Dispelling nutrition myths, ranting, and occasionally, raving

Something’s greasy about Dr Esselstyn’s diet

31 Comments

A friend and reader recently alerted me to this article about the horrors of including oils in your diet. I confess, I groaned when I started reading the article.

“Part of living a plant-strong life is letting go of oil. This includes all oil: olive oil, coconut oil, flax seed oil, hemp seed oil, ANY oil.

(You can keep motor oil for your cars!)”

According to the author, much touted healthy diets, such as the Mediterranean Diet, are healthy despite the oil included in them, not because of the oil included in them. I understand their argument that oil is made by processing whole foods, as a dietitian, I’m often advising people to consume foods in as close to their natural state as possible. However, in some cases this just doesn’t make sense.

Yes, oil is fat. This is not a bad thing. Fat is not the demonic food it was believed to be back in the 1980s. We need fat in our diets (about 20-35% of our calories should come from fat). Oils can provide us with some healthy fats. I honestly don’t know how I would cook my food or make a pesto if it weren’t for olive oil. How dull my diet would be if I were to only eat plant-based foods without any added fats.

I would venture to guess that the key is really consuming fewer convenience foods, not less plant oil.There is no evidence, aside from anecdotal, to support Dr Esselstyn’s diet. If he were simply advocating a plant-based diet I would say there was nothing particularly wrong with it. However, he advises against consuming any fat-containing foods such as nuts, avocados, and oils. I’m also wary of any doctor who is profiting from selling you a book that makes health promises.

Further in the article, the author suggests that a fat-free diet can be healthy and we can get enough fat in our diets by applying oil to our skin. This blew my mind a little. It shows a clear lack of understanding of nutrition and the digestive process. There is no way for fat or vitamins applied topically to be absorbed into our blood stream and used by our bodies. Oil applied to skin acts as a moisturizer not as food. It’s not just about the fat itself, it’s the ability that fat affords us to absorb the fat-soluble vitamins (ADEK).

For those concerned about omega-3s, fear not, Dr Esselstyn says, “It is difficult to be deficient in Omega 3 if eating 1-2 tablespoons of flax seed meal and green leafy vegetables at several meals”. That’s odd because 1-2 tablespoons of flax meal provides us with about 1.6 grams of omega-3 fatty acids. This can provide us with up to 0.064 g of DHA and 0.096 g of EPA (the essential fatty acids we can only obtain through dietary sources such as fatty fish). One cup of spinach provides about 0.044 g of omega-3 (0.0176 g DHA and 0.0026 g EPA). The general recommendations for EPA and DHA are 1.25 g each per day. This oil-free diet provides about 16% of our needed DHA and nearly 20% of our needed EPA. Perhaps moisturizing with mackerel will provide those missing omega-3s?

 

Author: Diana

I'm a registered dietitian from Nova Scotia, living and working in Ontario, Canada. My goal is to help people relearn how to have a healthy relationship with food.

31 thoughts on “Something’s greasy about Dr Esselstyn’s diet

  1. This is crazy! The only saving grace is that no one would be able to stick to this kind of fat-free living for more than a few days, I can’t imagine a diet without any fats. Love the line about moisturizing with mackerel :)

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  2. Have you heard anything about consuming algae supplements? The argument being that fish obtain their omega 3 from algae, so we could too.

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  3. Hi! I’m a poster child for the other side. I’ve been following the recommendations of Dr. McDougall (very similar to Dr. Esselstyn’s) since 2005 (lost 70 lbs, have kept it off for 7 years now, enjoy my food, no health problems). Below I’ve linked an article that shows the sort of thinking that makes their logic compelling for me. Jeff Novick is a dietician who works with both Dr. McDougall and Dr. Esselstyn.

    http://www.drmcdougall.com/misc/2013nl/mar/med.htm

    TomInTN from fitocracy

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    • Thanks for sharing Tom! I’m not convinced of much by that chart as Western food has become highly prevalent in many areas of the world. It would have been more interesting to have seen a table from before the infiltration of fast food and pop in countries like Egypt. That being said, different eating patterns can work for different people and if you are content and healthy on such a diet, I say “power to you”. I am a little curious what foods you consume for fats.

