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Old 05-05-2009, 08:32 PM   #1
Mark Cheney
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Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

So my parents have decided to adopt the dietary program prescribed by Caldwell Esselstyn in his book Prevent and Reverse Heart Disease. Not only that, they sent me a copy to "review." I'd like to be accurate on my response to them so any thoughts or articles on the following would be appreciated.

First - the part that I agree with.

Esselstyn emphasizes that physicians should be working to prevent cardiovascular disease, not treating they symptoms with stents, angioplasty, bypass surgery etc.

He (rightly) blames the typical Western diet for CVD. Included in this are some isolated side references to refined grains, sugar, and their impact on insulin. His best quote, "If Americans abandoned their toxic diets and learned a truly healthy approach to eating, we could largely limit . . . strokes, hypertension, obesity, osteoporosis, and adult-onset diabetes. Meanwhile we would see a marked reduction in cancers of the breast, prostate, colon, rectum, uterus, and ovaries."

Half of the book consists of recipes, many of which would seem to make good vegetarian, Paleo dishes.

So far, so good, until he assigns blame and prescribes the solution.

The cause of CVD? High cholesterol caused by dietary fat (all types).

Among his claims: "A person who maintains blood cholesterol under 150 mg/dL for a lifetime will not develop coronary arter disease - even if he or she smokes, has a family history of coronary disease, suffers from hypertension, and is obese!"

He also says, "If you follow a plant-based nutrition program to reduce your total cholesterol to below 150 mg/dL and the LDL level to less than 80 mg/dL, you cannot deposit fat and cholesterol into your coronary arteries"

"The medical literature is filled with evidence of the harmful effects of monousaturated oil."

Other claims - cultures that eat low fat, low cholesterol diets rarely have heart disease; eating fat causes the body to produce excess cholesterol; excess LDL helps form plaques; milk/casein causes prostate cancer; the brain has fat and sugar receptors that function the same as those responsible for narcotics addiction.

The solution? A strict vegetarian diet - vegetables, legumes, whole grains (including whole grain breads and pasta), and fruit. He also prohibits any type of oil (including EVOO), nuts, avocadoes. The resulting diet has only 50-70 grams of protein (from plants) per day, and aims for 10% fat.

Overall, there seems to be a high reliance on T. Colin Campbell and the China Study. Conversely, the number of references to other medical literature are relatively low (especially compared to GCBC).

So what are your thoughts, CrossFitters?
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Old 05-06-2009, 06:16 AM   #2
Laura Kurth
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

I like that he pushes a plant based diet and agree that cultures who follow said plant-based diets do tend to be much healthier than us.

However any diet that recommends cutting out entire food groups, including perfectly healthy foods like avocados and nuts/olive oil etc. is quite silly.

All in moderation. Take from his book that yes, a plant based diet is good. Yes, eating a ton of processed food is bad. Yes, good cholesterol numbers are good.

The problem is not that americans eat meat/fat/ etc. it is that they eat too much of it. Too much of everything, except fresh vegetables and fruits which they do not eat enough of.

And a diet of 50-70 g protein might keep you alive, but it is no diet for an athlete IMO.
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Old 05-06-2009, 06:36 AM   #3
Laura Kurth
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

i forgot to add that when looking at a diet/lifestyle change, adherence is a huge issue.

A diet that is extremely fat restricted will be incredibly hard to stick to. Fat gives food flavor, and makes a diet more satiating.

If somebody tries to go from a western diet to one with <10% calories from dietary fat, they will likely fail miserably, very early on.

I think many people forget that the biggest problem is adherence. Almost any diet 'works' if the person sticks to it. The problem is, most people do not stick with the diet. And a diet like this one, or like the PSMF/Velocity style diets etc. are just set up for failure right from the beginning. At least for most people.
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Old 05-06-2009, 06:57 AM   #4
John C Corona
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

I believe Dr. Esselstyn's track record speaks for itself. He is among few doctors that actually work to 'cure' patients. I also like his plant-based diet, which is why I follow it pretty strictly. I get about 50-70g of protein daily == 1g of protein per 1kg of body weight, and eat about 10-15% fat daily. I do eat avacados and olive oil in small bits. I went from a 205 total cholesterol to a 115 in about two years time following this mainly vegetarian diet. Would I have gotten similar results while still consuming high cholesterol foods in moderation, maybe, but I never had below 150 until I gave up the daily meat consumption.

