Dr. Esselstyn on Cardiovascular Health

We have the honor of hearing from Dr. Caldwell Esselstyn, who was trained as a surgeon at the Cleveland Clinic. He's a fellow of the American College of Cardiology, well known to any of you that have watched the movie Forks Over Knives. And in addition to his prestigious medical career and the great publications he's produced and the books he's produced for both medical and lay professionals, he also served in Vietnam and was awarded the Bronze Star and in 1986 won a gold medal with the U.S. Olympic rowing team. Dr. Esselstyn, please come join us. Thank you so much for coming, sir. I want to really thank Naomi and her team for putting together this incredible conference. And it's such a delight. And it's such a delight for us as speakers who have felt the passion for this type of research to see that there is this type of interest throughout the community. Now we've got a lot of ground to cover and I've been told I have to get you out. out of here by midnight, so I thought we ought to really get cracking. The key here is that we in this country have to hang our heads in recognition of the the fact that we have built a billion-dollar health industry around an illness that does not even exist in half the planet. If you're a cardiac surgeon and you decide you're going to hang out your shingle in Okinawa, perhaps rural China, Central Africa, the Tarahumara, the Papua Highlands, forget it. You better plan on selling pencils. Why? They don't have cardiovascular disease. Why? They all thrive on whole food, plant-based nutrition without oil. Now this slide is the oldest one in my presentation, taken in 1968 when I was leaving Vietnam as a combat surgeon. And it reminds me to share with the audience that if we do autopsies on our young GIs, average age 20, 80% of those in Korea who were autopsied had gross evidence of coronary artery disease that you could see without a microscope. Not enough for their cardiac. event ship, but here the disease was already with a foothold. That study was repeated then 45 years later, this time now looking at those young women and men between the age of 17 and 34 who have died of accidents, homicides, and suicides. Now the disease is ubiquitous. Not enough for your cardiac events. But here in this country, you graduate from high school, you get a diploma. and you also get the foundation for cardiovascular disease. Now, are there anybody here in the audience who's over the age of 17? Always so much more exciting when you're talking with patients. Okay. Now. We had a chance as a medical community to get it right in World War II. That's when the Axis powers of Germany overran the low countries of Holland and Belgium, and they occupied Denmark. in Norway. And in 1951, doctors Strom and Janssen, reporting in England's leading medical journal, The Lancet, looked at the death rates from stroke and heart attacks in Norway. Norway during this period. And it was interesting, together, if we look here in deaths from heart attack and stroke in Norway in 1927, going up, 1930, going up, 35, going up, 39, in come the Germans, whoo, 40, whoo, 41. Who knew these Germans were these great public health educators? But look what happened by 1945 with the death of Adolf Hitler, the cessation of hostilities in the European theater. Immediately back comes the meat, back comes the dairy, back comes the strokes, and back from the heart attacks. But sadly we just didn't get it, okay? Now here the plot thickens. These next four Four or five slides would be the most important of my presentation. If you look at the right, obviously that's a terribly diseased artery. And it has taken many, many decades to get that. And you're probably saying when that finally closes off, that little opening in that right artery, there'll be a heart attack. But actually, no. Only about 10% of heart attacks come from something that is this chronic and this severe. But I want you to notice on the left, Here we have a normal artery, and even those of you in the back of the room can see that that delicate innermost lining of a normal artery, that little tiny dark line, the endothelium, that all experts would agree. that endothelium is the life jacket and the guardian of our blood vessels. Why? Because it manufactures a truly magic molecule of gas, nitric oxide, which has some truly remarkable functions. On the left, when you start eating, the cheeseburger, the hamburger, the milkshake, pizza, everything suddenly begins to get sticky, sticky, sticky. Your platelets, your... your white cells, your LDL cholesterol, everything gets sticky. This is the interface. Blood is flowing up here in this blue area, and you can notice the little tiny endothelial cells which separate the artery wall from the flowing blood. Now up here in the upper left, these orange little molecules of LDL cholesterol have gotten so sticky from the pizza you've been eating, and the endothelium is sticky and it's got some cracks and fissures in it, so lo and behold, your LDL cholesterol migrates and finds its way into the subendothelial space where it rapidly becomes oxidized by these free radicals from this type of food you're eating. So now, the subendothelial space... space does not like these small, hard, dense LDL particles and calls for the SWAT team are white blood cells, which Peter Libby from Harvard here has painted blue in honor of Yale, and we like that. Now, here you see this macrophage gobbling up, gobbling up all these small, hard, dense LDL particles till we get all the way over to here. When we do what we do so often in medicine, we change the name. It's now called the phone. cell. And the foam cell is truly the Darth Vader of this sequence because it makes these nasty metalloproteinases and these nasty metalloproteinase enzymes. tend to thin out the cap over the plaque right here on the left. You can see how thin the upper part of this cap is. And what happens is that gets so thin that the sheer force of blood, charging over it, tears it. And now suddenly we have the rupture. This is a seminal moment. You have a rupture of a plaque that is no bigger than 10, 20, 30... 30, 40, or 50 percent. And now there is the oozing out of, or the extravasation of plaque content into the flowing blood, which activates our platelets, our clotting factor. And before you know it, we are over here to B. In a matter of minutes now, we are forming a clot. And this clot is in and of itself self-propagating. So in a matter of further minutes, we're now over the C, and the clot is completely blocking this artery. So all the downstream blood. Blood flow here is stops. This heart muscle down here is totally deprived of oxygen and nutrients and it starts to die. And that's 90% of your heart attacks. Now, if I do my job for you today correctly, every one of you and your friends and relatives should be able to make yourselves heart attack proof. We're not going to do this. You're not going to make yourself heart attack proof with another drug or a pill or a procedure or an operation. You're going to do it by changing your biochemistry. How are you going to change your biochemistry? by totally changing to whole food, plant-based nutrition. When you do that, you interrupt entirely this nasty cascade of events that I've just been describing. Things don't get sticky. You don't have migration of the LDL into the subendothelial space. There is no SWAT team. There's no foam cell. As a matter of fact, you will not be eroding or thinning out the cap over your plaque. You will strengthen the cap over the plaque. If you strengthen the cap over your plaque, it cannot rupture. If it cannot rupture, you have made yourself heart attack proof. We think it takes about three weeks to make that happen. Now, you can forget the x-ray here, but I want you to notice half of the opening is a plaque, half of it is still opening, and these are the endothelial cells. Now, we used to think, up until 1980, we used to think... of the endothelial cell as one of those cute little red bricks that was simply lining one of our pipes. That all changed in 1980. In 1980, Dr. Fershcott, working in Brooklyn, was taking the largest blood vessel in the rodent, the aorta, and he would do this sort of elliptical spiral staircase cut right through the endothelium, immerse it in a bath of saline, and it would constrict. One day, no cut, immerse the aorta. It dilated. Did it again. It dilated. Now suddenly, the race was on globally. What was the EDRF that Dr. Fershkot had discovered? Endothelial derived... relaxation factor. Thank heavens that term was with us only eight years when Dr. Fershkot, Lou Agnero, and Dr. Murad discovered that the EDRF was a gas. Nitric oxygen. for which they got the Nobel Prize in 1998. Now what is it about nitric oxide that makes it so special? One, nitric oxide keeps all the cellular elements in our bloodstream flowing smoothly like Teflon rather than Velcro. Nitric oxide is the strongest blood vessel dilator in the body. When you climb stairs the arteries to your legs, to your heart, they widen, dilate. nitric oxide. Number three, nitric oxide keeps the wall of your artery from becoming thickened, stiff, or inflamed. Protects you from getting high blood pressure or hypertension. Number four, nitric oxide. Nitric oxide in a normal, healthy amount will protect you from ever developing blockages or plague. So literally everybody on the planet, whether they are from Chicago, New York, London, Berlin... or Norfolk. If they have cardiovascular disease, it's because by now, over the previous decades, they have so seriously trashed, injured, and turned their endothelial system into a train wreck. They don't have enough nitric oxide to protect themselves from making blockages and plaque. But the good news is that this is not a malignancy. Once you get patients to understand that never again are they to have pass through their lips any food morsel that is going to further imperil, danger, and compromise the capacity of their endothelial cells to make nitric oxide, then the endothelial cells recover, your disease progression stops, and we often see significant elements of disease reversal. Now, how do you measure nitric oxide? You take an ultrasound probe, place it over the brachial artery at the elbow, and there on the screen is the readout. Then for five minutes you encircle the upper arm, inflate it above systolic blood pressure so that for five minutes there is zero blood flow to your forearm and hand. I've had that done. It's not exactly habit forming. But nevertheless, when you release the cuff, immediately we measure the brachial artery diameter, and the normal individual, it'll be 30% greater. Now, the next thing that happened... was interesting, was when Dr. Robert Vogel, chairman of cardiology at the University of Maryland, took a group of healthy young subjects to a certain fast food restaurant characterized by arches with charcoal. Half of them got the cornflakes, break your larder caturnica chest. Normal. Those that had the hash browns and sausage within 120 minutes, break your artery tourniquet test, they couldn't dilate the artery. That single meal of hash browns and sausage had so injured the capacity of their endothelial cells to make nitric oxide, they didn't have enough to dilate the artery. But being young, following them into the late afternoon, early evening, they began to recover. But you and I know that the next morning for breakfast it's going to be scrambled eggs and bacon. Lunchtime we'll have white bread with cold cuts and mayonnaise. Subber time baked potato with sour cream. Lamb chops, vegetables soaked in butter, ranch dressing on a salad, ice cream for dessert. Here in the good old USA, we start in our childhood hammering and pounding and injuring our endothelial cell system all day long. While I'm emphasizing right now the endothelial cell, these are three other highly important defense mechanisms. that our bodies have. If we went to midnight, we could discuss the other ones, but let me just say this. Every single one of these optimal defense factors become totally optimized when you eat plant-based nutrition. When you're eating plant-based nutrition, you're making all of these work the very best that they can. Let's get to some results. This is the earliest study that I did. It was small because I was still actively involved with surgery. Nothing against women. It's just the way the patients that were sent to me, they all had severe triple vessel coronary artery disease. I wanted them to avoid the foods that injure the endothelial cells every time they pass your lips. Any drop of oil. Olive oil, corn oil, soybean oil, safflower oil, sunflower oil. coconut