#290: Dr. Caldwell B. Esselstyn, Jr. - The Proof Is In The Plants! Real Stories of Heart Disease Reversal
We're wrapping up National Heart Health Month with an inspiring conversation with Dr. Caldwell B. Esselstyn, Jr., a true pioneer in heart health and a passionate advocate for the power of a whole-food, plant-based diet.
With decades of experience as Director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Center of Prevention and Wellness, he’s seen firsthand how a whole foods, plant-based diet without added oil, sugar, or sodium can not only prevent, but actually reverse heart disease.
Dr. Esselstyn shares nine of the ways he has shown reversal of disease through incredible stories from his patients who have transformed their heart health.
Measures of Cardiovascular Disease Reversal. Watch the full YouTube Presentation HERE.
Coronary Angiogram
Stress Test
Pet Scan
Carotid Ultrasound
Pulse Volume
Angina
Claudication
Erectile Dysfunction
Ejection Fraction
These real-life successes prove that change is possible—at any age and any stage. If you're looking for hope and a path to a healthier heart, this episode is for you!
Key Episode Highlights
Numerous studies and data have demonstrated that a whole food plant-based diet can effectively prevent and even reverse coronary artery disease in patients.
The success of heart disease reversal programs relies on thorough patient education and a significant commitment to dietary changes, emphasizing the importance of time with patients.
Evidence shows that cardiovascular patients can rapidly experience significant improvements in their health, including the reduction of angina and claudication, through dietary intervention and lifestyle changes.
Dr. Esselstyn highlights that it is never too late to begin implementing dietary changes to reverse heart disease, with patients of all ages experiencing benefits.
The podcast stresses the importance of avoiding added oils in the diet, as they can disrupt endothelial function and hinder nitric oxide production essential for cardiovascular health.
About Caldwell B. Esselstyn, Jr.
Caldwell B. Esselstyn, Jr., received his B.A. from Yale University and his M.D. from Western Reserve University. In 1956, pulling the No. 6 oar as a member of the victorious United States rowing team, he was awarded a gold medal at the Olympic Games. He was trained as a surgeon at the Cleveland Clinic and at St. George’s Hospital in London. In 1968, as an Army surgeon in Vietnam, he was awarded the Bronze Star.
Dr. Esselstyn has been associated with the Cleveland Clinic since 1968. During that time, he has served as President of the Staff and as a member of the Board of Governors. He chaired the Clinic’s Breast Cancer Task Force and headed its Section of Thyroid and Parathyroid Surgery. He is a Fellow of the American College of Cardiology.
In 1991, Dr. Esselstyn served as President of the American Association of Endocrine Surgeons, That same year he organized the first National Conference on the Elimination of Coronary Artery Disease, which was held in Tucson, Arizona. In 1997, he chaired a follow-up conference, the Summit on Cholesterol and Coronary Disease, which brought together more than 500 physicians and health-care workers in Lake Buena Vista, Florida. In April, 2005, Dr. Esselstyn became the first recipient of the Benjamin Spock Award for Compassion in Medicine. He received the Distinguished Alumnus Award from the Cleveland Clinic Alumni Association in 2009. In September 2010, he received the Greater Cleveland Sports Hall of Fame Award. Dr. Esselstyn received the 2013 Deerfield Academy Alumni Association Heritage Award In Recognition of Outstanding Achievement & Service, and the 2013 Yale University George H.W. Bush ’48 Lifetime of Leadership Award. Dr. Esselstyn has also received the 2015 Plantrician Project Luminary Award, the Case Western Reserve University School of Medicine 2016 Distinguished Alumni Award, and the American College of Lifestyle Medicine 2016 Lifetime Achievement Award.
His scientific publications number over 150, “The Best Doctors in America” 1994-1995 published by Woodward and White cites Dr. Esselstyn’s surgical expertise in the categories of endocrine and breast disease. In 1995 he published his bench mark long-term nutritional research arresting and reversing coronary artery disease in severely ill patients. That same study was updated at 12 years and reviewed beyond twenty years in his book, Prevent and Reverse Heart Disease, making it one of the longest longitudinal studies of its type. In July of 2014 he reported the experience of 198 participants seriously ill with cardiovascular disease. During 3.7 years of follow up of the 89% adherent to the program, 99.4% avoided further major cardiac events.
Dr. Esselstyn and his wife, Ann Crile Esselstyn, have followed a plant-based diet since 1984 and Dr. Esselstyn presently directs the cardiovascular prevention and reversal program at The Cleveland Clinic Center of Prevention and Wellness.
