#74: Dr. Brian Asbill - A Cardiologist's Switch from Stents to Sweet Potatoes
Dr. Brian Asbill
It’s not often that a doctor is inspired to make a lifestyle change because of a patient, but this is the incredible Galileo moment that Dr. Brian Asbill shares today on the PLANTSTRONG podcast.
As a cardiologist for 19 years, Dr. Brian Asbill had become adept at diagnosing and treating patients with medications and procedures, a variety of chronic diseases, yet many of his “optimally managed” patients continued to suffer from recurrent cardiovascular events.
A couple of years later, a patient gave him a copy of Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn and, shortly after finishing reading it, he met with a patient who was having daily angina and had been told that he would require a third open-heart surgery. Instead of immediate surgery, Asbill gave him the book and told him to come back and see him in three months unless his symptoms worsened.
Three months later, that patient returned and both of their lives were irrevocably changed. He had lost 27 pounds, dropped his cholesterol by 100 points, and, within a week of changing his diet, had started walking on a treadmill thirty minutes daily while requiring NO nitroglycerin tablets for relief of chest pain.
Procedures and prescriptions would not have matched the difference that he had made by simply changing to a whole-food, plant-based diet.
Why was this not routinely taught in medical school?
Because of this new truth, Dr. Asbill made the decision to fully transition from cardiology to lifestyle medicine, becoming the first in the world to do so. It was time to leave the “sick care” system behind and begin building a true “healthcare” system founded upon optimal nutrition, physical activity, and stress management.
He is now part of Ruckus Health and committed to helping clients prevent, treat, and even reverse their chronic medical conditions through permanent lifestyle change. Today, Dr. Asbill shares his personal journey and the inspiring stories of his patients who have saved their own lives with the power of plants.
Episode and PLANTSTRONG Resources:
Rip's Rescue - "Make Yourself Heart-Attack Proof” - LIVE on March 18th - with Dr. Brian Asbill and the Esselstyns - Register for FREE
Ruckus Health with Dr. Brian Asbill
PLANTSTRONG Rescue 10x - Hop on the waitlist for our next session.
PLANTSTRONG Meal Planner - Save $10 off the annual plan with code: PLANTSTRONG
PLANTSTRONG Foods - Pizza Crust is Back in Stock. Bookmark this page for upcoming food announcements!
FULL TRANSCRIPT
Dr. Brian Asbill:
... I'm a believer in just sharing, "This is the data."
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
"And now you get to decide what you want for you, and I will support you in that, and I'm going to push you as far as you let me push you to whole food plant-based. Because I know that that's the best outcome, for you." You've got complete veto power. You can say, "No, I'm not ready for that yet." No problem. It's a process, we're going to loosen the lid and then we're going to take the lid off next time.
Rip Esselstyn:
Season three of the PLANTSTRONG Podcast explores those Galileo moments where you seek to understand the real truth around your health, and dare to see the world through a different lens. This season, we honor those courageous seekers who are paving the way for you and me. So grab your telescope, point it toward your future, and let's get PLANTSTRONG together. Hello, this is Rip Esselstyn, and welcome to the PLANTSTRONG Podcast. I'm going to start today with a very depressing statistic. Right now, close to 650,000 people die each and every year of heart related disease. That's one in every four deaths. And despite the headlines surrounding COVID, which are tragic, heart disease is still the number one cause of death in the United States and around the world. To quote my father, Dr. Caldwell B. Esselstyn Jr. "Coronary artery disease is nothing more than a toothless paper tiger that need never exist. And if it does exist, it need never progress."
Rip Esselstyn:
I want you to get a visual on that, "A toothless paper tiger". I've heard my dad say it a thousand times, but really think about it. Heart disease sounds like a death sentence. And like a tiger, it's nothing something you want to have lurking in your body or stalking through your life. It sounds fatal, and final, and deadly. But it is toothless and made of paper. That's because heart disease is not just the luck of the draw or even some genetic crab sandwich served to you by your family members. Yes, you can be predisposed or even have risk factors baked into your genes, but it's your lifestyle that turns these genes on and off. You ultimately control the destination over that paper tiger and whether it grow fangs or remains toothless.
Rip Esselstyn:
Today, I want to introduce you to cardiologist, Dr. Brian Asbill. After years of treating patients wrecked with poor lifestyle choices, debilitating surgeries and multiple medications, Dr. Asbill had his own a-ha moment, that inspired him to divert from traditional cardiology and become the first person in the world to become certified in lifestyle medicine. What does that mean exactly? Well, in nut shell, lifestyle medicine focuses on the whole person and the importance of several factors, including nutrition, exercise, stress management, sleep, and our relationships as the foundation of good health. A healthy lifestyle is the medicine, instead of going straight to the pills and the procedures.
Rip Esselstyn:
Today, Brian, will tell us about that journey and share some of the dramatic stories and results that he's seen in some of his own heart patients who have been empowered to make positive lifestyle change. And as a bonus, make sure you keep listening because later, I'm going to tell you all about a free live event we'll be hosting with Dr. Asbill and my father, and you're invited. Here we are, season three of the PLANTSTRONG Podcast. I want to welcome Dr. Brian Asbill. Brian and I actually go back to 2018, I believe it was, when you came to Plant-Stock that was in Asheville-
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
... North Carolina. That was a doozy of a weekend that we had there, and I'm so glad you were able to come. And then since then, we've gotten together a handful of times. You came down to Austin, to visit the Whole Foods headquarters and John Mackey, and to see if you guys could arrange a little business deal there.
