The Incredibly Bad Science Behind Dr. Esselstyn's Plant-based Diet

txorito pamplona
Txorizo Pamplona. This delightful sausage of Navarra in the basque region of Spain is right out in Esselsystn’s plant-based diets.

The skeptical cardiologist has heard a few cardiologist colleagues rave about the movie “Forks Over Knives” and promote the so-called “whole-foods, plant based diet.”
One of the two major physician figures in the movie is Dr. Caldwell Esselstyn, a former surgeon and now a vegan evangelist.
You’ll be eating a lot of this on the Esselstyn diet but do not, under any circumstances add a salad dressing containing any oil of any kind to attempt to make it palatable or satiating.

Esselstyn, along with T. Colin Campbell (of the completely discredited “China Study” (see here for a summary of critical analyses of that data), Dean Ornish, and Nathan Pritikin, are the leading lights of a dying effort to indict any and all fat as promoting heart disease and all the chronic diseases of western civilization.
Esselstyn, in his book, “Preventing and Reversing Heart Disease” lists the following rules:

  • you may not eat anything with a mother or a face (no meat, poultry, or fish)
  • you cannot eat dairy products
  • you must not consume oil of any kind
  • generally you cannot eat nuts or avocados

What? No Fish or Olive Oil? You Cannot Be Serious!

Whatever oil this might be (?sunflower) is right out even though it comes from a plant. According to Esselstyn, using his brilliant ‘logic and intuition” all fats, whether saturated or unsaturated are going to damage the lining of your arteries.

The best randomized controlled trials we have for diet to prevent coronary artery disease (CAD, the cause of heart attacks) have shown that supplementing diet with olive oil and nuts substantially lowers CAD.
Every observational study in nutrition has demonstrated that fish consumption is associated with lower cardiovascular disease.

Esselsstyn’s Really Bad Science

While working at the Cleveland Clinic, Esselstyn developed an interest in using a plant-based diet to treat patients with advanced CAD. He says he had an epiphany one rainy, depressing day when he was served a slab of bloody roast beef.
In his own words:

“my original intent was to have one group of patients eating a very-low fat diet and another receiving standard cardiac care and then compare how the two groups had fared after three years.”

If he had followed his original intent, and randomized patients entering the study, he could claim that he had performed a legitimate, important scientific study. Twelve of the 24 would be allocated by lottery to the Esselstyn diet and 12 to whatever was the standard recommended CAD diet at the time. Unfortunately this approach, due to a “lack of funding, was not practical.”
So instead, 24 patients were sent to him, “all suffering from advanced CAD” and began the horrifically strict dietary program he had developed based on his “logic and intuition.”
Interestingly, patients not only were put on Esselstyn’s incredibly low fat diet, but they were also given cholesterol lowering medications and were “switched to statin as soon as these became available in 1987.”
In addition, 9 of the 18 patients who stuck with the program had previously undergone coronary bypass surgery and two had undergone angioplasty of a coronary artery.
6 of the 24 original patients “could not comply with the program” and were sent back to their regular cardiologists. This gives you an idea of how difficult it was to follow this diet.
Esselsstyn’s “data” then consists of following 18 patients, 9 of whom had already undergone coronary bypass surgery, all of whom were taking statin drugs with his diet without any comparison group.
This group of 18 did well from a heart standpoint, of course. It is impossible to know if the diet had anything to with their outcome.  Most of them had already undergone the “knife” or had had angioplasties that took care of their most worrisome coronary blockages. They were all taking statin drugs . They were all nonsmokers and they were all highly motivated to take good care of themselves in all lifestyle choices.
Any patients who were not intensely motivated to radically change their diet would have avoided this crazy “study” like the plague.
This “study” is merely a collection of 18 anecdotes, none of which would be worthy of publication in any current legitimate medical journal.
Three of the 18 patients have died, one from pulmonary fibrosis, one presumably from a GI bleed, and one from depression. Could these deaths be related to the diet in some way? We can’t know because there is no comparison group.

Should Anyone Eat Ultra-low Fat Diets?

It is possible that the type of vegan/ultra-low fat diets espoused by Esselstyn and his ilk have some beneficial effects on preventing CAD, but there is nothing in the scientific literature which proves it.
Scientific reviews of the effect of diet on CAD in the last 5 years have concluded that the evidence is best for the Mediterranean diet, which emphasizes fish consumption, olive oil and nuts. These reviews dismiss ultra-low fat diets because of a lack of evidence supporting them, and an inability to get people to follow them.
If you have ethical or philosophic reasons for only eating things with no mother or face, then by all means follow your conscience.
Too often, however, I find that those who choose veganism for philosophic reasons want to find health reasons to support their diet and mix the bad science and philosophy into a bland evangelical stew they recommend for all.
I remain, therefore, in favor of cioppino, paella, butter and all the glories of the omnivore that make life so rich.
Omnivorously yours,

I have updated this post with comments from readers and my response along with analysis of the latest “data” from Dr. Esseslstyn’s “study” at my post entitled:

For an amazingly complete (and surprisingly entertaining) dissection of the scientific inaccuracies of “Forks Over Knives” with humorous overtones, I recommend Denise Minger’s post “Forks Over Knives: Is the Science Legit? (A Review and Critique). Be prepared for lots of graphs!


207 thoughts on “The Incredibly Bad Science Behind Dr. Esselstyn's Plant-based Diet”

  1. I accidentally came across Dr E’s diet and then found my way to this post … thank goodness there are sensible people who question the “scientific studies”! Now in my mid-50s, I have been following a doctor-guided low carb real food lifestyle (which includes generous amounts of animal fats) for more than 18 months and feel the best I have for years – reversed fatty liver, avoided becoming pre-diabetic and as a bonus, lost weight. It’s the industrial seed oils, sugar and grains that are problematic for those of us with metabolic issues and we need fats to deliver the fat soluble vitamins. So those people who doubt humans should be omnivorous, should do themselves a favour and check out Barry Groves’ video ( and have a look around at all the vegetarians/vegans who need to supplement their diets because plant food cannot possibly deliver all the essential nutrients humans require.

  2. Give up CAFO animal products? Absolutely. They are horrible for the animals, the meat processors, the eaters, and earth. But it is very possible to purchase meat, dairy, and eggs from farmers and ranchers who practice regenerative agriculture.

    The work of Dr. Nicholas Gonzalez is really informative and supports this conversation. His main premise is there is no one perfect diet for all—everyone has different needs according to their metabolic type.

  3. I have recently decided to try a plant based whole food diet, mainly for an underlying health condition, but also because I love animals and nature and have considered myself a hypocrite for years for eating and enjoying meat and animal products.

    It’s amazing how animated people get about this subject. Anthony, you clearly are passionate and rightly want to question the validity of Dr E’s diet, which is a good thing, especially as science based. But you do seem to have an axe to grind about Dr E personally? I assure you, having spoke to him briefly once, he is like you, very passionate in his beliefs.

    I can see both sides of the argument. For years I followed a primal diet. On that diet I lost weight (I wasn’t really overweight to begin with), and my general health improved. The key for me was cutting out processed foods as much as possible and eating whole foods. And that for me has nothing to do with whether to eat meat and animal products or not. I believe there are big issues with meat & dairy due to the processes involved in production. These may be more a contributory factor than the produce itself.

    I am not a trained medical professional, but I do believe there is merit in both sides of the argument (Anthony & Dr Esselstyn). But there is synergy actually. Both agree on eating whole foods.both agree that plant based diets can be good for us. As for oils, I think a little oil is probably fine, and particularly Olive and Coconut, as each have known benefits. Nuts again in moderation are probably fine, as are avocados. As for meat, the jury’s out on whether there are any benefits in eating meat or animal products at all, but given the state of the respective industries I am happy to not eat it at all. Highly processed foods with lots of additives I do not believe are good for us at all.

    As above, I’ve only just started my plant based diet, so will see where I am in 4-5 months, if I’m still alive!

    • Rich,
      I am passionate about presenting the true scientific background for dietary choices. I have no axe to grind with Dr. E on a personal level and I have no issue with you or anyone who wants to eat the diet he espouses for ethical or personal reasons. I just want people to know that his diet has not been proven scientifically to prevent or reverse heart disease as he claims. That is just a totally inaccurate statement. If it were true I would be insisting all my patients get on it.
      As you point out he and I agree on many aspects of the optimal diet for cardiovascular disease prevention.
      Its been >5 months now since your comment (and apologies for my delayed response). How are things going for you
      dr. P

    • I completely agree with you. I tell people all the time that, my decisions to eat plant based is not for everyone. I fully believe that everyone should tailor their diets to fit their needs. I began my plant-based journey a year and a half ago because my cholesterol was high. I watched my father suffer from a bypass surgery to repair his arteries and I did not want that to be me. I wanted to live a long heathy life. I was able to reduce my cholesterol from 259 to 186 in a year. I’m not saying that it is for everyone but for me it works very well and I am happy with Dr Gregor’s studies and I try to live as closely to his recommendations as possible. Am I 100% compliant 100% of the time, no, but I try to stick to it as best as I can, and I feel so much better for it. I can definitely tell when I have a meal that is WFPB, and my body hates me for it. I don’t know what my arteries look like, but I imagine that they are happy with me.

      • Julie,
        See my comments to Renee.
        The drop in in your total cholesterol is likely related to a drop in both LDL and HDL components. One important questions is where does your LDL/apo B end up and is it still in a range where heart attack risk is high.
        You wrote “I can definitely tell when I have a meal that is WFPB, and my body hates me for it.” I assume you meant you have a meal that is NOT WFPB?
        You also wrote
        I don’t know what my arteries look like, but I imagine that they are happy with me.”
        There is a way for you to know what your arteries look like-coronary artery calcium-something I’ve written a lot about on this website.
        Dr. P

  4. I don’t have a dog in this fight, but I would point out that the traditional Okinawan diet had only 6% calories from fat, which is incredibly low, and yet these are Blue Zones people (or they were when they ate that way). So it seems that a very low fat diet can be healthy, no?

  5. I was given Dr Esselstyn”s book while I was in ICU after having the “widow Maker” HEart attack. LAD 100%blocked. Left with a low ejection fraction.
    We went on his diet and after three months, I was dying. Went to a holistic doctor and he suggested the Paleo diet. We did the 180 degree change and felt better in days. I lost 30 pounds and wife went from a size 10 to size 2. Afainst doctors orders, I take NO medications. Its been over 9 years that we are on the Paleo. Go figure.

  6. I was agreeing and following Esselstyn’s view of of nuts until I found out that nuts and seeds are necessary and essential in improving and sustaining not only a diseased heart but also the brain, especially among the aging along with EPA-DHA supplements. His refusal for the longest time – even with contrary scientific evidence as presented by Doctors Michael Greger, Joel Fuhrman, Joel Kahn and even Colin Campbell to show the opposite – has made me feel disillusioned with what Esselstyn’s claim about nuts. Even to this day, in many very recent videos, he still indicts all nuts as containing all saturated fat which is further from the truth. It makes me feel less confident in what he says and forces me to now check the validity of his statements. Very disappointed.

  7. While living at an ashram in India in 1980 I researched meatheads and vegheads. In the north are lots of meatheads and veg and ghee people. In the south are lots of vegheads. The highest rate of heart disease was in the vegetarian south. I finally came across the son of a vegetable oil empire whose father had died of a massive heart attack. He informed me that the vegetarian folk had switched to vegetable oil from coconut oil. Now, forty years later I am convinced that vegetable oils are a major suspect in heart disease. Whole foods are safest. Ghee has been around humans for thousands of years. Vegetable oil not so. My personal decision is to use a moderate amount of ghee and coconut oil with a plant based lifestyle and ZERO VEGETABLE OIL.