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      • Hi, Diana! Thanks for your response. The only thing I eat specifically for the omega-3 fat it contains is a small handful of walnuts on my breakfast. I just looked up kale (I eat at least 3 cups of steamed kale a day) on nutritiondata.com and discovered it’s more than 10% calories from fat (4.4 calories out of 36.4 in a cup of cooked kale).

        I know Dr. Esselstyn recommends against nuts for his cardiac patients who need to reverse their heart disease. On page 69 of “Prevent and Reverse Heart Disease,” Dr. E writes, “Those who have heart disease should avoid all nuts. Those without disease can consume walnuts in moderation because they can provide considerable omega-3 fatty acids, which are important for many essential bodily functions. But I am extremely wary of nuts. Although short-term studies funded by nut companies show that they may positively affect good and bad cholesterol, I know of no long-term studies indicating that they can arrest and reverse heart disease, and patients may easily overingest them, elevating their cholesterol levels.”

        I agree with you that Western food is taking over the world. I’m intrigued by the fact that even in the recent past, with that trend well in place, there are still places with under 5% of their populations being obese. I don’t have data to show it, but my guess is that the places with the lowest obesity rates are also the places where Western eating styles have penetrated the least.

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      • You’re a dumbass.
        Heart disease and arterial diseases kill more Americans than all other causes combined, not to mention the years of disability suffered prior to death, all attributable to the standard american diet.
        Where’s your research to back your claims?

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      • My previous reply is directed to that idiot, Diana.

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      • Phew! I was a little worried when I saw a comment come through calling me a “dumb ass”. Not that it hasn’t happened! ;)

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      • This is intended to be a reply to June. I couldn’t find a way to respond directly to her comment.

        Hi, June,

        Many folks I know would agree with your characterization of me. :)

        You wrote, “Heart disease and arterial diseases kill more Americans than all other causes combined, not to mention the years of disability suffered prior to death, all attributable to the standard american diet.”

        If you intended to be making that assertion, I agree with you. If you intended it sarcastically (which is what I think you intended), then yes, I do believe that the standard American diet is a major cause of the degenerative diseases that plague Western culture.

        With regard to research, I would suggest looking at the work of Dr. Esselstyn, Dr. John McDougall (www.drmcdougall.com), Dr. Neal Barnard (http://pcrm.org/), Dr. Michael Greger (http://www.nutritionfacts.org), and Dr. T. Colin Campbell (The China Study, Whole). They reference lots of studies to show that a low fat plant-based diet provides all the nutrients needed for good health and generally lead to better health outcomes.

        The only other bit of research I can mention is myself — I’ve been following the recommendations of these doctors since 2005, have lost 85 pounds since 2003, and am very active (run every day) and in great health.

        Have a great week,
        Tom

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  4. Dr. Esselstyn’s main focus is helping the endothelium of the arteries to heal. For those with cardiovascular disease (almost all of us have some atherosclerosis and plaques already–even children), extracted oils should be avoided and even nuts/avocados should be avoided until the integrity of the endothelial lining is restored. Bill Clinton’s coronary artery disease was reversed using this approach.

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  5. Hi, June,

    Many folks I know would agree with your characterization of me. :) Sorry I couldn’t find a way to reply directly after your comment.

    You wrote, “Heart disease and arterial diseases kill more Americans than all other causes combined, not to mention the years of disability suffered prior to death, all attributable to the standard american diet.”

    If you intended to be making that assertion, I agree with you. If you intended it sarcastically (which is what I think you intended), then yes, I do believe that the standard American diet is a major cause of the degenerative diseases that plague Western culture.

    With regard to research, I would suggest looking at the work of Dr. Esselstyn, Dr. John McDougall (www.drmcdougall.com), Dr. Neal Barnard (http://pcrm.org/), Dr. Michael Greger (http://www.nutritionfacts.org), and Dr. T. Colin Campbell (The China Study, Whole). They reference lots of studies to show that a low fat plant-based diet provides all the nutrients needed for good health and generally lead to better health outcomes.

