Have you seen the documentary, "Forks over Knives" and if so, what did you think? ;o)

AJ, you have inspired me to try your 18.21 diet, not yet, but maybe for Lent. Thanks!!

I think it's great. I also think that any steps one can take it tha direction would be use ful, even without being as strict as they would have us all ideally be. Bill Clinton worked with Esselytn after hhe needed stents following his bypass, etc.

Michael Pollan on animal protein-based diets, the lipid hypothesis and food as guilt vs. pleasure:

http://michaelpollan.com/interviews/michael-pollan-debunks-food-myths/

Hello AJ. Reposting missing data. Strong evidence does exist according to my professional association that keeping total fat intake between 20% to 35% calories, reducing calories from saturated fat and trans-fatty acids to less than 7% of calories, and keeping cholesterol consumption below 200mg per day does decrease the risk of heart disease. Saturated fat should be replaced with complex carbohydrates from fruits, vegetables, whole grains or with protein or with unsaturated fats from oils, nuts, fatty fish (omega-3), avocado. And I will add, not an easy way to eat for those of us who are used to a more traditional approach.

Ms. James, just noticed that Forks over Knives has a Facebook page you can Like. I didn't sift through all the comments so you may already know this. I have to say that, knowing you only through Food52, there is NO WAY you could go completely vegan with pleasure, but I could be wrong.

Hello AJ. Strong evidence does exist according to my professional association that keeping total fat intake between 20% to 35% calories, reducing calories from saturated fat and trans-fatty acids to <7%, and increasing intake of unsaturated fat (especially from fish, nuts, oils) and complex carbohydrate intake (especially whole grains or vegetables) can significantly lower low-density lipoprotein cholesterol and decrease risk of coronary heart disease. Other recommended interventions include increasing fiber and plant sterol intake, maintaining or achieving healthy body weight, and moderate regular exercise most days.

I am thankful I do not have to follow this regime because like you I love cheese, butter, cream, pork, bacon, sausage. With no family history and good cholesterol numbers, I can eat as I choose. Julia Child referred to my fellow dieticians as nutrition terrorists and food nazis and I would not disagree. But you know, there is a time and place for all things and you might want to consider a consultation with a dietitian who is sensible, realistic, and willing to help you individualize general guidelines for the specifics of your situation. On the other hand, many smart well education people have both time and skills to work the numbers out for themselves and it sounds to me as if you absolutely up to the job.

AJ - here's a link to something that came across my blog feed. I don't know too much about the science they use, but it might be interesting. http://civileats.com/2012/10/05/food-mythbusters-coming-to-a-city-near-you-on-food-day-october-24th/

It didn't work out so well for Steve Jobs.

If the answers were known, nobody would be making movies and selling books touting they know a secret. Researchers have been arguing over the lipid hypothesis for 150 years yet still can't even agree on what is cause and what is effect. We know there is a connection between cholesterol and heart disease but does cholesterol indicate that a problem exists, that it's a repair mechanism, or does it by itself cause heart disease? Simply put, we don't know and anyone who claims they do is either pushing their political views or attempting to separate you from your money with offers of false hope.

I maintain the best strategy is to live the best, fullest, happiest life you can in the short amount of time we're here. Concentrate on the joy, not the worry, if for no other reason than stress itself can cause disease.

AJ, Cooking with less meat or not meat is easy and fun. My favorite recipes are from Raw Recipe Books, although I do not eat 100% raw. These recipes are vegan so you don't have the nonsense like TVP and all that. I often include these recipes when making food for our meat eaters. Just don't use the terms vegan or vegetarian. Two books that may excite you are RAW by Charlie Trotter (yes, the Charlie Trotter from Chicago) and Roxanne Klein. Gorgeous, tasty, and great to riff off of. And THE RAW GOURMET by Nomi Shannon.

drbabs, I would never buy or consume the processed foods marketed to people eating only a plant-based diet. Bleehh! I do eat tofu, and have since it first was commercially available. That's about as processed as I get, apart from a few condiments. (I'm fortunate that there is a Korean grocery store about two blocks from my gym; they sell really fresh tofu, quite inexpensively, too.) Everything else I make myself. I picked up a couple of quite promising looking vegan cookbooks at the library only to find that they were full of recipes that relied heavily on non-dairy cheese (really bleeehh) and flavored tofu/seitan, etc. And TVP is just not an option. I'd stick with traditional foods from places where people rarely eat meat and are not trying to eat meat-like substitutes. Thanks again. ;o)

The researchers in "Forks Over Knives" and their disciples have solved this by prohibiting ALL animal product. No meat, chicken, fish, dairy, etc. A plant based diet entirely.

