Ditch the Heart Disease: An Interview with Dr. Caldwell Esselstyn, Jr.

The following is an interview I had with Dr. Caldwell Esselstyn, Jr, author of Prevent and Reverse Heart Disease. [We had some audio glitches due to a poor internet connection, so some parts are missing; but overall, the essentials are covered.]

A: Dr. Caldwell Esselstyn, welcome to Good Food UnEarthed’s YouTube Channel. If you could give us a brief introduction about yourself and your medical background, and then we’ll go into your journey towards your Prevent and Reverse Heart Disease Program.

E: Well, Aimee, I thank you for the opportunity to speak with St. John’s and your program. My background: I grew up on an Aberdeen Angus and dairy farm in upstate New York. I went to Yale University as an undergraduate, and then I went to medical school at Western Reserve University School of Medicine in Cleveland, Ohio. Then, I took my subsequent internship and postgraduate residency in general surgery at the Cleveland Clinic. Then, I had two years in the Army. My first year was in [...] North Carolina; my second year as a combat surgeon in Vietnam in 1967-68.

And then, when I returned, I was asked to join the staff at the Cleveland Clinic in the Department of General Surgery. And, it was in the late 1970s and early 80s when I was Chairman of the Breast Cancer Task Force. And I became increasingly disillusioned with the fact that for no matter how many women I was doing breast surgery on, I was doing absolutely nothing for the next unsuspecting victim.

And that led me to a bit of global research. And it was really quite striking to find that there were multiple cultures where breast cancer rates were 30-40 times less frequent than in the United States. And when you looked at rural Japan in the 1950s, breast cancer was very infrequently identified, and yet, as soon as the Japanese women would migrate to the United States, by the second and third generation, [...] Japanese American women, they now had the same rate of breast cancer as their Caucasian counterparts.

Now, even more compelling, perhaps, was cancer of the prostate. In the entire nation of Japan in 1958--how many autopsy-proven deaths [were due to] cancer of the prostate? 18--the most mind-boggling public health [number] I’ve ever encountered. Twenty years later in 1978, they were up to 137, which still pales in comparison to the 28,000 who will die from prostate cancer in this country this year.

So, somewhere along the line it became apparent to me that there would be more bang for the buck if we would look at cardiovascular disease, since it’s the leading killer of women and men in Western civilization; and yet I was encountering multiple cultures in this global review where cardiovascular disease was virtually nonexistent. And really, that led me to think that if we could really focus on people [willing] to save their heart, that at the same time, they would markedly diminish the likelihood of them developing the common Western cancers of breast, prostate, colon and, perhaps, pancreatic.

And that sort of led to doing a bit of research with a small number of patients with heart disease, who had failed their first or second bypass, they failed their first or second angioplasty, or they were too sick for these procedures or they had refused. Five were told by their expert cardiologists they wouldn’t survive the year; and those five all made it beyond 20 years. And it was really quite striking [to see that] when we took these patients with [severe] heart disease, and got them to eat totally whole food, plant-based nutrition, not only did it stop their disease, but we also found striking examples of disease reversal.

So that, when I retired from surgery, [it was] too exciting to leave it alone. And therefore, I got rehired by the Cleveland Clinic to direct the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute, where I work today. And, what we do there is we take once a month, we have a number of patients, [...] an intensive six-hour seminar trying to have them understand exactly how it is that they have [produced] this disease; and precisely how they can be empowered, as a locus of control, to halt and reverse their disease. So, that’s where I stand today, and, [I’m] happy to talk with you about any aspect of [this disease].

A: Alright, thank you. So, I was wondering if you could tell [us] a little bit more about your study, and how--what--was the type of diet, in detail, what was it that you recommended to your patients; what success you had with compliance; and, you mentioned they had success in reversing their heart disease--and was that with the majority of people who were in the study?

