Plant-based Dr. Caldwell Esselstyn explains healthy nutrition, reversing heart disease

Kale! Spinach! Swiss chard! Arugula!

Dr. Caldwell Esselstyn is a legendary doctor who has reversed and cured heart disease for thousands of patients, and advocated for a plant-based diet since 1984.

You may recognize him from the documentary Forks Over Knives, President Clinton thanking him, books or videos from his wife Ann, daughter Jane, or son Rip, the Cleveland Clinic, or piles and piles of well-cited nutrition papers, studies, and essays. Dr. Esselstyn also wrote the book Preventing and Reversing Heart Disease.

Heart disease is the *leading cause of death for Americans* and, as someone who was born in the US heartland, I could not recommend hearing what Dr. Esselstyn has to say more.

Hi Dr. Esselstyn, How are you doing? How's quarantine treating you?

Like everybody else.

Before we get started, I want to thank you so much for what you do. I said this on the phone, but you've not only kind of saved so many people's lives, but you've also delivered your message about the power of good nutrition in a way that has always been respectful and kind, and we've all noticed. So, thank you for doing what you do.

Thank you, Jenna.

Doctor, you've always said that heart disease is a foodborne illness and poor nutrition is the cause. If we know this to be true, in your opinion, why is it so, so hard for people to eat right still? Why are people so confused?

When you touch poison ivy, it's not going to be but an hour or two before you really are paying the price. But when you sit down and have a steak, or you have pork, or you have bacon, or you have cheese, it take sometimes decades, literally decades to build a cardiovascular disease. So there's no really immediate association there at all. And it really doesn't do any help when cardiologists - and again, with all due respect to my cardiovascular friends - really have no training in nutrition in medical school. They have no training in nutrition that's substantive in their postgraduate years.

So frequently when I end up seeing patients, they’ve had an unsuccessful bypass, they've had an unsuccessful stent, or they've been told because they have symptoms, they're going to have to have one of these procedures or some of the drugs.

None of the drugs that cardiology uses, none of the stents, none of the bypasses have one single solitary thing whatsoever to do with the causation of the illness.

When you have the profession that is treating this disease sort of deny the reality of the science that has been out there now for 30 years showing clearly that if we take patients who are seriously ill with cardiovascular disease, and we get them to change the way they're eating, and stop eating any foods that are going to injure the endothelial cell, then the endothelial cells will begin to recover. They make enough nitric oxide so we can call it disease progression. And often we'll see significant elements of disease reversal.

Leveling the playing field is so much better now than it was 30 years ago, 34 years ago when I started. In all fairness, there are cardiologists who have become aware of this. There are physicians who have become aware of it.

It's very awkward for physicians to try to believe in something for which they were never trained. And also, it's hard to imagine that there is something that is more magical and more powerful when you're speaking about brussels sprouts and broccoli than you are with somebody who's invented this drug which has taken many, many years to develop. It's going to cost a great deal of money to take regularly. It'll have hideous side effects. And it doesn't have anything to do with curing the disease, but it'll help the symptoms. So, it's coming.

It's really so embarrassing when you think that half of the planet earth doesn't have cardiovascular disease. If you were a cardiac surgeon and you were going to hang out your shingle in Okinawa, rural China, Central Africa, the Papua Highlands in New Guinea, Tarahumara in northern Mexico… forget it. You better plan on selling pencils. Why? They don't have any cardiovascular disease. Why? Because they all thrive on whole food, plant-based nutrition, essentially without oil.

In light of that, a lot of people think that genetics is the cause. They think genetics is the cause and pharmacology is the cure, right?

Okay. Let’s say genetics is the cause. Why is it then that Okinawa doesn't have any heart disease, but as soon as they move to the west, they all develop heart disease?

And there have been studies that have shown this?

Yes.

Okay. So you're much more, if we're looking at nature versus nurture…

Why is it you take a family, where no male has ever lived beyond the age of 50 or 55 because of heart disease, but if you get that younger male who is in his 40s who hasn't yet, you can absolutely vanquish cardiovascular disease? Yes.

But we're in such a habit. How many times do you go to a restaurant in this country and go to the menu and find there's no oil?

None.

