C:  "Let's suppose that you've got a form of nutrition, where people do not become obese, do not develop diabetes, do not have any cardiovascular disease, and do not have any hypertension.  The likelihood of common Western cancers is significantly diminished.  There are no gallstones, no diverticulitis.  There rarely is rheumatoid arthritis or multiple sclerosis, or lupus.  You know, we really have to take into account the fact that it's this Western-type diet that is responsible for 75 to 80% of these diseases that we see.  I will agree that when you switch from eating the traditional Western diet to a plant-based diet, it is a significant change.  Some would call it radical, but I think that some would even say "draconian," but let's look at "radical" and "draconian." 

" Draconian" means inhumanely cruel.  Now let's say I have these patients, and the hundreds of others that we've counseled, now eating this wonderful and delicious pile of food, and enjoying robust health, in one group.  Then we have another group that is eating the Traditional American Diet.  They are plagued by obesity, they are plagued by prostrate cancer, they are plagued by enlarged prostrates, they are plagued by hypertension and diabetes, and the whole list of disease we've mentioned earlier.  Now which is the "radical" approach?  The one that has you get sawed in half and have your veins taken out of your legs and stuffed onto your heart?  Is that not radical?  And tell me how often that is done in the United States every year... three or four hundred thousand times?  That's radical.  And "radical" is a cardiology budget that really takes up, oh, $250 billion, a quarter of a trillion dollars a year."

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ISSUE OF GENETICS

M:  "How do you respond to the typical, "my Uncle drank like a fish, ate meat five times a day, smoked like a chimney, and lived to be 99" question?  The issue of genetics?"

C:  "The wonderful thing there is actually what we call the "bell-shaped curve" that we see in all biological systems.  There are going to be people on every end of the bell-shaped curve, and obviously this person who lived to his 90s, he was on one far end of the bell-shaped curve.  About genetics... I like to use the analogy of a village right next to a river.  Let's say it's flood time, and only the very strongest swimmers can get across that river.  However, if we wait until August, and the dry season, when the river is four inches deep, everybody, even the toddlers,  gets across safely.  That's the way it is when we eat plant-based nutrition and your cholesterol is kept under 150 with the use of small doses of statin drugs, if necessary.  This is so profound in terms of cardiovascular disease, that there really is not a genetic component unless you're taking lethal doses of a Western diet.  There will be some whose gene protect them from the traditional Western diet more than others."

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ISSUE OF MODERATION

M:  "Great answer.  Now, the issue of moderation, that a little bit doesn't hurt, is so important that you devote a whole chapter to a discussion of this in your book.  You use the "car crash" analogy as part of your argument.  What do you mean?"

C:  "The car crash analogy was used to respond to the Women's Health Initiative which did the following:  they were trying to demonstrate whether or not there was any benefit to a low-fat diet, in terms of lessening the cardiovascular disease in a group of post-menopausal women who were admittedly overweight.  Half of that group had a diet of 34% fat, the other half was asked to eat a diet of 20%, but actually, when it was carefully analyzed, it turned out the group that was supposed to be eating 20% was actually eating around 29% fat, which is the level at which, it has been shown, the disease will worsen.  But, when the study was reported, it was said that there's no benefit from eating a low-fat diet, because at 29%, compared to 34%, there was no less heart disease.  Well the analogy that I used to explain this in a OpEd piece, is that it's a little bit like somebody who comes along with an idea and says if we slow down our driving, reduce speed, we will save lives.  Alright, so then somebody says we'll test that theory and we'll drive this group of volunteers into a wall at 90 m.p.h., and they all perish.  And somebody else does it with a group at 80 m.p.h. and they all perish.  And therefore the conclusion is that slowing down does not save lives, on the other hand, off to the side, there is this small study that shows if you go 10 m.p.h., everybody lives.  And so it is with heart disease and with moderation.  This is an area in which I disagree with some of my kindred spirits."

When I give a presentation to an audience, sometimes someone will raise their hand and say, look Dr. Esselstyn, what you're saying sounds pretty severe, and I'll say I think it's pretty significant.  But, they'll say, I'm fine and don't have any health problems, why should I eat this way?  And if the attendee is 40 or 50 years of age, I'll say, fine, this is America and you can make the choice, but let me say at this point in your life you're 50 years old and you're eating a diet that is absolutely injuring yourself with every meal.  And if the figures that I have are accurate, 50% of Americans by the time they're 85 have dementia, and a majority of males, of course, will have impotence and erectile dysfunction.  In addition, if you look at a 1000 people aged 50 who are eating the Western diet, and look at those same people, that is to say if they had normal blood pressure at age 50, and look at that same group of people at age 70, 90% will now have high blood pressure.  In other words, you may be well at 50, and maybe the ravages of eating the traditional diet haven't really hit you yet,  I would say to those people you can do what you want, but I think that you're heading for that same pitfall, because you may just be subjected to the Western disease from this diet at a later age."

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"A LITTLE BIT CAN'T HURT ME"

M:  "In your book you say that the first thing you ask of your patients is to remove the idea "this little bit can't hurt me" from their lexicon.  Is this a tough concept to get across?"