Episode Resources
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Full Episode Transcription via Transcription Service
Rip Esselstyn 00:00:00
I'm Rip Esselstyn and you're listening to the PLANTSTRONG podcast. I can't think of a better way to close out National Heart Health Month than with a man whose legacy and body of work has influenced me over the years and saved countless lives. Today, my father, Dr. Caldwell B. Esselstyn, or who I affectionately call Essy, is back for his sixth appearance on the PLANTSTRONG podcast, and he's gonna share with us the many ways that he has shown reversal of heart disease through the power of a whole food plant based diet. We'll have the heartwarming news right after this message from PLANTSTRONG. I know that you've heard me say that I am literally standing on the shoulders of giants, and I am. For decades now, my father, along with the likes of Dr. Dean Ornish, Dr. John McDougall, Dr. Joel Fuhrman, T. Colin Campbell, and Dr. Michael Klaper, amongst others, have been unwavering in their message that a whole food plant based diet can prevent and even reverse heart disease. And they haven't just been proclaiming this with zero data. Rigorous evidence based research and clinical trials have shown this to be true. And that is why I'm proud to carry the legacy of my father's work. Today, I welcome Esse back for a casual conversation as he shares multiple patient stories and the many measures that he has shown in patients of cardiovascular disease reversal. If you want to follow along with visuals and graphics, I would highly encourage you to watch it via YouTube. I'll put that link in the show notes for you, and I'll also link up to a presentation on this very topic that he did live for us a few years back. I cannot think of a better way to close out Heart Health Month than knowing that there is hope. You can get that beautiful heart pumping loud and proud. And the great news is it is never too late to start. Let's welcome Dr. Caldwell B. Esselstyn Jr. Este, so wonderful to see you for your. 1, 2, 3, 4, 5. You know, this is your sixth time on the PLANTSTRONG podcast.
Dr. Caldwell B. Esselstyn, Jr. 00:02:44
There you go.
Rip Esselstyn 00:02:45
Yeah. And just when you think that you've had, you've said it all, we realize that you haven't. And so this month, February is Heart Healthy Month, and we're celebrating all things Heart healthy. We had your friend from Montefiore, Dr. Robert Osfeld.
Dr. Caldwell B. Esselstyn, Jr. 00:03:05
Yeah.
Rip Esselstyn 00:03:05
On the podcast, we had Dr. Columbus Batiste.
Dr. Caldwell B. Esselstyn, Jr. 00:03:12
Great.
Rip Esselstyn 00:03:13
We had Dr. Joel Kahn.
Dr. Caldwell B. Esselstyn, Jr. 00:03:15
Sure.
Rip Esselstyn 00:03:15
And. And to kind of round things up and kind of bring it home, we've Got the man himself, Dr. Caldwell B. Esselstyn Jr. So thank you for. For joining us. So, you and I today, and Anne, and make a peek, because I want to wish you both Happy Valentine's Day. Right? I mean, from here.
Dr. Caldwell B. Esselstyn, Jr. 00:03:39
And.
Rip Esselstyn 00:03:40
And just make a. Make a blaze. Come. Come by so everybody can just see your streaking face. We can't see you.
Dr. Caldwell B. Esselstyn, Jr. 00:03:46
I kept my man. Hi.
Rip Esselstyn 00:03:50
And I love that blue. Oh, thank you.
Dr. Caldwell B. Esselstyn, Jr. 00:03:54
I love it when you wear blue, too.
Rip Esselstyn 00:03:56
I know. I'm wearing gray. So, Essie, what I would love to do today, and for those that. That are not aware, let me just kind of give a little summary of your current position at the Cleveland Clinic, where you've been since, what, 1960. You've been at the Cleveland Clinic in some form, right?
Dr. Caldwell B. Esselstyn, Jr. 00:04:17
61.
Rip Esselstyn 00:04:18
1961. Yeah. Exaggerated years.
Dr. Caldwell B. Esselstyn, Jr. 00:04:21
Yeah.
Rip Esselstyn 00:04:22
So you're currently the director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute. Would you agree with all that?
Dr. Caldwell B. Esselstyn, Jr. 00:04:35
Actually, recently, they changed the title of the will to the center of Prevention and Wellness.
Rip Esselstyn 00:04:41
Okay. Center of Prevention and Wellness. I guess that'll work. And so what I want to do is I'd love for us today to focus in on the 10 Ways over the course. Since you've been doing this since 1984, doing this research to show that heart disease is not only preventable, but it's also reversible. Let's talk about the 10 ways that you've been able to document that coronary artery disease is, in fact, preventable and reversible. Does that sound good to you?
Dr. Caldwell B. Esselstyn, Jr. 00:05:15
Yeah, let's do it. You have to help me out if I forget one.
Rip Esselstyn 00:05:19
Okay. Well, you got it. I don't. Unfortunately, I don't have the list of 10 in front of me, but I have some of them that I can remember.
Dr. Caldwell B. Esselstyn, Jr. 00:05:30
I have nine. We'll make it all right.
Rip Esselstyn 00:05:34
Okay. Okay.
Dr. Caldwell B. Esselstyn, Jr. 00:05:35
I'd like to start, first of all with saying that I think the thing that's so profound about knowing cardiovascular disease is to realize that everybody on the planet Earth who has cardiovascular disease at one time had no disease. Would you agree?
Rip Esselstyn 00:06:01
Absolutely.
Dr. Caldwell B. Esselstyn, Jr. 00:06:02
In other words, what we really have to examine is what do people do to themselves from a position of having absolutely wonderfully clean arteries, to have them begin to silt up, fill up with blockages and plaque? Why does that happen, for instance? And we have to be aware that when you think about it, the medical profession has a really a serious black eye about cardiovascular disease, because we have known for over 100 years that there are multiple cultures on this planet Earth, where cardiovascular disease historically was really relatively non existent. For instance, rural China, central Africa, the Tarahumara Indians in northern Mexico, Okinawa and the Papua highlands in New Guinea. No heart disease. Why they thrive on whole foods, plant based nutrition. But where the black eye occurs, Think about it. The American Heart association was formed in 1924. Now that means that's quite a few years. Matter of fact, that's a hundred years that they've been watching all these other societies without any heart disease. And what we've ended up sadly in western civilization. New Zealand, Australia. Right. And the United States and Europe, South Africa. We don't treat the causation of the disease. That's the black eye. What do we do? We use drugs, we use stents, we use bypasses. Not one of which has one single solitary thing whatsoever to do with the causation of the disease.