What does oil do to your endothelial cells? It injures them. I just wrote a paper last year in the International Journal of Disease Reversal and Prevention. The title was, Is Oil Healthy? And I review all the animal studies and human studies showing how oil injures the endothelial cells.

Doctor, it's kind of hard for people to hear that olive oil is something that we should avoid. And I'm sure you get this question a lot, which is why you wrote a paper on it. Can you outline your recommendations for how we all should eat?

First of all, what are the foods that every time they pass our lips, we injure the endothelial cells? Any drop of oil, olive oil, corn oil, soybean oil, safflower oil, sunflower oil, coconut oil, palm oil, oil in a cracker, oil in a piece of bread, oil in a salad dressing. Oil injures the endothelial cell.

I'll continue with that, but I want to just be sure that I say one thing. Your audience will probably say, “what is his credential for being able to say those things?” We will compete our results in reversing heart disease with anybody on the planet. We've written multiple papers about this before we ever wrote the book. And when we eliminate for patients who are seriously ill with heart disease, the foods that I've been sharing with you, oil and the rest that I'm about to comment on, not only did we stop their disease, but we showed that we were able to reverse it. Okay? Eliminate oil.

Also, anything with a mother or a face. Meat, fish, chicken, fowl, jerky and eggs - animal protein injures endothelial cells, as does dairy, milk, cream, butter, cheese, ice cream and yogurt and sugary foods. Diet colas, Pepsi coke - I don't like sugary foods. Cakes, pies, cookies, stevia, agave. Too much maple syrup or molasses. We have some maple syrup in some of our recipes and some in the book, but for patients who have heart disease, I'd like them to eliminate and have very little amounts of it. Also, I don't like nuts. Peanut Butter, cashew sauce or avocado. And too much saturated fat and coffee with caffeine, decaf okay. Tea with caffeine, okay. But coffee with caffeine injures endothelial cells.

Doctor, for people that are listening to you right now who eat most of those things… even just nuts, nuts like peanut butter, almonds, I've heard almonds are good? Even brazil nuts. Oftentimes brazil nuts are cited as something that's good for the heart. It's kind of overwhelming to hear it - “Not the coffee, don't take away the coffee, you're taking away my coffee!” I'm sure you get this a lot. It must be difficult having such tight recommendations.

That all stops when they suddenly find that, especially the patients who come with chest pain and angina, and suddenly they find out within four or five or six days, their chest pain is diminishing and going away. Why? Why am I so tough on nuts? You'll see a number of papers out in the scientific literature praising nuts. You have to look often very carefully at how this study was designed. And also, where was the money coming from? As the late Arnold Relman has said, he was formerly the editor of the New England Journal of Medicine, he said, "You must be extremely cautious in reading a paper where the authorship has a relationship with industry."

Now, the thing about nuts is interesting. Probably if the truth were known, you can't tell anybody this, but if I were to say, suppose I were to say that it was okay to have three walnut halves on your cereal. That's not what people would remember. They'd say, “hey, I heard Esselstyn say that nuts are okay.” So then they'll be in the glove compartment, they'll be in the bathroom, they'll be in the bedroom, they'll be in the kitchen, the hallway, the dining room, at the workbench - they're highly addicting. And it's interesting that I have yet to see in the scientific literature any group of patients who are seriously ill with heart disease where you give them nuts, and peanut butter, and cashew sauce, and have their disease ever halt or be reversed.

So it's more than just an omega-3 versus an omega-6 thing?

Omega-3 and omega-6 are essential fatty acids. You will very likely never be short on omega-6. Unlikely to be short on omega-3 if you're getting plenty of green leafy vegetables, chia seeds, or flaxseed meal. But if you do want to be sure, get checked and have a omega-3 check test. It says you can either be optimal, borderline, or low. You can always take a supplement of omega-3 algae until you bounce your numbers up where you're more optimal.

So in theory, if I was a very healthy individual that's in my 30s and 40s, in theory, I could consume a very small amount of nuts, that would be healthy, but ultimately, the recommendation is-

Yeah, on page 69 of my book, I’m not against patients who are otherwise healthy having nuts. This is for patients with heart disease.

Got it. I think about my Italian friends listening to you. So, no olive oil, no mozzarella, no pizza…

No, you can have all kinds of pizza, but you can't have cheese on it, and you can't have olive oil with it. They're going to be very delicious pizzas, vegetable pizzas.

