14
Simple Strategies
AS YOU HAVE ALREADY LEARNED, my nutrition program is quite different from most others. It is not about making moderate changes to slow the progression of heart disease. It is about embarking on a significant change in lifestyle that will actually arrest the disease’s progression and selectively reverse its effects.
Central to the program’s success is the fact that the patients themselves assume complete control over their disease. They alone have the capacity to abolish it. They alone, in sticking with my nutrition guidelines over time, have the ability to ensure that the beneficial effects will expand and endure. They treat more than the symptoms of heart disease. They treat its underlying cause—and with it, the underlying cause of a host of other chronic illnesses.
The program’s goal, to repeat, is maintaining total blood cholesterol below 150 mg/dL using a plant-based diet and, where necessary, cholesterol-reducing medication. And the key to success is attention to detail. In this program, we eliminate entirely the ingestion of all building blocks of atherosclerosis. There are no exceptions. Patients must erase the phrase “This little bit can’t hurt” from their vocabulary and from their thinking. As we have learned, the opposite is true: every little bit can hurt—and does.
At this point, if you are like most of the patients I see in person, you are probably thinking something like this: “How on earth will I be able to give up cheeseburgers, French fries, steak, mayonnaise, cheese, olive oil, and all the other things I love?” One friend of mine, a lawyer, was so put off by the idea of giving up all those foods that he asked me whether he couldn’t keep eating his high-fat diet until he developed symptoms of coronary artery disease—and then stop eating fat. I dissuaded him from this approach by explaining that in fully one out of four patients with heart disease, the first symptom is sudden death.
Still, there is no question that the high-fat diet typical of a Western lifestyle appeals to the palate. And its appeal is reinforced by the toxic food environment that surrounds us. The advertisements that bombard us feature foods with a much higher fat content than the level recommended by our government health agencies—and that recommended level itself is too high for optimal health. Culinary schools for chefs who eventually will be in charge of restaurant, hotel, and institutional cuisine do not teach them how to prepare healthful, tasty, attractive meals that contain only about 10 percent fat. Collectively, the media; the meat, oil, and dairy industries; most prominent chefs and cookbook authors; and our own government are not presenting accurate advice about the healthiest way to eat.
And it’s not just a matter of bad information. The truth is that we are addicted to fat—literally. Receptors in our brains account for our addiction to nicotine, heroin, and cocaine, and similar cravings have been identified for fat and sugars, as well.
The way to break the fat habit is to abstain entirely from eating it—just as those who use heroin, cocaine, and nicotine must give them up once and for all. We have all seen what happens with many people who go on reduced-fat diets in order to lose weight. A diet that permits even a modest amount of animal, dairy, and oil fat still feeds the habit. The craving remains. And the moment the diet is completed—or, more often, fails—the dieter too frequently returns to his or her old habits of eating and regains the lost weight.
About a decade ago, the Monell Chemical Census Center in Philadelphia tested the effect the consumption of fat has on our desire for it. In the Monell experiment, healthy volunteers were separated into three groups. One group continued eating a typically high-fat American diet. The second ate a diet in which fat was reduced to 20 percent of total calories. In the third group’s diet, the fat level was held to 15 percent or less. At the end of twelve weeks, the first two groups craved fat just as much as ever. But those who had eaten less than 15 percent dietary fat over that period had completely lost their desire for fat.
1The reason weight-loss diets fail is the same reason present cardiac rehabilitation for coronary artery disease fails: patients continue consuming fat. They may consume slightly less than they did before their heart disease was diagnosed, but this is still the very same fat that injured their arteries in the first place. Their heart disease continues to progress.
The people in my research study held their dietary fat to very low levels. (Although my nutrition plan requires no calorie counting, my research shows that a diet drawn from the recommended categories of foods holds fat consumption at 9 to 11 percent of total calories consumed.) Just like those in the Monell Center study, my patients lost their craving. After twelve weeks, they no longer felt as if they were in a constant state of denial, and they began to reap the myriad benefits of eliminating the fats from their nutrition. This is a lifestyle change that works.
