#125: Dr. Kim Williams - Have Heart Disease? Four Questions to Empower Your Reversal
Dr. Kim Williams at Plant-Stock
“There are two kinds of Cardiologists - those who are vegan and those who haven’t read the data.” - Dr. Kim Williams
Such a bold statement from someone, who, since 2013 has been the Head of Cardiology at Rush University Medical Center in Chicago, as well as the former president of the American College of Cardiology.
Dr. Kim Williams does not mince words.
He shares:
His personal background and story of what (and who) inspired him to become a doctor at the young age of 11.
Why, as a poor kid from the South side of Chicago, he adopted a plant-based diet many years ago.
How to calculate your 10-year risk of heart disease or stroke using the ASCVD
Resources and cookbooks from the Association of Black Cardiologists, Inc.
New research proving that vegan junk food is actually worse for your health than eating animals
The four biggest questions he asks all of his patients who have recently had stents or other surgical interventions.
These four simple magic questions often change the course and long-term outcomes of his patients when they hear the questions and provide their own answers.
Thank you, Dr. Kim Williams, for being an outspoken advocate and example of the future of medicine. Prevention and education starts with people like you and we are grateful that you heeded the call to becoming a doctor. You were made for medicine.
About Dr. Kim Williams is an American cardiologist. He is a Fellow of the American College of Cardiology and served as its president from 2015 to 2016. He is currently a trustee of the organization.
Episode and PLANTSTRONG Resources:
Association of Black Cardiologists
Cardiovascular Risk Calculator
Join us for our 2022 PLANTSTRONG Retreat in Black Mountain, NC
Full Transcript
Dr. Kim Williams:
And I say, "If you don't mind, I'm Dr. Williams, chief of cardiology, need to talk to you about what happened to you. I'm going to ask you the silliest questions you've ever heard. Can you just bear with me for a couple minutes?" And they usually say yes. "Okay, let's start. I'm going to ask you four questions. Number one, what's your understanding of why you ended up in here and needing a stent? And they'll say, look at me kind of funny, and they say, "I had a blocked artery."
Dr. Kim Williams:
I say, "That's exactly right. Good. That's number one. Number two, what was it blocked with? Prepositionally challenged, but they understand what I'm asking. Regardless of level of education and health literacy, they usually can say, plaque. I say, "That's right. And what's plaque made out of?" And they'll say, "I think it's made out of cholesterol and fat." I say, "Yeah, that's right. Question number four, where did that come from?"
Rip Esselstyn:
I'm Rip Esselstyn, and welcome to the PLANTSTRONG Podcast. The mission at PLANTSTRONG is to further the advancement of all things within the plant-based movement. We advocate for the scientifically proven benefits of plant-based living and envision a world that universally understands, promotes, and prescribes plants as a solution to empowering your health, enhancing your performance, restoring the environment, and becoming better guardians to the animals we share this planet with. We welcome you wherever you are on your plant strong journey, and I hope that you enjoy this show.
Rip Esselstyn:
All right, my cruciferous cousins, happy 2022. Incredible, but yet, here we are. Man, here we go into the unknown, into the wild. I sincerely hope that 2022 is a vast departure from 2020 and 2021. I think we can all toast a nice heating, serving of perfectly cooked kale to that effect. We are beginning our fourth year of the PLANTSTRONG Podcast. Hard to believe, but I'm proud to say that in just three short years, we have reached over 4 million downloads because of you. So, thank you each and every one of you for sharing, reviewing, and listening on a weekly basis.
Rip Esselstyn:
We've had some really special awe inspiring episodes in the past three years, and I want you to know we're just getting started. This whole plant-strong revolution is afoot and it is so beautiful to watch it unfold. We've already got a fantastic lineup of guests slated for 2022, starting with my guest today, Dr. Kim Williams. Now, I'm going to start out with a powerful quote from Kim that you may or may not have heard before. It is all over the internet, but he likes to say there are two kinds of cardiologists. Those who are vegan and those who have yet to read the data.
Rip Esselstyn:
This is a super bold state from someone who since 2013 has been the head of cardiology at Rush University Medical Center outside of, I should say inside, of Chicago. In addition, Dr. Williams is also the former president of the American College of Cardiology, and a man was not afraid to mince words. I love today's conversation because I got to learn all about Kim's personal background and story that I was absolutely clueless about, including how he got into medicine and why and how he was raised on the south side of Chicago, dirt poor, and also how, and what inspired him to adopt a plant-based diet.
Rip Esselstyn:
He also shares the four biggest questions that he asks all of his patients who have recently had a stent or some other surgical intervention. These four simple, magical questions often change the trajectory and long-term outcomes of these patients when they hear these engaging questions and become empowered. So, you'll definitely want to keep an ear out for these four questions. Now, before we dive into today's episode, I want to invite you to kick off 2022 by taking the PLANTSTRONG seven-day challenge. We have thousands of people that are engaged. You definitely need a little reboot, and I want you to know that we have tons of free horses for you. Simply head over to plantstrong.com and you can discover how great you will feel by adopting a plant-strong lifestyle.
Rip Esselstyn:
I would also like to share some very exciting news with you that we've been working on for a long, long time. We now have, for our upcoming retreat in black mountain, North Carolina, we have CME and CEU credits for physicians, physicians' assistants, nurse practitioners, and health coaches. We've got 20 hours of CME credits and two CEU credits. That's just part of the registration fee and we're super excited about that. This is jointly provided by UNC Health Sciences at MAHEC, and we are thrilled to reward healthcare providers for all that they learn at our immersion events. You can still join us March 1st through the 6th. Visit plantstrong.com today for all the details.
Rip Esselstyn:
Now, let's get back to our show. I know that you're going to feel empowered after this conversation with Dr. Kim Williams. A little side note, there is a little bit of background noise in the beginning because we caught Kim on a short break during a busy day. As you know, life happens. Okay. Enjoy this conversation. Thanks.
