Caldwell Esselstyn, Forks Over Knives, the documentary

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Caldwell B. Esselstyn, Jr., M.D.

Dr. Caldwell B. Esselstyn, Jr., received his B.A. from Yale University and his M.D. from Western Reserve University. In 1956, pulling the No. six oar as a member of the victorious United States rowing team, he was awarded a gold medal at the Olympic Games. He was trained as a surgeon at the Cleveland Clinic and at St. George’s Hospital in London. In 1968, as an Army surgeon in Vietnam, he was awarded the Bronze Star.

Dr. Esselstyn has been associated with the Cleveland Clinic since 1968. During that time, he has served as President of the Staff and as a member of the Board of Governors. He chaired the Clinic’s Breast Cancer Task Force and headed its Section of Thyroid and Parathyroid Surgery.

In 1991, Dr. Esselstyn served as President of the American Association of Endocrine Surgeons. That same year he organized the first National Conference on the Elimination of Coronary Artery Disease, which was held in Tucson, Arizona. In 1997, he chaired a follow-up conference, the Summit on Cholesterol and Coronary Disease, which brought together more than 500 physicians and health-care workers in Lake Buena Vista, Florida. In April, 2005, Dr. Esselstyn became the first recipient of the Benjamin Spock Award for Compassion in Medicine. He received the Distinguished Alumnus Award from the Cleveland Clinic Alumni Association in 2009.

His scientific publications number over 150. “The Best Doctors in America” 1994-1995 published by Woodward and White cites Dr. Esselstyn’s surgical expertise in the categories of endocrine and breast disease. In 1995 he published his bench mark long-term nutritional research on arresting and reversing coronary artery disease in severely ill patients. That same study was updated at 12 years making it one of the longest longitudinal studies of its type. It is most compelling, as no compliant patients have sustained disease progression. Today, 20 years later compliant patients continue to thrive.

Dr. Esselstyn and his wife, Ann Crile Esselstyn, have followed a plant-based diet for more than 20 years. They work together to counsel patients both in Cleveland, where they live, and in summer at the farm in upstate New York where Dr. Esselstyn grew up. Dr. Esselstyn concentrates on the medical details, and Ann focuses on healthy foods and how to prepare them.

FORKS OVER KNIVES examines the profound claim that most, if not all, of the so-called “diseases of affluence” that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods. The major storyline in the film traces the personal journeys of a pair of pioneering yet under-appreciated researchers, Dr. T. Colin Campbell and Dr. Caldwell Esselstyn. Dr. Campbell, a nutritional scientist at Cornell University, was concerned in the late 1960’s with producing “high quality” animal protein to bring to the poor and malnourished areas of the third world. While in the Philippines, he made a life-changing discovery: the country’s wealthier children, who were consuming relatively high amounts of animal-based foods, were much more likely to get liver cancer. Dr. Esselstyn, a top surgeon and head of the Breast Cancer Task Force at the world-renowned Cleveland Clinic, found that many of the diseases he routinely treated were virtually unknown in parts of the world where animal-based foods were rarely consumed. FORKS OVER KNIVES utilizes state of the art 3-D graphics and rare archival footage. The film features leading experts on health, examines the question “why we don’t know”, and tackles the issue of diet and disease in a way that will have people talking for years.

TRANSCRIPTION:

Caryn Hartglass: Hello, I’m Caryn Hartglass and you’re listening to It’s All About Food, and we’re here talking about the new documentary Forks Over Knives which will be premiering in theatres on May 2nd. My next guest is Dr. Caldwell B. Esselstyn Jr. and he is the author of a wonderful book, Prevent and Reverse Heart Disease. He’s got a wonderful website http://heartattackproof.com/ and is associated with his great work with the Cleavland Clinic Wellness Institute. Welcome, Dr. Esselstyn.

Dr. Caldwell Esselstyn: Good afternoon.

Caryn Hartglass: How are you?

Dr. Caldwell Esselstyn: I’m fine, thank you.