So when people call your recommendations ‘draconian,’ what they're really not seeing is that they actually have results attached to them, right?

I don't think they're draconian at all when you think about it.

They're draconian in the sense that they're so powerfully curative.

When somebody calls it severe, strict or draconian, let's look at the foods that are in our diet nutrition plan. There's not one food that we're asking people to eat that they haven't already eaten throughout their lives. The only thing that they are deciding is draconian is the fact that we're asking them to simply remove from that diet foods that, if they continue to eat them, will guarantee that they will become sick, ill and perish from disease.

Our draconian step is to take away the killing foods. And I don't think that's draconian.

If we were to take our diet to Okinawa, the Okinawans would look at us and say, well, it's about time you guys caught on. We've been doing this for centuries!

True or false, red meat has the same level of carcinogenicity as cigarettes?

That was the famous saying that came in October of 2015, from The World Health Organization. Imagine that. Representatives from countries throughout the world agreed that it was time to label red meat as having the same level of carcinogenicity as smoking cigarettes. What a tremendously powerful statement.

Doctor, what about people that say that fish and fowl, chicken are okay? Is that still in the-

They don't know the science. Animal protein.

If someone's making a choice for chicken because-

It's a question of whether you want to be shot or hung.

Wow. Neither, please. Okay. And so, let's say I'm listening to you right now and I'm in, but there's a lot of other information that I'm getting lately, there are trends towards intermittent fasting, or genetics-related dieting plans, or “inflammatory foods.” There are a lot of trends that are happening in the world of nutrition, no doubt you've seen them throughout your career. How do you feel first about intermittent fasting?

Well, look, if you just want to get comfortable about it, ask yourself, what do the rural Chinese do? What do the Okinawans do? What do those in Central Africa do? Do they all have intermittent fasting?

I don't have a problem with people who want to fast. That's not going to hurt them. Is what they do when they stop fasting that hurts them. I don't have a problem with that. There are different types of fasting. We have a situation when, let's say we, and this happens all the time, we get patients who come into our program, and let's say that they come in, they weigh 250, 300, 350, 400 lbs [113, 136, 158, 181 kg]. A month or two ago, I had a patient who weighed 500 pounds [226 kg]. You got to get to work on that.

We borrowed something from the National Institute on Aging about eight or nine years ago that I think it was a very powerful and very strong addition. And that is, and you have to watch it if they're diabetic because you don't want them to have hypoglycemic episode, but we'd like those patients to have a total water only fast, two days a week, 24 hours, water only. And that really kind of kick starts the weight loss along with the plant-based diet itself. And then they don't go through those awkward moments where they lose weight, plateau for a number of months, get discouraged, and get recidivism, and then they end up gaining the weight back. But if they have a program where they are successful, it really helps them to keep going and really achieve the goals that they're after.

I'm hearing you and I personally am totally bought into what you're saying.

But then, if you walk into a supermarket and you go to a frozen food section, there's such a long distance between how we should be eating and how we're currently eating throughout American society today.

And I'm wondering - are we destined to be addicted to unhealthy food when so much unhealthy, processed, fried food is around us every day? It seems like such a difficult thing for so many people, many of whom are just trying to put food on the table, to walk into a supermarket to see their choices, and to not choose something that's unhealthy.

How do you feel about compliance? I know you're not a psychologist, but how do you feel about compliance in a world where so many of the choices are so poor and addictive?

We recently looked up some 200 patients who had been through our program for close to four years. And we found that the compliance and adherence was about 89.3, that's almost 90%. A number of physicians often will attend our seminar just because they want to be familiar with it, and they're really quite astounded. And often they'll say, "Well, Dr. Esselstyn, I've tried your approach, but really, can I get a patient to follow this approach?"

Why is it that we're getting 90% adherence? And I think the answer to that, quite clearly, is that we're showing the patient respect.

How do you show a patient respect? The only way that I know to really show a patient respect is to give them our time.