  8. Bernando Lapallo lived to be 114 and he was a great believer in extra virgin olive oil. He used it on his skin and in his food. Other than that he was basically plant based, ate leafy greens every day, from what I understand. He ate fish 2 or 3 times a week, and chicken in moderation. Also Dr Hinohara is or was over 100 and he drank a tablespoon of olive oil every morning. As for meats he ate mostly fish in small amounts. So I don’t think there is real evidence that Dr E is right about olive oil, because people who have lived to be over 100 consumed olive oil daily. Although as Dr E says, this could be in spite of the olive oil. Hope this helps. Thanks.

  9. Thanks for the Denise Minger recommendation. I checked her blog site ( and was surprised to see that her current diet, “is some conglomeration of real-food plant-based no-crap fare with smaller amounts of seafood, eggs, and organ meats.” I wasn’t expecting that based on your article.

    • She has written some very detailed, well-researched articles on various dietary approaches. It doesn’t really matter to me what she currently eats but based on that description it is very similar to what I eat.

  10. I don’t question your motives regarding your critique of Caldwell Esselstyn. However, the one common thread that I notice from the omnivore community is that no one ever debunks the studies that show that there is endothelial damage that happens from eating a “bad meal” (meat/dairy/etc.) and the claim that the arteries don’t temporarily stiffen up for a short while after eating a meal of meat or dairy. Is the science for that sound or is that argument ignored for a particular reason?

    • The problem with the studies you describe is that they are describing a temporary physiological phenomenon (e.g. a change in flow-mediated dilatation-i.e. relaxation of arteries) not a true fixed anatomic change in the arteries (“endothelial damage”). Arteries are constantly dilating and contracting in response to various stimuli-cold, food, stress, exercise. What hasn’t been established is what the long term consequences of a temporary food-induced change in flow-mediated vasodilatation signifies.

  11. The diet for controls in that study is not defined, nor were instructions given.
    Vegans avoid animal products, but not oil, refined carbs or various sugars. It is an unhealthy diet. The Esselstyn does not allow added oil or more than a handful of nuts and no sugars or simple carbs. It is really a whole plant based diet without much of processed ingredients. There is an obvious and crucial distinction. O

  12. As far as I am concerned it doesn’t take a genius to realise that cow’s milk is supposed to be for calves. End of. So that’s dairy gone. If I see a rabbit or a cat I do not feel remotely hungry and have no means of eating it raw. Possibly a fish …. maybe. But that is the way my common sense has worked out what is best for me.

    • Hmmm. I wouldn’t advocate this approach to selecting food. When I see kale it doesn’t make me hungry and I’m pretty sure it wasn’t designed with my nutritional needs in mind.

  13. The skeptical cardiologist has made a fundamental error of categories. Dr Esselstyn does not advocate Veganism, rather a whole plant based diet. Know the difference

    • The term “plant-based diet” is vague. US News and World Report calls the Mediterranean diet “plant-based.” In actual practice Esselstyn’s diet is much closer to a vegan diet than Mediterranean diet. For example when asked what’s wrong with nonfat yogurt his website states “Egg whites, fat free milk and yogurt are ALL animal protein, and animal protein injures the lining of the arteries. Do not eat.”

  14. You seem to have not read the book and are misinformed, or are intentionally misleading. For example, about nuts and avocados. From the book “Equally important are some condiment foods that make you feel satisfied; dips and dressings, or small amounts of nuts, seeds, or avocado are all items that can quickly and easily transform a plate of, say, beans and steamed vegetables into a delicious and satisfying meal.” It goes on to give recipes containing nuts and avocados.

    • I have the 2007 version of his book which states at the beginning (page9)
      “Here are the rules of my program in their simplest form:
       You may not eat anything with a mother or a face (no meat, poultry, or fish).
       You cannot eat dairy products.
       You must not consume oil of any kind—not a drop. (Yes, you devotees of the Mediterranean
      Diet, that includes olive oil, as I‘ll explain in Chapter 10.)
       Generally, you cannot eat nuts or avocados.
      You can eat a wonderful variety of delicious, nutrient-dense foods:
       All vegetables except avocado. Leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellow and everything in between.
       All legumes—beans, peas, and lentils of all varieties.
       All whole grains and products, such as bread and pasta, that are made from them—as long as
      they do not contain added fats.
       All fruits.”
      When he is describing later (page 38) in more detail which vegetables are allowed he clarifies:
      “Almost any vegetable you can imagine is legal on this plan, with a single exception, for cardiac patients: avocados, which carry a high fat content
      unusual for vegetables. Those without heart disease can eat avocados as long as their blood lipid levels
      are not elevated.”
      On page 61 he repeats the rules for patients with heart disease (the intended audience of his book and those who would be interested in “reversing heart diseas”
      Do not eat avocados. That includes guacamole!
      There is only one other mention of the banished avocado and that is in one recipe for black bean cakes.
      “Put bowls of corn, onions, bean cakes, salsa, spinach, and cilantro on the table.
      Start with spinach, then add a bean cake or two, roasted corn, roasted onions, and top with salsa and cilantro. If you do not have heart disease, you might want to add some avocado.”
      On nuts, he says on page 38
      “Nuts. Those who have heart disease should avoid all nuts. Those without disease can consume
      walnuts in moderation because they can provide considerable omega-3 fatty acids, which are important for many essential bodily functions. But I am extremely wary of nuts. Although short-term studies funded by nut companies show that they may positively affect good and bad cholesterol, I know of no long-term studies indicating that they can arrest and reverse heart disease, and patients may easily overingest them, elevating their cholesterol levels.”
      So maybe you have a later version of his book in which he has modified his very passionate restriction of avocado and nuts from patients with heart disease.

  15. One thing I think about is calcification. In my mind, I imagine that a heart attack can be caused by a particle of hardened plaque being dislodged and settling where it shouldn’t and/or fat cells and red blood cells bumping up into a blockage. Now what is the significance of calcium? I have heart disease and I also get calcification inbetween my teeth which the Dental Hygenist has to remove every 6 months. Is this related? I remember asking a doctor in hospital about this and she basically shoo’d me off. Is it because I ingest too much calcium and/or is it because I can’t get rid of the stuff? Is this why it settles in my mouth (via the saliva glands)? Just a thought but I think that although large scientific studies are great they don’t answer an individual’s question and it is the individual who is important to me (of course). Perhaps Medical Science should really do singleton studies. i.e. answer my questions…..

  16. Five years ago, aged 70, despite what I thought was a healthy lifestyle – lots of exercise and a “low fat” diet, I had badly blocked arteries which caused a heart attack. Intervention within 2 hours and three stents gave me a second chance. I was advised that the high quantity of sugar in a low fat diet was my problem. After months of research and fine tuning, I plumped for the traditional mediterranean diet (as per the pyramid, but with minimal sugars), and now at age 75, I can walk faster than most people of any age, and speed up 5 flights of stairs without getting puffed. Your advice seems good to me.

  17. Oh good grief! I check out this site every year or so, and it’s the same old same old same old arguments — based on the totally unproven (i.e.
    “incredibly bad science”) hypothesis that the best advice to a patient is to advise going on ANY specific diet touted to be “the best” diet for the average person, in a world where no one is average (that’s the whole point of modern day “precision medicine”) and where even the world experts in the field argue endlessly over what exactly is the best diet for the world’s average human.
    I can’t believe that people are actually basing their diet choices on controversial data obtained from the indigenous peoples of Arctic regions.
    These diet wars are so … 20th century.
    Here’s what I (an oncologist, not a cardiologist) recommend:
    Get a CT calcium score.
    a. If it’s zero, then just don’t eat a lot of red or processed meat and eat a diet which includes high fiber, veggies, moderate fruits. Get exercise. Preferably enough exercise to get resting heart rate to 60 or below. Maintain ideal weight. You are already at low risk of heart disease; think more about cancer.
    b. If it’s above zero (particularly well above), get a bunch of baseline labs — risk factor stuff. Get accurate BP. Weight. Body mass index. Resting heart rate.
    Then pick out any type of diet/exercise plan which appeals. Probably take a statin. Stay on the diet/exercise plan for six months. Repeat baseline measurements. Labs, BP, heart rate (should ideally be less than 60), weight. If everything is getting better, keep doing it. If not, do something else.
    The point is that what works for me may not work for you, and vice versa. That’s the whole point of individualized, “precision medicine.”
    Diet wars are close to pointless.
    Everyone on this forum who is an Inuit, raise your hand.
    DNA is destiny. Respect it.
    – Larry Weisenthal/Huntington Beach CA

    • Stick to oncology: you are nutritionally undereducated. Tell me about human teeth similar to other 90+% herbivores, lack of fangs and claws, plant digesting enzyme in salivary glands, jaw action to crush, not scissors of carnivores… Ask a damn dentist what that mouth is supposed to ingest. Near vegans have perfect BP/cholesterol/TG/AIC, BUN, uric acid, fewer kidney stones, less cancer, no constipation,
      “and the list goes on.”

    • Thank you Dr. Larry. I agree with your DNA comment; however, natural selection gave rise to the DNA we have today. To ignore our origins is to ignore our DNA, as research into APOE has begun to reveal.
      Everyone on this forum who is a vegan over 60, with a resting pulse in the 50s, less than 10.4% body fat, and can lift double their bodyweight, raise your hand.
      ‘Nuff said.

      • I’m 72 years old; haven’t knowingly eaten red meat since 1972; am 6’0”; 154 pounds. Resting heart rate 38. Ran 5 marathons in past 21 months (3 in Boston Marathon qualifying times). I have a dreadful family history on my Mom’s side (100% Finnish … high meat; high full fat dairy). Grandfather and 3 uncles died of heart disease in late 50s/early 60s.
        There are vast genetic differences in response to various diet and exercise regimens. What works for me may not work for you and vice versa.
        With regard to your weight lifting question, what are you talking about? Dead lift or bench press or what?

    • No, DNA is not destiny. As Hans Diehl has often remarked, “Genes load the gun, but lifestyle pulls the trigger”.

  18. If Dr Esselstyn’s diet is not good for reversing heart disease, heart failure in particular, is there any diet that will? I am searching for a way to live a while longer & I had hope when I started this plan, now I am not so sure..Anyone? Worried ….

    • There are no diets that “reverse” heart failure.
      But we have outstanding medications that have been developed in the last 30 years for heart failure.
      With appropriate use of beta blockers, ACEI inhibitors and several other medications we typically see dramatic improvements in heart function and the signs and symptoms of heart failure and the mortality rate of heart failure is declining markedly

      • Thank you, I am on beta blockers & several others. Is there any diet that is the best one to eat with heart disease?

        • Well for decades a low salt diet was recommended. And obsessed over. I have never been pushed heavily on the low salt diet and interestingly very recently a study was published showing that low salt diets may be harmful in heart failure.
          So for my heart failure patients I recommend what I recommend to all my patients. A modifid mediterranean diet. See my diet page for details.

