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    The new Esselstyn study just released. What do you think
    waingapu posted:
    Just today, the long awaited larger Esselstyn study was published.

    You can read it for yourself

    Involved 198 participants for a average of 3.7 years.
    About 8 to 10 times more people than his prior study.

    Some interesting results but also lacking in much detail regarding definitions of outcomes.
    Many people entering into these kinds of diets are looking for the much advertised, "reversal" of coronary artery disease.
    Esselstyn himself often mentions it and shows slides of angiograms.

    However in this study, he says 22% of "adherent" subjects showed reversal either in angiograms or in stress tests.
    Left for the readers imagination is what reversal means and what portion of those were from actual angiograms compared to the much less precise stress tests.
    Only 1 angiogram is shown, but that one is a old one he has shown before and not part of this study (essentially anecdotal)

    If reversal is the motivating goal for so many to stay on these diets, then you'd think details and definitions would have been included.
    We are told, 22% had reversal and 10% had progression, which would seem to leave 68% halting CAD.
    That is a positive figure, but again, what is the definition of any of these three categories?
    How many of those considered in the 68% halting, were categorized as such by angiographic evidence?

    I'm hoping that others here will add to the discussion of these published results.

    Quite frankly I am disappointed in the details of this study compared to those found in prior studies by Dean Ornish, where he gave precise information about the percentage reversal in various groups depending on their adherence levels.

    JAMA in 1998

    Lancet in 1990

    Again, in this recent study, what does Esselstyn mean by "reversal"?

    What is positive in this recent study is the very low number of cardiac events in the group that was fully adherent to the diet, during the course of the study.
    Perhaps that outcome alone is good enough reason to follow the diet.
    Some of us like more detailed science to back up such general ideas, as our time frame for halting or reversing disease is longer than 3.7
    years. We like to see evidence pointing to a actual process underway.

    Again, how can a precise scientific definition of "reversal" not be included in such a published article?
    max9821 responded:
    Having suffered an MI and v fib and therefore having more than a casual interest in the results of the study, I do notice that Dr. Esselstyn's lectures always include phrases like Make yourself heart attack proof and Heart disease is a paper tiger which need never exist. Bold statements. Are they true? Should I put my money on believing these statements? Especially since I have a DES which itself can present a host of problems.

    It is entirely possible that for those starting out young before very much coronary artery damage has occurred, on the suggested way of eating, they really will become heart attack proof. I do not know if he can really claim this for patients with previous heart events or with conditions like diabetes (which predisposes to coronary events) although most of his patients seem to have done very well, for a pretty long period of time on the plant no fat diet.

    The report that some arteries neither reverse blockages nor halt blockages but progress, makes one less optimistic.

    However, although no one can guarantee a positive outcome over the years, it does look like adherent patients do have a statistically much better chance of not having another event, regardless of angiogram, stress test, biomarker evidence. Isn't that considered a hard endpoint? An event. As opposed to testing biomarkers? Or catalogueing degrees of blockages in arteries.?

    I personally would like a guarantee but I won't ever get it. So I have to ask myself, does this woe show a large reduction in angina, stroke, heart attack, sudden death or any visit to the ER with sirens blaring? It looks like the answer is yes. At least in those subjects selected for the study.

    Would you, even with the unsatisfactory evidence of angiograms and even with the knowledge of progression in some arteries, abandon this way of eating for something else? If so what else? And on what evidence.

    I would jump ship immediately if a good study were done showing, for instance, that eating fat and meat after an MI prevented further events. And to be honest, in addition, I believe the study was the plant diet against the SAD. I have never seen a long term study with patients like Esselstyn's, pitting wfpb, no fat, against a diet of meat, a lot of fat (jimmy moore is eating 85% fat) a few vegies and extremely low carbs (even the healthful ones.) For all we know, the claims of low carbers might be true. But no one in either camp has done such a study specifically using a Bernstein type, very low carb diet vs wfpb no fat.

    Eighty year old dr. Richard Bernstein has solved his own t1 diabetes problem with no complications and claims his patients do the same but I am not aware of any long term study with angiograms and statistics on rate of coronary events similar to Esselstyn's. Positive results would be amazing in diabetics who are much more prone to heart disease than the general public.

