Voices of the Food Revolution. John Robbins

born decades earlier.

      DR. CALDWELL ESSELSTYN: My work was kindled by reviewing the global literature on cardiovascular illness. It is quite striking that even today if you are a cardiac surgeon and you are going to set up your practice in rural China, Central Africa, or with the Tarahumara Indians in Northern Mexico, you might as well just forget it. You'll make more money selling pencils, because you are not going to have any cardiovascular disease to treat. There is none. These cultures, by heritage and tradition, are fully plant-based.

      Yet by way of contrast, when we looked at the autopsies of our 20-year-old GIs in Korea and Vietnam, fully 80 percent already had gross evidence of coronary disease that you could see without a microscope. That study was repeated about forty years later in 1999. This time it was done in the United States, looking at young women and men between the ages of 17 and 34 who had died of accidents, homicides, and suicides. This time the disease was ubiquitous. Everybody at that young age already had the foundation of coronary disease. So it is very discouraging to think that when you graduate from high school in the United States today, not only do you get a diploma, but you also get a foundation of coronary disease.

      This is further accentuated by a very interesting phenomenon that occurred during World War II when the Axis powers of Germany overran the low countries of Holland and Belgium and they occupied Denmark and Norway. It was characteristic that the Germans would take away the livestock from these cultures—specifically their cattle, sheep, goats, pigs, and turkeys. So now suddenly these Western-European nations were deprived of animal food and dairy during the war years. In 1951 it was quite striking to see the report in The Lancet, England's premier medical journal, by Doctors Strom and Jansen who reviewed the Norwegian experience with heart attacks and strokes during those war years. It was striking that from 1939 to 1945, deaths from stroke and heart attack in Norway plummeted. And yet, as soon as there was a cessation of hostilities, immediately back came the meat, back came the dairy, back came the heart attacks, and back came the strokes.

      JOHN ROBBINS: What propelled you to conduct the study you did?

      DR. CALDWELL ESSELSTYN: In the late 1970s and early 1980s, I was chairman of Cleveland Clinic's Breast Cancer Taskforce. I realized no matter how many women I helped with breast surgery, I was doing absolutely nothing for the next unsuspecting victim. That led me to a bit of global research. It was striking to find that breast cancer in Kenya was thirty to forty times less frequent than in the United States. In rural Japan after World War II, breast cancer was very infrequently identified and yet as soon as the Japanese women would migrate to the United States, by the second and third generation, they now had the same rate of breast cancer as their Caucasian counterparts. Perhaps even more striking was cancer of the prostate. In 1958 in the entire nation of Japan, how many autopsy-proven deaths were there from cancer of the prostate? Eighteen! By 1978, twenty years later, they were up to 137, but that still pales in comparison to the 28,000 who will die of prostate cancer this year in the United States.

      At about that time I made a decision to focus on the leading killer of women and men in Western civilization, which is coronary heart disease. It was apparent that there were multiple cultures that were plant-based where this disease was virtually nonexistent. I thought how exciting it would be if we could help people to eat in a way that would save their heart. Because if they were eating to save their heart, then they would probably also be saving themselves from the common Western cancers of breast, prostate, colon, and pancreas.

      In the summer of 1985, I went to our Department of Cardiology at Cleveland Clinic and asked for about twenty-four patients who were ill with coronary artery disease. Twenty-four patients was the maximum number I could manage and still carry out my surgical obligations.

      JOHN ROBBINS: So you were given twenty-four patients, most of whom were not doing too well.

      DR. CALDWELL ESSELSTYN: As my late brother-in-law said, they were the walking dead. They had failed their first or second bypass; they had failed their first or second angioplasty. They were too sick for these procedures or they had refused them, and five were told by their expert cardiologist that they would not live out the year. I am happy to say that all five of those went beyond twenty years, and all patients who were compliant were able to arrest their disease and we often would see a marvelous reversal of it. This was extremely exciting and very rewarding, because some of those actually occurred before the invention of statin drugs. So we recognized the power of correcting nutrition.

      JOHN ROBBINS: The power of nutrition, as you showed, is phenomenal to correct and sometimes reverse disease. Yet most medical schools hardly teach nutrition at all. The philosophy seems to be “a pill for every ill.” There is very, very little effort to support physicians in learning about nutrition and its power. Having been at this as long as you have, how would you say the battle is going overall?

      DR. CALDWELL ESSELSTYN: Nothing is going on in cardiovascular medicine today with any of the drugs, with any of the imaging, with any of the stents or the procedures or the bypass operations, to treat the causation of the illness. Even my wonderful friends who are cardiologists and cardiac surgeons will concede that these procedures do nothing to deal with the underlying problem. They are just a stop-gap patch job.

      There was a normal, and I think probably an appropriate, reticence with Dr. Ornish and me when we did our earlier studies. The medical community was willing to concede that we had demonstrated proof of concept but they felt very strongly that it would be impossible to get large numbers of people to change. But we are just now summarizing a group of more than 226 patients that we have counseled over the past ten years or so. These patients have come to see us from across the United States, and 198 of them had severe coronary artery disease. We have had about a 90 percent compliance rate. The number of new major cardiac events (death, heart attack and stroke) is 40 times less frequent than other representative studies. We have had in our group of compliant patients a total of just one event. This was one patient who had a mild stroke. That means that more than 99 percent had no new major cardiac events.

      Many people wonder how we have achieved that degree of compliance. Most cardiologists don't doubt that there would be benefit from our program—they just don't think patients would stick with it. But we have proven that it can be done.

      JOHN ROBBINS: How did you do it? I have heard so many people say, “Well, you just can't ask people to be that restrictive in their diet.”

      DR. CALDWELL ESSELSTYN: The first thing you have to do is to show patients respect. The way that a physician can show a patient respect immediately is by giving them their time. At the Cleveland Clinic Wellness Institute where I direct the Cardiovascular Disease Prevention and Reversal Program, we conduct a single five-hour intensive counseling seminar for ten or twelve participants at a time. Their spouses or partners can come for free. We explain to them in language that either a CEO of a company or a high school dropout is going to be able to understand exactly what has been the cause of their disease and exactly what it is that they can do to be empowered to halt and reverse this disease. In addition to this, we have a very hefty notebook that we give them with a copy of every one of my PowerPoint slides, another forty-four-page handout with additional concepts, and many more recipes to add to the 150 in our book, which we give them as well. We also incorporate an hour and a quarter presentation from a woman who has had twenty-eight years of experience acquiring and preparing plant-based nutrition, dealing with reading labels, dealing with travel, and dealing with restaurants. Then we give them a copy of a DVD of an entire seminar that we recorded earlier. We usually have a presentation from somebody who is local or regional who had a previous successful experience to share their story so that those who are there can say, “Listen, if he or she can do this, I can do it.”

      We give them a delightful plant-based lunch and stay in touch through email or phone calls as is necessary. What we really want to do is to make this the most significant interchange that they have ever had with a caregiver. I need the five hours. I need the same amount of time that the cardiac surgeon has, but I want it with the patient awake.

      JOHN ROBBINS: Currently, 45 percent of Medicare