Circulatory problems and heart disease: an interview with Caldwell B. Esselstyn, Jr., M.D

Nutrition Health Review, Spring, 2006

Q: You ask your patients to eliminate all oils in their diet, even olive oil. Would it matter whether they consumed it at room temperature or used it in cooking?

A: Olive oil is oil. Has there ever been a study in which people have been using lots of olive oil and arrested or reversed their heart disease? We all know about how conflicting those statements from the F.D.A. were and how selective the F.D.A. was in its language. No matter how the agency plays with the wording, the facts are the facts. Well-controlled studies, such those by Dr. David H. Blankenhorn of the University of Southern California School of Medicine and Dr. Lawrence Rudel of Wake Forest University Baptist Medical Center, published in peer-reviewed professional medical journals, show that olive oil causes and perpetuates these diseases.

Q: What is the Mediterranean Diet? What are its advantages and disadvantages?

A: Fifty years ago, the traditional Mediterranean Diet was largely composed of grains, beans, vegetables, fruit, and maybe a small amount of lean meat or fish. The antioxidants that were so plentiful in the plants in some ways compensated for the downside of the olive oil. Now, of course, the present-day Mediterranean Diet is nothing like the original. Fast foods and the Western diet that have been adopted have devastated those patients. The present-day "Mediterranean Diet" was in the news recently. In the Lyon Diet Heart Study, Dr. Michel de Lorgeril of Joseph Fourier University in Grenoble studied 300 patients in an experimental group and 300 control patients, all of whom had had a recent heart attack.

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One group received the American Heart Association Step 1 Diet; the other half followed the Mediterranean Diet. The Step 1 Diet is so close to being a traditional Western diet that those patients sadly, but not surprisingly, did terribly. If you had compared any other diet to the Step 1 Diet, they would have done better, which is why those following the Mediterranean Diet did better. After four years on the Mediterranean Diet, 25 percent of the people either died or had another major cardiac event. To me, that has absolutely nothing to do with the arrest and reversal of heart disease; that is simply slowing the rate of progression. We want to use nutrition that can arrest and reverse disease, not slow the rate of progression.

Q: Since you do not recommend that your patients consume olive oil, what can people use?

A: People are in the habit of using olive oil. When you put anything in a saucepan, you do not have to grease it in olive oil. You can simply use a non-stick pan and use water, tomato, or anything else to make it moist. You literally get over the habit. When you think about it, what does olive oil have in it? A tiny bit of vitamin E, no minerals, no other vitamins, and no fiber. All you are getting is 100 percent fat, 14 percent of which is artery-clogging.

Q: Are some people genetically more susceptible to heart disease?

A: We can look at genetics by way of an analogy. Let us suppose that you have a village located next to a river. During the flood season, only the strongest swimmers can get across that river. If we wait until the dry season, when the river is only four inches deep, everybody gets across safely. The analogy applies in the following way. When you have a traditional Western diet, where blood cholesterol and lipid levels are elevated above 200 mg./dL., some people will succumb sooner than others. That is just the way it is in biology. However, when we get rid of that toxic, traditional Western diet and we have everybody keeping total cholesterol levels under 150 mg./dL, and LDL-C levels under 80 mg./dL., everybody is spared. There are not enough fatty materials to injure the arteries.