Rip Esselstyn:
All right, everyone. I want to welcome you to another episode of the PLANTSTRONG Podcast. Today, I have one of the most, I would say, respected and well known cardiologists on the planet, and that's Dr. Kim Williams. Kim, I want to dive in and I want to talk to you about your background, I want to talk to you about being a cardiologist, I want to talk to you about how you discovered and became enamored with plant-based nutrition, and then just, if you think that we're doing a pretty good job in the medical field, moving that football down the field and if we're making progress or not.
Rip Esselstyn:
We'll talk about all those things, but for starters, I'd love to know, well, actually, let me backtrack for a sec. The last time that I saw you was in black mountain, outside of Asheville, North Carolina, 2018. You were very generous and you joined us for Plant-Stock and with about 700 other attendees, and we had an absolute blast. Your talk was riveting. You had everybody on the edge of their seats. I can remember we had a discussion a day or two beforehand, because these were like TEDx style talks, 20 to 30 minutes. I like to review people's decks just to make sure they were going to hit the mark, and yours was like 180 slides.
Rip Esselstyn:
I sent you a nice friendly text saying, "Hey, Kim, this is supposed to be 20 or 30 minutes here, not an hour and a half, two hours. And you're like, "Hey, Rip, I got this. I'm a pro. Don't sweat it." If you didn't go through all 180 in 27 minutes and 30 seconds, and anyway, I've learned not to question you with stuff like that.
Dr. Kim Williams:
No, no worries. No worries. Understandable. Understandable. It was a great conference. You did a marvelous job. It was very stimulating. The audience, getting up and dancing, that was unique. I hadn't seen that one before, so congrats on all you do. Thanks so much.
Rip Esselstyn:
Yeah. Well, and we played a lot of great music. What was that? There was that great movie that came out, and you actually loved the songs in it. It was the Greatest Showman, right?
Dr. Kim Williams:
Greatest Showman, yep.
Rip Esselstyn:
Greatest Showman. What a soundtrack. What a soundtrack. I'd love to start, Kim, just by asking you, where does your first name come from? It's very unique for a male. I've only known one other Kim. He was a guy I swam with. Is this a family name? How did you get it?
Dr. Kim Williams:
So, I'm supposed to say that it's British-Australian. Lots of guys are named Kim, but the truth is I was born during the Korean war. It was a common Korean surname, which as you know, goes first, and therefore, my mom as a south Korean sympathizer named me Kim. How about that. Little known fact.
Rip Esselstyn:
Yeah. How did you feel about your name growing up? Were you like, yeah? I mean, or did you get bullied at all or did you have to defend it?
Dr. Kim Williams:
Totally bullied. But the worst part of being bullied on the south side of Chicago was being promoted. So, I had like a few days of second grade. I already had that November birthday starting in September. The next thing you know, I'm two years younger than everybody else named Kim, which you know what? Makes you tougher. There are actually a science around it now. It talks about the resilience gene. The bullying and all of the adverse circumstances of growing up, single parent home, getting sick, being in and out hospital, all that stuff, it can break people or it can actually make you a whole lot stronger.
Dr. Kim Williams:
There actually is a phenotype of the resilience gene that gets induced in certain people. I think I'm one of those. That seems to be. I actually appreciate all of the difficulties and hardships that I had growing up.
Rip Esselstyn:
Well, it's obviously served you well as the getting cardiologist.
Dr. Kim Williams:
That's right.
Rip Esselstyn:
Right? Holy Toledo. Is that fair to say, I'd love to know a little bit about your background, so did you grow up with a single family parent?
Dr. Kim Williams:
Yeah.
Rip Esselstyn:
Yeah?
Dr. Kim Williams:
Yeah. I actually, I credit, air quotes, big air quotes, my dad, who I really got to meet when I was 10 going on 11. I'm on the south side of Chicago, not many resources, not a lot of food, but struggling in many ways, but he was the guy who promised me that he would get me a winter coat for my birthday, it's November 10th. November in Chicago, pretty cold. Until then, I was walking back and forth to school with no coat, and it turns out he never came through with the coat. December 5th, a few weeks after my 11th birthday, I was admitted to south Chicago hospital with a pneumonia.
Dr. Kim Williams:
That was about my third pneumonia because I had a mother who smoked. So, kids of smoking parents, lots of health issues, and so that was mine. It turned that, that was a very index hospitalization for me because I'd been through it before, I knew I needed that 500 milligrams of penicillin every eight hours, or I wasn't going to get back to school pretty quick, and it just wasn't coming. I started going to the nurses station and getting my own medication. Then I started getting the medicine that are supposed to be distributed to my roommate, and I'm making ... I laid on that hospital bed swearing that I was going to be the physician on the south side of Chicago and fix that hospital. It's not exactly what happened, but I did train the guy who's the chief of cardiology there now, so maybe a little bit.
Rip Esselstyn:
Incredible how that ... How old were you when you were admitted in the hospital with pneumonia? Can you remember?
Dr. Kim Williams:
Yeah, that was three weeks after my 11th birthday.
Rip Esselstyn:
It's amazing how that has informed your whole life's work and your path. Brilliant.
Dr. Kim Williams:
Oh yeah. Oh, I definitely was going to be a pediatrician on the south side and take care of sick kids. Then medical school actually happened. Once I escaped the inner city and got into the University of Chicago College, became a tennis player, so I was attracted to the medical school. When you get into medical school, you gravitate and you resonate with things. I hope everybody does that. If you're not doing something that you resonate with, you probably ought to look at trying to do something else. As it turns out, everything in the cardiovascular arena, from the basic science, the physiology, every aspect, it's like it was part of me, like I had done it before.