E: Well, you see, where the rubber hits the road on a study like this is whether or not you get compliance, adherence, because it is a very, very significant lifestyle change. And that was really where I was most concerned because I had no experience trying to achieve compliance. And so, for this first group of 24 patients, I thought it was going to be so important for this that I saw them every 2 weeks, and I would draw their cholesterol. Now, that was for the first [chuckle], for the first 5 years. And, by the end of 5 years, I got a little bolder: instead of seeing them every 2 weeks, I was seeing them once a month. And then, that continued until the end of a decade, and at the end of a decade, they were really by now pretty well on autopilot. And so, I began seeing them quarterly. And then, I wrote them up at the end of 12 years, which pretty well makes it the longest study of its time in the medical literature because most of these studies are 2 or 3 years or less. And, so [we were very--it was] very exciting to see what happens to these people after 4 years--excuse me, after 12 years. And, the excitement was [that] all of them lost [their] chest pain, angina; and when we carefully, in the [long group] of 11 of them, we did repeat angiogram, that is, we looked again at the blockages that were blocking the coronary arteries to the heart, and it was striking to see the degree of reversal in some of these. Now, it’s not going to be in everybody, but about a quarter of patients where the plaque is young and soft and made up of inflammation, fat, and cholesterol, the body has a remarkable capacity to reversal.

On the other hand, even those patients that have a blockage or a plaque that [is made up of] fibrosis and scar and calcification, and it’s not gonna go away [...] is that even those patients...even those patients were able to improve to the point where they absolutely were able to return to full activity without restriction. And the reason for that is that when you have these patients successfully eat whole food, plant-based nutrition [...], the entire coronary artery vascular [team] is supplying the entire heart, all those vessels begin to become more supple and regain their capacity to widen and dilate, which is why these patients improve as well.

Now, the adherence is the absolute key, I cannot emphasize that enough. But, what is the mechanism involved and why are we stressing whole food, plant-based nutrition? Because [...] fascinating to know that there is an [area] where all experts are in agreement, and that is the following: All experts would agree that where this disease, coronary artery disease, has its inception, its onset, its beginning, is when we progressively injure the lifejacket and the guardian of our blood vessels, which happens to be that delicate innermost lining called the endothelium.

If your audience can try to...these two scientific terms I’d like them to try to remember from this presentation: One is the Endothelium, the delicate, innermost lining of the arteries, and the other is the magic molecule of gas that the endothelium produces, nitric oxide. Because nitric oxide is truly the great protector and salvation of all of our blood vessels because of its remarkable functions, which are: 1) Nitric oxide keeps all the cellular elements within our bloodstream flowing smoothly, like Teflon rather than Velcro; it keeps things from getting sticky. 2) Nitric oxide is the greatest vasodilator in the body; when you climb stairs [the] arteries to your heart, the arteries to your legs, they widen, they dilate--that’s nitric oxide. 3) Nitric oxide keeps the wall of the artery from becoming thick or inflamed; protects us from getting high blood pressure, hypertension. 4) Now this is the absolute key, number 4: a safe and normal amount of nitric oxide will protect us all from ever developing blockages or plaque. So, literally everybody on the planet, whether they’re from London, Berlin, Chicago, New York, or from St. John’s in Canada--if they have cardiovascular disease, it is because, by now, they, in the past decades, they have so sufficiently trashed, injured, compromised and turned their endothelial cells into a train wreck, that they no longer have enough nitric oxide to protect themselves from developing blockages and plaque.

However, the good news here is this: This is not a malignancy. This is a benign, foodborne illness. And once you can get patients to understand what are the foods that must never again pass their lips [...], then what happens is the endothelium system is restored, it makes enough nitric oxide so you can halt the disease, and often we see significant elements of disease reversal.