Rip Esselstyn 00:07:53
Isn't that interesting? Yeah, well, so it sounds like a bit of a. Well, would you call it a charade? What would you call it? Is it just kind of misguided emphasis on what to do?
Dr. Caldwell B. Esselstyn, Jr. 00:08:08
There's a combination of things. One is that cardiovascular participants or physicians in medical school have no nutrition and they have none really of substance in their postgraduate training. And they've really never made it a science in their instruction about these nations where the disease is non existent. There's another wrinkle that sadly has entered this and I have always hated to mention it, but I think in reality we have to. And that is what do you suppose you would get in the way of remuneration if you talk to a patient about Brussels sprouts and broccoli compared to the remuneration there would be if you did a quadruple bypass or stents or spent time on drugs. So there is a financial conflict in methods of therapy. Because what I've been doing for years is that many of the patients that come to see me are those who have previously been told that they have to have a stent or a bypass and truly they don't have to have it. But the person who has been counseling them has no awareness or no training in this.
Rip Esselstyn 00:09:37
Well, to your understanding, what does a stent. The average stent run these days is about 50 to 75,000.
Dr. Caldwell B. Esselstyn, Jr. 00:09:45
Oh, I'm sure.
Rip Esselstyn 00:09:47
And then an open heart bypass is probably what, 125k?
Dr. Caldwell B. Esselstyn, Jr. 00:09:51
What, more than that? I would think.
Rip Esselstyn 00:09:53
Yeah. Yeah. Okay. As opposed to Brussels sprouts and steel cut oats. It'll run you a couple bucks. Okay, so anything else that you want to say before you dive into the nine or 10 ways that you've been shown to reverse heart disease?
Dr. Caldwell B. Esselstyn, Jr. 00:10:14
No, I think that's really. Yeah, I want to be sure that people understand there are a number of physicians who are aware of our program of arrest and reversal of disease. And sometimes I'll get a call from one of them saying, you know, Dr. Esselstyn, I believe, and I've in your, in the science that you've recorded, but I just am not able to get my patients to do that. And I said, well, then I will ask them usually, well, can you tell me how much, how much time do you spend with these patients? And the response usually is, well, Dr. Esselstyn, you have to know that I'm a very busy physician. If I can give these patients 10 minutes, that's about it. Well, if you're going to. And there is a rather profound lifestyle change that occurs when you're asking patients to commit to whole food plant based nutrition and give up consuming animal foods. And if you're going to have a patient make a significant lifestyle change, you've got to show a patient respect. The only way that I know to really give a patient respect is to give more time. So on our present format that we have in counseling patients, there are two main items. One, there's a five hour session. The patients are going to learn all about how they have created their disease and precisely how we want to empower them as the locus of control to halt and reverse their disease. And the other part of the commitment is that I'm afraid I have to say I'm a little bit old fashioned and that every patient who comes to our seminar, my secretary, will give me their phone number so that two weeks before they come, I'm able to call them and have an opportunity to get my arms around their story and at the same time permit them to ask questions of me. So that coming to the seminar, we have a strong platform from which we can all move forward. And that's why in our first study, in our first review of this approach, which was published in the Journal of family practice in 2014, some 198 patients was interesting that close to 90% were committed to our program in this follow up. And of those who were committed, none of them in that follow up period had either a heart attack, stroke or death.
Rip Esselstyn 00:13:19
So, meaning when you say committed, meaning they were adherent to the tenets of the program.
Dr. Caldwell B. Esselstyn, Jr. 00:13:25
That's correct.
Rip Esselstyn 00:13:27
Right, Right. Yeah. That's phenomenal results. And to have 90%, well, what, 10 recidivism 90 compliance is kind of unheard of.
Dr. Caldwell B. Esselstyn, Jr. 00:13:39
The reason that, that. The reason that happens is that the reason my program succeeds where others may fail. Nobody else is as mean as I am.
Rip Esselstyn 00:13:52
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:13:53
And I mean attention to detail.
Rip Esselstyn 00:13:56
Yeah, yeah, yeah. All right, well, let's. Let's dive in, dive into the 10 ways that you've been able to show the reversal of heart disease. What do you want to start with? The big mothership? The coronary angiogram?
Dr. Caldwell B. Esselstyn, Jr. 00:14:11
Why not?
Rip Esselstyn 00:14:12
All right, so what have you been able to do with the coronary angiogram?