Dr. Kim Williams:
I could understand EKGs like that, and I could hear the murmurs that other people couldn't hear. Next thing you know, I had to go to cardiology. I was just drawn to it. Then it just so happens, and this is ... You could think of this as divine intervention, that being from the south side of Chicago, living in an inner city, understanding that heart disease has been the leading killer of Americans since 1918 was the last time it took a break for one year because a Spanish flu. Wasn't taken out by COVID. It was still number one.
Dr. Kim Williams:
It wouldn't be number one in the United States. By the way, only developed country left in the world, where it's still number one. It wouldn't be number one if it wasn't for the 21% increase in cardiovascular mortality that my people have, like African-American population is worse than everybody else. If we could just get it down to the terrible rate that everybody else has, it wouldn't be number one anymore in the United States. I've been on a mission to try and fix that. It's good to interact with the community churches, tennis tournaments a few weeks ago on the south side of Chicago, getting into the dental offices, anywhere where we can meet people, measure blood pressure, measure risk factors, and try to get people to understand that they can make a difference, that their diseases are terrible, but they're all voluntary pretty much as your family has very well documented.
Rip Esselstyn:
Yes. Do you feel like, because what I've heard is that the black Americans are actually, as a culture, embracing veganism as rapidly as any ethnicity that's in America right now, is that what you're seeing right now as well?
Dr. Kim Williams:
Pushing hard for it. And many other organizations are as well. You may have heard that ... There's a person named Jasmine Leyva, if you haven't interviewed her, you probably should. Jasmine put together a movie called Invisible Vegan. It really talks some scientifically, sociologically, historically, practically about plant-based nutrition and how it isn't a white, suburban female thing. It's something that we need to adopt. It's something where the African-American history was before slavery, changed the diet completely. I know you're probably familiar with Columbus Batiste.
Rip Esselstyn:
Yeah, absolutely.
Dr. Kim Williams:
Absolutely. And he's got this very strikingly named podcast called Slave Food, and Jasmine Leyva talks about the Slave Food. If we could just get everyone to realize where that comes from and how deleterious it is, and if you're a slave and your life expectancy is 40, 45 years, you're never going to reap the cardiovascular disaster that we do now from kidney disease, brain, health, heart attacks, heart failure, all of it due to diet.
Rip Esselstyn:
I am awe struck at kind of so far, because I didn't know any of this as far as your story. It helps me to understand what drives you. It helps me understand what a leader that you've become in this field. But could you share with our audience when exactly did you become enamored with plant-based nutrition? I'd love for you to actually talk a little bit about how Dr. Tazewell Banks influenced your decision as well, because I think that's an important part.
Dr. Kim Williams:
Fantastic, and would love to talk about Tazewell, but let me go back even further. Part of my food insecurity, being in a single home, was when my mom who had a steady job as a secretary decided that she was going to just throw the dice and go back to school. That meant we went from poor to destitute in terms of income. But it set up an idea for the family. I then went to college, my sister later in life ended up, whom you met because she was in Nashville, she actually got a master's degree etc. So, it set up a pattern that's been continued through the generations.
Dr. Kim Williams:
Well, it turns out that one of her first courses in the local junior college was biology, and some professor, who she doesn't remember the name of, told her in no uncertain terms, "You have to become a vegetarian because your cholesterol will go down and you won't get heart disease, and by the way, you won't get cancer." I need to know who that person was. So, she came home and said, "Okay, we're vegetarians." We didn't know what we know now. So, it was sort of more of ovo-lacto vegetarian diet. I maintained that with one bad episode in college where the team didn't get me any lunch and all I had a chance was a hamburger or starve for the next match.
Dr. Kim Williams:
I ate the hamburger, and four all, and the first set, I was in the corner throwing it up. I've never eaten red meat ever again. But you try to grapple with the science, and the science, about the time I was getting married, was really about the American Heart Association diet, chicken and fish, no skin, not fried healthy diet. Turns out that might be healthy for some people, probably not. It is healthier than red meat, no question. But for me personally, it turns out that I have the genetics to have a higher cholesterol than normal.
Dr. Kim Williams:
As I sort of retired from being a national coach of a nationally ranked tennis player and I wasn't playing tennis twice a day anymore, plus there is such a thing as an age-related increase in LDL cholesterol. Put those two things together, and all of a sudden, my LDL wasn't 105, 110, it was all of a sudden 170. That is when I remembered Tazewell Banks. So, he had been, and one of the leaders in the Association of Black Cardiologists, as had I, and at that point, he was trying to influence the scientific meetings put on by the ABC to have more plant-based stuff.
Dr. Kim Williams:
He actually had some success and then a lot of pushback. I remember some very comical, loud pushback that he took. It turns out that those were really important lessons for me, so that, that's the first thing I did when I found out about the LDL, is I immediately changed the diet and got ... Then I actually went on the search engine and found out that chicken and fish, in general, beef and pork have more cholesterol than most species of fish. There are some seafood that's way higher, but chicken tends to be just a touch higher than beef.
Dr. Kim Williams:
If your problem is cholesterol, there are no safe animal products that may be egg whites, we used to say egg whites jello and honey, but those last two have such a high glycemic index that we don't do those. Those would be worse than animal products, but we didn't know that a few years ago. Now we do. Bottom line is that Tazewell really gave me the tool, talking particularly about Dean Ornish and his diet, that I could go then and look it up. The best part of this story is that, to me, was that the month that that happened, March of 2003, that is the time that Journal of American Medical Association published David Jenkins portfolio diet, plant sterols, almonds, making sure that you're getting soy protein and psyllium fiber. I sort of adopted that kind of vegetarian diet, and six weeks later, my LDL was down from 170 down to 90.
Rip Esselstyn:
Yeah. That's pretty darn dramatic. I've written a number of books. In my third book, we actually ... I have about 1,500 data points participants that actually do this for seven days than we do before and after biometric screenings. We actually are able to show that the vast majority of it happens in the first week or two if you're doing it properly. You did it in six weeks, but it would've been interesting to see what would've happened in two weeks or three weeks.