I feel your parents are in good hands, and you cant go wrong with eating more plants. There are so many questions surrounding meat and dairy, but no one questions the benefits of fruits and vegetables. Dr Esselstyn's has never had a patient die of heart disease with a below 150 total cholesterol. I also like that he not only advocates this diet, he follows it! Unlike my doctor who is overweight and is always full of mucus and sinus issues. I just wish my folks would follow this diet rather than eating blood pressure and cholesterol medication to control it.
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Old 05-06-2009, 06:58 AM   #5
Lawrence "Bo" Boland III
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

The problem here is that the flaws of the "western" diet isn't the fats... its the sheer amount of refined carbohydrates that we eat compared to other cultures.

I've been reading Good Calories, Bad Calories by Gary Taubes... and there is a staggering amount of evidence to back this up. That being said, during the time that I've read this book, I've thought of this exact scenario (Someone with the precursors to heart disease coming along, and trying to look for a diet to help them). Even though Taubes pretty much lays it out there that the current hypothesis on CVD (that the medical community endorses) is based on a poorly put together study... it would be very hard for me to try and suggest otherwise with all of the information that has been crammed down our throats for the last 40 yrs.

I really think that your parents need to sit down and get information from a few sources before they make up their minds... especially if their health condition depends on it.
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Old 05-06-2009, 07:55 AM   #6
Chris Lampe
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

Since my dad underwent quintuple bypass surgery this has become a major interest for me. I havent' read the book mentioned by the OP but would highly recommend Dr. Arthur Agatstons "South Beach Heart Program". He's the creator of the South Beach Diet but more importantly, he's a practicing cardiologist who created the "heart scan" measuring techniques that are being heavily promoted. In fact, when you have a heart scan you get an "Agatston Score". Thankfully, mine was zero (my dad's was 800). Dr. Agatston states that following an aggressive prevention plan will prevent almost all heart attacks, even in those with previous heart attacks.

Dr. William Davis has a similar book, also based on heart scans, called "Track Your Plaque". I haven't read this book but I've spent a lot of time reading his blog and forums and his approach is very similar to Dr. Agatston's.

Interestingly, Dr. Agatston recommends the South Beach Diet, which include whole grains, while Dr. Davis recommends cutting out grains entirely. In a recent blog post someone mentioned that Dr. Agatston actually follows a Paleo or near-Paleo diet but includes whole-grains in his books due to a belief that giving up grains is more than most people are willing to do. He's probably correct in his belief.

I would recommend buying your parent's one or both of these books and encouraging them to read them. They can then note the commonalities and the differences in the three programs and make a more informed opinion on a program to follow. I don't know about the "nobody with Cholesterol below 150 has a heart attack" statistic but I know that one or both books I read mentioned that 50% of people who have heart attacks have NORMAL cholesterol levels. The current belief seems to be that it's more a matter of particle (LDL and HDL) size rather than amount.
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Old 05-06-2009, 09:36 AM   #7
Jay Cohen
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

Mark;

So how healthy are your folks?
Over weight, Under weight, Posture, flexibility, the ability to move well????????????

I'd ditch the d-mn latest, bestest diet book and hook them up with Starting Strength.

Now before you all give me Sh-t, Rip has stated numerous times that the biggest debilitating factors for Seniors(other then mental health issues), is lose of mobility. The inability to get off a toilet seat, get in/out of a car, carry a bag of groceries up the steps.

Get them Strong along with a basic clean diet(don't need any diet of the month book for that) and they'll be good to go.

If they won't do the basic lifts, at least get them to a Crossfit CF to have basic movement skills shown and reviewed.

Picture the look on the kids and grand kids of the CURRENT CF posters on these boards, when they(CF'rs) reach 60/70/80 and are still doing Pull Ups, Squat, Deads and some Box Jumps. Are you all going to quit CF'ing or some scaled version of Lift Stuff Off the Ground, Press Overhead, just because you turned _________ insert age?

