More Incredibly Bad Science From Dr. Esselstyn’s Plant-Based (Vegan) Diet Study

A while back the skeptical cardiologist exposed “The incredibly bad science behind Dr. Esselstyn’s plant-based diet.

The diet has the catchy slogan “eat nothing with a face or a mother” and Esselstyn was featured in the vegan propaganda film “Forks Over Knives.”

After detailing the lack of science I concluded:

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.

The post garned little attention initially but in the last few months several hundred visitors per day apparently read it and Essesltyn followers have started leaving me testimonials to the diet along with nasty comments.

Here’s are some typical ones (with my comments in red)

“If your (sic) not backed by some meat industry or cardiac bypass group I would be much surprised.”

I am completely free of bias. Nobody is paying me anything to do the research and writing I do. My only purpose is to find the truth about diet in order to educate my patients properly. I have  saved many more patients from bypass surgery than I have referred for the procedure.

“it is so arrogant to think the only science could come from clinical studies which may be funded by an interested party.”

Doctors like randomized (and preferably blinded) clinical studies because they minimize the bias introduced by interested parties like patients and zealous investigators (like Dr. E)  motivated to see positive outcomes. Small, non-randomized studies can only generate ideas and hypotheses which larger, randomized studies can prove with a greater degree of certainty.

“the entire nentire western medical system is skewed due to the big pharma influence…unfortunately western medicine believes the only science is the pen and the scalpel..whereas …history is the best teacher of all…”

By pen I assume you mean medications. If we examine history as  you suggest we see that life expectancy was 50 years in 1945  but today in developed countries it is around 80 years. This advance corresponds to (among other things) advances in vaccines, antibiotics, anti-cancer drugs, cardiac and blood pressure medications and surgery: the pen and the scalpel. It does not correspond to following a vegan diet.

“Your foolishness is the embarrassment.”

Thank you for this insightful comment! I’m considering it as my epitaph.

One man felt that changing to the Esselstyn diet dramatically improved his cardiac situation and commented:

“Nothing like bashing something that works just because you want to eat meat. .”

I do enjoy meat in moderation but I also really enjoy vegetables, nuts, fish, legumes, olive oil and avocados. I looked into Esselstyn’s diet in detail because it stands out as particularly misguided in banning nuts, avocados, fish and olive oil to heart patients.

..”.So sicking (sic) to see people talk trash about something that works so well… It saved my life…”

I’m happy you are doing well with your cardiac condition but it is impossible to know what would have happened to you on a more reasonable diet such as the Mediterranean diet (which actually has legitimate scientific studies supporting it). And again criticizing Esselstyn’s ideas and “study” can hardly be considered trash talk.

“I personally have followed dr. esselstyn’s program for what will be 5 years in 11/17 and have made tremendous gains in my cardio pulmonary function….my cardiologist looks at me in wonder…why are you here? and often says , if everyone did what you have…Id be out of business…so…isnt that telling and sad?”

I’m glad you’re doing well with the program, most patients can’t follow this kind of diet for more than a few months.  But perhaps we shouldn’t judge its effectiveness until  we make sure you don’t suffer a heart attack next week. Your cardiologist is wrong: see what I wrote about “dealing with the cardiovascular cards you’ve been dealt.” Some individuals inherit genes that guarantee progressive and accelerated atherosclerosis that will kill them at an early age despite the best lifestyle.

“…the phrase “follow the money” comes to mind…and since theres no big money to be made….science will attempt to dispell the results and thousands of years of history that proves this dietary system works…”

Using a scientific approach to analyze Esselstyn’s diet (which tries to claim a scientific basis) seemed appropriate to me but I wasn’t motivated by money. I’m looking for what is best for my patients, pure and simple.

The Plural of Anecdote Is Not Data

One man wrote:

“But since this is only anecdotal evidence – it must be junk science…”

Esseslstyn devotees like to post what their personal experience is with the diet but as skeptical medicine has pointed out “the plural of anecdote is not data.” 

One woman described in detail a good response her husband had after starting the diet following a heart attack:

I’m concerned about the skeptical cardiologist going after the person of dr. Esselstyn versus the science, such as quoting how you States dr. Esselstyn came up with the diet. So there may be a personal bias there. I’m sure there are more people out there on the esselstyn diet that are not noted in the study years ago. I hope there is another book coming out

I’ve reviewed in detail my comments about how Esselstyn came up with the diet but I am at a loss to find any ad hominem attack.

