Making heart attacks history: Caldwell Esselstyn at TEDxCambridge

Dr. Caldwell Esselstyn argues that heart attacks, the leading cause of death for men and women worldwide, are a "food borne illness" and explains why diet is the most powerful medicine.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Coronary artery disease
is the leading killer

of women and men in Western civilization.

Yet the truth be known, it is nothing more

than a toothless paper tiger
that need never exist.

And if it does exist,
it need never ever progress.

This is a food borne illness.

My story begins, actually,
in the late 1970s, early 80s,

when I was chairman of the breast cancer
task force at the Cleveland Clinic.

My frustration was that no matter
for how many women

I was doing breast surgery, I was doing
nothing for the next unsuspecting victim.

This led to a bit of global research.

It was quite striking to find
that breast cancer rates in Kenya

were something like 30 or 40 times
less frequent than in the United States.

And if you looked at breast cancer rates
in rural Japan in the 1950s,

it was very infrequently identified.

And yet as soon as the Japanese women
would migrate to the United States,

by the second and third generation.

they now had the same rate
of breast cancer

as their Caucasian counterparts.

But even more powerful perhaps
was data on cancer of the prostate.

In 1958, in the entire nation of Japan,

how many autopsy proven deaths
were there from cancer of the prostate?

18.

That's the most mind-boggling public
health figure I think I've ever heard.

But I made a decision then,

that I was concerned
that my bones would long be dust

before I could really get answers
between nutrition and cancer.

And so I chose to deal
with cardiovascular disease,

which is the leading killer of women
and men in Western civilization.

And it was quite striking
that in this global review

there were a number of cultures,
by heritage and tradition,

that simply lack
any cardiovascular disease.

They were plant-based.

And so with that information
I came back to Cleveland.

And my wife and I decided to go
on this plant-based diet for a year.

And then I asked cardiology
if I could have

about 24 patients, which is the number

that I can handle and still carry out
my surgical obligations.

And the 24 patients that I received,

were, as my late brother-in-law
used to say, the walking dead.

But they were most cooperative

and it was within about, say,
15 months of starting this program

that we had something striking develop.

I was treating a 52-year-old gentleman
who, in addition to his heart disease,

had a partially blocked artery
in his right thigh.

And he told me about the fact

that when he was crossing the skyway
to my office, he had to stop five times

because of pain in this calf,
because of this blocked artery.

So I had him go to the vascular lab
and we got his pulse volume.

And then I forgot all about his leg,
so focused on his heart.

Eight months later, he said,
"Dr. Esselstyn do you recall

when I first started seeing you,

I had to stop five times crossing
the skyway here to your office?

This last month, it got to be four times,
then it was three, two, one,".

He said, "I don't stop anymore,
the pain is gone".

"Don, back you go to the vascular lab."

I think if you look here, you can see
the difference in pulse volume

when I first saw him,
and here we were eight months later,

it was now almost two times greater.

So the thing that was
so exciting about this was,

in science we had demonstrated
what we call "proof of concept."

Not only that, but this occurred one year
before the invention of the statin drugs.

So this was so powerful, because
it showed us that indeed with nutrition,

we can actually not only halt
this disease, but we could reverse it.

And not shortly thereafter, what occurred,
we saw this now in the heart.

This is a 54-year-oold security guard
where our angiography core laboratory

described this as a 30% improvement.

But what really got our attention
was a fellow surgeon at the clinic

who, at age 44 in 1996,
began to get chest pain.

He did not have hypertension,
he did not have diabetes,

he did not have a strong family history,
he was not overweight

and cardiology worked him up
in October of 1996, could find nothing.

Three weeks later, he was finishing
his surgical schedule.

Sat down to write
post-operative orders.

Splitting headache, immediately followed
by this crushing elephant in his chest,

pain in his shoulder down his arm.

Joe was having a heart attack.

Whipped down to the cath lab,
start the catheterization, cardiac arrest,

resuscitate, and finish
the catheterization.

And then he was sent up to the floors

and discharged three days later,
but very depressed.

Why?

Because what they identified was that

his left anterior descending coronary
artery, in the front of the heart,

the entire lower third
was moth-eaten and diseased,

over too long a segment to have stents,
too far down the artery to have a bypass.

So he was very depressed about this,

so my wife Anne and I had him out
to the house with his wife for supper,

two weeks after his heart attack.

"Joe you've been eating
this typical Western diet.

You've got the typical Western disease.

We've got 10 years of data,
how about going plant-based?"

"Okay Ess, I'll give it a shot,
they couldn't offer me anything else."

He became the absolute personification
of commitment to plant-based nutrition.

And over the next thirty months
he then had another angiogram.

You know, up in the surgical suites,
our offices are three doors apart.

And at noontime of the day
that I knew earlier that morning

he had his follow-up angiogram,

I found myself letting myself
into his office.

There he was sitting behind his desk,

"Joe, I understand you had the follow-up
angiogram this morning,

Mind sharing with me, how did it go?"

Got up from around his desk, put his arms
around me, "I think we're doing okay."

"Well, any chance I could see
the follow-up angiogram?"

