#169: Should You Drink Your Greens? With Dr. Caldwell B. Esselstyn
A few weeks ago, we hosted a Facebook live event with Dr. Caldwell B. Esselstyn to discuss the importance of green leafy vegetables in preventing and reversing heart disease. During the broadcast, Essy shared the science behind chewing vs. drinking your leafy greens and he also spent time answering viewer questions. It was packed with so much information and action, that we’ve decided to share the playback in podcast format.
Ann even got in on the action because she was so darn jazzed about it! And you know her, when she’s excited, she just can’t sit still!
Essy answers:
What do we need to know about endothelial function?
What is nitric oxide and what functions does it perform?
What is so magical about green leafy vegetables?
Why we should chew our greens, as opposed to drinking them? What is the science behind this recommendation?
Why do greens have to be steamed? Is raw ok?
Can I use apple cider vinegar on my greens, or is it only balsamic vinegar?
What does caffeine do to your artery cells?
If I chew my green leafy ands still have a smoothie, is that ok?
Should I limit spinach, or should I mix up my greens?
How long should I chew my greens? Is there an optimum amount of time?
What effect does wine have on the endothelium?
What is the best way to store greens?
Ann and Essy's thoughts on microgreens or baby greens?
Can we eat the stems from our greens?
Is insulin resistance the core cause of cardiovascular disease?
Is hyperthyroidism improved with a whole food plant-based diet?
If I have a problem with tooth decay, is it ok to use toothpaste with fluoride?
What are some of Ann’s favorite ways to get greens into her meals?
Does Menirges Disease have any correlation with heart disease?
Where does exercise come into play? How important is it to our health?
I’m wfpb and my cholesterol is still high. Anything I can do?
What can I do to raise my heart ejection fraction rate?
How quickly can a plant-based diet improve your arteries?
Episode Resources
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Full Transcript
Rip Esselstyn:
If you're ready to level up your PLANTSTRONG lifestyle, I want to personally invite you to join the just announced Team PLANTSTRONG, and let's celebrate all that our bodies can do when fueled with the world's strongest nutrition. Our first event is going to be February 19th, 2023 in my hometown of 40 years, incredible, eclectic, weird, and amazing, Austin, Texas.
Let's train together and complete your choice of either a 5K, half marathon, or a full marathon, all while connecting with other team members from all across the country. We'll be sure to provide you with coaching, training plans, tons of support, and a weekend you will never forget. Let's show Team Beef and Team Dairy, what all the fuss is about. Join us today. Thanks.
Caldwell B. Esselstyn:
And I guess that the reason I'm so absolutely optimistic about the future of health in this country is that I see before us really what could be a truly seismic revolution in health. And the seismic revolution in health is never going to come about, with the invention of another pill, another drug, another stent, another bypass. But truly the revolution that is going to come about in health will come about when we in the profession have the will and the grit and the determination to share with the public and the patients precisely what is the lifestyle. And most specifically, what is the nutritional literacy that is going to empower them as the locus of control to absolutely annihilate chronic illness? Thank you.
Rip Esselstyn:
I'm Rip Esselstyn, and welcome to the PLANTSTRONG podcast. The mission at PLANTSTRONG is to further the advancement of all things within the plant-based movement. We advocate for the scientifically proven benefits of plant-based living, and envision a world that universally understands, promotes, and prescribes plants as a solution to empowering your health, enhancing your performance, restoring the environment, and becoming better guardians to the animals we share this planet with. We welcome you wherever you are on your PLANTSTRONG journey, and I hope that you enjoy the show.
I have to apologize about my voice. It's a little horse. I was screaming at a swim meet last weekend, and it totally, totally fried my voice box. So here we go. Last Friday, I hosted a live event with my father on Facebook. We do these Facebook Lives every Friday on our PLANTSTRONG by Engine 2 channel. And I invited my father, Dr. Caldwell B. Esselstyn Jr to join me and to discuss the importance of green leafy vegetables, which are an integral part of his prescription in preventing and reversing heart disease with his heart disease patients.
And during the broadcast, I took a lot of Q&A from the audience, and we discussed the science behind why my father specifically wants his patients to chew their green leafies instead of drinking them. And it was jam packed with a ton of information and action, that I decided to share the playback with all of you today. And I want you to know that even my mother, Ann, got in on the action, because she was just so darn jazzed about everything we were talking about. And you know her, when she's excited, she can't even think about sitting still. So enjoy this playback of our Facebook Live on the importance of chewing your greens.
And if you know somebody that's out there that you think may benefit from this hour of power with my father, please, share it with them. And a reminder, again, if you're on Facebook, make sure to like and follow our page PLANTSTRONG by Engine 2, because every Friday I go live with tips, recipes, and education to fuel your best PLANTSTRONG life. Enjoy.
All right, we are live. You ready to rock and roll Essy?
Caldwell B. Esselstyn:
Let's do it.
Rip Esselstyn:
All right. Hey, everybody. Welcome to our Facebook Live. It is Friday, October, God, is it October 28th or 27th? Does anybody know?
Caldwell B. Esselstyn:
28th.
Rip Esselstyn:
28th. Wow, 28th. So Halloween is just around the corner. And we're pulling out all the stops today. Instead of just getting myself, you guys get a double dose of Esselstyns today. You get me, Rip Esselstyn, along with my father, Dr. Caldwell B Esselstyn, Jr. He is coming to us live from Cleveland, Ohio, and I'm sure, if we can get a sneak peek of Ann, you might be hiding in there somewhere as well. Ann, where are you?
Ann Crile Esselstyn:
Hi.
Rip Esselstyn:
Hi Ann.
Ann Crile Esselstyn:
Hiding.