oil, palm oil, oil in a cracker, oil in a piece of bread, oil in a salad dressing. And nothing with a mother or a face. Fish, fowl, chicken, turkey, eggs, and no dairy. Milk, cream, butter, cheese, ice cream, and yogurt. No sugar, and I don't like caffeinated coffee. Now, here's a peer-reviewed scientific article for those of you who are nervous about what I just said about oil. Olive. Olive, soybean, and palm oil intake have a similar acute detrimental effect over the endothelial function in healthy young subjects. This is the work of Stan from the Cleveland Clinic, and this is how you argue with those who are paleo. all these foods contain the molecules of lecithin and carnitine and Stan Hazen found that when you ingest these molecules through these foods persons who are omnivores possess in their microbiome, the bacteria in their gut, will metabolize lecithin and carnitine to TMA, trimethylamine, which is rapidly oxidized by your liver to trimethylamine oxide. And trimethylamine oxide injures your blood vessel. Here's the schematic. Lecithin in the quarantine, gut bacteria, trimethylamine oxide, vascular disease. However, however, Stan found that if those persons were totally plant-based, feed them a lamb chop, check their blood, no TMAO. pretty exciting stuff. However, if you decide to have that lamb chop four or five days in a row, you now convert your bacteria to the nasty one. I'm going to switch gears for just a moment because in October of 2015, the WHO, the World Health Organization, did what nobody thought it ever could do. All these different nations got together and agreed that Red meat had the same level of carcinogenicity as smoking cigarettes. So what are you going to eat? You're going to eat all these marvelous whole grains for your cereal, bread, and pasta, 101 different types of legumes and lentils, all these marvelous red, yellow, and green leafy vegetables, and some fruit. Now, a comment here. Something that we've started in the last six and a half, seven years, it's not in my book, but if I could persuade a patient... with heart disease to imagine shrinking their head so we could get inside their coronary artery they could see the plaque is an absolute a cauldron of oxidative inflammation now therefore we need antioxidants. But no, do not go down to the health food store and buy a jug of pills that says antioxidant because it doesn't work and it's going to be harmful. Antioxidants, we want to want you to get from your food. What food? Food that is high in what we call ORAC value, O-R-A-C, oxygen radical absorptive capacity. So if you're having raspberries, blueberries, strawberries, and blackberries on your morning oat cereal, that's a terrific start. But nothing, nothing can trump the antioxidant value of green leafy vegetables. So I ask these patients to chew, not smoothies, not juicing. to chew a green leafy vegetable roughly six times a day, roughly the size of their fist, after it has first been boiled in water, five and a half to six minutes so it's nice and tender, and then you must anoint it with several drops of a delightful balsamic vinegar. Why? Because the acetic acid in the balsamic vinegar has been shown to restore the nitric oxide synthase enzyme, which is contained within the enzyme. endothelial cell responsible for making nitric oxide. All right. So you're going to chew this alongside your breakfast cereal. Again, there's a mid-morning snack. Again, with your luncheon sandwich, that's three. Mid-afternoon, four. Dinner time, five. God, I adore it when you have that evening snack of kale. What are you doing? All day long you are bathing and basking that horrible oxidative cauldron of inflammation with nature's most powerful antioxidant. Now you're going to say, what are the grains that he's talking about? about. They are bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, napa cabbage, brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach, arugula, and asparagus. And the top five are kale, Swiss chard, spinach, arugula, and beet greens. See it also helps your memory. No oil! Now in this early group I want to share with you several angiograms of disease reversal. After you've seen these next three slides, you will now know more than 90% of physicians. in this country that this disease is reversible. This is the left anterior descending coronary artery of a 67-year-old retired pediatrician. This is as small an improvement as the eye can see when you look here from the left over to the right. On this next, it's a little easier to see. This is the circumflex and a 58 year old factory worker and this was described as a 20% improvement from here to the right to here. Even easier to see. In this next, the right coronary artery, where this was described as a 30% improvement from here over to here. Now, this next is the colleague of... mind. This is Joe Crow. And Joe replaced me as the chairman of the Breast Cancer Task Force. In 1996, at age 44, he began to get chest pain. Not a smoker, not a doctor, not diabetic, not hypertensive, no family history, regularly exercised, but cardiology worked him up in October of 1996, could find nothing. A month later, he finished his surgical schedule. He sat down to do post-operative orders when suddenly there was the elephant sitting on his chest, pain in his left jaw, shoulder, arm, having a heart attack. Whipped down to the cath lab. They start the catheterization, cardiac arrest, resuscitate. finished the catheterization, one more cardiac arrest. Then he stabilized, and three days later, discharged, but very depressed. Depressed because at the time of his angiogram, what they had found was that the entire lower one-third, of his left anterior descending the widow maker. The entire lower one-third was all moth-eaten and diseased over a much too long a segment to just pound and stent after stent, and it was too far down for bypass, so they couldn't do these interventions, and he was very depressed. So Ann and I had Joe and his wife out for supper. Two weeks after his heart attack. Joe, come on. You've been eating this horrible, horrible Western diet. You've got the typical disease. Why don't you think about going plant-based? We've got ten years of data. Okay, I'm going to give it a shot. They couldn't offer me anything else, but I'm not going to take any of those statin drugs. I don't trust them. Fine. That's your call. Not a problem. the absolute personification of commitment to whole food plant-based nutrition. And over the next two and a half years, his total cholesterol plummeted. His LDL cholesterol went from 98 to 38. Then he had another angiogram. And on the day at noontime that I knew that he had had the earlier in the morning, this follow-up angiogram, I walked into his office, and there he was sitting behind the desk. I said, Joe, listen, how'd the follow-up? angiogram go? He came around, put his arms around me and said, I think we're doing okay. So I said, well, that's great. But how about any chance that I could see the angiogram? And he said, sure. Now, this isn't going to happen to everybody, but when the plaque is young and soft and made up of inflammation and cholesterol and fat, the body has a remarkable capacity to rid this. However, it's going to be my job today, before this talk is over, to show you how even those patients who have plaque which is old, made up of fibrosis, scar, and calcium, classification, and unlikely to be changed or modified, how even those patients get back to full activity of daily living without restriction. Despite my sparkling personality, we had six of those original 24 patients. I knew within the first 24 months, excuse me, I knew within the first two or three months that they just didn't get it. I had no money for this study. So with my blessing and their say so, I released them back full-time to their experts. cardiologist and we followed them as a sort of a quasi control group over the next 12 years and four of the six had to have another operation and to die on the other hand what about the 18 that stayed with the program we wanted to know in the eight years prior to coming into the program while they were in the hands of expert cardiologists how many events of disease progression were there in those eight years prior to coming into our study. And there were these 49 events categorized, as you see listed here on this slide. However, once those 18 patients got into our study, over the next 12 years, 17 of those 18 had no further events. We did have one little sheep who wandered from the flock. After six years, got into the lamb chops, french fries, and glazed donuts. More pain, had a bypass. Now he's back with the flock, but proves the point that I'm trying to share with you today. So as exciting as that was for us, we took a pretty good hit. People said, wait a minute, this is a small study. Dr. Esselstyn, this diet of yours is really pretty extreme, strict, severe, draconian. And how do you know you can do this again and with a larger group and will you get similar results? And by the way, let me just say, when anybody calls our diet severe, strict, extreme, draconian, that's the diet that half the planet Earth is eating that never has this disease. The diet that truly is extreme, strict, severe, and draconian is the one that 97% of Americans are eating every day that guarantees before they die they will perish along with some horrible chronic illness. Okay. Now, so this is the second study. This is 200 patients. In the Journal of Family Practice, July of 2014, two were lost to follow-up, but what we're particularly proud about is that you can see how many were adherent. 89.3, almost 90 percent, were adherent to our program. How do you make that happen? Because most physicians who want to use this approach say, Dr. Esselstyn, I just couldn't get my patients to do this. And it's not that the message is wrong, it is how the message is articulated. The only way I think you're going to have people make a lifestyle change is to show them respect. The only way that I know to show a patient respect is to give them my time. So several things. Right now, once a month, usually for no... more than 12 or 16 patients always with their significant other or spouse. You must have the spouse or significant other there. We have a six-hour program one day because they're coming throughout Canada, throughout the United States. the United States, six-hour program. They're going to learn all about how they have created this disease and precisely how we are going to empower them as the locus of control to halt and to reverse their disease. And you got to have a little bit of fun with them. For instance, when we have the group there and I'll say, now remind me again, how often do you, I'll choose somebody, how often do you eat out? Oh, Dr. Esselstyn, not very often. Let me try that again. How often do you eat out? Well, maybe two or three times a week. Okay. So yeah, that's 156 days out of 365 that you are taking an already train wrecked endothelium, and you're trying to train wreck it further. That makes no sense. Look, there are four reasons to eat out. One, you don't do the cooking. Two, you don't do the dishes. Three, you don't do... No, it's... Three is the ambiance. Four is the companionship. You never, ever go out to eat to further destroy more endothelial cells. And I also should say that two weeks before we have our seminar, I get my secretary will send me a list of the patient's names and phone number, and then I personally insist upon calling every one of them because I want to get my arms around their story. And I want them to have an opportunity to ask questions of me so that by the time they come to the seminar, we have a strong platform from which we can all move forward. Now, I'm pretty proud about the fact that, look, how did they know they were sick? 119, that was 177. already had had a stent or a bypass. And here's what's growing a colossally. We now are at the point where practically anybody who was being asked to have an elective stent or elective bypass, if they're willing to go whole food, plant-based nutrition, rarely, rarely, rarely will they ever have to have that intervention. So here are the results of those who were adherent. We had one patient who had a small stroke. The 21 who were not adherent. adherent, 62% had disease progression. Now I decided to compare our results with some of the better known standard studies that are out there. And this is, on the left, is the major cardiac event, heart attack, stroke, and death. So let's look at over in the far right. That's the Mediterranean Leon diet heart study. At the end of four years, 25% will have have had a heart attack, stroke, or