Dr. Brian Asbill:
Definitely.
Rip Esselstyn:
That was really fun and exciting. But you are doing some really exciting things in the field of cardiology, and I want to get into that in a second. But before I do, I want to ask you just this, at what age were you when you knew that you wanted to go into medicine?
Dr. Brian Asbill:
That's a good question. Actually what comes to mind is say about 14. And I actually wanted to be a zoo vet. For a long time I wanted to take care of polar bears and tigers, and stuff like that. And I remember sitting at my grandmother's kitchen table, and she sat me down when I was about 14 and said, "No, you're going to be a doctor or you're going to be a pastor, and you're going to have pets." And I didn't want to be a pastor, so I'm a doctor. It worked out okay.
Rip Esselstyn:
And so at 14 that road was just already getting paved for you-
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
... and you never looked back. Is that right?
Dr. Brian Asbill:
I never looked back. It's funny, when I talk to other people who have had different careers. I think a lot of doctors sometimes are a little bit envious of those people who had more of a circuitous route. The only negative I could say about the doctor path is that it is just so strait. It's high school, college, med school, internship, residency, fellowship, and then you're finally there. It's a straight and narrow path, so I'm glad to have recently detoured.
Rip Esselstyn:
You have, and we going to talk about that. Where did you go to medical school?
Dr. Brian Asbill:
Medical University of South Carolina in Charleston.
Rip Esselstyn:
Got it.
Dr. Brian Asbill:
... in the country. I grew up in Columbia, South Carolina. And so that was a financially the right option for me.
Rip Esselstyn:
Yeah. So you're in medical school and what year were you in when you decided, you know what? I'm going into cardiology?
Dr. Brian Asbill:
Well, I didn't decide at that time. I decided to go into internal medicine because it was sort of what I thought a real doctor would be about, sort of intellectual. I didn't want to be a surgeon but I wanted to know a lot about everything. So internal medicine felt like the right fit. And then I wasn't even sure honestly, after my internal medicine residency into my last year. So I had a year where I was in private practice in between internal medicine residency and cardiology fellowship. Cardiology appealed because it was a mix of acute care, heart attacks, and more of chronic care. Where you really get to follow patients for a long time. Some procedures but completely procedural, it was just is a nice mix of things for me.
Rip Esselstyn:
Mm-hmm (affirmative). When did you get out of your residency?
Dr. Brian Asbill:
I finished my residency in 1997, and then finished my cardiology fellowship in 2001.
Rip Esselstyn:
Okay. So 2001, you're out into the big bad world-
Dr. Brian Asbill:
Your world.
Rip Esselstyn:
... and now you are a cardiologist, right?
Dr. Brian Asbill:
Correct.
Rip Esselstyn:
Help educate me here on there's probably lots of different types of cardiologists like interventional. What kind of cardiologist were you?
Dr. Brian Asbill:
So, I was what they call an invasive non-interventional cardiologist. Cardiology, just like everything else, has gotten really subspecialized. I did a little bit of everything in my training. I put in some pace makers, I did some stents. I did a lot of heart catheterization, stress test, echos, everything, really a broad base. But I didn't want to just be in the cath lab all the time. So I didn't want to be an interventionist, when you put the stents in. I didn't want to be an electrophysiologist, when you put pacemakers in. I didn't want to be a heart failure specialist, when you put in ventricular assist devices and things. So I wanted to be a general cardiologist. So I decided I wanted to continue to do heart cath, where we squirt the dye in, and we'll talk about that I'm sure. And look at blockage in the heart arteries. But then I had to call in one of my partners to do the fixing, the stenting.
Rip Esselstyn:
Okay. So that's what you mean when you say non-interventionist?
Dr. Brian Asbill:
Correct.
Rip Esselstyn:
Okay. Okay.
Dr. Brian Asbill:
Correct.
Rip Esselstyn:
All right. So you're doing that, and you started it in 2001 or so.
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
Season three of this podcast is about when the person I'm interviewing had their Galileo moment. When they had that a-ha moment that was like-
Dr. Brian Asbill:
Mm-hmm (affirmative).
Rip Esselstyn:
... you know what?
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
I think there's something to plants, and the power of plants that is absolutely undeniable. And you have such a powerful awakening that it shifts the course of your destiny, and of your life's work, and your belief system. I'd love to know when and how that happened with you?
Dr. Brian Asbill:
Yeah, I'd love to share that. I call that my epiphany. I enjoyed cardiology, I still do. My partners have been great. By the way, they've been very supportive, incredibly supportive sort of my right turn here. A lot of my patients still continue to speak with so many of them. It was about 2013, and I had realized over the first 12 years of my practice that no matter ... I was also a lipidologist. So I was a cholesterol expert, boarded in lipidology, cholesterol metabolism. So I had patients where I thought they were perfect. Their blood sugar is perfect, their blood pressure is perfect, their cholesterol is perfect, they're on all the right medications. But I was a little bit disappointed and shocked, frankly, at the number of patients that would continue to have recurrent events even though they seemed to well managed, on all the right stuff. I had not other tools in the tool box to offer them.
Dr. Brian Asbill:
And in that I think that learned helplessness a little bit, contributes to the whole physician burn out thing. I hesitate to use the word burnout but I think it's a real thing. In 2013, I had a patient come to see me who was in his mid-60s. I actually spent part of the year in Ohio, never Cleveland, and part of the year actually in Black Mountain. I mean it's incredible how [crosstalk 00:11:25] it's been really as interesting how all these connections have happened. But this man is the guy who changed my life. In fact, I'm putting my mud water tea on top of the card that he's recently sent me, a Christmas card that I still have on my desk because it just reminds me of where I came from. So he had had two open heart surgeries, two CABGs. We call them, coronary artery bypass grafts, C-A-B-G, CABG. So if you hear me say, "CABG." That's what I mean.
Rip Esselstyn:
Okay.
Dr. Brian Asbill:
Coronary heart surgery. Taking the arteries out of your wrist, out of your chest, the veins out of your leg and literally reconnecting them from your aorta, the major blood vessel coming out of the heart. Around the blockage so that you're bypassing the obstruction, bypassing the blockage. And he had had two of those procedures. And he was having angina, exertional chest pain every day. So he's taking about three to five nitroglycerine pills under the tongue for relief of his chest pain every single day, and obviously very frustrated. In fact, he was a little bit tearful in the office and recounting to me that he can't do what he wanted to do, recently retired.
Dr. Brian Asbill:
And he had come to see me for a second opinion, because it had been recommended to him that he have a third open heart procedure. And the first question he asked me was, "How many patients have you had who've had three?" And I've had two. And he said, "And how are they doing?" And I said, "Unfortunately, they're both deceased." They did get some quality of life for a little bit of time after that third procedure, but you've run out of what they call conduits at that point. You don't have any more bypasses to use that are yours, so you're using bypasses from cadavers. And our body sort of rejects those, and so-
Rip Esselstyn:
Okay. Can we stop for a second?
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
I want our listeners to understand this whole bypass thing-
Dr. Brian Asbill:
Okay, yeah. Please.
Rip Esselstyn:
... a little bit better.
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
So when you say that he had run out of conduits, so you basically take vessels from your own body. Typically, where do these vessels come from? You said, I think, the wrist and the leg.
Dr. Brian Asbill:
Yeah. Yeah.
Rip Esselstyn:
Okay.
Dr. Brian Asbill:
So we're talking about replacing coronary arteries, so we'd like to use arteries to be the bypass conduits. So the ones that really seem to work the best are the internal memory arteries which run down here on either side of your breast bone, your sternum, on the inside of your chest. Those work quite well. Really, really well. We use the radial arteries here in the wrist, leading up to the base of the thumb. We've used a couple of others in the past, but those are the arteries that we typically use. Conventionally, we also use the veins in the leg.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
But then we're asking veins to serve as arteries, and they don't work as well as we wish they did.
Rip Esselstyn:
So tell me, with these bypass procedures, typically, I've had some stats but I want to know if you've heard the similar ones. What percent usually fail after one and a half, two years, three years?
Dr. Brian Asbill:
Yeah. So that was actually data that was published in the New England Journal of Medicine, which is the Bible of medicine. That was 2009. The data that they shared was about 30 plus or minus a couple of percent. Okay, 35% to 50% of vein grafts will develop about a 75% narrowing within 12-18 months.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
It's not what you hear when you're having your third open heart surgery.
Rip Esselstyn:
No. So you have better results when you're using arteries from the wrist to the ...
Dr. Brian Asbill:
Generally speaking, yes.
Rip Esselstyn:
Right. And then what happens when you take that artery from the wrist that goes, you said, I think you said to the thumb. What happens there? Do you need a replacement there or does it ...
Dr. Brian Asbill:
No. No.
Rip Esselstyn:
No.
Dr. Brian Asbill:
You've got a radial artery here and you've got an ulnar artery here, and there's a circle in your hand. So you can feed your hand, as long as you've got an ulnar artery that works. So we do a test to make sure that you have a working ulnar artery before we carve out your radial artery. You can perfuse your whole hand just from the ulnar artery because of that circle in there.
Rip Esselstyn:
Got it.
Dr. Brian Asbill:
So it's like having two kidneys. When you have two kidneys, one seems to do okay.
Rip Esselstyn:
Right. So you some redundancy there and it works. Okay.
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
Good. Good. Good. Okay. So, I cut you off. But if you could continue with that, the patient.
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
So, well, he's looking at three-
Dr. Brian Asbill:
The three peat, we call that. And you think there's got to be another way. And as luck would have it, I had given been given a book by a patient of mine, called Prevent and Reverse Heart Disease.
Rip Esselstyn:
Never heard of it.
