Mad Cowboy Interview 05: Dr. Caldwell Esselstyn, Jr.
(Part 03 of 03)

M:  "I think your book's organization is excellent.  I've posted a Table of Contents on the Mad Cowboy website.  What intrigued me, too, is that you very carefully laid out the foundation for your argument through tight and methodical summaries.  The text is accessible --- you're not using an abstract academic vernacular that's incomprehensible to a lay person like myself.  It's almost like being taken by the hand and "guided" down the path to health.  Is this how you approached the matter with your patients?"

C:  "What I usually do as a first step is for two and a half hours I'll give them the background of the study.  Then I'll break away from the study and we'll go into the physiology of the disease and it's creation.  The most important illustration I share with them is showing how a "plaque" actually ruptures --- what is going on in there metabolically, because once they understand how a plaque can rupture, what forces it to and what creates it, then they understand what they have to do to make the metabolic changes so that cascade of events does not occur.  You may think that little changes are important, but let me tell you how very important little change is... you can think of it in this way:  suppose that you've got water at 33 degrees F.  What happens when that only goes down one degree?  You've got a force that is so strong it'll break up your sidewalk."

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  "I was noticed that the tone of your book is firm, but very gentle at the same time.  You effectively deal with any number of possible arguments to your conclusions and advice, while at the same time, and this is reflected also in the recipe and cooking advice section, there is this consistent tone of encouragement... you're not beating people over the head.   You may be a "compassionate authoritarian" of sorts!"

C:  (laughs)

M:  "It's hard to imagine how much went into getting this book out.  A lot of documentation, great set of media resources... recommended "safe food" section.  Clearly a lot of hard work and passion went into this effort.  Early in your life you won a Gold Medal at the Olympics.  Did that experience compare in some way to this work?"

C:  "In a way it does.  There's a little piece I wrote on the website in past few weeks about "from the Olympics to this study."  I think what the Olympics did, for me, in terms of this particular 20 year study... is learning that when the forces are pretty much against you and you're not given much of a chance, and yet you have a feeling that this is something that really ought to work, you dig in your heels and make absolutely certain that you're not going to be dissuaded.  I think the most important thing, at least in my lifetime, that you can discover about science more than perhaps sheer brilliance, is the willingness to be persistent when everything logically would indicate you may be correct.  I would think that sort of tenacity is a bit of a remnant from my athletic background."

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  "Do you find that people want to have to change --- you can lecture or try to convince them if there isn't that inherent desire.  As an example, I've some dear friends doing an "Atkins-style" diet and I want to scream.  You have to wait for them to come around?"

C:  "You could say that, although I think one of the things that brings people around very rapidly, that is thinking people, is education.  I'm not a great believer at all in trying denigrate the work of others at all.  Let's just say that when you have a program that advocates a program that is high in fat, high in meat and dairy, and denigrates the value of carbohydrates, I'm totally unaware that the author that you mentioned ever did any research that would indicate this is a nutritional profile that can arrest and reverse heart disease.  As a matter of fact, I've had experience with any number of patients who have tried that program and it left them filled with disease, and we were able to arrest and reverse it when they converted."

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"Who are the people who've most inspired you in your life?"

C:  "Oh, I think my Dad... even though he was ravaged with disease, I can remember a few years before he died that he was really appalled, this was probably early in the 1970s, he was so appalled at the way the amount of expenditures of health dollars was going through the roof.  And he said, "I don't know how it's going to happen, but we really have to figure out how to make people live healthier lives."  And that was really quite prophetic as he had no concept or idea about how that would be handled.  He certainly saw though, that was where the opportunity was to make this happen. 

Certainly I've been influenced by people like Pritikin... like John McDougall... by T. Campbell... Neal Barnard... all kindred spirits at the same time.  We always end up standing on the shoulders of a lot of people who have gone before us to try to make this happen.  We all have to have humility there, even if we often sometimes can't identify who those people are or where those thoughts came from, and that somehow an idea or concept just clicks in your brain.  All those multiple influences that made you have these thoughts, concepts, ideas, or drive to do this are in there somewhere.   It's hard to say anything except the fact that you have to be very thankful to those that have gone before and led the way.  They put us on a springboard that lets us go even farther, and we hope that there will be others that will stand on our shoulders and do the same."

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  "You are an incredibly gracious man... let's see... if you could have some dinner guests from history, who would you invite?"

