Sitting down with Dr. Caldwell B. Esselstyn, Jr. for an hour is like listening to your favorite college professor on a topic you’re fascinated by, however, instead of teaching you economics or social studies or history or biology, he teaches us how to live healthier lives, including having healthier sex lives, through the food choices we make.

Dr. Esselstyn, now 86 and sharp as ever, was one of the first doctors to insist that his patients adopt a plant-based diet for heart health, and he wants people to know how to live a long and healthy, active, vibrant life. Want a better sex life, healthier, younger organs and to reverse heart disease symptoms? All we have to do is eat a plant-based diet, Esselstyn says.  He teaches seminars on how to do it, which you can attend near Cleveland, where he was a revered surgeon at the famed Cleveland Clinic, for 50 years or so, or you can read this.

Caldwell Esselstyn was a surgeon at the Cleveland Clinic and treating breast cancer patients when he realized that he was doing nothing to help the future patients, those who were unsuspecting of their condition or who were getting sick even as he tried to save those who arrived at his surgical offices. He suspected that one of the main reasons people got sick was related to a lifelong diet of animal fat and protein. His studies of women in societies where there was very little breast cancer showed that their mostly plant-based diet played a role in how seldom women would get breast cancer in those cultures, and he decided to switch his focus from cancer to heart disease when he also began to understand that eating the typical American diet was making half of the population show symptoms of cardiovascular disease.

This led to a practice of helping his patients change their diet. What happened next was something short of a miracle. Heart disease symptoms were held in check and even reversed, among the "compliant" patients who managed to stay on the diet, and he recalls his phone ringing and a patient telling him "Something's come up!" and sharing with the doctor that during the weeks of eating plant-based his sex life had restored to his youthful prowess.

Here, Esselstyn, one of the two major doctors in the documentary Forks Over Knives, along with T. Colin Campbell, tells The Beet what he thinks of our current obsession with fake meat, the best way to eat to live a healthy life --and stay active and strong well into our 80's 90's and beyond. What I learned here will change the way I will eat forever. No more cheating with cheese. Pull up a chair and listen up, as the good doctor gives a lesson in living healthy.

Q: When did you go plant-based? And why? What prompted your decision?

A. Back in 1984. At that point, I had two responsibilities as a surgeon at the Cleveland Clinic. One I was head of the Breast Cancer Taskforce and two, head of thyroid surgery. I was increasingly disillusioned that for however many women I was treating who needed surgery, I was doing nothing for the unsuspecting next victim. So I started to do research and found that breast cancer was very low elsewhere, like  30 to 40 percent lower in Kenya and also much lower in Japan. But as soon as those Japanese women migrated to the United States, by the second and third generations, their risk was as high as their American counterparts.

At this point, I realized that there might be more bang for the buck if I could look at cardiovascular disease. It became increasingly apparent that there were multiple cultures where cardiovascular disease was non-existent -- Papua New Guinea and Japan and the northern Mexican highlands. Most of those cultures eat largely plant-based and without oil. So if you could get people to eat to save their heart, they could also avoid cancers like breast cancer, colon, pancreatic and others.

I thought I had to do a study. I knew people were unlikely to make this transition without some science.  We began running the study with 18 patients and had about a 90 percent adherence in terms of patients with cardiovascular disease. (Now our most recent paper of 200 patients that we published in 2014 had an 89 percent adherence to our program.)

I went to the chairman of the Dept of Cardiology and see if they would send me 24 patients who were seriously ill who had failed their first or second bypass and angioplasty and they were too sick for these procedures. They had been told by their cardiologists they would not live out the year. And my fear with this group was how could I get them to make this significant change, which was obviously extreme since we are asking them to stop eating foods that are going to injure the lining of their arteries. I saw them every two weeks to draw their blood and their cholesterol and go over every morsel they ate. And then I stretched it out to every month. And then at the end of ten years to stretch it out to quarterly. And at 12 years, we wrote it up and published it. In 12 years of follow up on these patients what we found was quite exciting: Of the original 24, there were six that within the first six or eight weeks I knew they didn't get it and I released them from the study to go back to their cardiologists. They became my quasi-control group, and those who dropped out, two of them died and the other four had to have further bypass surgeries. The other 18 who stayed with us -- we wanted to know in the eight years before they had come into our study, how many events of worsening coronary disease had they had? It turned out they had 49 events in the prior years. Once those 18 years came into our study, over the next 12 years 17 of them had no further cardiac events. One little sheep wandered from the flock and enjoyed glazed donuts and such, and he had to have another heart procedure. But then he was back. We got him back. No surprise.

Q. How can you convince healthy, as-of-yet asymptomatic people to eat plant-based before they end up in your office with a heart attack or signs of disease?

I am on the Nutrition Committee of the American College of Cardiology. First we are trying to educate cardiologists as to the causation of the disease they are being asked to treat.

