PreventandReverseHeartDisease

The group included twenty-three men and one woman. They agreed to follow a plant-based diet. (It turned out that between 9 and 11 percent of the calories they consumed on that diet were derived from fat.) I asked them to eliminate from their diet almost all dairy products (in the beginning, I allowed them to have skim milk and nonfat yogurt, but have since eliminated all dairy products because of the potential tumor-causing properties of caseine ¹ and the contribution of animal protein to the process of atherosclerosis), all oil and all fish, fowl, and meat. I encouraged them to eat grains, legumes, lentils, vegetables, and fruit. I asked them to keep daily food diaries listing everything they consumed, recommended that they take a daily multivitamin, and suggested that they moderate their consumption of alcohol and caffeine. And each participant received a prescription for a cholesterol-lowering drug. In the beginning, the drug was usually cholestyramine. In 1987, when the first of the statins, lovastatin, became available, that became our drug of choice.²

The most frequent objection I had heard to my ideas about nutrition—and it’s the same objection I hear to this very day—was that patients would never comply with such major changes in their diet. So I was determined to give them all the support I possibly could. Years before, I’d heard the pioneering physician J. Engelbert Dunphy quoted as saying that cancer patients are not afraid of suffering or dying, but are afraid of being abandoned. That became my mantra with my study group: I would never allow them to feel abandoned.

From the very start, I made it a point to be integrally involved in each participant’s treatment. It began with an initial interview of forty-five to sixty minutes with each patient and his or her spouse. We reviewed medical history, cultural variations in heart disease, research findings in human and animal studies, and the various therapeutic options that were available. I wanted everyone to understand just exactly what I was recommending—and why.

Then, every two weeks, I met each patient in my office to go over every morsel of food he or she had eaten in the previous fortnight. I checked blood pressure and weight and had blood cholesterol drawn and analyzed. During the first year of the study, I called each patient the night of the tests to report the results and make any adjustments in nutrition or medication that seemed necessary.

It is highly unusual for a physician to see a patient every two weeks for more than five years, but it seemed absolutely crucial to me that I provide all the support and focus for them that I possibly could. They had to recognize that even though an angioplasty or bypass operation might have failed them, they could achieve control over their own disease by totally eliminating the dietary fats that had been killing them in the first place.

I did not require participants in the study to commit to any extra measures, such as exercise or meditation. There are several reasons for that. For one, it was my observation that in those cultures where coronary disease does not exist, it was diet and low cholesterol, not exercise habits or personal tranquillity, that were responsible for warding it off. For another, I think every human being has just so many personal behavior modification units available—that is, if you’re asked to change too much, you will eventually balk!—and I was already asking a great deal of my patients. It was imperative that they focus all their capacity for changing their behavior on modifying their diets and reducing cholesterol levels in order to arrest and control their disease. So even though relaxation, meditation, and regular exercise have demonstrable health benefits, for this program, they remained entirely optional.

It was clear almost from the beginning that six patients just did not grasp what we were trying to accomplish, and that they would not comply with the experiment. So by mutual agreement, I returned them to their cardiologists for standard care with the understanding that I would periodically check to see how they were doing. But the rest stuck with the program. They ranged in age from forty-three to sixty-seven years old. And they represented a spectrum of the community. They were factory workers, teachers, office employees, company executives.

Each approached the program in his or her own way. Jerry Murphy, the one who had challenged me (“No male Murphy has ever lived beyond sixty-seven”), says he found it relatively easy to follow the rules, although his daughter, Rita, describes the new diet he adopted as “a life-changing event” for the rest of the family, whose members had to learn to cook and eat in an entirely new way.

Some felt they simply had no choice but to try what I recommended. Don Felton, for example, was fifty-four when he came to me. He had been suffering from heart problems since the age of twenty-seven, when he first experienced severe chest pain. “The doctors fluffed it off,” he says, and one even said that the problem was “all in his head”—a suggestion that infuriated him.

Three years later, still plagued by chronic pain, he underwent two days of tests and a catheterization at his local hospital. When he got the results, the news was not good. “People with the severity of disease you have average about a year,” the cardiologist told him. Since the doctors were afraid to operate, they prescribed medication for the pain, and the hospital dietician actually advised him to consume a stick of corn oil margarine every day—a prescription based on some study (we now know far better) that suggested corn oil was good for the heart and arteries! Don couldn’t stomach the idea of eating a stick of margarine, so instead, he dutifully poured corn oil into a glass and drank it before he went to bed each night for several years.

By the time Don was forty-four, he was sicker than ever. Several times, he collapsed on hunting trips. His wife, Mackie, recalls that every time an ambulance went by, their son, who worked at a gas station not far from the Feltons’ house, called home to see if it was carrying his father.

