Dr. Esselstyn FAQ

Dr. Caldwell Esselstyn

FAQ answered by Dr. Caldwell Esselstyn Jr., MD, Director, Heart Disease Reversal Program, Cleveland Clinic. Dr. Caldwell Esselstyn Jr., MD is an American physician, Olympic gold medalist and founder of the Heart Disease Reversal Program at the Cleveland Clinic. A former president of the American Association of Endocrine Surgeons, Dr. Esselstyn is also the author of the New York Times bestseller, Prevent and Reverse Heart Disease.

Why does the diet eliminate oil entirely?

NO OIL! Not even olive oil, which goes against a lot of other advice out there about so-called good fats. The reality is that oils are extremely low in terms of nutritive value. They contain no fiber, no minerals and are 100% fat calories. Both the monounsaturated and saturated fat contained in oils is harmful to the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease. It doesn’t matter whether it’s olive oil, corn oil, coconut oil, canola oil, or any other kind. Avoid ALL oil.

Why should I change? My health is excellent.

No one escapes in the end–eventually, the traditional western diet guarantees some form of disease in all of us. While it may not be heart disease at the moment, eventually it will be or hypertension, diabetes, stroke, obesity, gallstones, diverticulitis, rheumatoid arthritis, lupus, multiple sclerosis, or a greater likelihood of breast, prostate, colon, ovarian and uterine cancers. Even erectile dysfunction and dementia. The world-famous Framingham Heart Study now approaching its 60th year looked at 1,000 people at age 50 who had normal blood pressure. They looked at the same group at age 70, and 90% now had high blood pressure. But there is something that you can do now to stop the cascading events that occur in the body and lead to disease. You can change your diet and begin safeguarding your health for the future.

Protein – Where do I get my protein / What protein drink is best?

The protein available in a diet of whole grains, legumes, fruit and beans, and red, yellow and green vegetables is adequate to nourish even professional champion athletes such as those who compete in the Ironman races, professional football, mixed martial arts, track, and field. Avoid protein drinks. The extra protein is truly unnecessary and has the potential for harm if it contains animal protein.

Calcium – Where do I get calcium?

Calcium supplementation is unnecessary. There is more than adequate calcium in a plant-based diet of whole grains, legumes and grains and especially the green leafy vegetables.

Vitamins – What Vitamins should I take?

Take Vitamin B-12. If eating copious amounts of leafy green vegetables, a multivitamin is unnecessary. Have blood tested for Vitamin D level and supplement as appropriate to maintain blood level in the low normal range.

Fish Oil – Should I take fish oil?

Fish oil is not essential. Fish get their omega 3 from plants. It is difficult to be deficient in Omega 3 if eating 1-2 tablespoons of flax seed meal or chia seeds and green leafy vegetables at several meals. There is also research that suggests that those on plant-based nutrition become highly efficient in their own manufacture of omega 3. Patients on fish oil are also at increased risk for bleeding, and studies now indicate they are of no benefit for heart disease patients.

Omega 3 – How do I get my Omega 3’s?

Omega 3’s are essential fatty acids supplied in adequate amounts in people consuming plant-based nutrition with plenty of green leafy vegetables. However, 1-2 tablespoons of flax seed meal or chia seeds daily is perfectly acceptable. Avoid flaxseed oil.

Flax Seed Oil/ Flax Seed Meal/ Chia Seeds – What about flax seed oil?

Flaxseed meal  (flax needs to be ground) or Chia seeds are well tolerated and supply a bonus of omega 3 using 1 or 2 tablespoons on cereal daily. Avoid flaxseed oil.

Olive oil, canola oil, coconut oil, Sunflower oil, soybean oil, peanut oil, any oil – Which oil is best?

Avoid oils. They injure the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease. All oil is also empty calories.

Family history – I have a bad family history? Does it matter?

Our data indicates even those with strong family history when eating plant-based are protected from vascular disease. Family history loads the gun, but lifestyle pulls the trigger.

Nuts – What about nuts? I hear so many different opinions?

As nuts are a rich source of saturated fats, my preference is no nuts for heart disease patients. That also eliminates peanuts and peanut butter even though peanuts are officially a legume. For those with established heart disease to add more saturated fat that is in nuts is inappropriate. For people with no heart disease who want to eat nuts and avocado and are able to achieve a cholesterol of 150 and LDL of 80 or under without cholesterol-lowering drugs, some nuts and avocado are acceptable. Chestnuts are the one nut, very low in fat, it is ok to eat.