It all comes down to education. You must share with them what happens in their body when they eat meat. They have to be educated. We know that when we do autopsies of GIs who died in Korea -- the average age of 20 years old. About 80 percent of them see gross heart disease and you could see it with the naked eye. That study was repeated among young women and men who died of accidents and suicides, more recently, and when they look at coronary arteries, it's in all these people. It’s ubiquitous. When you go to high school, you get a diploma but you don’t learn to eat. If you are over the age of 17 you already have heart disease. You can decide whether you want to eat this way, but basically, if you don't cut out animal fat, you have a choice: You can have a heart attack or a stroke. Or both.

People don't eat plant-based, it's because they have never had a chance to sit down and understand how this disease behaves. The absolute key for people to understand is we all the experts are in agreement. Here's how cardiovascular disease works: The lifejacket of our health is the lining of the artery, the endothelium, which makes a magic gas, nitric oxide, that is the savior of all our bloodstream flowing smoothly. It keeps things from getting sticky. When you climb stairs or workout, the arteries dilate. Nitrate Oxide protects the wall of the artery from becoming thick and stiff and keeps blood flowing properly.

A safe amount of nitrate oxide protects us from cardiac disease. Everyone -- if they have CVD -- the preceding decades they have so damaged their cells that it keeps them from creating nitric oxide. So they get plaque and hardening of the arteries. However, the good news is this -- it's not a malignancy. It’s a foodborne illness. If you can get patients to understand that every time these [animal product] foods pass their lips they are further injuring their endothelial cells. So if you stop injuring those cells further you not only stop the injury but you can reverse it.

With heart patients, I explain to them that they need to get off all animal products and dairy, and all oil. That includes olive oil, coconut oil, palm oil, oil in crackers, oil in salad dressing. Plus anything with a mother or a face: Meat, pork, chicken, turkey, and fish. It includes dairy, cheese, yogurt, eggs, and sugary foods: cookies, cakes, donuts, pies, or an excessive amount of maple sugar and honey.

That’s the lineup. How do you get patients to make this type of transition? First thing is to show patients respect and the only way to show respect is go give them my time.

Once a month I conduct a seminar for six hours at the Clinic with their spouse or companion. If you think you can get anywhere without their spouses you’re wrong. 
You teach them that they have created their disease. And you need to empower them to see how they can be the locus of control to halt and reverse this disease. They get all the slides, notebooks and information they need to make the change when they get home, including 240 recipes and a DVD of the entire seminar -- so if they go home and get rusty they can flip this on and get up to speed.

Then we have them hear from two or three local participants who share their story of transformation and transitioning to a plant-based diet, and how it saved their lives, and those in attendance think: if he or she can do it then I can do this too. It works.

Q. What is the key function that going plant-based does to your body? And how do you explain this to non-science types?

A. They need to understand nitric oxide. Or both the endothelium and nitric oxide. These two terms need to be understood. They need to understand that if you put your hand above your head like shielding from the sun, we can see that 8-year-olds have this much nitric oxide and then in 20s, it's this much -- and I put my hand at my neck level -- and it keeps going down throughout our lives. If you die and we do an autopsy it's down to here, and I point to well below my waist, around your knees. You have heart disease by then, but not so much that you would show up with symptoms yet. Then in your 40s, you don’t have enough nitric oxide to protect you. So if you continue to destroy endothelial cells, it will end up destroying you.

I explain to them: All the mystery is gone as to why you have this disease. They destroyed their endothelial cells and are not be able to make nitric oxide. If we could open up their arteries and look inside, it's a cauldron of oxidation. They need antioxidants. Not from pills but from food. From food that is high in oxidated Value

Q. Okay now that we understand the method that greens help your body stay healthiest, let's talk about sex. Erectile dysfunction is a major topic among men of a certain age (and the ads on NFL TV broadcasts). How does food play a role?

A. When men eat a plant-based diet of heart-healthy greens, grains, and fiber-filled foods, It’s so powerful and so inexpensive, and it opens up their circulation. ED is the first sign of heart disease, often, since the exact same system works on that body part as all the other blood vessels in the body. So when that stops working, it may be because the person doesn't have a healthy cardiovascular picture in general. It’s hard for any cardiologist who is used to prescribing expensive drugs to instead tell their patients to just completely change their diet. But these plant-based foods can be as powerful as expensive drugs.

It's profound how exciting it can be for men. I often get a phone call to alert me that they have had a major development in their health.  "Dr. Esselstyn," they will call me out of the blue, like 11 months after nutrition counseling, and he says, "I thought I should give you a phone call to say, recently something has come up!" I'm not surprised. In the movie, The Game Changers, young athletes find that a single evening meal at dinner had an impact on how many erections they had throughout the night, and how strong those were. "One dinner made the difference for them because they were young, healthy athletes. For those with unhealthy arteries, it takes a little longer," Esselstyn explains. But if the patient is consistent the plant-based diet works wonders.