death. Next to it is the natural history of coronary disease from Columbia Hospital in New York City, 20% heart attack, stroke, and death at four years, and then next to it, the 19.4% Bill Bowden's Courage Study. But look, here Here we are, six-tenths of a percent. That's over a thirty-fold difference. What's going on here? Why is there such a difference between our results and theirs? Because ever since the days of Hippocrates, There's been a basic covenant of trust that wherever possible, the caregiver will share with the patient what is the causation of the illness. And sadly today in cardiovascular medicine, that's not being done. However, along with several of your other speakers today, I'm proud to join with them. We've been asked to become a member of the American College of Cardiology and Nutrition Committee. And we are very aggressively trying to see if we can't educate cardiologists. cardiologists on the importance of the causation of the disease they've been designated to treat. Now, of all things, the same month, I wrote another little paper on three patients. What right did I have writing about three patients? Well, all three of these were an absolute story of the disaster of President Carter. And by the way, let me be... Sure, you understand that I embrace as friends. I have great respect for the caring and the compassion and the fund of knowledge of my cardiovascular colleagues. But, you know, it's the old business. Can the best be even? been better. So here is an interesting study, three patients. The first actually is from Newfoundland, Canada. And I've not met Bob Mercer, but I've been corresponding with him by phone and by mail. When he was 44 years of age, he had a stroke. He had a partial occlusion of his right carotid, actually a total collusion, and a small stroke. But he had such severe angina, they found a daring surgeon in Toronto who would operate on him and he was very good. of one totally blocked carotid. He got through that operation, had a wonderful result, until he was now 69 years old. He was in trouble. Diabetic, severe angina, erectile dysfunction, and diabetes out of control, and his one remaining carotid artery was 90% blocked. Of all things to have happened at that time, his daughter, age 37, had a heart attack. During her convalescence, she found a book called called Prevent and Reverse Heart Disease, and said, Pop, we should do this together. They did. A year later, I got a letter from Bob Mercer. Dr. Esselstyn, thank you. My angina disappeared. I've lost 40 pounds. My diabetes disappeared. My erectile dysfunction disappeared. And my one remaining carotid artery, which was 90% blocked, is now 67% blocked. Here is Bob Mercer. mercy. Now these other two, Art Soteros is at age 32 in Cleveland, became diabetic. Age 42 in Cleveland, got angina. And at the Cleveland Clinic, my alma mater, he had his first of 14 stents. Then he was told, these aren't working, you need a bypass. That was great. For a year and a half, more angina. And they said there was nothing further they could do from the standpoint of intervention. you have to deal with drugs. And he found his way through our program, lost 40 pounds, got rid of his diabetes, got rid of all of his angina, and I think I have a picture of Art here as well. Yeah. And he appears every month at our seminar. And the other is Jim McNamara, who, small stroke, as he was pre-diabetic, right carotid artery. And then he began to get horrible claudication, and they failed his first... operation of his leg failed. First, second operation on his leg failed. Third operation on his leg failed. And he was miserable when he tried to put his leg up to go to sleep because of severe tingling. And he came on board and lost 40 pounds, lost all of his pre-diabetic state, and now can walk nonstop. with no problem with his circulation through his leg. So there's no mortality from the diet. There's no morbidity with the diet. The benefits are improved with time. There's no extra expense because you've got to eat. And think of the patient who has had a heart attack. They're walking. around with a sword of Damocles, hanging over their head. When do I get my next heart attack? Nonsense! You never have to have your next heart attack. You eat in a way that you make yourself heart attack proof. What in the world is the good of having a great heart if your brain isn't there? We got a lot of insight into this from the work of Megan Leary and her team from the West Coast. who in 2001 at the stroke meetings in Miami looked at over 5,500 MRIs of the brains of Americans. And they find that at age 50, she began to notice the... These little tiny white spots beginning to appear in the American brain. These are little strokes. But come on, you're age 50. Big brain, tiny stroke, not a problem. Suddenly, though, you're now 65. You're no longer 50. And more often than before, you say, sweetheart, where did I leave the car keys? You get through that. You're 75 years of age. You look at her and you say, sweetheart, where did I leave the car? Well, you get through that. Suddenly, you're 85. And you look at her and you say, are you my sweetheart? I can't reverse that. You don't suddenly get dementia on your 85th birthday. birthday. You work hard in all those preceding decades to lay the foundation for dementia. It doesn't have to happen. Now here is a normal MRI. I counted 90 in these. Can you imagine a message trying to go through that scar? Now, look carefully here. On the left, the brain is all the way out to the skull. Look carefully here on the right. There's a big gap between the brain and the skull. That is cerebral atrophy. You don't want that as you get older. You want your brain to grow as you get older. How do you do that? exercise. Alright? If you're going to do it walking four or five times a week, fast enough to almost break a sweat. Or you can bike, or you can swim. But exercise is the key, just as it is for this next situation. You can see on the left the normal thigh muscle of a 40-year-old triathlete. On the upper right, you see the thigh muscle in a 70-year-old couch potato. lower right thigh muscle of a 70-year-old triathlete. Keep it moving. Now, here on the left, you're looking at the pulse volume. And a patient who came to my office, in crossing the skyway, he had to stop five times because of pain in his right calf, claudication. And so I was so focused on his heart. I forgot all about his leg. Eleven months later, he said, Dr. Esselstyn, you recall when I first started seeing you, I was stopping five times crossing the skyway to your office. Yeah. He said, you know, this last month, it became four times, three times, two times, once. I don't stop anymore. Don, back you go to the vascular lab. Now look, on the right, the pulse volume is double. So we now had, within 15 months of starting the cell, study. We had absolutely irrefutable scientific data that food and food alone could absolutely reverse cardiovascular disease. And you're going to say, wait a minute, what about the statin drug? Well, this is the second patient I've shared with you today, Dr. Crow, who refused, and this patient, Don, 1986. We didn't have any statin drugs then. So even the many patients that come to see us who simply are crippled by statin drugs, we don't have any statins and can't take them are in no way precluded from enjoying these benefits. Here's another. This is a 78-year-old retired high school chemistry teacher. In his retirement, he and his wife loved to enter these square dance contests. But during the fast square dance, he was getting a bilateral calf pain. So he saw these vascular surgeons and they got the images that you see up here showing how severely diseased he was, but he didn't like that big operation. operation they had planned for him. He came to see us. During counseling he said, Dr. Esselstyn, if I happen to choose your method, how long will it take me to get rid of this pain in my calves? So I looked at him with great wisdom in my face. And I said, this will probably take about 10 or 11 months. And three months later, I got a phone call. Dr. Esselstyn. You do not speak the truth. The pain is gone. Okay. Now, I don't know, I'm assuming all of you are from this general Virginia area, but I should share with you that in Ohio... when you're watching a mystery or a sporting event, just before the advertisement comes on, you will hear the mellifluous tones of the announcer say something like, when the moment is right, will you be ready? Now, we all know that the peanut butter is a very good thing. Our artery is really quite tiny compared to the size of the coronary artery. So not infrequently, before somebody comes down with heart disease, they may find that they are no longer able to raise the flag. However, all is not lost. Not infrequently, 10 or 11 months after I've counseled somebody, I'll get a phone call. Dr. Esselstyn, yep. This is Mr. So-and-so. Sure enough, good to hear from you. Yeah, I said, I really thought I ought to give you a call because recently something has come up. And I wonder if I don't owe you another check. Now, I promised you today, before I wrap this up, I wanted to share with you how it is that those patients who have a plaque that is made up of fibrosis and scar and calcification can still get back to activities of daily living without restriction. What you're looking at here is a petrubidium diperidumal scan of the heart. And translation, if it is orange or yellow, that's good. Here on the left. But right down here, where it's green, that's bad. That's poor blood supply. We call that ischemia. Now, at the time that he had that first PET scan, I counseled him, and 10 days later, his cholesterol went from 248 to 137. And then, three weeks after his first PET scan, we repeated it. Now look on the right. It's all back. Wait a minute. We didn't wash out. Nobody got rid of a plaque in three weeks. What's going on here? Now here's what's the story. If you look carefully, you will see this is a heart without any... Without any muscle. You're looking at the heart and you see those three large epicardial arteries, the right coronary artery, the left anterior descending and the circumflex, which get all the publicity, all the interventions of stents and bypasses. But look where every single one of those arteries is going. It's going to get smaller and smaller as it dives into the heart muscle. That's where all the oxygen and nutrients carried by this artery go, into the mind. the muscle. There are thousands of them there. So I asked Rodriguez, who at the Cleveland Clinic is the director of the cardiovascular pathology lab, and he dissects 200 hearts a year from the deceased. And I said, how often do you ever see good old standard garden variety atherosclerotic plaque in the artery once it has entered the muscle? Never. Never. Once in a very, very great while in a severe diabetic. Otherwise, never. So here's what's going on. When we first see these patients, by now you know, their endothelial system is as trash. As a matter of fact, it is now your enemy. It's not making hardly any nitric oxide, your friend, and it is now making two molecules that are against you, endothelin and thromboxane, which are vaso blood vessel constrictors. So this entire package of arteries, when you first see them, all those thousands are. vasoconstricted and as soon as you get those patients to stop not injuring at all again their endothelial system as it recovers it stops making the vasoconstrictor it starts making the nitric oxide vasodilator dilator, and that entire enormous, enormous cascade of intramuscular vessels opens up. And that's why you hear patients telling you, those with angina, within days their disease is getting better. Pretty exciting. But that seems to be what's going on. Here are the eight measures of disease reversal. You can see it on an angiogram. You can see it on the stress test. I just talked to you about the PET scan. We talked about the carotid. We talked about pulse volume with the leg. And the three symptoms of angina, claudication, and erectile dysfunction. Wrapping it up, for those of you who don't get to Cleveland very often, this is the building where I worked on the eighth floor for many years as a surgeon and I bring it to you because I want you to know what the trees look like in Cleveland in February However, now that I've retired from surgery, I've moved into the Wellness Institute at the Cleveland Clinic. And although the budget is more modest, I can assure you the morale is quite high. And I always like to finish up with my favorite. This is a woman in Life magazine trying to learn how to do the splits. And although it's been 57 years since