  19. Essentially, Dr. AnthonyP is correct in saying that Dr. Esselstyn did not use good scientific methods in his work with heart patients. I also believe it to be foolish for anyone with cardiovascular disease to trust their fate to any diet plan without consulting with their cardiologist first.
    Cardiac medications kept me alive while significant lifestyle changes, over a five year period, made it possible for me to get off those drugs.
    Let me also say that I am not a vegan. Such diets make it very difficult for anyone interested in strength training to get an adequate amount of protein (one gram for each pound of lean body mass) and calcium without extensive supplementation. Whenever possible, I believe we should get our protein and calcium from food rather than supplements.
    Nevertheless, the work of Dr. Esselstyn and Ornish does have merit. I cannot tolerate a diet that goes much above 10% of calories from fat, nor can I tolerate well meat of almost any kind, or nuts for that matter. Such foods will give me chest pressure and some chest pain not long after ingesting them. In that regard, I follow the Ornish plan. (Esselstyn’s diet is too restrictive.) Each day, along with fruit, vegetables, whole grains, and legumes, I have two servings of non-fat diary (from a high-grade source), one cup of egg-white replacement, one-quarter cup of soy protein, one-quarter cup of whey protein (from a high-grade source), and five grams of creatine, which has drastically reduced my triglyceride level.
    My exercise plan includes three hours of aerobics and four hours of weight lifting each week, plus 20 to 30 hours of physical labor.
    With all that said, it stills remains to be seen whether my diet and exercise program will have any lasting value in keeping me alive so I might reach eighty years of age.

    • I have been eating whole food plant based, no refined’/processed oil for over 2 months. I eat nuts, seeds and avocados. I have dropped my total cholesterol by 42 points, lost 7 stubborn post menopause pounds, have more energy and mental clarity and interestingly bruise significantly less easily – and if I do, the bruise goes away more quickly. I am 56 years old and hope to live a long, heart healthy, active life!

      • Renee,
        I’m happy to hear you are doing so well! Hopefully, most of the 7 pounds you lost is visceral fat and not muscle mass. Hopefully your apo B has declined not just the total cholesterol and hopefully if you have coronary artery disease you are also taking a cholesterol modifying agent which has been shown to reduce your heart attack and stroke risk.
        I, too , wish you a long, heart healthy active life.
        The key limitation to the Esselstyn diet is difficulty maintaining lifelong. Let us know if you are still on it in 5 years
        The diet you are on shares common elements with the Mediterranean diet with a focus on whole , real foods and avoidance of ultra processed products, refined grains and sugar-sweetened beverages.
        Dr. P

  20. There are overweight vegans for sure, as there are plenty of ideal weight meat and dairy eaters, but statistically vegans are thinner, much less obese than their meat and dairy eating counterparts, in fact. Thinner than flexitarians and vegetarians too.
    Less obesity means: less diabetes, less heart disease, lower blood pressure, fewer cancers, fewer strokes, less disability, etc…If veganism did nothing else than make us thinner wouldn’t that be a worthy recommendation? How many type 2 diabetic complications could be avoided?
    Most people talk about how they don’t eat “that much” meat or eat mostly chicken and fish, and in conversation most everyone will recant that they eat “pretty healthy” most of the time, and of course the moderation word is used a lot–yet we are epidemically overweight and chronically ill. And it’s NOT from lack of exercise. Exercise is good for us but almost no one has the time, energy, or ability to exercise the hours it would take to make up for the extra calories we consume daily. We have to change the diet. Since vegans are the least overweight, it would seem that would be reasonable vs. offensive.
    Finally, let’s say Esselstyn is wrong, the data is skewed or whatever. That still doesn’t change the abject failure that modern medicine is. I am always a little taken back at the indignation of establishment medicine when anyone dares to think outside the box, as though what they are doing is working. Reminds me of oncologists who scoff and belittle patients when they just ask about vitamin supplements or natural remedies or whatever. Maybe they work, maybe they don’t, and maybe they are harmful, but it’s like why are you pissed off at the question; what you do isn’t working either.

    • Jenifer,
      Interesting post, but several points require clarification.
      1. Referring to “weight loss” is ambiguous because it does not differentiate between fat loss, muscle loss, and bone loss. One can lose weight by eating a protein-deficient diet or even cutting off their leg, but those provide no health benefits.
      2. “Thinner” is not the best measure of healthy body composition. Many vegans I know and have seen are what we call “skinny-fat.” That is to say, they have low body weight and would meet the BMI, but still have noticeable fat, especially around their mid-sections, which is the a the most metabolically active form of fat (not a good thing).
      3. The term “meat eaters” is not defined. A recent study published by British researchers used this term, without defining it. Grouping people who eat fast-food in with low-carb and paleo dieters is disingenuous, skews the data, and obscures the actual effect of nutrition on health outcomes. Would anyone believe a study that grouped Vegans in with people who eat fast food and called them all Vegans? After all, there is lettuce and tomato on the burgers they eat? French fries are vegan, but are they healthy?
      Most recently, a “celebrity trainer” said the ketogenic diet was the Atkins diet. It is not. The Ketogenic diet is moderate protein, high fat, and low carbohydrate; which is significantly different from Atkins. In addition, there are a range of low carb diets that are all different. In addition to Atkins and Keto, there is Paleo and low carb-high fat.
      If we are going to differentiate between vegan and vegetarian, objectivity requires that we differentiate between each of the low carb options, and especially the typical western/American diet.
      Finally, in 2013 the LA Lakers contracted with a nutritionist who put the entire team on a low carb, high fat diet. Kolbe Bryant has credited the diet with improving his performance and extending his career. The evidence is mounting in favor of eliminate grains and cereals, and replacing them with saturated fat.

    • As for “establishment medicine,” trauma care is outstanding. As for the rest, it’s a mixed bag. I wouldn’t make a blanket statement that everything else “…isn’t working…”
      Also, since you alluded to cancer in particular, treatments for certain cancers have improved. Not all types, unfortunately.
      Next, as for why conventional doctors get irritated at “alternative” healthcare, I now have some empathy for their position. Based on many years of personal experience, I’ve found much of “alternative” healthcare to be full of baloney. There are many great, well-intentioned providers, to be sure. However, there are also many providers who are perpetuating pseudoscience, in order to peddle expensive and unproven tests, supplements, and procedures.
      The explosion in “alternative” healthcare has been a gold rush for those who got in early (e.g. some of them becoming multimillionaires, based on their books, private label supplements, speaking engagements, etc.), though even recent acolytes are still doing very well with their cash-only businesses. They get to make shaky claims, deliver very little, and charge a lot for the privilege. If things don’t go well, they blame others.

  21. My wif and I switched to a mostly WFPB diet about two and a half years ago. We have never felt better. We eat a little fish, and we aren’t militant about enforcing our choices. . .when we’re invited to dinner and our friends are so proud to share their “barbecue chicken wings” recipe, we eat it. We don’t make it for ourselves, but we understand that everyone is not going to follow our ideas. We are thankful for what we learned from FOK. I appreciate your POV…be careful not to be too militant or engage in personal attacks. You only hurt yourself.
    Thank you,
    Mark & Ramona

  22. You wrote: “The best randomized controlled trials we have for diet to prevent coronary artery disease (CAD, the cause of heart attacks) have shown that supplementing diet with olive oil and nuts substantially lowers CAD.
    Every observational study in nutrition has demonstrated that fish consumption is associated with lower cardiovascular disease.” This simply is not so: the studies by K L Gould &D Ornish are “the best” studies to date & clearly showed that what Esselstyn is implying is correct & all 3 of their works fits identically wi my 50 years & 225,000 patient visits of cardiology practice recommending a 90+% ideally organic unprocessed whole foods diet that not only prevents heart disease but is the ticket for the simultaneous prevention & often reversal of multiple diseases and conditions. Don’t get hung up on fake science, read the recent critiques by Ionnaidis re PREDIMED. Read the criticisms of so many studies by John Carlisle, Pocock & Stone, and A B Hill.

    • A more precise summary of the data on fish consumption would use the phrase every meta-analysis of all observational data …..see the following
      2015 Twelve prospective cohort studies with 672 389 participants and 57 641 deaths were included in this meta-analysis. Compared with the lowest category, the highest category of fish intake was associated with about a 6% significantly lower risk of all-cause mortality (RR=0.94, 95% confidence interval (CI): 0.90, 0.98; I2=39.1%, P=0.06). The dose–response analysis indicated a nonlinear relationship between fish consumption and all-cause mortality. Compared with never consumers, consumption of 60 g of fish per day was associated with a 12% reduction (RR=0.88, 95% CI: 0.83, 0.93) in risk of total death.
      Gould’s contribution to Ornish studies is nuclear imaging which I’ve discussed elsewhere. It proves nothing about underlying atherosclerosis. I’ve also discussed Ornish’s very weak study. I probably should put that as a separate post.
      I am never “hung up on fake science”

    • Actually there is. Many theorize that the dramatic increase in human brain size was related to increase fat consumption.
      And some papers show marked differences in lipids between primate species (
      “The results suggest that as human cognition evolved, the types and amounts of fat in key brain areas were rapidly shifting and mutating—and this growth was crucial to the development of our complex abilities.”

      • Dear Dr AnthonyP-
        Thank you for this blog, it contains some great info. I wanted to comment specifically to your reply to the low fat primate comment that was added by the food scientist. You mentioned that humans need more & different types of fats in their diets to support our advanced brains. So basically eating only primate food with very low/limited fats would not support our human brain functionality, which may be true. Please consider this, monkeys mainly eat simple saccharides, if you were to naturally evolve their food it would be a polysaccharide (starch) which can be high in fat depending on the grains. Remember sugars and carbs are of the same class, don’t you think it’s a coincidence that we eat evolved monkey food and we are evolved primates ?. Carbohydrates = Carbon Hydrogen Oxygen. Some grains can be fatty… I eat a strict whole plant/starch based diet with no concentrates and I couldn’t add additional fats like nuts or avocado (etc) bc it would take me over the 7-15% calories from fat ratio I strive for. I do want fat and I get it naturally through my type of diet. My advice would be to read the nutritional facts on the back on grains, some have a lot of natural fat and are starch rich. My mother just reversed diabetes by following a whole food plant based diet which was recommended by her cardiologist when we asked for the nonpharmaceutical option. There’s too much big business money stifling these stories and quite frankly people don’t have to balls to take the bulls by the horns. Btw, if we were to get rid of commercial animal farming and production we could reduce greenhouse gas omissions by 75%. I’m not against eating some type of animal once in a while because you have to live your life and the blue zone shows that mediterranean diet do produce centurions but perhaps without any animal they could be Centurions & a quarter lol. Thank you for your blog Dr. P… Allspeed!

        • Adam, you are ignoring the anoxic zone in the Gulf of Mexico due largely to run-off from growing soybeans, wheat, and corn. Eliminating commercial agriculture, and having every family live totally on what they can grow in their home gardens or barter for with their neighbors would eliminate that environmental tragedy.

      • You are also taking that quote out of context. There is no evidence that the shift was fueled by dietary fat. Talk about bad science.

    • The Brits couldn’t go to sea without developing scurvy unless they had lemons and limes for vitamin C. How, pray tell, did the Inuit, who never saw a citrus fruit and who did not eat the low-fat ape diet ever survive? What is it about the fat / animal protein diet that protected from scurvy, not only the Inuit, but the Arctic explorers who adopted their diet? It looks like there is plenty of reason to suspect humans have significantly different nutritional needs than other apes. Finally, gorillas have horrific gas and chronic diarrhea, suggesting a significant amount of what they consume is passed through their digestive tracts after being fermented into methane; which represents carbon not metabolically available to the consumer. Some have theorized that humans can survive as lower intestine fermenters, but none have demonstrated it.