Caryn Hartglass: Great. Well, I was just talking to Dr. Campbell and both of you are two of my favorite heroes.

Dr. Caldwell Esselstyn: Oh, well I heard a good portion of that.

Caryn Hartglass: And I have had the good fortune to hear you a number of times and meet, and, as well, your wife, and the two of you are a remarkable team. I love all the work you’ve been doing for a long time. Just speaking of family, you have four children and I’m trying to glean some of the information from the website, but you’ve been on this health path for over twenty-five years, the plant-based food path.

Dr. Caldwell Esselstyn: That’s right.

Caryn Hartglass: And has your family been along with you on the path all along?

Dr. Caldwell Esselstyn: Oh yeah. Totally.

Caryn Hartglass: Because that’s always a challenging thing when the family, especially the children. And so your son, Rip Esselstyn, is right there too with his own book and spreading the message as well so you’re a great team. You’ve seen some amazing things with heart disease and some of the stories talked about in the film Forks Over Knives, but what is it like when people come to you and they’ve basically been given a death sentence where there is no hope?

Dr. Caldwell Esselstyn: Well, that was sort of the group that we started with. We had considerable guidance from the global review that I had done before we ever started the research because even today, if you were a cardiac surgeon, and you were to take your business and hang up your shingle in rural China or the Papua Highlands in New Guinea or the Central Africa or the Tara Humara Indians in Northern Mexico forget it. You better plan on selling pencils.

Caryn Hartglass: There’s no business.

Dr. Caldwell Esselstyn: Heart disease is virtually non-existent in these nations because their cultures, by heritage and tradition, are plant-based and they just are not eating any of the building blocks for heart disease and that is what is so striking. When you take patients, even those who have failed their first or second bypass, they’ve failed their first or second angioplasty, they are too sick for these procedures or, as in our original group, there were five who were told by expert cardiologists that they wouldn’t live out the year. Low and behold, those five made it well beyond twenty years and everybody after twelve years, who was totally compliant, had put an end to any progression in their disease and we often found striking reversal or regression of the disease.  The body has an incredible capacity to restore itself once that the injury is no longer occurring.

Caryn Hartglass: It has an incredible capacity and it is relatively quick, isn’t it?

Dr. Caldwell Esselstyn: Yeah, but as my friend, Dr. Ornish, confirmed as well, the patients that do it and do it completely are the ones that just absolutely sparkle. And we’ve just now been looking up, not beyond our original research group, but we are just about to report on another two hundred patients where again with over 92 percent compliance the disease is halted, it’s ended. It is just so powerful to think that compared to what sadly we are doing today in heart disease that we are using drugs, we are using procedures, using operations which are truly life-saving in an emergency or a heart attack, but for the majority of patients, the reason they don’t get well and they have to get their first or second stint, or their first or second bypass, is because even in those who do these procedures, they don’t treat the causation of the disease. And somehow, years ago, with physicians who were treating heart disease they kind of gave up on the idea that patients would ever really change their behavior. That’s what we’ve challenged and founded: that that is totally untrue.

Caryn Hartglass: I wanted to bring that up because I had a visit not too long ago with a cardiologist just for a baseline of a number of things and I had a discussion with him. He just kind of glossed over the first few things that you need for heart health. He went “Diet and exercise … and you need to take these drugs.” Why is it that so many cardiologists and doctors really believe that people don’t want to change? And yet I think that if the doctors told them “This is it,” they would have a lot more motivation.