And presently, with the seminar that I was conducting until the virus hit, once a month, we'd have 12 or 14 participants, always with their significant other or their spouse in attendance, which rarely happens at the doctor's office. Because both parties have to know what you're asking for. And then the seminar itself is six hours in length. These patients come in, they start at nine o'clock in the morning, and we finish about three o'clock in the afternoon. They're going to learn all about how they have created their disease, and precisely how we're going to empower them as the locus of control to halt and reverse their disease.

Why is it six hours? Because in six hours, they're going to learn all the details. They get a very hefty notebook that has a copy of every PowerPoint slide that I use. They get a copy of several of our scientific articles, a 44-page handout with many additional recipes that add to the 240 others, which will be in the two books that we provide them. There's a marvelous hour and a quarter from a woman who is at 33 years of plant-based nutrition, and she shows how to deal with restaurants and travel. And everybody receives a DVD of the entire seminar, so that when they go home and get forgetful or rusty, they can flip it on and get themselves back up to speed.

Then we always have two or three local or regional participants who've had a previous successful experience share their story with those in attendance, who can then say to themselves, “listen, if he or she can do this, I can do this.” And then, we have an opportunity to answer everybody's questions. We have a plant-based luncheon. And then stay in touch as necessary through email or phone call. Since these patients come from throughout the United States, 90% are outside the state of Ohio or from throughout Canada, or from overseas. I get them once. So I have really got to make those six hours very imperative and meaningful, and also to show them respect.

Two weeks before the seminar I ask my secretary to present me with a list of everybody who's coming plus their telephone number. And I then will call every one of these patients myself beforehand so that I can get my arms around their story. And at the same time, I will present them with an opportunity to ask questions of me. This is so that once they come to the seminar, we already have a strong platform from which we can all move forward.

And really, with all due respect to my fellow physicians who say that's unsuccessful, if you think that you're going to get somebody to change their lifestyle in a 12 or 15 minute office visit without the spouse, not going to happen. And I must say that’s where I think we really throw the hook. And I spend at least an hour on the endothelial cell and the gas that it produces, nitric oxide, which is the great salvation and protection of all our blood vessels.

Can you imagine somebody who has been with us for six hours who understands what I've said about the endothelial cell and nitric oxide? How could they possibly look me in the eye and say, "Dr. Esselstyn, Lois and I are going to have our 35th wedding anniversary in a couple of weeks. And boy, am I going to destroy my few remaining endothelial cells!" What? Not going to happen. So you provide them with this message, and enough science in the vocabulary that they can grasp and get their arms around. And I think that's why we have that degree of success. I'd like to have it be even better, I'd like to have it be 95 to 100%. It's a tough sell because everywhere that these people have been going through all their lives, anytime they're in any gathering, there's always the food that's going to destroy endothelial cells.

Doctor, we talked about things that people should avoid. In the light of knowledge is power, let's try and inspire people. What should we be eating?

I would start with all these marvelous whole, W-H-O-L-E, whole grains, and pasta, bread rolls, bagels, and so forth. 101 different types of legumes, lentils and beans. All these marvelous red, yellow and green leafy vegetables and some sweet potatoes, white potatoes and some fruit. In my book, and the one by wife and my daughter To Prevent and Reverse Heart Disease Cookbook, and books by John McDougall and Neal Barnard, There are hundreds of wonderful recipes that are available.

You've been advocating for a plant-based diet since 1984. As I recall, there's a story that you like to share about being at a dinner for doctors and they gave you a big steak and you didn't want it anymore. How do you feel about this new era in plant-based nutrition? Nowadays, there's a lot more news about it, there's a lot more adherence. People are kind of waking up to the idea that eating plant-based, formerly known as vegan is the right way to go. How do you feel about this new era, and I'm also curious about how you feel about the labeling ‘plant-based?’

I treat vegans for heart disease. Vegans who eat oil, vegans who eat french fries, vegans who eat glazed doughnuts. The terminology ‘whole food, plant-based nutrition’ really encapsulates exactly what we are striving for.

There's one thing I want to be sure to say in case some of your listeners have heart disease, that we've been using for the last eight or nine years. It's not in the book, but it's so important. And that is, if I have somebody who has heart disease and they have blockages in the coronary arteries to their heart, and I ask them to try to imagine shrinking their brain to a size that that could actually crawl inside that artery, they would see that the blockage is an absolute cauldron of oxidative inflammation. So, we need antioxidants.