I left medical school, did I just say that? While brains are important, nothing is as important as persistence, persistence, persistence. Best exemplified by this young damsel, 1939, Life magazine, trying to learn how to do the splits. But it's tough. She stuck with it. And of all things to happen, the other day in downtown Norfolk, Naomi Spotter and she now had got it right. I want to just summarize by a few comments. One, remember we started late. Oh, no, no, and you get questions still. I guess the reason that I find myself, when I was thinking about my career as a surgeon, I thought when I retire from surgery I'm going to learn two things. I'm going to learn how to play the piano and I'm going to learn how to windsurf. Well, neither of those things have happened. happened yet. But why? Because I really see in front of us in medicine what really I think could be an absolute seismic revolution. And this seismic revolution in health that is before us is never going to come about with another pill or another drug. The seismic revolution is never going to come about through another procedure or an operation. But the seismic revolution will come about. When we in the profession have the will, the grit, and the determination to share, to share with the public, what is the lifestyle, and most specifically, What is the nutritional literacy that will empower them as the locus of control to absolutely annihilate chronic illness? Thank you. Well, we're going to open up the floor for questions now. He's looking for tough ones. What are your thoughts on tap water and alkaline water and the benefits? Tap water and alkaline water, do you have any thoughts on those and potential benefits? Whichever you like. I mean, what type of water do the Okinawans eat? What type of water do they eat or drink in Central Africa? I think I have no problem, either one. Dr. Esselstyn, I'm over here, sorry, on the side. I have a question for you. You spoke earlier about how effective plant-based eating is on young soft plaque, and I know you mentioned at the end you were talking about some of the more advanced disease states. What I haven't heard, and I was just curious about how that affects somebody with a high calcium score and how that works on reversing calcium or stop the progression, and I have a quick second question, too. Something I haven't heard about addressing was the effects of this on elevated lipoprotein A. You know, the calcium score is kind of interesting and important. When you get a calcium score, that tells the physician two things. It tells us that you've got coronary artery disease. But it also tells us that you have got a number of non-calcified, inflamed... plaque. It's the non-calcified inflamed plaque that are the more dangerous ones because those are the ones that can rupture. But, and this is something that I think most physicians don't know, but it was something that I was taught years ago by Bill Costelli. Dr. Costelli was for many years the director of the world famous Framingham study. And he said, if you get somebody who has a high calcium score, and they absolutely get it right, and over the next year they're eating whole food plant-based nutrition. Then they have another calcium score. And if it was 100 at baseline, it may now be 175 or 200. But he said the patient is much better off. Because what has happened is... During the time that they are eating whole food plant-based nutrition, which is so powerful as an anti-inflammatory, as that those previously non-calcified inflamed plaque are losing their inflammation, it is as though the body wants to get in on the act and hasten along the quelling of this inflammation by dumping in some calcium. in those previously non-calcified. So if your physician says to you, my God, that plant-based diet you're on is making you worse, that's absolutely wrong. Okay, now the other was about LpA. LpA, yes, sir. What is it, 20% of the population will have LpA. What do you suppose they do about the LP small a in Central Africa, in Okinawa? How many of them ever check their LP small a? I think that the consensus pretty well is this. You have learned through that, hopefully, what I've shared with you today. We want everybody in this audience and all friends and relatives to eat in a way that you make an absolute endothelial fortress. Your endothelium is strong and tough and And therefore, if you have a strong endothelium, even if you have an LP small a, it's going to be harmless. You know, something you have to think about when we get a little bit too carried away with cholesterol. Do you think that when the human body was formed, hundreds of thousands of years ago, we have come all this way with an understanding, our body has this understanding, that every single cell membrane in our body is made up of cholesterol. Now, are we going to be able to just say that when we were formed, we were blessed with an organ that made cholesterol that would make us all vascular wrecks? I don't buy that. for one minute. I mean, if you have, let's say, a thousand people who absolutely follow the program that I espouse to the T, there'll be some who have a cholesterol of 110, others 140, 160, 180, 200, 220. But as long as they are eating in a way that they have an endothelial fortress, I don't think that should be a concern. The question is, the last slide you showed was where all Americans will have some sort of atherosclerotic disease. Most patients that we see in clinic, for example, middle-aged patients, know risk factors, exercise well, and arthrosclerotic, cardiovascular disease, risk factors score maybe less than 7.5%. But their LDL, it's hard to, for some of these patients, it's hard to get it below 105. In most cases, it stays in that range of 95 to 105. Do they still need a statin if they're even... following a whole food plant-based diet. Yeah, I think that's an excellent point. But you remember this. What are you going to do with your patient who, I mean, it'll make you feel better because their number will be lower. But I'm not sure that they have to have that because, as I mentioned, we have many patients who have come to us who simply cannot take a statin. There are four side effects of statins. One is brain fog. One is severe muscle pain. The other is, of course, a liver problem. And... So really, if the patient has an LDL of 105, and they're eating in a way that they are maintaining an absolute endothelial fortress, they should absolutely do fine. Because it's the injury to the endothelium. That's where this disease has its inception. That's where all experts that I'm familiar with... I agree that this disease has its onset. But to do this and do it right, you know, it really makes you have to think twice anytime to eat out. For instance, I just had a patient last week. nobody that I'd seen but somebody got a phone call said they'd been following our program and although four years earlier they had had a couple of stents and then after he finished a 5k run this past Sunday he was hospitalized with a heart attack. And he had told his wife that he was following our program 100%, but 100% does not include at every lunch at his workplace, he was eating the Beyond Burger. Beyond meat and so forth, which are loaded with coconut oil and all the oils that will just tear your endothelial cells asunder. Thank you so much for being here. And I would like to ask you specifically... Specifically said the importance of green leafy vegetables, kale, Swiss chard, spinach, beet greens. What if you are on a med, like warfarin, because of a genetic disorder, and you're not able to take these green leafy vegetables? How can you gain the benefit without actually eating them? The problem often comes up with patients who have atrial fibrillation and they are on Coumadin. And the question of the vitamin K that you're eating with these greens... makes it hard. And what pretty much is the consensus of those who understand this and do it right is that you talk with the physician who is doing the anticoagulation, if you're taking Coumadin, and you show... share with them, look, I am consistently going to be eating this amount of green leafy vegetables, and then they will appropriately adjust the level of coumadin so you achieve the level of anticoagulation that is appropriate. Now, on the other hand, what you've presented is a little bit more challenging. You have some congenital condition. I don't know, what is that condition? You likely have some clotting disorder that requires you to be on blood thinners that maybe increases the risk of blood clots in the legs or the legs. the lungs. Dr. Yeah, then I would again, if you are on Coumadin, you would talk with your physician and say, listen, I don't really think I ought to be precluded from enjoying the healthiest foods on the planet. And maybe they would agree. to allow you to increase your greens, and they will appropriately adjust the coumadin dose so that they still can achieve the level of anticoagulation that they feel is appropriate. Thank you so much. I feel so grateful and thankful to be here and that you're here today. My question is about homocysteine levels. How do you feel about that and why? Homocysteine? Yeah, I think most people will find that when they're eating whole food plant-based nutrition that their homocysteine will not be elevated. You know, a test we need to ask for and be proactive or does the doctor, even if you don't have heart disease, do you think you we need to have ours checked? You know... Is that a pre-indicator? One of the things that is taking us to debtor's prison as a country, faster than anything you can imagine, is health care. One of the things that we do with health care is we have all this testing. And it's amazing how much testing costs. Just to get a CT scan is thousands of dollars. And even when you go in and get a metabolic panel for blood tests, all these things cost. So I find myself increasingly... bending toward the following side, to try to keep the test to an absolute minimum we can, consistent with the safety for the patient. But I think that if somebody is eating totally, without exception, whole food, plant-based nutrition, they're going to make all their numbers, they're going to be somewhere where they ought to be. Now, we should mention a word about omega-3. There's going to be a lot of talk about omega-3. about Right now, the American Heart Association is having its annual meeting. And there's a paper that now, for the first time, contradicts what we had learned earlier, that's supposed to be beneficial with fish oil tablets. Now that paper was sponsored by the maker of fish oil tablets. And that always raises a flag. However, they're looking at... If you want to get omega-3, I don't want you to have to get it with oil, which may have PCBs, dioxin, and so forth, and mercury. If you want to get omega-3, you should be able to get it through flaxseed meal, chia seeds, and plenty of green leafy vegetables. However, if you check your omega-3 and get the omega check, it'll either be optimal, minimal, or moderate, or too low. And if it's too low, then I would say take omega-3 tablets, not in oil, but are made with algae. That's the thought. And this way, and also be a little conservative about these. These tests have just gotten to the point insurance carriers are still paying for them. But God, they are so expensive. All the money that we as a country have that should be going into education, restoring the grid and the infrastructure is going into health, which is crazy because if people could eat right, this would not be an issue. It's just interesting. that there are two authors from the University of Chicago in 1999, Topel and Murphy, writing in the Chicago University Press, estimate that if this country could eliminate heart disease, we would save $40 trillion. I'll probably get a reprimand from what I'm going to say, but this was my personal decision. I'm 66 years old. Nearly two years ago, I had a stent placed in a 90% block third. The doctor prescribed me four or five drugs, which I only took for two weeks because of how ill they made me. And because I was extremely concerned about the long-term effects, side effects of them. I've been on a whole... I will say that in making that decision not to take the drugs was extremely stressful because I didn't know if I was making the right decision or not. And so now I haven't been to a doctor in two years. years, I feel like I need to go to one, and I'm not sure what tests I should take or ask him because my doctor said if I wanted to fool myself, I could go away from my prescription drugs. But I'm feeling great, I'm strong, and I just started going P90X. Nice work.