This woman went on to say

We will keep you posted, as my husband is willing to get another cardiac Cath and 12 months to visually see the difference after the diet.

I have to point out that if his cardiologist performs a cardiac cath (which carries risks of stroke, heart attack and death) for the sole purpose of checking the effect of the diet he is engaging in unethical medical behavior and likely insurance fraud. By the way, I hope that your husband is on a statin like most of Dr. Esselstyn’s are!:)

and a man wrote

Calling Essylstein ilk shows a little too much biased hatred on your part

Please note the definition of ilk “a type of people or things similar to those already referred to.” No pejorative there. And no ad hominem attack.  I wrote:

 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.

I should be able to criticize the methods and ideas of Dr. E without it being considered an attack on his person

Completely wrong. Esselstyn has saved my life. His book explains it all, how the endothelium cells get ruined, inflammation … heart attack proof (his words). One does not continue as head of the Cleveland Wellness Center if one is a quack.

Words are easy to come by on the interweb but Dr. E’s are not supported by science and as for the “Cleveland Wellness Center” it is probably not wise to get me started. Dr. E ‘s program is listed as being part of the Cleveland Clinic Wellness Center which is an attempt to capitalize on the market for pseudoscientific enterprises. He is not the director. The director recently came under intense criticism for promoting anti vaccine quackery. (See here).

The Wellness Center promotes so-called functional, integrative, complementary and alternative approaches. (Functional medicine is fake medicine!) These are approaches that have not been proven to work and could arguably be called quackery. (Let me be clear, however, I am not calling Dr. Esselstyn a quack but the fact that he is part of the Wellness Center does not add any scientific validity to his work.)

“I’m sure there are more people out there on the esselstyn diet that are not noted in the study years ago. I hope there is another book coming out”

Fake News, Fake Science

As a matter of fact, Dr. E has been hard at work over the last 30 years and has added a grand total of 176 patients who are considered “adherent” to the diet: about 6 per year. The “original research” was published in The Journal of Family Practice in 2014. Unfortunately the bad science present in the original publication has only been amplified.

In addition to any randomization or suitable control group for comparison, the data collection techniques are unacceptable:

“In 2011 and 2012 we contacted all participants by telephone to gather data. If a participant had died, we obtained follow-up medical and dietary information from the spouse, sibling, off-spring or responsible representative.”

In other words, there was no actual systematic review of medical records, autopsies or death certificates, just word of mouth from whomever answered the phone.

“Patients who avoided all meat, fish, dairy, and knowingly, any added oils throughout the program were considered adherent.”

Imagine, if you will, that your husband died 10 years ago and you received a call from Dr. E’s office or perhaps Dr. E himself and he asks you if your husband “avoided all meat, fish, dairy and added oils.”  For one thing, it would be very difficult for you to answer that question with any degree of accuracy: was your husband cheating on Dr. E’s diet when you weren’t looking, do you remember his entire diet from 10 years ago?

For another thing, you know that the caller has an agenda. If your husband died of a heart problem the caller is not going to be happy until he/she gets you to admit that your husband had some guacamole on Cinco de Mayo in 2002. If he’s alive and doing well, the caller is likely to be satisfied with a simple answer that , yes, he’s following the diet.

Yes, we have more data from Dr. E but it turns out to be even more incredibly bad than the first lot.

Let the anecdotes and ad hominem attacks begin!

-ACP

7 thoughts on “More Incredibly Bad Science From Dr. Esselstyn’s Plant-Based (Vegan) Diet Study”

  1. Dr. P, I read your blog and find your opinions insightful and educational. I’m wondering about your opinion on Dr Dean Ornish’s Reversal Protocol and the the 30 years of research he’s done showing a vegetarian, ultra low fat diet can and does reverse blockages in your heart arteries.

    I’m not a radical animal rights activist or vegiitarian only person. I love meat. All kinds, cheeseburgers, pizza, fried fish and chips, sausage, bacon…..love it all and real butter too. Unfortunately at 33 years old I had my first 4xCABG. I followed the American Heart Associations protocol for my condition which in additional to diet included Stage 3 Cardiac Rehab for years. About 7 years later the ballon angioplasties started with restenosis after restenosis. 3 years later another emergency 4xCABG. After my recovery, I was having approx 7 angina episodes every day with no exertion and was eating Nitrostat like candy. This despite the efforts of some of the best cardios in the nation trying to help me. Luckily, I read an article in the Detroit newspapers about Dr’s Jodi and Felix Rodgers, cardiologists from Trenton, MI who had started a Orinish Reversal Ptrgram in their practice. Being out of options, I joined. After 6 weeks my angina episodes were down from 7 a day to 7 a month. After 6 months, my angina was gone. After a year I was walking 4 MPH most days, chasing the kids around, playing half court/full court basketball 4 days a week, moving heavy refrigerators and felt great. It wasn’t easy. Rarely ate out. My Top Doc’s from Beaumont Hospital In Royal Oak, MI were 100% supportive, eliminated some of my heart meds but cautioned the diet might be too restrictive for most people to stay on. I lasted 4 years. And another maybe 2 years partially following the diet.