    The only other bit of research I can mention is myself — I’ve been following the recommendations of these doctors since 2005, have lost 85 pounds since 2003, and am very active (run every day) and in great health.

    Have a great week,
    Tom

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  6. I find women have the most trouble letting go of fat. They have an emotional addiction to it.

    10% is all you need and that’s perfectly represented with fruit and veg.

    30 bananas a day bitch.

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    • I respectfully disagree.

      Fat is an essential nutrient. While we all have different needs I believe that consumption from a variety of sources is important and most of us need to consume more than 10% of our total daily calories from fats and oils.

      30 bananas a day is excessive.

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      • Hello Diana,
        Allow me to disagree even more respectfully. The statement “Fat is an essential nutrient” is, apart from being bullshit, irresponsible for you to make and, if actually someone trusts your diet advices, even dangerous. Let me explain:
        1. Essential nutrients are the ones that cannot be synthesized in our bodies. That being said you cannot say fat is essential, as fat is not a single nutrient, analogically to carbohydrates and proteins.
        2. You are, obviously for lack of education, mistaking fat for fatty acids. There are only two fatty acids, that the human body cannot synthesize on its own, but needs for very fundamental processes. The first essential fatty acid is LINOLEIC ACID, which happens to be an omega-6 fatty acid, because it has its final carbon double bond in the n-6 position, which is the 6th position counting from the tail of the molecule if we consider the head of the molecule to be where the carboxyl group is. The other essential fatty acid is ALPHA-LINOLEIC ACID, which happens to be an omega-3 fatty acid, because its final carbon double bond is in the n-3 position.
        3. First any of these fatty acids may serve as a building block for any omega-3 and omega-6 fatty acid the body may require for its biological functions, as these two fatty acids provide the basic structure and easyly they can be enlongated, shortened or modified to all other omega-3 and omega 6 fatty acid. OMEGA-9 fatty acids are NOT ESSENTIAL and only can be used as source of ebergy, and its not an easy source, lets say it is a dirty fuel. (not as dirty as proteins btw)
        4. Now that I’ve made it clear what is essential and for what purposes let’s examine what happens next. Oversimplified the biological effects of the omega-3 and omega-6 fatty acids are mediated by their mutual interactions. That means: the effects of an omega 3 fatty acid for a specific biological function is defined by the amount of the corresponding omega 6 fatty acid for the same function. In that way you may get pro-inflammatory environment if you have a certain ratio of the needed omega 3 and omega 6 fatty acids and the opposite effect if you have a different ratio and if you are deficient in let say ALPHA-LINOLEIC ACID your body is unable to make its complicated stuff and a pro-inflamatory environment develops, which means that inflammations begin very fast, stop slowly and last a long time for very trivial reasons.
        5. Now lets talk how much of these TWO you NEED to function properly, to live, to thrive, to be healthy (it’s the same when we talk biochemistry). You need a certain minimum amount and a certain ratio. The minimum amount is a low single digit number of grams per day for ALPHA-LINOLEIC ACID depending on your weight. Say 3 grams or 5 grams if you’re bigger, or more active. The acceptable ratio of these two fatty acids omega-3:omega-6 is between 1:1 and 1:4. so the amount of LINOLEIC ACID needed is a few grams also, and a bit more is acceptable.
        6. What happens if you follow some non scientific dietary advices, as those given by dietitians or even worse doctors (both groups of people consider themselves some kind of scientist – idiots). If you consume bad ratio of the said fatty acids, like 1:10 and up you force your body do work very hard to keep your basics running, which i find very stupid. And if you consume much higher amounts than needed, say 5 times higher and up you force your body to burn fat as fuel which not the most elegant(efficient) energy production biochemical process your body is equipped to perform.