Dr. Brian Asbill:
You're dead.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
And it's amazing. It truly is amazing how this happens. So I had read the book, and I had tried a couple of things. With that point, I was not completely plant-based, I went completely plant-based, my cholesterol dropped 45% in a month. So I said, "Listen, your symptoms are stable, this is not an emergency. Okay, this is not an emergency procedure. Go try this, read this book, and come back and see me in three months." Three months later, he came back, he's lost 27 pounds, which was what he needed, in over all. His cholesterol had dropped 100 points, as a lipidologists I have to say, there's nothing that I was trained to do or offer you that would have been as impactful as simply changing what you ate. And that was my moment. That's when I said, "I've got to find out more about this. And I have a feeling this is going to change my life and my career." And it has.
Rip Esselstyn:
And so, as a cardiologist as somebody that's trained to use a certain set of tools. And now you're facing this whole new paradigm. Can you remember at first thinking ... I don't want to look through the telescope and see that and go too far into that, because it's going to really mess with my life and confuse me? I mean, was there any of that for a little while?
Dr. Brian Asbill:
No, oh, yeah, absolutely. I mean, you've obviously talked to a number of doctors who've shared that, because, or else you just have incredible insight.
Rip Esselstyn:
No, I haven't. No, I haven't-
Dr. Brian Asbill:
That really took me some time. It was not an overnight thing, where I said, "Okay, this is what I'm going to do." I began to read more and more about it, and study more and more about it. Plant-based nutrition and lifestyle medicine in general, I became board certified. Well, I say, first I started offering CHIP. The Complete Health Improvement Program.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
Here in Nashville, in 2014. And I heard two things from that. I heard patients say, " I haven't felt this good in years." Which is not something that my patients had been telling me in the cardiology office on 10 different medications and side effects, and it just felt bad. And the other thing they said was, "Why has my doctor never told me this before?"
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
And that was another moment when I thought, what am I going to do here? Am I going to bury my head in the sand and making good income as a cardiologist and stay with that? Try to do the best I can? Or am I going to do something different? So 2014, we started doing CHIP. 2016, we started the Ornish Lifestyle Medicine Program here that I know you're familiar with. 2017, became board certified in lifestyle medicine, and told my practice that I was going to have to leave the practice to ... I'm still going to be the medical director of cardiac rehab at my hospital system. But I'm not seeing one on one cardiology patients now because I decided I needed to be a lifestyle medicine physician. And that's when we started a new practice. So it was very scary. And it took a lot of prayer and thought.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
It was about a two year transition for me.
Rip Esselstyn:
So you were at Asheville Cardiology and Mission Heart, and how many cardiologists are there at that hospital?
Dr. Brian Asbill:
We've added a couple since I left in August. I think now we're probably up to 27.
Rip Esselstyn:
Okay.
Dr. Brian Asbill:
Plus or minus.
Rip Esselstyn:
27?
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
So I have a couple questions for you about that. Of those 27, How many are also plant-based like you are?
Dr. Brian Asbill:
I'd say right now, completely, maybe two.
Rip Esselstyn:
And of those 27, were they willing to hear what you had to tell them about your results with your patients?
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
And how did they take that?
Dr. Brian Asbill:
They invited me to do cardiology grand rounds and talk about the program that we were going to bring, the Ornish Program in particular. In CHIP, they were very, very supportive. They were very open minded. Lots of good questions, lots of good discussions.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
Not unlike patients. I'm interested, I'm not sure that I'm ready to jump in with both feet yet, but I hear you, will support your intensive cardiovascular rehab program and send patients to you. They're like most people. Some of them said, "I'm all in." Some people said, "I'm skeptical." And a lot of people in the middle said, "I'm interested in you sort of plant the seed and let it grow at its natural time." Everybody's a little different.
Rip Esselstyn:
Yeah. So you gave that story of that one patient, they came in, he was staring at his third. Was it, did you say open heart?
Dr. Brian Asbill:
Yep.
Rip Esselstyn:
Third open heart. Oh, my gosh, I can't even imagine.
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
And where is he today?
Dr. Brian Asbill:
He moved back up to Ohio. I can't think of the name of the town, it's somewhere near Cleveland.
Rip Esselstyn:
Meaning, how's he doing?
Dr. Brian Asbill:
Oh, he's doing great.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
Let's see, that had been eight years. In eight years, I know that he had a stent in one of his bypasses. I don't know of more than that. He's also suffering a little bit from Parkinson's disease, which plant-based diet will help there as well, frankly. But he's had, instead of having third bypass surgery, he's had one stent in seven years, which is seven or eight years now. So yeah, much better.
Rip Esselstyn:
Yeah. So after him, you started working with other patients, and did you get really nice success with the other patients?
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
Again, yeah?
Dr. Brian Asbill:
Yes. Yeah. It's a spectrum. I mean, I think people who go all in, it depends on where you are. I mean, the people who were like him, desperate at the end of the road. They were the ones who are a little more motivated to say, "What? I'm going to go all out. I'm going to embrace this completely right out of the gate." Some other people say, "Well, I'm going to dabble." And I would say, "Look, there's data to support that the further you go towards that plant-based then the better your outcomes are going to be, I support wherever you want to be on that spectrum. I'm not going to not be your doctor because you are going to have steak once a week instead of every night. But, it depends on how you do it, if you haven't another event. We have to ratchet it up a notch. And the problem with heart disease, as you know, is that next event may be your last event. So that's pretty tricky."
