Dr. Caldwell Esselstyn Jr. and his wife Ann, in pink, consult with a couple interested in his plant-based diet for coronary heart disease, in the kitchen of his home.
Read excerpts from the book: "Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure."Esselstyn's rules to live by
• No meat, poultry, fish, dairy products or oils
• Eat vegetables (except avocado), fruits, legumes and whole grain products.
His Web site: Heartattackproof.com
Dr. Caldwell Esselstyn Jr. has no qualms about stepping inside the nation's No. 1 heart hospital and dishing on angioplasty.
Invasive treatment is a mainstay of cardiac care, and it pays the bills. It's also what's wrong with medicine, says the retired Cleveland Clinic surgeon who has been affiliated with the hospital for 40 years.
Esselstyn has turned his life's work to demonstrating that heart disease doesn't need to exist in the first place. And if it does, it can be reversed. The remedy is a plant-based diet, he says.
Learn to live with no meat, no fish, no dairy or oils of any kind, and make yourself "heart-attack proof."
Most doctors would agree a strict vegetarian diet is good for the heart. But the idea that a diet free of animal products and fat can cure the No. 1 killer in America is a point of debate among doctors.
Drug companies are in fierce competition to find a cholesterol drug that does what Esselstyn argues can be done better through diet. The call to attack artery-clogging plaque naturally is a challenge to the medical profession and an unspoken threat to the bottom line of the medical industry.
But Esselstyn has the audacity to take his message to Cosgrove Country, where Clinic chief Toby Cosgrove is building a glassy new center for heart treatment while also trying to build a reputation for prevention and wellness programs.
One recent morning, Esselstyn slipped on a white lab coat and told a group assembled in a Clinic classroom that treating heart disease with stents and statins is not the answer. He implored them to accept that the body, given the right fuel, can restore coronary arteries damaged by the fatty Western diet.
Why a stent when the right diet will do?
Esselstyn, a stalky 6-foot-3 former Olympic gold medalist, pointed to white branches of the heart's plumbing system illuminated on an overhead screen. They were X-rays of arteries belonging to patients who took up his nutrition program. The X-rays showed vessels narrowed by disease that appeared to open after patients shunned burgers and fries for greens and grains.
"Why do you have to have an operation or stent?" Esselstyn asked rhetorically. "Your body can do this so simply."
Esselstyn and his wife, Ann, have followed a plant-based, oil-free diet for more than 20 years. He has studied a number of heart patients under his counsel during that time and reports their remarkable success in a recently published a book called "Prevent and Reverse Heart Disease."
He lives in Pepper Pike and is part of a small fraternity of prevention activists who say a vegetarian diet can protect the heart, the best known of whom is best-selling author Dr. Dean Ornish.
"What really keeps me on fire about this is we have an epidemic of disease in this country that doesn't need to exist," Esselstyn said in an interview. "It's so ridiculously simplistic to turn around this epidemic, it's scary."
A diet that calls for extreme discipline
Simplistic perhaps, but demanding. The Esselstyn diet means never saying you ate "pretty good," or you only had a little ice cream.
The Esselstyn file
• Age: 74
• Member of Yale rowing team that won gold medal in 1956 Olympics.
• U.S. Army surgeon during the Vietnam War.
• Married to Ann Crile Esselstyn (above), granddaughter of Cleveland Clinic co-founder Dr. George Crile.
• Cleveland Clinic surgeon for 31 years.
• Quote: "I became disillusioned with a lot of what we were doing in medicine. No matter how many operations I did, I wasn't doing anything for the next victim."
Every forkful of fat, he says, causes an immediate biochemical assault on the endothelium, the lining of the arteries. White blood cells collect there, gobbling up bad cholesterol and creating fatty deposits over time.
For many people, especially those who smoke or have other risk factors, accumulation of plaque is a time bomb for a coronary event.
It might take something like that to convince an average meat-eater to adopt the Esselstyn diet. Even then, you wonder how many people at a heart attack survivors' convention would line up at his table.
Many doctors might agree with Esselsytn, but few are likely to push the no-mercy diet on patients, simply because it's thought to be unachievable.
"This diet is looked at as extreme as you can get, so many physicians instead of going to the extreme, go somewhere in the middle," said Dr. Joe Crowe, director of the breast center at the Clinic.
Crowe has followed Esselstyn's program since he suffered a heart attack at age 44 in 1996. He learned a new way of eating and said that once your taste buds adjust, you stop liking the taste of fat. You learn which restaurants to eat at and how to navigate social functions, which for Crowe involves moving stuff around the plate "so it looks like I've eaten something."
He was lean and healthy, with no sign of heart trouble when his heart attack struck. He learned that the lower third of a main artery leading to the front of his heart was significantly narrowed. They call this vessel the "widow maker." Crowe wasn't a candidate for surgical intervention, so he turned to Esselstyn. Two-and-a-half years later, an angiogram showed the diseased artery was normal.
A need for large-scale trials?
Esselstyn has meticulously followed more than a dozen patients with advanced coronary disease who adopted his program. He writes in his book that patients saw cholesterol levels plummet and their angina disappear. After five years, 11 patients who underwent follow-up angiograms had stopped or reversed progression of the disease, he wrote.
"Patients with heart disease and their families, their greatest fear is when the next shoe is going to drop," Esselstyn said. "This is a very powerful gift they have given themselves and their families."
He counts cardiologists among those who have come knocking at his door for help. But he is first to admit he has not won a large number of believers at the Clinic. He tiptoes carefully on the subject of how his mantra plays there.
Dr. Steven Nissen, chairman of cardiovascular medicine at the Clinic, said Esselstyn's premise is unproven because nobody has conducted a rigorous study to show whether diet alone can reverse coronary disease.
"This is the reality," Nissen said. "We do the large-scale trials that somebody has to fund."
Nissen also cautioned that there is no "one-size-fits-all" answer for patients at risk for heart trouble. "I generally advise patients don't go out and buy a book and decide that's what you're going to do," he said.
But medicine should be a forum for different ideas, Nissen said.
On that count, the Clinic has made room for Essesltyn in his second career (he retired from surgery in 2000). He is part of the hospital's new Wellness Institute, headed by celebrity health guru Dr. Michael Roizen.
Esselstyn's wife, Ann, who is granddaughter of Clinic co-founder George Crile, is also a partner in his efforts. She authored a chapter in the book and contributed a volume of recipes, from banana french toast to veggie stuffed peppers.
Ann asks people she meets right off what they ate for lunch.
Together they counsel patients in their home, hosting four-hour sessions on how to shop, cook and eat in ways that most people never contemplated.
Ann accompanied her husband on his recent Clinic lecture, cradling a bundle of leafy greens to demonstrate the art of stripping leaf from stem.
Who knows? In an institution known for the best cardiac treatment in the world, kale and collard greens might be just what the doctor ordered.
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