But no, do not go down to the health food store and buy a jug of pills that says antioxidant because it doesn't work and it's going to be harmful. I need them to get their antioxidants from food, fair enough, what food?

Food that is high in what we call ORAC, O-R-A-C, oxygen radical absorbance capacity. So this means that if you're having raspberries, blueberries, strawberries and blackberries on your morning oats cereal, that is a terrific start. However, nothing, nothing, nothing, nothing can trump the antioxidant value of green leafy vegetables.

So I need thee patients to chew, not smoothies, not juicing, to chew a green leafy vegetable six times a day, after it has first been boiled in water, five and a half to six minutes or steamed so it's nice and tender. Then you must then anoint it with several drops of a delightful balsamic vinegar. Why? Because it's the acetic acid in the vinegar that will restore the nitric oxide synthase enzyme, which is the enzyme contained within the endothelial cell responsible for making nitric oxide.

Now, therefore, you're going to chew this alongside your breakfast cereal, again as a mid-morning snack, again with your lunch and sandwich. That's three. Mid afternoon, for. Dinnertime, five. And of course, I adore it when you have that evening snack of kale.

What are you doing? All day long you're absolutely bathing that horrible oxidative cauldron of inflammation with nature's most powerful antioxidants. At the same time, you're helping to restore the endothelial capacity to make nitric oxide.

However, the second thing that chewing the greens does, chewing the greens will restore the capacity of your bone marrow to once again make the endothelial progenitor cells. What do they do? They replace our senescent, injured, worn out endothelial cells.

Now, the third thing, and this is so important, the third thing that chewing the greens does: when you are chewing the greens, you are chewing a nitrate, as you chew that nitrate, it is going to mix with the facultative anaerobic bacteria that reside in the crypts and grooves of your tongue. Those bacteria are going to reduce those nitrates that you are chewing to nitrites. Now when you swallow the nitrites, it is your own gastric acid, which is going to further reduce the nitrites to more nitric oxide. So, there you are, literally morning to dusk, all day long, you are absolutely restoring nitric oxide. The very molecule, the deficiency of which gave you this disease in the first place.

Now, there are some caveats here. One, you can't use mouthwash or antibiotics because they will destroy the beneficial bacteria in your mouth. Two, be careful of any antacids because antacids will reduce the amount of acidity in your stomach and you will not be able to convert the nitrites to more nitric oxide.

Now, what are the green leafy vegetables I'm talking about?

They are, ready?

Bok Choy, swiss chard, kale, collards, collard green, beet greens, mustard green, tender greens, napa cabbage, brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula and asparagus. And the top five are kale, Swiss chard, spinach, arugula, and beet greens!

And look what it does for your memory.

Next question for you. Currently in the United States, by the time that one graduates high school, they have the foundation for heart disease?

Right.

Many out there might be listening to/reading this and thinking, “well, I'm healthy, I don't need to do this. Six times a day? That sounds kind of crazy, I don't need to do this. Eating green leafy vegetables? I can get away with a burger on the weekends, right?”

Are we all a little bit unaware of our current state of health and what's happening inside? When I first read that statistic, I thought that was absolutely crazy, that there could be-

This is a very, very, very sickly country.

When public health experts outline the multiple things that people do to get their health: you get exercise, very few Americans are getting it regularly. You see lots of it on television but very few people are getting the appropriate amount of exercise. Sleep, no. Matter of fact, be sure you want to avoid sleep apnea. They're getting plenty of socialization. And most importantly of all, are they eating plant-based? This is why we have an epidemic of chronic illness. Here we are talking about cardiovascular disease.

However, if we look carefully, cardiovascular disease is not the only disease we're treating with plant-based nutrition. You're getting rid of diabetes, you're getting rid of obesity, you're getting rid of hypertension, you're getting rid of vascular dementia, you're decreasing the likelihood of any kind of Alzheimer's disease. And then of course, you're helping yourself be protected from all sort of colitis, Crohn's disease, rheumatoid arthritis, lupus, multiple sclerosis, allergies, asthma. The list goes on and on.

The heavens have opened up and given this profession the most powerful tool ever that we've had in our toolbox, whole food plant-based nutrition.

So people are a lot more sick than they realize?