Thank you so much for coming, sir. I want to really thank Naomi and her team for putting together this incredible conference. And it's such a delight.

And it's such a delight for us as speakers who have felt the passion for this type of research to see that there is this type of interest throughout the community. Now we've got a lot of ground to cover and I've been told I have to get you out. out of here by midnight, so I thought we ought to really get cracking. The key here is that we in this country have to hang our heads in recognition of the the fact that we have built a billion-dollar health industry around an illness that does not even exist in half the planet. If you're a cardiac surgeon and you decide you're going to hang out your shingle in Okinawa, perhaps rural China, Central Africa, the Tarahumara, the Papua Highlands, forget it.

You better plan on selling pencils. Why? They don't have cardiovascular disease.

Why? They all thrive on whole food, plant-based nutrition without oil. Now this slide is the oldest one in my presentation, taken in 1968 when I was leaving Vietnam as a combat surgeon.

And it reminds me to share with the audience that if we do autopsies on our young GIs, average age 20, 80% of those in Korea who were autopsied had gross evidence of coronary artery disease that you could see without a microscope. Not enough for their cardiac. event ship, but here the disease was already with a foothold.

That study was repeated then 45 years later, this time now looking at those young women and men between the age of 17 and 34 who have died of accidents, homicides, and suicides. Now the disease is ubiquitous. Not enough for your cardiac events.

But here in this country, you graduate from high school, you get a diploma. and you also get the foundation for cardiovascular disease. Now, are there anybody here in the audience who's over the age of 17? Always so much more exciting when you're talking with patients.

Okay. Now. We had a chance as a medical community to get it right in World War II. That's when the Axis powers of Germany overran the low countries of Holland and Belgium, and they occupied Denmark. in Norway.

And in 1951, doctors Strom and Janssen, reporting in England's leading medical journal, The Lancet, looked at the death rates from stroke and heart attacks in Norway. Norway during this period. And it was interesting, together, if we look here in deaths from heart attack and stroke in Norway in 1927, going up, 1930, going up, 35, going up, 39, in come the Germans, whoo, 40, whoo, 41. Who knew these Germans were these great public health educators? But look what happened by 1945 with the death of Adolf Hitler, the cessation of hostilities in the European theater.

Immediately back comes the meat, back comes the dairy, back comes the strokes, and back from the heart attacks. But sadly we just didn't get it, okay? Now here the plot thickens. These next four Four or five slides would be the most important of my presentation.

If you look at the right, obviously that's a terribly diseased artery. And it has taken many, many decades to get that. And you're probably saying when that finally closes off, that little opening in that right artery, there'll be a heart attack.

But actually, no. Only about 10% of heart attacks come from something that is this chronic and this severe. But I want you to notice on the left, Here we have a normal artery, and even those of you in the back of the room can see that that delicate innermost lining of a normal artery, that little tiny dark line, the endothelium, that all experts would agree.

that endothelium is the life jacket and the guardian of our blood vessels. Why? Because it manufactures a truly magic molecule of gas, nitric oxide, which has some truly remarkable functions. On the left, when you start eating, the cheeseburger, the hamburger, the milkshake, pizza, everything suddenly begins to get sticky, sticky, sticky.

Your platelets, your... your white cells, your LDL cholesterol, everything gets sticky. This is the interface.

Blood is flowing up here in this blue area, and you can notice the little tiny endothelial cells which separate the artery wall from the flowing blood. Now up here in the upper left, these orange little molecules of LDL cholesterol have gotten so sticky from the pizza you've been eating, and the endothelium is sticky and it's got some cracks and fissures in it, so lo and behold, your LDL cholesterol migrates and finds its way into the subendothelial space where it rapidly becomes oxidized by these free radicals from this type of food you're eating. So now, the subendothelial space... space does not like these small, hard, dense LDL particles and calls for the SWAT team are white blood cells, which Peter Libby from Harvard here has painted blue in honor of Yale, and we like that.

Now, here you see this macrophage gobbling up, gobbling up all these small, hard, dense LDL particles till we get all the way over to here. When we do what we do so often in medicine, we change the name. It's now called the phone.

cell. And the foam cell is truly the Darth Vader of this sequence because it makes these nasty metalloproteinases and these nasty metalloproteinase enzymes. tend to thin out the cap over the plaque right here on the left. You can see how thin the upper part of this cap is. And what happens is that gets so thin that the sheer force of blood, charging over it, tears it.

And now suddenly we have the rupture. This is a seminal moment. You have a rupture of a plaque that is no bigger than 10, 20, 30...

30, 40, or 50 percent. And now there is the oozing out of, or the extravasation of plaque content into the flowing blood, which activates our platelets, our clotting factor. And before you know it, we are over here to B.

In a matter of minutes now, we are forming a clot. And this clot is in and of itself self-propagating. So in a matter of further minutes, we're now over the C, and the clot is completely blocking this artery.

So all the downstream blood. Blood flow here is stops. This heart muscle down here is totally deprived of oxygen and nutrients and it starts to die.

And that's 90% of your heart attacks. Now, if I do my job for you today correctly, every one of you and your friends and relatives should be able to make yourselves heart attack proof. We're not going to do this. You're not going to make yourself heart attack proof with another drug or a pill or a procedure or an operation.

You're going to do it by changing your biochemistry. How are you going to change your biochemistry? by totally changing to whole food, plant-based nutrition. When you do that, you interrupt entirely this nasty cascade of events that I've just been describing. Things don't get sticky.

You don't have migration of the LDL into the subendothelial space. There is no SWAT team. There's no foam cell. As a matter of fact, you will not be eroding or thinning out the cap over your plaque.

You will strengthen the cap over the plaque. If you strengthen the cap over your plaque, it cannot rupture. If it cannot rupture, you have made yourself heart attack proof. We think it takes about three weeks to make that happen. Now, you can forget the x-ray here, but I want you to notice half of the opening is a plaque, half of it is still opening, and these are the endothelial cells.

Now, we used to think, up until 1980, we used to think... of the endothelial cell as one of those cute little red bricks that was simply lining one of our pipes. That all changed in 1980. In 1980, Dr. Fershcott, working in Brooklyn, was taking the largest blood vessel in the rodent, the aorta, and he would do this sort of elliptical spiral staircase cut right through the endothelium, immerse it in a bath of saline, and it would constrict. One day, no cut, immerse the aorta. It dilated.

Did it again. It dilated. Now suddenly, the race was on globally.

What was the EDRF that Dr. Fershkot had discovered? Endothelial derived... relaxation factor. Thank heavens that term was with us only eight years when Dr. Fershkot, Lou Agnero, and Dr. Murad discovered that the EDRF was a gas. Nitric oxygen.

for which they got the Nobel Prize in 1998. Now what is it about nitric oxide that makes it so special? One, nitric oxide keeps all the cellular elements in our bloodstream flowing smoothly like Teflon rather than Velcro. Nitric oxide is the strongest blood vessel dilator in the body. When you climb stairs the arteries to your legs, to your heart, they widen, dilate. nitric oxide.

Number three, nitric oxide keeps the wall of your artery from becoming thickened, stiff, or inflamed. Protects you from getting high blood pressure or hypertension. Number four, nitric oxide.

Nitric oxide in a normal, healthy amount will protect you from ever developing blockages or plague. So literally everybody on the planet, whether they are from Chicago, New York, London, Berlin... or Norfolk.

If they have cardiovascular disease, it's because by now, over the previous decades, they have so seriously trashed, injured, and turned their endothelial system into a train wreck. They don't have enough nitric oxide to protect themselves from making blockages and plaque. But the good news is that this is not a malignancy. Once you get patients to understand that never again are they to have pass through their lips any food morsel that is going to further imperil, danger, and compromise the capacity of their endothelial cells to make nitric oxide, then the endothelial cells recover, your disease progression stops, and we often see significant elements of disease reversal. Now, how do you measure nitric oxide?

You take an ultrasound probe, place it over the brachial artery at the elbow, and there on the screen is the readout. Then for five minutes you encircle the upper arm, inflate it above systolic blood pressure so that for five minutes there is zero blood flow to your forearm and hand. I've had that done. It's not exactly habit forming.

But nevertheless, when you release the cuff, immediately we measure the brachial artery diameter, and the normal individual, it'll be 30% greater. Now, the next thing that happened... was interesting, was when Dr. Robert Vogel, chairman of cardiology at the University of Maryland, took a group of healthy young subjects to a certain fast food restaurant characterized by arches with charcoal. Half of them got the cornflakes, break your larder caturnica chest. Normal.

Those that had the hash browns and sausage within 120 minutes, break your artery tourniquet test, they couldn't dilate the artery. That single meal of hash browns and sausage had so injured the capacity of their endothelial cells to make nitric oxide, they didn't have enough to dilate the artery. But being young, following them into the late afternoon, early evening, they began to recover.

But you and I know that the next morning for breakfast it's going to be scrambled eggs and bacon. Lunchtime we'll have white bread with cold cuts and mayonnaise. Subber time baked potato with sour cream. Lamb chops, vegetables soaked in butter, ranch dressing on a salad, ice cream for dessert. Here in the good old USA, we start in our childhood hammering and pounding and injuring our endothelial cell system all day long.

While I'm emphasizing right now the endothelial cell, these are three other highly important defense mechanisms. that our bodies have. If we went to midnight, we could discuss the other ones, but let me just say this.

Every single one of these optimal defense factors become totally optimized when you eat plant-based nutrition. When you're eating plant-based nutrition, you're making all of these work the very best that they can. Let's get to some results. This is the earliest study that I did.

It was small because I was still actively involved with surgery. Nothing against women. It's just the way the patients that were sent to me, they all had severe triple vessel coronary artery disease. I wanted them to avoid the foods that injure the endothelial cells every time they pass your lips.

Any drop of oil. Olive oil, corn oil, soybean oil, safflower oil, sunflower oil. coconut oil, palm oil, oil in a cracker, oil in a piece of bread, oil in a salad dressing. And nothing with a mother or a face. Fish, fowl, chicken, turkey, eggs, and no dairy.

