Dr. Esselstyn’s Method for Plaque Reversal

The book Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn is now a classic. Dr. Esselstyn was one of the early pioneers of plaque reversal and enjoyed considerable success at the well-known and respected Cleveland Clinic. What is particularly remarkable is that he achieved recognition in spite of the fact that he was a surgeon and not a cardiologist. Not only is he not a cardiologist, but he is a rare individual among M.D.’s, because he has devoted his time and energy to disease prevention and disease reversal through lifestyle means. What a concept!

Seriously, how many physicians do you know that believe lifestyle changes can cure medical conditions and discuss the same in any detail with their patients?  From what I have seen, the great majority of physicians are almost completely ignorant of this kind of preventative medicine and much prefer and respect pharmaceutical and surgical solutions. So kudos to Dr. Esselstyn for going against the current.

So just how does Dr. Esselstyn reverse plaque? Basially, the game plan is simple: eat a low fat vegan diet composed of legumes, fruit, vegetables and whole grains with the goal of dropping your total cholesterol below 150 and LDL less than 80. If you can’t achieve these numbers through diet alone, he will give a statin. But, in his case, a statin is a last resort and I have the impression used a relatively low percentage of the time with patients.

Again, the point is that Dr. Esselstyn believes that plaque reversal has been made too complex and summarized his philosophy nicely here:

“If you follow a plant-based nutrition program to reduce your total cholesterol to below 150 mg/dl and the LDL levels to less than 80 mg/dl, you cannot deposit fat and cholesterol into your coronary arteries. Period.” [1]

Sound too good to be true?  Well, Esselstyn states that his patients have cleared out between 10-30% of their arterial plaque just through following his dietary advice.  And thus leads to big improvements in blood flow.   He insists that his patients follow a strictly plant-based diet. Again, his rules are simple, but many would find them hard to follow, and include whole plant foods without nuts, oils or avocados. So he is very strict: no animal products, oils, fats, margarines, etc.

Again, this is so simple:  you eat four kinds of food – nothing more and nothing less.  Dr. Esselstyn does not emphasize stress management or exercise and believes those do not affect plaque reversal.  I also do not see any mention of triglycerides or HDL.  Again, his strategy relies on bringing LDL way down below the concentration at which it can be deposited in the arterial walls.

The reasoning here is based on the principles some of us learned in high school chemistry:  the concentration on one side of a membrane must be high enough to move molecules across that membrane.  In this case the membrane is the endothelium and the concentration at which LDL can be pushed into the arterial walls is right at 80 mg/dl according to a variety of research.  So basically if you lower the concentration below 80, then atherosclerosis cannot progress.

He also is a big believer in plant-based nutrition, because it a) is so powerfully anti-inflammatory and b) promotes endothelial function.  I don’t remember him directly saying this in the book, but low fat plant foods tend to increase nitric oxide and nitric oxide is a powerful anti-inflammatory.  Furthermore, low fat plant foods tend to lower blood pressure, which is critical, because even mildly increased blood pressure above 120/80 is very hard on arterial walls.  All of this is the subject of my book, The Peak Erectile Strength Diet, for example.

So his philosophy makes a lot of sense to me.  But let me briefly say – and I hope to discuss this in more detail in future web pages – that Dr. Esselstyn’s philosophy differs significantly from Drs. Davis and Gould. Let me give a few teaser points:

NOTE:  You can buy his book on Amazon:  Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn, Jr. M.D.
a) Drs. Gould and Davis believe that HDL, triglycerides and a variety of other parameters play a major role in plaque reversal.

b) Drs. Gould and Davis allow for some meat consumption and Dr. Gould for the consumption of dairy.  (Dr. Esselstyn started out allowing low fat dairy, but stopped that recommendation, because he believe that dairy may fuel some types of cancer.)

c) Drs. Gould and Davis do not exactly emphasize exercise but insist that you do some.  Dr. Esselstyn does not even make exercise part of his program.

This list could go on, but let me stop there and say also that the packed with lots of excellent information.  He has lots of practical tips, such as how to eat low fat when travelling and with family, recipes, case studies and on and on.  Again, this is another book that should be on your nightstand and read every night – it’s that important.

NOTE:  For those unfamiliar, I have discussed the other plaque-reversing strategies here:   A Review of Heal Your Heart by Dr. K. Lance Gould and A Review of Track Your Plaque by Dr. William Davis.


1)   Prevent and Reverse Heart Disease, by Caldwell Esselstyn, Jr., M.D., p. 33.

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