Rip Esselstyn:
Yeah. If you are someone you know has been affected by heart disease, I want to invite you to join us for a free educational event on Thursday, March 18th, from 6:00 to 8:00 PM, Eastern Time. This virtual event will be the first in a series of new educational touchpoints, aptly named, Rip's Rescue. In each one, I'm going to connect you with medical luminaries who will provide insight and actionable steps that you can take immediately to stop the progression of chronic Western disease. In this first event, you'll hear more from Dr. Brian Asbill, plus my parents, Ann and Essel, as well as a longtime patient of my father's Jim McNamara. All to help you do what you can to make yourself heart attack proof. As firefighters were trained to be first responders to any emergency.
Rip Esselstyn:
Now that I'm a retired firefighter, I want to be your first line of defense. I want to help you rescue yourself from all these chronic diseases, one paper tiger at a time. Visit the show notes to register, or simply go to plantstrongpodcast.com and click the link inside this week's episode. We want everyone to know that heart disease can be prevented. It can be stopped in its tracks, and you can make yourself heart attack proof. So you mentioned lifestyle medicine. I did a little homework here, and I found out that ... and this is so crazy to me, that you of everybody, of everybody out there on the planet. You were the first person to become registered in lifestyle medicine. You were 00001. How crazy is that? And I love the fact that you are number one, and you were a cardiologist.
Dr. Brian Asbill:
Yeah, that's kind of unusual, isn't it?
Rip Esselstyn:
Yeah. Yeah.
Dr. Brian Asbill:
I didn't know that. I was walking through at the board meeting, at the lifestyle medicine annual sessions, taking the exam at the end of the sessions. And someone came up behind me and was screaming down the hall, "Number one, number one." And I thought, what is that lunatic doing? And I realized not until he was right on me that he was talking to me. I said, "What are you talking about?" He said, "You're the first person to register for the exam. Your certificate is going to be number one, you have to pass the exam, but you're going to be number one."
Rip Esselstyn:
Well, basically, you are the Jacques Cousteau of lifestyle medicine. Jacques Cousteau was number one when it came to scuba diving, kind of certificate. Just so for our listeners that don't quite understand lifestyle medicine. Can you give us a short overview of the difference between lifestyle medicine and primary care or primary medicine?
Dr. Brian Asbill:
Yeah, so lifestyle medicine is all about the evidence based. And I'll stress evidence based. A practice of helping people adopt healthy behaviors, to sustain health and well being. It's not just health. Let me that clear too, it's also well being. Because you can be healthy and need a lot of work done, mentally, psychologically, emotionally. So it just resonated with me, lifestyle medicine really looks at six different focuses. Plant-based nutrition, well, nutrition, specifically, whole food plant-based nutrition would be one. Exercising more, stress management, sleep, which is important. If you don't sleep well, you don't have the energy to really dive into this stuff. Toxin avoidance, so things like smoking cessation, risky alcohol use, benzodiazepines, opioids, major crisis, everybody's familiar with.
Dr. Brian Asbill:
And the least that really attracts me a lot to is the connection piece, the social connection piece. It's very difficult to do this by yourself. And behavior change. So you need connection. So lifestyle medicine really looks at all that. Primary care is just the doctor who's primarily in charge of your care. Your doctor, your general practitioner, your internist, your family practitioner, that's primary care. So primary care doc's, historically, many of them have not practiced lifestyle medicine. But now more and more of them are being board certified in lifestyle medicine and using that as sort of the foundation of treating their patients.
Dr. Brian Asbill:
Instead of saying, "Okay, you're overweight with diabetes, we're going to put you on Metformin. And you have high blood pressure, we're going to put you on Lisinopril." Let's talk about this. Let me educate you about the importance of lifestyle behaviors and plant-based nutrition. And maybe that would be what you want to try first before the medicines, or maybe we use them both and then win the medicines off just a complimentary.
Rip Esselstyn:
Yeah. Yeah. Telling me this, as a lipidologist as well. What red flag is elevated cholesterol level, in your opinion? Yeah.
Dr. Brian Asbill:
Yeah, that's a major red flag. Bill Roberts, would say, he posted in AJC American Journal of Cardiology for years would say, "It's sort of the sine qua non of heart disease, if you don't have high cholesterol, you're not going to have heart disease." We have seen patients certainly who've had heart disease, who've had, "Normal range cholesterol". Depends on, of course, on how you define normal. But if your cholesterol is under 150, your total cholesterol is under 150. Your LDL, your bad cholesterol is under 70. Something we call non- HDL, which is total cholesterol minus the good, is under 100. You're in a pretty safe zone there. But if you're not, if you're at the 200 total cholesterol level, which for years was touted as sort of the target to be below that. That's not going to protect you, you're going to have trouble.
Rip Esselstyn:
So what do you think? And I think we've talked about it here, but I just want to bring it up again. I mean, I feel like cardiology, they almost can't see the forest through the trees. And do you think that's because it's a conflict of interest is with, if I can make 50,000 for this stent, and 110 for this open heart. Like you said, I mean, maybe they have their heads in the sands and they don't want to see the evidence. I mean, I just can't imagine a doctor in 2020 that's not reading the research and staying up to date with that. I can see it going back to the 1990s when my dad and onus were really the only guys that were doing it. But now it seems like it's much more, I'm not going to say mainstream, but it's out there between Kim Williams and a lot of others. I almost feel like you have to be trying to look the other way not to have smelled it, or seen it, or heard about it in the last decade.
