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
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.
6 comments:
I have been searching high and low to discover Dr Esselstyn's reason for not allowing avocados (and nuts)and I thank you for finding it.
Thank you for this informative post, as I have also been trying to reconcile conflicting information about nuts and avocado. I've heard about the importance of adding fat (nuts) to my greens to obtain their benefits. WFPB for six years now. Dr Essselstyn is still a hero of mine too.
This is important to me as I'm a recovering Heart patient with a stent and have been following the Esselstyn diet as closely as I can. Not eating meat wasn't difficult as I was already philosophically aligned against meat consumption, dairy a bit harder because I love cheese but it was easy to see how inflammatory and how much saturated fat was in it not to mention the ethics of the industrial dairy industry. Oil has been difficult and yet there is good evidence to support that it's a highly processed food that's easy to overconsume with high calories and is also inflammatory. Where I can find little scientific evidence is that raw nuts, seeds, and avocado is detrimental. So he has a hypothesis that these foods are detrimental can't we just test the theory? We need a study to investigate this further. If you know of any such research please share. Also, what other studies back up Esselstyn or is he a lone wolf in using this dietary approach?
I'm only now posting this in 2022. I've gone WFPB, but I continue to eat an avocado everyday. Esselstyn is the only person against avocados and nuts for a heart healthy diet. It was hard to find any reason for Esselstyn's decision to be against nuts and avocados, so I am very grateful to have found your blog with the answer. This means a lot. Thanks!
Not including nuts and seeds (or some other good fats) in one's diet is risking deleterious effects on the brain and on the general neurological system, especially when one gets older. This is not based on wishful thinking, it is plain fact. In fact, there are tons of studies out that have proven this. Nutritional and functional medicine doctors such as Michael Greger, Joel Kahn, Joel Furhman, Mark Hyman, Elizabeth Boham, Aseem Malhotra - people, the list goes on and on. The cause, in most cases, of endothelial destruction is excessive SUGAR consumption straight up or from processed foods containing processed and modified carbs, starches, and hydrogenated oils. These will attack the metabolic system which will lead to pre-diabetes which in turn to type 2 diabetes. Good fats do not do this. Essential fatty acids are essential. EPA/DHA are essential along with B12. Why aren't these things hardly mentioned when they are most critical in contributing to a healthy heart and healthy living. The fact that there are no legitimate studies that show that Nuts and Seeds and other good fats source cause damage to the endothelial cells of arterial walls does not prove that there is no proof of claims to the contrary. I've been so confused for around 5 years about what doctors, nutritional, and health experts think regarding major diseases and the diets that are best for everyone. I started on an Esselstyn diet after receiving a stent due to Angina and in just under a year my numbers have improved, no doubt with the help of a statin. However, at age 61 I became and felt frailer, lack of energy, lost too much weight, and a warning from my physician that I needed to include more fat and protein in my diet to battle the fatigue and the low IGF levels that were revealed in a blood test. He also warned me about my potential B12 levels getting too low and why I needed to keep them at a normal range which at that time they were of the normal range. The point is that the Esselstyn diet is appropriate more for drastic cardiac events but not for those whose cardiac situation may have been resolved by the Esselstyn diet or for those who've had a less severe situation. My situation has improved so much regarding my strength, thinking, energy, and physical training, and participation in sports after having included more plant-based fat and some animal products in my diet (a wild-caught mackerel per month and non-fat plain yogurt).
Johnnie, I like what you added about the effects on the brain and neurological system. I didn't even think about that. However, I never stopped eating avocados. I can't eat most nuts right now due to excess oxalates, but I do continue eating sunflower seeds and pumpkin seeds in a limited amount. I think the avocados provide more than enough of the healthy fat my body needs. I just wanted to take a minute to thank you for your input. Cheers!
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