Rip Esselstyn:
So as you all know, last week we did a Facebook Live all about green leafies and the importance of getting green leafies into your life. Before that, we did protein, we've done fiber, we've done calorie density, but so many of you in the Q&A session, were asking such fantastic questions about green leafies that I thought it was only appropriate that we really bring in the varsity program here to address green leafies. And should we or should we not drink our green leafies in the form of smoothies and drinks and such?
So with that, again, I want to welcome my father. For those of you that don't know that much about my father, he is quite an amazing gentleman. He has been my hero forever. He won a gold medal in the 1956 Olympic Games in the eight ore rowing competition in Melbourne, Australia. He then went to medical school, he went to Vietnam where he worked as a surgeon in a MASH unit there, and won the Bronze Star in Vietnam. He spent, gosh, 30 plus years at the Cleveland Clinic as head of the Breast Cancer Task Force, has been awarded all kinds of accolades and awards over the years. And obviously he has written the book Prevent and Reverse Heart Disease that came out in 2007.
Bess, if we could just show people that really quickly. There it is right there. And if anybody wants to find out more about my father, you can go to dresselstyn.com for all kinds of great information. And he currently is the director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute. So, anyway, it's my pleasure to have him join us here today. And if you guys don't mind the informalness, I'm going to refer to him as Essy when I ask him questions. So, Essy, how are things in Cleveland today?
Caldwell B. Esselstyn:
We got a beautiful bit of sunshine, and we got lots of leaves.
Rip Esselstyn:
Awesome. So let's just jump right in. So when you wrote Prevent and Reverse Heart Disease back in 2007, you mentioned in there that plant-based nutrition has a very, very profound and powerful effect on our endothelial cells, that you refer to as metabolic and biochemical dynamos that produce nitric oxide. So what I'd love to do before we jump into the importance of green leafies and whether we should drink them or not drink them, could you give us a little like endothelial and nitric oxide lesson, like 101?
Caldwell B. Esselstyn:
Yeah, sure. I think it's so exciting to be with your group today, and some of you may very well be familiar with what I'm about to say. But on the other hand, repetition is a mother of skill. And for some of you who haven't heard it, maybe it'll be okay for the first time, and you'll make sense to you.
When you really look at cardiovascular disease, the truth be told, it's nothing more than a toothless paper tiger that need never, ever exist. And if it does exist, it need never, ever progress. Why? This is a completely benign, foodborne illness, and it's really almost embarrassing for the medical profession. When you think of the fact that we have known for over a 100 years, there are multiple cultures then and now where cardiovascular disease is really almost virtually nonexistent. Why is that? Because they thrive on whole food, plant-based nutrition without oil.
And it's interesting that that information, knowing it for a 100 years, why haven't we brought that information to this country where we have an absolute epidemic, where cardiovascular disease is a leading killer of women and men in Western civilization? So maybe we can chat about that a little bit as well. But let's talk about where this disease has its inception, its onset, its beginning, is when we progressively injure that delicate innermost lining of our artery called the endothelium, E-N-D-O-T-H-E-L-I-U-M, the endothelium.
And what makes the endothelium remarkable is the magic molecule of gas that it produces called nitric oxide. And it is, believe it or not, nitric oxide, this wonderful gas, that is responsible for the salvation, the preservation, and the protection of all of our blood vessels, because of the remarkable functions that nitric oxide possesses.
For example, nitric oxide will keep all the cellular elements within our bloodstream flowing smoothly like Teflon rather than Velcro, keeps things from getting sticky. Number two, nitric oxide is the strongest blood vessel dilator in the body. When you climb stairs, the arteries to your heart, the arteries to your legs, they widen, they dilate. That's nitric oxide. Number three, nitric oxide will protect the wall of the artery from becoming stiff, thick, or inflamed, and protect us from getting high blood pressure or hypertension.
Now number four is the absolute key. Number four, a safe and normal amount of nitric oxide will protect us all from ever developing any blockages or plaque. So, literally, everybody on the planet Earth who has cardiovascular disease, whether they are from London, Berlin, Chicago, New York, or St. Louis, or even Austin, Texas, it is because by now in the preceding decades, they have so sufficiently trashed, injured, compromised, and turned their endothelium into an absolute train wreck, that they no longer have enough nitric oxide to protect themselves from making blockages or plaque.
However, the good news here is this, this is not a malignancy, it's a completely benign foodborne illness. And once you can get patients to understand that never, never, ever again are they to pass through their lips a single morsel that is going to further injure an already train wrecked endothelium, because then the endothelium will recover, make enough nitric oxide so we can halt any disease progression. And we often see significant elements of disease reversal. Now, Rip, if you want, I'll take a break there or I will continue right on with what are the foods that injured the endothelium?
Rip Esselstyn:
Well, tell me this, so the Nobel Prize that was awarded in 1998-
Caldwell B. Esselstyn:
Right, that went to doctors Furchgott, Murad, and Lou Ignarro.
Rip Esselstyn:
And what exactly was that for?
Caldwell B. Esselstyn:
Well, up until 1980, we always used to think of the endothelial cells as these cute, little, red bricks that were lining these wonderful pipes. But that all changed in 1980 because of what Dr. Furchgott, working in his laboratory in Brooklyn, New York, was doing. He would take the largest blood vessel in the rodent, the aorta, and then he would do this sort of elliptical, spiral staircase, cut on it, and then he would immerse it in a bath of saline, and it would contract. But one day Dr. Furchgott took that aorta, and no cut, no injury to the endothelium and immersed it, and it dilated. This is new. Did it several more times, it dilated.
Now the race was on globally. What was this EDRF that Dr. Furchgott had discovered? Endothelial derived relaxation factor, thank heavens, that term was with us only eight years, because it was in 1988 that Dr. Furchgott, Dr. Lou Ignarro, and Dr. Murad discovered that the EDRF, the endothelial derived relaxation factor, indeed was a gas, and that gas was nitric oxide. And believe it or not, it was 10 years after that discovery that those three men received the Nobel Prize, because of the remarkable functions that nitric oxide possesses, which we've just discussed. That's what makes it so remarkable. That's why it was deserving of the Nobel Prize.
Rip Esselstyn:
Right. So it's the combination of realizing that the endothelial cells were these metabolic, biochemical dynamos, and the fact that they produce this magical gas nitric oxide.
Caldwell B. Esselstyn:
Yeah, and that's why everybody wants to understand the endothelial cell, because if you protect those, you'd make yourself heart attack proof.
Rip Esselstyn:
Roger. Thank you so much. So Essy, what are the foods that injure the endothelium?
Caldwell B. Esselstyn:
Well, we want to stop 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 chip, oil in a piece of bread, oil in the salad dressing, oil injures endothelial cells. Also, anything with a mother or a face, meat, fish, chicken, foul, turkey, and eggs. Also, dairy, milk, cream, butter, cheese, ice cream, and yogurt. Also, we want to go easy on sugar, sugary drinks, diet colas, Pepsi and Coke. We want to be sure go easy on sugary foods such as cakes, pies, cookie, stevia, agave, excesses of maple syrup, molasses, and honey.
For my heart, patients I don't like nuts, peanut butter, nut butters, cashew sauce, or avocado. And lastly, we want to avoid coffee with caffeine, decaf. Now, that list that I've just given you is not for people who don't have cardiovascular disease. That's the people who do have heart disease.
But while we're talking about that, in a way you could argue that I am talking to people who do not have heart disease. Because when you think about it, every single patient that I've ever seen for heart disease, at one time did not have heart disease. And how did they develop it? By the eating the foods that I've just described. So really what we want to do is have people become aware of this, because when you look at studies, for example, the pathobiologic determinants of atherosclerosis of the... that was a study in 1999, where they did autopsies on young women and men between the ages of 17 and 34 who had died of accidents, homicides, and suicides.
And now that piece is ubiquitous, everybody had an early onset, not enough for their cardiac events yet, but everybody by that late teenage early 20s already had the disease. So what I'm saying today, in essence, applies to everybody if you look at it and you want to be like those countries where cardiovascular disease is virtually nonexistent.
Rip Esselstyn:
Yes-
Caldwell B. Esselstyn:
We are never going to get rid of this epidemic with the present drugs, stent, and bypasses that cardiology... The cardiology tools we have today utterly fail. Why? Because they don't address the causation of the illness.
Rip Esselstyn:
Understood. Absolutely understood. I want to take a quick moment and say that we have some comments here and I want everybody to know we are going to take your questions probably in about 20 minutes or so. So think about any questions that you want to ask my father, and he'll be happy to answer them. We have a very, I think, funny comment here from Return to Jehovah that said, "Anne wasn't hiding, she was probably dragging a tire up some hill. That was the noise."
Caldwell B. Esselstyn:
That's her style.
Rip Esselstyn:
Yes, that definitely is her style. So, Essy, you just talked about the foods that we want to avoid.
Caldwell B. Esselstyn:
What are we going to eat?
Rip Esselstyn:
So what are the foods that we want to eat that are going to allow our endothelium to flourish?
Caldwell B. Esselstyn:
You want to eat all those marvelous whole grains, W-H-O-L-E, whole grains, for your cereal, bread, pasta, rolls, and bagels, 101 different types of legumes, lentils and beans. All these marvelous red, yellow, and especially green leafy vegetables, white potatoes and sweet potatoes and fruit. And nowadays, they're some wonderful books out with hundreds of recipes for that type of food.
Rip Esselstyn:
Yeah. Now, do you happen to know any off the top of your head?
Caldwell B. Esselstyn:
Any what?
Rip Esselstyn:
Any books that have some of these recipes?
Caldwell B. Esselstyn:
Well, we already saw one. Ann has 140 recipes in my book. Then she and Jane wrote The Prevent and Reverse Heart Disease Cookbook. And then there's one that has just come out after Anne and Jane worked on it for two years, and it's-
Rip Esselstyn:
Oh, Be a Plant-Based Warrior.
Caldwell B. Esselstyn:
... Be a Plant-Based Woman Warrior. And its got another... So there really, there's three or 400 recipes in those books. And there are other books, Neal Barnard, John McDougall, Rip Esselstyn.
Rip Esselstyn:
Okay. So let's dive in here. One of the things that you are really adamant about with your heart disease patients is that they consume, ideally, six servings of green leafies a day. What in your words is so magical about green leafies? Why are you so in love with them? And has that always been the case? When did that love affair with green leafies start for you? Because I don't remember seeing it in The Prevent and Reverse Heart Disease Cookbook. I mean, I'm sorry, book.
Caldwell B. Esselstyn:
No, that was probably about 10 years ago when I ran into Nathan Bryan.
Rip Esselstyn:
Yep.
Caldwell B. Esselstyn:
And the book that he'd written, and because by that time, nitric oxide was kind of on the scene. And I should share with you how this works. And that is, let's say, any patient that I have with heart disease, in addition to the food discussion that we just had of the foods that we want to avoid and the foods that we like to eat, I also started probably a decade ago asking people to eat the grains, and I'll tell you why.
I need them to chew, not smoothies or juicing. I want them to chew a green leafy vegetable six times a day, roughly the size of, let's say, half of their fist. After it has first been steamed five and a half to six minutes, so it's nice and tender. And then I want them to be sure to anoint it with several drops of a delightful either balsamic or rice vinegar.
Why? Because research has shown that the acidic acid from those vinegars, within your endothelial cell, they can restore the nitric oxide synthase enzyme, which is within that endothelial cell and essential for making nitric oxide. So I need you to chew this alongside your breakfast cereal, again as a mid-morning snack, again with your luncheon sandwich, that's three, mid-afternoon, four, dinnertime, five, and, of course, I adore it when you have that evening snack of arugula or kale.