Dr. Caldwell Esselstyn: Well, they’re a number of things obviously now that have come into play. One is the fact that most physicians have seen twenty or twenty-five patients a day and they don’t have the time to do the counseling themselves. They don’t have the passion for this. The truth be known, physicians really never get the training in nutrition; they really don’t possess the skillset for it. So, what is very frustrating to them is that the most powerful tool that we have for ending this disease is something with which they are not familiar. Now also we can’t overlook the fact that in the present-time, there is no insurance mechanism or reimbursement for physicians who are committed to this counseling endeavor. It’s very hard for physicians to be enthusiastic about spending a great deal of time and effort on something for which they are not being reimbursed. Hopefully that will change as time goes on and as insurance companies begin to come on board with this

Caryn Hartglass: Yeah, we were talking about it earlier and has to change. We read all the time about how our healthcare costs are probably one of the largest chunks in the country’s budget and we don’t have better healthcare than other developed countries. It might even be worse than most of them yet we have the highest costs. We need to change.

Dr. Caldwell Esselstyn: It could turn around in a heartbeat. I think the reason we feel that we can succeed with this is that right now we have sort of fine-tuned our counseling approach because so many of our patients come from out-of-state when they come to the Cleveland Clinic Wellness Institute where I direct the prevention and reversal of cardiovascular disease program. These people obviously can’t come to Cleveland and stay for a number of days at a time so we, about a decade ago, pretty well perfected this very intense counseling seminar which lasts for about five hours.  We start at about nine o’clock in the morning, finish at two. They give them a forty-four-page handout of a couple of scientific articles and a signed copy of the book . Plus we go over in great detail exactly what is the science behind what has caused their illness. We do this with an opportunity for them to understand the presentation by sort of getting rid of the medical jargon or where necessary converting the medical jargon and into something they can understand and be comfortable with and really grasp. Here are patients who have had failed bypasses and failed stints, and have had stents and bypasses but don’t want to have anymore of these, or they’ve had a heart attack and they just simply want to end it. It’s very very exciting for them to recognize the fact that wait a minute, here is a physician spending five hours on this, I really begin to understand that this is pretty darn important, this is how I got the disease in the first place. For instance, if you happen to get poison ivy we don’t spend the day talking to you about different potions, creams, and salves that we can keep putting on this throughout the summer. We are often guided by saying “You know those funny little three leaves in the backyard? I want you to no longer crawl through those.” It’s something that really has been a basic covenant of trust since the days of Hippocrates: to really inform patients on the causation of their disease. When they do this, we have an incredible track record of success. But here we have the leading killer of women and men in Western Civilization where literally physicians are not doing this. And if the patients should bring it up, they are often insulted.

Caryn Hartglass: That’s true. Now, I hear this a lot, you probably do too, but people say “We are all going to die, so why don’t I just eat what I want to eat?”

Dr. Caldwell Esselstyn: Beg your pardon? I really would like to spend the last fifteen years of my life drooling out of a wheelchair after I’ve had a stroke. Come on. We can do better than that.

Caryn Hartglass: How quickly can things turn around if someone has high blood pressure, for example? And what do they have to do to make a change?

Dr. Caldwell Esselstyn: Well, everybody is different. Whether it’s high blood pressure they’ve got or diabetes type two or cardiovascular disease of the carotid to the brain, the vessels to the legs, or the coronary arteries to the heart, what I try to do is to get patients to understand the following: that what we understand about heart disease today (and all experts pretty well agree on this) that what really breaks down at the outset is that we begin to injure the lifeguard or the guardian of our blood vessel which is that marvelous layer of cells that is one cell layer thick and it has this enchanting name: the endothelium. The endothelial cell has a remarkable job of making this amazing molecule that protects it and it’s a gas that is called nitric oxide. That’s where it comes from. You don’t get this from a pill. You get nitric oxide from your food, from the endothelial cells themselves manufacture it. What was so sad about our country that we see at the start is that if you look at the autopsy results of our GIs who die in Korea and Vietnam, by age twenty, eighty percent of them will already have coronary artery disease that you can see without a microscope. Somebody would say “Well wait a minute, maybe that’s the stress of the military.” So forty years later it was repeated, this time with women and men between the ages of seventeen and thirty-four. Low and behold, the disease is now ubiquitous. Those are people who died of accidents, homicides, and suicides and so nobody is really escaping. It’s not enough at that age to have the clinical cardiac event, but there it is already established. Why? Because going back to what I just said about the endothelium and the nitric oxide. Every time certain foods pass our lips, the endothelium is injured. So the level of nitric oxide we have when we are five, six, and seven years of age may be up as high as our eyebrows. By the time we are teenagers, it is down by our waist and by the time we are fifty and sixty it’s down at our toes. There’s not enough nitric oxide left to even protect us from making all of these blockages. What really happens to these patients, and it’s a long way of answering your question, is when patients just get it and they stop every last morsel of food that is going to injure their endothelium it begins to recover. We often see patients who will either have a marked lessening or diminution of their chest pain within ten days to two weeks and sometimes it will be completely gone at that time. It’s very very impressive and everybody is going to be a little different. The same thing applies to their blood pressure: as the artery begins to restore, its elasticity becomes more flexible and responsive. Again, in some patients this may be several weeks, others may take longer.