    Other than certain biomarkers, so far as I know, regardless of the weaknesses in the Esselstyn studies, no one in any other treatment camp has shown any results, other than weight loss in some cases, that says nothing about coronary disease improvement. You can lose weight on a diet of twinkies after all. And although LDL increases proponents of low carb say they do not matter.

    So, as a heart patient, should I just wait around until i get results from a study that passes muster on all counts and satisfies even low carbers or should I act now and make a choice? No matter what it is.

    waingapu replied to max9821's response:
    Very nice reply Dolores. You make a lot of valid points.
    While I don't have time right this minute for a lengthy reply, let me say a few things.

    The title of the journal article is "A way to reverse CAD?"
    It is not "A way to treat CAD".

    It is "A way to REVERSE CAD"

    In the article it specifically identifies patients who reversed CAD.
    It singles them out as a different group.
    But it never tells us anything about them. It doesn't even give us a definition of what it means to "reverse" CAD.

    As a scientific study if fails to answer its own MAIN stated question. "A way to reverse CAD?"

    I'd give Esselstyn a bit of a break, but as you indicated the title of his books, the subject title of his videos, etc. is specifically stated as "reversing" heart disease.
    Yet in this long awaited study he fails to give any direct evidence. He fails to even give a definition.
    Yet he finds time to post a very old anecdotal before and after angiogram from a fellow doctor who worked at the Cleveland Clinic. That individual was not part of either his first or most recent study. Why pick out that one man, who BTW was younger than the rest of his subjects. More likely to have a blockage made up of more softer material as opposed to calcified or fibrous material which is unlikely to be reversed.

    Look at his website
    Look at what is emphasized. REVERSAL front and center.s

    The other huge problem with the study is that he talks about the dietary influence but never lets the reader know how many of the patients in each outcome category were on statins.
    It is left to the reader to guess what portion of the benefits or so-called reversal was attributable to a statin and what was achieved from diet.

    There may have been a few participants who were NOT on a statin. What was there outcome. Were any of them in the reversal category? If not, the it might indicate that the addition of a statin was critical in the reversal this study...
    Of course you can go back and say, 'well Ornish got reversal without statins'.... but Ornish also included medication and exercise.

    No, the huge problem with this Esselstyn study is that he reveals so little about what the methods were for each group.
    Goodness, how can you leave out the fact that a huge percentage, perhaps 95% were on statins. Possibly high doses.

    One almost suspects that the specificity of statin use was left out, because it goes counter to everything that Esselstyn emphasizes during his many speeches and videos.
    You've seen and listened to his talks. Statins are almost a dirty word. Real men don't need statins.
    Truth is, according to both of Esselstyn's studies, that we need both if we want to get the outcome achieved in both of his studies.

    As you may know, but it is totally under emphasized, 100% of the folks in his first study were given statins as part?
    This time all he says is that the 177 patients were kept on the drugs their own doctors had them on. They were all diagnosed heart disease patients. We all know that probably 98% of such patients are on statins during normal treatment.
    Yet we hear no discussion of statin use being a major contributor to the outcome of this particular study.
    The details and rate of usage are hidden from the reader.

    Left up to guessing, just as the definition and degree of "reversal" are left up to the reader to imagine.

    He seems to report only those outcomes and details that fit with his theme and ongoing show... the lectures, the books, the appearances, the son's productions and books.

    Look, I believe the guy is sincere and isn't only in this for the money, but even sincere proponents can become so one sided that they are prone to admit anything that doesn't prop up their narrative.

    My question for Dr. Esselstyn is .... why did you leave out all those critical details regarding statin use and reversal.
    You gave us next to nothing about those... Next to nothing.

    BTW, I continue this WOE, but the study is sadly lacking in science.
    max9821 replied to waingapu's response:
    I don't think we disagree about anything. The only way to get around the statin thing is to have a group of patients on an identical diet without any statins if indeed E's patients were taking statins. He has said many times that he does the food trial part and the patients are still under the care of their physicians. And he specifically said he had the first group of patients on statins. I never got the impression that to him statins was a dirty word. I did get the impression that it is his opinion that statins alone, without the diet do not work as well. I do not take statins. Stopped about three months after my MI. Latest cholesterol two years after MI 118, LDL 52. It was 166 when I had my MI. Almost 300 twenty years ago.