Now, the second benefit that comes from showing the green leafy vegetable, research has shown that it restores the capacity of your bone marrow to once again make the endothelial progenitor cell. What does the endothelial progenitor cell do? The endothelial progenitor cell replaces our senescent, injured, worn out endothelial cells.
Now the third and most important of all, when you are chewing a green leafy vegetable, you are chewing a green nitrate. As you chew the green nitrate, it is going to mix with the facultative anaerobic bacteria that reside in the crips and grooves of your tongue. Those bacteria are going to reduce that green nitrate that you're chewing to a nitrite. Once you swallow the nitrite, it is now your own gastric acid, which is going to further reduce the nitrite to more nitric oxide, which can enter your nitric oxide pool.
So think about it, what you've been doing to acquire this green leafy vegetable, minimal expense, no hideous side effects, literally, and what you're doing is all day long dawn to dusk, you are absolutely restoring the molecule, nitric oxide, the very molecule that the deficiency of which has given you this heart disease in the first place.
Now, there's a caveat, and that is that according to Nathan Bryan toothpaste with fluoride, public drinking water with fluoride, and mouthwash can injure the beneficial bacteria in your mouth. And I do not like antacids because antacids will reduce your gastric acidity and you will not be able to reduce the nitrite to more nitric oxide. Now, the time the six top greens would be kale, Swiss chard, spinach, arugula, beet greens, and beets.
Rip Esselstyn:
And what about the wrap? Can you give us the wrap? Somebody's asking for the wrap, the green leafy wrap.
Caldwell B. Esselstyn:
You mean all of them?
Rip Esselstyn:
Well-
Caldwell B. Esselstyn:
You mean bok choy, Swiss Chard, kale, collards, collard green, beet greens, mustard greens, turnip greens, Napa cabbage, brussel sprouts, broccoli, cauliflower, cilantro, parsley, spinach, and arugula and asparagus. And the reason I like to do this is because it's to tell your audience how important whole food, plant-based nutrition is for maintaining your memory.
Rip Esselstyn:
Absolutely.
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So what are your thoughts on, do you still think that everybody should only chew their greens as opposed to... I get a lot of people-
Caldwell B. Esselstyn:
Yeah, I could be a little rigid on that. The reason I like it, quite frankly, is that when you think about it, many people, if they just fill a blender with greens and really blend it up, and it's so tart that they can't enjoy it at all. So they put in an apple or an orange or a banana. Now, I have no trouble with your eating an apple and orange or a banana, because when you eat it as a fruit, the fructose is so bound to the fiber that the absorption is slow, and it is safe. But once you put in an apple and orange and banana and beat it up with those green leafy vegetables, now, as you glog this into your stomach, it goes off like a rocket. Injures the liver glycase protein, and injures the endothelial cells.
And that's the very thing we don't want to have happen. So I'm a little bit against that, because of the fructose problem. Now, there is some data, but I'm not sure this is quite that solid, that also indicates that when you chew, it's a better form of fiber for your intestine than it is if you're just beat it up. Although there have been some, I think, people like Brooke Goldner have shown, I'm sure that she's had remarkable results with her reversing lupus with having a green smoothie.
Rip Esselstyn:
All right. You know what? We're getting enough questions here that I think it's time that we should dive into some of these questions. So let me just find this one to start it off with. It was about... Here it is, so it's by Connie Mayer. So she says, "Why do the greens have to be steamed? Isn't raw okay?" And my answer to this is, Essy, this is the way that Ann prepares them for you. And so you're very accustomed to that. I don't want to dissuade people from eating green leafies any way they can get them, whether it's raw, steamed, boiled, roasted. Do you not agree with that?
Caldwell B. Esselstyn:
Yeah, I think that, for instance, let's take, for example, the mid-morning and the mid-afternoon, maybe somebody's really highly at work and that's so terribly inconvenient. They just want to grab a handful of something that's raw. Certainly, I'm not against it. The reason I push for the heating is that there is some data that indicates that when you heat the green leafy vegetable, it greatly assists in the chewing process to break down the cell membrane, and get a maximum exposure to these wonderful phytonutrients.
Rip Esselstyn:
All right. I'm going to move on. This is a question from Chris B, he wants to know, is it only balsamic vinegar to get that acidic acid or are you okay with apple cider vinegar?
Caldwell B. Esselstyn:
No, it might well be that when it's tested that apple cider vinegar would work. However, what I try to do as a scientist is stick with the research. And the research that I'm aware of has been done with the balsamic and the rice vinegar. I have not seen any research that apple cider would work. It might work. But for my patients, I want to stick with what has been proven by research.
Rip Esselstyn:
All right, this question's from Annie Dahl, and we are getting a lot of questions regarding caffeine. What does caffeine do to your artery cells in particular? I've had a hard time finding a very direct and scientific answer. Can you please explain in more detail?
Caldwell B. Esselstyn:
Yeah. No, I'll tell you where that came from. There are two studies, one Greek, one Italian. I can share with you the Italian study. Oh, first, let me, explain first, the brachial artery tourniquet test. This is a way of testing, what's your level of nitric oxide. We don't have a really a handy way in the office to do this yet, but this is how it's done in research.
You take an ultrasound probe and you place it over a brachial artery at your elbow, and there you get a readout of the diameter of your brachial artery. And then for five minutes, you then encircle the upper arm with a blood pressure cuff that you inflate above systolic blood pressure so that for five minutes you have absolutely zero blood flow to your forearm and hand. And I can assure you I've had that done, but it's not exactly habit forming. Then you release this cuff after five minutes, immediately take the ultrasound probe, and, again, measure the new diameter of the brachial artery at the elbow. And in the normal individual, it'll be 30% greater.
