Full transcript of Dr. Caldwell Esselstyn’s TEDx Talk: Making Heart Attacks History at TEDxCambridge 2011 conference.
Listen to the MP3 Audio here: making-heart-attacks-history-by-caldwell-esselstyn-at-tedxcambridge-2011
Dr. Caldwell Esselstyn – American physician, author and former Olympic rowing champion
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 eighties when I was chairman of the Breast Cancer Task Force at the Cleveland Clinic. And my frustration was that no matter for how many women I was doing breast surgery, I was doing nothing for the next unsuspecting victim and 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 lacked any cardiovascular disease. They were plant-based.
And so with that information I came back to Cleveland and with 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 twenty-four 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 to 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 sky alley to my office he had to stop five times because of pain in his 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 sky alley here to your office? This last month it got to be four times and 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 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 old 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 postoperative 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 discharge 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 sense, 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 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 30 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 old 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?”
So 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, and you probably say 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.
All right, 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 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.