You are what you eat....

Following the heart attack I spent some time wandering around in the wilderness, feeling a little depressed and dis-empowered. It felt as if I could at best delay the inevitable but no better than that. After seeing various videos featuring ex-president Bill Clinton discussing the changes he had made to his diet under the influence of Doctors Dean Ornish and Caldwell Esselstyn I began to realise that there might be a better way. I did a little research the internet and found several sites relating to these issues, in particular, Esselsytn's own site was most informative and easily understood. He has the happy knack of explaining sometimes quite complex ideas in simple terms.

Having the possibility, through adherence to Esselstyn's dietary and lifestyle suggestions, of not only slowing the progress of the disease but actually reversing its effects felt tremendously encouraging and empowering to me. I could once more be the master of my own destiny.

Esselstyn himself has been a vegan of long standing but often the term 'vegan' is noticeable by its absence in his writings. Perhaps because some people have a very dismissive attitude to vegetarianism and veganism in general Esselstyn tends to adopt the term 'plant-based'. From my personal point of view, I have no problem with whatever they call the diet as long as it is efficacious in relation to the underlying problem. As old Bill Shakespeare once wrote (in Romeo and Juliet): “A rose by any other name smells just as sweet!”

The diet itself is as much about what it omits as what it includes. In very simple terms, all animal based foods are not allowed. This includes the more direct examples such as meat, fish and poultry but also foods derived from animals such as eggs, butter, cheese and any other dairy products. There are no exceptions. In that way the dietary advice is very clear on this point. An interesting way of thinking about this is why would you want to consume your nutrients second-hand only after they have been consumed by an animal when you can get the nutrients directly? Most of the common animals we eat get their nutrients via eating plants. We then eat them. Surely it is better to cut out the middle man (or middle animal in this case!), and get to the source of the nutrients directly?

Esselstyn is also very strong on the avoidance of all oils, even those that are oft touted as 'good oils'. According to the Doctor, for human beings there are no such things as good oils, in the long run they all damage our arteries. Even those often touted as healthy such as olive oil and canola oil are banned. Doctor Ornish is not quite so binary on this issue but I prefer the simplicity and clarity of Esselstyn's approach.

Refined grains are also to be avoided in favour of whole grains. White bread, white rice, even so-called enriched flour such as that to be found in bagels and most generally available baked goods are deemed to be off the menu. You are allowed grains but only in their whole variety rather than after they have been processed in some way.

Nuts are also banned because of the amounts of fats involved. This may seem drastic but having a heart attack is also pretty drastic in itself. I suppose it depends on how motivated you are to avoiding succumbing to further cardiac events. The one exception he makes is walnuts because of their high omega-3 content. Even this exception is directed at those who are trying to avoid a heart attack rather than those who already have suffered one. In the latter case he suggests that nuts of all sorts are best avoided altogether.

Finally, although these last two are so obvious that they hardly needs stating, avoid sugars and sugar based confections and do not smoke. Concentrated sugars are simply awful for the body but I think by now this is common knowledge. Not smoking goes without saying. If someone still believes that they can improve their health against a background of smoking one would wonder what planet he/she has been of for the last thirty years. To make an unequivocal statement: smoking is terrible for your heart and terrible for your lungs (amongst other unpleasant physiological effects).

After that rather long and wide ranging summation of what you cannot eat you are probably wondering what exactly you are allowed to consume! This is clearly not a diet for those who wish to compromise. The idea is reduce cholesterol down to levels scarcely seen in America and the Western world. This is not simply an attack on cholesterol though as it role in heart disease is far more subtle than was first realised. It is part of an overall and comprehensive strategy that will, if successful, allow your arteries the chance to repair themselves and for normal life to return.

You are allowed to eat just about any type of vegetable and, contrary to our normal idea of a diet, in whatever quantity you desire. You definitely need never go hungry on this diet although there may be a few problems whilst you adjust your mindset away from the unhealthy and disease causing foods towards the more healthy alternatives. After quite a short period it becomes second nature. At this stage the thought of consuming the greasy, fatty, processed fayre that is often served up in the name of food may even begin to become a little unappetising, to say the least. Even the sight of the stuff can become quite off-putting once you have adapted to a healthier, plant-based diet.