Dr. Caldwell B. Esselstyn, Jr. 00:14:18
The angiogram as a follow up is really rather challenging. And I will. Let me just, at the very outset, say that I do not like to ever think about using an angiogram as a follow up to show reversal of disease, because people can die getting an angiogram when you thread that catheter up into an artery to the heart. And especially if you're doing a stent or something, because the heart was never designed to accept these catheters, especially into the vessel. And then patients can develop really a fatal arrhythmia. And I'm aware of patients. When we were first starting our study back in 85, I was aware of patients who had died as a follow up to how they're doing after they've been on the program. There have been some angiograms that have been done where it has been insisted. But the patient, or in our very first group, there were expert cardiologists who had sent me these patients, and they were as insistent as were the original patients in saying that they wanted to know what was happening. And that group did fine. Nobody got seriously ill and gave us the information that we wanted. But subsequent to that, I've now treated. At last count, it was a little over 1,800 patients this way. And my preferred way of follow up is, as I said, not an angiogram. But it can be a stress echo stress test, which has no radiation and has no contrast that might injure the kidney. So a stress echo stress test is my preferred method, especially when you see that usually within 10 or 12 months after starting it, if it was abnormal at the start, it'll now be markedly improved or back to normal. But I want to come back to an angiogram for a minute because there are some people who have been skeptical. When I published the original works showing the angiograms, I should say that every one of the angiograms from that original group was reviewed in the Cleveland Clinic Angiography core laboratory in triplicate by senior technicians that do this all the time for national medical studies. So there was absolutely rock solid accuracy in the way they did this. And.
Rip Esselstyn 00:17:16
And for people that don't know what an angiogram is, will you explain how it's kind of like an. An X ray of the.
Dr. Caldwell B. Esselstyn, Jr. 00:17:23
Of the disease nowadays? Originally, a catheter was introduced through the groin, up into the aorta, and then up into the right and left artery of the heart. And then contrast was injected, and then an X ray was taken, and you could see whether there were blockages of significance in the vessel.
Rip Esselstyn 00:17:50
How many times would you say you have been able to show reversal through before and after angiograms?
Dr. Caldwell B. Esselstyn, Jr. 00:17:59
On multiple occasions? Yeah, there are at least five or six that we've got. And that's. It's really quite spectacular. Some people will often say, how long does it take to have that happen? Well, I can give you evidence that it varies between one or two or three years to get it all the way. Some plaques that are made up of fibrosis and scar and calcification.
Rip Esselstyn 00:18:31
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:18:31
Actually may be very stubborn. And although they don't go away, it's interesting that even those patients can get back to full activity of daily living without restriction. And I should make a further comment on that. Actually. There was a wonderful slide that actually came from you, RIP Several years ago. It shows a heart and a contrast has been injected into the arteries. So you see all the main arteries which are on the top of the heart, and where do they go? They all dive eventually into the heart muscle where they bifurcate and join other arteries. So you have this amazing constellation of thousands and thousands of interconnected intramuscular arteries. Now, the reason this is important is the following. We learned some time ago that when patients who come to us with chest pain or angina, they will actually, within, sometimes within two, four, six, eight or 10 days of starting our program, their angina will either markedly diminish or disappear. And there's another study that we're going to talk about shortly called a PET scan. But my fascination was how in the world was it that I just knew that we couldn't get rid of a blockage within two to three days. So I called down to Rodriguez, who actually is the chairman of cardiovascular pathology at the Cleveland Clinic. He looks at the heart of 200 patients who come through autopsy, and I asked him, how often do you ever see a plaque or blockage? The thing that was fascinating, when Rodriguez said that they never had any plaque, then, then I had the answer as to why they were getting better within two, four, or six days. Why is that? Because when we first see these patients, they are absolutely. Their endothelial cells are so injured, they are barely making any nitric oxide, which is the great dilator of the blood, of the arteries to the heart. And at the same time, when we first see these patients, they're so sick. They're endothelial cells which normally make this wonderful vessel dilator. They are now your enemy. They're making two molecules of endothelin and thromboxane, which are vasoconstrictors. So what happens is, obviously, not only are those three main arteries to the heart constricted, but all those thousands upon thousands of interconnecting intramuscular arteries are blocked not by blockage of plaque buildup, but they blocking because they are vasoconstricted because of these two molecules of endothelin and thromboxane. But the exciting thing, as soon as you get these patients to convert, they start once again making this nitric oxide vasodilator on their own. And at the same time, they stop making the vasoconstrictor. What does that translate to? That means that all within two, four, or six days, all those thousands upon thousands of intramuscular arteries that are sort of clamped down and narrowed open up. You recall in Poissier's law of flow through the hollow viscous, it's related to the fourth power of the radius translation. Tiny increase in diameter, a huge increase in blood flow.
Rip Esselstyn 00:22:47
Yeah. All right, fantastic. So you want to move on. So that's the angiogram.
Dr. Caldwell B. Esselstyn, Jr. 00:22:55
Yep.
Rip Esselstyn 00:22:56
What you want to move on to, the stress test or the PET rubidian scan. What do you want to talk about?
Dr. Caldwell B. Esselstyn, Jr. 00:23:01
Well, let's take the stress test. That's often a key for the cardiologist when he's first beginning to evaluate a patient who. Where it's kind of iffy whether he should really go ahead and. And get a lot of the cardiology tests or not. But it's a stress echo. Stress test is safe, easily performed, and it also can pick up or help pick up other. So you don't have to do an angiogram or something more extensive. It can pick up whether or not the heart is actually suffering from a deprivation of its normal supply of oxygen and blood and nutrients. Because what happens on a stress echo stress test, you're looking at the heart beating, and you're looking at how well the wall is constricting. And if somebody has a deprivation of blood flow to a portion of the heart, you will see that at rest, it seems to be doing just fine. But then you put the patient under a little stress. Stress echo. And at stress, because of the narrowing of blood vessels, there is insufficient blood supply, so that muscle cannot constrict as it normally should or as it did when the patient was at rest. And so you can then identify heart segments that are being poorly defined with blood. And then it may indicate that you should do some further testing to clarify just how significant is the blockage. That's the stress test. Stress echo. Yeah.