    The non adherent patients did have events and one can presume that they were possibly taking statins. I am not taking statins, my lipids are better than with statins according to my doctor. But I stopped taking aspirin. My doctor wants me to start again. I am still thinking about it. Apparently even without statins most take aspirin.

    I wrote to him once and asked about aspirin use among his patients. I asked in many different ways. I was not looking for a recommendation, just wanted to know how many of his patients were taking aspirin. Got no answer other than ask your doctor.

    I also think he doesn't have all the money in the world to work with. And I would be darned if I would undergo an angiogram just to satisfy the requirements of the study. If I thought I had to do that I would not participate in the study.

    So maybe Esselstyn's study would not be convincing enough for most. Perhaps it would not be a good study to bring up in a debate with a low carber like Bernstein. But I am on the internet all the time and have yet to come across anything better.

    I believe that Nathan Pritikin claimed his diet would cause reversal and I think there was a study using green monkeys which did show some reversal. And I am very nervous about the fact that even on this diet some arteries progress with blockages, a fact that you don't hear when Esselstyn gives his lectures but is clearly stated in his published study.

    engineerguy replied to max9821's response:
    Hi waingapu,

    Glad to make your acquaintance, and a very warm welcome to you here!!

    Hi Dolores,

    Always great to chat! A very warm welcome to you too, as always.

    Oh, here's another Esselstyn recent publication. 3 case histories of heart patients at the end of the line, for standard medical treatment. Doesn't heart disease normally get worse, in time? All 3 stopped getting worse, and quickly improved, on the Esselstyn diet. You could kinda call it "reversal."

    I appreciate that it would be nice to get angiograms, to verify reversal of artery blockages. But Ornish already did that. Ornish' patients, without statins, had a 6% increase in the opening at blockages. The control group got worse. A 6% increase in the opening at a constriction does not sound that terrific, but this corresponds to much more than a 6% increase in blood flow. Note that nearly all the experts at the time, told Ornish that he shouldn't bother to run such a study, because it was impossible to enlarge the opening in the blockages. That is why Ornish could not raise money from the NIH (National Institute of Health), which dispenses all the government money to run studies. Ornish had to raise money from private industry. Enron was one of the contributers, and is credited in Ornish' book.

    I believe the participants in Ornish study, deserve a lot of credit, for getting angiograms at the end of the study. Angiograms are not harmless. You can Google the chances of heart attack, stroke, or death, during an angiogram. There is also injury to the artery walls, due to the catheter, as well as chance of little silent mini-strokes, due to the procedure. So, Dr Esselstyn did not want to ask his patients to do this. If my heart disease were "reversing", I wouldn't want to get an angiogram. Would it change anyone's opinion? Would it change Heretic's opinion?

    Esselstyn's study compared standard medical care, which included lots of statins, and any diet recommended, versus the Esselstyn diet, including statins and other medications. Esselstyn does not claim any special insight to a greater benefit from medications. They are continued as needed, and usually gradually reduced, and often eliminated as the patient improves. Why would anyone exclude statins? The purpose is to help the patient, not compare statins versus diet. Again, Ornish already showed statins versus diet. Actually, I wonder why Dr. Ornish did not include statins in his study. Ornish does prescribe statins for his heart patients, today.

    Interestingly, the most super dramatic angiogram, that Dr. Esselstyn shows on his website, was without statins. That was because the patient, Dr. Crowe, refused to take statins.

    Another interesting item is that all of Dr. Esselstyn's studies have not had any grants. It was simply a study done in a doctor's office.

    "2). Of adherent patients with CAD, radiographic or stress testing results were available to document disease reversal in 39 (22%)."