Dr. Kim Williams:
Absolutely. David Jenkins did the two week, four week and the curve went like this.
Rip Esselstyn:
Interesting.
Dr. Kim Williams:
So, a lot of change. Well, the C-reactive protein, so he did cholesterol and inflammation, and everybody's heard, oh, cholesterol doesn't cause heart disease alone. It's the inflammation as well. Both of which are increased, LDL and C-reactive protein, are increased by eating animal products and decreased by eating vegetables. Well, it turns out that the C-reactive protein responds to diet a little more slowly, just a bit, than LDL does, but absolutely, those changes do occur.
Rip Esselstyn:
Yeah. That's interesting. They don't necessarily correlate, but it's a good reason to stay with the veggies, for sure.
Dr. Kim Williams:
Absolutely.
Rip Esselstyn:
Have you been in touch with Tazewell Banks? Is he alive still? Is he around?
Dr. Kim Williams:
I was unfortunate ... Well, actually I guess I was honored to be chairman of the board of the Association of Black Cardiologist a few years ago and to attend and be the official representative at his funeral. He was a wonderful guy. And unfortunately, in DC, there was ... He was accosted and had a dramatic outcome. Just very saddened to see someone who'd given his entire career to making people healthy endure such a tragic outcome.
Rip Esselstyn:
Yeah. I'm sorry to hear that. That's super sad. What year was that?
Dr. Kim Williams:
That would've been, I think 2010. I'd have to go back and yeah, I'd have to go back and take a look.
Rip Esselstyn:
He didn't have the opportunity to see you go on with all these leadership is at Rush University Medical Center and as president of the American College of Cardiology and things like that. But I'm sure that sounds like he really inspired you and he's probably up there watching you.
Dr. Kim Williams:
I think so. He was such a leader and everyone remembers him. We actually did memorialize him, for those who of you who are interested, we actually have, believe it or not, Association of Black Cardiologist vegan cookbook. It's on the website, A-B-C-A-R-D-I-O, so abcardio.org under the patient resources. It was actually, I did nothing, but come up with the idea and insist that it'd be vegan. Everybody else did the work. Most of that work was actually another person who you know very well, and that is Baxter Montgomery from Houston. He's done a wonderful job in Houston and he did a wonderful job putting together recipes. I have the science it, but what to do about it, I wasn't so clear. Now I'm cooking all the time. That's COVID. Once you have COVID, you have to cook, but ...
Rip Esselstyn:
Now, is Baxter a cardiologist or is he a general practitioner?
Dr. Kim Williams:
Yes.
Rip Esselstyn:
He is a cardiologist.
Dr. Kim Williams:
He's a cardiologist. Absolutely. He's a proud alumni of Rice University and he's been in the community changing lives left and right.
Rip Esselstyn:
Yeah. Fantastic. So, you've been at the helm at Rush University Medical Center, the helm of cardiology since 2013, how has the department changed under your leadership?
Dr. Kim Williams:
Well, there really is a lot more in terms of prevention. As you know, most university cardiologists have some idea about prevention and many of the private practices, they just nose to the grindstone trying to get everyone taken care of without a lot of attention to the prevention side. It could be time limitations, it could be training. We have this very famous publication saying that 1% of cardiologists feel like they had adequate nutrition training and the rest of us are just out there. Well, it turns out that we've adopted a lot of that prevention mode at Rush, and we still do interventions, and a very successful program, a lot of programmatic growth.
Dr. Kim Williams:
A lot of our plant-based nutrition efforts actually turn into interventions because people come to trying to figure out if they can just avoid the intervention, but not everybody can. I have certainly some who are able to follow an Esselstyn diet, try to get some plaque regression. For those who need a jumpstart, we can actually do stenting. If I can say there's something that's unique about our program is that we really struggle on one side with traditional medication and stenting, stress testing, all of this classical cardiology, not focusing on nutrition.
Dr. Kim Williams:
Now, it's in our guidelines. In the 2017, a little bit for hypertension than 2018 for cholesterol. Then 2019, it's really in there that people should be improving their nutrition, avoiding cholesterol. When you say avoid cholesterol in the guideline, that essentially translates, as you know, to being a vegetarian because that's the only way to avoid. But decreasing sodium, decreasing saturated fat, these are all principles of the American College of Cardiology and the American Heart Association, so a big transition now for those guidelines. We're trying to edge our way into practice.
Dr. Kim Williams:
They say it takes 17 years for guidelines to get into practice. We don't have 17 years. We need to do this now. I have the other side, a lot of plant-based nutrition people who want to improve outcomes of patients, and they can, but you'll hear these occasional bad outcomes. Well, that's because those folks weren't taking advantage of what the other side has to offer. It's not usually stents and bypass surgeries. It's usually statins. So, many people have heard bad things about statins. There are people, fairly frequently, who have bad outcomes with statins in terms of muscle soreness, bad outcomes in terms of the liver failure and stuff like that, that doesn't happen so much.
Dr. Kim Williams:
But people want to avoid medications. I understand that, but, and I tell them, "All you need is a time machine. Go back to 20 years. Change your plant-based diet then. You don't have all this plaque. You won't need the medication." But once you have significant disease, the two work hand in hand. So, if I could get both sides to recognize the strength of the other side, and that's pretty much what we do at Rush.
Rip Esselstyn:
A couple follow up questions on what you just said there. Is it fair to say then ... So, you're a fan of statins, I guess, when it makes sense. Let's say I don't have any outward signs of heart disease, but I've got a total cholesterol of 235, what would you recommend that I do?