Rip Esselstyn 00:24:50
Right. And you've had great success with that.
Dr. Caldwell B. Esselstyn, Jr. 00:24:55
Oh, it's exciting because that's the safest way for the patient to see whether our program is working as far as they're concerned. Because let's say that they start at baseline and they fail their stress test. And if they Repeat that at 10 or 11 months, it'll either be markedly improved or back to normal.
Rip Esselstyn 00:25:18
And so. And so you mentioned, like with the coronary angiogram, that's usually 1, 2, 3 years. It's all dependent. I remember seeing one of a patient from Florida where after six months, there was a reduction from about 100% to 80% blockage.
Dr. Caldwell B. Esselstyn, Jr. 00:25:35
You're absolutely right. It was a reduction at six months, but he actually had to go on for another year and a half to get it. Actually, it all went away with Brown. But while you're on that, I want to come back to a patient that after all these years, this one was really unique from Seattle. This is a gentleman who. In September, it's very important to follow these dates because it actually portrays precisely the point that I'm trying to make. So In September of 2023, he began to get discomfort in his abdomen when he was eating. And it wasn't much, and he kind of put up with it and thought it was just he had gas or something. And now in December, though, of 2023, it began to get severe enough that he made some changes in his diet. Well, that didn't seem to work. So it was still in December of 2023. On the 26th, just after Christmas, he had some further changes in his diet. And then suddenly, now we went to 2024 in January, about a week or two later, he made some changes, and he gave me a call. And he gave me a call because in that first week of January, he had had imaging done of his vessels in his abdomen and his superior mesenteric artery, which supplies all the blood supply to your small intestine. His superior mesenteric artery had a 75% blockage. Wow. And that's when I. That's the first week in January. Two and a half, three weeks later, he noticed that his pain was not only improved, but the pain was gone. So believe it or not, now this is after his first imaging that was done in early January. Now the first week in February. This is four weeks after being on treatment. He had another imaging and the area in the same radiologist when they imaged the blockage in the superior mesenteric artery had completely 100% gone.
Rip Esselstyn 00:28:19
Four weeks. That seems hard to believe. What do you attribute that to?
Dr. Caldwell B. Esselstyn, Jr. 00:28:22
No, but I want to stay on that a little because I don't think I ever would have believed that until it just had worked out that way. Think about it. In that sort of situation, when the plaque or the blockage is made up of inflammation, fat and cholesterol, there's nothing there that's, that's rock solid. So the cellular constituents of that blockage are really prone to reversal when the patients do it as accurately as this patient is from Seattle. And so when the tides are right, when the plaque is made up of inflammation, fat and cholesterol, and the patients clearly commit, it's really quite exciting. So actually we have a range of reversal, sometimes as soon as three weeks. Other times it may take three, three and a half years.
Rip Esselstyn 00:29:19
Right.
Dr. Caldwell B. Esselstyn, Jr. 00:29:20
Wow.
Rip Esselstyn 00:29:21
Well, so speaking of, you know, three and a half weeks, I've seen your, your PET Rubidian scans, which is the third way that I think you've. You've documented reversal with just as little as two weeks where you have documented amazing increased blood flow to the, to the heart.
Dr. Caldwell B. Esselstyn, Jr. 00:29:42
Yeah, that goes back to what we talked about in my early memory. When you change that way, back comes the nitric oxide back and you get rid of the endothelial and thromboxane, which are the vasoconstrictors. And that's why you see this wonderful change in the PET scan within a few weeks. Yeah, yeah.
Rip Esselstyn 00:30:04
I mean, I've seen your PET Rubidian scans and they're also. You have photos of them in your book Prevent Reverse Heart Disease. But you've got many, many of these before and afters, and it is alarming the amount of increased blood flow that happens literally in just two weeks. And I think you do a combination of what, low dose statin and then of course, the whole food plant based diet. Is that correct?
Dr. Caldwell B. Esselstyn, Jr. 00:30:34
Yeah. Except in there, there are many patients that we see who, long before they ever heard of me, found out that they were unable to take a Statin. Either there was just severe muscle pain or was injuring their liver or gave them diabetes or brain fog. And yet, as you look in the book, two of our most profound examples of disease reversal occurred in people who could not take a statin.
Rip Esselstyn 00:31:02
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:31:03
Yeah.
Rip Esselstyn 00:31:04
Okay. So we started with coronary angiograms, then stress tests, PET rubidian, and then. What's the next word after pet rubidian? Dye something.
Dr. Caldwell B. Esselstyn, Jr. 00:31:21
Rubidium. Dipyridamol.
Rip Esselstyn 00:31:23
Dipyridamol scans. And then. I know I've heard you talk a bunch about the carotid ultrasound.
