PART ONEThe Heart of the MatterIEating to LiveIT WAS A FRIDAY in NovemberI had operated all day I finished, said good bye to my last patient, and got a very, very bad headache It hit me in a flash I had to sit down A minute or two after that, the chest pain started It radiated up my arm and shoulder and into my jawThese are the words of Joe Crowe, the doctor who succeeded me as chairman of the breast cancer task force at the Cleveland Clinic He was having a heart attack He was only forty four years old He had no family history of heart disease, was not overweight or diabetic, and did not have high blood pressure or a bad cholesterol count In short, he was not the usual candidate for a heart attack Nonetheless, he had been struckand struck hardIn this book, I tell Joe Crowes story, along with those of many other patients I have treated over the past twenty years My subject is coronary artery disease, its cause, and the revolutionary treatment, available to all, that can abolish it and that has saved Joe Crowe and many others My message is clear and absolute coronary artery disease need not exist, and if it does, it need not progress It is my dream that one day we may entirely abolish heart disease, the scourge of the affluent, modern West, along with an impressive roster of other chronic illnessesHere are the facts Coronary artery disease is the leading killer of men and women in Western civilization In the United States alone,than half a million people die of it every single year Three times that number suffer known heart attacks And approximately three millionhave silent heart attacks, experiencing minimal symptoms and having no idea, until well after the damage is done, that they are in mortal danger In the course of a lifetime, one out of every two American men and one out of every three American women will have some form of the diseaseThe cost of this epidemic is enormousgreater, by far, than that of any other disease The United States spendsthanbillion a year on heart disease Thats about the same amount the nation spent on the first two and half years of its military venture in Iraq, and fully twice as much as the federal government allocates annually for all research and developmentincluding Rspecifically, in abandoning the toxic American diet and maintaining cholesterol levels well below those historically recommended by health policy expertsThe bottom line of the nutritional program I recommend is that it contains not a single item of any food known to cause or promote the development of vascular disease I often ask patients to compare their coronary artery disease to a house fire Your house is on fire because eating the wrong foods has given you heart disease You are spraying gasoline on the fire by continuing to eat the very same foods that caused the disease in the first placeI dont want my patients to pour a single thimbleful of gasoline on the fire Stopping the gasoline puts out the fire Reforming the way you eat will end the heart diseaseHere are the rules of my program in their simplest form You may not eat anything with a mother or a face no meat, poultry, or fishYou cannot eat dairy productsYou must not consume oil of any kindnot a drop Yes, you devotees of the Mediterranean Diet, that includes olive oil, as Ill explain in ChapterGenerally, you cannot eat nuts or avocadosYou can eat a wonderful variety of delicious, nutrient dense foods All vegetables except avocado Leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellow and everything in betweenAll legumesbeans, peas, and lentils of all varietiesAll whole grains and products, such as bread and pasta, that are made from themas long as they do not contain added fatsAll fruitsIt works In the first continuous twelve year study of the effects of nutrition in severely ill patients, which I will describe in this book, those who complied with my program achieved total arrest of clinical progression and significant selective reversal of coronary artery disease In fully compliant patients, we have seen angina disappear in a few weeks and abnormal stress test results return to normalAnd consider the case of Joe Crowe After his heart attack in , tests showed that the entire lower third of his left anterior descending coronary arterythe vessel leading to the front of the heart and nicknamed, for obvious reasons, the widowmakerwas significantly diseased His coronary artery anatomy excluded him as a candidate for surgical bypass, angioplasty, or stents, and at such a young age, with a wife and three small children, Dr Crowe was understandably disconsolate and depressed Since he already exercised, did not use tobacco, and had a relatively low cholesterol count ofmilligrams per deciliter mg dL , there seemed to be nothing he could modify, no obvious reforms in lifestyle that might halt the diseaseJoe was aware of my interest in coronary disease About two weeks after his heart attack, he and his wife, Mary Lind, came to dinner at our house and I had a chance to share the full details of my research Both Joe and Mary Lind immediately grasped the implications for Joe of a plant based diet All at once, instead of having no options, they were empowered In Mary Linds words, It was our own personal disaster, and suddenly there was something small we could do Immediately, Joe embarked on my nutrition program, refusing to take any cholesterol lowering drugs, and he redefined the word commitment He stuck to the plan rigorously, eventually reducing his total blood cholesterol count to justmg dL and cutting his LDL, or bad cholesterol, frommg dL tomg dLAbout two and a half years after Joe adopted a strict plant based diet, there came a point when he was exceptionally busy professionally, under considerable stress, and he noted a return of some discomfort in his chest His cardiologists, worried about the recurrence of angina, asked fortests to see what