The way to a man's heart - lowering cholesterol levels through diet

Vegetarian Times, Sept, 1996 by Luise Light

FEW MEDICAL EXPERTS dispute the notion that an extremely low-fat diet helps prevent heart disease. Yet many cardiologists still rely solely on drugs and surgery to treat heart disease, because they assume that patients accustomed to eating steak and cheesecake cannot or will not change their habits.

Ten years ago, Caldwell B. Esselstyn, Jr., M.D., a physician in Cleveland, set out to disprove this theory. He recruited 22 men with severe coronary artery disease, clinically documented signs of artery blockage and/or heart damage, and cholesterol levels of 240 or higher. Without treatment, most of these patients would be dead of heart disease today.

To his medical peers, Esselstyn's goal--to reduce this group's cholesterol levels through dietary reform to 150 or lower and keep it there for 10 years--seemed impossible. Although most physicians believe that dietary modifications are beneficial, they don't trust their patients to make such sweeping lifestyle changes. Despite the skepticism, Esselstyn put his patients on a vegetarian diet with less than 10 percent of all calories from fat. They were asked to avoid oil, meat, fish, fowl and dairy products; eat mostly unprocessed grains, legumes, vegetables and fruit; and consume caffeine and alcohol only in moderation. Because of the gravity of their disease, the patients were also given smaller dosages of cholesterol-lowering drugs than are normally given to cardiac patients.

Five dropped out of the program almost immediately, but the other 17 patients stayed with it for at least five years. Of the patients who conformed to the diet for five years, all managed to get their cholesterol levels below 150--a staggering reduction of 246 percent. These patients' heart disease either reversed itself or remained stable. Only six patients completed the entire 1 0-year study. These six "long-haulers" had no further heart attacks or strokes. The five patients who dropped out at the start of the program and went back to their old dietary habits reported an average of two heart attacks each. The health of those who left the program while it was ongoing was not tracked.

Basil Rifkind, M.D., senior scientific advisor to the National Heart, Lung, Blood Institute (NHLBI) of the government's National Institutes of Health, commented that Esselstyn's study is important in several ways. "First, it confirms what [Dr. Dean] Ornish and others have found, that the lower the blood cholesterol level, the lower the risk of heart disease. Second, it takes very aggressive action to reverse coronary heart disease once you have it, including very low-fat diets (ten percent of calories from fat or less) and, in most cases, cholesterol-lowering drugs as well. Third, we see from Esselstyn's study that it is quite feasible to follow a very low fat diet for many years without great difficulty... I hope physicians take note of this."

Currently, the NHLBI recommends blood cholesterol levels of 180 to 200 and diets containing 25 percent to 30 percent of calories from fat. These recommendations may change in light of Esselstyn's findings.