Dr. Caldwell B. Esselstyn, Jr. 00:31:31
Yeah, that's really something that an alert physician, every time they find something going on with the heart, they'll be sure to put their stethoscope over the neck to see if they hear a bruit. A brui is a little sound that you will hear when. When the blood is rushing over a plaque and is turbulent and it gives an indication, or even if you don't hear a bruit, it's probably nice to check on the carotid artery as well, because there's no satisfaction in having a stroke. So it really is very easy to check. And I think the way to demonstrate how that can work in reversal is a patient actually I had from Canada. And it was interesting that at age 44, this gentleman had a stroke, all right. And he actually had recovered extremely well. He was 44 years old, and believe it or not, at the same time, he had such severe angina. They found a courageous physician, a surgeon in Toronto, who actually agreed to operate on him for his heart, and he had a wonderful result until he was now about 69 years of age, and he was now again in trouble. He was obese, he had angina, he had developed diabetes, he had erectile dysfunction. And when they checked his one remaining carotid, it was now 90% blocked. Now, of all things to have happen at this time, his 37 year old daughter had a heart attack. And during her convalescence, she found a book, prevent and reverse heart disease, and said, pop, we got to do this together. They did. A year later that I first heard about the couple. And at this time he said, Dr. Esselstyn, I wrote you this letter because I wanted to thank you for writing the book. Since my daughter and I have started the program, I have lost 40 pounds, all my angina has gone away, my diabetes has gone away, my erectile dysfunction has gone away, and my one remaining carotid artery, which was 90% blocked when I started this program, it is now 67% blocked. That was really kind of a provocative, exciting story.
Rip Esselstyn 00:34:24
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:34:25
Now the next one we wanted to look at is pulse.
Rip Esselstyn 00:34:29
Before you go to pulse volume, can I just ask you on the carotid artery ultrasounds. So what. What kind of. So that was a 90 to 67% reduction in a year.
Dr. Caldwell B. Esselstyn, Jr. 00:34:44
Yeah.
Rip Esselstyn 00:34:45
Have you heard about greater reductions?
Dr. Caldwell B. Esselstyn, Jr. 00:34:49
Oh, yeah. We've had some patients where it's just simply gone. It's gone away.
Rip Esselstyn 00:34:54
Uhhuh. And what are we talking again? Six months to a year to two years on the carotid?
Dr. Caldwell B. Esselstyn, Jr. 00:35:01
The one I can recall right now is a year. Yeah.
Rip Esselstyn 00:35:08
And. And do those arteries have a tendency? Can they fill up with the, with the calcium as well or. Yeah, yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:35:18
Okay.
Rip Esselstyn 00:35:20
All right, great. So next thing you said you wanted to visit was pulse volume. What's that?
Dr. Caldwell B. Esselstyn, Jr. 00:35:26
Well, that's interesting. I'm going to take a patient example. A 54 year old gentleman with heart disease who also had. Was getting claudication in his right calf. Claudication, as you know, is pain from a decreased blood supply. And he noticed this claudication in his right calf. When he was crossing the skyway to my office. He had to stop five times. When it would stop, the claudication would go away. Then he could resume walking. But I was so focused on his heart, I sort of forgot about his leg until he'd been with us about 10 months. And one visitor in my office, he said, Dr. Esselstyn, do you recall when I first started seeing you, I had to stop five times and crossing the skyway to your office? And I said, yes. And he said, you know, in the last month the problem got less and now it's completely gone away. I said, well, Don, you go to the vascular? Because at the time that we had first seen him, when we had had the diagnosis of claudication, we did a pulse volume, which is an evaluation of the blood supply at the ankle of that leg. So we went back and repeated that now 10 months later, when his pain was gone, and it was absolutely. I don't have the graph here, but it was doubled. It was absolutely doubled. And this was shortly after we started the study. So we now suddenly had in our study, absolutely rock solid, irrefutable hard data.
Rip Esselstyn 00:37:16
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:37:16
That we could absolutely halt and reverse disease with food and food alone. And somebody's going to say, well, wait a minute, what about the statin drugs? Well, this was 1986, before the statin drugs were even invented. So it really confirmed the absolute power of. Of plant based nutrition. Well then.
Rip Esselstyn 00:37:39
And wasn't There a woman that worked, a physician at the clinic, was it Bernadine Healy, that said, that essay you've just shown proof of concept.
Dr. Caldwell B. Esselstyn, Jr. 00:37:47
Yeah.
Rip Esselstyn 00:37:48
Is that right? So pulse volume. Wonderful. And what we'll try and do here for the listener is we'll try and insert that pulse volume graph that you did of that, that patient so they can see exactly what you're talking about. Yeah. So you also mentioned, with him and some other people already, angina, the reduction or elimination of angina. And you also mentioned the term claudication. You want to, you want to talk about those two things at all?
Dr. Caldwell B. Esselstyn, Jr. 00:38:22
Well, I think if we looked at all three. Angina, claudication and erectile dysfunction.
Rip Esselstyn 00:38:29
Hmm.
Dr. Caldwell B. Esselstyn, Jr. 00:38:31
These are all symptoms the patients will have when they have deprivation of a blood supply to a certain organ system. Obviously, if it's to the heart, deprivation of adequate blood supply will result in symptoms of heart pain, which we call angina. When the same thing happens to the leg, it's called claudication. And when the same thing happens to the blood supply to the penis, that's erectile dysfunction. And the exciting thing is that all three of those symptoms can be reversed with whole food plant based nutrition. There's one final measure that I'd like to mention, and that's ejection fraction. This isn't so much necessarily that somebody feels as a symptom, although it can be part of angina. But the ejection fraction is a measurement that the cardiologist will make either during an angiogram or during an ultrasound. It is a measure of the capacity of the left ventricle to squeeze. How hard does it squeeze? And anything over 50% is normal. And I'm happy to say that we've had a number of patients with heart failure, because when you get much below 45%, that's beginning to be defined as congestive heart failure. But some of those actually can be restored to normal when you can restore enough of the blood supply. So the heart begins to begin squeezing as it should.
