But even as Dr.
Esselstyn plays hardball, he does so with a soft edge. "I am
an uncompromising but caring presence," he says. He eats the
way his patients eat. He calls them, carefully monitoring progress.
He insists that spouses participate. He has them over for dinner,
sharing recipes and encouragement with those who choose to live by
the rules. And when they fall off the wagon, he's there to pick them
up. Perhaps that's the secret to his 15-year patient success rate.
about Esse," says Abraham Brickner, PhD, former director of
the Office of Health Services Research and Program Development at
the Cleveland Clinic and an Esselstyn diet follower, "he is
single-mindedly focused. He is not deterred from his position, and
his patients are ready to jump out the window for him."
says compliance has been the key to success. "When they see
their [cholesterol] numbers going down and feel their angina disappear,
they are able to stick with it," he says. For Dr. Brickner
this is true. His cholesterol dropped from 235 to 123. But he moved
grudgingly toward this diet. It took Dr. Esselstyn's hand-holding
to get him past the cravings and ready to maintain the diet on his
The way Dr.
Esselstyn's patients tell it, they succeed because he gives them
a chance at life -- a chance that far outweighs previous predictions.
Oswick, a communications professor at John Carroll University near
Cleveland. After her second heart attack, her cardiologist gave
her little hope. "He told me to go home and wait to die. But
he did tell me about a doctor starting a research program,"
says Oswick, referring to Dr. Esselstyn.
came to talk to me and at first I thought, I'll never do this. I
love my chocolate and desserts. But I thought about it for a couple
weeks, and I really didn't want to die. When I showed up, Esse laughed
and said, 'You're the last person I expected.' "
one of the first to join Dr. Esselstyn's ongoing study and has been
faithfully following the program for 15 years. "I know without
this program, I would not be here today. But you have to want to
do it; you have to want to live."
So how did
a world-renowned surgeon and head of the section of thyroid and
parathyroid surgery at the Cleveland Clinic get so wrapped up in
broccoli, rice and grains?
he was frustrated. "That was the rub," Dr. Esselstyn says.
"I was successfully performing mastectomies and partial mastectomies,
but what was I doing for people getting disease?"
started looking for ways to keep patients out of surgery. After
working long days in the operating room, he scoured the literature
looking for answers -- for ways to help people prevent disease.
like Kenya and rural Japan, breast cancer, prostate cancer and coronary
artery disease were almost nonexistent," he says. Why? Dr.
Esselstyn points to dietary patterns and plant-based diets. He decided
to focus his research on coronary artery disease, something he believed
he could change in his lifetime.
the nutritional elements of his study after that of Asian rural
diets, he has conducted the longest ongoing longitudinal study of
its kind. The Asian diet is made up of complex carbohydrates that
come from rice, whole grains and noodles. There is little or no
red meat or dairy, and the fat content is about 20%. In Dr. Esselstyn's
diet there is no meat or dairy and 10% fat.
patients -- some with heart disease so advanced that standard intervention
techniques such as bypass and angioplasty were no longer an option
-- have had the progression of their disease stopped or reversed
after adopting the strict regimen. "Sadly for patients, doctors
practice palliative cardiology. That is totally unacceptable,"
he says. "Angio stents ... are temporary fixes. There's the
drama of the angio, but there's not much drama in talking about
broccoli. Diet is not very sexy."
Like most in
the study, Joseph Crowe, MD, a surgical oncologist and director
of the breast center at the Cleveland Clinic, credits Dr. Esselstyn
with saving his life.
out of the OR and had a crushing chest pain, severe headache. It
was pretty dramatic," he says. "My cholesterol was low,
I was relatively active, I didn't know what I could do to change
things," Dr. Crowe says.
called him; the diet was something Dr. Crowe could do. "I have
three little kids. I wanted to live." Four years later, Dr.
Crowe had a cardiac cath with totally normal results. "[Dr.
Esselstyn] is one unusual guy; the work he has done is out of his
devotion to helping people," says Dr. Crowe. "Many times
he's going against the grain. Here's this world-renowned surgeon
who's spent weeks, months, years devoted to coronary artery disease
prevention out of the goodness of his heart."
likens his diet to patterns uncovered by the China Project, one
of the world's largest ongoing culturally related nutritional studies.
