Studies similar to those of Ornish have been carried out by Caldwell Esselstyn Jr.
of the Cleveland Clinic Foundation with equally impressive results. In his book,
Prevent and Reverse Heart Disease, Esselstyn described patients who, although
they were receiving aggressive treatment with surgery and drugs, remained ill with
advanced coronary artery disease and were experiencing increasing symptoms such
as angina. His goal was to reduce his patient’s total cholesterol levels to those seen
in populations where heart disease is essentially nonexistent.
Stress management and moderate exercise were not emphasized by Esselstyn’s program,
but his patients had essentially the same beneficial improvements in cardiovascular
health as those in the Ornish program.
Within a few months of initiating a
very low-fat plant-based diet, the study subjects experienced a rapid decline in their
cholesterol levels and relief of their angina symptoms. All patients who maintained
the Esselstyn diet achieved a total cholesterol goal of less than 150 mg/dL and had
no recurrent cardiac events during a 12-year follow up. Patients who adhered to the
program are still free from heart-related symptoms after 20 years. Esselstyn’s study
also showed that a nutrition-based intervention could stop and reverse the progression
of very severe coronary artery disease.
Terry Shintani has also carried out studies of the power of proper nutrition to rapidly
improve the risk factors for cardiovascular disease. Participants in his study
consumed a high carbohydrate, low-fat traditional Hawaiian diet without calorie or
portion size restriction for 21 days. The Hawaii diet is high in complex carbohydrates
(77% of calories), very low in fat (12% of calories), and moderate in protein
(11% of calories). Even though encouraged to eat to satiety, study participants had
a significant weight loss, averaging 10.8 lbs. The participants also had improved
biomarkers: lower blood pressure, lower total cholesterol, lower LDL-C, lower triglycerides,
and lower glucose.
These studies provide an important argument for the adoption of whole-food plant-based
ULF diets. They are the only ones demonstrated to bring about regression of
coronary atherosclerosis, as shown by objective measurement techniques, including
As I mentioned in a previous blog, when I was at Continental Health
Enhancement Center (CHEC), I witnessed the same remarkable clinical results
among cardiac cripples who adopted an ULF diet, participated in stress management
exercises and undertook physical activity to the extent possible allowed by
their physical condition. Patients with the debilitating cardiac symptoms of chest
pain (angina) and shortness of breath became free from pain, and improved their
exercise tolerance after just a few weeks on an ultra-low-fat whole-food plant-based
So, what could be wrong with the argument for ULF diets? The limitations on the
type of foods required for an ULF diet are likely to make adherence challenging.
There are not enough well-designed large-scale epidemiological studies of ULF diet
risks and benefits. Perhaps most of the benefit of ULF eating is because the diet
is whole-food plant-based rather than very low in fats. It is unclear if it is really
necessary to eliminate those plant-based foods that are associated with health but
are high in fat, such as nuts and avocados. Although high in monounsaturated fat,
avocados have been shown to be beneficial for cardiovascular health.
There is even stronger evidence that nuts are a healthful food. Total nut intake has
been found to be associated with lower overall and cause-specific mortality.
A meta-analysis found that higher nut intake was associated with reduced risk of
cardiovascular disease, cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections, with most of these diseases showing a 20% to 35% reduction in mortality. However, a Swedish study found that other healthy
behaviors accounted for most of the health benefits attributed to nuts.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel,