PreventandReverseHeartDisease

But that level of fat consumption has never been shown to arrest or reverse coronary artery disease. Quite the contrary, research has shown that while cutting fat consumption to that level from even higher levels may help to slow the disease’s progression, the disease, nonetheless, will progress.

The truth is that the medical profession knows better. We have known for a long time that one out of every four persons who have heart attacks has a blood cholesterol level between 180 and 210 mg/ dL,² and we know that more than a third of those in the Framingham Heart Study who had heart disease showed cholesterol levels between 150 and 200 mg/dL.³ That means that millions of Americans who are doing the best they can to meet the standards set by national health officials are, in spite of their efforts, getting sick.

Here’s a clear, plain English translation of what our government and the national health agencies have done: they have chosen a “safe” cholesterol level for the public that virtually guarantees—if everyone actually met their stated goal—that every year more than 1.2 million Americans will suffer heart attacks and that millions more will watch the inevitable progression of their coronary artery disease.

What is going on here? If the evidence is so clear that the goal for cholesterol levels should be set below 150 mg/dL, why don’t the national experts and policy makers tell us that? When we ask representatives of our government to establish safe levels of bacteria in our drinking water, they do not select a level at which a substantial proportion of the population will contract cholera and dysentery; instead, they set a level that guarantees none of us will be infected. The case is similar with official standards for other contaminants. We do not choose a level at which 20 percent of our children will develop lead-induced brain disease from lead in the water. We choose a level that ensures the safety of everyone. So why is the policy so different when it comes to levels of cholesterol in the blood?

The answer lies in a complex blend of culture, habit, taste, realpolitik, and other factors—including, frankly, a somewhat condescending attitude among medical experts toward the lay public. Let’s look at the facts.

To begin with, it is true that people have a craving for oil, dairy, and animal fat, and that includes the medical scientists who study the problem. We are immersed in an environment of toxic food that is attractive, tasteful, reasonably priced, and heavily advertised. And there are powerful commercial interests that want no change in the American diet. Over the years, there have been a number of attempts to bring nutritional recommendations more into line with what the science actually shows. In every case, intensive lobbying by industry—the producers and purveyors of dairy products, meat, and poultry—has caused those who set the standards to pull their punches.

To put it quite simply, the fox is in the henhouse. Nowhere is this more apparent than at the United States Department of Agriculture, which since the late 1970s has been issuing the government’s official guidelines on what American citizens should be eating. In a recent editorial for Nutrition Action Health Letter, a publication of the Center for Science in the Public Interest, Michael Jacobsen named the major officeholders in the USDA and described what each had done for a living before going to work for the Department of Agriculture.⁴ Every single one had previously been employed by the dairy, meat, or poultry industry. And as recently as October 2000, the Physicians Committee for Responsible Medicine successfully litigated to find out exactly who was compensating the members of the USDA’s U.S. Dietary Guidelines Committee. It turned out that six of the eleven committee members, including the chairman, had financial ties to the food industry.

In my opinion, the Department of Agriculture, which by definition is supposed to protect and promote the nation’s agricultural interests, should disqualify itself from responsibility for setting nutrition standards. That duty belongs more properly to the Centers for Disease Control and Prevention. But so far, the USDA still holds the power to advise Americans on what they should be eating, and every five years, when it updates its advice, its guidelines end up misleading the public and betraying the science. As long ago as 1991, for example, proposed changes in the food pyramid would have relegated meat and dairy foods to lesser importance. But by the time the lobbying was finished, the USDA agreed on a misleading compromise for the new proposals that still emphasized consumption of animal protein.

Not much has changed since then. Here are some examples, drawn from a written critique I delivered to the 2005 Food Guidelines Committee:

1. USDA Recommendation: “Consume three or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from whole-grain products. In general, at least half the grains should come from whole grains.”

In other words, the other half of the grains consumed may come from refined grains, which have lost many of their natural nutrients and fiber content—and which cause elevated levels of triglycerides in the bloodstream, a recognized risk factor in coronary artery disease.

2. USDA Recommendation: “Consume three cups per day of fat-free or low-fat milk or equivalent milk products.”

Even low-fat milk contains significant amounts of saturated fat, which will clog arteries. In addition, fully 50 million Americans are lactose intolerant. For them, ingesting milk causes gastrointestinal upsets. Milk consumption has also been linked to the development of prostate cancer. Casein, the major protein in milk, has been shown in animal studies to powerfully promote cancer growth.⁵

3. USDA recommendation: “Consume less than 10 percent of calories from saturated fat and less than 300 mg/day of cholesterol, and keep trans-fatty acid consumption as low as possible.”

This is strange, impractical advice. I don’t know of any food scientist, nutritionist, physician, or other expert who, on a daily basis, would go to the enormous trouble of calculating how many calories’ worth of saturated fat they are ingesting, or who have more than a general notion of how many milligrams of cholesterol and trans fat they consume. It is absurd to ask the public to follow rules that even the scientists who invent them do not. It would be far simpler—and clearer—to advise people to avoid animal-based products (the source of all cholesterol and most saturated fat) and also to avoid products labeled “hydrogenated” or “partially hydrogenated,” since these contain the most harmful trans fats.

4. USDA recommendation: “Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fat, such as fish, nuts, and vegetable oils.”

This recommendation is of major concern. In effect, your government is suggesting a level of fat consumption that cannot arrest vascular disease and—quite the contrary—has actually been shown to promote it. In Chapter 10, I will discuss the documented harmful effects of monounsaturated oils. But fish consumption poses a set of dangers all its own. Filled with toxins such as PCBs and mercury, fish are a known hazard—so much so that pregnant women are advised to eat them sparingly. And the development of fish farming, made necessary by the steady depletion of the Earth’s oceans, poses some new dangers. Fish farming is so unhealthy that its products must be treated with antibiotics, and many health authorities advise against eating farm-grown fish. There is no doubt that the omega-3 fatty acids found in fish are valuable, but there are other, safer sources of these acids, which I will discuss in Chapter 8.

5. USDA recommendation: “When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.”

This is largely obfuscation—confusing and misleading for the vast majority of people who are unfamiliar with the science. There are no fat-free meats. Some meat is merely less fat than other meat—and thus slightly less toxic. The same is true of poultry. And that’s just the start of the problem. Mass-produced poultry is so contaminated with bacteria that poultry inspectors, intimately acquainted with its condition, rarely consume it. In fact, you are regularly advised by our health experts not to allow it to infect foods in your refrigerator or on your countertop. As for milk and milk products, they have been clearly implicated in the development of heart disease, strokes, hypertension, diabetes, osteoporosis, and prostate cancer. And their labeling can be very misleading indeed. Are you under the impression that milk labeled “2%” delivers only 2 percent of its calories from fat (as compared with whole milk, which delivers 55 percent of its calories from fat)? Wrong. In fact, 35 percent of the calories from “2%” milk are from fat. Similarly, 21 percent of the calories in “1%” milk are from fat.

How can it be that an arm of the United States government would design and promote dietary guidelines that, if followed, guarantee that millions of Americans will perish prematurely? This is an international embarrassment and a public health disaster. The truth is that giving the U.S. Department of Agriculture, as presently configured, the responsibility for issuing such guidelines is much like inviting Al Capone to prepare your income tax returns.

But our medical organizations have also waffled when it comes to this subject. Although they have been advising us for well over a decade that dairy products, oil, and animal fat are bad for us, and although it becomes clearer with every passing year that vascular disease, cancer, and other illnesses are the direct result of the toxic Western diet, these organizations just cannot bring themselves to radically change nutritional recommendations. Instead, the experts keep suggesting that we reduce consumption of animal and dairy fats, that we eat red meat only once or twice a week, for example, and that we remove the skin from chicken—advice that is imprecise and vague and does not significantly reduce fat intake.

Almost all experts will agree that coronary artery disease is rarely seen in individuals with cholesterol levels consistently below 150 mg/dL. Almost all would also agree that reducing fat intake to less than 10 percent of calories consumed will help mightily in achieving low cholesterol levels. And they would concede that it is impossible to eat a diet built around meat, poultry, dairy products, and oil, and still derive less than 10 percent of calories from fat.

But rather than state these facts clearly to the public, rather than set a truly safe level of blood cholesterol and advise Americans how they can achieve it, the experts balk—often explaining that the public might have an overwhelming sense of frustration at not being able to comply with the nutrition changes necessary.

I think this is wrong. We should tell the public what is healthiest for them. People will decide for themselves whether they wish to comply. We, as scientists, must at least tell them what is optimal.

In 1991, I assembled a blue-ribbon faculty nationally known and respected for their expertise in cardiology, nutrition, pathology, pediatrics, epidemiology, and public health for the First National Conference on Lipids in the Elimination and Prevention of Coronary Artery Disease. During two days of presentations in Tucson, Arizona, these scientists were challenged to develop what they felt constituted the optimal diet for health, one least likely to develop coronary artery disease. I asked them to answer the question: What do you tell the patient who says, “I’ll do anything, but I never want to have heart disease,” or, “I have had a heart attack, and I never want another”?