And, you probably want to know, or your audience should know now, what are the foods that, every time you eat them, they injure your endothelial cells? They are: any drop of oil. Olive oil, corn oil, soybean oil, safflower oil, sunflower oil, coconut oil, palm oil, oil in a cracker, oil in a piece of bread, oil in a salad dressing. Oil injures the endothelial cells. As does anything with a mother or a face. That is to say: meat, fish, chicken, fowl, turkey, and eggs--injure endothelial cells. As does dairy: milk, cream, butter, cheese, ice cream and yogurt. And [...] Coke, Pepsi, sugary drinks, and sugary foods: cakes, pies, cookies, stevia, agave, excessive [use] of maple syrup, molasses and honey. And coffee with caffeine for patients who have [heart disease]. Yes, they can have tea with caffeine--black tea, green tea. They can have coffee that is decaf, but not with coffee with caffeine for my patients.

[...] The absolute key of what I’ve just said, have your audience understand, the endothelial cell and also nitric oxide. Alright?

A:Yes. Nitric oxide, I think, is in Dr. Michael Greger’s book, How Not to Die. He talks about some vegetables that are really good sources of nitric oxide, like beets, for example.

E: Rather than have [...] First of all, I love Mike, Michael Greger, we’re good friends. I don’t want you, [the people] to focus simply on--I think beets are wonderful, I have no problem with that--but, you have to remember that half of planet Earth has never heard of heart disease. If you’re a cardiac surgeon, and you’re gonna hang your shingle in Okinawa, rural China, the Papua Islands, Central Africa, the Tarahumara Indians in northern Mexico, forget it! You better plan on selling pencils. They don’t have heart disease. Why? They all thrive on whole food, plant-based nutrition without oil. So--and it’s not because they’re all living on beets.

It’s not eating any of the foods that are going to injure their endothelium. But, if you want to enhance, sure, have some beets on a frequent basis. Remember, there are a whole host of these wonderful vegetables that get the job done. So, what do we want you to--I’ve mentioned what we’ve taken away--what do we want you to eat then? We want you to eat all these marvelous whole grains: [grains in your] cereal, bread, [pasta], rolls and bagels; 101 different types of legumes--beans and lentils; red, yellow, and green leafy vegetables; sweet potatoes; white potatoes. And, it’s really quite exciting to think that food can be so incredibly powerful. It can injure you, or it can enhance. Try to stay away from processed food. Those are [...] that’s really where the danger is, as well.

Now, there are some studies [...] you mentioned when does this begin. Actually, in childhood. In the autopsies of children who died [of natural causes], you already see the fatty streaks in early childhood. There’s an interesting study of women and men between the ages of 17 and 34, who have died of accidents, homicides, and suicides. [Cough] Between the ages of 17 and 34. And, at those autopsies, the disease is now ubiquitous. [...] You go to school [...] and you go to high school, and you graduate and you get a diploma; but, you also get the foundation for heart disease. Not enough to have your cardiac events yet. So therefore, it’s not at all surprising that [if] you’ve got the foundation for heart disease when you’re a late teenager, that if you eat this horrible Western diet through your 20s, 30s and 40s, and continue to further destroy the endothelium and its ability to make nitric oxide, it’s not surprising that by the time you’re in your 40s, 50s and 60s, we now start to see these current cardiovascular events: heart attack and stroke.

A: And, for people here who grew up eating fish, and now they’re told that fish is heart-healthy, what do you have to say in response to that?

E: I think the studies would say that that is absolutely not true. When you look at the studies that are available on the Inuit, Eskimos who thrive on fish, they’re loaded with cardiovascular disease. It’s very unhealthy.

And, as a matter of fact, this rage for this Ketogenic diet, only because it helps with weight loss, it’s absolutely lethal on your vessels. And, high in meat, high in animal protein. And, that’s the work of Stanley Hazen (sp?) and his team from the Cleveland Clinic who showed that when you at the molecules of lecithin and carnitine, which are in all meats, dairy, seafood and so forth--when people who are omnivores, who eat those foods, eat them, they develop, because of the bacteria that reside in the intestinal tract of persons who are omnivores eating those foods, those bacteria will convert the molecules of lecithin and carnitine into a molecule called TMA, trimethylamine. [And it’s] rapidly oxidized by your liver to trimethylamine oxide. TMAO has been shown to injure your blood vessels.

