"Just a Little" Can Kill You?
How strictly do you need to follow the recommendations of Dr. McDougall or Dr. Esselstyn to get protection from heart disease?
Well, when my father was in his early 80s, he had chest pains due to arterial blockages, and he had a couple stents put in. It scared him and he spoke on the phone with Dr. Esselstyn and Dr. McDougall, and decided to go onto a lowfat plant-based program. He ate pretty clean and managed to get his numbers down and to get off cholestrol-lowering and other heart medications they had put him on.
For a few years he ate a pretty tight diet. But as time went on, when I'd visit my folks, I'd see that they weren't really adhering to the lowfat plant-based diet as much as I thought they should. I saw peanut butter, sometimes my dad would eat something oily if they went out for dinner, or eat something he should have avoided altogether at a dinner party at a friend's home. I told my mom to ditch the vegan mayo that I found in their fridge at one point.
When my dad was about 87, one day he started having chest pains, went to the hospital, and while sitting there talking with the ER doc -- he had a major heart attack. Left anterior descending, aka the "widow maker." His heart stopped and was restarted with the paddles. Because he was in the ER and 50 feet away from a cath lab when he had the heart attack, he survived. They rushed him in and ballooned the blockage, did a lot of miraculous stuff and he survived.
The cardiologist told him after that he shouldn't have survived and would not have survived if he hadn't been at the ER when it hit.
Before he left the hospital, my dad was also diagnosed with Atrial fibrillation (A-Fib) and they wanted to put him on a blood thinner like Warfarin (Coumadin). But my dad refused the blood thinner. (He had fallen a couple of times including hitting his head because he had post-polio syndrome which caused muscle weakness, and he didn't want to fall and bleed to death, which coumadin can cause.)
After he got out of the hospital, this time my dad decided he had to go 100% with the diet. My parents hired someone to cook for them, and strictly followed McDougall and Esselstyn recipes (he selected recipes from their books and emailed the cook, she had the same books, and would cook a few days worth of food and drop it off a couple times a week).
Because this heart attack had been a huge thing which almost took him out, this time my dad didn't deviate much or just "try to do his best" with the diet. He was determined 100% to not have heart problems again so he didn't screw around with fake mayo or peanut butter or guacamole or any of the foods Dr. Esselstyn and McDougall say to look out for.
The result was that my dad got off heart meds again, and he never had another heart problem for the rest of his life, which was more than 5 years. He died last year at age 93 from post polio syndrome (he'd had polio in the 1950s, had a complete recovery, then had it start to come back in the past decade, and became increasingly weak toward the end).
So what I took from my dad's experience with diet, is that he had heart disease. Pretty serious heart disease, but probably also pretty typical. A lot of my parents' friends, probably a majority of them, have died from heart disease. When my dad went on the McDougall/Esselstyn diet the first time (after the scare but before the big heart attack), he went on it full blast at first, then continued on it "mostly." He got great results initially, then apparently felt things were okay and loosened it up some. He felt he could deviate from time to time, have more fat than was recommended sometimes, like with fake mayo or a peanut butter sandwich or a rich meal at a restaurant. And he thought he had the heart disease at bay eating this way -- but he didn't. He had been very sick when he had his first episode when he got stents, blocked arteries, but his "mostly McDougall" diet didn't end up protecting him. He ended up having that massive heart attack that would have killed him, if he hadn't been lucky enough to be in a hospital.
But since he survived that major heart attack, and then had really found religion and realized that doing McDougall "mostly" wouldn't protect him from dying of heart disease, when he got that second chance he went all the way. And never had a heart problem in the next five years.
And my mom, once they had someone cooking and they were both only eating 100% McDougall and Esselstyn recipes, she lost a chunk of weight in this more dedicated "second phase" of McDougalling. That told me they had finally "got it" because when you eat a clean, no-cheat McDougall, you generally do lose weight if you have weight to lose, whereas if you're adding the occasional oil/mayo/rich restaurant dinner/too much avocado and so on, of their "mostly" McDougall diet, she hadn't lost much weight.
If you have had a brush with heart disease, or have a family history of it and have started following Dr. McDougall or Dr. Esselstyn's programs to combat the disease, my advice is to really follow the program, not "mostly." Mostly can let you still die from heart disease, like my dad almost did.
I don't mean that someone can NEVER have a piece of some treat or other on some special occasion, but that the "mostly" diet of going 80 or 90 or even 95% -- may not protect you from heart disease as much as you need.