He is not a household name, but Caldwell Esselstyn Jr. has been a constant and outspoken advocate of what some would call a vegan diet. His 2007 book, "Prevent and Reverse Heart Disease," inspired President Bill Clinton to adopt a plant-based diet free of fats and dairy products. Dr. Esselstyn is also featured in the documentary "Forks Over Knives," a film that has changed the way many Americans look at their food. He graduated from Yale University and won a gold medal rowing with his eight-man crew in the 1956 Summer Olympics. He went to Case Western Reserve University School of Medicine, served in the Vietnam War as a surgeon and became a researcher at the Cleveland Clinic. At 79 he is still going strong.
How long have you and your wife, Ann, been vegan?
First, I should say I retired 10 years ago from general surgery. The reason we got started with this in the first place was in the late 1970s early '80s, when I was chairman of our breast cancer task force, it was very disconcerting that for however many I was doing breast surgery on, I was doing nothing for the next unsuspecting victim.
I thought it would be much more bang for the buck if we could get people to eat to save their heart. Saving their heart would also save them from 80 percent of these other chronic, killing diseases. So to answer your question: 1984 is when Ann and I totally committed to plant-based nutrition.
Did you do it cold turkey (yum) or did you ease in?
with Dr. Caldwell Esselstyn, Jr..
See the "Breakfast With ..." archive.
What did you miss most initially?
It's hard to pin that down. I guess I could say maybe smoked salmon [laughs].
Many people say after doing it for a while they lose those food addiction cravings.
What happens is increasingly scientifically understood. In the brain, we all have a fat receptor. As you rapidly down-regulate the fat receptor [by not eating fats], you begin to lose the craving for fatty foods. It makes it so much easier, which is why we always try to get patients to go cold turkey. If you try to do it gradually, you are constantly in a situation of misery and denial because you have not down-regulated the fat receptor.
So basically your taste buds are hypnotized by fats until you snap them out of it.
I like that, yes.
In your mission to change the American diet, you are up against big food corporations, drug companies and even the government.
To me, the challenges in life are really what make it exciting. If you step back for a minute and look at the big picture and ask what is the most extreme radical food consumption on the planet, it would be here, right now, in the United States.
Ninety-five to 98 percent of Americans have no concept of what really is a healthful eating pattern. There are foods that literally within minutes of passing through your lips are going to begin to disseminate, injure and compromise the ability of the guardian and life jacket of your blood vessels, the endothelial cells, [to do their job]. It is really no great surprise that everybody practically ends up with some kind of cardiovascular illness.
You have to remember, I grew up on a beef and dairy farm, and the plant-based diet was quite a transition for me, but when you eliminate the injurious foods [dairy products and meat], diabetes, strokes, hypertension, heart attacks, dementia and common Western cancers such as breast, prostate and colon are markedly diminished.
I really feel we could be on the cusp of a seismic revolution in health in this country. It is never going to come about with the invention of another pill or electronic medical records or building another cardiac cathedral. It will come about when we in the profession have the will and the grit and the determination to share with the public what is the optimal lifestyle and to inform them with a degree of nutritional literacy. Then they can become the locus of control.
Do your endothelial cells repair when you eliminate fats and dairy?
There is no question your endothelial cells start to recover, but it would be a bit of a stretch to say your artery would go back to as normal as it was when you were 5 or 10 years old. It can recover sufficiently so that you don't have to have stents and bypasses and can carry on the daily activities of living without a cardiac crisis.
In your efforts to get people to see food as medicine, do you use the mantra you used as an Olympic rower: "Press on regardless"?
[Laughs] That is something you have to use from time to time when you are seriously challenged. For instance, there are still physicians who are not familiar with this research and will thumb their nose at the idea that food has this incredible power. Yet when they have a heart attack, it is very exciting to see where they are going to get their ideas and treatment.
Increasingly, we have had a number of physicians who have seen the power of this. One reason it is difficult for physicians is they never receive any training about nutrition in medical school, and it is very hard for them to embrace a form of therapy for which they are not remunerated. There is very little or any insurance that will reimburse physicians who commit themselves to instruct and educate the public about the lifestyle, which will allow them to avoid these illnesses.
The American Heart Association diet does not eliminate dairy.
It is very tragic that the leaders in cardiovascular illness -- the American Heart Association and the American College of Cardiology -- really have not come forward and acknowledged the fact that coronary artery disease and heart attacks are nothing more than a toothless paper tiger that need never, ever exist. If it does exist, it need never, ever progress. It is a benign food-borne illness. There are multiple cultures on the planet today where if you were to hang out your shingle as a cardiac surgeon -- forget it. You'd better plan on selling pencils. They don't have cardiovascular illness because by culture, heritage and tradition they consume a plant-based diet.
If food is medicine, how do you feel about genetically modified crops?
I don't think I want to get into that right now because that would really take a great deal of additional educational background. There are some serious unknowns about genetically modified foods, and sadly so much of it right now is being created purely for profit. It is so disgraceful what the government has done. They permit the Department of Agriculture to design every five years a food pyramid or plate for the public. On that plate are the very foods if consumed will guarantee that millions of Americans will perish. The USDA is nothing more than the handmaiden of the food industry. Having the USDA design a food pyramid for the public is like having Al Capone do your taxes.
You wrote "Prevent and Reverse Heart Disease" in 2007. Is there anything you would add today?
Oh yeah, several things I think are critical. These blockages and plaque in people's arteries are an oxidative cauldron of inflammation. We need antioxidants, not the kind you buy as a jug of pills, but a greater emphasis on natural antioxidant foods -- raspberries, strawberries, blueberries and more specifically, green leafy vegetables -- bok choy, kale, Swiss chard, collard greens, broccoli, spinach, parsley, arugula -- and I am sure I left some out, but you just can't get enough of those.
The other thing we did not know when the book was written is that one of the real rascals in this whole thing is sugar. Maple syrup, molasses and honey were in our book. We can't do that anymore. Fructose injures the lining of the blood vessels. Even orange juice or apple juice. It is fine to eat an orange or an apple, but when you have the juice, the sugar is separated from the fiber and the absorption is so rapid.
Are you still against the avocado?
I am a little tough on the avocado, along with nuts. Nuts have a lot of saturated fat and if I ever said that people could have nuts, they would have them in the glove compartment of the car, at work, the bathroom, the bedroom, the living room. How many people do you know that have eaten one nut? So I've been tough on the avocado and the nut because very few of my patients need to gain weight. They almost always carry extra pounds.