      • Sea mammals such as walrus, seal, and whale. Whale meat generally comes from the narwhal, beluga whale and the bowhead whale. The latter is able to feed an entire community for nearly a year from its meat, blubber, and skin. Inuit hunters most often hunt juvenile whales which, compared to adults, are safer to hunt and have tastier skin. Ringed seal and bearded seal are the most important aspect of an Inuit diet and is often the largest part of an Inuit hunter’s diet.[1]
        Land mammals such as caribou, polar bear, and muskox
        Birds and their eggs
        Saltwater and freshwater fish including sculpin, Arctic cod, Arctic char, capelin and lake trout.
        While it is not possible to cultivate native plants for food in the Arctic, Inuit have traditionally gathered those that are naturally available including:
        Berries including crowberry and cloudberry
        Herbaceous plants such as grasses and fireweed
        Tubers and stems including mouse food, roots of various tundra plants which are cached by voles in underground burrows.
        Roots such as tuberous spring beauty and sweet vetch
        Here’s a post from Dr. john McDougall, a top physician who has studied and practiced diet and health for about 50 years….FYI the Inuits suffer from a 20% +- lower life expectancy

        • Steve,
          It’s fun to look at cultures that live successfully on extreme diets but ultimately I don’t find these descriptions are useful to help we humans understand optimal current diet. Certainly, lots of hypotheses can be developed but nothing proven.
          Personally, I never cite the Inuits as support for fat consumption and I don’t cite the Hazda as support for honey consumption.

  23. You write, “The best randomized controlled trials we have for diet to prevent coronary artery disease (CAD, the cause of heart attacks) have shown that supplementing diet with olive oil and nuts substantially lowers CAD.”
    Could you provide links to the studies you’re thinking of? Just beginning my journey into learning about this stuff — citations really help. — thanks

      • PREDIMED results in ONLY a 30 % reduction in endpoints. Esseltyn, 90+% vegan,& Ornish -> 90+% reduction in Ischemic ASCVD events. Esselstyn,etc in my list above = FAR BETTER. HRS, MD, FACC

    • predimed is a study funded by the spanish nut and olive oil industry…and further had more biased factors…oil and nuts (Other than a small amount of raw nuts occasionally) contribute to heart disease

      • It is not accurate to dismiss PREDIMED as “funded by the spanish nut and olive oil industry”
        Here is the complete description of funding
        The Spanish Ministry of Health—Instituto de Salud Carlos III (ISCIII) funded the project for the period 2003–05 (RTIC G03/140). In 2006 a new funding modality was established by ISCIII through the CIBER (Centros de Investigación Biomédica En Red). Fisiopatología de la Obesidad y Nutrición (CIBERobn), which is providing funding for 7 of the original research groups, whereas the other 12 were funded by a new research network (RTIC RD 06/0045). Other official funds from Spanish government agencies have been obtained for subprojects related to intermediate outcomes (lipoproteins, inflammatory markers, vascular imaging, genomic and proteomic studies, etc.). Obviously, the donation by food companies of all the VOO and mixed nuts needed throughout the duration of the study is a substantial contribution. None of these companies (Patrimonio Comunal Olivarero, California Walnut Commission, Borges, La Morella Nuts and Hojiblanca) played or will play any role in the design, collection, analysis or interpretation of the data or in the decision to submit manuscripts for publication.
        And if you really want to read about the design and methods of the study go here (

        • Dr AnthonyP,
          In the PREDIMED study what was the control diet? it just says low fat diet. No instructions were given to the control diet participants, they were just asked to follow a low fat diet, while instructions were given in the other two arms. There is thus a bias.
          Was it 20% fat, 30% fat or 10–12 % fat as advocated by Dr. Esselstyn? Was saturated fat and animal products allowed? Was it a whole plant based diet or an omnivorous one? What was the. genotype, E3 vs E4 and of Lp(a) distribution in the three groups?

  24. Has anyone checked out that vegetable plant seeds have pesticides. So my question is how healthy are they and where can we buy truly healthy veggies and by the way extra virgin olive is very healthy and Braggs Organic Apple Cider Vinegar and in the Bible it also has a list of meat, bird, fish and shell fish to eat and not to eat I believe diet should be balanced to much of anything is NO good

    • Always do as best you can, Amimla protein concentrates the toxins in veg food they eat. Tru=y to be organic, BUT u will be better off & with a 50% lower carbon footprint being 90% vegan,. HRS, MD, FACC

  25. Great article.
    Thanks for debunking this poor science.
    Another thing I find interesting is that both Esselstyn and I believe Ornish’s studies contained animal foods such as dairy(skim milk and no-fat yogurt) and in Ornish’s case egg whites also.
    So it is interesting to see vegans use these studies as reasoning to go strict vegan, when these diets appear to be more low-fat vegetarian plant-based diets.
    Esselstyn and co also claim that olive oil impairs endothelial function, which doesn’t appear to be an evidence-based claim. The latest systematic review/meta-analysis actually found the opposite, which is that olive oil improves FMD and may exert a beneficial effect on endothelial function.

        • As just above, 90% will do just fine: that gets u an “A” in most endeavors, including this one to be disease free. HRS,MD, FACC

        • The reason I come to this site and also read lots of comments here is because i want to read some opposing views to the vegan doctors, and then judge for myself if vegan diet really is a heart healthy diet. the vegan doctors sound sincere, whereas your emphasis of “Yes. Nothing with a face or a mother.” contains hints of disdains. You sounded more like a person with an anti-vegan agenda. If you really just want to critically analyst Dr. Esselstyns’s recommendation, do just that, don’t need to add things like:
          “I remain, therefore, in favor of cioppino, paella, butter and all the glories of the omnivore that make life so rich.
          Omnivorously yours,”
          as that reflected your not-purely-for-science sentiment..

          • When I reiterate the phrase “nothing with a face or a mother” which is Esselstyn’s guiding principle I am emphasizing the lack of science in his program. Thus, any disdain that you are detecting is towards Esselstyn’s claims of being science-based. And obviously, the entire point of my post is to point out the incredibly bad science behind his diet.
            And if one realizes that there is no scientific support for the health benefits of eschewing butter and shellfish, for example, one can enjoy them in moderation and enjoy the rich diversity of food sources available during life.
            I will concede that my enjoyment of the complete palette of foods available is purely subjective but based on my observations through 30 years of discussing diet with patients , it seems to be the norm.

        • It’s a pity that the human race is indifferent to the suffering and horrific slaughter animals endure so people can eat a piece of rotting flesh. We are the most damaging species on this planet. For no other reason we should leave animals off our plates !

    • Esselstyn is less the issue than his type of diet. He is correct at the 90% level which is far more than other approaches (excepting Ornish & “relaxed” unprocessed, ideally organic, whole foods 90 % veganism. HRS, MD, FACC.

  26. Reblogged this on Heart Matters and commented:
    I’m not one to be manipulated by the use of formalism, or authoritative professional opinion which are used to control philosophy, science, and medicine. I’m just a person who has been a macrobiotic vegan once for years. I simply know I can see social engineering and this as an agenda.
    The fact is veganism ( and little concern if that diet is based on genetically modified plants) is part of the new world’s order of UN’s Sustainable Development goals numbers 2 and 15.
    Veganism is part of the UN, FAO, and Codex Alimentarius
    I agree with this doctors take on this plant diet.

    • This remark by “Mia” strikes me as very odd & unnecessarily accusatory: “formalism…control philosohy, science, and medicine… social engineering,,,new world order…” VERY strange remarks that cause me concern about Mia’s thinking. I stand by what I said which is largely factual and decent deductive reasoning.” HRS, MD, FACC

  27. You know now I hope that angiolpasties are nonsensical? No advantage mortality wise? They fail even with reduction of symptoms. Not better than placebo.
    Do I sense a worry about your salary? 😉

    • No worries. I don’t do invasive coronary procedures. My goal with coronary patients is to avoid stents and bypasses as much as possible. See my 2017 year end wrap up discussion of the ORBITA stent study and my articles on subclinical atherosclerosis and preventing sudden death.

      • I remain a big fan. We have some honest differences of opinion regarding conclusions to be reached, considering the totality of world data, but yours is an informed and welcome contribution to the conversation. Keep up the good (and too often unappreciated) work. 🙂
        – Larry Weisenthal/Huntington Beach

  28. I make olive oil here in California. Olive oil is really a form of fruit juice without the fiber like orange juice or vegetable juice that is juice with no or little fiber. It’s the juice of olives which are naturally high in oil. Fresh organic raw unfiltered olive oil is not only delicious but very healthful. When you use my oil on a salad which is full of fiber and other nutrients you balance the oil and add even better fiber than what is removed when the olive oil is milled. I never heat my oil as in cooking. I cook in water and add the oil after the food is cooked. Better flavor and much better for you. Unfortunately oil like the kind I produce is hard to find and is nothing like commercial olive oil in the supermarkets. I know that Dr Esselstyn has no idea of the value of olive oil that is fresh and properly produced and prepared (no heating). And by the way I have been a vegan (with the exception of ethically produced honey) for 47 years and will be 70 in a few months. I feel almost too good.

    • Tom,
      Thanks for your comments. Recently, after doing some reading about adulterated olive oil, I purchased some Bariani olive oil which comes from a family owned farm in California and seems to be closer to the oil that you produce.
      I’ve been very happy with the oil.
      It boggles my mind that some diets proclaim it not heart healthy
      Dr. Pearson

    • Yes you are right, the secret of the Mediterranean diet seems to be having a bottle of olive oil on the table at meal times to drizzle over your food. I remember a new study, on mice, examined a type of chemical called nitro fatty acids.
      The researchers state that nitro fatty acids could be produced from foods consumed as part of the Mediterranean diet, as chemicals in olive oil and fish could combine with chemicals in vegetables.
      In this study, nitro fatty acids were found to inhibit (block the action of) an enzyme called soluble epoxide hydrolase, and this, in turn, lowered blood pressure. They went on to show that the enzyme was also inhibited when mice were fed components of the Mediterranean diet.

  29. I’m a 45y man, do a lot of sport and since I followed a 100% whole food plant based diet, no cheat or junk food, starting 1 year ago, I saw many improvements but after one year…iron went down, cholesterol increased (yes it did, I don’t know how, maybe too many grains?), some fatigue, my hands are always cold, bloating. One can argue it is some problem with phytates (I eat many legumes) or some grain (gluten?), I’m still trying to figure it out, point is that the idea veganism proposes is so zealot in some MD’s speeches that there is no space for doubt, which is a problem for the individuals who, as I, don’t respond very well after eliminating ALL animal foods. This can even challenge the adherence to this regimen, since an “all or nothing” mentality can only push you away from veganism if it does not work well.

  30. I am a 57 yo female with high cholesterol. I am 5′-2″ and in January of this year weighted 154 and had TC of 350. I started reducing fat intake and in June, at the urging of my son, began a plant based diet. I did not do it for ethical reasons, although I can am certainly aware of the environmental problems associated with meat and dairy production. I would say until last month, October, I was 97% plant based in my diet. My cholesterol dropped to 293 in October, not low enough. I realize now that although I have been eating vegan, I have been consuming high oil foods, such as olive oil (a lot of it), nuts (too many), avocado (a whole bunch because I live in Texas)!
    I read all of the above comments with interest and I believe we, as a culture, are on the cusp of understanding about what a healthy diet really is. IMHO all human bodies are generally the same but have intricate differences. That means to me that there is possibly an ideal human diet but within that, a variety of foods that can be eaten by individuals with different tastes and health requirements. I don’t think we know the ideal diet. It is one big melting pot of studies and opinions. But we will get there. Dr. Esselstyn is on to something. So are many others as they experiment and discover. That is a process. I think it best to be open minded about ANY method that has positive results. If it hasn’t been clinically and statistically validated, support that research instead of criticizing.
    With all due respect Dr., when you say things like, “I am saddened when vegans make unscientific claims…” your position is weakened and leads me to wonder about your motive. Your emotion about the vegan lifestyle is truly irrelevant if you are attempting to teach or lead with your critique. Unsubstantiated claims are simply…unsubstantiated. Does that mean there isn’t evidence out there, albeit some yet unknown, that can substantiate? Dr. Esselstyn and many others are working toward an understanding and hopefully scientific substantiation. It takes money and time. I am intrigued, yet not “all in” on ANY diet yet. However, I am open and supportive and willing to learn.