Well, obviously when you think about the progression of this, you don't see much of any heart disease at age seven or eight. But by the time you get autopsied, if you're a late teenager or in your early 20s, you've already got the foundation of the disease. And therefore, it’s not a great surprise that by the time people are in their 40s we now start seeing the clinical cardiac events of heart attack and stroke.

Many are worried about switching to a whole foods plant-based diet because they're unaware of how to achieve the nutrition required for a child who's growing. Children need more fat.

It's interesting. When the late Bill Connor went down to northern Mexico and he studied the Tarahumara Indians, the Tarahumara Indians eat the three sisters: beans, corn, and squash. No nutritional deficiencies. They are absolutely champion athletes and runners. Now, people sensibly have whole grain cereal in the morning with maybe a few raisins, banana, and raspberries, blueberries, strawberries and blackberries. And at lunchtime, you can have a soup in which you put every conceivable kind of vegetables and greens. They can be delicious.

And then, of course, my favorite for supper is beans and rice, with all the various cut up vegetables, with peas, corn, cut up peppers, and chestnuts. You've got an absolute feast, and it's a delicious way to eat. You're not going to be protein deficient. As a matter of fact, if your listeners have seen the movie, The Game Changers, you'll never see those incredible athletic specimens, muscles bulging everywhere, and the strongest man on the planet, the German Patrik Baboumian, who is plant-based.

And you would know about that because you were an Olympic rower.

Thank you.

Nowadays, your business is not just your own, your family's very involved. It's really incredible to see your son out there advocating, your wife and daughter. Back in 1984, this message was a lot harder to get out there than it is now. Where do you see the current nutrition movement? Are you excited about it? You just cited the Game Changers, that's a new documentary that's been making a lot of rounds. How do you feel about the current nutrition movement, the next generation, in light of all that we know now?

You cannot even begin to compare the difference - 34 years ago to today. I get very excited about this.

In 1991, I put together a conference with what I thought was really a blue ribbon panel of physicians, and I titled the conference, The First National Conference on Elimination of Coronary Artery Disease. We had 100 people. But the speakers were great, we had a couple from Boston, Dr. Ornish was there, Colin Campbell was there, Castelli was there, Dr. Alexander was there. And it was really kind of exciting.

And I thought, “boy, this is the way to do it,” but nothing happened. Eating is such an ingrained situation. So we had another one, this time in 1997. We had 500 people, and it was really well received.

Again, it was kind of slow but after that, as we moved into the early 2000s, Ornish came out with his data, we came out with our data. Suddenly it was possible for this disease to be halted, and excitingly, even reversed. But the thing that was holding it back was that physicians never learned about any of this in medical school. It was very bizarre. But I should share with you that next month, I've been asked to speak to Harvard Medical School. This will be my third visit to Harvard. And there are some very important people there who I think are beginning to realize the efficacy of this. It's just so hard for physicians to still make the transition to think that brussels sprouts and broccoli, which have never been designed by a great pharmaceutical company, they've simply been designed by the ground from a seed, would be so powerful as plants. And increasingly, there is an awareness that we should eat to avoid any injury to the endothelium. This will really help to turn this around.

I think what also is going to happen is that there's been a basic covenant of trust since the days of Hippocrates, that whenever possible the caregiver, meaning the physician, will share with the patient what is the causation of the illness. And sadly today in cardiovascular medicine, that’s not being done. But I think increasingly, there is that developing awareness, and it will begin to happen.

We now have several absolutely stunning examples of angiograms, which show the blockage in the artery, and then, as these patients have gone into whole food plant-based nutrition, and they've had subsequent follow up angiograms, you can see that area of narrowing begin to enlarge. For those who have had older plaques that have now filled up with scar and calcification and won't go away, even those patients amazingly develop such strong collateralization, and an opening that’s much wider, for all those vessels that are in the heart muscle. Even the older patients have enormous benefit from this approach.

Doctor, it must be funny being interviewed for news channels, going to events and always running into your friends. So T. Colin Campbell, Dr. Ornish, Dr. Greger. Who are some researchers and people in the field that you wish we would know a little bit more about? Whether it's someone who may not be US-based, or any women within the US that have been doing this type of research for a while? Are we really just at the beginning?