So here's how the Italian study was done. It took two healthy young groups of men and women, half of them drank coffee with caffeine, the other drank decaf. Then after they drank it, they had the brachial artery tourniquet test measured. It was always the group that was having coffee with caffeine that injured and compromised the ability of their endothelial cells to make nitric oxide. Now, I don't have a problem with caffeine. I mean, I let my patients have green tea and black tea, but there's something about the combination. It's doesn't seem to be caffeine alone. It's something about the combination of coffee and caffeine in this study that resulted in a compromise to the endothelial cells to put out nitric oxide.
Rip Esselstyn:
Right. It's amazing how people do not want to give up their smoothies. They are just like, "What if I..." I see several questions. One is, "What if I chew my green leafies six times a day? Can I also still have a smoothie in the middle of the day as well?"
Caldwell B. Esselstyn:
Why not?
Rip Esselstyn:
Okay. And then somebody else is wanting to know if they drink their smoothies but then chew before they actually put it down their throat.
Caldwell B. Esselstyn:
As Michael Greger says, "You have to put it-
Ann Crile Esselstyn:
Put it to the test.
Caldwell B. Esselstyn:
... to the test."
Rip Esselstyn:
You got to put it to the test.
Caldwell B. Esselstyn:
Yeah. I think it would be fine. As long as you're getting green leafy vegetables safely down your throat.
Rip Esselstyn:
Chewing them.
Caldwell B. Esselstyn:
Yeah, chewing them is right.
Rip Esselstyn:
There's some questions about spinach. Do you have any issues with spinach because of the oxalates in there?
Caldwell B. Esselstyn:
No, occasionally, there'll be a patient... We've not seen that, let's see, in some 1400 patients over the last 30 years. It doesn't seem to have been an issue. But what you can do, because I think these patients, naturally, if they have a calcium oxalate stone and having kidney stones is no picnic, you can look up the green leafy foods that we've just talked about and choose the ones that are really low in oxalate.
Ann Crile Esselstyn:
But I have to add that you've got to mix it up. I mean, the more you get, the more variety the better. Not just spinach, not just anything-
Caldwell B. Esselstyn:
Oh, yeah.
Ann Crile Esselstyn:
... mix it up.
Caldwell B. Esselstyn:
I would second Ann in that. This is what I mentioned, that the top six greens would be kale, Swiss chard, spinach, arugula, beet greens, and beets. And almost all those are readily available. And the variety is really where the magic is.
Rip Esselstyn:
This is from Jennifer Diamond, she's like, "Why do some doctors say that smoothies are good for autoimmune disease like Goldner, and others, like you, say to chew them? It's very confusing for me."
Ann Crile Esselstyn:
It's different things.
Caldwell B. Esselstyn:
Well, I think that the investigators do what works. I'm sure that my patients would benefit powerfully from smoothies, and I'm sure that Goldner's patients would benefit powerfully from chewing them. I just have a little bit of... the way I have reviewed the research on this and also the results that I'm getting make me feel that I have pretty strong allegiance when you've got a winner. And I just don't like the idea of, I mentioned about the sugar, which is something that I don't want in excess of patients who have been injury to the endothelial cells, because I don't think we want to compromise their endothelial cells anymore.
Rip Esselstyn:
Well, you certainly have been very consistent with your message for a very long time and you have gotten some really incredible results. This is from Laurie Hayes, she wants to know, "Dr. Esselstyn, how long should you chew the greens? A few seconds or try for a minute?"
Caldwell B. Esselstyn:
Eating has to be an absolute pleasure and I don't want anybody to have to eat with a calculator. I think you would chew a green leafy vegetable and swallow it just as you would ordinarily, or with any other thing. Chew it until it's ground up enough that your mouth says it's time to swallow.
Rip Esselstyn:
This is from Judy McNary-Sherman, she wants to know, "What effect does wine have on the endothelium?"
Caldwell B. Esselstyn:
What's the word? Lime?
Ann Crile Esselstyn:
Wine.
Rip Esselstyn:
Wine. Wine.
Caldwell B. Esselstyn:
Wine.
Rip Esselstyn:
It's up on the screen if you can see that. It's up on the screen. What effect does wine have?
Caldwell B. Esselstyn:
There's no studies that I'm aware of that really directly show that it impacts endothelium. But alcohol is a toxin, whether it's beer or wine or whiskey, it's a toxin. It's toxic to your brain. It's toxic to your heart. It's toxic to your liver. And it's interesting that through the years, science has gone through of an evolution in this business. There was a period maybe eight or 10 years ago when it was thought that moderately drinking would help some of these people to live longer, and that's all pretty well been blown out of the water now. And the bottom line of it is that alcohol is a toxin, but being such a flexible person, I have told my patients that if on either Friday night or Saturday night they wanted one glass of wine or a beer, I think that's okay.
Rip Esselstyn:
All right. Liz Vallell, I think I'm pronouncing that right, this is probably better for Ann Essy. She wants to know, "What are the best ways to store greens, refrigerate, freeze blanch, et cetera?"
Ann Crile Esselstyn:
Well-
Rip Esselstyn:
And Ann, we can't see you. If you could get... There you go.
Caldwell B. Esselstyn:
There you go.
Ann Crile Esselstyn:
I'm hiding. Some people like to put things in a glass of water and store things like kale on the counter. I don't. I have a sort of a little compartment in our refrigerator and I often just wrap it in a kitchen towel. And by golly, it all lasts forever. I mean, it's amazing. Bok choy is particularly good at lasting, and romaine is great at lasting. I like to have three hearts of romaine, and you can tear off the bad part side, and it may last a month or more. Crazy.