Q. What exactly would you tell men to eat to improve their sex lives?

A. For breakfast: Oatmeal and blueberries. That's a good start. But you need to chew green leafy vegetables, six times a day for best results. Chew these leafy veggies after they have been boiled in water for 5 or 6 minutes, and drizzled with Balsamic vinegar, which has been shown to replace the endothelial cells and create nitric oxide. So you take leafy greens at breakfast, as a mid-morning snack, then lunch, then after lunch mid-afternoon, then again at dinner and after dinner. Kale and swiss chard and these greens can restore the capacity of your bone marrow to restore your Endothelial progenitor cells.

By chewing the greens, it allows the bacteria of the plants to mix with the bacteria of the mouth to help create even more nitric oxide. All-day long by chewing these greens, you are restoring to your body that can reverse the disease. 

The greens you need to chew on every few hours should be dark, green leafy vegetables, including: Kale, Swiss Chard, Spinach, Arugula, Beet Greens, Bok Choy, Collard Greens, Mustard Greens, Asparagus, Brussel Sprouts and Chard.

These can be as powerful as expensive drugs. 

Q. Break up the fight: Which is better for you: Keto plan or plant-based eating?

A. The thing you have to go again is to look at the science. I am totally unaware of patients seriously ill with cardiovascular disease, where the ketogenic diet has halted disease. Plant-based does.

The Keto diet has meat in it. The research from Stanley Hazen from Cleveland Clinic from persons who are omnivores who are eating various products: beef, pork, chicken, turkey and those foods contain lecithin and carnitine. When an omnivore eats lecithin and carnitine, they have within their micro-biome bacteria that reduces these to the molecule called TMA  in the gut -- which in turn gets reduced to trimethylamine oxide or TMAO, by the liver. And that has been shown to injure the body’s blood vessels. So every time you eat meat you injure your blood vessels. Then Dr. Hazen took someone who is totally plant-based and gave them meat and they did not create any TMAO because they do not have the bacteria in their gut to convert it into TMA or TMAO, it's gone after about three weeks, but if they continue they do start to eat pork, chicken, meat or fish, they make that bacteria and then they do start to injure their blood vessels again. So once you're off it, a trace amount won't hurt you. But if you go back to eating meat the gut microbiome changes again and you go back to hurting yourself.

This isn't just the science of a handful of leading doctors here or across the country. The World Health Organization -- which represents cultures throughout the world -- published a report saying red meat has the same level of carcinogen as smoking cigarettes.

If you don't believe it, just look at the Harvard Nurses study and the incidents of death is up 12 percent over time, for those who ate red meat and 20 percent over the same period, for those eating hot dogs and ham and bacon.

Q. But this is super strict. You tell your patients no oil, no nuts, and only greens and gruits and grains? I thought almonds and certain nuts were beneficial.

A. I only tell the strictest version to those who are already sick. We say "No oil or nuts" for those patients with heart disease -- I do not tell patients who don’t have heart diseases they have to give up oil and nuts. But I struggle with this. When I lecture before an audience there are those with diagnosed CVD and those who don’t, who don’t have symptoms. So the people in the audience who are well also have heart disease, they just don’t know it yet.

Q. What about all those alternative meats? Here at The Beet we say they are a helpful gateway food, a conversation starter to show people they can live very happily without beef.

A. The healthiest food is whole food, plant food.  Processed foods are awful. Alternative meats are terrible for you. If you compare alternative meats and what it does for your health versus real meats, it’s a question of asking the patient whether you want to be shot or hung. These all have saturated fat, a lot of sodium and Impossible has heme iron, which is not good for you. And there are no long-term studies whatsoever on the effects of eating this.


Q. Okay you convinced me to skip the Impossible Whopper next time I drive out of town on Long Island, even though I think it's delicious. So what do you eat in a day?

A. I don't cook.

Breakfast: I have oats. I eat them as dry cereal. I put them in the bowl, add some raisins, maybe a banana, raspberries, blueberries, strawberries. Add oat milk. It’s a caloric feast. Cooking them is fine but you don't need to. Whenever I am on the road I can’t rolled oats I can oatmeal. When you’re on the road and you’ve got oatmeal you don’t even need the almond milk -- the water is enough to wet them down. Add the bananas and berries and raisins

Lunch: That depends on the season. In the summer ann always wants to make open sandwiches. Toasted. Hummus, things like kale, scallions, some sort of slice of apple or a slice of cucumber, and sprinkles of Mrs. Dash, which is a mix of various herbs, spices and seasoning.

Snack: I usually like to grab a whole wheat bagel and I'm crazy about hummus. I heat or toast the bagel and I love gobs of hummus. Never eat hummus with oil. Make sure not made with oil. Whole Foods one contains no oil. Or make your own.

Dinner: My favorite meal is beans and rice and on top of that I'll add some peas, corn, cut up scallions, other greens, chestnuts and mango it’s an absolute feast. And on the  edge of it Kale. Of course.

Treat or Sweet: Jane my daughter makes me a scone, it's dairy-free, with a little maple syrup in there somewhere.

Q. How long are you going to keep at it, treating patients and making videos, books and holding seminars?

A. It's a lot of fun to wake up every day with a little excitement. I am more excited than ever to keep going because of the profound changes we are seeing in how to treat patients. There is so much going on in this area now. My whole family is in it!



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