Stopping coronary disease in its tracks

Medical evidence is mounting that a plant-based diet, consisting of unprocessed grains, legumes (beans, lentils and peas), vegetables and fruits, combined with lipid-lowering drugs, can pre-vent, arrest and even reverse coronary artery disease.
One of the nation's leading advocates of this approach is Cleveland Clinic surgeon Caldwell B. Esselstyn Jr., M.D. In 1985, frustrated with what he perceived as the lack of serious effort at preventing major illnesses such as heart disease, Dr. Esselstyn recruited 24 patients with triple-vessel coronary artery disease for a research study, originally designed to last five years.

"My goal was to achieve, through plant-based nutrition and cholesterol-lowering drugs, a serum cholesterol level less than 150 milligrams per deciliter (mg/dL), as is seen in cultures where coronary artery disease is virtually absent," Dr. Esselstyn explains. "Research shows that people with a total cholesterol that is consistently below 150 mf/dL rarely have coronary disease."
Participants were asked to adopt a plant-based diet and eat mostly unprocessed grains, legumes, vegetables and fruit; and consume alcohol and caffeine only in moderation. Patients were also given cholesterol-lowering drugs, as appropriate.

Landmark Results

According to an article in the August 1 issue of The American Journal of Cardiology, 18 of the participants were followed for 12 years. Although as a group the participants had a history of 49 coronary events - increasing angina (chest pain), heart attack or bypass surgery - during the eight years prior to the study, all but one had no events since the study began. The exception is a patient who was off the study for two years and experienced angina. He has since resumed the study's diet and medications, following a bypass operation.

The six patients who did not adhere to the diet were released from the study within the fi rst 15 months and returned to standard care. All had further coronary events, 13 during the 12 years of follow-up. One patient who adhered to the program died shortly after the fi ve-year mark from a cardiac arrhythmia, "probably due to damage to the heart caused by his original mas-sive myocardial infarction prior to the start of our study," Dr. Esselstyn notes. Angiograms taken just two months before the patient's death showed reversal of coronary lesions.

Prior to the study, Dr. Esselstyn's group had average total cholesterol levels of 237 mg/dL. The group now averages 145 mg/dL. Low-density lipoprotein (LDL) cholesterol levels are around 82 mg/dL. About 70% of the partici-pants have experienced regression of their dis-ease, meaning that the plaques appeared smaller and smaller on successive angiograms.
"These results are particularly important because they show that this therapy stops, rather than just slows, atherosclerosis," Dr. Esselstyn says. "Patients become empowered and feel that they are now in control of the dis-ease that was previously destroying their lives."

Because adherence to the program was key, Dr. Esselstyn used four rather unusual techniques to promote patients' compliance. He conducted a 60-90 minute interview with each patient and the patient's spouse at the start of the study.
He monitored patient cholesterol and overall progress with offi ce visits every two weeks for the fi rst fi ve years. Patients learned the results of their blood work by a personal phone call from Dr. Esselstyn the night of their offi ce visit. And several times a year, participants and Dr. Esselstyn gathered at one of their homes to review treatment objectives, exchange menus and socialize.

This and other studies are starting to convince physicians that coronary artery disease can, in fact, be reversed by aggressively lowering cho-lesterol through a very low fat vegetarian diet and, in many cases, lipid-lowering drugs.

Despite skepticism among medical professionals that patients would be willing and able to stick to this diet, Dr. Esselstyn insists that it is "scientifically and ethically imperative to inform the public what constitutes an optimal diet."

Of note: Dr. Esselstyn follows the same diet as his patients. In 1985, his total cholesterol was around 185 mg/dL. It now hovers around 110.

About Dr. Esselstyn

Having published more than 150 scientific articles, Caldwell Esselstyn, Jr. MD is Head of the Section of Thyroid and Parathyroid Surgery at the Cleveland Clinic and Associate Professor in the Department of Surgery at the Ohio State University School of Medicine. He received his A.B. degree from Yale University and his M.D.from Western Reserve University.

Born in New York City, Dr. Esselstyn grew up on a cattle farm in Upper State New York. In 1956, he won an Olympic gold medal as a member of the U.S. 8-oared rowing team.