Rip Esselstyn:
And you love using romaine, and then taking it as spoons in hummus, on road trips?
Ann Crile Esselstyn:
Sure.
Rip Esselstyn:
Yeah.
Ann Crile Esselstyn:
I kale that lasts for a really long time. And the other thing is when it gets droopy, et cetera, use it anyway, because it's going to droop when you eat it. So don't feel it has to be always perky.
Rip Esselstyn:
Got it.
Ann Crile Esselstyn:
Just as perky if you're doing a food show.
Rip Esselstyn:
Ann don't go too far away, because we're going to have more questions for you. But I'm going to pivot back to Essy now. This is from Tammy Omar, and she wants to know, "What are your thoughts, Dr. Esselstyn on microgreens?" You have any thoughts on microgreens?
Caldwell B. Esselstyn:
What are they?
Rip Esselstyn:
So microgreens are just kind of more like baby greens.
Caldwell B. Esselstyn:
Yeah. I think it sounds like they're fine.
Rip Esselstyn:
Yeah. I think that that's probably safe to say.
Ann Crile Esselstyn:
And start, I mean, gosh, I always have broccoli sprouts on hand. I grow them. I mean, I grow them furiously and they go in everything. And they're just wonderful.
Rip Esselstyn:
And when did you start getting so furious about growing broccoli sprouts and stuff?
Ann Crile Esselstyn:
About a year ago or more?
Rip Esselstyn:
Is that because of Doug Evans?
Ann Crile Esselstyn:
No, it's because of Polly LaBarre.
Rip Esselstyn:
Oh, there you go. All right, I like it.
Ann Crile Esselstyn:
But Doug Evans is a good influence. He's got great ideas.
Rip Esselstyn:
So Essy, this is a question from Tammy Perry-Cockrell and she asked, "Do you feel insulin resistance is the core cause of cardiovascular disease?"
Caldwell B. Esselstyn:
No. There can be plenty of patients who have no diabetes, no diabetic tendencies, and still they've been able to successfully destroy their endothelial capacity to make nitric oxide. Obviously, this whole process is often accelerated if you have hypertension or if you have diabetes.
Rip Esselstyn:
Got it. This is from Shobanna Holder, and she or he writes, "Does hyperthyroid get help with a whole food, plant-based diet?"
Caldwell B. Esselstyn:
No. That would be unfair to say that hyperthyroidism would be resolved with whole food, plant-based nutrition. No.
Rip Esselstyn:
Okay. This is from Janet Carlson, "I have a big problem with tooth decay and my dentist prescribed extra strong fluoride toothpaste. You have any thoughts on that?"
Caldwell B. Esselstyn:
Yeah, no, go ahead and protect your teeth. And really, it's so important, really overall, your risk for cardiovascular disease is increased if you have a lot of gum disease, and a lot of really problems with health of your teeth and your gums. Here's what I'd like to make a suggestion, if you stop and you're not going to use any fluoride, just to see... Because remember long before we ever sort of discovered nitric oxide, we were getting reversal of our patients just by eating carefully. We did not have them eating the foods that I mentioned earlier. Now, I forget what I was trying to say initially.
Rip Esselstyn:
Well, I think it was regarding the toothpaste, right?
Caldwell B. Esselstyn:
Oh, yeah. Because what you have now, you can see how you're doing with nitric oxide, if you will take your computer and write on it, nitric oxide test strips. You will find that there are a number of ways you can get these. You'll get a little plastic vial. It'll contain maybe 25 of these test strips. If you put a drop of saliva on it, it will turn either mildly pink or maybe moderately pink, or it will be a nice deep purple pink, which is an indication that you've got plenty of nitric oxide.
Rip Esselstyn:
Got it. I am looking through here, and, wow, a lot of great questions here. Ann, while I am sorting through some of these questions, what are some of your favorite ways of getting green leafies into your and Essy's mouths?
Ann Crile Esselstyn:
I put them everywhere. Whatever kind I've got. They can go in your morning oats. They can go beside your morning oats. They go in every sandwich. Of course, when you're having a salad, just load that salad with all the different kinds, not just one kind. All different kinds. For instance, if you've got one of Rip's pizza crusts, mix the greens in with that little packet of pasta sauce, and spread it out. And you wouldn't even know you had greens. And then top your pizza with salad greens and then a little sprinkle of a great balsamic vinegar. And oh, my gosh, it is awesome. You can just fill your pasta with a whole bunch of kale that you just cut up a little bite size pieces and cook it with the pasta. I mean, just get that everywhere. And if you have kids, they probably put it in whatever you're making. Make it part of it.
Rip Esselstyn:
Gotcha. Yep. Yep. This is a question from an Angela Ochoa, and she says, "Hi, doctor. Question, does Ménière's disease have any correlation with heart disease?"
Caldwell B. Esselstyn:
Well, Ménière's is sort of a imbalanced do to the problem with the inner ear, and that's a good question. But I don't know that we really had any solid research to show that Ménière's will be helped. We know that when you're eating plant-based, it will tend to preserve your hearing. Because if you have cardiovascular disease and it's affecting some of the vessels that are going to your ear, there will be a compromise in your hearing acuity.
Rip Esselstyn:
That makes a lot of sense. So a couple weeks ago we did a Facebook Live on the importance of exercise, and all the reasons we want to exercise. But Essy we have a question from Robin Martin-Turner and she wants to know, "Dr. Esselstyn, where does exercise come into play? How important is it? What do you recommend?"
Caldwell B. Esselstyn:
Well, exercise is an absolutely huge bonus. It does wonderful things for your brain, your head, your endorphins, especially if you're doing exercise that involves all your muscles. You can imagine what it's like to keep your muscles from going into sarcopenia or atrophy. And if your muscles are going to carry you up, it's going to be helpful for your balance. It's going to be helpful for your digestion. It's helpful for your sleep. I mean, you just can't strictly realize because some people make the mistake knowing that there's so many wonderful benefits from exercise. I will occasionally get a phone call a patient saying that to me, something like this, "Dr. Esselstyn, I have no business having heart disease ever. I'm 65 years old, but ever since I left high school, I've gone to the gym five days a week."