Rip Esselstyn 00:40:27
No, that's, that's, that's super exciting. I think I've told you about the story of a gentleman who came to me. I referred him to you. He was a coffee owner in Costa Rica and he weighed 420 pounds. And after following your program to the letter and probably doing 8 to 10, eating 8 to 10 servings of green leafies every single day, his ejection fraction went back to 100%. I think it was at 10% at one point. And his, he and his cardiologists were talking about a potential open. I mean, heart. Heart transplant, and he was down now £250. And just. It's miraculous what he was able to do just with the power of food. Okay, so that's really the nine, then. Right. And just for a quick kind of review, tell me if I missed anything. So coronary angiogram, stress test, pet, rubidian scan, carotid ultrasound, pulse volume, angina claudication, erectile dysfunction. And then you just said the last one. Ejection fraction. Yep. And then, you know, it's funny. So I had Dr. Robert Osfeld on the first week of February on the podcast, and he refers to the standard American diet as the Erectile dysfunction starter Kit.
Dr. Caldwell B. Esselstyn, Jr. 00:42:09
That's excellent.
Rip Esselstyn 00:42:11
Yeah, yeah. And so, I mean, from your. From your vantage point. What. What is it? Let's just talk about, you know, Ed, because I know you say that you've had lots of patients that have been. That have had erectile dysfunction have turned that around.
Dr. Caldwell B. Esselstyn, Jr. 00:42:30
Oh, yeah.
Rip Esselstyn 00:42:33
And then they. And then they're. They're wondering if they should be writing you another check.
Dr. Caldwell B. Esselstyn, Jr. 00:42:39
Right. Well, you know, the thing that I think probably Robert. Dr. Robert Osfeld emphasizes this as well, that when you think about it, the. Since the penile artery is so much smaller than the coronary artery, that not infrequently, long before the patient will have a manifestation of heart disease, they may experience erectile dysfunction. It's sort of like the canary in the cold, because once you have erectile dysfunction, that's the first tip off that you're beginning to acquire a significant heart disease, enough to give you these septum, and it won't be much longer down the line. Then as those symptoms increase, it'll begin to be enough to block off the arteries to the heart. So it's key to. As a really, as a risk factor almost, if somebody comes and is complaining of erectile dysfunction, you want to be sure to check out their heart.
Rip Esselstyn 00:43:45
You know, what's interesting, too, is that in the male anatomy, and I remembered when I was doing my research for one of my books and I wrote about this, but the area of the male anatomy that has more endothelial cells per square inch than any other, other than any other part, is the. The penis.
Dr. Caldwell B. Esselstyn, Jr. 00:44:04
Right.
Rip Esselstyn 00:44:05
So, you know, not surprising that.
Dr. Caldwell B. Esselstyn, Jr. 00:44:08
That.
Rip Esselstyn 00:44:08
That. That can rebound in. In pretty short order when you're eating.
Dr. Caldwell B. Esselstyn, Jr. 00:44:13
Right.
Rip Esselstyn 00:44:14
Let me ask you this before we have to go. In your opinion, is it ever too late to bring the endothelial cells back to life? Have you ever so trashed Them sufficiently that you can't do that.
Dr. Caldwell B. Esselstyn, Jr. 00:44:27
No. I think. Let me use another patient example. The oldest patient that I ever had started our program was 87 years of age, and he had been told that he had to have bypass surgery. But he was convinced that as frail he was at 87, that the bypass operation would kill him. So he wanted to go plant based. And every year he'd give us a phone call to let us know how he was progressing. Two years ago, when he called, he didn't ask for me. He asked after I answered the phone. He asked for Ann. The reason he asked for Ann was he wanted some recipes, a whole bunch of them, because he was having a party. And Ann asked, well, what was the special occasion? He said, well, he was celebrating his 100th birthday.
Rip Esselstyn 00:45:21
Yeah.
Dr. Caldwell B. Esselstyn, Jr. 00:45:23
Last year when we got a phone call from him, he wanted to be sure that we knew that he was now 101. And this year when we got his phone call, he wanted to be sure that we knew that he was now 102.
Rip Esselstyn 00:45:37
Wow. So he's been a patient of yours and following the program for over 14 years.
Dr. Caldwell B. Esselstyn, Jr. 00:45:42
That's right.
Rip Esselstyn 00:45:43
Wow. Since he was 87. How's he holding up?
Dr. Caldwell B. Esselstyn, Jr. 00:45:49
He's amazing. He's amazing.
Rip Esselstyn 00:45:52
And he actually had full blown heart disease to the point to where they wanted to do bypass surgery.
Dr. Caldwell B. Esselstyn, Jr. 00:45:59
That's right, man.
Rip Esselstyn 00:46:00
That's something else. Let me ask you one more question before. Before we got to go. And that is explain to the audience, I think it bears repeating, why you're such a stickler with no added oils.