    The quote said that, for 22% of the compliant patients, radiographic or stress testing was available to document reversal. What this means is that either angiogram, or improved stress test, showed that the heart disease was "reversing". This implies the definition of "reversal", that is, angiogram or stress test improvement. This does not say anything about the other 78%. Most of the 78% were also "reversing" their heart disease, but the proof is lacking. This says that Dr. Esselstyn did not insist on exposing his patients to the dangers of an angiogram.

    Dr. Ornish needed to ask for angiograms, because angiograms were required to document the changes, for all patients to follow. Without angiograms, cardiologists would not be convinced, and the study would be pointless. Now that Ornish demonstrated it, it is much less necessary, to expose patients to the risk.

    engineerguy replied to engineerguy's response:
    Sorry to be so long winded...

    Re: "But no one in either camp has done such a study specifically using a Bernstein type, very low carb diet vs wfpb no fat."

    I know you are simply giving every benefit of the doubt to Heretic, bless his heart. He's a nice guy. And I know you know everything that I'll reply. But let me mention, for anyone reading.

    Well, we do have some information. And I enlist anyone with additional information to provide it!!

    Richard Bernstein "cured" his t1 diabetes with a very low carb diet. There were many publications in the 1940's about very low carb diets lowering blood sugar. When a person eats no carbs, need for insulin is greatly reduced. But not long after these studies were published, insulin became available, and interest dropped for this diet, since doctors thought insulin would cure diabetes.

    But all the evidence we can find suggests strongly that high fat, high protein is a very unhealthy diet, promoting heart disease, and yes, diabetes. Pritikin came along and showed that a high complex carb plant based diet would eliminate insulin requirements for most diabetics. This was "curing" diabetes, since the body was handling carbs fine.

    Recall the Masai, who live on high fat, high cholesterol diet. They are very lean, and exercise a great deal. Dr. George Mann of Vanderbuilt University said these people have no heart disease, and show that the cholesterol theory is wrong. Much controversy ensued, and Dr. Mann ran a study to settle the issue. Dr. Mann arranged to have 50 consecutive male deaths, sent to Vanderbuilt U, for careful autopsy. The results were startling.

    Dr. Mann stated that the Masai had atherosclerosis equal to elderly US males. Boys 10 years old shows fibrosis, which was scarring of the artery wall, from atherosclerosis. It is to Dr. Mann's credit, that he published this paper, proving that his original statement was completely false.

    Dr. Fleming ran a test of heart muscle blood flow, for heart patients. He compared a low fat plant based diet, versus people following the Atkins diet. The plant based diet heart patients had improved blood flow to the heart, and the Atkins group worsened.

    It is well known that Dr. Atkins himself, had heart disease. His family said it was cardiac myopathy, due to a virus, not hardening of the arteries. When Dr. Atkins died, he was obese. His family could have taken the opportunity to have Dr. Atkins' autopsy published, to prove that the heart disease was a virus, not hardening of the arteries. Instead, the family went to court to ask that the coroner's report, which normally is made public, be kept secret. Also, they had no autopsy. Also, they turned around and sold the Atkins name for many millions of dollars, as a healthy diet. And the family then said that the doctor that forwarded some information on Dr. Atkins poor health, was unethical!! The doctor forwarded that information on the mistaken belief that the coroners information was public, as it usually is, prior to learning of the court action to keep it secret.

    So, Dr Atkins, whose name is synonymous with high protein high fat diets, and has had celebrity status since the 1970's, died obese, probably had heart disease, and probably died of a stroke. But we can't really say, because Dr. Atkins' millionaire family says that's not ethical.

    And Jimmy Moore? And Weston Price? And Sally Fallon? And Stephen Byrne? Try this link to see.

    Re: "Look, I believe the guy is sincere and isn't only in this for the money,..."

    There is no money in this healthy diet stuff. That's why the medical world is running ... the other way.

    Best regards, EngineerGuy (Stacy)
    waingapu replied to engineerguy's response:
    Thank you for the reply, but you really do go on about things which I never wrote about.

    I said nothing about Dr. Atkins, Jimmy Moore, Weston Price, Sally Fallon, or the guy you call Heretic, or about any of the ideas they promote. You seem to be all revved up about them for reasons unrelated to what I actually wrote.