    • I’m open to any and all diets that help my patients maintain ideal body weight and have healthier hearts. Esselstyn’s diet has clearly worked for some out there. . My personal philosophy is to eat lots of fresh vegetables. I think vegetarian diets can be healthy and contribute to weight loss.
      However, Esselstyn’s diet radically restricts all oils, even those shown to be beneficial for the heart (olive oil being the prime example). My post points out that although Esselstyn makes claims that his diet has scientifically proven to prevent heart disease, regress plaque and prevent heart attacks it has not.
      To promulgate such a radical diet one should have a solid scientific foundation.
      I’m not sure why my being saddened by vegans making unscientific claims weakens my position or makes my motive suspect. I’m saddened when any one makes unscientific claims to support their positions.
      The internet is full of wildly unscientific promotion of supplements, vitamins, nutraceuticals, superfoods and radical diets which only contribute to the confusion of the public when it comes to nutrition.
      I feel I can help with that confusion by focusing on what is scientifically supported (more olive oil, nuts, fish (not fish oil pills) for example) and what is not (not eating oils of any kind, taking the fat out of yogurt, veganism for example).

      • Great blog. It would seem logical if bio-chemistry were fully understood the drug researchers would have found the universal solution. It is my understanding they are not even close. I would like to know if adding fairly small amounts of oils to Esselstyn’s diet neutralizes it? Negates it?

  31. It’s near impossible to know what’s right. As any adult knows, food, like everything else, follows fashion. I can’t help but wonder if different people thrive on different diets: Some do well as vegans or vegetarians while others need flesh to feel good. What we can all agree on, I think, is that excessive saturated fat, salt and sugar will make us sick and fat. The problem for many people is that it’s difficult to eat well for a variety of reasons: The food industry is very powerful and going toe to toe with it everyday is tough; good food costs a lot of money and lots of people don’t have lots of money; and, fast food is popular because it’s convenient. Real people need realistic solutions and none of the really radical diets are realistic for most of us.

  32. I think the problem is simple. Highly processed foods cause highly problematic health conditions. I hate when I see anyone start blaming macronutrients for our health problems, that macronutrient shamming is the foundation for all fad diets. The problem is crap foods plus a hypercaloric intake. Expanding on heart disease specifically, it’s a very complex disease. So complex that diet isn’t the only factor. We’ve proven that something so little as not enough sleep can increase heart disease risk. Also, what about the lack of collagen in our diets? Collagen keeps the arteries nice and flexible. Without collagen the arteries start to harden. It’s definitely not the macronutrients. The French have some of the lowest heart disease rates and they eat high fat diets. Likewise the Okinawa eat a high carb diet and have low heart disese as well. JUST EAT REAL FOOD!!! And possibly take collagen, personally I take one scoop of collagen peptides and two scoops of bone broth protein powder a day.

  33. Interesting points on all sides. All I know is that a follow-up angiogram in December 2015 rendered the diagnosis from the cardiologist: “I am sorry, there is nothing we can do for you medically.”, which I took to be doctor-speak for “start making your arrangements”. We started the Esselstyn regimen on December 27, and I saw my husband come back to life – within days breathing better, within weeks climbing stairs and walking at a normal pace. His heart meds have been reduced 3 times in 18 months. He has also lost about 30 lb almost effortlessly. Blood tests show that he needs minimal supplements (B12, iron), so he is getting enough in what he eats.
    It may not be for everyone, but I do not think we were ever meant to eat the meat and dairy in the amounts and levels of processing that so many do today. I do not have heart disease, and follow it about 80%, and have found my overall feeling of well-being has improved, and I too have lost weight with little exercise and effort. Eating oil-free plant based whole foods over time cleanses the palate and all foods taste amazingly wonderful.
    I would say try it for six weeks and see how you feel, then adjust for your own personal tastes/needs/desires.

  34. A family friend subscribed to this diet following an emergency angioplasty with stent placements and statins. He has a terrible family history. After several years he had another angioplasty with a 95 percent occlusion. This diet did nothing for him. He looks like a corpse and had no life. This is quackery, and it frightens me that people believe this stuff.

    • Then he didn’t actually follow and eat right.. I’ve been 5 years am highly active and look and feel great… also… the amount of occlusion often has little to do with a cardiac event… eliminating chronic low grade inflammation… type of cholesterol and endothelial function means much more i feel

  35. “I have nothing against veganism or vegetarianism.”
    “Txorizo Pamplona. This delightful sausage of Navarra in the basque region of Spain is right out in Esselsystn’s plant-based diets.”
    “You’ll be eating a lot of this on the Esselstyn diet but do not, under any circumstances add a salad dressing containing any oil of any kind to attempt to make it palatable or satiating.”
    it seems apparent from the above comments that you DO indeed have much against veganism by suggesting that vegan food is unsatisfying and that only the flesh, milk and eggs of exploited farmed animals makes eating enjoyable.
    that said, the health benefits are secondary to the environmental and ethical aspects-and this is from a 50 year old who has been vegan for over a decade and has not been to a doctor in 15+ years yet have perfect scores on my free annual blood test at work. focusing only on the health aspect excludes the non-human victims entirely from the equation and equates eating someone’s body with consuming an apple or an orange. the tremendously negative environmental damage driven by raising and killing farmed animals is undeniable. according to the World Watch Institute:
    “The human appetite for animal flesh is a driving force behind virtually every major category of environmental damage now threatening the human future – deforestation, erosion, fresh water scarcity, air and water pollution, climate change, biodiversity loss, social injustice, the destabilization of communities and the spread of disease.”
    if you wish to see why veganism is a moral imperative and an issue of social justice, i would very high;y recommend checking out the 2005 documentary “Earthlings” on youtube.
    “A man can live and be healthy without killing animals for food; therefore, if he eats meat, he participates in taking animal life merely for the sake of his appetite. And to act so is immoral.” -Leo Tolstoy
    “The real struggle in being vegan doesn’t involve food. The hardest part about being vegan is coming face-to-face with the darker side of humanity and trying to remain hopeful. It’s trying to understand why otherwise good and caring people continue to participate in needless violence against animals – just for the sake of their own pleasure or convenience.” -Jo Tyler
    “Livestock farmers, no matter what kind — from the largest, most cynical, and inhumane factory farm­ers to the smallest, seemingly most ethical pasture-based farmers — traffic in death. It is death that is our aim, our purpose. Death is the end. Life is the means. Money the reward.”- Bob Comis, former pig farmer

    • Indeed, I agree that there are compelling ethical and environmental reasons to promote more vegetable and less animal consumption. I respect those who follow plant-based diets for these reasons. Too often, however, there is an attempt to claim health benefits to support the moral reasons which are not based in science.

  36. Thanks for posting this. Very helpful. When Dr. Greger mentioned him, it sounded credible – until I read your post. THANKS!!!

  37. Dr. Pearson. I’ve just completed reading your critiques of the Esselstyn work, and my opinion is that you are being much too dismissive.
    The Journal of Family Practice published two critical letters, an author’s response, and an editorial commentary. I believe that these are considerably more helpful and balanced. The Journal is open source, and I’d urge interested readers to read, in addition, the original paper for themselves, along with the comments, authors’ response, and editorial.
    Esselstyn’s data present a high class problem. He has a sizable group of patients, with a sizable degree of pre-existing coronary pathology. Folowing the dietary intervention, this group of patients did impressively well, by any standard. True, some did receive other interventions, including statins, and it’s impossible to conclude for certain that it was the diet which was the critical factor. But the strong suggestion is that the diet, in addition to usual care, produced unexpectedly favorable outcomes.
    Yes, the follow up methodology would not meet the standards of the NEJM or of a high impact specialty journal, but they clearly merited publication, as defended by the Journal’s editor.
    The results of this single study should not, of course, be viewed in a vacuum. The paper also contains a table reviewing the published results of other similar dietary interventions. I think a fair conclusion is that, in select groups of highly compliant subjects with coronary artery disease, the preponderance of evidence indicates objective benefit, with no suggestion of untoward effects.
    Now, I of course found your website because of a personal issue. I’m a 70 year old physician (medical oncologist) who has been a lifelong masters endurance athlete, and I was training to qualify for the Boston Marathon. I’ve been highly compliant with a Mediterranean style diet since the 1990s, after following the Pritiken Diet in the 1980s. On the Pritiken diet, I ran TCs of 135 – 147 with TC/HDLs of about 5. On the Mediterranean diet, my TCs ran in the 170s, with TC/HDLs in the low 3s.
    Because of my age, and a very strong maternal family history of premature death from CVD, and my strenuous athletic training, I felt it prudent to get tested for CAC and to receive a CT coronary angio. To my utter shock, these revealed both calcification and LAD plaque.
    Now, I know that I will have no difficulty at all being compliant with the rigorous plant based diet proposed by Esselstyn, Campbell, Ornish, et al. I have my baseline radiographic and lipid studies. I know the results of usual therapy alone (statins, anti-platelets), and I don’t find these to provide dependably acceptable benefit — where acceptable is plaque regression and calcium stabilization at non-toxic doses of statins.
    I believe that the preponderance of evidence indicates that I may well benefit from the Esselstyn diet, and I see no downside whatsoever in giving it a try, along with low dose statin and anti-platelet therapy, monitoring my lipids and CRP and perhaps eventually repeating the CAC and CT angio at some point. I also see no compelling reason to wait another 20 years before the definitive prospective randomized trial is carried out and published.
    Would I advocate this diet for the entire population of the USA? Obviously not, given the lack of definitive population evidence. But I’m not a “population;” I’m a specific individual with a specific problem, and I find Esselstyn’s findings to be highly relevant to my situation, and I am more than willing to take the informed “risk” in following his recommendations.

    • @Larry Weisenthal MD PhD
      I’m in a similar situation – 63 years old with CAC of 47 on the LAD.
      Question – what do you consider a non-toxic statin dose to be? I currently take 5 mgs of Crestor ED.
      I switched from 20 mgs of Atorvastation ED on advice of my cardiologist.
      LAst blood work (on Atorvastatin) was
      Triglycerides – 44 mg/dL
      HDL- 67 mg/dL
      LDL Calculated – 70 mg/dL
      Total Cholesterol/HDL ratio is: 2.18
      HDL/LDL ratio is: 0.957
      triglycerides/HDL ratio is: 0.672

      • Dear Mr. Grashow, I’m an oncologist and not a cardiologist. Your question is better addressed to Dr. Pearson. I wasn’t intending that my comment be generalized to anyone else. I was simply trying to explain the way I viewed this situation from my own unique individual perspective.
        I am grateful that Dr. Pearson cleared my comment to appear on his blog, which I think is quite excellent in its scientific rigor.
        I do wish to make one final comment. My avocations (since I’m no darn good at golf) are endurance athletics and arguing stuff on the Internet. I’ve been doing this since the early 1990s, beginning with the CompuServe Cancer forum. At one time, a search for my name on Google groups yielded more than 50,000 unique hits (they’ve cleaned out their attic somewhat, but if you google my name “Weisenthal” or “weisenthal/huntington,” you’ll still get a lot of stuff.
        I’ve argued cancer; I’ve argued sports; I’ve argued religion; I’ve argued politics (mostly politics); and I’ve argued diet and nutrition. As a result of 25 years of fighting Internet flame wars, I can say with complete confidence that nothing but nothing evokes more in the way of hot emotionalism than diet. Diet is intensely personal. You can disparage politics, religion, sports teams and people don’t take it personally. When you disparage diet, it is akin to disparaging the person him or herself and the reaction is immediate, visceral, and intense.
        I’m an evangelist for politics, sports, fitness, religion; and cancer. But I don’t do diet and nutrition evangelism any more. The only reason that I posted what I did is that — last week — I got the shock of my lifetime and I’m still in the Kubler-Ross stage of bargaining with it. I’m enough of a scientist to quickly move beyond denial, when faced with irrefutable evidence.
        Anyway, I’ll stop here, and I again want to thank Dr. Pearson for his intellectual integrity in allowing my comments to appear on his blog.