        Dear Dianna, please check your science! Your calculations are a complete bullshit. The body is extremely efficient when it needs to be and if it needs to be efficient a lot of times it becomes even more efficient. The DHA EPA thing is plainly stupid: if you consume regularly those fatty acids the body will down-regulate their synthesis and vice-versa. The 1.6 grams of ALPHA-LINOLEIC ACID found in flax seed meal is absolutely enough even on its own in any way science can look at it. 1.6 grams in flax seed meal is not rancid, damaged or malabsorbed don’t forget. Flax seed oil on the other hand has the rancid problem hugely. The fish oils have it too. Heating omega 3 fatty acids is not very clever you know…do you eat your fish raw most of the time? The japanese are onto something!
        As far as science is concerned Dr Esselstyn’s diet is completely acceptable and is capable of sustaining a healthy human being over very long periods. As a young scientists I see a lot of reason in such a diet and not many problems. This is the right way of medicine as fat as I am concerned and pseudo-dietary experts should keep the bold statements to themselves.
        If you’re interested in helping anyone I advise you to start learning from more reliable sources first. Women magazines are not such sources. Then bring your tone done when commenting on areas where you’re not sure you understand the complexities and interconnections between things.
        And before all-DO NOT MISLEAD PEOPLE

        Thank you!

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      • And you are right about the bananas…for too long 30 bananas a day may even be carcinogenic, because of some radioisotopes issues and their slow elimination in such amounts ;)

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  7. The greasy irony is this: I eliminated oils from my diet based on the non-anecdotal, science-based research presented in the works by Drs. Esselstyn and McDougall. I make luscious meals that are oil free. But on occasion, I eat meals at the cafeteria of my local health food store, and these meals contain olive oil. To me, the food tastes “greasy”, actually, “oily”, and the oil detracts from the flavors. I have become accustomed to, and now prefer, meals that are oil free.
    Our tastes and taste buds are socialized from the time we are tots. Changing behaviors and beliefs is a chore. I empathize with your resistance to the information that the doctors have presented. I used to find oils tasty, too. Good luck.

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  8. I have been on the Esselstyn diet for 3 years and have been getting all of the benefits as advertised. Cholesterol is down, weight is down (lost 45 lbs), I have a ton of energy, I eat a lot of great food. I eat when I’m hundgry, and don’t have to bother counting calories. Its easy to stick to the diet because I have felt absolutely great! And Esselstyn’s proof is much more than anecdotal if you take the time to look at his resaearch as well as the research by Colin T Campbell. Its absolutely not about selling books either, unlike others, all of the information is available online. I respect that you’re a registered dietician, but you need to get your facts straight!

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    • The problem is, you hear exactly the same type of glowing reports from people who follow the Wahls Protocol — which Dr. Wahls used to overcome her Multiple Sclerosis (M.S.) — which is based on a Paleo diet. The Wahls diet requires eating a bucketload of vegetables, but it also allows good fats. If you do a Google search, people using the Wahls Protocol have seen major improvement in M.S., Parkinsons, and a host of other diseases. See amazon.com for her latest book, The Wahls Protocol.

      The point is, the Wahls Protocol involves eating a ton of vegetables. And not just more vegetables. Terry Wahls was a vegetarian before she got M.S., and merely eating more veges did not help her. It was only when she started eating a select ration of vegetables designed to provide a range of nutrients needed for her brain that she started to see progress. From being unable to sit up in a wheelchair, within 12 months she was riding horses and long-distance bike rides.

      The Wahl’s Protocol has three levels that you can select to implement. All of them allow good oils. In fact, the third level is a high fat diet.

      So, when people like Neil from Calgary imply that the proof is in the pudding for Esselstyn zero-fat diet, maybe the Esselstyn diet provides great results because of the ton of extra vegetables – and in spite of not having oil, while other diets like the Wahls Protocol offer similar success stories, once again, because of the ton of vegetables, while allowing the fun of eating good oils.

      http://www.amazon.com/s/ref=nb_sb_noss/189-7361077-1730841?url=search-alias%3Daps&field-keywords=wahls

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  9. I’m writing mainly because a new, larger study was just published (2014) showing effectiveness, along with an in-depth case study article:

