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PYP 089: Dr. Caldwell Esselstyn on Ending the War Against Our Hearts

essyI'm delighted to share my interview with one of the most important medical figures of the 20th and 21st centuries. I hope this recording will be around in a hundred years so my descendants can brag that great-great grandpa knew both T. Colin Campbell and today's guest, Caldwell B. Esselstyn, Jr, MD.

I figure that will be like being buddies with Galileo and Copernicus when everyone thought they were nuts.


This interview comes at a really important time, as the US government appears to be on the verge of removing recommended limits on dietary cholesterol based on flawed and misunderstood research. About halfway through this interview, Essy (what everyone calls him) cuts through all the confusion with a simple explanation of when high cholesterol matters, and when it doesn't.

And it's probably not what you think.

Both in the interview and show notes, I skip over Essy's back story, largely because it's so well known. If you aren't familiar with his illustrious lineage and remarkable research and clinical results, check out the documentary Forks Over Knives.

In our 90-minute conversation, we cover a wide range of topics (hey, I was going to keep asking questions until he hung up, and he was very generous with his time!):

  • the career impact of his 2-year experience as a combat surgeon in Vietnam (“the lowest denominator that man can sink to”)
  • how he became disillusioned while chairing the Cleveland Clinic breast cancer task force – and how that led him to study other cultures
  • the Kenyan and Japanese cancer conundrum, and how it got Essy thinking differently about disease causation
  • why he shifted his focus from cancer to heart disease (seeking answers “before my bones turned to dust”)
  • how culture, heritage, and tradition has protected billions of people around the globe from heart disease – but not us
  • why most doctors and researchers can’t seem to see the truth about the connection between diet and disease
  • how the lack of medical training in nutrition and behavior modification keeps the profession thinking small and achieving very little
  • how to convince patients to become their own locus of control (and it’s not 3-4 minutes of nutrition advice at the end of an office visit)
  • the two health education techniques that reliably change patient behavior and eating pattern
  • what patients with cancer are truly afraid of (and it’s not suffering or death)
  • his latest protocol for getting people to change their diets in less than six hours in a single day (with 89% adherence after up to a decade)
  • the importance of getting his arms around his patients’ stories
  • the only way of showing respect to patients (something that our current medical system discourages)
  • the origin of heart disease – destruction of the endothelium lining of our blood vessels
  • the shocking discovery from autopsy results for 17-34 year olds who died in accidents
  • why the results of his original heart disease study got me teary-eyed
  • his favorite part of medicine: the excitement of seeing sick people get better by taking control over their health destiny)
  • the broken “covenant of trust” between patient and physician in modern medicine (not revealing the cause of their illness)
  • why heart disease is the simplest disease to treat
  • how quickly people go from “this is rabbit food” to appreciating delicious plant-based meals
  • his childhood as a confirmed “cholesterolaholic” growing up on an Angus beef and dairy farm
  • his dad’s first heart attack at 43
  • the first plant-based meal that Essy fell in love with (Puerto Rican beans, rice, and scallions)
  • which is extreme: a plant-based diet or that of a nation that’s crumbling because they can’t pay their own health bill?
  • how to cut through the cholesterol confusion (especially relevant in light of the latest government statements on cholesterol)
  • why the Tarahumara (and the rest of us) can have high cholesterol but no heart disease (integrity of the endothelial barrier
  • the common denominator of all healthy societies
  • all the foods that injure endothelial tissue (and the most serious threat, animal protein)
  • why he doesn’t mind that some people call his program “severe”
  • the six ways to demonstrate reversal of cardiovascular disease
  • the link between heart disease and erectile dysfunction
  • the giant misconception about the relationship between “strictness” and compliance (it doesn’t have to be inverse if you communicate effectively to the right people)
  • why his patients rejoice at the news that they can halt their own disease through diet
  • the fury of his patients that they were never told about it by their cardiologists – and how it can be useful in getting them to change successfully
  • the successes and failures of the Cleveland Clinic cardiac surgery unit (and their ignorance of Essy's work at the other end of campus)
  • the importance of a like-minded community for cardiac patients who choose to fight back with dietary changes
  • his two remarkable studies – perhaps the most profound in all of medicine
  • Evelyn’s story (one of his first study participants, told by the medical establishment she would not last past 1986) – her hilarious motivation and her current life
  • the impetus for his most recent study
  • how his views and dietary protocols have changed since the 2007 publication of Reverse and Prevent Heart Disease
  • how his fame has affected his ability to influence patients
  • the importance of ORAC values
  • and much more…

Enjoy, add your voice to the conversation via the comment box below, and please share – that's how we spread our message and spread our roots.


Essy's book: Prevent and Reverse Heart Disease

The China Study, by T. Colin Campbell and Thomas M. Campbell II

Essy's website:

The second Heart Disease Reversal Study with 198 participants (science-y PDF to impress your friends)

Forks Over Knives – the film, the community, the recipes, the articles, the inspiration


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3 comments on “PYP 089: Dr. Caldwell Esselstyn on Ending the War Against Our Hearts

  1. Jeff Hoyt says:

    I’ve been following Essy and Engine 2 for years now and live a totally plant based lifestyle now as well. I have one question about cholesterol numbers. In some instances, it sounds like the blood lipid numbers are important and that we should try to keep our total at 150 or below and LDL and Tri below 80, etc. However, so often it’s mentioned that cholesterol numbers are NOT very important. I know there is a VERY high statistic that something like 75% of all heart attack victims have good cholesterol numbers and many who have bad numbers never have issues. So my question is are the numbers important or not? Thanks so much.

    Jeff Hoyt

    1. Howard says:

      Thanks for your question, Jeff. My understanding is that blood cholesterol is generally a marker for dietary cholesterol, as well as a prime culprit in damaging an already compromised endothelium. So there can be individuals whose livers produce higher than “normal” amounts of cholesterol, but if they aren’t eating an endothelium-damaging diet, the cholesterol just passes harmlessly through the bloodstream.

      Rather than focus on cholesterol in a reductionist way, I believe the wiser approach is to achieve a dietary pattern of excellence.

      Is that helpful?

  2. Thank You says:

    Thank You

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