Milk, cream, butter, cheese, ice cream, and yogurt. No sugar, and I don't like caffeinated coffee. Now, here's a peer-reviewed scientific article for those of you who are nervous about what I just said about oil. Olive.

Olive, soybean, and palm oil intake have a similar acute detrimental effect over the endothelial function in healthy young subjects. This is the work of Stan from the Cleveland Clinic, and this is how you argue with those who are paleo. all these foods contain the molecules of lecithin and carnitine and Stan Hazen found that when you ingest these molecules through these foods persons who are omnivores possess in their microbiome, the bacteria in their gut, will metabolize lecithin and carnitine to TMA, trimethylamine, which is rapidly oxidized by your liver to trimethylamine oxide. And trimethylamine oxide injures your blood vessel.

Here's the schematic. Lecithin in the quarantine, gut bacteria, trimethylamine oxide, vascular disease. However, however, Stan found that if those persons were totally plant-based, feed them a lamb chop, check their blood, no TMAO.

pretty exciting stuff. However, if you decide to have that lamb chop four or five days in a row, you now convert your bacteria to the nasty one. I'm going to switch gears for just a moment because in October of 2015, the WHO, the World Health Organization, did what nobody thought it ever could do. All these different nations got together and agreed that Red meat had the same level of carcinogenicity as smoking cigarettes.

So what are you going to eat? You're going to eat all these marvelous whole grains for your cereal, bread, and pasta, 101 different types of legumes and lentils, all these marvelous red, yellow, and green leafy vegetables, and some fruit. Now, a comment here.

Something that we've started in the last six and a half, seven years, it's not in my book, but if I could persuade a patient... with heart disease to imagine shrinking their head so we could get inside their coronary artery they could see the plaque is an absolute a cauldron of oxidative inflammation now therefore we need antioxidants. But no, do not go down to the health food store and buy a jug of pills that says antioxidant because it doesn't work and it's going to be harmful. Antioxidants, we want to want you to get from your food.

What food? Food that is high in what we call ORAC value, O-R-A-C, oxygen radical absorptive capacity. So if you're having raspberries, blueberries, strawberries, and blackberries on your morning oat cereal, that's a terrific start. But nothing, nothing can trump the antioxidant value of green leafy vegetables. So I ask these patients to chew, not smoothies, not juicing.

to chew a green leafy vegetable roughly six times a day, roughly the size of their fist, after it has first been boiled in water, five and a half to six minutes so it's nice and tender, and then you must anoint it with several drops of a delightful balsamic vinegar. Why? Because the acetic acid in the balsamic vinegar has been shown to restore the nitric oxide synthase enzyme, which is contained within the enzyme. endothelial cell responsible for making nitric oxide.

All right. So you're going to chew this alongside your breakfast cereal. Again, there's a mid-morning snack.

Again, with your luncheon sandwich, that's three. Mid-afternoon, four. Dinner time, five. God, I adore it when you have that evening snack of kale. What are you doing?

All day long you are bathing and basking that horrible oxidative cauldron of inflammation with nature's most powerful antioxidant. Now you're going to say, what are the grains that he's talking about? about.

They are bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, napa cabbage, brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach, arugula, and asparagus. And the top five are kale, Swiss chard, spinach, arugula, and beet greens. See it also helps your memory. No oil! Now in this early group I want to share with you several angiograms of disease reversal.

After you've seen these next three slides, you will now know more than 90% of physicians. in this country that this disease is reversible. This is the left anterior descending coronary artery of a 67-year-old retired pediatrician.

This is as small an improvement as the eye can see when you look here from the left over to the right. On this next, it's a little easier to see. This is the circumflex and a 58 year old factory worker and this was described as a 20% improvement from here to the right to here. Even easier to see. In this next, the right coronary artery, where this was described as a 30% improvement from here over to here.

Now, this next is the colleague of... mind. This is Joe Crow.

And Joe replaced me as the chairman of the Breast Cancer Task Force. In 1996, at age 44, he began to get chest pain. Not a smoker, not a doctor, not diabetic, not hypertensive, no family history, regularly exercised, but cardiology worked him up in October of 1996, could find nothing. A month later, he finished his surgical schedule.

He sat down to do post-operative orders when suddenly there was the elephant sitting on his chest, pain in his left jaw, shoulder, arm, having a heart attack. Whipped down to the cath lab. They start the catheterization, cardiac arrest, resuscitate.

finished the catheterization, one more cardiac arrest. Then he stabilized, and three days later, discharged, but very depressed. Depressed because at the time of his angiogram, what they had found was that the entire lower one-third, of his left anterior descending the widow maker.

The entire lower one-third was all moth-eaten and diseased over a much too long a segment to just pound and stent after stent, and it was too far down for bypass, so they couldn't do these interventions, and he was very depressed. So Ann and I had Joe and his wife out for supper. Two weeks after his heart attack. Joe, come on.

You've been eating this horrible, horrible Western diet. You've got the typical disease. Why don't you think about going plant-based?

We've got ten years of data. Okay, I'm going to give it a shot. They couldn't offer me anything else, but I'm not going to take any of those statin drugs. I don't trust them. Fine.

That's your call. Not a problem. the absolute personification of commitment to whole food plant-based nutrition.

And over the next two and a half years, his total cholesterol plummeted. His LDL cholesterol went from 98 to 38. Then he had another angiogram. And on the day at noontime that I knew that he had had the earlier in the morning, this follow-up angiogram, I walked into his office, and there he was sitting behind the desk.

I said, Joe, listen, how'd the follow-up? angiogram go? He came around, put his arms around me and said, I think we're doing okay.

So I said, well, that's great. But how about any chance that I could see the angiogram? And he said, sure. Now, this isn't going to happen to everybody, but when the plaque is young and soft and made up of inflammation and cholesterol and fat, the body has a remarkable capacity to rid this.

However, it's going to be my job today, before this talk is over, to show you how even those patients who have plaque which is old, made up of fibrosis, scar, and calcium, classification, and unlikely to be changed or modified, how even those patients get back to full activity of daily living without restriction. Despite my sparkling personality, we had six of those original 24 patients. I knew within the first 24 months, excuse me, I knew within the first two or three months that they just didn't get it. I had no money for this study.

So with my blessing and their say so, I released them back full-time to their experts. cardiologist and we followed them as a sort of a quasi control group over the next 12 years and four of the six had to have another operation and to die on the other hand what about the 18 that stayed with the program we wanted to know in the eight years prior to coming into the program while they were in the hands of expert cardiologists how many events of disease progression were there in those eight years prior to coming into our study. And there were these 49 events categorized, as you see listed here on this slide. However, once those 18 patients got into our study, over the next 12 years, 17 of those 18 had no further events.

We did have one little sheep who wandered from the flock. After six years, got into the lamb chops, french fries, and glazed donuts. More pain, had a bypass.

Now he's back with the flock, but proves the point that I'm trying to share with you today. So as exciting as that was for us, we took a pretty good hit. People said, wait a minute, this is a small study.

Dr. Esselstyn, this diet of yours is really pretty extreme, strict, severe, draconian. And how do you know you can do this again and with a larger group and will you get similar results? And by the way, let me just say, when anybody calls our diet severe, strict, extreme, draconian, that's the diet that half the planet Earth is eating that never has this disease.

The diet that truly is extreme, strict, severe, and draconian is the one that 97% of Americans are eating every day that guarantees before they die they will perish along with some horrible chronic illness. Okay. Now, so this is the second study.

This is 200 patients. In the Journal of Family Practice, July of 2014, two were lost to follow-up, but what we're particularly proud about is that you can see how many were adherent. 89.3, almost 90 percent, were adherent to our program.

How do you make that happen? Because most physicians who want to use this approach say, Dr. Esselstyn, I just couldn't get my patients to do this. And it's not that the message is wrong, it is how the message is articulated. The only way I think you're going to have people make a lifestyle change is to show them respect.

The only way that I know to show a patient respect is to give them my time. So several things. Right now, once a month, usually for no...

more than 12 or 16 patients always with their significant other or spouse. You must have the spouse or significant other there. We have a six-hour program one day because they're coming throughout Canada, throughout the United States.

the United States, six-hour program. They're going to learn all about how they have created this disease and precisely how we are going to empower them as the locus of control to halt and to reverse their disease. And you got to have a little bit of fun with them.

For instance, when we have the group there and I'll say, now remind me again, how often do you, I'll choose somebody, how often do you eat out? Oh, Dr. Esselstyn, not very often. Let me try that again.

How often do you eat out? Well, maybe two or three times a week. Okay. So yeah, that's 156 days out of 365 that you are taking an already train wrecked endothelium, and you're trying to train wreck it further. That makes no sense.

Look, there are four reasons to eat out. One, you don't do the cooking. Two, you don't do the dishes. Three, you don't do... No, it's...

Three is the ambiance. Four is the companionship. You never, ever go out to eat to further destroy more endothelial cells. And I also should say that two weeks before we have our seminar, I get my secretary will send me a list of the patient's names and phone number, and then I personally insist upon calling every one of them because I want to get my arms around their story. And I want them to have an opportunity to ask questions of me so that by the time they come to the seminar, we have a strong platform from which we can all move forward.

Now, I'm pretty proud about the fact that, look, how did they know they were sick? 119, that was 177. already had had a stent or a bypass. And here's what's growing a colossally. We now are at the point where practically anybody who was being asked to have an elective stent or elective bypass, if they're willing to go whole food, plant-based nutrition, rarely, rarely, rarely will they ever have to have that intervention. So here are the results of those who were adherent.

We had one patient who had a small stroke. The 21 who were not adherent. adherent, 62% had disease progression. Now I decided to compare our results with some of the better known standard studies that are out there. And this is, on the left, is the major cardiac event, heart attack, stroke, and death.

So let's look at over in the far right. That's the Mediterranean Leon diet heart study. At the end of four years, 25% will have have had a heart attack, stroke, or death.

Next to it is the natural history of coronary disease from Columbia Hospital in New York City, 20% heart attack, stroke, and death at four years, and then next to it, the 19.4% Bill Bowden's Courage Study. But look, here Here we are, six-tenths of a percent. That's over a thirty-fold difference.