    I’ve been completely off the Ornish Protocol for about 15 years now and after 4 stents, 2 AFIB ablutions, an Aflutter ablation and being told no more interventions are possible, I rue the day I fell off the Ornish wagon. I’m currently trying to jump back on but find it very difficult without the great support group I had in 1993. Is this scientific? No. But I am confident that Ornish’s research has held up and am praying it will help me again.

    1. May be I am wrong what people consider meat in the US, to me cheeseburgers, pizza, fried fish and chips, sausage, bacon it is not meat at all it is crap junk food full of bad heavy processed flour, sugarS, bad oils etc, even the bacon it is cheap pork fed with crap flours and then processed with cheap salts, preservatives and sugar. To me meat it is a good trout, salmon, sardines (mainly fresh) a good steak etc and my good extra virgin olive oil (home made, we are in the season in my part of the world and just collecting the fresh olives), and with my 70 years I do not need a cardiologist or a doctor, 0 Coronary calcium score 2 years ago, perfect blood pressure and the only medication than I can think of in the last 40 years I antibiotics for an infection in my cut in my foot.
      Regarding Dr. E I have a good laugh about 2 or 3 years ago when I enjoy a YouTube video from this pseudo researcher, to me was like one of the classics videos from one of so many sect and churches exist in that country.
      It is true anyone than stops consuming cheeseburgers, pizza, fried fish and chips, sausage, bacon and going in a fast (no food) and having only water will improve from that rubbish, from there to extrapolate than Dr. it is a Saint it is along way.
      To be healthy you have feed the engine with the proper stuff and be prepared to spend the time in the kitchen (I dot see more than 1 hour or TV a week, I do not have the time) or be prepared to spend the time in hospitals, clinics, doctors and pharmacies, yes healthy food is not cheap but sickness it is a lot more expensive and more complicated.

  2. I am a woman and had a heart attack at age 55 immediately following menopause. I had 5 bypasses
    10 years later I felt I was on the verge of another heart attack even though I passed a stress test and ok cholesterol scores
    Cath was done and discovered 4 of 5 bypasses no longer working and clogging in a volunteer artery.
    I was fine with dying but my family freaked so I went to Cleveland and got a stent.
    I also started on the Esselstyn diet 9 mo ago. I could not tell any difference in my energy etc but I lost about 18 pounds which was good for my self esteem.
    My father had his first heart attack at 36, died at 57. I’ve never smoked, always been active and not obese. I don’t think you can fight genes. I stay on the diet 98% because it makes my family feel better and I like being thinner. Otherwise I doubt Esselstyns science but figure it can’t hurt.

  3. Very interesting. One would think that the creators/proponents of these alternative approaches, be they diets or supplements would want to prove empirically that their wholistic approach/supplement or whatever is as good as or better than the “western medicine” approach that they so quickly dismiss. Why don’t they subject their approaches to clinical study just like “big pharma” has to? Why does the FDA allow the supplement manufacturers and people like Dr. Esselstyn to say their product is effective without having to prove it? I for one am open to using any approach that is safe and effective, but how do I know a diet or supplement is either? At least with conventional drugs there was a rigorous protocol that had to be followed before it could be marketed. ________________________________

  4. As a scholar and researcher–of course, primarily in the social sciences–I am very interested in the way that constructs develop over time. Generally, my interest is piqued due to the accepted (albeit understandable) limiting frameworks on which you base your arguments in this post. Specifically, I am interested in the point that you make that “The Wellness Center promotes so-called functional, integrative, complementary and alternative approaches. (Functional medicine is fake medicine!) These are approaches that have not been proven to work and could arguably be called quackery. (Let me be clear, however, I am not calling Dr. Esselstyn a quack but the fact that he is part of the Wellness Center does not add any scientific validity to his work.).”