Now, the other interesting thing is… So, therefore, just recycling backing to what we said about the Ketogenic diet, all that meat is resulting in high levels of TMAO in these persons who are eating it, and they’re really trashing their blood vessels.

But, the other interesting thing about Stan’s study is when he took people who were totally plant-based, and gave them, let’s say, a lambchop, and measured their blood levels of TMAO. It wasn’t there. It wasn’t there, because persons who are totally plant-based do not possess the intestinal bacteria that are capable of converting lecithin and carnitine into TMAO.

[...] Of all the meats that people eat [that] make TMAO, there’s none other than fish that make it higher.

A: So that’s pretty interesting to learn. A lot of people hear that fish is a healthier food to eat, so when they try to get healthy, they’ll go for boneless, skinless chicken breast and fish foods.

E: If you’re comparing red meat to fish, it’s a question of whether you want to be shot or hung.

A: Right. I think it’s an amazing thing that people are doing a lot of research into the microbiome, and how the bacteria, or the microorganisms, that we have in our bodies, is actually--we create that environment based on the food that we eat.

E: Right. You change your internal bacterial environment either to a positive one when you’re eating plant-based, or a negative one if you’re eating as an omnivore, and a lot of meat, dairy and seafood.

A: So we know now the benefits of a whole food, plant-based diet on the cardiovascular system, and the power it has to prevent and reverse heart disease. So, can you tell me, because you got interested in this because of breast cancer, what would be the link then towards breast cancer, prostate cancer, or other cancers?

E: Well, there are several things that are of interest here. For instance, if you look at colon cancer, we know that Denis Burkitt,who was a missionary for 17 years in Africa, he never saw a case of colon cancer, in 17 years, which is one of the most common cancers [in this country]--cancer of the large intestine. [...] nonexistent there.

As far as breast cancer is concerned, I think I mentioned when I started this program with you, there are multiple cultures where breast cancer rates are 30-40 times less frequent than the United States. That’s really quite powerful when you think about it. And prostate cancer in Japan, I mentioned, in 1958, there [were] 18 cases identified, autopsy-proven, in the entire nation. So that’s pretty powerful information.

A: What are the links to dementia and Alzheimer’s?

E: Well, again, those that study dementia, I was thinking right now of Ayisha and Dean Sherzai (sp?) who are working at Loma Linda University in California. It’s interesting that the things that are so important, to try to avoid dementia are: 1) Whole food, plant-based nutrition, 2) Get adequate sleep, 3) Adequate exercise, 4) Adequate socialization; meditation seems to help; they’d like you to focus not on too many things all at once, but have a [single] focus. [...] Really rather fascinating to also look, in the West, if you are eating a typical Western diet, by age 50, MRIs of the brain begin to show these little white spots. What are these little white spots? They are little strokes.

Now, at age 50, not a problem, you’ve got a big brain and you’ve got tiny little strokes, apparently you can still get along fine. But, if you keep eating that same diet, and you’re no longer 50, and you’re 65 years old, you may find yourself saying, more often than before, “Sweetheart, where’d I leave the car keys?” Well, you blink your eyes and now suddenly you’re 75. You’re still eating the same old Western diet, and you find yourself saying, “Sweetheart, where’d I leave the car?” Now, you get through that, and now you’re 85, and you look at her and you say, “Are you my sweetheart?” I can’t reverse that disease! You don’t suddenly wake up at age 85 with dementia. You work hard in all those preceding decades to lay the foundation for that disease that doesn’t have to happen.

A: So would you say that diet is more influential than genetics?