One panelist replied, “Have him eat beans, beans, and more beans.” Another, Professor T. Colin Campbell of Cornell, one of the world’s most respected nutritionists and coauthor of The China Study, said most clearly and forcibly what other faculty members were feeling:

“If we are reasonably sure of what our data from these studies are telling us, then why must we be reticent about recommending a diet which we know is safe and healthy? Scientists can no longer take the attitude that the public cannot benefit from information they are not ready for. We must have the integrity to tell them the truth and let them decide what to do with it. We cannot force them to follow the guidelines we recommend, but we can give them these guidelines and then let them decide. I personally have great faith in the public. We must tell them that a diet of roots, stems, seeds, flowers, fruit, and leaves is the healthiest diet and the only diet we can promote, endorse, and recommend.”⁶

Following the conference, I prepared a summary that was ultimately approved by ten of the thirteen faculty participants. The following four paragraphs reveal the strong stand of these acknowledged experts—and might serve as a model for more useful nutritional advice for Americans than what the U.S. government and national health organizations currently provide:

“Present governmental and national heath organization guidelines do not provide a maximal opportunity to either arrest or prevent coronary artery disease. Studies demonstrate persons following present guidelines will have increased rates of disease progression when compared to persons achieving lower serum lipid levels through diet and/or lipid-lowering drugs.

“A diet which would achieve superior results in reducing atherosclerosis would be a 10-15 percent fat diet provided largely by grains, legumes, vegetables, and fruit. This diet offers protection against the common neoplasms of breast, prostate, colon, and ovary. It also lessens the likelihood of developing obesity, hypertension, strokes, and adult-onset diabetes. There are no known adverse effects of such a diet when mineral and vitamin contents are adequate.

“Children and adolescents require major attention to develop early habits of optimal nutrition. Schools should assume a significant leadership role in achieving this goal.

“Speculation about the degree of public compliance must not influence the accuracy of the recommendations.”⁷

Indisputably, in recommending that Americans convert to plant-based nutrition, we would be asking Americans to undertake profound taste transitions. But there are some potential allies in the cause: the professional chefs of the world, those employed by up-scale hotels, restaurants, businesses, clubs, and other venues that require food of exquisite taste, texture, variety, and presentation. These chefs are masters at achieving delightful meals no matter what the basic foods.

Several years ago, I was invited to speak about arresting and reversing heart disease at a luncheon meeting of health maintenance organization directors at the Broadmoor Hotel in Colorado Springs. I agreed to speak on one condition: if I could be responsible for the luncheon menu. The planners of the HMO convention agreed.

After my presentation, one doubting audience member declared that nobody would eat a diet consisting of 10 percent fat or less.

“Did you enjoy your lunch?” I asked.

“Yes, it was delicious,” he replied.

“Fine,” I answered. “You should know that it was 10 percent fat, which was my requirement of the chef if I were to speak here today.”

Point made, with the help of a master chef. Unfortunately, he may have been an exception. A decade ago, I was asked to make a presentation for a highly respected culinary institute. By the time I arrived, the director had decided that he did not want his chefs-in-training to hear what I had to say, since it clearly conflicted with what they were being taught; instead, I gave a thumbnail sketch of my data to a much smaller audience—the director and his assistant. A few years later, I was asked to speak at another meeting, the annual national chefs’ convention in Nashville, Tennessee. I presided at a special breakout session with approximately twenty chefs, all of whom had coronary artery disease. They’d been done in by their own cooking.

The good news is that the word is spreading. Americans are steadily growing more health conscious. Since I started my research twenty years ago, there has been a marked increase in the number of experts who believe that nutrition plays a critical role in helping you maintain safe cholesterol levels and in protecting you from the common killer diseases, especially from coronary artery disease.

And many laymen come to that understanding on their own. A few years after his first bypass surgery, Abe Brickner joined a study of people who had undergone the operation. “I began to sense from my reading that something was going on,” he says. “If 50 percent of people go back for a second bypass, I wanted to know what was in store for me.” Through the study, Abe had another angiogram, which led to his second bypass surgery when he was sixty-five. But as he says today, “If I had the knowledge base I have now, I would not even have had the first bypass.” That second surgery provided “the final flash of insight and self-awareness, and sent me into the preventive mode. I was ready when Dr. Esselstyn came along.”

It took hand-holding to get Abe past his cravings for the fat-filled diet he had enjoyed for so many years. But he committed himself to my nutrition plan, and he has stuck with it ever since. His cholesterol dropped from 235 mg/dL to 123, where it remains to this day. Now in his eighties, Abe Brickner is convinced that he will live to be one hundred. Best of all, he says, “The locus of control is me! The doctor isn’t responsible for my health—I am.”