Get Strong-Get Real, Eat Real Food. Sorry, Meat trumps Weeds any day of the week.
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Old 05-06-2009, 09:54 AM   #8
Katherine Derbyshire
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

There is lots and lots of evidence suggesting that plant-based diets are better. It's not just the China study: essentially all of the world's long-lived cultures eat diets with lots of vegetables.

However, there's a big difference between "plant-based" and "strict vegetarian." And since he's cutting out nuts, avocados, and plant-based oils -- even olive oil, which is pretty much universally agreed to be ok -- he's going well beyond even a "typical" vegetarian diet.

Since the best diet is the one you can follow consistently, I think your parents would be better off with a far less radical prescription.

Katherine
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Old 05-06-2009, 02:18 PM   #9
Robert Callahan
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

Quote:
Originally Posted by Mark Cheney View Post
The solution? A strict vegetarian diet - vegetables, legumes, whole grains (including whole grain breads and pasta), and fruit. He also prohibits any type of oil (including EVOO), nuts, avocadoes. The resulting diet has only 50-70 grams of protein (from plants) per day, and aims for 10% fat.
http://www.ncbi.nlm.nih.gov/pubmed/10744590 (WFS)

Here is one article demonstrated walnuts used in a Mediterranean diet has a potent cholesterol lowering effect.

I think avoiding fats is just silly. They are an integral part of our bodies and essential for life.

If I had to recommend anything it would be eliminating refined carbs from their diet and not getting a surplus of their daily fat from saturated fat. Red meat and bacon won't kill them, but it won't help them either.

Also have them check their blood work regularly, as in every 2-6 months. That way they can track what their cholesterol, triglycerides, and other blood markers are doing and then make more informed decisions over what to change in their diet.
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Old 05-06-2009, 02:36 PM   #10
Phillip Garrison
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Re: Thoughts on Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn

Quote:
Originally Posted by Mark Cheney View Post
So my parents have decided to adopt the dietary program prescribed by Caldwell Esselstyn in his book Prevent and Reverse Heart Disease. Not only that, they sent me a copy to "review." I'd like to be accurate on my response to them so any thoughts or articles on the following would be appreciated.

First - the part that I agree with.

Esselstyn emphasizes that physicians should be working to prevent cardiovascular disease, not treating they symptoms with stents, angioplasty, bypass surgery etc.

He (rightly) blames the typical Western diet for CVD. Included in this are some isolated side references to refined grains, sugar, and their impact on insulin. His best quote, "If Americans abandoned their toxic diets and learned a truly healthy approach to eating, we could largely limit . . . strokes, hypertension, obesity, osteoporosis, and adult-onset diabetes. Meanwhile we would see a marked reduction in cancers of the breast, prostate, colon, rectum, uterus, and ovaries."

Half of the book consists of recipes, many of which would seem to make good vegetarian, Paleo dishes.

So far, so good, until he assigns blame and prescribes the solution.

The cause of CVD? High cholesterol caused by dietary fat (all types).

Among his claims: "A person who maintains blood cholesterol under 150 mg/dL for a lifetime will not develop coronary arter disease - even if he or she smokes, has a family history of coronary disease, suffers from hypertension, and is obese!"

He also says, "If you follow a plant-based nutrition program to reduce your total cholesterol to below 150 mg/dL and the LDL level to less than 80 mg/dL, you cannot deposit fat and cholesterol into your coronary arteries"

"The medical literature is filled with evidence of the harmful effects of monousaturated oil."

Other claims - cultures that eat low fat, low cholesterol diets rarely have heart disease; eating fat causes the body to produce excess cholesterol; excess LDL helps form plaques; milk/casein causes prostate cancer; the brain has fat and sugar receptors that function the same as those responsible for narcotics addiction.

The solution? A strict vegetarian diet - vegetables, legumes, whole grains (including whole grain breads and pasta), and fruit. He also prohibits any type of oil (including EVOO), nuts, avocadoes. The resulting diet has only 50-70 grams of protein (from plants) per day, and aims for 10% fat.

Overall, there seems to be a high reliance on T. Colin Campbell and the China Study. Conversely, the number of references to other medical literature are relatively low (especially compared to GCBC).

So what are your thoughts, CrossFitters?
Most of what he says can be supported by research so technically he's not wrong
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