Incidentally, is there anything in dispute in Forks over Knives about the environmental impact of factory-farming animals? I'm really confused about the whole sustainable meat thing, too. Is there enough pasture land on the planet, and do the economics work, or can they be made to work somehow, to allow everyone who's now eating meat from factory-farmed animals to eat meat solely from animals who've been pastured instead? Resources/research on that topic would be appreciated, too! ;o)

The China Study by T. Colin Campbell, PhD
The Most Comprehensive Study of Nutrition Ever Conducted (on front of book)
"Everyone in the field of nutrition sciences stands on the shoulders of Dr. Cam[bell, who is one of the giants in the field. This is one of the most important books about nutrition ever written..." Dean Ornish, MD

Thanks again, everyone. What I'd really like to know, having read these answers, is whether there is any good research out there one way or the other about whether a change in diet can reverse heart disease -- where the starting point is a fairly balanced, totally junk-food-free, virtually-processed-food-free diet that does include regular consumption of fat derived from animals (especially pork, bacon, sausage, etc., cheese, butter, cream, etc.). "Forks over Knives" includes some fairly dramatic graphics of such reversal, specifically with respect to the reduction in plaque within the arteries. I am primarily motivated in all this to avoid taking drugs to prevent the worsening of my condition and to reduce my LDL levels, which are currently off the charts. Yes, I know that half the people who have heart attacks do not have high cholesterol and that half of the people with high cholesterol do not suffer from heart attacks, but I have also been told that those numbers are fairly meaningless in the case of a strong family history, which is my situation. Any sources of good, reliable research to shed light on this would be most appreciated. I have a family that depends on me and a lot of things I want to do, but also have the skill and the motivation when it comes to cooking and eating to make the best choices for the long term. ;o)

In my opinion, then only thing that the "documentary" really demonstrated was that extreme dietary changes in people who have extremely bad health, who were eating an extremely poor diet, can have an extremely profound effect. You notice I used "extreme" a lot: I don't think this "documentary" is necessarily applicable to the general public, or can be generalized, for the same reason I put documentary in quotations: this is not a particularly honest or un-biased examination of the entire scientific data set. If you do some digging, you will actually find that the data the movie does discuss is not portrayed in an entirely honest way. Much of the research done by the two main subjects is either ignored, because it does not support or refutes their claims, or is mis-characterized and portrayed to imply something it doesn't actually demonstrate, such as the China Study. It was an interesting movie, but once I started looking at the criticisms of the stories and characters in it, it was revealing and disappointing.

Quoting Graham Kerr? That is interesting.

Even if the premise were true and you could prove it, I wouldn't change a single thing about my diet. I cook for maximum taste and pleasure. Compromising out of fear is simply not an option. To quote me quoting Graham Kerr, "Madame, you could go outside and get run over by a bus and just think what you would have missed!" My last meal, whenever it comes, will not be tofu.

That is not to say I don't eat my vegetables or eschew exercise nor eat so much that I'm even a single pound overweight. There are reasonable, rational guidelines to follow. But a life lived in fear is a life half lived. Enjoy.

Full disclosure, I am a physician and saw this movie as part for Social Medicine Rounds. The science in the movie is sound, and the diet can make big differences in health. Promoted by one of the cardiologists in our hospital who follows a vegan diet and takes the stairs throughout the hospital (quite a shock for the students and residents rotating through cardiology).
For me, I love all kinds of foods, but like Dr. Babs, am trying to trope more towards plants and whole grains, along with more exercise.
My family also has a strong fam hx heart disease, so I do pay attention, but I think being happy with what you eat contributes to heart health as well.