      • Dr. Pearson, I’ve now taken more time to more extensively review the content herein. I don’t see where you’ve ever discussed the implications of the North Karelia (Finland) experience, which is, in my opinion, the most relevant and compelling real world intervention effort ever carried out and published.
        True, it was a global lifestyle intervention (smoking cessation, exercise, etc.) but a very prominent component was a massive reduction in whole fat dairy intake (where whole fat dairy is as integral to the traditional Finnish diet — as an aside, I’m half Finnish and was raised on a robust whole fat dairy diet).
        I would suggest that it would, perhaps, be appropriate to consider the North Karelia experience in a future blog post, in the context of your overall recommendations relating to consumption of whole fat dairy.

        • I am saddened by this. In reviewing this propaganda booklet I note that they quote Michael Pollan extensively. Michael Pollan is not even close to a vegetarian. In his book Cooked he celebrates roasting a pig and I think he would be appalled at this diet,
          Clearly, a vegan is in control of the Kaiser “Lifestyle Program”

            • I have nothing against veganism or vegetarianism. If an individual wants to pursue that as a diet on moral, religious, or philosophical grounds I am fine with it. However, veganism too often ends up like a cult or a religion in that its proponents feel compelled to convert the uninitiated to their diet. To accomplish conversion, frequently science is distorted. I am saddened when vegans make unscientific claims to support their diet in order to gain more adherents.
              Also, organizations like CSPI which are vegan for philosophical reasons should be more transparent about their dietary recommendations.

  38. I have seen “Forks over Knives” and have read “The China Study” and I contest that this diet works!!!! I am a cancer survivor and gave up all animal protein and diary. Best thing I ever did. As one who works in the poultry industry I KNOW what is going into these animals. These animals are fed so many pharmaceuticals it’s beyond belief. Even so called grass fed, free range organic meat is garbage today. Don’t eat it!!!
    I would bet the people here are paid by one of the animal protein suppliers, diary or the government. They are EASY to spot!
    Genesis 1:29
    Then God said, “Behold, I have given you every plant yielding seed that is on the surface of all the earth, and every tree which has fruit yielding seed; it shall be food for you

    • Russ D Hadick wrote:
      “I would bet the people here are paid by one of the animal protein suppliers, diary or the government. They are EASY to spot!”
      “Then God said…”
      hahahaha – Your tinfoil hat is showing!

      • Russ,
        I’m the only one here. There are no other people other than me.
        I receive nothing from “animal protein suppliers” (whoever they are) or the government.
        Some day I hope to publish my diary and then perhaps all the work on the blog will pay off.:)
        Dr. Pearson

  39. Thank you for giving us good balanced information in your blog. It is incredibly interesting and, as someone whose doctor is adamant that I get on statins right away, i now need to educate myself. I look for expert opinions based on good science, without an agenda – or supported by drug companies or selling supplements or some other quick fast way to cure CAD. I am wading through past and current research and finding a ton of controversy on the subject. Who to trust, who to believe, how to make the best decision for my personal health outcomes. I keep going back to the science, to primary sources of research and I am shocked at what I am finding. Ok, lest this turn into a rant, I’ll finish by again thanking you for a most interesting blog.

    • This is what I struggle with, there is almost too much information out there!! The more I read, the more I’m left wondering what the heck to eat!

  40. Dr. Esselstyn’s very much promotes the intake of nuts and avocados…why lie? If your science is so great you don’t need to pad what you see as his down fall…the diet includes all nuts and avocados.

    • On page 9 of my copy of Esselstyn’s 2007 book “Prevent and Reverse Heart Disease” he says
      “Here are the rules of my program in their simplest form:
       You may not eat anything with a mother or a face (no meat, poultry, or fish).
       You cannot eat dairy products.
       You must not consume oil of any kind—not a drop. (Yes, you devotees of the Mediterranean
      Diet, that includes olive oil, as I‘ll explain in Chapter 10.)
       Generally, you cannot eat nuts or avocados.”
      Later on in the book he says if you have heart disease no nuts but if you don’t have heart disease and your lipid levels are not elevated he will condone walnuts.
      “Those who have heart disease should avoid all nuts. Those without disease can consume
      walnuts in moderation because they can provide considerable omega-3 fatty acids, which are important for many essential bodily functions. But I am extremely wary of nuts. Although short-term studies funded by nut companies show that they may positively affect good and bad cholesterol, I know of no long-term studies indicating that they can arrest and reverse heart disease, and patients may easily overingest them, elevating their cholesterol levels.”

    • I have read Dr Esselstyn’s book several times, and he bans nuts and avocados when on the heart disease reversal diet. I believe he and Drs Ornish, McDougall and Greger have the best method of preventing, or reversing, heart disease.

    • Wrong. From his very own website: As nuts are a rich source of saturated fats, my preference is no nuts for heart disease patients. That also eliminates peanuts and peanut butter even though peanuts are officially a legume. For those with established heart disease to add more saturated fat that is in nuts is inappropriate. For people with no heart disease who want to eat nuts and avocado and are able to achieve a cholesterol of 150 and LDL of 80 or under without cholesterol lowering drugs, some nuts and avocado are acceptable. Chestnuts are the one nut, very low in fat, it is ok to eat.

    • Funny that you bring up Dr. Esselstyn’s latest “study”. I happened to hear his presentation on this at the American College of Cardiology Meetings yesterday. This is his anecdotal report on 198 patients that have somehow gotten in touch with him over the last few decades. There is no science or objective data in this report. For example, the “paper” states “In the remaining 195 patients, angiogram results confirmed the diagnosis of CAD in 180 (92%).” We have no idea what the criteria for CAD is being used. There is no systematic follow up of imaging.
      The two figures that are in the 2014 paper (one patient’s angiograms and one patient’s nuclear studies) were trotted out at his ACC presentation.
      These prove nothing. The lack of blinding or randomization in his “study” discredits any findings.
      It was embarrassing to witness such poor science with a diet that has been discredited by recent studies.

      • very interested, which recent studies discredit Esselstyn’s diet and what do you think of Grundy’s diet?

  41. If you cheat on the Esselstyn diet (may I assume the majority do cheat on their diet?) you end up on the Mediterranean. If you cheat on the Mediterranean you end up on … something not good.

  42. I appreciate your comment. But if statins alone could even only improve blood flow, surely wouldnt we be hearing more about this, since any positive statin news is typically highly touted everywhere? Re Vogel’s ‘ Big Mac test…if he produved endothelial dysfunction or inflammation with sat fat, even only for a few hours, repeatably, is it such a stretch to deduce likely long term damage from cascades of daily fat consumption? (Btw I’m not a vegetarian, though I’ve been leaning more toward Fuhrmans veggie n fruit recommendations, minimizing salt and tramsfat)

    • Before I forget, let me say I am in total agreement with you about Bleak House. Love it. I have a “Nonesuch Dickens” volume of it that I treasure.
      About statins and endothelium, this 2007 review concluded “Statins have been shown to have pleiotropic effects apart from serum lipid-lowering effect in human. One of the major target organs for the effects of statins is the vascular endothelium, which plays an important role in the development of atherosclerosis and angiogenesis. Recent numerous studies have shown that the statins’ cholesterol-independent vascular effects appear to involve directly restoring or improving endothelial function by increasing NO production, promoting re-endothelialization after arterial injury, and inhibiting inflammatory responses within the vessel wall that are thought to contribute to atherosclerosis. This review provides an update of the unique effects of statins on endothelial cells including endothelial progenitor cells as well as highlighting the therapeutic potential of statins beyond their established lipid-lowering effects.”(
      How much of a stretch is it from an experiment in 10 volunteers which showed a drop in flow-mediate vasoactivity after 50 gram fat meal to a real effect on atherosclerosis of long term fat from real food? It is a HUGE step. let’s call it hypothesis-generating and let Jarndyce and Jarndyce settle it.

  43. Numerous PET scans in his book show plaque regression. You fail to mention Dr. Vogel’s demonstrations of endothelial tumult upon ingestion of fat. All those that stuck with his diet lived. Agenda, much?

    • I wrote about PET scans in response to a similar query posted on my “It’s time to end the war on fat” post as follows “A PET scan is a type of nuclear imaging perfusion scan (under the general category of myocardial perfusion imaging or MPI). As such it is not directly looking at plaque but at coronary flow heterogeneity. Areas supplied by significantly narrowed coronary arteries (usually due to plaque) receive less of the radiotracer than area of muscle supplied by non-critically narrowed arteries. An improvement in a PET scan does not prove regression or elimination of plaque. I have dozens of patients who had critically narrowed coronry arteries with abnormal baseline MPI scans who improved to normal MPI scans over time. The most likely mechanism is recruitment of new arteries supplying blood to the heart muscle (collaterals).
      So , showing a PET scan or two on patients that improved proves nothing about the value of his diet. Also, many of his patients were on statins.”
      I pulled up the PDF referenced by Jack Runte in the previous comment and Dr. Esselstyn mentions a PET scan showing improvement after 21 days on the diet. Why on earth would you expose your patient to all the radiation from a nuclear PET scan after 21 days? No credible researcher would do this. It simply proves nothing, especially when the “study” is not randomized and the researcher running the study has a strong bias to find good results. The idea that plaque would regress this much in 21 days is absurd and this kind of anecdotal stretching to show improvement further weakens Esselstyn’s arguments.
      And even if patients were doing better on Esselstyn’s program, we don’t know what aspect was working. it is much more likely the statin drugs were the key to doing better.
      I think the experiment you refer to is after a Big mac equivalent and it is interesting but proves nothing about the long term effects of diet on atherosclerosis.
      Finally, you imply I have an agenda. My agenda is the truth. I’m not supported by any industry, company, food special interest group or philosophy other than utilizing science to find what is true about diet and cardiovascular disease.