E: Oh far, oh absolutely, no question. Well, there’s this saying: Genes loads the gun, but lifestyle pulls that trigger. For example, let’s say I’ve had a family where all the parents and grandparents have had some type of cardiovascular disease, either heart attack or stroke. And these people are petrified that without a doubt that they’re going to be victims of these diseases as they get more senior. Nothing is further from the truth.

Really, lifestyle change can change gene expression. It can turn on genes and turn genes off; and you can turn on a gene that is favorable for protecting from heart disease when you’re eating plant-based. When you’re eating the Western diet, you are enhancing he genes that are going to precipitate the formation of vascular disease.

A: So what would you say to somebody who thinks, “Well, you know, I don’t really want to change what I eat, and I’ll just follow my doctor’s advice, and I’ll take high blood pressure medications or a statin for my cholesterol.”?

E: That’s tragic. [...] I think the best word to describe that is tragic. Because that’s, look--none of those drugs with cardiovascular disease, none of the drugs, none of the stents, none of the bypasses, have one single, solitary thing to do with the causation of the illness. Okay?

And it’s been so profound, that we’ve noticed here, we’ve now treated close to a thousand patients with cardiovascular disease, and time after time after time we have been able to show, not only do you reverse the blockage that is forming in the carotid arteries to the brain, the blockage that is forming in the coronary arteries to the heart, the blockage that is forming in the arteries to the legs, [...] profound change; but, it’s no different than the millions and millions of people that have never had cardiovascular disease throughout the planet who’ve eaten plant-based.

And now there are literally hundreds upon hundreds of absolutely delicious plant-based meals [for people] to treasure and look forward to, that are going to protect them. In other words, all we have to do is get people to give up a delicious type of food that is absolutely destroying them, for a delicious [type of] food that is going to enhance their health.

Remember the two words that I want you’re audience to remember today: the endothelial cell, which they have trashed with their Western diet; and nitric oxide, which is the magic gas that the endothelium produces that protects the [...] vasculature.

A: I do think it’s amazing---I changed to a vegetarian when I was 16, and at first, people think, you give up food, the Standard American Diet, and what are you going to eat? There’s nothing to eat. You’re just going to have vegetables. But, what I have found personally is there’s this whole cornucopia of plant foods, and the tastes are just incomparable. And the feeling you get after eating is so much better than any feeling you get eating the Standard American Diet. What is your experience with it?

E: Oh yeah. I think the greatest gift that we have given our children and our grandchildren is eating whole food, plant-based nutrition. Because all you have to [do is] look at our family tree. Now, look at my parents and grandparents, my wife’s parents and grandparents--loaded with strokes, vascular disease and the common Western cancers. They were all, really, a walking billboard of the tragedy of Western nutrition. And, it’s just so exciting to feel, exciting to think that without resorting to these hideous drugs that are so expensive and have brutal side effects, you can simply reverse all this with food.

Because, we’ve been talking about cardiovascular disease today, but let’s just talk about the other benefits.

Obviously, what happens to our patients who have obesity? Gone. What about the risk of stroke? It’s gone. The risk of vascular dementia? Gone. The risk of diabetes? Gone. Hypertension? Gone. Ulcerative colitis, Crohn’s disease? Gone. Rheumatoid arthritis, lupus, multiple sclerosis? Gone. Allergies and asthma? Gone.

And imagine, we have never before in medicine, and I guess this is why I’m so passionate still about medicine even though it’s been a number of years since I’ve retired from surgery--we are truly, right now, at the cusp of what could be a seismic revolution in medicine. And the seismic revolution is never going to come about to the invention of another pill or drug, or from another stent or another procedure, or another bypass operation.

So the seismic revolution 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 lifestyle that will empower them, through the knowledge of nutritional literacy, to be able to absolutely annihilate chronic illness.

