Introduction: More Than Coronary Artery Disease
MAKING THE CHANGE
by Caldwell B. Esselstyn, Jr., MD
Life's Journey |
the Change |
Medicine must focus, as never before, on how to support
personal behavior modification. Exercise, smoking cessation, and
moderation in alcohol consumption are integral parts of this strategy,
but space permits me to focus only on diet.
With its lack of fiber and antioxidants, and its
emphasis on animal protein, fat, and extreme free- radical production, the
US diet is largely responsible for the bitter harvest of diseases
mentioned above. Dr. Robert Kradjian has said that our single most important interface with our environment is the cell membrane, which is 1
one-thousandth of 1 micrometer (10--8 m) thin.'0 This delicate interface
is subjected to irreversible metabolic injury with each and every Western
meal. We define this summation of injury as a disease, whether it be
cancer, vascular disease, diabetes, or some other condition.
How will we get this message to the public? In the case
of smoking cessation, physician behaviors have been admirable, and as a
group, we have contributed greatly to the reduction of tobacco
consumption. Whether we can achieve these same inroads with plant-based
nutrition remains to be seen.
One great stumbling block has been the govern ment and
national health organizations that support the target of 30% dietary fat
and a cholesterol level <200 mg/dL. The First National Conference on the
Elimination and Prevention of Coronary Artery Disease concluded that
these guidelines did not offer the best chances to arrest and reverse
coronary artery disease, essentially corroborating what the government' s
own scientists had said in the 1989 epic Diet and Health. Namely,
greater health benefits would be derived from even less fat than the 30%
recommendation. The reason given for not advocating lower levels was that
it might frustrate the public, who would have difficulty maintaining a
lower level. It seems to me that the public's greatest frustration would
come from not being informed of the optimal diet for health.
Now, at this second conference 6 years later, there is
additional support for the need for further lipid reduction. It is time
for these organizations to re evaluate their recommendations of a
cholesterol level <200 mg/dL and a diet composed of <30% fat. It is time
for a concerted and consistent effort to inform the public and the medical
profession of what the existing data show will be most optimal.
In many cultures, coronary disease is practically
unheard of when total serum cholesterol levels are 90--150 mg/dL. We
cannot continue to have public and private organizations on the forefront
of health leadership recommend to the public a dietary plan that
guarantees that millions will perish from the very
disease the guidelines were supposed to prevent. If we are to truly shift
the paradigm from only technologic intervention to prevention, then
significant lifestyle changes are needed and justified.
I am acutely aware of the castigation that accompanies
recommending a plant-based diet--namely that the recommendation will be
met with skepticism and hostility on the part of the general public. This
attitude is peculiar, because many cultures sustain themselves with such a
diet, enjoying its taste, texture, and vanety, as well as its
health-promoting qualities. How ever, diet preference is deeply personal,
and one can easily be offended. Nevertheless, the public has a right to
know the truth as understood by experts in nutritive biology about what
constitutes the safest and healthiest diet.
Some criticize this exclusively plant-based diet as
extreme or draconian. Webster's dictionary defines draconian as
"inhumanly cruel." A closer look reveals that "extreme~~ or "inhumanly
cruel" describes not plant- based nutrition, but the consequences of our
present Western diet. Having a sternum divided for bypass surgery or a
stroke that renders one an aphasic invalid can be construed as extreme,
and having a breast, prostate, colon, or rectum removed to treat cancer
may seem inhumanly cruel. These diseases are rarely seen in populations
consuming a plant-based diet.
We are presently witnessing a meltdown of the tobacco
industry. Science and the public are aware that using addictive tobacco
products exactly as advertised often leads to irreversible illness and
death. The data of Drs. Berenson and McGill, defining the ravages of
atherosclerosis in the young, tempt one to place cheeseburgers, steak, and
cold cuts under similar scrutiny, since these and similar foods'
composition destroy the vascular health of the young, as well as of
The next step toward rectangularization of the survival
curve involves personal lifestyle changes--par amount being a plant-based
diet. This is not vegetarianism. Vegetarians often consume oils,
margarine, and animal products such as milk, cream, butter, cheese, ice
cream, and eggs. This new paradigm is exclusively plant-based nutrition.
Technology will have little place in this new preventive paradigm. It will be people--physicians and allied health personnel
with the knowledge, patience, powers of persuasion, and communications
skills--who will en able this transition. Assistance in this endeavor from
government agencies, national health organizations, insurance companies,
and culinary institutes is welcome and needed. The very foundation of the
healing arts, a bastion of integrity, mandates that we define for our
patients and the public this opportunity to avoid these common chronic and
killer diseases through practical, achievable personal choices.