Eventually, Don had to quit his job as manager of an Ohio plant that manufactured hydraulic power units for airplane simulators. He went on disability. And finally, when he was forty-eight, he had bypass surgery. But within a few years, the veins used for the bypass closed. After a frightening episode of chest pain while on a hunting trip when he was fifty-four, Don’s doctor said there was nothing more he could do. “But he wanted to offer me something,” Don says, so he mentioned that a physician named Esselstyn was offering some kind of program. At that point, Don says, “I was willing to try anything. What did I have to lose?”

Similarly, Emil Huffgard had pretty much run out of choices by the time he came to see me. At the age of thirty-nine, he had suffered a stroke. A few years later, he had bypass surgery—and then, in rapid succession, three more strokes. He was in dreadful shape, relying on nitroglycerin to get him through days of terribly constricted activity. “Any walking brought on the angina,” says Emil. “I could shower, shave, read the paper. And I was pretty good at sitting down.” Surgery was out of the question—likely to kill him, the cardiologist explained. After years of agony, the cardiologist told Emil about Dr. Esselstyn, and suggested that he have a talk with me.

His back was against the wall. There was no mechanical intervention he could have. He was gobbling nitro all day to stave off the angina, and couldn’t even lie down flat to sleep. Every day, his wife, Margie, had to cover his thorax and abdomen with nitroglycerin paste, which she then covered with plastic wrap to protect his clothes, just so that Emil could perform the most basic tasks of taking care of himself without suffering incapacitating pain. She had actually advised their daughter to move up her wedding date if she wanted her father to walk her down the aisle—advice their daughter took. When he joined my program, with a cholesterol count of 307, Emil was desperate.

So was Anthony Yen. He had been raised in China before the Communist takeover, a member of one of that nation’s wealthiest families. While growing up, he ate a relatively healthy diet that contained very little meat and oil. But when he came to the United States to attend the Massachusetts Institute of Technology, everything changed. It was not long before he was positively bingeing on the artery-clogging American diet: “lots of hamburgers and lots of cheeseburgers, a lot of spaghetti and meatballs.” For breakfast, he routinely ate bacon and eggs. And he came to love fried food—especially French fries.

Anthony graduated from MIT, and after serving an apprenticeship in corporate America, he started his own international business, with headquarters in Cleveland. Through his family’s many contacts in Korea, Japan, Taiwan, and Hong Kong, he set up operations in Southeast Asia to develop metalworking industries. He traveled a great deal, and whether at home or on the road, he continued to be—his own description—a “glutton.” “I was gaining weight,” he says, “but since I had my clothes tailor-made in Hong Kong, I’d have a suit made every trip, and didn’t really notice that the old suits didn’t fit.”

On New Year’s Eve, 1987, when Anthony was fifty-eight, he and his wife, Joseanne, booked a two-day holiday package deal at a hotel, which included dinner and dancing. Although it was the sort of activity he ordinarily loved, he felt awful—tired, overheated, and weak. And he felt pressure on his chest. The next morning, he says, he felt what he describes as a “boom” in his chest, and his wife insisted that he go to the Cleveland Clinic for a checkup.

After he underwent a stress test—quickly aborted when it showed abnormalities—and an angiogram, Anthony had quintuple bypass surgery. He went home to recuperate, but was utterly terrified, frightened even of moving, and grew deeply depressed. The family made an appointment with a psychologist. “I blamed myself for what I had done to myself,” Anthony recalls. “I wanted to know what caused my disease, and how do I stop it.” After listening to his story, the psychologist told him there was a doctor in the building named Esselstyn whose program might be of interest to him.

When Anthony informed his cardiologist that he was going to see me, the cardiologist objected. “Esselstyn is not a cardiologist,” he declared. “If you go to him, don’t come back to see me.” Anthony was furious. “I wanted to get to the cause, and the doctor was so negative. So I fired the cardiologist, and went to Dr. Esselstyn on my own.” As Joseanne explains, “He had no hope. He was willing to do anything.”

Not everyone was quite so open to my message. Take Evelyn Oswick, for example—the group’s only woman. She had been fifty-three when she suffered the first signs of heart trouble. She and her husband, Hank, had delivered their daughter to college, and were carrying a light chair up the stairs to the dormitory’s second floor when Evelyn suddenly felt breathless. “It was scary, because my mother had had a heart condition and my brother had died of a heart attack in his early fifties,” she says. So she went to the Cleveland Clinic for a checkup. She was pedaling away on a bicycle used for stress tests, and feeling no pain. But suddenly the doctor started shouting: “You’re having a heart attack! You’re having a heart attack!” The very next day, she had a triple bypass.

For the next five years, Evelyn, who taught speech and communication at John Carroll University in Cleveland, continued to eat all the food she loved. But there came a time, as she recalls, when she realized she just didn’t feel well. “I had no pains scaring me, but there was a little pain in my left arm.” The discomfort continued, and finally, Evelyn decided to go to the clinic. Hank was out of town on business, so she asked her daughter to go with her. As she lay on the examining table, the doctor started yelling, “She’s having a heart attack!” (“Those words, once again!” Evelyn exclaims.) They rushed her to an angiography room, where she suddenly felt quite breathless.