And that's an absolute mistake. I mean, to think that going to the exercise is going to preclude you destroying your endothelial cells every day by the food you eat, actually, when preserve your endothelial cells and you exercise, now you've got the best of all worlds.
Rip Esselstyn:
Right.
Ann Crile Esselstyn:
Essy's already today biked. And I already today-
Caldwell B. Esselstyn:
Dragged your tire.
Ann Crile Esselstyn:
... have dragged my tire.
Rip Esselstyn:
Oh, you did. So you were doing it up the stairs, that's what all that noise was.
Ann Crile Esselstyn:
Yeah.
Rip Esselstyn:
So Ann, this is from John Stump, and he wants to know what are your thoughts on eating the stems from beets and kale?" Are you a fan of that? I know that you've done it before.
Ann Crile Esselstyn:
I'm a fan of it. Sometimes it's a pain, because I have so many stems that I just want to throw them out. But I remember one time when Rip was coming to visit and I cut up my kale stems, I cooked them, and I gave them to Rip, and I said, "Rip, what do you think?" And he said, "I don't know what vegetable that is." So I mean, cook your kale stems. I mean it's nice to strip kale, only, because otherwise it's not cooked evenly. But put the kale stems in soup, cook them, and offer them to your guests. Dogs love them.
Rip Esselstyn:
Judy just got back from swimming and eating a kale salad,
Ann Crile Esselstyn:
Oh, Rip, Rip, Rip, I forgot something. I mean use the beet stems, they're wonderful and to soup. I mean, they give a little great red color. So I always try and find a way to use the beet stems.
Rip Esselstyn:
Lovely. This is from Charlotte Thompson, Essy, she wants to know, "How large is the recommended six daily servings of steamed leafy greens, a total of six cups or three cups per day?" People want to know exactly, when you say six servings, they want to know what that means.
Caldwell B. Esselstyn:
I said something that's roughly half of your fist, or it can be a little bit less than half of your fist, depending upon what size it is. But I don't think that should be too much of a concern here.
Rip Esselstyn:
Well, and a follow up question to that, that I've seen is people want to know, "Well, could I eat six servings over the course of breakfast, lunch, and dinner, or do I need to spread it out throughout?"
Caldwell B. Esselstyn:
That really should be something that's subjected to research. But I guess my gut instinct is this, since these heart patients are so desperately devoid of enough nitric oxide to protect themselves, I want them to have streaming into their metabolism all day long, dawn to dusk. I want them to be creating nitric oxide. I don't want it just at breakfast.
Rip Esselstyn:
Okay. All right. There you go. All right. Let's see here. I am finding... So this is just a nice testimonial from Lorr, "My life has changed since finding you and Jane and Rip on the internet. I have all of your books, cookbooks, and I cannot thank you enough. I have lost 77 pounds. My BMI, blood pressure, cholesterol, and A1C are all normal and perfect levels. I am plant exclusive, no oils, no added salt, no sugar. I go to the gym five days a week. I weigh 135 pounds and I am finally normal. Bless you all."
Ann Crile Esselstyn:
Wow.
Caldwell B. Esselstyn:
Tough to beat that.
Rip Esselstyn:
Isn't that great?
Ann Crile Esselstyn:
Great.
Rip Esselstyn:
So this is from Judy, and occasionally, Essy, we get questions similar, Judy Lynn. "I'm whole food, plant based and I'm trying to do everything, but my cholesterol is still high. Anything that I can do?" To me, there's a lot of things that... I would say, first of all, I'm going to take the front half of this question for you is that it's really important to know what exactly you're eating. Because a lot of times people think they're doing it correctly and inadvertently they're not. What would you like to add to that, Essy?
Caldwell B. Esselstyn:
Over the years at this seminar that I conduct once a month, I have about somewhere between 20 and 25 patients, all of whom I have personally called beforehand, maybe for 30 or 40 minutes to try to understand their story and get my arms around their concerns. And then at the same time, what we often find is that patients who come to the seminar have discovered, long before they came, that they simply cannot take a statin. So their cholesterol is 180, 200, 220. And if I had a 1,000 patients who perfectly followed all the recommendations we have, there are going to be some patients who have a total cholesterol of a 102, a 130, 160, 180, 200, 220.
But what we have found is if they are eating as we've indicated, they are going to be absolutely fine. Now, one way, and I wanted to add this, that they can confirm this, suppose their cholesterol is 200 and no matter what they do, how pure they are, that's the thermostat of their liver. That's what their liver wants to produce. Now, what we then do is I asked them to ask their doctor to see if they will get these anti-inflammatory tests. I'm going to read them off to you. There are five of them, an oxidized LDL, ADMA, which stands for asymmetric dimethylarginine, myeloperoxidase, TMAO, and HSCRP. Those will measure inflammation.
If you've got a cholesterol at 200, 220 and all those inflammatory tests and indices are in the normal and acceptable range, you're going to be fine. You suppose that everybody in rural China, Okinawa, the Papua Highlands in New Guinea, that never had a cholesterol of 200. Sure there are. They don't I have a heart disease. Why? Because they have no inflammation.
Rip Esselstyn:
Got it. All right. So, Essy, I have a couple people saying they want to raise their heart ejection rate. You have any thoughts on that?
Caldwell B. Esselstyn:
Let me talk about the ejection fraction. What this measures is the capacity of your left ventricle to eject blood into the aorta and it goes throughout your body. Anything over 50% is supposed to be normal. Now the things that can make it abnormal are when you've got some problem with that heart muscle. Now, one of the things that can happen is you've had a heart attack. All right? Think of it this way.