"Yeah!"

It was really quite striking and exciting
to see what actually can happen;

when you give the body
every opportunity it can.

The healing capacity is incredible.

So now let's talk a little bit
about how do you injure the artery

in the first place,
what seems to be going wrong.

Now on the right, there is
a seriously diseased artery.

You're probably saying,
"That's going to have a heart attack."

No, that only causes
about 10% of heart attacks,

but it certainly will cause chest pain
and shortness of breath.

What I really want you
to notice is on the left,

and here, on the inside of this artery,

there's a very, very, tiny, little dark
single layer of cell "magic carpet",

that all experts would agree is where
the inception of this disease occurs.

This magic carpet is called
the endothelium.

And the endothelium has an absolutely
magic molecule that it produces.

It's a gas, nitric oxide.

Nitric oxide has a number
of wonderful functions.

Nitric oxide keeps
our blood flowing smoothly

like Teflon, rather than velcro.

Two, nitric oxide is the strongest
vasodilator in the body.

When you climb stairs,
the arteries to your heart dilate,

the arteries to your legs dilate.

Nitric oxide inhibits inflammation
from the wall of the artery,

protect you from getting hypertension,
and most importantly

nitric oxide, in plentiful amounts,

will protect you from ever
developing blockages or plaque.

Alright, how do those
90% of heart attacks occur?

You will see here the artery is divided.

And what you're looking at
in the first serial on the left,

is that when you start
eating that cheeseburger,

the pizza, the milkshake,
your blood flow gets sticky.

And certain elements
like your endothelial cells get sticky,

your LDL cholesterol gets sticky,
and then the LDL bad cholesterol

migrates into the sub endothelial space,

where it sets up this absolute
cauldron of inflammation.

And that cauldron of inflammation
begins making inflammatory enzymes

that gradually begin to thin out
this delicate cap over the plaque.

It gets thinner and thinner
until it's as thin as a cobweb,

and then the sheer force of blood going
over that thinned out plaque ruptures,

and now we have spillage
of plaque content into the flowing blood,

which activates our platelets,
our clotting factor.

Now we are at the beginning
of a clot, a thrombosis,

which is in and of itself,
self-propagating.

So in a matter of minutes, now we have
an artery that is totally blocked,

and all the downstream heart muscle
has been deprived of oxygen and nutrients

and starts to die.

That's the heart attack.

But there is something absolutely
magically exciting about this series,

because if I can convince you
that all you have to do

is change your nutrition,

so your internal biochemistry is such

that you will not injure or thin out
the cap over your plaque,

you will actually diminish your plaque,

and you will strengthen
the cap over the plaque.

Alright, how do we do this?

It's very easy, we avoid the foods
that injure the endothelium.

What are they?

Even pure virgin olive oil,
corn oil, soybean oil,

safflower oil, sunflower oil,
coconut oil, palm oil, dairy.

Anything with a mother
or a face, meat, fish.

(Laughter)

Meat, fish, chicken, and turkey,
and also caffeine in coffee, and fructose.

Alright what are you going to eat?

(Laughter)

All those marvellous whole grains
for your cereal, bread and pasta.

101 different types
of legumes, vegetables,

which are red, yellow,
and green leafy, and fruit.

But especially the green leafy vegetables
are like water on the fire.

What green leafy vegetables?

Bok choy, swiss chard, kale, collards,
collard greens, pink greens,

mustard greens, brussels sprouts,
broccoli, cauliflower, cilantro,

parsley, spinach, and arugula
and I'm out of breath.

(Applause)

But remember, no oil!

(Laughter)

Now conventional cardiology,

with all those procedures
and all that expense,

is high mortality, high morbidity,
and sadly it does not cure the disease,

and the expense is unsustainable.

However, when you're treating causality
with plant-based nutrition,

no mortality with the diet,
no morbidity with the diet.

And what happens with the passage of time,
the benefits just continue to improve.

And lastly nobody has greater fear
of another heart attack

than somebody who's already
had a heart attack.

And how empowering it can be
for them and their family to know

that they themselves can now become

the locust of control
for this disease, destroying it.

Whereas in the past,
it had been trying to destroy them.

And that, lastly,
I want to just share with you,

this isn't just
that original earlier study.

But what we're about to publish
another 200 patients.

And the reason we have
91% compliance

is because we have a very strong intense
single five hour counselling seminar.

That's the same amount of time
the cardiac surgeon has,

but I have the patient when they're awake.

(Laughter)

So how do we do?

If we look at the vertical axis,

what you're seeing here is the average
of about three independent

cohorts cardiology studies
that are quite well known.

And the recurrent cardiac events,
after four years,

run about 20% on average.

Our own, which is called
"Treating The Cause,"

is a half of one %, that means
roughly a 40 fold difference.

So in summary,
it is so exciting what happens

when you treat the causation of disease.

Because it is not only prompt,

it is powerful, and it is persistent.

And for those who, in the future,

are coming down
with cardiovascular disease,

I hope it is going to be unconscionable
not to inform them

of the power of this option
from which they can thrive.

Thank you.

(Applause)