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Monday, October 27, 2014

Nuts and Avocados

Last week, I attended the annual meeting of the American College of Lifestyle Medicine.  Not only was it an opportunity to hear some of my favorite speakers, but I had the chance to meet plenty of like-minded medical professionals, who like me feel that medicine is more than just a handful of pills.

One of my plant-based heroes, Dr. Caldwell Esselstyn, author of Prevent and Reverse Heart Disease, presented at the first morning of the conference.  His work has demonstrated that not only can people adhere to a whole-food plant-based diet, but that when they do amazing things can happen.  He has demonstrated that changes in diet can lead to a decrease in angina, fewer cardiac events, and even reversal of plaque build-up in the arteries as seen on an angiogram.
Dr. Caldwell Esselstyn

The diet that Dr. Esselstyn advocates is free of meat, fish, dairy, egg, oil, nuts, seeds, and avocados.  In other words, it's more intensive than just a vegan diet, and inherently quite low in fat.

I have a number of patients who have successfully followed Dr. Esselstyn's program, and not a single one of then has has a recurrent cardiac event or needed another stent.  But, the question that I have been asked, and I have wondered, why no nuts or avocados?  I can understand avoiding animal products and oils since these are inflammatory to the body, but why go so far to restrict the diet?

So, I approached the microphone at the end of Dr. Esselstyn's talk, and I asked.  His answer was that because they are high in fat, they are not helpful to most cardiac patients.  But what about those cardiac patients who are normal body weight, can they enjoy nuts and avocados?  His succinct answer?  "No."  So I pressed him on the question and asked, "Why?".

Dr. Esselstyn answered that this is how his studies were designed, the diet has worked so well, and as a result he hasn't wanted so change up a successful formula.  Some participants who I spoke with found this to be an unsatisfying and unscientific answer.
from www.goodhousekeeping.com

And, yet, at the same time, minutia like nuts and avocados, does it matter?  Does it really matter when, to paraphrase President of the American College of Lifestyle Medicine, Dr. David Katz, "most people are eating glow-in-the-dark junk"?

My take on all of this -- I would love to see all of my coronary disease patients on Esselstyn's diet.  That said, I eat avocados and nuts, and I don't believe most people should avoid these foods since they have plenty of important nutrients.  But, for those patients with coronary disease who are so motivated, I encourage them to follow the program espoused by Esselstyn.

But, the majority of my patients, while they are willing to make positive diet and lifestyle changes, may not feel ready to go quite this far.

And some of my patients have far less than ideal diets, those who may eat the majority of their meals at fast food outlets, or when asked about fruits and vegetables will tell me that they eat "eggs and potatoes."  In these cases, it might be a victory just to get this patient to eat one fruit and one vegetable per day.

We can all agree that more fruits and vegetables, less processed food, less refined sugar, less sodium are all good choices.  So let's start there, at the very least, when encouraging lifestyle change.

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