was going onOn the day of his follow up angiogram, I went to Dr Crowes office after work After we greeted each other, I thought I saw moisture in his eyes Is everything OK I askedYou saved my life, he declared Its gone Its not there any Something lethal is gone My follow up angiogram was normalNearly ten years later, Mary Lind recalled that they had wondered, that first evening at our house, how the Esselstyns did ithow we had managed to completely change the way we eat Now its part of our family, she says Weve eaten the same things for a long time, and Im on autopilotLater, when I asked Joe what made him decide to change, he responded very simply We believed you, he said, and added, since I had nothing else, the diet came first If I had had bypass surgery, diet would not have been first The diet set us on another path, empowered to do something we knew we could doJoe Crowes angiogramsboth the original, taken after the heart attack, and the follow up, two and a half years laterare shown in Figuresee insert It is the most complete resolution of coronary artery disease I have seen, graphic proof of the power of plant based nutrition to enable the body to heal itselfThe dietary changes that have helped my patients over the past twenty years can help you, too They can actually make you immune to heart attacks And there is considerable evidence that they have benefits far beyond coronary artery disease If you eat to save your heart, you eat to save yourself from other diseases of nutritional extravagance from strokes, hypertension, obesity, osteoporosis, adult onset diabetes, and possibly senile mental impairment, as well You gain protection from a host of other ailments that have been linked to dietary factors, including impotence and cancers of the breast, prostate, colon, rectum, uterus, and ovaries And if you are eating for good health in this way, heres a side benefit you might not have expected for the rest of your life, you will never again have to count calories or worry about your weightAn increasing number of doctors are aware that diet plays a crucial role in health, and that nutritional changes such as those I recommend can have dramatic effects on the development and progression of disease But for a number of reasons, current medical practice places little emphasis on primary and secondary prevention For most physicians, nutrition is not of significant interest It is not an essential pillar of medical education each generation of medical students learns about a different set of pills and procedures, but receives almost no training in disease prevention And in practice, doctors are not rewarded for educating patients about the merits of truly healthy lifestylesOver the past one hundred years, the mechanical treatment of disease has increasingly dominated the medical profession in the United States Surgery is the prototype, and its dramatic progresslight years removed from the cathartics, bloodletting, and amputations that dominated medicine in previous centuriesis nothing short of breathtaking But surgery has serious flaws It is expensive, painful, and frightening, often disabling and disfiguring, and too often merely a temporary stopgap against the disease it is intended to treat It is a mechanical approach to a biological problemPerhaps no area of medicine better illustrates the mechanical approach to disease than cardiology and cardiac surgery Consider the United States contains justpercent of the global population, but every year, physicians in American hospitals performthanpercent of all the angioplasties and bypass procedures in the entire world One reason is that mechanical medicine is romantic and dramatic, a natural magnet for media attention Remember the drama several years ago surrounding implants of artificial hearts Most of the recipients died within weeks of their surgery, and all lived their last days tethered to life support machinery that, far from enhancing their quality of life, drastically reduced it But no matter the dramatic interventions engaged the national imagination for months on endAll told, there has been little incentive for physicians to study alternate ways to manage disease, so the mechanical procedural approach continues to dominate the profession even though it offers little to the unsuspecting millions about to become the next victims of disease Modern hospitals offer almost nothing to enhance public health They are cathedrals of sicknessThere are some signs of change Physicians and researchers increasingly agree that lifestyle changescontrolling blood pressure, stopping smoking, reducing cholesterol, exercising, and modifying dietsare essential to overall health It is hard to deny the evidence, mounting with every passing year, that people who have spent a lifetime consuming the typical American diet are in dire trouble Dr Lewis Kuller of the University of Pittsburgh recently reported the ten year findings of the Cardiovascular Health Study, a project of the National Heart, Lung, and Blood Institute His conclusion is startling All males overyears of age, exposed to a traditional Western lifestyle, have cardiovascular disease and should be treated as suchEven interventional cardiologists are beginning to question the rationale of their procedures In , cardiologist David Waters of the University of California performed a study that compared the results of angioplastyin which a balloon is inserted into a coronary artery to widen the vessel and improve blood flowwith the use of drugs to aggressively reduce serum cholesterol levels There was no disputing the outcome The patients who had the drug treatment to lower cholesterol had fewer hospitalizations for chest pain and fewer heart attacks than those who underwent angioplasty and standard postoperative careThe larger lesson of that study is that systemic treatment of disease through aggressive reduction of