood supply,” Dr. Esselstyn reports. “It was completely eliminated in two and much improved in the remaining seven, including the patient who died. Exercise capacity improved. Sexual activity was enhanced.”

The Explanation

Here’s how Dr. Esselstyn describes what happened to the people in the study: “The blood supply through their coronary arteries to their heart muscles has improved. In the majority of patients, the arteries themselves are measurably wider.” Exploring the causative factors, Dr. Esselstyn continues: “Profound reduction of cholesterol has increased the capacity of the endothelium, the arteries’ inner lining, to produce nitric oxide, which in turn dilates [expands] the arteries themselves—even diseased arteries.” On the role of the diet, he adds: “The patients’ plant-based diet, eliminating the ingestion of foods that injure vascular tissues, has restored strength and integrity to the endothelium as a whole.” Importantly, “Any plaques in these patients were protectively capped and could not rupture or initiate the cascade of clotting that defines a heart attack.”

“These patients are now heart-attack-proof,” Esselstyn states emphatically.


I’m impressed—and encouraged. My diet is largely plant-based, but not as strict as Dr. Esselstyn would like. “I stress the need for total commitment,” says the doctor. “My first request is that patients and their families eliminate from their vocabulary, from their thinking, from their basic belief systems, the phrase ‘This little bit can’t hurt.’” He adds “that just a little bit of forbidden food—fats, dairy products, oils, animal proteins—can hurt, and will.”

I wouldn’t pass muster, because I use a small amount of canola oil, measured amounts of nut butter, several cups of skim milk and non-fat yogurt, and frequently have modest portions of fish or (less often) chicken with my evening meal. I also eat two to four eggs a week. (A major study from Harvard found no association between eggs and heart disease, except in people with diabetes.)

This seems to be working well for me, based on the results of my latest blood test.

My total cholesterol is 158, about 5% over Dr. Esselstyn’s “safe” number. I believe that puts me in a pretty good place, because my HDL “good” cholesterol, at 62, is almost twice the 36-average level for the participants in Dr. Esselstyn’s study. My total cholesterol-HDL ratio is substantially better than the study participants, 2.55 to 3.8; <4.5 is considered acceptable. My LDL “bad” cholesterol, at 82, is the same as the average for the participants, but my HDL-LDL ratio is far better, 1.32 compared to 2.28.  

I believe my high HDL is due to daily exercise (weights, aerobics or walking), something that Esselstyn encourages, but does not require.

Carol and I are making some changes, nevertheless. For one thing, we’re going to include Dr. Esselstyn’s “thick soup” suggestions several times a week in our evening meal. We’ve already tried the “Sweet Potato and Lentil Soup with Shiitake Mushroom.” It’s delicious and very satisfying. We’re also looking for other places to use Esselstyn’s recipes, and reduce unhealthy fat. (Some fat in the diet is desirable. Adding a tablespoon of oil—olive and then flaxseed—reduced my triglycerides by half; see article 18 in our Diet & Nutrition category for the details.) 

Could your diet be improved? Before you decide, I encourage you to read Dr. Esselstyn’s inspiring book Prevent and Reverse Heart Disease (Penguin, 2007). A paperback version was just released (January, 2008). I ordered mine on Amazon, but you can probably find it in your local book store. It’s also offered on Dr. Esselstyn’s website: www.heartattackproof.com.

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Copyright © 2008 Clarence and Carol Bass.  All rights reserved.