    A way to reverse CAD?
    http://www.jfponline.com/fileadmin/qhi/jfp/pdfs/6307/JFP_06307_Article1.pdf

    The Nutritional Reversal of Cardiovascular Disease — Fact or Fiction? Three Case Reports
    http://cardiologyacademicpress.com/?p=20690

    As a dietician, I hope you’ll consider the outcomes the Esselstyn/Campbell low-fat, whole foods, plant-based diets. People with very significant cardiovascular disease are able to stop and even reverse their disease, discontinue or reduce use of statins and insulin, and lead much happier lives. As far as I am aware, there are no negative side effects from this diet. Trying to answer the interesting questions about what absolute minimal requirements makes the diet so effective or how it should be tweaked (e.g., what if I add avocado? what if I add nuts/olive oil/coconut oil/etc? what if I have grass fed meat once a week? how can a low-fat diet be healthy?) is ignoring the forest for the trees: here is a diet that works; embrace it fully and you will not die from heart disease. It works in practice very effectively, even if we don’t understand why in theory. This line of research deserves much more study.

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  10. Pingback: Revisiting Dr Esselstyn | bite my words

  11. I don’t understand why you think not adding oil, nuts, avocado or coconut to your diet is somehow fat free. With a tablespoon of chia and 2 tablespoons of flax seed, plus whatever is in all the vegetables, occasional tofu, occasional seitan, I’m getting 27 g of fat and 300% of the RDA for omega 3.
    June IS a dumbass and you really don’t sound as though you know what you’re talking about. Thank god. It’s scary when uninformed people sound as though they are.
    With all the history of heart disease in my family, and all that I’ve studied in the past 5 years, the Paleo diet is not an option for me. For people with healthy cholesterol levels and low blood sugar and who believe that the lives and deaths of animals should be subject to our gluttony, I’m sure it’s just fine.

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  12. it’s very difficult to get less than 15% of our caloric intake from fat if you follow dr. Esselstyn’s diet. 6 grams omega 6 will be met, also omega 3 won’t be a problem.

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  13. Uh, sorry but what you LIKE and what the best science shows are two completely different things! I was diabetic and following the ADA diet for years with no change. After my diabetic husband lost his leg I decided there HAS to be a better way, and got on board with a 10%fat or less, high carb, WHOLE food plant based diet for a 30 day trial to judge for myself if it would help. Being a former nature camper I had a really good take on how our ancestors would eat and how we evolved. so it just made sense to me. In less than two weeks my blood sugars were normal, and many other health issues (arthritis, fibromyalgia, IBS, high BP, etc) began to improve, I eventually lost 100 lbs and that was 5 years ago. YES, change is difficult at first, but we acclimate amazingly well when the benefits are so dramatic and unquestionable! Humans are able to survive on about anything for a time, nature only cares that we pass on our genes. After that all our mistakes catch up with a vengeance. Quite unlike what we’ve been brainwashed to believe, it is FAT, both animal and concentrated veg. sources, NOT sugar/carbs that causes diabetes and other issues. Intramyocellular lipids, too much fat in our cells that prevents insulin from being able to do it’s job of regulating the entry of glucose into the cell as fuel. If it can’t get in, it circulates in the blood and the kidneys struggle to filter it out… diabetes! High glucose is a SYMPTOM, not the cause, and the diet Essy recommends REVERSES it and many other diseases, and I can vouch for that, so should be the default to also PREVENT the rampant diseases of Western diets! You need to educate yourself on actual nutritional fact, not your personal preferences, you can kill people! Any oil is the *waste product* left over after all the nutrients and fiber is processed out. A habit, NOT a benefit!!!
    http://nutritionfacts.org/video/diabetes-as-a-disease-of-fat-toxicity/

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    • That’s great that this worked for you. However, your anecdotal evidence is not scientific “nutritional fact”. Your personal experience does not prove that Esselstyn’s poorly designed research is actually good research. The Internet is a wonderful place to find information but Google is no substitute for a degree in nutrition.