A: I think it’s an amazing turn, because I myself grew up...my grandmother was a nurse, and [people] thought, you know, you follow all of your doctor’s advice. And you end up with relatives who have ziplock baggies full of medications, and they gain weight, and they don’t feel well. And then there’s...you get to a certain age where everybody just talks about how unwell they feel, and aches and pains. They think it’s just expected. [And] then you have people who work hard all their lives, wait for retirement to enjoy themselves--when they get to that point, they’re sick, and they can’t enjoy it. It’s really just a shame. But it’s nice to know that people like yourself, and some of the other doctors who are coming out and giving us this information, telling people they have the potential to prevent and reverse these chronic degenerative diseases, to have optimal health in their lives...advice coming from someone such as yourself is really powerful.

E: Thank you.

A: So, what I’d like to ask is if you could---you talked about your current work at the Cleveland Clinic, and if you’d like to address some of the work of your family members, because I know that they are involved in helping to advocate for whole food, plant-based nutrition.

E: Well [I never could have gotten to this goal without] Anne, my wife, with her support. She did all the recipes in my book, Prevent and Reverse Heart Disease. And then she had also worked with my daughter, Jane, who is a nurse. Jane is quite remarkable in that she, 3 or 4 years ago, she initiated the first national conference for cardiovascular disease for women, which I thought was very exciting because often women sort of get treated as a second-class citizen or patient. And Jane has worked with Anne, my wife, and they have [written] the Prevent and Reverse Heart Disease Cookbook. [And Jane has] aso worked on a number of books with my son, Rip, who is a fireman, who has gotten into this because--he now works for Whole Foods Market--because he found that the leading killer of firemen is not fires, it’s cardiovascular disease. Often [...] at a young age. You can’t fight fires when your arteries to your heart are clogged with cholesterol and plaque. So, [laugh] there have been a few other members of the family who have really come on board. And it’s very exciting for our children now to know as they grow senior that they are not going to have to worry about these chronic diseases as well. We think it’s the greatest gift we could have given our kids and grandkids.

A: So, you started a whole food, plant-based diet in 1984, is that right?

E: That’s right.

A: And I think you are, are you 85 now?

E: Yeah.

A: So, how do you feel?

E: [Laugh] I feel like I’ve been eating plant-based nutrition now for, what is it now, is it 34 years? Something like that. No, I’m very excited. When I look at other of my colleagues who are my age who have continued to eat the Western diet, they’re, you know, they’re beginning to drop off, sadly. Many of our friends have succumbed to the common Western illnesses, or they’re living with these illnesses. But, on the other hand, there are a number who have said they’re gonna make the change, and they have, and it’s very exciting to see how they have really blossomed.

So, in our own family, we try to really walk the walk. You’ve got to do that. I mean, I can’t ask my patients to do something that I wouldn’t be willing to do myself. And my father had his first heart attack at age 43, so there’s your genes, if somebody wants to talk about genes. But, as I said earlier, genes loads the gun, but lifestyle pulls the trigger.

The analogy that sometimes I use is, to explain that, is think of a village or community that is right next to a river, and during the wet season, only the very, very strongest swimmers can get across, alright? However, if you look at the dry season, everybody can walk across, without getting wet over their knees even. Well, that’s the kind of way it is when you’re eating a whole food, plant-based nutrition. [It] wipes out any of the dangerous genes, and [converts] them to a gene that is going to enhance your health. And, again, as I said before, genes loads the gun, but lifestyle pulls the trigger.

A: So, could you tell us, give us an example, of what you eat in a day?

E: Sure. I particularly love old-fashioned Quaker oats as a dry cereal. Okay? Put them in a bowl, dry cereal. I wet them down with oat milk.

A: That oat milk has no oil in it, right? You can get that in the States.

E: No, you can’t have oil. Right. And raisins, banana, and always raspberries, blueberries, strawberries and blackberries. You cannot believe that number of phytonutrients that are in these berries. You have those, as easy to eat, those berries with the cereal. The oats are loaded with polyphenolic compounds and antioxidants as well, so you’re really getting a wonderful bunch of nutrients.

