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eÉ~êí=aáëÉ~ëÉ=
with Dr. Caldwell B. Esselstyn Jr.
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This lecture will cover the following topics
1. Introduction 2. Prevent and Reverse Heart Disease 3. Absence of Coronary Artery Disease 4. Plant Based Nutrition 5. Birth of a Plaque 6. Endothelial Cells 7. Nitric Oxide 8. Moderation Kills 9. We are Going to Put the Fire Out 10. Review of the First 12 Years 11. Arrest and Reversal Treatment Regimen 12. Monell Chemical Senses Study 13. Summary/Shift to the Brain 14. Brain Debris 15. Finally: Endothelial Cells 16. Old and Frail: A Matter of Heart
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Introduction
Dr. Caldwell Esselstyn, M.D. is a preventative cardiology consultant and former president of the medical staff at the Cleveland Clinic. He studied at Yale and was trained as a surgeon at St. George’s Hospital in London, England. His scientific publications number over 150 and he is regarded as one of the best doctors in America. During the past two decades, Esselstyn has devoted his practice to preventative medicine targeting heart disease. His 1995 benchmark longitudinal study showed how diet can arrest and reverse coronary artery disease without medication and surgery. Esselstyn also received a gold medal in the Olympics and served as an army surgeon in Vietnam.
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Prevent and Reverse Heart Disease
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Breast Cancer Surgery
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Prevent and Reverse Heart Disease
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Breast Cancer Less Frequently Seen in Other Cultures
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Prevent and Reverse Heart Disease
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Tackling Cardiovascular Disease
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Prevent and Reverse Heart Disease
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Focus on Heart Disease
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Prevent and Reverse Heart Disease
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Eating to Save Their Hearts
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Absence of Coronary Artery Disease
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American Way of Eating
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Absence of Coronary Artery Disease
▸ Rural China
▸ Papua Highlanders
▸ Central Africa
▸ Tarahumara Indians
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Absence of Coronary Artery Disease
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Statin Drugs
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Absence of Coronary Artery Disease
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American Soldiers Return Home
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Absence of Coronary Artery Disease
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Absence of Coronary Heart Disease
▸ “All males 65 years and older, and all females 70 years and older, who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.”
Lewis Kuller, M.D. University of Pittsburgh
April 2007
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Plant Based Nutrition
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Soldiers in WWII
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Plant based Nutrition
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Death-Rate Per 10,000 Population
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Birth of a Plaque
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Birth of a Plaque
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Clogging of the Arteries
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Birth of a Plaque
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Birth of a Plaque
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Birth of a Plaque
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Birth of a Plaque
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Birth of a Plaque
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Arterial Wall
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Endothelial Cells
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Nitric Oxide
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Moderation Kills
“I won’t have any tonight.”
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Moderation Kills
“I’ll just have a little bit.”
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Moderation Kills
▸ Most lipid lowering studies show a slower progression of coronary artery disease
▸ 30% fewer new heart attacks
▸ 30% fewer heart attack deaths
▸ 30% fewer interventions needed
▸ What about the remaining 70%?
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Intervention and Cardiac Drug Downside
▸ Mortality
▸ Morbidity
▸ Expense
▸ Increasing failure rate with time
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Intervention and Cardiac Drug Downside
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▸ Mortality
▸ Morbidity
▸ Expense
▸ Increasing failure rate with time
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Intervention and Cardiac Drug Downside
…a little bit scary
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Intervention and Cardiac Drug Downside
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Intervention and Cardiac Drug Downside
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Expanded Stent
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Intervention and Cardiac Drug Downside
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We are Going to Put the Fire Out
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“How did I get another blocked artery when I’ve been doing everything right?”
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We are Going to Put the Fire Out
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Review
A Strategy to Arrest and Reverse Coronary Artery Disease:
A 12-Year Longitudinal Study of a Single Physician’s Practice
Caldwell B. Esselstyn, Jr., MD
Background 1984
Epidemiological Data
Animal Studies
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Review
Participants 1985-1988 23 men, 1 woman with severe triple vessel coronary artery
disease – age range 44-68
Goal
Maintain total serum cholesterol < 150 mg/dl
Maintain LDL serum cholesterol < 80 mg/dl
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Review
Method
Avoid
▸ Oil
▸ Fish
▸ Fowl
▸ Meat
▸ Dairy
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Review
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Arrest and Reversal Treatment Regimen
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Arrest and Reversal Treatment Regimen
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Arrest and Reversal Treatment Regimen
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Arrest and Reversal Treatment Regimen
Foods to be Included
▸ Grains
▸ Legumes, lentils
▸ Vegetables
▸ Fruit
▸ Diet ~ 11% fat – plant-based
▸ Cholesterol lowering medication
▸ Unstructured exercise
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Arrest and Reversal Treatment Regimen
▸ Initial interview with patient and spouse
“Patients with cancer are not afraid to suffer
Patients with cancer are not afraid to die
but Patients with cancer are afraid
of being abandoned
By their physician or by their family”
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Arrest and Reversal Treatment Regimen
▸ Initial interview with patient and spouse
▸ Bi-monthly clinic visit – diet diary
▸ Periodic group gatherings
▸ Physician leader participation
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Arrest and Reversal Treatment Regimen
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Physician leader participation
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Monell Chemical Senses Study
▸ Fat craving lost in 90 days
▸ Baseline Mean Cholesterol ▸ 237 mg/dl
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Reversal of Coronary Disease
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Coronary Angiograms: Pediatrician 67 years old
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Reversal of Coronary Disease
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Factory Worker 58 years old
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Reversal of Coronary Disease
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Security Guard 54 years old
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Reversal of Coronary Disease
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Joseph Crowe, M.D.