Dr. Kim Williams:
First of all, we actually have, and hoping everybody can download it, is the ACC AHA risk calculator. That risk calculator, everybody should have it on their phone. Next time you have a giving virtual dinner, "Hey, uncle Joe, tell me what was your last blood pressure, and how old are you now?" And put all the numbers in. It'll tell you what the 10 year risk of having a heart attack stroke or death is. If that risk is more than 7.5%, that's about the point where a statin is generally beneficial, but we don't do that. That's not in our guidelines, just because, it was in 2013, but now our guidelines have morphed to do lifestyle first. Let's see what happens with an exercise program, losing some weight, changing your diet, plant-base as much as you can.
Dr. Kim Williams:
Once you do that, remeasure everything. The LDL will have gone down, the blood pressure will go down. The risk will have dropped substantially. We did this as a five week vegan intervention on the south side of Chicago in a church. It happened to be Obama's old church. And we saw a 19% decrease in cardiovascular risk using the risk calculator. Fat, if you, and you bring it down 19%, you may not need a statin at that point. So, it used to be that we gave it for high cholesterol, not anymore. Now we give it for risk. There are plenty of people with high cholesterol and they happen to be 42-years-old Caucasian rather than African-American, female instead of male, all the things that increase your a risk.
Dr. Kim Williams:
If that's the case, their risk is low enough that they don't need a statin. Then you have some people whose cholesterol is normal, but they have such a high risk profile because they're 77-year-old and have a little high blood pressure and the moderate cholesterol isn't good for them. Then we do use statin. Everything changed a few years ago where we use it for risk, not for, and for disease, disease and risk, not necessarily for cholesterol alone.
Rip Esselstyn:
Yeah. How many cardiologists do you have in your department?
Dr. Kim Williams:
If I include all of my advanced practitioners, it's about 53 and growing.
Rip Esselstyn:
Tell me this, is 53 ... Where does that put you in the United States as far as the size of your cardiology department?
Dr. Kim Williams:
Oh gosh, that's a really good question. I'm not sure that I ... I'd like to go and look that up.
Rip Esselstyn:
I'm wondering if you're the top 50, top 10, top 20-
Dr. Kim Williams:
Well, size is one thing. We do have, in terms of locations, Rush actually has a couple places in the suburbs, a couple places on the south side, north side. So, we are widening our footprint as we speak. I would say more important than the number and where we rank by a number of physicians, it would be where we rank in quality. If anybody's interested, the Vizient quality of care rankings, and we're typically number one in the country. Sometimes Mayo Clinic edges us out and we're number two, but the top five are always NYU, Emory, Cleveland Clinic, Rush, and Mayo Clinic. Where we are exactly right now in that top five, I'm not sure, but it's usually us versus Mayo that's number one.
Dr. Kim Williams:
The other one is the U.S. News & World Report. The cardiovascular service line has gradually improved since the two 2013, and that has to do with quality and recognition, reputation and quality of care. We're now to number 33. Went from unranked when I took over the program to clearly inside the top 50, and hopefully going up.
Rip Esselstyn:
That's a lot to be proud of. Let me ask you this, and if you have any idea, so of the 51 or so cardiologists at Rush, do you have any idea how many of them identify as vegan or plant-based?
Dr. Kim Williams:
I actually had that number, and I used to put it on a slide, and then it kept changing, and it didn't include all of the trainees. The trainees are actually the ones who hear my lecture and say, "Okay, that's it, I'm done. I'm not donating any more animal products." Adopting the literature. A little less uptake in the old senior faculty who probably need it the most. I actually don't have that number anymore. I'd have to go back and do a biopsy, but I can tell you that when I actually have to do the so-called FPPE, the focused physician practice evaluation, and so I'm looking at faculty notes and making nutrition recommendations is almost 100%, and that's something that you just don't see in other places.
Rip Esselstyn:
Yeah. Well, I can remember, I think it was when you were at Plant-Stock in 2018 after your presentation, I think I asked you how many of the cardiologists, and at that point in time, I think you said like 23. And maybe there were 30 something on staff then. I think you've grown. To me, that's just a Testament to the influence that you have, the great example that you're setting there. So, thank you for that.
Dr. Kim Williams:
I hope. Well, I mean, it's a very deep topic Rip, but that many people are not aware of, but physicians have the number one spot in the country in suicide, and then there's depression, and then there's divorce, and then there's drugs. It's not all cardiology, but it's everywhere. A healthy lifestyle can really help protect against burnout. Every time I'm talking about a healthful approach to living with predominantly diet and exercise, and you see me in my tennis gear right now, I'm hoping that we can be the division that avoids the burnout. It's also being able to talk to people, so really, and know that you have each other's back.
Dr. Kim Williams:
If we do that, this whole issue of burnout, worsened by COVID, but it was there before, and it'll be there long after. Something that we will continue to deal with.
Rip Esselstyn:
Yeah. So, you were the president of the American College of Cardiology, 2015 to '16. You've been a fellow there for a while. Any big takeaways from your year at the reign there and the direction that this ... Because there's, in my opinion, correct me if I'm wrong, there's two big heart associations organizations in America. It's the American Heart Association and the ACC. Do you feel like these two organizations are moving in the right direction with plant-based as kind of the holy grail for treating and potentially reversing heart disease?
Dr. Kim Williams:
I feel like we are. I mean, as I mentioned, our guidelines are much more evidence based in terms of lifestyle change, adopting lifestyle change, and talking about the mechanism of getting people to do a lifestyle change than it was before. We don't have industry relationships at the ACC anymore. We got rid of them years ago. I do hear from my colleagues that the American Heart Association has still got a lot of support from organizations that don't fit our guidelines, but hey, American heart association signed off on the guidelines.
Dr. Kim Williams:
As an organization, they are behind the plant-based nutrition idea, and I hope that they will continue to be ... I don't don't work as much with them as with the ACC, but I would say the biggest impact, first of all, coming in into the position, I thought I would be known as the first African American. No. I was known as the first vegan President of ACC. That's all anyone talked about. As it turns out, I was able to...