C:  "Oh, I would like to have dinner with Abe Lincoln and George Washington."

M:  "Now THAT would be an interesting conversation..."

C:  "I think it would be terrific... then I have Sir William Osler, who I think was one of the greatest physicians at the turn of the century.  It be great to have someone like that on board.  It would really be quite exciting."

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  "Okay, someone has read your book, followed your program, and decided to give you a million dollars in appreciation.  What would you do with the money?"

C:  "There is some very exciting research on the endothelial cells that still has to be done.  But I think here's what I would probably do right off the bat --- of course it might be a shortcut to getting the public to come around. I would use that million dollars to do a Brachial Artery Tourniquet Test (BART) on almost all the foods that people regularly eat.  If you can do this, if you can demonstrate the fact that all these oils, animal-based foods, and processed flour, are absolutely devastating our endothelium immediately with each bite and with each meal, and here are all these plants foods that are absolutely enhancing that capacity, then I think you can take the next logical argument, and that go to our nation's schools to deal with the notorious lunch problem --- that our schools are providing a lunch that is absolutely ghastly for the vascular system.  That'll put a lot of pressure on the USDA.  We have to also then go to the culinary institutes of the world.  They are the ones that design and create all these education materials, training all these magnificent chefs.  These chefs take their skills to the greatest hotels, spas, retreats, and business cafeterias throughout the world, and we're going to say "now wait a minute... when you print out this menu, you're going to have to tell people whether this is the kind of food that is immediately damaging or injuring their blood vessels, or the kind that's going to enhance them.  We can put a "skull'n'crossbones" next to the ones that are going to injure them, and we'll put a smiling sunshine next to the ones that will help [laughs]."

M:  "You obviously work very hard.  Do you experience burnout?  How do you relax?"

C:  "It was very exciting putting this book together as you've no idea when you're doing all this how it will be received.  The fact that we didn't know where this would end up when we started doing the research, we didn't know where it'd end up starting the book, and now when things work out, makes you just want to work even harder.  As far as relaxing goes, my wife likes to go biking and I try to swim a mile every day.  That really keeps me going pretty well.  And of course we have the farm in Upstate New York in the summer, where there are trails we can hike and be outdoors."

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  "Hi Ann!  Glad you could join us.  Y'know, when I first looked at the second half of the new book, I wondered if your husband was some sort of gourmet chef in addition to being a world-class surgeon.  Then I realized it was you!  You were responsible for the 150 recipes section...  it's amazing.  Your helpful hints and tips, as well as the recipes themselves, show the same encouraging and friendly tone of Essy's in the first half.  You even have a recipe from the co-owners of the incredible vegan Millennium Restaurant.  Some very creative work.  Let me ask you the basics:  what are the rules you cook under?"

A:  "Well, plant-based, of course.  No oil.  I don't use salt, I use low-sodium Bragg Liquid Amino or Tamari... occasionally miso... no nuts or avocados... if I use tofu, I use a lite tofu.  As you noticed, I use tofu mainly in some of the dessert recipes.  There are some times when tofu makes a good a good dip or sauce."

M:  "I think that's marvelous, regarding tofu.  Many people don't realize the high-fat content of most tofu and tend to lean on it a bit too much, say for entrees.  I found it unique that your "main dish" recipes were essentially "tofu-less."  You obviously worked with Essy's patients in helping them learn to eat differently.  Did people have a hard time adjusting to the new approach?"

A:  "It's weird.  I find that by the time people get here, in most cases, they have made up their minds, their health is so bad, that they have to do something and they're willing to do it.  If you're aren't fighting it all along, if you're not saying "I CAN'T live without olive oil,"  but if your attitude is "well, that's interesting, I'll try it" you don't even know don't have any olive oil --- you don't miss it.  Our food is so good we have to not eat too much of it!"

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  "Well, the recipes are just so interesting.  What happens to the cravings for fat?"

C:  "Within about 8 to 12 weeks you've down-regulated the fat receptors and it's no longer an issue."

A:  "I don't have any cravings for fat, the thing that is tempting is more towards sweets.  Not fat."

M:  "You do a very useful identification of the common problems and solutions to same, that people might experience in switching over to your recommended program.  Can you summarize some of them?"

A:  "I think eating out is a big challenge.  In fact, an even bigger challenge may be eating at a friend's house, and especially if you go to a friend's house who knows how you eat, and has made a huge effort to make something very special for you, and it turns out to be not at all what you can eat."