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  14. In your article you (rather mockingly) said: “Further in the article, the author suggests that a fat-free diet can be healthy and we can get enough fat in our diets by applying oil to our skin. This blew my mind a little. It shows a clear lack of understanding of nutrition and the digestive process.”

    First off, the diet isn’t fat free (lots of sources including flaxseed, vegetables, legumes and beans, etc). Secondly, he wasn’t advising that everyone get their fat via topical application of safflower oil, he was merely talking about a real treatment for people with essential fatty acid deficiency due to intravenous feeding. Here’s an actual quote of what he said, “Essential fatty acid deficiency is seen when sick patients are fed intravenously by fat-free parenteral nutrition. In these cases, correction of the deficiency can be accomplished by applying small amounts of soybean or safflower oil to their skin—giving you some idea of the small amount of oil we require.”

    Perhaps Esselstyn was referencing this study: http://www.ncbi.nlm.nih.gov/pubmed/406855
    Excerpt: “Human essential fatty acid deficiency: treatment by topical application of linoleic acid. … The cutaneous manifestations (scalp dermatitis, alopecia, and depigmentation of hair) were reversed with continued, topical application of safflower oil, which contains 60% to 70% linoleic acid.”

    Or, you know, maybe the many other studies and topical treatment protocols for EFA deficiency that pop up with a 5 minute google search.

    Umm… maybe apply your degree in nutrition to a little research next time you hear something that seems a little unusual? I know at first I thought “wait, he said WHAT? Surely THAT can’t be accurate…” but then I thought of all of the other topical treatments such as testosterone therapy via the application of a topical gel. So I used my vast non-nutrition-degree skills to look it up for 5 minutes, and sure enough treatment of EFA deficiency in some cases via topical application of safflower oil IS a thing. Maybe try a tiny bit of research next time before you bring the snark?

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  15. Diana,

    You are completely wrong on so many levels but I’ll choose to address the main bone of contention you keep mentioning repeatedly. You cite Dr. Esselstyn’s “poorly designed research”.

    May I ask you how his research is poorly designed? Sufficient control mechanisms were in place alongside the main group. If you’re not happy with the sample size, have you considered how many people are on his program to this day and have reversed heart disease?

    Secondly, I’m sorry to say this, and respectfully will though, that although Google may not be sufficient research, neither is the pharma-gov-backed so-called “nutrition” degree you have. Sorry, but this is the truth. You believe what you believe because you’ve bought into it. It doesn’t make it the truth. It’s your version of it. 50 years ago Doctors told patients that smoking was okay. You’re telling people to eat oil because you think it’s normal convention.

    Thirdly, no one – including Drs. Esselstyn, Barnard, Campbell, McDougall, Greger, Davis, etc. – are recommending we eliminate fat from our diet. They’re recommending the complete removal of added oils, sugars and salts. There are still foods that have fat.

    Lastly, for those that have heart disease, the focus is on REVERSAL – which includes repair of the endothelial function. I haven’t read ALL your comments here but if you don’t know what that is as a “registered dietician”, I question your authority and ability to dispense food and nutritional information to anyone, let alone those that suffer from diabetes, cholesterol, etc.

    Please consider meeting and speaking with these Doctors in real life and ask them for their sources.

    My best to you.

    Omar

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    • If “pharma” backed my degree wouldn’t that also go for any MD, including Esselstyn? Fortunately, pharma didn’t fund my university degrees.

      I’m not promoting any one diet. I don’t believe that there is one diet that is optimal for everyone. Unlike Esselstyn, I don’t have books to sell. I don’t profit from peddling a cure-all diet. I write this blog to combat the myriad of nutrition misinformation floating around in the world.

      It’s been a long time since I wrote this post, so I can’t recall specifics about his research methods. If you’re not convinced that his research was poorly designed and biased by looking at it yourself, surely there’s nothing I can say to convince you otherwise.

      Doctors are not infallible and they quite often have very little nutrition education. That’s why dietetics is a profession. We all have our areas of expertise.

      We should all apply critical thinking to research and the media. You’ve clearly been critical of my stance and education. You might want to apply that same critical eye to the doctors you listed above.

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