Thanks for posting this, Antonia James. I sent my dear mother a link to some of the info that has been posted in the responses. Our family history unfortunately isn't great either, and while her health isn't poor, I always worry about what may lurk around the corner. I would love to hear a dr, scientist, or nutritionist weigh in on the other side, because it seems the results are undeniable.

And, I think that Gourmet Metrics is right in that cooking at home, which you also do, AJ, is one of the most beneficial things one can do. That said, it is not the only piece, as Laurie Colwin (and my older sister) died tragically young from a heart attack. Sometimes genetics is very strong.

AJ I am with you on the scary family history though so far my own lab results have been in the OK range they could be better - one cardiologist wanted me to get my LDL down to 70!). From what you share on this site, it appears that you have a a healthy lifestyle with exercise and wonderful whole foods. I guess I skew towards drbabs' approach and try to find a balance. I have made the choice for now to stick with extra vegetables, mostly whole gains (almost no white flour or rice), and meats and other highter sat fat animal protein in limited moderation, treating foods outside those parameters the way we do dessert: not everyday and in smaller portions. I also walk or do some other exercise almost every day - at least 5 days a week, usually more, and have just gone back to yoga after a couple of year hiatus. I doubt I could completely give up wonderful cheeses, meatballs and spaghetti, eggs, etc. I have, however, learned to love kale and farro and rye. As i get older if my numbers get worse, I figure I will reconsider the food choice/medication dilemma. The very complicated thing is that as persuasive as Esselstyn is, so are those who advocate for the evils of sugar and white foods, etc. There is so much one can read on this and I've read so much of what's out there, Gary Taubes, Marion Nestle, and so little consensus that it is challenging to really know what the right path is. I think that if one is happy as a vegan and doesn't feel deprived all the time, then why not. If one is miserable doing it, then why? I suspect this is an issue that will become more and more timely, even here, as people age and find themselves with cholesterol, sugar, bp issues.

I actually have not seen the documentary and I should check it out. But the conversation and controversies are all worth reading. As one of those "dietitians" Sam refers to, I will come clean. I eat a high fat diet, moderate portions of all proteins, and have always since my California childhood loved lots of fresh vegetables, fresh fruits, and whole grains. My weight is so good Weight Watchers refused to hire me. And I too like butter and real milk in coffee, a habit I picked up living in France for a couple of years. The level of nutrition confusion is mind boggling. And the conclusion I have finally reached is that people who cook most days are the ones who have the best chance of keeping healthy. Cooking may in fact be more important that what gets cooked.

I agree with Sam. Humans are omnivores and have developed different eating strategies for different habitats. Most of the strategies were successful and people were able to reproduce and carry on. Perhaps we should look at the fast and processed food diet as an attempt to create a new strategy for our 'new', modern environment. i will argue that the strategy has failed given the high degrees of dietary diseases and allergies.

You hear similar claims of great benefits from proponents of veganism, the Paleo diet, etc. etc. It all seems to have a religious fervor about it--do this and find salvation or be prepared for hellfire and damnation, And they all claim to have scientific proof of the diets' benefits. All of this leaves a person wondering just what on earth he should do.

I am convinced that the strategy that works best for me is simply to eat real food. I eat tons of fruit, vegetables, legumes. I buy as much of these foods locally as I can, but since I live half the year in Germany, I have to rely on fruits and vegetables from Italy and France as well. I don't shy away from whole fat dairy products or meats--but I am careful about my sourcing of these products, and almost all of the meat and dairy products I consume are local. I cut back on bread and pasta but will not entirely eliminate those foods. I walk a lot and get a fair amount of exercise. All in all, I believe I am living and eating much like my ancestors did and the strategy was successful for them.

I would love to see more real scientific evidence of benefits of various diets. but when money for scientific research is coming from vested interests, how can you trust the results?

The thing to ask..and I''ve seen it here...is where are the Farmers? Not the food they grow. The USA is a big country, moving from A to B is expensive..moving small farmed food is expensive. Finding a market for premium local food in an economy that's a just a touch off from depression is harder still especially for the small farmers that sell the food and try to make a living off the land.