Even so, I concede that it is not easy to change. In my experience, there are four primary challenges that confront those who embark on this program. Over the years, we have identified a variety of strategies to deal with each one:
1. You are craving fat. Have faith. As I explained above, that craving will disappear after three months of consuming no fat. (By “no fat,” I mean no animal, dairy, or oil fat—no additional fat beyond the natural amounts in vegetables, fruits, and grains.) You will develop a new taste for the natural flavors of food and you’ll discover new herbs, spices, and sauces for seasoning. Eating safely in this culture is a daily challenge, but attention to detail assures success. And remember: you should beware of the “0 fat per serving” products such as salad dressing, butter substitutes, mayonnaise, and pastries. They may contain less than 0.5 grams per serving, but that little bit is enough to ensure that you will continue to crave fat. It also may increase your fat intake to more than 20 percent of the calories you consume, adding pounds of artery-clogging fat to your diet each year.
2. You are invited out to eat at someone’s home. If the person inviting you is a close friend, this shouldn’t be a problem. But if it is someone you don’t know well, it can seem awkward at first. The key in this situation is candor—and, of course, basic good manners. Explain to your hosts at the time of the invitation that you follow an unusual nutrition plan and do not eat any meat, fish, fowl, dairy products, or oils. Emphasize that you would very much enjoy the pleasure of their company, and that you’d love to come, but don’t want to cause any extra effort on your behalf. You might suggest that you could eat before arriving, then join the dinner party for a glass of wine. Almost always, the host will insist that you come for food, as well, and will ask what you can eat. In that case, tell him or her that you’d be happy just to partake of plain salad and bread—or that simple steamed vegetables or a baked potato would be just fine. (Perhaps this goes without saying, but you should always avoid pressing the issue of your diet on others unless they seem genuinely interested.)
3. You must eat out in a restaurant. Restaurants can be lethal if you don’t think ahead. It is a good idea to get to know several in your area that already provide or are willing to fix a “safe” meal that you will enjoy. If you must eat in an unfamiliar restaurant, try calling the chef or maitre d’ a few hours in advance—even sooner, if you have a chance. Explain that you need a meal that includes no food of animal origin, and no oil. They may well surprise you: often, restaurateurs are quite pleased to be challenged to accommodate you. And they will always be grateful that you gave advance notice.
4. You are traveling, either at home or abroad. Airlines can be responsive to special requests for no-fat vegetarian meals, but they often need a reminder twenty-four hours before takeoff. Of course, you always have the option of packing a picnic of your own that meets your specifications exactly. As for restaurants in unfamiliar locales, use the same tactics while traveling that you use at home: try to call ahead and let the chef or maitre d’ know what kind of meal you will need.
You will doubtless come up with strategies of your own. My patient Anthony Yen, who travels far and wide on business, has shown particular ingenuity over his twenty-plus years on the program. Among other things, he put together a set of cards that request—in a variety of languages—plant-based food that contains no oil. That way, no matter where in the world he finds himself, he can confidently request the sort of meal he needs.
But if his forward planning fails, Anthony is perfectly capable of improvising. Not long ago, he went out for lunch with his son and ordered a very simple vegetable meal at a Chinese restaurant. When the food arrived, however, he could see that there was oil on it. Anthony’s solution: he ordered two bowls of hot water, and washed the oil out of the vegetables. Satisfied that it now met his standards, he happily consumed the oil-free meal.
Sometimes, there’s not such a ready solution. On a recent trip to the Far East, the airline forgot to load Anthony’s special meal. In that case, he simply didn’t eat anything but a couple of bananas on the whole twenty-hour flight. (Anthony, incidentally, mentions a side benefit to plant-based nutrition: he no longer experiences jet lag. “It used to take a week to ten days to recover” from a trip to China, he reports. “Since Esselstyn’s program, I have no more jet lag.” I have no scientific reason to believe that my nutrition plan is actually responsible for this, but I am happy to take credit!)
In our house, my wife, Ann, is the cook, and over the past twenty years she has learned a great deal about how to concoct wonderful meals that meet the strict standards of my nutrition plan. During the sixty- to ninety-minute counseling sessions I hold with all prospective patients and their spouses, Ann shares her own experiences and insights into how to plan and prepare dishes and menus that they will enjoy for the rest of their lives. In the following chapters, she will do the same for you. She will describe general principles and imaginative techniques that will help you put together delicious, nutritious meals for a lifetime of healthy eating.
Remember—I cannot stress this often enough—attention to detail is the key. If you eat in this wonderful new way, you need never develop heart disease. If you already have heart disease, you will conquer it. That is my promise to you, the sum of everything I have learned. Pay attention.
You are in control.