Caryn Hartglass: Right. There’s a great graphic example in the film, Forks Over Knives, about the endothelium and how it works which makes it very easy to understand what is going on. Let’s see, we just have a couple minutes left. I was commending Dr. Campbell and I wanted to do that for you too. You’re at a time in your life where you’ve done so much incredible work and you can just sit back and relax and enjoy it all, yet you’re just non stop, keep going, putting this information out there. What motivates you?

Dr. Caldwell Esselstyn: I think that as exciting as my surgical career was, here I am, ten years since I’ve retired from surgery and I find myself really more passionate about medicine than perhaps ever before because I really feel that with the information we have now, I mean we really don’t have to even discover anything more. We are at the cusp of what could absolutely be a seismic revolution in health. That is a revolution that is not going to come because we discover another pill or because we discover another procedure or operation. This revolution can come about when we understand the need to show the public and get them to become educated with enough nutritional literacy that they can make the kind of selections of nutrients that will protect them from having an absolute whole host of common chronic killing diseases. Everything from diabetes, hypertension, obviously heart disease, strokes. Mark Diminution of the common Western cancers of breast, prostate, colon, gallstones, osteoporosis…

Caryn Hartglass: And on and on and on and on…

Dr. Caldwell Esselstyn: …and rheumatoid, lupus, allergies, asthma. It’s very impressive.

Caryn Hartglass: Don’t you want to just burst sometime? You have the answer. You know that if the whole world would just get it, what an amazing thing this would be. It makes me want to scream sometimes but you can’t because then people won’t listen to you.

Dr. Caldwell Esselstyn: And also, as Colin mentioned, that we are fortunate. We are quite optimistic because of the new electronic ways of communicating. Many people will be able to hear this message. Before, obviously, the tremendous work of Forks Over Knives was so uptaken with the generosity of Brian Wendell who funded and was the producer of Forks Over Knives, John Corry and Allison Boon, Lee Fulkerson and all who were deeply committed to make this a real goal, to try to share it with the public, some of the information that is out there and that is known. And of course we are up against a tremendous lobby of resistance here. Can you imagine when just today on National television on The OZ Show, Mehmet Oz was with Neil Barnard and they were more or less going over, very clearly on the foods one should eliminate to gain optimal health. This included meat, dairy, and oils. Can you imagine the tremendous lack of enthusiasm from the people who were manufacturing those products? They are really going to fight tooth and nail to hold on to the fact that they want America to continue to consume these foods, which is going to guarantee that sadly millions will perish. The economics of this gets to be very exciting.

Caryn Hartglass: Yes, exciting and interesting and that’s the end of our show. I hope the fight is short and quick and we get to the good part sooner than later. Thank you so much. Thank you for all of your work. Visit http://heartattackproof.com/ to learn more about Dr. Esselstyn and his fabulous career. Go to http://www.forksoverknives.com/ to find out where you can see the documentary, Forks Over Knives. Thank you for joining me. Thank you Dr. Esselstyn and have a delicious week. This has been It’s All About Food.

Transcribed by Alysa Bushert, 2/9/2014

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