While we can feel good about ourselves 'eating local' from our gardens, or truck farmers, markets etc. It's rather expensive compared to wal-marts. And even if walmart was magically removed, you'd still have people looking for food that didn't cost as much.
Sure, you'll find bargains on veggies, fruits, truck farmers, farmer markets..etc..etc. But again you have to be able to travel to those places, and the food has to travel as well.
Small farmers are coming back..at premium prices to sell to upscale resturants and markets. But in reality of mid-America, that product is expensive in Whole Foods..or other upscale places. Yes, we can point to a few projects for urban farmers that make a miniscule harvest, or someone growing some back yard gardens. Still where are the small farmers, and their replacements as they get older and retire? They make news, and pointed out as 'man bites dog' stories in media...instead of being common place.

AJ, another doc to check out is Dr. MacDougall http://www.drmcdougall.com/. He is in California, and his work is consistent with Dr. Esselstyn. Love the question and the inquiry.

Have you seen "Hungry for Change"?

Have you seen "Hungry for Change"?

The idea has been around for decades. Starting with the 'health food' craze in the 60's, Macrobiotics, and cancer preventive diets in the 80's..etc..etc.

Which all try to replicate lifespan, cancer, heart diseases stats in other countries. The "French Diet" the "Japaneese Diet" and the " Mediterranean Diet", and even today with Michael Pollan. In the 70's fat was the magic thing we should get rid of in our diet...which was replaced with butter subs with whipped with Trans-Fats...(which is objectively bad for you, via sound studies). Even Mc Donalds replaced beef tallow oil with other oils to cut down on fat: results the super large serving of fries.

Those diets all overlook one simple fact...in all those cultures, people walk a lot, and eat small portions of almost everything, often throughout the day; and ENJOY their meals for the taste, happiness, and socialization; instead of looking for one 'magic' bullet that's the path to wellness and treating food as medicine.
They don't give it a thought about their 'diet'..but enjoy things instead of eating for gluttony or simply 'fuel' for their needs.

I do agree with SKK that more veggies, grains, and fruits are needed. In my childhood meat was mostly a side dish...and we had sit down dinners---1 hour of TV, no video games, and lots of outside work and play. And coca-cola was 6 oz bottles...SOooo Good after mowing the lawn, and using a swing blade to cut larger things.

By the way, AJ, my understanding is Bill Clinton is a vegan at the urging of his daughter Chelsea, who is also a vegan.

I saw Forks over Knives and it was illuminating. Consistent with The China Study by Dr. T. Colin Campbell. Before I saw it I had seriously upped my vegetables and fruits and whole grains and greatly lowered meat and dairy. Processed foods aren't even in my house.

I have seen profound positive changes in friends with diabetes, high blood pressure and allergies who have followed this kind of eating.

The research is good. Marion Nestle supports this way of eating. A lot to be learned.

For anyone interested, Forks Over Knives "examines the profound claim that most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods".

I seriously doubt that. Reminds me of "The Road to Wellville". Dr. Kellogg meet Dr. Esselstyn; I think you two might have a lot in common.

Hi AJ. I saw it a while ago, and I follow a blog: happyhealthylonglife.com in which the author writes about "evidence-based living," and she has adopted this diet whole hog (sorry). I would say that it has caused me to eat more plant-based than I used to, and to limit fat more than I used to (My father is a heart patient who had his first bypass operation at 57, and there's Alzheimer's disease on both sides of my family.) I struggle with absolute restrictions mostly because I'm not overweight or sick, my numbers are good, and hell, I just like food and love to cook. However, I do find myself making oatmeal for breakfast and salads for lunch more often than I used to. And I tried but I can't stand coffee without real milk. So I try to strike a balance. I think there's probably scientific validity to the eating plan, and if I were a heart patient I might be more vigilant about it. But since we're talking about prevention and not active disease, i have decided that being an omnivore who skews towards plants is the right choice for me. Besides, my husband would divorce me if we ate beans and salads every night. (kidding.)