Seeds (sunflower, pumpkin, sesame, etc.) Are seeds ok to eat?

1 -2 tablespoons of ground flax seeds or chia seeds daily for omega 3 are appropriate for everyone to eat including heart patients if they wish. Some seeds baked in bread or crackers is acceptable. Just don’t eat handfuls.

Egg whites, fat-free milk, yogurt – So What is wrong with egg whites, fat-free yogurt, skim milk?

Egg whites, fat-free milk and yogurt are ALL animal protein, and animal protein injures the lining of the arteries. Do not eat.

Triglycerides– Why did my triglycerides go up?

If your triglycerides are high, cut back on simple carbohydrates, which would include alcohol, wine, beer, white flour products, sugars including dried fruit, honey maple syrup, molasses, rich desserts, fruit juice or an excess of fruit.

HDL– My doctor is so concerned because my HDL has gone down?

It is not uncommon for HDL to fall when consuming plant-based nutrition. Do not be alarmed. The capacity of HDL to do its job has been shown recently by scientific research that there is no relationship between the capacity of the HDL molecule to function optimally and its blood level. Recent research has confirmed that the HDL molecule can be injured and weakened when one is ingesting a pro-inflammatory western diet and conversely it appears despite a lower than normal level to be optimized by anti-inflammatory plant based-nutrition.

LDL – Where should my LDL be?

LDL is the bad cholesterol. The closer it can be to 80-85 or lower, the better. However, if one is unable to take statin drugs and eating plant-based nutrition, and the LDL won’t go lower than 95-105, it would appear that they will still be fine. The lesson we learned from the Tarahumara Indians, who never have cardiovascular disease, is that the most key protective element is not so much the pure LDL number as is knowing that nothing ever is eaten which is a building block of vascular disease or can injure endothelium.

Juicing– Is it all right to juice?

Do not juice. Fructose separated from fiber is too rapidly absorbed and injurious. You lose the benefits of fiber best obtained eating the fruit. Chew your food.

Fruit juice – What about fruit juice?

Drinking fruit juice is like pouring the sugar bowl down your throat. It is fine to eat the whole fruit. Do not drink the juice.

Smoothies – How about smoothies? I love them!

Avoid smoothies.  When the fiber is pureed,  it is not chewed and does not have the opportunity to mix with the facultative anaerobic bacteria which reside in the crypts and grooves or our tongue.  These bacteria are capable of reducing the nitrates in green leafy vegetables to nitrites in the mouth.  When the nitrites are swallowed, they are further reduced by gastric acid to nitric oxide which may now enter the nitric oxide pool.   Furthermore, when chewing fruit the fructose is bound to fiber and absorption is safe and slow.  On the other hand, when fruit is blenderized, the fructose is separated from the fiber and the absorption is very rapid through the stomach.  This rapid absorption tends to injure the liver, glycated protein and injures the endothelial cells.

Reference: http://www.dresselstyn.com/site/faq/

What About Coffee & Caffeine?

One of the studies that concern Dr. Esselstyn was published in the European Journal of Clinical Nutrition in 2010.  After drinking caffeinated coffee, the participants’ systolic and diastolic blood pressure increased. At both 30 and 60 minutes, systolic blood pressure had increased from 113 to 116 (2.7% increase) and diastolic blood pressure increased from 68 to 72 (5.9% increase) (p<0.05).

Arterial flow decreased after drinking caffeinated coffee, to an average maximum of 22.1% at 60 minutes (p<0.05).

How did the researchers interpret the results?

The researchers conclude that: “caffeinated coffee induces significant endothelial dysfunction”. They suggest that coffee may have unfavorable acute cardiovascular and metabolic effects on endothelial function

After drinking caffeinated coffee, the participants’ systolic and diastolic blood pressure increased. At both 30 and 60 minutes, systolic blood pressure had increased from 113 to 116 (2.7% increase) and diastolic blood pressure increased from 68 to 72 (5.9% increase) (p<0.05).

Arterial flow decreased after drinking caffeinated coffee, to an average maximum of 22.1% at 60 minutes (p<0.05).

They did not see this effect with decaffeinated coffee.

How did the researchers interpret the results?

The researchers conclude that: “caffeinated coffee induces significant endothelial dysfunction”. They suggest that coffee may have unfavorable acute cardiovascular and metabolic effects on endothelial function.

Referenced Study: https://www.nature.com/articles/ejcn20109

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