          • Allow me, as an oncologist and not as a cardiologist or nutritionist, to make a comment relevant to the whole Esselstyn/statin thing.
            Let’s take a step back and actually try to have the opportunity to possibly consider a new idea.
            Is it true that all of Esselstyn’s patients took statins? Or that most of them did? Or that the most impressive individual cases did?
            What sort of hypothesis generating opportunity do we have here?
            Is there actually a clinical trials literature trying to define the “best” diet to follow *in conjunction with* statin therapy?
            (n.b. I’ll provide me own individual n = 1 case report, when I have time. Right now I’ve got other professional priorities — just wanted to spit out a thought I just had).
            If we believe the facts included in Esselstyn’s case reports and what passes for his data, we have a high class problem. His patients reportedly did very well. But we don’t know if it was because of the diet or because of statins and other attributes of the medical care of his patients. But, whatever, they did very well.
            Take a step back … what is the “best” diet — not for people with heart disease in general, but specifically for people with heart disease (coronary atherosclerosis) *who are being treated with statins*?
            Statins inhibit endogenous synthesis of cholesterol. There are two main pathways for endogenous cholesterol synthesis. A carbohydrate pathway and a lipid pathway. The common molecule is acetyl-CoA. With a high carb diet, most acetyl-CoA is produced via the carb pathway. With a low carb diet, most is produced via the lipid pathway. On top of endogenous synthesis, there is dietary (exogenous) ingestion of cholesterol. With a plant diet, there is no exogenous cholesterol intake.
            Now, let’s take two diets. With diet A, there is a lot of cholesterol in the diet; with diet B, there is no cholesterol in the diet. So you add in a statin, which blocks endogenous cholesterol synthesis. This makes the only source of serum cholesterol the exogenous, dietary source.
            Common sense would suggest that Diet B + statin would produce the lowest serum cholesterol levels.
            Now, I totally understand that there is a lot more to atherosclerosis than serum cholesterol, per se. I also understand that there are both “good” and “bad” cholesterols.
            But my point is that it is entirely plausible that the more optimum diet for preventing untoward heart events in patients with coronary atherosclerosis *in combination with a statin* would be a no exogenous cholesterol diet.
            I don’t view Esselstyn’s research as being “incredibly bad.” I view it as being important “hypothesis generating” research.
            – Larry Weisenthal/Huntington Beach CA

        • Truthfully the statin dose & duration are likely irrelevant as the diet achieves the ASCVD-regressing nonHDL cholesterol of much less than 90 + BP <120/70, & all other C-V risk are nullified by the diet alone (except tobacco). I did not say it was fun or easy, but what is the price freedom? HRS, MD, FACC

    • Have you actually read Dr. Vogel’s study??
      Effect of a Single High-Fat Meal on Endothelial Function in Healthy Subjects
      “Following this, subjects ate either a high or low-fat meal in varied order at least 1 week apart. The high-fat meal (900 calories, 50 g of fat, 14 g of saturated fat, and 255 mg of cholesterol) consisted of an Egg McMuffin, Sausage McMuffin, 2 hash brown patties, and a non-caffeinated beverage (McDonald’s Corporation). The isocaloric low-fat meal (0 g of fat, 13 mg of cholesterol) consisted of Frosted Flakes (Kellogg Company, Battle Creek, Michigan), skimmed milk, and orange juice. Lipoprotein and glucose determinations were repeated 2 and 4 hours after eating.”
      These meals are GARBAGE!!
      I don’t eat like this – I took an EndoPat test and my score was 3.56.
      “There are three basic categories for EndoScores:
      Red Zone: Score of 1.68 and lower. You do not have proper endothelial function and this could be an important signal of an imminent cardiac problem. This EndoScore may indicate the presence of disease and that an immediate evaluation and intervention may be needed, whether it is aggressive medical therapy or a medical procedure. It’s imperative that endothelial health be restored.
      Yellow Zone: Score between 1.69 and 2. Your endothelium is healthy and while you don’t have any additional risk, you are still not in the well-protected Green Zone. It’s vitally important that you now take charge of your own health and do everything you can to improve your EndoScore. Good health depends of certain lifestyle choice you make that include what you eat, how active you are, whether or not you smoke, the precautions you take to avoid injuries and accidents, and how you deal with tension and anxiety. The choice is yours. Choose health!
      Green Zone. Score between 2.1 and 3. Your endothelium is functioning optimally, and you have maximum protection. Keep up whatever it is that you are doing, because the foods that you have been eating and the physical activity you have been performing regularly have affected a number of risk factors implicated in vascular health and longevity, particularly blood cholesterol levels, hypertension, and obesity.”
      Just to be clear – I’n NOT a vegan/vegetarian. I eat full fat raw goat milk, full fat goat milk kefir, nuts, seeds, rice, legumes, fatty fish, fruits, veggies, etc.

  44. Your dead wrong Doctor. Dr. Esselstyn’s diet saved my life.
    See: Search Results
    [PDF]A way to reverse CAD? – Dr. Esselstyn
    THE JOURNAL OF FAMILY PRACTICE | JULY 2014 | VOL 63, NO 7. Caldwell B. Esselstyn Jr,. MD; Gina Gendy, MD;. Jonathan Doyle, MCS;. Mladen Golubic .

    • The Massai tribe eat a diet of several pounds of meat per day, combined with milk, and do not have heart disease. The Inuit people ate a diet that was 75% saturated fat/ 25% protein most of the year and did not have heart disease. Now that they eat fruit, “veggies,” and grain-based products, they have soaring rates of breast cancer in addition to heart disease. These facts are being ignored by many in the medical establishment, and we have to ask them to explain them in light of the current debate.

      • “Massai tribe eat a diet of several pounds of meat per day”
        Well said J.J. Harris.
        Imo veganism is part of an one world order and UN agenda.
        Much like climate change veganism is based on a decided science and
        official narratives. People parrot climate change but never bother to speak of the seven decades of weather & climate modification, this
        this plant based diet is no different.

          • My brother died today in the or after being on the esseltine diet rigidly for 7 years. It doesn’t work. Don’t listen to this crap. A very grieving sister whose heart is broken.

          • No, veganism is not the ‘new world order’.
            And we shouldn’t think of it that way anyway.
            Because it will fail, for a significant number of people,
            and then they will likely go back to the, ‘SAD’, diet.
            That’s why I’ll always be an advocate, for a whole foods,
            plant-based, diet.

        • They’re not eating fruits and vegetables, they’re eating the standard western diet, low in fruits and vegetables. Produce isn’t highly consumed in northern regions for painfully obvious regions. They’re lifespans have increased though from their previous 60 year expectancy up to 68 years.

          • The standard western diet emphasized grains and cereals (remember the food pyramid?). Meat and fats were a minor component (<25% of calories). The more grain and cereal people ate, the less healthy they became. Grain, cereals, starch, sugar (even from fruit) have lead to the obesity / diabetes / heart disease we currently see. Alleged "vegetable oils" that are staples of the Western diet, are actually seed oils (canola, corn) and were developed for industrial purposes. The inflammatory effects of these oils are now being documented. The French eat butter, not olive oil, and have less heart disease than those who eat olive oil. The full picture is just now coming into focus, but to say Massia and Inuit populations were eating a Western diet is disingenuous.

        • Very familiar with this diet. Had a close friend convert to it 10 years ago. In the meantime, I have seen loss of analytic ability, dry skin and loss of muscle mass in that person. And this person seems very unhappy. It has become this person’s religion.
          The term ”science” is thrown around a lot lately. In this article, the writer is talking about quantified, objective method used in science, random studies, etc. It is not sufficient if one person had success.
          Furthermore, my friend has suggested over time that I drop my excellent cardiologists, GI doctors (I have an enlarged heart but clear arteries) to go to her nurse practioners who are subvegans ala Esselystein. I tried to explain to her that a lot of my problems are genetic and structural, she ignored it. When I had to get a heart conversion for AFib, she disapproved stating that obviously, conversions were ”not a solution” for Afib. What is the solution? Esselytein’s radical subvegan diet! I would have been dead if I had dropped my doctors and gone to her subvegan nurse practitioners.
          She now blames all sick people for their illnesses. If you do not follow Esselystein, you are not morally pure. I’ve told her that all the diets in the world would not save people from Lupus, Alzheimer’s, etc. She looks at me with that subvegan blank stare.
          This is a religion, friends. Be aware, it is not a foray into another culture. It can hurt you, seriously.
          Oh and in Esselystein’s book, he states: If you follow my diet, I GUARANTEE you will never have a stroke or a heart attack. No responsible doctor in the world would ever make this statement. My dad had both a stroke and a heart attack and his cholestrol was 130, clean arteries. My mother had clear arteries and died from a stroke.
          I eat lots of fresh fish, vegetables from the backyard, and fruit. I think we’re doing fine at my house. At least we love our bounty of great food.

          • “godgaveusgoodfood” I agree that Esslsyn’s diet is dangerous, but you are in error in your comment that “all the diets in the world would not save people from Lupus, Alzheimer’s, etc.” A ketogenic diet can prevent & treat Alzheimer’s & the carnivore diet can heal many autoimmune diseases such as Lupus, not to mention mental illnesses such as Bipolar Disorder.

          • Like your friend, I stuck rigidly to the diet for 2 months. Felt great for the first 3 weeks, then, like your friend began to loose muscle mass, lost aerobic fitness, mood dipped and I was hungry all the time. Looking back, I felt strangely brainwashed by the forks over knives book. Perhaps it does suit some people, not quite as scientific as Dr Esselstiens .. A study of one person.. Me!
            On balance, Dr Esselstien, makes reference to Afib, and states his diet does not address this.
            As a rowing enthusiast, I salute Dr Esselstiens Olympic gold medal 1956…Indeed, that’s where I came across him. He was blessed with great physiology,although, I have to say… So many vegans look too thin with sagging skin.
            It’s true that processed food is bad, too much meat is bad and too many calories are bad.
            Balance is the key

        • The Maasai tribe people have a life expectancy of 45 years old. You can search yourself for the answer. Facts speak louder than words.

        • This tribe does not get their meat from America where it is filled with hormones, antibiotics and raised in deplorable conditions in their own filth.

        • Massai are among the most impoverished of nations. HIV and other diseases kill them as they do most extremely poor populations. Maybe you can tell them what to eat to cure AIDS, malaria, dysentery, tuberculosis, etc. I didn’t think so.

          • • Tanzania has a population of 37 million.
            • The Maasai number around 37,000.
            • Life expectancy in Tanzania is 42 for men and 44 for women.
            • Tanzania exports sisal, cloves, coffee, cotton, cashew nuts, minerals, tobacco.
            • A common Maasai greeting is: “I hope your cattle are well”.

        • My thought is that they also walk, barefoot, miles a day to gather the things they need for survival. You can not compare sedentary Westerners with a tribe whose life has NO similarities.

        • From your first reference ” The major modifiable CVD risk factors were smoking (84%), obesity (49%) (body mass index of greater than 30 kg/m2) and elevated blood pressure (130/85 mmHg or greater) (18%).
          84% of the Inuit are apparently smoking, by far the biggest risk factor for atherosclerotic disease.
          The second reference comes from T. Colin Campbell’s site. It references the 1964 GV Mann article which concludes
          A field survey of 400 Masai men and additional women and children in Tanganyika indicates little or no clinical or chemical evidence for atherosclerosis. Despite a long continued diet of exclusively meat and milk the men have low levels of serum cholesterol and no evidence for arteriosclerotic heart disease. The reasons for this disagreement with the popular hypothesis relating animal fat intake to coronary disease are examined. The authors concede that some overriding protective mechanism such as freedom from emotional stress or abundance of physical exercise may be present. They favor the conclusion that diet fat is not responsible for coronary disease.

          • The low carbers love to quote outdated poor quality studies to support their view:
            “We’re left with a bit of a confusing picture, made murky by a lack of data. We don’t have mortality or illness statistics but have conflicting clinical and pathological reports. We don’t have good dietary data. Impressions of high animal food intake, primarily in the form of milk intake, have been supported, but blood and meat intake may have been misconstrued. Making things more complicated, these were people who may have been in relative calorie deficiency because of extreme daily physical activity. They may have been experiencing intermittent fasting.”
            The Masaai also have genetic adapations to a high fat diet:
            Lactase Persistence and Lipid Pathway Selection in the Maasai.
            “Our analysis suggest that the identified regions harbor known and novel genetic polymorphisms responsible for the unusual lipid metabolism, cholesterol homeostasis, protection against cardiac diseases and adult lactase persistence in the Maasai.”