When you have a heart attack, there's a portion of that heart muscle that dies and is replaced by scar or fibrosis. And the scar and the fibrosis doesn't contract. So if you had a ejection fraction of 65, it may now drop down to 55. Or if the heart attack is large enough, it will go into the 40s or even the 30s. Now you've got to think of what the heart muscle is like adjacent to the part that died. So here you have this scar, and then after the scar stops, then you get viable heart muscle. But remember this, that the muscle that is next to the part that die has really got less than optimal blood supply. And we call that hibernating muscle.
Hibernating muscle. And it appears that when you begin to eat plant-based, let's say, that your ejection fraction was 38, now you're eating plant-based. And what's happening is as you eat plant-based, you are beginning to open up all those small little tiny hibernating vessels. And now you've got to open those vessels, you've got enough oxygen and nutrients from blood that those previously hibernating muscles, which were not contracting, now contribute to the contraction. And your ejection fraction will go from 38 maybe to 45, often it will go over 50, and get you back into the normal range.
Rip Esselstyn:
Wonderful answer. Thank you for that. Have you ever heard this? This is from Barb Wire, she... That's great name Barb wire, wow. 12 years she's been whole food, plant-based. And she says that her nails are weak and must be watched daily. Have you ever heard of that or any thoughts?
Caldwell B. Esselstyn:
I've heard of weak nails, but I've not heard of any study that indicated that a whole food, plant-based nutrition would compromise your nail health.
Ann Crile Esselstyn:
She may not be eating leafy greens.
Caldwell B. Esselstyn:
Yeah. Try eating more green leafy vegetables, let's see.
Rip Esselstyn:
Yeah. You guys are doing such a wonderful job asking such great questions. You're welcome. A lot of people appreciate you jumping on Essy and taking time to do this. I think, gang, that we are very close to a stopping point here. So I just want to say thank you to Ann and Essy for jumping in today as we kind of tackle the second part of this green leafy issue, which is should we chew our green leafies? And is it okay to drink them? And I hope you feel a little more comfortable going forward about, I think, that according to my father and what has worked with his patients over the last, what? Since 1984, how many years is that Essy? Ann?
Caldwell B. Esselstyn:
37.
Rip Esselstyn:
So the last 37 years is actually not having them then drink their green leafies, but to chew them. But it sounds like that's tried and true for him.
Ann Crile Esselstyn:
I'd say keep chewing them until you get so old you don't have any teeth, and then it's really nice to be able-
Rip Esselstyn:
There, we love it.
Ann Crile Esselstyn:
And the other thing is, for kids, don't feed kids smoothies. They will never learn-
Caldwell B. Esselstyn:
Learn to chew.
Ann Crile Esselstyn:
... to like anything except having something sweet. Green be something sweet.
Rip Esselstyn:
I think a great way to end this Essy and Ann is with this question here that I really like, and let me see. Oh, here it is, it's from TJ Samuel, it came in at 1:55 Bess. So how soon can a plant-based diet turn your arteries around?
Caldwell B. Esselstyn:
I think we have evidence that probably that... Let me address that in terms of when do we see the endothelial cells coming around? And that was best defined, I think, by a study that I did with patients with triple vessel heart disease. And they did a PET scan. And the PET scan shows the area of heart muscle that has been well-perfused with blood as being orange or yellow. But this patient has a little patch that was absolutely green. And the green area, it clearly indicated that that was being poorly perfused with blood.
And then I counseled him, and it was three weeks later that we repeated the PET scan. And the patch that was green, that indicated poor perfusion was now re-perfused. So while I tell you three weeks, that's when we measured it. But suppose we measured it at two weeks and six days or two weeks and five days? In other words, it was probably even sooner than that.
And I think that where we see that happening is in, let's say, I have a patient come who has angina chest pain after they walk, let's say two blocks, they begin to get chest pressure. As soon as they really commit often to whole food, plant-based nutrition, it is staggering how rapidly within two, four to six, eight or 10 days, they say, "Dr. Esselstyn, remember, I used to have to walk two blocks to get that chest pressure. Now, I've got to walk six or eight blocks before I get chest pressure." They now know that what they're doing is absolutely working. And I have one final comment, Rip, if I may.
Rip Esselstyn:
Please.
Caldwell B. Esselstyn:
And I guess the reason I'm so absolutely optimistic about the future of health in this country is that I see before us really what could be a truly seismic revolution in health. And the seismic revolution in health is never going to come about with the invention of another pill, another drug, another stent, another bypass. But truly the revolution that is going to come about in health will come about when we in the profession have the will and the grit and the determination to share with the public and the patients precisely, what is the lifestyle. And most specifically, what is the nutritional literacy that is going to empower them as the locus of control to absolutely annihilate chronic illness? Thank you.
Rip Esselstyn:
Hey, thank you. All right. Hey, I'll talk to you guys later today. Thanks for joining our PLANTSTRONG Live. All right. Everybody chew your green leafies, six servants a day. Thanks. Bye-bye.
Thanks so much as always for listening and asking wonderful questions. If you happen to have an idea for a live Facebook event or even a podcast, please feel free to reach out to me at hello@planstrong.com. I would love to hear from you. In the meantime, get those six, count them six servings of green leafies in every day. And when you do, you'll be keeping it real and keeping it PLANTSTRONG. Yeah, as in kale yeah.
The PLANTSTRONG podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin, and Wade Clark. This season is dedicated to all of those courageous, truth seekers who weren't afraid to look through the lens with clear vision and hold firm to a higher truth. Most notably my parents, Dr. Caldwell B Esselstyn Jr, and Ann Crile Esselstyn. Thanks for listening.