What's going on here? Why is there such a difference between our results and theirs? Because ever since the days of Hippocrates, There's been a basic covenant of trust that wherever possible, the caregiver will share with the patient what is the causation of the illness. And sadly today in cardiovascular medicine, that's not being done.

However, along with several of your other speakers today, I'm proud to join with them. We've been asked to become a member of the American College of Cardiology and Nutrition Committee. And we are very aggressively trying to see if we can't educate cardiologists.

cardiologists on the importance of the causation of the disease they've been designated to treat. Now, of all things, the same month, I wrote another little paper on three patients. What right did I have writing about three patients? Well, all three of these were an absolute story of the disaster of President Carter. And by the way, let me be...

Sure, you understand that I embrace as friends. I have great respect for the caring and the compassion and the fund of knowledge of my cardiovascular colleagues. But, you know, it's the old business. Can the best be even?

been better. So here is an interesting study, three patients. The first actually is from Newfoundland, Canada. And I've not met Bob Mercer, but I've been corresponding with him by phone and by mail. When he was 44 years of age, he had a stroke.

He had a partial occlusion of his right carotid, actually a total collusion, and a small stroke. But he had such severe angina, they found a daring surgeon in Toronto who would operate on him and he was very good. of one totally blocked carotid.

He got through that operation, had a wonderful result, until he was now 69 years old. He was in trouble. Diabetic, severe angina, erectile dysfunction, and diabetes out of control, and his one remaining carotid artery was 90% blocked.

Of all things to have happened at that time, his daughter, age 37, had a heart attack. During her convalescence, she found a book called called Prevent and Reverse Heart Disease, and said, Pop, we should do this together. They did. A year later, I got a letter from Bob Mercer.

Dr. Esselstyn, thank you. My angina disappeared. I've lost 40 pounds.

My diabetes disappeared. My erectile dysfunction disappeared. And my one remaining carotid artery, which was 90% blocked, is now 67% blocked.

Here is Bob Mercer. mercy. Now these other two, Art Soteros is at age 32 in Cleveland, became diabetic.

Age 42 in Cleveland, got angina. And at the Cleveland Clinic, my alma mater, he had his first of 14 stents. Then he was told, these aren't working, you need a bypass. That was great.

For a year and a half, more angina. And they said there was nothing further they could do from the standpoint of intervention. you have to deal with drugs. And he found his way through our program, lost 40 pounds, got rid of his diabetes, got rid of all of his angina, and I think I have a picture of Art here as well. Yeah.

And he appears every month at our seminar. And the other is Jim McNamara, who, small stroke, as he was pre-diabetic, right carotid artery. And then he began to get horrible claudication, and they failed his first... operation of his leg failed.

First, second operation on his leg failed. Third operation on his leg failed. And he was miserable when he tried to put his leg up to go to sleep because of severe tingling. And he came on board and lost 40 pounds, lost all of his pre-diabetic state, and now can walk nonstop. with no problem with his circulation through his leg.

So there's no mortality from the diet. There's no morbidity with the diet. The benefits are improved with time. There's no extra expense because you've got to eat. And think of the patient who has had a heart attack.

They're walking. around with a sword of Damocles, hanging over their head. When do I get my next heart attack?

Nonsense! You never have to have your next heart attack. You eat in a way that you make yourself heart attack proof.

What in the world is the good of having a great heart if your brain isn't there? We got a lot of insight into this from the work of Megan Leary and her team from the West Coast. who in 2001 at the stroke meetings in Miami looked at over 5,500 MRIs of the brains of Americans. And they find that at age 50, she began to notice the... These little tiny white spots beginning to appear in the American brain.

These are little strokes. But come on, you're age 50. Big brain, tiny stroke, not a problem. Suddenly, though, you're now 65. You're no longer 50. And more often than before, you say, sweetheart, where did I leave the car keys?

You get through that. You're 75 years of age. You look at her and you say, sweetheart, where did I leave the car?

Well, you get through that. Suddenly, you're 85. And you look at her and you say, are you my sweetheart? I can't reverse that.

You don't suddenly get dementia on your 85th birthday. birthday. You work hard in all those preceding decades to lay the foundation for dementia. It doesn't have to happen.

Now here is a normal MRI. I counted 90 in these. Can you imagine a message trying to go through that scar? Now, look carefully here.

On the left, the brain is all the way out to the skull. Look carefully here on the right. There's a big gap between the brain and the skull.

That is cerebral atrophy. You don't want that as you get older. You want your brain to grow as you get older. How do you do that?

exercise. Alright? If you're going to do it walking four or five times a week, fast enough to almost break a sweat. Or you can bike, or you can swim.

But exercise is the key, just as it is for this next situation. You can see on the left the normal thigh muscle of a 40-year-old triathlete. On the upper right, you see the thigh muscle in a 70-year-old couch potato.

lower right thigh muscle of a 70-year-old triathlete. Keep it moving. Now, here on the left, you're looking at the pulse volume.

And a patient who came to my office, in crossing the skyway, he had to stop five times because of pain in his right calf, claudication. And so I was so focused on his heart. I forgot all about his leg. Eleven months later, he said, Dr. Esselstyn, you recall when I first started seeing you, I was stopping five times crossing the skyway to your office. Yeah.

He said, you know, this last month, it became four times, three times, two times, once. I don't stop anymore. Don, back you go to the vascular lab.

Now look, on the right, the pulse volume is double. So we now had, within 15 months of starting the cell, study. We had absolutely irrefutable scientific data that food and food alone could absolutely reverse cardiovascular disease. And you're going to say, wait a minute, what about the statin drug?

Well, this is the second patient I've shared with you today, Dr. Crow, who refused, and this patient, Don, 1986. We didn't have any statin drugs then. So even the many patients that come to see us who simply are crippled by statin drugs, we don't have any statins and can't take them are in no way precluded from enjoying these benefits. Here's another.

This is a 78-year-old retired high school chemistry teacher. In his retirement, he and his wife loved to enter these square dance contests. But during the fast square dance, he was getting a bilateral calf pain. So he saw these vascular surgeons and they got the images that you see up here showing how severely diseased he was, but he didn't like that big operation.

operation they had planned for him. He came to see us. During counseling he said, Dr. Esselstyn, if I happen to choose your method, how long will it take me to get rid of this pain in my calves? So I looked at him with great wisdom in my face.

And I said, this will probably take about 10 or 11 months. And three months later, I got a phone call. Dr. Esselstyn.

You do not speak the truth. The pain is gone. Okay. Now, I don't know, I'm assuming all of you are from this general Virginia area, but I should share with you that in Ohio...

when you're watching a mystery or a sporting event, just before the advertisement comes on, you will hear the mellifluous tones of the announcer say something like, when the moment is right, will you be ready? Now, we all know that the peanut butter is a very good thing. Our artery is really quite tiny compared to the size of the coronary artery. So not infrequently, before somebody comes down with heart disease, they may find that they are no longer able to raise the flag.

However, all is not lost. Not infrequently, 10 or 11 months after I've counseled somebody, I'll get a phone call. Dr. Esselstyn, yep. This is Mr. So-and-so.

Sure enough, good to hear from you. Yeah, I said, I really thought I ought to give you a call because recently something has come up. And I wonder if I don't owe you another check. Now, I promised you today, before I wrap this up, I wanted to share with you how it is that those patients who have a plaque that is made up of fibrosis and scar and calcification can still get back to activities of daily living without restriction. What you're looking at here is a petrubidium diperidumal scan of the heart.

And translation, if it is orange or yellow, that's good. Here on the left. But right down here, where it's green, that's bad. That's poor blood supply. We call that ischemia.

Now, at the time that he had that first PET scan, I counseled him, and 10 days later, his cholesterol went from 248 to 137. And then, three weeks after his first PET scan, we repeated it. Now look on the right. It's all back. Wait a minute.

We didn't wash out. Nobody got rid of a plaque in three weeks. What's going on here?

Now here's what's the story. If you look carefully, you will see this is a heart without any... Without any muscle. You're looking at the heart and you see those three large epicardial arteries, the right coronary artery, the left anterior descending and the circumflex, which get all the publicity, all the interventions of stents and bypasses. But look where every single one of those arteries is going.

It's going to get smaller and smaller as it dives into the heart muscle. That's where all the oxygen and nutrients carried by this artery go, into the mind. the muscle.

There are thousands of them there. So I asked Rodriguez, who at the Cleveland Clinic is the director of the cardiovascular pathology lab, and he dissects 200 hearts a year from the deceased. And I said, how often do you ever see good old standard garden variety atherosclerotic plaque in the artery once it has entered the muscle? Never.

Never. Once in a very, very great while in a severe diabetic. Otherwise, never.

So here's what's going on. When we first see these patients, by now you know, their endothelial system is as trash. As a matter of fact, it is now your enemy. It's not making hardly any nitric oxide, your friend, and it is now making two molecules that are against you, endothelin and thromboxane, which are vaso blood vessel constrictors. So this entire package of arteries, when you first see them, all those thousands are.

vasoconstricted and as soon as you get those patients to stop not injuring at all again their endothelial system as it recovers it stops making the vasoconstrictor it starts making the nitric oxide vasodilator dilator, and that entire enormous, enormous cascade of intramuscular vessels opens up. And that's why you hear patients telling you, those with angina, within days their disease is getting better. Pretty exciting.

But that seems to be what's going on. Here are the eight measures of disease reversal. You can see it on an angiogram. You can see it on the stress test. I just talked to you about the PET scan.

We talked about the carotid. We talked about pulse volume with the leg. And the three symptoms of angina, claudication, and erectile dysfunction.

Wrapping it up, for those of you who don't get to Cleveland very often, this is the building where I worked on the eighth floor for many years as a surgeon and I bring it to you because I want you to know what the trees look like in Cleveland in February However, now that I've retired from surgery, I've moved into the Wellness Institute at the Cleveland Clinic. And although the budget is more modest, I can assure you the morale is quite high. And I always like to finish up with my favorite.