C:  "It really isn't any longer... it's almost a Litmus Test before I'm willing to counsel somebody...  For instance, they can go to the website, now they can go to the book, and they can get comfortable for where I'm coming from... But, my intention when I'm asked to consul somebody with heart disease, is for them to understand that my goal is NOT to continue to promote a smaller progression of the disease.  My goal is to absolutely annihilate the disease, and that has to be a shared goal.  Therefore the Litmus Test before I'm willing to see a patient is are they willing to forever give up the following phrase which is:  "this little bit can't hurt."   Why do I say that?  It's because now we have data from the Brachial Artery Tourniquet  Test (BART), which really tells us that with every single Western meal, whether you're eating meat, whether it's dairy, whether it's olive oil, you injure your endothelium.  That is the LAST thing that I want my heart patients to have to have --- any further injury to their endothelium.  I want it to recover, I want it to be restored, I want it to blossom, and that's why for patients who are completely compliant within two to three weeks we start getting rid of their heart pain and their angina, because their endothelium has recovered and when it recovers, it can once again make nitric oxide, which is the strongest vasodilator in the body.  That is to say it opens the arteries and makes them relax."

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DAIRY PRODUCTS

M:  "Since this is "National Heart Month" I went on the Internet to the American Heart Association's website to see what their recommendations are, and I was stunned to see how similar they are to the USDA's dietary recommendations, which you definitively dissect and dismiss in your book.  I've three of them here to see what you have to say about their validity.  The first is, "what's wrong with low or no-fat dairy products?"

C:  "With dairy products you've got the whole problem of animal protein which is known to contribute to this disease, and you have casein, and that's where Dr. T. Colin Campbell has really gotten four stars --- he's shown absolutely how horrifically powerful casein is as a tumor promoter, not to mention the IGF, which is the "Insulin-like Growth Factor" in milk, which is another tumor promoter."

M:  "Is that why you recommend your patients read "The China Study" (by Dr. Campbell)?"

C:  "Well, there are many reasons why they should read "The China Study."  There are a lot of wonderful things that Campbell has recorded there."

M:  "The USDA has recommended that 25 to 30% of calories should come from fat..."

C:  "Well why don't we do this...  why don't we just say to the USDA and to the American Heart Association, because look, I've been doing this for over 20 years, and Ornish has been doing it for over 20 years, why doesn't the AHA do their own study?  I mean, even if it's for four or five years, why don't they do a study and say that the foods that they are recommending can reverse heart disease?  It's that simple.  What could be simpler with all the money that they've got?  Just take the same number of patients that we had with severe disease and let them eat the food they recommend and compare it with our group and see how they do."

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FISH & NUTS

M:  "How do you address the question about people wanting to eat fish?"

C:  "For the question about whether or not you want to eat fish, here I refer to my friend and colleague Dr. John McDougall, a kindred spirit, John has explained it this way:  that a piece of muscle, whether with claws with a hoof, whether it flaps a wing, whether it wiggles a fin, all animal muscle is made of animal protein, animal fat, and animal cholesterol, none of what you want.  Now you do get some Omega-3s from fish, but you also get a lot of PCBs and mercury, and other things you don't want.  But you can get Omega-3 through flaxseed meal, which is what I prefer."

M:  "Your program disallows walnuts for those who have heart disease, and I was wondering about, well, pecans, almonds, and so on."

C:  "To make it easier for the patient, to understand where I'm coming on nuts, anybody I have to see with heart disease, I don't want them to have any nuts.  Now, there are a number of nut studies out there..."

M:  "...no pun intended..."

C:  "...that show they will raise the good cholesterol and lower the bad cholesterol, but there are no nut studies out there that I'm aware of that you can arrest and reverse heart disease.  And nuts very often, have over 40 to 70% fat, and that means a lot more calories.  So if you have patients that are eating oil and getting fat.  When they lose weight, their blood pressure goes down, cholesterol goes down, they feel better, it's better for them, and their likelihood of getting diabetes is less.  When I am at a conference and I hear someone present a paper on nuts, and cite another 26 papers on nuts,  my first question to them is "where is the funding source for these studies?"   Almost invariably, it appears to be the manufacturers of nuts.  And I don't see the study that I really want to see:  where is the BART test, to show that when you eat nuts, you don't injure the endothelium?"

M:  "At the risk of sounding silly, do you include sunflower and sesame seeds in that equation?"

C:  "Well, again, it's another source of... if you're eating a lot of seeds you're getting a lot of fat.  I just don't want my patients to have a lot of extra fat."

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ONE DISEASE OR MANY?

M:  "Okay... one of the terms in your book that I found particularly interesting was "nutritional extravagance" in reference to the Western diet.  In pre-interview discussions you talked about this in relation to the conceptualization of several diseases actually being one.  Can you elaborate?"

C:  "I think the best way to say this is that right now there is sort of a disconnect, because you have a Department of Endocrinology for diabetes, you have a Dept. of Hypertension and Nephrology for high blood pressure, you have a Department of Neurology for strokes, you have a Dept. of Cardiology for the heart problems, and a Dept. of Obesity for people who are overweight.  It's almost as if these are all separate diseases, they all have their separate list of drugs employed, and the patients are taken care by a particular speciality.  But let's take the example of a case where I'm seeing man who weighs 250 lbs. and he's had a heart attack and he really wants to not have any problems with this, and he happens to be not only 250 lbs. and coming out of a heart attack, but he is also diabetic and he also has high blood pressure.   Off we go with a plant-based diet.  Suddenly it's seven months later, and he now weighs 190 lbs. he's no longer obese, his diabetes is gone, his hypertension is gone, and there's no further heart disease, while he's keeping his LDL cholesterol at 80 mg/ dL3.  Where are all those diseases?  They're gone... and where are all those special medication and drugs?  It's all gone away.

When we eat the Traditional Western Diet, those foods:  the meat, cheese, butter, eggs, beef, thick oils, desserts, gravies, sauces --- somehow marinate our delicate cellular structures, and that marinating process ends up with enough injury and multiple hits to our cellular structure that over the decades, those accumulated hits become what we as physicians will now declare a disease."