There are wonderful people. Four years ago, I was invited by the American College of Cardiology to become a member because they wanted me to join their nutrition committee, which I have done. And it's really a glowing group of people who are totally committed to plant-based nutrition. It's very empowering to be a part of that group. It really gives you a great sense of pride and reassurance that this is eventually going to get there because right now, this poor nation is being drawn into debtors prison. Now, it's really been accelerated by this virus, obviously, but before then we have social security, which is fine. Then we have Medicaid and Medicare. Medicare is an enormous expense for this nation. What do you think is 45% of Medicare? Cardiology. All the drugs, all the imaging, all the procedures, the bypasses, the stents. All these things costs enormous amounts of money. And yet, this is a disease that doesn't even exist in half the planet.

With all the news around COVID-19 right now, do you find that people, if we all were eating a lot better - a whole foods, plant-based diet - we would be in a much better position when it would come to fighting this virus, right?

It's very easy to state right at the outset that if people have a strong immune system, they might do much better. I'm convinced that's probably the case. But there may be something in the genetics of our immune system that is different in all of us so that we respond differently to the virus, because there are some people who literally have had COVID-19 coronavirus, and they never even know it. They're testing positive or they tested with antibodies knowing that they've had it. In others it’s mild, for others it obviously is very crippling, and for others it actually kills them.

One of the things that's been fascinating is some data from when the SARS virus was around. It was made aware that somehow the gas nitric oxide was very capable of injuring the virus. And so, the Massachusetts General Hospital has taken that information to heart. They have started two studies. One study where there are identifying patients with coronavirus where they three times a day have them inhale for 30 minutes nitric oxide - morning, noon and late afternoon early evening. And they want to see if they can shorten the course of the illness in these patients. And the other study they're doing, they're taking health care workers who are very susceptible to developing and acquiring this disease because of their exposure and they're giving them inhalations of nitric oxide. 30 minutes when they come to work, 30 minutes when they leave. It would be fascinating.

I wrote a little editorial piece about nitric oxide and Coronavirus because I feel that if people will eat in a way that you keep your nitric oxide levels very, very high, and you do that especially by eating the green leafy vegetables that I've already mentioned six times a day for heart disease, well, it's six times a day to try to, because if if a virus tries to infect your wind pipe or your trachea and you're making plenty of nitric oxide, the hope is that will greatly diminish the likelihood that you will acquire the disease or if acquired, it may mitigate against the intensity of the disease.

Is this why you're still doing what you're doing? I feel like a lot of your friends at this point must be like, “you know what, it's time for me to relax. Been there, done that.” But you're still talking to me right now, you're still running seminars, you're still writing op eds. Is it because you see such a distance between where we're at in the United States and where we could be?

What's driving you at this point to continue to put in this much time and effort into spreading this message? Listening to you rattle off all of the leafy greens that we should eat, I mean, you've certainly said that so many times, countless times. I've actually felt kind of guilty asking you to say that again…

What's driving you at this point, Doctor, because you've written the book, you literally wrote the book on preventing and reversing heart disease. You did so much. Why do you feel this need to continue?

Well, it’s the reason I went into medicine in the first place, maybe you'll be able to help out. And suddenly after a surgical career, it became obvious to me that while you can help people one at a time with something like surgery, when you are able to get information out about nutrition that will vanquish 80% of chronic disease - you talk about getting bang for the buck.

It's so enormous, where you would, if it all worked out, you would save the planet as well as saving lives throughout the world. It's been very exciting when I've had a chance to travel to Singapore, to China, to Denmark, to Iceland…

I would simply have to say that right now I really visualize in front of us what I call the “seismic revolution in health.” And the seismic revolution in health is never going to come about with another pill, another procedure, another operation.

The seismic revolution in health will come about when we in the profession have the will, and the grit, and the determination to share with the public what is the lifestyle and most specifically, what is the nutritional literacy that will empower them to absolutely annihilate illness and disease. •

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By Jenna Matecki
Photo from Dr. Esselstyn’s Instagram
Special thanks to the T. Colin Campbell Center for Nutrition Studies

Follow Dr. Esselstyn to stay up to date with the amazing work he’s doing. There is also an upcoming online conference run by the Esselstyn family called Plant-Stock 2020.

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