M:  "How do you recommend people deal with that situation?"

A:  "Well... if it's your life, then you don't eat it.  We have gone out to dinners where you have salad with oily dressing, I mean there isn't one thing I can sort of focus on, and they have nothing.  And Essy always tells his patients:  "you don't have eat."  It's your friend, and that's a hard one.  You can also offer to bring something to the event... that's often the easiest thing to do.  Then you eat what you've brought."

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"I loved how you approached a challenge in converting recipes in some cases.  You write about seeing a "lemon pie" in the movie "Million Dollar Baby" and were "determined to find" a "legal lemon pie."  You pulled actually did it!"

A:  "Ah!! I worked and worked on that, and then one day..."

M:  (laughing)

A:  "...I got this lemon juice and added tofu, and swirled it around... then I decided, "I've got to do this in a cake."  I took the birthday cake, and split in half, and made layers of the lemon tofu topping and thickened pineapple juice filling.  It's just fabulous!  Of course it's messy.  I love that lemon taste and the cake looks very elegant."

M:  "That positive attitude shows throughout.  I can honestly say your work is one of the most unique collections I've seen anywhere.  I kept looking for the fat and salt... not there.  You really pulled it off."

A:  "I think following these recipes without salt may be hard for some people at first, but I find when it might taste a little flat, one of the first things I'll add is a little lemon or vinegar.

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  "This seems like a family affair... I noticed that some of your children contributed recipes?"

A:  "All the children gave us recipes."

M:  "And they're all vegan?"

A:  "Yes... our son-in-law, Brian,  cooked for "Outward Bound" for a long time and gave us a lot of recipes.  He's the Chef in the family.  Now, our son, Rip, there's a lot of his recipes there, too... he's a fireman in Austin, Texas.  Rip has always eaten plant-based.  Do you want to hear the whole story?"

M:  "Sure!"

A:  "His fellow firefighters do a lot of competitions in their off time, and there was this "cholesterol-checking" competition.  JR's cholesterol was way over 300, and he's pretty young... in his 30s or 40s... and his father died at 50-something.  There was heart disease in his family, so they decided to eat plant-based at the firehouse.  Somehow this got out to the Austin Herald, and there was an article about "Tofu Outmuscling Red Meat in the Firehouse," NPR [National Public Radio] picked that up, and a year ago Thanksgiving they had a national piece on the firehouse and Rip, and then the New York Times must have picked that up, and they had a half-page Sunday National Page on Rip and the firehouse.  And THAT led to all sorts of agents and writers e-mailing Rip, and he decided to right a book.  He'd already been thinking about it, and they have a website.

And now, Rip is doing something absolutely fascinating... he was going to get 30 people to go on a six-week program and take measurements of cholesterol, blood pressure, and weigh them, and all that before and after.  Well, it turns out he's now he's got 66 people in that group.  He's put together this amazing six-weeks of menus, of meal plans... it's stunning."

M:  "That's fantastic!  I have to ask you this... did you and your children all go vegan at the same time together?"

A:  "Well... that's what we were eating at home, and anyone that was here, that's how they ate!"

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  "Let me just say towards the end here, that Howard was absolutely right:  you are an amazing couple and Essy's research is incredibly important.  A tremendous job on a ground-breaking book that really nails heart disease, pulls no punches, and provides some wonderful recipes as a guide for eating heart safe."

C:  "There's a point that I'd like to add that I don't think I mentioned earlier.  Where this is really so very powerful from an emotional standpoint, is the following:  you've got a patient, and their family, but a patient who has had a heart attack.  That family is going to live, with every day and week that goes by, with that deep fear of when the next shoe is going to drop.  When is Grandpa going to have his next heart attack?  Or if you're a relative and live with him or her, when is it going to happen again?  And that really takes away a lot of the humor and spontaneity of life, if so many people have it in the back of their mind that concern of when that next event is going to happen.  What is so powerful for people who've had heart disease where this has occurred, when they KNOW that as long as they can eat a plant-based diet where they keep that LDL cholesterol at 80 and under, I have not seen a heart attack.  You have made yourself, and will remain, heart attack proof by maintaining adherence to this nutritional lifestyle change.  This is such a great relief... and we know that it works because we now have data beyond 20 years as proof."