Dr. Brian Asbill:
Wow. I mean, there's so many that takes me in so many directions, mentally. First kudos to Kim Williams. Hearing you speak, it reminds me of him saying the other two types of cardiologists in the world. Those who are plant-based and those who don't know the data. I know I'm going to die, but I don't want it to be my fault.
Rip Esselstyn:
Right.
Dr. Brian Asbill:
So, I love that. And I told him I love that when I was at plants doc. There's a lot of reasons that cardiologist still do what they do. One is that, this is still what we're trained. I mean, you're trained to do a certain thing. We're trained in pharmacology, we're trained in procedures, we've spent years working on our knowledge of different medications, different interactions. We've spent years working on honing our skills in the cath lab. And we do what we do. I mean, we're to add plant-based nutrition, or for that matter, any other thing that has been in the future will prove to be something that we ought to be adopting. As you got to learn how to use the new tool. And when you're in a busy practice environment, seeing more and more patients in less and less time, it is incredibly difficult to pull out that new tool. We'll have time to learn how to use the new tool.
Dr. Brian Asbill:
It took me a long time to study for that American College or the lifestyle medicine boards. That's not something that just happens overnight, it takes a lot of time. And that's one thing we don't have. And the other thing is when we're seeing patients, if I have seven minutes to see you, it is far easier for me to write a prescription for you than to say, "You know what, we need to talk about your nutrition. Or, well, we only got two more minutes. We've talked about it next time. I'll say, once you come back in three months." Just this never ending circle. I applaud them for everything that they do. I will tell you that my joy in practicing cardiology was completely restored. When I was able to share with my patients, all that I learned from studying for the board exam, lifestyle medicine. And it was just a different style of practice, we're still managing the same thing.
Dr. Brian Asbill:
I'm still managing coronary disease, I'm still managing atrial fibrillation, still managing diabetes, hypertension, obesity, cholesterol, but just in a different way. And what I found is that patients really that's what they want. That's what they want. So, we'll get there. We're going to get there. And the other thing is that the lifestyle medicine residency curriculum is now out there. We're training the new doctors a lot more in nutrition than then the old school like me we're trained. And so they're going to have that tool in their tool belt when they come out, and it's going to be better for everyone.
Rip Esselstyn:
When you say that's what the patients want. Were you referring to this lifestyle, the new lifestyle, or the pills, and just that? No. Okay.
Dr. Brian Asbill:
They want to know that they have power. They love being empowered to care for themselves, to understand that this isn't something that's just some unavoidable process is happening to me. I have control over this. And I just need to get educated, I need the education first. I think that's always the first part, you don't know what you don't know. And then you need the opportunity to build the skills and the support as you're building those skills. And I just saw the light come on for so many patients when they thought, "Wow, I can do this myself." Yes, you can.
Rip Esselstyn:
Yeah, no. To me, there's nothing as powerful as a patient taking control of their health. And really, I like to say rescuing their health themselves. Because they are in control ultimately. But they just, many of them don't know it. They think, it's bad genes or it's my parents, it's my ... they'd like to blame it on their maybe their doctor, or their whatever their friends. But yeah, I have just found that when somebody really decides to own this, there's no stopping them. I want to pivot and throw this out at you. So today, we just crossed 500,000 people dying from COVID-19. I looked on the CDC website, and it shows that on average, we have about 655,000 Americans that die from, basically, heart disease every year. So it's about 155,000 more than have died of COVID in the last year.
Rip Esselstyn:
To me, the tragedy and all this is that ... and I'd love to hear your opinion. Is that, that 655K could probably be cut. It could be down 80% if not more so, if people would embrace what you're prescribing now with your lifestyle medicine. And then the spillover effect into the people that are dying from COVID because they don't have the heart disease, and they don't have the hypertension, and the morbid obesity, that number would probably be drastically lower as well. So anyway, I just find it also very tragic.
Dr. Brian Asbill:
Honestly, I can hear the emotion in your voice. The common denominator really in a lot of this COVID, cardiovascular disease, other chronic diseases is inflammation. Our bodies are just, we're beating them up all the time with what we eat and what we're drinking, what we're smoking, not resting, not exercising, and we're chronically inflamed. That's not ever going to yield optimal health. What I love most about lifestyle medicine, is that it is not, I'll never say that anything is a complete panacea.
Dr. Brian Asbill:
However, if you really do change your life, change what you eat, change how you move, change how you sleep, honestly, even change how you think. The mental piece, it treats it all. And it really treats it all. You lose weight, you're inflammation, your heart's better, your immune system is better able to fight off bacteria and viruses like coronavirus. You're never bulletproof. But you're pretty damn well armored. If you eat right you are. And it just, there's nothing else out there. There's no pill out there that attacks so many different disease processes. So, I'm 100% agree with you. 1,000% agree with you.
Rip Esselstyn:
Yeah, yeah. So remind me, when did you take that detour? And when did you leave, Asheville Cardiology?
Dr. Brian Asbill:
So, I left in August. I was rehired as the medical director of heart cardiac rehab for Mission Health, for Mission Hospital and several outlying hospitals.