Legumes of all sorts are also highly recommended on this diet. Any type of bean or pea and lentils of all kinis are allowed. This gives a huge range of choice. Once you start to look into these things you begin to realise just what a huge variety of healthy food stuffs there are out there for you to choose from. Oddly, once you get into the swing of things, you may even find that your daily diet becomes far richer and more varied than it ever was before.

All whole grain products are allowed. This means that the grain has not been processed in any way (which often reduces it nutritional value). It is not at all uncommon these days for manufacturers even to add oil in the process of producing a loaf of bread. Clearly this is a big no-no on this diet!

Fruits of all sorts are definitely allowed and even encouraged but just be careful not to overdo it. When it is consumed it should be as close to its natural state as possible rather than in any desserts or sweetened forms. There is a type of sugar called fructose in fruits and over consumption of this bears the same dangers as many other forms of sugar consumption. Fruit juices, for this reason, are to be avoided.

You can drink a wide range of beverages such as tea, coffee, water, oat milk and no-fat soy milk. Personally, I can have a few problems with coffee as a strong cup can send the pulse racing so I tend to keep it down to one every now and then. Most of the time when I am in a situation where I previously drank coffee I tend to pick from a pretty comprehensive and wide range of teas that are available in this day and age. In my own case, and particularly when writing, I especially enjoy a pot of fresh green tea.

Even alcohol is allowed on this diet though keep it to sensible levels. Getting drunk on a regular basis is not good on any diet!

To cover for the possibility of any deficiencies, Dr. Esselstyn recommends taking a multivitamin tablet each day, vitamin C and D and a supplement of B12 (1000 mcg daily). People over 50, should look after their levels of vitamin D, therefore Esselstyn advocates supplementing with a tablet each day although getting sufficient exposure to sunshine would also help in its production. Finally, as regards supplements, Esselstyn recommends taking a tablespoon of flaxseed meal every day. This can be taken directly or added to your cereal.

Statins can be a controversial area but the cholesterol lowering effects are clear. Some claim many other benefits and feel that most people would be wise to use them once they approach middle age. Others point out possible negative side effects. If you are able to reduce your cholesterol levels to below 150 milligrams per decilitre then you can probably avoid the need to take statins. If above that, Doctor Esselstyn himself generally comes down on the side of using statins, particularly if you have already had a heart attack.

Ideally, as with many other such interventions, when one goes on this diet one should consult with a doctor before beginning. Have some blood tests done that inform both you and him/her of your cholesterol profile. Then, every three months afterwards have these levels re-checked to ascertain what progress you have made. Medication such as statins may become unnecessary if your levels have reduced below the 150 mg/dl mark.

In next weeks post we will address the problem of cholesterol and its relationship to a healthy heart. There is much misunderstanding in these areas and much controversy too. Again I would urge, in this day of huge amounts of free information (not always accurate though – be careful!) via the internet, to do some of your own research and familiarise yourself with the concepts involved. It is your heart, your health and, to some extent at least, your responsibility!

 For many years there was an attitude afoot wherein the person suffering health problems went to their doctor and hoped to get some kind of medication to make the problem go away. Essentially, the role of the patient was almost entirely passive whilst the doctor and the medical profession were cast in an almost omnipotent role. Increasingly in recent years, this is no longer the case. Your health is your own responsibility. So many of the ailments we suffer in these times are as the result of unhealthy lifestyles and attitudes, and poor diets. Merely allowing doctors to intervene when you suffer the effects is not good enough! It is your life, your health and your choice.  

New Hope...

It is good to feel oneself empowered, to feel one has choice, that one has control. After suffering the heart attack I had endured a long period where this did not feel to be the case. On the contrary, the feeling had been one of not being in control, of having no choice, of being helpless. Learning about the work of Doctor Esselstyn, understanding the experiments and studies on which it was based, and finally, with some relish, consuming his excellent book 'Prevent and Reverse Heart Disease' all helped to completely change my mindset.

Esselstyn had been a very successful surgeon at the Cleveland Clinic following his return from service during the Vietnam conflict. At this stage of his career he had focussed on the treatment of cancer but became interested in cardiac problems when he began to realise how reactive the traditional treatments were. For the most part, they were focussed on repairing the damage done rather than preventing further damage or even preventing the conditions altogether.