Dr. Caldwell B. Esselstyn, Jr. 00:46:17
Well, what we're trying to do with patients who have coronary artery disease, think of it as the following. You have all these wonderful little endothelial cells that are lining the inside of the artery, and they produce a magic molecule of gas called nitric oxide. And nitric oxide has a stream of wonderful functions that all have to do with keeping your arteries clean and having them work properly. So what happens is, when you eat the western diet, you progressively destroy the capacity of your endothelial cells to make sufficient nitric oxide to protect you. And when you run short on nitric oxide now, you begin to get buildup of these blockages in plaque. Think of it this way. Think of coronary artery disease, heart disease, cardiovascular disease, as a nitric oxide deficiency disease. And what we strive for in all of our therapy is to have the patients increase their production of nitric oxide for protecting their endothelial cells and at the same time, giving themselves a daily dose of nitric oxide when they eat green leafy vegetables six times a day.
Rip Esselstyn 00:47:48
But. So what is it about the oil? The oil kind of disrupts.
Dr. Caldwell B. Esselstyn, Jr. 00:47:52
Yeah. Oil is part of the inflammation and the destruction of the endothelial cell.
Rip Esselstyn 00:47:59
So with your patients, then, your heart disease patients, you don't want them to have a thimbleful, is that correct?
Dr. Caldwell B. Esselstyn, Jr. 00:48:06
Oh, absolutely. Not even a. Not even a wisp.
Rip Esselstyn 00:48:09
And. And just as a cautionary tale, you had, like, tell the story of one of your patients that started introducing it back into their diet. And what happened?
Dr. Caldwell B. Esselstyn, Jr. 00:48:23
Well, immediately, it doesn't take long. They suddenly begin to find out, especially the ones that angina, that their chest pain has recurred. And they, with their little feeling, very chagrined. They'll call us back and say, Dr. Esselstyn, I've screwed up. And I said, well, let's just show you how quickly you can restore this again. Get back on the bandwagon. Not a drop of oil of any kind, any source, anytime, any place.
Rip Esselstyn 00:48:55
Well.
Dr. Caldwell B. Esselstyn, Jr. 00:48:59
What.
Rip Esselstyn 00:49:00
What did Anne just chime in there?
Dr. Caldwell B. Esselstyn, Jr. 00:49:02
Can you remember another. Another patience story?
Rip Esselstyn 00:49:07
Yeah. We got time if you want to share it.
Dr. Caldwell B. Esselstyn, Jr. 00:49:10
I don't remember it.
Rip Esselstyn 00:49:18
Ann, are you there?
Dr. Caldwell B. Esselstyn, Jr. 00:49:20
Oh, yes. No, there was one. I do recall one patient who had been doing very well, and he was still having angina, and we got to take a careful history, and he said, gosh, I'm following your program so carefully, and my wife and I have heard about how important it is to have olive oil, and we make it sure that we have it at every meal. I said, jesus, let's see if we can't absolutely get rid of it at every meal and see what happened. And sure enough, yeah, all of his pain disappeared.
Rip Esselstyn 00:50:04
Yeah. I guess he didn't get the memo on the oil somehow or another.
Dr. Caldwell B. Esselstyn, Jr. 00:50:10
Right.
Rip Esselstyn 00:50:13
Well, listen, that is. That's awesome. I mean, love. Love how you are. You've been such a. You know, some people say you're a taskmaster. You just have a system that's. That's. That's tried and proven, and you've been at it since, what, 1984? So is this, like, the longest running study on the reversal of heart disease ever? Is that fair to say?
Dr. Caldwell B. Esselstyn, Jr. 00:50:45
Well, I don't know. I wouldn't want to go that far, because somewhere in the weeds, there are other people who are tipping this way. Certainly. I have to congratulate my friend Dean Ornish. He and I apparently started about the same time, and Dean actually was more courageous than I was, and he published sooner than I did. But I think the thing to remember is that we're both really focusing on the absolute value of whole food, plant based nutrition, and the more people and more physicians that we can have develop an understanding of this and commit to it, it's going to really be quite exciting.
Rip Esselstyn 00:51:29
Yeah. Ann, can you come back for. For goodbye here?
Dr. Caldwell B. Esselstyn, Jr. 00:51:35
Yeah.
Rip Esselstyn 00:51:36
Hi. Bye. And I can see your right eye. It's so fantastic to see you guys. Thanks for coming back on the PLANTSTRONG podcast, Essy, you both. I wish you happy Valentine's. I hope you'll be my Valentine and I'll call you later tonight. All right. Love you. Happy birthday too. Yeah. Hey, hey. Give me a PLANTSTRONG virtual fist bump on the way out. Ready?
Dr. Caldwell B. Esselstyn, Jr. 00:52:07
Let's do it.
Rip Esselstyn 00:52:08
Boom. PLANTSTRONG. Thank you, Essy, for your tireless efforts to share this research. As I mentioned in the intro, I'll have a couple of links in the show notes if any of you want to watch the presentation via YouTube, which features all kinds of great graphical representations of the items that he discussed today. And I'd be remiss if I didn't give a huge plug for his groundbreaking book, Prevent and Reverse Heart Disease, the revolutionary scientifically proven nutrition based cure, along with the Prevent and Reverse Heart Disease Cookbook that was written by my mother, Ann Crile Esselstyn, and my sister, Jane Esselstyn. From my family to yours, thanks for filling our hearts with your love and your encouragement. We appreciate you and continue to wish you happiness and health until next week. As always, always keep it PLANTSTRONG. The PLANTSTRONG podcast team includes Carrie Barrett, Laurie Kortowich and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn Jr. And Ann Crile Esselstyn. Thanks so much for listening.