Rip Esselstyn:
Well, you're a threat.
Dr. Kim Williams:
Yeah, indeed. Well, it caused some chuckling.
Rip Esselstyn:
But you also, you are a threat, and let's face it, when you say stuff, which I applaud you for, when you say stuff like, wouldn't it be laudable if the goal of the ACC was to put ourselves out of business, you're going to ruffle feathers and get these people nervous.
Dr. Kim Williams:
Interestingly enough, I got a lot of support, maybe not outside of ACC, but within ACC leadership, because everything we do, the whole strategic plan, the mission statement, transform cardiovascular care and improve heart health, that means put ourself out of business. That's really what we're supposed to be doing. I did have a lot of support for that. I was able to start some programs like getting our cardio oncology section going and supporting the young people. But the one that I hopefully will be remembered for is that we started the, during my tenure, we started the nutrition work group.
Dr. Kim Williams:
This is a wonderful set of people. Your dad's on it. We have so many people who ... And some of it has been referred to as the ACC's vegan mafia. It's not exactly right. We do have one keto person. We have a handful of Mediterranean people. I always point out, Mediterranean diet does not improve outcomes for the cardiologist, only neurology, and then they go back and they look at the article and they say, "Oh my gosh, how did we miss that?" That 30% decrease when you switch from red meat to fish was only stroke. Heart attack, cardiovascular death, and total mortality were unchanged, and that was the randomized trial that's supposed to support cardiovascular people using Mediterranean diet, not so.
Dr. Kim Williams:
Neurology be jumping up and down. Our stroke center at Rush is overwhelmed. We're doing thrombolytic therapy and trying to get the clots out of people's brains when they happen. It's just amazing amount of work. Cutting that by 30% would give them a break. But for cardiovascular disease, no evidence that it's going to help.
Rip Esselstyn:
Yeah. Well, so one of the things that you impressed me so much at Plant-Stock with your slides, and you had study after study, after study that was showing the effects of a plant-based diet. You had some studies that were just three days old. To me, I was impressed with how on top of the research and the data that you are. This is leading to probably the most famous quote that you've ever thrown out. When you Google yourself, you'll see this associated with every photo of you. That basically is there are two kinds of cardiologists, right? Vegans, and those who haven't read the data. My question to you is, Kim, in 2021, how can you be a cardiologist, a practicing cardiologists, and not be up to speed with all these piles and piles and piles of research that indicate what a plant-based diet can do?
Dr. Kim Williams:
It's interesting that cardiology is so big. It's such an effort being number one in terms of mortality and being one number one for so long that the science is incredible. The techniques that we have, and it's been characterized as mopping up the floor instead of turning off the faucet, but we've got some amazing mops come and see the mops. Truth be told that it's only the preventive cardiologist, it's a whole different specialty now. My interventionists, they understand a bit about it, kind of the way I understand a little bit about intervention, but they will actually send patients to the prevention group.
Dr. Kim Williams:
Not everyone takes full charge of all the problems because we are highly segmented. Fact of the matter is medical knowledge doubles every 73 days. There's no way that they all can keep up with it. Now, I hope that you're right, that someday there be a basics, that the basis of education is prevention, on top of which you build heart failure, electrophysiology, structural heart, and all the other subspecialties in cardiology. Why? Because we're losing cardiologist to cardiovascular disease. It should not be the number one killer of cardiologists. That's something that we have to work on.
Rip Esselstyn:
Is that right? Is it the number one killer of cardiologists?
Dr. Kim Williams:
Yeah. The cardiologist and physicians, it's heart disease.
Rip Esselstyn:
Yeah. Well, if that isn't ironic, I don't know what is. Wow.
Dr. Kim Williams:
Right.
Rip Esselstyn:
I want to throw another quote at you because you got some great ones, and this one is not complete, so I'd love for you to complete it for me, but it's like, "I don't mind dying, I just don't want it to be my fault." I think somewhere in there is processed meat and also red meat. Is that correct? That's one of your quotes, right?
Dr. Kim Williams:
Yes. What that really means is that I keep my nose to the grindstone in terms of the evidence based literature, and I do some things better than others. I will exercise because I'm addicted to tennis. I will maintain a whole food plant based diet. And it's a better vegan diet than it was before because everybody in your audience needs to know that an unhealthy plant-based diet, and it's published by ACC in the Journal American College of Cardiology 2017, that unhealthy plant-based diet is actually worse than eating animals. We didn't have that for most of my vegan career.
Dr. Kim Williams:
Those vegan vinyls and those, in Paris, there's this place where you can go and get chocolate, vegan croissant. Well, they're wonderful, except that they're real damaging. It's refined flour, it's saturated fat. These are things that people should not be eating, but we didn't know that, but now we do. So, what happens to me is I developed, I would say, an ability, probably should say an addiction to data. When I see something, I can make the change like that. I wish I could put that little phenotypic gene in every patient of mine, just turn away, turn and walk away and never think about eating something unhealthy again.
Rip Esselstyn:
Well, speaking of that and your patients, I mean, what do you do to motivate your patients, especially with somebody that's not motivated? Because I would imagine, if I'm your patient and you, Kim Williams, are looking at me saying, "Listen, you can totally conquer this disease and this is what you need to do. I've been doing it since 2003. Let's give you these tools. You're off to the races." I mean, I would imagine that you get some pretty good success. Am I wrong?
Dr. Kim Williams:
I do get good success, but let me tell you if you have a minute.
Rip Esselstyn:
Yeah.
Dr. Kim Williams:
How I do this, because it hit me a couple years ago, and it's been the most successful thing during my vegan cardiology career.
Rip Esselstyn:
Oh, lay it on us.