        • Closer reading of the article states,
          “Perhaps the best dietary survey done on Masai people is from the early 1980s, done by the International Livestock Centre of Africa[2]. This was at a time there had already been a dietary transition occurring among the Masai.”
          In the first, the author opines that the “best dietary survey” of the Massai was from the 1980s, but admits it was after they had begun transitioning to an agronomic diet (grains and cereals). This clearly is not representative of the population originally studied.
          Regarding his assertion that urinary nitrogen is a poor proxy for protein intake, it is utterly false. The East German athletic program measured the nitrogen content of their athletes’ urine to determine how much of the protein they ingested was incorporated into their muscles (called nitrogen retention) vs. how much passed out as waste. That tiny country didn’t dominate the world of Olympic competition by using poor proxies for protein metabolism / catabolism. Protein is the almost exclusive source of nitrogen in urine.
          Finally, using food questionnaires to determine diet has been demonstrated inaccurate many times. It is the least accurate form of collecting data. Researcher went into an area after the import of the Western diet, and asked some people if they ate a traditional diet? Based on those responses, the researchers then assert we should disregard the direct observations of nutrition made prior to the import of the Western diet. That is not the kind of research anyone can take seriously.
          Finally, there is a tremendous movement to eat meat, saturated fat, and whole foods excluding grain, cereal, sugar, and many legumes. That group is debunking the saturated fat / cholesterol myth. Finally, in 2013, the LA Lakers switched their athletes to low carb / high fat diet. Labron James credits it for extending his career. The Australian National rugby team has followed suit.

          • The blue zones (longest living people on Earth, eats the most starch), the adventists, the strongest man alive is vegan Patrik Baboumian, the new movie by James Cameron called the Game Changers includes a ton of athletes who are vegan. Serana Williams, Hamilton, Carl Lewis, Patrik Baboumian etc.
            There is a lot of evidence that a low fat vegan diet is the healthiest, which is why WHO is also recommending it as the optimal way of eating.

            • The WHO recommendations were based on MINIMUM NUTRITIONAL NEEDS and SUSTAINABILITY, not optimum health. I predict Game Changers will join Forks over Knives on the pop-culture trash heap as the growing evidence mounts against vegan diets and the hazards from low fat diets.

      • Such a dishonest comment. The inuits eat fruits and vegetables and now have soaring rates of breast cancer. So your claim is fruits and vegetables causes cancer? The inuits abandoned their traditional diet of seal blubber and cold water fish for a western diet and that’s why their rates of cancer/disease are soaring. Not because they are eating fruits and vegetables. Keep eating the western diet and pointing to people’s like the inuits traditional diet as proof to what you’re doing is fine, even though your diet doesnt reflect their’s in the slightest. Heart disease is the number one killer for men and women in the US and the world. Enjoy your heart disease, diabetes, various cancers etc that are all associated with the type of diet you eat.

        • The Inuit ate a hight fat diet w/o fruits,veggies, and grains and had lower disease rates than now, when their diet now includes those items. My statements stand.

            • I think there is growing evidence that insulin is inflammatory to coronary arteries. Protein and fat tend to have a blunted insulin response, as to many plant foods; much of which changes when those plant foods are “juiced.” My triglycerides typically run between 34 and 45 when i’m low carb, and if i eat one hard boiled egg after each workout, i can maintain my HDL above 60. Some research suggests the T:HDL ratio above 2 is a better CVD risk measure than LDL. Time will tell. It always does

        • Actually, there is significant research documenting cancer cells thrive on sugar and appear to lack the ability to use fat for energy.
          The 1st link below is to an NBC story linking fructose (a major sugar in fruit) to cancer, especially breast cancer (a link is not the same as a cause).
          The 2nd link is to a science direct article identifying cancer cells’ enhanced nutrient uptake (glucose and amino acids) compared to normal cells.
          The 3rd link is to the abstract for research documenting sugar driving insulin driving IGF-1 higher. Elevated IGF-1 is related to increased cancer and diabetes.
          The 4th link discusses cancer cells relying on sugar metabolism and turning off fat metabolism (anoxic conditions occur during rapid cell growth).

          While they do not support assertions that simple carbohydrates cause cancer, read together they provide a stepping off point for more discussion of the confounding effect of simple carbohydrates (including fruit) on Western health, such as diabetes and cancer.

          • Oh good freaking grief. While I (a medical oncologist) was admonished for having the temerity to offer an opinion relating to diet and heart disease, I can’t let this last affront to actual science stand unchallenged. Cancer is caused by inherited genetics and by DNA mutations. Diet plays a role only insofar as it facilitates either mutagenesis or interferes with DNA repair. All of this metabolic stuff bears only on behavior of the cancer horse after the cancer horse has left the barn.
            The fundamental issue is this: what sort of diet causes or facilitates DNA mutations. For example, alcohol contributes to DNA mutagenesis via the acetaldehyde metabolite. High temperature cooking generates mutagenic molecules during the cooking of meat. And so forth.
            I happen to think that the best evidence are the blue zone diets. But all of this is based on trying to define the best diet for the average person, where no one is average.
            – Larry Weisenthal/Huntington Beach CA

            • “The fundamental issue is this: what sort of diet causes or facilitates DNA mutations.”
              Then I’m sure, Dr. Weisenthal, you agree with the following:
              1. Some cancerous mutations are initiated by hormones (prostate cancers are initiated by estradiol, not testosterone as had been previously accepted).
              2. Obese post-menopausal women have higher estradiol titers and higher breast cancer rates than lean women, implicating E2 in initiating breast cancer.
              3. Fat cells, especially visceral, are very active sites for estradiol synthesis, and
              4. DIET is directly linked to obesity. That is, the standard American diet has caused the obesity epidemic.
              5. Oh, and the World Health Organization and American Cancer Society have identified estradiol as a carcinogen.
              So to say that metabolic stuff bears only on cancer after it has developed may be correct, or it may be a bit myopic. The effect of diet on hormones (including IGF-1, m-Tor, etc.) and the cellular environment they create is little understood. The larger picture will eventually come into focus.

              • I’ll look forward to addressing the issues you now raise. I’m currently traveling (Midwest and then Beijing). Too much to tackle with my iPad keypad. Will answer in another week, upon my return.
                Larry Weisenthal/Huntington Beach

        • I was staying on an Inuit island and ate with the people there. They ate a very bad Western diet of food fried in Crisco and junk food, eggs and spam for breakfast fried in crisco. However, they do go fishing and eat muck tuck and the salmon there is the best I’ve ever had in my life cooked over a fire, so fresh and tasty even without seasoning. But the majority of their diet now is horrible. That’s where the heart disease and cancer comes in.

        • The Iniut ate out of necessity what they did, not choice. No selection pressure as such diets let you live, or may give an advantage during the reproductive years. What happens after that is not necessarily natural selection.

      • “The Massai tribe eat a diet of several pounds of meat per day, combined with milk, and do not have heart disease.”
        Also consider that the average life span of the Massai people is around 50 years. Perhaps if they live as long as 60, 65, 70, 75, etc. you see the results of their bad diet. We also do not know what else is or isn’t controlled for.
        Same with your claims about them eating more grains and fruit but now they have more disease. That is just ridiculous and obviously indicates that you, or whatever study you read, is leaving out lots of information that also impacted the before and after group.

      • I can tell you that you really need to go check the data of those inuit people and see their age. turns out their lifespan was very short and almost all of them had some form of heart disease.

        • You need to read V. Stefeansson’s research on the Inuit, not someone’s “analysis” of it. He conducted his research in the early 1900’s, before western influence reached these isolated people, and he relied on direct observation while living with the people for a full year (not food questionnaires used by more recent researchers).
          People often comment to lifespan. The lifespan of Americans in the early 1900’s was likewise, not very long.
          Understand that 2-year highly controlled Israeli study demonstrated the Mediterranean diet was superior to low fat (like vegan diet). But it demonstrated high fat diets were superior to both for improving health markers in their overweight subjects.
          Finally, PJ, you need to cite your sources, rather than make unsupported statements.

          • Vegan diet is mot necessarily low fat, it can be high fat. There is no limitation to plant derived oils. Wrong comparison. Compare with whole plant based diet, which is not just vegan.

      • The maasai people walk ALOT during the day. and their diet consists of 76% carbs from maize, potatoes, wheat. 3% bananas and the last 21 % is from animal sources. No wonder they recover well eating all the good starches.

        • Researchers Mann and Sharper, who directly observed the Massai and the Samburus , respectively, confirmed high fat and meat consumption through most of the year. Piror to that work, a Brittish study conducted in the 1920’s compared the near-vegetarian Akikuyu to the Massai, finding higher disease rates, lower body weight, and lower strength among the Akikuyu.
          You need to cite sources for your allegations. The internet has a wealth of misinformation.

      • Where is your citation for any scientific data that supports your absurd claim that eating fruit and veggies and grains has caused the “soaring rates of breast cancer in addition to heart disease” in Inuit populations? I have a citation for a study that completely contradicts that claim. The fact of the matter is a large percentage of Inuit people are heavy smokers, drinkers, and eat very low amounts of fruit and veggies. Here is a quote from the study followed by a link where you can verify the data yourself. “In addition to smoking, other cancer risk factors include heavy alcohol use, low dietary intake of fruits and vegetables, obesity and physical inactivity. Changes in the population prevalence of these health determinants have occurred among Arctic populations as they experienced relatively rapid social, cultural, economic and political change (2). It should be recognized that given the long lag time for cancer to develop, even if smoking and other risk factors are dramatically reduced today, it would be decades before any impact on cancer rates would be observed.”
        The idea that veggies cause cancer is ridiculous and not supported by any peer reviewed science at all.

        • Actually, Indy1, there is a growing low carb / high fat population in the industrialized world. U.S., Europe, Australia. Everything from Atikins to Keto to Paleo, and we are illustrating the health benefits of switching back to animal fats as our energy food. We live in the same environment you do, and also use toothpaste, but we are dropping body fat and raising HDL just the same.
          Finally, I am a United States veteran, so do not tell me to go live somewhere else. It bespeaks a lack of civility and gratitude.

      • Did the Masabi tribe work in America where industrial ill effects have attacked the environment and everyday products that we use including toothpaste???
        Pls go live with the tribes and follow their diet. The question here is about what DIET is suitable in industrially advanced and saturated environment like developed counties

      • False info and not true.
        Study done on Eskimos shows they do have heart disease from a early age, even ice preserved bodies that dies hundreds of years ago had the progression of plaqued arteries.

    • Adding beef to my diet and 100% eliminating all starches/sugars/processed foods saved mine.

      Hypertension: gone. T2 diabetes: reversed. Triglycerides: normal. HDL and LDL: normal.

    • Probably, because change hurts.
      Although Caldwell Esselstyn suggesting that cardiologists would make good farmers, probably didn’t help.

    • I was quite intrigued by your article. I am a big believer diet is the cause of most our disease and sickness. That said, I went to the Cleveland Clinic’s website. Dr. E. says he runs he cardiovascular disease and prevention and reversal program. Under the heading “follow a heart-healthy diet” WAS THE FOLLOWING:

      “”The old saying “You are what you eat,” may be truer than ever – especially when it comes to cardiovascular disease. Four risk factors are related to diet: high blood pressure, high blood cholesterol, diabetes, and obesity.

      Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats), and refined sugar.
      Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts.
      Mono-unsaturated fats also are preferred and are found in olive, canola and peanut oils.
      Also eat plant-based foods such as fruit and vegetables, nuts, and whole grains.”””

      SO MUCH FOR HIS NO FATS! On the webpage of the department he directs, certain fats are are part of the goals. Next sentence recommends nuts! crazy


Please leave your comments. The skeptical cardiologist loves feedback. He reads all and replies to all that warrant a reply.