Monday, January 2, 2012

Prevent and Reverse Heart Disease: My Thoughts and Opinions

I recently read Caldwell B. Esselstyn, Jr., M.D.'s book called Prevent and Reverse Heart Disease. The China Study by T. Colin Campbell with Thomas M. Campbell II is next on my reading list; however, in retrospect, I realize that I should have read it first. Esselstyn's book is primarily centered on his study, involving 24 subjects, and Campbell's epidemiological study in China. There are several points that I really can't begin to discuss until I read Campbell's book, but I'll do my best to review Esselstyn's book and then will fill in the gaps later.

I think we can all agree that Americans eat way too much fat, meat, and refined grains while not eating enough fruits, vegetables, and whole grains. Esselstyn really harps on this and I agree with him. If we all reduced our portions of meat, replaced our refined grains with whole grains, cut down on the desserts, and filled our plates with more fruits and vegetables, we would certainly be a lot healthier. I would also be willing to bet that chronic diseases would be diagnosed with much less frequency. I even agree that it wouldn't hurt to eat a vegetarian meal here and there. Meat does not need to be the center of every meal.

Despite the fact that Esselstyn and I agree on some points, I would not recommend this book for several reasons. First of all, Esselstyn bases most of his beliefs on his study, which contained only 24 subjects, and Campbell's China Study. Given the small sample size of his study it is hard to put much faith in the outcomes. My second major criticism of the book is that Esselstyn adamantly promotes a vegan diet. I have never been a supporter of a vegan diet unless a patient is following it due to religious or ethical reasons. Based on available science, I do not believe that there are any health reasons to follow such a strict diet. Because Vitamin B12 is only naturally found in animal products, you would need a supplement to insure you were getting adequate amounts of Vitamin B12. Any diet that is lacking in an essential nutrient makes me very leery.

Certainly, decreasing animal products in the diet would result in a decreased total blood cholesterol; however, do we really need to play the "how low can you go" game? Many things in life, including the human body, are about balance. Cholesterol is essential to the body, but too much can be a bad thing. Effort should be focused on maintaining a balance, not on racing to see who can achieve the lowest possible cholesterol level. That being said, I cannot agree that eliminating animal products is the answer. Animal products, including meat and dairy, provide us with a host of important nutrients that keep us healthy and thriving. Because this is a blog post and not a book, I won't go into all of the details.

Speaking of cholesterol levels, Esselstyn states that if you can achieve a total cholesterol of less than 150 mg/dL, you will not develop heart disease. He says that even if you smoke, are obese, have a family history of heart disease, or hypertension, you will still not develop heart disease. Any of you who have any experience with heart disease patients probably just experienced your jaw dropping. I have personally worked with numerous patients who had total cholesterol levels well below 150 mg/dL, yet they still had a heart attack. Not that this has been backed up by a study, but I would rather see a patient with a total cholesterol of 180 mg/dL and be a non-smoker than to have a total cholesterol of 130 mg/dL and light up 5 times each day.

Esselstyn also promotes a diet very low in dietary fat. Again, while I do agree that Americans eat too much fat, I don't agree that we should aim to ingest as little fat as humanly possible. Fat is necessary for absorption of fat soluble vitamins, satiety, synthesis and repair of vital cell parts, and other important functions. Research has also shown that omega-3 fatty acids decrease inflammation, which is a key factor in preventing heart disease. Research also supports that a diet rich in omega-3 fatty acids helps to decrease the risk of dementia and Alzheimer's disease. In fact, it can even help to delay the progression of dementia and Alzheimer's disease after the onset. Esselstyn actually states that his diet could possibly save a person from senile-impairment. I am not sure how he came to this conclusion as he sites no research. He even says that you should avoid avocados and nuts (although he does mention that you can have some nuts if you do not have heart disease). Although he pushes a plant-based diet, he denies the diet of some very nutrient-dense plant foods that other experts believe to be healthy. In fact, there is plenty of research showing the benefits of nuts, especially walnuts. Furthermore, the American Heart Association actually recommends two servings of fatty fish each week due to its disease protective benefits.

If you ever want to celebrate your birthday with a little cake, you won't be able to follow this diet completely. Esselstyn does not believe in moderation or the occasional treat. For this reason, I feel that his diet is totally unrealistic for the average person to follow, including myself! Although I know that ice cream isn't good for me, I don't see the harm in an occasional splurge. I believe in keeping treats to a minimum and watching the serving size. But, to think I could never make Christmas cookies with my kids or treat them to ice cream on a hot summer day makes me a little sad.

I have a list of notes that I took while reading this book and I have much more to say; however, I am trying not to turn this into a book! I leave you all with this: this book did not sway my stance on nutrition. A balanced diet that contains fruits, vegetables, whole grains, dairy, meat, fish, beans, and nuts is healthy as shown by science. I did not feel that this book produced any compelling evidence that proves otherwise. As I said, I will be reading
The China Study next and will look forward to reporting on the text.


  1. Thank you for this very thorough review of Esselstyn's book. I find it disturbing that information from a study of so few subjects can be presented as absolute fact. I too have encountered many people who were astounded that they need stent placement or a bypass graft although their cholesterol levels were normal. It is obvious that there are numerous issues to debate regarding this book.

  2. Always watch for diet, because our food have big effect in our health. Prevention is better than cure :)

  3. Esselstyn's statements about being "heart attack proof" are not just drawn from thin air. They are based on the decades-long, meticulously studied Framingham Heart Study, including a very large population. It is also significant that his patients were at the end of their ropes and most had basically exhausted all options to treat their heart disease, and that more than 20 years later, the ones who stuck with it are thriving. It is certain that everyone is different, and each person will find different results with this plan. It is also a medical fact that a stent or bypass is only temporary unless the diet is radically changed. Esselstyn's results with his patients also correlate studies of large populations that he cited in his book (among them the studies in Czechoslovakia during World War II when meat was unavailable and when it was reintroduced). Campbell's study in China is a must to read before getting too critical of the success Esselstyn has had with his program. As to fat in the diet, people who follow the Esselstyn program get about 10% of their calories from fat...just not the saturated variety, ideally.

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  6. I am suffering from heart disease from very long time. Doctor advised me to eat vegetarian diet and avoid oily food. But it seems to be impossible for me but due to efforts my wife I started to avoid oily food. Moreover in doing so I read guidance book from amazon . It really provoke me and now I have started to take care of my health!