Rip Esselstyn:
Did you see that happening? Was that part of your-
Dr. Brian Asbill:
Yeah. I thought that was going to happen. This is one of those moments in any podcast when you wonder if you should say this. So I'm going to say this. Mission Hospital, decided to get rid of their Ornish Program at the end of December. I had to go through the stages of grief. And I was pretty, pretty incensed, frankly, by the whole thing. Because I knew it was a financial decision. I get it. But I'm not happy about it. And so I was going to say, "No way. No way, do I want to do this. You're getting rid of my baby. I know this works." And they're going to transition, pivot to the Pritikin system. I know you're familiar with that, too. And a lot of your listeners. Nathan Pritikin, Pritikin Center in Miami. We're going to start that probably in June. Probably, some legal stuff needs to be done. But that's in process.
Dr. Brian Asbill:
The reason I said yes, there were two reasons that I said yes. Number one is that only 20% of people chose Ornish, you had to opt into Ornish. And it's a heavy lift as you know, there's a lot is required of you there. Okay, there really is, as eight hours a week for nine weeks. But only 20% of people chose that. And the Pritikin system is going to be the default cardiac rehab system for Mission Health. So everybody is going to go through Pritikin, so the reach is greater. I like that. I can't really compare it to Ornish, which I really loved because I haven't done it yet but I'm learning about it. The other reason I said yes, is that I'm really excited about doing a pilot project that just very briefly tell you it has to do with discharging patients from the hospital not only with their discharge medications, but with their discharge food.
Dr. Brian Asbill:
And how we will get it to them over a period of a month. And I think if we do that, I think everybody wins. I think the hospital wins because readmission rates are going to go down, and the patients are going to win because they're eating the right foods. The doctors win because they're going to get the experience of the patients not getting readmitted, and their light bulbs are going to continue to glow brighter and brighter. And they're going to say, "I remember Brian talking to me about this making a difference." And then it's going to get published in the medical literature, and then more doctors are going to see it. Pritikin wins because they're going to get ... they're going to have to give the patients the food. I just love projects like that where I don't see a loser.
Rip Esselstyn:
Yeah, that's good. That's good. We like no lose.
Dr. Brian Asbill:
Yes.
Rip Esselstyn:
So I have a question for you. So I know that the Pritikin program used to be pretty darn pure as far as being whole food plant-based. Has it gotten a little muddy over the years? I mean, have you looked at the program? And do they allow egg whites and some low fat dairy and stuff like that? And maybe that's part of the spectrum.
Dr. Brian Asbill:
Yeah, I think it is part of the spectrum. I don't have any long term experience with them since I'm just getting into this now. But Ornish said egg whites and no fat dairy. Not completely, it's not plant pure. Pritikin, just from what I was looking at this morning, actually. Fish, occasionally, four ounces of fish, fatty fish, salmon, anchovies, sardines, that sort of thing. It's not plant pure, it's not. And that was another issue for me as I decided to agree to do that. I wasn't sure if I wanted to put my stamp on that, quite honestly, so to speak. But I think it gives you an opportunity, it gives me a megaphone. This is the program, let's really dive into the data.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
And I will say that Pritikin says, it's really interesting. They said, "The best outcomes, the reversal, if you want reversal," this is what they said in the literature that I read this morning. "If you want reversal, you need to go whole food plant-based."
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
But this is a heart healthy diet. So, do you want the best outcomes? Do you want slightly less than? I want 87% of the best outcome. Okay, so I'm going to eat fish three ounce portion every other Thursday. It gets slippery. And you wonder, honestly, if they don't just say, This is what we think people can do. So we're going to propose this." Instead of, "This is what is best, and we're not sure that many people are going to do it. So we're not going to roll that out." I'm a believer in just sharing, "This is the data, and now you get to decide what you want for you. And I will support you in that. And I'm going to push you as far as you'll let me push you to whole food plant-based, because I know that that's the best outcome for you." But you are the one who gets to say, you've got complete veto power here. And you can say, "No, I'm not ready for that yet. No problem. It's a process. We're going to loosen the lid, and then we're going to take the lid off next time."
Rip Esselstyn:
Mm-hmm (affirmative). That sounds good. I'm glad you're doing that. What else do you have? Anything else that's really exciting you, these days?
Dr. Brian Asbill:
Oh, it's super exciting. So we co founded a business called Ruckus Health. Ruckus creating a ruckus.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
Disrupting a current sick care system and making it a healthcare system. Several of us are working on that project right now. And that really is what's taking most of our time. We're excited about where that's going to lead us. We could talk about that a long time. I'll leave it there for now. But we really just want to collaborate with anyone who's interested in supporting people as they recover their innate ability to live in physical, mental, emotional and spiritual balance. That's what we do.
Rip Esselstyn:
I like it. Ruckus baby, ruck yourself.
Dr. Brian Asbill:
Yeah. Sure.
Rip Esselstyn:
Let me ask you this before I let you go. What do you have to eat today so far? What do you have for breakfast? Let's start there.
Dr. Brian Asbill:
Great question. So I'm a creature of habit, although not as habitual as it sounds like your dad is. I had kind of your dad's breakfast. So I had oatmeal, a bowl of oats. In the winter, I have oats with a banana cut up for the sweetener.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
Half an apple. And then I microwave that so it just stir it all up.