This is a woman in Life magazine trying to learn how to do the splits. And although it's been 57 years since I left medical school, did I just say that? While brains are important, nothing is as important as persistence, persistence, persistence.

Best exemplified by this young damsel, 1939, Life magazine, trying to learn how to do the splits. But it's tough. She stuck with it.

And of all things to happen, the other day in downtown Norfolk, Naomi Spotter and she now had got it right. I want to just summarize by a few comments. One, remember we started late. Oh, no, no, and you get questions still. I guess the reason that I find myself, when I was thinking about my career as a surgeon, I thought when I retire from surgery I'm going to learn two things.

I'm going to learn how to play the piano and I'm going to learn how to windsurf. Well, neither of those things have happened. happened yet.

But why? Because I really see in front of us in medicine what really I think could be an absolute seismic revolution. And this seismic revolution in health that is before us is never going to come about with another pill or another drug.

The seismic revolution is never going to come about through another procedure or an operation. But the seismic revolution will come about. When we in the profession have the will, the grit, and the determination to share, to share with the public, what is the lifestyle, and most specifically, What is the nutritional literacy that will empower them as the locus of control to absolutely annihilate chronic illness? Thank you. Well, we're going to open up the floor for questions now.

He's looking for tough ones. What are your thoughts on tap water and alkaline water and the benefits? Tap water and alkaline water, do you have any thoughts on those and potential benefits?

Whichever you like. I mean, what type of water do the Okinawans eat? What type of water do they eat or drink in Central Africa? I think I have no problem, either one.

Dr. Esselstyn, I'm over here, sorry, on the side. I have a question for you. You spoke earlier about how effective plant-based eating is on young soft plaque, and I know you mentioned at the end you were talking about some of the more advanced disease states. What I haven't heard, and I was just curious about how that affects somebody with a high calcium score and how that works on reversing calcium or stop the progression, and I have a quick second question, too.

Something I haven't heard about addressing was the effects of this on elevated lipoprotein A. You know, the calcium score is kind of interesting and important. When you get a calcium score, that tells the physician two things.

It tells us that you've got coronary artery disease. But it also tells us that you have got a number of non-calcified, inflamed... plaque.

It's the non-calcified inflamed plaque that are the more dangerous ones because those are the ones that can rupture. But, and this is something that I think most physicians don't know, but it was something that I was taught years ago by Bill Costelli. Dr. Costelli was for many years the director of the world famous Framingham study. And he said, if you get somebody who has a high calcium score, and they absolutely get it right, and over the next year they're eating whole food plant-based nutrition.

Then they have another calcium score. And if it was 100 at baseline, it may now be 175 or 200. But he said the patient is much better off. Because what has happened is... During the time that they are eating whole food plant-based nutrition, which is so powerful as an anti-inflammatory, as that those previously non-calcified inflamed plaque are losing their inflammation, it is as though the body wants to get in on the act and hasten along the quelling of this inflammation by dumping in some calcium.

in those previously non-calcified. So if your physician says to you, my God, that plant-based diet you're on is making you worse, that's absolutely wrong. Okay, now the other was about LpA. LpA, yes, sir. What is it, 20% of the population will have LpA.

What do you suppose they do about the LP small a in Central Africa, in Okinawa? How many of them ever check their LP small a? I think that the consensus pretty well is this.

You have learned through that, hopefully, what I've shared with you today. We want everybody in this audience and all friends and relatives to eat in a way that you make an absolute endothelial fortress. Your endothelium is strong and tough and And therefore, if you have a strong endothelium, even if you have an LP small a, it's going to be harmless. You know, something you have to think about when we get a little bit too carried away with cholesterol. Do you think that when the human body was formed, hundreds of thousands of years ago, we have come all this way with an understanding, our body has this understanding, that every single cell membrane in our body is made up of cholesterol.

Now, are we going to be able to just say that when we were formed, we were blessed with an organ that made cholesterol that would make us all vascular wrecks? I don't buy that. for one minute. I mean, if you have, let's say, a thousand people who absolutely follow the program that I espouse to the T, there'll be some who have a cholesterol of 110, others 140, 160, 180, 200, 220. But as long as they are eating in a way that they have an endothelial fortress, I don't think that should be a concern.

The question is, the last slide you showed was where all Americans will have some sort of atherosclerotic disease. Most patients that we see in clinic, for example, middle-aged patients, know risk factors, exercise well, and arthrosclerotic, cardiovascular disease, risk factors score maybe less than 7.5%. But their LDL, it's hard to, for some of these patients, it's hard to get it below 105. In most cases, it stays in that range of 95 to 105. Do they still need a statin if they're even...

following a whole food plant-based diet. Yeah, I think that's an excellent point. But you remember this. What are you going to do with your patient who, I mean, it'll make you feel better because their number will be lower.

But I'm not sure that they have to have that because, as I mentioned, we have many patients who have come to us who simply cannot take a statin. There are four side effects of statins. One is brain fog. One is severe muscle pain.

The other is, of course, a liver problem. And... So really, if the patient has an LDL of 105, and they're eating in a way that they are maintaining an absolute endothelial fortress, they should absolutely do fine.

Because it's the injury to the endothelium. That's where this disease has its inception. That's where all experts that I'm familiar with... I agree that this disease has its onset.

But to do this and do it right, you know, it really makes you have to think twice anytime to eat out. For instance, I just had a patient last week. nobody that I'd seen but somebody got a phone call said they'd been following our program and although four years earlier they had had a couple of stents and then after he finished a 5k run this past Sunday he was hospitalized with a heart attack.

And he had told his wife that he was following our program 100%, but 100% does not include at every lunch at his workplace, he was eating the Beyond Burger. Beyond meat and so forth, which are loaded with coconut oil and all the oils that will just tear your endothelial cells asunder. Thank you so much for being here. And I would like to ask you specifically...

Specifically said the importance of green leafy vegetables, kale, Swiss chard, spinach, beet greens. What if you are on a med, like warfarin, because of a genetic disorder, and you're not able to take these green leafy vegetables? How can you gain the benefit without actually eating them? The problem often comes up with patients who have atrial fibrillation and they are on Coumadin. And the question of the vitamin K that you're eating with these greens...

makes it hard. And what pretty much is the consensus of those who understand this and do it right is that you talk with the physician who is doing the anticoagulation, if you're taking Coumadin, and you show... share with them, look, I am consistently going to be eating this amount of green leafy vegetables, and then they will appropriately adjust the level of coumadin so you achieve the level of anticoagulation that is appropriate.

Now, on the other hand, what you've presented is a little bit more challenging. You have some congenital condition. I don't know, what is that condition?

You likely have some clotting disorder that requires you to be on blood thinners that maybe increases the risk of blood clots in the legs or the legs. the lungs. Dr. Yeah, then I would again, if you are on Coumadin, you would talk with your physician and say, listen, I don't really think I ought to be precluded from enjoying the healthiest foods on the planet. And maybe they would agree.

to allow you to increase your greens, and they will appropriately adjust the coumadin dose so that they still can achieve the level of anticoagulation that they feel is appropriate. Thank you so much. I feel so grateful and thankful to be here and that you're here today.

My question is about homocysteine levels. How do you feel about that and why? Homocysteine? Yeah, I think most people will find that when they're eating whole food plant-based nutrition that their homocysteine will not be elevated. You know, a test we need to ask for and be proactive or does the doctor, even if you don't have heart disease, do you think you we need to have ours checked?

You know... Is that a pre-indicator? One of the things that is taking us to debtor's prison as a country, faster than anything you can imagine, is health care. One of the things that we do with health care is we have all this testing. And it's amazing how much testing costs.

Just to get a CT scan is thousands of dollars. And even when you go in and get a metabolic panel for blood tests, all these things cost. So I find myself increasingly...

bending toward the following side, to try to keep the test to an absolute minimum we can, consistent with the safety for the patient. But I think that if somebody is eating totally, without exception, whole food, plant-based nutrition, they're going to make all their numbers, they're going to be somewhere where they ought to be. Now, we should mention a word about omega-3.

There's going to be a lot of talk about omega-3. about Right now, the American Heart Association is having its annual meeting. And there's a paper that now, for the first time, contradicts what we had learned earlier, that's supposed to be beneficial with fish oil tablets.

Now that paper was sponsored by the maker of fish oil tablets. And that always raises a flag. However, they're looking at...

If you want to get omega-3, I don't want you to have to get it with oil, which may have PCBs, dioxin, and so forth, and mercury. If you want to get omega-3, you should be able to get it through flaxseed meal, chia seeds, and plenty of green leafy vegetables. However, if you check your omega-3 and get the omega check, it'll either be optimal, minimal, or moderate, or too low.

And if it's too low, then I would say take omega-3 tablets, not in oil, but are made with algae. That's the thought. And this way, and also be a little conservative about these. These tests have just gotten to the point insurance carriers are still paying for them. But God, they are so expensive.

All the money that we as a country have that should be going into education, restoring the grid and the infrastructure is going into health, which is crazy because if people could eat right, this would not be an issue. It's just interesting. that there are two authors from the University of Chicago in 1999, Topel and Murphy, writing in the Chicago University Press, estimate that if this country could eliminate heart disease, we would save $40 trillion. I'll probably get a reprimand from what I'm going to say, but this was my personal decision. I'm 66 years old.

Nearly two years ago, I had a stent placed in a 90% block third. The doctor prescribed me four or five drugs, which I only took for two weeks because of how ill they made me. And because I was extremely concerned about the long-term effects, side effects of them. I've been on a whole... I will say that in making that decision not to take the drugs was extremely stressful because I didn't know if I was making the right decision or not.

And so now I haven't been to a doctor in two years. years, I feel like I need to go to one, and I'm not sure what tests I should take or ask him because my doctor said if I wanted to fool myself, I could go away from my prescription drugs. But I'm feeling great, I'm strong, and I just started going P90X. Nice work.

Transcript for:Dr. Esselstyn on Cardiovascular Health

Transcript for:
Dr. Esselstyn on Cardiovascular Health