    A few points. I'm getting awfully tired of Dr. Esselstyn throwing in 3 case studies,, only one of which related to coronary arteries, as some kind of substitute for revealing what he meant by "reversal" in the 22% reported as such.

    I am even more tired of seeing Dr. Crowe trotted out for the umpteenth time because he has one angiogram showing substantial reversal. Dr. Crowe was not part of any study.
    He isn't even a case report. His case is as close to anecdotal as you can get.
    Everyone knows there can be a wide spectrum of results.
    I think Dr. Esselstyn is guilty of throwing Dr. Crowe out to people who want to believe, without telling them that Dr. Crow's outcome is probably seen in less than 1% of patients.
    He was younger than average. Much of his blockage is less likely to be calcified or fibrous than a typical 60 year old patient. Thus much more susceptible to reversal.
    For the most part you don't reverse calcified or fibrous materials which make up over 80% of blockages.
    If you doubt that, take a look at this doctor in one of McDougall's videos.
    For the thousands who might read Esselstyn's study, the use of the old angiogram from Dr. Crowe is down right misleading. His outcome, from all we know, is most unusual. Like those folks we see in diet ads.

    As to the results you put forth about Dr. Ornish and his study, which I follow and admire, you once again allow your enthusiasm to get away from the facts.
    You talk about the patients getting 6% reversal.
    In fact, of those 19 in the experimental group who were rated, the results were as follows for the tertiles of adherence.
    6 got 0.37% reversall
    7 got 3.02% reversal
    6 got 6.81% reversal
    (changes in percentage diameter of stenosis)
    By contrast, the ONE angiogram that Esselstyn chooses to show his followers in the recent ariticle is Dr. Crowe's reversal which looks to be ten times greater at about 60% plus.
    I just think that is misleading to the point of being dishonest.
    Give us no definition or measurements and then let the gullible see Dr. Crowe and assume they can do the same thing.

    You say, "Most of the 78% were also "reversing" their heart disease, but the proof is lacking. "
    Sadly you have nothing from which to make that statement.
    In fact, you completely ignore the 18 patients who got worse, making up 10% of those who followed the diet. Wouldn't it have been nice to know if that group wasn't on statins?

    Look, I respect the studies done by Ornish. I was hoping for something better from Esselstyn. I will take into consideration the number of cardiac events in the 3.7 years.
    I eat 99% the way Ornish and Esselstyn advise. I also take a statin because patients differ. Only Ornish gave us that info, but his study was so tiny. Only six patients in the most adherent group.

    My problem with Esselstyn is that he totally oversells the concept of reversal. Even the study title, asks the question, then fails to answer it,. Listen to his video's on Youtube. Total oversell of the reversal. Total underplay of the degree of statin use in his subjects.
    Total misuse of Dr. Crowe's angiogram, in misleading people's hopes.

    I might also add his total misuse of blood flow after "oil" .
    You've heard him hundreds of times... How Dr. Robert Vogel tested it and found how bad it was... right?
    Problem, Dr Esselstyn leaves out the other half of the study, about canola oil and salmon. Both of which were far less harmful

    Just saying, there is great reason to read Esselstyn carefully as he takes great liberties with the facts.
    max9821 replied to waingapu's response:
    Firstly, I do not know the amount of funding Esselstyn had as compared to Ornish. Also I believe Ornish is an MD but is a researcher. Esselstyn is a surgeon.

    I have the same thoughts as you when I read or hear of Esselstyn's study. So paleo advocates are rightly able to point out the differences between Esselstyn's study and the way things are usually done in science. What they can't do however, is point to a "correctly" done study proving their own diet is superior. Can such a study be done to anyone's satisfaction without keeping people in a metabolic ward for years and years?

    It is highly likely that those who dropped out of Esselstyn's studies were taking statins. It would be unusual if they were not. So that does say something, at least about statins preventing heart events because the non compliant drop outs had a much higher rate of events than the compliant patients regardless of whether or not the compliant patients used statins. So we don't know from the study whether the diet alone without any statins would be as successful but we do know that diet does influence the likelihood of events and as it is likely that the dropouts were statin users it is evident that statins alone do not prevent heart events.