    Some historians or rather more accurately some Foucauldian scholars might argue that the practice of the predecessors of modern medicine was considered to be nothing more than quackery for years. From a reading of Foucault’s (1963) “The Birth of the Clinic,” some could easily deduce that it was not until after continued work in establishing methods of scientific research and “scientistic bias” in addition to various paradigm shifts in cultural norms and beliefs that this negative perception of medicine changed.

    As a practitioner in a field and a scholar of the same, do you not find it problematic that all doctors should ignore clinical evidence and disregard experienced observations just because they say they are not “scientific”? Are there not various forms of viable empirical research that are not based on blinded studies? Are you discrediting ethnographic, phenomenological, and other qualitative and naturalistic methods simply because they don’t follow your definition of rigorous science? Do you discredit the peer-review process (I’ve noted that many if not most of these studies criticized are in refereed journals of medicine) and the reviewers that conduct the process, in my experience typically a double-blinded one? Are not new theoretical perspectives and conceptual frameworks as important to the advancement of medicine as any given field of science? Do you find no value in evidence-based medicine (Bernstein, 2004; Diederich & Salzmann, 2015; Eckermann & Coelli, 2013) which “integrates clinical experience and patient values with the best available research information” (Masic, Miokovic, & Muhamedagic, 2008)? (As a note, I realize there are specific criteria for evidence-based study, and I am aware of that criteria, but the quotes used in this comment get at the fundamental nature). Can we so confidently dismiss empirical “data” (i.e. experiential information or that which is verifiable by observation and experience) collected through ongoing practice, experience, and the development of expertise (e.g. a surgeon can learn surgery and even be able to perform it, but doesn’t experience and practice work to develop one’s expertise in performing surgery)?

    Additionally, should not medicine like all sciences value continued evaluation and refinement and therefore give due consideration to “alternative approaches”? Should not emergent and nascent ideas be valued as a motive to further test theories and hypotheses through various methodological approaches and not simply discredited? Should we likewise dismiss all institutions of higher education that have added colleges of osteopathic medicine to their programs as well because they do not follow the prescriptions of the degree of Doctor of Medicine — no pun intended (http://www.aacom.org/become-a-doctor/us-coms)?

    Ultimately, I see that these new alternative views have a value to the progress of new thoughts in medicine that are facing more or less the same criticisms and challenges that modern medicine did when it was emerging as a scientifically based practice. To assume that new findings in medicine historically did not occur after new theories and evidenced-based observations that “integrate individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett, 1996) is disturbing. As with any new medicine that is first administered in human trials, the research for the effect in will have in humans is non-existent. For example, when new medical treatments are first tried on humans no one can truly say that the research is available for how well humans would respond to it. It can be inferred from the laboratory trials but whether humans will respond positively is a matter of study. Could it be possible that plant-based science as a nascent and emerging quest for improved health is no different? These questions are not intended to be antagonistic. My apologies if they come across as such. I am only establishing a line of inquiry as someone very interested in not only in this topic of plant-based health but also in the social and cultural constructs that define and legitimize research.

    1. Sorry about my delayed response to this. I was on vacation in Europe and the enormity of the questions required a more thoughtful response than I could muster while traveling.
      You ask “should not medicine like all sciences value continued evaluation and refinement and therefore give due consideration to “alternative approaches”? Should not emergent and nascent ideas be valued as a motive to further test theories and hypotheses through various methodological approaches and not simply discredited?”
      I (and speaking for)/medical science definitely value continued evaluation and refinement. It is the essence of the scientific method and it is how we continue to refine medicine and understand what truly works. But emergent and nascent ideas before they are accepted as true must be tested in some way. Once they are tested and proven beneficial they are added to our medicinal or surgical armamentarium .
      “Should we likewise dismiss all institutions of higher education that have added colleges of osteopathic medicine to their programs as well because they do not follow the prescriptions of the degree of Doctor of Medicine — no pun intended”
      Doctors of osteopathy go through allopathic , scientific medicine training like MDs and often end up in similar post graduate training programs so they are not dismissed.
      On the other hand doctors of naturopathy and chiropractic are not practicing science-based medicine, most of them are quacks and charlatans and are dismissed.
      In the good clinician physician there is a combination of science-based treatment and decisions as well as experience-based decisions. We just don’t have evidence to apply to every situation that comes up and therefore we MDs have to make judgements based on our best estimate of the outcome and our experience in the past.
      However, time and time again, we have found that when certain treatments that we presumed were effective are actually tested scientifically they turn out to be no better than placebo or worse. Therefore, whenever we can, we rely on proven treatment modalities.

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