Dr. Kim Williams:
I'm the typically being rounding with the interns and residents and the fellows. The next morning, I'm in the coronary care unit, somebody has had a stent the night before. I say, "If you don't mind, I'm Dr. Williams, chief of cardiology, need to talk to you about what happened to you. I'm going to ask you the silliest questions you've ever heard, can you just bear with me for a couple minutes?" And they usually say yes. "Okay, let's start. I'm going to ask you four questions. Number one, what's your understanding of why you ended up in here and needing a stent?" And they'll say, look at me kind of funny, and they say, "I had a blocked artery."
Dr. Kim Williams:
I say, "That's exactly right. Good. That's number one. Number two, what was it blocked with?" Prepositionally challenged, but they understand what I'm asking. Regardless of level of education and health literacy, they usually can say plaque. I say, "That's right. And what's plaque made out of." And they'll say, "I think it's made out of cholesterol and fat. I say, "Yeah. That's right. Question number four, where did that come from?" To a person, they can answer that question, they say, "I ate it." And I say, "Here is your vegetarian diet. We're going to order vegetarian food for you. We're going to give you handouts on how to do it. And if you choose not to do this, we'll make more money." They always laugh. It really does capture them. If you give them the tools, you give them the time, people will make a change.
Rip Esselstyn:
When did you first start using that method to talk to your patients?
Dr. Kim Williams:
I remember it was January of 2019. The whole idea of motivational interviewing and getting ... If I tell them the answer to those four questions, they're partly listening, they're partly absorbing, they're partly traumatized by what they just went through and facing their own mortality. But when they answer those questions with their own mouth, it connects the dots better than I ever could.
Rip Esselstyn:
Well, it connects the dots, and plus, what I love about out it is you're not preaching to them. You're not telling them, "Listen, this is what you need to do." You're saying, you're asking them questions with curiosity, you're leading with curiosity. Then they're, exactly what you just said, they're filling in the dots or connecting the dots, it comes out of their mouth, and now you've got them. You've got them.
Dr. Kim Williams:
That's right.
Rip Esselstyn:
Anyway, this is pure gold right here. This is pure kale. Pure kale, I love it. Let me ask you this, because I want to be respectful of your time. We got about eight minutes. What are your thoughts on this crazy keto carnivore craze that just seems to ratchet up and get crazier. We started with Atkins, then it's paleo, then it's keto, then it's carnivore any, any, any message that you'd like to deliver to all of our listeners out there?
Dr. Kim Williams:
I really would. I used to tell people, all you need to do is put in your search engine two words, keto and mortality. Several studies will pop up. We have the Eric trial and the [Saddleman 00:48:24] article and Italy, and Greece, and Japan, and everybody's got data that, that a keto diet done with animal products increases mortality, increases cardiovascular events. It's because it increases, even though it improves some risk factors, people talk about it for diabetes. It actually can. If you lose weight, your diabetes will get better.
Dr. Kim Williams:
And your blood pressure can get better too, but at the cost of increasing inflammation and increasing the cholesterol level. That's very well documented in the literature. What we didn't have until recently is the understanding, Rip, and this was not part of my 2018 talk because we didn't know this back then. It's about the microbiome. If I could just spend a moment bringing your audience up to ... I say, don't put in your search engine, keto mortality, put in microbiome, and eating animal products versus vegetable products. And it turns out I did talk at your conference about TMAO, trimethylamine N-oxide, which was-
Rip Esselstyn:
Not texting my ass off, but TMAO. Yes.
Dr. Kim Williams:
There you go. As it turns out, trimethylamine N-oxide comes from having a bad microbiome. You eat animal products. When you're eating decaying flesh, it may be fresh, but it's still decay. It's just hopefully decaying less by the time you eat it. You're still-
Rip Esselstyn:
It doesn't sound very appetizing.
Dr. Kim Williams:
Exactly. But you are actually ingesting the bacteria and you're ingesting bacteria when you're eating plants as well. It's just that the ones associated with plants are actually very benign for your GI tract. And the ones associated with eating animal products are very deleterious. They've got the science now down to the species. They know which species are good for you and which ones are not. Believe it or not, if I were to give you that same talk right now, every section, the hypertension, obesity, diabetes, high cholesterol, they all would be preceded by the effect of the microbiome.
Dr. Kim Williams:
I mean, we don't have quite enough time to go through each one of them, but I'll just give you one, the ISMA gene. The ISMA gene is in some bacteria and not in others. The more plant-based you are, the more likely you are to have the ISMA gene in your bacteria, in your GI tract. Well, guess what that does. It takes cholesterol and it changes it to coprostanol. We were thinking that vegans have a better cholesterol profile because they're eating less. It's way more than that, is that you're metabolizing and getting rid of it through your microbiome. Well, why is this all of a sudden big science? Well, first of all, the recognition that kidney disease, chronic kidney disease, not just heart attack, stroke, heart failure, death, but chronic kidney disease and dialysis can be improved by plant-based diet.
Dr. Kim Williams:
We don't have a lot of reversal studies for end stage renal disease, but stage four, almost end stage, going to three, three to two, and that sort of thing by plant-based nutrition, that is in the kidney literature now. It turns out that's the effect of the microbiome on kidney disease. So, it's comprehensive you. What you'll find is startling, that it's not just all of the things that I'm talking about. It's your brain as well. Everything from multiple sclerosis to Alzheimer's, to Parkinson's disease, all of them controlled by the microbiome.
Dr. Kim Williams:
The loudest noise in this area is COVID. Now, I got to add question ... Can I just reverse roles for just a second, just ask you a quick question?
Rip Esselstyn:
Sure.
Dr. Kim Williams:
How many vegans do you know died of COVID?
Rip Esselstyn:
I don't know any.
Dr. Kim Williams:
I don't know any either. And it turns out this was published a few weeks ago, that there was a 73% reduction in severity of moderate to severe illness in COVID if you were doing a plant-based diet. If you were doing a keto diet, it was dramatically increased. Pesco-vegetarian was somewhere close to the vegan, but not quite as good. It's the microbiome that determines your cytokine storm that kills you with COVID, and the vegans have a better microbiome. This is where we need to be.