Rip Esselstyn:
Is that Apple sliced up as well?
Dr. Brian Asbill:
It's chopped up. Yep. Half an apple chopped up. That Apple gets soft, the banana just turns into the oatmeal. Or I mean, you can't there's no banana pieces in anymore. It's just sweetened oatmeal. The riper the banana the better because I like it sweet. No added sugar. And then, let's see, then about a half a cup of mixed berries. Wyman's is what I use frozen because I put the frozen berries in there and it cools it off to where I can eat it faster. And then two tablespoons of flax meal.
Rip Esselstyn:
Yep.
Dr. Brian Asbill:
And then about, maybe a quarter cup of walnuts, a quarter cup of pepitas. Pumpkin seeds, the green ones. I love those. Occasionally, a few almonds. Occasionally, a little bit of hemp seeds, hemp hearts. Oh, and cinnamon. And a couple of good shakes of cinnamon and a pinch of salt. And then ...
Rip Esselstyn:
How big is that bowl? That sounds like a bit of a mother bowl right there.
Dr. Brian Asbill:
I haven't learned how to fill up the bowl without it in the microwave oozing over like a lava.
Rip Esselstyn:
Yeah.
Dr. Brian Asbill:
So the microwave where you have to clean it up. I'm 90% clean free. This thing probably weighs about a pound. I mean, it's a bowl as big as my head. It's a good start for breakfast. For lunch, actually, I had leftovers. I had tofu tacos. I did little cooking demo yesterday. And for Appalachian Sustainable Agriculture Project. I'm the president of board for ASAP.
Rip Esselstyn:
Wow.
Dr. Brian Asbill:
A little bit of board movement. And they wanted me to do a little video. So I video tofu tacos, and I had that leftovers for lunch.
Rip Esselstyn:
Nice. Nice. And is your family on board?
Dr. Brian Asbill:
Yes. Not 100% though. My wife is 100% on board. My older son's in college. And my younger son is a sophomore in high school. My boys are probably, I'd say they're 90% on board. I mean, they eat what I make. I'm generally the cook at my house. And so we, supper together all the time, breakfast together all the time. Lunch is kind of on your own. Occasionally, the boys might sneak in chicken into a salad or something. But yeah, I'd say I can say with confidence, I'd say 90% kids, 100% parents.
Rip Esselstyn:
Yep. Yep. It's a beautiful thing. It's a beautiful thing.
Dr. Brian Asbill:
Yeah, it is.
Rip Esselstyn:
Well, Brian, I want to thank you for being part of the PLANTSTRONG Podcast. I want to thank you for your courage and for making this detour that is really going to be impactful. And for doing your best to help further the mission of people seeing the light and being an advocate for people's health. Thank you very much.
Dr. Brian Asbill:
Thank you, Rip. Appreciate it. And thanks to you for doing the same.
Rip Esselstyn:
Oh, yeah. All right. Peace.
Dr. Brian Asbill:
Peace.
Rip Esselstyn:
Into two.
Dr. Brian Asbill:
Into two.
Rip Esselstyn:
Keep it PLANTSTRONG.
Dr. Brian Asbill:
Yeah.
Rip Esselstyn:
All right. Okay, don't forget, March 18th. You're going to hear from Dr. Asbill plus my father, my mother, and myself. It's live, it's free, and it's going to be our first Rips Rescue event called Make yourself Heart Attack Proof. To register visit this podcast episode page at plantstrongpodcast.com. Next week, I'm thrilled to welcome Team Sherzai, doctors Dean and Ayesha Sherzai, back to the PLANTSTRONG Podcast to talk about the release of their upcoming new book, The 30-Day Alzheimer's Solution. From heart disease to neurological disorders and beyond, we're here to help eradicate chronic Western disease the PLANTSTRONG way. Hope to see you next week. And one other insider note for our podcast listeners, we're about to open our Rescue 10X Mindset Mastery Program to those who are on the wait list.
Rip Esselstyn:
This program only is offered a few times a year and gives people who need it 10 weeks of group coaching, accountability and support. If you've tried absolutely everything, I can't stay on track with a PLANTSTRONG lifestyle. This program is for you. If you want to finally jump off the cycle of yo-yo dieting and get yourself in the mindset for success. I want to invite you to check out the program, go to rescue10x.com, that's the number 10 followed by the letter X and enter your phone number. We'll then text you a VIP discount code as soon as the program opens. Don't miss out. Visit rescue10x.com or click the link in the show notes today. Thanks.
Rip Esselstyn:
Thank you for listening to the PLANTSTRONG Podcast. You can support the show by taking a quick minute to subscribe, rate and review at Apple Podcasts, Spotify, Amazon Music or wherever you listen to your favorite shows. Sharing the show with your network is another great way to help us reach as many people as possible with the great news about plants. Thank you in advance for your support, it means everything to me. Have you had your own Galileo moment that you'd like to share? What happened when you stepped into the arena and shed the beliefs that you thought to be true? I'd love to hear about it. Visit plantstrongpodcast.com to submit your story, and to learn more about today's guests and sponsors. The PLANTSTRONG Podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin, and Wade Clark. This season is dedicated to all 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.
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