The doctors told Evelyn that there was nothing they could do. Surgery, they said, was out of the question. Her primary doctor did mention a physician at the clinic who was doing a study, and he called me in to see her. I told her about the nutrition program.

Evelyn clearly remembers her reaction: “No way! I was very adamant. I loved my chocolate candy, cake, pie, and banana splits. I liked all the bad things. All the things I liked, he said I couldn’t have. There was no way I would do that.”

After she spent a few days in the hospital, Evelyn’s doctor said, “Go home. Find a rocker.” Evelyn remembers her response: “I should find a rocking chair and rock until the day I die?” The doctor replied, kindly enough, “That’s what I mean.” As Evelyn saw it, he had told her to go home and wait to die.

So she did. And for several days, she and Hank talked over the situation. The more they talked, the more Evelyn began to reexamine her attitude. “I was fifty-eight,” she recalls. “Hank and I were at the peak of our lives. We had nothing when we started. Now we had everything we had ever wanted. There was no way I was going to die and have Hank marry someone else. Would I die and leave this money for another woman? No way. Then Hank laughed, and I laughed, and I said, ‘I think we’ll go to see Dr. Esselstyn.’”

Jim Trusso, the youngest of the group, was also a surprise. At first, I was pretty sure he wouldn’t stick with the program. He’d been thirty-four when he had his first heart attack. He was washing his car one Sunday and suddenly felt breathless and congested. His self-diagnosis was that he was suffering a bronchitis attack. The next day, he was in a meeting at the elementary school where he was the principal, and he felt pressure in his chest. He decided to go to the hospital for some medicine to combat the “bronchitis.”

He suspected, before anyone told him, that something was seriously wrong. “Electrocardiograms were taken on a roll of tape back then,” Jim recalls. “A cute little nurse walked out without tearing the tape, and it was trailing behind her, unraveling out of the emergency room door.” Sure enough, it turned out, the electrocardiogram indicated that Jim needed a catheterization.

During that procedure, the doctors discovered that he had sustained a massive heart attack, and they reported that there was too much muscle damage to allow surgery. No one told Jim the whole story at the time, but one of the physicians did tell Jim’s wife, Sue, that he didn’t have long to live and she might have to go back to work as a teacher to support their two small children.

A month later, Jim felt considerably better. He underwent a second catheterization. This time, the doctor said the muscle damage was not as great as they originally had feared, and declared him a prime candidate for bypass surgery.

Sue remembers wondering what on earth they were doing wrong. Then Jim heard of me from a former patient of mine who was painting Jim’s condominium. When Jim informed his cardiologist that he wanted to see Dr. Esselstyn, the cardiologist bet him a steak dinner that he couldn’t get his cholesterol below its level at the time—a frightening 305 mg/dL.

At first, I thought Jim was something of a wise guy, not entirely serious about the enterprise before us. We always seemed to be at loggerheads. He was constantly challenging me. What would he do at restaurants? While traveling? How could he possibly eat this food? He had always hated fruits and vegetables. “Big Macs, French fries, milk shakes were favorite foods,” he readily admits. “My favorite thing was chocolate.”

From the start, Jim made it sound as if what I asked him to do was absurd, a constant inconvenience. He deeply treasured the food that had gotten him in trouble. But he was an intelligent person, and what finally won him over was the logic of the program. We were trying to follow the nutritional example of countries where disease was nonexistent. To an educator, a man blessed with a supremely logical mind, it made sense.

It also made sense to Jack Robinson. Jack’s father had died of heart disease while in his forties, and all three of Jack’s brothers died of heart disease in their fifties. Jack was approaching that age in 1988, when he had an angiogram at the Cleveland Clinic. It showed multiple blockages of his coronary arteries. “They marched what seemed like eighty doctors through my room, insisting that I have bypass surgery,” Jack says. But he adamantly refused, recalling the serious complications one of his brothers had experienced during a bypass operation. Unable to budge him, Jack says, “they suggested I consider seeing Dr. Esselstyn.”

During counseling, Jack listened intently and fully understood what he had to do. He would have to follow the program at a distance. At the time, he was employed by General Tire in Akron. He told his local cardiologist, who was fully aware of the severity of disease shown by the Cleveland Clinic angiogram, how he planned to proceed. The cardiologist, despite serious misgivings, agreed to the plan.

In October 1985, we began our experiment with this diverse group of heart patients. Every three to four months, the entire group convened—usually at Ann’s and my house—to share recipes, to compare how they were doing and emphasize the fact that they were not alone, and to reinforce their sense of commitment—to themselves and to each other. As a result, they developed lasting friendships and family connections. A strong sense of community and common purpose helped sustain them and encourage compliance.

I will tell you how things turned out for all these patients, and for others, as well. But first, you need to understand—just as I make sure my patients understand—the science behind what we were trying to accomplish.