In 1983 researchers
from Cornell University in New York, the Chinese Academy of Preventive
Medicine in Beijing, and Oxford University in England began gathering
data on how people lived and died in 65 rural Chinese counties.
"We found that their nutritional habits are very different
from Americans," says Banoo Parpia, PhD, a Cornell University
Division of Nutritional Sciences senior research associate.
main hypothesis: The greater the proportion of a variety of good-quality
plant-based foods, the lower the rate of chronic degenerative diseases.
Researchers charted weights, blood pressures, disease and reproductive
histories. While analysis and study continues, one of its major
findings to date asserts that risk of coronary artery disease decreases
with increased consumption of plant-based foods and decreased consumption
of animal foods. To fully prevent coronary artery disease, plasma
cholesterol must be maintained at well under 150.
to following the links between these dietary patterns and diseases,
the researchers also charted the migration patterns of Asians coming
to America as they conformed to Western diets. Men in China have
a 1-in-100,000 rate of prostate cancer. Chinese-American men living
in San Francisco had a 19-times-greater rate of the disease.
moved to the United States from China when he was 17, and quickly
developed a love of all things American: greasy hamburgers, deep-fried
foods, prime rib and ice cream by the quart. By the time he was
58 he couldn't breathe. "When I would walk into the wind my
chest would tighten," he says. "This was my wake-up call."
ago this international businessman, now 70, had a quintuple bypass.
"I wanted to know why I had this problem and how to stop it.
My cardiologists could not help me. I tried biofeedback, but I still
wanted to know how to stop the disease. I wanted to be around to
see my children grow up," Yen says. "Someone said, there's
this guy named Esselstyn."
no cracks in the door
is the kind of man who makes you feel immediately comfortable. He
laughs easily. He's impassioned about most things he takes on. And
he's reluctant to shine a light on his own accomplishments. It's
always those around him who helped him succeed. He credits his wife,
Ann, whom he met while a medical student at Cleveland's Western
Reserve University (now known as Case Western Reserve), with the
success of his 17-year research study. "I couldn't have done
it without her," he says.
wasn't always dairy-, meat- and oil-free. He grew up on a cattle
farm in upstate New York. The hardest foods for him to give up were
peanut butter and cheese. But after 16 years, he doesn't crave the
foods he now calls hideous.
people had to know I was asking them to make a significant change,"
he says, referring to those participating in his research. "They
also had to know that Ann and I were willing to eat the way they
in rural New York gave him the winning edge. He went to the local
public school; four boys and six girls were in his elementary school
class. After eighth grade, he went to Deerfield Academy in Massachusetts
and then Yale. But summers he worked construction back home. "I
worked on the New York State Thruway and the Taconic Parkway,"
And even though
he's been awarded a host of degrees, medical honors and the Bronze
Star while an Army surgeon in Vietnam, the pinnacle of his career
occurred in 1956. Pulling the No. 6 oar as a member of the U.S.
Olympic rowing team, he won the Olympic gold medal in Melbourne,
Australia. "There's nothing quite like it," he says of
winning the medal. "It's one of the most spectacular moments
you can have as a human being."
In June 2000
Dr. Esselstyn gave up his surgical post at the Cleveland Clinic.
But he's not retired. He just has more time to devote to what has
been his avocation, arresting heart disease through dietary changes.
returned from a 16-day, 27-stop presentation tour in India, which
was funded by the Physicians Committee for Responsible Medicine.
He believes that getting the word out will begin a process of change.
there are 30 million people with heart disease," he says. "Even
though there is a broad base of vegetarians, they eat a lot of clarified
butter, ghee. They worship dairy and cheeses, and they now even
have a Kentucky Fried Chicken."
to the dietary campaign, the Esselstyns enjoy their 400-acre farm
in New York's Hudson Valley. They spend time with their four children
and five grandchildren.
But even when
Dr. Esselstyn speaks of his personal life, the conversation always
winds back to food and changing eating habits. He's impassioned
about food labels and adamant against pushing moderation.
increasingly apparent that not one single morsel can pass through
their lips," he says. "Moderation kills. Once you let
them have a crack in the door, their rehabilitation is finished.
It's gasoline on the fire."