Now, lunch--here, as we get into wintertime, we almost always will have a soup with some sort of whole grain bread that we toast with it, and...kinda light there.

And then supper--my favorite meal would be beans and rice, covered with cut-up peppers, cut-up tomatoes, cut-up scallions, maybe some corn, and maybe some cranberry, and then some salsa over the beans and rice, and that’s just absolutely delicious. Or, Rip has some wonderful lasagnas that he makes that are [delicious].

For snacks, maybe a whole wheat bagel with some hummus that does not have tahini or olive oil.

A: That sounds pretty simple and really tasty!

E: Yeah!

A: So, for here in Newfoundland, we’re actually pretty lucky because we have tons of wild berries, and if people are happy enough to go out, they can pick their own berries. We’ve got wild blueberries, raspberries, strawberries, just a load of berries that [we] can get during the end of summer, early fall. But we also have--and one of the things I like to address with people is the food security and sustainability issue, and I’m just going to tell you some of the stuff that people can grow here, and then maybe you can tell me if it’s adequate for a whole food, plant-based nutrition lifestyle.

One of the big things is potatoes, cabbage, rutabaga (we call it turnip), kales, carrots, beets, cauliflower, broccoli--mostly root vegetables used to be grown, but now it’s kind of a bit more expansive, but those are [still] the main things that people grow here. And then, we have access to lentils. I know Canada is one of the [largest] producers of lentils in the world, and people here grew up eating yellow split peas. So, with those foods, can people thrive on them nutritionally?

E: Absolutely.

When you think about the nutrition of professional athletes, [they] are suddenly getting so interested in plant-based nutrition because they have--not only do they have greater stamina, but their recovery time is less. And the strongest human being on the planet, Bobodeon (sp?), is a German who can lift over 1,200 pounds--it’s enormous--and he’s totally plant-based. Because people who are naive about this think, “Well, how are you going to get your protein?” Well, spinach is 57% protein, hamburger is 37% protein.

And really, it’s exciting to think that increasingly as you have these public figures turning to plant-based nutrition, hopefully the pendulum is going to swing.

So, it’s just ridiculous to think that a government as [wealthy?] as the United States is being pulled back into debtors’ prison by the healthcare costs of this nation. [...] so much of the wealth of this country is going into the health industry, which is totally imbalanced, and it’s only because Americans are so sick. And [...] if we can get people to eat plant-based, it’s interesting that...there [were] a couple of economists from the University of Chicago, and they reported in the Chicago University Press in [1999?] they estimated that if we could get rid of heart disease, we would save our nation $40 trillion. What would that do to our national budget? [Not only could we] begin taking care of the infrastructure, the grid system, education, all these other things that have been left behind because there isn’t [...] money, it’s just being poured into the healthcare industry. It’s crazy.

A: There is a favorite saying of mine I’d like to share with you, and it’s from a Buddhist monk. You’ll have to excuse my language, but this is verbatim. “The only you have to worry about, the only thing you have to do is eat, sleep, and shit. The rest is none of your business.” And I’ve thought about that, and it’s kind of stuck with me, but it actually makes a lot of sense. If people know how to feed themselves right, if they know how to look after their health, then it seems that it ends up solving a lot of issues. It’s really cost-effective, it’s sustainable, it’s good for your health and for the health of the environment. What do you think about that?

E: I’m totally in agreement there. There’s so many other benefits that we don’t talk about. Look what it does for the planet, look what it does for the contamination you’re getting from all the nitrogenous wastes of the animal industry--it’s just crazy.

And I don’t know anybody who would suggest that red meat is healthy. I mean, Walter Willett, who is the Professor of Public Health at harvard, is on record as saying the ideal amount of red meat to eat is zero. Pretty powerful.

I want to just say, you mentioned a few vegetables and there’s something that I always mention to my patients when they say, “Which are the vegetables that I want them to eat?” They are: bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, napa cabbage, brussel sprouts, broccoli, cauliflower, cilantro, parsley, spinach, arugula and asparagus. And the top five are: Swiss chard, spinach, arugula, beet greens and beets. And look what it does for memory!

