Famed heart surgeon Caldwell Esselstyn Jr. has long rallied against the overuse of stents, cholesterol drugs and other conventional heart disease treatments. His solution? A diet rich in green, leafy vegetables. Doctors generally agree that a healthy diet is beneficial, but it's usually considered one piece of a larger treatment plan. To Esselstyn, however, heart disease is a "foodborne illness, one that can be prevented, reversed and even abolished by eating a plant-based, oil-free diet, one that eliminates meat, milk, fish, eggs and dairy."
"The concept that food can be more powerful than any procedures or drugs is really almost anathema," said Esselstyn, director of the Cardiovascular Prevention and Reversal Program at the Cleveland Clinic Wellness Institute.
We asked Esselstyn, who starred in the documentary "Forks Over Knives," about his plant-based prescription for health.
If you are considering changing your diet, talk with your doctor to see what is appropriate for you. An edited transcript of the interview follows.
Q: Why has the plant-based diet been slow to take root?
A: Many cardiologists are in enormous conflict. On one hand, insurance makes enormous amounts of money for procedures — stents and bypass surgery — that have nothing to do with the cause of the disease. But if they talk about nutrition, insurance won't pay for it. Also, most physicians don't get any, any, any kind of nutritional education in medical school.
Q: Is that changing?
A: When I speak to academic groups, especially in the cardiovascular community, they don't have a clue as to what I'm talking about.
Q: What causes heart disease?
Q: How does food cause — or cure — heart disease?
A: The endothelial cell pumps out marvelous amounts of nitric oxide, the absolute guardian and life jacket of our vessels. Nitric oxide keeps cells within our blood vessels flowing smoothly like Teflon, rather than Velcro. Nitric oxide also prevents inflammation from developing in the walls of the arteries, keeps us from getting stiff vessels and has a role in keeping us from developing blockages or plaque.
Every time we ingest certain foods, it compromises and injures the endothelial cell's capacity to make nitric oxide. As we are constantly getting less and less nitric oxide, we are less able to prevent coronary artery disease.
Q: Which foods compromise the endothelial cells the most?
A: Animal and processed foods, primarily oil, dairy, anything with mother or face — meat, fish and fowl — and sugar, coffee with caffeine.
Q: Wow. That's restrictive. How do you eat on the road?
A: When you go to these little places wherever everything looks horrible, you have to be creative. I say, "I'd like the panini, but I don't want the oil, butter, cheese or olive oil. Just give me the vegetables and bread." You have to be hard and tough.
Q: Why no oil?
A: The last thing you need is oil. You never need it. It injures the endothelial lining. For people who don't have heart disease, I won't say they can't have oil or nuts. But I don't like the idea of people eating foods that we know are injuring the endothelial cells.
Q: What can you eat?
A: Whole grains for their cereal, bread and pasta, beans, vegetables — yellow, red, green — and fruit. Bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, Napa cabbage, Brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula and asparagus.