cholesterol is clearly superior to selective intervention at a single site where an artery has been clogged and narrowed And it caused considerable uproar among cardiologists As Dr Waters observes, There is a tradition in cardiology that doesnt want to hear thatWhy Money For many years, I resisted that conclusion, but the weight of the evidence is overwhelming Interventional cardiologists earn hundreds of thousands of dollars annually, and particularly busy ones make millions In addition, cardiology procedures generate huge revenues for hospitals And the insurance industry supports the mechanical procedural approach to vascular disease It is far easier to document and quantify procedures for reimbursement than it is to document and quantify lifestyle changes that prevent the need for such procedures in the first placeAs a physician, I am embarrassed by my professions lack of interest in healthier lifestyles We need to change the way we approach chronic diseaseThe work I will describe in the following chapters confirms that sustained nutrition changes and, when necessary, low doses of cholesterol reducing medication will offer maximum protection from vascular disease Anyone who follows the program faithfully will almost certainly see no further progression of disease, and will very likely find that it selectively regresses And the corollary, overwhelmingly supported by global population studies, is that persons without the disease who adopt these same dietary changes will never develop heart diseaseCardiologists who have seen my peer reviewed data often concede that coronary artery disease may be arrested and reversed through changes in diet and lifestyle, but then add that they dont believe their patients would follow such radical nutritional changesBut the truth is that there is nothing radical about my nutrition plan Its about as mainstream as you can get Forbillion of the worldsbillion people, the nutrition program I recommend is standard fare, and heart disease and many other chronic ailments are almost unknown The word radical better describes the typical American diet, which guarantees that millions will perish from withering vascular systems And in my experience, patients who realize that they have a clear choicebetween invasive surgery that will do nothing to cure their underlying disease and nutritional changes that will arrest and reverse the disease and improve the quality of their liveswillingly adopt the dietary changesOne of the most outstanding projects in health research of the past century It s relevant, it s caring, it s innovative, it s extremely well executed and it s very, very useful T Colin Campbell, PhD author of The China StudyDr Caldwell Esselstyn has directed pioneering research demonstrating that the progression of even severe coronary heart disease can often be reversed by making comprehensive change in diet and lifestyleDean Ornish, MD, founder, president and director of Preventive Medicine Research Institute and author of Dr Dean Ornishs Program for Reversing Heart DiseaseI highly recommend Dr Esselstyns bookKathy Freston, author of VeganistDr Esselstyn has always been ahead of his time His focus on the healing powers of proper nutrition on diseased coronary arteries has now proven right, raising another unthinkable notionthat heart patients can cure themselvesBernadine Healy, MD former Director of the National Institutes of HealthA hard nosed scientist shows us his secrets for successfully cleaning the rusting arteries of so many patients and it doesn t even hurtMehmet Oz, MD coauthor, You The Owners ManualDr Caldwell Esselstyn, Jr is certainly the father and the mother of the now proven hypothesis that you can reverse severe arterial disease including severe disease of the arteries supposed to nourish your heart He proved that radical changes in diet and that alone cause radical changes in the age and disease of your arteriesand that you can make your arteries much younger So even if you only want to try this plan five days a week, this book is a must purchase because of its great recipes that spice low fat plant based food to high tasteyou may even want to enjoy and know I am using that word specifically and as intentionally as the proposal I made to my wifeyears ago the recipes alldaysMichael Roizen, MD coauthor of YOU The Owner s Manual and YOU On A Diet The Owner s Manual to Waist ManagementThis powerful program will make you virtually heart attack proof Based on decades of research, Dr Caldwell Esselstyn has shown not only how to prevent heart disease, but how to reverse it even for people who have been affected for many years I strongly recommend this important book Neal D Barnard, MD President, Physicians Committee for Responsible Medicine, and author of Breaking the Food SeductionIf you have heart disease, this book should be essential reading It could save your life Michael F Jacobson, Executive Director, Center for Science in the Public Interest Prevent and Reverse Heart Disease provides a practical approach for people to regain their lost health Considering the worldwide prevalence of coronary artery disease this book should become the bestseller of all timesJohn McDougall, MD author of The McDougall ProgramDr Esselstyns solution in Prevent and Reverse Heart Disease is as profound as Newtons discovery of gravity Half of all Americans dying today could have changed their date with the undertaker by following Dr Esselstyns planHoward F Lyman, author of No More Bull andMad CowboyDr Esselstyn s eminently successful arrest and reversal therapy for heart disease through patient education and empowerment as the treatment of choice will send shock waves through a mercenary medical system that focuses largely on pills and proceduresHans Diehl, Founder Director of the Coronary Health Improvement Program CHIP


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