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Reversal of Coronary Disease
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November 27, 1996 July 22, 1999
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12-Year Analysis of Dropouts
6 Patients – 13 New Cardiac Events
Increased angina 4
Ventricular tachycardia 2
Bypass surgery 4
Angioplasty 1
Congestive heart failure 1
Death from arrhythmia 1
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8 Years Prior to Study
49 Coronary Events in 18 Patients
Increased angina 18
Angiographic disease progression 13
Bypass surgery 7
Infarctions 4
Strokes 3
Angioplasty 2
Worsening stress test 2
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8 Years Prior to Study
18 Patients Followed 12 Years
▸ 49 coronary events during 8 years prior to study
▸ None in 17 compliant patients during 12 years
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8 Years Prior to Study
Arrest and Reversal Outcomes
▸ No mortality from the diet
▸ No morbidity from the diet
▸ Benefits improve with time
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Quality of Life Issues
“Patients are empowered by the knowledge that they are in control of the disease that was destroying their lives.”
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Shift to the Brain
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Shift to the Brain
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Normal Brain MRI Injured Brain MRI
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Brain Debris Pierre Aramenco
▸ Measured the thickness of atherosclerotic debris growing on the inside of each patient’s ascending aorta
▸ He divided the men into three groups:
Group 1 = 1 millimeter
Group 2 = between 1 and 3.9 millimeters
Group 3 = more than 3.9 millimeters
▸ Followed the patients for three years
▸ The group with the greatest amount of plaque growth shed the greatest number of emboli, and had the most strokes
▸ When an aorta that contains plaque is clamped during coronary bypass surgery, plaque debris is loosened and enters the bloodstream as an embolus
▸ If the patient dies during surgery, the plaque debris may be found in the brain at autopsy
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What About the Legs?
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Angina Patient Back to Normal After Plant Based Diet
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Finally: the Endothelial Cells
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PET Scan - School Bus Driver 58 years old
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Finally: the Endothelial Cells
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PET Scan - Retired Tool Maker 58 years old
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Finally: the Endothelial Cells
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PET Scan - Retired Barber 58 years old
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Finally: the Endothelial Cells
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PET Scan - Stock Broker 58 years old
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Finally: the Endothelial Cells
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Arterial Wall
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Old and Frail: A Matter of Heart
Dr. Anne Newman, CHS Dr. Tamara Harris, NIH
The 400-Meter Walk Study
▸ 2,700 community-dwelling white and African-American men and women aged 70-79 years of age
▸ Ten 40-meter laps in a corridor
▸ Follow them for six years
▸ After six years, those in the slowest 25 percent for walk time had the greatest onset of new partial and total disability, and the greatest difference in mortality
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Old and Frail: A Matter of Heart
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The 400-Meter Walk Study
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Old and Frail: A Matter of Heart
Parts of the brain that grow with exercise:
▸ The Hippocampus
▸ The Frontal Lobes
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The 400-Meter Walk Study
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Old and Frail: A Matter of Heart
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Scary Platform
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Old and Frail: a Matter of Heart
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Helicobacter Pylori
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Old and Frail: A Matter of Heart
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Warren and Marshall
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Old and Frail: A Matter of Heart
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Barry Marshall Robin Warren
2005 Nobel Prize in Medicine
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Old and Frail: A Matter of Heart
Cleveland Clinic Heart Center
Best in the Nation
15 Years in a Row
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Unhealthy Eating
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Old and Frail: A Matter of Heart
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Diabetic Patient Back to Normal After Plant Based Diet
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Old and Frail: A Matter of Heart
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Urinary Calcium Back to Normal After Plant Based Diet
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Old and Frail: A Matter of Heart
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Just Diet