At first his thinking was influenced by several epidemiological studies involving countries where the diets were fundamentally different to the United States with its reliance on dairy, meat, processed and fast foods. As he examined the evidence it became clearer and clearer that countries that avoided the excesses of the Western diet seemed to have much lower instances of coronary disease. Another factor that emerged from examining these studies was that as countries, such as Japan, began to adopt a diet high in dairy, meat and processed foods so their rates of cardiac problems increased. There was also a curious benefit for many countries during World War 2. In many lands there was a shortage of meat and dairy because of occupation, supply problems and rationing. In many of these countries the health of the population actually improved as their diets became simpler and more plant based. Following the war and the ending of these restrictions (and the return of meat and dairy) the problems had returned.

My own personal experience seemed to confirm many of Esselstyn's findings. I had the privilege of travelling to India and Nepal about 25 years back and then, six months later, I found myself in Florida in the US. The contrast was huge and unmissable and I struggled to comprehend the number of obese people I came across. This was my first visit to the States and I was ill prepared for the bombardment of fast food that was awaiting me. I remember one particular occasion where I stopped at a 'Wendys' and ordered pancakes and coffee. Within minutes I found myself confronted by a pile of about seven pancakes smothered in syrup with a dollop of ice cream placed on top. Manfully, or at least I thought so at the time, I ploughed through this mountain of 'food' only to find that the waitress wanted to replace it with even more when I finished, for no extra charge. Generous as this was, I realised that it was far from healthy. The same with the coffee; ordering a coffee seemed to entail a bottomless jug of the stuff.

I was aware at the time of the health and diet problems of the United States but, at this stage, it had not become a personal issue. Over the years I became aware of how the changing diet in the UK, leaning more and more towards the American model, was adversely affecting the health of the nation and producing more and more obese (a comfortable euphemism, we used to simply say 'fat'!) people.

Back in those days I would go swimming on a regular basis and would often come across classes of kids waiting to get into the pool following the adult session. As a child there would sometimes be one 'fatty' to a class, often the unfortunate recipient of many a jibe. Looking at the average class in the 1990's there were suddenly about 25% of the kids who would comfortably qualify for this category. It is much worse now, the obese kid has de facto more or less become the norm.

I am also someone who likes to travel on a frequent basis. On these travels over the years one could visibly see how changes in diet, mostly moving closer and closer to the American model, was affecting the populace. Places where one would rarely see anyone particularly overweight were increasingly filled with youngsters struggling with these issues. Even such places as China and Thailand were clearly becoming increasing and negatively affected.

 These are, of course, subjective opinions on my part but for all the controversy of the debate I feel one should not ignore the evidence of one's own eyes. Statistics and studies can be bandied about endlessly as people attempt to justify the excesses of the Americanised diet but the reality of its effects are often to be see all too obviously in the physique of people ingesting it.  

Esselstyn decided to run his own study with a group of severely incapacitated heart patients. The patients referred to him were mostly considered beyond the reach of the conventional medical interventions employed at the time so, for many of them, Esselstyn's study offered a last resort. The main emphasis in the study he designed was dietary: these patients were asked to keep their diet to plant based foods and avoid all diary, meat, fish, excess sugars, oils and processed foods. I will go into more exact details of his dietary recommendations in a later blog but, for now, merely give a basic outline. The experiment was a great success, almost all of the patients not only surviving much longer than their prognosis but actually returning to good health.

This return to good health is the moot point in all this. On Esselstyn's diet not only did most of his patients halt the progress of the disease, something that was thought to be highly problematic at the time, but they actually managed to reverse it. Angiograms show evidence of previously diseased arteries returning to health, a phenomenon thought impossible previously. Esselstyn for his part had always been an advocate of the bodies remarkable abilities to repair itself if given the building blocks to do so.

I think for my own part, the images of the recovered arteries were perhaps the most compelling evidence. Such pictures offered the hope that not only could I avoid further deterioration but could actually repair the damage done and become fit and healthy once again.

 Despite the nay sayers and critics that I found on the internet the evidence seemed compelling enough for me to embark on this diet...