Just wrapping this up with you, a final thing I want to mention. When I have somebody who has heart disease, and they’re converting to  whole food, plant-based nutrition, there’s one other thing that is not in my book that we have added in the last seven years, and that is this: I ask them to imagine if they could shrink their head to a size that could fit inside the artery to their heart, believe it or not, and look at the plaque. They would see that what they’re looking at is an absolute cauldron. A cauldron of oxidative inflammation. So, we need truly antioxidants, all right. No, don’t go down to the health food store and buy a jug of pills that says antioxidants because it doesn’t work and it’s gonna be harmful. We want them to get their antioxidants from food. Alright. What food? Food that is high in what we call ORAC value. O-R-A-C: Oxygen radical absorptive capacity. So, if they’re having raspberries, blueberries, strawberries and blackberries on their morning oat cereal, that is a terrific start. However, I need them to know that nothing is more powerful than green leafy vegetables [for antioxidants].

I need them to chew 6 times a day--not juicing and not smoothies---I want them to hew a green leafy vegetable 6 times a day that is roughly the size of their fist after it has been boiled in water five and half to six minutes, so it’s nice and tender; and then they must anoint it with a drop of a delightful balsamic vinegar, because the acetic acid in the vinegar has been shown to  restore the nitric oxide synthase enzyme contained within the endothelial cell that is responsible for making nitric oxide.

And then [they] chew this alongside their breakfast cereal, again as a midmorning snack, again with their lunch and sandwich--that’s 3--mid-afternoon, 4, dinnertime, 5, and of course, I adore it when they have that evening snack of kale. What are you doing? All day long, they are basking and bathing that horrible oxidative cauldron of inflammation with nature’s most powerful antioxidant. And this is really a very, very effective way, it’s safe, it’s not an expensive medicine; we’ve never seen anybody go to the emergency room with an overdose of green leafy vegetables. [Laugh]

A: Would you say that you could include cabbage in there? I know it is a cruciferous vegetable, it’s not super leafy, but…

E: You could do that, you could do that. Remember what we’re trying to do. We’re trying to restore nitric oxide. I’ve mentioned how the greens do it for the endothelial cell. What the greens also do is they enhance the capacity of the bone marrow to produce more endothelial progenitor cells. What are they? The endothelial progenitor cells replace are senescent, injured, worn-out endothelial cells, so they’re key. And they’re enhanced when you’re eating green leafy vegetables. They increase the number of endothelial progenitor cells. And also, when you are chewing a green leafy vegetable, you are chewing a nitrate. As you chew that nitrate, and it mixes with the facultative anaerobic bacteria that reside in the crypts and grooves of your tongue, those bacteria reduce the nitrate you are chewing to a nitrite in your mouth. Now, when you swallow the nitrite, it is further reduced by your gastric acid into more nitric oxide, [which will] now enter your nitric oxide [pool]. So, you can see how absolutely powerful, in 3 different mechanisms, [how] green leafy vegetables are [in] enhancing the health of the person who has cardiovascular disease, or anybody for that matter.

(We clarified that the nitrates in vegetables are not the same thing as the nitrates and nitrites you want to avoid from processed meats. This is the end of the conversation. You can view it, with English subtitles, on my YouTube Channel: Good Food UnEarthed.)

For more information on Dr. Esselstyn’s Prevent and Reverse Heart Disease Program, please visit his website at www.dressestyn.com.

You can also purchase his book, Prevent and Reverse Heart Disease, and the Prevent and Reverse Heart Disease Cookbook.

Jane Esselstyn has a fantastic YouTube Channel, sharing lots of recipes; she is also active on other social media outlets.

Rip Esselstyn has written The Engine2Diet, and creates Engine2Diet foods for Whole Foods Market. He is also active on social media.