Rip Esselstyn:
This is where we need to be. I need to make sure that Dr. Will Bulsiewicz listens to this episode. Do you know Bill? Will, who wrote ... He wrote Fiber Fueled. He's a gastroenterologist. He's brilliant. But anyway, he's on top of this stuff as well. Let me ask you this as we're winding down, who are some of your heroes in life? It sounds like your mother was one of them.
Dr. Kim Williams:
Well, so, in many ways she was. I would say my great-grandmother, when I had the food insecurity, she was the one who would bail me out. I would say that I learned a lot from my parents. A lot of them were lessons to reverse for raising my own kids. I would say that I had wonderful mentors at University of Chicago, that I had wonderful mentors at Moody Bible Institute, where I went for eight years and learned really from the scripture of how to manage a division of cardiology, believe it or not. I have a lot of folks that I look up to in organized medicine. Wonderful people at the AMA.
Dr. Kim Williams:
A lot of people don't understand that the AMA is not the old AMA where blacks couldn't get in. Not that AMA, okay? This is full of young, vibrant, vibrant people who are concerned about healthcare and health of care delivery, and how to do more for the poor and not burn out at the same time. It's an incredible organization. But the American College of Cardiology had great leaders and great people that I look up to and aspire to be. I would say that I learned quite a bit from so many places. I would say that to anyone in my leadership training, always listen, always be prepared to be the servant of everybody else that you're leading, and never lead alone. If you do those three things, you'll be successful.
Rip Esselstyn:
Beautiful. Are you getting ready to play tennis or did you just get done playing tennis?
Dr. Kim Williams:
Okay. Little secret, I used to be a teaching pro. Okay?
Rip Esselstyn:
Yeah.
Dr. Kim Williams:
I always have tennis clothes on. TMI. I might be wearing a white coat in the suit, but I have tennis clothes on.
Rip Esselstyn:
Nice. How about our plant-based boy Novak Djokovic? He almost had, almost had the grand slam, almost did.
Dr. Kim Williams:
I really hope that he's able to see his way through to negotiate his way into the Australian Open. It's his best surface. He is an amazing athlete to get to be his age, to go through all he went through, and then really take off when he became completely plant-based. That's the majority of his grand slams. I'd like to see him get that 21st. I love Nadal, love Federer, they're unique individuals, incredible athletes, but to get that plant-based message out, Novak Djokovic, really is the person who I'm cheering for the most.
Rip Esselstyn:
Yes. Well, I got one last question for you, Kim, and then I'm going to let you skate off, and that is, you're a busy guy, how do you make this plant-based vegan lifestyle work as far as breakfast, lunch, dinner, you're making rounds, you're seeing patients? I'd just love to end with that.
Dr. Kim Williams:
Well, I used to do a lot of delivery. There are some really wonderful whole food plant-based delivery services, and then COVID happened and I ended up doing a lot of cooking. Just ordering stuff and spending more time ... I still don't use recipes. I just throw things in there as sort of a gut feeling. There's a way in which that's very natural and let your body tell you what it wants. I pretty much do that and I go from there. I have some things that are fast that I can just heat up for a moment and then run off to clinic.
Dr. Kim Williams:
I always carry, so I know that the Esselstyn diet doesn't have a lot of nuts and seeds, but there are some people, and that's because most of the patients are overweight, but there are some of us who are really thin. The nuts provide really good nutrition. I have always a bag of something in my computer bag and do as much as I can to do that whole food plant-based diet. Because I tease the vegans who are not doing whole food plant-based, that an unhealthy plant-based diet, now that we have the data, I say it's really good for the planet. Animal rights are taken care of, no animal cruelty, and it kills humans.
Rip Esselstyn:
Yeah. Yes. Whole food, plant-based.
Dr. Kim Williams:
Absolutely.
Rip Esselstyn:
Absolutely. Kim, you're a beautiful man. You are gentle. You're humble. And you are, like you said, you've been a servant and an amazing leader. I appreciate everything you're doing and the example that you're setting. Thank you for joining us today.
Dr. Kim Williams:
Well, I'm trying to hold up a mirror because you really should be talking about yourself, Rip. I really appreciate that. I'm glad that you have the immediate impact that you have in everything that you're doing. So, sally forth and can continue.
Rip Esselstyn:
Yeah. Thank you. All right. Plant-strong.
Dr. Kim Williams:
Take care. Thank you. Right, bye-bye.
Rip Esselstyn:
Thank you. Thank you, Dr. Kim Williams, for being an outspoken advocate and example of what the future of medicine can look like. Prevention education starts with people like you, and we are grateful that you heeded the call to become a doctor at the paltry age of 11. You were truly made for medicine. Now, before I go, I want to stress one thing that Dr. Williams said in this interview that I believe bears repeating. There is new research showing that the highly processed plant-based foods that we see everywhere now, littering the store shelves is less healthy and potentially more harmful to your health than animal foods.
Rip Esselstyn:
Once again, I want to stress plant-strong goal of eating a whole food plant-based diet, one that is choke-full of all kinds of legumes, which are beans, peas, and lentils, green leafy vegetables, the rockstars, whole intact grains, all kinds of wonderful, colorful, magnificent fruits, and of course, the wide world of vegetables that are out there and limited amounts of nuts and seeds.
Rip Esselstyn:
For resources on today's episode and all of our programs at PLANTSTRONG, simply visit the episode page at plantstrongpodcast.com. Thanks so much for listening, and here is to a stellar healthy 2022. The PLANTSTRONG Podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin, and Wade Clark. This season is dedicated to all of those courageous true 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 Esselstyn Jr., and Ann Crile Esselstyn. Thanks for listening.
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