As my late brother-in-law said, they were the walking dead. They had failed their first or second bypass; they had failed their first or second angioplasty. They were too sick for these procedures or they had refused them, and five were told by their expert cardiologist that they would not live out the year. I am happy to say that all five of those went beyond twenty years, and all patients who were compliant were able to arrest their disease and we often would see a marvelous reversal of it. This was extremely exciting and very rewarding, because some of those actually occurred before the invention of statin drugs. So we recognized the power of correcting nutrition.
JOHN ROBBINS: The power of nutrition, as you showed, is phenomenal to correct and sometimes reverse disease. Yet most medical schools hardly teach nutrition at all. The philosophy seems to be “a pill for every ill.” There is very, very little effort to support physicians in learning about nutrition and its power. Having been at this as long as you have, how would you say the battle is going overall?
DR. CALDWELL ESSELSTYN: Nothing is going on in cardiovascular medicine today with any of the drugs, with any of the imaging, with any of the stents or the procedures or the bypass operations, to treat the causation of the illness. Even my wonderful friends who are cardiologists and cardiac surgeons will concede that these procedures do nothing to deal with the underlying problem. They are just a stop-gap patch job.
There was a normal, and I think probably an appropriate, reticence with Dr. Ornish and me when we did our earlier studies. The medical community was willing to concede that we had demonstrated proof of concept but they felt very strongly that it would be impossible to get large numbers of people to change. But we are just now summarizing a group of more than 226 patients that we have counseled over the past ten years or so. These patients have come to see us from across the United States, and 198 of them had severe coronary artery disease. We have had about a 90 percent compliance rate. The number of new major cardiac events (death, heart attack and stroke) is 40 times less frequent than other representative studies. We have had in our group of compliant patients a total of just one event. This was one patient who had a mild stroke. That means that more than 99 percent had no new major cardiac events.
Many people wonder how we have achieved that degree of compliance. Most cardiologists don't doubt that there would be benefit from our program—they just don't think patients would stick with it. But we have proven that it can be done.
JOHN ROBBINS: How did you do it? I have heard so many people say, “Well, you just can't ask people to be that restrictive in their diet.”
DR. CALDWELL ESSELSTYN: The first thing you have to do is to show patients respect. The way that a physician can show a patient respect immediately is by giving them their time. At the Cleveland Clinic Wellness Institute where I direct the Cardiovascular Disease Prevention and Reversal Program, we conduct a single five-hour intensive counseling seminar for ten or twelve participants at a time. Their spouses or partners can come for free. We explain to them in language that either a CEO of a company or a high school dropout is going to be able to understand exactly what has been the cause of their disease and exactly what it is that they can do to be empowered to halt and reverse this disease. In addition to this, we have a very hefty notebook that we give them with a copy of every one of my PowerPoint slides, another forty-four-page handout with additional concepts, and many more recipes to add to the 150 in our book, which we give them as well. We also incorporate an hour and a quarter presentation from a woman who has had twenty-eight years of experience acquiring and preparing plant-based nutrition, dealing with reading labels, dealing with travel, and dealing with restaurants. Then we give them a copy of a DVD of an entire seminar that we recorded earlier. We usually have a presentation from somebody who is local or regional who had a previous successful experience to share their story so that those who are there can say, “Listen, if he or she can do this, I can do it.”
We give them a delightful plant-based lunch and stay in touch through email or phone calls as is necessary. What we really want to do is to make this the most significant interchange that they have ever had with a caregiver. I need the five hours. I need the same amount of time that the cardiac surgeon has, but I want it with the patient awake.
JOHN ROBBINS: Currently, 45 percent of Medicare spending is in cardiology.
DR. CALDWELL ESSELSTYN: Those tax dollars are being spent on drugs, imaging, procedures, and operations that have absolutely nothing to do with the causation of the disease. So a poor patient today with a cardiovascular illness is going to have their first stent, their second stent, maybe their third, fourth, or fifth, and then a bypass, and then more stents. Eventually they'll have congestive heart failure and sadly end up dying of a food-borne illness that was never treated.
Right now what we are doing in medicine is really sort of insane. A few years ago, it was disappointing that they didn't teach nutrition in medical school. Quite frankly, at this point it is disgraceful.
JOHN ROBBINS: Your work was featured in the popular documentary, Forks Over Knives. The film basically examines the claims that most, if not all, of the degenerative diseases that afflict us can be controlled or even reversed by shifting away from our present diet of animal-based and processed foods. What do you hope people take away after seeing this film?
DR. CALDWELL ESSELSTYN: I think that the film is powerful and enlightening because it is all evidence-based. It is so compelling when you see the science that whole food, plant-based nutrition trumps everything else. It is the absolute cornerstone of what I feel can be a revolution in health.
Even in their teenage years people have coronary artery disease. Yet the human frame is so remarkable that it will go on for several more decades doing the very best it possibly can to resist this assault. Eventually, the assault on the vasculature gets to a point where the body can no longer protect against the development of these plaques and you see the rupture and clinical disease that have taken decades to develop.
The same thing is true, of course, of what happens with hypertension. You don't suddenly wake up as a teenager eating horribly and have hypertension. No, you keep that up, and eventually your body can no longer keep your blood pressure normal. It starts to be elevated. The same thing is true with diabetes. Interestingly enough, the same thing is true of dementia. Why is it that at age 85, 50 percent of Americans or Swedes have dementia? You don't wake up at 85 suddenly with dementia. You have worked doggone hard all through your life to really mess up the vasculature to the brain as well as all the beta-amyloid and the tangles that occur in Alzheimer's. You have to work very hard to set the ground work for that to happen.
It is so exciting to think that this seismic revolution will not only get the United States out of debt, but it will remarkably enhance the lives of so many.
JOHN ROBBINS: One of the things that strikes me about your work is that you are asking people to change something basic, which is the food that they eat. People don't always like that. What keeps you going in the face of opposition and resistance?
DR. CALDWELL ESSELSTYN: Well I think the tenacity of purpose comes from years ago when I used to do some athletics in college. I was on a boat crew, and we actually won a gold medal in the 1956 Olympics. We had a motto, and that motto was “press on, regardless.”
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Neal Barnard, M.D.
Eating to Thrive
Neal Barnard, M.D., is one of America's leading advocates for health, nutrition, and higher standards in research. He is the president of the Physicians Committee for Responsible Medicine,