    Canola oil and salmon are less harmful than saturated fats and less harmful than olive oil and apparently do not affect dilation. But do we know if canola oil and salmon will produce the same results as a wfpb NO FAT diet? Salmon, for instance might not affect dilation but it does contain saturated fat. Will this fat add to existing blockages or not? But I do agree that Dr. E is remiss in not mentioning these facts. Or was he just speaking of olive oil because everybody and his grandmother think it is a health food? The Lyon heart study used canola oil but for some reason when people hear Mediterranean diet they think of olive oil. And the study did have a good number of deaths from heart disease.

    Despite its limitations and despite the exaggerated claims and despite the fact that patients used statins, I do think Esselstyn's study does show that diet can have a positive effect on people's health. But yes, I have to agree with your assessment.

    engineerguy replied to waingapu's response:
    Hi Waingapu,

    Sorry to take so long to reply. I was out last week.

    Say, you make some great points. And, THANKS for the correction on Ornish' results:

    6 got 0.37% reversall[br>7 got 3.02% reversal[br>6 got 6.81% reversal

    I appreciate your inputs.

    I didn't get that Dr. Esselstyn is misleading, but maybe that's just me. The important thing is that we follow the lifestyle. I wouldn't have come up with this stuff on my own. I am very grateful to Pritikin, Fuhrman, Ornish, Esselstyn, McDougall, Barnard, McGreger, and others.

    Hi Dolores,

    I don't believe Esselstyn had any funding at all. His first study, with the 18 patients, had none, for sure. In the second study, note that there was not a consistent measure for all patients, in terms of an angiogram, IMT test, stress test, or any test. I'm guessing that there was no funding.

    A note for anyone reading...

    In my case, Dr. Fuhrman has definitely improved my health, by recommending to be very lean, check blood level of D, take DHA/EPA, and I have found taurine to be very helpful. Also emphasis on veggies, fruit, beans, nuts & seeds. Fewer meals.

    Best regards, EngineerGuy (Stacy)
    wonderweenie responded:
    In 2003 I had dbl cabg with about 250 total C I have never had TG>130 or HDL <50. Glucose around 99. BMI around 26 calculated. At the time I was under tremendous stress and I was eating cookies and drinking Diet Coke and Coke Classic.

    Post CABG I was put on 40mg Zocor and had muscle weakness and pain although my LDL dropped <100. I was age 56. I am now 67. I have tried nearly every statin with the same pain and muscle weakness and with Crestor, cognitive problems that resulted in me blowing a $38K deal which was scary. So I quit statins and the pains, weakness and cognitive problems went away. But my lipids stayed for years pretty much LDL about 148 HDL about 71and TG about 70

    I tried the Esselstyn diet but did not eliminate bread or rice. This resulted in an increase in my LDL which I imagine many would attribute to the bread and rice which were whole grain. My TG went up to 130. I did lose weight but the increase in LDL and TG scared me into bewilderment.

    So recently, after all the bad press on refined carbs, I pretty much eliminated refined carbs and also fruits like bananas and ate more meat and nuts and avocados and leafy vegetables. This has resulted in LDL 120, HDL 77, TG 59, which remains unsatisfactory to my cardiologist who continues to insist on statins.

    However, since 2003 I have had no cardio events, only normal EKG and passed a standard stress test and a nuclear stress test. So I remain bewildered and anxious and fully aware that those emotions are contrary to health.

    Maybe I am lucky? Maybe I have collaterals? Maybe I have 8 years left to live as some have insinuated? Going to a new cardio. Trying RRY with CoQ and Pu-erh tea and Garlic and Pomegranate powder. Still don't know about those avocados? Even get all kinds of contradictory info on how much and what kind of exercise. Still bewildered after all these years.
    josvin84 replied to wonderweenie's response:
    LDL 120, HDL 77, TG 59. Wow really amazing results. Does your cardio have shares in drug companies?
    My results are something like LDL:125, HDL 35, TG 100. They have been like that for almost ten years.
    I don't take any statins no matter what my cardio says. My cardio gave me 6 - 12 months and so far I have survived 12 years without his help. Definitely no statins!


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